Our preliminary data suggest that in patients with dSSc and recent, clinically apparent alveolitis, early treatment with MMF and small doses of corticosteroids (CS) may represent an effective, well-tolerated and safe alternative therapy.
Introduction: Secukinumab, a fully human monoclonal antibody that directly inhibits interleukin-17A, has demonstrated robust efficacy in the treatment of moderate to severe psoriasis (PsO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), with a rapid onset of action, sustained long-term clinical responses and a consistently favourable safety profile across phase 3 trials. Here, we report the clinical data at enrolment from SERENA, designed to investigate the real-world use of secukinumab across all three indications. Methods: SERENA is an ongoing, longitudinal, observational study conducted at 438 sites across Europe in patients with moderate to severe plaque PsO, active PsA or active AS. Patients should have received at least 16 weeks of secukinumab treatment before enrolment in the study.
Background Accurate diagnosis of cardiovascular involvement in systemic lupus erythematosus (SLE) remains challenging, due to limitations of echocardiography. We hypothesized that cardiovascular magnetic resonance can detect cardiac lesions missed by echocardiography in SLE patients with atypical symptoms. Aim To use cardiovascular magnetic resonance in SLE patients with atypical symptoms and investigate the possibility of silent heart disease, missed by echocardiography. Patients/methods From 2005 to 2015, 80 SLE patients with atypical cardiac symptoms/signs (fatigue, mild shortness of breath, early repolarization and sinus tachycardia) aged 37 ± 6 years (72 women/8 men), with normal echocardiography, were evaluated using a 1.5 T system. Left and right ventricular ejection fractions, T2 ratio (oedema imaging) and late gadolinium enhancement (fibrosis imaging) were assessed. Acute and chronic lesions were defined as late gadolinium enhancement-positive plus T2>2 and T2<2, respectively. Lesions were characterized according to late gadolinium enhancement patterns as: diffuse subendocardial, subepicardial and subendocardial/transmural, due to vasculitis, myocarditis and myocardial infarction, respectively. Results Abnormal cardiovascular magnetic resonance findings were identified in 22/80 (27.5%) of SLE patients with normal echocardiography, including 4/22 with recent silent myocarditis, 5/22 with past myocarditis (subepicardial scar in inferolateral wall), 9/22 with past myocardial infarction (six inferior and three anterior subendocardial infarction) and 4/22 with diffuse subendocardial fibrosis due to vasculitis. No correlation between cardiovascular magnetic resonance findings and inflammatory indices was identified. Conclusions Cardiovascular magnetic resonance in SLE patients with atypical cardiac symptoms/signs and normal echocardiography can assess occult cardiac lesions including myocarditis, myocardial infarction and vasculitis that may influence both rheumatic and cardiac treatment.
Our objective was to determine whether a purified protein derivative (PPD) skin test and subsequent isoniazid administration to patients with systemic rheumatic disease, who react positively and are about to receive corticosteroids, is necessary. For this purpose, 451 unselected patients with systemic rheumatic diseases, such as rheumatoid arthritis, giant cell arteritis, polymyalgia rheumatica, systemic lupus erythematosus, scleroderma, poly- and dermatomyositis, mixed connective tissue disease, eosinophilic fasciitis, systemic necrotising vasculitis and Behçet's disease, were observed over a 6-year period. All patients had been started on steroids after commencement of the study and had received the drug for at least 1 year by the end of the study. A chest X-ray was performed before entry, every 6 months for the first year and yearly thereafter. A PPD skin test had been performed in 40 patients by other physicians, but it was our policy to omit the test. We divided our patients into age groups by decades. Steroid dosage varied according to diagnosis and severity. An initial chest X-ray revealed old inactive tuberculosis in 65 patients. During the follow-up period, none of the patients exhibited clinical or radiological evidence of reactivations of tuberculosis. However, at least 184 of the patients would have had a positive PPD skin test reaction, if tested. This figure is derived from the results of several studies on Greek army recruits whose current ages correspond to those of our patients. In conclusion, our results suggest that screening with a PPD and isoniazid prophylaxis, with all the potential risks for those who test positive, may not be necessary in patients with systemic rheumatic disease who will receive steroids.
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