Erstellt am 15 Sep 2018 14:31
Zuletzt geändert: 15 Sep 2018 15:38
Depression
- Simon GE. Treating depression in patients with chronic disease: recognition and treatment are crucial; depression worsens the course of a chronic illness. West J Med. 2001 Nov;175(5):292-3.
Chronic medical illness is consistently associated with an increased prevalence of depressive symptoms and disorders.
Effective treatment of depression reduces depressive symptoms and improves daily functioning. Treating depression has also been shown to have a positive effect on biologic indicators of disease severity or progression, such as the level of glycosylated hemoglobin in diabetes15 or platelet activation in ischemic heart disease.
- Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Jan 26;315(4):380-7. doi: 10.1001/jama.2015.18392.
The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation).
Diabetes mellitus
Kardiovaskuläre Erkrankungen
- EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update
- Chronic inflammatory diseases and atherosclerotic cardiovascular disease: Innocent bystanders or partners in crime?
Malignome
- Raheel S, Crowson CS, Wright K, Matteson EL. Risk of Malignant Neoplasm in Patients with Incident Rheumatoid Arthritis 1980-2007 in relation to a Comparator Cohort: A Population-Based Study. Int J Rheumatol. 2016;2016:4609486.
- Raaschou P, Simard JF, Asker Hagelberg C, Askling J; ARTIS Study Group.Rheumatoid arthritis, anti-tumour necrosis factor treatment, and risk of squamous cell and basal cell skin cancer: cohort study based on nationwide prospectively recorded data from Sweden. BMJ. 2016 Jan 28;352:i262. doi: 10.1136/bmj.i262.
SETTING:
Nationwide data from Sweden.
PARTICIPANTS:
Cohort of patients with rheumatoid arthritis naive to biologics (n=46 409), cohort of patients with rheumatoid arthritis starting TNF inhibitor treatment as first biologic in 1998-2012 (n=12 558), and matched general population comparator cohort, identified through national quality of care and health registers.
RESULTS:
For basal cell cancer, the hazard ratio was 1.22 (95% confidence interval 1.07 to 1.41) comparing biologics-naive rheumatoid arthritis patients with the general population and 1.14 (0.98 to 1.33; 236 v 1587 events) comparing TNF inhibitor treated patients with biologics-naive patients. For squamous cell cancer, the hazard ratio was 1.88 (1.74 to 2.03) comparing biologics-naive rheumatoid arthritis patients with the general population and 1.30 (1.10 to 1.55; 191 v 847 events) comparing TNF inhibitors with biologics-naive patients; the latter translated to an annual number needed to harm in the order of 1600. Among people with a history of squamous cell or basal cell cancer, TNF inhibitors did not further increase risks.
CONCLUSION:
A small to moderately increased risk of basal cell cancer was seen in biologics-naive rheumatoid arthritis patients, with no further effect of TNF inhibitors.
- Rubbert-Roth A, Sebba A, Brockwell L, et al. Malignancy rates in patients with rheumatoid arthritis treated with tocilizumab. RMD Open. 2016 May 10;2(1):e000213. doi: 10.1136/rmdopen-2015-000213.
RESULTS:
In total, 4009 patients in the tocilizumab all-exposure population were included. Mean treatment duration was 4.0 years (mean 5.1 (range 0.0-6.8); total observation time was 16 120.1 patient-years (PY). The adjudicated malignancy rate (95% CI) was 1.26/100 PY (1.09 to 1.44) and remained constant over time. The SIR (95% CI) for all malignancies combined, excluding non-melanoma skin cancer, was 1.36 (1.01 to 1.80) for US and 1.81 (1.44 to 2.23) for non-US populations, driven primarily by higher rates in lung and bronchus (US/non-US) malignancies and prostate cancer and non-Hodgkin lymphoma (non-US), in contrast to those for the general populations; these higher rates are in line with those expected in patients with RA or in the geographic regions studied.
CONCLUSIONS:
Malignancy rates remained stable with long-term tocilizumab treatment, and malignancy types and rates were consistent with those expected in patients with RA.
- Wadström H, Frisell T, Askling J; Anti-Rheumatic Therapy in Sweden (ARTIS) Study Group. Malignant Neoplasms in Patients With Rheumatoid Arthritis Treated With Tumor Necrosis Factor Inhibitors, Tocilizumab, Abatacept, or Rituximab in Clinical Practice: A Nationwide Cohort Study From Sweden. JAMA Intern Med. 2017 Nov 1;177(11):1605-1612. doi: 10.1001/jamainternmed.2017.4332.
DESIGN, SETTING, AND PARTICIPANTS:
This was a national register-based prospective cohort study of the public health care system in Sweden from 2006 to 2015.
EXPOSURES:
Treatment with tocilizumab, abatacept, rituximab, or TNFi.
MAIN OUTCOMES AND MEASURES:
Outcomes included a first invasive solid or hematologic malignant neoplasm, or skin cancer. Hazard ratios were calculated using Cox-regression, adjusted for age, sex, disease and treatment characteristics, and educational level.
RESULTS:
We identified a total of 15 129 initiations of TNFi as the first or second bDMARD, 7405 initiations of other bDMARDs, and 46 610 csDMARD users.
CONCLUSIONS AND RELEVANCE:
The overall risk of cancer among patients with RA initiating TNFi as first or second bDMARD, tocilizumab, abatacept, or rituximab does not differ substantially from that of biologic drug-naive, csDMARD-treated patients with RA, although altered risks for specific cancer types, or those with longer latency, cannot be excluded.
- Wilton KM, Matteson EL. Malignancy Incidence, Management, and Prevention in Patients with Rheumatoid Arthritis. Rheumatol Ther. 2017 Dec;4(2):333-347.
Die Beiträge in diesem Wiki zu "Erkrankungen und Behinderungen", gesundheitlichen Problemlagen und Indikationen erheben weder den Anspruch, umfassend noch hinsichtlich der Einsortierung in einer Rubrik immer unstrittig zu sein.
Die Beiträge sind aus sozialmedizinischem Blickwinkel und mit dem Schwerpunkt der sozialmedizinischen Begutachtung einsortiert. Aus der Einordnung in einer Rubrik resultiert weder eine Wertung noch eine objektive Feststellung hinsichtlich der Bedeutung einer gesundheitlichen Problemlage/Erkrankung.
Alle Darstellungen medizinischer Sachverhalte, Erkrankungen und Behinderungen und deren sozialmedizinische Einordnung und Kommentierungen hier im Wiki dienen nicht einer "letzt begründenden theoretisch-wissenschaftlichen Aufklärung", sondern sind frei nach Karl Popper "Interpretationen im Licht der Theorien."*
* Zitat nach: Bach, Otto: ''Über die Subjektabhängigkeit des Bildes von der Wirklichkeit im psychiatrischen Diagnostizieren und Therapieren''. In: Psychiatrie heute, Aspekte und Perspektiven, Festschrift für Rainer Tölle, Urban & Schwarzenberg, München 1994, ISBN 3-541-17181-2, (Zitat: Seite 1)
Alle medizinischen Aussagen und Informationen in diesem Wiki dienen nicht der medizinischen Beratung und können und sollen eine persönliche fachliche ärztliche Beratung nicht ersetzen!
Neue Seite anlegen