A nationwide survey on patient's versus physician's evaluation of biological therapy in rheumatoid arthritis in relation to disease activity and route of administration : the Be-Raise study

Objectives : Biological treatment of rheumatoid arthritis (RA) is one of the cornerstones of current treatment strategies for the disease. Surprisingly little information exists on whether the route of administration affects patients' treatment satisfaction. It is equally unclear whether rheumatologists are able to accurately perceive their patients' appreciation. Thus, the Belgian Beraise survey aimed to examine whether RA patient's experience of their current biological treatment coincided with the treating physician's perception. Methods : A nationwide cross-sectional survey was conducted by 67 Belgian rheumatologists providing data obtained from 550 RA patients. Patients under stable dose of biologics for at least 6 months, were enrolled consecutively and all completed questionnaires. Separate questionnaires were completed by the treating rheumatologist which evaluated their patient's perception of the route of treatment administration. This study therefore evaluates whether a treating physician perceives the satisfaction with the route of administration to the same degree as the patient. Results : Completed questionnaires were obtained from 293 and 257 patients who obtained treatment via the intravenous (IV) or subcutaneous (SC) route of administration, respectively. 58.4% of patients were in DAS28-CRP(3) remission. Patient satisfaction with disease control was higher (44% scored >= 9) than that of the treating physician (35%), regardless of the route of administration (p<0.01). No differences were seen for the patients treated with an IV as opposed to a SC route of administration. The physician's perception of patient's satisfaction with disease control was markedly lower for IV treated patients as opposed to SC treated patients (p<0.001). Conclusions : Patients' satisfaction with biological treatment is high, but there is a considerable mismatch between patients' and rheumatologists' appreciation on the route of administration of biological therapy in RA. Physicians consistently consider IV biological therapy to be less satisfactory. Patient's appreciation is largely dependent on disease control, irrespective of the route of administration. Therefore, and encouraging shared decision making, we suggest that physicians and patients discuss the route of administration of biologicals in an open way

Seven-year follow-up of infliximab therapy in rheumatoid arthritis patients with severe long-standing refractory disease: attrition rate and evolution of disease activity

This study is based on the results from a Belgian expanded access program in which patients with active refractory and erosive rheumatoid arthritis (RA) were treated with intravenous infusions of infliximab in combination with methotrexate. The objectives of this study were to evaluate the continuation rate of infliximab and its clinical effect over a 7-year period and to document the reasons for discontinuation

A rare case of tuberculosis-induced hypercalcemia

Laboratory investigations of hypercalcemia involve testing of various biochemical parameters such as parathyroid hormone (PTH), 25-(OH) Vitamin D (25-(OH) VitD), 1,25-(OH)2 Vitamin D3 (calcitriol) and PTH related peptide (PTHrp). We herein present an atypical case of severe hypercalcemia in a patient with rheumatoid arthritis who has been treated for years by various biological disease-modifying antirheumatic drugs (DMARDs) and suddenly presented with general state alteration, oedema and ulceration of her right ankle. We illustrate how tuberculosis (TB) can cause high calcitriol concentration and subsequently lead to potentially severe hypercalcemia. Moreover, we highlight the importance of TB testing and follow-up in patients treated with biological DMARDs

Baseline Objective Inflammation by Magnetic Resonance Imaging as a Predictor of Therapeutic Benefit in Early Rheumatoid Arthritis With Poor Prognosis

Objective: High magnetic resonance imaging (MRI )–detected inflammation is associated with greater progression and poorer outcomes in rheumatoid arthritis (RA ). This analysis aimed to determine if baseline MRI inflammation was related to clinical response and remission in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT ) study. Methods: AVERT was a phase III b, randomized, controlled trial with a 12‐month, double‐blind treatment period enrolling patients with early (≤2 years' duration), anti‐citrullinated peptide–positive methotrexate (MTX )‐naive RA . In this post hoc analysis, patients in the abatacept plus MTX (n = 114) and MTX (n = 111) arms with available MRI results were stratified into low and high baseline MRI inflammation groups based on previously developed cutoffs of synovitis and osteitis on unilateral hand–wrist contrast‐enhanced MRI . Simplified Disease Activity Index (SDAI ) remission (≤3.3), Clinical Disease Activity Index (CDAI ) remission (≤2.8), Boolean remission, and Disease Activity Score in 28 joints using the C‐reactive protein level (<2.6) were assessed. Results: Overall, 100 of 225 patients (44.4%) had high baseline MRI inflammation. In patients with high baseline MRI inflammation, a significantly greater proportion achieved remission at 12 months with abatacept plus MTX versus MTX across SDAI (45.1% versus 16.3%; P = 0.0022), CDAI (47.1% versus 20.4%; P = 0.0065), and Boolean indices (39.2% versus 16.3%; P = 0.0156). In patients with low baseline MRI inflammation, remission rates were not significantly different with abatacept plus MTX versus MTX (SDAI : 39.7% versus 32.3%; P = 0.4961). Conclusion: In seropositive, MTX ‐naive patients with early RA and presence of objectively measured high inflammation by MRI , indicating poor prognosis, remission rates were higher with abatacept plus MTX treatment versus MTX

The Belgian MIRA (MabThera In Rheumatoid Arthritis) registry: clues for the optimization of rituximab treatment strategies

This study describes the results of the Belgian 'MabThera In Rheumatoid Arthritis (MIRA)' registry: effectiveness, safety and evaluation of the current retreatment practice on the background of the Belgian reimbursement criteria for rituximab

74-week follow-up of safety of infliximab in patients with refractory rheumatoid arthritis

The objective was to describe the prevalence, types, and predictors of adverse events (AEs) in rheumatoid arthritis (RA) patients treated with infliximab and methotrexate in a daily clinical setting.0Journal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tREMITRACT study groupinfo:eu-repo/semantics/publishe

Thermal analysis and efficiency enhancement of solar modified PV panels through organic PCM under climate conditions of Pakistan

Passive cooling of photovoltaics (PV) using phase change materials (PCM) may be extremely effective owing to their enormous implicit specific heat. However, the low rate of heat transfer, high solar radiation, and ambient temperature drop its efficiency by 0.45%/ᵒC. Only such a small fraction of solar irradiance is turned into electrical energy by PV cells; most of the irradiation is transformed into heat; hence, cells start operating above ambient temperature. Therefore, the exterior heat of photovoltaic panels is controlled by applying artificial cooling to enhance their efficiency. The current research aims on the significant benefits of using PCM to reduce panel surface temperature in terms of boosting energy efficiency and maintaining thermal comfort. This study demonstrates a successful design of PV controlled-temperature module using phase change materials for hot climate, especially for south Asian regions. The surface temperature of solar panels has been reduced using computational analysis and experimental study on paraffin wax. In this work, Paraffin wax used, which reduced the panel surface temperature by 5-7ᵒC, generating a 29% increase of the modified PV panel relative efficiency compared to its standard value

Modelling and optimization of phase change materials (PCM)-based passive cooling of solar PV panels in multi climate conditions

To address the increasing energy demand, replacing conventional energy systems with non-conventional resources like solar power generation is crucial. Photovoltaic (PV) panels play a significant role in harnessing solar energy and converting it into electrical power. However, the solar cells’ temperature dramatically influences the panel’s performance, particularly in hot climates. In this study, a detailed mathematical model is developed and conducted simulations using three different phase change materials (PCMs)—RT21, RT35, and RT44—integrated with PV panels in various climate conditions worldwide during the summer season. An optimization model is also created using MATLAB and a genetic algorithm to identify the most suitable PCM for specific climate zones. The findings revealed that incorporating PCM resulted in a surface temperature reduction of PV panels, leading to a 6% increase in efficiency and a 16% boost in electrical output. Specifically, when using a PCM with a melting point of 21°C, the maximum cell temperature during summer operation decreased from 65°C to 38°C. Similar temperature reductions were observed when using PCMs with melting points of 35°C and 44°C. Current analysis demonstrates that the correct selection of a phase change material can decrease panel temperature by approximately 39% in June. Furthermore, PCM with a melting point of 21°C exhibited the best outcomes in terms of maximum electrical performance, efficiency, and PV cell temperature reduction