RESUMEN
OBJECTIVES: The aim was to determine the non-melanoma skin cancer (NMSC) risk in patients with RA or PsA exposed to MTX and other DMARDs. METHODS: Information on medication was collected on 405 patients with RA or PsA in two private rheumatology practices and was matched to comprehensive histologically confirmed cancer registry data for the years 1978-2005. Relative risks (RRs) were estimated by logarithmic binomial modelling, and standardized incidence ratios (SIRs) were calculated from year-, sex- and age-specific rates of NMSC for the local population. RESULTS: Compared with no MTX usage, any MTX usage was associated with a higher rate of at least one histopathologically confirmed NMSC (SIR 4.64, 95% CI: 0.67, 33.2). The SIR was 4.81 (95% CI: 3.60, 6.29) for those receiving a cumulative dose >8000 mg compared with SIR 2.31 (95% CI: 1.58, 2.36) for <5000 mg. An increased risk was shown for both basal cell carcinomas and squamous cell carcinomas, with an apparent dose-response relationship for basal cell carcinomas but not for squamous cell carcinomas. There was an increased risk of NMSC in patients taking CSA (RR = 2.51, 95% CI: 1.23, 5.13) and D-Pen (RR 3.49, 95% CI: 1.34, 4.63) in addition to MTX, but not for patients taking AZA or LEF. CONCLUSION: MTX, and concurrent MTX and CSA or D-Pen use, is associated with an increased risk of NMSC. These results should encourage greater clinical vigilance for NMSC in treated patients with RA and PsA.
Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Carcinoma Basocelular/inducido químicamente , Carcinoma de Células Escamosas/química , Metotrexato/efectos adversos , Neoplasias Cutáneas/inducido químicamente , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We describe 21 and 19 year followup of 2 patients with severe rheumatoid arthritis (RA) who in 1984 and 1986 underwent allogeneic bone marrow transplantation (BMT) after full myeloablative conditioning, for therapy-induced aplastic anemia. Regarding the arthritis, both patients are well, taking no medications, and free of signs or symptoms of active RA. One patient is in excellent health overall, while the other has coronary artery disease and chronic obstructive pulmonary disease attributable to smoking. We suggest that allogeneic BMT may be a curative treatment for severe RA.
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Artritis Reumatoide/cirugía , Trasplante de Médula Ósea , Adulto , Artritis Reumatoide/fisiopatología , Femenino , Estado de Salud , Humanos , Persona de Mediana Edad , Recuperación de la Función , Inducción de RemisiónRESUMEN
The Commonwealth Government constituted the Medicare Services Advisory Committee (MSAC) to implement its commitment to entrench the principles of evidence-based medicine in Australian clinical practice. With its recent review of positron emission tomography (PETReview), the Commonwealth intervened in an established MSAC process, and sanctioned the stated objective to restrict expenditure on the technology. In our opinion: The evaluation of evidence by PETReview was fundamentally compromised by a failure to meet the terms of reference, poor science, poor process and unique decision-making benchmarks. By accepting the recommendations of PETReview, the Commonwealth is propagating information which is not of the highest quality. The use of inferior-quality information for decision-making by doctors, patients and policy-makers is likely to harm rather than enhance healthcare outcomes.
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Medicina Basada en la Evidencia , Formulación de Políticas , Evaluación de la Tecnología Biomédica , Tomografía Computarizada de Emisión , Australia , Benchmarking , Interpretación Estadística de Datos , Humanos , Reproducibilidad de los Resultados , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Whiplash is a common problem, particularly following motor vehicle accidents and may have significant sequelae in terms of disability and financial compensation. Recent research has demonstrated that a number of commonplace medical practices as well as the compensation system may lead to unfavourable outcomes. OBJECTIVE: This article discusses recent research into whiplash and its implications for clinical practice. DISCUSSION: A full assessment of biopsychosocial factors in the acute phase of the injury is essential to predict those at risk of chronicity. Simple therapeutic and educational measures should be employed and early referral to a psychologist or pain specialist considered for those at high risk.