Glucocorticoids (GCs) rapidly reduce disease activity in early and advanced rheumatoid arthritis (RA). This systematic review on behalf of the task force on recommendations for the management of RA addresses the efficacy of GCs in RA. A literature search was performed in Medline, Embase, the Cochrane database, and the ACR/EULAR abstracts 2007 and 2008 on a set of questions relating to the use of GCs in RA. Eleven publications (including three Cochrane reviews comprising 33 trials) that met the criteria for detailed assessment were found. Robust evidence that GCs are effective as bridging therapy was obtained. The addition of GCs, to either standard synthetic disease-modifying antirheumatic drug (DMARD) monotherapy or combinations of synthetic DMARDs, yields clinical benefits and inhibition of radiographic progression that may extend over many years. In early RA, the addition of low-dose GCs (<7.5 mg/day) to DMARDs leads to a reduction in radiographic progression; in longstanding RA, GCs (up to 15 mg/day) improve disease activity. There is some evidence that appropriate timing of GC administration may result in less morning stiffness. Only indirect information was found on the best tapering strategy, supporting the general view that GCs should be tapered slowly in order to avoid clinical relapses. GCs are effective in relieving signs and symptoms and inhibiting radiographic progression, either as monotherapy or in combination with synthetic DMARD monotherapy or combination therapy.
"Thus, the treatment of LORA patients with corticosteroids did not reduce radiological progression, despite the positive effects of these drugs on inflammatory activity. Treatment with low doses of prednisolone as a monotherapy, or in combination with DMARDs, has previously been reported to have positive effects with respect to the remission rate and inhibition of radiographic progression [46-48]. However, contrasting results were reported by Paulus et al., who found that monotherapy with low-dose corticosteroids did not prevent radiological progression . "
[Show abstract][Hide abstract] ABSTRACT: Disease activity, severity and co-morbidity contribute to increased mortality in patients with rheumatoid arthritis (RA). We evaluated the impact of age at disease onset on prognostic risk factors and treatment in early disease.
In this study, 950 RA patients were followed regularly from inclusion (<12 months from symptom onset) for disease activity (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender/swollen joints, visual analogue scale (VAS) pain/global, disease activity score (DAS28)) and function (health assessment questionnaire (HAQ)). Disease severity, measured by radiographs of hands/feet (erosions, Larsen score), extra-articular disease, nodules and co-morbidities and treatment (disease-modifying anti-rheumatic drugs (DMARDs), corticosteroids, biologics, nonsteroidal anti-inflammatory drugs (NSAIDs)) were recorded at inclusion and after 5 years. Autoantibodies (rheumatoid factor (RF), anti-nuclear antibodies (ANA), antibodies against cyclic citrullinated peptides (ACPA)) and genetic markers (human leukocyte antibody (HLA)-shared epitope, protein tyrosine phosphatase nonreceptor type 22 (PTPN22)) were analyzed at inclusion. Data were stratified as young (YORA) and late (LORA) onset RA, defined as being below/above median age (58 years) at onset.
LORA was associated with lower frequency of ACPA (P <0.05) and carriage of PTPN22-T variant (P <0.01), but with greater disease activity at inclusion measured as ESR (P < 0.001), CRP (P <0.01) and accumulated disease activity (area under the curve for DAS28) at 6 (P <0.01), 12 (P <0.01) and 24 months (P <0.05), and a higher HAQ score (P <0.01) compared with YORA. At baseline and 24 months, LORA was more often associated with erosions (P <0.01 for both) and a higher Larsen score (P <0.001 for both). LORA was more often treated with corticosteroids (P <0.01), less often with methotrexate (P <0.001) and biologics (P <0.001). YORA was more often associated with early DMARD treatment (P <0.001). Multiple regression analyses supported our findings regarding impact of age on chosen treatment.
YORA patients were more frequently ACPA-positive. LORA was more often associated with erosions, higher Larsen scores, disease activity and HAQ at baseline. Nevertheless, YORA was treated earlier with DMARDs, whilst LORA was more often treated with corticosteroids and with less DMARDs in early disease. This could have implications for development of co-morbidities.
[Show abstract][Hide abstract] ABSTRACT: Hintergrund
Ausgangspunkt der neuen S1-Leitlinie waren die 2010 erschienenen EULAR Recommendations zum Management der rheumatoiden Arthritis (RA), die nach umfangreichen systematischen Literaturrecherchen (SLR) evidenzbasiert erstellt worden sind. Die SLR wurde für die deutschen Empfehlungen aktualisiert und wird in ihrer Methodik vorgestellt.
Die SLR wurde für den Zeitraum von Januar 2009 bis Ende August 2011 durchgeführt. Es wurden alle kontrollierten Studien eingeschlossen, die die krankheitsmodifizierende Therapie der RA hinsichtlich ihrer Wirksamkeit auf Klinik, Funktion und Struktur untersucht haben.
Von 6869 gesichteten Arbeiten wurden 138 Artikel und 56 Abstracts für die Erstellung der Leitlinie berücksichtigt. Auf einem Konsensustreffen wurden die Ergebnisse der SLR vorgestellt. Auf dieser Grundlage formulierte das Expertengremium modifizierte Empfehlungen und verabschiedete diese mittels Konsensus.
Mithilfe der aktualisierten SLR konnten wesentliche neue Daten im Entscheidungsprozess für die neue S1-Leitlinie zur medikamentösen Therapie der RA berücksichtigt werden.
Zeitschrift für Rheumatologie 09/2012; 71(7). DOI:10.1007/s00393-012-1048-y · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Microprocessors are used in nearly every system of a rail vehicle
from the brake controls to the automatic train control. Microprocessors
are being used in systems that have been traditionally designed using
fail-safe hardware techniques proven safe over the years. The use of
microprocessors to replace these traditional systems raises a new set of
concerns and methods to verify their safe operation. This paper
concentrates on the safety related aspects of software as a basic primer
on software safety giving some of the concerns and methods to mitigate
Railroad Conference, 1999. Proceedings of the 1999 ASME/IEEE Joint; 02/1999
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