Take the Guess Work Out of Biologic Rheumatoid Arthritis Choice

April 9, 2024

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that not only affects the joints but can exert systemic influence, potentially impacting various body systems. The journey through RA treatment is unique for each individual, necessitating a personalized approach. Enter precision medicine for rheumatoid arthritis—the practice of tailoring treatment to the individual characteristics of each patient.

Today we delve deep into how molecular signature testing is revolutionizing treatment decision-making in RA.

Understanding Molecular Signature Testing

Within precision medicine for rheumatoid arthritis, molecular signature testing is emerging as a novel way we can identify whether individuals might benefit from certain biologic medications. The molecular signature is essentially a unique ‘barcode’ of gene expression within an individual’s immune cells. This can predict the body’s response to different treatments.

The Study At Hand: A Pivotal Discovery

Recently, a critical study titled “Patient outcomes improve when a molecular signature test guides treatment decision-making in rheumatoid arthritis,” published in the Expert Review of Molecular Diagnostics, has provided substantial evidence supporting the integration of molecular signature testing in managing RA.

In the study, researchers elucidated the role of a specific test—the Molecular Signature Response Classifier (MSRC). The MSRC is designed to predict whether patients with RA will respond to tumor necrosis factor inhibitor (TNFi) therapies, a common class of biologic drugs used in treatment. These medications include Enbrel, Humira, Cimzia, Simponi, and Remicade as well as their biosimilar equivalents.

Unlocking Personalized Treatment Strategies

Biologic medications, which target specific components of the immune system, have transformed the landscape of RA treatment. However, the response to these drugs can vary significantly among patients—a challenge that precision medicine for rheumatoid arthritis seeks to address.

The Molecular Signature Response Classifier (MSRC) test functions as a sophisticated investigative tool employed to decipher the intricate workings of your immune system, particularly in relation to rheumatoid arthritis (RA). At its core, the MSRC examines the patterns of gene expression, which can be envisioned as the “on” or “off” switches of genes within your immune cells. These patterns can provide crucial insights into your body’s unique response to specific medications, specifically tumor necrosis factor inhibitors (TNFis)—a class of biologic drugs frequently utilized in RA treatment.

By measuring these gene expressions, the MSRC can predict with a remarkable degree of accuracy whether your body is likely to respond favorably to TNFis, thus avoiding the potential trial and error associated with medication effectiveness. This personalized approach not only guides your healthcare provider in selecting the most appropriate treatment for your condition but also reflects a conscientious and empathetic stride towards optimizing your healthcare experience, minimizing unnecessary interventions and focusing on treatments that align with your body’s individual genetic makeup.

The study showcases how MSRC testing can predict the efficacy of TNFi medications for individuals with RA. This innovative approach posits that using a patient’s molecular signature could improve rates of remission and help in selecting the most fitting biologic therapy.

Simply put, it seeks to take the guess work out of biologic therapy choice.

The Research Outcomes: A Patient-Centric View

Improving Patient Journeys

By analyzing a pooled cohort of patients who were subjected to MSRC testing to guide biologic therapy selections, the study demonstrated a significant improvement in patient outcomes, notably in remission rates and achieving low disease activity. Specifically, patients in the MSRC-tested arm achieved higher proportions of clinical disease activity index (CDAI) low disease activity or remission (CDAI-LDA/REM) and remission alone (CDAI-REM), compared to those in the external control group, over a six-month period. Furthermore, a notable improvement was observed in minimally important differences (MID) in CDAI scores, indicating a meaningful reduction in disease activity from baseline.

The Promise of Precision Medicine in Action

Each RA patient’s battle is distinct, often filled with trials and adjustments in treatment regimens. The clear message from this research is that precision medicine for rheumatoid arthritis, epitomized by molecular signature testing, can facilitate a more targeted treatment approach—a leap forward from the one-size-fits-all strategy.

What This Means for You: Precision Medicine’s Role

Contemplating Biologic Treatment Options

If you are considering initiating biologic therapy or are reevaluating your current regimen, precision medicine for rheumatoid arthritis offers a scientific beacon. By assessing your unique molecular signature, clinicians can better forecast which therapy aligns with your body’s intrinsic biology.

Precision Medicine for Rheumatoid in Clinical Practice

The clinical implications are considerable. The integration of molecular testing in treatment planning could not only enhance patient outcomes but potentially streamline the therapeutic trajectory, reducing the trial-and-error approach that many patients and their doctors face.

Collecting the Pieces: The Broader Implications

Beyond Individual Outcomes

Precision medicine’s implications extend beyond individual patient care not only for rheumatoid arthritis but also other autoimmune conditions such as multiple sclerosis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, etc. This paradigm has the potential to enhance healthcare resource utilization by optimizing medication selection and reducing the economic burden of ineffective treatments.

Concluding Thoughts: The Precision Medicine Landscape

As we navigate the intricate landscape of RA, molecular signature testing stands as a promising lighthouse, guiding us towards safe harbors of effective treatment options. By embracing the tailored approach that precision medicine for rheumatoid arthritis offers, we can look forward to a future where patients are not only treated but understood on a molecular level.

Call to Action: Partner with Precision

If you are at a crossroads in your RA treatment journey, consider discussing molecular signature testing with your healthcare provider. It is a step towards a personalized treatment plan crafted with your unique genetic makeup in mind, offering the potential for improved outcomes and quality of life.

References

Molecular Signature Testing: PrismRA

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advise you to speak with your medical professional if you have questions concerning your symptoms, diagnosis, and treatment.

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Diseases and Conditions Self-Injection Videos

How to Inject Orencia at Home

April 2, 2024

Orencia, also called abatacept, is a biologic medication prescribed for rheumatoid arthritis and now, psoriatic arthritis. It comes both as an autoinjector/pen or as a prefilled syringe. In previous posts we covered how to inject Humira, Enbrel, Simponi, and Cimzia as well as how to inject methotrexate. In this week’s post, we’ll learn how to inject Orencia at Home.

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the autoinjector or prefilled syringe out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Chose an area to inject – Thigh or Stomach.
- Chose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

Injecting Orencia with an autoinjector/pen

Observe the medication in the window to be sure that it is clear (no cloudiness or crystals)
- You will see a small air bubble within the window, this is normal and will not cause harm when injecting
Remove the cap
Press the tip of the auto-injector down in the skin at a 90 degree angle until it is flush with the skin
Press button and hold for 15 seconds
Viewing window will turn yellow or blue, but continue to hold the button for the full 15 seconds
Lift the auto-injector straight up

Injecting Orencia with a prefilled syringe

Pull off the cap and observe the syringe to be sure that it is clear (no cloudiness or crystals)
Pinch the skin around the injection site and enter at a 45-degree angle
Press the plunger (slowly) to administer the medication
Once the medication is fully administered, the plunger will reach the bottom and a spring will place a cover over the needle

After the injection

Properly dispose of the entire autoinjector/pen or prefilled syringe
- Sharps Container
  - Can be purchased at your local pharmacy
  - Disposal
- - Hospitals and nursing homes may take full sharps containers, ask first.
  - Pharmacies and Doctors’ offices are not allowed to take used syringes or needles
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

For more information regarding Orencia, please follow this link.

Medical Disclaimer

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Diseases and Conditions

Empowerment Against Lyme Arthritis: A Guide to Victory

March 5, 2024

A thorough look at Lyme disease focusing on symptoms, diagnosis, and treatments, with an empathetic deep dive into Lyme arthritis

The battle against Lyme disease is a modern medical crusade, with Lyme arthritis as one of its quintessential adversaries. Understanding the intricacies of this condition, from its harbinger symptoms to the latest evidence-based treatment strategies, is crucial for both patients and medical professionals to combat and manage this insidious disease.

Lyme disease, caused by the spiral-shaped bacteria Borrelia burgdorferi and transmitted by the bite of an infected Ixodes tick, often manifests in multiple stages with distinguishing symptoms. Thus, the crux of today’s discussion centers upon recognition, diagnosis, and management, with a special focus on the rheumatic embodiment of this bacterial invasion: Lyme arthritis.

Understanding Lyme Disease: A Primer

Lyme disease begins stealthily, often with a characteristic rash called erythema migrans. It resembles a bull’s-eye, a clear central area surrounded by redness. But not everyone with Lyme disease gets or sees this rash. Fatigue, fever, chills, headache, and joint or muscle pain may follow suit. For some, this is just the onset. When Lyme disease progresses untreated, myriad complications can arise, including what is known as Lyme arthritis.

Diving Deeper into Lyme Arthritis

Lyme arthritis, a frequent late-stage manifestation of this bacterial infection, emerges as episodic bouts of swelling and pain, generally in the large joints, especially the knees. It is often overshadowed by its more serious counterparts—neurological and cardiac manifestations—but it carries a unique burden: chronic assault on the skeletal system.

The symptoms of Lyme arthritis can be severe, and they often mimic those of other diseases. The most common signs include:

Pain in one or more joints, especially the knees, ankles, elbows and wrists

Swelling in these same areas
Redness around the affected joints
Warmth over the affected area

The disease can also be confused with other conditions, such as rheumatoid arthritis or osteoarthritis.

Decoding the Diagnosis of Lyme Disease and Lyme Arthritis

The diagnosis of Lyme arthritis, much like other manifestations of Lyme disease, hinges on a synthesis of clinical, epidemiological, and diagnostic test findings. Clinically, Lyme arthritis typically presents as periodic bouts of inflammation and pain in the larger joints, predominantly affecting the knees. It is important to determine the risk of exposure to ticks in endemic areas, which forms an integral part of the epidemiological assessment.

To confirm the diagnosis, serological testing is employed. The Centers for Disease Control and Prevention (CDC) recommends a two-step process, beginning with an enzyme immunoassay (EIA) or an indirect immunofluorescence assay (IFA). If the result is positive or borderline, a Western blot test is conducted for verification. It’s important to note, however, that false positives can occur, and test results should be interpreted in context of the overall clinical picture.

Once Lyme arthritis is diagnosed, fluid from the affected joint(s) may be aspirated and tested to rule out other causes of joint inflammation and to confirm the presence of Lyme disease. It’s crucial to ensure accurate diagnosis to enable prompt and appropriate treatment.

The Clinical Practice Guidelines on Lyme Disease

Per the Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR),the approach to prevention, diagnosis, and treatment is methodical. For patients presenting with early signs without Lyme arthritis or other significant manifestations—such as fever or rash—oral antibiotics are the mainstay of therapy. The antibiotic of choice is doxycycline unless there is a contraindication. Other antibiotic choices include amoxicillin.

The Predicament and Approach to Lyme Arthritis

When Lyme disease evolves into Lyme arthritis, the treatment canon requires augmentation. The round of treatment is oral antibiotics. If this doesn’t work, a second round of oral antibiotics is recommended. If the second round doesn’t work, then intravenous antibiotics like ceftriaxone is started.

The Reinforcement Against Lyme Arthritis

Lyme arthritis, whilst potentially persistent and damaging, is generally responsive to antibiotic therapy. However, approximately 10% of patients may experience what’s termed antibiotic-refractory Lyme arthritis, a condition not relenting even after appropriate antibiotic treatment. In such scenarios, symptomatic management, including nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular steroids, or disease-modifying antirheumatic drugs (DMARDs), may be necessitated. Some of these DMARDs include hydroxychloroquine and methotrexate.

Chronic Lyme Disease Controversy and the Lyme Arthritis Link

Chronic Lyme Disease—a term that has been the subject of much controversy, in part because it is used to describe a range of non-specific symptoms that persist after treatment. Clinical guidance emphasizes a guarded approach; the evidence supports treating Lyme arthritis clearly defined by objective signs, cautioning against prolonged antibiotic use without definitive Lyme disease evidence.

Advancing Towards Precision Medicine in Lyme Arthritis

The IDSA guidelines highlight the importance of personalized management plans, accounting for the variability in individual responses and the progression stages of Lyme disease and Lyme arthritis. The ability to study the genome and identify biomarkers for diagnosis and prognosis is a captivating horizon that could revolutionize our approach, allowing treatments tailored to an individual’s molecular makeup.

Combating Misinformation and the Future of Lyme Arthritis

The prevalence of misinformation about Lyme disease makes it important to reiterate that evidence-based medicine is the foundation for medical management, including Lyme arthritis.

Future endeavors include vaccines against Lyme disease, novel diagnostics, and even disease-modifying therapies that could alter the very foundations of Lyme arthritis treatment.

The Empathy Behind Lyme Arthritis Care

For some, Lyme arthritis is a chronic condition that can be difficult to diagnose and treat. In cases where medical therapies alone are not enough, a multi-pronged approach that combines physical therapy and lifestyle modifications can help to cushion the joints from further assaults.

One must never disregard the personal odyssey of those touched by Lyme arthritis—the pain isn’t merely physical but also psychological. Patient support groups and mental health care are equally pivotal in dealing with the repercussions of chronic illness.

In Conclusion: Your Lyme Arthritis Action Plan

Fighting Lyme arthritis is daunting, yet knowledge furnishes us with the weaponry to surmount this challenge. Remain vigilant for the signs, adhere to preventive measures, and if you suspect Lyme disease or arthritis, consult healthcare professionals promptly. They are your allies, guiding you through the forests of uncertainty toward a clearing of health.

With persistence, resilience, and informed choices, the journey with Lyme arthritis is not one of indefinite suffering but of hope, recovery, and triumph over adversity.

Call to Action

Remember, your proactive steps can signify the difference between lingering symptoms and reclaiming well-being. Take the information here as your starting point and journey towards a healthier future.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis, and treatment.

References

Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021 Jan 23;72(1):1-8. doi: 10.1093/cid/ciab049. PMID: 33483734.

Diseases and Conditions RheumDoctor Learning Center

What is the Link Between HLA-B27 and Uveitis Explained

February 15, 2024

Introduction to HLA-B27

HLA-B27 is a gene that provides instructions for making a protein called major histocompatibility complex, class I, B 27 (MHC Class 1 B 27). This protein plays an important role in the immune system by presenting antigens to T-cells. Approximately 6-8% of the general population carries the HLA-B27 gene, though prevalence varies among different ethnic groups. HLA-B27 positivity is closely associated with a group of inflammatory joint conditions known as seronegative spondyloarthropathies. The most well-known of these is ankylosing spondylitis, where up to 90% of patients test positive for HLA-B27. Other associated conditions include reactive arthritis, psoriatic arthritis, inflammatory bowel disease, and acute anterior uveitis. While the exact mechanism is unclear, it is believed that HLA-B27 may present self-antigens to T-cells, triggering an autoimmune response that leads to chronic inflammation in the joints and eyes.

HLA-B27 and the Eye

The main ocular manifestation of HLA-B27 is uveitis, which is inflammation of the middle layer of the eye called the uvea. Up to 50% of cases of acute anterior uveitis are associated with HLA-B27. Although HLA-B27 is strongly linked to acute anterior uveitis, which involves the iris and ciliary body, it can also be associated with intermediate, posterior and panuveitis.

The exact mechanism for how HLA-B27 leads to increased uveitis risk is not fully understood. One theory is molecular mimicry, where HLA-B27 is similar in structure to molecules found in the eye, leading to cross-reactivity of the immune system. Another theory suggests HLA-B27 misfolds and elicits an inflammatory response. Regardless of the mechanism, HLA-B27 positive individuals have a greatly increased lifetime risk for developing recurrent uveitis.

Types of HLA-B27 Uveitis

The most common type of uveitis associated with HLA-B27 is acute anterior uveitis, which involves inflammation of the iris and ciliary body in the front of the eye. Up to 50% of all cases of acute anterior uveitis are linked to HLA-B27 positivity [1]. Anterior uveitis leads to redness, pain, and blurred vision.

While anterior uveitis is most typical, HLA-B27 positive individuals can also develop inflammation involving the posterior segment of the eye, including intermediate uveitis, posterior uveitis, and panuveitis [2]. Posterior inflammation is less common but can lead to more severe visual complications if not treated promptly.

Symptoms of HLA-B27 Uveitis

The most common symptoms of HLA-B27 associated uveitis are:

Acute onset of redness in one eye
Eye pain and discomfort, often severe
Blurred vision or reduced visual acuity
Photophobia or increased sensitivity to light
Tearing and discharge

Patients often describe a sudden onset of symptoms including severe pain, redness, and light sensitivity in one eye. Vision becomes blurred or cloudy. Discharge and tearing may occur as inflammation sets in. The symptoms arise rapidly and reach peak intensity over the course of a few days. Attacks often recur periodically in the same eye.

The acute anterior uveitis associated with HLA-B27 has a classic presentation but posterior uveitis involving the retina or choroid can also occur. Symptoms help differentiate anterior versus posterior inflammation. Vision loss, floaters, and photopsias point more to posterior segment issues.

In summary, the typical symptoms of HLA-B27 uveitis are unilateral red eye with blurred vision, pain, and tearing. The acute onset and recurrent nature helps differentiate it from other types of uveitis. Prompt diagnosis and treatment is key to prevent complications from repeated bouts of inflammation.

Diagnosis

Diagnosing HLA-B27 uveitis involves a comprehensive eye examination, medical history assessment, and laboratory tests. Ophthalmologists may use several methods to evaluate the type and severity of uveitis:

Slit lamp exam – This allows close inspection of the front structures of the eye. Signs of inflammation in the anterior chamber such as flair and inflammatory cells can be observed. The architecture of the iris and lens are also examined for abnormalities.

Intraocular pressure measurement – Increased pressure may indicate inflammation of the trabecular meshwork or steroid response. Low pressure can occur with severe inflammation.

Dilated pupil exam – Drops are used to open up the pupil so the ophthalmologist can thoroughly inspect the posterior segment with an ophthalmoscope. Active inflammation of the retina or choroid may be visible.

Optical coherence tomography (OCT) – This non-invasive imaging technique can reveal subtle changes in the retina and measure areas of macular edema.

Fluorescein angiography – A dye injected into the arm travels to the blood vessels in the eye. This allows detailed visualization of retinal vasculitis, vascular leakage, and macular edema.

Lab tests – HLA-B27 blood testing confirms the genetic marker. Complete blood count, inflammatory markers, syphilis testing, and x-rays may be ordered to rule out other potential causes of uveitis.

Treatment

Treatment for HLA-B27 uveitis focuses on controlling acute flare ups and preventing recurrent episodes of inflammation. The main treatments include:

Topical corticosteroid eye drops such as prednisolone or dexamethasone are used to rapidly decrease inflammation and symptoms during an acute attack. High potency drops may be given frequently (up to every hour) upon onset of a flare up.
Immunomodulatory medications can be used to reduce the body’s autoimmune response and prevent recurrent episodes of uveitis. Common options include methotrexate, mycophenolate mofetil, cyclosporine, and newer biologic agents like adalimumab or infliximab. These are often used along with low-dose corticosteroid drops to maintain remission.

According to research, “Treatment for HLA-B27 uveitis can range from local corticosteroids to immunosuppressive drugs, and now numerous studies have highlighted the benefits of tumor necrosis factor alpha inhibitors in the management of HLA-B27-associated uveitis” (Source)

The treatment plan is tailored to the individual patient based on the severity and recurrence pattern of their inflammation. The goal is to find the lowest effective doses needed to control the uveitis long-term.

Monitoring

Ongoing monitoring by an ophthalmologist is important for HLA-B27 uveitis patients to screen for potential complications and recurrent inflammation. According to the American Academy of Ophthalmology, patients should be examined 1-2 weeks after an acute attack and then every 3-6 months indefinitely if the condition is chronic. More frequent follow-up is required if ocular complications develop.

During monitoring exams, the ophthalmologist will perform a slit lamp exam to carefully inspect the anterior chamber for signs of recurrent inflammation. Intraocular pressure will also be checked to screen for steroid-induced glaucoma. Dilated fundus exam and optical coherence tomography may be done to check for cystoid macular edema and other posterior segment complications. Patients are instructed to contact their ophthalmologist immediately if symptoms of recurrent uveitis flare up between scheduled visits.

Regular monitoring aims to achieve quiescence of inflammation and prevent permanent vision loss from complications. Studies show that 60-90% of patients respond well to proper management and maintain 20/20 visual acuity long-term. However, ongoing adherence to treatment and follow-up care is imperative.

Complications

Chronic inflammation due to HLA-B27 uveitis can lead to several complications that threaten vision and eye health. The most common complications include:

Posterior Synechiae

Up to 40% of patients develop posterior synechiae, which are adhesions between the iris and lens [1]. These adhesions can permanently damage the drainage system and cause angle closure glaucoma.

Cataract

Around 20% of HLA-B27 uveitis cases result in cataract formation, particularly with repeated inflammation [2]. Cataracts cause blurred vision and eventual blindness if left untreated.

Glaucoma

Increased eye pressure is common in HLA-B27 uveitis. Glaucoma develops in up to 10% of patients and can lead to optic nerve damage and vision loss if uncontrolled [3].

Cystoid Macular Edema (CME)

Chronic inflammation can also result in CME, which is fluid accumulation in the macula causing blurred central vision. Regular eye exams are key to detecting CME early.

Prognosis

With timely diagnosis and proper management of HLA-B27 associated uveitis, the prognosis for vision is generally good. Studies show that with consistent steroid and immunomodulatory treatment to control inflammation, most patients can maintain useful vision and experience minimal complications.

According to a 10-year study published in Ocular Immunology and Inflammation, 95% of HLA-B27 positive uveitis patients achieved complete remission or only rare episodic inflammation when treated with systemic immunosuppression along with steroid eye drops. The study concluded that recurrent HLA-B27 anterior uveitis responds well to therapy and monitoring.

Patients need to work closely with their ophthalmologist for regular exams and screenings to detect recurrences early. With vigilant monitoring and treatment compliance, most can retain 20/20 vision despite having a chronic uveitis condition.

Conclusion – the importance of recognizing HLA-B27 uveitis and controlling inflammation

HLA-B27 associated uveitis can lead to significant ocular complications and vision loss if left uncontrolled. However, with prompt diagnosis and proper management, the prognosis for maintaining good vision is favorable. It is critical for both patients and physicians to be aware of the connection between HLA-B27 and uveitis.

Patients who test positive for HLA-B27 should have regular dilated eye exams to screen for signs of uveitis, even in the absence of symptoms. At the first sign of inflammation, aggressive treatment is needed to eliminate active disease and prevent recurring attacks. Though challenging to manage, chronic uveitis in HLA-B27 patients can typically be well-controlled with corticosteroid therapy and secondary immunosuppressive medications as needed.

Close monitoring for elevated eye pressure, cataracts, macular edema and other complications is also essential. Early intervention with surgery may be required in some cases. With a tailored treatment approach and ongoing care, most HLA-B27 positive patients can achieve lasting remission and preserve their vision.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional

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Diseases and Conditions Journal Club

Exploring New Ways to Keep ANCA Vasculitis in Check

February 12, 2024

ANCA Vasculitis is a rare but serious condition where the body’s immune system mistakenly attacks its own blood vessels, causing inflammation. This falls into a group of illnesses known as autoimmune diseases. Each year, about 3 out of every 100,000 people get diagnosed with it, mainly those who are between 50 and 70 years old. One of the biggest hurdles in treating ANCA Vasculitis is preventing it from coming back, which calls for some creative solutions to keep the disease in remission.

A groundbreaking study titled “Maintenance of Remission of ANCA Vasculitis by Rituximab Based on B Cell Repopulation Versus Serological Flare: A Randomised Trial” sheds light on a novel tactic for tackling this challenge. It zeroes in on the drug Rituximab, which helps calm the immune system’s overreaction that’s at the heart of this condition.

Why Focus on Rituximab for ANCA vasculitis?

Rituximab targets B cells, which play a big part in the body’s overactive immune response seen in ANCA Vasculitis. Doctors usually give this medication when they notice B cells coming back after treatment or when there’s a spike in ANCA levels, which can mean the disease is flaring up.

The Two Approaches Explained

The study looks at two ways of deciding when to give extra doses of Rituximab:

The first way is based on whether B cells are starting to show up again after being knocked down by treatment.
The second way relies on monitoring ANCA levels in the blood, even if the patient isn’t showing any symptoms, to catch any potential flare-ups.

What the Study Found

This research offers new insights by comparing these two strategies. It found that using Rituximab based on the return of B cells leads to fewer relapses than waiting for ANCA levels to rise, over an average follow-up of 4.1 years. This result supports the idea that tailoring treatment to each patient’s specific situation can really make a difference in managing complex autoimmune diseases like ANCA Vasculitis.

However, both methods have their challenges, such as predicting disease flares accurately and the feasibility of frequent testing. The study also closely monitored safety, noting similar side effects in both groups but a slightly higher risk of serious issues related to COVID-19 in those treated based on B cell repopulation.

Personalized Care for ANCA Vasculitis is Key

The findings highlight that there’s no one-size-fits-all answer to treating ANCA Vasculitis. Some patients might do better with one approach over the other, emphasizing the importance of customizing treatment plans.

Looking Ahead

This study is a significant step forward in improving how we maintain remission in ANCA Vasculitis. It encourages us to keep asking questions and searching for better ways to care for those affected by this disease.

Even though the medical terms might sound complex, they’re part of understanding how to best manage ANCA Vasculitis. As we work to unravel these complexities, it’s crucial to keep learning, adapting, and showing compassion for those living with this condition.

This research marks an important progress in our journey, and we’re committed to sharing the latest and most accurate information to help make informed health decisions. Our dedication to understanding and empathizing with your health challenges stands firm.

References

Zonozi R, Cortazar FB, Jeyabalan A, Sauvage G, Nithagon P, Huizenga NR, Rosenthal JM, Sipilief A, Cosgrove K, Laliberte KA, Rhee EP, Pendergraft WF 3rd, Niles JL. Maintenance of remission of ANCA vasculitis by rituximab based on B cell repopulation versus serological flare: a randomised trial. Ann Rheum Dis. 2023 Dec 11:ard-2023-224489. doi: 10.1136/ard-2023-224489. Epub ahead of print. PMID: 38123922.

Medical Disclaimer

Diseases and Conditions Tips and Tricks

How to Care for Your Oral Health with Sjogren’s Syndrome

February 6, 2024

Today we’re going to learn about Sjogren’s syndrome oral health and steps you can take to protect your teeth and gums. But before we delve into the matter, let’s talk about Sjogren’s Syndrome.

Introduction to Sjögren’s Syndrome

Sjögren’s syndrome is an autoimmune disorder that affects the body’s moisture-producing glands like the salivary and tear glands. This causes symptoms of dry eyes and dry mouth and can negatively affect your oral health. Sjögren’s syndrome mostly affects middle-aged women, with 9 out of 10 Sjögren’s patients being female. The condition can occur at any age though, including childhood.

Sjögren’s syndrome is considered a systemic disease because it can affect organs and body systems beyond the eyes and mouth. However, the hallmark symptoms remain dry eyes and dry mouth due to impaired gland function. According to a 2014 study, the prevalence of primary Sjögren’s syndrome ranges from 0.01 to 0.72% of the population).

How Sjögren’s Syndrome Affects Saliva Production

Sjögren’s syndrome is an autoimmune disease that attacks the body’s exocrine glands, including the salivary glands. This leads to significant reductions in saliva and tear production. The hallmark symptom of Sjögren’s is dry mouth, also known as xerostomia. With Sjögren’s, the salivary glands become inflamed and damaged, impairing their ability to produce saliva. This results in chronic feelings of dry mouth.

Saliva plays a critical protective role in oral health. Having minimal saliva in the mouth due to Sjögren’s syndrome can allow bacteria to grow, leading to increased risk of tooth decay and fungal infections. Lack of saliva also makes chewing and swallowing food more difficult. According to the National Institutes of Health, nearly all patients with primary Sjögren’s syndrome report symptoms of dry mouth.

Without adequate saliva to lubricate and rinse the teeth and gums, Sjögren’s patients face heightened risk of cavities, gum disease, mouth sores, and other dental problems. Ensuring proper oral hygiene is especially important for Sjögren’s patients due to reduced saliva production.

Dry Mouth and Sjogren’s Syndrome Oral Health Complications

Sjögren’s syndrome dramatically reduces saliva production, resulting in a chronic dry mouth condition known as xerostomia. Saliva is critical for oral health, and without adequate saliva flow, Sjögren’s patients experience uncomfortable dry mouth symptoms and an increased risk of dental problems.

Common dry mouth symptoms caused by Sjögren’s syndrome include:

Chapped or cracked lips
Burning or tingling sensation in the mouth
Difficulty chewing, speaking, and swallowing
Dry, sticky, or burning tongue
Mouth sores or infections
Bad breath

With decreased saliva production, Sjögren’s patients are also at higher risk for complications like gum disease, tooth decay, and oral fungal infections. Dry mouth creates an environment favorable to bacteria growth, acid damage, and irritation.

Specifically, Sjögren’s patients may experience:

Increased dental cavities due to lack of saliva’s buffering capacity and remineralization properties
Gingivitis and periodontitis as saliva is not present to wash away plaque and acids
Oral thrush or candidiasis fungal infections in the mouth

Left untreated, dry mouth can seriously impact oral health over time. That’s why managing symptoms and dental care are so important for Sjögren’s patients.

Other Sjogren’s Syndrome Oral Health Problems

In addition to dry mouth, Sjögren’s syndrome can lead to several other oral health issues including:

Tooth decay – With less saliva to wash away food and neutralize acids, cavities can develop more frequently (https://pearlypros.com/category/cosmetic-dentistry/oral-health-tips/).

Gum disease/infections – Dry mouth allows bacteria to grow, increasing risk of gingivitis, periodontitis and other infections (https://m.facebook.com/kabanidental/posts/4169354456419345/).

Fungal infections – Candida fungus thrives in the dry mouth environment.

Mouth sores – Lack of protective saliva causes sensitive tissue in mouth to crack and ulcerate.

Loss of taste – Saliva helps stimulate taste buds. Reduced saliva flow can diminish the sense of taste.

Importance of Saliva for Oral Health

Saliva is critical for maintaining good oral health. It serves several key functions:

Lubricates and Protects Tissues – Saliva acts as a lubricant for the mucous membranes in the mouth and throat. This helps protect against friction that can cause irritation or damage. The lubricating properties of saliva also keep the mouth comfortable and aid in functions like talking and swallowing.

Neutralizes Acids – Saliva contains minerals like calcium and phosphate that help neutralize acids in the mouth. Acids are produced when plaque bacteria metabolize sugars and attack tooth enamel. Saliva helps restore a neutral pH balance to prevent acid erosion of enamel.

Contains Minerals That Strengthen Enamel – Saliva provides a constant source of calcium, phosphate, and fluoride ions that are essential for re-mineralizing and strengthening tooth enamel. Minerals in saliva help protect teeth from bacterial acids and also aid in repairing early tooth decay.

With reduced saliva production, these protective factors are diminished. This puts Sjögren’s patients at a much higher risk of gum disease, tooth decay, and other problems.

Managing Dry Mouth

There are several methods Sjögren’s syndrome patients can use to help manage dry mouth symptoms and increase comfort:

Sipping cool water – Keeping hydrated by frequently sipping cool water can help provide relief and moisture.
Saliva substitutes – Artificial saliva sprays or gels can serve as saliva substitutes to coat and lubricate the mouth. Some examples are Biotene, Oasis, and Xerolube.
Alcohol-free mouth rinses – Swishing with alcohol-free oral rinses without irritating ingredients can help moisten the mouth. Some options are Biotene, ACT Total Care, and Crest Pro-Health rinses.
Chewing gum – Chewing sugar-free gum stimulates saliva production and can help keep the mouth moist. Look for brands containing xylitol.
Moisturizing sprays and gels – Moisturizing oral sprays and gels provide quick, temporary relief. Products like Mouth Kote and Oasis moisturizing gels can coat and hydrate the mouth.

Patients should work with their dentist to determine the best dry mouth remedies based on their symptoms. Using a combination of methods throughout the day provides the most effective relief.

Source: https://sjogrens.org/sites/default/files/inline-files/Sjogrens-DryMouth.pdf

Daily Sjogren’s Syndrome Oral Health Recommendations

Maintaining good oral hygiene is essential for Sjögren’s patients to prevent cavities, gum disease, and other dental problems. Here are some tips for keeping your mouth healthy on a daily basis:

Brush gently with a soft-bristled toothbrush. Use gentle, circular motions when brushing and avoid scrubbing aggressively on your teeth and gums. This helps prevent abrasions or irritation of the soft tissues.

Use a fluoride toothpaste. Fluoride helps strengthen enamel and prevent cavities, which is very important for those with dry mouth. If your mouth is very dry, look for toothpastes specially formulated for dry mouth.

Floss once daily. Flossing removes plaque and food particles between teeth that brushing misses. Be very gentle when flossing if you have inflamed gums.

Ask your dentist about fluoride treatments. In-office fluoride treatments or prescription high-concentration fluoride gels can help protect your teeth by strengthening weakened enamel.

Don’t forget to brush your tongue to help freshen breath. End each day with a thorough brushing and flossing to keep your mouth clean while sleeping.

Seeing the Dentist Regularly

It is critical for Sjögren’s patients to see their dentist regularly, every 6 months, so they can monitor symptoms and get preventive treatments.

During dental checkups, patients should discuss any dry mouth symptoms, cavities, tooth sensitivity, gum recession, and other issues with their dentist. Getting exams twice a year allows dentists to track changes in oral health over time.

The dentist may recommend more frequent cleanings or fluoride treatments to help prevent cavities in Sjögren’s patients. They can also advise patients on proper brushing techniques for sensitive teeth and receding gums.

Other preventive dental treatments that may help Sjögren’s patients include dental sealants to protect teeth from decay and prescription strength fluoride toothpaste or varnish.

Finding a dentist experienced in treating Sjögren’s patients can provide specialized care and advice. Research local dentists to find one familiar with dry mouth management and preventive dental care.

With routine exams and treatments, Sjögren’s patients can minimize oral health issues despite reduced saliva. Seeing the dentist regularly is key to maintaining dental health.

Sjogrens Syndrome Oral Health Considerations

There are some special dental considerations for Sjögren’s syndrome patients to be aware of.

Toothpaste for Dry Mouth

Using a toothpaste made specifically for dry mouth can help Sjögren’s patients protect their teeth. These toothpastes are formulated to be extra gentle and to help stimulate saliva production. They also contain ingredients like xylitol and calcium to help strengthen tooth enamel and neutralize mouth acids.

Finding Support for Oral Health

Living with Sjögren’s syndrome and dealing with the oral health complications can feel overwhelming at times. However, there are excellent resources and support systems available to help you manage your oral health:

Connect with national and local patient foundations like the Sjögren’s Syndrome Foundation (SSF). The SSF provides education, awareness, and support programs to empower patients. Joining local support groups can also help you connect with other patients facing similar challenges.
Build a collaborative relationship with your dentist so you can work as a team to protect your oral health. Make sure to discuss all your symptoms openly and get specialized guidance for your unique needs.
Ask your dentist to coordinate with your rheumatologist for a more integrated treatment approach.
Consider getting a second opinion if you feel your oral health needs are not being adequately addressed.
Stay on top of regular dental visits and cleanings every 6 months.

You don’t have to manage Sjögren’s oral health complications alone. By utilizing available resources and being your own advocate, you can maintain better dental and gum health.

Medical Disclaimer

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