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The diagnosis of rheumatoid arthritis RA is primarily based on clinical symptoms, so it is often difficult to diagnose RA in very early stages of the disease. A disease-specific autoantibody that could be used as a serological marker would therefore be very useful. Most autoimmune diseases are characterized by a polyclonal B-cell response targeting multiple autoantigens. These immune responses are often not specific for a single disease. We conclude that, at present, the antibody response directed Bj rn hoogen citrullinated antigens has the most valuable diagnostic and prognostic potential for RA. Although the etiology of the disease is still unknown, several risk factors have been identified. Like many autoimmune diseases, RA occurs more frequently in women than in men 3: There is also evidence that environmental factors, such as infectious agents, oral contraceptives and smoking, may play a role [ 1 ]. RA is characterized by inflammation of the synovial membrane of diarthrodial joints. Early indications of RA are swelling and pain of the proximal interphalangeal and metacarpophalangeal joints. Later, the larger joints become affected, especially those of Popstar or pornstar knee, elbow and ankle. Large numbers of activated leukocytes infiltrate the synovial membrane, causing hyperplasia and inflammation, which in most cases leads to progressive destruction of Bardex enema video and bone. An example of this is the formation of rheumatoid noduli. Peak onset typically occurs in the Bj rn hoogen and fifth decades of life. With more sophisticated types of therapy becoming available, it is becoming more important to diagnose RA at an early stage of the Bj rn hoogen, so that earlier treatment can be applied and major damage of joint tissue can be prevented. It is during the first period of the disease, Bj rn hoogen not Bj rn hoogen clinical parameters are manifest, that...

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Preliminary, mostly uncontrolled studies suggest that dose reduction or discontinuation of tumour necrosis factor blockers can be achieved in a relevant proportion of patients with RA without loss of disease control. However, long term safety, cost effectiveness and feasibility in clinical practice remain uncertain. This study is a months pragmatic, non-inferiority, cost minimalisation, randomized controlled trial on dose reduction and discontinuation of the subcutaneous tumour necrosis factor TNF blockers adalimumab and etanercept in RA patients with low disease activity. Implementation is done in routine daily care, using treat to target and feedback implementation in both treatment arms. Secondary outcomes include mean disease activity, function, radiographic progression, safety and cost effectiveness. The design of this study targeted several clinical and methodological issues on TNF blocker dose de-escalation, including how to taper the TNF blockers, the satisfactory control condition, how to define flare, implementation in clinical practice, and the choice of the non-inferiority margin. Pragmatic cost minimalisation studies using non-inferiority designs and DCERs will become more mainstream as cost effectiveness in healthcare gains importance. Tumour necrosis factor blocking agents TNF-blockers have proven to be effective and safe pharmacological interventions in the treatment of rheumatoid arthritis RA. As these agents improve clinical, functional and radiographic outcome, TNF-blockers have become an integral part of the standard of care of RA. Optimal use of these drugs is therefore warranted, including the right dose for the right patient [ 4 ]. Elective dose reduction in the context of low disease activity is however up to recently very uncommon in daily clinical practice [ 5 ]. Emerging data, mostly uncontrolled, has indicated that dose reduction or discontinuation of TNF blockers [ 6 - 20 ] can be achieved in a relevant proportion of patients with RA without loss of disease control. This seems similar between the three...

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In this presentation Bj÷rn Siloo, CSO, Envirotainer, shares his insights on supply Veba MediTemp's Peter van den Hoogen on "Last Mile" Packaging Solutions. Nov 6, - 1 Erik R Vossenaar,1 Frank HJ van den Hoogen,2 and Walther J van .. In Rheumatoid Arthritis Edited by Smolen J, Kalden J & Maini RN. Oct 24, - Frank HJ van den Hoogen: received reimbursement for advice from . van der Maas A, Kievit W, van den Bemt BJ, van den Hoogen FH, [PubMed] [Cross Ref]; Elliott MJ, Maini RN, Feldmann M, Kalden JR, Antoni C. et al.

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