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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Education for people with inflammatory arthritis

INTRODUCTION
Patient education is a planned interactive learning process designed to support and enable people with inflammatory arthritis to manage their life and optimise their health. Patient education activities include giving help and advice on healthy living and how to stay well. Receiving patient education helps people to manage their own illness and to have better health and well-being. EULAR recommendations give advice to doctors and patients about the best way to treat and manage diseases. EULAR has published in 2015 recommendations on patient education for people with inflammatory arthritis. Inflammatory arthritis is a group of conditions where the joints become stiff and painful due to the immune system attacking the body’s own tissues and causing inflammation. The main conditions include rheumatoid arthritis, spondyloarthritis/ankylosing spondylitis and psoriatic arthritis. Doctors, nurses, health professionals and patients worked together to develop these recommendations. Including patients in the team ensured that the patient point of view was integrated in the recommendations. The authors looked especially at the evidence on what type of patient education is provided, who provides it and how it is provided. They also looked at the evidence on how well patient education works. Continue reading Education for people with inflammatory arthritis

Biologics should be compared to the highest possible dose of methotrexate

Some drugs work better at higher doses. Traditionally, studies designed to show that biologic drugs are better than methotrexate have not used the highest possible dose of methotrexate to compare against.

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. Methotrexate is a disease-modifying antirheumatic drug (also called a DMARD). Methotrexate is often considered to be the anchor drug in the treatment of rheumatoid arthritis, and it is recommended as the first drug to be used in people with the disease. The dose of methotrexate should be gradually increased according to a person’s disease activity, and it tends to work better at higher doses. Methotrexate is usually first tried as an oral pill, but if the disease continues to be active then methotrexate can be given as an injection instead, which help to get more of the drug into your system where it is needed. Methotrexate should be taken once a week and the maximum dose usually does not exceed 25 mg each week. New drugs with biologic activity (called biologics or bDMARDs) have been developed for the treatment of rheumatoid arthritis, and many studies have concluded that they are better than methotrexate. For a fair comparison, studies designed to show that biologics are better should use methotrexate at its highest possible dose.

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Treat to target may be a possibility in lupus in the near future

A composite definition of low disease activity in lupus may protect against poor 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. In many diseases, having a definition of a treatment target has meant people get better care. For example, if you have high blood pressure, it is not enough to just lower it – your doctor will try to get it below a target level that has been shown to be associated with better results. Targets like these have been defined in rheumatoid arthritis as remission or ’low disease activity state’ (LDAS), but this has never been attempted in lupus.

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A quarter of patients do not agree with their doctor about their disease

Disagreement between people with early axial spondyloarthritis and their doctors happens in one-quarter of cases, and can affect how people are treated.

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) causing back pain and stiffness. It is well known that there is often a difference of opinion between doctors and patients when deciding how severe a disease is, or what the impact is on a person’s life. This difference in opinion (also called discordance) can make it hard to decide on the appropriate treatment, or might mean that people suffering with the disease feel dissatisfied with the care that they receive from their doctor.

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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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Continuous NSAID offers no benefit over on-demand in ankylosing spondylitis

More evidence is needed to confirm whether continuous NSAID can reduce joint damage in people with ankylosing spondylitis.

INTRODUCTION
Ankylosing spondylitis is a chronic inflammatory disease. It mainly involves the joints, but may be associated with other diseases, such as psoriasis (a skin disease), inflammatory bowel disease and uveitis (an inflammation in the eye). These non-joint symptoms are known as extra-articular manifestations and they may arise from the same underlying causes, typically inflammation in the body. 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 the spine, causing back pain and stiffness. Diclofenac is a non-steroidal anti-inflammatory drug (also called NSAIDs). It is given to people with ankylosing spondylitis to reduce inflammation and control pain.

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Treatment-free remission may soon be a realistic goal in rheumatoid arthritis

Tapering and sometimes discontinuation of DMARDS is possible in people with rheumatoid arthritis who achieve sustained remission, hinting at the possibility that the disease could be cured.

INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that causes 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, affecting women more frequently than men. Disease modifying antirheumatic drugs (often referred to as DMARDs) are a type of medicine used to treat rheumatoid arthritis. The term DMARD includes traditional drugs such as methotrexate, as well as newer biologic therapies. DMARDs can prevent joint damage and help people to control their disease. With increasing understanding of rheumatoid arthritis and more available treatment options, today patients are often treated earlier and get better results. Effective, early treatment means that patients with rheumatoid arthritis often achieve remission, where they have no clinical signs or symptoms. There is a growing desire for patients to stop taking their medicine once they have achieved remission, but this needs to be done gradually and under the supervision of a doctor. This procedure is called tapering.

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Women with rheumatoid arthritis and those treated with TNF inhibitors may be at increased risk of cervical cancer

Women with rheumatoid arthritis have a higher risk of cervical cancer, and those treated with TNF inhibitors have a further increased risk, though the link is not conclusive.

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. People with rheumatoid arthritis also have an increased risk of getting cancer. TNF inhibitors belong to a group of medicines called biologic disease modifying antirheumatic drugs, or biologics (sometimes also called bDMARDs), 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 in rheumatoid arthritis. Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix – the opening of the uterus (womb) that can be felt inside the vagina. Dysplasia changes are not cancer, but they are considered to be precancerous. Cancer of the cervix (cervical cancer) in women has been linked to the human papilloma virus (HPV). It has been suggested that TNF inhibitors might affect the immune system’s ability to deal with viruses. Whether treatment with TNF inhibitors increases the risk of cancers associated with viruses is not known.

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