Papers by Chetan Mukhtyar
Journal of Rheumatology, 2007
Damage denotes the aspects of chronic disease that do not reverse with therapy. This concept is p... more Damage denotes the aspects of chronic disease that do not reverse with therapy. This concept is particularly important for the primary systemic vasculitides, since the careful differentiation between activity and damage may help avoid unnecessary exposure to cytotoxic medications. Damage significantly influences both longterm prognosis and quality of life. Because the primary systemic vasculitides have diverse manifestations, the use of a damage assessment instrument is crucial to ensure reproducibility. The Vasculitis Damage Index (VDI) is the only validated measure for damage assessment in vasculitis. Use of the VDI in recent clinical trials has shown that it may not adequately determine the full spectrum of damage experienced by patients with vasculitis of small-and medium-size vessels. We propose reexamining the way in which damage is assessed, focusing on vasculitides of small-and medium-size vessels, and outline an initiative to create a substantially revised and improved damage assessment instrument using data-driven approaches. This initiative is part of a larger international effort to create a unified approach to disease assessment for the primary systemic vasculitides.
Annals of the Rheumatic Diseases, 2007
Journal of Rheumatology, 2007
Clinical and Experimental Rheumatology, 2006
The systemic vasculitides are multi-system disorders with significant mortality and morbidity and... more The systemic vasculitides are multi-system disorders with significant mortality and morbidity and frequent relapses. Treatment is usually effective but fraught with potentially serious effects. Disease Assessment is important to ensure that patients receive the appropriate treatment. Disease Assessment should comprise measurement of disease activity, chronic irreversible damage and impairment of function. Serological markers can be helpful in assessing disease activity but lack sufficient sensitivity and specificity to be used on their own. Radiological techniques such as Magnetic Resonance Imaging, Ultrasound and Positron Emission Tomography show promise in the large vessel vasculitides but require validation in large studies. Clinical Assessment tools are the current gold standard for the assessment of disease activity, damage and function.
Autoimmunity Reviews, 2006
The recent development of biologic therapies capable of selectively targeting components of the i... more The recent development of biologic therapies capable of selectively targeting components of the immune system has revolutionised the treatment of inflammatory arthritides. The steady increase in use of biologic agents coupled with the expansion in the knowledge of the pathogenesis of vascular inflammation has led to their application in the treatment of primary systemic vasculitis. These agents may have a role in addition to or in place of conventional immunosuppression and also be effective when the latter fails to induce remission. The use of biologics as targeted therapies has also, in reverse, improved our understanding of the pathophysiology of vascular inflammation. While the advent of biologics heralds a new era in the management of the systemic vasculitis, evidence for their efficacy is still in its infancy and has yet to match that of conventional immunosuppressants. In this review, we examine the up-to-date evidence for the use of biologics in systemic vasculitis, including TNF-α inhibitors, and highlight the challenges facing their use. We examine the rationale for using biologics based on the pathophysiology of vasculitis. Issues of toxicity and pharmacovigilance with the use of biologics are also discussed. Finally, future directions and predictions are presented.
Annals of the Rheumatic Diseases, 2005
Tumour necrosis factor alpha (TNF alpha) is likely to be involved in the pathogenesis of Wegener’... more Tumour necrosis factor alpha (TNF alpha) is likely to be involved in the pathogenesis of Wegener’s granulomatosis. This paper reviews published clinical trials of the anti-TNFa agents etanercept and infliximab with regard to their efficacy and safety in the treatment of Wegener’s granulomatosis. On the basis of the high rate of adverse events, particularly an increased incidence of cancers, the use of etanercept in the management of Wegener’s granulomatosis is not justified. However, the potential role for infliximab or the as yet untested adalimumab cannot be discounted. The development of novel approaches focusing on blockade of specific molecules including TNFa in the treatment of Wegener’s granulomatosis is awaited.
Rheumatology (Oxford), 2005
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Papers by Chetan Mukhtyar