Objective. To compare tumor necrosis factor ␣ inhibitors directly regarding the rates of treatment response, remission, and the drug survival rate in patients with rheumatoid arthritis (RA), and to identify clinical prognostic factors for response.Methods. The nationwide DANBIO registry collects data on rheumatology patients receiving routine care. For the present study, we included patients from DANBIO who had RA (n ؍ 2,326) in whom the first biologic treatment was initiated (29% received adalimumab, 22% received etanercept, and 49% received infliximab). Baseline predictors of treatment response were identified. The odds ratios (ORs) for clinical responses and remission and hazard ratios (HRs) for drug withdrawal were calculated, corrected for age, disease duration, the Disease Activity Score in 28 joints
Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the frequent sicklisting.
Nearly one-third of AS patients in clinical practice switched biological treatment. Response rates and drug survivals were lower among switchers, however, half of switchers achieved treatment response.
AimTo monitor joint infl ammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/ methotrexate combination therapy using MRI and ultrasonography. To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring. Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/ radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy. Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off. Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001). Patients with progression on CT had higher baseline MRI bone oedema scores. The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and timeintegrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p<0.05). With CT as the reference method, sensitivities/specifi cities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively. Median intraobserver correlation coeffi cient was 0.95 (range 0.44-0.99). Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased. Infl ammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.Radiographic data from randomised placebocontrolled studies of rheumatoid arthritis (RA) patients show that erosive progression is arrested, and occasionally even reversed, when starting methotrexate and tumour necrosis factor alpha (TNFα) antagonist combination therapy. 1 -3 MRI is more sensitive than radiography for bone erosions, including erosive progression, and MRI enables visualisation of synovitis and bone oedema. 4 -7 Diminished size of MRI bone erosions during TNFα antagonist therapy was reported from a study of fi ve RA patients, 8 but no systematic MRI studies addressing the repair of erosions are available.Ultrasonography is also more sensitive for bone erosions than radiography, 5 9 -12 but follow-up data are few. 13 -16 Ultrasonography allows the detection of synovial thickening by grey-scale ultrasonography (B-mode) 5 17 and increased synovial blood fl ow using Doppler techniques. 18 -21 CT is considered a reference method for bone destructions, and is more sensitive for bone erosions than radiography, MRI and ultrasonography. 12 22 No longitudinal RA studies comparing MRI,...
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