High burden of adverse events is associated with reduced remission rates in early rheumatoid arthritis

Adverse events (AEs) are common during disease-modifying antirheumatic drug (DMARD) treatment, but their influence on treatment results is unclear. We studied AEs in relation to disease activity in early rheumatoid arthritis (RA). Ninety-nine patients started intensive treatment with three conventional synthetic DMARDs (csDMARDs) and oral prednisolone, and were randomized to a 6-month induction treatment with infliximab or placebo. All AEs during the first 12 months of treatment were recorded. We scored each AE based on severity (scale 1-4) and defined the burden of AEs as the sum of these scores. Patients were divided into tertiles according to the burden of AEs. As outcomes, we assessed 28-joint disease activity score (DAS28) levels and remission rates at 12 and 24 months. Three hundred thirty-one AEs in 99 patients were reported, and 27 (8%) were categorized as severe or serious. Mean burden of AEs per patient was 5.4 +/- 4.3. Seventy-nine AEs (24%) led to temporary (n = 52) or permanent (n = 27) csDMARD discontinuation. Of discontinuations, 1, 21, and 57 were detected in the first, second, and third tertiles, respectively. DAS28 remission rates decreased across tertiles at 12 months (94, 94, and 76%; p for linearity 0.029) and at 24 months (90, 86, and 70%; p for linearity 0.021). Mean DAS28 levels increased across tertiles at 12 months (1.5 +/- 1.0, 1.7 +/- 0.9, and 1.9 +/- 1.2; p for linearity 0.021) and at 24 months (1.4 +/- 0.8, 1.6 +/- 1.0, and 1.9 +/- 1.1; p for linearity 0.007). High burden of AEs is associated with higher disease activity and lower likelihood of remission in early RA.Peer reviewe

Pretreatment resistin levels are associated with erosive disease in early rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs and infliximab

Objective: Resistin is an adipocytokine related to insulin resistance and inflammation. We investigated whether resistin is associated with disease activity and inflammation in disease-modifying anti-rheumatic drug (DMARD)-naive rheumatoid arthritis (RA) patients, whether it has predictive value for radiological disease progression, and whether tumour necrosis factor-alpha (TNF-alpha) is involved in these effects. Method: Ninety-nine patients with early, DMARD-naive RA participated in the NEO-RACo study. Patients were treated for the first 4 weeks with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone (FIN-RACo treatment). Thereafter, they were randomized to receive either infliximab or placebo added to the combination for 6 months. Patients were followed for 5 years. Disease activity was evaluated using the Disease Activity Score based on 28-joint count-erythrocyte sedimentation rate, radiographs were scored with the modified Sharp-van der Heijde method, and plasma resistin concentrations were measured by immunoassay. Human THP-1 macrophages were used in the in vitro studies. Results: A high resistin level at baseline was associated with active inflammatory disease and predicted more rapid radiological progression during 5 year follow-up. Adding infliximab to the DMARD combination delayed radiological progression and overcame the poor predictive value of resistin. Resistin increased TNF-alpha production in human macrophages, indicating a possible connection between resistin and TNF-alpha. Conclusion: The results suggest that high resistin concentration may be a useful marker to distinguish patients with an increased risk of erosive disease in early active RA, and that adding TNF-alpha antagonist to the traditional DMARD combination may delay radiological progression of the disease in these patients.Peer reviewe

Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach

Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient's global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician's global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19-3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01-2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.Peer reviewe

Young People in the Labour Market

Bakalářská práce se zabývá mladými lidmi na trhu práce. Mladí lidé jsou často spojování s nedostatkem zkušeností, dovedností či kvalifikace, a proto jsou také řazeni mezi rizikové skupiny trhu práce. Jejím cílem je na základě teoretických znalostí identifikovat problémy mladých lidí na trhu práce v České republice se zaměřením na Moravskoslezský kraj a navrhnout opatření politiky zaměstnanosti, které mohou přispět k podpoře zaměstnatelnosti a zaměstnanosti mladých lidí v ČR a Moravskoslezském kraji. Vytyčený cíl se podařilo v průběhu jednotlivých kapitol naplnit. Bakalářská práce je rozčleněna do 6 kapitol. První kapitola je úvod. Druhá kapitola na základě teoretických znalostí popisuje mladé lidi jako znevýhodněnou skupinu na trhu práce. Třetí kapitola je zaměřena na podporu zaměstnávaní mladých osob v Evropské unii, České republice a Moravskoslezském kraji. Ve čtvrté kapitole je provedena analýza nezaměstnanosti mladých lidí v Moravskoslezském kraji. Také jsou zde popsány vybrané problémy trhu práce. Návrhy a doporučení ke zlepšení postavení mladých osob na trhu práce jsou součástí páté kapitoly. Poslední kapitolu tvoří závěr.The bachelor thesis deals with young people at the labour market. Young people are often associated with a lack of experience, skills or qualifications and are therefore also ranked among risky groups of the labour market. The aim of the thesis is to identify on the basis of theoretical knowledge the problems of young people at the labour market in the Czech Republic focusing on the Moravian-Silesian Region and to propose employment policy measures that can contribute to supporting the ability employment and employment of young people in the CR and the Moravian-Silesian Region. The goal has been fulfilled in the individual chapters. The bachelor thesis is divided into 6 chapters. The first chapter is an introduction. The second chapter based on theoretical knowledge describes young people as a disadvantaged group at the labour market. The third chapter focuses on supporting the employment of young people in the European Union, the Czech Republic and the Moravian-Silesian Region. The fourth chapter analyzes the unemployment of young people in the Moravian-Silesian Region. There are also described selected problems of the labour market. Suggestions and recommendations for improving the position of young people in the labour market are part of the fifth chapter. The last chapter is the conclusion.153 - Katedra veřejné ekonomikyvýborn

Glycoprotein YKL-40 : A potential biomarker of disease activity in rheumatoid arthritis during intensive treatment with csDMARDs and infliximab. Evidence from the randomised controlled NEO-RACo trial

Objective YKL-40, a chitinase-like glycoprotein associated with inflammation and tissue remodeling, is produced by joint tissues and recognized as a candidate auto-antigen in rheumatoid arthritis (RA). In the present study, we investigated YKL-40 as a potential biomarker of disease activity in patients with early RA at baseline and during intensive treatment aiming for early remission. Methods Ninety-nine patients with early DMARD-naive RA participated in the NEO-RACo study. For the first four weeks, the patients were treated with the combination of sulphasalazine, methotrexate, hydroxychloroquine and low dose prednisolone (FIN-RACo DMARD combination), and subsequently randomized to receive placebo or infliximab added on the treatment for further 22 weeks. Disease activity was evaluated using the 28-joint disease activity score and plasma YKL-40 concentrations were measured by immunoassay. Results At the baseline, plasma YKL-40 concentration was 57 +/- 37 ( mean +/- SD) ng/ml. YKL-40 was significantly associated with the disease activity score, interleukin-6 and erythrocyte sedimentation rate both at the baseline and during the 26 weeks' treatment. The csDMARD combination decreased YKL-40 levels already during the first four weeks of treatment, and there was no further reduction when the tumour necrosis factor-alpha antagonist infliximab was added on the combination treatment. Conclusions High YKL-40 levels were found to be associated with disease activity in early DMARD-naive RA and during intensive treat-to-target therapy. The present results suggest YKL-40 as a useful biomarker of disease activity in RA to be used to steer treatment towards remission.Peer reviewe

Prevalence of cartilaginous tumours as an incidental finding on MRI of the knee

OBJECTIVES: The purpose was to determine prevalence of enchondromas and atypical cartilaginous tumour/chondrosarcoma grade 1 (ACT/CS1) of the knee on MRI in a large cohort study, namely the Netherlands Epidemiology of Obesity (NEO) study. METHODS: Participants aged 45 to 65 years were prospectively included, oversampling overweight and obese persons. Within a subgroup of participants, MRI of the right knee was performed and screened for incidental cartilaginous tumours, as defined by their characteristic location and appearance. RESULTS: Forty-nine cartilaginous tumours were observed in 44 out of 1285 participants (estimated population prevalence 2.8 %, 95 % CI 2.0–4.0 %). Mean largest tumour diameter was 12 mm (range 2–31 mm). Eight participants with a tumour larger than 20 mm or a tumour with aggressive features were referred to rule out low-grade chondrosarcoma. One was lost to follow-up, three had histologically proven ACT/CS1 and four had dynamic contrast MRI findings consistent with benign enchondroma. CONCLUSIONS: Incidental cartilaginous tumours were relatively common on knee MRI and may be regarded as a normal concurrent finding. However, more tumours than expected were ACT/CS1. Because further examination was performed only when suspicion of chondrosarcoma was high, the actual prevalence might be even higher. KEY POINTS: • Incidental cartilaginous tumours are relatively common on knee MRI. • Most incidental cartilaginous tumours are small and lack suspicious features. • Small cartilaginous tumours without suspicious findings may be a normal concurrent finding. • Large tumours and/or those with suspicious findings should be further investigated. • Atypical cartilaginous tumour/chondrosarcoma grade 1 was found more often than expected

Advantages and disadvantages of unstructured cardiovascular risk factor screening for follow-up in primary care

Prevention, Population and Disease management (PrePoD

Overweight can be used as a tool to guide case-finding for cardiovascular risk assessment

Clinical epidemiolog

Smoking is associated with increased resting energy expenditure in the general population: The NEO study

Diabetes mellitus: pathophysiological changes and therap

Psychological benefits of exercising with another

155 étudiantes et étudiants ont pratiqué un exercice sur bicyclette seuls ou en compagnie d'une personne de même sexe ou de l'autre sexe et rapporté immédiatement après et un jour après leur niveau de tension, de calme, d'énergie et de fatigue