Rheumatology (musculoskeletal system / joints)

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Research outputs from the Rheumatology team at the RD&E.

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Now showing 1 - 5 of 21
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    Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England
    (Oxford University Press, 2023-11-11) Quick, V.; Abusalameh, M.; Ahmed, S.; Alkoky, H.; Bukhari, M.; Carter, S.; Coath, F. L.; Davidson, B.; Doddamani, P.; Dubey, S.; Ducker, G.; Griffiths, B.; Gullick, N.; Heaney, J.; Holloway, A.; Htut, E. E. P.; Hughes, M.; Irvine, H.; Kinder, A.; Kurshid, A.; Lim, J.; Ludwig, D. R.; Malik, M.; Mercer, L.; Mulhearn, B.; Nair, J. R.; Patel, R.; Robson, J.; Saha, P.; Tansley, S.; Mackie, S. L.
    OBJECTIVES: The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. METHODS: Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse. RESULTS: 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median (interquartile range, IQR) of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6% respectively had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% of relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017); in those not in remission at qwTCZ cessation (P = 0.0036); and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing, and conventional synthetic DMARD use were not associated with time to relapse. CONCLUSION: Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.
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    Treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs: British Society for Rheumatology guideline scope
    (Oxford University Press, 2023-05-15) Zhao, S. S.; Harrison, S. R.; Chan, A.; Clarke, N.; Davis, C.; Eddison, J.; Gregory, W. J.; Jones, G. T.; Marzo-Ortega, H.; Murphy, D. J.; Sandhu, V.; Sengupta, R.; Siebert, S.; Thompson, B.; Webb, D.; Yates, M.; Gaffney, K.
    Pharmacological management has advanced considerably since the 2015 British Society for Rheumatology axial spondyloarthritis (axSpA) guideline to incorporate new classes of biologic DMARDs (bDMARDs, including biosimilars), targeted synthetic DMARDs (tsDMARDs) and treatment strategies such as drug tapering. The aim of this guideline is to provide an evidence-based update on pharmacological management of adults with axSpA (including AS and non-radiographic axSpA) using b/tsDMARDs. This guideline is aimed at health-care professionals in the UK who care directly for people with axSpA, including rheumatologists, rheumatology specialist nurses, allied health professionals, rheumatology specialty trainees and pharmacists; people living with axSpA; and other stakeholders, such as patient organizations and charities.
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    Diagnosis of cauda equina syndrome in the emergency department
    (BMJ, 2023-09-01) Metcalfe, D.; Hoeritzauer, I.; Angus, M.; Novak, A.; Hutton, M.; Woodfield, J.
    Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.
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    Saving the planet with reduced routine DMARD blood monitoring frequency
    (BMJ, 2023-07-01) Wood, N. A. E.; Farmer, L.; Croker, R.; Kyle, S.; Lewis, T.
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    The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs
    (Oxford University Press, 2022-08-30) Tucker, L.; Allen, A.; Chandler, D.; Ciurtin, C.; Dick, A.; Foulkes, A.; Gullick, N.; Helliwell, P.; Jadon, D.; Jones, G.; Kyle, S.; Madhok, V.; McHugh, N.; Parkinson, A.; Raine, T.; Siebert, S.; Smith, C.; Tillett, W.; Coates, L. C.