tag:blogger.com,1999:blog-65392834982649314612024-03-15T03:03:41.235-07:00Joint VentureThe blog of Dr. Antoni Chan, MD PhD.
From tweeting to blogging, this is my adventure in sharing my thoughts and opinions with anyone interested in all things related to arthritis and rheumatology. The sharing of information is dynamic and involves many.
Our contributions together in the quest for knowledge in rheumatology makes this a Joint Venture.
Follow me on Twitter @synovialjointsJoint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-6539283498264931461.post-32645961521454382632019-12-24T00:27:00.000-08:002019-12-24T00:27:53.693-08:00The Christmas Playlist - songs that best represent a specialty<br />
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">My
playlist for Christmas <o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Song that best
represents a specialty. Enjoy listening to them<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Anaesthetics<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Take my
breath away (Berlin)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Intensive
Care<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Every Breath
You Take (The Police) <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">I See You
Baby; Shaking that ass (Groove Armada)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Respiratory
Medicine<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">I Don’t Want
to Miss A Thing (Aerosmith) <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><span style="mso-spacerun: yes;"><br /></span></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Neurology<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Imagine (John
Lennon)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Don’t stop
believing (Journey)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Rheumatology</span></u></b><span style="font-family: "Segoe UI",sans-serif;"> <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Just keep
moving (Supergrass)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">You've Got A
Friend in Me for rheumatology (Randy Newman)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Joints and
Jams (Black eyed peas)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Firestarter
(The Prodigy)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Halo (Beyoncé)
(Giant Cell Arteritis on ultrasound)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Rock the
Joint (Bill Hayley and the Comets)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Bariatrics<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Fat bottom
girls (Queen)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Emergency
Department<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Help (Beatles)
<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Memory
Clinic<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Forget You –
CeeLo Green <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Podiatry<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">These Boots
Were Made For Walking (Nancy Sinatra) <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Ophthalmology<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">I Can See
Clearly Now (Jimmy Cliff)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Eye of the
tiger (Survivor)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Dental<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Everybody
Hurts (REM) doing dental extractions.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Cardiology<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Unbreak my
heart (Toni Braxton) <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Achy Breaky
Heart (Bily Ray Cyrus)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Sexual
Health<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Sex on fire (Kings
of Leon)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Acute
Medicine<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Under Pressure
(Queen)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Plastic
Surgery<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Under Your
Scars (Godsmack)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Dermatology<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">I’ve got you
under my skin (Frank Sinatra)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Radiology<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">I still
haven’t found what I’m looking (U2)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Podiatry<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Footloose (Kenny
Loggins)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Dieticians<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Sugar Sugar (The
Archies) <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Psychiatry<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Mr
Brightside (The Killer) <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Internal
Medicine<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Lay you
hands on me (Bon Jovi) </span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Pain
Clinic<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">King of pain
(Police)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Metabolic
Bone <o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Jump Around <span style="mso-spacerun: yes;"> </span>(House of Pain)<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><span style="mso-spacerun: yes;"><br /></span></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Physiotherapy<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Heads
shoulders knees and toes (nursery rhyme)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Segoe UI",sans-serif;">Orthopaedics<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Can we fix
it (Bob the Builder)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Segoe UI",sans-serif;">Sledgehammer
(Peter Gabriel) <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<br />Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-62581723072911000832018-04-28T10:22:00.001-07:002018-04-28T10:22:50.457-07:00BSR Spondyloarthritis Special Interest Group (SIG) meeting 2018The British Society for Rheumatology (BSR) Spondyloarthritis Special Interest Group (SIG) will meet on Tuesday 1st May at 14.15-15.45 at the BSR Conference in Liverpool.<br />
<br />
The programme is as follows:<br />
<br />
SESSION SIG 08 - Spondyloarthritis SIG<br />
May 1, 2018, 2:15 PM - 3:45 PM<span style="white-space: pre;"> </span> 1B<br />
<br />
Aim<br />
To increase knowledge and understanding of the unmet needs in spondyloarthritis<br />
Outcome 1<br />
To understand the diagnostic challenges within the spectrum of spondyloarthritis<br />
Outcome 2<br />
To understand and manage the burden of fatigue in spondyloarthritis<br />
Outcome 3<br />
To understand the impact of spondyloarthritis on work disability and productivity<br />
<br />
7 Presentations<br />
2:15 PM - 3:45 PM<span style="white-space: pre;"> </span>- Chair<br />
Antoni Chan, Royal Berkshire NHS Foundation Trust, Department of Rheumatology, Reading, UNITED KINGDOM.<br />
<br />
2:15 PM - 3:45 PM<span style="white-space: pre;"> </span>- Chair<br />
Bruce Kirkham, Guy's & St Thomas' NHS Fondation Trust, Rheumatology, London, UNITED KINGDOM.<br />
<br />
2:15 PM - 2:30 PM<span style="white-space: pre;"> </span>i141 - Diagnostic challenges in SpA: differentiating PsA from OA using imaging factors<br />
Ai Lyn Tan, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM.<br />
<br />
2:30 PM - 2:45 PM<span style="white-space: pre;"> </span>i142 - Management of fatigue and fibromyalgia in spondyloarthritis<br />
Neil Basu, University of Aberdeen, School of Medicine and Dentistry, Aberdeen, UNITED KINGDOM.<br />
<br />
2:45 PM - 3:00 PM<span style="white-space: pre;"> </span>i143 - Update from BRITSPA<br />
Andrew Keat, Northwick Park Hospital, Department of Rheumatology, London, UNITED KINGDOM.<br />
<br />
3:00 PM - 3:15 PM<span style="white-space: pre;"> </span>i144 - Update from BRITPAC<br />
Bruce Kirkham, Guy's & St Thomas' NHS Foundation Trust, Rheumatology, London, UNITED KINGDOM.<br />
<br />
3:15 PM - 3:30 PM<span style="white-space: pre;"> </span>i145 - Understanding and managing the impact of work disability in spondyloarthritis<br />
Suzanne Verstappen, Centre for Musculoskeletal Research, Arthritis Research UK Epidemiology Unit, Manchester, UNITED KINGDOM.<br />
<br />
If you are attending the BSR Conference 2018, I look forward to seeing you there.<br />
<br />
<br />
<br />Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-74929143070182935282017-11-01T17:12:00.003-07:002017-11-01T17:12:56.319-07:00NICE Guidelines on Spondyloarthritis - a guide for GPs and referrers<br />
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif";">The NICE Guidelines on
Spondyloarthritis – A guide for GPs and referrers<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif";"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif";">Dr. Antoni Chan, PhD FRCP<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif";">Consultant Rheumatologist, Royal
Berkshire Hospital and Spire Dunedin Hospital, Reading<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif";"><br /></span></b></div>
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">A summary of the National Institute for Health
and Care Excellence. Spondyloarthritis in over 16s: diagnosis and management
(NICE guideline NG65) 2017.<span class="apple-converted-space"> </span></span><a href="http://www.nice.org.uk/guidance/ng65"><span style="background: white; border: 1pt none windowtext; color: #2a6ebb; font-family: Helvetica, sans-serif; padding: 0cm; text-decoration-line: none;">www.nice.org.uk/guidance/ng65</span></a><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">Background<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<b><u><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";"><br /></span></u></b></div>
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">The spondyloarthropathies (SpAs) encompasses a
group of inflammatory conditions with shared features. These include
extra-articular manifestations such as iritis, colitis and psoriasis. The SpAs
can be divided into:<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">Axial
(spinal) spondyloarthritis<o:p></o:p></span></u></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">Non-radiographic
axial spondyloarthritis (positive MRI, negative X-ray for sacroilitis)</span><o:p></o:p></li>
<li class="MsoNormal"><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">Radiographic
axial spondyloarthritis (also called Ankylosing Spondylitis)</span><o:p></o:p></li>
</ul>
<div class="MsoNormal">
<b><u><span style="background: white; color: #333333; font-family: "Helvetica","sans-serif";">Peripheral
spondyloarthritis<o:p></o:p></span></u></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Psoriatic Arthritis (arthritis related to skin
psoriasis)<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Reactive Arthritis (arthritis occurring after
gastrointestinal or genitourinary infection)<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Enteropathic Arthritis (arthritis related to
Ulcerative or Crohn’s colitis)<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif";">The clinical manifestations of
spondyloarthritis include<o:p></o:p></span></u></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Enthesitis – inflammation at sites of tendon
insertion in the bone eg. Achilles tendon<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Dactylitis – inflammation of the whole digit giving
‘sausage’ like appearance<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Acute anterior uveitis</span></li>
</ul>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif";">When to suspect SpA and refer to
rheumatologist?<o:p></o:p></span></u></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Presence of inflammatory low back pain before the
age of 45 years and has lasted for more than 3 months<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Low back pain that improves with movement and worse
with rest<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Alternating buttock pain<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Waking during the second half of the night due to
symptoms<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Improvement within 48 hours of taking NSAIDs<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Current or previous arthritis (swelling, tenderness
of joints)<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Current or previous enthesitis<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Current or previous dactylitis<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Current or previous psoriasis<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">First degree relative with spondyloarthritis<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<b><i><span style="font-family: "Arial","sans-serif";">If 4 or more of these
clinical features are present please refer.<o:p></o:p></span></i></b></div>
<div class="MsoNormal">
<b><i><span style="font-family: "Arial","sans-serif";">If 3 clinical features
are present, check the HLA- B27 blood test and refer.<o:p></o:p></span></i></b></div>
<div class="MsoNormal">
<b><i><span style="font-family: "Arial","sans-serif";">If 2 or fewer clinical
features are present, advise repeat assessment if new signs or symptoms related
to SpAs develop<o:p></o:p></span></i></b></div>
<div class="MsoNormal">
<b><i><span style="font-family: "Arial","sans-serif";"><br /></span></i></b></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif";">What further tests can be done by a
rheumatologist after referral?<o:p></o:p></span></u></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">X-ray of sacroiliac joint<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">MRI of whole spine and sacroiliac joints<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Inflammatory markers (ESR, CRP)<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">HLA-B27<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif";">What treatments are available?<o:p></o:p></span></u></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Physiotherapy <o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Injections<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Clinical Psychology<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Occupational Therapy<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">NSAIDs<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Disease modifying drugs (DMARDs)`<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Anti-TNF (biologics)<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif";">Secukinumab (biologic)<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif";">GPs and referrers can refer to their
local rheumatology departments for suspected AS or SpA.<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif";"><br /></span></u></b></div>
<br />
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">There
is a dedicated Ankylosing Spondylitis clinic at the Royal Berkshire Hospital,
Reading (NHS) and Spire Dunedin Hospital, Reading (private). Dr. Chan runs both
clinics with physiotherapists.<o:p></o:p></span></div>
Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-21806627326129147512017-01-15T13:18:00.000-08:002017-01-15T13:18:22.170-08:00My Rheumatology Highlights 2016<b><br /></b>
<div style="text-align: justify;">
<b><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><u>My Rheumatology highlights from 2016</u></span></b></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">As we start the new year 2017, here are my rheumatology highlights from papers and abstracts in 2016. These were papers and abstracts in no particular order. I discussed these papers with colleagues at conferences, meetings and journal clubs. I hope you find them useful. </span></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">They were many other papers but due to space and time, I have not included all of them here. </span></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">Do share your favourite rheumatology papers from 2016 too.</span></div>
<div style="text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="highlight"><b><span style="font-size: 16pt; line-height: 150%;">Baricitinib</span></b></span><span class="apple-converted-space"><b><span style="font-size: 16pt; line-height: 150%;"> </span></b></span><b><span style="font-size: 16pt; line-height: 150%;">in Patients with Refractory<span class="apple-converted-space"> </span><span class="highlight">Rheumatoid
Arthritis</span>.<o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27028914" title="The New England journal of medicine."><span style="color: windowtext; text-decoration: none; text-underline: none;">N Engl J Med.</span></a><span class="apple-converted-space"> </span>2016 Mar 31;374(13):1243-52<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Genovese%20MC%5BAuthor%5D&cauthor=true&cauthor_uid=27028914"><span style="color: windowtext; text-decoration: none; text-underline: none;">Genovese MC</span></a>
et al<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Phase 3 study involving 527 patients with an inadequate
response to or unacceptable side effects associated with one or more tumor
necrosis factor inhibitors, other biologic DMARDs, or both, we randomly
assigned the patients in a 1:1:1 ratio to<span class="apple-converted-space"> </span><span class="highlight">baricitinib</span><span class="apple-converted-space"> </span>at
a dose of 2 or 4 mg daily or placebo for 24 weeks. Significantly more patients
receiving<span class="apple-converted-space"> </span><span class="highlight">baricitinib</span><span class="apple-converted-space"> </span>at the 4 -mg dose than those receiving
placebo had an ACR20 response at week 12 (55% vs. 27%, P<0.001). In patients
with<span class="apple-converted-space"> </span><span class="highlight">rheumatoid
arthritis</span><span class="apple-converted-space"> </span>and an
inadequate response to biologic DMARDs,<span class="apple-converted-space"> </span><span class="highlight">baricitinib</span><span class="apple-converted-space"> </span>at
a daily dose of 4 mg was associated with clinical improvement at 12 weeks.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="highlight"><b><span style="font-size: 16pt; line-height: 150%;">Sifalimumab</span></b></span><b><span style="font-size: 16pt; line-height: 150%;">, an anti-interferon-α monoclonal antibody, in moderate to severe
systemic lupus erythematosus: a randomised, double-blind, placebo-controlled
study.<o:p></o:p></span></b></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Khamashta%20M%5BAuthor%5D&cauthor=true&cauthor_uid=27009916"><span style="color: windowtext; text-decoration: none; text-underline: none;">Khamashta M</span></a>
et al<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27009916" title="Annals of the rheumatic diseases."><span style="color: windowtext; text-decoration: none; text-underline: none;">Ann Rheum Dis.</span></a><span class="apple-converted-space"> </span>2016 Nov;75(11):1909-1916.<o:p></o:p></span></span></div>
<div style="background: white; line-height: 150%; margin-bottom: 6.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">The efficacy and safety of<span class="apple-converted-space"> </span><span class="highlight">sifalimumab</span><span class="apple-converted-space"> </span>were assessed in a phase IIb,
randomised, double-blind, placebo-controlled studyof adults with moderate to
severe active systemic lupus erythematosus (<span class="highlight">SLE</span>). Compared
with placebo, a greater percentage of patients who received<span class="apple-converted-space"> </span><span class="highlight">sifalimumab</span><span class="apple-converted-space"> </span>(all dosages) met the primary end
point of <span class="highlight">SLE</span><span class="apple-converted-space"> </span>responder
index response at week 52 (placebo: 45.4%; 200 mg: 58.3%; 600 mg: 56.5%;
1200 mg 59.8%). <span class="highlight">Sifalimumab</span><span class="apple-converted-space"> </span>is a promising treatment for adults
with<span class="apple-converted-space"> </span><span class="highlight">SLE</span>.
Improvement was consistent across various clinical end points, including global
and organ-specific measures of disease activity.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1;">
<br /></div>
<h2 style="background: white; line-height: 150%; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b><span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Efficacy and Safety of Switching Between Certolizumab Pegol and
Adalimumab after Primary Anti-TNF Treatment Failure: 2-Year Results from a
Randomized, Investigator-Blind, Superiority Head-to-Head Study<o:p></o:p></span></span></b></h2>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 150%; text-transform: uppercase;">A</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 150%; text-transform: uppercase;">CR ABSTRACT NUMBER: 602<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"><span style="font-family: Arial, Helvetica, sans-serif;">Fleischmann
R et al<b><o:p></o:p></b></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 150%;">EXXELERATE is the first
randomized controlled trial (RCT) to address immediate switching to another TNFi,
in a TNFi IR patient population.</span> EXXELERATE was a 104-wk randomized,
investigator-blind, parallel-group, head-to-head superiority study comparing the
early (Wk 12)- and Wk 104 efficacy and safety of certolizumab pegol (CZP)+MTX vs
adalimumab (ADA)+MTX. Pts were randomized 1:1 to CZP+MTX or ADA+MTX.<span class="apple-converted-space"> </span>Clinical improvement was
observed in a considerable proportion of pts; 33 pts (55.9%) switching to CZP
and 40 pts (60.6%) switching to ADA responded 12 wks later (Wk 24) by achieving
DAS28(ESR) ≤3.2 or a DAS28(ESR) reduction from Wk 12 of ≥1.2.<span class="apple-converted-space"> </span>EXXELERATE demonstrated that
efficacy can be achieved using a second TNFi in a proven primary TNFi failure
pt population. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; mso-outline-level: 1; text-align: justify;">
<b><span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Tapering biologic and conventional DMARD therapy
in rheumatoid arthritis: current evidence and future directions.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27261493" title="Annals of the rheumatic diseases."><span style="color: windowtext; text-decoration: none; text-underline: none;">Ann Rheum Dis.</span></a> 2016
Aug;75(8):1428-37<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Schett%20G%5BAuthor%5D&cauthor=true&cauthor_uid=27261493"><span style="color: windowtext; text-decoration: none; text-underline: none;">Schett G</span></a><sup>
</sup>et al<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">This
review article discusses the current developments of DMARD tapering and provides
an overview of existing studies on this topic and addresses new strategies to
reach drug-free remission. Defining patients eligible for DMARD tapering are
described and potential future strategies in using biomarkers in predicting the
risk for disease relapse after initiation of DMARD tapering are addressed.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<br /></div>
<h2 style="line-height: 150%; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b><span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Efficacy and Safety of Tocilizumab in Patients with Giant Cell
Arteritis: Primary and Secondary Outcomes from a Phase 3, Randomized,
Double-Blind, Placebo-Controlled Trial<o:p></o:p></span></span></b></h2>
<div class="mworthynumber" style="line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<strong><span style="font-weight: normal; text-transform: uppercase;"><span style="font-family: Arial, Helvetica, sans-serif;">ACR 2016 ABSTRACT NUMBER: 911<o:p></o:p></span></span></strong></div>
<div class="mworthynumber" style="line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">Stone JH et al<span style="text-transform: uppercase;"><o:p></o:p></span></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #444444;">The early results of GiACTA study confirm the efficacy of
tocilizumab (TCZ) in giant cell arteritis.<sup> </sup></span><span style="background: white;">TCZ with a
26-week prednisone taper was superior to both short- and long-course prednisone
tapers for the achievement of sustained remission at 52 weeks. The addition of
TCZ to prednisone also led to a substantial reduction in the cumulative
prednisone doses required to control GCA.</span><o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<br /></div>
<h2 style="line-height: 150%; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b><span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Combination Therapy of Apremilast and Biologic Agent As a Safe
Option of Psoriatic Arthritis and Psoriasis<o:p></o:p></span></span></b></h2>
<div class="mworthynumber" style="line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<strong><span style="font-weight: normal; text-transform: uppercase;"><span style="font-family: Arial, Helvetica, sans-serif;">ACR ABSTRACT NUMBER: 1725<o:p></o:p></span></span></strong></div>
<div class="mworthynumber" style="line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">Metyas et al<span style="text-transform: uppercase;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Apremilast can be safely and effectively combined with biologic
agents in patients with plaque psoriasis or psoriatic arthritis not responding
adequately to these agents alone. No major side effects of cancer or sever
infection were reported other than nausea and/or vomiting that were manageable
in some patients.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<br /></div>
<h2 style="line-height: 150%; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b><span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">No Increased Risk of Inflammatory Bowel Disease Among
Secukinumab-Treated Patients with Moderate to Severe Psoriasis, Psoriatic
Arthritis, or Ankylosing Spondylitis: Data from 14 Phase 2 and Phase 3 Clinical
Studies<o:p></o:p></span></span></b></h2>
<div class="mworthynumber" style="line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><strong><span style="font-weight: normal; text-transform: uppercase;">ACR ABSTRACT NUMBER: 962</span></strong><span style="text-transform: uppercase;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Deodhar
A et al<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Events of CD and UC in the 14 clinical studies were reported
infrequently in secukinumab-treated pts with psoriasis, PsA, or AS; rates were
similar across the psoriasis and PsA cohorts. EAIR rates of CD and UC
observed in secukinumab-treated pts are consistent with those reported in the
literature in psoriasis, PsA, and AS populations.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<br /></div>
<h2 style="line-height: 150%; margin-bottom: 7.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b><span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">A Single Infusion of Rituximab Delays the Onset of Arthritis in
Subjects at High Risk of Developing RA<o:p></o:p></span></span></b></h2>
<div class="mworthynumber" style="line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="text-transform: uppercase;">ACR 2016 ABSTRACT
NUMBER: 3028</span><span style="text-transform: uppercase;"><o:p></o:p></span></span></div>
<div class="authors-and-affiliation" style="line-height: 150%; margin-bottom: 5.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">Gerlag DM et al<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #444444; font-size: 12.5pt; line-height: 150%;">The PRAIRI study
reporting preliminary data from a randomized, blinded study of 81 participants.
When given to individuals with preclinical RA (elevated antibodies to
citrullinated proteins and rheumatoid factor but no synovitis on baseline
examination), </span><span style="background: white;">a single infusion of 1000 mg rituximab significantly delays
the development of arthritis in subjects at risk of developing RA</span> by
about 12 months.<o:p></o:p></span></div>
<h1 style="background: white; line-height: 150%; text-align: justify; vertical-align: baseline;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 16pt; line-height: 150%;"><o:p><span style="font-family: Arial, Helvetica, sans-serif;"> </span></o:p></span></h1>
<h1 style="background: white; line-height: 150%; text-align: justify; vertical-align: baseline;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 16pt; line-height: 150%;">Cardiovascular Safety of Celecoxib, Naproxen, or
Ibuprofen for Arthritis</span><span style="font-size: 16pt; line-height: 150%;"><o:p></o:p></span></span></h1>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background: white;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27959716" title="The New England journal of medicine."><span style="color: windowtext; text-decoration: none;">N Engl J Med.</span></a></span><span class="apple-converted-space"> 2016 Dec 29;375(26):2519-29</span><o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="background: white;"><span style="font-family: Arial, Helvetica, sans-serif;">Nissen SE et al<o:p></o:p></span></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">The
cardiovascular safety of celecoxib was compared with nonselective nonsteroidal antiinflammatory
drugs (NSAIDs). At moderate doses, celecoxib was found to be noninferior to
ibuprofen or naproxen with regard to cardiovascular safety.<o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<br /></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="highlight"><b><span style="font-size: 16pt; line-height: 150%;">Ustekinumab</span></b></span><span class="apple-converted-space"><b><span style="font-size: 16pt; line-height: 150%;"> </span></b></span><b><span style="font-size: 16pt; line-height: 150%;">as Induction and Maintenance Therapy for<span class="apple-converted-space"> </span><span class="highlight">Crohn's</span><span class="apple-converted-space"> </span><span class="highlight">Disease</span>.</span></b><b><span style="font-size: 16pt; line-height: 150%;"><o:p></o:p></span></b></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27959607" title="The New England journal of medicine."><span style="color: windowtext; text-decoration: none; text-underline: none;">N Engl J Med.</span></a><span class="apple-converted-space"> </span>2016 Nov 17;375(20):1946-1960<b><o:p></o:p></b></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; tab-stops: 177.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Feagan%20BG%5BAuthor%5D&cauthor=true&cauthor_uid=27959607"><span style="color: windowtext; text-decoration: none; text-underline: none;">Feagan BG</span></a>
et al. <o:p></o:p></span></div>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; tab-stops: 177.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;">Patients received a single
intravenous dose of<span class="apple-converted-space"> </span><span class="highlight">ustekinumab</span><span class="apple-converted-space"> </span>(either
130 mg or approximately 6 mg per kilogram of body weight) or placebo in two
induction trials. The UNITI-1 trial included 741 patients who met the criteria
for primary or secondary nonresponse to tumor necrosis factor (TNF) antagonists
or had unacceptable side effects. The UNITI-2 trial included 628 patients in
whom conventional therapy failed or unacceptable side effects occurred.
Patients who completed these induction trials then participated in IM-UNITI, in
which the 397 patients who had a response to<span class="apple-converted-space"> </span><span class="highlight">ustekinumab</span><span class="apple-converted-space"> </span>were
randomly assigned to receive subcutaneous maintenance injections of 90 mg of<span class="apple-converted-space"> </span><span class="highlight">ustekinumab</span><span class="apple-converted-space"> </span>(either every 8 weeks or every 12 weeks)
or placebo. Patients with moderately to severely active<span class="apple-converted-space"> </span><span class="highlight">Crohn's</span><span class="apple-converted-space"> </span><span class="highlight">disease</span>,
those receiving intravenous<span class="apple-converted-space"> </span><span class="highlight">ustekinumab</span><span class="apple-converted-space"> </span>had
a significantly higher rate of response than did those receiving placebo.
Subcutaneous<span class="apple-converted-space"> </span><span class="highlight">ustekinumab</span><span class="apple-converted-space"> </span>maintained
remission in patients who had a clinical response to induction therapy.<o:p></o:p></span></div>
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<h1 style="background: white; line-height: 150%; margin-bottom: 11.25pt; text-align: justify;">
<span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Tumour necrosis factor inhibition versus rituximab for
patients with rheumatoid arthritis who require biological treatment (ORBIT): an
open-label, randomised controlled, non-inferiority, trial<o:p></o:p></span></span></h1>
<h1 style="background: white; line-height: 150%; margin-bottom: 11.25pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">Lancet</span><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">. <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00380-9/abstract"><span style="color: windowtext; text-decoration: none; text-underline: none;">2016; 388: 239-247</span></a></span><span style="font-size: 12pt; font-weight: normal; line-height: 150%;"><o:p></o:p></span></span></h1>
<div style="line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-size: 12.5pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Porter D et al<o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 150%;">Data from
the Optimal Management of Rheumatoid Arthritis Patients Requiring Biologic
Therapy (ORBIT) study showed that </span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 150%;">initial
treatment with rituximab is non-inferior to initial TNF inhibitor treatment in
patients seropositive for rheumatoid arthritis and naive to treatment with
biologicals, and is cost saving over 12 months.</span><o:p></o:p></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
<h1 style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span class="highlight"><span style="font-size: 16pt; line-height: 150%;">BSR</span></span><span class="apple-converted-space"><span style="font-size: 16pt; line-height: 150%;"> </span></span><span style="font-size: 16pt; line-height: 150%;">and BHPR<span class="apple-converted-space"> </span><span class="highlight">guideline</span><span class="apple-converted-space"> </span>on
prescribing drugs in<span class="apple-converted-space"> </span><span class="highlight">pregnancy</span><span class="apple-converted-space"> </span>and
breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic
drugs and corticosteroids.<o:p></o:p></span></span></h1>
<h1 style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; text-align: justify;">
<span style="font-family: Arial, Helvetica, sans-serif; font-weight: normal;"><span style="font-size: small;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: 150%;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/26750124" title="Rheumatology (Oxford, England)."><span style="color: windowtext; text-decoration: none;">Rheumatology (Oxford).</span></a></span><span class="apple-converted-space"> 2016 Sep;55(9):1693-7</span></span><o:p></o:p></span></h1>
<h1 style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; text-align: justify;">
<span style="font-size: 12pt; font-weight: normal; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Flint%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26750124"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: windowtext; text-decoration: none;">Flint J</span></a> et al<o:p></o:p></span></span></h1>
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</h1>
<h1 style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; text-align: justify;">
<span style="font-size: 12pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: normal;">Updated guidelines on prescribing
DMARDs and biologics in pregnancy and breastfeeding. A very useful resource for
clinicians.</span><span style="font-weight: normal;"><o:p></o:p></span></span></span></h1>
<h1 style="background: white; line-height: 150%; margin-bottom: 4.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt; text-align: justify;">
<sup><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-size: 12pt; font-weight: normal; line-height: 150%;"><o:p><span style="font-family: Arial, Helvetica, sans-serif;"> </span></o:p></span></sup></h1>
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<span style="font-size: 16pt; line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;"> </span></span></h1>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-15352123323131188282016-11-08T15:50:00.002-08:002016-11-08T16:00:59.395-08:00Update and highlights from EULAR Congress 2016 London<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"><b><u>Update and highlights from EULAR 2016</u></b></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;">I</span><span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"> attended the
European League Against Rheumatism (EULAR) Annual Congress in June 2016. This
was held on home ground in London. This annual meeting brings together
rheumatologists and allied health professionals from across the world.</span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;">There was a tweet up
at EULAR 2016 and it was good meeting up face to face with colleagues and
friends.<o:p></o:p></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUADGX0Z_ANCBzRBn9tPXFMXc42KXnHhec4MgLZ7ONqfA9WAoC4L6HILQOeBeye2teKA-j61AGVCNi2eb7Hv_SF8Dbq0mHYWRzTvYH8y46Gz4h5_IPBShQb8v1RSxuTYfXwlEiNWCoDHZO/s1600/IMG_3690.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUADGX0Z_ANCBzRBn9tPXFMXc42KXnHhec4MgLZ7ONqfA9WAoC4L6HILQOeBeye2teKA-j61AGVCNi2eb7Hv_SF8Dbq0mHYWRzTvYH8y46Gz4h5_IPBShQb8v1RSxuTYfXwlEiNWCoDHZO/s320/IMG_3690.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">EULAR 2016 at the Excel Centre, London, UK<br />
<br /></td></tr>
</tbody></table>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;">There were many
abstracts presented at the meeting. See the EULAR website for the link to the
abstracts.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt;">
<a href="http://www.abstracts2view.com/eular/sessionindex.php"><span style="font-family: "arial" , sans-serif; font-size: 12.5pt;">http://www.abstracts2view.com/eular/sessionindex.php</span></a><span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;">Post EULAR, I have
led a journal club and presented my highlights from the sessions at the
conference. The following abstracts were my highlights of the meeting. You may
wish to have a discussion with your team using these or other abstracts.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.0pt;"><b><u><i>THU0058 (Tweehuysen L et al) </i></u></b>– A systematic review
looking at predictors of successful dose reduction or discontinuation of
biologics in patients with RA. Over 3000 non-duplicate articles were included
and biomarkers reviewed. </span><span style="font-family: "arial" , sans-serif; font-size: 12.0pt;">Three predictors were identified for prediction
of successful dose reduction and successful discontinuation of a biologic.
These were higher adalimumab trough level for successful dose reduction; and
lower Sharp/van der Heijde erosion score and shorter symptom duration at the
start of a biologic for successful discontinuation.</span><span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"><b><i><u>OP0225 (Glintborg B
et al) </u></i></b>– Results from the Danish (DANBIO) registry showed that for patients with
inflammatory arthritis (647 patients, 50% had RA and the other 50% were AS or
PsA), a non-medical switch from infliximab (Remicade) to the biosimilar
(Remsima) did not appear affect disease activity or risk of having a flare.
This was up to 3 months and longer follow up will be interesting to assess this
switch.<o:p></o:p></span></div>
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<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"><b><i><u>OP0182 (Gerlag D et al) </u></i></b>– Results from the PRAIRI study (81 patients
included) showed a single infusion of anti-CD20 antibody rituximab can delay
the onset of rheumatoid arthritis for up to 1 year in individuals at risk of
developing the condition. The participants have CCP and RF positivity, raised
CRP and subclinical synovitis on ultrasound or MRI of hands.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"><b><i><u>OP0001 (Braun J et
al)</u></i></b> – Results from the MEASURE 1 trial looking at the radiographic change with
the use of interleukin-17A inhibitor Secukinumab in ankylosing spondylitis.
Secukinumab (both 75mg and 150mg doses) resulted in no radiographic progression
in approximately 80% of patients over 104 weeks.</span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="background-color: transparent; color: #333333; font-family: "arial" , sans-serif; font-size: 12pt;"><b><i><u>THU0158
(Frisell T et al) </u></i></b>– The effect of baseline characteristics in channelling the
choice of the second biologic after first anti-TNF failure in RA. Data from the
Swedish Rheumatology Register from 2010-2012. </span><span style="background-color: transparent; color: #333333; font-family: "arial" , sans-serif; font-size: 12pt;">The most common biologic after
initial TNFi therapy were rituximab and etanercept. Those initiating a second
TNFi were slightly younger, less often rheumatoid factor (RF) positive, and had
slightly lower DAS28 than those initiating a non-TNFi biologic. Initiators of
rituximab had longest disease duration, highest proportion RF+ and with history
of malignancy or COPD, while etanercept-initiators had the lowest proportion
with history of malignancy. Those initiating a second TNFi had more often
switched due to adverse events.</span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify;">
<span style="color: #444444; font-family: "arial" , sans-serif; font-size: 12.5pt;"><b><i><u>OP0002 (van der
Heijde D et al)</u></i></b> – Results from the phase 2 study of the oral Janus kinase (JAK)
inhibitor tofacitinib in ankylosing spondylitis. In this placebo-controlled
double-blind study, the dose-response, efficacy and safety were evaluated.
Patients were randomised to placebo, 2mg bd, 5mg bd and 10mg bd for 12 weeks.
ASAS20 was achieved in 40.1%, 56.0%, 63.0%, 67.4% respectively. BASDAI50 was
achieved in 23.5%, 46.2%, 42.3%, 42.3% respectively. There was no difference in
the safety profile between any of the tofacitinib groups and the placebo group.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 6.0pt; text-align: justify;">
<strong><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12pt;"><i><u>FRI0154 (Serhal L et al)</u></i></span><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt; font-weight: normal;"> – Looks at
the effect on disease activity and function with failed anti-TNF dose reduction
in rheumatoid arthritis.</span></strong><strong><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;"> </span></strong><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;">RA
patients who failed dose reduction had higher DAS28 than those who were
successful despite reintroduction of a standard dose of anti-TNF. Failed dose
reduction did not appear to cause loss of functional capacity (HAQ) or a greater
cumulative exposure to inflammation (AUC<sub>CRP</sub>) compared to successful
reduction. The functional capacity (HAQ) at anti-TNF initiation appears to
predict the likelihood of successful dose reduction. Non-reducers had a higher
HAQ score (1.59) compared to failed dose reduction (1.28) and successful dose
reduction (0.95). Following dose re-escalation, 32% had achieved DAS28
remission, 20% developed lower (LDA), 44% moderate (MDA) and 4% severe disease
activity (SDA).</span><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 6.0pt;">
<span style="background: white; color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;"><b><i><u>FRI0155
(Sigaux J et al)</u></i></b> – Results from the STRASS trial showing that 50% of patients
who tapered anti-TNF while in stable remission were able to maintain tapered
regimen at 3 years. </span><span style="background: white; color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;">Maintenance of anti-TNF was high (68% at 3 years) in
patients with established RA treated according to the treat-to-target paradigm,
with no difference between the 2 initial RCT arms (S-arm, progressive injection
spacing and M-arm (full regimen). More than 1/3 of patients received the tapered
anti-TNF regimen.</span><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 6.0pt; text-align: justify;">
<span style="font-family: "arial" , sans-serif; font-size: 12.0pt;"><i><u><b>FRI0447 (Kavanaugh A et al) </b></u></i>– 3 year
treatment data from the PALACE study of apremilast (APR) in patients with
active PsA despite previous conventional disease-modifying antirheumatic drug
(DMARD) or biologic therapy. 504 randomized patients received ≥1 dose of study
medication (PBO: n=168; APR30: n=168; APR20: n=168). In an “as observed”
analysis, 53.2% (APR30) and 59.6% (APR20) of patients achieved a modified ACR20
response at Wk 52. In year 2, 65.3% (APR30) and 60.9% (APR20) attained these
responses at Wk 104. Patients receiving APR30 at Wk 156 demonstrated sustained
improvements, as shown by ACR20 of 65%, swollen/tender joint count mean percent
improvements of -81.2% and 73.2%, and HAQ-DI mean change of -0.37, and 41.9% of
patients reaching DAS (CRP) <2.6. No new safety concerns were identified
with up to 156 wks of APR treatment. </span><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;"><o:p></o:p></span></div>
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<strong><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12pt;"><i><u>AB0324 (I’Ami MJ et al)</u></i></span><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt; font-weight: normal;"> – Interim
analysis at Week 26 of tapering of Adalimumab based on therapeutic drug
monitoring in rheumatoid arthritis. </span></strong><span style="color: #333333; font-family: "arial" , sans-serif; font-size: 12.0pt;">Patients with an
adalimumab concentration >8 mL/L were randomly (1:1) assigned to
continuation of adalimumab every other week (continuation group) or
prolongation of the dosage interval to once every 3 weeks (tapering group),
independently of disease activity score in 28 joints (DAS28). At 26 weeks, mean
ΔDAS28 did not meet the criteria for a clinically relevant difference in both
continuation group (0.29± 0.58 standard deviation (SD)) and tapering group
(-0.06±0.58 SD) and did not significantly differ (p=0.06) between groups. This interim analysis shows that disease activity remains stable in RA patients
with adalimumab concentrations >8 mL/L who prolonged their dose interval to
once in the three weeks compared to patients who continued adalimumab every
other week.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><strong><span style="font-weight: normal;"><o:p></o:p></span></strong></span></div>
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<span style="color: #333333; font-family: "arial" , sans-serif;">These were my highlights from EULAR 2016.</span></div>
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<br /></div>
Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-82546536779361425932016-04-09T12:23:00.003-07:002016-04-09T12:23:27.240-07:00Spondyloarthritis Special Interest Group (SIG)<span style="font-family: Arial, Helvetica, sans-serif;">The programme for this year's Spondyloarthritis Special Interest Group (SIG) at the British Society for Rheumatology (BSR) Annual General Meeting in Glasgow, 26th April 2016 is now out.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.blogger.com/null" name="Spondyloarthritis"><b><u><span style="font-size: 13.5pt;"><span style="color: blue;">Spondyloarthritis</span></span></u></b></a><b><u><span style="font-size: 13.5pt;"><span style="color: blue;"> Special Interest Group (SIG) of
the British Society of Rheumatology (BSR)</span><o:p></o:p></span></u></b></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span></div>
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<span style="font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;">The Spondyloarthritis (SpA) SIG covers issues
relating to the group of conditions, including ankylosing spondylitis and
psoriatic arthritis. This SIG aims to keep all members up to date with a broad
range of topics including early detection, assessment and new therapies. It also covers research, guidelines and nationally
relevant issues such as NICE guidelines and commissioning. The group meet once
a year at the BSR and also aims to keep all members updated via email during
the rest of the year. The field of SpA is evolving rapidly, and members will
find this SIG an invaluable way of keeping up to date.</span><span style="font-family: Times New Roman, serif;"><o:p></o:p></span></span></div>
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<b><u><br /></u></b></div>
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<span style="color: blue; font-family: Arial, Helvetica, sans-serif;"><b><u>1</u></b><b><u>3 SIG08 -
Spondyloarthritis special interest group</u></b></span></div>
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<b><span style="color: blue; font-family: Arial, Helvetica, sans-serif;"><br /></span></b></div>
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<b><span style="color: blue; font-family: Arial, Helvetica, sans-serif;">April 26, 2016, 11:30
AM - 1:00 PM <o:p></o:p></span></b></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">DESCRIPTION<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">This is the SIG meeting for spondyloarthritis. This is a
rapidly expanding field and this SIG aims to be the umbrella group bringing all
the work in this area together. It will provide the latest update in
pathogenesis and treatments in this field. There will also be an update of
intiatives to improve outcomes in spondyloarthritis. This includes updates from
partner groups and collaborators. The session will also cover the organisation
and delivery of rheumatology services local the venue of the BSR 2016 (Glasgow).<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">6 Presentations<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">11:30 - 1:00 PM - Chair<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Antoni T. Chan, Department of Rheumatology, Royal Berkshire
NHS Foundation Trust, Reading, UNITED KINGDOM.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">11:30 - 1:00 PM - Chair<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Bruce Kirkham, Department of Rheumatology, Guys and St.Thomas
NHS Foundation Trust, London, UNITED KINGDOM.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">11:30 - 11:48 AM </span><span style="font-family: Arial, Helvetica, sans-serif;">-
Factors affecting the composition of the gut microbiota</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Karen Scott, Rowett Institute of Nutrition and Health,
Aberdeen, UNITED KINGDOM.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">11:48 - 12:06 PM -
50 shades of grey in Glasgow<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">David Marshall, Department of Rheumatology, Inverclyde Royal
Hospital, Greenock, UNITED KINGDOM.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">12:06 - 12:24 PM -
Update from BRIT-SPA<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Helena Marzo-Ortega, Department of Rheumatology, NIHR Leeds
Musculoskeletal Biomedical Research Unit, Leeds, UNITED KINGDOM.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">12:42 - 1:00 PM - New
therapies in spondyloarthritis<o:p></o:p></span></div>
<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">I</span><span style="font-family: Arial, Helvetica, sans-serif;">ain McInnes, Institute of Infection, Immunity and
Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM.</span></div>
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<o:p></o:p></div>
Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-52731643097314209212015-12-10T16:39:00.001-08:002015-12-10T16:39:08.111-08:00Updates from ACR 2015 San Franscisco<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJFbSijcWU2kq3a1MOXht5ykXL-mS36FYf7P4qWAqt5VMSfXs9x2N0sf2CtyBCwDMQzwa2Evtqtm5BjxyltWiGVLi5AFcBktP-7NFsp5rh6Chyphenhyphen2_6DYhcmiKhHtvcJJ9VsT44IjS8BSvGf/s1600/ACRabstracts.org-hero-image.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJFbSijcWU2kq3a1MOXht5ykXL-mS36FYf7P4qWAqt5VMSfXs9x2N0sf2CtyBCwDMQzwa2Evtqtm5BjxyltWiGVLi5AFcBktP-7NFsp5rh6Chyphenhyphen2_6DYhcmiKhHtvcJJ9VsT44IjS8BSvGf/s320/ACRabstracts.org-hero-image.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
I enjoy attending the American College of Rheumatology (ACR) meeting. It is a chance to meet and discuss with colleagues from across the world on topics of interest in rheumatology.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<blockquote class="twitter-tweet" lang="en">
<div dir="ltr" lang="en">
Discuss with colleagues, share knowledge, bring back to clinic - why I attend <a href="https://twitter.com/hashtag/acr15?src=hash">#acr15</a> <a href="https://twitter.com/RheumNow">@RheumNow</a> <a href="https://twitter.com/carvicab">@carvicab</a> <a href="https://twitter.com/ACRheum">@ACRheum</a> <a href="https://t.co/bFnuA9XlPk">pic.twitter.com/bFnuA9XlPk</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/664499530860072960">November 11, 2015</a></blockquote>
<br />
Since returning from the ACR 2015, I've shared my highlights with my team. This was through our Journal Club. It takes about 60 minutes to cover a session.<br />
<br />
Here are some of my highlights from ACR 2015. I hope you may find it useful to discuss in your Journal Club or educational meetings.<br />
<br />
You can find further details of the presentations and abstracts at the ACR 2015 website:<br />
<br />
<a href="http://acrabstracts.org/meetings/2015-acrarhp-annual-meeting">http://acrabstracts.org/meetings/2015-acrarhp-annual-meeting</a><br />
<br />
<br />
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">1.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">IL-17 inhibition in Ankylosing Spondylitis<o:p></o:p></span></u></b></div>
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<br /></div>
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There were many presentations covering this topic at ACR 2015.<br />
<br />
The posters that covered this topic were #2887, #2890,
#2896, #974, #981, #6L, </div>
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<b><u><br /></u></b></div>
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<b><u>Secukinumab in AS,
52 week study #2890 (Baeten D et al)<o:p></o:p></u></b><br />
<b><u><br /></u></b></div>
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Secukinumab is an anti-IL17A mAb
used to treat AS. Data from MEASURE 1 and MEASURE 2 were analysed. Secukinumab
vs placebo. Included anti TNF-naïve and anti-TNF IR (not more than one anti-TNF). <br />
<br />
ASAS 40 response at Week 52 was measured. The
outcome in different groups were:</div>
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<i>10mg/kg IV 0,2,4 weeks to 150mg sc every 4 weeks<o:p></o:p></i></div>
<div class="MsoNormal" style="text-align: justify;">
Anti-TNF
naïve 67.1%, Anti-TNF IR 45.8% </div>
<div class="MsoNormal" style="text-align: justify;">
<i>10mg/kg IV 0,2,4 weeks to 75mg sc every 4 weeks<o:p></o:p></i></div>
<div class="MsoNormal" style="text-align: justify;">
Anti-TNF
naïve 48.8%, Anti-TNF IR 50.0%</div>
<div class="MsoNormal" style="text-align: justify;">
<i>150mg sc Week 0,1,2,3 and q4w<o:p></o:p></i></div>
<div class="MsoNormal" style="text-align: justify;">
<i> </i>Anti- TNF
naïve 64.1%, Anti-TNF IR 45.5%</div>
<div class="MsoNormal" style="text-align: justify;">
<i>75mg sc Week 0,1,2,3 and q4w<o:p></o:p></i></div>
<div class="MsoNormal" style="text-align: justify;">
<i> </i>Anti-TNF naïve
47.6%, Anti-TNF IR 26.3%<br />
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
Response was better in the anti
TNF naïve group. There was no incremental increase in efficacy conferred by the
initial iv loading. Secukinumab 150mg sc provides sustained improvement of AS
both anti-TNF naïve and IR patients.<br />
<br /></div>
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<b><u>Safety and Tolerability, 52 week results #2887 (Deodhar et al)<o:p></o:p></u></b><br />
<b><u><br /></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
Secukinumab was well tolerated in
patients with active AS with a low incidence of AE/SAE (65.7/3.3% in
Secukinumab and 58.7/4.1% in placebo groups).<br />
<br />
Nasopharyngitis was the commonest
AE with secukinumab (11.2% vs 6.1% in placebo).<br />
<br />
Discontinuation due to AE was
4.7% in Secukinumab and 5.6% in placebo. 3 deaths (1 suicide in placebo, 1
respiratory failure and 1 acute MI in secukinumab group)<br />
<br /></div>
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<b><u>Secukinumab in AS, 104 week results #2896
(Baeten D et al)<o:p></o:p></u></b><br />
<b><u><br /></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
The data from 104 weeks showed
sustained response to </div>
<div class="MsoNormal" style="tab-stops: 272.25pt; text-align: justify;">
<i>10mg/kg IV 0,2,4 weeks to 150mg sc every 4
weeks <o:p></o:p></i></div>
<div class="MsoNormal" style="text-align: justify;">
ASAS 20/40 was 79.3/64.4%<br />
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
In anti-TNF naïve, ASAS 20/40 was
85.5/69.6%<br />
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
In anti-TNR IR, ASAS 20/40 was
55.6/44.4%</div>
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<i>10mg/kg IV 0,2,4 weeks to 75mg sc every 4 weeks<o:p></o:p></i></div>
<div class="MsoNormal" style="text-align: justify;">
ASAS 20/40 was 72.1/53.5%<br />
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
In anti-TNF naïve, ASAS 20/40 was
72.3/52.3%<br />
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
In anti-TNF IR, ASAS 20/40 was
71.4%/57.1%<br />
<br /></div>
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<b><u>Effects of
Secukinumab on Radiographic Progression, 2 year data #6L (Baraliakos, X et al)<o:p></o:p></u></b><br />
<b><u><br /></u></b></div>
<div class="MsoNormal">
Study on radiographic progression in patients with active
AS, phase 3 study with Secukinumab. Data from MEASURE 1 was analysed. Lateral
radiographs of cervical and lumbar spine were performed at baseline and Week
104 and the mSASSS score used.<br />
<br /></div>
<div class="MsoNormal">
Patients received a loading dose at baseline Wk 0, 2, 4 then 150mg sc or 75mg
sc every 4 weeks.Placebo patients switched to Secukinumab at Wk 16 (if ASAS20
non-responder) and at Wk 24 (if ASAS20 responder).<br />
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
Secukinumab data was pooled and
compared against the placebo group. There was no major difference between the
secukinumab only group (mSASSS 0.30 ±
2.53) compared to the placebo group in terms of mSASSS change through week 104.<br />
<br />
80% of patients on Secukinumab did not show radiographic progression. Factors
predicting radiographic progression were baseline syndesmophytes, male gender
and elevated CRP at baseline. This showed IL-17A inhibition on structural
change in AS.<br />
<br /></div>
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<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">2.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">IL-17 inhibition in Psoriatic Arthritis<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b>1.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal;">
</span></b><!--[endif]--><b>Ixekizumab
in PsA, Phase 3 , 24 week Study, #977
(Mease P et al)<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Ixekizumab, an IgG4
anti-IL17A mAb was studied in psoriatic
arthritis (PsA).<br />
<br />
Biologic naïve patients, receiving Ixekizumab 80mg q2w or q4w
vs Adalimumab 40mg q2w vs placebo.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<i>ACR 20/50/70 response at 24
weeks were:<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Placebo 30.2 / 15.1 /
5.7 %<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Adalimumab 57.4 / 38.6 / 17.8 %<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Ixekizumab 80mg q2w 62.1 / 46.6 / 34.0 %<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Ixekizumab 80mg q4w 57.9 / 40.2 / 23.4 %<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
There was also
improvement in skin scores PASI 75/90/100 responses compared to placebo at
weeks 12 and 24. There were greater adverse events in the Ixekizumab and
Adalimumab groups compared to placebo.<br />
<br />
Discontinuation due to treatment
emergent adverse events was similar across groups and no deaths occurred. Ixekizumab
showed significant, clinically meaningful improvement in psoriatic arthritis.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -36.0pt;">
<!--[if !supportLists]--><b>2.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal;"> </span></b><b>Ixekizumab
in biologic naïve PsA – effects on QOL, function, work # 2145 (Gottlieb A et
al)<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
Ixekizumab
improved QOL, physical function, work productivity in biologic DMARD-naïve
patients (HAQ-DI, SF-36, EQ-5D, WPAI)with active PsA.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">3.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">IFNa in SLE<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b><u>Phase 2 study, 48 week study #3223 (Furie R et al)<o:p></o:p></u></b><br />
<b><u><br /></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
Anifrolumab,
an IFNa receptor MAb was studied in moderate SLE. N=305. Patients were randomized to receive
Anifrolumab IV 300mg or 1000mg every 4 weeks for 48 weeks vs placebo.<br />
<br />
The SLE
Responder Index (SRI) was used as the outcome measure together with reduction in
oral corticosteroid (OCS) use at days 169 and 365. The groups were divided by IFN gene signature (IFN high vs IFN low). <br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
A greater proportion of Anifrolumab treated
patients (300mg: 34.3%, 1000mg: 28.8%) vs placebo (17.6%) at day 169 and
continued to day 365 (300mg: 51.5%, 1000mg 38.5%) vs placebo (25.5%).<br />
<br />
Anifrolumab efficacy was similar or better in the IFN high patients. The lack
of dose response is due to nearly
similar degress of IFN gene signature inhibition with two Anifrolumab doses. </div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<br />
There was a
higher frequency of influenza and herpes zoster in the Anifrolumab arms. This
study shows promise for IFNa inhibition in the treatment of SLE.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">4.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">Rituximab, new biomarker to predict relapse?<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b><u><span style="font-size: 12.0pt; line-height: 115%;">Use of CD4+ T cells
for monitoring #1656 (</span></u></b><b><span style="font-size: 12.0pt; line-height: 115%;">Lavielle M et al)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<br />
CD4+ T cells
are depleted of a first cycle on rituximab (RTX) in patients with RA. This
effect was seen in responders to RTX. This raises the possibility that CD4+ T
cells levels may be linked to disease activity post RTX treatment.<br />
</div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
Post
treatment, RTX-induced CD4 T cell depletion was temporary and was followed by
normalization of counts to the pre-treatment level. In comparison, B cells
counts remain low when patients were re-treated. Patients who did not respond
to the first cycle of RTX showed only a small decrease in CD4+ T cell levels.
Those who had a high depletion of CD4+ T cells (> 33%) in the second cycle
were more likely to respond. 80% of
those who responded had greater CD4+ T cell depletion in the second cycle
compared to the first.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
This study
shows CD4+ T cell levels depletion occurs over successive cycles of RTX. CD4+ T
cell levels are related to changes in disease activity more than B cells which
remain depleted.<br />
<br />
Monitoring CD4+ T cells may be a useful biomarker to assess
response to RTX, disease activity and further evaluation of treatment efficacy
and re-treatment intervals of RTX.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">5.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">JAK kinases in RA<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<div style="text-align: justify;">
<b>Baricitinib in RA, Phase 3 study against placebo and adalimumab #2L (Taylor P et al)<o:p></o:p></b></div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<br />
<div style="text-align: left;">
Baricitinib
(bari) is an oral JAK 1 and JAK 2 inhibitor. This is a Phase 3 study, placebo
(PBO) controlled trial,
reporting the 24 wk results of a 52 wk study in MTX inadequate responders (IR).</div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<div style="text-align: left;">
</div>
<div style="text-align: left;">
Patients
with active RA(TJC>6, SJC>6, hsCRP>6mg/L) were randomized to PBO, bari
4mg od, or adalimumab (ADA) 40mg every 2
weeks (Q2W). </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
The primary endpoint was
ACR 20 response at Wk 12 for bari
vs PBO. At Wk 12, the ACR 20/50/70 response for PBO was 40/17/5% respectively and for bari 70/45/19% respectively. At Wks 12
and 24 there were improvement in ACR 20/50/70
for bari vs PBO.</div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<div style="text-align: left;">
</div>
<div style="text-align: left;">
Compared
to ADA, bari was superior with respect to ACR 20 at Wk 12 (bari 70 vs ADA 61) and DAS28-CRP. Compared to PBO,
serious adverse events rates were similar for bari and lower for ADA. Serious infection rates were
similar across groups.</div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<div style="text-align: left;">
</div>
<div style="text-align: left;">
Baricitinib
is a treatment option in active RA despite background MTX with significant
clinical improvements compared to
PBO and ADA. There was acceptable safety and tolerability.</div>
<div style="text-align: left;">
<br /></div>
</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">6.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">IL-6 inhibition in Giant Cell
Arteritis <o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
There were reports on the use of
Tocilzumab in<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>GCA #1979, #1980.
#3142, #1L<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>PMR #1986, #1987,
#1985<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>Tocilizumab in GCA #1980 (Regent A et al)<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Tocilizumab (TCZ) is a humanized
IgG1k mAb against IL-6 receptor and was studied in the treatment of GCA. N=34 patients were included.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
TCZ 8mg/kg monthly + GC vs
Placebo + GC<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Week 12 remission rates in TCZ vs
placebo groups were 85% vs 40%<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Week 52 no relapse in TCZ vs
placebo groups were 85% vs 20%<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
TCZ is beneficial
for induction and maintenance
therapy in GCA<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>GiACTA Study #1979 (Tuckwell et al)<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>TCZ and T Regs in GCA #3142 (Unizony S et al)<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
TCZ treated patients had higher frequency of
Tregs compared to placebo (1.3% vs 0.6%)</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">7.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">ANA negative, ENA positive, clinical
relevance ?<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>Krause ML et al #773<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
ANA + ENA testing in a single
centre<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
ANA –ve 79%, ENA +ve 6.8% (of
this 96% were a single ENA positive)<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Anti-RNP was the commonest (54%)
followed by anti –Ro (19%) , anti-La (16%) and Scl-70<br />
(14%). Sm and Jo-1 were
rare.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
ANA negative but positive ENA is rare and
uncommon to have connective tissue disease.<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">8.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">Ultrasound in Giant Cell Arteritis<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>TABUL USS vs TAB, role of ultrasound compared to TAB (Luqmani et al) #2160<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
TAB typically negative in 10-30%
of true cases<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Sensitivity of biopsy / USS 39% / 54%<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Specificity of biopsy / USS 100% / 81%<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
USS + clinical judgement - sensitivity 93%, specificity 77%<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Biopsy + clinical judgement –
sensitivity 91%, specificity 81%<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<u>USS for all suspected cases
followed by biopsy in medium to high risk patients with negative USS was cost
effective (sensitivity 95%, specificity 77%)<o:p></o:p></u><br />
<u><br /></u></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Calibri;">9.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">Videocapsule (VCE) endoscopy in SPA<o:p></o:p></span></u></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>Uncovering Crohn’s Disease in SpA (Seidman
E et al) #2061<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
SpA and Crohn’s clinical
association 5-15%, colonoscopy 33%</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Significant small bowel
inflammation by VCE 41% vs colonoscopy 13.1% </div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Correlated with elevated faecal
calprotectin but not clinical features or raised CRP</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -36.0pt;">
<!--[if !supportLists]--><b>10.<span style="font-size: 7pt; font-stretch: normal; font-weight: normal;">
</span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">Scleroderma lung study</span></u><o:p></o:p></b><br />
<b><u><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<b>SLSII Oral CYC and MMF in ILD (Clements
PJ et al) #1075<o:p></o:p></b><br />
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Oral CYC 2mg/kg/day for 1 year
followed by placebo in year 2<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
MMF 1.5g bd for 2 years</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Slightly higher modified Rodnan
skin scoring (MRSS) higher in MMF group at baseline</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
At 24 months<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
FVC improvement in MMF 1.86 vs
CYC 2.24<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
MRSS decline in MMF 2.9 vs CYC
6.1<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
More premature withdrawal of CYC
– weight loss, leucopenia, thrombocytopenia<br />
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
MMF vs CYC – comparable and both
efficacious in treating SSc-ILD</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I hope you will find this useful for review and discussion @synovialjoints<br />
<br />
<b>These are results from studies and not medical advice. Views are my own. This cannot be taken as specific medical advice and cannot replace the need to see your physician if needed for review.</b></div>
<br />
<div class="MsoNormal">
<br /></div>
<br />
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-18608853358727949472015-11-15T16:36:00.004-08:002015-11-15T16:36:58.588-08:00Updates from the American College of Rheumatology (ACR) Scientific Congress, San Francisco, 2015<br />
<b><u>Updates from ACR Scientific Congress, San Francisco, 2015</u></b><br />
<b><u><br /></u></b>
I attended the ACR Scientific Congress in San Francisco from 6-11 November 2015. This was an opportunity to share, discuss and exchange information on topics and subjects in rheumatology.<br />
<br />
<b><i>I will be sharing with you my notes from the ACR Scientific Meeting so watch this space! </i></b><br />
<br />
Thanks for following my tweets @synovialjoints during the ACR.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwjWIgiBxCQSULXEywLlUCavrtZn_WulPndFdec-Aq_PaXP444uU9UplNszqCIzzEoPWGM8ftiPfQ3d1r4m71y0bw53ZJon4JAAuMAJ6Cl4CHqPJxQolKJ2ZkQgFPaimziJbK0au4CA05N/s1600/ACR+Moscone.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwjWIgiBxCQSULXEywLlUCavrtZn_WulPndFdec-Aq_PaXP444uU9UplNszqCIzzEoPWGM8ftiPfQ3d1r4m71y0bw53ZJon4JAAuMAJ6Cl4CHqPJxQolKJ2ZkQgFPaimziJbK0au4CA05N/s320/ACR+Moscone.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Moscone Centre, San Francisco</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2W4rtytBxgwdL918l5kYmIy4lsiWkvatku5dc3unb-PDOmyPzKitCekcQXVHWnhcIPSTt6ds1ICGbs7zEW1gF_27XH3G2z9l5q8fRF8VhWpOAbpX9fAR43EX_TxApXiLI3Cg4hoNhquaR/s1600/ACR+Tweet+Up.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2W4rtytBxgwdL918l5kYmIy4lsiWkvatku5dc3unb-PDOmyPzKitCekcQXVHWnhcIPSTt6ds1ICGbs7zEW1gF_27XH3G2z9l5q8fRF8VhWpOAbpX9fAR43EX_TxApXiLI3Cg4hoNhquaR/s320/ACR+Tweet+Up.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Meeting international colleagues at the ACR</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1kVxQla4O0P2FdoZj4vGYJOnVYc5n2neeB09tbz23pGfnNgt7gq_3sI1dAVO-kH2Jne7BITEgX8wfBtlTE-0ODdpadt-pqbUF6eg0OweQ2mxZul9cfMLlb7pDGb_h4HdHBCh8Sje4h1zw/s1600/ACR+Meeting.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1kVxQla4O0P2FdoZj4vGYJOnVYc5n2neeB09tbz23pGfnNgt7gq_3sI1dAVO-kH2Jne7BITEgX8wfBtlTE-0ODdpadt-pqbUF6eg0OweQ2mxZul9cfMLlb7pDGb_h4HdHBCh8Sje4h1zw/s320/ACR+Meeting.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Great discussion and sharing of knowledge with colleagues</td></tr>
</tbody></table>
<br />Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-89829993961102694112015-05-28T02:09:00.002-07:002015-05-28T02:35:32.692-07:00Reflections from British Society for Rheumatology Conference 2015<br />
<br />
<div class="MsoNormal">
<b><i><u>Reflections from the British Society for Rheumatology Conference 2015,
Manchester UK<o:p></o:p></u></i></b><br />
<b><i><u><br /></u></i></b></div>
<div class="MsoNormal" style="text-align: justify;">
I had the privilege of attending
the recent British Society for Rheumatology AGM in Manchester, UK from the 28<sup>th</sup>
-30<sup>th</sup> April. It was a privilege as this was the first time in 5 years
that I was able to attend the whole conference. In years past, I had the
responsibility of looking after the ward and department. So, this year was my turn to attend and I was looking forward to the attending UK's premier rheumatology gathering.<br />
<blockquote class="twitter-tweet" lang="en">
<div dir="ltr" lang="en">
2 weeks to go to BSR 2015 looking forward to it <a href="https://twitter.com/RheumatologyUK">@RheumatologyUK</a> join in the conversation at <a href="https://twitter.com/hashtag/rheum2015?src=hash">#rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/588425985932005376">April 15, 2015</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>
</div>
<div class="MsoNormal" style="text-align: justify;">
As soon as the train passed
Stockport, the weather changed from the Berkshire sunshine to the Lancashire
grey and wet. I had forgotten to bring my raincoat and umbrella! Soon I was at
the conference centre, all warm and dosed up with caffeine from the exhibition booths.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_3oJdD9W2dzpQwrmuJwAugvYKE91LNzk_9L3-5MrCdoxJZYgjsUMGM99ZSyP6Yni_cpGHcHVtNGyVszw7_NhnhjOP6VABqwfsFTL_LN4Z_h21XL8iYwk_0HeqansxggS2fSnjA3JBezqf/s1600/IMG_1507.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_3oJdD9W2dzpQwrmuJwAugvYKE91LNzk_9L3-5MrCdoxJZYgjsUMGM99ZSyP6Yni_cpGHcHVtNGyVszw7_NhnhjOP6VABqwfsFTL_LN4Z_h21XL8iYwk_0HeqansxggS2fSnjA3JBezqf/s320/IMG_1507.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Manchester Central - venue for BSR 2015</td></tr>
</tbody></table>
It
was nice meeting up with colleagues from far and wide, sharing and discussing
all things in and out of rheumatology. One of the first delegates I met was Martin Lau @ImpactSports9 . It was good to meet him in person, our previous contact was on twitter.<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8Y-c2U3I2RPMrJ58D6dZTeIn8_jMYZzJejvnUW5LNjV9BnPoZmNCH4jyvIbv-ogUuVJEHF-izL3Aw-oSj923ViORekjBWyjyIFvnTLuKBUZHb7R-wDZPM6aiSgas_u8Pjl3S2mAgX1A65/s1600/IMG_1497.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8Y-c2U3I2RPMrJ58D6dZTeIn8_jMYZzJejvnUW5LNjV9BnPoZmNCH4jyvIbv-ogUuVJEHF-izL3Aw-oSj923ViORekjBWyjyIFvnTLuKBUZHb7R-wDZPM6aiSgas_u8Pjl3S2mAgX1A65/s320/IMG_1497.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Martin Lau @ImpactSports9</td></tr>
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I hv finally met the lovely <a href="https://twitter.com/synovialjoints">@synovialjoints</a> in person!</div>
— Martin Lau (@ImpactSports9) <a href="https://twitter.com/ImpactSports9/status/593012005235200000">April 28, 2015</a></blockquote>
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The BSR 2015 app was helpful in planning the day at the conference. After poster viewing on the first morning, I attended the session on optimising service to RA patients. A very relevant session in the current NHS climate where the challenge is to deliver the best service with finite resources.<br />
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Hakim - know your business, measure and have your clinic data available as evidence for service development <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593121101615636481">April 28, 2015</a></blockquote>
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After lunch, the next session was aptly named Jewels in the Crown. The keynote address was from Sir Mark Walport who gave an excellent review of how future healthcare will be shaped.<br />
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Walport - the next big revolution will be the advance in informatics and how this shapes healthcare <a href="https://twitter.com/hashtag/future?src=hash">#future</a> <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593117732192821248">April 28, 2015</a></blockquote>
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This was followed by the prestigious Heberden Round which was delivered by Prof. David D'Cruz. The lecture was titled Lupus and the art of clinical medicine. The lecture kept to the high standards and tradition of William Heberde<span style="font-family: inherit;">n (<span style="background-color: white; font-size: 14px; line-height: 22.3999996185303px; text-align: start;">1710 –1801)</span></span>, a distinguished physician.<br />
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D'Cruz - caution when deciding to do renal biopsy SLE patient with APS and thrombotic disease as risk of bleeding <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593122110828085249">April 28, 2015</a></blockquote>
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key lesson in SLE and APS <a href="https://t.co/REkIYlVFbZ">https://t.co/REkIYlVFbZ</a></div>
— Susan Oliver (@rheumatologynur) <a href="https://twitter.com/rheumatologynur/status/593683359345303552">April 30, 2015</a></blockquote>
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There was a lot of new information on the use of technology including apps and software that could be used in clinical practice. More work needs to be done to see how applicable these technologies will be. The day ended with a session on the use of such technologies and if they may break boundaries in RA care.<br />
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Isaacs - studying the patient endotype will determine matching treatment and patient outcome. Big data in the next 10 years <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593117057295745026">April 28, 2015</a></blockquote>
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The second day started with poster viewing and then the session on essentials in rheumatology. This was a session on disease assessment and management. A very practical and useful session.<br />
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Herrick - digital ulceration, tissue injury, abnormal nail fold capillaroscopy - not primary Raynaud's. Look for secondary cause <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593468160877166594">April 29, 2015</a></blockquote>
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Snowden - the exoticas of monoarthritis include PVNS and lipoma arborescens. Some present initially as undifferentiated cause <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593469203472097280">April 29, 2015</a></blockquote>
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A quick dose of coffee was then followed by viewing of posters on the spondyloarthropathies. Lots on new initiatives in the area which is really exciting. The next three sessions were focused on infection, autoimmunity and the role of the microbiome in inflammatory arthritis.<br />
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P gingivalis has unique ability to citrullinate enolase protein through bacterial PAD : autoimmunity in RA - Venables <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593689621021761536">April 30, 2015</a></blockquote>
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Ritonavir in HIV increases Prednisolone bioavailability so adjust dose of steroid in treating arthritis - Walker Bone <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593680939303186434">April 30, 2015</a></blockquote>
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Gut derived stimuli from microbiome involved in regulatory B cell differentiation in arthritis - Claudia Mauri <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593684787140886528">April 30, 2015</a></blockquote>
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Microbiota changes with age and disease. Dysbiosis and reduced diversity may be cause or consequence of disease - Scott <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593681781334867968">April 30, 2015</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>
In the afternoon, it was the turn of the second of the Heberden presentations. The Herberden Oration was presented by Prof. David Scott. A tremendous presentation on the excellent work through the years to improve RA outcomes.<br />
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Early treatment in pre-clinical phase RA with Abatacept - will it prevent / delay RA onset APPIPRA trial will inform - DL Scott <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/594959623683186690">May 3, 2015</a></blockquote>
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Combination DMARDs with corticosteroid has greatest benefit in ACPA +ve vs -ve RA in CARDERA trial - DL Scott <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/594957688112599040">May 3, 2015</a></blockquote>
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Combination DMARDs with corticosteroid has greatest benefit in ACPA +ve vs -ve RA in CARDERA trial - DL Scott <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/594957688112599040">May 3, 2015</a></blockquote>
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The day was finished on the high at the Conference dinner held at Old Trafford, the home to Manchester United. I took the pre-dinner stadium tour and got the see the Theatre of Dreams in a little more detail. The highlight was visiting the home team changing room and walking down to tunnel leading to the arena. We were entertained by an after dinner speech by ex-Red Devil star, Norman Whiteside.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj847CEU7I2Zox_q6iHkNOb-Po19DBRVcABDt-myr_QCFCSJBsU6vi1js2eJUefBfMKBkjzl4pu54adgSUHlmjpFzerYG8_LFjO3FKfNV5V6EKKPNagrCiivcNJvpjYD0qqoEoeTFbZVRqP/s1600/Old+Trafford.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj847CEU7I2Zox_q6iHkNOb-Po19DBRVcABDt-myr_QCFCSJBsU6vi1js2eJUefBfMKBkjzl4pu54adgSUHlmjpFzerYG8_LFjO3FKfNV5V6EKKPNagrCiivcNJvpjYD0qqoEoeTFbZVRqP/s320/Old+Trafford.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Theatre of Dreams</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHCS_Ozyd9cQBQRXA9wDVQnSGNm_zDj7cNMu_sv8ZCYptBCL60oUKvcY8h4Yii_c_-szPRK-EJmwoVtJN4QaFefRqLLeMdPNQO72gA9bN2SUU7jhdWKNRuA_KBk1OSdbrw_jiUQXWKrzD1/s1600/Norman+Whiteside.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHCS_Ozyd9cQBQRXA9wDVQnSGNm_zDj7cNMu_sv8ZCYptBCL60oUKvcY8h4Yii_c_-szPRK-EJmwoVtJN4QaFefRqLLeMdPNQO72gA9bN2SUU7jhdWKNRuA_KBk1OSdbrw_jiUQXWKrzD1/s320/Norman+Whiteside.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Norman Whiteside</td></tr>
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The final day of the conference started with poster viewing. The next few sessions were very clinical, focusing on clinical guidelines, management and use of biologic treatments.<br />
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Prescribe biosimilars by brand to avoid any possible immunogenicity with switching between products - J Galloway <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/594961292730970112">May 3, 2015</a></blockquote>
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New clinical guidelines on prescribing rheumatic drugs in pregnancy in development and will inform all - I Giles <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/594960775405514752">May 3, 2015</a></blockquote>
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Jaw claudication , not jaw tenderness is a sign of GCA. Pain worse with chewing - Dasgupta <a href="https://twitter.com/hashtag/Rheum2015?src=hash">#Rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593681252319887360">April 30, 2015</a></blockquote>
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DiCicco EULAR response to anti TNF highest in RA synovial pathotype lymphoid > myeloid > paucimmune <a href="https://twitter.com/hashtag/rheum2015?src=hash">#rheum2015</a></div>
— Dr. Antoni Chan (@synovialjoints) <a href="https://twitter.com/synovialjoints/status/593067607026245635">April 28, 2015</a></blockquote>
Finally, to round up the conference, I chaired the Spondyloarthritis Special Interest Group Meeting. This was the last session at the conference and I was encouraged that 80 attended! We even had the main auditorium for the meeting. The speakers did an excellent job updating us on topics relevant to the area of spondyloarthritis.<br />
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I came away from the meeting with new information that will be shared with the team as we deliver our service to patients. It was a well organised meeting and an opportunity to share and exchange information with fellow rheumatologists. I look forward to BSR Glasgow 2016.<br />
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<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-42250740363636280632015-02-01T08:46:00.000-08:002016-04-09T12:34:00.111-07:00The Rheumatology Voice - increasing arthritis awareness<br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><b>Increasing Arthritis Awareness</b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Initiatives in 2014 to increase Arthritis Awareness</span></h1>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The NHS landscape changed with
the creation of the Health and Social Care Act 2012. This means the greater
need for collaboration between GPs, specialists and patients. Together, the aim
is for new care pathways that deliver benefit to patients. In arthritis, key to
the success of the care pathway is the early recognition of arthritis. This is
done by increasing awareness of arthritis.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The benefits of increased awareness include earlier
recognition, diagnosis, referral and treatment of a potentially painful and
disabling condition. Earlier diagnosis and treatment will lead to better
outcomes. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">All of this work would not have been possible without the
help of members of my rheumatology unit and the teams involved in the many
events in 2014. This includes patient
groups who have been very supportive of the drive to increase arthritis
awareness.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> Over 2014, my department hosted GP
events that focused on topics that included early inflammatory arthritis, polymyalgia
rheumatica, osteoporosis, gout and the spondyloarthropathies. This was geared
for colleagues in primary care, to increase awareness and improve referral to
specialists. It is important to approach this from the perspective of GPs. A
recent posting by Paula Wright in the BMJ has been helpful <a href="http://careers.bmj.com/careers/advice/advice-overview.html"><span style="color: blue;">http://careers.bmj.com/careers/advice/advice-overview.html</span></a></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> In May, I chaired an Inflammatory
Back Pain (IBP) seminar for GPs, nurses and physiotherapists. This is to
increase awareness of IBP which is a feature of ankylosing spondylitis (AS).
The message is that not all back is the same. Early detection of AS will
improve long term outcomes.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdICl3MDm7C0TrdUldyWGau8xyfBV8Y6RLiDvdM6vuPpVY_igF9Q_H4scewhp5kOPDnUdMmPz5MWr7yYp-xtC7nvVUBSeDGhYziHIrkuOi3cV7UwO_9r891OD3rCDu2RW_pxtlNNXfS1rK/s1600/Back+pain+seminar.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdICl3MDm7C0TrdUldyWGau8xyfBV8Y6RLiDvdM6vuPpVY_igF9Q_H4scewhp5kOPDnUdMmPz5MWr7yYp-xtC7nvVUBSeDGhYziHIrkuOi3cV7UwO_9r891OD3rCDu2RW_pxtlNNXfS1rK/s1600/Back+pain+seminar.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With the team at the Back Pain Seminar</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> In July, there was public engagement
with the ‘Don’t Turn Your Back On It’ campaign. This initiative was supported
by the National Ankylosing Spondylitis Society (NASS). The team spoke to many
people in Reading Town Centre on inflammatory back pain. There were acrobats to
highlight the event on the day.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX2wiw0sf1Fw37XQ1l6-9xIc9dKU4DLLqwcp6WnY4_TvbATM5izsTcsng1F1fECO74ZsBvmqkUy8MvomttK9i8e62mvnkpgXig56-ID4FQxmf-sisr7iXhd61ay-k4sKc-e2ZIHwwhLjM9/s1600/Reading_048.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX2wiw0sf1Fw37XQ1l6-9xIc9dKU4DLLqwcp6WnY4_TvbATM5izsTcsng1F1fECO74ZsBvmqkUy8MvomttK9i8e62mvnkpgXig56-ID4FQxmf-sisr7iXhd61ay-k4sKc-e2ZIHwwhLjM9/s1600/Reading_048.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Sue Hicks, Specialist Physiotherapist in Reading Town Centre</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> In October,
the Reading Fibromyalgia Society held their first anniversary celebration at Prospect
Park Hospital in Reading. I and other members of the Rheumatology Team were
able to support this. The event was attended by Alok Sharma, MP for Reading
West and also by Cllr. Sarah Hacker, Reading Deputy Mayor. See their blogs on
this event:</span></div>
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<a href="http://www.aloksharma.co.uk/content/sharma-speaks-reading-fibromyalgia-support-group-anniversary"><span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">http://www.aloksharma.co.uk/content/sharma-speaks-reading-fibromyalgia-support-group-anniversary</span></a></div>
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<a href="http://www.getreading.co.uk/news/local-news/reading-fibromyalgia-support-group-marks-8135939"><span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">http://www.getreading.co.uk/news/local-news/reading-fibromyalgia-support-group-marks-8135939</span></a></div>
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<a href="http://cllrsarahhacker.blogspot.co.uk/"><span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">http://cllrsarahhacker.blogspot.co.uk/</span></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> In November,
two seminars were held to increase awareness of arthritis. A public seminar was
organised by the Royal Berkshire Hospital for members on early arthritis and
rheumatoid arthritis. The event was also attended by the National Rheumatoid
Arthritis Society (NRAS) <span style="color: blue;">http://www.nras.org.uk/</span></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzp6qZ0kRd-9-MaxCIf3cuLQw6NW7a2ZMsVXzrwbsANB6qnlZ3VyPj8Hs_mK3fTSkXWFqpj0EGSw4E-rUgAAKeO668icJW-alPeEpWsH-ofO3fyjObUZPaJRpCaZsCZKpNnQMy1GCaf259/s1600/NRAS.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzp6qZ0kRd-9-MaxCIf3cuLQw6NW7a2ZMsVXzrwbsANB6qnlZ3VyPj8Hs_mK3fTSkXWFqpj0EGSw4E-rUgAAKeO668icJW-alPeEpWsH-ofO3fyjObUZPaJRpCaZsCZKpNnQMy1GCaf259/s320/NRAS.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: 12.8px;">With the NRAS at the Trust Public Seminar on rheumatoid arthritis</span></td></tr>
</tbody></table>
<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> In the same
month, there was a GP teaching event on topics such as early referral to
specialists, what to look out for, how to manage arthritis in primary care.
There was also a practical session on how to perform the disease activity score
28 (DAS28), an outcome measure used in rheumatoid arthritis. We were supported
by our local arthritis charity, Arthritis Matters for this event </span><a href="http://www.arthritismattersreading.co.uk/"><span style="color: blue; font-family: "arial" , "helvetica" , sans-serif;">http://www.arthritismattersreading.co.uk/</span></a></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmyq6ta4RwI9_4EUAhbT5QBEihWtdicMMrJAt6xHD5pakbsYQ3cY0DBKSLHcBoxO00v5ZaLRCOP8AkbHFLOOUL7s06xStDP1AV2bfYEONjKqJzUhmYLhdMwu_b8-5GVOHakHwBm2zzWRVz/s1600/GP+Nov+2014.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmyq6ta4RwI9_4EUAhbT5QBEihWtdicMMrJAt6xHD5pakbsYQ3cY0DBKSLHcBoxO00v5ZaLRCOP8AkbHFLOOUL7s06xStDP1AV2bfYEONjKqJzUhmYLhdMwu_b8-5GVOHakHwBm2zzWRVz/s1600/GP+Nov+2014.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">GP Teaching event to increase awareness of arthritis</td></tr>
</tbody></table>
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<o:p><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></o:p></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> November
was a busy month as it was also the month that the National Ankylosing
Spondylitis Society (NASS) organised the parliamentary event to raise awareness
of the need to increase access to physiotherapy. This is the next step of the
NASS As It Is campaign <a href="http://nass.co.uk/news/as-it-is---next-steps-in-the-campaign/?keywords=as+it+is"><span style="color: blue;">http://nass.co.uk/news/as-it-is---next-steps-in-the-campaign/?keywords=as+it+is</span></a></span></div>
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<div class="MsoNormal">
<o:p><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></o:p></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4ZTmS_W3ARb34SvOu-JRnjLqm_UIVHhxCzhooBNs9QGmpw45y_8ZRDVzV4f96Lh2-D8tg9fZQkJVFvegQW41nXjtg6BixxI2ZZY3aSlzqXqoT5wREN6Z6X-ao9nklUqT4HUiCGGX3V29o/s1600/NASS+Debbie+Cook.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4ZTmS_W3ARb34SvOu-JRnjLqm_UIVHhxCzhooBNs9QGmpw45y_8ZRDVzV4f96Lh2-D8tg9fZQkJVFvegQW41nXjtg6BixxI2ZZY3aSlzqXqoT5wREN6Z6X-ao9nklUqT4HUiCGGX3V29o/s1600/NASS+Debbie+Cook.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Debbie Cook, NASS Director</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVuV1eDF5Nj8bteFFCa2A7Q-fctzaOKPmAgl6l1J_0WVPwOgwA68e1PXqSWelh6FHSjsCGbNCi6ihm_dEuEcCEwxSwBQePXqSzGkV5f3U8tkftB0qsLYzqkM4bcjobh1oJFWxpOa6oP3KM/s1600/NASS+As+it+Is.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVuV1eDF5Nj8bteFFCa2A7Q-fctzaOKPmAgl6l1J_0WVPwOgwA68e1PXqSWelh6FHSjsCGbNCi6ihm_dEuEcCEwxSwBQePXqSzGkV5f3U8tkftB0qsLYzqkM4bcjobh1oJFWxpOa6oP3KM/s1600/NASS+As+it+Is.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">At the NASS event with the team from Portsmouth</td></tr>
</tbody></table>
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<o:p><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></o:p></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> In 2015,
more such events are planned to continue the drive to increase awareness of
arthritis. Rheumatology needs a voice and together, our efforts no matter how
small or big, will go towards improving patient access and care. This is <b><i><u>A Joint Venture.</u></i></b></span></div>
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<b><span style="color: #222222; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">@synovialjoints</span></b><span style="color: #222222; font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></div>
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<b><span style="color: #222222; font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><br /></span></b></div>
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<div class="MsoNormal" style="background: white;">
<span style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;">Views are my
own. These are opinions, not specific medical advice and cannot replace the
need to see your physician for review of your individual medical condition.</span><span style="font-size: 10pt; line-height: 115%;"><o:p></o:p></span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-20740146071582251042014-11-23T13:35:00.000-08:002016-04-09T12:27:43.395-07:00As it Is - Back to Action at the Houses of Parliament<div class="MsoNormal">
<b><u><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></u></b></div>
<div class="MsoNormal">
<b><u><span style="font-family: "arial" , "helvetica" , sans-serif;">As It Is - Back to
Action at the Houses of Parliament <o:p></o:p></span></u></b></div>
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<b><u><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">In the last
decade, great advance has been made in treatment of ankylosing spondylitis (AS).
This has been focused on therapies such as the biologics eg. Anti-TNF. One of
the cornerstones in treatment of AS remain exercise and physiotherapy. This
spans the treatment pathway for AS as recommended by ASAS/EULAR.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Studies have shown that exercise in AS improves function <!--[if supportFields]><span
style='mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:
Arial'><span style='mso-element:field-begin;mso-field-lock:yes'></span>ADDIN
CSL_CITATION { "citationItems" : [ { "id" :
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"PMID" : "21150624", "abstract" :
"Ankylosing spondylitis (AS) is a disease that tends to affect younger
individuals, many of whom are in the prime of their lives; therefore,
incorporating the most up-to-date evidence into physiotherapy practice is
critical. The purpose of this review is to update the most recent evidence
related to physiotherapy intervention for AS and highlight the application of
the findings to current physiotherapy research and clinical practice.",
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}<span style='mso-element:field-separator'></span></span><![endif]-->(Passalent, 2011)<!--[if supportFields]><span
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mso-field-lock:yes'></span>ADDIN CSL_CITATION { "citationItems" : [ {
"id" : "ITEM-1", "itemData" : { "DOI" :
"10.1016/S1521-6942(02)90240-8", "ISSN" :
"15216942", "PMID" : "12406432",
"abstract" : "Physical therapy plays an important role in the
overall treatment of ankylosing spondylitis. Apart from exercising at home,
patients are advised to follow weekly group physical therapy. In addition, many
patients often follow annual courses of in-patient physiotherapy or spa therapy
in which exercises also play a central role. This chapter focuses on evidence
for benefits of physical therapy and spa therapy in ankylosing
spondylitis.", "author" : [ { "dropping-particle" :
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: "ITEM-1", "issued" : { "date-parts" : [ [
"2002" ] ] }, "page" : "653-666",
"title" : "Spa and exercise treatment in ankylosing spondylitis:
fact or fancy?", "type" : "article-journal",
"volume" : "16" }, "uris" : [
"http://www.mendeley.com/documents/?uuid=34c1c182-afab-4862-92a1-bd3d75285dbd"
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Tubergen & Hidding, 2002)", "plainTextFormattedCitation" :
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}<span style='mso-element:field-separator'></span></span><![endif]-->(van Tubergen & Hidding, 2002)<!--[if supportFields]><span
style='mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:
Arial'><span style='mso-element:field-end'></span></span><![endif]-->. <span style="color: #333333;">A Cochrane review suggest that an
individual home-based or supervised exercise program is better than no
intervention </span><!--[if supportFields]><span style='mso-ascii-font-family:
Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri;
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style='mso-element:field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
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"itemData" : { "DOI" :
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"0315162X", "PMID" : "18254008",
"abstract" : "BACKGROUND: Ankylosing spondylitis (AS) is a
chronic, inflammatory rheumatic disease. Physiotherapy is considered an
important part of the overall management of AS. OBJECTIVES: To summarise the
available scientific evidence on the effectiveness of physiotherapy
interventions in the management of AS. SEARCH STRATEGY: We searched the
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE,
AMED, CINAHL and PEDro up to January 2007 for all relevant publications,
without any language restrictions. We checked the reference lists of relevant
articles and contacted the authors of included articles. SELECTION CRITERIA: We
included randomised and quasi-randomised studies with AS patients and where at
least one of the comparison groups received physiotherapy. The main outcomes of
interest were pain, stiffness, spinal mobility, physical function and patient
global assessment. DATA COLLECTION AND ANALYSIS: Two reviewers independently
selected trials for inclusion, extracted data and assessed trial quality.
Investigators were contacted to obtain missing information. MAIN RESULTS:
Eleven trials with a total of 763 participants were included in this updated
review. Four trials compared individualised home exercise programs or a
supervised exercise program with no intervention and reported low quality
evidence for effects in spinal mobility (Relative percentage differences (RPDs)
from 5-50%) and physical function (four points on a 33-point scale). Three
trials compared supervised group physiotherapy with an individualised
home-exercise program and reported moderate quality evidence for small
differences in spinal mobility (RPDs 7.5-18%) and patient global assessment
(1.46 cm) in favour of supervised group exercises. In one study, a three-week
inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group
physiotherapy (without spa) was compared with weekly outpatient group
physiotherapy alone; there was moderate quality evidence for effects in pain
(18%), physical function (24%) and patient global assessment (27%) in favour of
the combined spa-exercise therapy. One study compared daily outpatient
balneotherapy and an exercise program with only exercise program, and another
study compared balneotherapy with fresh water therapy. None of these studies
showed significant between-group differences. One study compared an
experimental exercise program with a conventional program; statistically
significant change scores were reported on nearly\u2026",
"author" : [ { "dropping-particle" : "",
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"container-title" : "Journal of Rheumatology",
"id" : "ITEM-1", "issued" : {
"date-parts" : [ [ "2005" ] ] }, "page" :
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}<span style='mso-element:field-separator'></span></span><![endif]--><span style="color: #333333; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(Dagfinrud, Kvien, &
Hagen, 2005)</span><!--[if supportFields]><span style='mso-ascii-font-family:
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style='mso-element:field-end'></span></span><![endif]--><span style="color: #333333; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">. Supervised
group physiotherapy is better than home exercises and that combined inpatient
spa-exercise therapy followed by group physiotherapy is better than group
physiotherapy alone. The benefit of group therapy may be due to both the
motivation and opportunity for exercise that it provides. Both these factors
are important in improving function is AS </span><!--[if supportFields]><span
style='mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;
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CSL_CITATION { "citationItems" : [ { "id" :
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"10.1016/j.semarthrit.2012.09.007", "ISSN" :
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"abstract" : "OBJECTIVES: Exercise is reported to improve
function for people with ankylosing spondylitis (AS) but it is not clear if
this effect is causal or if patients with milder disease find it easier to
exercise. This study examines the effect of exercise and motivation to exercise
on function, while controlling for disease severity.\n\nMETHODS: Participants
who were members of an existing AS cohort were asked about physical activity,
motivation to exercise, function, and disease severity. Path analysis on STATA
was used to examine the correlation between factors associated with function at
time of exercise and with function after 3 months of follow-up.\n\nRESULTS: The
response rate to the questionnaire was 88% (326/371). Improvement in function
was greatest for people with higher physical activity levels and those who were
more motivated to exercise-this was especially the case for patients with the
most severe disease activity. The effect of motivation to exercise not only had
a direct effect on function, but also an indirect effect of improving activity
levels thereby improving both current and future function. People with high
intrinsic motivation (driven by pleasure) had the greatest benefit to activity
and function.\n\nCONCLUSIONS: Exercise does improve function, especially for
those with severe disease. In addition, motivation alone improves function as
much as exercising itself. Therefore, interventions targeting motivation to
exercise would have as much effect on improving function as interventions
offering exercise opportunities. In addition, any intervention that both
improves motivation and increases opportunities to exercise would have a 2-fold
influence on function.", "author" : [ {
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: "Seminars in arthritis and rheumatism", "id" :
"ITEM-1", "issue" : "6", "issued" : {
"date-parts" : [ [ "2013", "6" ] ] },
"page" : "619-26", "publisher" :
"Elsevier", "title" : "The effect of physical activity
and motivation on function in ankylosing spondylitis: a cohort study.",
"type" : "article-journal", "volume" :
"42" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=fb710781-7c9e-4418-9e61-bba1638b6764"
] } ], "mendeley" : { "formattedCitation" : "(Brophy
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}<span style='mso-element:field-separator'></span></span><![endif]--><span style="color: #333333; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(Brophy et al., 2013)</span><!--[if supportFields]><span
style='mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:
Arial;color:#333333'><span style='mso-element:field-end'></span></span><![endif]--><span style="color: #333333; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">. In a small study, </span>high intensity exercise
improved disease activity and reduced cardiovascular risk factors in patients
with active axial SpA <!--[if supportFields]><span style='mso-element:field-begin;
mso-field-lock:yes'></span>ADDIN CSL_CITATION { "citationItems" : [ {
"id" : "ITEM-1", "itemData" : { "DOI" :
"10.1371/journal.pone.0108688", "ISSN" :
"1932-6203", "PMID" : "25268365", "abstract"
: "BACKGROUND: Physical therapy is recommended for the management of axial
spondyloarthritis (axSpA) and flexibility exercises have traditionally been the
main focus. Cardiovascular (CV) diseases are considered as a major health
concern in axSpA and there is strong evidence that endurance and strength
exercise protects against CV diseases. Therefore, the aim of this study was to
investigate the efficacy of high intensity endurance and strength exercise on
disease activity and CV health in patients with active axSpA.\n\nMETHODS: In a
single blinded randomized controlled pilot study the exercise group (EG)
performed 12 weeks of endurance and strength exercise while the control group
(CG) received treatment as usual. The primary outcome was the Ankylosing
Spondylitis (AS) Disease Activity Score (ASDAS). Secondary outcomes included
patient reported disease activity (Bath AS Disease Activity Index [BASDAI]),
physical function (Bath AS Functional Index [BASFI]), and CV risk factors
measured by arterial stiffness (Augmentation Index [Alx]) and Pulse Wave
Velocity [PWV]), cardiorespiratory fitness (VO2 peak) and body composition.
ANCOVA on the post intervention values with baseline values as covariates was
used to assess group differences, and Mann Whitney U-test was used for outcomes
with skewed residuals.\n\nRESULTS: Twenty-eight patients were included and 24
(EG, n\u200a=\u200a10, CG, n\u200a=\u200a14) completed the study. A mean
treatment effect of -0.7 (95%CI: -1.4, 0.1) was seen in ASDAS score. Treatment
effects were also observed in secondary outcomes (mean group difference
[95%CI]): BASDAI: -2.0 (-3.6, -0.4), BASFI: -1.4 (-2.6, -0.3), arterial
stiffness (estimated median group differences [95% CI]): AIx (%): -5.3 (-11.0,
-0.5), and for PVW (m/s): -0.3 (-0.7, 0.0), VO2 peak (ml/kg/min) (mean group
difference [95%CI]: 3.7 (2.1, 5.2) and trunk fat (%): -1.8 (-3.0, -0.6). No
adverse events occurred.\n\nCONCLUSION: High intensity exercise improved
disease activity and reduced CV risk factors in patients with active axSpA.
These effects will be further explored in a larger trial.\n\nTRIAL
REGISTRATION: ClinicalTrials.gov NCT01436942.", "author" : [ {
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"issue" : "9", "issued" : {
"date-parts" : [ [ "2014", "1" ] ] },
"page" : "e108688", "title" : "Efficacy of
high intensity exercise on disease activity and cardiovascular risk in active
axial spondyloarthritis: a randomized controlled pilot study.",
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}<span style='mso-element:field-separator'></span><![endif]-->(Sveaas et al., 2014)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. </span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">The evidence
from the many studies have form the recommendations for the management of AS <!--[if supportFields]><span
style='mso-element:field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
"citationItems" : [ { "id" : "ITEM-1",
"itemData" : { "DOI" : "10.1136/ard.2005.041137",
"ISSN" : "0003-4967", "PMID" :
"16126791", "abstract" : "OBJECTIVE: To develop
evidence based recommendations for the management of ankylosing spondylitis
(AS) as a combined effort of the 'ASsessment in AS' international working group
and the European League Against Rheumatism.\n\nMETHODS: Each of the 22
participants was asked to contribute up to 15 propositions describing key
clinical aspects of AS management. A Delphi process was used to select 10 final
propositions. A systematic literature search was then performed to obtain
scientific evidence for each proposition. Outcome data for efficacy, adverse
effects, and cost effectiveness were abstracted. The effect size, relative
risk, number needed to treat, and incremental cost effectiveness ratio were
calculated. On the basis of the search results, 10 major recommendations for
the management of AS were constructed. The strength of recommendation was
assessed based on the strength of the literature evidence, risk-benefit
trade-off, and clinical expertise.\n\nRESULTS: The final recommendations
considered the use of non-steroidal anti-inflammatory drugs (NSAIDs) (conventional
NSAIDs, coxibs, and co-prescription of gastroprotective agents), disease
modifying antirheumatic drugs, treatments with biological agents, simple
analgesics, local and systemic steroids, non-pharmacological treatment
(including education, exercise, and physiotherapy), and surgical interventions.
Three general recommendations were also included. Research evidence (categories
I-IV) supported 11 interventions in the treatment of AS. Strength of
recommendation varied, depending on the category of evidence and expert
opinion.\n\nCONCLUSION: Ten key recommendations for the treatment of AS were
developed and assessed using a combination of research based evidence and
expert consensus. Regular updating will be carried out to keep abreast of new
developments in the management of AS.", "author" : [ {
"dropping-particle" : "", "family" :
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"dropping-particle" : "", "family" :
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"dropping-particle" : "", "family" :
"Inman", "given" : "R D",
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"dropping-particle" : "", "family" :
"Kvien", "given" : "T K",
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}, { "dropping-particle" : "", "family" :
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"dropping-particle" : "", "family" :
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"dropping-particle" : "", "family" :
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"non-dropping-particle" : "", "parse-names" :
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"B J", "non-dropping-particle" : "van",
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"dropping-particle" : "", "family" : "Braun",
"given" : "J", "non-dropping-particle" :
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"" } ], "container-title" : "Annals of the rheumatic
diseases", "id" : "ITEM-1", "issue" :
"4", "issued" : { "date-parts" : [ [
"2006", "4" ] ] }, "page" : "442-52",
"title" : "ASAS/EULAR recommendations for the management of
ankylosing spondylitis.", "type" : "article-journal",
"volume" : "65" }, "uris" : [
"http://www.mendeley.com/documents/?uuid=4fd8af31-a42c-4fb3-9924-47c69f783894"
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}<span style='mso-element:field-separator'></span><![endif]-->(Zochling, van der Heijde, Burgos-Vargas, et al.,
2006)<!--[if supportFields]><span style='mso-element:field-end'></span><![endif]-->.
Exercise and physiotherapy forms the non-pharmacological treatments for AS <!--[if supportFields]><span style='mso-element:
field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
"citationItems" : [ { "id" : "ITEM-1",
"itemData" : { "DOI" : "10.1136/ard.2005.041129",
"ISSN" : "0003-4967", "PMID" :
"16126792", "abstract" : "OBJECTIVE: To assess
available management strategies in ankylosing spondylitis (AS) using a
systematic approach, as a part of the development of evidence based
recommendations for the management of AS.\n\nMETHODS: A systematic search of
Medline, Embase, CINAHL, PEDro, and the Cochrane Library was performed to
identify relevant interventions for the management of AS. Evidence for each
intervention was categorised by study type, and outcome data for efficacy,
adverse effects, and cost effectiveness were abstracted. The effect size, rate
ratio, number needed to treat, and incremental cost effectiveness ratio were
calculated for each intervention where possible. Results from randomised
controlled trials were pooled where appropriate.\n\nRESULTS: Both
pharmacological and non-pharmacological interventions considered to be of interest
to clinicians involved in the management of AS were identified. Good evidence
(level Ib) exists supporting the use of non-steroidal anti-inflammatory drugs
(NSAIDs) and coxibs for symptomatic treatment. Non-pharmacological treatments
are also supported for maintaining function in AS. The use of conventional
antirheumatoid arthritis drugs is not well supported by high level research
evidence. Tumour necrosis factor inhibitors (infliximab and etanercept) have
level Ib evidence supporting large treatment effects for spinal pain and
function in AS over at least 6 months. Level IV evidence supports surgical
interventions in specific patients.\n\nCONCLUSION: This extensive literature
review forms the evidence base considered in the development of the new ASAS/EULAR
recommendations for the management of AS.", "author" : [ {
"dropping-particle" : "", "family" :
"Zochling", "given" : "J",
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false, "suffix" : "" }, { "dropping-particle" :
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"container-title" : "Annals of the rheumatic diseases",
"id" : "ITEM-1", "issue" : "4",
"issued" : { "date-parts" : [ [ "2006",
"4" ] ] }, "page" : "423-32", "title" :
"Current evidence for the management of ankylosing spondylitis: a
systematic literature review for the ASAS/EULAR management recommendations in
ankylosing spondylitis.", "type" : "article-journal",
"volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2ecc29ba-9f4e-42d5-a3d8-8317a9193984"
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"(Zochling, van der Heijde, Dougados, & Braun, 2006)",
"plainTextFormattedCitation" : "(Zochling, van der Heijde,
Dougados, & Braun, 2006)" }, "properties" : {
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}<span style='mso-element:field-separator'></span><![endif]-->(Zochling, van der Heijde, Dougados, & Braun,
2006)<!--[if supportFields]><span style='mso-element:field-end'></span><![endif]-->.
<span style="color: #333333; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">As it is, I was back at the Houses of Parliament on November 18<sup>th</sup>
November 2014, to highlight the need for better access to physiotherapy for
patients with AS. The event organized by NASS was hosted by Huw Irranca-Davies
MP.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyddJyUU8oLi2nQzmTknKFjQLzDJhxYV5qx-SWmcQBqSpCGHXIH7dgtJubcO0li33ly5Sle3lywW3nM73s6glw3TShIJnAy_cK00qTyduvymMJkW-80FqTXWmN4Cu_Ud2wv_PwO326XnLV/s1600/NASS2.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyddJyUU8oLi2nQzmTknKFjQLzDJhxYV5qx-SWmcQBqSpCGHXIH7dgtJubcO0li33ly5Sle3lywW3nM73s6glw3TShIJnAy_cK00qTyduvymMJkW-80FqTXWmN4Cu_Ud2wv_PwO326XnLV/s1600/NASS2.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif;">With the team from Portsmouth, L-R: Roger, me and physiotherapists Emma, Claire and Ronnie</span></td></tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigGqc2fGiPpjfm31AzF8d5dE9CMlol79XxHsqePdAgZRCLiUbixPSY_wFOdNIgBhHv6-mv3S9aaMhejMvSihML3pFV-fV5LpcUen2vX8BhkjX_kr80UF-DQwXFPt3jZQNwD9jaPa1jZoCW/s1600/NASS3.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigGqc2fGiPpjfm31AzF8d5dE9CMlol79XxHsqePdAgZRCLiUbixPSY_wFOdNIgBhHv6-mv3S9aaMhejMvSihML3pFV-fV5LpcUen2vX8BhkjX_kr80UF-DQwXFPt3jZQNwD9jaPa1jZoCW/s1600/NASS3.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif;">With the NASS Team, Hedley Hamilton, Laura G and Laura R</span></td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtOLC8iUJm3aI-sYSnUou-5fJmjnGjwfr20vMSAnM1KNArROFI_1edVjvYB0ZZkc69vFMR0ztOBv43Maf0Bl-_gsYjqoPjSe9eM2ehtSNkOCTvHFZenarvFTAl-CXgvXLKMhfX9sqzkyZW/s1600/NASS+Debbie+Cook.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtOLC8iUJm3aI-sYSnUou-5fJmjnGjwfr20vMSAnM1KNArROFI_1edVjvYB0ZZkc69vFMR0ztOBv43Maf0Bl-_gsYjqoPjSe9eM2ehtSNkOCTvHFZenarvFTAl-CXgvXLKMhfX9sqzkyZW/s320/NASS+Debbie+Cook.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Debbie Cook, Director of NASS</td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXOpIW_HMOVKKpYTbEcAgvrQeKGMpvuFK5pMyud2GHKfMyvxOWa4S1wvifwHvFyG89fXhVkoAZ-9sVIR3I2Qczbii_DxCpbVTNM8O53SlpFu4n6y7kfFo0nghulV0a5tptvB2fPn1xDhND/s1600/NASS+5.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXOpIW_HMOVKKpYTbEcAgvrQeKGMpvuFK5pMyud2GHKfMyvxOWa4S1wvifwHvFyG89fXhVkoAZ-9sVIR3I2Qczbii_DxCpbVTNM8O53SlpFu4n6y7kfFo0nghulV0a5tptvB2fPn1xDhND/s1600/NASS+5.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif;">With Gillian Eames, Sebastian, Paul Curry and wife. Paul shared his story of AS.</span></td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">A survey in 2013 by NASS showed that
60% of people in UK with AS do not have regular access to physiotherapy. The evidence supports the role
of physiotherapy and exercise as key to managing the condition. Physiotherapy
remains one of the cornerstones of treatment for AS and is provided by 90
physiotherapy branches. Improved access to the right care for patients with AS
including physiotherapy will ensure that patient remain physically active and
in work where possible.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">#AS_It_Is<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><span style="color: #222222;">@synovialjoints</span></b><span style="color: #222222;"><o:p></o:p></span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 18.3999996185303px;">Views are my own. These are opinions, not specific medical advice and cannot replace the need to see your physician for review of your individual medical condition.</span><span style="line-height: 18.3999996185303px;"><o:p></o:p></span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>References</u></b></span></div>
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style='mso-element:field-begin;mso-field-lock:yes'></span>ADDIN Mendeley
Bibliography CSL_BIBLIOGRAPHY <span style='mso-element:field-separator'></span></span><![endif]--><span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Brophy, S., Cooksey, R., Davies, H., Dennis, M. S., Zhou,
S.-M., & Siebert, S. (2013). The effect of physical activity and motivation
on function in ankylosing spondylitis: a cohort study. <i>Seminars in Arthritis
and Rheumatism</i>, <i>42</i>(6), 619–26. doi:10.1016/j.semarthrit.2012.09.007<o:p></o:p></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span></div>
<div style="margin-left: 24.0pt; text-indent: -24.0pt;">
<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Dagfinrud,
H., Kvien, T. K., & Hagen, K. B. (2005). The cochrane review of
physiotherapy interventions for ankylosing spondylitis. <i>Journal of
Rheumatology</i>. doi:10.1002/14651858.CD002822.pub3<o:p></o:p></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Passalent,
L. A. (2011). Physiotherapy for ankylosing spondylitis: evidence and
application. <i>Current Opinion in Rheumatology</i>, <i>23</i>, 142–147.
doi:10.1097/BOR.0b013e328342273a<o:p></o:p></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Sveaas,
S. H., Berg, I. J., Provan, S. A., Semb, A. G., Hagen, K. B., Vøllestad, N., …
Dagfinrud, H. (2014). Efficacy of high intensity exercise on disease activity
and cardiovascular risk in active axial spondyloarthritis: a randomized
controlled pilot study. <i>PloS One</i>, <i>9</i>(9), e108688.
doi:10.1371/journal.pone.0108688<o:p></o:p></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span></div>
<div style="margin-left: 24.0pt; text-indent: -24.0pt;">
<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Van
Tubergen, A., & Hidding, A. (2002). Spa and exercise treatment in
ankylosing spondylitis: fact or fancy? <i>Best Practice & Research.
Clinical Rheumatology</i>, <i>16</i>, 653–666.
doi:10.1016/S1521-6942(02)90240-8<o:p></o:p></span></span></div>
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<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span></div>
<div style="margin-left: 24.0pt; text-indent: -24.0pt;">
<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Zochling,
J., van der Heijde, D., Burgos-Vargas, R., Collantes, E., Davis, J. C., Dijkmans,
B., … Braun, J. (2006). ASAS/EULAR recommendations for the management of
ankylosing spondylitis. <i>Annals of the Rheumatic Diseases</i>, <i>65</i>(4),
442–52. doi:10.1136/ard.2005.041137<o:p></o:p></span></span></div>
<div style="margin-left: 24.0pt; text-indent: -24.0pt;">
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<div style="margin-left: 24.0pt; text-indent: -24.0pt;">
<span style="font-size: 11pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Zochling,
J., van der Heijde, D., Dougados, M., & Braun, J. (2006). Current evidence
for the management of ankylosing spondylitis: a systematic literature review
for the ASAS/EULAR management recommendations in ankylosing spondylitis. <i>Annals
of the Rheumatic Diseases</i>, <i>65</i>(4), 423–32.
doi:10.1136/ard.2005.041129</span><span style="font-family: "calibri" , sans-serif;"><o:p></o:p></span></span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-82922523373943633522014-09-23T01:31:00.001-07:002014-09-23T01:31:32.698-07:00Going Head over Heels for inflammatory back pain<br />
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<b><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><u>Reading goes Head over Heels for inflammatory back pain<o:p></o:p></u></span></b><br />
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<b><span lang="EN" style="font-family: "Arial","sans-serif";">Increasing awareness of inflammatory low back pain in Reading</span></b></div>
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<span style="font-family: Arial, sans-serif;">On Saturday 19th July 2014 I spent the day in Reading Town Center promoting awareness of inflammatory back pain to the public. Reading is the first site nationally for the <i>Don't Turn Your Back on It </i>campaign. This is a campaign backed by the National Ankylosing Spondylitis Society (NASS).</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjr85HAjl3nYS-E91JcXCT-WdPZ92T6xyxtm7qZ8muYuuxuIOsjY53R38YwvFCDGfvGyOTSVgy3ZmbPsFzG_NSrrPW4E9U-lNIy-4xnHmKjHqIiX87eHT9A2QTWPikhp9e5Z72e30O75si/s1600/Antoni+Chan+chatting.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjr85HAjl3nYS-E91JcXCT-WdPZ92T6xyxtm7qZ8muYuuxuIOsjY53R38YwvFCDGfvGyOTSVgy3ZmbPsFzG_NSrrPW4E9U-lNIy-4xnHmKjHqIiX87eHT9A2QTWPikhp9e5Z72e30O75si/s1600/Antoni+Chan+chatting.jpg" height="320" width="214" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Speaking to public on inflammatory back pain. <br />
The children of parents were attracted to the 'dinosaur' spine.</td></tr>
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<span style="font-family: Arial, sans-serif;">The</span><i style="font-family: Arial, sans-serif;"> Don't
Turn Your Back On It </i><span style="font-family: Arial, sans-serif;">campaign came to Broad Street, Reading to help people suffering from chronic lower back pain to identify if the cause of their pain. Identifying inflammatory low back pain is the key to early diagnosis of ankylosing spondylitis (AS). Currently there is a still an average delay of 8.5 years from symptom onset to diagnosis of AS. With increase public awareness, this should help reduce delay in patients seeing their GPs for onward referral to a Rheumatologist for a diagnosis of AS.</span></div>
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<span lang="EN" style="font-family: "Arial","sans-serif"; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">A group of
acrobats performed at the event to bring attention to the
issue. This got the crowd thinking and talking about back pain seeing the acrobats bending and flexing their spines. We talked to hundreds of people and were interested to hear their individual stories.<o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">Acrobats performing in the middle of Reading Town Center (Broad Street).</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisBQnNZR54aiKG7ICR4NDHD1wj7Ny__kCDYgcIygfapD9NoAw7wevA84gP-9hPgXMkB_fdHYU7OqBCroAJsUnCTu_A83kWqMsOm-oNN-XGpsajbaofTw0kDyUDB-VXbrsgyIdcQHr68Pg2/s1600/Acrobats+1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisBQnNZR54aiKG7ICR4NDHD1wj7Ny__kCDYgcIygfapD9NoAw7wevA84gP-9hPgXMkB_fdHYU7OqBCroAJsUnCTu_A83kWqMsOm-oNN-XGpsajbaofTw0kDyUDB-VXbrsgyIdcQHr68Pg2/s1600/Acrobats+1.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"> It was a wonderful performance from the acrobats on a wonderful Saturday afternoon. <br />
The rain stayed away despite the forecast of heavy showers!</td></tr>
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<span lang="EN" style="font-family: "Arial","sans-serif"; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Information
leaflets on inflammatory back pain were handed out by the team on the day. This </span><span lang="EN" style="font-family: "Arial","sans-serif";">included Claire Harris, physiotherapy advisor at NASS and Chair of AStretch. </span><span style="font-family: Arial, sans-serif; text-align: center;">Sally
Dickinson from NASS was also on the stand along with NASS trustee Peter
Wheatley-Price. I was also supported by Susan Hicks, specialist physiotherapist from the Royal Berkshire Hospital. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0HBDXM1kdKX9TEjP7j1CAnLERCUR6Ij0vJSWbvBF78O30TAb4FelHlry9C0pzLA0fwt5Q9Teyu7aa33QNWFFy4wdgfFeAof4V2gEx03nsQS6zBxaYmvrfziA6NjFZKu2F5qyuUXFHc1kJ/s1600/team+pic+for+web.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0HBDXM1kdKX9TEjP7j1CAnLERCUR6Ij0vJSWbvBF78O30TAb4FelHlry9C0pzLA0fwt5Q9Teyu7aa33QNWFFy4wdgfFeAof4V2gEx03nsQS6zBxaYmvrfziA6NjFZKu2F5qyuUXFHc1kJ/s1600/team+pic+for+web.jpg" height="223" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The team on the day promoting awareness of inflammatory back pain in Reading.</td></tr>
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<span lang="EN" style="font-family: "Arial","sans-serif"; mso-ansi-language: EN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The campaign
hopes to help people suffering from chronic lower back pain for more than 3 months and encouraged them to visit the <span style="color: windowtext; text-decoration: none; text-underline: none;"><a href="http://www.dontturnyourbackonit.co.uk/" target="_blank">campaign website</a>. Here they can </span>complete a short symptom checker to
assess if their back pain may be inflammatory. They are advised that the
results can then be discussed with their GP. Further information about the
campaign, types and causes of back pain and educational resources offering
insights into the lives of people living with chronic back pain are also
available on the website. <o:p></o:p></span></div>
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<b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10pt;">@synovialjoints</span></b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10pt;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt; line-height: 15.3333320617676px;">Views are my own. These are opinions and not consultations. It cannot replace the need to see your physician for review of your individual medical condition.</span><span style="font-size: 10pt; line-height: 15.3333320617676px;"><o:p></o:p></span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com2tag:blogger.com,1999:blog-6539283498264931461.post-72257169966683192132014-07-11T12:48:00.001-07:002014-07-11T12:48:51.021-07:00Not all back pain is the same<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Not
all back pain is the same<o:p></o:p></span></u></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">In
the last 10 years, much progress has been made in defining chronic low back
pain (CLBP). CLBP is defined as back
pain > 3 months duration. There are 2 different types of CLBP, namely
inflammatory and mechanical back pain. This takes into account the exclusion of
CLBP with red flags or sinister features. Inflammatory back pain (IBP) is known
to be a presenting feature of ankylosing spondylitis (AS). AS is a chronic
inflammatory arthritis with predominant involvement of the spine resulting in
inflammation of joints, in particular the sacroiliac (SI) joints.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I
wanted to take some time to appreciate the papers from the beginning of the
last decade (from 2004) which has highlighted the features and use of IBP
identification. IBP is part of the new classification of the
spondyloarthritides (SPA) by the Assessment of SpondyloArthritis International
Society (ASAS)</span><!--[if supportFields]><span style='font-size:12.0pt;
line-height:115%;font-family:"Arial","sans-serif"'><span style='mso-element:
field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
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"itemData" : { "DOI" : "10.1136/ard.2008.104018",
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"19433414", "abstract" : "The field of
spondyloarthritis (SpA) has experienced major progress in the last decade,
especially with regard to new treatments, earlier diagnosis, imaging technology
and a better definition of outcome parameters for clinical trials. In the
present work, the Assessment in SpondyloArthritis international Society (ASAS)
provides a comprehensive handbook on the most relevant aspects for the
assessments of spondyloarthritis, covering classification criteria, MRI and x
rays for sacroiliac joints and the spine, a complete set of all measurements
relevant for clinical trials and international recommendations for the
management of SpA. The handbook focuses at this time on axial SpA, with
ankylosing spondylitis (AS) being the prototype disease, for which recent progress
has been faster than in peripheral SpA. The target audience includes
rheumatologists, trial methodologists and any doctor and/or medical student
interested in SpA. The focus of this handbook is on practicality, with many
examples of MRI and x ray images, which will help to standardise not only
patient care but also the design of clinical studies.", "author"
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"container-title" : "Annals of the rheumatic diseases",
"id" : "ITEM-1", "issued" : {
"date-parts" : [ [ "2009", "6" ] ] },
"page" : "ii1-44", "title" : "The Assessment
of SpondyloArthritis international Society (ASAS) handbook: a guide to assess
spondyloarthritis.", "type" : "article-journal",
"volume" : "68 Suppl 2" }, "uris" : [
"http://www.mendeley.com/documents/?uuid=69fb3dd4-4b11-45c7-ae7e-4103af37b5cd"
] } ], "mendeley" : { "previouslyFormattedCitation" :
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}<span style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><sup>1</sup></span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">. SPA is a group of
inflammatory conditions with AS being the characteristic clinical condition.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> On average it takes 8.5 years for the diagnosis of AS to
be made. It is important that patients with IBP are detected early and referred
for further investigation and treatment. IBP is the leading symptom for axial
SPA and is present in 70% of patients with SPA</span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
"citationItems" : [ { "id" : "ITEM-1",
"itemData" : { "DOI" : "10.1002/art.1780341003",
"ISBN" : "1529-0131", "ISSN" :
"0004-3591", "PMID" : "1930310",
"abstract" : "Classification criteria for most of the disorders
belonging to the spondylarthropathy group already exist. However, the spectrum
of spondylarthropathy is wider than the sum of these disorders suggests.
Seronegative oligoarthritis, dactylitis or polyarthritis of the lower
extremities, heel pain due to enthesitis, and other undifferentiated cases of
spondylarthropathy have been ignored in epidemiologic studies because of the
inadequacy of existing criteria. In order to define classification criteria
that also encompass patients with undifferentiated spondylarthropathy, we
studied 403 patients with all forms of spondylarthropathy and 674 control
patients with other rheumatic diseases. The diagnoses were based on the local
clinical expert's opinion. The 403 patients included 168 with ankylosing
spondylitis, 68 with psoriatic arthritis, 41 with reactive arthritis, 17 with
inflammatory bowel disease and arthritis, and 109 with unclassified
spondylarthropathy. Based on statistical analysis and clinical reasoning, we
propose the following classification criteria for spondylarthropathy:
inflammatory spinal pain or synovitis (asymmetric or predominantly in the lower
limbs), together with at least 1 of the following: positive family history,
psoriasis, inflammatory bowel disease, urethritis, or acute diarrhea,
alternating buttock pain, enthesopathy, or sacroiliitis as determined from
radiography of the pelvic region. These criteria resulted in a sensitivity of
87% and a specificity of 87%. The proposed classification criteria are easy to
apply in clinical practice and performed well in all 7 participating centers.
However, we regard them as preliminary until they have been further evaluated
in other settings.", "author" : [ {
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"Dougados", "given" : "M",
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"dropping-particle" : "", "family" : "Juhlin",
"given" : "R", "non-dropping-particle" :
"", "parse-names" : false, "suffix" :
"" }, { "dropping-particle" : "",
"family" : "Huitfeldt", "given" : "B",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Amor", "given" :
"B", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Calin", "given" : "A",
"non-dropping-particle" : "", "parse-names" :
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"A", "non-dropping-particle" : "",
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"", "family" : "Olivieri", "given" :
"I", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Pasero", "given" : "G",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" } ], "container-title" :
"Arthritis and rheumatism", "id" : "ITEM-1",
"issued" : { "date-parts" : [ [ "1991" ] ] },
"page" : "1218-1227", "title" : "The
European Spondylarthropathy Study Group preliminary criteria for the
classification of spondylarthropathy.", "type" :
"report", "volume" : "34" }, "uris" : [
"http://www.mendeley.com/documents/?uuid=fa4e323a-e817-4730-8323-fc9066056a01"
] } ], "mendeley" : { "previouslyFormattedCitation" :
"<sup>2</sup>" }, "properties" : {
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}<span style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><sup>2</sup></span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">. The features of IBP
are </span><!--[if supportFields]><span style='font-size:12.0pt;line-height:
115%;font-family:"Arial","sans-serif"'><span style='mso-element:field-begin;
mso-field-lock:yes'></span>ADDIN CSL_CITATION { "citationItems" : [ {
"id" : "ITEM-1", "itemData" : { "DOI" :
"10.1136/ard.2009.108233", "ISSN" : "1468-2060",
"PMID" : "19297344", "abstract" :
"OBJECTIVE: To validate and refine two sets of candidate criteria for the
classification/diagnosis of axial spondyloarthritis (SpA).\n\nMETHODS: All
Assessment of SpondyloArthritis international Society (ASAS) members were
invited to include consecutively new patients with chronic (> or =3 months)
back pain of unknown origin that began before 45 years of age. The candidate
criteria were first tested in the entire cohort of 649 patients from 25
centres, and then refined in a random selection of 40% of cases and thereafter
validated in the remaining 60%.\n\nRESULTS: Upon diagnostic work-up, axial SpA
was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New
York criteria and, therefore, were classified as having
\"non-radiographic\" axial SpA. Refinement of the candidate criteria
resulted in new ASAS classification criteria that are defined as: the presence
of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at
least one SpA feature (\"imaging arm\") or the presence of HLA-B27
plus at least two SpA features (\"clinical arm\"). The sensitivity
and specificity of the entire set of the new criteria were 82.9% and 84.4%, and
for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the
new criteria was much better than that of the European Spondylarthropathy Study
Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and
slightly better than that of the modified Amor criteria (sensitivity 82.9,
specificity 77.5%).\n\nCONCLUSION: The new ASAS classification criteria for
axial SpA can reliably classify patients for clinical studies and may help
rheumatologists in clinical practice in diagnosing axial SpA in those with
chronic back pain. Trial registration number: NCT00328068.",
"author" : [ { "dropping-particle" : "",
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T", "non-dropping-particle" : "",
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"Gu", "given" : "J",
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"dropping-particle" : "", "family" :
"Ozgocmen", "given" : "S",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Roussou", "given" :
"E", "non-dropping-particle" : "",
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"dropping-particle" : "", "family" :
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"dropping-particle" : "", "family" :
"Wei", "given" : "J",
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false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Sieper", "given" : "J",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" } ], "container-title" :
"Annals of the rheumatic diseases", "id" :
"ITEM-1", "issue" : "6", "issued" : {
"date-parts" : [ [ "2009", "6" ] ] },
"page" : "777-83", "title" : "The development
of Assessment of SpondyloArthritis international Society classification
criteria for axial spondyloarthritis (part II): validation and final
selection.", "type" : "article-journal",
"volume" : "68" }, "uris" : [
"http://www.mendeley.com/documents/?uuid=f7a162d2-f60b-4de1-8ece-267afd1e623f"
] } ], "mendeley" : { "previouslyFormattedCitation" :
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}<span style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><sup>3</sup></span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">,</span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
"citationItems" : [ { "id" : "ITEM-1",
"itemData" : { "DOI" : "10.1002/art.21619",
"ISSN" : "0004-3591", "PMID" :
"16447233", "abstract" : "OBJECTIVE: Back pain
associated with ankylosing spondylitis (AS) is referred to as inflammatory back
pain (IBP). The value of the clinical history in differentiating IBP from
mechanical low back pain (MLBP) has been investigated in only a few studies. In
this exploratory study, we sought to evaluate the individual features of IBP
and to compose and compare various combinations of features for use as
classification and diagnostic criteria.\n\nMETHODS: We assessed the clinical
history of 213 patients (101 with AS and 112 with MLBP) younger than 50 years
who had chronic back pain. Single clinical parameters and combinations of
parameters were compared between the AS and MLBP patient groups.\n\nRESULTS:
Morning stiffness of >30 minutes' duration, age at onset of back pain, no
improvement in back pain with rest, awakening because of back pain during the
second half of the night only, alternating buttock pain, and time period of the
onset of back pain were identified as independent contributors to IBP.
Importantly, none of the single parameters sufficiently differentiated AS from
MLBP. In contrast, several sets of combined parameters proved to be well
balanced between sensitivity and specificity. Among these, a new candidate set
of criteria for IBP, which consisted of morning stiffness of >30 minutes'
duration, improvement in back pain with exercise but not with rest, awakening
because of back pain during the second half of the night only, and alternating
buttock pain, yielded a sensitivity of 70.3% and a specificity of 81.2% if at
least 2 of these 4 parameters were fulfilled (positive likelihood ratio 3.7).
If at least 3 of the 4 parameters were fulfilled, the positive likelihood ratio
increased to 12.4.\n\nCONCLUSION: A new set of criteria for IBP performed
better than previous criteria in AS patients with established disease. A
prospective study is needed to validate the diagnostic properties of the new
candidate criteria set in patients with early disease.", "author"
: [ { "dropping-particle" : "", "family" :
"Rudwaleit", "given" : "Martin",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Metter", "given" :
"Anke", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Listing", "given" : "Joachim",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Sieper", "given" :
"Joachim", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Braun", "given" : "J\u00fcrgen",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" } ], "container-title" :
"Arthritis and rheumatism", "id" : "ITEM-1",
"issue" : "2", "issued" : {
"date-parts" : [ [ "2006", "2" ] ] },
"page" : "569-78", "title" : "Inflammatory
back pain in ankylosing spondylitis: a reassessment of the clinical history for
application as classification and diagnostic criteria.", "type"
: "article-journal", "volume" : "54" },
"uris" : [
"http://www.mendeley.com/documents/?uuid=06c896f8-e62f-4b51-9a0e-e38f76a75dae"
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}<span style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><sup>4</sup></span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr>
<td style="background: #00B0F0; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 478.8pt;" valign="top" width="638">
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Inflammatory back pain (if 4 out of 5 features are
present)</span><!--[if supportFields]><span style='font-size:12.0pt;
line-height:115%;font-family:"Arial","sans-serif"'><span style='mso-element:
field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
"citationItems" : [ { "id" : "ITEM-1",
"itemData" : { "DOI" :
"10.1136/ard.2008.101501", "ISSN" :
"1468-2060", "PMID" : "19147614", "abstract"
: "OBJECTIVE: Inflammatory back pain (IBP) is an important clinical
symptom in patients with axial spondyloarthritis (SpA), and relevant for
classification and diagnosis. In the present report, a new approach for the
development of IBP classification criteria is discussed.\n\nMETHODS:
Rheumatologists (n = 13) who are experts in SpA took part in a 2-day
international workshop to investigate 20 patients with back pain and possible
SpA. Each expert documented the presence/absence of clinical parameters
typical for IBP, and judged whether IBP was considered present or absent
based on the received information. This expert judgement was used as the
dependent variable in a logistic regression analysis in order to identify
those individual IBP parameters that contributed best to a diagnosis of IBP.
The new set of IBP criteria was validated in a separate cohort of patients (n
= 648).\n\nRESULTS: Five parameters best explained IBP according to the
experts. These were: (1) improvement with exercise (odds ratio (OR) 23.1);
(2) pain at night (OR 20.4); (3) insidious onset (OR 12.7); (4) age at onset
<40 years (OR 9.9); and (5) no improvement with rest (OR 7.7). If at least
four out of these five parameters were fulfilled, the criteria had a
sensitivity of 77.0% and specificity of 91.7% in the patients participating
in the workshop, and 79.6% and 72.4%, respectively, in the validation
cohort.\n\nCONCLUSION: This new approach with real patients defines a set of
IBP definition criteria using overall expert judgement on IBP as the gold standard.
The IBP experts' criteria are robust, easy to apply and have good face
validity.", "author" : [ { "dropping-particle" :
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"J", "non-dropping-particle" : "",
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"dropping-particle" : "", "family" :
"Burgos-Vagas", "given" : "R",
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pain: a real patient exercise by experts from the Assessment of
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</td>
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<tr>
<td style="background: #DBE5F1; border-top: none; border: solid windowtext 1.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 478.8pt;" valign="top" width="638">
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Age of onset
< 45 years<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Insidious
onset<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Improvement with exercise<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">No improvement
with rest<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Pain at night
(with improvement on getting up)<o:p></o:p></span></li>
</ol>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">SPA
affecting the spine (axial SPA) is present in 5% of patients with CLBP</span><!--[if supportFields]><span
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questionnaire for inflammatory back pain. This was positive in 46 (15%), who
were invited for a further examination. Only two of these patients had definite
ankylosing spondylitis. Eighteen of them (39%) had other features associated
with spondyloarthropathy. It is suggested that up to 5% of back pain sufferers
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axial SPA falls to less than 2%</span><!--[if supportFields]><span
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radiographic sacroiliitis, sometimes by many years.\n\nOBJECTIVE: To assign
disease probabilities and to develop an algorithm to help in the early
diagnosis of axial SpA.\n\nMETHODS: Axial SpA comprises AS and undifferentiated
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acute anterior uveitis, a positive family history, psoriasis, inflammatory
bowel disease, and good response to NSAIDs. Associated laboratory findings
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presence of axial SpA, depending on the presence or absence of the above
clinical features of SpA, was determined. A probability of > or = 90% was
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5% prevalence to 14%. The presence of 2-3 SpA features was necessary to
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HLA-B27 and MRI. Diagnostic algorithms to be used in daily practice were
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style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">. This is an
important point as IBP alone is not enough to make a diagnosis of axial SPA. To
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features are needed </span><!--[if supportFields]><span style='font-size:12.0pt;
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The
features of axial SpA that should be identified include clinical features,
laboratory tests (eg. HLA-B27) and radiological imaging (eg. MRI). The clinical
features that may point towards axial SPA include a good response to NSAIDs
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HLA-B27-associated inflammatory spine diseases is referred to as axial
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their subsequent referral to a rheumatologist for establishing a correct
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HLA-B27. Following diagnostic work-up by a rheumatologist, these referral
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many as 33-45% of patients within this target population with axSpA, 41-62% of
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IBP, the presence of 3 or more features of SPA increases the likelihood of definite
axial SPA (80-95%). If 1 or 2 additional features of SPA are present, then the
likelihood of axial SPA is lower between 35-70%</span><!--[if supportFields]><span
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sacroiliitis, sometimes by many years.\n\nOBJECTIVE: To assign disease
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predominant axial involvement. Clinical features include inflammatory back pain
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anterior uveitis, a positive family history, psoriasis, inflammatory bowel
disease, and good response to NSAIDs. Associated laboratory findings include
raised acute phase reactions, HLA-B27 association, and abnormalities on
skeletal imaging. Sensitivities, specificities, and likelihood ratios (LRs) of
these parameters were determined from published studies. A 5% prevalence of
axial SpA among patients with chronic LBP was used. The probability of the
presence of axial SpA, depending on the presence or absence of the above
clinical features of SpA, was determined. A probability of > or = 90% was
used to make a diagnosis of axial SpA.\n\nRESULTS: The presence of inflammatory
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5% prevalence to 14%. The presence of 2-3 SpA features was necessary to
increase the probability of axial SpA to 90%. The highest LRs were obtained for
HLA-B27 and MRI. Diagnostic algorithms to be used in daily practice were
suggested.\n\nCONCLUSIONS: This approach can help clinicians to diagnose with a
high degree of confidence axial SpA at an early stage in patients with IBP who
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5-10 years between the appearance of first symptoms and the diagnosis of AS,
particularly because effective treatments have now become available. Referral
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(1) chronic low back pain (duration >3 months) and (2) onset of back pain
before <45 years of age to a specialist rheumatology outpatient clinic for
further diagnostic investigation if at least one of the following screening
parameters was present: (1) inflammatory back pain, (2) positive human
leucocyte antigen B27, and (3) sacroiliitis detected by imaging. The final
diagnosis was made according to expert opinion.\n\nRESULTS: In total, 350
referred cases were analysed. A diagnosis of definite axial spondyloarthritis
(axial SpA), comprising established AS and pre-radiographic axial SpA, could be
made in 45.4% of all referred patients (of which 50.3% were classified as AS
and 49.7% as preradiographic axial SpA), whereas 45.4% were classified as
non-SpA and 9.1% as possible SpA. A diagnosis of definite axial SpA could be
made in 34.2% if only one referral parameter was positive, and in 62.6% if
there was >1 positive referral parameter.\n\nCONCLUSIONS: The proposed
referral parameters have proven useful when applied in primary care in
identifying patients with AS/pre-radiographic axial SpA among young to
middle-aged patients with chronic low back pain.", "author" : [
{ "dropping-particle" : "", "family" :
"Brandt", "given" : "Henning Christian",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Spiller", "given" :
"Inge", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Song", "given" : "In-Ho",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" }, { "dropping-particle" :
"", "family" : "Vahldiek", "given" :
"Janis L", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, { "dropping-particle"
: "", "family" : "Rudwaleit", "given" :
"Martin", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Sieper", "given" : "Joachim",
"non-dropping-particle" : "", "parse-names" :
false, "suffix" : "" } ], "container-title" :
"Annals of the rheumatic diseases", "id" :
"ITEM-1", "issue" : "11", "issued" : {
"date-parts" : [ [ "2007", "11" ] ] },
"page" : "1479-84", "title" : "Performance
of referral recommendations in patients with chronic back pain and suspected
axial spondyloarthritis.", "type" : "article-journal",
"volume" : "66" }, "uris" : [
"http://www.mendeley.com/documents/?uuid=cd84fc18-78a2-4cfe-a067-2c5d081cea6c"
] } ], "mendeley" : { "previouslyFormattedCitation" :
"<sup>11</sup>" }, "properties" : {
"noteIndex" : 0 }, "schema" :
"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"
}<span style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><sup>11</sup></span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">. When IBP, clinical,
laboratory and radiological factors are brought together, the sum of the
presence of each factor can be calculated to give the probability of definite
axial SPA</span><!--[if supportFields]><span style='font-size:12.0pt;
line-height:115%;font-family:"Arial","sans-serif"'><span style='mso-element:
field-begin;mso-field-lock:yes'></span>ADDIN CSL_CITATION {
"citationItems" : [ { "id" : "ITEM-1",
"itemData" : { "DOI" :
"10.1093/rheumatology/ket176", "ISSN" :
"1462-0332", "PMID" : "23681397",
"abstract" : "OBJECTIVES: Several sets of criteria for the
diagnosis of axial SpA (including non-radiographic axial spondyloarthritis)
have been proposed in the literature in which scores were attributed to
relevant findings and the diagnosis requests a minimal sum of these scores. To
quantitatively estimate the probability of axial SpA, multiplying the
likelihood ratios of all relevant findings was proposed by Rudwaleit et al. in
2004. The objective of our proposal is to combine the advantages of both, i.e.
to estimate the probability by summing up scores instead of multiplying
likelihood ratios.\n\nMETHODS: An easy way to estimate the probability of axial
spondyloarthritis is to use the logarithms of the likelihood ratios as scores
attributed to relevant findings and to use the sum of these scores for the probability
estimation.\n\nRESULTS: A list of whole-numbered scores for relevant findings
is presented, and also threshold sum values necessary for a definite and for a
probable diagnosis of axial SpA as well as a threshold below which the
diagnosis of axial spondyloarthritis can be excluded. In a diagram, the
probability of axial spondyloarthritis is given for sum values between these
thresholds.\n\nCONCLUSION: By the method proposed, the advantages of both, the
easy summing up of scores and the quantitative calculation of the diagnosis
probability, are combined. Our method also makes it easier to estimate which
additional tests are necessary to come to a definite diagnosis.",
"author" : [ { "dropping-particle" : "",
"family" : "Feldtkeller", "given" :
"Ernst", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" }, {
"dropping-particle" : "", "family" :
"Rudwaleit", "given" : "Martin", "non-dropping-particle"
: "", "parse-names" : false, "suffix" :
"" }, { "dropping-particle" : "",
"family" : "Zeidler", "given" :
"Henning", "non-dropping-particle" : "",
"parse-names" : false, "suffix" : "" } ],
"container-title" : "Rheumatology (Oxford, England)",
"id" : "ITEM-1", "issue" : "9",
"issued" : { "date-parts" : [ [ "2013",
"9" ] ] }, "page" : "1648-50", "title"
: "Easy probability estimation of the diagnosis of early axial
spondyloarthritis by summing up scores.", "type" :
"article-journal", "volume" : "52" },
"uris" : [ "http://www.mendeley.com/documents/?uuid=7723c0da-7055-415e-afbf-4cdd4687bb15"
] } ], "mendeley" : { "previouslyFormattedCitation" :
"<sup>12</sup>" }, "properties" : {
"noteIndex" : 0 }, "schema" :
"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"
}<span style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><sup>12</sup></span><!--[if supportFields]><span
style='font-size:12.0pt;line-height:115%;font-family:"Arial","sans-serif"'><span
style='mso-element:field-end'></span></span><![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">. This will mean a
better and quicker way to make a diagnosis of axial SPA and better outcome for
patients.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The
identification of IBP in patients presenting to their general practitioners
(GPs) in primary care with CLBP is the first step towards further assessment
and investigations of axial SPA. Education of GPs and physiotherapists who see
patients in primary care is important. On the 29<sup>th</sup> May 2014, I ran a
Back Pain Seminar in Reading which was attended by over 70 GPs and
physiotherapist. The focus was on the importance of identifying IBP in patients
with CLBP. Patients with IBP can then be assessed for any clinical features
associated with SPA and referred for any relevant investigations. This will
help reduce the delay in diagnosing axial SpA and ankylosing spondylitis.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN7N7bJVFrZHpzVyqdYAxBkIAHHHfspUc9oC6E835ejAX-qHG2TZVavsFgZjIMfLOPgvvWWa9qCcnVx8LIfhnD2SRkBQ6xK6TKSzKUoxZYrtprTK_BCChIGVSiW-UTLOIVB8GL1brqUNUV/s1600/photo+2.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN7N7bJVFrZHpzVyqdYAxBkIAHHHfspUc9oC6E835ejAX-qHG2TZVavsFgZjIMfLOPgvvWWa9qCcnVx8LIfhnD2SRkBQ6xK6TKSzKUoxZYrtprTK_BCChIGVSiW-UTLOIVB8GL1brqUNUV/s1600/photo+2.JPG" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Faculty (L-R): Berit Sund (organiser), Sally Dickinson, Claire Harris, Dr. Antoni Chan, Susan Hicks, Claire Jeffries</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQ9GzExhf8tAgO47LtMs1NQFZPOzlNaHQQXTdO0_fMeQ9iYoufJ3119hu6gQ2N0P2GhXGrFPxwc4jgvCc8Cxc7pM8zC4HB99s6wQGhyphenhyphenkMp2Rmf3Jtg3Tywf43KU4LMHMSA-Iz5mIGzrXEh/s1600/photo+3.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQ9GzExhf8tAgO47LtMs1NQFZPOzlNaHQQXTdO0_fMeQ9iYoufJ3119hu6gQ2N0P2GhXGrFPxwc4jgvCc8Cxc7pM8zC4HB99s6wQGhyphenhyphenkMp2Rmf3Jtg3Tywf43KU4LMHMSA-Iz5mIGzrXEh/s1600/photo+3.JPG" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sally Dickinson from the National Ankylosing Spondylitis Society (NASS) giving an update on the role of NASS</td></tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">References<o:p></o:p></span></u></b></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<!--[if supportFields]><span
style='font-family:"Arial","sans-serif"'><span style='mso-element:field-begin;
mso-field-lock:yes'></span>ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY <span
style='mso-element:field-separator'></span></span><![endif]--><span style="font-family: "Arial","sans-serif";">1. Sieper J, Rudwaleit M, Baraliakos X, et
al. The Assessment of SpondyloArthritis international Society (ASAS) handbook:
a guide to assess spondyloarthritis. <i>Ann Rheum Dis</i>. 2009;68 Suppl
2:ii1-44. doi:10.1136/ard.2008.104018.</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast; mso-no-proof: yes;"><o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">2. Dougados
M, van der Linden S, Juhlin R, et al. <i>The European Spondylarthropathy Study
Group Preliminary Criteria for the Classification of Spondylarthropathy.</i>;
1991:1218-1227. doi:10.1002/art.1780341003.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">3. Rudwaleit
M, van der Heijde D, Landewé R, et al. The development of Assessment of
SpondyloArthritis international Society classification criteria for axial
spondyloarthritis (part II): validation and final selection. <i>Ann Rheum Dis</i>.
2009;68(6):777-83. doi:10.1136/ard.2009.108233.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">4. Rudwaleit
M, Metter A, Listing J, Sieper J, Braun J. Inflammatory back pain in ankylosing
spondylitis: a reassessment of the clinical history for application as
classification and diagnostic criteria. <i>Arthritis Rheum</i>.
2006;54(2):569-78. doi:10.1002/art.21619.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">5. Sieper
J, van der Heijde D, Landewé R, et al. New criteria for inflammatory back pain
in patients with chronic back pain: a real patient exercise by experts from the
Assessment of SpondyloArthritis international Society (ASAS). <i>Ann Rheum Dis</i>.
2009;68(6):784-8. doi:10.1136/ard.2008.101501.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">6. Underwood
MR, Dawes P. Inflammatory back pain in primary care. <i>Br J Rheumatol</i>.
1995;34(11):1074-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8542211.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">7. Rudwaleit
M, van der Heijde D, Khan M a, Braun J, Sieper J. How to diagnose axial
spondyloarthritis early. <i>Ann Rheum Dis</i>. 2004;63(5):535-43.
doi:10.1136/ard.2003.011247.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">8. Rudwaleit
M, Khan M a, Sieper J. The challenge of diagnosis and classification in early
ankylosing spondylitis: do we need new criteria? <i>Arthritis Rheum</i>.
2005;52(4):1000-8. doi:10.1002/art.20990.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">9. Sieper
J, Rudwaleit M. Early referral recommendations for ankylosing spondylitis
(including pre-radiographic and radiographic forms) in primary care. <i>Ann
Rheum Dis</i>. 2005;64(5):659-63. doi:10.1136/ard.2004.028753.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">10. Rudwaleit
M, Sieper J. Referral strategies for early diagnosis of axial
spondyloarthritis. <i>Nat Rev Rheumatol</i>. 2012;8(5):262-8.
doi:10.1038/nrrheum.2012.39.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">11. Brandt
HC, Spiller I, Song I-H, Vahldiek JL, Rudwaleit M, Sieper J. Performance of referral
recommendations in patients with chronic back pain and suspected axial
spondyloarthritis. <i>Ann Rheum Dis</i>. 2007;66(11):1479-84.
doi:10.1136/ard.2006.068734.<o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<span style="font-family: "Arial","sans-serif"; mso-no-proof: yes;">12. Feldtkeller
E, Rudwaleit M, Zeidler H. Easy probability estimation of the diagnosis of early
axial spondyloarthritis by summing up scores. <i>Rheumatology (Oxford)</i>.
2013;52(9):1648-50. doi:10.1093/rheumatology/ket176. <o:p></o:p></span></div>
<div style="margin-left: 32.0pt; text-indent: -32.0pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 13.85pt;">
<b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt;">@synovialjoints</span></b><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 13.85pt;">
<br /></div>
<div class="MsoNormal" style="background: white;">
<span style="font-family: Arial, sans-serif; font-size: 10pt; line-height: 115%;">Views are my
own. These are opinions and cannot replace the need to see your physician for
review of your individual medical condition.</span><span style="font-size: 10pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<br /></div>
Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-64484168142658587572014-04-06T13:07:00.001-07:002014-04-06T14:17:34.178-07:00Feeling tired all the time<div class="MsoNormal">
<b><u><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 18.0pt;">Feeling tired all the
time</span></u></b></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";"><br /></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Fatigue is a major
component of rheumatic diseases. Despite its high prevalence, recognising and
treating it remains an unmet need. In ankylosing spondylitis and rheumatoid
arthritis, up to 70% of patients are affected by fatigue. It has a profound
effect on physical and psychosocial outcomes in rheumatic conditions. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";"> Fatigue
is caused by a host of factors. It means that no one single treatment may
improve or cure fatigue. An individual but yet wholistic view of fatigue is
necessary to address multifactorial nature of the symptom. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">The multifactorial nature
of fatigue also means that is not easily measured or assessed. Fatigue
measurement include the use of the functional assessment of chronic illness
therapy-fatigue (FACIT-F) or short-form 36 (SF-36) vitality scores. Assessing
both the frequency and severity of fatigue is important.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="background: #8DB3E2; border-collapse: collapse; border: none; mso-background-themecolor: text2; mso-background-themetint: 102; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 426.1pt;" valign="top" width="568"><div class="MsoNormal" style="text-align: justify;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Fatigue is caused by<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 426.1pt;" valign="top" width="568"><ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Biological factors</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. Cytokines that are produced
during inflammation such as TNF-a, IL-1, IL-6, IL-12, IL-17 can cause central
effects to cause fatigue. Using biologic drugs to block these signals in treating
inflammatory arthritis may improve fatigue.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Physical activity</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. lack of or inability to exercise<o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Sleep</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. disrupted or poor sleep,
imbalance of rest and activity<o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Drugs</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. few studies report the impact of
drugs on fatigue. Disease modifying drugs
in RA improve fatigue but the effect is small.<o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Nutrition</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. inadequate nutritional intake<o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Emotional</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. Depression, anxiety, stress<o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif";">Other medical conditions</span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Eg. anaemia, diabetes, renal
impairment<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";"> <o:p></o:p></span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span lang="EN-GB" style="font-family: "Arial","sans-serif";">Steps that can be taken include
pacing, exercise, sleep hygiene and treating the underlying condition. There
are useful resources by Arthritis Research UK (ARUK) and patient groups NASS
and NRAS on managing fatigue.<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "Arial","sans-serif";">In managing fatigue the
confounding factors such as depression, sleep disorders and pain need to be
evaluated and managed. This is an area for active research in the future
especially on the effect of fatigue in arthritis and its impact on work. The
challenge is to link the clinical observations of fatigue with the immunologic,
biochemical and genetic data, so that there can be a wholistic understanding of
why some feel tired all the time.<o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: "Arial","sans-serif";"> </span><b style="line-height: 13.85pt;"><span lang="EN-GB" style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt;">@synovialjoints</span></b></div>
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<span lang="EN-GB" style="font-family: Arial, sans-serif; font-size: 10pt;">Views are my own. These
are opinions and cannot replace the need to see your physician for review of
your individual medical condition.</span><span lang="EN-GB" style="font-size: 10pt;"><o:p></o:p></span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-81123765124475703202014-01-04T03:53:00.002-08:002014-01-04T03:53:46.960-08:0010 out of 10 - My favourite 10 rheumatology papers from 2013<div class="MsoNormal" style="text-align: center;">
<b><u><span lang="EN-GB" style="font-family: Arial; mso-ansi-language: EN-GB;"><span style="color: blue;">10 out of 10 in 2013 – My favourite 10 Rheumatology Articles in 2013</span><span style="color: cyan;"><o:p></o:p></span></span></u></b></div>
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<span lang="EN-GB" style="font-family: Arial; mso-ansi-language: EN-GB;">With Christmas and New Year celebrations now over, you’ve had your dose
of the Top 10 songs for the year end. Here are my favourite 10 papers from 2013.
I have chosen original papers and have not included reviews, recommendations or
meta-analyses. I have also focused on clinical papers as I could make another
list of basic science papers. There are many other papers which are worthy of
mention but to keep to 10, here is my list. I provide a short synopsis of each
paper. For further details, please refer to the original references.<o:p></o:p></span></div>
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<b><span style="font-family: Arial;"><span style="color: blue;">10. The effect of vitamin D supplementation on
inflammatory and hemostatic markers and disease activity in patients with
systemic lupus erythematosus: a randomized placebo-controlled trial.</span><o:p></o:p></span></b></div>
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<i><span style="font-family: Arial;"><span style="color: #0b5394;">Abou-Raya A, Abou-Raya S, Helmii M. </span><u><span style="color: #0b5394;">J Rheumatol.
2013 Mar;40(3):265-72. Epub 2012 Dec 1.</span><o:p></o:p></u></span></i></div>
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<span style="font-family: Arial;">This paper assesses vitamin
D status in patients with SLE and determined alterations in inflammatory and
haemostatic markers and disease activity before and after vitamin D
supplementation. This is done on the basis that Vitamin D has immunomodulatory
functions.<o:p></o:p></span></div>
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<span style="font-family: Arial;">Patients with SLE received
either oral cholecalciferol 2000 IU/day or placebo for 12 months. Serum levels between 10 and 30 ng/ml were
classified as vitamin D insufficiency and levels < 10 ng/ml as vitamin D
deficiency. The mean 25(OH)D level at baseline was 19.8 ng/ml in patients
compared to 28.7 ng/ml in controls. The overall prevalence of suboptimal and
deficient 25(OH)D serum levels among
patients with SLE at baseline was 69% and 39%, respectively. Lower 25(OH)D
levels correlated significantly with higher SLE disease activity. At 12 months
of therapy, there was a significant improvement in levels of inflammatory and
haemostatic markers as well as disease activity in the treatment group compared
to the placebo group.<o:p></o:p></span></div>
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<span style="font-family: Arial;">Vitamin D supplementation
in patients with SLE improves infflammatory and haemostatic markers and show a
tendency toward subsequent clinical improvement<o:p></o:p></span></div>
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<b><span style="font-family: Arial;"><span style="color: blue;">9. Head-to-head comparison of subcutaneous abatacept
versus adalimumab for rheumatoid arthritis: two-year efficacy and safety
findings from AMPLE trial.<o:p></o:p></span></span></b></div>
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<i><span style="font-family: Arial;"><span style="color: #3d85c6;">Schiff M, Weinblatt ME,
Valente R, van der Heijde D, Citera G, Elegbe A,<o:p></o:p></span></span></i></div>
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<i><span style="font-family: Arial;"><span style="color: #3d85c6;">Maldonado M, Fleischmann
R. <u>Ann Rheum Dis. 2014 Jan 1;73(1):86-94. Epub<o:p></o:p></u></span></span></i></div>
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<i><u><span style="font-family: Arial;"><span style="color: #3d85c6;">2013 Aug 20.</span><o:p></o:p></span></u></i></div>
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<span style="font-family: Arial;">The second head to head
study of biologics in RA in 2013. This study compares over 2 years the safety,
efficacy and radiographic outcomes of subcutaneous abatacept (125 mg weekly)
versus adalimumab (40mg every 2 weeks), in combination with stable dose of
methotrexate (MTX).<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial;">The ACR 20, 50 and 70
responses at year 2 were 59.7%, 44.7% and 31.1% for abatacept and 60.1%, 46.6%
and 29.3% for adalimumab. There were similar rates of adverse events (AEs) and
serious adverse events (SAEs) but there were less discontinuations due to AEs,
SAEs, serious infections and fewer local ISRs with abatacept. In RA patients
with an inadequate response to MTX, subcutaneous abatacept and adalimumab were similarly
efficacious based on clinical, functional and radiographic outcomes. Overall,
AE frequency was similar in both groups <o:p></o:p></span></div>
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<b><span style="font-family: Arial;"><span style="color: blue;">8. Surgery versus
physical therapy for a meniscal tear and osteoarthritis.</span><o:p></o:p></span></b></div>
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<span style="font-family: Arial;"><span style="color: #3d85c6;"><i>Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole
BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA,
Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson
BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP,
Stuart MJ, Wright J, Wright RW, Losina E. </i><u><i>N Engl J Med. 2013 May
2;368(18):1675-84. Epub 2013 Mar 18.</i><o:p></o:p></u></span></span></div>
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<span style="font-family: Arial;">This paper helps answer the
question whether arthroscopic partial meniscectomy for symptomatic patients
with a meniscal tear and knee osteoarthritis results in better functional
outcomes than nonoperative therapy. Symptomatic patients 45 years of age or
older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on
imaging were randomly assigned to surgery and postoperative physical therapy or
to a standardized physical-therapy regimen
<o:p></o:p></span></div>
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<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">The mean improvement in the
WOMAC score after 6 months was 20.9 points in the surgical group and 18.5 in
the physical-therapy group (mean difference, 2.4 points). At 6 months, 51
active participants in the study who were assigned to physical therapy alone
(30%) had undergone surgery. The frequency of adverse events did not differ
significantly between the groups. There was no significant difference between
the study groups in functional improvement 6 months after randomization;
however, 30% of the patients who were assigned to physical therapy alone
underwent surgery within 6 months. The results at 12 months were similar to
those at 6 months.<o:p></o:p></span></div>
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<b><span lang="EN-GB" style="font-family: Arial; mso-ansi-language: EN-GB;"><span style="color: blue;">7. </span></span></b><b><span style="font-family: Arial;"><span style="color: blue;">Tocilizumab monotherapy versus adalimumab monotherapy
for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind,
controlled phase 4 trial. </span><o:p></o:p></span></b></div>
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<br /></div>
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<span style="color: #3d85c6;"><i><span style="font-family: Arial;">Gabay C, Emery P, van Vollenhoven R, Dikranian A,
Alten R, Pavelka K, Klearman M, Musselman D, Agarwal S, Green J, Kavanaugh A;
ADACTA Study Investigators</span>. </i><i><u><span style="font-family: Arial;">Lancet.
2013 May 4;381(9877):1541-50</span></u></i><u><span style="font-family: Arial;">.<o:p></o:p></span></u></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">One of the two head to head
biologic studies in RA from 2013. Tocilizumab 8mg/kg iv 4 weekly (an IL-6
receptor signaling inhibitor) monotherapy was superior to adalimumab
monotherapy 40mg sc 2 weekly for reduction of signs (DAS28 -3.3 in the
Tocilizumab group and -1.8 in the Adalimumab group) and symptoms of rheumatoid
arthritis in patients intolerant of Methotrexate at 24 weeks. The adverse event
profiles of tocilizumab (12% SAE) and adalimumab(10% SAE) were consistent with previous findings with
raised LDL-cholestrol and ALT in the Tocilizumab group.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<b><span style="font-family: Arial;"><span style="color: blue;">6. Efficacy and safety of ustekinumab in patients
with active psoriatic arthritis: 1 year results of the phase 3, multicentre,
double-blind, placebo-controlled PSUMMIT 1 trial.<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<i><span style="font-family: Arial;"><span style="color: #0b5394;">McInnes IB, Kavanaugh A, Gottlieb AB, Puig L, Rahman
P, Ritchlin C,<o:p></o:p></span></span></i></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #0b5394;"><i><span style="font-family: Arial;">Brodmerkel C, Li S, Wang Y, Mendelsohn AM, Doyle MK;
PSUMMIT 1 Study Group. </span></i><u><span style="font-family: Arial;">Lancet.
2013 Aug 31;382(9894):780-9. Epub 2013 Jun 13</span></u><span style="font-family: Arial;">.<i><o:p></o:p></i></span></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">Introduces a new agent in
the treatment of psoriatic arthritis. Ustekinumab (monoclonal antibody directed
against IL-12/IL-23) 45mg or 90mg, significantly
improved active psoriatic arthritis compared with placebo (ACR 20 achieved in
42.4% in the 45mg group, 49.5% in the 90mg group and 22.8% in the placebo
group) and was maintained at week 52. The proportions of patients with adverse
events were similar in the ustekinumab (41.8%) and placebo (42.0%) groups at week 16.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: Arial;"><span style="color: blue;">5. Efficacy of certolizumab pegol on signs and
symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week
results of a double-blind randomized placebo-controlled Phase 3 study.</span><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<i><span style="font-family: Arial; font-size: 11.0pt;"><span style="color: #3d85c6;">Landewé R, Braun J, Deodhar A,
Dougados M, Maksymowych WP, Mease PJ, Reveille JD, Rudwaleit M, van der Heijde
D, Stach C, Hoepken B, Fichtner A, Coteur G, de<o:p></o:p></span></span></i></div>
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<i><span style="font-family: Arial; font-size: 11.0pt;"><span style="color: #3d85c6;">Longueville M, Sieper J. <u>Ann
Rheum Dis. 2014 Jan 1;73(1):39-47. Epub 2013 Sep 6.<o:p></o:p></u></span></span></i></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">This paper evaluates the
efficacy and safety of certolizumab pegol (CZP) in patients with axial
spondyloarthritis (axSpA), including patients with ankylosing spondylitis(AS)
and non-radiographic axSpA (nr-axSpA). Patients with active axSpA were
randomised to placebo, CZP 200 mg every
2 weeks or CZP 400 mg every 4 weeks. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">Baseline disease activity
was similar between AS and nr-axSpA. At week 12, ASAS20 response rates were
significantly higher in CZP 200 mg (57.7%) and CZP 400mg (63.6%) arms versus
placebo (38.3). At week 24, combined CZP arms showed significant (p<0.001)
differences in change from baseline versus placebo in BASFI (-2.28 vs -0.40),
BASDAI (-3.05 vs -1.05), and BASMI (-0.52 vs<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: Arial;">-0.07). Improvements were observed as early as week
1. Similar improvements were reported with CZP versus placebo in both AS and
nr-axSpA subpopulations. Adverse events were reported in 70.4% vs 62.6%, and
serious adverse events in 4.7% vs 4.7% of All CZP versus placebo groups. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">CZP rapidly reduced the
signs and symptoms of axSpA, with no new safety signals observed compared to
the safety profile of CZP in RA. Similar improvements were observed across CZP
dosing regimens and in AS and nr-axSpA patients.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: Arial;"><span style="color: blue;">4. Efficacy of remission-induction regimens for
ANCA-associated vasculitis.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<i><span style="font-family: Arial;"><span style="color: #3d85c6;">Specks U, Merkel PA, Seo P, Spiera R, Langford CA,
Hoffman GS, Kallenberg CG, St Clair EW, Fessler BJ, Ding L, Viviano L, Tchao
NK, Phippard DJ, Asare AL, Lim N, Ikle D, Jepson B, Brunetta P, Allen NB,
Fervenza FC, Geetha D, Keogh K, Kissin EY, Monach PA, Peikert T, Stegeman C,
Ytterberg SR, Mueller M, Sejismundo LP,Mieras K, Stone JH; RAVE-ITN Research
Group. </span></span></i><u><span style="font-family: Arial;"><span style="color: #3d85c6;">N Engl J Med. 2013 Aug
1;369(5):417-27.</span><i><o:p></o:p></i></span></u></div>
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<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">Provides choice and an alternative
agent for the treatment of patients with severe ANCA-associated vasculitis. This
paper shows 18-month efficacy of a single course of rituximab (375mg/m<sup>2</sup>
weekly for 4 weeks) as compared with conventional immunosuppression with
cyclophosphamide (3 to 6 months) followed by azathioprine (12 to 15 months) in
patients with severe (organ-threatening) antineutrophil cytoplasmic antibody
(ANCA)-associated vasculitis. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt; text-justify: inter-ideograph;">
<span style="font-family: Arial;">There was non-inferiority
of Rituximab (remission rate of 64% at 6 months, 48% at 12 months and 39% at 18
months) compared to continuous conventional immunosuppressive therapy (remission
rate of 53%, 39% and 33% at 6,12 and 18 months respectively) for the induction
and maintenance of remissions over the course of 18 months. There was no
significant between-group difference in adverse events.<o:p></o:p></span></div>
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<b><span style="font-family: Arial;"><span style="color: blue;">3. Therapies for active
rheumatoid arthritis after methotrexate failure.<o:p></o:p></span></span></b></div>
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<i><span style="font-family: Arial;"><span style="color: #3d85c6;">O'Dell JR, Mikuls TR, Taylor TH, Ahluwalia V, Brophy
M, Warren SR, Lew RA,<o:p></o:p></span></span></i></div>
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<i><span style="font-family: Arial;"><span style="color: #3d85c6;">Cannella AC, Kunkel G, Phibbs CS, Anis AH, Leatherman
S, Keystone E; CSP 551 RACAT Investigators. <u>N Engl J Med. 2013 Jul
25;369(4):307-18. Epub 2013 Jun 11.<o:p></o:p></u></span></span></i></div>
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<span style="font-family: Arial;">A real world study
addressing a common scenario in clinic. This study compares conventional
therapy consisting of a combination of disease-modifying antirheumatic drugs
(methotrexate, sulphasalazine, hydroxychloroquine) with biologic agents
(etanercept) in patients with rheumatoid arthritis who have active disease
despite treatment with methotrexate. <o:p></o:p></span></div>
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<span style="font-family: Arial;">Triple therapy (sulfasalazine
and hydroxychloroquine added to methotrexate) was noninferior to etanercept
plus methotrexate in patients with rheumatoid arthritis who had active disease
despite methotrexate therapy. Participants (27%) in both groups who switched
therapies at 24 weeks had improvement after switching. The change between
baseline and 48 weeks in the DAS28 was similar in the two groups (-2.1 with
triple therapy and -2.3 with etanercept and methotrexate. There were no
significant between-group differences in adverse events associated with the
medications.<o:p></o:p></span></div>
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<b><span style="font-family: Arial;"><span style="color: blue;">2. Mortality in rheumatoid arthritis: the impact of
disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab</span><o:p></o:p></span></b></div>
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<i><span style="font-family: Arial;"><span style="color: #3d85c6;">Listing J, Kekow J, Manger B, Burmester GR, Pattloch
D, Zink A, Strangfeld A. <u>Ann Rheum Dis. 2013 Nov 29.<o:p></o:p></u></span></span></i></div>
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<span style="font-family: Arial;">This paper investigates the
impact of disease activity, the course of the disease, its treatment over time,
comorbidities and traditional risk factors on<o:p></o:p></span></div>
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<span style="font-family: Arial;">survival using data of the German biologics register
RABBIT were used. <o:p></o:p></span></div>
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<span style="font-family: Arial;">During 31 378 patient-years
of follow-up, the standardised mortality ratio was 1.49. Patients with persistent,
highly active disease (mean DAS28</span><span lang="ZH-CN" style="font-family: "MS Gothic"; mso-bidi-font-family: "MS Gothic";"> </span><span style="font-family: Arial;">></span><span lang="ZH-CN" style="font-family: "MS Gothic"; mso-bidi-font-family: "MS Gothic";"> </span><span style="font-family: Arial;">5.1) had a significantly
higher mortality risk (adjusted HR
(HRadj)=2.43) than patients with
persistently low disease activity (mean DAS28</span><span lang="ZH-CN" style="font-family: "MS Gothic"; mso-bidi-font-family: "MS Gothic";"> </span><span style="font-family: Arial;"><</span><span lang="ZH-CN" style="font-family: "MS Gothic"; mso-bidi-font-family: "MS Gothic";"> </span><span style="font-family: Arial;">3.2).
Poor function andtreatment with glucocorticoids > 5 mg/d was significantly
associated with anincreased mortality, independent of disease activity.
Significantly lower<o:p></o:p></span></div>
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<span style="font-family: Arial;">mortality was observed in patients treated with
tumour necrosis factor α (TNFα)<o:p></o:p></span></div>
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<span style="font-family: Arial;">inhibitors (HRadj=0.64), rituximab (HRadj=0.57), or
other biologics (HRadj=0.64), compared to those receiving methotrexate. To
account for treatment termination in patients at risk, an HRadj for patients
ever exposed to TNFα inhibitors or rituximab was calculated. This resulted in
an HRadj of 0.77.<o:p></o:p></span></div>
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<span style="font-family: Arial;">RA patients with long-standing
high disease activity have increased risk of mortality. Effective control of
disease activity decreases mortality.
TNFα inhibitors and rituximab seem to be superior to conventional DMARDs in
reducing this risk.<o:p></o:p></span></div>
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<span style="color: blue;"><b><span style="font-family: Arial;">1. Validation of the methotrexate-first strategy in
patients with early, poor-prognosis rheumatoid arthritis: results from a
two-year randomized, double-blind trial</span></b><span style="font-family: Arial; font-size: 10.0pt;">.</span></span><b><span style="font-family: Arial;"><o:p></o:p></span></b></div>
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<span style="color: #3d85c6;"><i><span style="font-family: Arial;">O'Dell JR, Curtis JR, Mikuls TR, Cofield SS, Bridges
SL Jr, Ranganath VK, Moreland LW; TEAR Trial Investigators<u>. Arthritis Rheum.
2013 Aug;65(8):1985-94. </u></span></i><u><span style="font-family: Arial;"><o:p></o:p></span></u></span></div>
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<span style="font-family: Arial;">Adds to our understanding
of treatment strategies in RA (step up treatment vs. initial combination
treatment). Patients were randomized to on of 4 groups: immediate treatment
with MTX plus etanercept, immediate oral triple therapy (MTX plus sulfasalazine
plus hydroxychloroquine), or step-up from MTX monotherapy to one of the
combination therapies (MTX plus etanercept or MTX plus sulfasalazine plus
hydroxychloroquine). All treatment arms included matching placebos. <o:p></o:p></span></div>
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<span style="font-family: Arial;">At week 24, subjects in the
2 immediate-treatment groups demonstrated a greater reduction in the DAS28-ESR compared
with those in the 2 step-up groups (3.6 versus 4.2). Between week 48 and week 102, subjects randomized to the
step-up arms had a DAS28-ESR clinical response that was not different from that
of subjects who initially received combination therapy, regardless of the
treatment arm. At week 102, there was a statistically significant difference in
the change in radiographic measurements from baseline between the group
receiving MTX plus etanercept and the group receiving oral triple therapy (0.64
versus 1.69). This study demonstrates that initial MTX monotherapy with the
option to step-up to combination therapy results in similar outcomes to
immediate combination therapy. Approximately 30% of patients will not need
combination therapy, and the 70% who will need it are clinically and
radiographically indistinguishable from those who were randomized to receive
immediate combination therapy.<o:p></o:p></span></div>
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<br />Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-33209896381150355322013-12-08T06:18:00.003-08:002013-12-08T06:18:41.361-08:00A cup of Green Tea a day keeps the doctor away<div class="MsoNormal">
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<span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"> Far away in the hills of </span><st1:country-region><st1:place><span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;">China</span></st1:place></st1:country-region><span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"> </span><span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;">centuries ago there appeared something mystical about what was being drunk by the people there. An elixir of life or just another new found health fad? An age old remedy with new found health benefits or a new found commercial opportunity of an age old drink?<o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"> Green tea is identified by its characteristic appearance. Served hot or cold, it can be pretty tasteless to what our taste buds would compute as being tea. Not a standard cuppa yet it is one of most widely consumed beverages in the world. Green tea is a product of a tea plant <i>Camellia sinenis</i>, the same plant that gives us dark tea. It is the processing of the tea leaves that gives green tea its characteristic colour and not that it comes from a different plant.<o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"> So what’s so special about green tea? It contains antioxidants called polyphenols which possess anti-inflammatory response. It could potentially be beneficial for treatment and prevention of arthritis. In rat models of rheumatoid arthritis, rats that were fed with green tea in drinking water (poor rats I think they would have preferred milk), had significantly reduced severity of arthritis and inflammatory cytokine levels compared to water-fed controls</span><a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftn1" name="_ftnref1" title=""><span class="MsoFootnoteReference"><span style="background: white; color: #222222; font-family: Arial; font-size: 11pt;"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-size: 11pt;">[1]</span></span><!--[endif]--></span></span></a><span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;">. <o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"> The polyphenols that is most active in green tea is the compound <b>EGCG</b> (</span><span style="background: white; color: #222222; font-family: Arial; font-size: 11pt;">Epigallocatechin-3-gallate). This acronym often gets me thinking of the <b>ECG</b> or electrocardiogram, a test that is done to measure the heart activity. This brings me to think of the biological effect of EGCG in reducing inflammation and thus providing possible benefit in reducing heart or cardiovascular risk. EGCG has been shown to reduce arthritis related inflammation cytokines in the mouse model of arthritis<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftn2" name="_ftnref2" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="color: #222222; font-size: 11pt;">[2]</span></span><!--[endif]--></span></a>. </span><span style="background-color: white; font-family: Arial; font-size: 11pt;">It is the link between inflammation in the joint and generalized inflammation that the benefits of EGCG in regulating these two processes may be realized. One could hypothesize that EGCG may have potential cardiovascular benefit along with anti-rheumatic activity in arthritis such as rheumatoid arthritis<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftn3" name="_ftnref3" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="color: black; font-size: 11pt;">[3]</span></span><!--[endif]--></span></a>.</span><span style="background: white; color: #222222; font-family: Arial; font-size: 11pt;"><o:p></o:p></span></div>
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<span style="background-color: white; font-family: Arial; font-size: 11pt;">In osteoarthritis, recent studies have shown an association between dietary polyphenols and the prevention of osteoarthritis-related musculoskeletal inflammation<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftn4" name="_ftnref4" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="color: black; font-size: 11pt;">[4]</span></span><!--[endif]--></span></a>.<span class="apple-converted-space"> </span>EGCG exerts anti-inflammatory effects by inhibiting signaling events and gene expression of the cytokine interleukin-1beta (IL-1β) which is a principal cytokine linked to cartilage degradation in osteoarthritis. </span><span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"> In bone resorption, <span style="background-color: white;">p</span></span><span style="background-color: white; font-family: Arial; font-size: 11pt;">olyphenols in<span class="apple-converted-space"> </span><span class="highlight">green</span><span class="apple-converted-space"> </span><span class="highlight">tea</span>, particularly EGCG, inhibit matrix metalloproteinases (MMP) expression and activity which can possibly reduce bone loss<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftn5" name="_ftnref5" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="color: black; font-size: 11pt;">[5]</span></span><!--[endif]--></span></a>.</span><span lang="EN-GB" style="font-family: Arial; font-size: 11pt; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
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<span style="background-color: white; font-family: Arial; font-size: 11pt;">As EGCG has been shown to be anti-inflammatory and protective in several studies using animal models of inflammatory<span class="apple-converted-space"> </span><span class="highlight">arthritis</span>, clear recommendations of its use in humans cannot be made. Future research should evaluate EGCG's efficacy in treating autoimmune diseases and data from human studies are needed. </span><br />
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<span style="background-color: white; font-family: Arial; font-size: 11pt; text-indent: 36pt;">I recently received a set of Keep Calm mugs which I now use to serve green tea to visitors to my office. If you don’t fancy an apple, a cup of green tea a day could be considered to keep the doctor away. You can also find it as ice-cream or chocolate wafers if you don't fancy a cuppa.</span><br />
<span style="font-family: Arial;"></span></div>
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<span style="background-color: white; font-family: Arial; font-size: 11pt;"><br /></span></div>
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<span style="font-family: Arial; font-size: 11pt;"> <o:p></o:p></span></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">@synovialjoints</span></b></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 7.5pt;">Views are my own. These are opinions and cannot replace the need to see your physician for review of your individual medical condition.</span><span style="color: #545454; font-family: Verdana; font-size: 9pt; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<hr align="left" size="1" width="33%" />
<!--[endif]--><br />
<div id="ftn1">
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-size: 12pt;">[1]</span></span><!--[endif]--></span></a> <span style="background: white; color: #222222; font-family: Arial; font-size: 10pt;">Kim HR, J Nutr. 2008 Nov;138(11):2111-6.</span></div>
</div>
<div id="ftn2">
<div class="MsoFootnoteText">
<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftnref2" name="_ftn2" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-size: 10pt;">[2]</span></span><!--[endif]--></span></a> <span lang="EN-GB">Byun JK, I</span><span style="background: white; color: #222222; font-family: Arial;">mmunol Lett. 2013 Nov 12</span><span lang="EN-GB"><o:p></o:p></span></div>
</div>
<div id="ftn3">
<div class="MsoFootnoteText">
<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftnref3" name="_ftn3" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-size: 10pt;">[3]</span></span><!--[endif]--></span></a> Riegsecker S, <span style="background-color: white; font-family: Arial; font-size: 8.5pt;">Life Sci 2013 Sep 3;93(8):307-12<o:p></o:p></span></div>
</div>
<div id="ftn4">
<div class="MsoFootnoteText">
<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftnref4" name="_ftn4" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-size: 10pt;">[4]</span></span><!--[endif]--></span></a> <span lang="EN-GB">Shen CL, </span><span style="background-color: white; font-family: Arial; font-size: 8.5pt;"><a href="http://www.ncbi.nlm.nih.gov/pubmed" title="The Journal of nutritional biochemistry."><span style="color: #660066;">J Nutr Biochem.</span></a><span class="apple-converted-space"> </span>2012 Nov;23(11):1367-7</span><span lang="EN-GB"><o:p></o:p></span></div>
</div>
<div id="ftn5">
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<a href="file:///C:/Documents%20and%20Settings/Administrator/My%20Documents/Antoni/A%20Cup%20of%20Green%20Tea%20a%20day%20keeps%20the%20doctor%20away.doc#_ftnref5" name="_ftn5" title=""><span class="MsoFootnoteReference"><!--[if !supportFootnotes]--><span class="MsoFootnoteReference"><span style="font-size: 10pt;">[5]</span></span><!--[endif]--></span></a> <st1:place><span lang="EN-GB">OKa</span></st1:place><span lang="EN-GB"> Y, </span><span style="background-color: white; font-family: Arial; font-size: 8.5pt;"><a href="http://www.ncbi.nlm.nih.gov/pubmed" title="Journal of pharmacological sciences."><span style="color: #660066;">J Pharmacol Sci.</span></a><span class="apple-converted-space"> </span>2012;118(1):55-64</span><span lang="EN-GB"><o:p></o:p></span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-71014820140668350592013-11-20T14:09:00.001-08:002013-11-20T15:23:16.420-08:00AS of Baths, SpAs and movies @B27<div class="Section1">
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<b><u><span style="font-family: Arial;">AS of Baths, Spas and
movies @ B27<o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="font-family: Arial;">There is just something special about
rheumatology. It has acronyms and
associations due to the multisystem nature of the conditions we see.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial;">The spondyloarthropathies <b><u>(SpAs)</u></b> are a
group of conditions with multiple associations of which Ankylosing Spondylitis <b><u>(AS)</u></b>
is the hallmark condition. Patients with AS benefit from physio and hydrotherapy.
The latter may sometimes take place in a local health <b><u>spa</u></b>. We use
the <b><u>Bath</u></b> AS Scores to assess disease activity. AS has strong genetic
association with the gene HLA-<b><u>B27</u></b>. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<b><i><span style="font-family: Arial;">AS of Baths and SpAs –
what do we know about B27?<o:p></o:p></span></i></b></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 35.45pt;">
<span style="font-family: Arial;">The genetic association between Human Leukocyte Antigen
(HLA)-B27 and Ankylosing Spondylitis was first discovered in the <st1:place w:st="on"><st1:placename w:st="on">Westminster</st1:placename> <st1:placetype w:st="on">Hospital</st1:placetype></st1:place> by Brewerton and Sturrock in
1973 with their publication in the Lancet. It remains one of the strongest associations
between gene and disease.<o:p></o:p></span></div>
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<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 2.75pt; mso-padding-alt: 2.75pt 2.75pt 2.75pt 2.75pt; mso-table-layout-alt: fixed;">
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<td style="background: #0099FF; border: solid black 1.0pt; mso-border-alt: solid black .1pt; padding: 2.75pt 2.75pt 2.75pt 2.75pt; width: 482.1pt;" valign="top" width="643"><div class="TableContents">
<b><span style="font-family: Arial;">What is known about HLA-B27<o:p></o:p></span></b></div>
</td>
</tr>
<tr>
<td style="background: #99CCFF; border-top: none; border: solid black 1.0pt; mso-border-bottom-alt: solid black .1pt; mso-border-left-alt: solid black .1pt; mso-border-right-alt: solid black .1pt; padding: 2.75pt 2.75pt 2.75pt 2.75pt; width: 482.1pt;" valign="top" width="643"><div class="TableContents" style="layout-grid-mode: char; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: Arial;">Present in 95%
of patients with AS<o:p></o:p></span></div>
<div class="TableContents" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: Arial;">Present in 8%
of normal population<o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: Arial;">1 in 15 people
who are HLA-B27 positive go on to develop AS<o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: Arial;">The child who
is HLA-B27 positive with a parent with AS has a 15% chance of developing the
condition<o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: Arial;">HLA-B27
accounts for up to 50% of overall genetic susceptibility to AS<o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: Arial;">Different
subtypes of HLA-B27 have different strengths of association with AS<o:p></o:p></span></div>
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</tbody></table>
</div>
<span style="font-size: 12pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: auto;" />
</span>
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<div class="Section2">
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<a href="https://www.blogger.com/blogger.g?blogID=6539283498264931461" name="__p8"></a><a href="https://www.blogger.com/blogger.g?blogID=6539283498264931461" name="sec2title"></a><span style="font-family: Arial;">(HLA)-B27
or B27 is a protein that is expressed on the cells and has function in both
health and disease. It can be a double-edged sword. It presents fragments of
bacteria or viruses called peptide and present this to active immune cells (T
cells) to overcome infection. Aberrations in the structure or processing of B27
are proposed as the mechanism for the development of AS. <o:p></o:p></span></div>
<div class="MsoBodyText" style="text-align: justify;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 2.75pt; mso-padding-alt: 2.75pt 2.75pt 2.75pt 2.75pt; mso-table-layout-alt: fixed;">
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<td style="background: #0099FF; border: solid black 1.0pt; mso-border-alt: solid black .1pt; padding: 2.75pt 2.75pt 2.75pt 2.75pt; width: 482.0pt;" valign="top" width="643"><div class="TableContents">
<b><span style="font-family: Arial;">Mechanism of action of HLA-B27 in AS<o:p></o:p></span></b></div>
</td>
</tr>
<tr>
<td style="background: #99CCFF; border-top: none; border: solid black 1.0pt; mso-border-bottom-alt: solid black .1pt; mso-border-left-alt: solid black .1pt; mso-border-right-alt: solid black .1pt; padding: 2.75pt 2.75pt 2.75pt 2.75pt; width: 482.0pt;" valign="top" width="643"><div class="MsoBodyText" style="layout-grid-mode: char; margin-left: 36.0pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><b><span style="font-family: Arial;">Arthritogenic
peptide hypothesis </span></b><span style="font-family: Arial;">– small
proteins (peptides) from our own body presented by HLA-B27 become the target
of immune cells (CD8</span><span style="font-family: Arial; font-size: 9.5pt; mso-bidi-font-size: 12.0pt; mso-text-raise: 4.0pt; position: relative; top: -4.0pt;">+</span><span style="font-family: Arial;"> T cells)
because they look like peptides from bacteria or viruses. This results in
joint inflammation.<o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><b><span style="font-family: Arial;">HLA-B27
homodimers hypothesis</span></b><span style="font-family: Arial;"> – cell
surface HLA-B27 can form homodimers (a pair of two chains of B27 joined
together by a bond). B27 homodimers
bind to specific receptors expressed on Natural Killer and T lymphocytes
which could play a role in the <a href="https://www.blogger.com/blogger.g?blogID=6539283498264931461" name="__tag_327734357"></a><a href="https://www.blogger.com/blogger.g?blogID=6539283498264931461" name="__tag_327734454"></a>development of AS. <o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><b><span style="font-family: Arial;">HLA-B27
misfolding hypothesis - </span></b><span style="font-family: Arial;">accumulation
of misfolded HLA-B27 in the endoplasmic reticulum (ER) during protein
processing, produces an inflammatory response. <a href="https://www.blogger.com/blogger.g?blogID=6539283498264931461" name="__tag_327734403"></a>ER
stress resulting from the accumulation of misfolded HLA-B27 then activates
the unfolded protein response (UPR) or the ER-overload response (EOR) that
can result in joint inflammation.<o:p></o:p></span></div>
<div class="MsoBodyText" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><b><span style="font-family: Arial;">Enhanced
intracellular microbial survival hypothesis </span></b><span style="font-family: Arial;">- the inability of HLA-B27-positive individuals to
eliminate certain bacteria or viruses. Ineffective loading of these pathogens
by HLA-B27 leads to reduced clearance and prolonged abnormal immune system
activation.<o:p></o:p></span></div>
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</tbody></table>
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<div class="MsoBodyText">
<b><i><span style="font-family: Arial;">Novel roles
– B27 at the movies<o:p></o:p></span></i></b></div>
<div class="MsoBodyText">
<b><i><span style="font-family: Arial;"><br /></span></i></b></div>
<div class="MsoBodyText" style="text-align: justify; text-indent: 35.45pt;">
<a href="https://www.blogger.com/blogger.g?blogID=6539283498264931461" name="__p151"><span style="font-family: Arial;">T</span></a><span style="font-family: Arial;">hese mechanisms have provided the basis for several
explanations as to how HLA-B27 might predispose individuals to AS. I am
particularly interested in the HLA-B27 homodimer hypothesis having worked on
this in my doctoral thesis. The ability of HLA-B27 to form homodimers which are
a pair of two chains of B27 joined together by a bond is interesting. <b><i>Bond
and Dimers</i></b>, proponents of this hypothesis would say <i>'<b>Dimers are
Forever'</b></i>. But like the secret agent 007, could B27 dimers unlock some
secrets to why AS develops?<o:p></o:p></span></div>
<div class="MsoBodyText" style="text-align: justify; text-indent: 35.45pt;">
<br /></div>
<div class="MsoBodyText" style="text-align: justify; text-indent: 35.45pt;">
<span style="font-family: Arial;">B27 dimers can interact with Natural Killer (NK)
receptors called KIRs which are expressed both on NK and T cells. B27 dimers
bind to a specific KIR called KIR3DL2. As of <b><i>Bond and Dimers</i></b>, this KIR
is the <b><i>KIR Royale</i></b>. The new kid on the block in the proinflammatory
response is the T helper 17 cells (Th17)
which produce IL-17. IL-17 can further induce the secretion of cytokines such
as TNF-α which are involved in the pathogenesis of AS. Th17 cells which express
KIR3DL2 have been shown to produce increased amounts of IL-17 in response to
another cytokine IL-23</span><sup><span style="font-family: Arial; mso-font-kerning: 12.0pt;">1</span></sup><span style="font-family: Arial; mso-font-kerning: 12.0pt;">. B27 dimers also cause an expansion of
inflammatory T cells in AS<sup>2</sup>. <o:p></o:p></span></div>
<div class="MsoBodyText" style="text-align: justify; text-indent: 35.45pt;">
<span style="font-family: Arial; mso-font-kerning: 12.0pt;"><br /></span></div>
<div class="MsoBodyText" style="text-align: justify; text-indent: 35.45pt;">
<span style="font-family: Arial; mso-font-kerning: 12.0pt;">Two recent papers
also add to our understanding of the HLA-B27 story. Cauli et al<sup>2 </sup>showed
that the HLA-B27 subtype 05 forms more B27 dimers than the non-disease related
of HLA-B27 subtype 09. B27 dimers promote the survival of KIR3DL2 expressing
cells which may result in inflammation seen in AS. Another interesting model is
the on the role of mechanical stress in AS. Jacques et al<sup>4 </sup>showed
that by reducing mechanical stress and loading on the Achilles tendon in mice,
there is reduced inflammation, scarring and new bone formation. HLA-B27 and
IL-23 may alter the inflammatory response of joints or tendons to mechanical
stress. One can postulate on galactic battles between inflammatory cells taking
place at sites of mechanical stress. McGonagle D summarises this in the
editorial ‘<b><i>SpA :May the Force be with you’</i></b> <sup>5</sup>.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoBodyText" style="text-align: justify; text-indent: 35.45pt;">
<span style="font-family: Arial;">Great strides have been made to understand this
mechanism of action. </span><span style="font-family: Arial; mso-font-kerning: 12.0pt;">The links HLA-B27, inflammatory cells (IL-17/IL-23) and response to
mechanical stress could all be targets for future</span><span style="font-family: Arial; text-indent: 35.45pt;"> research and treatment.</span></div>
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<br /></div>
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<b><u><span style="font-family: Arial; font-size: 10.0pt;">References:<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 13.5pt; mso-hyphenate: auto; mso-pagination: widow-orphan;">
<span style="font-family: Arial; font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-language: EN-GB; mso-font-kerning: 0pt;">1.
Bowness P et al. <a href="http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21248258" target="pmc_ext"><span style="color: #642a8f; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-language: EN-GB;">J Immunol. 2011 February 15; 186(4):
2672–2680.</span></a><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 13.5pt; mso-hyphenate: auto; mso-pagination: widow-orphan;">
<span style="font-family: Arial; font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-language: EN-GB; mso-font-kerning: 0pt;">2.
</span><span style="background-position: initial initial; background-repeat: initial initial; font-family: Arial; font-size: 10pt;">Wong-Baeza I et al. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23440420" title="Journal of immunology (Baltimore, Md. : 1950)."><span style="color: #660066;">J
Immunol.</span></a><span class="apple-converted-space"> </span>2013 Apr
1;190(7):3216-24.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 13.5pt; mso-hyphenate: auto; mso-pagination: widow-orphan;">
<span style="background-position: initial initial; background-repeat: initial initial; font-family: Arial; font-size: 10pt;">3. Cauli A et al. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23804219" title="Rheumatology (Oxford, England)."><span style="color: #660066;">Rheumatology
(Oxford).</span></a><span class="apple-converted-space"> </span>2013
Nov;52(11):1952-62<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 13.5pt; mso-hyphenate: auto; mso-pagination: widow-orphan;">
<span style="background-position: initial initial; background-repeat: initial initial; font-family: Arial; font-size: 10pt;">4. Jacques
P et al. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23921997" title="Annals of the rheumatic diseases."><span style="color: #660066;">Ann Rheum
Dis.</span></a><span class="apple-converted-space"> </span>2013 Aug 6.<span class="apple-converted-space"> <o:p></o:p></span></span></div>
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et al <a href="http://www.ncbi.nlm.nih.gov/pubmed/24220157" title="Annals of the rheumatic diseases."><span style="color: #660066;">Ann Rheum
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>@synovialjoints</b></span></div>
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<span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: xx-small; line-height: normal;">Views are my own. These are opinions and cannot replace the need to see your physician for review of your individual medical condition.</span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-78086206899010962772013-11-09T14:03:00.003-08:002013-11-12T17:13:18.232-08:00Rheumatology comes to Town<span style="font-family: Arial, Helvetica, sans-serif;"><b><u>Rheumatology community descends on Reading</u></b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">What happens when you get 70 people from the Rheumatology community coming together? A fiesta! Yes, a fiesta or celebration of knowledge, exchange of information, collaboration and networking. A joining of great minds and people to forward our joint cause in rheumatology.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Reading is the host of the famous annual summer rock festival but this was a different party. Yesterday 8/11, I hosted the Winter Oxford Regional Rheumatology Conference in Reading.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPeldTFoLjUsN0VaPjTrbdgHk6yerm33rSzzYXekLYqo-VtkYKakSFO3mEpvTx0GjLNxm1m4luanyVdgEHE7NpfM6xx5sSvCAdZfeBYVmQpQqLO9UsFVIm54kBJ4sDwpC3fQCC1SLUHsS_/s1600/Regional+1.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPeldTFoLjUsN0VaPjTrbdgHk6yerm33rSzzYXekLYqo-VtkYKakSFO3mEpvTx0GjLNxm1m4luanyVdgEHE7NpfM6xx5sSvCAdZfeBYVmQpQqLO9UsFVIm54kBJ4sDwpC3fQCC1SLUHsS_/s1600/Regional+1.JPG" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Discussion time at the Oxford Regional Conference</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">There were 7 abstracts presented by trainees with the best presentation winning the inaugural Royal Berkshire Rheumatology Prize. The lion signifies the Royal County of Berkshire, UK. There is a statue of the Maiwand Lion in Forbury Park to commemorate the valour and devotion to men from the 66th (Berkshire) Regiment of Foot during the campaign in Afghanistan between 1878 and 1880</span><span style="font-family: Arial, Helvetica, sans-serif;">. The home team won the prize, public voting of course!</span></div>
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<tr><td class="tr-caption" style="text-align: center;">The Royal Berkshire Rheumatology Prize</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">Professor John Isaacs, University of Newcastle, UK was the keynote speaker and he gave us a superb overview on Biosimilars - friend or foe? Will Dixon from the Arthritis Research UK Manchester, gave us a review of the risk of infections with biologics and steroids, data from the BSR Biologics Register.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi94kZLRi9QVmzr7349ckwrXApWAvsEhOsWRxr8ZbRTb1uezIf3pwG0126ggakJ2ErEmf9hK2meSTyEzdwxb8kSFiMYh-0Le3k5KswOjAvrDRV351IXwbZjxoLjeG7tVHsLikmVu_TYVKmN/s1600/Regional+%25283%2529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi94kZLRi9QVmzr7349ckwrXApWAvsEhOsWRxr8ZbRTb1uezIf3pwG0126ggakJ2ErEmf9hK2meSTyEzdwxb8kSFiMYh-0Le3k5KswOjAvrDRV351IXwbZjxoLjeG7tVHsLikmVu_TYVKmN/s1600/Regional+%25283%2529.JPG" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Keynote address by Prof. John Isaacs</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">In the afternoon, we shifted to the BSR Simple Tasks campaign. I have been very enthusiastic about this initiative to improve patient outcome. This will bring together a joint collaboration between the BSR, ACR and patient groups NRAS, NASS and Arthritis Care. Having seen the Simple Task initiative at the ACR 13 in San Diego, it was nice to have this now on home turf. What 3 things can we do for this campaign? Follow the conversation on Twitter #SimpleTasksUK</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi60AfgJsibD0Y0ZRqUgNLkmQ6khG_3pmMPAPi3vH4yx2Lk9B440Ak2iQvMWch9Q1gvD5nUR7YnX7O6Shhk0K46m18yjCDTA78VdxcAFkhpQJtTVnt-UrSCB2V8LexAAXU3EX4dRMBcO7rt/s1600/Regional+%25284%2529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi60AfgJsibD0Y0ZRqUgNLkmQ6khG_3pmMPAPi3vH4yx2Lk9B440Ak2iQvMWch9Q1gvD5nUR7YnX7O6Shhk0K46m18yjCDTA78VdxcAFkhpQJtTVnt-UrSCB2V8LexAAXU3EX4dRMBcO7rt/s1600/Regional+%25284%2529.JPG" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">BSR Simple Tasks presentation by Dr. Peter Prouse </td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">The final presentation was from my senior colleague, Dr. Tony Bradlow a gave an account of Rheumatology then and now. In 25 years we have seen a real revolution in rheumatology. We are now in the 'new' rheumatology with better diagnostics and treatment.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">So as I reflect on this day, I think of this quote:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b><i>Every generation needs a new revolution - Thomas Jefferson</i></b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Intensive DMARDs and biologics (and in the future probably biosimilars) has revolutionised treatment of arthritis. As a rheumatology community we have an obligation to renew, reinvent and redefine our specialty to improve patient outcomes. Two campaigns come to mind #SimpleTaskUK and #AS_it_is (see my previous blog), where we can all do our part to make this happen.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>@synovialjoints</b></span></div>
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<span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: xx-small; line-height: normal;">Views are my own. These are opinions and cannot replace the need to see your physician for review of your individual medical condition.</span></div>
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Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-83725741504536904202013-11-07T15:13:00.000-08:002013-11-07T15:13:27.227-08:00AS it is +2 days post Guy Fawkes night<b><u><span style="font-family: Arial, Helvetica, sans-serif;">AS it is 7/11 at the Palace of Westminster - NASS Campaign</span></u></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><i>Thesaurus: Adv.1.as it is - in the actual state of affairs and often contrary to expectations</i></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The average time it takes to diagnose Ankylosing Spondylitis (AS) is 8.5 years. Yes, you heard it right. This is the actual state of affairs and certainly contrary to what we would expect.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We can do better. We need to make it happen. We can make it happen.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">I was in Parliament today 7/11 at the launch of the National Ankylosing Spondylitis Society's (NASS) <b>'AS it is' </b>campaign. The reception was hosted by Huw Irranca-Davies MP and Andrew George MP.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">'AS it is' aims to set a higher standard of care for people with AS. This follows the whole journey from diagnosis to treatment to follow up. This calls for better access to treatment, physiotherapy and employment support. Debbie Cook, NASS Director, summed this up eloquently in her speech.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">'AS it is' also calls for more. It calls for the introduction of a national clinical guidance and quality standard of care for AS patients. Peter Kay, National Clinical Director for MSK services spoke about the need for better detection of inflammatory back pain (IBP) and access to services for patients with AS.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">As I go around 'preaching' the IBP message to GPs and allied health professionals in primary care, I hope it will make early detection a reality. Early detection improves outcomes.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">So as we recall +2 days post the Gunpowder plot of 1605, today there was a real sense of explosion and bang at the launch of 'AS it is'. Let's do our part to make it happen. #AS_it_is</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Houses of Parliament 7/11 NASS Campaign</span></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">With Debbie Cook, NASS Director at launch of 'AS it is'</span></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">At the NASS reception, Houses of Parliament</span></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><b><span style="font-family: Arial, Helvetica, sans-serif;">@synovialjoints</span></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Views are my own. These are opinions and cannot replace the need to see your physician for review of your individual medical condition.</span>Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0tag:blogger.com,1999:blog-6539283498264931461.post-37235751307777617962013-11-06T13:39:00.001-08:002013-11-06T13:47:53.697-08:00Welcome to the blog of Dr. Antoni Chan<b><u><span style="font-family: Arial, Helvetica, sans-serif;">Joint Venture</span></u></b><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Welcome to my blog. This is my journey from tweeting (follow me on Twitter @synovial joints ) to blogging. I started tweeting in September 2013 to find out who was attending the 2013 American Congress of the Rheumatology (ACR) in San Diego. Very quickly, I was able to make contact with rheumatologists across the world. What impressed me more was the rapid exchange and dissemination of information. The tweets were updates from meetings, seminars, conferences attended or articles read. These were sent out in real time. There is no system that can match the speed of these medical updates. This however relies on the goodwill of fellow rheumatologists and patients willing to share and discuss information, thoughts and ideas. I call this a<b><i> Joint Venture</i></b>.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">This Joint Venture was best demonstrated at the #ACR 13 in San Diego where there was rapid fire of tweets across the many sessions at the conference. It added a new dimension to the ACR which I have been attending for a decade. I had a chance to meet the people who make this Joint Venture possible at the ACR Tweetup evening. This has encouraged me to share my thoughts and ideas on my new blog. Hope you enjoy reading future posts from my blog!</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">New friends met at the ACR Tweetup 2013, San Diego.</span></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>@synovialjoints</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Views are my own. These are opinions and cannot replace the need to see your physician for review of your individual medical condition.</span>Joint Venturehttp://www.blogger.com/profile/09980427546045835120noreply@blogger.com0