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icians use multicomponent brief therapies for insomnia for the treatment of chronic insomnia disorder in adults. Masitinib (CONDITIONAL). 3. We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 4. We suggest that clinicians use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 5. We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 6. We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL).

The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations.

The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations.

The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the , the balance of benefits vs harms, patient values and preferences, and resource use considerations.

Despite remarkable improvements in rheumatoid arthritis (RA) treatment, there is evidence indicating that the mortality gap between patients with RA and the general population is not closing. The increase in mortality rates in patients with RA is predominantly due to cardiovascular disease (CVD). Literature suggests that important links exist between RA inflammation and atherosclerosis in CVD. Dyslipidemia is a well-known risk factor of atherosclerosis. Previous studies have suggested that antimalarials, chloroquine diphosphate, and hydroxychloroquine (HCQ), used in the treatment of autoimmune diseases, have a beneficial effect on the lipid levels. However, the studies had small sample sizes. We analyzed a Veterans Affair RA cohort of 2,925 patients to characterize the effect of 4 months' use of HCQ on the lipid levels.

Data for this cohort were obtained from the department of Veterans Affairs administrative database. Individuals (age ≥18 years) with a diagnosis of RA (ICD-9 code) at 2 or more outpatient hers" was more influential.

Our results suggest that sex and race influences the HCQ effect on the lipid profiles in patients with RA. Use of HCQ in males is found to be associated with positive changes in the lipid profiles independent from the use of statins. There is a suggestion that whites and African Americans might be less susceptible to HCQ effect on lipid profiles than other races.

Our results suggest that sex and race influences the HCQ effect on the lipid profiles in patients with RA. Use of HCQ in males is found to be associated with positive changes in the lipid profiles independent from the use of statins. There is a suggestion that whites and African Americans might be less susceptible to HCQ effect on lipid profiles than other races.

Combination therapies have been proposed as a strategy to control inflammation more effectively in patients with rheumatoid arthritis (RA). Few studies examine the combined effect of methotrexate (MTX) and leflunomide (LFN). This study evaluated the symptom control and side effects of the combination of MTX and LFN compared with LFN monotherapy.

We conducted a retrospective analysis of 113 patients with RA treated with either LFN alone (n=22) or in combination with MTX (n=91). Data on disease activity score 28 erythrocyte sedimentation rate (DAS-28 ESR), DAS-28 C-reactive protein (DAS-28 CRP), blood cell count, liver enzymes, and creatinine levels were determined. Samples were collected on day 0 (initiation of LFN) and at 6 and 12 months.

We found no differences between the 2 groups in DAS-28 on day 0 and at 6 and 12 months (p=0.89, p=0.42, and p=0.09, respectively, for DAS-28 ESR; p=0.97, p=0.27, and p=0.63, respectively, for DAS-28 CRP). In addition, we observed no differences in the blood cell count, liver enzymes, and creatinine levels between the treatment groups at any of the time points (all p>0.05).

Our results suggest that the efficacy of the combined treatment with MTX and LFN is similar to that of LFN alone. No increase in toxicity was observed with the combination therapy.

Our results suggest that the efficacy of the combined treatment with MTX and LFN is similar to that of LFN alone. No increase in toxicity was observed with the combination therapy.Multifocal osteonecrosis (MFO) is an uncommon and disabling condition. A few cases have been described in association of systemic lupus erythematosus (SLE). We describe 2 clinical cases of patients with SLE along with MFO and also perform review of the literature.Fibrosis, inflammation, and vasculopathy are the main determinants of systemic sclerosis (SSc) pathogenesis. Cyclophosphamide (CYC), an alkylating agent, has been used to treat skin fibrosis and interstitial lung diseases in SSc for many years and still represents a mainstay in hematopoietic stem cell transplantation. Despite significant effect in reducing lung functional impairment and skin tightness, CYC has a significant safety burden, including infection risk and bone marrow and bladder toxicity. Moreover, it can affect fertility and also cause a predisposition for cancer development in the future, particularly in the bladder. This review summarizes the current evidences regarding the use of CYC to treat SSc, its efficacy and safety profile, and currently available or tested alternative drugs for lung and skin involvement in SSc.