OBJECTIVE: To evaluate the treatment duration with MTX monotherapy or in association with DMARDs or TNFalpha inhibitors and the incidence and typology of adverse events (AE) occurred in rheumatoid arthritis (RA) patients. METHODS: A retrospective large cohort study of RA outpatients, consecutively seen from January 2000 to June 2005 was performed. Study group were RA patients classified according to the 1984 ACR criteria for the classification of rheumatoid arthritis. The patients were divided in 3 groups according to the treatment regimen: MTX monotherapy, MTX in combination with DMARD or with anti TNFalpha agents. We analyzed 348 therapeutic cycles, 177 of whom using MTX monotherapy. RESULTS: The 224 RA patients accumulated 800 person-years of follow up. Follow up for each of the groups was: MTX monotherapy 479.4 person-years, MTX in combination with DMARDs 244.5, or with TNFalpha inhibitors, 75.7 person-years. From the Kaplan-Meier analysis, the probability of patients remaining on treatment 5 years was 58.5 after starting MTX. The incidence of any AE was 8.87 per 100 person-years. From all, 69 (97.2%) AE were no severe. Among those, more frequently were observed at gastrointestinal tract (31%), liver (19.7%), skin (15.5%). Incidence of severe AE (lung adenocarcinoma, 1 case; pancreatitis, 1 case) was 0.25 per 100 person-years, occurring in patients taking MTX monotherapy or MTX in combination with DMARDs, respectively. CONCLUSIONS: These data confirm that methotrexate is well tolerated in clinical practice in the medium-long term. Nevertheless, the occurrence of severe AE require an accurate vigilance for methotrexate toxicity.

Aged↗

PubMedDate not supplied

[Clinico-developmental aspects in 44 cases of polymyositis/dermatomyositis].

A retrospective study, paying particular attention to the clinical and evolutive aspects of the disease, was performed on 44 subjects affected by polymyositis/dermatomyositis (PM/DM) and hospitalized at the Institute of Medical Clinics of the 1st School of Medicine of Naples University. On the basis of the different clinical pictures, the cases were classified into the following groups: primary PM (4); primary DM (19); DM/PM associated with malignancy (6); childhood DM/PM (3); PM/DM associated with connective tissue disorders (12). Diagnosis was established in terms of the following criteria: a) symmetrical and mostly proximal bilateral muscle weakness (100%); b) elevation of serum enzymes (86.3%); c) electromyographic findings of myopathy sometimes with fibrillation potentials, increased insertional irritability and pseudo-myotonic discharges (93.1%); d) muscle biopsy changes compatible with a clinical form of polymyositis (83.3% out of 30 cases); e) dermatological manifestations including particularly pink or lilac edema-erythema over the periorbital areas, wine-red maculae, Gottron's sign, "poikiloderma vasculare atrophicans", telangiectasias and skin vasculitis (86.3%). An involvement of the extraneural apparatus and organs was present in 40 patients; the most damaged was the osteoarticular apparatus, followed by esophagus, lung, heart and kidney; such pathology was rarely present in the childhood form. A follow-up of the disease has been performed in 36 cases and the therapy consisted fundamentally of high dose corticosteroids (mostly prednisone), associated, in a minority of cases, with methotrexate. A clinical improvement was observed in most cases and a remission of the disease in part of the latter. However, a worsening of the illness was noticed only in the patients suffering from PM/DM associated with malignancy, and mortality rate was 11.1% in all.

Adolescent↗

PubMedDate not supplied

Clinical pattern of pain in rheumatoid arthritis.

OBJECTIVE: To evaluate whether rheumatoid arthritis (RA) is associated with a characteristic clinical pattern of pain which may be useful as a criterion to differentiate RA from other rheumatic diseases. METHODS: 2300 patients from the ReumaLink data bank project with definite rheumatic diseases were studied. Of these 907 patients (39.5%) fulfilled the ARA/ACR revised criteria for RA, while 1393 had rheumatic diseases other than RA. The following diagnostic attributes of pain were considered: localization, symmetry, continuity, modulation, relationship with time and with loads/movements, tenderness. RESULTS: After a descriptive analysis, some pain characteristics were selected individually and others were combined. Only 8 variables were considered for a predictive analysis. Univariate analysis showed that symmetric pain is the most potent discriminating item, with 82.2% sensitivity, 69.2% specificity, a 61% positive predictive value and a 83.3% negative predictive value. A higher probability of RA was present in patients with symmetric pain than in those with asymmetric pain (odds ratio = 7.8). A multivariate analysis performed on 1627 patients showed that a specific clinical pattern of pain (symmetrical pain, pain following joint pressure, mainly present at night or in the morning, continuous) could predict RA patients with a 68.9% likelihood. The lack of these symptoms excluded RA with 92% probability. CONCLUSION: The clinical pattern of pain defined by us can predict RA with a 70% probability. This value reaches 86% when the variables "pain in a fixed joint" and "pain decreased by load/movements" are added. These results indicate that determining the clinical pattern of pain is a useful screening tool for suspected RA, in particular early in the disease course.

Adult↗