Results. Sixty-four patients were eligible for entry and were switched from oral MTX to 15 mg/week IM MTX. At baseline, the mean ؎ SD DAS28 was 5.6 ؎ 0.88; after 6 weeks of IM MTX, the DAS28 had improved by a mean of 0.42 (95% confidence interval [95% CI] 0.15-0.69). At 6 weeks, 54 patients still had a DAS28 of >3.2 and were therefore eligible for randomization. By 22 weeks, 1 patient (3.7%) in each group achieved the primary outcome of a DAS28 <3.2 (95% CI for the difference between the groups ؊15% to ؉15%). Five patients (18.5%) in each group showed an improvement of >1.2 in the DAS28 (95% CI for the difference between the groups ؊18% to ؉18%). One patient (3.7%) in each group achieved an ACR20 response, but none achieved a good response as defined by the EULAR response criteria. One patient in each group had a serious adverse reaction; minor adverse reactions were more frequently reported in the dose escalation group.Conclusion. Switching from oral to parenteral MTX 15 mg/week results in a minor improvement in disease control. For patients with active RA receiving 15
Dual energy x ray absorptiometry and a wide range of blood and urine tests were used to assess the propensity ofpatients with systemic lupus erythematosus to develop an impairment of bone mineral density. Surprisingly, in this preliminary study no significant differences in bone mineral density were found when patients taking 10 mg or more of prednisolone for six months or longer were compared with those who had never taken prednisolone.
Objectives-To determine which heat shock proteins (hsps) are overexpressed in systemic lupus erythematosus (SLE), and to examine the relevance of these findings to clinical disease activity. Methods-Hsp levels in peripheral blood mononuclear cells (PBMC) of patients with SLE and normal controls were measured. Levels were analysed with respect to detailed clinical activity scores. Other hsps were also quantified in 30-50% of these samples. Results-There was significant increase of the 90 kilodalton heat shock protein (hsp90) in patients with SLE and active neuropsychiatric (p<0005) and cardiorespiratory (p<001) disease. There was also significant increase of the inducible 72 kilodalton member (hsp72), but not the constitutive 73 kilodalton member (hsp73) of the hsp70 family, and no increase of the 60 kilodalton hsp (hsp6O) was seen in patients compared with controls. There was no association of hsp72 with disease activity, and no correlation between hsp90 and hsp72 levels was seen in individual patients. Conclusion-There may a specific role for hsp90 in distinct, clinically active subsets of patients with SLE.
Female patients with osteoporosis have reduced generic HR-QOL compared with the age-matched female general population, irrespective of a history of prior fracture. The causal relationship between osteoporosis and HR-QOL, if any, is unclear. Further studies are needed to define this relationship and to determine whether treatment of osteoporosis has a beneficial effect on HR-QOL independent of fracture risk.
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