地奥司明联合尼美舒利治疗膝关节创伤性滑膜炎的临床疗效观察

目的 探究地奥司明和尼美舒利联用治疗膝关节创伤性滑膜炎的临床疗效。方法 选取解放军第425医院收治的符合诊断标准和本研究要求的患者60名，分为3组，联合组、尼美舒利组、地奥司明组各20例，联合组给予地奥司明和尼美舒利联合治疗，尼美舒利组予以尼美舒利治疗，地奥司明组予以地奥司明治疗，均以14 d为1疗程。分别对治疗前后各组进行膝关节VAS、AKS评分、肿胀程度评级，并根据以上数据进行疗效判定。结果 经过14 d治疗后，3组患者治疗后膝关节肿胀、疼痛程度均较前有不同程度改善，治疗前后差异明显（P<0.05），且联合组的前后差异幅度更大（P<0.05），有效率更高。结论 地奥司明和尼美舒利分别对创伤性滑膜炎治疗均有一定疗效，但单独使用不及两者联合治疗疗效显著。联合使用可更加明显的缓解患者的疼痛，阻止病情进展，减轻炎症反应，稳定病情，达到满意的治疗效果。     

Musculoskeletal immune-related adverse events in 927 patients treated with immune checkpoint inhibitors for solid cancer

ObjectiveThe prevalence of the musculoskeletal immune-related adverse events (irAEs) is probably underestimated, as most studies report only severe side effects. Our aim was to describe and characterize all musculoskeletal irAEs in a large cohort of patients treated with immune checkpoint inhibitors (ICI).MethodsWe conducted a retrospective study among patients who received ICI from 07/27/2014 to 05/08/2020 at the medical oncology department of the Institut Paoli-Calmettes, Marseille, France. All medical files were systemically reviewed by a rheumatologist who collected clinical features, time of occurrence, treatment regimen, irAEs management, course and outcomes. We also assessed tumor response 3 months after introduction of ICI, according to severity and treatments used to manage musculoskeletal irAEs.ResultsAmong 927 patients treated with ICI for a solid tumor, 118 patients (12.7%) presented a musculoskeletal irAE. Their median age was 66.5, 61% were male, and they mainly had a lung (57.6%) or urological cancer (27.1%). The most frequently involved ICI was an anti PD-1. Arthralgias and myalgias were the most frequent musculoskeletal irAEs (9.8%) and inflammatory rheumatic features were reported in 36 patients (3.9%) with elevated acute phase reactants and negative immunological markers. The median time of onset was 2 months (IC 95% 1.8; 2.7). Tumor response at 3 months did not differ according to musculoskeletal irAE severity, type of manifestation (arthralgias/myalgias versus inflammatory rheumatic features), pain patterns (mechanical versus inflammatory) or irAE treatments.ConclusionMusculoskeletal irAEs in this large cohort of patients treated with ICI were frequent (12.7%), mostly mild and well tolerated.     

Disease burden and costs for patients with hip and knee osteoarthritis and chronic moderate-to-severe refractory pain on treatment with strong opioids in Spain

Introduction and objectivesTo determine the disease burden and costs in patients with hip or knee OA and chronic moderate-to-severe refractory pain, receiving strong opioids in Spain.Materials and methodsThis was a 36-month longitudinal secondary analysis of the real-word OPIOIDS study. Patients aged ≥18 years with hip or knee OA and chronic moderate-to-severe refractory pain receiving strong opioids were considered. The disease burden included analgesia assessments (NRS scale), cognitive functioning (MMSE scale), basic activities of daily living (Barthel index), and comorbidities (severity and frequency). Costs due to the use of healthcare resources and productivity loss were estimated.Results2832 patients were analyzed; age was 72.0 years (SD = 14.3), 76.8% were women. Patients had mainly been treated with fentanyl (n = 979; 37.6%), tapentadol (n = 625; 24.0%), oxycodone (n = 572; 22.0%), and buprenorphine (n = 425; 16.3%). Pain intensity decreased by 1 point (13.7%), with a 2.6-point decline in the cognitive scale (14.3%, with a 5.3%-increase in patients with cognitive deficit) over a mean treatment period of 384.6 days (SD: 378.8). Barthel scores decreased significantly yielding to a slightly increase in proportion of patients with severe-to-total dependency; 1.2%–2.9%. In the first year of treatment, average healthcare costs were €2013/patient, whereas the average productivity loss cost was €12,227/working-active patient.Discussion and conclusionsStrong opioids resulted in high healthcare costs with a limited reduction in pain, an increase in cognitive deficit, and a slight increase of patients with severe to total dependency over 36 months of treatment.     

French practical guidelines for the diagnosis and management of relapsing polychondritis

Relapsing polychondritis is a rare systemic disease. It usually begins in middle-aged individuals. This diagnosis is mainly suggested in the presence of chondritis, i.e. inflammatory flares on the cartilage, in particular of the ears, nose or respiratory tract, and more rarely in the presence of other manifestations. The formal diagnosis of relapsing polychondritis cannot be established with certainty before the onset of chondritis, which can sometimes occur several years after the first signs. No laboratory test is specific of relapsing polychondritis, the diagnosis is usually based on clinical evidence and the elimination of differential diagnoses. Relapsing polychondritis is a long-lasting and often unpredictable disease, evolving in the form of relapses interspersed with periods of remission that can be very prolonged. Its management is not codified and depends on the nature of the patient's symptoms and association or not with myelodysplasia/vacuoles, E1 enzyme, X linked, autoinflammatory, somatic (VEXAS). Some minor forms can be treated with non-steroidal anti-inflammatory drugs, or a short course of corticosteroids with possibly a background treatment of colchicine. However, the treatment strategy is often based on the lowest possible dosage of corticosteroids combined with background treatment with conventional immunosuppressants (e.g. methotrexate, azathioprine, mycophenolate mofetil, rarely cyclophosphamide) or targeted therapies. Specific strategies are required if relapsing polychondritis is associated with myelodysplasia/VEXAS. Forms limited to the cartilage of the nose or ears have a good prognosis. Involvement of the cartilage of the respiratory tract, cardiovascular involvement, and association with myelodysplasia/VEXAS (more frequent in men over 50 years of age) are detrimental to the prognosis of the disease.     

非甾体抗炎药治疗我国中老年骨关节炎疗效和安全性的网状Meta分析

目的 系统评价不同非甾体抗炎药(NSAIDs)治疗中国中老年骨关节炎(OA)患者的疗效和安全性.方法 检索PubMed、Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集关于NSAIDs治疗中国中老年OA患者的随机对照试验,检索时限均从建库至2020年11月17日.由两位研究人员独...     

Safety,reactogenicity, and immunogenicity of Ad26.COV2.S: Results of a phase 1, randomized,double-blind,placebo-controlled COVID-19 vaccine trial in Japan

BackgroundThis study evaluated safety, reactogenicity, and immunogenicity of a 2-month homologous booster regimen of Ad26.COV2.S in Japanese adults.MethodsIn this multicenter, placebo-controlled, Phase 1 trial, adults (Cohort 1, aged 20–55 years, N = 125; Cohort 2, aged ≥ 65 years, N = 125) were randomized 2:2:1 to receive Ad26.COV2.S 5 × 10¹⁰ viral particles (vp), Ad26.COV2.S 1 × 10¹¹ vp, or placebo, followed by a homologous booster 56 days later. Safety, reactogenicity, and immunogenicity were assessed.ResultsTwo hundred participants received Ad26.COV2.S and 50 received placebo. The most frequent solicited local adverse event (AE) was vaccination-site pain, and the most frequent solicited systemic AEs were fatigue, myalgia, and headache. After primary vaccination, neutralizing and binding antibody levels increased through Day 57 (post-prime) in both cohorts. Fourteen days after boosting (Day 71), neutralizing antibody geometric mean titers (GMTs) had almost reached their peak value in Cohort 1 (5 × 10¹⁰ vp: GMT = 1049; 1 × 10¹¹ vp: GMT = 1470) and peaked in Cohort 2 (504; 651); at Day 85, GMTs had declined minimally in Cohort 2. For both cohorts, binding antibody levels peaked at Day 71 with minimal decline at Day 85.ConclusionA single dose and homologous Ad26.COV2.S booster increased antibody responses with an acceptable safety profile in Japanese adults (ClinicalTrials.gov Identifier: NCT04509947).