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Micu M.C.,Clinical Rehabilitation Hospital | Micu R.,Gynecology I Clinic | Surd S.,Gynecology I Clinic | Girlovanu M.,Gynecology I Clinic | And 2 more authors.
Rheumatology (United Kingdom) | Year: 2014

Objective: The aim of this study was to study the influence of active disease status and TNF-α antagonists on sperm quality in a group of AS patients. Methods: Twenty-three active AS patients and 42 controls were recruited. Patients' sperm samples were analysed at baseline (previous to) and at 3-6 months after TNF-a therapy (adalimumab, infliximab, etanercept) administration. Baseline assessment was made for only 20 patients, 2 of them proving to have normal fertility, 2 having a pregnant stable partner and the third having a 9-month-old child. Six patients were retested after 12 months of biologic therapy. Each patient acted as his own comparator. Results were further compared with sperm samples from age-matched controls. Sperm analysis was performed according to the World Health Organization (WHO) 1999 guidelines. Results: Patients' baseline assessment showed normozoospermia in 91% and oligozoospermia in 9% of patients. No significant differences in sperm quality were noticed at follow-up visits compared with baseline. Comparison to controls showed no statistically significant differences in semen quality, with some exceptions: the control group presented a higher percentage of non-progressive and immobile sperm cells and higher numbers of head and tail atypias. Conclusion: Sperm quality in patients with active AS and after receiving short- and long-term TNF-a blocker therapy is comparable to sperm quality in healthy controls. Our study confirms that the disease process of AS does not have a major impact on sperm quality and that treatment with anti-TNF has no negative impact on sperm quality even under long-term treatment. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Source

Yellin M.,Medarex | Yellin M.,Celldex Therapeutics, Inc. | Paliienko I.,Bogomolets National Medical University | Balanescu A.,St. Maria Clinical Hospital | And 11 more authors.
Arthritis and Rheumatism | Year: 2012

Objective CXCL10 (also known as interferon-γ-inducible 10-kd protein [IP-10]) is a chemokine that potentially plays a role in the immunopathogenesis of rheumatoid arthritis (RA). We undertook this phase II study to evaluate the efficacy and safety of MDX-1100, a fully human, anti-CXCL10 (anti-IP-10) monoclonal antibody, in RA patients whose disease responded inadequately to methotrexate (MTX). Methods Patients with active RA receiving stable doses of MTX (10-25 mg weekly) were randomized to receive intravenous doses of 10 mg/kg MDX-1100 (n = 35) or placebo (n = 35) every other week. The primary end point was the proportion of patients meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) on day 85, and patients were followed up for safety to day 141. Results The ACR20 response rate was significantly higher among MDX-1100-treated patients than among placebo-treated patients (54% versus 17%; P = 0.0024). Statistically significant differences in the ACR20 response rate between treatments were observed starting on day 43 (P < 0.05). The ACR50 and ACR70 response rates on day 85 did not differ between the groups. Overall, 51.4% of MDX-1100-treated patients and 30.3% of placebo-treated patients experienced at least 1 adverse event (AE). No study drug-related serious AEs were reported. Conclusion MDX-1100 was well tolerated and demonstrated clinical efficacy in RA patients whose disease responded inadequately to MTX. This is the first study to demonstrate clinical efficacy of a chemokine inhibitor in RA and supports the notion of a potential role of IP-10 in the immunopathogenesis of RA. Copyright © 2012 by the American College of Rheumatology. Source

To assess inter-observer reliability in US detection of tendon inflammatory and structural changes at wrists and ankles in RA patients. Fourteen consecutive RA patients underwent bilateral US assessment of the extensor carpi ulnaris (ECUT) and tibialis posterior tendons (TPTs) by two blinded rheumatologists, with different level of experience in musculoskeletal (MS) US. Grey scale and power Doppler (PD) US assessment was focused on detection of tenosynovitis, tenosynovial and intra-tendon PD signal and structural lesions (i.e. tendinosis, tendon erosion, partial or total rupture). The frequency of US findings detected by Investigator 1 was 28.6% for inflammatory changes and 51.8% for structural damage changes while Investigator 2 detected 34 and 53.6% for the corresponding abnormalities. A high overall agreement (82.7%) was found for inflammatory pathology and 89.7% for structural lesions in all tendons. Mean kappa (κ) values for all tendons and pathology was moderate (κ = 0.42), with fair level of agreement for the wrist region (0.27-0.34) and moderate to good values for the ankle region (κ = 0.47-0.62). Subclinical abnormalities were detected in 37.5% of the tendons by Investigator 1 and 28.6% of the tendons by Investigator 2. MSUS showed high overall agreement and fair to moderate inter-observer κ-values between investigators with different levels of experience in detection of tendon pathology at the wrist and ankle in RA patients. Further standardization of scanning method and pathology definitions may improve MSUS reproducibility. Source

Radulescu D.,University of Medicine and Pharmacy, Cluj-Napoca | Parv A.,5th Medical Clinic | Pripon S.,Clinical Rehabilitation Hospital | Radulescu M.L.,5th Medical Clinic | And 2 more authors.
Endocrinologist | Year: 2010

Thyrotoxic periodic paralysis is a rare condition with only sporadic cases described in the medical literature. It occurs as a neuromuscular disorder characterized by recurrent attacks of severe muscle weakness associated with low serum potassium and thyrotoxicosis. We report the unusual case of a 21-year-old man who complained of lack of strength in his legs and generalized weakness in his upper and lower limbs, severe hypokalemia was detected during routine laboratory examinations. Thyrotoxic periodic paralysis as the underlying cause was suggested by suppressed thyroid stimulating hormone, elevated free T3 and free T4, and the presence of thyroid stimulating hormone-receptor antibodies. Treatment with intravenous potassium, an antithyroid drug, nonspecific beta-blocker, and anxiolytic agents resulted in a rapid resolution of symptoms. We also discuss the pathogenesis and characteristics of this rare disorder by reviewing the current medical literature. Copyright © 2010 by Lippincott Williams & Wilkins. Source

Micu M.C.,Clinical Rehabilitation Hospital | Alcalde M.,Hospital Universitario Severo Ochoa | Saenz J.I.,Hospital Universitario Severo Ochoa | Crespo M.,Hospital Universitario Severo Ochoa | And 3 more authors.
Arthritis Care and Research | Year: 2013

Objective To evaluate the impact of musculoskeletal ultrasound (MSUS) as a complementary method to clinical assessment on rapid diagnosis and therapeutic decisions in a busy outpatient rheumatology clinic. Methods Sixty patients with different musculoskeletal symptoms were included in the study. Three expert rheumatologists performed the clinical examination and filled out a standardized clinical report sheet with the following parameters: general and/or local diagnoses, planned systemic and/or local treatment, and their decision concerning the use of MSUS evaluation complementary to clinical examination. Another rheumatologist, blinded to clinical data, performed the MSUS assessment of the anatomic areas selected by the clinicians. The impact of the new information obtained by MSUS on the initial diagnosis and therapeutic strategy was estimated by the degree of change in the initial clinical diagnosis and therapy decisions. Results Of 60 patients (67 anatomic areas), MSUS was considered as necessary after clinical examination in 39 patients (65%), totaling 43 anatomic areas (64.17%). An overall change of the initial clinical diagnosis was present in 60% of the anatomic areas (P = 0.0175). In all of the anatomic areas (100%), the new diagnosis was more objective and detailed. An overall change of the initial systemic therapy was present in 25% of anatomic areas (P = 0.0014) and in 36% of anatomic areas (P = 0.095) for local therapy. A guided diagnostic aspiration was decided to be performed in 15% of anatomic areas and a guided therapeutic injection in 22% of anatomic areas. Conclusion Enhanced information obtained by MSUS evaluation leads to changes, with a significant impact on the initial diagnosis and treatment strategy designed after clinical examination. Copyright © 2013 by the American College of Rheumatology. Source

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