Introduction: Rheumatoid arthritis (RA) is an autoimmune rheumatic disease which often found in daily practice and requires certain considerations in recognizing clinical appearance also managing the disease as it often causes permanent joint damage, disability, even premature death. This recommendation is expected to become the latest reference for diagnosis and management of RA in Indonesia. Methods: The steering committee was formed by the Indonesian Rheumatology Association (IRA) to formulate key questions; conduct literature search, selection, and review; then formulate recommendation statements for diagnosis, therapy, and monitoring of RA. Furthermore, the steering committee determined the level of evidence and grades of the recommendations. After that, the level of agreement (LOA) was determined for each item by panelists including rheumatology consultants who have been appointed by IRA to represent Indonesia regions. Results: The steering committee established 30 recommendations including diagnosis, the role of laboratory and radiology tests, general treatment, the use of glucocorticoids, sDMARD, bDMARD, and tsDMARD. This recommendation also discusses guidelines on monotherapy, combination therapy, treatment strategies (treat-to-target), tapering, and continuous clinical remission. Treatment on co-morbidities and complications are also included in brief. Conclusion: IRA recommendations regarding the diagnosis and management of RA was made by considering various aspects such as the availability of drugs and supporting facilities, socioeconomic and cultural conditions in Indonesia, as well as the latest research that can be applied to Indonesian population.
Aim S‐flurbiprofen plaster (SFPP) is a novel topical nonsteroidal anti‐inflammatory drug (NSAID) patch. This study aimed to assess the efficacy and safety of SFPP in knee osteoarthritis (OA) patients compared to diclofenac gel. Methods This study was a multicenter, randomized, active‐controlled, open‐label, non‐inferiority phase III trial. There were 311 enrolled patients treated by SFPP or diclofenac gel for 2 weeks. The primary efficacy outcome was the knee pain when rising from the specially arranged chair assessed by visual analog scale (rVAS). The other efficacy outcomes were clinical symptoms, pain on walking, global assessment by both investigator and patient, and use/non‐use of the rescue drugs during the treatment period. Adverse events (AEs) were evaluated as the safety outcome. Results The least‐squares mean (95% CI) of ΔrVAS at the end of the study was 41.52 (39.16‐43.88) mm in the SFPP group and 36.01 (33.69‐38.33) mm in the diclofenac gel group, with a between‐group difference of 5.51 (2.20‐8.82), indicating non‐inferiority. There were statistically significant differences between the groups in rVAS, clinical symptoms, pain on walking, and the global assessment by both investigator and patient. The incidence rate of AEs in the SFPP group was 5.8%, and there was no statistically significant difference from that in the diclofenac gel group (5.2%). Most of the AEs were mild, and no AE led to discontinuation. Conclusion Non‐inferiority of SFPP to diclofenac gel was demonstrated in the efficacy for pain on rising from a chair. SFPP was also well‐tolerated in knee OA patients.
Background: In the early stages of the disease, some of the signs and symptoms of joint inflammation in rheumatoid arthritis (RA) may resemble that of spondyloarthritis (SpA). An examination that can help distinguish RA and SpA is warranted. One such examination is the measurement of serum leucine-rich alpha-2 glycoprotein (LRG) levels. This study aimed to measure serum LRG levels in RA and SpA patients and determine the role of LRG in the diagnosis of RA and SpA. Methods: This is a cross-sectional study consisting of 26 RA subjects and 26 SpA subjects. The SpA subjects were further grouped into ankylosing spondylitis (AS), psoriatic arthritis (PsA), and peripheral SpA. Measurement of serum LRG levels were conducted using ELISA. Difference between LRG levels of the two groups were compared using the Mann-Whitney test. Results: LRG levels were elevated in 76.9% and 84.6% of subjects with RA and SpA, respectively. The median LRG levels were higher in RA subjects (77.03 (27.16–107.73)) than SpA (68.67 (33.15–115.18)). There was no significant difference in LRG levels in RA and SpA subjects (p = .442). The RA and PsA group were predominated by diseases of moderate activity, 88.5% and 58.3%, respectively. In comparison, AS was dominated by high disease activity (85.7%). The highest median LRG levels in AR and SpA subjects were in new-onset patients (82.21 vs. 72.25 µg/dL). Conclusions: There was no significant difference in LRG levels between RA and SpA subjects. The role of LRG in the diagnosis of RA and SpA remains to be determined in future studies.
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