Attila Dunky

Strength and endurance training lead to different post exercise glucose profiles in diabetic participants using a continuous subcutaneous glucose monitoring system

Background  Although both strength training (ST) and endurance training (ET) seem to be beneficial in type 2 diabetes mellitus (T2D), little is known about post‐exercise glucose profiles. The objective of the study was to report changes in blood glucose (BG) values after a 4‐month ET and ST programme now that a device for continuous glucose monitoring has become available.

Increased C282Y Heterozygosity in Gestational Diabetes

Background: Hereditary hemochromatosis is an autosomal recessive disorder of iron metabolism that is characterized by excess accumulation of iron in various organs and often leads to diabetes mellitus (DM). To study whether mutations in the hemochromatosis gene (HFE) could be a risk factor for the development of gestational diabetes mellitus (GDM), the prevalence of HFE mutations in patients with GDM was compared to that of healthy pregnant controls. Methods: GDM was diagnosed in 208 of 2,421 pregnant woman screened between the 24th and 28thweek of gestation over a period of 18 months. Patients and 170 matched control subjects were screened for the HFE gene mutations C282Y and H63D. Results: In North and Central European GDM patients, the allele frequency of the C282Y mutation (7.7%) was higher than in pregnant controls (2.9%; p = 0.04), while the frequency of the H63D mutation was not different (p = 0.45). Three patients with GDM were homozygous for H63D (3.1%), 1 patient was homozygous for C282Y (1.0%), 2 patients were compound heterozygous (2.0%) and 26 were heterozygous [11 C282Y (11.2%) and 15 H63D (15.3%)]. C282Y and H63D allele frequencies were not different between controls and GDM patients of Southern European or non-European origin. Irrespective of the HFE-mutation status, serum ferritin levels were increased in patients with GDM compared to healthy pregnant controls (p = 0.01), while transferrin saturation was similar in both groups. Conclusions: In North and Central European patients with GDM, the C282Y allele frequency is higher than in healthy pregnant women, suggesting a genetic susceptibility to the development of GDM.

The public neglect of rheumatic diseases: insights from analyses of attendees in a musculoskeletal disease awareness activity

Objectives: To obtain data on the care received by individuals counselled during a public health awareness campaign on painful musculoskeletal conditions (MSC). Methods: Easy non-formal access to rheumatologists/pain specialists was offered using a mobile unit (Rheuma-Bus) at widely accessible sites. Clients were asked to assess their severity of pain using a 100 mm visual analogue scale (VAS). Age, gender, disease duration, diagnosis if known, current and previous treatment as well as tentative diagnoses assigned and recommendations given to each individual by the counselling physicians were recorded. Results: Average (SD) VAS pain rating was 59 (20.6) mm. Approximately 40% of clients had never consulted a physician for their condition before, but had lower pain scores than those who had seen a physician. Patients with inflammatory MSC had higher pain scores than those with non-inflammatory conditions. More than 2% of the clients had a newly detected inflammatory rheumatic disease. Conclusions: Many individuals having painful MSC seek medical help only when a very high threshold of pain is reached. Even while under treatment, the high mean pain scores suggest neglect of MSC that are not adequately recognised as important contributors to disability and decreased quality of life.

Short-term infliximab therapy improves symptoms of psoriatic arthritis and decreases concentrations of cartilage oligomeric matrix protein

Objective:  The aim of the current study was to evaluate the short‐term effects of anti‐tumour necrosis factor alpha (infliximab) therapy on serum cartilage oligomeric matrix protein (COMP) levels, a possible biomarker of cartilage destruction.

Psoriasis Arthritis@@@Psoriatic arthritis

SummaryThis article presents an overview of psoriatic arthritis, including the origin, genetic influence and immunologic factors involved in its evolution. The clinical features of psoriatic arthritis are also reviewed in this article, and a discussion of the diagnosis and treatment is included. We have highlighted the current psoriasis treatments, new biological therapies, and their use in practice. This paper reviews the efficacy of these agents, and the importance of their early appliance. The available published data on the efficacy of antimalarials, sulfasalazine, methotrexate, azathioprine and ciclosporin are described, as well as new data on leflunomide and other novel agents.ZusammenfassungDieser Artikel gibt einen Überblick über Psoriasis Arthritis, in dem die Ätiologie, der genetische Einfluss aber auch die immunologisch beeinflussenden Faktoren dieser Erkrankung beschrieben werden. Sowohl klinische Parameter als auch diagnostische Maßnahmen werden in diesem Artikel zusammengefasst. Es werden aktuelle Therapien diskutiert, ebenso werden neue biologische Therapien und ihr Einsatz in der täglichen Routine beschrieben. Zusätzlich wird die unterschiedliche Effektivität der verschiedenen krankheitsmodifizierenden antirheumatischen Therapien und die Wichtigkeit eines raschen Einsatzes überprüft. Die publizierten Ergebnisse über den Einsatz und die Wirksamkeit von Antimalariamittel, Sulfosalazin, Methotrexat, Azathioprin, und Cyclosporin ebenso wie Leflunomid und anderen neuen Wirkstoffen werden beschrieben.

Methotrexat‐Therapie bei rheumatologischen Erkrankungen – ein Update

ZusammenfassungDiese Literaturübersicht faßt die Ergebnisse einer niedrig dosierten Methotrexat-Behandlung bei rheumatologischen Erkrankungen zusammen. Es werden die Wirksamkeit, der Einsatz von Kombinationstherapien und die Wichtigkeit eines frühen Therapiebeginnes beleuchtet. Die entzündungshemmende und immunsupprimierende Wirkung sowie die Toxizität dieses Medikaments werden sowohl bei der rheumatoiden Arthritis als auch anderen rheumatologischen Erkrankungen zusammengefaßt.SummaryThis article summarizes the recent literature on low-dose methotrexate in the rheumatologic illnesses. It reviews the efficacy of these agents, the use of combination therapy, and the importance of early treatment with this disease modifying antirheumatic drug. The anti-inflammatory and immunosuppressive effects as well as the toxicity of the drug in rheumatoid arthritis and other diseases are further defined.

THU0036 The effect of infliximab on plasma lipoproteins

Background We investigated the effect of Infliximab, a mouse-human chimaeric monoclonal antibody that binds and inhibits the activity of TNF a, on Lipid Metabolism in patients with Rheumatoid arthritis (RA) and Psoriatic arthritis (Psa). Objectives Methods Fifteen persons hospitalised in our division of rheumatology were studied. Over a period of eight months 5 male and 10 female patients with a mean age of 56,7 years (age range: 30–81) were included in this study. The subjects included 7 patients with rheumatoid arthritis (RA) according to the ARA criteria (12) and 8 patients with Psoriatic arthritis (PsA). Eight patients had been treated with methotrexat (MTX), 4 with other DMARDs than MTX, 2 patients only received NSAIDs and 5 corticosteroids. Treatment resistant patients with active disease (fulfilling inclusions criteria) received infusions of 3 mg/kg infliximab (at week 0, 2, 6 14, 22 and 30). Two of the patients received 4 mg/kg infliximab after 14 weeks. Lipoprotein (a), Cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol were measured by commercially available kits from Boehringer Mannheim (Mannheim, Germany). Results Infliximab was well tolerated; no toxic effects were observed, no major abnormalities in hematologic findings were noted during or after the study. There was no significant difference either in total cholesterol before and after treatment (209 ± 25 vs. 25 ± 36 mg/dl) or in LDL-cholesterol (1311 ± 24 vs. 1188 ± 4 mg/dl). Lp (a) levels also did not show a change during treatment (median: 1,1 vs. 1,4 mg/dl). However there was a significant rise in triglyceride (TG) levels during treatment with Remicade (1122 ± 48 vs. 1333 ± 5 mg/dl, p < 0.01). HDL levels on the other hand were significantly lowered (566 ± 12 vs. 50 ± 1 mg (dl, p < 0.006) by the treatment. The changes of the main parameters are summarised in Table 1.Abstract THU0036 Table 1 Before Remicade After Remicade Significant p-value TC 209 ± 25 205 ± 36 LDL-Chol 131 ± 24 118 ± 43 HDL-Chol 56 ± 12 50 ± 13 p < 0.006 TG 112 ± 48 133 ± 53 p < 0.01 Lpa 1.1 1.4 Values of the lipid parameters in our 15 patients. Conclusion This study shows that elevated TG and decreased HDL levels occur in patients with RA and PsA after Infliximab therapy. We suggest that these changes in lipid metabolism may be a factor responsible for an increased development of vascular pathology.