Publications (20)76.44 Total impact
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Article: Self-administration of intravenous C1 esterase inhibitor in hereditary angioedema.
Canadian Medical Association Journal 04/2013; · 8.22 Impact Factor -
Article: Self-administration of intravenous C1 esterase inhibitor (Berinertâ) in patients with Hereditary Angioedema decreases number of days spent in an emergency room.
Allergy Asthma and Clinical Immunology 11/2011; 7 Suppl 2:A40. -
Article: Canadian recommendations for clinical trials of pharmacologic interventions in rheumatoid arthritis: inclusion criteria and study design.
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ABSTRACT: Current clinical trial designs for pharmacologic interventions in rheumatoid arthritis (RA) do not reflect the innovations in RA diagnosis, treatment, and care in countries where new drugs are most often used. The objective of this project was to recommend revised entry criteria and other study design features for RA clinical trials. Recommendations were developed using a modified nominal group consensus method. Canadian Rheumatology Research Consortium (CRRC) members were polled to rank the greatest challenges to clinical trial recruitment in their practices. Initial recommendations were developed by an expert panel of rheumatology trialists and other experts. A scoping study methodology was then used to examine the evidence available to support or refute each initial recommendation. The potential influence of CRRC recommendations on primary outcomes in future trials was examined. Recommendations were finalized using a consensus process. Recommendations for clinical trial inclusion criteria addressed measures of disease activity [Disease Activity Score 28 using erythrocyte sedimentation rate (DAS28-ESR) > 3.2 PLUS ≥ 3 tender joints using 28-joint count (TJC28) PLUS ≥ 3 swollen joint (SJC28) OR C-reactive protein (CRP) or ESR > upper limit of normal PLUS ≥ 3 TJC28 PLUS ≥ 3 SJC28], functional classification, disease classification and duration, and concomitant RA treatments. Additional recommendations regarding study design addressed rescue strategies and longterm extension. There is an urgent need to modify clinical trial inclusion criteria and other study design features to better reflect the current characteristics of people living with RA in the countries where the new drugs will be used.The Journal of Rheumatology 07/2011; 38(10):2095-104. · 3.69 Impact Factor -
Article: Assessment of thiopurine S-methyltransferase activity in patients prescribed thiopurines: a systematic review.
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ABSTRACT: The evidence for testing thiopurine S-methyltransferase (TPMT) enzymatic activity or genotype before starting therapy with thiopurine-based drugs is unclear. To examine the sensitivity and specificity of TPMT genotyping for TPMT enzymatic activity, reducing harm from thiopurine by pretesting, and the association of thiopurine toxicity with TPMT status in adults and children with chronic inflammatory diseases. MEDLINE, EMBASE, the Cochrane Library, and Ovid HealthSTAR (from inception to December 2010) and BIOSIS and Genetics Abstracts (to May 2009). Two reviewers screened records and identified relevant studies in English. Data on patient characteristics, outcomes, and risk for bias were extracted by one reviewer and independently identified by another. 54 observational studies and 1 randomized, controlled trial were included. Insufficient evidence addressed the effectiveness of pretesting. Genotyping sensitivity to identify patients with low and intermediate TPMT enzymatic activity ranged from 70.33% to 86.15% (lower-bound 95% CI, 54.52% to 70.88%; upper-bound CI, 78.50% to 96.33%). Sparse data precluded estimation of genotype sensitivity to identify patients with low to absent enzymatic activity. Genotyping specificity approached 100%. Compared with noncarriers, heterozygous and homozygous genotypes were both associated with leukopenia (odds ratios, 4.29 [CI, 2.67 to 6.89] and 20.84 [CI, 3.42 to 126.89], respectively). Compared with intermediate or normal activity, low TPMT enzymatic activity was significantly associated with myelotoxicity and leukopenia. Available evidence was not rigorous and was underpowered to detect a difference in outcomes. Insufficient evidence addresses the effectiveness of TPMT pretesting in patients with chronic inflammatory diseases. Estimates of the sensitivity of genotyping are imprecise. Evidence confirms the known associations of leukopenia or myelotoxicity with reduced TPMT activity or variant genotype. Agency for Healthcare Research and Quality.Annals of internal medicine 06/2011; 154(12):814-23, W-295-8. · 16.73 Impact Factor -
Article: Assessment of Thiopurine Methyltransferase Activity in Patients Prescribed Azathioprine or Other Thiopurine-based Drugs.
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ABSTRACT: To examine whether pretreatment determination of thiopurine methyltransferase (TPMT) enzymatic activity (phenotyping) or TPMT genotype, to guide thiopurine therapy in chronic autoimmune disease patients, reduces treatment harms. Other objectives included assessing: preanalytic, analytic, and postanalytic requirements for TPMT testing; diagnostic accuracy of TPMT genotyping versus phenotyping; association of thiopurine toxicity with TPMT genotypic or phenotypic status; and costs of testing, care, and treating drug-associated complications. MEDLINE®, EMBASE®, and Healthstar were searched from inception to May 2010; the Cochrane Library® to October 2009; and BIOSIS®, Genetics Abstracts, and EconLit™ to May 2009, for English language records. A reviewer screened records, and a second reviewer verified exclusions and subsequent selection of relevant studies. Studies in patients with leukemia and organ transplant were excluded. Additionally, laboratories that provide TPMT analytical services were surveyed to assess means of TPMT testing in practice. Where possible, risk of bias was assessed using standard criteria. Meta-analyses estimated diagnostic sensitivity, and specificity; and odds ratios of associations. 1790 titles or abstracts, and 538 full text records were screened. 114 observational studies and one RCT were included. Majority of studies were rated fair quality, except for diagnostic studies with 37 percent of studies rated poor. In general, there were few patients who were homozygous (or compound heterozygous) for TPMT variant alleles in the included studies limiting applicability. There is insufficient evidence examining effectiveness of pretesting in terms of reduction in clinical adverse events. Sufficient preanalytical data were available regarding preferred specimen collection, stability and storage conditions for TPMT testing. There was no clinically significant effect of age, gender, various coadministered drugs, or most morbidities (with the exception of renal failure and dialysis). TPMT phenotyping methods had coefficients of variation generally below 10 percent. TPMT genotyping reproducibility is generally between 95-100 percent. The sensitivity of genotyping to identify patients with low or intermediate TPMT enzymatic activity is imprecise, ranging from 70.70 to 82.10 percent (95 percent CI, lower bound range 37.90 to 54.00 percent; upper bound range 84.60 to 96.90 percent). Sensitivity of homozygous TPMT genotype to correctly identify patients with low to absent enzymatic activity was 87.10 percent (95 percent CI 44.30 to 98.30 percent). Genotyping specificity approached 100 percent. Leukopenia was significantly associated with low and intermediate enzymatic activity (low activity OR 80.00, 95 percent CI 11.5 to 559; and intermediate activity OR 2.96, 95 percent CI 1.18 to 7.42), and homozygous and heterozygous TPMT variant allele genotype (OR 18.60, 95 percent CI 4.12 to 83.60; and 4.62, 95 percent CI 2.34 to 9.16, respectively). In general, TPMT phenotyping costs less than genotyping, although estimates across studies are quite heterogeneous. There is insufficient direct evidence regarding the effectiveness of pretesting of TPMT status in patients with chronic autoimmune diseases. Indirect evidence confirms strong association of leukopenia with lower levels of TPMT activity and carrier genotype already established in the literature.Evidence report/technology assessment 12/2010; -
Article: Correlation of a multi-cytokine panel with clinical disease activity in patients with rheumatoid arthritis.
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ABSTRACT: Explore the potential use of a cytokine panel as biochemical markers of disease activity in rheumatoid arthritis (RA) patients. 57 adult RA patients were assessed using five validated clinical disease activity tools: Health Assessment Questionnaire (HAQ), standard 28-joint Disease Activity Score (DAS28), DAS28 using C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), and Simple Disease Activity Index (SDAI). Plasma cytokine levels (IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFN-γ, TNF-α, IL1α, IL1β, MCP1, and EGF) were measured in 47 of the 57 patients and correlated with clinical indicators. We found significant correlations between plasma levels of IL-6 and all clinical measures of disease activity; Spearman coefficients (p values) were: HAQ: 0.347(0.017); DAS28: 0.409(0.005); DAS-CRP: 0.378(0.011); CDAI: 0.312(0.033); SDAI: 0.310(0.039); ESR: 0.448(0.002); and CRP: 0.513(0.001). IFN-γ also correlated with DAS-CRP: 0.309(0.039) and SDAI: 0.301(0.044). Furthermore, the levels of IL-6 and IFN-γ increased significantly with worsening disease, as defined by the European League Against Rheumatism (EULAR) classification of disease activity. A significant correlation between plasma levels of IL-6 and clinical disease activity in patients with RA suggests a future role of IL6 as a disease activity marker.Clinical biochemistry 11/2010; 43(16-17):1309-14. · 2.02 Impact Factor -
Article: Successful prevention of thrombotic thrombocytopenic purpura (TTP) relapse using monthly prophylactic plasma exchanges throughout pregnancy in a patient with systemic lupus erythematosus and a prior history of refractory TTP and recurrent fetal loss.
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ABSTRACT: The occurrence of thrombotic thrombocytopenic purpura (TTP) in the setting systemic lupus erythematosus (SLE) is rare. In women of childbearing age, TTP is associated with high rates of recurrence in pregnancy. Furthermore, both TTP and SLE are associated with a significant risk of adverse pregnancy outcomes. We describe the case of a 36 year old female in her first trimester of pregnancy with a prior history of SLE-associated severe refractory TTP who was treated with a combination of corticosteroids and prophylactic plasma exchanges (PLEX) throughout pregnancy to prevent TTP recurrence. She delivered a healthy infant at 33 weeks of gestation after the onset of preterm labor. There was no evidence of TTP recurrence in the antepartum or postpartum period in this high risk patient. Prophylactic PLEX should be considered as a therapeutic option to prevent recurrent TTP during pregnancy in high risk patients, including patients with previous SLE-associated TTP.Transfusion and Apheresis Science 08/2010; 43(1):29-31. · 1.25 Impact Factor -
Article: Comparison of the anti-cyclic citrullinated peptide and rheumatoid factor in rheumatoid arthritis at an arthritis center.
Saudi medical journal 04/2009; 30(3):446-7. · 0.52 Impact Factor -
Article: The percentage of patients with seronegative spondyloarthritis requiring magnetic resonance imaging to meet the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada guidelines for access to anti-tumor necrosis factor treatment.
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ABSTRACT: To determine what percentage of patients would require a magnetic resonance imaging (MRI) scan to qualify for treatment in a Canadian tertiary care setting. Consecutive patients with established axial seronegative spondyloarthropathy were recruited. Patients completed a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath AS Functional Inquiry (BASFI) questionnaire and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were measured. Patients were categorized into groups, those who would qualify for anti-tumor necrosis factor (TNF) agents without an MRI, those who would require an MRI to determine eligibility, and those who would not qualify, even with active inflammation on an MRI. Twenty-nine patients were recruited in a 1-year period and 12 (41.3%; 95% confidence interval 25.5%-59.3%) would require an MRI to gain access to an anti-TNF agent. Extrapolating published estimates of prevalence of seronegative arthritis and AS and assuming 1/3 will have severe resistant disease, about 9000 patients in Canada would require an MRI to determine eligibility for anti-TNF treatment. Canada currently ranks 13/22 countries studied in terms of MRI resources per capita. Given the limited MRI resources in Canada, Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada guidelines could present an additional barrier to timely treatment in 41% of patients.The Journal of Rheumatology 05/2008; 35(4):658-61. · 3.69 Impact Factor -
Article: The Canadian Rheumatology Association/ Spondyloarthritis Research Consortium of Canada treatment recommendations for the management of spondyloarthritis: a national multidisciplinary stakeholder project.
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ABSTRACT: Development of treatment recommendations for arthritis has traditionally relied on the compilation of evidence-based data by experts in the field despite recommendations by various bodies for broad stakeholder input. Our objectives were: (1) To develop evidence-based treatment recommendations for the management of spondyloarthritis (SpA) in Canada that also incorporate the perspective of multiple stakeholders. (2) To generate a procedural template for the multidisciplinary development of treatment recommendations. The process was directed by a steering committee comprising the SPARCC Executive, rheumatologists from academic and community-based practice, patient consumers, and a representative from the John Dossetor Health Ethics Centre. Guidelines established by EULAR and stipulated in the AGREE instrument were followed. First, a working document was drafted that included a referenced summary of the evidence-based data and the 12 national arthritis care standards developed by the Alliance for the Canadian Arthritis Program. Second, a Web-based survey was conducted among patient consumers to address the relevance to patients of 2 primary outcome instruments that assess the effectiveness of treatment. Third, a list of questions was generated for drafting propositions by the ethics consultant. A Delphi consensus exercise was then conducted. Consensus was generated on a final list of 38 treatment recommendations categorized under the subject headings of general management principles, ethical considerations, target groups, definition of target disease, disease monitoring, and specific management recommendations. Using broad stakeholder input, we provide treatment recommendations to guide clinical practice and access to care for patients with SpA in Canada.The Journal of Rheumatology 12/2007; 34(11):2273-84. · 3.69 Impact Factor -
Article: Haverhill fever with spine involvement.
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ABSTRACT: Haverhill fever and rat-bite fever are closely-related syndromes caused by Streptobacillus moniliformis. This infection is characterized by the abrupt onset of fever with rigors, myalgias, headache, polyarthritis, and rash. We report a case of infection with S. moniliformis that manifested as acute polyarthritis with involvement of the spine. To our knowledge, involvement of the spine has not been reported previously with this infection. Diagnosis can be particularly difficult in the absence of fever or obvious exposure to rodents, as in our case. A high degree of awareness is necessary to make the diagnosis of this potentially fatal infection, which is easily treatable.The Journal of Rheumatology 08/2006; 33(7):1409-10. · 3.69 Impact Factor -
Article: Immune reactivity to a glb1 homologue in a highly wheat-sensitive patient with type 1 diabetes and celiac disease.
Diabetes Care 06/2006; 29(5):1108-10. · 8.09 Impact Factor -
Article: Association of the frequency of respiratory illness in early childhood with a change in the distribution of blood lymphocyte subpopulations.
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ABSTRACT: Little is known about the distribution of lymphocyte phenotypes in young children and the association specific phenotypes may have with respiratory illnesses. The objective of this study was to describe lymphocyte distributions in children at approximately 2 years of age and to test for associations with the frequency of respiratory illness during the first 2 years of life. We hypothesized that an increased frequency of illness would be associated with those phenotypes that reflect previous antigen exposure and/or immune activation. Seventy-three children were followed during their first 2 years of life with daily symptom diaries and twice-monthly telephone calls to ascertain the incidence of respiratory illness. After the children reached 2 years of age, the phenotypes of circulating blood lymphocytes were measured by flow cytometry. Associations between illness and phenotypes were adjusted for education level of parents; hours per week in day care; hours per week exposed to environmental tobacco smoke, mould, or water damage in bedroom; and parental history of allergy and asthma. The resulting median lymphocyte count was 4.0 x 109 per litre (standard deviation, 1.3) with a CD4/CD8 count of 2.28, consistent with published values. Illness rates were positively associated with the percentage of CD8+ CD38+ T cells (unadjusted p = .03, adjusted p = .014), CD8+ CD45RO+ T cells (unadjusted p = .06, adjusted p = .036), and CD4+ CD45RO+ T cells (unadjusted p = .01, adjusted p = .005). Our conclusions is that there is an association between the distribution of lymphocyte phenotypes and the incidence of respiratory illness early in life. Future research is recommended to determine the directionality of this association.Allergy Asthma and Clinical Immunology 12/2005; 1(4):135-41. -
Article: Bilateral simultaneous central retinal artery occlusions in wegener granulomatosis.
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ABSTRACT: A 46-year old woman developed simultaneous central retinal artery occlusions (CRAOs) in Wegener granulomatosis (WG). She had presented six years earlier with xerostomia, skin rash, and arthralgias and received a diagnosis of Sjogren syndrome. Anti-neutrophilic cytoplasmic antibody (ANCA) was negative. Months prior to the CRAOs, she had developed hearing loss, proptosis, and scleritis that were not responsive to prednisone 50 mg/d. The CRAOs occurred while she was being treated at this dose level. ANCA was now positive. This is the 12th case of CRAO in WG and the 6th case of bilateral CRAOs reported in the English literature. It emphasizes that serious irreversible visual complications may occur even when the patient is being treated with substantial corticosteroid doses.Journal of Neuro-Ophthalmology 04/2005; 25(1):29-32. · 1.45 Impact Factor -
Article: Effects of methylprednisolone and a biocompatible copolymer circuit on blood activation during cardiopulmonary bypass.
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ABSTRACT: Cardiopulmonary bypass (CPB) induces derangements in physiology characterized by activation of blood pathways that may contribute to multiorgan dysfunction. This trial addresses the efficacy of a biocompatible surface alone and in combination with steroids in inhibiting these changes. In a factorial design, patients undergoing coronary artery bypass grafting were randomized (four groups; n = 17 per group) to CPB utilizing control circuits or a circuit prepared with a surface modifying active copolymer (SMA-CPB), with or without methylprednisolone (MPSS, 1 g intravenous). Leukocyte and complement activation, cytokine release, and bradykinin generation were measured. Clinical outcomes (blood loss, transfusion, arterial pressure response, and postoperative cardiac and pulmonary functions) were also examined. The SMA-CPB was associated with a significant inhibition of elastase release (p = 0.026) and bradykinin generation (p = 0.027) during CPB. Terminal complement complex (TCC) generation was inhibited as an effect of SMA-CPB (p = 0.047). There was an interaction of SMA-CPB and MPSS to decrease both TCC (p = 0.042) and bradykinin generation (p = 0.028). There were strong effects of MPSS in inhibiting release of interleukin 6 (IL-6) (p = 0.007) and IL-8 (p < 0.001) and tissue plasminogen activator over time (p = 0.009) as well as decreasing peak day 1 creatine kinase (CK, p = 0.015) levels. Clinical effects of MPSS included decreased atrial fibrillation (p = 0.02), improved cardiac index over time, increased pulmonary compliance, and increased insulin need. This trial suggests a potential beneficial effect for combined strategies to minimize inflammation after CPB. The specific effect of MPSS in decreasing postoperative atrial fibrillation and CK warrants further investigation of its role as a potential myocardial protective agent.The Annals of thoracic surgery 03/2005; 79(2):655-65. · 3.74 Impact Factor -
Article: The association between allergy and diabetes in the Canadian population: implications for the Th1-Th2 hypothesis.
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ABSTRACT: T-lymphocytes may preferentially differentiate towards a Th1 subtype, which is thought to be involved in the autoimmune aspects of diabetes, or a Th2 subtype, which is thought to mediate allergic disease. The activation of one subtype is thought to inhibit the other. To determine if diabetes is less common among those with allergic disease, consistent with the postulated TH1/Th2 paradigm, we used data from the 2000-2001 Canadian Community Health Survey of those at least 12 years of age from 125,159 households. Diabetes requiring insulin was reported in 1% whether or not allergies were reported. The crude odds ratio between diabetes and allergies for the entire population was 1.06 (95% confidence interval (CI): 0.90, 1.24). Adjusted for household size, number of bedrooms, immigrant status, income adequacy, educational level, smoking status, alcohol drinking status, regular exercise, and age, there was a positive association between allergy and diabetes with an odds ratio of 1.25 (95% CI: 1.06, 1.49). These results do not provide evidence for the existence of the Th1/Th2 paradigm as a determinant of disease patterns in the general population.European Journal of Epidemiology 02/2005; 20(8):713-7. · 4.71 Impact Factor -
Article: The association between allergy and rheumatoid arthritis in the Canadian population.
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ABSTRACT: Antagonism between Th1 and Th2 lymphocyte mediated responses has been proposed to explain the observed 20th Century population increase in Th2 mediated allergic disease and reciprocal decrease in infectious disease, which stimulates a Th1 mediated response. To determine if Th1/Th2 antagonism would be consistent with associations between non-infectious diseases, we tested the hypothesis that the population prevalence of Th2 mediated allergies is inversely related to the prevalence of Th1 mediated rheumatoid arthritis. The analysis was based on data from the Canadian Community Health Survey conducted by Statistics Canada in 2000-2001 of those at least 12 years of age from 125,129 households. Each subject was asked if he or she had certain chronic health conditions that had been diagnosed by a health professional. Logistic regression models were used to evaluate the association between rheumatoid arthritis and allergies with consideration of other important variables. Allergy history was positively related to the prevalence of rheumatoid arthritis both in women (adjusted odds ratio (OR): 1.57, 95% CI: 1.43, 1.73) and in men (adjusted OR: 1.55, 95% CI: 1.36, 1.77). The reported population prevalences of allergies and rheumatoid arthritis were positively associated and not explained by Th1/Th2 anatagonism suggesting that this mechanism may only be applicable to the association between an infectious and an immunologic disease. Mechanisms accounting for positive associations between immunologic diseases deserve further study.European Journal of Epidemiology 02/2005; 20(9):783-7. · 4.71 Impact Factor -
Article: The clinical assessment of patients with psoriatic arthritis: results of a reliability study of the spondyloarthritis research consortium of Canada.
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ABSTRACT: To evaluate whether rheumatologists experienced in psoriatic arthritis (PsA) assess peripheral and axial involvement in the same way and to consider core clinical measurements that should be included in clinical trials in PsA. Ten patients with PsA, representing a broad range of joint inflammation, joint damage, and spinal involvement, were selected for the study. Each patient was examined by each of 10 rheumatologists, members of the Spondyloarthritis Research Consortium of Canada, according to a Latin Square design. Assessments included scoring actively inflamed joints and damaged joints, dactylitis, enthesitis, and spinal measurements. Variance components analyses were conducted for continuous measurements based on models with observer, patient, and order effects. Estimates of intraclass correlation coefficients and associated 95% confidence intervals were obtained. There was substantial reliability in the assessment of the number of actively inflamed joints and excellent agreement in the number of damaged joints. Only moderate agreement was found for the number of digits with dactylitis. There was excellent agreement among observers in the intermalleolar distance measurements, but there was not as good agreement in the other measurements of spinal mobility. There was good agreement among the observers in detecting plantar fasciitis, however, the other entheses did not fare as well. In this first multicenter study of the assessment of clinical evaluation of patients with PsA we found that the assessment of peripheral joint disease is reliable although training should be performed prior to initiation of drug trials or comparative studies in this disease. The assessment of back measurements in PsA and other spondyloarthritis requires further study.The Journal of Rheumatology 07/2004; 31(6):1126-31. · 3.69 Impact Factor -
Article: Canadian Rheumatology Association Consensus on the use of anti-tumor necrosis factor-alpha directed therapies in the treatment of spondyloarthritis.
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ABSTRACT: Spondyloarthritis (SpA) represents a group of related arthritides characterized by their association with HLA-B27 and the development of sacroiliitis and enthesitis. Functional impairment, disability, and loss of quality of life may resemble that observed in rheumatoid arthritis. The SpA Research Consortium of Canada (SPARCC) is an informal association of rheumatologist members of the Canadian Rheumatology Association (CRA) with a special interest in therapeutics and outcomes research in SpA. Recent experience with anti-tumor necrosis factor-a (anti-TNF-a) directed therapies prompted a consensus-based evaluation of the evidence supporting their efficacy, safety, and appropriate use in SpA. We evaluated the clinical evidence in support of anti-TNF-a directed therapies in SpA. Medline was searched using appropriate keywords. Abstracts of the 1999-2002 annual meetings of the American College of Rheumatology and the European Congress of Rheumatology were extracted and admitted if sufficient detail was available to determine the level of evidence. Recommendations were based on randomized placebo-controlled trials (Level A evidence) and clinical studies without randomization (Level B evidence). Where the scientific literature was incomplete, recommendations reflected the consensus of SPARCC members (Level C evidence). Following development of an original draft document, consensus for revisions was achieved among members of SPARCC. The document was then posted on the CRA website prior to its final revision. The following recommendations have been endorsed by the Therapeutics Committee of the CRA: Infliximab and etanercept are indicated for reduction of signs and symptoms of moderate to severely active SpA in patients who have had an inadequate response to maximal doses of > or = 2 nonsteroidal antiinflammatory drugs (NSAID) over a 3-month period of observation; and either sulfasalazine or methotrexate is indicated in those with predominantly active peripheral arthritis. Current evidence supports their use as monotherapy (level of evidence A) for at least one year. NSAID and/or second line therapy with either sulfasalazine or methotrexate can be continued concomitantly. There is no evidence addressing potential advantages or disadvantages of combining methotrexate with anti-TNF therapy for SpA. Recommended doses for adults are: infliximab 5 mg/kg at 0, 2, and 6 weeks and every 8 weeks thereafter; etanercept 25 mg subcutaneously twice weekly. No therapy has been shown to slow progression of axial disease in SpA, and prognostic factors for determining response to therapy remain to be determined. It is the position of the CRA that all therapeutic options should be equally available according to the best judgments of the treating physician and the informed decision of the patient.The Journal of Rheumatology 07/2003; 30(6):1356-63. · 3.69 Impact Factor -
Article: An anaphylactic reaction to intra-articular triamcinolone: a case report and review of the literature.
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ABSTRACT: The primary objective was to report a case of triamcinolone-induced anaphylaxis and review the proposed mechanisms of corticosteroid-associated hypersensitivity reactions. Articles in French and English were identified from references in relevant articles and from articles retrieved from the PubMed web site. Indexing terms consisted of corticosteroids in conjunction with the terms anaphylaxis, hypersensitivity reactions, asthma, urticaria, and angioedema. We reviewed all articles that described a case or cases of allergic-type reaction in association with corticosteroid use and for which we could obtain the full text of the article (>95%). We report an anaphylactic reaction occurring after an intraarticular injection of triamcinolone in a 75-year-old man who had positive prick skin tests to triamcinolone and negative tests to lidocaine, methylprednisolone, and hydrocortisone. To date, there have been approximately 100 published reports of immediate hypersensitivity reactions occurring after oral and parenteral administration of corticosteroids. Both immunologic and nonimmunologic mechanisms are proposed, but there is no definitive evidence in favor of either hypothesis. Our patient demonstrated positive prick skin tests to triamcinolone in a dose-response manner, suggesting the likelihood that an immunoglobulin E-mediated hypersensitivity mechanism may play a role.Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 02/2003; 90(2):254-8. · 2.83 Impact Factor
Top co-authors
Top Journals
Institutions
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2005–2011
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The Ottawa Hospital
- Department of Medicine
Ottawa, Ontario, Canada -
Ottawa Hospital Research Institute
Ottawa, Ontario, Canada
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2009
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King Abdulaziz University
Jeddah, Mintaqat Makkah, Saudi Arabia
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2003–2008
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University of Ottawa
- Department of Medicine
Ottawa, Ontario, Canada
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