https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)02530-7.pdf

Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial

ALTHOUGH osteonecrosis, the in situ death of a segment of bone, has been recognized since the early part of this century, it still presents challenges to the biologist, the physician in the applied...

Nontraumatic necrosis of bone (osteonecrosis).

As in previous years, the consensus group to consider the use of biological agents in the treatment of rheumatic diseases met during the 13th Annual Workshop on Advances in Targeted Therapies in April, 2011. The group consisted of rheumatologists from a number of universities among the continents of Europe, North America, South America, Australia and Asia.

Pharmaceutical industry support was obtained from a number of companies for the annual workshop itself, but these companies had no part in the decisions about the specific programme or about the academic participants at this conference. Representatives of the supporting sponsors participated in the initial working groups to supply factual information. The sponsors did not participate in the drafting of the consensus statement.

This consensus was prepared from the perspective of the treating physician.

In view of the new data for abatacept, B cell-specific agents, interleukin 1 (IL-1) antagonists, tocilizumab (TCZ) and tumour necrosis factor α blocking agents (TNF inhibitors), an update of the previous consensus statement is appropriate. To allow ease of updating, the 2010 (data from March 2009 to January 2010) updates are incorporated into the body of the article, while 2011 updates (February 2010–January 2011) are separated and highlighted. The consensus statement is annotated to document the credibility of the data supporting it as much as possible. This annotation is that of Shekelle et al and is described in appendix 1.1 We have modified the Shekelle annotation by designating all abstracts as ‘category D evidence’, whether they describe well-controlled trials or not, as details of the study were often not available in the abstracts. Further, the number of possible references has become so large that reviews are sometimes included; if they contain category A references, they will be referred to as category A evidence.

The rheumatologists and bioscientists who attended …

https://ard.bmj.com/content/annrheumdis/72/suppl_2/ii2.full.pdf

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2010

Retroperitoneal fibrosis encompasses a range of diseases characterised by the presence of a fibro-inflammatory tissue, which usually surrounds the abdominal aorta and the iliac arteries and extends into the retroperitoneum to envelop neighbouring structures—eg, ureters. Retroperitoneal fibrosis is generally idiopathic, but can also be secondary to the use of certain drugs, malignant diseases, infections, and surgery. Idiopathic disease was thought to result from a local inflammatory reaction to antigens in the atherosclerotic plaques of the abdominal aorta, but clinicolaboratory findings—namely, the presence of constitutional symptoms and the high concentrations of acute-phase reactants—and the frequent association of the disease with autoimmune diseases that involve other organs suggest that it might be a manifestation of a systemic autoimmune or inflammatory disease. Steroids are normally used to treat idiopathic retroperitoneal fibrosis, although other options—eg, immunosuppressants, tamoxifen—are available. The outlook is usually good, but, if not appropriately diagnosed or treated, the disease can cause severe complications, such as end-stage renal failure. Here, we review the different aspects of retroperitoneal fibrosis, focusing on idiopathic retroperitoneal fibrosis and on the differential diagnosis associated with the secondary forms. 

Retroperitoneal fibrosis

SAPHO syndrome: a long-term follow-up study of 120 cases.

Objective. To compare the effectiveness and toxicity of cyclosporin A (CsA) vs low-dose methotrexate (MTX) over a period of one year in the treatment of psoriatic arthritis (PsA) with peripheral involvement. Methods. Thirty-five patients with PsA were enrolled in a prospective, controlled, randomized trial. CsA was initially given in doses of 3 mg/kg/day to a maximum permitted dose of 5 mg/kg/day ; MTX was given in oral doses of 2.5 mg every 12 hours for 3 consecutive doses each week up to a maximum dose of 15 mg/weekly. Clinical and laboratory evaluations were performed at entry and monthly thereafter. Results. After 6 and 12 months the number of painful joints, the number of swollen joints, the Ritchie index, the duration of morning stiffness, grip strength, CRP, the patient's and the physician's assessment of PsA activity, as well as the PASI, were significantly improved in both treatment groups. ESR values were significantly reduced only in the MTX group (p < 0.01), which also showed a significantly increase of liver enzymes. The changes in the main clinical and laboratory parameters during the course of CsA or MTX treatment were not significantly different except for the AST and ALT levels (p < 0.05). After one year of therapy CsA and MTX were withdrawn in 41.2% and 27.8% of the patients respectively, but these differences were not statistically significant. Conclusion. Our one-year prospective trial shows that low-dose CsA and MTX are both effective in the treatment of PsA, but the differences in the tolerability of these drugs must be considered at the start of therapy.

Comparison of cyclosporin A and methotrexate in the treatment of psoriatic arthritis: a one-year prospective study.

Sonography of the knee was performed in 28 patients with chrondrocalcinosis and in 46 normal subjects. In each joint the authors examined synovial membrane, articular cartilage of femoral condyles, synovial fluid and menisci; they also searched for Baker's cysts. A significant thickening of synovial membrane was present. In 43 joints sonography showed linear hyperechoic images within condylar cartilage; they were parallel to bone surface and were interpreted as calcifications because of the coincidence with radiographic images. A significant thinning of articular cartilage was also found. Sonography of the knee is a useful method of examination for the evaluation of articular changes in chondrocalcinosis.

/pdf/chondrocalcinosis-sonographic-study-of-the-knee-2ym2lsg1lm.pdf

Chondrocalcinosis: sonographic study of the knee.

Monoclonal antibody investigations showed that the vast majority of cells infiltrating the synovial tissue of 8 patients with longstanding psoriatic arthritis stained for both mononuclear phagocyte and class II major histocompatibility (MHC) antigens and were therefore referred to as type I synoviocytes. A minor though consistent number of cells bore solely class II MHC antigens and were recognized as type II synoviocytes, a subpopulation that has been reported to be characteristically augmented in immune synovitides. In contrast, no immunophenotypically identifiable lymphoid cells were seen. It is suggested that type I and II synoviocytes represent the late phase of the phlogistic process and contribute to maintaining the tissue injury.

Phenotypic profile of major synovial cell populations in longstanding psoriatic arthritis.

The radiological and tomographic aspects of the sternoclavicular joint were examined in 10 patients with psoriatic arthritis to evaluate better how this joint was affected using different radiological techniques. Imaging of the sternoclavicular joint showed that computed tomography provides a better visualisation of erosions, subchondral cysts, and sclerosis than standard radiography and conventional linear tomography.

https://ard.bmj.com/content/annrheumdis/51/3/372.full.pdf

Sternoclavicular joint disease in psoriatic arthritis.

Objectives. The aim of this study was to determine the cumulative probability of taking CsA in comparison to other DMARDs, as well as the reason for discontinuation of each DMARD, in a large cohort of PsA patients. Methods. We prospectively studied 172 consecutive patients with a diagnosis of PsA who had been admitted to our rheumatological unit since 1984. We collected information about treatment with DMARDs including: number, dose, duration and causes of withdrawal, including side effects or inefficacy. Cumulative survival analysis was performed by the Kaplan-Meier test and the differences between these survival curves were detemined by the Mantel-Hanszel test. Results. The probability curve of continuing to take CsA was significantly lower than that of MIX (p < 0.046). The rate of adverse effects responsible for stopping DMARD therapy was higher in the CsA group, especially with respect to the antimalarial group (p < 0.014). The most common cause of CsA withdrawal was hypertension. The rate of withdrawal due to inefficacy in the CsA group was not significantly different from those observed in the other groups. Nevertheless, the total frequency of discontinuation due to toxicity and inefficacy in the MIX group was significantly lower compared to the gold salts (p < 0.05) and CsA groups (p < 0.01). Conclusions. Life-table analysis suggests that PsA patients taking CsA are less likely than patients on MTX to continue long term treatment. Therefore CsA, which seems to be less safe than the antimalarials, could be considered a useful drug in the treatment of PsA, but does not seem to represent the drug of first choice, particularly when compared to MTX.

Life-table analysis of cyclosporin A treatment in psoriatic arthritis: comparison with other disease-modifying antirheumatic drugs.

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