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This work on advances in anti-rheumatic therapy covers topics such as: outcome measures in clinical trials of anti-rheumatic drugs; azapropazone (AZP); the mode of action of glucocorticoids; and clinical trials of oral chondroitin sulphate in the treatment of osteoarthritis.
This issue covers the latest developments in the understanding of rheumatoid arthritis at the early stage. Treatments such as with newer biologic agents and conventional disease-modifying antirheumatic drugs are reviewed. Also included are articles on imaging modalities as a means of identifying those in the early stages and monitoring response to treatment.
Emphasizes the importance of early intervention in RA with focus on pharmacologic treatment of RA. Detailed information on the various medications employed in treatment, including corticosteroids, NSAIDs DMARDs, biologic agents, and combination therapy is reviewed, including evidence based data on efficacy, safety, side effects, and monitoring requirements. Clinical evaluation is presented, including lab findings, joint scoring, diagnostic criteria, and radiographic outcomes. Surgical options and the management of advanced RA are disussed.
At present we may be at the cross-roads in the therapeutic approaches we have for the treatment of the 100 or more rheumatic conditions. This is be cause we now recognise that although some advances have been made with the development of a large range of non-steroidal and steroidal drugs during the past two decades or so, we now recognise that many, if not all, of these have rather limited effects on many of the disease processes which underlie the manifestations of the various rheumatic states. Advances in molecular bi- 010gy in the past 5-10 years have enabled these tools to be applied extensive ly for developing further our understanding of the rheumatic disease processes. In some cases these molecular tools (e. g. ,),-interferon, interleukin- 2, T-cell antibodies) have been directly employed as therapies themselves. While the outcome from trials with such agents in rheumatoid arthritis in particular has not been as would have been hoped, these results as with cy closporin A and low-dose methotrexate in the therapy of rheumatoid arth ritis have given us important indications for the approach employing what are generally described as "immunomodulators" to control this disease. But this may not be the same type of approach which is desirable for all types of rheumatic conditions. Indeed, even the way which the present range of drugs and other therapies are applied may not be the most effective and safe means of treating different types of arthritic conditions.
Important strides have been made in understanding the pathophysiologic basis of many inflammatory conditions in recent years, but rheumatology remains a discipline in which diagnosis is rooted in the medical history skillfully extracted from the patient, the careful physical examination, and the discriminating use of laboratory tests and imaging. Moreover, selection of the most appropriate therapy for patients with rheumatic diseases also remains heavily reliant upon clinical experience. Medical disciplines such as rheumatology that depend significantly upon clinical wisdom are prone to the development of systems of ‘Pearls’ and ‘Myths,’ related to the diseases they call their own, a ‘Pearl’ being a nugget of truth about the diagnosis or treatment of a particular disease that has been gained by dint of clinical experience and a ‘Myth’ being a commonly held belief that influences the practice of many clinicians – but is false. This book will pool together the clinical wisdom of seasoned, expert rheumatologists who participate in the care of patients with autoimmune diseases, systemic inflammatory disorders, and all other rheumatic conditions.
Offering a broad appeal to microbiologists, immunologists, and infectious disease specialists, this four volume encyclopedia covers all autoimmune, tropical, and infectious diseases. Emphasis will also be placed on genetics, physiology, metabolism, pathogenesis and applied microbiology. Under the leadership of some of the most world renowned names in the field, the encyclopedia will bring together an outstanding collection of contributions by top scientists in a variety of fields. Volumes 1-3: Diseases will be divided by the 11 main sections of the body, namely Integumentary, Skeletal, Respiratory, Digestive, Urinary, and Reproductive. For some of the autoimmune disease, more then one system will be involved but the delineation serves to broadly break down the diseases into systems. Volume 4 will cover the vaccines for said diseases and future prospects will be offered by leaders in industry and academia. Volume 4 will also be broken down into all the body systems, as in the other two volumes. For each vaccine, for each disease, and in each system the following will be included: • A list of the vaccines currently available along with a list of the companies that manufacture them • Molecular Immunology of the Vaccine • Type of Immunity involved in protection • Mode of Vaccination for each vaccine; repeated boosters and length of immunological memory • Commercial production of vaccines • Storage of vaccines • Standardization and Control of Vaccines • WHO programs and World-Wide Disease Eradication Programs based upon Vaccines.
This WHO Global report on psoriasis brings the public health impact of psoriasis into focus. The report is written to help raise awareness of the range of ways that psoriasis can affect peoples' lives. It intends to empower policy-makers with practical solutions to improve the health care and social inclusion of people living with psoriasis in their populations. The report highlights that much of the suffering caused by this common and complex disease can be avoided. Improving access to early diagnosis and appropriate treatment for psoriasis requires universally accessible health-care systems that provide people-centered care for patients with complex, lifelong conditions. Governments also have a key role to play in seeking to address the unnecessary social consequences of psoriasis by the challenging the myths and behaviors that lead to the exclusion of patients from healthcare settings and daily life.
This book provides a comprehensive overview of the available biologic therapies whilst comparing them to standard disease modifying anti-rheumatic drugs, and discusses how best to determine which therapy is most appropriate for an individual patient in the framework of current guidelines. Biologics for the Treatment of Rheumatoid Arthritis is an up-to-date and concise practical guide to the latest therapeutic developments in this field. This book is an invaluable source of topical information for all rheumatologists and health care professionals treating patients with rheumatoid arthritis.
Significant progress has been acquired in the treatment of rheumatic conditions with the introduction of biologic therapies, which has enabled better control of disease activity and improved patients' long-term outcome. Apart from several biologic treatments already licensed for use in autoimmune rheumatic conditions, numerous other agents are currently under investigation. This rapid expansion of the therapeutic armamentarium requires a critical analysis of individual biologic options and their clinical indications, in order to facilitate the optimal use of these new therapies. The authors felt that a comprehensive book revisiting all the evidence available regarding the efficacy, cost-effectiveness and health implications of the use of biologics in rheumatology was needed in order to integrate the clinical, ethical and socio-economic aspects related to their use. This book is aimed at specialist doctors, trainees, nurses and health professionals working in the field of rheumatology. It critically appraises the level of evidence behind the use of biologic agents in diverse autoimmune diseases, comprising separate chapters which focus on rheumatoid arthritis, systemic lupus erythematosus, myositis, systemic sclerosis, Sjogren's syndrome, seronegative spondyloarthropathies, psoriatic arthritis and psoriasis, small, medium and large vessel vasculitis, osteoporosis, and interstitial lung disease associated with rheumatic conditions. In addition, the book explores aspects related to the use of biologic agents, such as ethical considerations of consenting patients to take part in clinical trials with biologics, and adolescent and adult rheumatology nurse perspectives related to patients' benefits of biologic therapies. Particular interest is given to the use of biologics during pregnancy and assessment of their infectious risks. A separate chapter explores the off-target benefits associated with the use of anti-TNF therapies. Several chapters include data about cost-effectiveness, and national and international guidelines for the use of biologic agents in different rheumatic conditions.
Our goal for this book is to examine the contemporary therapy of rheumatoid arthritis (RA) from the increasingly important perspective of impact upon quality of life, costs and long-term health outcomes. For too long the focus has been on short term, symptomatic, and surrogate indicator outcomes. Yet RA is a life-long disor der with the majority of impact on an individual patient many years following onset. Further, even in the short-term, researchers and rheumatologists have tended to emphasize measurements of disease activity such as joint counts, ESR and physi cian's opinion as to the amount of disease activity present. It is only relatively recently that measures of structural damage, quality of life and impact on broad domains of health have been given increasing emphasis. Also, the significance of early treatment of RA in order to optimise long-term outcomes has a relatively short history [1]. We have been focussed on the disease processes as surrogates for long term outcomes. Until the short-term process measures are validated as surrogates of long-term effects we should also turn our attention to outcomes of disease and the impact of our management on those outcomes [2). Inour view, this book is especially timely. We are at the dawn of a revolution in the management of RA and other complex immunological inflammatory disorders because their molecular, genetic and environmental mechanisms are being unrav elled. Inthe process, we are revealing a substantial number of novel and significant targets for pharmacotherapy.