Nonradiographic axial spondyloarthritis: expanding the spectrum of an old disease: A narrative review.

Nonradiographic axial spondyloarthritis (nr-axSpA) represents a distinct phenotype within the spectrum of axial spondyloarthritis (axSpA), which is characterized by a range of clinical manifestations. Despite a high disease burden that is comparable to ankylosing spondylitis (also known as radiographic axSpA), there is an unmet need to recognize and effectively manage patients with active nr-axSpA.A targeted literature search was conducted in OVID (MEDLINE and Embase databases) to identify articles on nr-axSpA, including its definition, demographics, epidemiology, burden, diagnosis, clinical presentation, and treatment guidelines.

A systematic review of pharmacologic therapies for the cardiomyopathy of Duchenne muscular dystrophy.

Objective: To perform a systematic review of studies evaluating pharmacologic therapies for the cardiomyopathy of Duchenne muscular dystrophy (DMD).

Methods: PubMed, Google Scholar, and Embase were searched through October 8, 2020. Articles were selected using pre-determined criteria; 26 underwent detailed review by two co-authors.

Association of Secukinumab Treatment With Tuberculosis Reactivation in Patients With Psoriasis, Psoriatic Arthritis, or Ankylosing Spondylitis.

Importance: Approximately one-quarter of the global population have latent tuberculosis infection (LTBI), and tuberculosis (TB) is accountable for more than 1.5 million deaths annually. Methotrexate, cyclosporine, and tumor necrosis factor inhibitors may be associated with increased risk of TB and LTBI reactivation, although data are limited on the risks of TB with use of newer biologics.

The American College of Rheumatology Fibromyalgia Criteria Are Useful in the Evaluation of Fibromyalgia Symptoms in Patients With Ankylosing Spondylitis: A Cross-Sectional Study.

Background: Fibromyalgia (FM) is common among patients with ankylosing spondylitis (AS), and its coexistence is believed to interfere with the measurement of patient-reported outcomes of disease activity and function in AS because of overlapping symptoms between the 2 diseases. This can confound clinical assessment and treatment decisions.

Aims: The aim of this study was to assess the relationship between the Fibromyalgia Symptom Scale (FSS) and its components, the Widespread Pain Index (WPI), and System Severity Scale with measures of disease activity, function, and patient-reported outcomes in AS.

Predictors of remission in patients with non-radiographic axial spondyloarthritis receiving open-label adalimumab in the ABILITY-3 study.

Background: This analysis assessed baseline predictors of remission in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who received open-label adalimumab therapy.

Methods: ABILITY-3 enrolled 673 adult patients with nr-axSpA who had objective evidence of inflammation by MRI or elevated high-sensitivity C reactive protein at screening, active disease and an inadequate response to two or more non-steroidal anti-inflammatory drugs. Patients received adalimumab 40 mg every other week during a 28-week open-label lead-in period.

Efficacy and safety of continuing versus withdrawing adalimumab therapy in maintaining remission in patients with non-radiographic axial spondyloarthritis (ABILITY-3): a multicentre, randomised, double-blind study.

Background: Success of treatment withdrawal in patients with non-radiographic axial spondyloarthritis who are in remission remains unknown. The ABILITY-3 study explored the ability to withdraw adalimumab treatment in patients with non-radiographic axial spondyloarthritis who achieved sustained clinical remission after open-label treatment with adalimumab.

Methods: ABILITY-3 was a multicentre, two-period study done in 107 sites in 20 countries.

Progressive left ventricular dysfunction and long-term outcomes in patients with Duchenne muscular dystrophy receiving cardiopulmonary therapies.

Objective: To describe the natural history of cardiomyopathy in patients with Duchenne muscular dystrophy (DMD) who are receiving contemporary therapies.

Methods: This is a single-institution retrospective cohort study of 57 patients aged >15 years with DMD. Serial digital echocardiograms were performed over a median follow-up of 8 years.

Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia.

Fibromyalgia is a chronic debilitating medical syndrome with limited therapeutic options. Pregabalin, an anticonvulsant and α-2-Δ subunit receptor ligand, is one of the anchor drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. The drug has shown clinically meaningful benefits across multiple symptom domains of fibromyalgia.

Identification of plasma microRNA expression profile in radiographic axial spondyloarthritis-a pilot study.

At present, there are no studies that have established a microRNA (miRNA)-based signature profile in patients with radiographic axial spondyloarthritis (rad-axial SpA), and we hypothesized that these patients may have aberrantly expressed circulating miRNAs reflective of underlying disease and inflammation. This study aims to determine the expression profile of miRNAs in plasma of patients with rad-axial SpA and compare it with healthy, age, and sex-matched controls. Fifteen subjects with rad-axial SpA based on ASAS classification criteria and 5 controls were recruited from our local SpA registry.

Factors associated with two different protocols of do-not-resuscitate orders in a medical ICU*.

Objective: The State of Ohio in the United States has the legislation for two different protocols of do-not-resuscitate orders. The objective of this study was to examine the clinical/demographic factors and outcomes associated with the two different do-not-resuscitate orders.

Design: Data were concurrently and retrospectively collected from August 2002 to December 2005.

The role for prudence before describing novel infectious etiologies for acute pancreatitis. The experience of one institution before describing influenza B pancreatitis.

Context: While the majority of acute pancreatitis is secondary to alcohol and gallstones in the developed world, infectious causes are recognized and recent evidence has linked influenza A to acute pancreatitis.

Case Report: We report a patient with acute pancreatitis deemed secondary to influenza B virus; however considering this would be the first reported case, retesting showed that the initial PCR was falsely positive and a system-wide contamination discovered that unearthed other false negatives.

Conclusions: While research must continue to describe novel infectious etiologies of acute pancreatitis, caution must be exercised before new associations are described.

Methionine metabolism in human pregnancy.

Background: Hyperhomocysteinemia during pregnancy, which is a consequence of perturbations in methionine and/or folate metabolism, has been implicated in adverse outcomes such as neural tube defects, preeclampsia, spontaneous abortion, and premature delivery. The adaptive changes in methionine metabolism during pregnancy in humans have not been determined.

Objective: Our objective was to examine the kinetics of methionine and its rate of transsulfuration and transmethylation in healthy women with advancing gestation.

Anemia treatment with Q2W darbepoetin alfa in patients with chronic kidney disease naïve to erythropoiesis-stimulating agents.

Objective: To evaluate the efficacy and safety of darbepoetin alfa dosed every-other-week (Q2W) to treat anemia in subjects with chronic kidney disease (CKD), not receiving dialysis, who were naïve to erythropoiesis-stimulating agent (ESA) therapy.

Research Design And Methods: This was an open-label, multicenter, single-arm study enrolling ESA-naïve CKD subjects with baseline hemoglobin (Hb) < 11.0 g/dL.

Effect of decisions to withhold life support on prolonged survival.

Background: The effect on long-term mortality of decisions made to withhold life-supporting therapies (LST) for critically ill patients is unclear. We hypothesized that mortality 60 days after ICU admission is not influenced by a decision to withhold use of LST in the context of otherwise providing all indicated care.

Methods: We studied 2,211 consecutive, initial admissions to the adult, medical ICU of a university-affiliated teaching hospital.

Gestational diabetes induces placental genes for chronic stress and inflammatory pathways.

A physiological state of insulin resistance is required to preferentially direct maternal nutrients toward the feto-placental unit, allowing adequate growth of the fetus. When women develop gestational diabetes mellitus (GDM), insulin resistance is more severe and disrupts the intrauterine milieu, resulting in accelerated fetal development with increased risk of macrosomia. As a natural interface between mother and fetus, the placenta is the obligatory target of such environmental changes.

Gestational diabetes and insulin resistance: role in short- and long-term implications for mother and fetus.

Gestational diabetes and obesity are the common metabolic abnormalities occurring during pregnancy. Decreased maternal pregravid insulin sensitivity (insulin resistance) coupled with an inadequate insulin response are the pathophysiological mechanisms underlying the development of gestational diabetes. Insulin-regulated carbohydrate, lipid and protein metabolism are all affected to a variable degree.

The effect of gender and gestational diabetes mellitus on cord leptin concentration.

Objective: The purpose of this study was to determine the relationship of neonatal sex and gestational diabetes mellitus on cord leptin concentration and to determine whether cord leptin has a stronger correlation with fat mass compared with birth weight or lean body mass. We hypothesized that there are no significant differences in fetal leptin concentration between male and female or between neonates of mothers with gestational diabetes mellitus and control neonates, when adjusted for body composition.

Study Design: Cord blood leptin concentrations were measured in newborn infants of 78 women (44 control neonates and 34 gestational diabetes mellitus).

Clinical utility and approaches for estimating insulin sensitivity in pregnancy.

Insulin sensitivity as estimated by using the hyperinsulinemic-euglycemic clamp during pregnancy has been related to maternal energy expenditure, fat accretion and fetal growth. To determine whether less time consuming and invasive methods could be employed, we examined whether selected indices of insulin sensitivity derived from an oral glucose tolerance test (IS(OGTT)) or fasting glucose/insulin levels (IS(QUICKI) and IS(HOMA)) can be used to predict insulin sensitivity in women before and during pregnancy. A 2-h euglycemic-hyperinsulinemic clamp (5 mol/L glucose, 40 mU x m(-2) x min (-1) insulin), and 120 min OGTT (75 g load pregravid, 100 g pregnant), was repeated on 15 women [10 with normal glucose tolerance (NGT) and 5 with gestational diabetes mellitus (GDM)], pregravid, and during both early (12-14 weeks) and late (34-36 weeks) pregnancy.

TNF-alpha is a predictor of insulin resistance in human pregnancy.

Historically, insulin resistance during pregnancy has been ascribed to increased production of placental hormones and cortisol. The purpose of this study was to test this hypothesis by correlating the longitudinal changes in insulin sensitivity during pregnancy with changes in placental hormones, cortisol, leptin, and tumor necrosis factor (TNF)-alpha. Insulin resistance was assessed in 15 women (5 with gestational diabetes mellitus [GDM] and 10 with normal glucose tolerance) using the euglycemic-hyperinsulinemic clamp procedure, before pregnancy (pregravid) and during early (12-14 weeks) and late (34-36 weeks) gestation.

Modulation of insulin signaling in human skeletal muscle in response to exercise.

Exercise is widely recommended for the treatment of obesity, insulin resistance, and type II diabetes mellitus. Recent discoveries in the molecular and cellular regulation of insulin-mediated glucose metabolism in skeletal muscle have provided a deeper understanding of how exercise modulates insulin action.

Human aging is associated with altered TNF-alpha production during hyperglycemia and hyperinsulinemia.

Changes in tumor necrosis factor-alpha (TNF-alpha) may provide a mechanism to explain impaired glucose metabolism with advancing age. Hyperglycemic clamps (180 min, 10 mM) were performed on seven older [67 +/- 2 yr; body mass index (BMI) 24.7 +/- 1.