A prospective, open, multicentre, randomized study with a blinded radiological end-point was started in 1991. The aim of the study was to assess whether cyclosporin A (CyA) controls ongoing anatomical damage in active early rheumatoid arthritis (RA) better than conventional disease-modifying anti-rheumatic drugs (DMARDs) as used in everyday clinical practice. A total of 340 consenting patients with early RA (mean duration 1.4 yr) were recruited; 167 were randomized to CyA 3mg/kg per day and 173 to DMARDs. Hand, wrist and foot X-rays were blindly scored by a central committee of three radiologists using the Larsen-Dale method. Any side-effects were carefully recorded. The control of clinical symptoms was similar in both groups. Radiological evaluation of 284 patients (141 on CyA; 143 on DMARDs) after 12 months showed a significant decrease in the mean progression in the eroded joint count (1.3 +/- 3.1 vs 2.4 +/- 3.0, P < 0.001). There was also better maintenance on treatment with CyA than in the group treated with DMARDs (89.2 vs 77.5%, respectively; P = 0.002). CyA seems to offer greater control of ongoing anatomical joint damage in early RA than conventional DMARDs after 12 months.
A 46-year old man, affected by Darier's disease (DD), was seen because of right hand pain, later extended to shoulders and ankles. Physical examination showed swelling and tenderness of the wrist, metacarpophalangeal and metatarsophalangeal joints, of the right Achilles tendon's enthesis and of the left knee, with psoriatic-like lesions of the scalp. A diagnosis of seronegative spondyloarthritis, supported by HLA-B27 positivity and by the magnetic resonance imaging finding of hand synovitis and unilateral sacro-iliitis, was made. The correlation between DD, spondyloarthritis and psoriasis has been already anecdotally reported. Further observations may clarify if this association is more than casual.
BackgroundRheumatic diseases (RD) predominantly affect young women during reproductive age. Pregnancy, contraception and family planning (FP) are crucial for the quality of life of these patients.ObjectivesWe aimed to investigate 'women's health' through a self-reported questionnaire. Answers from patients with connective tissue diseases (CTD) vs chronic arthritis (CA) were compared.Methods24 centres distributed the questionnaire (65 multiple-choice and 12 open-answer questions) to women with RD (18–45years) regularly attending their outpatient clinics.ResultsAnswers were collected from 249 CTD vs 149 CA patients. Their desire to have children was influenced by RD in 40% of cases: half of them reduced the number of children they wanted (Table 1). 39% CA vs 29% CTD were afraid of being mother because of disability.24% CTD vs. 18% CA had at least one miscarriage; 21% CTD vs. 2% CA had more than one.31% CTD and 34% CA were never asked about their desire to have children. 61% CTD vs 70% CA received counselling about contraception, given by a gynaecologist (G) (58% vs 64%), rheumatologist (R) (22% vs 14%) or both (7% vs 9%). 60% in both groups received a counselling before pregnancy: 34% vs 39% from R and G, 14% vs 22% by R. This positively changed family planning in 64% vs 59%. We created a Knowledge Index (based on the average of the normalized performed scores on 6 key questions for different sections): 55% CTD patients vs 44% CA had a medium-high score. A higher score directly correlated with the desire to became pregnant and with a multidisciplinary counselling.ConclusionsThis survey suggested that CTD have a major impact on FP and family size, possibly mediated by the increased rate of miscarriages as compared to CA. Concerns about reproductive issues could be positively overcome by adequate counselling.Rheumatologists should implement the discussion about FP and the compatibility of drugs with pregnancy in the management of young women with RD, especially those with CTD for whom contraception and pregnancy have particular implications.AcknowledgementsStatistical analysis supported by an unrestricted grant by UCB PharmaThanks to Patients' Associations and ParticipantsDisclosure of InterestNone declared
2 Aigon A, Billecocq S. [Prevalence and impact on quality of life of urinary incontinence in an adult population with chronic obstructive pulmonary diseases, literature review].
BackgroundAminaphtone (1,4-Dihydroxy-3-methyl-2-naphthyl-4-aminobenzoate) is a vasoactive drug that was recently demonstrated to improve the symptoms of Raynaud's phenomenon (RP) and to down-regulate endothelin-1 production by endothelial cells (1–3).ObjectivesTo evaluate skin blood perfusion and clinical symptom changes during aminaphtone treatment in patients with both primary and secondary RP, during a six-month follow-up.MethodsForty-six patients with active RP were enrolled during routine clinical assessment in November 2015 (11 primary RP, mean age 49±19SD years, mean RP duration 6±3 years; 35 secondary RP to systemic sclerosis, mean age 61±17 years, mean RP duration 11±9 years), after informed consent. Aminaphtone was administered 75 mg twice daily (off label) in addition to current treatments (the patients were on a stable drug regimen for at least two months before, which remained unmodified during the follow-up). Blood perfusion was measured by Laser Speckle Contrast Analysis (LASCA) and values recorded as perfusion units (PU) (4), at the level of fingertips, periungual areas, dorsum and palm of hands, and face, at baseline (T0), after one (T1), four (T4), twelve (T12) and twenty-four (T24) weeks of treatment. Raynaud's condition score (RCS) and both frequency and duration of Raynaud's attacks were assessed at the same time. Forty-six patients with RP (9 primary RP and 37 secondary RP to systemic sclerosis) not treated with aminaphtone were also enrolled as a control group and evaluated at T0 and T24.ResultsA progressive statistically significant increase of blood perfusion was observed from T0 to T12 in all skin areas analyzed (median PU at T0, T1, T4, T12, T24 respectively: fingertips 55, 88, 101, 107, 98 periungual areas 44, 88, 91, 92, 92; dorsum of hands 38, 61, 71, 75, 75; palm of hands 56, 85, 89, 94, 82; whole face 127, 138, 144, 159, 129; p<0.001 for all areas). From T12 to T24 was not observed any further increase of blood perfusion. A progressive statistically significant decrease of RCS (median at T0, T1, T4, T12, T24: 7, 6, 4, 4, 4; p<0.0001), frequency of Raynaud attacks/day (median: 2, 2, 1, 1, 1; p<0.0001) and Raynaud duration (median: 20, 20, 10, 4, 4 minutes; p<0.0001) was also recorded from T0 to T12. The results were similar in both primary and secondary RP patients (p=0.40). Aminaphtone administration had to be stopped in 2 patients due to headache, and one patient was lost during follow-up. Any statistically significant variation of blood perfusion was not observed in the control group (median PU at T0 and T24 respectively: fingertips 70, 71; periungual areas 68, 70; dorsum of hands 57, 57; palm of hands 59, 59; whole face 132, 130; p=n.s. for all areas).ConclusionsThis study demonstrates that aminaphtone treatment seems able to increase skin blood perfusion and to improve RP symptoms, even in patients affected by systemic sclerosis. These preliminary results should be further confirmed by a randomized clinical trial, also to assess the role that aminaphtone plays in the treatment/p...
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