[Well controlled comparative study in early rheumatoid arthritis with gold sodium thiomalate vs. auranofin].
Sachiko YamamotoN MitomoTerunobu SaitoK. NishiokaKazuhiko InoueShoko UchidaNatsuki OhataMurasawa AkiraA. SuzukiT. Mitsui
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RA Center Liaison Council conducted a comparative study of Auranofin and GST by envelope method on the patients with early RA who experienced the onset of the disease not more than two years ago. In final assessment of overall improvement, 57.9% of Auranofin-administered cases (22/38) showed moderate improvement or above. The comparable figure for GST group was 71.8% (28/39), but there was no statistically significant difference. Adverse reaction ADR incidence for Auranofin group was 12.2% (5/41), while 22.0% for GST (9/41), but the difference was not statistically significant. Drop out due to ADR was observed in 9.8% of Auranofin-administered cases and in 19.5% of GST-administered cases. The results of the study indicate that Auranofin is a most suitable DMARD than GST to be used for early RA, and GST is suitable for more active RA in view of its efficacy. But GST should be administered carefully because of its high ADR incidence.Keywords:
Auranofin
Clinical study
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We treated 20 patients diagnosed under the new ARA criteria for rheumatoid arthritis (RA) with Bucillamine 100mg-300mg/day.There was an improvement rate of 85%. Effectiveness was especially marked in early RA patients but it was seen also progressed RA patients, and it was seen in about eight weeks after administration.The drug was effective in patients who had changed over from injectable gold salts, Dpenicillamine and Auranofin. It's side effects were seen in 30% of the patients, but severe ones were not seen in our cases. Among remission inducing agents, this drug was one that could be administered early.
Auranofin
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Abstract Objectives To prospectively investigate the effect of tofacitinib (TOFA), the first oral reversible inhibitor of JAK approved for RA treatment, on the levels of NT-proBNP, as a predictor of congestive heart failure (CHF) in patients (pt) with active RA. Methods Twenty six RA pt (median age 54 [40; 62] years, 81% female, disease duration 44 [24; 63,0] month (m), moderate to high activity (SDAI–27 (22; 35)), positive for ACCP (73%)/RF (77%), who were non-responders to methotrexate (MTX) at least 15 mg/week and other synthetic DMARDs) free of clinical overt cardiovascular disease were treated with TOFA and followed for 12 m. TOFA therapy was started in all pt in dose 5 mg BID per os with dose escalation to 10 mg BID in 8 (31%) pt. TOFA used in combination with MTX in 24 (92%) pt, leflunomide in 1 (4%). Low-dose oral corticosteroids (<10 mg/day prednisone or equivalent) were received by 9 (35%) pt. Remission was achieved in 38,5% (SDAI). Cardiovascular risk factors (CVRF) and the NT-proBNP levels were measured at baseline and after 12m. At baseline the most of pt had multiple CVRF and subclinical organ damage. Cardioprotective therapy received 16 (57%) pt (beta-AB–7, ARA/ACE inhibitors–11, statins–11, dihydropyridine CCB-7). Twenty controls matched for CVRF were included for comparison of normal NT-proBNP levels. Results The NT-proBNP level was significantly higher in RA pt than in the control group (median 62.2 (26.9–101.7) pg/mL vs 44.0 (34.0–54.3) pg/mL, p<0.05). At baseline NT-proBNP level was higher in female than in male (p=0,019). All 3 (11,5%) RA pt with a NT-proBNP level over 125 pg/mL were asymptomatic and exhibited normal echocardiography. Median SDAI were significantly reduced following TOFA treatment (from 26.8 to 4.7, p<0.001, respectively). During follow-up, no RA pt exhibited a cardiovascular event or CHF. NT-proBNP levels decreased by 63% over the 12-m of TOFA treatment (from 62.16 pg/mL to 14.8 pg/mL, p=0.011). The incidence rate of arterial hypertention (58% vs 65%), overweight (62% vs 62%), abdominal obesity (58% vs 62%), smokers (27% vs 27%), menopausal status (52% vs 52%), DM type 2 (7% vs 7%), mSCORE≥5% (23% vs 27%), subclinical carotid atherosclerosis (58% vs 58%) did not change significantly. An increase in body mass index (BMI) was observed from 26.5 [22.9; 29.0] to 26.9 [24.0; 30.1], p<0.001 and in HDL level from 1.37 [1.06; 1.87] to 1.90 [1.29; 2.16], p<0.01. The percentage change in the NT-proBNP level significantly correlated with the percentage change in the BMI (r=0,6, p=0,007), SDAI (r=0.51, p=0.009). Changes in NT-proBNP levels in RA pt with remission was greater than that observed in pt who didn't achieve remission (−87% vs −26%, p=0,005). The percentage change in the NT-proBNP level was not correlated with the percentage change in other CVRF. Conclusion TOFA decreased the NT-proBNP level in patients with RA without clinical overt cardiovascular disease and CHF. TOFA may have a cardioprotective effect in those with active RA.
Leflunomide
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The results of treatment of 73 transcervical and 49 extracapsular fractures of the femoral neck in patients with rheumatoid arthritis were compared with the results in 152 normal patients. In undisplaced transcervical fractures that were internally fixed and followed up for more than six months, there was no significant difference in results between the rheumatoid patients (5 acceptable results in 8 patients) and the control patients (8 acceptable results in 9 patients). In displaced fractures, when internally fixed, the rheumatoid group (8 acceptable results in 27 patients) did significantly less well than the control group (17 acceptable results in 30 patients). In hips affected by the disease, the results were worse (1 acceptable result in 9 patients). Hemiarthroplasty gave acceptable results in two-thirds of the rheumatoid patients with transcervical fractures, whether used as primary treatment of displaced fractures or as revision of failed pinnings. This was not affected significantly by the presence of disease in the joint. In extracapsular fractures, the presence of rheumatoid arthritis, whether or not it affected the hip, did not appear to affect the outcome. The presence of osteoporosis was associated with poor results.
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Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease characterized by synovitis and symmetrical joint destruction. RA has become one of the key diseases endangering human health, but its etiology is not clear. Therefore, identifying the immunopathogenic mechanisms of RA and developing therapeutic drugs to treat autoimmune diseases have always been difficult. This article mainly reviews the immunopathogenic mechanism of RA and advances in the study of anti-inflammatory drugs in order to provide a reference for the treatment of RA and drug development in the future.
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Between 1978 and 1995, 98 total hip arthroplasties (THA) and 142 total knee arthroplasties (TKA) were carried out in 152 patients with rheumatoid arthritis (RA). Multiple joint arthroplasties (three or more joints) were performed on 30 THAs and 31 TKAs in 17 patients with RA. The mean age was 51.4 years at the first operation and 56.4 years at the final surgery. The mean interval between each surgery was 4.5 years.Of the 16 rheumatoid patients, 11 improved to independent ambulation, 2 deteriorated to limited ability, one was confined to a wheelchair and 2 had died. General complications were found in 8 patients (14.1%), but they did not influence the patient's life span. There were a few local complications (28%) resulting from the total 57 arthroplastic procedures and 11 joints required reoperation.Surgical therapy plays an important part in management of RA once joint destruction has occurred, and therefore arthroplasty must be considered as soon as possible.
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Auranofin, an oral chrysotherapeutic agent, administered at 3.0 mg. b.i.d., p.o. to eight rheumatoid arthritic patients produced improvement in objective and subjective clinical signs, as well as biochemical and immunological parameters. Adverse effects reported were minimal and generally limited to gastrointestinal disturbances. During auranofin administration, gold concentrations in the blood gradually increased to a mean level of 0.70 microgram Au/ml by week 12 of treatment. Daily oral administration of auranofin appears to provide constant blood gold levels over longer periods of time compared to existing parenteral gold therapy and may provide an improved method of controlling chrysotherapy in rheumatoid arthritic patients.
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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