Publications by authors named "Alexandros A Drosos"

161 Publications

Pleural effusion in psoriatic arthritis patients: a case series and review of the literature.

Clin Rheumatol 2021 Mar 29. Epub 2021 Mar 29.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. Pulmonary involvement is a rare extra-articular manifestation of the disease characterized by rigidity of the chest wall and apical pulmonary fibrosis. Pleural effusion is uncommon in PsA. We present four cases of patients with PsA who developed pleural effusions. We report for the first time a PsA patient who was drug-naïve and developed unilateral pleuritis. We also describe one PsA case with pleuritis while he was on methotrexate (MTX) and two PsA cases on tumor necrosis factor (TNF) inhibitors. The literature review revealed six cases with pleural effusion, which were drug-induced. These patients presented pleural effusions while they were treated with MTX (2 patients) and TNF inhibitors (4 patients). In PsA patients with pleuritis, a detailed investigation to rule out infections is necessary. In addition, increased pharmacovigilance will detect cases of drug-induced serositis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10067-021-05712-9DOI Listing
March 2021

Use of conventional synthetic and biologic disease-modifying anti-rheumatic drugs in patients with rheumatic diseases contracting COVID-19: a single-center experience.

Rheumatol Int 2021 05 3;41(5):903-909. Epub 2021 Mar 3.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.

To examine whether patients with inflammatory arthritis (IA) treated with conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) and/or biologic (b) DMARDs, could be affected from SARS-CoV-2 infection and to explore the COVID-19 disease course and outcome in this population. This is a prospective observational study. During the period February-December 2020, 443 patients with IA who were followed-up in the outpatient arthritis clinic were investigated. All patients were receiving cs and/or bDMARDs. During follow-up, the clinical, laboratory findings, comorbidities and drug side effects were all recorded and the treatment was adjusted or changed according to clinical manifestations and patient's needs. There were 251 patients with rheumatoid arthritis (RA), 101 with psoriatic arthritis (PsA) and 91 with ankylosing spondylitis (AS). We identified 32 patients who contracted COVID-19 (17 RA, 8 PsA, 7 AS). All were in remission and all drugs were discontinued. They presented mild COVID-19 symptoms, expressed mainly with systemic manifestations and sore throat, while six presented olfactory dysfunction and gastrointestinal disturbances, and all of them had a favorable disease course. However, three patients were admitted to the hospital, two of them with respiratory symptoms and pneumonia and were treated appropriately with excellent clinical response and outcome. Patients with IA treated with cs and/or bDMARDs have almost the same disease course with the general population when contract COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-021-04818-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925256PMC
May 2021

Insulin resistance in patients with rheumatoid arthritis.

Rheumatol Int 2021 Feb 26. Epub 2021 Feb 26.

Department of Internal Medicine, Medical School, Rheumatology Clinic, University of Ioannina, 45110, Ioannina, Greece.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-021-04814-6DOI Listing
February 2021

Correspondence on 'Cardiovascular effects of biological versus csDMARD therapy in treatment naive, early rheumatoid arthritis'.

Ann Rheum Dis 2021 Feb 8. Epub 2021 Feb 8.

Rheumatology Clinic, Internal Medicine, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/annrheumdis-2021-219891DOI Listing
February 2021

Incidence, risk factors and validation of the RABBIT score for serious infections in a cohort of 1557 patients with rheumatoid arthritis.

Rheumatology (Oxford) 2020 Dec 9. Epub 2020 Dec 9.

Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.

Objectives: Predicting serious infections (SI) in patients with rheumatoid arthritis (RA) is crucial for the implementation of appropriate preventive measures. Here we aimed to identify risk factors for SI and to validate the RA Observation of Biologic Therapy (RABBIT) risk score in real-life settings.

Methods: A multi-centre, prospective, RA cohort study in Greece. Demographics, disease characteristics, treatments and comorbidities were documented at first evaluation and one year later. The incidence of SI was recorded and compared with the expected SI rate using the RABBIT risk score.

Results: A total of 1557 RA patients were included. During follow-up, 38 SI were recorded [incidence rate ratio (IRR): 2.3/100 patient-years]. Patients who developed SI had longer disease duration, higher HAQ at first evaluation and were more likely to have a history of previous SI, chronic lung disease, cardiovascular disease and chronic kidney disease. By multivariate analysis, longer disease duration (IRR: 1.05; 95% CI: 1.005, 1.1), history of previous SI (IRR: 4.15; 95% CI: 1.7, 10.1), diabetes (IRR: 2.55; 95% CI: 1.06, 6.14), chronic lung disease (IRR: 3.14; 95% CI: 1.35, 7.27) and daily prednisolone dose ≥10 mg (IRR: 4.77; 95% CI: 1.47, 15.5) were independent risk factors for SI. Using the RABBIT risk score in 1359 patients, the expected SI incidence rate was 1.71/100 patient-years, not different from the observed (1.91/100 patient-years; P = 0.97).

Conclusion: In this large real-life, prospective study of RA patients, the incidence of SI was 2.3/100 patient-years. Longer disease duration, history of previous SI, comorbidities and high glucocorticoid dose were independently associated with SI. The RABBIT score accurately predicted SI in our cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/rheumatology/keaa557DOI Listing
December 2020

Cutaneous Autoimmune Phenomena of the Anti-TNFa Biosimilars. Casebased Review.

Curr Rheumatol Rev 2020 Nov 19. Epub 2020 Nov 19.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina. Greece.

Psoriasis (Pso) is a common chronic inflammatory disease affecting the skin, both sexes and all ages. It can be associated with other chronic inflammatory musculoskeletal disorders and certain drugs, including tumor necrosis factor α (TNFα) antagonists. A 64-years-old man with seronegative rheumatoid arthritis (RA) refractory to leflunomide and prednisone was treated with SB-4 (Benepali), an etanercept biosimilar 50mg/week subcutaneously. He responded well to the treatment but a year later, he developed erythematous skin eruptions affecting mainly the palms of both hands. Skin biopsy showed a picture compatible with Pso. SB-4 was discontinued and the skin lesions disappeared with the addition of topical steroid therapy. This is the only case of psoriatic skin lesions associated with SB-4 treatment. Thus, we review and discuss the relevant literature of Pso cases related to SB-4 and other anti-TNFα biosimilars. Rheumatologists dealing with patients on anti-TNFα biosimilars should be aware and recognize these complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1573397116666201119151349DOI Listing
November 2020

Calcified constrictive pericarditis resulting in tamponade in a patient with systemic lupus erythematosus.

Rheumatol Int 2021 Mar 18;41(3):651-670. Epub 2020 Nov 18.

Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110, Ioannina, Greece.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiorgan involvement, including heart. Pericarditis-the most common cardiac manifestation-occurs in up to 50% of cases, resulting in positive treatment outcomes. Rarely, it evolves to hazardous complications. A 50-year-old woman with SLE in clinical remission, receiving hydroxychloroquine 400 mg/day, presented to us with severe chest pain and low-grade fever. Physical examination revealed a friction rub and decreased breath sounds at the right lung base. Laboratory evaluation demonstrated leukopenia, thrombocytopenia, low C4 levels, and high acute phase reactants. Chest X-ray exhibited cardiomegaly, calcified pericardium, and right pleural effusion, confirmed by CT scan. PPD skin test and IGRA were both negative. Pericardial fluid, blood, and urine cultures for bacteria and fungi, as well as Gram and Ziehl-Neelsen stains were negative. Serological tests for viruses were also negative. The patient was diagnosed with calcified constrictive pericarditis (CP) due to SLE. She was treated with cyclophosphamide and methylprednisolone pulses, without improvement. Her clinical condition deteriorated, developing signs and symptoms compatible with cardiac tamponade (TMP), which was confirmed by Doppler echocardiography. The patient underwent pericardiectomy. A dramatic response was noted and she was discharged with prednisone 50 mg/day and azathioprine 100 mg/day. Thus, we review and discuss the relevant literature of SLE cases with CP or TMP. When an SLE patient presents with CP, infectious causes should be excluded first. To the best of our knowledge, this is the only case of SLE and calcified CP leading to TMP, hence physicians should be aware of this complication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-020-04747-6DOI Listing
March 2021

Anti-Rheumatic Drugs for the Fight Against the Novel Coronavirus Infection (SARSCoV-2): What is the Evidence?

Mediterr J Rheumatol 2020 Sep 21;31(Suppl 2):259-267. Epub 2020 Sep 21.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

SARS-CoV-2 is a positive-sense single-stranded RNA virus that causes the COVID-19 infection. Spike proteins are the most important proteins found on its capsule using the host's ACE2 receptors to invade respiratory cells. The natural course of the COVID-19 infection is variable, from asymptomatic to severe and potentially fatal. A small percentage of the severely infected patients will end up in an intensive care unit for ventilatory support. Elderly male patients with pre-existing medical conditions and smokers are at a disproportionate high risk to develop severe complications. Studies have shown that deaths occur due to a dysregulated immune system that overreacts, producing a plethora of cytokines, leading to the so-called "cytokine storm" phenomenon. In this direction, many drugs that are used in the everyday practice of Rheumatologists have been used. Indeed, pro-inflammatory cytokines such as the IL-1 and IL-6 have been shown to be the pivotal cytokines expressed, and anti-cytokine treatment has been tried so far with various results. In addition, hydroxychloroquine, an antimalarial drug, has been shown to reduce COVID-19 symptoms. Other drugs have also been used, such as intravenous pulses of immunoglobulins, and colchicine. Robust clinical trials are needed in order to find the suitable treatment. Current data indicate that hydroxychloroquine and cytokine targeting therapies may prove helpful in the fight of SARS-CoV-2 in appropriately selected patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31138/mjr.31.3.259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656133PMC
September 2020

Preclinical discovery and development of adalimumab for the treatment of rheumatoid arthritis.

Expert Opin Drug Discov 2021 Mar 18;16(3):227-234. Epub 2020 Nov 18.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

: Rheumatoid arthritis (RA) is an autoimmune disease that is characterized by progressive joint disorders with significant pain and stiffness. In the past, RA was a difficult -to-treat ailment, but nowadays with the advent of biologics and better treatment strategies, disease remission is an achievable goal. Tumor necrosis factor α (TNFα) inhibitors were the first category of biologics to emerge with adalimumab being the first fully human TNFα.: the authors provide an overview of the historical events that led to the discovery of TNFα inhibitors and more specifically the drug adalimumab. Several key trials are presented regarding the safety of the drug as well as its successful journey, but there is also a narrative description of the drug's future after patent expiration.: Adalimumab is a fully human TNFα inhibitor with a fairly rapid onset of action. It has a generally good safety and efficacy profile. Clinicians must be aware of the possible side effects and treat them in a timely manner or discontinue the drug where appropriate. Due to the success of the bio-originator adalimumab, a multitude of biosimilars have emerged but not, thus far, for all of the indications of the bio-originator.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17460441.2021.1846516DOI Listing
March 2021

Recent advances in the opioid mu receptor based pharmacotherapy for rheumatoid arthritis.

Expert Opin Pharmacother 2020 Dec 2;21(17):2153-2160. Epub 2020 Nov 2.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina , Ioannina, Greece.

Introduction: Opioids are used for severe forms of acute and cancer pain. Over the last years, their potential use in patients with noncancer pain such as those with rheumatoid arthritis (RA) has been postulated. A recent population-based comparative study showed that chronic opioid use was 12% vs. 4% among RA and non-RA patients, respectively. Another study showed an increase from 7.4% to 16.9% (2002 to 2015). In general, there has been an increasing tendency to use opioids in recent years.

Areas Covered: The authors have performed an extensive literature search using PubMed for articles including noncancer pain and the use of the mu opioid receptor (MOR) agonists in patients with RA.

Expert Opinion: Data is not sufficient to support opioid use for the treatment of chronic pain in patients with RA. Data is scarce and inconclusive. Rheumatologists should think and ponder the question: Why is this patient in pain? Differential diagnosis should include a disease flare, degenerative changes of the musculoskeletal system, and fibromyalgia. And while there are new strategies for opioid administration currently being researched, unfortunately, they are far from being applied to human subjects in the everyday clinical setting, and are still being evaluated at an experimental level. : Central nervous system; : delta opioid receptor agonists; : Gastrointestinal; : G protein-coupled receptors; Interleukin; Janus kinase; : kappa opioid receptor agonists; Metacarpophalangeal joints; Mu opioid receptor agonists; Metatarsophalangeal joints; Non-steroidal anti-inflammatory drugsOA: Osteoarthritis; : Opioid receptors; : Pharmacodynamic; Proximal interphalangeal joints; : Pharmacokinetic; : Peripheral nervous system; Rheumatoid arthritis; : Regulator of G protein signaling; : Selective serotonin reuptake inhibitors; Tumor necrosis factor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14656566.2020.1796969DOI Listing
December 2020

Biosimilars and retention rates in patients with ankylosing spondylitis.

Clin Exp Rheumatol 2021 Mar-Apr;39(2):440. Epub 2020 Oct 18.

Division of Rheumatology, University of Ioannina Medical School, Greece.

View Article and Find Full Text PDF

Download full-text PDF

Source
October 2020

Current therapeutic options for the treatment of juvenile idiopathic arthritis.

Curr Rheumatol Rev 2020 Sep 17. Epub 2020 Sep 17.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina. Greece.

Juvenile idiopathic arthritis [JIA] is a chronic inflammatory disease and an exclusion diagnosis that includes all forms of arthritis that persist more than 6 weeks under the age of 16. Although there is not yet a cure for JIA, recent advances in the therapeutic field have created a more hopeful present and future for the patients. In the past, therapies for JIA have depended on non-steroidal medication, conventional synthetic disease modifying antirheumatic drugs and corticosteroids. However, over the last decades, the advent of biologic therapies in JIA contributed to the preservation of functional activity, control of pain, avoidance of joint damage and extra-articular manifestations. Furthermore, over the last years, international institutions such as the American College of Rheumatology have released recommendations and guidelines for rheumatologists for optimal JIA management. All the above, have revolutionized the treatment of JIA with promising outcomes. To this end, we review and discuss appropriately the relevant literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1573403X16999200917151805DOI Listing
September 2020

Incidence of spondyloarthritis and its subtypes: a systematic review.

Clin Exp Rheumatol 2020 Sep 4. Epub 2020 Sep 4.

Division of Rheumatology, University of Ioannina Medical School, Greece.

Objectives: Several epidemiologic studies of spondylarthritis (SpA) and its subtypes have been reported during the last decades. The majority of these studies provided prevalence estimates and showed a considerable variation in the reported frequency of SpA subtypes. Most systematic reviews published in this field aimed to summarise the results of prevalence studies, however, incidence studies are important for an accurate picture of a disease occurrence in a defined population. We conducted a systematic review regarding the incidence of SpA subtypes on studies published during the last 25 years, to compare their methodology and summarise their results.

Methods: A systematic literature search of PubMed was performed to identify all published studies on the incidence of SpA subtypes between 1/1/1995 and 31/12/2019. Studies were considered eligible if the incidence of one or more SpA subtypes was measured in the general population, and met concrete inclusion criteria. Incidence rates (IR) were summarised using a random effect model.

Results: A total of 24 publications fulfilled the inclusion criteria. Most of them included results for two or more SpA subtypes. Sixteen studies presented the incidence of psoriatic arthritis, which gave an overall IR estimate of 9.7 cases per 100.000 person-years. Thirteen studies presented the incidence of ankylosing spondylitis with an overall IR estimate of 4.8, and eight studies presented reactive arthritis incidence with an overall IR estimate of 3.4. A small number of studies referred to the incidence of enteropathic arthritis or undifferentiated spondyloarthritis.

Conclusions: Incidence studies of SpAs differ considerably in their methods, and result in a wide variation of the IRs for all SpA subtypes. Methodological differences may only partly explain the differences in disease occurrence observed among studies. More studies from different populations based on specific classification criteria are needed for a more accurate picture of SpA epidemiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2020

Clinical, Serological and Immunological Characteristics in Greek Patients with Psoriatic Arthritis: The Role of IL-17, IL-23, and Sclerostin.

Mediterr J Rheumatol 2020 Jun 10;31(2):235-236. Epub 2020 Jun 10.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

Psoriatic arthritis (PsA) is an inflammatory form of arthritis that belongs to the family of spondyloarthritis (SpA) and is related to skin psoriasis. The incidence and prevalence of the disease vary considerably between countries. PsA is classified into axial PsA and peripheral PsA, with a wide range of other extra-articular manifestations. Although the aetiology of the disease is unknown, genetic, environmental, and immunologic factors appear to affect its appearance. In recent years, the role of the immune system in the pathogenesis of PsA has been increasingly investigated. Specific cytokines such as tumour necrosis factor (TNF), interleukin (IL-) 17 and IL-23, play an essential role affecting joint structures. This observation led to the emergence of tumour necrosis factor inhibitors (TNFi) that offer considerable therapeutic benefit to PsA patients. However, chronic inflammation causes bone loss, while new bone formation may also occur in both peripheral and axial skeleton. The molecular mechanisms underlying these processes have not yet been fully understood. So far, the role of the Wnt/β-catenin pathway and its inhibitors (Dickkopf and sclerostin) has been evaluated in ankylosing spondylitis (AS), but in PsA has not been studied sufficiently. The present study aims to investigate the epidemiological characteristics and clinical features (articular and extra-articular manifestations) as well as the treatment of PsA patients in the region of northwestern (NW) Greece. It also aims to evaluate the role of specific cytokines and sclerostin in patients with PsA, giving evidence to possible future biomarkers or even therapeutic targets for the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31138/mjr.31.2.235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362117PMC
June 2020

Comparable or higher prevalence of comorbidities in antiphospholipid syndrome vs rheumatoid arthritis: a multicenter, case-control study.

Rheumatology (Oxford) 2021 01;60(1):170-178

Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens.

Objectives: Evidence on comorbidity prevalence in antiphospholipid syndrome (APS) and its difference from high comorbidity burden rheumatic diseases is limited. Herein, we compare multiple comorbidities between APS and RA.

Methods: A total of 326 patients from the Greek APS registry [237 women, mean age 48.7 (13.4) years, 161 primary APS (PAPS), 165 SLE-APS] were age/sex matched (1:2 ratio) with 652 patients from a Greek multicentre RA cohort of 3115 patients. Prevalence of cardiovascular (CV) risk factors, stroke, coronary artery disease (CAD), osteoporosis, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), depression and neoplasms were compared between APS and RA patients using multivariate regression analysis.

Results: Ηyperlipidemia and obesity (ΒΜΙ ≥ 30 kg/m2) were comparable while hypertension, smoking, stroke and CAD were more prevalent in APS compared with RA patients. Osteoporosis and depression were more frequent in APS, while DM, COPD and neoplasms did not differ between the two groups. Comparison of APS subgroups to 1:2 matched RA patients revealed that smoking and stroke were more prevalent in both PAPS and SLE-APS vs RA. Hypertension, CAD and osteoporosis were more frequent only in SLE-APS vs RA, whereas DM was less prevalent in PAPS vs RA. Hyperlipidaemia was independently associated with CV events (combined stroke and CAD) in PAPS and SLE-APS, while CS duration was associated with osteoporosis in SLE-APS.

Conclusion: Comorbidity burden in APS (PAPS and SLE-APS) is comparable or higher than that in RA, entailing a high level of diligence for CV risk prevention, awareness for depression and CS exposure minimization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/rheumatology/keaa321DOI Listing
January 2021

Therapeutic Options and Cost-Effectiveness for Rheumatoid Arthritis Treatment.

Curr Rheumatol Rep 2020 06 26;22(8):44. Epub 2020 Jun 26.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.

Purpose Of Review: During the last two decades, the therapeutic decisions and strategies for rheumatoid arthritis (RA) management have improved dramatically. Today, the therapeutic armamentarium is significantly augmented, and by using both old and new drugs, remission or low disease activity is a reasonable goal. The use of conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) in combination with biologic (b) or targeted synthetic (ts) DMARDs has revolutionized RA treatment. Methotrexate administration is considered fundamental among other csDMARDs for the treatment of RA. It is recommended as the initial drug (monotherapy), or in combination with other csDMARDs, bDMARDs, and tsDMARDs in a step-up strategy. Furthermore, it can be used with other csDMARDs as initial combination-therapy. On the other hand, despite the fact that bDMARDs and ts DMARDs are highly efficacious and can also be used as monotherapy in certain cases, cost-effectiveness is still questionable when compared with csDMARDs. In this direction, the classic argument of utmost importance has to do with the most appropriate treatment strategy that shall be initially applied: csDMARD combination-therapy versus monotherapy, or step-up combinationtherapy with bDMARDs, especially tumor necrosis factor-α (TNFa) blockers. For this reason, a literature review of the most important csDMARDs combination and bDMARDs combination studies has been deployed.

Recent Findings: The results showed that the triple csDMARDs therapy approach is more effective and less expensive. In addition, workers' productivity is higher than any other treatment options for RA. Triple-therapy constitutes a smart, efficacious, and significantly cheaper choice for RA therapeutic management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11926-020-00921-8DOI Listing
June 2020

Bertolotti syndrome: a not-to-miss cause of chronic low back pain in young adults.

Acta Reumatol Port 2020 Jan-Mar;45(1):58-60

University Hospital of Ioannina.

Low back pain (LBP) in young adults is a common condition that needs to be appropriately examined in cases of refractory to classic treatment strategies. We present two cases of chronic LBP with challenging diagnosis and treatment refractoriness. The first case corresponds to a young lady that has been treated mistakenly with an anti-tumor necrosis factor because her treating doctors diagnosed unilateral sacroiliitis which turned out to be a magnetic resonance imaging (MRI) artifact (partial volume artifact). The second case is about another young lady with chronic LBP that did not respond to the classic treatment with non-steroidal anti-inflammatory drugs. Both cases have been diagnosed as having Bertolotti syndrome. Bertolotti syndrome is an anatomical abnormality consisting of partial unilateral or bilateral fusion of the transverse process of the lowest lumbar vertebrae to the sacrum. The presentation of both cases highlights the importance of a minute history taking and clinical examination especially in young patients with chronic LBP.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2020

The lipid paradox in rheumatoid arthritis: the dark horse of the augmented cardiovascular risk.

Rheumatol Int 2020 Aug 10;40(8):1181-1191. Epub 2020 Jun 10.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation that, if left untreated, can cause joint destruction and physical impairments. The inflammatory process is systematic, and it is associated with increased morbidity and mortality. Over the last years, mortality presents a decreasing trend; still, there is a high burden of cardiovascular disease (CVD) in RA that seems to be related to coronary atherosclerosis. Chronic inflammation, physical inactivity, and drugs used to treat RA are some of the reasons. Thus, the management of CVD risk is essential and involves the patient's stratification using distinct parameters that include assessment of the blood lipid profile. However, 'dyslipidemia' in RA patients follows a different pattern under the impact of inflammatory processes, while therapies that target the underlying disease change the levels of specific lipid components. In this review, we explore the relationship between blood lipids and inflammation in the so-called ΄lipid paradox΄ in RA, and we present the existing knowledge over the influence of antirheumatic drugs on the lipid profile of RA patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-020-04616-2DOI Listing
August 2020

Fasting mimicking diets: A literature review of their impact on inflammatory arthritis.

Mediterr J Rheumatol 2019 Dec 31;30(4):201-206. Epub 2020 Mar 31.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

Fasting is an act of restricting, for a certain length of time, food intake or intake of particular foods, and has been part of religious rituals for centuries. Religions such as Christianity and Islam use this practice as a form of sacrifice, self-discipline, and gratitude. However, in the past decade, fasting has penetrated the mainstream as a diet trend. There are several ways of fasting; existing fast mimicking eating methods promise accelerated weight loss, and many more benefits: lower cholesterol, prevention of type 2 diabetes and a longer lifespan. Even more, it has been proposed that fasting can downregulate the inflammatory process and potentially be used as a treatment regimen for several diseases. Here, we review the effects of fasting on immune and inflammatory pathways. Also, we present current knowledge about the role of fasting in the activity of inflammatory arthritides with a focus on rheumatoid arthritis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31138/mjr.30.4.201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241659PMC
December 2019

Neuroinflammatory events after anti-TNFα therapy.

Ann Rheum Dis 2020 May 20. Epub 2020 May 20.

Internal Medicine, Division of Rheumatology, University of Ioannina Faculty of Medicine, Ioannina, Greece

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/annrheumdis-2020-217723DOI Listing
May 2020

Radiological Findings of the Cervical Spine in Rheumatoid Arthritis: What a Rheumatologist Should Know.

Curr Rheumatol Rep 2020 05 13;22(6):19. Epub 2020 May 13.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.

Purpose Of Review: Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting mainly the peripheral skeleton in a symmetrical manner rather than the axial skeleton, but when it occurs it can affect the cervical spine (CS). Although CS involvement is a frequent radiographic finding in RA, the clinical features are scarce, but potentially life-threatening with severe neurological deficits or even death due to brain stem compression. The commonest site of inflammation of the CS is the articulation between C and C vertebrae, the atlanto-axial region. The radiological finding observed in this region is the atlanto-axial subluxation (AAS). For the evaluation of CS in RA the classical diagnostic technique used mostly is conventional radiography (CR). Since CR does not provide good information regarding synovial inflammation, other imaging modalities are used such as magnetic resonance imaging and computed tomography. However, CR is the most valuable tool for screening CS in RA patients. Thus, we reviewed the literature until December 2019 for studies regarding CS radiological manifestations using CR in RA patients.

Recent Findings: We found that the frequency of radiological findings varies substantially, ranging between 0.7-95% in different studies. The commonest radiological feature was the AAS followed by subaxial subluxation. Because CS involvement can often be clinically asymptomatic, its assessment should not be forgotten by physicians and should be assessed using CR which is an easy to perform technique and gives important information as a screening tool.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11926-020-00894-8DOI Listing
May 2020

Adalimumab-induced myasthenia gravis: case-based review.

Rheumatol Int 2020 Nov 22;40(11):1891-1894. Epub 2020 Apr 22.

Department of Internal Medicine, Medical School, Rheumatology Clinic, University of Ioannina, 45110, Ioannina, Greece.

Myasthenia gravis (MG) is an autoimmune disease characterised by the presence of acetylcholine receptor antibodies and by blocking the transmission of the signal in the neuromuscular junction causing muscle weakness. It can be associated with several autoimmune diseases and certain drugs, between them Etanercept an anti-tumour necrosis factor (TNF) agent. A 42-year-old woman with rheumatoid arthritis (RA) refractory to methotrexate, was treated with adalimumab (ADA), a human monoclonal antibody against the TNF, in a dosage scheme of 40 mg every 14 days subcutaneously. The patient responded well to ADA therapy with sustained remission for 18 months when she developed blurred vision and eyelid ptosis of the left eye. The diagnosis of ocular MG was made. ADA has been discontinued and she started a treatment with pyridostigmine showing an excellent response and complete remission within a 2-month period. This is the first report making an association of ADA and ocular MG. Thus, rheumatologists dealing with patients treated with TNF inhibitors should be aware of the possible development of neurological adverse events, among them MG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-020-04587-4DOI Listing
November 2020

Persistence and Adherence during the First Six Months of Tocilizumab Treatment Among Rheumatoid Arthritis Patients in Routine Clinical Practice in Greece. Results from the Single Arm REMISSION II Study (NCT01649817).

Mediterr J Rheumatol 2019 Sep 30;30(3):177-185. Epub 2019 Sep 30.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

Objective/aim: One of the most important factors that affect a treatment's performance in rheumatoid arthritis (RA) is adherence to medications. According to literature, there are several reasons for non-adherence in RA patients with some of them being related to a specific patient profile of the study population. In this study, we investigated persistence to intravenous tocilizumab (TCZ) therapy in RA during routine clinical practice in Greece and identified causes for non-adherence.

Methods: 183 RA patients who mostly attended private practice Rheumatologists and received intravenous TCZ treatment at a schedule of 1 infusion per 4-weeks in the first 6 months were recorded retrospectively.

Results: Persistence estimated rate to TCZ therapy was 92.0% for patients that received 6 infusions and 83.4% for patients that received 7 infusions of TCZ. Potential factors that influence persistence to therapy were the occurrence of adverse events and response to the therapy. The main reasons for non-adherence to TCZ therapy were non-medically related with the most common being drug supply issues. The 6-month mean change from baseline in DAS28-ESR after initiation of TCZ therapy was -1.3, and the mean CDAI dropped from 29.6 at baseline to 16.7 at 6 months. Good/Moderate response was achieved by 89.1% of patients and remission by 23.5%. The safety profile was similar to that observed in other TCZ trials with the most common being infections, hematologic manifestations and musculoskeletal disorders.

Conclusion: Overall, persistence to therapy appeared to be high in the rheumatology private practice setting and non-adherence to the TCZ treatment schedule is attributed mainly to non-medical reasons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31138/mjr.30.3.177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045860PMC
September 2019

Treatment strategies are more important than drugs in the management of rheumatoid arthritis.

Clin Rheumatol 2020 Apr 22;39(4):1363-1368. Epub 2020 Feb 22.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.

The treatment of inflammatory arthritides has been changed dramatically in the past two decades with the introduction of the biological (b) disease-modifying anti-rheumatic drugs (DMARDs) as well as the targeting synthetic (ts) DMARDs that can be used as monotherapy or in combination with conventional synthetic (cs) DMARDs. The concept of treat to target (T2T) and tight control monitoring of disease activity represents a therapeutic paradigm of modern rheumatology. In rheumatoid arthritis (RA), this treatment approach has proven to be effective in many clinical trials and is now a well-established approach. The most common treatment strategies rely on the combination of csDMARDs (mainly methotrexate, sulfasalazine and hydroxychloroquine). This comes from different studies which compare the outcomes of combination therapies versus csDMARD monotherapy or versus methotrexate plus biologics in early RA patients. Here, we review the literature of the most important T2T studies for RA patients. The results showed that a tight control strategy appears to be more important than a specific drug to control RA. T2T approach aiming for remission or low disease activity can be achieved in early RA patients using less expensive drugs in comparison to newer drugs and this may need to be recognised in the future recommendations for the management of RA. KEY POINTS: • Tight-control and treat-to-target (T2T) strategies are the cornerstone in achieving remission or low disease activity in rheumatoid arthritis (RA) • A plethora of clinical trials has confirmed the efficacy of csDMARDs when the tight-control and T2T strategies are applied • T2T and tight-control strategies are a less expensive option in comparison to newer drugs and may be recognised in the future recommendations for the management of RA. • Treatment decisions and strategies are more important than just the drugs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10067-020-05001-xDOI Listing
April 2020

Clinical evaluation of the safety, efficacy and tolerability of sarilumab in the treatment of moderate to severe rheumatoid arthritis.

Ther Clin Risk Manag 2019 4;15:1073-1079. Epub 2019 Sep 4.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

Rheumatoid arthritis (RA) is an autoimmune disease that is characterised by synovial inflammation and progressive joint disorder with significant pain and stiffness, which lead to functional disability and systemic complications if left untreated. Although methotrexate (MTX) is the cornerstone in the RA therapy, it is ineffective or intolerable in up to 50% of patients. In addition, tumour necrosis factor (TNF) inhibitors which are regarded as the standard of care for those patients, have not been proven a panacea creating a therapeutic gap. In this direction, other cytokines such as the interleukin (IL)-6 in combination with MTX or as monotherapy have been approved. Sarilumab has already been approved for the treatment of moderate to severe RA, but more studies are on their way including polymyalgia rheumatica, giant cell arteritis, juvenile idiopathic arthritis, and indolent systemic mastocytosis. On the other hand, a study was prematurely discontinued after approximately 1.5 years, when the ankylosing spondylitis development program was discontinued due to lack of efficacy. Regarding safety, efficacy and tolerability of the molecule, three pivotal clinical trials have established sarilumab as one of the safe and efficacious choices for the treatment of RA (mobility, target and monarch trials). Significant decreases in progression of structural damage have been demonstrated. Infections and neutropenia are two of the most common adverse events. Sarilumab is beyond any doubt another molecule that can be added to the clinicians' armamentarium for the treatment of patients with moderate to severe RA with a good safety and efficacy profile.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/TCRM.S167452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732515PMC
September 2019

Reply to the Editor.

Semin Arthritis Rheum 2020 04 1;50(2):e7. Epub 2019 Aug 1.

Department of Internal Medicine Medical School, University of Ioannina Rheumatology Clinic, 45110 Ioannina, Greece. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.semarthrit.2019.07.005DOI Listing
April 2020

Eight-year survival study of first-line tumour necrosis factor α inhibitors in rheumatoid arthritis: real-world data from a university centre registry.

Rheumatol Adv Pract 2019 14;3(1):rkz007. Epub 2019 Mar 14.

Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, Ioannina, Greece.

Objective: This study aimed to investigate the efficacy, safety and survival of TNF-α inhibitors in patients with RA.

Methods: A total of 178 patients >18 years of age were treated with TNF-α inhibitors. A total of 74 patients were treated with infliximab, 75 with adalimumab and 29 with etanercept. Each patient was followed-up for a period of 8 years.

Results: Anti-TNF-α therapy resulted in rapid clinical improvement. The rate of good/moderate response according to EULAR response criteria for the index 28-joint DAS with CRP in the first 6 months was 82% for infliximab, 89.6% for adalimumab and 95.6% for etanercept. The rate of withdrawal in 8 years was 80% for patients on infliximab, 61.4% for patients on adalimumab and 47.6% for patients on etanercept. The main reasons for discontinuation were allergic reactions for infliximab (rate of discontinuation 25.7%) and inefficacy for adalimumab and etanercept (17.5% and 23.8%, respectively). Systemic allergic reactions and infections were significantly more frequent in the infliximab group ( < 0.05 and  < 0.001, respectively). However, there was no significant difference among the three drugs concerning serious infections. According to Kaplan-Meier survival analysis, a significantly faster withdrawal for infliximab patients was depicted compared with adalimumab ( = 0.003) and etanercept ( = 0.019), while adalimumab and etanercept were not statistically different ( = 0.089).

Conclusions: TNF-α inhibitors establish an effective therapeutic option in RA showing an acceptable safety profile. Infections and allergic reactions appear more often with infliximab, while serious infections did not differ among them. RA patients treated with infliximab are more likely to discontinue treatment earlier compared with the other alternatives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/rap/rkz007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649942PMC
March 2019

Rheumatoid Arthritis Treatment. A Back to the Drawing Board Project or High Expectations for Low Unmet Needs?

J Clin Med 2019 Aug 16;8(8). Epub 2019 Aug 16.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece.

Despite the significant progress in Rheumatoid Arthritis (RA) therapeutics, there are several reports in the literature claiming that the size of unmet needs in RA is large. In the era before biologics, there was indeed a significant number of patients who did not achieve low disease activity (LDA) or disease remission due to limited therapeutic choices in the doctors' armamentarium. Treatment wise, great progress has been achieved over the last decades with the discovery and introduction in therapeutics of new molecules, such as the biological (b) disease-modifying anti-rheumatic drugs (DMARDs), and the targeted synthetic (ts) DMARDs. Today, with such a plethora of conventional synthetic (cs) DMARDs, tsDMARDs, and bDMARDs, why are we unable to successfully treat RA patients? What is wrong? However, a new drug for RA does not mean it is necessary to switch to a new treatment. It is very easy to change and switch therapies when the patient complains about pain and stiffness. In this setting, it is obligatory to rule out other comorbidities and disorders that may be the cause of the pain first. Thus, clinicians must have a deep knowledge of the drug therapy and be able to adjust the treatment when needed. A minute clinical examination must be carried out on every visit with close monitoring of the patient. A treat-to-target (T2T) approach and the application of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) recommendations and strategies should minimize the unmet needs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8081237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722985PMC
August 2019

Cardiovascular Disease in Spondyloarthritides.

Curr Vasc Pharmacol 2020 ;18(5):473-487

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

The spondyloarthritides are a group of chronic systemic inflammatory joint diseases, the main types being ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Evidence accumulating during the last decades suggests that patients with AS or PsA carry an increased risk for cardiovascular disease and cardiovascular death. This risk appears to be mediated by systemic inflammation over and above classical cardiovascular risk factors. The excess cardiovascular risk in those patients has been formally acknowledged by scientific organizations, which have called physicians' attention to the matter. The application by Rheumatologists of new effective anti-rheumatic treatments and treat-to-target strategies seems to benefit patients from a cardiovascular point of view, as well. However, more data are needed in order to verify whether anti-rheumatic treatments do have an effect on cardiovascular risk and whether there are differences among them in this regard. Most importantly, a higher level of awareness of the cardiovascular risk is needed among patients and healthcare providers, better tools to recognize at-risk patients and, ultimately, commitment to address in parallel both the musculoskeletal and the cardiovascular aspect of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1570161117666190426164306DOI Listing
December 2020

Maintained Clinical Remission in Ankylosing Spondylitis Patients Switched from Reference Infliximab to Its Biosimilar: An 18-Month Comparative Open-Label Study.

J Clin Med 2019 07 2;8(7). Epub 2019 Jul 2.

Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece.

Background: Switching from reference infliximab (RI) to biosimilar infliximab (BI) had no detrimental effects on efficacy and safety. However, long-term follow-up data is missing.

Objective: To evaluate patients with Ankylosing Spondylitis (AS) in clinical remission who were switching from RI to BI, in terms of the safety and efficacy of this, in a long-term fashion.

Methods: One hundred and nine consecutive unselected AS patients were investigated. All were naïve to other biologics and were followed-up at predefined times receiving RI. Patients in clinical remission were asked to switch from RI to BI. Those who switched to BI were compared with a matched control-group receiving continuous RI. During follow-up, several parameters were recorded for at least 18 months. Disease activity was measured using the Bath Ankylosing Spondylitis disease activity index (BASDAI), and the Ankylosing Spondylitis disease activity score (ASDAS), using the C-reactive protein. Remission was defined as BASDAI < 4 and ASDAS < 1.3.

Results: Eighty-eight patients were evaluated (21 excluded for different reasons). From those, 45 switched to BI, while 43 continued receiving RI. No differences between groups regarding demographic, clinical and laboratory parameters were observed. All patients were in clinical remission. During follow-up, five patients from the BI-group and three from the maintenance-group discontinued the study (4 patients nocebo effect, 1 loss of efficacy). After 18 months of treatment, all patients in both groups remained in clinical remission. No significant adverse events were noted between groups.

Conclusion: BI is equivalent to RI in maintaining AS in clinical remission for at least 18 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8070956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679061PMC
July 2019