ObjectiveTo investigate whether antidrug antibodies and/or drug non‐trough levels predict the long‐term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.MethodsA total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme‐linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non‐trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.ResultsAmong patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.ConclusionPharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months.
Patients undergoing re-resection after a diagnosis of high-grade non-muscle-invasive bladder cancer had higher disease-specific and overall survival rates due to more accurate diagnosis and appropriate subsequent radical treatment. Re-resection carries greatest benefit to patients with lamina propria invasion at diagnosis.
Haemolytic anaemia caused by a paravalvular leak presenting as progressively worsening red urine. Haemoglobinuria was easily mistaken for gross haematuria, resulting in extensive invasive urological investigation that proved to be futile. Further investigation following an emergency admission led to the realisation that intravascular haemolysis secondary to a paravalvular leakâ€"presenting 43 years following metallic valve insertionâ€"was the cause of discoloured urine and newly presenting symptomatic anaemia. This case highlights that there remains other causes of what often appears to be haematuria, and further exploration of alternative causes should be considered when no urological cause is found.
Background: Rituximab (RTX) in combination with methotrexate (MTX) has been licensed since 2006 for the management of severe active rheumatoid arthritis (RA) in patients who have failed at least one anti-tumour necrosis factor (anti-TNF) therapy. Published clinical trials have demonstrated the efficacy of RTX in improving both clinical symptoms and patients' physical function. This study aimed to assess the effectiveness of RTX in RA patients treated in routine clinical practice by examining clinical and patient reported outcomes six months after receiving a first course of RTX. Methods: The analysis involved 550 RA patients registered with the BSRBR, who were starting RTX and were followed up for at least 6 months. Change in Disease Activity Score (DAS28) and European League Against Rheumatism (EULAR) response were used to assess the clinical response while change in Health Assessment Questionnaire (HAQ) score was used to assess the physical function of the patients 6 months after starting RTX. The change in DAS28 and HAQ was compared between seronegative and seropositive patients and anti-TNF naïve patients versus anti-TNF failures. The response was also compared between patients receiving RTX in combination with MTX, other non-biologic disease modifying anti-rheumatic drugs (nbDMARDs) or no nbDMARDs. Results: The mean (S.D.) age of the cohort was 59 (12) years and 78% of the patients were females. The patients had a mean (S.D.) of 15 (10) years of disease duration. 16% were biologic naïve while 84% were anti-TNF failures. 32% of the patients were seronegative and 68% were seropositive. The mean (95% CI) DAS28 at baseline was 6.2 (6.1, 6.3) which decreased to 4.8 (4.7, 4.9) at 6 months of follow up. 16% were EULAR good responders, 43% were moderate responders and 41% were non responders. The mean (95% CI) change in HAQ was À0.1 (À0.2, À0.1) (Table 1). The mean change in DAS28 was similar in seropositive and seronegative patients (p ¼ 0.18) while the anti-TNF naïve patients showed a greater reduction in DAS28 scores than anti-TNF failures (p ¼ 0.05). Patients receiving RTX in combination with MTX showed similar changes in DAS28 and HAQ compared to patients receiving RTX alone or with other nbDMARDs. Conclusions: RTX has proven to be effective in the routine clinical practice. Anti-TNF naïve patients seem to benefit more from RTX treatment than anti-TNF failures.
rethral complications are recognised in patients post spinal cord injury (SCI) and can be challenging to manage. Our aim was to review the literature to identify the aetiology, incidence, risk factors and management for urethral complications in spinal cord injured patients.
METHODSA search was carried out using the PubMed database for peer reviewed articles on 01/01/18. The following search terms were used: "spinal cord injury", "cauda equina", "neuropathic bladder" "neurogenic bladder" and were combined with "urethral complications", "urethral stricture", "urethral di- J Reconstr Urol 2018;8(1):21-7
21Urethral Complications in Spinal Cord Injury A AB BS S T TR RA AC CT T Spinal cord injury may pose a difficulty for the bladder to empty efficiently. In this scenario catheters are utilised, either in the form of clean intermittent catheterisation (CIC) or indwelling catheters. Little has been collated in the literature regarding the urethral complications associated with these methods of bladder drainage. We reviewed the literature of the published articles reporting on the urethral complications associated with catheter use in the spinal cord injured population. Long term, both methods carry a risk of urethral complications including tructuring, erosion, fistulation and diverticulum formation with less risk reported for CIC. Although reports of the management of these complications are limited in the literature, surgical repair forms the mainstay of management and in severe cases urinary diversion is required.K Ke ey yw wo or rd ds s: : Urethral complications; urethral erosion; urethral diverticulum; urethral stricture; urethral fistula; spinal cord injuries; clean intermittent catheterisation Ö ÖZ ZE ET T Spinal kord yaralanması, mesanenin etkin boşaltılmasında önemli güçlük çıkarabilir. Bu durumda "clean intermittent" kateterler (CIC) ve/veya "indwelling" kateterler kullanılabilir. Bu metotlarla mesanenin boşaltılmasına ilişkin üretral komplikasyonları ele alan literatürü gözden geçirdik. Spinal kord hasarı yaşamış popülasyonda kateter kullanımına ilişkin üretral komplikasyonları ele alan makaleleri derledik. Uzun dönemde, her iki kateter yönteminde de sık rastlanan komplikasyonlar erozyon, fistülasyon ve divertikulum formasyonu olmakla beraber, bu riskler CIC ile daha az rapor edilmiştir. Bu komplikasyonların yönetimine ilişkin makalelerin raporların sayısı az olmakla birlikte, bunların tedavisinde ana yöntem cerrahi onarım olmaktadır. Şiddetli olgularda üriner diversiyon gerekmektedir.A An na ah h t ta ar r K Ke e l li i m me e l le
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.