[Show abstract][Hide abstract] ABSTRACT: Rheumatoid arthritis is a complex multifactorial disease, whose pathogenesis has not been fully elucidated. Biologic agents have revolutionized RA treatment, but a significant percentage of patients does not obtain an adequate response to the therapy. Most of the biologic agents do better if combined with conventional immunosuppressive DMARDs and they show a similar efficacy profile: most of the responders achieve the minimum desirable level of response (ACR20) and only few patients obtain a worthwhile clinical improvement (ACR70 or better). We need to identify new strategies of treatment, able to comply the non satisfied needs of RA patients. Taking inspiration from other medical fields, we could hypothesize a combined regimen in which biologic agents are administered simultaneously at a low or ultra-low dosage, targeting several pathogenetic mechanisms but avoiding important side effects. Alternatively it should be useful to identify rapid succession regimens in which biologic drugs are taken according to an established sequence. Research in this field is obviously not encouraged by pharmaceutical industries, but our efforts should be driven in this direction. According to these observations, adequate clinical trials should be designed to search for appropriate drugs associations and dosages.
No preview · Article · Sep 2013 · Medical Hypotheses
[Show abstract][Hide abstract] ABSTRACT: Glucocorticoid-induced osteoporosis (GIO) is the most frequent cause of secondary osteoporosis. GIO is linked to GC daily assumption with maximum effect within first months of treatment and decreasing to basal levels as the therapy is discontinued. In Italy, primary prevention of GIO is suggested when GC therapy (prednisone >5mg/day or equivalent) is taken for longer than 3 months. Lazio GISMO (Italian Group for Study and Diagnosis of Bone Metabolism Diseases) group organized the GC and Osteoporosis Epidemiology study (EGEO) to evaluate physician's approach in preventing GIO. The study involved 19 osteoporosis centres. Patients taking long-term GC therapy were recruited and information collected: medical history and anthropometric data, GC therapy, primary disease, physician's specialty, osteopororosis screening and pharmacological intervention. 1334 patients were included in the study. Mean age was 63±13 years; 243 (18%) patients had a history of falls from standing position in the previous 12 months, 78 (35%) vertebral fractures, 91 (41%) fractures other than vertebral, 27 (12%) femoral fractures and 27 (12%) multiple sites fractures. The molecules of GC more often prescribed were prednisone and 6-metil prednisolone. 1040 patients (78%) were taking GC longer than 6 months. GC therapy was prescribed more frequently by rheumatologists (62%). Anti-osteoporotic drugs for GIO prevention were prescribed in 431 patients (32%). Only 27% of patients (360) received Calcium and Vitamin D supplements and 39% of patients (319) treated by rheumatologists received antiresorptive drugs. In conclusion our data show that in Italy, as already described elsewhere, only a small subpopulation of GC treated patients was supported by an anti-osteoporotic therapy, indicating the need to further stimulate awareness of both patients and specialists, prescribing GC therapy, to an appropriate and prompt GIO prevention.
No preview · Article · Mar 2012 · Journal of endocrinological investigation