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Berlin Brandenburg

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  • 1
    Language: English
    In: Clinical Rheumatology, 2012, Vol.31(8), pp.1163-1168
    Description: Recent data suggest that atherosclerotic disease is increased in patients with idiopathic inflammatory myositis (IIM) and that dyslipidemia is a significant risk factor for cardiovascular events. Lipid-lowering agents may be associated with myopathic side effects. The current work evaluates the use of lipid-lowering therapy in patients with IIM treated by IIM specialists belonging to the International Myositis Assessment and Clinical Studies (IMACS) Group. The IMACS Group is a multidisciplinary coalition of experts with significant interest and experience in IIM. IMACS members were asked to complete an 18-item online survey detailing their clinical practice on monitoring and treating hypercholesterolemia in IIM patients. Specific questions regarding the types of lipid-lowering therapies used in IIM patients and any side effects associated with treatment were asked. Sixty-three IMACS members representing 23 countries and a minimum of 1,641 IIM patients participated in the online survey. Seventy-six percent of these specialists treating adult IIM patients use lipid-lowering therapies in their patients. HMG co-enzymeA reductase inhibitors (statins) were the most commonly used agents (93 %). Thirty-six cases of worsening myositis associated with statin use were reported in over 300 patients using lipid-lowering therapies. Seven of eight responders who reported worsening in myositis with lipid-lowering therapies reported cases in which the myositis improved after holding therapy. This survey suggests that statins are commonly used by physicians specializing in the treatment of patients with IIM and that some myositis patients worsen with statin use and may improve on dechallenge. More research regarding the safety of lipid-lowering agents in patients with IIM is warranted.
    Keywords: Dermatomyositis ; Dyslipidemia ; Idiopathic inflammatory myositis ; Inclusion body myositis ; Myositis ; Polymyositis ; Statins
    ISSN: 0770-3198
    E-ISSN: 1434-9949
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  • 2
    In: Arthritis & Rheumatism, June 2013, Vol.65(6), pp.1430-1438
    Description: Objective To study changes in lipid profiles at 24 weeks among patients with early rheumatoid arthritis (RA) participating in the Treatment of Early RA (TEAR) trial and randomized to receive methotrexate (MTX) plus etanercept, triple therapy (MTX plus sulfasalazine plus hydroxychloroquine), or aggressively titrated MTX monotherapy. Methods This TEAR substudy included 459 participants with biologic specimens. Serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol were measured at 0 and 24 weeks. Results At 24 weeks, there were statistically significant increases in mean cholesterol levels in the MTX plus etanercept, triple therapy, and MTX monotherapy arms. The observed increases were 31.4 mg/dl, 28.7 mg/dl, and 30 mg/dl in LDL cholesterol, 19.3 mg/dl, 22.3 mg/dl, and 20.6 mg/dl in HDL cholesterol, and 56.8 mg/dl, 53 mg/dl, and 57.3 mg/dl in total cholesterol (P 〈 0.0001 versus baseline for each comparison). There was a statistically significant decrease in the ratio of total cholesterol to HDL cholesterol at 24 weeks in all 3 treatment groups versus baseline. There was no difference in any lipid changes between the 3 treatment arms. After multivariable adjustment, change in C-reactive protein, but not the Disease Activity Score in 28 joints, was associated with change in LDL cholesterol (P = 0.03) and total cholesterol (P = 0.01). Baseline glucocorticoid use was associated with changes in HDL cholesterol (P = 0.03) and total cholesterol (P = 0.02). Conclusion Levels of total cholesterol, LDL cholesterol, and HDL cholesterol increased comparably shortly after initiation of MTX plus etanercept, triple therapy, and MTX monotherapy among patients with early RA with active disease participating in a clinical trial. The clinical relevance of short-term changes in traditional lipids on cardiovascular outcomes remains to be determined. [PUBLICATION ]
    Keywords: Adult–Administration & Dosage ; Aged–Therapeutic Use ; Antirheumatic Agents–Drug Therapy ; Antirheumatic Agents–Blood ; Arthritis, Rheumatoid–Blood ; Cholesterol, HDL–Administration & Dosage ; Cholesterol, LDL–Therapeutic Use ; Drug Therapy, Combination–Administration & Dosage ; Female–Therapeutic Use ; Humans–Administration & Dosage ; Hydroxychloroquine–Therapeutic Use ; Hydroxychloroquine–Administration & Dosage ; Immunoglobulin G–Therapeutic Use ; Immunoglobulin G–Administration & Dosage ; Male–Therapeutic Use ; Methotrexate–Therapeutic Use ; Methotrexate–Therapeutic Use ; Middle Aged–Therapeutic Use ; Receptors, Tumor Necrosis Factor–Therapeutic Use ; Receptors, Tumor Necrosis Factor–Therapeutic Use ; Sulfasalazine–Therapeutic Use ; Sulfasalazine–Therapeutic Use ; Treatment Outcome–Therapeutic Use ; Cholesterol ; Drug Therapy ; Methotrexate ; Antirheumatic Agents ; Cholesterol, HDL ; Cholesterol, LDL ; Immunoglobulin G ; Receptors, Tumor Necrosis Factor ; Tnfr-Fc Fusion Protein ; Sulfasalazine ; Hydroxychloroquine ; Methotrexate;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 3
    Language: English
    In: Annals of the Rheumatic Diseases, 20 July 2012, Vol.71(7), p.1157
    Description: Reverse cholesterol transport (RCT) is a major antiatherogenic function of high density lipoprotein (HDL). In the current work, the authors evaluated whether the RCT capacity of HDL from rheumatoid arthritis (RA) patients is impaired when compared to healthy controls.
    Keywords: Medicine;
    ISSN: 0003-4967
    ISSN: 00034967
    E-ISSN: 1468-2060
    E-ISSN: 14682060
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  • 4
    Language: English
    In: Rheumatology International, 2012, Vol.32(9), pp.2725-2729
    Description: Patient overall satisfaction with health (PSH) was measured by a subset of questions from the Arthritis Impact Measurement Scales II. Based on longitudinal observations for 267 early rheumatoid arthritis (RA) patients of the United States Western Consortium (WC) cohort receiving first non-biologic DMARD treatment, we estimated the 1-year change in PSH ( $$\Updelta$$ PSH). Logistic regression analysis was used to estimate the association of improvement in $$\Updelta$$ PSH with the core set of clinical and patient-reported components of disease activity scores (DAS). Most patients were more satisfied with health after 1 year of treatment (80%); few achieved DAS28-ESR minimal disease activity (27%) or remission (7%). Laboratory and joint count measures were not associated with improved 12-month PSH. Patients with greater HAQ-DI ( P = 0.0473) and self-reported stiffness ( P = 0.0669) were more likely to have a perceived overall health benefit from treatment. Regardless of objective disease status, patients are generally satisfied with first-line treatment, which could present a challenge to implementing DAS-guided treatment change. Patients with greater self-reported functional limitations might have lower expectations for treatment benefit and be less willing to modify their current therapy; subjective assessments of function and stiffness could be particularly useful in identifying these patients.
    Keywords: Disease activity score ; Disease-modifying antirheumatic drugs ; Remission ; Rheumatoid arthritis ; Patient-reported outcome ; Patient satisfaction ; Stiffness
    ISSN: 0172-8172
    E-ISSN: 1437-160X
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  • 5
    Language: English
    In: Arthritis & Rheumatism, October 2009, Vol.60(10), pp.2870-2879
    Description: OBJECTIVE: To characterize the antiinflammatory function of high-density lipoprotein (HDL) in patients with rheumatoid arthritis (RA) and to identify specific differences in HDL-associated proteins and enzymes that distinguish proinflammatory HDL from normal, antiinflammatory HDL.METHODS: We studied 132 RA patients. The antiinflammatory function of HDL was assessed by a cell-free assay, and proinflammatory HDL was defined by an HDL inflammatory index 〉 or =1. Plasma and HDL-associated protein levels of apolipoprotein A-I (Apo A-I), haptoglobin, hemopexin, hemoglobin, and myeloperoxidase (MPO) were measured by direct and sandwich enzyme-linked immunosorbent assays, respectively. Lecithin:cholesterol acyltransferase (LCAT) activity was measured by a commercially available assay.RESULTS: Age, disease activity, the presence of erosive disease, non-Caucasian race, and smoking were significantly associated with proinflammatory HDL on multivariate analysis. Patients with proinflammatory HDL had higher measures of systemic inflammation, and a significant correlation was observed between RA disease activity (using the Disease Activity Score in 28 joints) and the HDL inflammatory index (r = 0.54, P 〈 0.0001). Compared with patients with antiinflammatory HDL, patients with proinflammatory HDL had significantly higher levels of haptoglobin, hemoglobin, Apo A-I, and MPO associated with HDL (P 〈 0.05 for all comparisons except MPO, which was P = 0.05). LCAT activity was lowest in patients with proinflammatory HDL, but was also significantly reduced in RA patients with antiinflammatory HDL as compared with healthy controls (P = 0.001).CONCLUSION: Proinflammatory HDL in this RA patient cohort was associated with active disease and an altered protein cargo as compared with antiinflammatory HDL in RA patients and in healthy controls. The antiinflammatory function of HDL was inversely correlated with systemic inflammation in RA patients and may warrant further investigation as a mechanism by which active RA increases cardiovascular morbidity and mortality.
    Keywords: Medicine;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 6
    Language: English
    In: The Journal of rheumatology, July 2007, Vol.34(7), pp.1459-64
    Description: Patients with rheumatoid arthritis (RA) have a 2-3-fold increased risk of myocardial infarction. Recent work suggests that plasma high density lipoproteins (HDL) from patients with RA are more proinflammatory than HDL from controls. We examined the effects of atorvastatin 80 mg daily on the inflammatory properties of HDL and clinical disease activity in RA. Twenty subjects with active RA (mean Disease Activity Score 5.13 +/- 0.92) without dyslipidemia and no history of coronary artery disease were randomized in a double-blind placebo-controlled trial to receive 80 mg of atorvastatin (A) or placebo (P) daily in addition to stable antirheumatic drug therapy. Disease activity variables were followed over 12 weeks and the anti-/proinflammatory properties of HDL were determined by a cell-free assay (CFA) that measures lipid oxidation products. After 12 weeks, subjects completing the A protocol had a mean reduction in CFA values of 14.8 +/- 21.7%, while subjects completing P protocol had a mean increase in CFA values of 7.1 +/- 13.2% (p = 0.026). There was a trend for a decrease in highly sensitive C-reactive protein (hs-CRP) over 12 weeks in the A group compared to an increase in hs-CRP in the P group (p 〉 0.05), but changes in measures of clinical disease activity and plasma cytokine/intercellular adhesion molecule-1 levels were not significantly different in the A and P groups. In patients with active RA, HDL was rendered more antiinflammatory by high-dose atorvastatin compared to placebo. Functional characterization of HDL may warrant further investigation as a method of cardiovascular risk assessment in RA patients without traditional coronary risk factors. (ClinicalTrials.gov number NCT00356473).
    Keywords: Anti-Inflammatory Agents -- Therapeutic Use ; Anticholesteremic Agents -- Therapeutic Use ; Arthritis, Rheumatoid -- Drug Therapy ; Heptanoic Acids -- Therapeutic Use ; Lipoproteins, HDL -- Drug Effects ; Pyrroles -- Therapeutic Use
    ISSN: 0315-162X
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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