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Biomedical subjects

Alexandros A Drosos

Publications and source records attributed to Alexandros A Drosos.

At least 19 recordsLinked to original sources
PubMed2007

Clinical features and personality traits associated with psychological distress in systemic sclerosis patients.

OBJECTIVE: The aim of the present study was to identify certain clinical parameters and personality characteristics associated with various forms of psychopathology in systemic sclerosis (SSc) patients. METHODS: Fifty-six SSc patients participated in the study, and 74 healthy participants served as controls. A wide range of clinical information was collected, and the following self-report instruments were used: General Health Questionnaire, Symptom Distress Checklist-90-R, Defense Style Questionnaire, Sense of Coherence (SOC) Scale, and Hostility and Direction of Hostility Questionnaire. RESULTS: The odds of being assessed with a psychiatric diagnosis upon interview were 4.5 times greater among SSc patients compared with controls. Disease duration and lower rates of SOC were found to be associated with elevated symptoms of general psychological distress. Elevated symptoms of depression were strongly associated with esophageal involvement, hostility, and defense style used. Elevated symptoms of anxiety were mainly associated with arthritis-related painful conditions and SOC, while psychotic-like symptoms were only associated with age and a specific personality structure. CONCLUSIONS: SSc patients experience elevated symptoms of psychological distress. Several clinical parameters are associated with distress, but the role of various personality traits could not be disregarded. Early psychiatric assessment and intervention could prevent psychological distress in SSc patients.

Adaptation, Psychological↗
PubMed2006

Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review.

OBJECTIVES: To conduct a systematic review of incidence and prevalence studies of rheumatoid arthritis (RA), based on the 1987 revised American College of Rheumatology (ACR) criteria, to compare their methodologies and summarize their results, and to investigate the possible geographic variations and changes over time in the frequency of the disease. METHODS: We conducted a Medline search between January 1988 and December 2005. Studies reporting the incidence and prevalence of RA in adult populations (16 to 20 years and over), based on 1987 ACR criteria, were eligible for inclusion. From each study included, we extracted the country, year of publication, type of study (retrospective, prospective, or cross-sectional), and incidence or prevalence rates. The study areas were grouped into (a) North American countries; (b) north European countries; (c) south European countries; and (d) developing countries. We examined the geographical differences of prevalence and incidence rates using the Mann-Whitney and the Kruskall-Wallis tests. RESULTS: A total of 28 studies were identified meeting the inclusion criteria. Nine were incidence studies, 17 were prevalence studies, and 2 estimated both prevalence and incidence rates. Incidence studies were not available from developing countries. There is a significant difference of prevalence estimates between northern European and American countries and developing countries. South European countries have lower median incidence rates than North American and north European countries. As concerning the time trends of RA occurrence, only 3 incidence studies provided secular data from the same study area, based on ACR criteria, using the same methods of case ascertainment. Two of these studies indicate a decreasing incidence of RA in Finland and United States of America. CONCLUSIONS: The occurrence of RA varies among countries and areas of the world. A decreasing trend has been observed in countries characterized by high rates of RA incidence and prevalence. However, the relatively small number of studies for most areas of the world and the lack of incidence studies for the developing countries limits the understanding of worldwide RA epidemiology.

Adolescent↗
PubMed2006

Atherogenic lipid profile is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment--a prospective, controlled study.

We investigated lipid profiles and lipoprotein modification after immuno-intervention in patients with early rheumatoid arthritis (ERA). Fifty-eight patients with ERA who met the American College of Rheumatology (ACR) criteria were included in the study. These patients had disease durations of less than one year and had not had prior treatment for it. Smokers or patients suffering from diabetes mellitus, hypothyroidism, liver or kidney disease, Cushing's syndrome, obesity, familiar dyslipidemia and those receiving medications affecting lipid metabolism were excluded from the study. Sixty-three healthy volunteers (controls) were also included. Patients were treated with methotrexate and prednisone. Lipid profiles, disease activity for the 28 joint indices score (DAS-28) as well as ACR 50% response criteria were determined for all patients. The mean DAS-28 at disease onset was 5.8 +/- 0.9. After a year of therapy, 53 (91.3%) patients achieved the ACR 20% response criteria, while 45 (77.6%) attained the ACR 50% criteria. In addition, a significant decrease in the DAS-28, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were observed. ERA patients exhibited higher serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides, whereas their serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower compared to controls. As a consequence, the atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C was significantly higher in ERA patients compared to controls. After treatment, a significant reduction of the atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C was observed, a phenomenon primarily due to the increase of serum HDL-C levels. These changes were inversely correlated with laboratory changes, especially CRP and ESR. In conclusion, ERA patients are characterized by an atherogenic lipid profile, which improves after therapy. Thus, early immuno-intervention to control disease activity may reduce the risk of the atherosclerotic process and cardiovascular events in ERA patients.

Arthritis, Rheumatoid↗
PubMed2006

Effects of infliximab treatment on lipoprotein profile in patients with rheumatoid arthritis and ankylosing spondylitis.

OBJECTIVE: To investigate the longterm effects of the anti-tumor necrosis factor (TNF) therapy infliximab, a drug known to reduce disease activity in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). METHODS: Eighty-two patients (50 with RA, 32 with AS) aged 17-77 years were enrolled. All patients were treated with intravenous infliximab. Lipid profile was assessed at baseline and after 6 months of treatment. RESULTS: Disease activity significantly decreased in patients with RA and AS at the end of infliximab therapy. Infliximab treatment significantly increased total cholesterol from 206 to 216 mg/dl (p < 0.05) and triglycerides from 109 to 122 mg/dl (p < 0.05). The low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol did not change during treatment. Furthermore, the total cholesterol/HDL cholesterol and triglycerides/HDL cholesterol ratios did not change significantly. CONCLUSION: The influence of infliximab treatment on lipid profile seems to be neutral, since neither LDL cholesterol levels nor total cholesterol/HDL cholesterol and triglycerides/HDL cholesterol ratios changed significantly during the 6-month therapy. Our findings suggest that the favorable effect of infliximab treatment on cardiovascular comorbidity may not be mainly mediated by the effects on the lipid profile, but further investigations are needed in order to confirm this hypothesis.

Adult↗
PubMed2006

Adalimumab for rheumatoid arthritis.

In the last few years significant advances have been made in our understanding of the molecular mechanisms underlying rheumatoid arthritis pathogenesis. Pro-inflammatory cytokines, such as TNF-alpha, play a pivotal role in its pathogenesis. Anti-TNF-alpha biological agents are considered a major advance in the treatment of rheumatoid arthritis. Adalimumab is a fully human monoclonal antibody that binds specifically to TNF-alpha, thereby neutralising its activity. It had significant efficacy in well-designed, placebo-controlled trials in patients suffering from rheumatoid arthritis, both as monotherapy and in combination with various disease-modifying antirheumatic drugs, including methotrexate. Adalimumab was generally well tolerated during both concomitant therapy with methotrexate or standard antirheumatic therapy and monotherapy. In addition, the radiographic progression of structural joint damage was significantly inhibited by adalimumab and improved quality of life. This review summarises the recent available data.

Adalimumab↗
PubMed2006

Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with adalimumab.

OBJECTIVE: To investigate the clinical response and to evaluate by magnetic resonance imaging (MRI) the inflammatory tissue changes in patients with refractory rheumatoid arthritis (RA) treated with adalimumab. METHODS: Thirteen patients with refractory RA who were treated with adalimumab (40 mg every 2 weeks subcutaneously) were examined with MRI of the dominant affected wrist and hand before treatment and one year after therapy. The volume of the enhanced inflammatory tissue (VEIT) was evaluated in fat-suppressed contrast-enhanced T1-weighted MRI images using the Analyse 4.0 software. Disease activity was evaluated using the Disease Activity Score 28-joint (DAS-28). Clinical improvement was evaluated according to the American College of Rheumatology 20% response criteria (ACR20%). RESULTS: We studied 12 women and one man, with mean age 52.0 +/- 10.9 years and mean disease duration 13.0 +/- 8.5 years. Eight patients had positive IgM rheumatoid factor. One year after treatment, 11 (84.6%) patients showed a decrease of the VEIT. Moreover the values of C-reactive protein (CRP; 4.3 +/- 6.6 mg/l), the erythrocyte sedimentation rate (ESR; 26.3 +/- 19.5 mm/h), the DAS-28 (3.5 +/- 1.1), and the VEIT (21.6 +/- 10.7 cm3) after treatment were significantly lower compared to the corresponding values before treatment (CRP 41.6 +/- 39.2), (ESR 54.3 +/- 28.6) (DAS-28 5.8 +/- 0.8), and (VEIT 36.9 +/- 16.8) (p < 0.01). All but 3 (76.9%) patients with RA achieved the ACR20% response, while 7 (53.8%) and 5 (38.5%) patients achieved ACR50% and ACR70% response, respectively. A positive correlation between VEIT, swollen joint count, and ESR was found before treatment (r = 0.59, r = 0.64, respectively; p < 0.05). CONCLUSION: In patients with refractory RA, treatment with adalimumab resulted in improvement of clinical, laboratory, and MRI findings. MRI assessment of the VEIT may represent an additional tool for investigation of joint disease activity and responsiveness to treatment.

Adalimumab↗
PubMed2005

Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with infliximab.

AIM: To investigate the clinical response and to evaluate by magnetic resonance imaging the inflammatory tissue changes in refractory rheumatoid arthritis patients treated with infliximab. METHODS: Sixteen refractory rheumatoid arthritis patients who were treated with intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter were examined with magnetic resonance imaging of the dominant affected wrist and hand before treatment and 1 year after therapy. The volume of the enhancing inflammatory tissue was evaluated in fat suppressed contrast enhanced T1-weighted images by using the Analyse 4.0 software. Disease activity was evaluated by assessing the disease activity score for 28 joint indices. The clinical improvement was evaluated according to the American College of Rheumatology 20% response criteria. RESULTS: There were 13 females and 3 males with mean age 49.5 (17.0) years and mean disease duration 10.5 (8.0) years. Ten patients had positive IgM rheumatoid factor. One year after treatment, a significant reduction of the erythrocyte sedimentation rate, the C-reactive protein, the disease activity score for 28 joint indices and the volume of the enhancing inflammatory tissue was observed. All but two of the rheumatoid arthritis patients achieved the American College of Rheumatology 20% response criteria, while 9 (56.25%) and 5 (31.25%) patients achieved the 50% and 70% American College of Rheumatology response criteria, respectively. A positive correlation among the volume of the enhancing inflammatory tissue, swollen joint count, tender joint count, as well as disease activity score for 28 joint indices (r=0.66, r=0.79, r=0.57 respectively) was found before treatment. CONCLUSIONS: In refractory rheumatoid arthritis patients, the addition of infliximab therapy may result in clinical, laboratory and magnetic resonance imaging improvement. Magnetic resonance imaging assessment of the volume of the enhancing inflammatory tissue may represent an additional tool for the investigation of joint disease activity and responsiveness to treatment.

Adult↗
PubMed2005

Infliximab therapy in established rheumatoid arthritis: an observational study.

PURPOSE: To investigate the efficacy, toxicity and drug discontinuation rate in an observational study of patients with established rheumatoid arthritis treated with infliximab. SUBJECTS AND METHODS: Between September 1999 and June 2003, we enrolled 84 patients with rheumatoid arthritis who were being treated with infliximab. All patients met the American College of Rheumatology criteria for rheumatoid arthritis and had been refractory to (or did not tolerate) at least two disease-modifying antirheumatic drugs. Patients entering the study had a negative purified protein derivative skin test, were fully informed about the treatment regimen, and were followed up at predefined times according to a standardized protocol. Data concerning infliximab dosage, tolerability, adverse events, concomitant therapy, dosage interval, and drug discontinuation were all recorded. In addition, the clinical and laboratory variables according to the American College of Rheumatology 20% and 50% response criteria and the disease activity score for the 28 joint indices were also recorded. RESULTS: There were 61 women and 23 men with a mean age of 59 +/- 8 years and mean disease duration of 11 +/- 6 years. Seventy-five percent (63/84) were seropositive for IgM rheumatoid factor. After the first year of treatment, 84.5% of patients continued to be treated with infliximab, whereas this percentage was 73% after the second year and 59% after the third year of treatment. The American College of Rheumatology 20% response criteria was met by 59/84 (70%) of patients, and 38/84 (45%) of the patients achieved the 50% response criteria in the first year of treatment. At the second year of therapy, the American College of Rheumatology 20% response criteria were reached by 35/84 (42%) of the patients and the 50% response criteria by 27/84 (32%). At the third year of treatment with infliximab, the American College of Rheumatology 20% and 50% response criteria were achieved by 13/84 (15.5%) and 10/84 (12%) of the patients, respectively. Twenty-eight of eighty-four (33%) patients discontinued infliximab therapy. The risk of drug discontinuation decreased with the concomitant use of methotrexate. The main reasons for drug discontinuation were adverse drug reactions (16/84, 19%), followed by lack of efficacy (9/84, 11%). The main reasons for drug discontinuation due to side effects were immediate hypersensitivity reactions (9/84, 11%) and infections (6/84, 7%). CONCLUSION: Infliximab was found to be an alternative treatment with a relatively acceptable toxicity profile, despite the fact that two patients developed pulmonary tuberculosis. After the third year of therapy, 59% of patients continued to be treated with infliximab. The concomitant use of methotrexate was associated with the continuation of infliximab therapy.

Antibodies, Monoclonal↗
PubMed2005

Epidemiology of adult rheumatoid arthritis.

Several incidence and prevalence studies of rheumatoid arthritis (RA) have been reported during the last decades, suggesting a considerable variation of the disease occurrence among different populations. The majority of studies carried out in Northern European and North American areas estimate a prevalence of 0.5-1%, and a mean annual incidence of 0.02-0.05%. The occurrence of the disease seems to be lower in other parts of the world. Some studies from North American, North European, and Japanese populations suggest a decline in both the prevalence and incidence of the disease after the 1960s. RA is related to an increased mortality, and the expected survival of RA patients is likely to decrease 3-10 years. There is epidemiological evidence that genetic factors are related to an increased risk of RA. However, RA is considered to be a multifactorial disease, resulting from the interaction of both genetic and environmental factors, which contribute to its occurrence and expression. The main risk factors for the disease include genetic susceptibility, sex and age, smoking, infectious agents, hormonal, dietary, socioeconomic, and ethnic factors. Most of these factors are likely to be associated with both disease occurrence and severity.

Adult↗
PubMed2005

Epidemiology of systemic sclerosis in northwest Greece 1981 to 2002.

OBJECTIVES: To investigate the incidence and prevalence, as well as the mortality and survival rates, of systemic sclerosis (SSc) in a defined area of northwest Greece with a population of about 500,000 inhabitants. MATERIALS AND METHODS: Cases have been recorded from the following sources: (1) inpatients and outpatients referred to the Rheumatology Clinics of the Ioannina University Hospital and the Ioannina General Hospital; (2) patients referred to the private rheumatologists practicing in the study area. All patients recorded between 1/1/1981 and 31/12/2002, resident in the study area, were included in the study. Diagnosis was based on the American College of Rheumatology classification criteria for SSc. Incidence and prevalence rates were calculated as number of cases per 10(5) inhabitants. Population data were based on the National Census of 1981, 1991, and 2001. RESULTS: The age-adjusted prevalence of SSc was 15.40 cases/10(5) inhabitants on 31/12/2002. A total of 109 new cases were diagnosed during the study period, giving a mean annual age-adjusted incidence rate of 1.10 cases/10 5 inhabitants. There were 98 women and 11 men, giving a ratio of 8.9/1. Limited SSc was diagnosed in 75% and diffuse in 25% of the patients. Esophageal involvement was found in 59%, lung involvement in 56%, and renal disease in 5%. Thirty-six deaths were recorded during the study period in this incidence cohort. The 5-year survival rate was 83% and the 10-year survival rate was 70%. CONCLUSIONS: The incidence and prevalence of SSc in northwest Greece were found to be lower than those of the USA and Australia, and higher than those of northern European countries and Japan. The survival rates were similar to those reported by other studies.

Adolescent↗
PubMed2005

Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study.

OBJECTIVE: To investigate the frequency and the severity of radiological cervical spine involvement in patients with rheumatoid arthritis (RA). METHODS: We investigated 165 consecutive unselected patients with RA who fulfilled the revised American College of Rheumatology criteria for RA. All patients had a complete physical and laboratory evaluation. Patients had a radiological evaluation that included hand and wrist radiographs, as well as cervical spine radiographs in anteroposterior, lateral, and lateral in full flexion views. Hand radiographs were evaluated according to the Larsen criteria, while cervical radiographs were evaluated according to Winfield classification. RESULTS: There were 143 women and 22 men, with a mean age of 59.6 +/- 12.5 and disease duration 12.3 +/- 13.9 years. Positive rheumatoid factor was found in 63.6% of patients. One hundred forty-six patients presented radiological findings related to cervical spine involvement: atlantoaxial subluxations were found in 20.6% and erosions of the odontoid process in 2.4%; none presented vertical subluxation. Subaxial subluxations were found in 43.6%, disc space narrowing at C2-C3, C3-C4, C4-C5 levels in 66.1%, and vertebral plate sclerosis and erosions in 43.6%. CONCLUSION: Cervical spine radiological involvement is a frequent finding in our patients with RA, but the severity of the disease is rather mild, possibly related to the ethnic background.

Aged↗
PubMed2004

Cryoglobulinemic purpura in visceral leishmaniasis.

Visceral leishmaniasis may present with cytopenias along with the formation of many autoantibodies and, rarely, with the presence of mixed cryoglobulinemia, type II, resembling an autoimmune disease. The syndrome of mixed cryoglobulinemia is characterized by the triad of purpura, arthralgias, and asthenia, in conjunction with cryoglobulins in the serum. In this article mixed cryoglobulinemia, type II, was diagnosed in a negative for hepatitis B or C patient suffering from visceral leishmaniasis. Antimicrobial therapy against leishmania eliminated the cryoglobulin titer, as well as the clinical manifestations of cryoglobulinemia. The role of the immune system and the type of immune response for the formation of cryoglobulins are discussed.

Aged, 80 and over↗
PubMed2004

SCIO-469 Scios Inc.

SCIO-469 is a small-molecule p38 mitogen-activated protein (MAP) kinase inhibitor under development by Scios Inc as a potential oral therapy for inflammatory disorders. By July 2004, SCIO-469 was in phase lib clinical trials for rheumatoid arthritis.

Animals↗
PubMed2003

Visceral leishmaniasis resembling systemic lupus erythematosus.

We describe three cases with visceral leishmaniasis (VL) associated with autoimmune manifestations. The patients presented with anemia, leukopenia, thrombocytopenia, renal involvement and low complement levels. Autoimmune features were present (antinuclear and anticardiolipin antibodies, VDRL, RF, positive direct Coombs' test), which subsided after therapy. Leishmaniasis should be taken into consideration in the differential diagnosis of autoimmune disorders.

Adult↗
PubMed2003

Primary Sjögren syndrome in the paediatric age: a multicentre survey.

UNLABELLED: Primary Sjögren syndrome (SS) is very rare in childhood. We collected a series of primary paediatric SS cases from different centres. A data collection form was prepared and sent to rheumatologists who were willing to participate. Data on 40 cases of primary SS with onset before the 16th birthday were collected. Almost all patients (35/40) were females, age at onset varied from 9.3 to 12.4 years (mean 10.7 years). Signs and symptoms at disease onset were mainly recurrent parotid swelling followed by sicca symptoms. Abnormal laboratory tests were found in the majority of cases. Regarding treatment, 22 patients were treated at some time with oral corticosteroids, seven with non-steroidal anti-inflammatory drugs, and five with hydroxychloroquine; two patients needed cyclosporine and one cyclophosphamide. Follow-up varied from 0 to 7.5 years from onset, without major complications in the majority of patients. CONCLUSION: recurrent parotid swelling is a common feature of primary Sjögren syndrome in childhood and often occurs as a presenting feature. Sicca symptoms may be rarer.

Child↗