Day 1 :
Keynote Forum
Malgorzata Wislowska
Warsaw Medical University, Poland
Keynote: Rheumatoid arthritis (RA) and heart diseases
Time : 10:00-10:40
Biography:
Margaret WisÅ‚owska, Head of The Department of Internal Medicine and Rheumatology CSK MSW is a specialist in internal medicine, rheumatology, rehabilitation medicine, hypertension, and the author of over 200 scientific papers and books. She has participated in numerous scientific meetings and is a promoter of 12 Ph.D. theses. She took training at Guy and St. Thomas’ Hospitals in London, Charity Hospital in Berlin, Rheumatology Institutes in Prague and Moscow. In 2003, she started the Department of Internal Medicine and Rheumatology, and in 2010 the Clinic of Internal Medicine and Rheumatology CSK MSW. She is a Professor at the Warsaw Medical University.
Abstract:
RA is a chronic inflammatory disease affecting approximately 0.5-1% of the population, characterized by symmetric, erosive arthritis of the synovial joints and variable extra-articular features. The primarily affected site is the synovium where “pannus” is gradually formed. Typical articular symptoms include pain, stiffness and swelling. The progressive destruction of the articular cartilage may lead to deformation and loss of function of affected joints. The goal of treatment is to reduce mortality and to prevent joint damage and disability. RA imposes a substantial economic burden on both patients and society. The etiopathogenesis of RA is only partially understood. Its onset is triggered by environmental factors on the basis of a genetic predisposition in combination with altered immune responses. Tobacco and infection by Porphyromonas gingivalis during periodontal diseases favor ACPA production which has a crucial role in RA pathogenesis. Cytokine networks involving TNFα, IL-1β, 6, 15 and 17, matrix metalloproteinases and many other factors participate in disease perpetuation. Bone and cartilage destruction are primarily mediated by osteoclasts and fibroblasts – like synoviocytes, respectively. Although RA is primarily considered a disease of the joints, abnormal systemic immune responses can cause a variety of extra – articular manifestations. One of the current issues in rheumatology is the type and extent of pathological changes in the heart in the course of rheumatoid arthritis. The problems with diagnosis are due to a very limited number of clinical symptoms showing that cardiac muscle is affected by a disease process and that symptoms do not always appear. The results of epidemiological studies point to the presence of an increased risk of cardiovascular disease (CVD), particularly atherosclerosis and congestive heart failure (CHF) in RA. Necropsy examinations of RA hearts revealed a higher prevalence of clinically silent myocardial nodules, restrictive pericarditis and coronary vasculitis in RA compared to non-RA patients. At least 50% of abnormalities remained asymptomatic. Pathological conditions contributing to myocardial dysfunction such as high serum levels of IL-6, C-reactive protein and TNF alpha are present both in RA and CHF patients. The most common pathological mechanism leading to the development of heart failure is left ventricular diastolic dysfunction, which remains clinically asymptomatic for a long time. The presence of heart disease in RA patients is not only dependent on concurrent heart disease but is also caused by RA disease.
Keynote Forum
C. Kent Kwoh
University of Arizona Arthritis Center, AZ
Keynote: Imaging biomarkers of Pain in Knee Osteoarthritis
Time : 10:40-11:20
Biography:
Dr. Kwoh’s research group has had a long interest in the epidemiology of a broad spectrum of rheumatic and musculoskeletal diseases, with a particular focus on the epidemiology of, and outcome assessment in osteoarthritis. He is currently engaged in several lines of research examining biomarkers, early indicators, pain, outcome assessment, and the examination of risk factors for the development and progression of osteoarthritis. His current work focuses on the identification of biomarkers for outcomes in knee osteoarthritis. One line of research examines quantitative and semi-quantitative assessment of imaging features on MRI that are associated with the incidence of radiographic knee osteoarthritis or progression to total joint replacement. Another line of research examines the characterization of knee pain patterns and MRI features associated knee pain in osteoarthritis.
Abstract:
Pain is an important feature of osteoarthritis and is the most common presenting symptom. Multiple standardized measures have been developed to assess pain. The etiology of pain in osteoarthritis is unclear, however, and is likely to be heterogeneous. Osteoarthritis is recognized as being a disease of the whole joint. Cartilage is aneural, but the subchondral bone, the periosteum, peri-articular ligaments, peri-articular muscle, synovium and the joint capsule are all richly innervated and may be sources of nociceptive pain in osteoarthritis. Central sensitization may also play a role in chronic knee pain. The complexity of pain in osteoarthritis is highlighted by the apparent lack of correlation between individual’s report of pain and the changes seen on knee radiographs. Advances in magnetic resonance imaging (MRI), however, have improved our understanding of the relationship between pathology and the structural changes to cartilage, subchondral bone and the surrounding soft-tissues of joint in osteoarthritis. Relationship between morphologic features and knee pain is dependent on the specific MRI feature and method of assessing knee pain. Cross-sectional studies suggest that morphologic changes on MRI such as bone marrow lesions (BMLs), effusion-synovitis, denuded bone area and meniscal extrusion are associated with frequent knee pain and weight-bearing pain, whereas longitudinal studies suggest that incident frequent knee pain is associated with new bone marrow lesions, new denuded bone area, or enlarging bone marrow lesions and development of inflammation such as effusion-synovitis or Hoffa-synovitis. Recent studies have advanced our understanding of potential etiologies for osteoarthritis-related pain and have helped to identify potential targets for pharmacologic and non-pharmacologic treatments.
- Osteoarthritis
Session Introduction
Chedo M. Bagi
Global Science & Technology, Connecticut, USA
Title: Oral Administration of Undenatured Native Chicken Type II Collagen (UC-II) Diminished Deterioration of Articular Cartilage in a Rat Model of OA
Biography:
Chedo M. Bagi, MD, Ph.D. is a highest ranked (Senior Research Fellow) scientist at Worldwide Science & Technology group at Pfizer Inc., with over 25 years of research experience in academic and pharmaceutical research organizations. Current research focuses on the OA and RA, metabolic diseases, immunological disorders and bone cancers. Dr. Bagi’s responsibilities include implementation of translational disease animal models and diverse technologies to provide preclinical efficacy and safety data and enable rapid translation of novel medicines to clinic, and ultimately to patients. Accomplishments of past work include patents, numerous publications, book chapters, presentations and memberships in professional organizations.
Abstract:
Objective: The aim of this study was to determine the ability of undenatured native chicken type II collagen (UC-II) to prevent excessive articular cartilage deterioration in a rat model of osteoarthritis (OA).
Methods: Twenty male Lewis rats were subjected to partial medial meniscectomy tear (PMMT) surgery to induce OA. Immediately after the surgery rats received vehicle or oral daily dose of UC-II at 0.66 mg/kg for a period of 8 weeks. Ten naïve rats were used as an intact control and another 10 rats received sham surgery. Study endpoints included an assessment of weight-bearing capacity of the operated extremity with a dynamic weight bearing (DWB) system, bone and cartilage metabolism with serum biomarkers, the subchondral bone at the medial tibial plateau and the cancellous bone at the tibial metaphysis with Micro Computed Tomography (mCT) and cartilage pathology at the medial tibial plateau with various histological methods.
Results: Partial medial meniscectomy surgery produced moderate OA at the medial tibial plateau. Specifically, the deterioration of articular cartilage negatively impacted the weight bearing capacity of the operated limb. Immediate treatment with the UC-II preserved the weight-bearing capacity of the injured leg, preserved integrity of the cancellous bone at tibial metaphysis and limited the excessive osteophyte formation and deterioration of articular cartilage.
Conclusion: Our results demonstrate that a clinically relevant daily dose of UC-II when applied immediately after injury can improve the mechanical function of the injured knee and prevent excessive deterioration of articular cartilage. Additional studies are warranted to elucidate the mechanism of action and to determine if there is efficacy in established disease models
- Fracture
Session Introduction
Peter Peichl
Hospital of Vienna, Austria
Title: Fracture healing: Is there a need for acceleration?
Biography:
Peter Peichl has completed his MD at the age of 25 years from University of Vienna and postdoctoral studies from Novartis Institute of Biochemical Research and Kaiser Franz Joseph Hospital Vienna. He is Specialist for rheumatology and osteology and Associate Professor from University of Vienna. His current position is chairman of the protestant ( evangelisches ) hospital of Vienna. He has published more than 60 papers in reputed journals. His research are currently focusing on osteoimmunolgy and fracture healing.
Abstract:
The advancement of new methodologies to improve the recuperating of cracks keeps on developing with the presentation of both locally and systemically conveyed mixes.
- Rheumatid Disorders
Session Introduction
Song G Zheng
Milton S. Hershey Medical Center, Penn State University USA
Title: Therapeutic role of GMSC in autoimmune diseases
Time : 15:50-16:30
Biography:
Song G Zheng completed his PhD in Immunology at University of Orleans and French National Center for Scientific Research. He completed his Post-doctoral studies at UCLA and University of Southern California (USC). He was appointed as an Assistant Professor at USC in 2004. He has been a full Professor of Medicine with tenure and Director at Milton S. Hershey Medical Center at Penn State University since 2013. He has expertise in Pathogenesis, Cytokines and Immune Regulation of Autoimmune Diseases. He and his colleagues discovered “induced regulatory T cells” and is a pioneer in the field of GMSC and immune-regulation.
Abstract:
Rheumatoid arthritis (RA) is a chronic symmetrical autoimmune disease characterized by synovial inflammation that affects primarily the small diarthrodial joints. None of the current treatments can cure the disease. Mesenchymal stem cells have been shown in maintaining immune homeostasis and preventing autoimmunity, and may be a potential therapeutic approach for RA. Recently, we observed that gingiva derived mesenchymal stem cells (GMSCs) also have the capacity to inhibit immune responses and control the development and severity of collagen-induced arthritis (CIA) in mice that is dependent on CD39/CD73 signal pathway and partially on the induction of CD4+CD39+FoxP3+T regulatory cells. Moreover, GMSCs dramatically and directly inhibited NF-κB and RANKL-mediated osteoclast formation, as well as bone erosion in CIA. To evaluate their clinical translational value, we have developed a humanized animal model, xeno-GVHD, to demonstrate that the infusion of GMSC can markedly inhibit human PBMCs-initiated xenogenic graft-versus-host-disease (GVHD) and this effect requests the CD39/CD73 and IDO signals. More importantly, the effect of GMSCs is significantly better than bone marrow-derived mesenchymal stem cells (BMSCs). Taken together, the manipulation of GMSCs could provide a promising approach for curing autoimmune diseases, such as rheumatoid arthritis and xenograft-versus-host-disease.
Martin-Martin Luis Severino
Regina Apostolorum, Italy
Title: Phoenix project for improving the quality of life in rheumatic diseases: preliminay results.
Biography:
1988: Luis Severino Martin Martin has completed his PhD from University School of Medicine of Seville (Spain) with full marks.
Since at present: Medical Consultant at U.O. Medicina Interna, Ospedale “Regina Apostolorum” in Albano Laziale (Rome, Italy), Responsible of the Internal Medicine – Rheumatology Ambulatory at Ospedale “Regina Apostolorum” in Albano Laziale (Rome, Italy) and Responsible of the Osteoporosis prevention and therapy Ambulatory at Ospedale “Regina Apostolorum” in Albano Laziale (Rome, Italy). Author of 157 scientific publications including original articles on prominent italian and foreign journals such as “Reumatismo”, “Annali Italiani di Medicina Interna”, “Clinical Rheumatology”, “Annals of the Rheumatic Diseases”, “Osteoporosis International”, “Revista Española de Reumatologia”, “New trends in Experimental and Clinical Psychiatry”, “Clinical and Experimental Rheumatology”, “European Journal of Internal Medicine”
Abstract:
Rheumatic chronic diseases (RCD) are among the most common chronic non-communicable diseases. They are the leading cause of disability in developed countries, and consume a large amount of health and social resources.
The purpose of this preliminary study (PHOENIX PROJECT) was to evaluate changes in pain and quality of life of patients suffering from RCD followed by talks in Group Counseling for emotional support. Group Counseling talks for emotional support is a behavioural intervention to facilitate patients adopt and sustain their own health related goals. The Counseling Group talks has been divided into eight meetings for a period of four months according to the cycle of the Gestalt contact, each meeting lasted two hours. During the first and the last meeting it is given the self-assessment questionnaire SF-36, in order to make measurable the results obtained.
In patients there was a significant improvement in quality of life, without any change of the treatment set by the specialist; patients have expressed great satisfaction with the procedures of the meetings and for their given opportunity to express their emotional state linked to the basic chronic disease .
Our preliminary study suggests that Group Counseling talks for emotional support could be extremely effective in patients with chronic rheumatic diseases.
Tao-Hsin Tung
Cheng-Hsin General Hospital, Taiwan
Title: Prevalence and metabolic factors of hyperuricemia in an elderly agricultural and fishing population in Taiwan
Biography:
Tao-Hsin Tung was born in Kaohsiung, Taiwan, in 1972. He received the BSC degree in Science from Medicine Sociology, Kaohsiung Medical University, Kaohsiung, Taiwan, in 1994, and the MSC in Science and Ph.D. degrees in Public Health, National Yang-Ming University, Taipei, Taiwan, in 1996 and 2005, respectively.
In 2004, he joined the Department of Medical Research and Education, Cheng-Hsin General Hospital, as an Associated Researcher, and in 2008 became a Researcher. Since September 2006, he also has been with the Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, where he was an Adjunct Associate Professor. His current research interests include clinical epidemiology, biostatistics, disease screening and medical law.
Abstract:
Purpose. To investigate the prevalence of and risk factors associated with hyperuricemia in the elderly agricultural and fishing population in Taipei, Taiwan. Methods. This study included 4,372 healthy elderly agricultural and fishing professionals (2,766 men and 1,606 women) voluntarily admitted to a teaching hospital in Taipei, Taiwan for physical exams in 2010. Their fasting blood samples were drawn through venipuncture, and they were administered a structured questionnaire by clinical nurses. Results. The overall prevalence of hyperuricemia was 30.4%, which increased significantly with increasing age (p < 0.001). The prevalence was similar in men (30.2%) and women (30.6%) (p = 0.78). Age, obesity, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia as well as low HDL and high BUN, creatinine, and ALT levels were significantly associated with hyperuricemia. Hypercholesterolemia (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.05–2.50) and high creatinine levels (OR = 3.75, 95% CI: 2.64–5.33) were significantly associated with hyperuricemia in men, whereas type 2 diabetes (OR = 1.54, 95% CI: 1.22–1.93) and high ALT levels (OR = 1.79, 95% CI: 1.31–2.43) were significantly associated with hyperuricemia in women. Hyperuricemia disparity among age groups was also revealed. Conclusion. Several sex-related differences in the prevalence of hyperuricemia were indicated in this specific elderly population.
- Rheumatology
Session Introduction
Yasser El Miedany
King’s College, London
Title: Workshop: Biomarkers that can help in setting a Treat to Target approach tailored for Carpal Tunnel Syndrome patients.
Time : 15:10-15:50
Biography:
Professor El Miedany, graduated from Ain Shams University, Cairo, Egypt with an honor degree in 1984. He underwent early postgraduate training at the University Hospitals. He furthered his training in rheumatology at the Centre for Rheumatic Diseases, Royal Infirmary, Glasgow University; where he carried out his MD thesis about pulmonary affection in patients with rheumatoid arthritis and whether it is genetically related. Dr. El Miedany got Diploma in internal medicine, Master degree and MD in Rheumatology. Dr. El Miedany has been appointed Professor of Rheumatology and Rehabilitation, Ain Shams University, Egypt, since 2005. Currently he is honorary senior clinical lecturer, King’s college, London; and also Consultant Rheumatologist, NHS England. Prof. El Miedany is a fellow of the Royal College of Physicians (FRCP, London), American College of Rheumatology, British Society for Rheumatology and is a regional coordinator for the Paediatric Rheumatology International Organization (PRINTO). Prof. El Miedany works closely with skilled and highly motivated medical colleagues and a team of dedicated musculoskeletal occupational and physiotherapists. This allows access to the full range of therapies available for simple and complex musculoskeletal disease including the Biologic therapies. He has special interest in Musculoskeletal Ultrasonography with wide experience in both diagnostic and US guided therapeutic procedures. He was an early proponent of the targeted treatment of inflammatory arthritis and the importance of measuring disease activity as well as patient reported outcomes in order to help guide treatment decisions. Prof. El Miedany has more than 200 publications published in international peer reviewed journals as well as elite conferences such as EULAR, ACR and BSR. He has been an invited speaker at many international rheumatology meetings and symposia worldwide. He authored/ co-authored several chapters in international rheumatology text books and has been the editor for 3 books, Publisher Springer. He is a reviewer for several international rheumatology journals and is associate editor for BMC: Musculoskeletal. His h-index is 20 and i10-index of 30. His has a research gate score of 40.17. His is currently working on a new book about “Comorbidity in Rheumatic Diseases” (Publisher: Springer). His website: www.rheumatology4u.com, provides specialized help to both patients suffering from variable rheumatic diseases as well as rheumatologists and specialist rheumatology nurses.
Abstract:
Evaluation of patients presenting with carpal tunnel syndrome (CTS) symptoms has long relied on their clinical assessment as well as nerve conduction studies. However, whilst standard symptoms and positive provocative testing may enable identifying some of the cases, the subjectivity and sensitivity of these measures results in very poor reliability and diagnostic accuracy. Similarly, though studies revealed sensitivity and specificity data in favour of electrodiagnostic testing for the CTS diagnosis, abnormal nerve conduction testing results do not necessarily equate to the correct diagnosis. Nerve conduction studies can be normal in early cases. Furthermore, nerve studies were reported as not sensitive to change or management, hence, a poor predictor of treatment outcomes. Inspite of some limitations, ultrasonography was found to be a good tool not only for the CTS diagnosis, but also for identifying the median affection severity. The search for markers identifying key targets for the assessment of major outcomes in musculoskeletal diseases has become one of the hot issues in rheumatology. Possible markers should be objectively measured, indicatory of normal biology as well as the pathologic process, indicator of response to therapy and prognosis. It should also be a good indicator of modification of the pathological process and help to identify (in early cases) the patients who are going to respond quickly to therapy with the vision to tailor management to the patient status. This presentation will discuss the outcomes of a recent study investigating the feasibility of initial CTS assessment parameters for setting up a treatment plan tailored to the patient’s needs and its ability to predict treatment outcomes.
Mohamed A Mortada
Faculty of Medicine, Zagazig Universty, Egypt
Title: Multiple Versus Single Ultrasound Guided Suprascapular Nerve Block In Treatment Of Frozen Shoulder In Diabetic Patients
Biography:
Mohamed Mortada, Lecturer of Rheumatology, faculty in medicine, Zagazig University, completed his MD in 2011, published many papers in the field of musculoskeletal ultrasonography in rheumatology practice.
Abstract:
Background: Suprascapular nerve block (SSNB) is used with increasing frequency by anesthetists and rheumatologists in the management of frozen shoulder.
Objective: To compare between single and multiple (nine) SSNB in the treatment of diabetic frozen shoulder.
Patients and methods: Type 2 diabetic patients with frozen shoulder divided into 2 equal groups. Patients in group1 were subjected to single SSNB. Patients in group 2 were subjected to multiple (nine) SSNB 3 times per week. Participants will be assessed clinically and by ultrasound at baseline and after 3 weeks and 4 months.
Results: At assessment points(3 weeks&4 months), there was a significant improvement of all clinical & ultrasound parameters in both groups in comparison with the base line parameters (p ≤ 0.001). But the improvement in the multiple injection protocol was significantly better than the improvement in the single injection protocol was used
Conclusion: course of multiple (nine) injections for suprascapular nerve block gave a better outcome than a single injection for suprascapular nerve block.
- Rheumatoid Arthritis
Biography:
Syahida Ahmad is a Senior Lecturer at Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia. She received her Ph.D. in Drug Discovery at UPM in 2006. Her fields of studies are biochemistry, animal cell biotechnology and natural products biochemistry. Her current research project is focused on the mechanism of action of potential therapeutic compounds, which are chemically synthesized or isolated from natural products on cellular model of pigmentation disorders (e.g psoriasis) or chronic inflammatory diseases (e.g. rheumatoid arthritis, osteorthritis and Alzheimer’s disease). For the past 10 years she has developed simple bioassays to screen for anti-inflammatory, antioxidant and depigmenting activities using animal cell lines. Currently, she is developing a fast and cheap toxicity assay using zebrafish embryo as an animal model under a trade name of Danio AssayTM. Since graduated until present she had published more than 30 papers in the international journals either as corresponding or co-author.
Abstract:
Statement of the Problem: Synovial fibroblast has emerged as a potential cellular target in progressive joint destruction in rheumatoid arthritis development. Our preliminary findings had shown that the newly synthesized curcumin analogue [2,6-bis(2,5-dimethoxybenzylidene) cyclohexanone] or BDMC33 exhibited improved anti-inflammatory activity by inhibiting nitric oxide synthesis, PGE2 synthesis and cyclooxygenase (COX) expression in activated macrophage cells. In this study, we further investigated the potency of BDMC33 on molecular and cellular basis of synovial fibroblasts (SF) in vitro.
Methodology & Theoretical Orientation: Synovial fibroblast cells (HIG-82) were cultured in vitro and induced by phorbol-12-myristate acetate (PMA) to stimulate the expression of matrix metalloproteinase (MMPs) and pro-inflammatory cytokines. The protective effects of BDMC33 were evaluated toward MMP activities, pro-inflammatory cytokine expression and nuclear factor kappa-B (NF-kB) activation by using various bioassay methods, including zymography, Western blotting, reverse transcription polymerase chain reaction, immunofluorescence microscopy and electrophoretic mobility shift assay.
Findings: The results showed that BDMC33 significantly inhibited the pro-gelatinase B (pro-MMP-9) and collagenase activities via suppression of MMP-1 in activated SF. In addition, BDMC33 strongly suppressed MMP-3 gene expression as well as inhibited COX-2 and IL-6 pro-inflammatory gene expression. We also demonstrated that BDMC33 abolished the p65 NF-kB nuclear translocation and NF-kB DNA binding activity in PMA-stimulated SF.
Conclusion & Significance: BDMC33 represents an effective chemopreventive agent and could be used as a promising lead compound for further development of rheumatoid arthritis therapeutic intervention.
Key words: BDMC33, curcumin, HIG-82, matrix metalloproteinase, NF-kB, synovial fibroblast.
Yasser El Miedany
King’s College, London
Title: Towards Rheumatoid Arthritis Cure: Optimizing Therapy and Prediction of Relapse after Tapering Medications
Biography:
Professor El Miedany, graduated from Ain Shams University, Cairo, Egypt with an honor degree in 1984. He underwent early postgraduate training at the University Hospitals. He furthered his training in rheumatology at the Centre for Rheumatic Diseases, Royal Infirmary, Glasgow University; where he carried out his MD thesis about pulmonary affection in patients with rheumatoid arthritis and whether it is genetically related. Dr. El Miedany got Diploma in internal medicine, Master degree and MD in Rheumatology. Dr. El Miedany has been appointed Professor of Rheumatology and Rehabilitation, Ain Shams University, Egypt, since 2005. Currently he is honorary senior clinical lecturer, King’s college, London; and also Consultant Rheumatologist, NHS England. Prof. El Miedany is a fellow of the Royal College of Physicians (FRCP, London), American College of Rheumatology, British Society for Rheumatology and is a regional coordinator for the Paediatric Rheumatology International Organization (PRINTO). Prof. El Miedany works closely with skilled and highly motivated medical colleagues and a team of dedicated musculoskeletal occupational and physiotherapists. This allows access to the full range of therapies available for simple and complex musculoskeletal disease including the Biologic therapies. He has special interest in Musculoskeletal Ultrasonography with wide experience in both diagnostic and US guided therapeutic procedures. He was an early proponent of the targeted treatment of inflammatory arthritis and the importance of measuring disease activity as well as patient reported outcomes in order to help guide treatment decisions. Prof. El Miedany has more than 200 publications published in international peer reviewed journals as well as elite conferences such as EULAR, ACR and BSR. He has been an invited speaker at many international rheumatology meetings and symposia worldwide. He authored/ co-authored several chapters in international rheumatology text books and has been the editor for 3 books, Publisher Springer. He is a reviewer for several international rheumatology journals and is associate editor for BMC: Musculoskeletal. His h-index is 20 and i10-index of 30. His has a research gate score of 40.17. His is currently working on a new book about “Comorbidity in Rheumatic Diseases” (Publisher: Springer). His website: www.rheumatology4u.com, provides specialized help to both patients suffering from variable rheumatic diseases as well as rheumatologists and specialist rheumatology nurses.
Abstract:
The substantial improvement in the management of inflammatory arthritis and the control of the inflammatory process whether by using synthetic or biologic disease-modifying anti-rheumatic drugs (DMARDs), have led to a significant change in the patients’ clinical outcomes and targets of management. After inducing remission was considered, by all the disease management guidelines, as the treatment goal; sustained remission became the desired target. Reaching this stage paved the way for another query regarding the optimal management approaches and whether the patients have reached a phase of disease control that warrants stopping the treatment, i.e. disease cure. This presentation will discuss the recent concepts of defining remission in patients with inflammatory arthritis and the outcomes of a recent study carried out studying the optimum strategies towards drug discontinuation and best biomarkers, whether radiologic, laboratory or clinical; which may help in predicting the risk of relapse in the subgroup of inflammatory arthritis patients who achieved that target and stopped their treatment. The presentation will also present how to set a tailored and dynamic treatment strategy for inflammatory arthritis patients who achieved full disease control; with views towards pre-medication discontinuation assessment as well as post-treatment stopping monitoring.