Biologic treatments in rheumatoid arthritis and juvenile idiopathic arthritis

A number of biological approaches to the management of inflammtory arthropathies have been explored. These include the development of IL-1 receptor antagonists and TNF antagonists. Four biological agents are currently marketed in Europe. Most studies have revolved around Rheumatoid Arthritis, but an increasing number of studies are now completed or ongoing in the other inflammatory joint diseases. These studies are reviewed in this article with a view to guiding practice and usage in the Maltese Islands.peer-reviewe

Calcium, vitamin D and bone

Calcium, protein and vitamin D are the main nutrients relevant to bone health. This short article discusses the importance of vitamin D and its relation to calcium homeostasis. The various causes, clinical manifestations and treatment are outlined.peer-reviewe

Factors related to fatigue in systemic lupus erythematosus : a cohort cross-sectional study

Background Fatigue is the most prevalent symptom in Systemic Lupus Erythematosus (SLE) as it is present in up to 90% of patients; it is considered to be the most disabling symptom in around half of the patients [1,2]. Its aetiology is multi-factorial and there is conflicting evidence on the relationship between fatigue and SLE disease activity, and between fatigue and vitamin D deficiency. The Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria for Fatigue recommended the Fatigue Severity Scale (FSS) for the measurement of fatigue in SLE [2,3].peer-reviewe

Sand Penetration: A Near Nose Investigation of a Sand Penetration Event

This paper presents experimental and computational results of a long-rod penetrating dry granular sand at velocities near 100 m/s. The objective of this work is to develop a fundamental understanding of the formation and transmission of dynamic force chains, and the motion and fracture of the individual sand grains as the projectile passes. This is accomplished by launching a projectile along a view window, backed by sand, in order to directly view and photograph the projectile/sand interactions. Within the sand system, a two-wave structure was observed, composed of a compaction wave (bow shock) that detaches from the dart and moves through the sand at a wave speed near 100 m/s and a damage wave, which remains near the leading edge of the dart. The compaction wave removes porosity and the damage wave fractures grains in the region near the projectile nose. Grain fracture is not observed at dart speeds below 35 m/s. In addition the axial strain to failure of individual sand grains was measured in a quasi-static configuration. These results were used in conjunction with a simple analytic force balance model to predict the depth of penetration. The analytic results compare favourably with experiments until the dart slows below 35 m/s

Translation and validation of the Fatigue Severity Scale, Pittsburgh Sleep Quality Index and Modified Health Assessment Questionnaire into the Maltese language, in a cohort of Maltese Systemic Lupus Erythematosus patients

PURPOSE: The assessment of fatigue, sleep quality and functional disability requires the use of validated instruments such as the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI) and the Modified Health Assessment Questionnaire (mHAQ) respectively. The aim of this study was to translate and validate these instruments into the Maltese Language. METHOD: Forward translation from the original English version into Maltese was carried out by two translators. The two versions were compiled to produce a preliminary initial Maltese translation. This was translated back into English by two other translators. This led to the development of the pre-final version of the Maltese translation, which was pilot-tested in 20 bilingual patients with systemic lupus erythematosus. RESULTS: Psychometric testing revealed good reliability of the Maltese translation of the three questionnaires. Cronbach’s alpha of the Maltese versions of the FSS, PSQI and mHAQ were 0.877, 0.859 and 0.897 respectively, showing good internal consistency. Validity of the Maltese version of the FSS was shown, since it had a significant positive correlation with visual analogue scale for fatigue (r=0.809, p<0.001). CONCLUSION: The Maltese translations were thus finalised, and could be used for clinical assessment or research purposes.peer-reviewe

Seronegative spondyloarthropathies : a review : part I: classification and differential diagnosis

The seronegative spondyloarthropathies comprise a group of non-rheumatoid disorders with similar clinical, laboratory and genetic features. Recognition of new clinical features has supported the notion that they all form part of a clinical spectrum. These features and the classification of the seronegative spondyloarthropathies are discussed in the review.peer-reviewe

Seronegative spondyloarthropathies : a review : part II: genetics and pathogenesis

In none of the spondyloarthropathies is the pathogenesis well understood. Much of the investigation into the aetio-pathogenesis of these diseases has focused on the association with HLA-B27 and the known triggering potential of certain infectious agents. In this article the author describes that the HLA linked genes which is subdivided into three groups, class I, class II and class III, which are structurally and functionally distinct from each other.peer-reviewe

Cardiovascular risk assessment and management in rheumatoid arthritis : are guidelines being followed?

Aim: The aim of the audit was to determine whether the cardiovascular risk assessment and management in rheumatoid arthritis patients at Mater Dei Hospital is in concordance with the recommendations by the European League Against Rheumatism (EULAR). Background: Patients who suffer from rheumatoid arthritis have an increased risk of morbidity and mortality from cardiovascular disease. This is due to both the high prevalence of traditional risk factors, and systemic inflammation. Method: This audit was carried out retrospectively on 91 patients by using the medical notes to collect data on demographics, co-morbidities, drug history and cardiovascular risk assessment and management over a two year period (August 2010 to July 2012). The data was then analysed in order to assess whether the management of cardiovascular risk in rheumatoid arthritis patients was in concordance with EULAR recommendations. Results: Cardiovascular risk factors were documented as follows over the two year period audited: weight in 27.5%, BMI in 0%, smoking status in 72.5%, blood pressure in 72.5%, blood glucose in 72.5% and lipid profile in 54.9%. Smoking cessation advice was given in 15.8% and advice on other lifestyle changes in 14.3%. 81.1% of hypertensive patients were on treatment recommended as first-line by the guidelines and HbA1c was adequately controlled in 85.7% of diabetic patients in whom it was monitored. Conclusion: Cardiovascular risk factors are highly prevalent in rheumatoid arthritis patients. This audit identified aspects of cardiovascular risk assessment that require improvement. This would enable a better identification of cardiovascular risk factors that could be treated in order to reduce the patients’ cardiovascular morbidity and mortality.peer-reviewe

Concordance with the British Society of Rheumatology (BSR) 2010 recommendations on eligibility criteria for the first biologic agent

Aims: The aim of this study is to assess concordance with the British Society of Rheumatology (BSR) 2010 recommendations on the use of biologic therapy in Rheumatoid Arthritis (RA). The Disease Activity Score in 28 joints (DAS 28), a composite numerical score is included in these recommendations to assess disease activity and response to treatment. Methods: Clinical notes of fifty patients who were commenced on biologic treatment between March 2010 and June 2011 were reviewed for documentation of DAS 28 scores at baseline, after approximately 6 months of commencement of treatment and at approximately 6 monthly intervals during treatment. Results: Twenty two patients were eligible for this audit. Of these patients only half had a DAS 28 score performed prior to starting treatment, four patients had the score performed within 3-9 months of commencement of therapy and only 2 patients had continuous scores performed at six monthly intervals during treatment. Conclusions: This audit shows that we are not adhering to the BSR recommendations. In order to improve our adherence we plan to train all staff in contact with patients on biologic treatment to perform DAS 28 scores and have a DAS 28 calculator readily available at out patients. A proforma is being developed for patients on biologic therapy to ensure that DAS 28 scores are performed at baseline and during treatment.peer-reviewe