Latest news with #rheumatoidArthritis
Medical News Today
09-07-2025
- Health
- Medical News Today
Clinical test may predict best rheumatoid arthritis biologic for each individual
Rheumatoid arthritis is a painful, progressive joint disease characterized by particularly acute used to treat autoimmune diseases such as rheumatoid arthritis, target symptom mechanisms without compromising the entire immune system.A new test may take the guesswork out of finding the right biological therapy for people with rheumatoid at Queen Mary, University of London, have announced a new machine-learning-based method for predicting the biological therapy, or biologic, most likely to successfully relieve symptoms for an individual with rheumatoid scientists say that their system successfully predicted the optimal biologic for 79–85% of patients on its first try in validation the last 20 years, biologics have revolutionized the treatment of rheumatoid arthritis (RA) due to their potential to focus on the underlying cellular cause of a patient's RA is an immune disorder, conventional treatments suppress the function of the entire immune system to reduce symptoms of the condition. Absent a robust immune system, the patient is left vulnerable to idea behind biologics is that a more precise approach can be effective at reducing RA symptoms without significantly compromising the immune to its inventors, prior to the newly announced technique, identifying the correct biologic for each patient was somewhat of a hit-or-miss procedure — 40% of biological therapies fail due to inaccurate new prediction technique pinpoints which of the three main types of biologics shows the most promise for a patient.'This innovation could have major benefits for patients and healthcare providers alike. Prescribing the right treatment the first time would reduce patient suffering,' Professor Constantino Pitzalis, study author, tells Medical News scientists announced their new method of identifying the best biologic for an individual RA patient in Nature rheumatoid arthritis is treatedRheumatoid arthritis is an autoimmune disease that causes pain and inflammation in and around the joints.'The persistent inflammation can impair mobility and dexterity, making daily tasks difficult or impossible,' explained Syeda S. Nasrin, MSc, graduate of the Center for Regenerative Sciences in Dresden, Germany, who was not involved in the Bowen, PhD, bioethicist at SUNY Upstate Medical University, who was also not involved in the study, is someone who has personal experience with RA. 'When I developed RA, the pain was shocking. I'd wake up in tears in the middle of the night and no amount of NSAIDs, ice, heat, movement, rest — any of the usual things you'd try for joint pain — even began to offer relief. It spreads all over the body and makes basic life tasks, like putting on a shirt or opening a car door, agonizing,' she is a chronic and progressive condition, and may also involve other parts of the from biologics, people with RA may be treated with immune suppressors such as methotrexate and Janus kinase (JAK) inhibitors, which target the overactive immune system. For pain, doctors prescribe NSAIDs, which are notoriously hard on the stomach and GI tract with long-term use, and corticosteroids to control do biological therapies work?'Biologics,' said Nasrin, 'target specific cellular pathways in the immune system that play key roles in the inflammatory process of RA.'The idea is to address the mechanism causing an individual patient's RA-related joint inflammation without attacking the immune system itself.'For instance,' she explained, 'Interleukin-6 (IL-6) is a cytokine that is involved in immune cell modulation and inflammation. Tocilizumab (Actemra), a monoclonal antibody, can inhibit this IL-6 cytokine and reduce inflammation.'Nasrin made clear, however, that 'as far as I know, these molecular targeted therapies are able to reduce inflammation, slow joint damage, and improve physical function, but they do not cure the disease.'Why getting the right biologic is importantSince it currently takes time to identify a biologic that can address a specific patient's RA, there is an extended period during which no symptom relief are also risks associated with this period of experimentation, pointed out Nasrin. 'As these approaches often include altering the immune system at a molecular level, that means there is a suppression of the immune system in the body. This could increase infection susceptibility.'Bowen pointed out as well that even the right biologic takes time to have a positive effect on symptoms. Extended periods of trial and error may be accompanied by uncertainty in addition to the ongoing physical Bowen described it, 'What works for one person may not work for another. So it can be really demoralizing and isolating if, say, you're looking around and seeing all these people who are doing great on [one biologic], but it's doing nothing for you.''It's grueling,' she said, 'not just on a physical level but also a psychological one, where you might be dealing with huge amounts of fear, hopelessness, and doubt that you will ever find something that works.'Predicting the best drug for each individualThe new method identifies which of three biologics — etanercept, tocilizumab, or rituximab — is most likely to work for a a recent clinical trial that involved deep molecular phenotyping, the scientists developed a database of gene differences in RA patients who had responded well to biologics, compared to others who did were also able to ascertain the response of specific groups of RA-related cells to each of the drugs. From there, they built three predictive models for the three biologics to test how well a patient would do with a given predict the correct biologic for a specific patient, they extract a tissue sample from a joint affected by RA, and score the levels of activity in 524 genes they have identified as relevant. They can then match those scores to the most promising Mary, University of London, is seeking commercial partners to help develop the predictive system for real-world use. No timetable for when this may occur has yet been the validation results are promising, Nasrin, struck a note of caution:'Personalized medicine is still at a very early stage of development. So the approach should be taken with caution and only proceed with having solid clinical trial data.'Clinical trials are reportedly underway.
Medscape
03-07-2025
- Health
- Medscape
Rheumatoid Nodules: Rare, Recurrent, and Still a Challenge
Despite the rising incidence of rheumatoid arthritis (RA), extra-articular manifestations have become rare in the era of modern treat-to-target therapy. However, they still present clinical challenges — particularly in the case of rheumatoid nodules. In addition to the need to rule out serious differential diagnoses and address potential complications, especially those involving the lungs, these recurrent inflammatory granulomas can affect daily life not only cosmetically but also functionally. Christopher Edwards, MD, professor of rheumatology at University Hospital Southampton in Southampton, England, discussed the clinical relevance and management of rheumatoid nodules during the 2025 Annual Meeting of the European Alliance of Associations for Rheumatology. When Edwards began his career in rheumatology, the presence of rheumatoid nodules was considered a key diagnostic criterion for RA. If not found on the hands, clinicians often examined the elbows and Achilles tendons, which are also common sites. Histologically, rheumatoid nodules are granulomatous inflammatory lesions that evolve through multiple stages. While often subcutaneous, they can also be found on the sclera, larynx, heart valves, and — most significantly — in the lungs. Biopsy When Malignancy Is Suspected Pulmonary nodules can present diagnostic difficulties. 'I've seen patients who were initially told they had lung metastases,' Edwards recalled. Waiting for further imaging and biopsy can be highly distressing for patients. Granulomatosis with polyangiitis can also resemble rheumatoid nodules, further complicating the diagnosis. It is especially important to distinguish these nodules from infections such as tuberculosis. Patients with RA are at increased risk for infection due to both the underlying disease and immunosuppressive treatment. Like tuberculomas, pulmonary rheumatoid nodules can undergo central necrosis when exposed to tumor necrosis factor-alpha inhibitors, leading to cavitation or even pneumothorax. 'Any cavity in the lung can become infected,' Edwards cautioned. Diagnosing Peripheral Nodules Diagnosing peripheral rheumatoid nodules is usually straightforward. These nodules typically feel rubbery on palpation and are movable relative to the underlying tissue. Important differential diagnoses include gouty tophi, lipomas, epidermoid cysts, infectious granulomas, sarcoidosis, and neoplastic lesions. Imaging tools such as ultrasound or fine-needle aspiration can help clarify the diagnosis, particularly when gout is suspected. 'Biopsy is rarely required — only if there's concern about a neoplastic or malignant process,' Edwards explained. Better Disease Control, Fewer Nodules 'In my practice, I see very few nodules these days,' said Edwards. Epidemiological data support this trend: The 10-year cumulative incidence of subcutaneous nodules in RA patients decreased from 30.9% between 1985 and 1999 to 15.8% between 2000 and 2014. Multiple factors likely contributed to this decline, including the earlier initiation of more effective therapies and a reduction in smoking rates. Smoking remains a major risk factor for nodule development, along with long-standing, severe RA, male sex, and seropositivity for rheumatoid factor or anti-cyclic citrullinated peptide antibodies. 'Patients with nodules are almost always seropositive,' Edwards noted. These findings suggest that maintaining tight control of disease activity is more critical for preventing nodules than concerns about drug-induced nodulosis. Little Reason to Discontinue Methotrexate 'There was a time when we worried that methotrexate might be causing nodules,' Edwards said, referring to anecdotal reports of increased nodulosis after initiating methotrexate (MTX). 'But now we're using more MTX and seeing fewer nodules.' He emphasized that the presence of nodules alone should not prompt discontinuation of MTX. 'It wasn't a reason to stop methotrexate back then, and it's not a reason now — though in some cases, it may justify a more aggressive treatment approach.' Other medications — particularly tumor necrosis factor inhibitors like etanercept — have also been linked to nodule development, though Edwards suggested this may reflect reporting bias. 'It might not be causal,' he said. Often, treatment isn't necessary. 'Sometimes it's just a matter of observation,' Edwards noted. Painful or functionally limiting nodules may be managed with local glucocorticoid injections to reduce discomfort and soften the nodules. However, he admitted he had never personally injected a rheumatoid nodule. He also cautioned against injections over the elbow. 'There's something about the skin and the olecranon bursa that makes infections more likely in that area. I saw one patient who needed plastic surgery after an infection left a significant wound.' Rheumatoid nodules also have a tendency to recur. When to Consider Surgery 'Surgery can benefit some patients,' Edwards said. Surgical removal may be warranted for nodules that ulcerate, become infected, or impair function — such as large nodules on the thumb or fingertip that interfere with gripping. 'Patients are usually happy to regain function, even if the nodule comes back a couple of years later.' Nodules that are consistently irritated by shoes or clothing straps may also merit removal. Pulmonary rheumatoid nodules — unlike subcutaneous ones — often contain B cells and typically respond well to rituximab or abatacept. 'These lung nodules tend to shrink or stabilize with rituximab, and certainly, no new ones seem to develop,' Edwards noted. Case reports and small series have also documented improvement with Janus kinase inhibitors.
Daily Mail
02-07-2025
- Health
- Daily Mail
I've been diagnosed with an autoimmune disease - here are all the warning signs I missed
A woman with an autoimmune disease has revealed all the symptoms she missed in a bid to warn others. Nicky, from Plymouth, said she has just been diagnosed with rheumatoid arthritis by doctors. This type of arthritis is a long-term condition that causes pain, swelling and stiffness in the joints and usually affects the hands, feet and wrists. She said she had many symptoms that she thought were normal but were actually a result of her medical condition. But she got a shock a couple of months ago when she could not get out of bed one day and said that her 'life has changed'. Nicky spoke about the first sign she ignored and said: 'For the last couple of years I'd wake up in pain and my whole body would hurt, but it would only last for 30 seconds maybe, maximum a minute. 'And then you forget... I thought that was normal.' The beautician also said she felt very achy while sitting down after working for the day, but she just put this down to having a busy job. She added: 'But then it started when I wasn't working and I haven't done anything and when I say aching, I mean [it felt] like I had ran a marathon.' Nicky said that she has also not been able to control her body heat for 'many years', adding that she could not sit in the sun for long periods of time. She said: 'It could be winter but I would be boiling hot and sweating. I can't sit in the sun [as] I'd get rashes and I feel like I'm cooking from the inside out. I thought that was normal.' Nicky said that she has also experienced joint pain in her hands over the years, but she thought that this was because she is a hairdresser. 'I used to put that down to my job and thought that was normal,' she added. She's also had problems sleeping and said that she has not been able to go for a kip for many years. She said: 'I just couldn't function, fatigue, tired constantly, again, I thought that was normal. I work a busy, busy job, I run a salon and I've got my own business so I just put it down to that.' Nicky urged anyone who is experiencing these symptoms to get themselves checked out, as it could be an underlying health issue. The clip racked up more than 560,000 views on TikTok and Nicky got thousands of comments from people sharing their thoughts The clip racked up more than 560,000 views on TikTok and Nicky got thousands of comments from people sharing their thoughts. One wrote: 'I have psoriatic arthritis, I'm on so much medication... it's so hard,' to which Nicky responded: 'I feel you.' Another penned: 'I was diagnosed with RA as well but two years later they changed the diagnosis to Psoriatic arthritis. I only have psoriasis on my nails so it confused them. The pain was as you say, debilitating.' A third said: 'I was first told I had fibymalgia then menopause and then rheumatoid arthritis, I think it's a bit of them all to be honest.' A fourth commented: 'I have the same symptoms as you. But I've been diagnosed with Fibromyalgia. I've got so bad I had to give up my job.'
Health Line
23-06-2025
- Health
- Health Line
What Are Intramuscular Injections?
An intramuscular injection is a technique for delivering medication deep into the muscles. This allows the medication to absorb quickly into the bloodstream. You may have received an intramuscular injection at a doctor's office the last time you got a vaccine, like the flu shot. In some cases, a person may also self-administer an intramuscular injection. For example, certain drugs that treat multiple sclerosis or rheumatoid arthritis may require self-injection. What are intramuscular injections used for? Intramuscular injections are a common practice in modern medicine. They're used to deliver drugs and vaccines. Several drugs and almost all injectable vaccines are delivered this way. Intramuscular injections are used when other types of delivery methods are not recommended. These include: oral (swallowed into the stomach) intravenous (injected into the vein) subcutaneous (injected into the fatty tissue just under the layer of skin) Intramuscular injections may sometimes be used instead of intravenous injections because some drugs are irritating to veins or because a suitable vein cannot be located. However, not all intravenous medications can be administered intramuscularly. They may be used instead of oral delivery because some drugs are destroyed by the digestive system when you swallow them. Intramuscular injections are absorbed faster than subcutaneous injections. This is because muscle tissue has a greater blood supply than the tissue just under your skin. Muscle tissue can also hold a larger volume of medication than subcutaneous tissue. Intramuscular injection sites Intramuscular injections are often given in the following areas: Deltoid muscle of the arm The deltoid muscle is the site most typically used for vaccines. However, this site is not common for self-injection because its small muscle mass limits the volume of medication that can be injected — typically no more than 1 milliliter. It's also challenging to use this site for self-injection. A caregiver, friend, or family member can assist with injections into this muscle. To locate this site, feel for the bone (acromion process) located at the top of your upper arm. The correct area to give the injection is two finger widths below the acromion process. At the bottom of the two fingers will be an upside-down triangle. Give the injection in the center of the triangle. Vastus lateralis muscle of the thigh The thigh may be used when the other sites are not available or if you need to administer the medication on your own. Divide the upper thigh into three equal parts. Locate the middle of these three sections. The injection should go into the outer top portion of this section. Ventrogluteal muscle of the hip The ventrogluteal muscle is the safest site for adults and children older than 7 months. It's deep and not close to any major blood vessels or nerves. However, this site is difficult for self-injection and may require the help of a friend, family member, or caregiver. Place the heel of your hand on the hip of the person receiving the injection, with your fingers pointing toward their head. Position your fingers so your thumb points toward their groin, and you feel the pelvis under your pinky finger. Spread your index and middle fingers in a slight V shape, and inject the needle into the middle of that V. Dorsogluteal muscles of the buttocks For many years, healthcare professionals most commonly selected the dorsogluteal muscle of the buttocks. However, due to the potential for injury to the sciatic nerve, the ventrogluteal muscle is most often used instead. This site in the dorsogluteal muscle is difficult to use for self-injection and is not recommended. You should not use an injection site that has evidence of infection or injury. If you'll be giving the injection more than once, rotate the injection sites to avoid injury or discomfort to the muscles. How to administer an intramuscular injection Anyone who administers intramuscular injections should receive training and education on proper injection techniques. The needle size and injection site will depend on many factors. These include the age and size of the person receiving the medication, and the volume and type of medication. Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication. The needle should be long enough to reach the muscle without penetrating the nerves and blood vessels underneath. Generally, needles should be 1 inch to 1.5 inches for an adult and will be smaller for a child. They'll be 22-gauge to 25-gauge thick, noted as 22g on the packaging. Follow these steps for a safe intramuscular injection: 1. Wash your hands Wash your hands with soap and warm water to prevent potential infection. Be sure to thoroughly scrub between your fingers, on the backs of your hands, and under your fingernails. The Centers for Disease Control and Prevention (CDC) recommends lathering for 20 seconds, which is the time it takes to sing the 'Happy Birthday' song twice. 2. Gather all the needed supplies Assemble the following supplies: needle and syringe with medication alcohol pads gauze puncture-resistant container to discard the used needles and syringe (typically a red, plastic sharps container) bandages 3. Locate the injection site To isolate the muscle and target where you'll place the injection, spread the skin at the injection site between two fingers. The person receiving the injection should get into a comfortable position that allows easy access to the location and keeps the muscles relaxed. 4. Clean the injection site Clean the site selected for injection with an alcohol swab and allow the skin to air dry. 5. Prepare the syringe with medication Remove the cap. If the vial or pen is multidose, note when the vial was first opened. The rubber stopper should be cleaned with an alcohol swab. Draw air into the syringe. Draw back the plunger to fill the syringe with air up to the dose that you'll be injecting. This is done because the vial is a vacuum, and you need to add an equal amount of air to regulate the pressure. This also makes it easier to draw the medication into the syringe. If you forget this step, you can still get the medication out of the vial. Insert air into the vial. Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial. Inject all of the air into the vial. Be careful not to touch the needle to keep it clean. Withdraw the medication. Turn the vial and syringe upside down so the needle points upward, and pull back on the plunger to withdraw the correct amount of medication. Remove air bubbles. Tap the syringe to push any bubbles to the top and gently depress the plunger to push the air bubbles out. 6. Self-inject with a syringe Hold the needle like a dart and insert it into the muscle at a 90-degree angle. You should insert the needle in a quick but controlled manner. Do not push the plunger in. 7. Inject the medication Push the plunger slowly to inject the medication into the muscle. 8. Remove the needle Withdraw the needle quickly and discard it into a puncture-resistant sharps container. Do not put the cap back on the needle. A sharps container is a red container that you can purchase at any pharmacy. It collects medical waste, such as needles and syringes. You should not put these materials into the regular garbage, as needles can be hazardous to anyone who handles the trash. 9. Apply pressure to the injection site Use a piece of gauze to apply light pressure to the injection site. You can even massage the area to help the medication be absorbed into the muscle. It's routine to see slight bleeding. Use a bandage if necessary. Tips for an easier injection To minimize possible discomfort before your injection: Apply ice or an over-the-counter topical numbing cream to the injection site before cleaning it with the alcohol pad. Allow the alcohol to dry completely before the injection. Otherwise, it might cause stinging. Warm the vial of medication by rubbing it between your hands before drawing the medication into the syringe. Have someone you trust give you the injection. Some people find it difficult to inject themselves. What are the complications of intramuscular injections? It's typical to experience some discomfort after an intramuscular injection. However, certain symptoms may be signs of a more serious complication. Call your doctor or healthcare professional right away if you experience: You may have some anxiety about performing or receiving an injection, especially an intramuscular injection, due to the long needle. Read through the steps several times until you feel comfortable with the procedure, and take your time. You can ask your doctor or pharmacist to go through the procedure with you beforehand. They're more than willing to help you understand how to perform a safe, proper injection.
Medscape
20-06-2025
- Health
- Medscape
EULAR Updates Recommendations for Managing RA
BARCELONA, Spain — Patients with rheumatoid arthritis (RA) who have not responded to first-line methotrexate therapy should be started on a biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD), according to new recommendations by the European Alliance of Associations for Rheumatology (EULAR). These updated recommendations contain five overarching principles and nine recommendations — two fewer than those in the 2022 iteration. Several of the recommendations remain unchanged, and a few were merged or modified to provide greater clarity. 'The availability of an increasing number of good drugs and increasing evidence due to wonderful clinical trials made the task force in charge of these recommendations produce increasingly leaner recommendations,' said Josef S. Smolen, MD, of the Medical University of Vienna, Vienna, Austria, who presented them at the EULAR 2025 Annual Meeting. 'It's nice because it makes life simpler.' Josef S. Smolen, MD EULAR continues to recommend methotrexate and short-term glucocorticoids as the first treatment strategy for RA. (In the case of contraindications, leflunomide or sulfasalazine should be considered.) 'We have yet to find something that beats methotrexate plus glucocorticoids [as a first therapy strategy],' Smolen said. However, if the treatment target is not reached with this first conventional synthetic (cs)DMARD approach, then the patient should be started on a b/tsDMARD. Second-Line Therapy With b/tsDMARDs This update eliminates treatment based on stratification according to poor prognostic factors, such as the presence of autoantibodies or high disease activity. In the 2022 recommendations, patients without these factors could start another csDMARD, whereas those with these poor prognostic factors could start a b/tsDMARD. 'The task force felt that the stratification was not necessary because if you fail methotrexate plus glucocorticoids, you already have a bad prognostic sign,' Smolen explained. Alexandre Sepriano, MD, PhD, an assistant professor of rheumatology at NOVA University Lisbon, Lisbon, Portugal, thought this change was the 'most important modification' to these RA treatment guidelines and would have 'significant implications for clinical practice.' He co-moderated the session where these updated recommendations were presented. Alexandre Sepriano, MD, PhD 'In some countries (eg, the United Kingdom), patients previously had to fail two csDMARDs before being eligible for a biologic or JAK inhibitor,' added Kim Lauper, MD, PhD, of Geneva University Hospitals, Geneva, Switzerland, the other moderator of the session. 'This new recommendation could help support policy changes that allow for earlier escalation, potentially helping more patients reach remission faster.' EULAR still recommends that b/tsDMARDs be combined with a csDMARD. In patients who cannot use a csDMARD as a co-medication, interleukin 6 inhibitors and JAK inhibitors 'may have some advantages compared with other bDMARDs,' the recommendations state. More Research Needed on JAK Inhibitors EULAR advises that clinicians should evaluate cardiovascular and malignancy risk factors before prescribing a JAK inhibitor. While the ORAL Surveillance trial found that the risk for major cardiovascular events and cancer was more common with tofacitinib than with TNF inhibitors, patient registries have not shown these same patterns, Smolen said. More randomized controlled trials are therefore needed to understand what could be driving the risk, he added. Kim Lauper, MD, PhD 'We're awaiting more data, and we would love to see and understand the mechanisms that led to a higher incidence of malignancies and cardiovascular events [in the ORAL Surveillance trial],' he said. Once a patient achieves sustained remission, they can taper to a lower DMARD dose; however, the new guidelines emphasize the importance of remaining on DMARDs and not stopping them entirely, Smolen said. 'Now, we more clearly state that this task force, based on newer data, felt that continuation of DMARDs — whether traditional [synthetic], biologic, or targeted synthetic DMARDs — is recommended, but dose reduction may be considered,' he continued.
