Treatment of rheumatoid arthritis with methotrexate in Congolese patients
Identifieur interne : 000299 ( Istex/Corpus ); précédent : 000298; suivant : 000300Treatment of rheumatoid arthritis with methotrexate in Congolese patients
Auteurs : J. J. Malemba ; J. M. Mbuyi Muamba ; J. Mukaya ; X. Bossuyt ; P. Verschueren ; R. WesthovensSource :
- Clinical Rheumatology [ 0770-3198 ] ; 2013-09-01.
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Abstract
Abstract: Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) but data concerning the effectiveness of treatment with this compound are lacking in the Congolese population. In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. Implementation of a regular follow-up is a major issue.
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DOI: 10.1007/s10067-013-2269-4
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ISTEX:AB2D15A11890979C03CDDE657DF5F5251C5549BALe document en format XML
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In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. Implementation of a regular follow-up is a major issue.</div></front></TEI><istex><corpusName>springer-journals</corpusName><author><json:item><name>J. J. Malemba</name><affiliations><json:string>Unit of Rheumatology, Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo</json:string></affiliations></json:item><json:item><name>J. M. Mbuyi Muamba</name><affiliations><json:string>Unit of Rheumatology, Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo</json:string></affiliations></json:item><json:item><name>J. Mukaya</name><affiliations><json:string>Unit of Radiology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo</json:string></affiliations></json:item><json:item><name>X. Bossuyt</name><affiliations><json:string>Experimental Laboratory Immunology, Department of Medical Diagnostic Sciences, KU Leuven, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>P. Verschueren</name><affiliations><json:string>Rheumatology, Neuromusculo-skeletal Research Unit, Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>R. 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In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 >2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. 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In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. 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Grant="Restricted"></ESMGrant></ArticleGrants></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>J.</GivenName><GivenName>J.</GivenName><FamilyName>Malemba</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>J.</GivenName><GivenName>M.</GivenName><FamilyName>Mbuyi Muamba</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>J.</GivenName><FamilyName>Mukaya</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff3"><AuthorName DisplayOrder="Western"><GivenName>X.</GivenName><FamilyName>Bossuyt</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff4"><AuthorName DisplayOrder="Western"><GivenName>P.</GivenName><FamilyName>Verschueren</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff4" CorrespondingAffiliationID="Aff4"><AuthorName DisplayOrder="Western"><GivenName>R.</GivenName><FamilyName>Westhovens</FamilyName></AuthorName><Contact><Email>rene.westhovens@uzleuven.be</Email></Contact></Author><Affiliation ID="Aff1"><OrgDivision>Unit of Rheumatology, Department of Internal Medicine</OrgDivision><OrgName>University Hospital of Kinshasa</OrgName><OrgAddress><City>Kinshasa</City><Country Code="CD">Democratic Republic of the Congo</Country></OrgAddress></Affiliation><Affiliation ID="Aff2"><OrgDivision>Unit of Radiology</OrgDivision><OrgName>University Hospital of Kinshasa</OrgName><OrgAddress><City>Kinshasa</City><Country Code="CD">Democratic Republic of the Congo</Country></OrgAddress></Affiliation><Affiliation ID="Aff3"><OrgDivision>Experimental Laboratory Immunology, Department of Medical Diagnostic Sciences</OrgDivision><OrgName>KU Leuven</OrgName><OrgAddress><City>Leuven</City><Country Code="BE">Belgium</Country></OrgAddress></Affiliation><Affiliation ID="Aff4"><OrgDivision>Rheumatology, Neuromusculo-skeletal Research Unit, Department of Development and Regeneration</OrgDivision><OrgName>KU Leuven</OrgName><OrgAddress><Street>Herestraat 49</Street><Postcode>3000</Postcode><City>Leuven</City><Country Code="BE">Belgium</Country></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En" OutputMedium="All"><Heading>Abstract</Heading><Para>Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) but data concerning the effectiveness of treatment with this compound are lacking in the Congolese population. In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. Implementation of a regular follow-up is a major issue.</Para></Abstract><KeywordGroup Language="En" OutputMedium="All"><Heading>Keywords</Heading><Keyword>DR Congo</Keyword><Keyword>Evolution</Keyword><Keyword>Methotrexate</Keyword><Keyword>Rheumatoid arthritis</Keyword></KeywordGroup></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Treatment of rheumatoid arthritis with methotrexate in Congolese patients</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Treatment of rheumatoid arthritis with methotrexate in Congolese patients</title></titleInfo><name type="personal"><namePart type="given">J.</namePart><namePart type="given">J.</namePart><namePart type="family">Malemba</namePart><affiliation>Unit of Rheumatology, Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="given">M.</namePart><namePart type="family">Mbuyi Muamba</namePart><affiliation>Unit of Rheumatology, Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Mukaya</namePart><affiliation>Unit of Radiology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">X.</namePart><namePart type="family">Bossuyt</namePart><affiliation>Experimental Laboratory Immunology, Department of Medical Diagnostic Sciences, KU Leuven, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Verschueren</namePart><affiliation>Rheumatology, Neuromusculo-skeletal Research Unit, Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">R.</namePart><namePart type="family">Westhovens</namePart><affiliation>Rheumatology, Neuromusculo-skeletal Research Unit, Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium</affiliation><affiliation>E-mail: rene.westhovens@uzleuven.be</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Springer London</publisher><place><placeTerm type="text">London</placeTerm></place><dateCreated encoding="w3cdtf">2012-11-13</dateCreated><dateIssued encoding="w3cdtf">2013-09-01</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><abstract lang="en">Abstract: Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) but data concerning the effectiveness of treatment with this compound are lacking in the Congolese population. In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. Implementation of a regular follow-up is a major issue.</abstract><note>Original Article</note><subject lang="en"><genre>Keywords</genre><topic>DR Congo</topic><topic>Evolution</topic><topic>Methotrexate</topic><topic>Rheumatoid arthritis</topic></subject><relatedItem type="host"><titleInfo><title>Clinical Rheumatology</title><subTitle>Journal of the International League of Associations for Rheumatology</subTitle></titleInfo><titleInfo type="abbreviated"><title>Clin Rheumatol</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>Springer</publisher><dateIssued encoding="w3cdtf">2013-08-23</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><subject><genre>Journal-Subject-Collection</genre><topic authority="SpringerSubjectCodes" authorityURI="SC11">Medicine</topic></subject><subject><genre>Journal-Subject-Group</genre><topic authority="SpringerSubjectCodes" authorityURI="SCH">Medicine & Public Health</topic><topic authority="SpringerSubjectCodes" authorityURI="SCH57009">Rheumatology</topic></subject><identifier type="ISSN">0770-3198</identifier><identifier type="eISSN">1434-9949</identifier><identifier type="JournalID">10067</identifier><identifier type="IssueArticleCount">21</identifier><identifier type="VolumeIssueCount">12</identifier><part><date>2013</date><detail type="volume"><number>32</number><caption>vol.</caption></detail><detail type="issue"><number>9</number><caption>no.</caption></detail><extent unit="pages"><start>1323</start><end>1327</end></extent></part><recordInfo><recordOrigin>Clinical Rheumatology, 2013</recordOrigin></recordInfo></relatedItem><identifier type="istex">AB2D15A11890979C03CDDE657DF5F5251C5549BA</identifier><identifier type="ark">ark:/67375/VQC-JH7SSRDG-K</identifier><identifier type="DOI">10.1007/s10067-013-2269-4</identifier><identifier type="ArticleID">2269</identifier><identifier type="ArticleID">s10067-013-2269-4</identifier><accessCondition type="use and reproduction" contentType="copyright">Clinical Rheumatology, 2013</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-3XSW68JL-F">springer</recordContentSource><recordOrigin>Clinical Rheumatology, 2013</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/VQC-JH7SSRDG-K/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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