Mazen Elyan

Does physical therapy still have a place in the treatment of ankylosing spondylitis

Purpose of reviewTo review studies of various physical therapy programs in ankylosing spondylitis and identify their benefits and potential indications in the treatment of this disease. Recent findingsVarious exercise and physical therapy programs have been evaluated in clinical studies. Home exercise programs have been shown to improve symptoms, mobility, function and overall quality of life. Formal physical therapy under the supervision of a physical therapist has been shown to improve posture, fitness, mobility, function and mood. Water therapy may improve symptoms, function and overall sense of health. Inpatient rehabilitation may provide rapid short-term improvement in pain and stiffness, mobility, function and quality of life for patients with severe active disease. SummaryDespite the advances in the pharmacological therapy of ankylosing spondylitis, physical therapy remains an essential part of the management plan. Even though data are not sufficient to determine which specific physical therapy program should be recommended, physicians should implement such nonpharmacological therapy as part of a comprehensive management strategy for this disease. All patients should receive instructions on proper posture and home exercises and be encouraged to perform water exercises if they can. Formal physical therapy and, in most severe cases, inpatient rehabilitation may be of benefit to select patients with ankylosing spondylitis.

Pericarditis: a rare complication of methotrexate therapy

Serositis is a rare complication of methotrexate (MTX) administration. We report a 60-year-old man with rheumatoid arthritis who developed pericarditis after taking his weekly MTX dose, which recurred within hours after 2 subsequent weekly MTX doses. Pericarditis has not recurred after discontinuance of MTX over 3xa0years ago. We conclude that he had MTX-induced pericarditis, based on the close temporal relationship between MTX ingestion and manifestations of pericarditis on three distinct occasions because of the previous reports of MTX-induced pericarditis and because pericarditis has not recurred after MTX withdrawal.

The effectiveness and safety of mycophenolate mofetil in lupus nephritis

The purpose of this study is to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) for inducing and/or maintaining remission of lupus nephritis (LN). This is a retrospective study of 25 LN patients consecutively treated with MMF. The primary outcome was complete renal remission (CR) defined by urine protein/creatinine ratio ≤0.5xa0g/g and inactive urine sediment and serum creatinine within <15% above baseline. For induction, 21 episodes of active, moderate to severe LN were treated with MMF. Twelve cases (57%) achieved CR over a median of 8.5xa0months. Of 13 patients who had LN for <12xa0months and took ≥2xa0g/day of MMF, 11 achieved CR, compared to one out of the eight patients who did not meet both criteria (pu2009=u20090.0022). For maintenance therapy, 15 patients received MMF for a median of 20xa0months (range 5–55xa0months). Two patients (13%) experienced renal flares while taking MMF. Most adverse events were transient and did not require change in therapy. This study suggests that MMF is an effective treatment for both induction and maintenance of remission of moderate to severe LN with a relatively favorable safety profile. Early treatment and a dose ≥2xa0g/day are essential for optimal outcome. CR may take >6xa0months.

A Systematic Review and Meta-analysis of Efficacy and Safety of Novel Interleukin Inhibitors in the Management of Psoriatic Arthritis

Objective The aim of this study was to systemically review the efficacy and safety of inhibitors of interleukin 6 (IL-6): clazakizumab, IL-12/23: ustekinumab, and IL-17A: secukinumab, brodalumab, and ixekizumab in psoriatic arthritis (PsA). Methods The literature search was conducted using MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science. We included randomized controlled trials that assessed the efficacy of IL inhibitors and reported American College of Rheumatology 20 response at 24 weeks. Meta-analysis was done using random-effects model utilizing the DerSimonian and Laird method. Quality assessment was done using RobotReviewer Cochrane Risk-of-Bias Assessment Tool. Heterogeneity was assessed with Q statistic and quantified with I2. Publication bias was assessed with a funnel plot. Results Eight studies including 2722 subjects demonstrate the efficacy of IL inhibitors clazakizumab, secukinumab, ixekizumab, brodalumab, and ustekinumab in the treatment of PsA. The American College of Rheumatology 20/50/70 risk ratios were 2.02 (95% confidence interval [CI], 1.65–2.47; P = 0.000), 2.95 (95% CI, 2.32–3.73; P = 0.00), and 5.14 (95% CI, 3.28–8.06; P = 0.00), respectively, in favor of treatment versus placebo. There was no evidence of significant heterogeneity between trials. Subgroup analysis showed efficacy in patients who were tumor necrosis factor naive, as well as tumor necrosis factor nonresponders or inadequate responders. The number of adverse events was higher in the treatment groups versus placebo, the majority were mild and did not require treatment adjustment (risk ratio, 1.17; 95% CI, 1.06–1.28; P = 0.001). There was no significant difference in drug withdrawals. Conclusions Our meta-analysis shows that the inhibitors of IL-6 (clazakizumab), IL-12/23 (ustekinumab), and IL-17A (secukinumab, brodalumab, ixekizumab) are efficacious and generally well tolerated when used to treat patients with PsA.