Remission spontaneous

Rheumatoid arthritis is the most common systemic inflammatory disease, and is characterized by symmetrical joint involvement. Extra-articular involvement including rheumatoid nodules, vasculitis, eye inflammation, neurologic dysfunction, cardiopulmonary disease, lymphadenopathy, and splenomegaly are manifestations of the disease. Although the usual disease course is chronic, some patients will enter a remission spontaneously. 

Anxiety disorders are characterized as chronic in nature with low rates of spontaneous symptom remission and high rates of relapse. Research illustrates that symptoms of anxiety disorders tend to wax and wane, with less than a third of patients remitting spontaneously.7 In a 12-year follow-up study of anxiety disorder patients, recurrence rates were similar between PD with and without agoraphobia (56% and 58%, respectively) despite great differences seen in reported rates of remission (48% and 82% with treatment, respectively).8 Fifty-eight percent of treated GAD patients experienced symptom remission, with 55% experiencing recurrence during the follow-up period. While individuals with SAD had the lowest remission rate with treatment (37%), those who did respond had the lowest rate of recurrence (39%) compared with patients with other anxiety disorders. 

The main goal of ITP treatment is to maintain the platelet count (greater than 20,000-30,000/mm3, 20-30 x 103/( iL or 20-30 x 109/L) while awaiting spontaneous or treatment-induced remission.31... 

One of the main difficulties in this work was that until the late 1940s the only means of assay for the active principle was to test the effect of the preparations on human patients. The disease could not be produced in animals. Patients with pernicious anemia are very sick. They also sometimes show spontaneous remissions so that monitoring the purification was extremely difficult. Nevertheless by 1945 patients were satisfactorily treated by taking less than 1 mg/day of active material compared with 400 g raw liver in 1926. 

The long-term course of MDD is highly variable but in approximately half of patients evolves into a chronic, relapsing illness. Untreated, a major depressive episode typically lasts about 6-12 months before resolving spontaneously. The emotional, physical, and social toll exacted during these months of depression can be tremendous. When the illness remits, most patients are able to function at their previous level however, 20% experience only a partial remission with persistent depressive symptoms that may last months or even years. 

Withdrawal of therapy If, after long-term therapy, the drug is to be stopped, it must be withdrawn gradually. If spontaneous remission occurs in a chronic condition, discontinue treatment gradually. 

Autoimmune diseases may have an acute or a chronic insidious onset with a chronic progressive course with varying periods of severe or mild disease activity and spontaneous remissions in a minority of patients. Inherent to the initially chronic progression, reversible autoimmune inflammation and disability are susceptible to effective therapy when still no irreversible organ damage has occurred. Nowadays these reversible joint or organ changes in autoimmune arthritis and autoimmune nephritis can be normalized with novel treatment modalities. 

The spectrum of Systemic Lupus Erythematosus (SLE) includes latent lupus, discoid lupus, drug-induced lupus, neonatal lupus, lupus profundus, neuropsychiatric lupus, lupus vasculitis, pulmonary lupus, etc. The disease course is characterized by unpredictable exacerbations, drug-induced remissions and spontaneous remissions. SLE is characterized by a wide range of variable individual clinical manifestations which are controllable at early stages. 

The onset of effect of these drugs is slow 2-A weeks is required before stored hormons are depleted and clinical signs of improvement are observed. Short-term treatment is indicated to prepare patients for surgery or radioiodine therapy, while long-term treatment is indicated for cases inappropriate for surgery or radioactive modalities or where medical therapy alone is used. Usually the patient is advised to continue treatment for 1-2 years spontaneous remission occurs in about 50% of cases treated in this way. There is no way to predict remission confidently, however hormone levels, TSAb titer, and goitre size are useful guides. 

It is not always easy to assess the success of antidepressant treatment accurately because depression often tends to spontaneous healing or remission. Cyclic and periodic forms of endogenous depression follow a phasic pattern the depressive episode lasting weeks or months can, in the bipolar form, shill into mania or there is a gradual lightening of the depression, as may be... 

Like almost all relevant authors, Lader and Petursson (1983) also advise against the long-term use of anxiolytics and they emphasize that most anxiety states and phases of insomnia generally last for only a limited period of time either the acute stress fades or the patient becomes used to the situation (or copes with it successfully), or a spontaneous remission occurs. In many cases the patient can be managed with advice and reassurance, and thus without medicaments. 

Despite this favorable result, lithium was hardly considered as a psychopharmaceutical for many years. There were a variety of reasons for this. Firstly, mania is not a very common psychosis and there is spontaneous remission in many cases. There were thus not so many occasions where lithium treatment was indicated. Secondly, lithium salts were considered to be toxic because for some time they had been given in excessive doses to patients with heart failure and in this way, had led to a number of fatalities (Cade, 1970). Thirdly, a few years after Cade s first publication psychiatrists attention had been claimed by chlorpromazine and the subsequent neuroleptics and antidepressants, thus explaining why lithium almost fell into oblivion. It was onl> in the 1960s that it once more attracted some interest, after the Danish psychiatrist Mogens Schou had shown that lithium salts were not only useful in the manic phase of manic depressive illness but also could prevent depressive episodes in patients suffering from bipolar psychoses. 

Natural course of the disorder. Scone apparent placebo effects may be due to spontaneous remissions whereas others are clearl not. Spontaneous remissions are only partly predictable for a given time interval. Patients on waiting lists show clearly the natural course of the disease, spontaneous remission and worsening (see Fig. 5.3). 

The drug therapy of depression differs in a number of critical points from that given to schizophrenics. Depressions are phasically occurring deviations from the norm that, in the majority of cases, show spontaneous remission, although this often may be only after a period of some months. The majority of depressives can be treated as outpatients a fact that explains why the illness generally does not make as severe an encroachment into the family and social surroundings of the patient as does schizophrenia. Outsiders are able to imagine what a depression must be like, or at least believe that they can everyone is occasionally sad. disappointed or devoid of hope. In the eyes of his fellow men and women a depressive consequently tends to be a person to be pitied but not one who is necessarily mad. 

Initial treatment consists of NSAIDs, low dose corticosteroids. If the symptoms are not controlled then second line/disease modifying drugs (DMDs) are added. Since it is a progressive disease, spontaneous remissions are rare and joint damage occurs early, DMDs are started early and continued indefinitely with regular monitoring. 

If the results following the in vitro evaluation of a macromolecular anticancer agent are promising, in vivo tests are then warranted. Animal tumor models are the status quo for the in vivo study of anticancer agents. An animal tumor model should be reproducible, have a low rate of spontaneous cures or remissions, and a low and nonvariable immunogenicity in the host. For tests of mechanisms that also occur in human tumors, the parameters involved in these mechanisms should be similar to those of human tumors [210],... 

Graves disease is considered to be an autoimmune disorder in which helper T lymphocytes stimulate lymphocytes to synthesize antibodies to thyroidal antigens. The antibody described previously (TSH-R Ab [stim]) is directed against the TSH receptor site in the thyroid cell membrane and has the capacity to stimulate growth and biosynthetic activity of the thyroid cell. Spontaneous remission occurs but some patients require years of antithyroid therapy. 

Because episodes of mental disease can undergo spontaneous remission and due to the potency and undesirable side effects of these drugs,they are carefully prescribed and their effects closely monitored. 

Patients with beta-thalassemia major have an increased risk of primary hypothyroidism. In 23 patients with beta-thalassemia amiodarone was associated with a high risk of overt hypothyroidism (33 versus 3% in controls) (43). This occurred at up to 3 months after starting amiodarone. The risk of subclinical hypothyroidism was similar in the two groups. In one case overt hypothyroidism resolved spontaneously after withdrawal, but the other patients were given thyroxine. After 21-47 months of treatment three patients developed thyrotoxicosis, with remission after withdrawal. There were no cases of hyperthyroidism in the controls. The authors proposed that patients with beta-thalassemia may be more susceptible to iodine-induced hypothyroidism, related to an underlying defect in iodine in the thyroid, perhaps associated with an effect of iron overload. 

High-dose IL-2 is approved for the treatment of metastatic renal cell carcinoma. The tumor is intrinsically immunogenic, and can elicit a host immune response that infrequently results in spontaneous remission of disease administration of IL-2 is believed to augment the normal immune response [53]. In a Phase II study that supported the approval of high-dose IL-2 for this indication, 15% of patients achieved objective responses (8% were partial responses and 7% complete responses). In this trial, patients received IL-2 at 600 000 or 720 000 U/kg per dose. The cumulative dose and the efficacy were similar between dose groups patients receiving the higher dose tolerated fewer cycles of therapy due to toxicity. 

Patients with a nonclassical syndrome that resolves or significantly improves after cancer treatment without concomitant immunotherapy (unless spontaneous remission is known to occur)... 

This classification allows for seronegative patients to be classified as having PNS (no. 1). In addition, the set of definitions takes into consideration that new antibody specificities are still being characterized (no. 3). Different clinical subtypes are still being described in association with well-known antibodies, and such cases are also included. Finally, a negative screening for malignancy does not exclude PNS, as spontaneous remission is known to occur. As cancer is ultimately detected in the majority of patients with symptoms and a well-characterized antibody, the number of false positives is probably low (no. 4). 

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