BackgroundPsoriatic arthritis (PsA) is an inflammatory spondyloarthritis associated with psoriasis. Over the recent years the treatment of PsA has changed dramatically with the use of synthetic (s) disease modified anti-rheumatic drugs (DMARDs) as well as biologic (b) DMARDs, particularly tumor necrosis factor inhibitors. The goal of all these therapies is to achieve remission or minimal disease activity (MDA) [1]. Once remission is achieved and sustained the question is whether the treatment should be continued at full dosage, at a tapered dosage or should be discontinued. For PsA there are no recommendations for dosage tapering or discontinuation of biologic therapy and literature data regarding maintained clinical remission is conflicting.B-mode (BM) musculoskeletal (MS) ultrasound (US) has been widely shown to be more sensitive than clinical assessment in detecting joint synovitis and enthesitis [2,3] and Doppler technique is able to identify inflammatory activity [3,4].ObjectivesTo describe and compare clinical and MSUS features between PsA patients treated with full and tapered dosage of bDMARDs. The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant sDMARDs.MethodsWe evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or MDA according to their attending rheumatologist and with the patient acceptance. The bDMARDs tapering consisted of the followings: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of BM and colour Doppler (CD) synovitis, tenosynovitis, enthesopathy and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments and laboratory results.ResultsSeventy four (72.5%) patients received full dosage of bDMARDs and 28 (27.5%) received tapered dosage. The duration with biologic therapy and with current biologic therapy were significantly higher in patients with tapered dosages (p=0.008 and p=0.001, respectively). We found no significant differences between clinical, laboratory and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD.ConclusionsClinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.ReferencesGossec L et al. Ann Rheum Dis. 2012 Jan;71(1):4-12Balint PV et al. Ann Rheum Dis 2002;61:905-10D'Agostino MA et al. Arthritis Rheum 2003;48:523-33Naredo E et al. Arthritis Rheum 2008;58:2248-56Disclosure of InterestNone declared
Appropriate isolation and oseltamivir use in flu positive patients: 2018=27% (6/22); 2019=74% (17/23). Conclusion and relevance Increased flu screening in 2019 despite a national fall in hospitalised flu cases compared with 2018 suggests that clinicians were more likely to consider influenza when rapid diagnostics were available on-site. Onsite testing significantly reduced TAT, having a measurable impact on the appropriateness of isolation and oseltamivir use. The absence of isolation facilities in the coronary care unit represented a significant clinical risk of influenza exposure.
underwent surgery twice for wound debridement and samples were taken. After 6 days of empirical treatment, microbiological culture of exudate revealed Streptococcus pyogenes, and directed antibiotic therapy with penicillin and clindamycin was given. Skin lesions improved progressively with the treatment and lymphocyte count was 1.12×10×3/mL. However, he had to undergo plastic surgery for loss of granulated substance in the affected tissue. Clindamycin was suspended after 7 days and penicillin G after 14 days of treatment. One month later, a significant improvement in cutaneous injuries caused by baricitinib was observed, although he continued to need daily cures for sequels. Conclusion and relevance This adverse reaction was reported to the pharmacovigilance centre and caused baricitinib discontinuation. Immunosuppression caused by baricitinib and probable subsequent infections should be taken into account when starting this treatment in susceptible patients.
was 70 (57-83) years. Background: 50% had arterial hypertension, 37.5% heart disease, 25% diabetes, 25% chronic obstructive pulmonary disease and 12.5% active neoplasia. The diagnosis was severe pneumonia in all cases. The average duration of hospitalisation was 29 (4-73) days. 50% of patients were admitted to the ICU and required mechanical ventilation. In 75%, the dose was 600 mg and the rest required 400 mg, all single doses. The average time from symptom onset to drug administration was 15 (10-30) days. Concomitant drug therapy for SARS-CoV-2: 100% hydroxychloroquine with azithromycin, 87.5% lopinavir/ritonavir, 37.5% methylprednisolone boluses, 25% oral methylprednisolone and 12.5% interferon-ß-1b. 87.5% of patients were discharged. No adverse reactions were reported. Conclusion and relevance Treatment with tocilizumab could be considered a safe and effective option in patients with severe SARS-CoV-2 pneumonia. Further studies are necessary to confirm these preliminary results. Adjustment of the treatments to the criteria established by the regulatory agencies and the recording of health outcomes could contribute to more efficient therapies.
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