Search

Radboud University, 27 januari 2022, Promotor : Hoogen, F.H.J. van den Co-promotores : Maas, A. van der, Broeder, A.A. den, Contains fulltext : 241557.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext

Contains fulltext : 252946.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext

Item does not contain fulltext, Guidelines on management of polymyalgia rheumatica (PMR) recommend early introduction of methotrexate (MTX), especially in patients with worse prognosis, although evidence on clinical efficacy of MTX in PMR is limited. Our objective was to assess MTX efficacy in real-world PMR care. Retrospective data of newly diagnosed PMR patients who started MTX were compared to control patients in whom MTX was not started at the first flare. Main outcomes were number of flares per year (Poisson regression) and weighted daily glucocorticoid (GC)-dose (linear regression), and flare incidence rate ratio in the MTX group only. 240 patients were selected; 39 patients in the MTX group and 201 in the control group. The yearly incidence rate ratio of flares in the MTX versus control group was 0.80 (95% CI 0.45-1.42). The yearly flare rate was 1.22 before and 0.43 after MTX initiation, resulting in an incidence ratio of 0.35 (95% CI 0.23-0.52). Adjusted time weighted daily GC dose was higher in the MTX versus control group (ratio 1.37, 95% CI 1.04-1.80). No clear effect of MTX on flares was found and time weighted daily GC dose was higher, possibly due to residual confounding by indication. However, the clearly reduced flare rate after MTX start might be suggestive for a beneficial effect of MTX.

Item does not contain fulltext

Contains fulltext : 214026.pdf (publisher's version ) (Open Access)

Item does not contain fulltext, BACKGROUND: Radial artery catheterization is associated with endothelial denudation and impaired vasodilator function, while postcatheterization exercise training may enhance artery function. The impact of catheterization and subsequent exercise training on low-flow mediated vasoconstriction (L-FMC) has not previously been studied. The aim of this study was to examine whether radial artery L-FMC is impaired by catheterization and consequent endothelial denudation. A further aim was to examine the effect of local handgrip exercise training on radial artery L-FMC and flow-mediated dilation (FMD) after transradial catheterization. METHODS AND RESULTS: Thirty-two subjects undergoing transradial catheterization underwent assessment of L-FMC and FMD in the catheterized and contralateral radial artery before, and the day after, catheterization. A further 18 patients were recruited and randomly assigned to either a 6-week handgrip exercise training program (N=9) or a nonexercise control period (N=9). L-FMC was attenuated 1 day postcatheterization in the catheterized arm (-2.07+/-0.84 to 0.35+/-0.83), but unchanged in the noncatheterized arm (-0.93+/-0.86 to -0.90+/-0.92; P<0.05). In the training study, both FMD and L-FMC of the catheterized arm were preserved in the exercise group 7 weeks after catheterization (FMD-pre, 6.84+/-0.79; FMD-post, 6.85+/-1.16; L-FMC-pre, -2.14+/-1.42; L-FMC-post, -3.58+/-1.04%), but reduced in the control group (FMD-pre, 8.27+/-1.52; FMD-post, 4.66+/-0.70; P=0.06; L-FMC-pre, -3.26+/-1.19; L-FMC-post, -1.34+/-1.27%; P<0.05). CONCLUSIONS: Catheterization, and associated endothelial denudation, decreases L-FMC in the radial artery, suggesting that it is endothelium-dependent. Moreover, we demonstrate for the first time that exercise training has beneficial impacts on radial artery vasodilator and constrictor function.