Rabu, 11 Juni 2014


Perpustakaan Keluarga :
Helmut Todo Tua Simamora dan dr. Olga Y.V Hutapea

Berikut merupakan kutipan ilmiah kedokteran yang sangat bermanfaat sehingga disusun dan digunakan sebagai referensi pribadi.

A new drug called brodalumab appears to be effective in treating patients suffering from psoriatic arthritis, a study says.
Patients who responded to brodalumab had a significant improvement in their skin and reduction in the swelling of the fingers and toes, a condition called dactylitis that is common in psoriatic arthritis, according to the study's lead researcher, Dr. Philip Mease, a rheumatologist at Swedish Medical Center in Seattle.
"We have a medication with a different mechanism of action than currently available drugs, increasing our chances to control this disease, which can be disabling and significantly affects patients' function and quality of life," said Mease.
"We know that many patients will lose response to some medications or develop adverse effects, so there is a need for medicines that work differently," he said. "We have a chance to bring patients back closer toward their normal state of being."
The study was funded by Amgen, the maker of brodalumab. Results of the study were published June 12 in the New England Journal of Medicine. The study's findings were also scheduled to be presented on Thursday at the European Congress of Rheumatology's annual meeting in Paris.
Psoriatic arthritis is a type of arthritic inflammation that affects as many as 30 percent of people who have psoriasis, according to background information in the study.
Psoriasis causes scaly red and white patches on the skin, according to the American College of Rheumatology (ACR). In psoriatic arthritis, the immune system attacks the joints as well, causing inflammation. Persistent inflammation from psoriatic arthritis can lead to joint damage, according to the ACR.
Like psoriasis, psoriatic arthritis symptoms come and go, vary from person to person, and even change locations over time.
Psoriatic arthritis may affect one joint or several. For example, it may affect one or both knees. Affected fingers and toes can become swollen. Fingernails and toenails also may be affected.
Mease noted that psoriatic arthritis has a genetic component that makes it distinct from other types of arthritis.
"There are also certain genes that are present in people who develop the arthritis that are not present in people with psoriasis. So there seems to be a heavy genetic component for determining who gets psoriasis and goes on to get psoriatic arthritis," he said.
Current treatment for psoriatic arthritis depends on how much pain the patient has. Treatment usually starts with painkillers such as ibuprofen (Motrin or Advil) or naproxen (Aleve).
Mease noted that many patients are also given methotrexate (Trexall), which treats both arthritis and psoriasis. Other drugs, known as biologic therapy, that are also used to treat both conditions include adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade).
Current drugs such as methotrexate target a substance called tumor necrosis factor-alpha, which is produced in response to inflammation. But these drugs tend to be less effective over time, Mease said.
Brodalumab works differently. It acts against interleukin-17 receptor A, a substance found in higher levels in people with psoriatic arthritis, according to the study.
For the current phase 2 trial of brodalumab, Mease and colleagues randomly assigned 168 patients with psoriatic arthritis to a low (140 milligrams) or high dose (280 milligrams) of brodalumab, or a placebo.
The average age of the study participant was 52 years. Two-thirds of the study volunteers were women and 94 percent were white (which included Hispanics and Latinos). The average amount of time they'd had psoriatic arthritis was nine years, according to the study.
After 12 weeks, patients taking either dose of brodalumab had a greater response to treatment than those receiving placebo (37 percent and 39 percent versus 18 percent).
Moreover, 14 percent of those taking brodalumab had a 50 percent improvement in symptoms based on the American College of Rheumatology response criteria, compared with 4 percent who received the placebo, the researchers found.
Improvements were seen in both patients who had previous biologic therapy, as well as those who had not had biologic therapy in the past, the researchers noted.
After 24 weeks of treatment, 51 percent of patients taking the lower dose of brodalumab and 64 percent taking the higher dose responded to the drug. In addition, 44 percent of the patients who switched from placebo to brodalumab responded to treatment.
These responses were maintained through a year, the researchers said.
At week 12, serious side effects occurred in 3 percent of patients in the brodalumab groups and in 2 percent of those in the placebo group, they add. These included stomach pain and a skin infection called cellulitis. "This is consistent with what had been seen with other so-called biologic medications," Mease said.
Dr. Robert Kirsner is a professor and vice chairman of the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine. "The results of this, albeit small study are extremely encouraging for patients who suffer from these conditions and for the physicians who treat them," Kirsner, who was not part of the study, said.
A phase 3 trial -- the last step before potential U.S. Food and Drug Administration approval -- is under way, testing brodalumab as a treatment for psoriasis. According to Mease, Amgen hopes to have the drug approved for psoriasis first, and then as a treatment for psoriatic arthritis.
Treatment options have come a long way toward helping control the symptoms of psoriatic arthritis. Yet many people are living with the joint damage they suffered before newer treatment and prevention methods came along. And even now -- since psoriatic arthritis can be difficult to diagnose -- it can do lasting harm before treatment begins.
The good news: Combining your medical treatment with simple but significant lifestyle changes can help with the emotional and physical challenges of living with psoriatic arthritis and improve your outlook from day to day.

Psoriatic Arthritis: Coping With Your Emotions

Karen, who asked that her full name not be used, is 60 years old and has been living with psoriatic arthritis for 20 years.  She wakes up each day hoping her psoriatic arthritis has gone away. And each day, she has to confront the fact that it's still with her. She once had an active, outdoorsy life. Now she is limited by pain and exhaustion. She has to cope with anger and guilt. "I know it's not realistic, but I think I should be able to control this," she says.
When it comes to emotions, coping strategies are as diverse as the people using them. Unfortunately, some methods can do more harm than good. For instance, many people turn to food or alcohol while turning away from friends and family.
Healthier, more lasting ways to deal with the emotional effects of psoriatic arthritis include:
  • Finding professional help for depression. Depression is often at the root of harmful coping behaviors. In one study, 32% of people with psoriasis were diagnosed with depression, compared to about 7% of the general population.  If you have a feeling of sadness or emptiness that you can't shake, talk with a health care provider. Depression is a serious condition that can be treated.
  • Connecting with others. "Knowing that you are not alone is crucial," says therapist Madelyn Petrow-Cohen. "Whether with a good friend or in a group, it's very important to have a chance to voice your emotions."

Dealing With the Stress of Psoriatic Arthritis

"People tell me that stress causes this; like I could just do away with the stress in my life," Karen says. Arthritis pain and stress have a way of building on each other. "Just dealing with this disease is stressful," she says.
"Patients are overwhelmed with the disease, and the time it takes to manage it," says Christopher Ritchlin, MD, a rheumatologist and professor at the University of Rochester Medical Center. You may not be able to rid your life of stress, but you can take steps to keep it under control, including:
  • Plan ahead. In her daily schedule, Karen makes time for herself, for relaxation. "I go to work early so I can get home and spend time outdoors while it's still light," she says.
  • Step back. Petrow-Cohen suggests listening to a relaxation CD, taking a walk, or working on a puzzle to shift your focus away from stressors.
  • Meditate. "Meditation and mindfulness can train you to watch your thoughts without becoming attached to them," Petrow-Cohen says.

Sumber : MD

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