The early clinical history of salicylates in rheumatology and pain

The first clinical reports on the treatment of fever and pain with salicylate-containing natural willow bark remedies were made by the English clergyman Edward Stone in 1763. The pharmacologically active principles were isolated from natural sources by Italian, German and French scientists between 1826 and 1829. Salicylic acid was first synthesised by the German Gerland in 1852 and a year later the Frenchman Gerhardt synthesised acetylsalicylic acid. The first reports on the clinical use of salicylic acid in rheumatic disorders were made independently by the two German physicians Stricher and Reiss in 1876. Acetylsalicylic acid was rediscovered by Hoffmann in 1897 and by the turn of the century it had gained worldwide recognition in the treatment of pain and rheumatological disorders. Reports on adverse events relating to gastrointestinal intolerance and bleeding appeared early, but were largely neglected until the 1950s. Today, salicylates are still widely used as analgesic, antipyretic and anti-inflammatory drugs. New indications, such as thrombosis prophylaxis, have emerged during the last decades, and yet others are being explored.     

Skin capillary abnormalities as indicators of organ involvement in scleroderma (systemic sclerosis), Raynaud's syndrome and dermatomyositis

Forty-four study patients with scleroderma (systemic sclerosis) (28 patients), Raynaud's syndrome (13 patients) or dermatomyositis (three patients) were observed for skin capillary abnormalities by widefield microscopy and compared with three control groups of 20 subjects each: (1) patients with other rheumatic disease, (2) hospitalized patients with nonrheumatic conditions, and (3) healthy volunteers. The distinctive microvascular pattern (dilated and distorted capillary loops alternating with avascular areas) previously reported in scleroderma and dermatomyositis was observed almost exclusively in the study patients. The severity of capillary abnormalities varied among the diagnostic subgroups, and a positive correlation was found between the degree and extent of abnormal microvascular patterns and multisystem involvement.On this basis, widefield nailfold capillary observations are proposed as a simple, inexpensive, reproducible technic for making an improved early diagnosis and predicting multisystem involvement in scleroderma, Raynaud's syndrome and dermatomyositis, presently a group of loosely associated and overlapping connective tissue disorders which often defy early and precise diagnosis.     

风湿内科护理常见的伦理问题及对策研究

目的探究风湿内科护理常见的伦理问题与解决对策,提高风湿内科临床护理质量。方法收集所有病例资料,以及护理内容,统计护理伦理问题的类型,以我院自制调查问卷的形式,选取近些年我院风湿内科临床护理时遇到的伦理问题,对其进行总结分析,从而提出针对性的解决对策。结果在风湿内科20例发生护理伦理问题的个例中,其中13例是由于对患者隐私部位护理引起的,4例由于患者合并感染性疾病引起的,3例是由于人文关怀程度不够引起的。而对40名护理人员进行调查显示,其中19例护理人员对基础伦理护理知识掌握不到位,占47.5%,13例护理人员面对伦理问题时做出错误选择,占32.5%。结论风湿内科同其他科室一样,同样存在伦理护理问题,通过伦理护理宣教、临床带教等模式可以有效提高护理人员伦理护理技能,并且减少伦理护理问题的产生,对提高风湿内科护理质量有显著价值,值得推广。     

Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes

There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at an increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with the risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to the risk of infection and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune-mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.     

Osteocondromatosis sinovial extraarticular secundaria con afectación de pierna,tobillo y pie. Un caso excepcional

Extraarticular synovial osteochondromatosis is a very rare benign disease whose aetiology may be primary or secondary to pre-existing pathology or after trauma. The diagnosis can be made with plain radiography and CT, and MRI is necessary to evaluate the non-mineralized soft tissue component and assess extension. It must be confirmed with a pathological study by biopsy or resection. There is up to a 5% chance of malignant transformation. The treatment of choice for the extensive extra-articular form is surgery by open resection.The case presented illustrates an atypical form of secondary extraarticular OCS with multiple involvement of the leg, ankle and foot.     

Effect of tocilizumab combined with methotrexate on circulating biomarkers of synovium,cartilage, and bone in the LITHE study

Objective

We investigated the effects of tocilizumab (TCZ) on joint tissue remodeling in patients with moderate to severely active RA by measuring tissue-specific biomarker.

Methods

The LITHE biomarker study (n = 740) was a phase III study of 4- and 8-mg/kg TCZ in combination with MTX. Early response was evaluated at week 16 as ±20% improvement in swollen/tender joint counts; and ACR50 was evaluated at week 52. Biomarkers (tissue inflammation: C3M, CRPM, and VICM; cartilage degradation: C2M; and bone turnover: CTx and osteocalcin) were tested in serum from baseline, week 4, 16, 24, and 52, and dose-dependent effect was investigated. Patients were divided into the following three groups: early non-responders (ENR), ACR50 responders, and non-responders; their biomarker profiles were compared.

Results

At week 52, CRP was inhibited to 4% and 40% of baseline by TCZ8 and TCZ4, respectively. CRPM (63%), C2M (84%), C3M (69%), and VICM (42%) were significantly (p < 0.05) reduced by TCZ8, but not by TCZ4. MMP3 and osteocalcin changed to <58% and >111%, respectively, in response to TCZ. CTx was not changed significantly. ENRs had significantly less inhibition of CRPM (p < 0.05), C2M (p < 0.01), and C3M (p < 0.01) compared to early responders. There was a significant difference in the C2M, C3M, and CRPM profiles of the ENRs, non-responders, and responders. ACR50 responders had significantly inhibited levels (p < 0.001), irrespective of dose.

Conclusions

TCZ8 strongly inhibited the biomarkers of joint tissue remodeling suggesting that TCZ actively suppresses key pathobiological processes at the site of inflammation in RA patients. The differences in biomarkers' profiles of responders and non-responders indicate that specific responder profiles exist.     

Health related utility measurement in rheumatology: an introduction

Utility measures of health-related quality of life are preference values that patients attach to their overall health status. In clinical trials, utility measures summarize both positive and negative effects of an intervention into one single value between 0 (equal to death) and 1 (equal to perfect health). These measures allow for comparison of patient outcomes of different diseases and allow for comparison between various health care interventions. There are two different approaches to utility measurement. The first is to classify patients into categories based on their responses to a number of questions about their functional status, as for instance the Quality of Well-Being questionnaire. The second approach is to ask patients to assign a single rating to their overall health by means of rating scale, standard gamble, time trade-off, or willingness to pay. The Quality Adjusted Life Year (QALY) as outcome measure includes both effects in terms of quality and quantity of life. Utilities are used as weights to adjust life years for the quality of life in order to calculate QALYs. Both QALYs and utilities are useful in decision-making regarding appropriate procedures for groups of patients.