Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 33-year-old man with generalized vulgar psoriasis type I and psoriatic arthritis was admitted to the Naftalan Special Hospital on February 21, 2000. He was immobile and complained of severe pain in all his joints. Since the patient had suffered from the disease for 10 years without showing any improvement after different therapies, his cutaneous and joint lesions gradually worsened and eventually resulted in generalized psoriasis and mutilating arthritis. Nevertheless, the patient was discharged from our hospital in better condition. To avoid such severe consequences of psoriatic arthritis, we believe that patients with either type I or type II psoriasis should undergo locomotor system screening. It would significantly decrease the number of unrecognized and undiagnosed cases of psoriatic arthritis and allow their early treatment, and prevention of more severe forms. Administration of new therapeutic agents, e.g. Alefacept (IgG1 fusion protein), Etanercept (inhibitor of TNF activity), and Efalizumab (monoclonal antibody that blocks the leukocyte integrin CDIIa/CD18(LFA-1), could provide successful management of the disease in future.
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PMID:Psoriasis vulgaris and arthritis psoriatica gravis mutilans. 1271 92

Efalizumab is a recombinant humanised IgG1 kappa isotype monoclonal antibody against the CD11a molecule. Efalizumab is approved for the treatment of moderate-to-severe psoriasis and is currently administered as a weekly subcutaneous injection. Throughout October 2005, 19,000 patients were treated with efalizumab. According to the package insert that is based on 2762 subjects, the most common adverse reactions associated with efalizumab are a first dose reaction complex that includes headache, chills, fever, nausea and myalgia within two days following the first two injections. These reactions are dose-level-related in incidence and severity and were largely mild-to-moderate in severity when a conditioning dose of 0.7 mg/kg was used as the first dose. Adverse events occurring at a rate between 1 and 2% greater in the efalizumab group compared with placebo were arthralgia, asthenia, peripheral oedema and psoriasis. Efalizumab is associated with a rebound flare reaction in approximately 5% of patients when therapy is ceased. Antiefalizumab antibodies develop in approximately 5% of the subjects who were treated with efalizumab, but the clinical significance of these antibodies is unclear. Efalizumab has rare but serious haematological side effects. Immune-mediated thrombocytopenia platelet counts at or below 52,000 cells/microl have been observed in 0.3% of cases and monitoring of platelet counts monthly for the first 3 months of use and each 3 months thereafter. Reports of four cases of haemolytic anaemia diagnosed four to six months after patients started on the monoclonal antibody exist. Infrequent new onset or recurrent severe arthritis events, including psoriatic arthritis events, have been reported in clinical trials and postmarketing surveillance. Symptoms associated with a hypersensitivity reaction (e.g., dyspnoea, asthma, urticaria, angioedema, maculopapular rash) were rarely noted in the first 12 weeks of the controlled clinical studies. The overall incidence of malignancies of any kind was 1.8 per 100 patient-years for efalizumab-treated patients compared with 1.6 per 100 patient-years for placebo-treated patients. One case each of the following serious adverse reactions was observed: transverse myelitis, bronchiolitis obliterans, aseptic meningitis, idiopathic hepatitis, sialedenitis and sensorineural hearing loss. In the complete safety data from both controlled and uncontrolled studies, the overall incidence of hospitalis ation for infections was 1.6 per 100 patient-years for efalizumab-treated patients compared with 1.2 per 100 patient-years for placebo-treated patients. The rate of infection was 26% in the control group and 29% in treated cases. The most common findings on laboratory assessments in patients using efalizumab were reversible increases in lymphocyte count and total white blood cell. Efalizumab is a safe, effective, but expensive treatment for psoriasis.
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PMID:Efalizumab: a review of events reported during clinical trials and side effects. 1650 42

With the coming of the biological therapies, long-term maintained control of psoriasis is becoming a reality and means a significant improvement in the quality of life in some patients with persistent clearing of the disease. This result was difficult to obtain previously. Efalizumab, a recombinant IgG1 anti-CD11a antibody approved for the treatment of psoriasis in moderate-to-severe chronic plaques, has an excellent safety profile and its therapeutic results in the clinical practice have surpassed the expectations based on the clinical trials. At 12 weeks of treatment (when its efficacy should be evaluated), a PASI 75 response can be expected in 35 to 40% of the patients and a PASI 50 response in two thirds of them. This degree of improvement may be maintained and may even increase in 80% of the patients, making it possible to achieve an almost complete clearing in more than 40% of the patients who continue the treatment over several years. Localized, transitory exacerbations may appear, especially in the beginning of the treatment, but these can generally be managed in combination with another treatment. There may also be generalized inflammatory outbreaks, especially in patients with scarce or null response, who require treatment with a rapid effect systemic drug at the onset. This is because they may be a prelude to the development of rebounds, that may acquire an erythrodermic or pustular morphology or be accompanied by arthritis, and which tend to appear after the sudden withdrawal of the drug. An adequate selection of the patients may maximize the possibilities of success. Patients without arthritis and with stable, extensive and non-inflammatory forms of the disease tend to be the best candidates. Special attention should be given to the administration of systemic agents in transition regimes when efalizumab is introduced or withdrawn. The clinical criteria is fundamental to optimize the therapeutic results with efalizumab, that may be an attractive challenge but may also be an especially satisfactory therapeutic option when long-term control is the disease is proposed.
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PMID:[Which patient is a candidate for treatment with efalizumab and why?]. 1834 53

Psoriasis and psoriatic arthritis (PsA) are chronic inflammatory disorders. Efalizumab targets several T-cell interactions central to psoriasis immunopathogenesis. Etanercept and infliximab are antitumor necrosis factor (anti-TNF) agents that modify the inflammatory and cell-mediated immune responses involved in the pathogenesis of psoriasis and PsA. All 3 agents are approved for the treatment of plaque psoriasis, and etanercept and infliximab are also approved for the treatment of PsA. Twenty patients with psoriasis and PsA have been successfully treated with a combination of efalizumab (1 mg/kg/wk) and etanercept (25 mg or 50 mg/wk) or infliximab (5 to 6 mg/kg). To date, no serious adverse events have been reported. Combination therapy was well tolerated and effectively controlled both skin disease and arthritis. The complementary activity of efalizumab with an anti-TNF agent is most likely attributable to their differing mechanisms of action. Further investigation is warranted.
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PMID:Treatment of psoriatic arthritis and recalcitrant skin disease with combination therapy. 1911 Jul 45

A 49-year-old female was started on efalizumab for severe psoriasis. Three weeks later, she developed rapidly progressive inflammatory polyarthritis associated with high titers of both rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) antibody. To our knowledge, this is the first reported case of efalizumab-induced anti-CCP-positive rheumatoid arthritis (RA). The polyarticular form of psoriatic arthritis (PsA) is associated with HLA-DR4, an antigen also associated with RA, and the presence of shared epitope alleles in PsA patients correlates with erosive disease, indicating a possible common mechanism of disease. CD4 T-cells play a prominent role in the pathogenesis of RA and PsA. Efalizumab theoretically modulates that role, appearing clinically to precipitate arthritis in a subset of PsA patients. On April 8, 2009, the makers of efalizumab announced a phased voluntary withdrawal of the drug from the US market because of progressive multifocal leukoencephalopathy cases. Further research using animal models of inflammatory polyarthritis is needed to determine the exact relationship between efalizumab and inflammatory arthritis, as well as to further explore the apparent connection between the inflammatory polyarticular form of PsA and RA.
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PMID:Efalizumab-induced inflammatory polyarthritis: what are the implications? 2022 9