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Yang Z, Chen M, Tai Y, Tong H, Huang Z, Gao J, Tang C. Improvement of clinical outcomes and liver function in cirrhotic patients by selective COX-2 inhibitors: A retrospective study. Chin Med J (Engl) 2024; 137:2871-2873. [PMID: 39474722 DOI: 10.1097/cm9.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Indexed: 12/17/2024] Open
Affiliation(s)
- Zhu Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ming Chen
- Digestive Disease Institute, West China Clinical College, Chengdu, Sichuan 610041, China
| | - Yang Tai
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Huan Tong
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhiyin Huang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jinhang Gao
- Digestive Disease Institute, West China Clinical College, Chengdu, Sichuan 610041, China
| | - Chengwei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Bellamy CO, Burt AD. Liver in Systemic Disease. MACSWEEN'S PATHOLOGY OF THE LIVER 2024:1039-1095. [DOI: 10.1016/b978-0-7020-8228-3.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Lin CY, Huang SC, Tzou SJ, Yin CH, Chen JS, Chen YS, Chang ST. Tendon Disorders in Chronic Liver Disease: A Retrospective Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4983. [PMID: 36981892 PMCID: PMC10049230 DOI: 10.3390/ijerph20064983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
To investigate the relationship between chronic liver disease and tendon disorder, a retrospective cohort study was conducted using the Kaohsiung Veterans General Hospital database. Patients >18 years with newly diagnosed liver disease and with at least a two-year follow-up in the hospital were included. An equal number of 20,479 cases were enrolled in both the liver-disease and non-liver-disease groups using a propensity score matching method. Disease was defined using ICD-9 or ICD-10 codes. The primary outcome was the development of tendon disorder. Demographic characteristics, comorbidities, use of tendon-toxic drugs, and status of HBV/HCV infection were included for analysis. The results showed 348 (1.7%) and 219 (1.1%) individuals developed tendon disorder in the chronic liver disease group and non-liver-disease group. Concomitant use of glucocorticoids and statins may have further raised the risk of tendon disorder in the liver disease group. The co-existence of HBV/HCV infection did not increase the risk of tendon disorder in the patients with liver disease. Considering these findings, physicians should be more aware of tendon issues in advance, and a prophylactic strategy should be adopted in patients with chronic liver disease.
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Affiliation(s)
- Ching-Yueh Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114202, Taiwan
| | - Shih-Chung Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Shiow-Jyu Tzou
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
- Teaching and Researching Center, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114202, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
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Gong X, Dang G, Guo J, Liu Y, Gong Y. A sodium alginate/feather keratin composite fiber with skin-core structure as the carrier for sustained drug release. Int J Biol Macromol 2020; 155:386-392. [PMID: 32234435 DOI: 10.1016/j.ijbiomac.2020.03.224] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/10/2020] [Accepted: 03/25/2020] [Indexed: 02/01/2023]
Abstract
To alleviate the serious gastrointestinal side reaction of indomethacin (IDM), sodium alginate/feather keratin (SA/FK) fiber with skin-core structure was prepared via wet spinning as the carrier for sustained release of IDM. Fourier translation infrared (FT-IR) spectroscopy was adopted to investigate the reaction mechanism among SA, FK and IDM, and Ultraviolet-visible (UV-Vis) spectroscopy was used to systematically evaluate the sustained release capacity of SA/FK fiber in three simulated fluids. Scanning electron microscope (SEM) was employed to observe the apparent morphology of SA/FK fiber. The results indicate that, release amount of IDM exhibits an increase trend along with time; the release amount of IDM reaches 80% after 12 h in colon fluid and small intestinal fluid, and is less than 20% in digestive fluid. Simultaneously, FK can effectively control the release of IDM, and with the increase of FK content, IDM release time of the carrier fiber extends.
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Affiliation(s)
- Xueyong Gong
- Dalian Polytechnic University, Liaoning 116034, PR China; Shandong First Medical University, Taian, 271016, PR China
| | - Guangyao Dang
- Shandong First Medical University, Taian, 271016, PR China
| | - Jing Guo
- Dalian Polytechnic University, Liaoning 116034, PR China; Liaoning Engineering Technology Research Center of Function Fiber and Its Composites, Dalian Polytechnic University, Dalian 116034, PR China.
| | - Yuanfa Liu
- Dalian Polytechnic University, Liaoning 116034, PR China; Liaoning Engineering Technology Research Center of Function Fiber and Its Composites, Dalian Polytechnic University, Dalian 116034, PR China.
| | - Yumei Gong
- Dalian Polytechnic University, Liaoning 116034, PR China; Liaoning Engineering Technology Research Center of Function Fiber and Its Composites, Dalian Polytechnic University, Dalian 116034, PR China
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Theiler-Schwetz V, Zaufel A, Schlager H, Obermayer-Pietsch B, Fickert P, Zollner G. Bile acids and glucocorticoid metabolism in health and disease. Biochim Biophys Acta Mol Basis Dis 2019; 1865:243-251. [DOI: 10.1016/j.bbadis.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/18/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
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Clinical connection between rheumatoid arthritis and liver damage. Rheumatol Int 2018; 38:715-724. [PMID: 29627896 DOI: 10.1007/s00296-018-4021-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
Abstract
When liver damage is present in rheumatoid arthritis (RA) patients, it is sometimes difficult to determine whether it is a hepatic manifestation of RA, associated primary liver disease or hepatotoxic liver disease which developed during the treatment of RA. Liver damage during RA is most common in the form of asymptomatic abnormal liver tests. Occasionally, liver damage may progress to cirrhosis. Patients with RA are more susceptible to an associated autoimmune liver disease. Medications used in rheumatology are often hepatotoxic and it is difficult to differentiate between hepatic manifestations of the primary disease and potential hepatotoxicity of the administered medications. The significance of the paper is in the fact that it includes the most relevant and the latest information on this commonly present problem in clinical practice. The aim of the author is to provide comprehensive but at the same time concise data which will be useful to the doctors who come into contact with RA patients with symptomatic or asymptomatic liver disease. Timely diagnosis and treatment of liver disease in RA patients can significantly influence the course and outcome of rheumatoid arthritis.
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Gómez-Luque I, Alconchel F, Ciria R, Ayllón MD, Luque A, Sánchez M, López-Cillero P, Briceño J. Spontaneous liver rupture as first sign of polyarteritis nodosa. World J Hepatol 2016; 8:1414-1418. [PMID: 27917267 PMCID: PMC5114477 DOI: 10.4254/wjh.v8.i32.1414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/22/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
Polyarteritis nodosa (PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.
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Liver Governs Tendon: A Theory from Traditional Chinese Medicine-Evidence from a Population-Based Matched Cohort Study in Taiwan for the Association of Chronic Liver Disease and Common Diseases in the Chiropractic Office. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:7210705. [PMID: 27437024 PMCID: PMC4942639 DOI: 10.1155/2016/7210705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 12/20/2022]
Abstract
In traditional Chinese medicine (TCM) theory, the liver governs the tendons. This retrospective cohort study investigated the relationship between chronic liver disease and common orthopedic conditions by utilizing the National Health Insurance Research Database of Taiwan. The populations included within this study were chronic liver disease patients (International Classification of Diseases/ICD-9 code: 571) and a comparison group composed of patients with nonchronic liver disease. The medical event that was evaluated was internal derangement of joints (ICD-9 codes: 717-718). In comparison with the control group, patients with chronic liver disease were 1.29 times more likely to develop internal derangement of joints when major trauma had also occurred. We did not find the association of viral hepatitis with internal derangement of joints. Patients with chronic liver disease as well as anemia were 3.01 times more likely to develop joint derangements. Our study shows that patients with anemia in addition to chronic liver disease are more prone to develop joint derangements. This is the first documented research study that endorses “the liver governs the tendons which gives the body the ability to move” theory of TCM. The incidence rate of internal derangement of knee joints was higher in patients with chronic liver disease.
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Li C, Liu T, Sun W, Wu L, Zou ZY. Prevalence and risk factors of arthritis in a middle-aged and older Chinese population: the China health and retirement longitudinal study. Rheumatology (Oxford) 2014; 54:697-706. [PMID: 25288780 DOI: 10.1093/rheumatology/keu391] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The aims of this study were to estimate the prevalence of arthritis and to identify risk factors of arthritis in a middle-aged and older Chinese adult population. METHODS The China Health and Retirement Longitudinal Study (CHARLS) national survey data were used to estimate overall arthritis prevalence and prevalence by age and gender groups taking into account the complex survey design and response rate. The PROC SURVEYLOGISTIC procedure (SAS 9.3; SAS Institute, Cary, NC, USA) was applied to identify factors associated with arthritis using the CHARLS national survey data. Significant factors were further evaluated in the longitudinal CHARLS pilot study. RESULTS The overall prevalence of arthritis among middle-aged and older Chinese adults was 31.4% (95% CI 30.3, 32.4). Prevalence increased with age. Females had a higher prevalence of arthritis than males in each age group. In the cross-sectional analysis, age, gender, education, BMI, sleep duration, vigorous physical activity and self-reported doctor-diagnosed chronic lung disease, hypertension, chronic liver disease, cardiovascular disease, stroke, chronic kidney disease and chronic digestive disease were associated with arthritis. Age, gender, vigorous physical activity and cardiovascular disease were confirmed to be risk factors of arthritis in the longitudinal analysis. Participants with cardiovascular disease were 1.67 times (95% CI 1.02, 2.74) more likely to have self-reported arthritis in a 4-year period of follow-up in the CHARLS pilot study. CONCLUSION Middle-aged and older Chinese adults had a high prevalence of arthritis. Cardiovascular disease is a novel risk factor for arthritis in this population.
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Affiliation(s)
- Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Tingting Liu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Wenjie Sun
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Lang Wu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhi-Yong Zou
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
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Quaglia A, Burt AD, Ferrell LD, Portmann BC. Systemic disease. MACSWEEN'S PATHOLOGY OF THE LIVER 2012:935-986. [DOI: 10.1016/b978-0-7020-3398-8.00016-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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12
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Efe C, Purnak T, Ozaslan E, Ozbalkan Z, Karaaslan Y, Altiparmak E, Muratori P, Wahlin S. Autoimmune liver disease in patients with systemic lupus erythematosus: a retrospective analysis of 147 cases. Scand J Gastroenterol 2011; 46:732-737. [PMID: 21348808 DOI: 10.3109/00365521.2011.558114] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We aimed to investigate the characteristics of autoimmune liver disease (AILD) developed in patients with systemic lupus erythematosus (SLE), including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) and the AIH/PBC overlap syndrome. We also evaluated the accuracy of diagnostic criteria and scoring systems for AILD in SLE. METHODS A retrospective analysis of patients attending the rheumatology and gastroenterology clinics in Ankara, Turkey, between 1999 and 2010. SLE patients with elevated liver enzymes were investigated for liver diseases. RESULTS A total of 147 SLE patients were identified and 36 of them had liver enzyme abnormalities. AILD was diagnosed in 4.7% of all SLE patients, in 19.4% of those with elevated liver enzymes. Of patients with liver enzyme abnormalities, 72.3% fulfilled the criteria for AIH proposed by the International Autoimmune Hepatitis Group (IAIHG), whereas 66.7% had AIH by using the simplified criteria. Yet, only 13.8% of these patients had liver biopsy findings consistent with AIH. Patients with AILD were treated with conventional therapy including ursodeoxycholic acid, prednisolone, azathioprine or combinations of these. Treatment failure and subsequent advanced liver disease developed in one patient. CONCLUSIONS AILD may occur during the course of SLE. Due to biochemical similarities between AIH and SLE, AIH could be considered very probable by using both IAIHG scoring system and simplified criteria. For definitive diagnosis of AIH, liver biopsy should be performed in all SLE patients with chronic enzyme abnormalities. The response to therapy is favorable in these patients, and early diagnosis is important for preventing advanced liver disease.
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MESH Headings
- Adult
- Antibodies, Antinuclear/analysis
- Azathioprine/therapeutic use
- Biopsy
- Enzyme-Linked Immunosorbent Assay
- Female
- Hepatitis, Autoimmune/complications
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/drug therapy
- Humans
- Hydroxychloroquine/therapeutic use
- Immunoblotting
- Immunoglobulin G/analysis
- Liver Cirrhosis, Biliary/complications
- Liver Cirrhosis, Biliary/diagnosis
- Liver Cirrhosis, Biliary/drug therapy
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Middle Aged
- Prednisolone/therapeutic use
- Prevalence
- Retrospective Studies
- Syndrome
- Treatment Outcome
- Ursodeoxycholic Acid/therapeutic use
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Affiliation(s)
- Cumali Efe
- Department of Internal Medicine, Ankara Numune Research and Education Hospital, Ankara, Turkey.
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Jain R, L. Thiele D. Gastrointestinal and Hepatic Manifestations of Systemic Diseases. SLEISENGER AND FORDTRAN'S GASTROINTESTINAL AND LIVER DISEASE 2010:557-592.e11. [DOI: 10.1016/b978-1-4160-6189-2.00035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Rolny P, Goobar J, Zettergren L. HBsAg-negative chronic active hepatitis and mixed connective tissue disease syndrome. An unusual association observed in two patients. ACTA MEDICA SCANDINAVICA 2009; 215:391-5. [PMID: 6731049 DOI: 10.1111/j.0954-6820.1984.tb05024.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Two patients are described who suffered from both HBsAg-negative chronic active hepatitis and mixed connective tissue disease syndrome. The diagnosis of liver disease was made prior to the diagnosis of collagenosis in one of the patients, whereas the opposite was the case in the other. In spite of the fact that symptoms and laboratory data suggesting both diagnoses were present from the moment of presentation, there was a considerable delay in establishing the second diagnosis in both patients. To our knowledge, this is the first report on an association between chronic active hepatitis and mixed connective tissue disease syndrome. It illustrates the difficulties when diagnosing overlap conditions.
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Ramos-Casals M, Font J, Ingelmo M. [Prevalence and clinical significance of hepatitis C virus infection in systemic autoimmune diseases]. Med Clin (Barc) 2001; 116:701-9. [PMID: 11412684 DOI: 10.1016/s0025-7753(01)71958-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M Ramos-Casals
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínic, Barcelona, Spain
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Baraldo M, Ferraccioli G, Pea F, Gremese E, Furlanut M. Cyclosporine A pharmacokinetics in rheumatoid arthritis patients after 6 months of methotrexate therapy. Pharmacol Res 1999; 40:483-6. [PMID: 10660945 DOI: 10.1006/phrs.1999.0539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To evaluate the effects of a 6-month methotrexate (MTX) treatment period on cyclosporine A (CsA) pharmacokinetics were subsequently added in patients with rheumatoid arthritis (RA) in comparison with patients treated with CsA only, CsA was administered to 30 subjects with RA (group A) treated with MTX (10 mg week-1 i.m.) for 6 months and to 30 patients (group B) who received no MTX treatment. The mean doses +/- SD of CsA used in groups A and B were 3.2 +/- 0.5 and 3.3 +/- 0.4 mg kg-1, respectively. CsA levels were determined in whole blood by means of a fluorescence polarization immunoassay (FPIA) method with a specific monoclonal antibody. The following pharmacokinetics parameters were calculated: area under the curve from 0 to 24 h (AUC0-24), half-life of the elimination phase (T1/2 beta), total body clearance CL.F-1; V.F-1 and apparent volume of distribution (Vd beta). The mean blood concentrations and the pharmacokinetic parameters calculated in group A did not present significant statistical differences in comparison to group B. In conclusion, a 6-month MTX therapy does not produce liver function modifications to such an extent as to modify the pharmacokinetics of CsA subsequently added. Therefore, from a clinical pharmacological point of view, an MTX-CsA cotreatment appears feasible.
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Affiliation(s)
- M Baraldo
- Chair of Pharmacology, DPMSC, School of Medicine, University of Udine, Italy
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Beyeler C, Banks RE, Thompson D, Forbes MA, Cooper EH, Bird H. Bone alkaline phosphatase in rheumatic diseases. Ann Clin Biochem 1995; 32 ( Pt 4):379-84. [PMID: 7486797 DOI: 10.1177/000456329503200405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A double monoclonal immunoradiometric assay specific for bone alkaline phosphatase (BAP) was used to determine whether the raised total alkaline phosphatase (TAP) often found in patients with active rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is derived from bone or liver. Fifty-eight patients with RA were compared to 14 with AS and 14 with non-inflammatory rheumatic diseases (NI). None had clinical liver disease and only one had a slightly elevated aspartate transaminase activity. Elevated BAP concentrations were found in seven patients (5 RA, 1 AS, 1 NI), only two of whom also had abnormal TAP. Abnormal TAP activities were found in only three patients (all RA). BAP did not correlate with disease activity in RA or AS. In contrast, TAP correlated with disease activity (assessed by plasma viscosity) in RA (P < 0.002) and gamma-glutamyl transferase (GGT) also correlated with plasma viscosity in RA (P < 0.01). Both TAP and BAP were significantly correlated with GGT in RA (P < 0.001 and P < 0.02, respectively). These findings are discussed, together with possible reasons for the conflicting nature of some of the observations.
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Affiliation(s)
- C Beyeler
- Department of Rheumatology, University of Berne, Switzerland
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Weidensaul D, Imam T, Holyst MM, King PD, McMurray RW. Polymyositis, pulmonary fibrosis, and hepatitis C. ARTHRITIS AND RHEUMATISM 1995; 38:437-9. [PMID: 7880199 DOI: 10.1002/art.1780380324] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Polymyositis has been associated with several viral infections, and a spectrum of immune-related diseases may occur with hepatitis C virus (HCV) infection. Both polymyositis and HCV infection may be accompanied by interstitial lung disease; however, no association between polymyositis and HCV infection has been reported previously. We report a new association in a patient with HCV infection: anti-Jo-1 positive polymyositis and interstitial lung disease.
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Affiliation(s)
- D Weidensaul
- Health Sciences Center, University of Missouri, Columbia 65212
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22
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Jurima-Romet M, Crawford K, Huang H. Comparative cytotoxicity of non-steroidal anti-inflammatory drugs in primary cultures of rat hepatocytes. Toxicol In Vitro 1994; 8:55-66. [DOI: 10.1016/0887-2333(94)90208-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/1992] [Revised: 03/29/1993] [Indexed: 12/19/2022]
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Walker AM, Funch D, Dreyer NA, Tolman KG, Kremer JM, Alarcón GS, Lee RG, Weinblatt ME. Determinants of serious liver disease among patients receiving low-dose methotrexate for rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1993; 36:329-35. [PMID: 8452577 DOI: 10.1002/art.1780360307] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess the risk of serious liver disease in patients with rheumatoid arthritis (RA) taking methotrexate (MTX). METHODS We surveyed members of the American College of Rheumatology to determine previous use of MTX in the treatment of rheumatoid arthritis and to identify cases of cirrhosis and liver failure. Cases were confirmed by review of pathology specimens, findings from diagnostic testing, and clinical presentations. A case-control study was then conducted to ascertain prognostic factors. Case and control medical records were reviewed for information on MTX therapy as well as other possible determinants of serious liver disease. RESULTS Twenty-four cases of cirrhosis and liver failure were identified, giving a 5-year cumulative incidence of approximately 1/1,000 treated patients. Six of the 24 patients had died: 4 died of the initial liver disease, 1 of hepatic complications of another illness, and 1 of unrelated causes. Two patients continue to have active liver disease. Late age at first use of MTX and duration of therapy with MTX were independent predictors of serious liver disease. CONCLUSION Serious liver disease is an uncommon, age- and dose-related complication of low-dose MTX therapy for RA.
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Affiliation(s)
- A M Walker
- Epidemiology Resources Inc., Newton Lower Falls, MA 02162-1450
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24
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Selley ML, Bourne DJ, Bartlett MR, Tymms KE, Brook AS, Duffield AM, Ardlie NG. Occurrence of (E)-4-hydroxy-2-nonenal in plasma and synovial fluid of patients with rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1992; 51:481-4. [PMID: 1586244 PMCID: PMC1004696 DOI: 10.1136/ard.51.4.481] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
(E)-4-Hydroxy-2-nonenal (HNE), a cytotoxic propagation product of lipid peroxidation, is present in the synovial fluid (0.54 (0.19) mumol/l; mean (SE), n = 9) and plasma (0.34 (0.09) mumol/l, n = 9) of patients with rheumatoid arthritis. This compound was also found in the synovial fluid (0.24 (0.19) mumol/l, n = 9) and plasma (0.09 (0.03) mumol/l, n = 9) of patients with osteoarthritis. The concentration of HNE in the plasma of patients with rheumatoid arthritis was significantly greater than in patients with osteoarthritis.
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Affiliation(s)
- M L Selley
- Division of Clinical Sciences, John Curtin School of Medical Research, Australian National University, Royal Canberra Hospital, Garran, ACT
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25
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Scully CJ, Anderson CJ, Cannon GW. Long-term methotrexate therapy for rheumatoid arthritis. Semin Arthritis Rheum 1991; 20:317-31. [PMID: 2068577 DOI: 10.1016/0049-0172(91)90032-u] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A retrospective review of methotrexate (MTX) treatment assessed the clinical course in 124 rheumatoid arthritis (RA) patients. After 5 years, 39 (31%) patients continued MTX with clinical benefit. Although patients continuing MTX after 5 years were younger (45 +/- 13 v 54 +/- 12 yrs, P less than .001) and had a shorter disease duration of RA (9.3 +/- 8.1 v 14 +/- 11 yrs, P less than .05) than patients who discontinue the drug, these differences were not considered clinically significant. MTX was discontinued in 20 patients for a lack of clinical benefit, in 21 patients for non-drug-related reasons, and in 44 patients for suspected adverse drug reactions. The adverse drug reactions requiring permanent discontinuation of MTX were nausea, stomatitis, hair loss, rash, pulmonary reactions, elevated liver enzymes, hematologic abnormalities, and hepatic fibrosis. At least one adverse drug reaction was reported by 115 (93%) patients receiving MTX, but the majority did not require permanent drug discontinuation. Although the prevalence of adverse reactions increased with longer duration of therapy, no differences existed in the type of reactions reported over 5 years of treatment. There were no risk factors identified that were clearly associated with the development of toxicity. Long-term therapy was primarily limited by adverse reactions rather than loss of efficacy.
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Affiliation(s)
- C J Scully
- Division of Rheumatology, University of Utah, Salt Lake City
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26
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Affiliation(s)
- K H Meyer zum Büschenfelde
- I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität Mainz, Federal Republic of Germany
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27
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Abstract
An overview of European experience with ketoprofen, a nonsteroidal anti-inflammatory drug (NSAID) with analgesic properties, from the time of its marketing in 1973 until the present is presented. Orally administered ketoprofen (200 mg/day) has been proven effective in treating rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Furthermore, several alternate dosage forms, including intramuscular injection for relief of acutely painful conditions, suppositories, two slow-release forms (a sustained-release tablet [IBP 200] and a controlled-release capsule [Oruvail] ), and a topical gel for local treatment of certain superficial conditions and minor rheumatologic disease are available. The safety of ketoprofen has also been proven in several European postmarketing surveillance studies and more importantly, by French and British drug monitoring data. Ketoprofen was rated as one of the safest NSAIDs available in the United Kingdom (UK) by the Committee on the Safety of Medicine in 1986. For incidence of gastrointestinal complaints per million prescriptions, ketoprofen ranked seventh among 19 NSAIDs in its first five years of marketing in the UK. Ketoprofen has been associated with a very low incidence of serious renal, hepatic, or cutaneous reactions. Thus ketoprofen, in 15 years of marketed use in Europe, has proven to be an effective anti-inflammatory and analgesic agent with an excellent safety profile and several convenient dosage forms.
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Affiliation(s)
- B Avouac
- Department of Rheumatology, Henri Mondor Hospital, Paris, France
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28
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Lunec J, Winkles JW, Griffiths HR. Clinical biochemical measurements in rheumatology. BAILLIERE'S CLINICAL RHEUMATOLOGY 1988; 2:131-52. [PMID: 2458191 DOI: 10.1016/s0950-3579(88)80007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite 50 years of intensive research in the field of RFs, autoimmunity and chronic inflammation, some of the serological tests used for measuring autoantibodies remain an anachronism. Clinical chemistry has the potential technology to provide the rheumatologist with automated quantitative antibody/antigen measurements. It can also widen the range of tests available for disease monitoring, which would be helpful in the management of the chronic rheumatic diseases. Traditional laboratory tests must be superseded by new developments, derived from fundamental research, if we are to improve the diagnosis and management of the rheumatic diseases.
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29
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Lamy PP. Non-steroidal anti-inflammatories in the elderly. SIDE-EFFECTS OF ANTI-INFLAMMATORY DRUGS 1987. [DOI: 10.1007/978-94-010-9772-7_12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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30
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Szanto E, Sandstedt B, Kollberg B. Hepatotoxicity associated with low-dose, long-term methotrexate treatment of rheumatoid arthritis. Scand J Rheumatol 1987; 16:229-34. [PMID: 3629206 DOI: 10.3109/03009748709102922] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Liver biopsies were performed in 17 patients with therapy-refractory rheumatoid arthritis who were treated successfully with 5-15 mg/week methotrexate (mtx). The average duration of exposure to mtx therapy for each patient was 2.8 years (range 1.5-5 years). Total cumulative mtx doses ranged between 633 and 1,655 mg (mean 1,060 mg). The biopsies revealed 16 cases of normal histology, of which 3 showed nuclear variability in the hepatocytes; 4 with mild fatty infiltration, 2 with mild fatty infiltration and portal round cell infiltration. Portal fibrosis was found in one patient who had psoriasis in addition to clinical RA.
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31
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Day RO, Graham GG, Williams KM, Champion GD, de Jager J. Clinical pharmacology of non-steroidal anti-inflammatory drugs. Pharmacol Ther 1987; 33:383-433. [PMID: 3310039 DOI: 10.1016/0163-7258(87)90072-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R O Day
- Department of Clinical Pharmacology, St. Vincent's Hospital, Darlinghurst, N.S.W., Australia
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32
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Abstract
Ketoprofen (Orudis), a highly potent and safe nonsteroidal antiinflammatory drug of the propionic acid derivative group, was synthesized in France by Rhône-Poulenc chemists in 1967, 3 years after the prototype ibuprofen. Ketoprofen was introduced in 1973 in France and the United Kingdom for antiinflammatory use. Today the drug is available in about 80 countries and has recently been approved in the United States for treatment of rheumatoid arthritis and osteoarthritis. The therapeutic experience with ketoprofen is estimated to have exceeded 3 million patient-years. Double-blind trials have established its therapeutic equivalence with aspirin, indomethacin, and ibuprofen in rheumatoid arthritis and with aspirin in osteoarthritis. Ketoprofen has a short half-life, a simple metabolism, and a broad therapeutic window, and does not accumulate with multiple doses. These features contribute to a rapid onset of action, flexible dosing, and a reliable tolerance profile.
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34
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Abstract
Rheumatoid arthritis is a disorder characterized by chronic inflammation affecting predominantly articular tissues, leading in some instances to disruption of the normal structure and function of the joint. In some patients extra-articular manifestations are also present. In the joints, the pathologic lesion consists of synovial cell proliferation with infiltration by inflammatory cells. The complex interaction among these cells is likely responsible for the connective tissue abnormalities that characterize the rheumatoid lesion. The factors responsible for inducing the inflammatory process are unknown.
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35
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Cooper C, Cotton DW, Minihane N, Cawley MI. Azathioprine hypersensitivity manifesting as acute focal hepatocellular necrosis. J R Soc Med 1986; 79:171-3. [PMID: 3701755 PMCID: PMC1290239 DOI: 10.1177/014107688607900313] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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36
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Abstract
Although rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have certain features in common, the literature suggests that the two diseases are inversely related to each other in at least eight major respects, viz., age of onset in relation to reproductive fertility; psychosis; kidney disease; nutritional status; and the differential effects of pregnancy, oral contraceptive use, jaundice, and penicillamine. It is suggested that associated with RA and SLE are differing blood and/or tissue levels of a common but as yet undetermined factor: deficient levels in RA, toxic levels in SLE.
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37
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Abstract
The availability of easy to use microcomputers and medical information retrieval systems will result in fundamental and important changes in medical practice. The acquisition of information literacy and fluency will be mandatory techniques for the future practice of medicine and should be taught at the institutional level by faculty sophisticated in the use of information retrieval systems. The resulting improvements in the practice of medicine go beyond simple cost savings to fundamentally alter the ways patients and their disorders are looked upon and handled.
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38
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Abstract
Since its introduction in the United States in 1974, ibuprofen (Motrin, Upjohn) has been shown to be safe and effective for the treatment of pain, dysmenorrhea, inflammation, and fever. A careful review of pre-registration and postmarketing data from both patients and normal subjects clearly indicates ibuprofen's remarkable safety profile compared with that of aspirin and other commonly prescribed nonsteroidal anti-inflammatory agents. Continued safety can be anticipated on the basis of the past 15 years of review experience.
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39
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Abstract
Auranofin is a chemically unique gold coordination complex with demonstrated antiarthritic properties on oral administration. Its pharmacokinetic and immunologic profiles are distinct from injectable gold compounds. When auranofin is added to a regimen of salicylates and/or a nonsteroidal antiinflammatory drug for the treatment of RA, significant additional therapeutic benefit is observed. Published studies indicate that auranofin given 6 mg per day approaches the efficacy of parenteral gold salts in the treatment of rheumatoid disease. Noticeable improvement in clinical and laboratory parameters of disease activity has been observed by the third month of auranofin therapy. Further benefit occurs in some patients during the remainder of the first year of treatment. In the more than 3,000 patients treated with auranofin, the most frequently reported side effects were gastrointestinal (mainly diarrhea) and mucocutaneous. Most side effects were mild in nature and the withdrawal rate due to all adverse reactions averaged 11%. Auranofin differs from injectable gold by producing more gastrointestinal but fewer mucocutaneous reactions. The severity of these reactions is less with auranofin and causes fewer withdrawals from therapy.
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Sheehan NJ, Slavin BM, Kind PR, Mathews JA. Increased serum alkaline phosphatase activity in ankylosing spondylitis. Ann Rheum Dis 1983; 42:563-5. [PMID: 6138002 PMCID: PMC1001297 DOI: 10.1136/ard.42.5.563] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Raised serum alkaline phosphatase (AP) levels were found in 13 of 76 patients (17%) with ankylosing spondylitis (AS), and 11 of these 13 underwent further investigation to determine the origin of the increased enzyme activity. Three had levels within the normal reference range on re-estimation, and, of the remaining 8, AP isoenzyme studies indicated an increased liver fraction in 6. Serum gamma-glutamyl transpeptidase (GGT) was raised in only 3 patients. Increased AP activity did not appear to be directly related to disease activity or to drug therapy. These findings confirm the occurrence of increased serum AP activity in AS but challenge a previously reported suggestion that bone is the source of the increased enzyme.
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Abstract
Adult Still's disease is a recently recognised syndrome which is an important and often unrecognised cause of pyrexia of unknown origin. A knowledge of the clinical features of this disease may save patients with undiagnosed fever from prolonged and invasive investigations. The condition usually responds to conservative therapy with non-steroidal anti-inflammatory agents and bed rest, although in a minority of patients more toxic drugs may be required. The prognosis is usually good although long-term follow-up studies of these patients are small in number, and the most recent review sounds a warning as to the incidence of chronicity. Sufficient evidence now exists to identify Still's disease as a separate nosological entity in adults. It should be added to the ever-expanding list of causes of pyrexia of unknown origin.
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