Introduction: Drug-free remission (DFR) and its maintenance have been defined as the most desirable outcome for rheumatoid arthritis (RA) patients. DFR is linked to resolution of arthritis-related... Show moreIntroduction: Drug-free remission (DFR) and its maintenance have been defined as the most desirable outcome for rheumatoid arthritis (RA) patients. DFR is linked to resolution of arthritis-related symptoms and restoration of normal functioning. However, there is currently no consensus if an optimal strategy, upon the initiation of treatment to the proper drugs withdrawal, is enough to induce it, or whether it is a predetermined condition related to patients' intrinsic characteristics. Areas covered: This review focuses on two key concepts around DFR. First, we analyze patients' intrinsic factors that may increase the chance of DFR, regardless of therapeutic choices. Second, we discuss on the evidence that it can be induced thanks to adequate, extrinsic disease management. Finally, we provide a glimpse into consequences of drugs discontinuation .Expert opinion: The early initiation of DMARD and the subsequent strict monitoring and drug adjustments are of primary importance to allow patients to achieve DFR, irrespective of initial treatment strategy. Once remission is obtained and maintained, it is possible to gradually taper and discontinue drugs with no dramatic consequences on the disease course. Among those who stop medication, ACPA-negative patients more often maintain the remission. Thus, DFR might depend on a combination of intrinsic and extrinsic factors. Show less
Stanescu-Segall, D.; Gauzy, T.S. de; Reynolds, R.; Faes, L.; Pohlmann, D.; Pakzad-Vaezi, K.; ... ; Touhami, S. 2020
Introduction Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require... Show moreIntroduction Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression. Areas covered This collaborative work proposes practical management and follow-up criteria for uveitis patients in the context of the ongoing SARS-CoV-2 pandemic. Expert opinion Management should proceed as usual when access to health care possible in patients who do not belong to a group at high risk of severe SARS-CoV-2 infection, and in uncontrolled uveitis cases. In case of reduced access to eye clinics or high risk of SARS-CoV-2 infection, patients' management should be stratified based on their clinical presentation. In non-severe uveitis cases, the use of systemic steroids should be avoided, and local steroids preferred whenever possible. In uncontrolled situations where there is real risk of permanent visual loss, high-dose intravenous steroids and/or systemic immunosuppressants and/or biotherapies can be administered depending on the severity of eye disease. Immunosuppressive therapy should not be withheld, unless the patient develops SARS-CoV2 infection. Show less
Introduction: Placebo effects are powerful modulators in clinical outcomes and can either result in treatment benefits or harms, known as placebo and nocebo effects. To harness these outcomes, it... Show moreIntroduction: Placebo effects are powerful modulators in clinical outcomes and can either result in treatment benefits or harms, known as placebo and nocebo effects. To harness these outcomes, it is important to focus on the underlying processes that steer these effects, namely by learning through expectations and conditioning. In this review, we focus on the influence of placebo effects on subjective and physiological levels of immune-related conditions (e.g. lymphocyte proliferation, cytokine production or other inflammatory markers).Areas covered: A literature search is conducted in the databases PubMed and PsychInfo by making use of keywords such as ‘expectations’, ‘classical conditioning’, ‘cytokines’, ‘immune system’, ‘learned immunosuppression’, and covers studies done in animals, experimental studies in healthy controls as well as studies performed in immune-related patient populations.Expert commentary: We report on the presence of placebo effects in RCTs in immune-related conditions and review findings that demonstrate the ability to learn immune responses in both experimental animal and human placebo studies making use of conditioning paradigms with immunomodulating drug agents. We also discuss results to utilize placebo effects by means of classical conditioning principles in medication regimens for patient populations and elaborate on promising findings of preliminary studies focusing on this topic. Show less
The Lambert Eaton myasthenic syndrome (LEMS) is an autoimmune disease in which antibodies against voltage-gated calcium channels inhibit cholinergic neurotransmission LEMS is clinically... Show moreThe Lambert Eaton myasthenic syndrome (LEMS) is an autoimmune disease in which antibodies against voltage-gated calcium channels inhibit cholinergic neurotransmission LEMS is clinically characterized by muscle weakness and autonomic dysfunction 3 4-diaminopyridine (3 4-DAP) blocks potassium channels in nerve terminals resulting in an increase in acetylcholine release This article describes the four randomized placebo-controlled trials of 3 4-DAP in patients with LEMS All trials demonstrated a significant effect on muscle strength and compound muscle action potential amplitude Furthermore the safety and tolerability of 3 4-DAP are reviewed The side effects of 3 4-DAP are generally mild and most frequently consist of paresthesias but epileptic seizures and arrhythmias have been described in patients using high doses Given the efficacy and safety of 3 4-DAP in LEMS, this drug is the mainstay for symptomatic treatment of LEMS Show less
