Turkey and the European Sclerosis

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Objective: Silent myocardial involvement is associated with poor prognosis in patients with systemic sclerosis SSc. Here we aimed to evaluate the subclinical left ventricular LV and right ventricular RV systolic dysfunction in patients with SSc without any cardiovascular diseases, by using both strain imaging methods, speckle tracking echocardiography STE and real-time 3D echocardiography RT3DE. Methods: A total of 47 patients with SSc and 20 age- and gender-matched healthy controls HC were studied. Clinical and serological findings were sought.

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Conclusion: SSc is associated with myocardial systolic dysfunction. A deformation scrutiny conducted by both the STE-based strain imaging and end-systolic LV volume analysis by real-time 3D echocardiography are promising modalities that allow us for non-invasive, comprehensive investigation of subtle deterioration in the biventricular systolic function of patients with SSc. Subclinical biventricular systolic dysfunction in patients with systemic sclerosis. Interstitial lung disease was detected in 55 patients ANA positivity was detected in Anti-centromer was positive in The median follow-up time of all SSc patients was 48 months Conclusion: In conclusion, we found in our study from northwestern part of European Turkey that SSc prevalence Favorite Tweet.

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Pamuk , None; M. Balci , None; S. Donmez , None; G.

The monoclonal antibody natalizumab can only be administered to patients with MS by certified centres. In these severe cases, natalizumab should be stopped: anaphylaxis may be expected if repeated. In addition, such reactions may correlate with the development of neutralizing autoantibodies and therefore the patient would become a non-responder. It has been suggested that HLA-DRB1 genotyping before treatment may help to identify those patients with MS who are at heightened risk of developing the serious systemic hypersensitivity reactions associated with natalizumab administration, but the practicality of this is questionable.

Serum salusin-α levels in systemic lupus erythematosus and systemic sclerosis

In addition to biochemistry and haematology studies, aJCV-Ab status is needed when considering natalizumab use, and when planning further risk management strategies for progressive PML in patients found to be aJCV-Ab-positive. Once patients begin natalizumab they should be monitored closely. If aJCV-Ab status is negative we perform MRI annually for the first 2 years and every 6 months thereafter unless any clinical change is observed in the meantime. Cognitive testing is repeated annually, unless cognitive and personality changes are reported in the meantime.

Close monitoring for the development of any new neurologic symptom s as well as any unusual MRI findings in a patient at heightened risk should alert the physician of the potential for PML development. The use of high dose intravenous methylprednisolone is controversial. Recent case reports that indicate improvements in some patients with PML who received the antiretroviral agent maraviroc mg b.

However, these were observational case reports and currently this therapy has no evidence basis. Alemtuzumab is a humanized monoclonal antibody to CD52 approved for the treatment of MS.


As alemtuzumab can cause an immediate infusion reaction, the current practice is to administer mg IVMP on the first 3 days of each treatment course, with antihistamines. Oral prophylaxis for herpes simplex virus infection acyclovir mg twice daily for 1—2 months following each alemtuzumab treatment cycle should be given.

As any of these conditions may occur years after the last dose of alemtuzumab, extended follow-up for safety issues should continue at least until 48 months after the last infusion. Monthly CBC with differential, biochemistry-serum creatinine levels , 3-monthly thyroid function tests TSH and autoantibodies and urinanalysis with microscopy need to be checked regularly for the first 4 years and whenever there is a suspicion thereafter. It has been shown that B lymphocytes are involved in the pathophysiology of MS, and the monoclonal antibody rituximab directed against the CD20 antigen acts as a B-cell-targeted therapy in the treatment of relapsing-remitting MS.

Rituximab is not approved for MS treatment, but recently its use has increased in some centres for patients with treatment-resistant MS who have not suited other regimens. There are different treatment protocols for rituximab. The most common one is to give twice mg intravenous infusions of rituximab on days 1 and 15, repeated every 6—9 months.

Infusion reactions may occur during its administration. As there is a probability of cardiac arrhythmias with rituximab administration, cardiac monitoring should be planned during this phase. Rare reported adverse effects are renal toxicity, bowel obstruction and perforation. A hepatitis panel of tests should be performed due to the risk of hepatitis B reactivation, with fulminant hepatitis, in patients. Other potential safety issues involving current MS treatment practices relate to the processes involved when a treatment from one group of agents may be stopped, switched, or combined with an agent from the same or another drug group.

Some drugs such as the relatively older immunosupressants including mitoxantrone, which has been approved for treating MS and cyclophosphamide, which has not been officially approved for treating MS but is widely used especially for more aggressive forms of the disease have a limited duration of usage and an upper dosage limit due to their potential for severe side-effects.

Mitoxantrone is associated with treatment-related haematologic malignancies, cardiomyopathy and reproductive system complications. However, using a lower-dose regimen of mitoxantrone may reduce the probability of these adverse events without compromising the short-term potential efficacy. Cyclophosphamide use has been associated with adverse events such as bladder malignancies, but with proper management the risks to the individual with MS remain low. The practice of MS management has changed substantially over the past decade as new options have emerged. Although each new drug has its own safety and tolerability issues, once the practicing neurologist is knowledgeable of them, their application is justified.

Many MS centres have established programmes for monitoring patients on the newer long-term therapy regimens, to ensure they are used safely.

However, for the solo physician who treats people with MS in a private clinic, safety issues should not prevent them from considering these therapies: they just need to be fully aware of the initiation and follow up protocols. It should be kept in mind that, for some patients, MS treatment is a balance between accepting disability and reduced health-related quality of life HRQoL versus expecting reduced disability and better HRQoL , while also accepting the higher probability albeit still a relatively low risk of severe adverse events.

Proper management of highly active MS patients is a practice of risk-management.

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In summary, as our alternatives for the long-term treatment of MS expand and we enter the era of personalized medicine, we are likely to improve our understanding and detection of disease course and severity, and to learn about treatment responses and safety issues. One major issue is to be aware of the current safety profiles of therapies.


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This enables us to monitor properly our patients, to reduce therapy related adverse events and prevent any harm secondary to therapy, whether we work within large hospital departments or in small clinic settings. This is a copyrighted resource for the sole purpose of education. It is backed by a publishing license, signed by the author.