DMARD-free remission as novel treatment target in rheumatoid arthritis: A systematic literature review of achievability and sustainability

OBJECTIVES: Although current treatment guidelines for rheumatoid arthritis (RA) suggest tapering disease-modifying anti-rheumatic drugs (DMARDs), it is unclear whether DMARD-free remission (DFR) is an achievable and sustainable outcome. Therefore, we systematically reviewed the literature to determine the prevalence and sustainability of DFR and evaluated potential predictors for DFR. METHODS: A systematic literature search was performed in March 2019 in multiple databases. All clinical trials and observational studies reporting on discontinuation of DMARDs in RA patients in remission were included. Our quality assessment included a general assessment and assessment of

Influence of diagenetic processes and terrestrial/anthropogenic sources in the REE contents of the Cascais submarine canyon (Iberian western coast)

ABSTRACT: Temporal variations of rare earth elements (REE) and their fractionation patterns, major elements, Pb and Hg were determined in two multicores collected at 445 and 2100 m water depth (mwd) in the Cascais submarine canyon (CSC). The PAAS-normalized REE patterns suggest mixing of Tagus estuarine and marine sediments, marked by MREE (Nd‐Dy series) enrichment and by positive Eu-anomaly, with marine sediments. The positive Eu/Eu* implies incorporation of detrital feldspar minerals derived from the estuary. Ce/Ce*, (La/Yb)PAAS and (Nd/Yb)PAAS show differences between the two cores. Core 252-35 from the shallower site is enriched in HREE (Ho‐Lu series) over LREE (La‐Pr series), a pattern also found in the Tagus estuary in the vicinity of an abandoned chemical complex, where the environment is affected by the legacy of massive-sulfide ores processing. There seems to be only limited down-canyon sediment transport to the deeper reaches where core 252-32 was collected. This deeper site shows Ce/Ce* peaks coinciding with low (La/Yb)PAAS values suggesting preferential diagenetic remobilization of LREE relative to HREE. Upcore Pb/Al and Hg/Corg trends observed in both cores indicate dispersion of the anthropogenic component from the estuary through the CSC, which is less obvious from the ∑REE/Al trends particularly in the deeper site. This may suggest the influence of diagenetic processes in the REE signal, associated with relatively low sediment accumulation rates.info:eu-repo/semantics/publishedVersio

Is shoulder involvement in clinically suspect arthralgia an early feature of rheumatoid arthritis? A longitudinal ultrasound study

Pathophysiology and treatment of rheumatic disease

Patients with rheumatoid arthritis presenting with monoor oligo-arthritis and high VAS-ratings remain the most fatigued during 5 years of follow-up

ObjectivesThe severity of fatigue in RA has improved very little in recent decades, leaving a large unmet need. Fortunately, not all RA patients suffer from persistent fatigue, but the subgroup of patients who suffer the most is insufficiently recognizable at diagnosis. As disease activity is partly coupled to fatigue, DAS components may associate with the course of fatigue. We aimed to identify those RA patients who remain fatigued by studying DAS components at diagnosis in relation to the course of fatigue over a 5-year follow-up period in two independent early RA cohorts.MethodsIn all, 1560 consecutive RA patients included in the Leiden Early Arthritis Cohort and 415 RA patients included in the tREACH trial were studied. Swollen joint count, tender joint count, ESR and Patient Global Assessment (PGA) [on a Visual Analogue Scale (VAS)] were studied in relation to fatigue (VAS, 0–100 mm) over a period of 5 years, using linear mixed models.ResultsHigher tender joint count and higher PGA at diagnosis were associated with a more severe course of fatigue. Furthermore, patients with mono- or oligo-arthritis at diagnosis remained more fatigued. The swollen joint count, in contrast, showed an inverse association. An investigation of combinations of the aforementioned characteristics revealed that patients presenting with mono- or oligo-arthritis and PGA ≥ 50 remained the most fatigued over time (+20 mm vs polyarthritis with PGA ConclusionThe RA patients who remain the most fatigued were those characterized by mono- or oligo-arthritis and high PGA (VAS ≥ 50) at diagnosis. This understanding may enable early-intervention with non-pharmacological approaches in dedicated patient groups.Pathophysiology and treatment of rheumatic disease

Realising early recognition of arthritis in times of increased telemedicine:the value of patient-reported swollen joints

Pathophysiology and treatment of rheumatic disease

Submarine Cascais Canyon as a sediment conduit to the deep sea : comparison with adjacent slopes

Submarine canyons are known to be important conduits that trap, accumulate and deliver both natural and anthropogenic sediments from the shelf to the deep sea. Ten multi-cores from the Cascais Canyon and from the neighbour slopes (off Estremadura and Sines) were dated by 21Opb methodologies and analyzed for texture, major and trace metals to evaluate the role of submarine canyons in the transport of anthropogenic metals to the abyssal plains. Higher accumulation mass rates were determined in the upper Cascais Canyon than in the lower canyon and slopes. Enrichment factors (EF) were used to evaluate the level of metal enrichment in the studied areas. EF values exceeding natural background concentrations were obtained for Pb suggesting an anthropogenic and/or diagenetic source for Pb enrichment in the Cascais Canyon, but also, to a lesser extent, in the Estremadura and Sines slopes. Studies of provenance based on the ratio of different stable Pb isotopes can help to determinethe origin of such metal in the sediments

Alterações recentes nas razões isotópicas de Pb em sedimentos do Canhão Submarino de Cascais, Portugal

Temporal variations in lead concentrations and stable lead isotopic ratios in two sediment cores from the Cascais Canyon shows changes in sources of Pb during the last two centuries. The increase of total Pb contents wIth the evolution of Pb ratio recorded in both cores reveals the Increase of Pb from industrial sources. Nevertheless, this increase is lower in deeper core location (252-32) due to dilution and mixing with uncontaminated marine materials. An isotopic shift towards lower Pb/Pb in the shallower core (252-35) during the 1970s may reflect the increasing number of vehicles in the Lisboa area during that time