Baricitinib in rheumatoid arthritis – real world cross-sectional study

© 2020 The Authors. Published by Bentham Open. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: 10.2174/1874312902014010028Introduction: Rheumatoid arthritis (RA) is the most common cause of inflammatory polyarthritis. In RA, increased circulating levels of pro-inflammatory cytokines contribute to the overall symptomatology of fatigue, pain, and joint stiffness. Baricitinib is an orally administered biologic DMARD, used in RA patients, inhibiting signaling via JAK1/JAK2 inhibition, reducing the release of pro-inflammatory cytokines. Objective: To explore the efficacy and tolerability for baricitinib in a local population. Methods: A cross-sectional study was carried out to review data of RA patients on Baricitinib from the researchers’ own clinic, since its approval in August 2017. The data was collected from an anonymized electronic patient records report. The clinical response was then classified into mild, moderate, and significant improvement. Results and Discussion: Overall, 27 out of 37 patients (72.9%) showed clinical improvement with baricitinib. In 9(24.3%) out of 37 patients, the dose had to be reduced to either 2mg/day or 2mg/day - 4mg/day on alternate days. In four of the 9 patients’ where the dose was reduced due to infections (UTI or sinuses), they subsequently experienced fewer infections while maintaining moderate improvement in their RA. Conclusion: There is a need for longer-term and larger studies to evaluate the full side effects profile of baricitinib in the local population

Exploring the efficacy and safety of cannabis in the management of fibromyalgia

© 2022 The Authors. Published by Innovare Academic Sciences. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.22159/ijcpr.2022v14i1.44109Fibromyalgia is a chronic health condition characterized by chronic pain fatigue, sleep disturbances and many other symptoms affecting a patient’s quality of life. Patients with fibromyalgia often visit rheumatology outpatients with a long list of symptoms and often receive multiple medications. Many have seen multiple specialists and have done a lot of reading about alternative modalities of treatment. The limited effectiveness of conventional therapy coupled with widespread media attention raises the question of cannabis use. This review examines the literature on cannabinoid use in fibromyalgia against the context of the international variation in legal frameworks, the available products and the outcomes reported. A detailed review was performed using the EMBASE and PUBMED databases. It was concluded that despite the interest in the use of cannabinoids in the management of fibromyalgia, there is insufficient evidence to prescribe the currently available licensed medicines or to recommend the complementary health products available for legal purchase. There is a need for more global clinical randomised trials to accurately determine medicinal cannabis short and long-term long efficacy and safety for its acute and chronic use

Dual energy computed tomography in gout: our experience

© 2021 The Authors. Published by Radiance Research Academy. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: http://dx.doi.org/10.31782/IJCRR.2021.131432Introduction: Gout is a common medical problem, affecting at least 1% of men in Western countries, with a male: female ratio ranging from 7:1 to 9:1. For many patients, traditional investigations can be inconclusive. Dual Energy Computed Tomography (DECT) is emerging as a valuable tool for non-invasive confirmation of urate deposits in painful joints. Aim: To establish the effectiveness of the DECT in the identification of gout in patients with complex presentations where the diagnosis is not clear. Method: DECT at 140 kV and 80kV was used to image patients where the clinical diagnosis was unclear Results: Seven case studies are presented where an unclear clinical presentation was successfully diagnosed with the use of DECT. Conclusion: In a specialist tertiary referral centre, treating many patients whose presentation is atypical, DECT has become a valuable tool in confirming the presence or absence of gouty arthritis, in difficult cases with a diagnostic dilemmaPublished versio

Steroid-sparing agents in giant cell arteritis

Background: Giant cell arteritis is the commonest form of medium-to-large vessel vasculitis, requiring long-term corticosteroid therapy. The short- and long-term side effects of corticosteroids are many, including weight gain, psychological effects, osteoporosis, cardiometabolic complications, and infections. Materials and Methods: Various agents used in place of or in combination with corticosteroids to reduce corticosteroid-related side effects were reviewed. However, considerable variation in practice was identified giving unclear guidance. This review included the most recent evidence on methotrexate, mycophenolate mofetil, azathioprine, cyclophosphamide, abatacept, and tocilizumab Results and Discussion: Also discussed are encouraging results with tocilizumab in GCA patients. Amongst the agents available for steroid-sparing effects, tocilizumab demonstrated the most robust data and is consequently recommended as the agent of choice for steroid-sparing, for remission induction, remission maintenance, and treating relapsing and refractory cases of GCA.Published versio

Giant cell arteritis: a new perspective on investigations and diagnostic criteria

© 2020 The Authors. Published by Research Trends. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: http://www.researchtrends.net/tia/abstract.asp?in=0&vn=21&tid=36&aid=6576&pub=2020&type=3Giant cell arteritis (GCA) is a common form of granulomatous inflammation of large blood vessels. It can cause irreversible blindness in nearly 20% of untreated cases. It has an incidence of 15-30 per 100,000 persons aged 50 years and over in North American and European countries. GCA is a medical emergency and requires early confirmation of diagnosis and initiation of treatment. Recent development in non-invasive imaging modalities, with higher sensitivities and specificities than temporal artery biopsy (TAB), improved the standard for GCA diagnosis. The recent updates on British Society for Rheumatology guidelines elaborated on the role of ultrasound (US) in the diagnosis of GCA and use of the guidelines provides a new approach for GCA confirmatory diagnosis. A search was conducted using EMBASE and Medline databases to identify recent published research on the diagnosis of GCA. Only human studies published in English between 2010 to 2020 were considered in this systematic narrative review. This review also summarises the evidence available for non-invasive imaging and recommends an approach combining the recently published algorithm for diagnosis decision making of cranial GCA using scoring system. This review proposes a combined approach to use a clinical diagnostic decision making in suspected cranial GCA and use the scoring system based on the clinical history, examination findings, laboratory results and the imaging results combined to give a score to diagnose GCA from other vasculitides. The approach to investigate a case of GCA needs to be modified and should include newer imaging techniques available and new diagnostic criteria should be used in combination with the rapid access pathways for clinical decision

EXPLORING THE EFFICACY AND SAFETY OF CANNABIS IN THE MANAGEMENT OF FIBROMYALGIA

Fibromyalgia is a chronic health condition characterized by chronic pain fatigue, sleep disturbances and many other symptoms affecting a patient’s quality of life. Patients with fibromyalgia often visit rheumatology outpatients with a long list of symptoms and often receive multiple medications. Many have seen multiple specialists and have done a lot of reading about alternative modalities of treatment. The limited effectiveness of conventional therapy coupled with widespread media attention raises the question of cannabis use. This review examines the literature on cannabinoid use in fibromyalgia against the context of the international variation in legal frameworks, the available products and the outcomes reported. A detailed review was performed using the EMBASE and PUBMED databases. It was concluded that despite the interest in the use of cannabinoids in the management of fibromyalgia, there is insufficient evidence to prescribe the currently available licensed medicines or to recommend the complementary health products available for legal purchase. There is a need for more global clinical randomised trials to accurately determine medicinal cannabis short and long-term long efficacy and safety for its acute and chronic use