Managing the use of glucocorticoid therapy in rheumatic disease

This is the patient version of the EULAR recommendations for the management of glucocorticoid medicines in people with rheumatic diseases. The original publication can be downloaded from the EULAR website: www.eular.org.

INTRODUCTION
Glucocorticoids (prednisone or prednisolone) are medicines to reduce inflammation. They are used in rheumatic diseases such as rheumatoid arthritis, polymyalgia, lupus and vasculitis for a long time. Documents called recommendations give advice to doctors and patients about the best way to treat and manage diseases. EULAR has written recommendations on glucocorticoids for people with rheumatic diseases before. Those recommendations focused on low (small) doses (less than 7.5 mg every day) rather than the medium or high (large) doses that some people need to take – sometimes as much as 100 mg every day. These new recommendations will make sure that higher doses are used safely. The recommendations were written by doctors and patients. The authors looked at the evidence on the use of medium and high doses of glucocorticoids. They looked especially at the adverse events (side effects) that the medicine can cause.
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Newly updated advice on the treatment of patients with AAV

INTRODUCTION
A central focus of newly updated recommendations on treating ANCA-associated vasculitis (AAV) is shared decision-making between patients and doctors. The updated recommendations, produced by a collaboration between the European League Against Rheumatism (EULAR) and European Renal Association – European Dialysis and Transplant Association (ERA-EDTA), taking account of recent research on the benefits and safety treatments for AAV.
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New cut-offs for the DAPSA may aid disease activity scoring

The DAPSA is a disease-specific, validated and feasible tool for the assessment of psoriatic arthritis.

INTRODUCTION
Psoriatic arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. The disease often causes swelling of the fingers and toes. It gets its name from the link between this type of arthritis and a skin condition called psoriasis, which causes redness and scaling. Being able to measure disease activity in psoriatic arthritis allows doctors to see how well medicines are working. There are many different disease activity scores available that look at different parameters. The Disease Activity Index for Psoriatic Arthritis (also known as DAPSA) is one of these and has been developed to include a series of key disease elements. High disease activity generally means that a person’s disease is not well controlled, and may be causing joint damage and pain. Being in low disease activity or remission (no signs of symptoms) is the goal of treatment for psoriatic arthritis. Continue reading New cut-offs for the DAPSA may aid disease activity scoring

Negative life events may cause chronic pain

Negative life events are a risk factor for the onset of chronic pain, suggesting that psychosocial factors play a role in triggering the development of this condition.

INTRODUCTION
Some people experience chronic, long-term pain with no obvious medical reason. It is thought that this could be caused by stressful events in a person’s life that cause areas of the brain and nervous system to become extra sensitive. Stress is a normal biological response to a threat. The biological stress system is a complicated interaction between the body’s stress hormones, the immune system and the nervous system. Some parts of this are sometimes called the ‘fight or flight’ response. Continue reading Negative life events may cause chronic pain

Inflammation in rheumatoid arthritis results in shortened lifespan

Much of the increase in mortality in people with rheumatoid arthritis who are also diagnosed with cancer may be due to the inflammatory effects of the arthritis or its treatment, and not the cancer.

INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It can affect both men and women of all ages. The inflammation can also affect people’s internal organs. Patients with rheumatoid arthritis have a higher risk of developing cancer and a shorter lifespan compared to healthy people of the same age. Decreased survival in people with rheumatoid arthritis is still a problem despite the availability of new treatments for the disease. Continue reading Inflammation in rheumatoid arthritis results in shortened lifespan

Economic background can have an impact on patient-reported outcomes

There are differences in outcomes across countries, with worse physician-reported outcomes but better patient reported outcomes in low-income countries.

INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It can also affect internal organs. Rheumatoid arthritis is more common in older people, but there is also a high prevalence in young adults, adolescents and even children, and it affects both men and women. Inequalities in the health of people with rheumatoid arthritis have been reported. Previous studies have noticed that rheumatoid arthritis patients with lower incomes or lower levels of education have higher disease activity than those who are wealthier or have completed higher education. This link also seem to be true at international level, as people in less wealthy countries tend to have worse disease activity than people living in richer countries. Continue reading Economic background can have an impact on patient-reported outcomes

Ulcers on the fingers may predict disease worsening and survival in people with systemic sclerosis

People with digital ulcers early in the course of their systemic sclerosis may be more likely to suffer complications of the disease.

INTRODUCTION
Systemic sclerosis is a serious disease of the connective tissues, where the tissue grows abnormally and triggers the immune system to attack itself (autoimmunity). This can cause hardening (fibrosis) and swelling of the skin, as well as joint pain, digestive problems and lung disease caused by fibrosis and scarring. People with systemic sclerosis are at increased risk of cardiovascular and heart problems. Systemic sclerosis usually starts in people aged 30–50 years of age, and is more common in women than men. Digital ulcers are breaks in the skin that can be painful and disabling. These often occur on the fingertips or finger joints. Because there is a reduced blood flow in these areas, digital ulcers can be slow to heal and may get infected. Continue reading Ulcers on the fingers may predict disease worsening and survival in people with systemic sclerosis

Early remission can minimise the risk of developing heart disease

Rheumatoid arthritis is associated with heart disease, and each disease flare has an additive effect. But achieving early remission may reduce the risks.

INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints and sometimes their internal organs, causing pain and disability. Many studies have suggested that treatment and interventions should target disease in the early stages to help prevent disability and long-term damage to the joints. People with rheumatoid arthritis have an increased risk of suffering from cardiovascular diseases such as heart attacks and stroke. This is because the inflammation involved in rheumatoid arthritis can have an effect on other systems in the body, as well as the joints.

Continue reading Early remission can minimise the risk of developing heart disease

Smoking can reduce the efficacy of medicines for axial spondyloarthritis

Smoking may interfere with how biologic medicines reduce inflammation and joint damage in people with axial spondyloarthritis.

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. Axial disease affects the sacroiliac joint (in the back part of the pelvis and spine) causing back pain and stiffness. TNF inhibitors belong to a group of medicines called biologic disease modifying antirheumatic drugs, or bDMARDs, (sometimes also called biologics), and include adalimumab, etanercept, infliximab, golimumab and certolizumab-pegol. These drugs work by targeting specific molecules that cause inflammation. By doing so they reduce inflammation in the joints, and decrease pain and disease worsening.

Continue reading Smoking can reduce the efficacy of medicines for axial spondyloarthritis

New imaging techniques may help to assess disease activity in RA

New imaging techniques may offer hope for quicker and cheaper and less invasive imaging in people with rheumatoid arthritis, allowing disease activity and progression to be more closely monitored.

INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints and sometimes their internal organs, causing pain and disability. Rheumatoid arthritis can cause inflammation in the lining of joints (the synovium). This inflammation is known as synovitis. 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, but these can be expensive and time consuming, and may not always be used. Optical spectral transmission (shortened to OST) is a new, non-invasive imaging technique that uses light from a special machine to measure synovitis. Other techniques that use light to measure synovitis also require the person to have an infusion of a special dye into their bloodstream, but OST can take the measurement simply by shining light on the skin and recording the way in which it is reflected back. As well as being noninvasive, OST may be quicker and cheaper to use than other imaging techniques.

Continue reading New imaging techniques may help to assess disease activity in RA