Twenty-one patients with multidrug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia were treated with nebulized polymyxin E (colistin). Overall clinical and ...microbiological response rates were 57.1% and 85.7%, respectively. Nebulized colistin may be reasonably efficacious and safe for treatment of MDR pneumonia. Its role in therapy warrants further investigation in comparative studies.
Nailfold capillaroscopy (NFC) is increasingly used in the early identification of systemic sclerosis (SSc)-related disorders. A consensus "Fast Track algorithm" was developed by the European Alliance ...of Associations for Rheumatology to aid differentiation of scleroderma from nonscleroderma pattern on NFC. Our objective was to evaluate the online training of NFC using the Fast Track algorithm in the assessment of scleroderma vs nonscleroderma NFC pattern.
Participants attended the NFC online training workshop and were taught the Fast Track algorithm. Following the training, participants independently evaluated 45 NFC images in the same session, and then 2 to 4 weeks later, through the online platform. Participants had to differentiate between scleroderma vs nonscleroderma pattern, and additionally nonscleroderma pattern (normal) vs nonscleroderma pattern (nonspecific). The inter- and intrarater Cohen Formula: see text agreement was calculated.
Ninety-eight participants took part in the baseline evaluation, and 61 in the reevaluation session. For identification of scleroderma vs nonscleroderma pattern, the mean (95% CI) inter- and intrarater Formula: see text were 0.86 (0.83-0.88) and 0.83 (0.79-0.87), respectively. The overall inter- and intrarater Formula: see text in the identification of scleroderma, nonscleroderma (normal), and nonscleroderma (nonspecific) patterns were 0.71 (0.69-0.74) and 0.71 (0.67-0.75), respectively. For nonscleroderma (normal) vs nonscleroderma (nonspecific) pattern, the inter- and intrarater Formula: see text were 0.59 (0.55-0.63) and 0.59 (0.54-0.65), respectively.
In this first study evaluating NFC online training using the Fast Track algorithm, we showed very good inter- and intrarater agreement for the identification of scleroderma and nonscleroderma NFC pattern, supporting the feasibility of online NFC standardized training workshops.
Objective
To assess work productivity, identify associated factors and evaluate the economic burden of systemic sclerosis (SSc) in a multiethnic Asian population.
Methods
Data on employment status ...and work productivity loss were collected. Associations between demographic and disease characteristics and unemployment status, work productivity loss, and activity impairment were examined using logistic and linear regression analyses, as appropriate. Costs of unemployment and work productivity loss were estimated using the human capital approach.
Results
Of 111 patients with a mean disease duration of 9.1 years, 33 (29.7%) were unemployed. Their mean age at unemployment was 44.2 years, equating to 22.8 years of lost employment. No demographic and disease characteristics were significantly associated with unemployment status in multivariable analysis. Of 73 employed patients, 39 (53.4%) reported work productivity loss, accounting for 45.9% of the working week. The presence of hyperlipidemia (coefficient –19.01, P = 0.03) was associated with work productivity loss in multivariable analysis. In total, 37 of 78 employed patients (47.4%) and 19 of 33 unemployed patients (57.6%) reported activity impairment, accounting for 42.2% and 50.0%, respectively, of the preceding week. The presence of hyperlipidemia (coefficient –18.56, P < 0.01) was associated with activity impairment in multivariable analysis. Annual cost of unemployment and work productivity loss were estimated to be $53,244 and $13,045 (Singapore dollar) per patient, respectively.
Conclusion
SSc imposes significant unemployment and work productivity loss and causes a substantial economic burden to both affected individuals and society. Modifying the identified factors associated with unemployment and work productivity loss may reduce the burden of SSc.
ObjectivesPoor symptom appraisal (detection, interpretation and response to symptoms) plays a major role in prolonged prediagnosis interval in various health conditions. Theories and models have been ...proposed to study the symptom appraisal process but how they could be employed to improve symptom appraisal remains unclear. We therefore aimed to review approaches to improving symptom appraisal in the literature and to develop a theoretical framework that could guide the development of approaches to improving symptom appraisal among individuals in the general population.DesignSystematic review.Data sourcesMedline, Web of Science, PsycINFO, Embase, CINAHL and Scopus were searched from inception to 30 March 2021.Eligibility criteriaWe included original articles in English in which approaches to improve the detection, interpretation or response to symptoms for symptomatic individuals were described. We excluded articles in which approaches were developed to improve symptom appraisal among healthcare professionals.Data extraction and synthesisA predefined data extraction form was used to extract the development, characteristics and evaluation of approaches to improving symptom appraisal. This formed the basis for the narrative synthesis.ResultsOf 19 046 publications identified from the literature search, 112 were selected for full-text review and 29 approaches comprising provision of knowledge of symptoms/signs and additional components (eg, symptom self-examination and comparison) for symptom appraisal were included in the synthesis. Less than half (41.4%) of these approaches were developed based on theories/models. Interestingly, despite the variety of theories/models adopted in developing these approaches, the components of these approaches were similar.ConclusionSymptom appraisal is an essential process in a patient’s journey that can be targeted to facilitate early diagnosis but is largely unstudied. Building on the literature, we proposed a theoretical framework and approaches to improving symptom appraisal. This could facilitate early identification of a variety of health conditions in the general population.Trial registration numberCRD42021279500.
Objective
Patients with pulmonary arterial hypertension (PAH) may be stratified as low, intermediate, or high risk of 1‐year mortality. In 2022, the European Society of Cardiology (ESC) updated and ...simplified its risk stratification tool, based on three variables: World Health Organization functional class, serum N‐terminal pro‐brain type natriuretic peptide and six‐minute walk distance, applied at follow‐up visits, intended to guide therapy over time.
Methods
We applied the 2022 ESC risk assessment tool at baseline and follow‐up (within 2 years) to a multinational incident cohort of systemic sclerosis‐associated PAH (SSc‐PAH). Kaplan‐Meier curves, Cox hazards regression, and accelerated failure time models were used to evaluate survival by risk score.
Results
At baseline (n = 260), the majority of SSc‐PAH (72.2%) were graded as intermediate risk of death according to the 2022 tool. At follow‐up, according to 2022 tool, half (55.5%) of the cohort were classified as low or intermediate‐low risk. The 2022 risk model at follow‐up was able to differentiate survival between risk strata. All three individual parameters (World Health Organization functional class, N‐terminal pro‐brain type natriuretic peptide, six‐minute walk distance) were significantly associated with mortality at baseline and/or follow‐up.
Conclusion
The 2022 ESC risk assessment strategy applied at baseline and follow‐up predicts survival in SSc‐PAH. Treatment decisions for SSc‐PAH should include risk assessments, aiming to achieve low‐risk status according to the 2022 ESC guidelines.
Abstract
Aim
Social cognitive theory (SCT) has been successfully employed to improve symptom appraisal and help‐seeking among patients with various conditions but is yet to be applied in the context ...of autoimmune rheumatic diseases (ARDs). This study aimed to explore the applicability of SCT in and possible approaches to improving symptom appraisal and help‐seeking of patients with ARDs, one of the key barriers to earlier diagnosis.
Methods
Semi‐structured interviews were conducted with 33 ARD patients with a prolonged pre‐diagnosis interval (>3 months). We coded the transcripts deductively using SCT as the overarching framework and inductively for approaches identified from the interviews.
Results
All six main concepts of SCT (behavioral capacity, expectations, self‐efficacy, observational learning, reinforcements, and reciprocal determinism) were observed in the three stages of symptom appraisal and help‐seeking (detection, interpretation, and response) of patients with ARDs. While many participants reported that they were able and confident to detect their symptoms, they lacked the behavioral capacity and self‐efficacy to interpret symptoms correctly, which resulted in delayed help‐seeking and diagnosis. Possible approaches to address this suggested by participants (such as education of the general population) could improve behavioral capacity and self‐efficacy in symptom interpretation and enhance expectations, observational learning, reinforcements, and reciprocal determinism in symptom response.
Conclusion
Lack of behavioral capacity and self‐efficacy was observed in symptom interpretation of patients with ARDs, which resulted in delayed help‐seeking. Approaches could target the behavioral capacity and self‐efficacy for symptom interpretation to facilitate early help‐seeking and, in turn, earlier diagnosis among individuals with possible ARDs.
Studies of flares of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination are limited by small sample size, short follow up or at risk of selection bias.
A national ...retrospective cohort study of consecutive AIIRD patients ≥12 years old, across 8 hospitals who received at least one dose of a COVID-19 mRNA vaccine. Patients were included from the date of 1st vaccine dose and censored at the time of flare or on the date of the clinic visit at least 3 months from cohort entry, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis.
4627 patients (73% Chinese, 71% female) of median (IQR) age 61 (48, 70) years were included; 42% Rheumatoid arthritis, 14% Systemic lupus erythematosus and 11% Psoriatic arthritis. 47% were in remission, 41% low disease activity, 10% moderate disease activity and 1% in high disease activity. 18% patients flared, of which 11.7% were within the 3-month period of interest. 11.8% patients improved. Median (IQR) time-to-flare was 60 (30, 114) days. 25% flares were self-limiting, 61% mild-moderate and 14% severe. Older patients (53–65 years and >66 years) had a lower risk of flare HR 0.6 (95% CI 0.5–0.8) and 0.7 (0.6–0.8) respectively. Patients with inflammatory arthritis and with active disease had a higher risk of flare HR 1.5 (1.2–2.0) and 1.4 (1.2–1.6), respectively. Treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), immunosuppression and prednisolone was also associated with an increased risk of flare HR 1.5 (1.1–2), 1.2 (1.1–1.4) and 1.5 (1.2–1.8) for prednisolone ≤7.5 mg respectively.
There was a moderately high rate of AIIRD flares after mRNA vaccination but also improvement in several patients. Severe flares and hospitalisation were rare. Thus, vaccination remains safe and highly recommended.
•Our large inception cohort of consecutively vaccinated AIIRD patients yielded a flare rate of 4.5/100 patient-months.•Predictors of flares were younger age, inflammatory arthritis, active disease and immunosuppressive treatment.•Severe flares were rare; thus vaccination is safe and highly recommended for our vulnerable patients with AIIRD.
To evaluate the utility of magnetic resonance imaging (MRI) in systemic sclerosis (SSc)-associated arthropathy.
MRI of the hand was performed in patients presenting with joint pain/swelling in order ...(1) to determine the frequency of inflammation on MRI, and (2) to compare MRI with radiography.
Of 17 patients with SSc, 10 (59%) had inflammatory MRI findings with synovitis (n = 8), erosions (n = 7), joint effusion (n = 7), or tenosynovitis (n = 8). Bone edema was present in 9 patients. Of 7 patients with MRI erosions, only 2 had radiographic erosions.
Our study illustrates the usefulness of MRI in the accurate diagnosis and characterization of SSc-associated arthropathy.
Aim
We aimed to characterize work disability in patients with newly diagnosed rheumatic diseases and compare work characteristics between patients with rheumatic diseases and controls without ...rheumatic diseases at diagnosis.
Methods
Patients with inflammatory arthritis (IA) and osteoarthritis (OA), surrogates for autoimmune and non‐autoimmune rheumatic diseases, respectively, and controls of working age were surveyed at diagnosis. Patients with rheumatic diseases who were employed before symptom onset were characterized as having work disability if they reported reduced work ability and productivity while remaining in the same job as before symptom onset, changed to a less demanding job or stopped working/retired. Work characteristics at diagnosis were compared between rheumatic diseases patients and controls.
Results
The unemployment rate before symptom onset was lower in patients with IA (20%) compared to patients with OA (32%). Among patients with IA and OA who were employed before symptom onset, 59% and 43% reported work disability, respectively (P = .04). The unemployment rate at diagnosis was comparable in patients with IA (26%) and higher in patients with OA (38%) compared to controls (29%). Employed patients with IA and OA, when compared with controls, reported poorer work ability (score: 37 vs 39 vs 41, P < .01; proportion with poor/moderate work ability: 48% vs 33% vs 21%, P < .01) and greater work productivity loss (score: 32 vs 29 vs 17, P < .01) at diagnosis.
Conclusion
Rheumatic diseases impose significant work disability at diagnosis, highlighting the need for identification and interventions targeting work disability early in the course of disease.
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