The role of the nurse in inflammatory arthritis

Introduction
Nurses play an important role in looking after people with arthritis, and they are often the person that a patient sees at clinic appointments. The nurse role has changed in modern clinics, and nurses may now perform some tasks that would traditionally have been done by doctors. Nurse specialists trained in rheumatology are able to give patient education and support, give injections, and recommend and prescribe medicines. However, the role for nurses can differ between different countries in Europe.

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Moving young people with rheumatic diseases from paediatric to adult care

Introduction

Recommendations give advice to doctors, other health professionals, patients and their families about the best way to treat and manage diseases. EULAR has written recommendations in partnership with Pediatric Rheumatology European Society (PReS) on the transitional care of young people with rheumatic diseases.
Transitional care means moving young people from their childhood paediatric healthcare team into healthcare systems that look after adults. The recommendations were written by adult and paediatric doctors from rheumatology, young people with rheumatic diseases as well as allied health professionals who are expert in transitional care. They looked at the evidence on the movement of young people with rheumatic diseases. They also discussed their expert opinion to achieve a level of agreement.

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The management of lupus

Introduction

Recommendations give advice to doctors and patients about the best way to treat and manage diseases. EULAR has written recommendations on the management of people with systemic lupus erythematosus (also called SLE or Lupus for short). Lupus is an autoimmune disease where the immune system attacks the body’s own tissues and causes inflammation. Lupus is a complicated disease. It has many different symptoms, including joint pain, fatigue (tiredness) and skin rash. Lupus can also affect internal organs such as the kidneys and cause neurological problems. The recommendations were written by doctors. They looked at the evidence on the management of people with Lupus. They also discussed their expert opinion to achieve a level of agreement. More recently EULAR has created additional recommendations for specific aspects in the care of people with Lupus, namely Neuropsychiatric Lupus, Lupus Nephritis, and fertility and pregnancy in Lupus (see ‘other recommendations’ at the end of this document). The recommendations summarised here look at Lupus in general.

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MRI may be a valid biomarker in RA

MRI measures of inflammation and structural damage correlate independently with physical function, pain and patient global assessments

INTRODUCTION

Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It is more common in older people, and affects both men and women.
The use of patient-reported outcomes (often shortened to PROs) helps to improve communication between
people and their doctors. However, PROs do not always reflect the inflammatory disease burden and can be influenced by other underlying conditions. Therefore disagreement between people and their doctor about the impact of severity of the disease is common.
Imaging techniques allow doctors to see inside the joints to assess any damage and to monitor disease activity and progression (worsening). Common imaging techniques include X-ray, magnetic resonance imaging (MRI) and ultrasound.

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Secukinumab is effective in biologic-naïve and -experienced patients

Secukinumab provides sustained improvements in signs and symptoms of ankylosing spondylitis

INTRODUCTION

Spondyloarthritis is an umbrella term for several conditions that share many of the same features and symptoms, including ankylosing spondylitis, psoriatic arthritis and reactive arthritis. Patients can also be classified as having axial or non-axial (peripheral) disease, according to which joints in their body are affected. Ankylosing spondylitis (often shortened to AS) mainly affects the axial skeleton and the sacroiliac joints (in the back part of the pelvis), causing back pain and stiffness.
Secukinumab (brand name COSENTYX) is a new drug for ankylosing spondylitis. Secukinumab is a type of biologic medicine (also called a biologic disease-modifying antirheumatic drug, or bDMARD). It works by
blocking interleukin-17A – a molecule involved in the development of inflammation.

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Towards a universally accepted definition of remission in lupus

A framework for testing different definitions of remission against long-term outcomes

INTRODUCTION

Systemic lupus erythematosus (also known as SLE or lupus) is an autoimmune disease. It typically affects women between the ages of 15 and 50, and symptoms flare up unpredictably. Lupus is caused by complicated interactions between the immune system and environmental factors leading to an imbalance in the way the immune system works. This imbalance causes inflammation which, if untreated, can lead to disability and shortened lifespan. Different factors may trigger lupus in different people, and symptoms may vary considerably. In some the illness is never life threatening, but can cause chronic skin rashes or arthritis. Others develop potentially life threatening disease in the kidneys, lungs or heart.

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Vaccination for people with autoimmune inflammatory rheumatic diseases

Introduction

Vaccinations are a way of preventing infections before they happen. Vaccines help the immune system to recognise viruses and bacteria that cause disease.

Recommendations give advice to doctors and patients about the best way to treat and manage diseases. EULAR published in 2011 the current recommendations on vaccination for people with autoimmune inflammatory rheumatic diseases such as rheumatoid arthritis, lupus or sclerosis.

The recommendations were written by doctors. They looked at the evidence on the use of vaccines in people with autoimmune conditions. They also discussed their expert opinion to achieve a level of agreement.

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Seronegative patients have higher disease activity

The 2010 ACR/EULAR classification criteria for rheumatoid arthritis may not be appropriate for people withseronegative disease

INTRODUCTION

Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It can also affect internal organs. It is more common in older people, but there is also a high prevalence in youngadults, adolescents and even children and affects both men and women.
An antibody is a protein that the immune system makes to attack foreign substances in the body, such as viruses or bacteria. In autoimmune disease, the body makes antibodies that attack its own tissues. Antibodies can be detected in a person’s blood. Certain antibodies can be used as a marker to classify people with rheumatoid arthritis. The two most common are called rheumatoid factor (or RF) and anticitrullinated protein antibodies (often shortened to ACPA). People with rheumatoid factor or ACPA are said to have seropositive rheumatoid arthritis, which is often thought to be more severe. Not as much is known about seronegative rheumatoid arthritis.

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No increased risk of melanoma with TNF inhibitors

A large European collaborative project.

INTRODUCTION

Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It can also affect internal organs. It is more common in older people, but there is also a high prevalence in young adults, adolescents and even children and affects both men and women. People with rheumatoid arthritis naturally have an increased risk of developing some types of cancer due to their underlying disease, as well as some of the medicines that are used to treat it. Melanoma is a type of cancer that starts in the cells that produce a pigment called melanin. Melanin is what gives us colour in our skin, hair and eyes. Melanoma most often affects the skin, but it may also develop on mucous membranes or in the eyes. Melanomas often start as a dark spot like a mole. They can usually be cured with surgical removal, as long as they have not spread.
Tumour necrosis factor inhibitors (often shortened to TNF inhibitors or TNFi) are a type of medicine known as biologic disease-modifying antirheumatic drugs (also called bDMARDs or biologics). Examples include adalimumab (brand name Humira), etanercept (brand name Enbrel) and infliximab (brand name Remicade). They work by blocking the action of certain molecules involved in the development of inflammation in the body. Some studies have suggested that biologic medicines may increase the risk of developing some types of cancer as they can also alter the biology of tumours.

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Some cancer drugs may cause people to develop autoimmune disease

As immunotherapies are increasingly used for a range of cancers, new cases of rheumatic disease are likely to emerge.

INTRODUCTION

Immune checkpoint inhibitors are a group of medicines used to treat some cancers. They work with a person’s immune system to fight the cancer. Immune checkpoint inhibitors include drugs called nivolumab
(also known by its brand name Opdivo), pembrolizumab (brand name Keytruda) and ipilimumab (brand name Yervoy). Although these medicines work well to treat the cancer, but there have been some reports of people developing side effects in their immune system, which may cause them to get infections, or develop autoimmune diseases.
An autoimmune disease is where the body’s immune system attacks a person’s own tissues instead of
germs and viruses. Rheumatic diseases are autoimmune diseases. This includes many types of inflammatory
arthritis – for example, rheumatoid arthritis – as well as other diseases such as sicca syndrome (also called Sjögren’s syndrome). People with sicca syndrome have dry eyes and mouth in combination with musculoskeletal problems.

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