Rheumatic Disease : Article and Solution

S. F. Carville1, L. Arendt-Neilson2, H. Bliddal3, F. Blotman4, J. C. Branco5, D. Buskila6, J. A. P. Da Silva7, B. Danneskiold-Samsøe3, F. Dincer8, C. Henriksson9, K. G. Henriksson10, E. Kosek11, K. Longley12, G. M. McCarthy13, S. Perrot14, M. Puszczewicz15, W. Samborski16, P. Sarzi-Puttini17, A. Silman18, M. Späth19, S. Wessely20, E. H. Choy1 1Academic Rheumatology, King’s College London, London, United Kingdom, 2Centre for Sensory-Motor
Interaction, Aalborg University, Aalborg, 3The Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark, 4Rheumatology Department, Hospital Lapyeronie, Montpellier, France, 5Serviço de Reumatologia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal, 6Department of Medicine, Soroka Medical Center, Beer Sheva, Israel, 7Reumatologia, Hopitais Da Universidade, Coimbra, Pakistan, 8Department of Physical and Rehabilitation Medicine, Hacettepe Medical School, Ankara, Turkey, 9INR, Section of Occupational Therapy,
10Neuromuscular Unit, University Hospital, Linkoping, 11Pain Centre, Department of Neurosurgery, KarolinskaUniversity Hospital, Stockholm, Sweden, 12 -, -, Bath, United Kingdom, 13Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland, 14Pain Clinic, Hospital Cochin, Paris, France, 15Department of Rheumatology, Rheumatology and Internal Medicine University of Medical Sciences, 16Akademia Medyczna im. Karola Marcinkowskiego Poznaniu, Klinika Fizjoterapil Reumatologli I Rehabilitacji, Poznan, Poland, 17Rheumatology Unit, L. Sacco University Hospital, Milan, Italy, 18Faculty of Medical and Human Sciences ARC Epidemiology Unit, The University of Manchester, Manchester, United Kingdom, 19Friedrich-Baur-Institute, University of Munich, Munich, Germany, 20Psychological Medicine, Institute of Psychiatry, London, United Kingdom

Objective: To develop evidence based recommendations for the management of fibromyalgia syndrome (FMS). Methods: A multidisciplinary fibromyalgia task force was formed consisting of rheumatologists, pain specialists, experts in rehabilitation, a neurologist, an occupational therapist, a bio-scientist, psychiatrist, epidemiologist and a patient representing eleven European Countries: UK, Ireland, Portugal, Sweden, Germany, Italy, Turkey, Israel, Denmark, Poland and France. (more…)

David Isenberg
United Kingdom

B lymphocytes are an essential component of the adaptive immune response. The surface antigen CD20 is expressed throughout B cell differentiation except at the very earliest and plasma cell stages. It is thought to act as a cross membrane calcium ion channel and to play a key role in B cell activation. In consequence it has been hypothesised that targeting CD20 may prove therapeutic in the management of diseases like lupus that are largely B cell mediated. B cell depletion using rituximab, a chimeric human-mouse monoclonal antibody, was first utilized for the treatment of non-Hodgkin’s lymphoma in 1997. For the past six years my colleagues and I have been treating patients with severe SLE who have failed conventional immunosuppressive therapy (N=40) and although our studies remain open label the results have been extremely encouraging. Our preferred therapeutic regime is 1g rituximab IV, 750mg of cyclophosphamide IV and 250mg of Methylprednisolone IV - each infusion is given on two occasions two weeks
apart. Our results (1,2) have indicated that this combination of drugs will achieve B cell depletion in virtually every case and that mean period of B cell depletion is approximately six months. (more…)

CC Mok (MD, FRCP, FHKCP, FHKAM)
Department of Medicine, Tuen Mun Hospital
Hong Kong SAR, China

Therapy of lupus nephritis can be divided into an induction phase and a maintenance phase. Initial treatment is usually more aggressive and aims at inducing remission of nephritis while maintenance therapy is needed to prevent renal flares. Mycophenolate mofetil (MMF) has been shown by randomized controlled trials to be superior to, or at least as effective as, oral or intravenous pulse cyclophosphamide (CYC) as induction therapy for severe lupus nephritis. Adverse effects such as amenorrhoea and major infections are less frequent with MMF than CYC. (more…)

David Isenberg
United Kingdom

Systemic lupus erythematosus (SLE) is a complex autoimmune rheumatic disease whose outlook has improved significantly from the 1950’s when 50%, 4 year survival was noted, to the present when around 80%, 15 year survival is generally recorded. However significant numbers of patients continue to die early from lupus and its morbidity is also significant in some patients. In a cohort of 442 patients with lupus followed up in the Centre for Rheumatology at University College London between 1978 and 2005, 65 patients died with an average age of 47.1 years. The major causes of death were infection, cancer and atherosclerosis. We have recorded deaths in several young teenagers and others in their early twenties. Thus, although the outlook for patients with lupus is much improved and newer, principally biological agents, now offer the prospect of far more focussed and appropriate treatment for this disease, there is a continuing need to understand rather better its precise aetiopathogenesis. (more…)

John Edmonds
Dept of Rheumatology
St George Hospital, Sydney, Australia

‘Disease Activity’ in rheumatoid arthritis is a concept that attempts to capture, in some quantitative sense, the energy of pathological processes that result in the damage of rheumatoid arthritis. Rheumatologists speak of disease that is more or less ‘active’, of persistent ‘disease activity’ resulting in ‘joint damage’. Given that the thrust of RA therapy is ‘disease control’, clinicians need some measure of ‘disease activity’. Disease activity is the target of antirheumatic
therapy but how can we know whether treatment is ‘adequate’ if we cannot measure the target of our therapy? (more…)