Protocol for a population-based Ankylosing Spondylitis (PAS) cohort in Wales

<p>Abstract</p> <p>Background</p> <p>To develop a population-based cohort of people with ankylosing spondylitis (AS) in Wales using (1) secondary care clinical datasets, (2) patient-derived questionnaire data and (3) routinely-collected information in order to examine disease history and the health economic cost of AS.</p> <p>Methods</p> <p>This data model will include and link (1) secondary care clinician datasets (i.e. electronic patient notes from the rheumatologist) (2) patient completed questionnaires (giving information on disease activity, medication, function, quality of life, work limitations and health service utilisation) and (3) a broad range of routinely collected data (including; GP records, in-patient hospital admission data, emergency department data, laboratory/pathology data and social services databases). The protocol involves the use of a unique and powerful data linkage system which allows datasets to be interlinked and to complement each other.</p> <p>Discussion</p> <p>This cohort can integrate patient supplied, primary and secondary care data into a unified data model. This can be used to study a range of issues such as; the true economic costs to the health care system and the patient, factors associated with the development of severe disease, long term adverse events of new and existing medication and to understand the disease history of this condition. It will benefit patients, clinicians and health care managers. This study forms a pilot project for the use of routine data/patient data linked cohorts for other chronic conditions.</p

Golimumab in refractory uveitis related to spondyloarthritis. Multicenter study of 15 patients

Objective: To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA). Methods: Multicenter study of SpA-related uveitis refractory to at least one immunosuppressive drug. The main outcome variables were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness. Results: Fifteen patients (13 men/2 women; 18 affected eyes; mean age 39±6 years) were evaluated. The underlying SpA subtypes were ankylosing spondylitis (n=8), psoriatic arthritis (n=6) and non-radiographic axial SpA (n=1). The ocular involvement patterns were recurrent anterior uveitis in 8 patients and chronic anterior uveitis in 7. Before GLM they have received methotrexate (n=13), sulfasalazine (n=6), pulses of methylprednisolone (n=4), azathioprine (n=3), leflunomide (n=2) and cyclosporine (n=1). Ten of them had also been treated with TNF-? blockers; etanercept (n=7), adalimumab (n=7), infliximab (n=6), and certolizumab (n=1). GLM was given at the standard dose (50 mg/sc/monthly) as monotherapy (n=7) or in combination with conventional immunosuppressive drugs (n=8), mainly methotrexate. Most patients had rapid and progressive improvement of intraocular inflammation parameters. The median number of cells in the anterior chamber at 2 years (0 [0-0]) was significantly reduced compared to baseline findings (1 [0-3]); p=0.04). The mean best corrected visual acuity value also improved (0.84±0.3 at 2 years versus 0.62±0.3 at baseline; p=0.03). Only minor side effects were observed after a mean follow-up of 23±7 months. Conclusions: Our results indicate that GLM may be a useful therapeutic option in refractory SpA-related uveitis

Ankylosing Spondylitis and Mesenchymal Stromal/Stem Cell Therapy: A New Therapeutic Approach

Ankylosing spondylitis (AS) is an inflammatory rheumatoid disease categorized within spondyloarthropathies (SpA) and manifested by chronic spinal arthritis. Several innate and adaptive immune cells and secreted-mediators have been indicated to play a role in AS pathogenesis. Considering the limitations of current therapeutic approaches (NSAIDs, glucocorticoids, DMARDs and biologic drugs), finding new treatments with fewer side effects and high therapeutic potentials are required in AS. Mesenchymal stem cells (MSCs) with considerable immunomodulatory and regenerative properties could be able to attenuate the inflammatory responses and help tissue repair by cell-to-cell contact and secretion of soluble factors. Moreover, MSCs do not express HLA-DR, which renders them a favorable therapeutic choice for transplantation in immune-mediated disorders. In the present review, we describe immunopathogenesis and current treatments restrictions of AS. Afterwards, immunomodulatory properties and applications of MSCs in immune-mediated disorders, as well as recent findings of clinical trials involving mesenchymal stem cell therapy (MSCT) in ankylosing spondylitis, will be discussed in detail. Additional studies are required to investigate several features of MSCT such as cell origin, dosage, administration route and, specifically, the most suitable stage of disease for ideal intervention

Detecting the reversals of the American stock market

Le but de cette thèse est de construire un modèle de détection des changements de phase -passages de marché haussier à baissier et vice versa - du marché des actions américaines cotées, en utilisant un nombre relativement important de variables à la fois fondamentales (macroéconomiques et microéconomiques) et issues de l’analyse technique.Le modèle statistique retenu est la régression logistique statique, avec un retard pour les variables explicatives allant de zéro à trois mois. Les huit variables les plus significatives parmi vingt candidatesont été sélectionnées à partir des données mensuelles du S&P500 sur la période 1963-2003. Le modèle obtenu a été testé sur 2004-2013 et sa performance a été supérieure à celles de la stratégie Buy & Holdet d’un modèle univarié utilisant la variable ayant le plus fort pouvoir de détection - ce dernier modèle ayant fait l’objet d’une étude dans la littérature.Il a également été montré que des variables non encore considérées dans la littérature - la moyenne mobile sur les six derniers mois des créations nettes d’emplois non-agricoles, la base monétaire et le Composite Leading Indicator de l’OCDE - ont un pouvoir de détection significatif pour notre problématique. D'autre part, la variable binaire indiquant la position du S&P500 par rapport à sa moyenne mobile des dix derniers mois - variable de type analyse technique - a un pouvoir prédictif beaucoup plus élevé que les variables fondamentales étudiées. Enfin, les deux autres variables les plus statistiquement significatives sont macroéconomiques : l'écart entre les taux à dix ans des T-bonds et à trois mois des T-bills et la moyenne mobile des créations d’emplois non-agricoles.The goal of this thesis is to build a model capable of detecting the reversals - shift from bull market to bear market or vice versa - of the American stock market, by using a relatively large number of explanatory variables, both of fundamental (macroeconomic and microeconomic) and of ‘technical analysis’ types.The statistical model used is static logistic regression, with lags for the independent variables ranging from zero to three months. Starting with twenty variables, the eight most significant ones have been selected on a training set consisting of monthly data of the S&P500 between 1963 and 2003. There sulting model has been tested over the 2004-2013 period and its performance was better than those of a buy & hold strategy and of a univariate model based on the variable with the highest predictive power – the latter model being the focus of a paper in the current literature. Another contribution of the thesis is that some variables not yet studied in the literature – the six month moving average of net non-farm job creations, the monetary base and the OECD Composite Leading Indicator – are statistically significant for our problem. Moreover, the predictive power of the binary variable indicating whether the S&P500 is above or below its ten-month moving average – a technical analysis variable – is much higher than that of the fundamental variables which have been considered. Finally, the two other most significant variables are macroeconomic ones: the spread between the ten-year T-bond and three-month T-bill rates and the moving average of non-farm jobs creations

Hybrid Connectionist Approach for Knowledge Discovery from Web Navigation Patterns

International audienc

Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis

Mortality rates in patients with rheumatoid arthritis (RA) have been reported to be higher than for the general population. Fortunately, efficient therapies have reduced disease activity and may be able to diminish the excess mortality risk. This study was designed to investigate RA mortality over the last 50 years by systematic review of the literature and meta-analysis

Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials

Several lines of evidence have emphasized an improvement in aerobic capacity and muscle strength after physical exercise programs in rheumatoid arthritis (RA) patients. Our objective was to evaluate the efficacy of aerobic exercises in RA on quality of life, function, and clinical and radiologic outcomes by a systematic literature review and a meta-analysis