Advances in rheumatology: new targeted therapeutics

Treatment of inflammatory arthritides - including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis - has seen much progress in recent years, partially due to increased understanding of the pathogenesis of these diseases at the cellular and molecular levels. These conditions share some common mechanisms. Biologic therapies have provided a clear advance in the treatment of rheumatological conditions. Currently available TNF-targeting biologic agents that are licensed for at east one of the above-named diseases are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Biologic agents with a different mechanism of action have also been approved in rheumatoid arthritis (rituximab, abatacept, and tocilizumab). Although these biologic agents are highly effective, there is a need for improved management strategies. There is also a need for education of family physicians and other healthcare professionals in the identification of early symptoms of inflammatory arthritides and the importance of early referral to rheumatologists for diagnosis and treatment. Also, researchers are developing molecules - for example, the Janus kinase inhibitor CP-690550 (tofacitinib) and the spleen tyrosine kinase inhibitor R788 (fostamatinib) - to target other aspects of the inflammatory cascade. Initial trial results with new agents are promising, and, in time, head-to-head trials will establish the best treatment options for patients. The key challenge is identifying how best to integrate these new, advanced therapies into daily practice

Perfil dos idosos atendidos em um centro de atenção psicossocial: álcool e outras drogas Perfil de los ancianos asistido en el centro de atención psicosocial: alcohol y otras droga Profile of the elderly assisted in a psychosocial care center: alcohol and other drugs

O objetivo do estudo foi identificar o perfil dos idosos usuários de substâncias psicoativas atendidos no Centro de Atenção Psicossocial de álcool e drogas no interior paulista, no período de 1996 a 2009. O desenho metodológico é descritivo, do tipo retrospectivo, baseado em dados secundários. A amostra foi composta por 191 clientes com idade acima de 60 anos, que correspondem a 3,2% de todos os atendidos no referido serviço. Os idosos caracterizaram-se por serem predominantemente do sexo masculino; a média de idade foi 64 anos, com baixo nível de escolaridade; 78,4% tinham até o ensino fundamental; e 86% eram aposentados. As drogas de maior uso foram: o álcool, a maconha, o crack e a cocaína. Conclui-se que o número de idosos que buscam assistência especializada é muito baixo. Estudos dessa natureza são importantes para avaliar as necessidades desse grupo em evidente crescimento, bem como o uso de substâncias psicoativas para o planejamento de práticas efetivas.<br>El objetivo del estudio fue identificar el perfil de los ancianos del Centro de Atención Psicosocial de alcohol y otras drogas de Ribeirao Preto, SP, en el período 1996 a 2009. El diseño metodológico es descriptivo del tipo retrospectivo basado en los datos secundarios. La muestra consistió de 191 (3,2%) clientes mayores de 60 años asistidos en ese servicio. La muestra se caracterizó por los ancianos con media de edad de 64 años con un predominio masculino, con bajo nivel educacional: 78,4% tenía estudios primarios y el 86% eran jubilados. Las drogas de mayor uso fueron: alcohol, marihuana, crack y cocaína. Se concluye que el número de ancianos que buscan la asistencia de expertos es muy bajo. Estudios de esa naturaleza son importantes paraevaluar las necesidades de ese grupo en el evidente crecimiento, así como el uso de sustancias psicoactivas para la planificación de prácticas efectivas.<br>The objective was to identify the profile of the elderly at the Center for Psychosocial Care - alcohol and other drugs in Ribeirão Preto SP, in the period of 1996 to 2009. The methodological design was the descriptive retrospective study based on secondary data. The sample consisted of 191 (3.2%) customer over 60 years assisted in the service. The sample was characterized by elders with a mean age of 64 years, predominantly male, with low educational level, 78.4% had primary school and 86% were retired. The most commonly drugs used were alcohol, marijuana, crack and cocaine. It concludes that the number of elderly who seeks for expert assistance is very low. Studies of this nature are important to assess the needs of this group in the clear growth as well as the use of psychoactive substances for planning effective practices