Soluble transferrin receptor (sTfR) is considered to be a useful biomarker for the diagnosis of iron deficiency, especially in the setting of inflammation, as it is thought to not be affected by ...inflammation. We analyzed the relationship between sTfR levels and inflammatory markers in patients with known or suspected inflammatory rheumatic disease (IRD).
Blood samples of 1001 patients with known or suspected IRD referred to a tertiary rheumatology center were analyzed. Study participants were classified as patients with active IRD and patients with inactive IRD or without IRD. Correlation analyses were used to explore the relationship between sTfR levels and inflammatory markers (ie, C-reactive protein CRP, erythrocyte sedimentation rate ESR). We applied multiple linear regression analysis to evaluate the predictive value of CRP levels for sTfR concentrations after adjustment for potential confounding factors.
There were positive correlations between inflammatory markers (CRP, ESR) and serum sTfR levels (ρ 0.44, ρ 0.43, respectively;
< 0.001), exceeding the strength of correlation between inflammatory markers and the acute phase reactant ferritin (ρ 0.30, ρ 0.23, respectively;
< 0.001). Patients with active IRD demonstrated higher serum sTfR levels compared to patients with inactive or without IRD (mean 3.99 SD 1.69 mg/L vs 3.31 SD 1.57 mg/L;
< 0.001). After adjustment for potential confounding factors, CRP levels are predictive for serum sTfR concentrations (
< 0.001).
The study provides evidence against the concept that sTfR is a biomarker not affected by inflammation.
There is a lack of documented real-world evidence about the efficacy of current therapeutics for autoimmune inflammatory rheumatic diseases (AIIRD)-associated adult macrophage activation syndrome ...(MAS).
To analyze the efficacy of different treatments, especially plasma exchange (PE), in AIIRD-associated MAS.
Among 5775 patients with AIIRD in Tongji Hospital from 2014 to 2020, 62 AIIRD-associated MAS cases were collected. Unadjusted logistic regression, least absolute shrinkage and selection operator (LASSO), and inverse probability of treatment weight (IPTW) analyses were used to characterize the clinical features and potential factors related to the prognosis. Paired t-test was used to compared the changes of inflammatory indicators before and after PE treatment.
The baseline data was defined as the data collected at the onset of MAS, and all of the 62 patients were diagnosed as AIIRD before MAS onset. The prevalance rate of MAS in AIIRD was 1.1%, and the most common types of AIIRD were systemic lupus erythematosus (45.2%) and adult-onset Still's disease (33.9%). All 62 MAS patients received glucocorticoids, 87.1% patients used at least one immunosuppressive agent, and 54.8% received PE. LASSO regression indicates a positive effect of PE on the basis of variables. After PE treatment, serum levels of multiple inflammatory cytokines were rapidly reduced, accompanied by improvements in clinical symptoms and laboratory indecies including ferritin, lactate dehydrogenase, and C-reactive protein. LASSO regression indicates that PE treatment was associated with a marked reduction of mortality (from 53.6% to 11.8%), with a hazard ratio (HR) of 0.148 (p < 0.001) after adjustment for confounding factors using IPTW analysis.
With the background therapy of glucocorticoids and immunosuppressive agents, PE is an effective approach to rapidly clear inflammatory cytokines and reduce mortality of AIIRD-associated MAS.
This study provided real-world information on the efficacy of PE in AIIRD-associated MAS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Zusammenfassung Hintergrund Eine frühe Diagnose und Behandlung entzündlich-rheumatischer Erkrankungen kann Folgeschäden wie dauerhafte Einschränkungen der Mobilität und Gelenk- oder Organschäden ...verhindern. Gleichzeitig besteht ein größer werdendes Versorgungsdefizit aufgrund fehlender rheumatologischer Kapazitäten. Betroffen sind besonders die ländlichen Regionen. Ziel der Arbeit Die vorliegenden nicht bestätigten Diagnosen der Studie Rheuma-VOR wurden hinsichtlich des Vorliegens einer anderen definitiven entzündlich-rheumatischen Erkrankung analysiert. Material und Methoden Die eingegangenen Fragebögen der an der Rheuma-VOR-Studie teilnehmenden Rheumatolog:innen wurden nach Vermerken anderer entzündlich-rheumatischer Erkrankungen als der geforderten Diagnose einer rheumatoiden Arthritis, Psoriasis-Arthritis oder Spondyloarthritis gescreent. Ergebnisse Von 910 „nicht bestätigten“ Diagnosen waren bei 245 Patient:innen andere gestellte Diagnosen auszuwerten. Insgesamt 29,8 % der Diagnosen entsprechen degenerativen Gelenkveränderungen oder chronischen Schmerzsyndromen, bei 26,1 % lagen verschiedene Formen entzündlicher Arthritiden vor. Der Großteil der Diagnosen (40,5 %) entfiel auf Kollagenosen und Vaskulitiden, wobei die Polymyalgia rheumatica mit 20 % am häufigsten diagnostiziert wurde (49 Patient:innen). Diskussion Die vorliegenden Daten zeigen, dass bei einem Großteil der Patient:innen die rheumatologische Vorstellung indiziert war. Aufgrund der ambulanten Versorgungsdefizite ist eine vorherige Selektion des Patientenguts essenziell, um die eingeschränkten Kapazitäten bestmöglich zu nutzen.
Abstract Background Early diagnosis and treatment of inflammatory rheumatic diseases can prevent consequential damage such as permanently limited mobility and joint or organ damage. Simultaneously, there is an increasing deficit in medical care owing to the lack of rheumatological capacity. Rural regions are particularly affected. Objectives The available unconfirmed diagnoses of the study Rheuma-VOR were analysed regarding another definitive inflammatory rheumatic disease. Materials and methods The returned questionnaires of the rheumatologists participating in Rheuma-VOR were screened for definitive inflammatory rheumatic diseases other than the required diagnosis of rheumatoid arthritis, psoriatic arthritis or spondyloarthritis. Results Of 910 unconfirmed diagnoses, in 245 patients another definitive diagnosis could be confirmed. A total of 29.8% of the diagnoses corresponded to degenerative joint changes or chronic pain syndrome, whereas 26.1% involved different forms of inflammatory arthritis. The majority of diagnoses (40.5%) were collagenosis or vasculitis, Discussion The available data show that a rheumatological presentation was indicated for the majority of patients. Owing to the increasing deficits in medical care a prior selection of the patients is crucial to make optimal use of restricted rheumatological capacities.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious ...Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measles-mumps-rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults. (J Rheum Dis 2020;27:182-202)
Zusammenfassung
Trotz beeindruckender Weiterentwicklungen pharmakotherapeutischer Möglichkeiten in den vergangenen Jahren und einem großen zur Verfügung stehenden Armamentarium an Wirksubstanzen ...haben Patienten mit entzündlich-rheumatischen Erkrankungen häufig einen erheblichen Rehabilitationsbedarf. Dies ist zum einen darauf zurückzuführen, dass viele entzündlich-rheumatische Erkrankungen einen chronischen Verlauf aufweisen und nicht selten zu Funktions- und Strukturdefiziten am Bewegungssystem führen. Zum anderen wird selbst unter einer modernen immunmodulierenden Therapie nur bei einem Teil der Patienten eine langfristige Remission erzielt, sodass die Gelenkdestruktionen und damit die Funktionseinschränkungen häufig weiter voranschreiten. Im Fokus der rehabilitativen Interventionen stehen daher eine Verbesserung von Gelenkfunktion und -stabilität, ein Aufbau von Muskelkraft und -ausdauer sowie Schmerzreduktion und Entzündungsdämpfung. Je nach Krankheitsbild müssen aber auch sensible und motorische Störungen sowie (psycho)vegetative Dysregulationen und Adaptationsprozesse adressiert werden. Bei Patienten mit entzündlich-rheumatischen Erkrankungen gehört neben einem Erhalt bzw. einer Verbesserung von Gelenkfunktion und posturaler Kontrolle auch ein Erhalt bzw. eine Verbesserung der Gesamtmobilität zu den primären Rehabilitationszielen. Der folgende Artikel fokussiert auf die aktuelle Evidenz physikalischer Therapiemaßnahmen im Rahmen der Rehabilitationsbehandlung bei entzündlich-rheumatischen Erkrankungen.
Introduction: Management of inflammatory rheumatic diseases has evolved based on improved treatment strategies and better management of comorbidities, specifically cardiovascular risk. Methotrexate ...is one of the first-line treatments in the management of inflammatory rheumatic diseases, but its cardiovascular effects are poorly understood. The purpose of this review is to assess the cardiovascular impact of methotrexate in inflammatory rheumatic disease.
Areas covered: Current knowledge about the mechanism of action of methotrexate on cardiovascular tissue is presented. A review of the literature in the Medline, Cochrane and Embase databases was performed. Current data about the cardiovascular effects of methotrexate in rheumatoid arthritis, psoriatic arthritis, and psoriasis are presented.
Expert opinion: Mechanism of action of methotrexate is based on the antagonism of purines. It reduces systemic inflammation and oxidative stress and improves the major cardiovascular risk factors. Methotrexate improves cardiovascular risk in rheumatoid arthritis, psoriasis and psoriatic arthritis, but the mechanisms involved are partially identified. Data are controversial regarding its effects on endothelial function and atherosclerosis. Conversely, in the general population and in patients with HIV infection, methotrexate does not modify cardiovascular outcomes. Thus, methotrexate only improves cardiovascular risk by reducing systemic inflammation, and should not be used to prevent cardiovascular events.
L´hydroxychloroquine est un agent utilisé comme traitement mais aussi envisagé comme prophylaxie pour l'infection au SARS-CoV-2. Nous rapportons le cas d´un patient qui a développé COVID-19 pendant ...qu´il était sous hydroxychloroquine pour une connectivité mixte associée à une spondyloarthrite. Bien que d´autres travaux soient nécessaires pour pouvoir tirer des conclusions, cela amène à s´interroger sur le rôle protecteur de ce médicament contre l´infection. Sont-ils vraiment protégés contre le COVID-19 ou développeront des formes pauci-symptomatiques?
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Interstitial lung disease (ILD) is a severe pulmonary complication in inflammatory rheumatic diseases (IRD) and associated with significantly increased morbidity and mortality. That is why ILD ...screening at a very early stage, at the onset of IRD, is essential. The objective of the present study was to evaluate the diagnostic value and utility of a stepwise approach as a potential ILD screening tool in patients with newly diagnosed IRD.
Consecutively, 167 IRD patients were enrolled. To homogenize the study cohort, an age and gender matching was performed. The case-control study included 126 patients with new onset of IRD (mainly connective tissue diseases CTD, small vessel vasculitis, and myositis). We applied a stepwise screening algorithm in which all patients underwent pulmonary function testing (PFT) and/or additional chest radiography. If there was at least one abnormal finding, pulmonary high-resolution computed tomography (HRCT) was subsequently performed.
With our stepwise diagnostic approach, we identified 63 IRD patients with ILD (ILD group) and 63 IRD patients without ILD (non-ILD group). A reduced diffusing capacity for carbon monoxide (DLCO) < 80% showed a sensitivity of 83.6% and a specificity of 45.8% compared to chest X-ray with 64.2% and 73.6%, respectively, in detecting ILD. The combination of reduced DLCO and chest X-ray revealed a sensitivity of 95.2% and a specificity of 38.7%. The highest sensitivity (95.2%) and specificity (77.4%) were observed for the combination of reduced DLCO, chest X-ray, and pulmonary HRCT. The most common pulmonary abnormalities on HRCT were ground-glass opacities (GGO; 36.5%), followed by non-specific interstitial pneumonia (NSIP; 31.8%) and usual interstitial pneumonia (UIP; 9.5%).
The combination of reduced DLCO (< 80%), chest X-ray, and pulmonary HRCT yielded the highest sensitivity and specificity in detecting ILD at the onset of IRD. Therefore, this stepwise approach could be a new screening algorithm to identify IRD patients with pulmonary involvement already at the time of the initial IRD diagnosis.
Background: Autoimmune inflammatory rheumatic disease (AIRD) patients are at high risk of the coronavirus disease 2019 (COVID-19), but the medium-term effects of immunosuppressants on vaccine ...efficacy are unknown. We investigated the duration of humoral responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wild-type and Omicron variant in AIRD patients administered with two doses of the BNT162b2 (Pfizer–BioNTech) vaccine. Methods: Serum-neutralizing antibody (NAb) and anti-receptor-binding domain (RBD)/spike antibody levels were measured. Short- and medium-term effects of immunosuppressants were analyzed pre-vaccination (Term 1) and 14–42 days (Term 2) and 100–200 days (Term 3) after the second vaccination. Findings: From Feb 1, 2021, to Feb 28, 2022, 439 AIRD patients and 146 healthy controls were investigated. The seropositivity rate and log10-NAb titers were significantly lower in AIRD patients than in controls at Terms 2 and 3. In rheumatoid arthritis patients, tumor necrosis factor-α inhibitors (TNFis) at Term 3, and older age, glucocorticoids, and abatacept at Terms 2 and 3 were risk factors for reduced responses. Anti-Omicron RBD/spike IgG levels strongly correlated with NAb titers. Interpretation: Glucocorticoids, TNFis, and abatacept treatments negatively affect the longevity of humoral responses to SARS-CoV-2, including Omicron, after two vaccine doses. These findings may inform the timing of additional vaccination for AIRD patients. Funding: Cloud Funding of Peace Winds Japan; Center of Innovation Program from the Ministry of Education, Culture, Sports, Science and Technology of Japan; Japan Society for the Promotion of Science KAKENHI; Japan Agency for Medical Research and Development; Kansai Economic Federation; Mitsubishi Zaidan; and Research Grant from Japan Agency for Medical Research and Development—Core Research for Evolutional Science and Technology.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•Patients with rheumatic diseases have an influenza vaccination rate of 25.3%.•Higher age is significantly associated with an increased vaccination rate.•Therapy with biological DMARDs is associated ...with a positive vaccination status.•Recommendation of vaccination by a physician is the most significant predictor.
Patients with inflammatory rheumatic diseases are at higher risk for influenza and current guidelines recommend vaccination for this group of patients. The aim of this study was to evaluate the vaccination coverage and predictors for influenza vaccination among patients with inflammatory rheumatic diseases.
This survey was conducted at the outpatient rheumatology clinic at the Medical University of Vienna between July and October 2017. All patients diagnosed with an inflammatory rheumatic disease and receiving immunosuppressive therapy were asked to complete a questionnaire about their influenza vaccination status for 2016/17.
490 patients with rheumatic diseases completed a questionnaire (33% male, mean age 55.3 years). The influenza vaccination rate for the previous season was 25.3% (n = 124/490). Predictors for a positive influenza vaccination status were higher age (Adjusted Odds Ratio 5.0, 95% Confidence Interval 2.4–10.4) and treatment with biological disease-modifying antirheumatic drugs (AOR 2.0, 95% CI 1.3–3.1). Patients who received a recommendation for influenza vaccination by their general practitioner were significantly more likely to be vaccinated than those who did not (57% vs. 15%, AOR 6.6, 95% CI 4.1–10.8); even more so if they received a recommendation by their rheumatologist (62% vs. 19%, AOR 9.0, 95% CI 4.9–16.5). The main reasons for patients to decline influenza vaccination were fear of side effects (36%), concerns that vaccination might not be effective due to their immunosuppressed condition (38%) or that it might worsen the rheumatic disease (20%).
A moderate influenza vaccination rate of 25.3% was detected among patients with inflammatory rheumatic diseases. Recommendation of the influenza vaccine by a physician exerts the most effective impact on a positive vaccination status.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
