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Elawad T, Scott G, Bone JN, Elwell H, Lopez CE, Filippi V, Green M, Khalil A, Kinshella MLW, Mistry HD, Pickerill K, Shanmugam R, Singer J, Townsend R, Tsigas EZ, Vidler M, Volvert ML, von Dadelszen P, Magee LA. Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG 2024; 131:46-62. [PMID: 36209504 DOI: 10.1111/1471-0528.17320] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare pre-eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre-eclampsia prevention. DESIGN Our search strategy provided hierarchical evidence of relationships between risk factors and pre-eclampsia using Medline (Ovid), searched from January 2010 to January 2021. SETTING Published studies and CPGs. POPULATION Pregnant women. METHODS We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review. MAIN OUTCOME MEASURE Pre-eclampsia. RESULTS Of 78 pre-eclampsia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre-eclampsia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre-eclampsia (high-quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre-eclampsia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight; 'prehypertension' at booking; and blood pressure of 130-139/80-89 mmHg in early pregnancy. CONCLUSIONS Pre-eclampsia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed.
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Affiliation(s)
- Terteel Elawad
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Georgia Scott
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- North West London Foundation School, London, UK
| | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Helen Elwell
- British Medical Association (BMA) Library, BMA, London, UK
| | - Cristina Escalona Lopez
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Asma Khalil
- St George's Hospital NHS Foundation Trust, London, UK
| | - Mai-Lei W Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Hiten D Mistry
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Reshma Shanmugam
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- West Midlands Central Foundation School, Birmingham, UK
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Vancouver, Canada
| | | | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Marie-Laure Volvert
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
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2
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Nune A, Durkowski V, Pillay SS, Barman B, Elwell H, Bora K, Bilgrami S, Mahmood S, Babajan N, Venkatachalam S, Ottewell L, Manzo C. New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review. Vaccines (Basel) 2023; 11:1571. [PMID: 37896974 PMCID: PMC10610967 DOI: 10.3390/vaccines11101571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
A comprehensive, up-to-date systematic review (SR) of the new-onset rheumatic immune-mediated inflammatory diseases (R-IMIDs) following COVID-19 vaccinations is lacking. Therefore, we investigated the demographics, management, and prognosis of new R-IMIDs in adults following SARS-CoV-2 vaccinations. A systematic literature search of Medline, Embase, Google Scholar, LitCovid, and Cochrane was conducted. We included any English-language study that reported new-onset R-IMID in adults following the post-COVID-19 vaccination. A total of 271 cases were reported from 39 countries between January 2021 and May 2023. The mean age of patients was 56 (range 18-90), and most were females (170, 62.5%). Most (153, 56.5%) received the Pfizer BioNTech COVID-19 vaccine. Nearly 50% of patients developed R-IMID after the second dose of the vaccine. Vasculitis was the most prevalent clinical presentation (86, 31.7%), followed by connective tissue disease (66, 24.3%). The mean duration between the vaccine's 'trigger' dose and R-IMID was 11 days. Most (220, 81.2%) received corticosteroids; however, 42% (115) received DMARDs such as methotrexate, cyclophosphamide, tocilizumab, anakinra, IV immunoglobulins, plasma exchange, or rituximab. Complete remission was achieved in 75 patients (27.7%), and 137 (50.6%) improved following the treatment. Two patients died due to myositis. This SR highlights that SARS-CoV-2 vaccines may trigger R-IMID; however, further epidemiology studies are required.
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Affiliation(s)
- Arvind Nune
- Department of Rheumatology, Southport and Ormskirk NHS Trust, Southport PR8 6PN, UK
| | - Victor Durkowski
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L9 7AL, UK
| | | | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati 781101, India
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London WC1H 9JP, UK
| | - Kaustubh Bora
- Haematology Division, ICMR-Regional Medical Research Centre, Dibrugarh 786001, India
| | - Syed Bilgrami
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Sajid Mahmood
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Nasarulla Babajan
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | | | - Lesley Ottewell
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Ciro Manzo
- Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3, 80065 Sant'Agnello, Italy
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Kouranloo K, Dey M, Elwell H, Nune A. A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19. Rheumatol Int 2023; 43:1221-1243. [PMID: 36786873 PMCID: PMC9927056 DOI: 10.1007/s00296-023-05283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
A literature review on new-onset autoimmune connective tissue diseases (ACTDs) following COVID-19 is lacking. We evaluated potential associations between COVID-19 and the development of new-onset ACTDs. The "population" was adults with disease terms for ACTDs, including systemic lupus erythematosus (SLE), Sjogren's syndrome, systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), anti-synthetase syndrome, mixed CTD and undifferentiated CTD, and "intervention" as COVID-19 and related terms. Databases were searched for English-language articles published until September 2022. We identified 2236 articles with 28 ultimately included. Of the 28 included patients, 64.3% were female, with a mean age was 51.1 years. The USA reported the most cases (9/28). ACTD diagnoses comprised: 11 (39.3%) IIM (including four dermatomyositis); 7 (25%) SLE; four (14.3%) anti-synthetase syndrome; four (14.3%) SSc; two (7.1%) other ACTD (one lupus/MCTD overlap). Of eight, four (14.3%) patients (including that with lupus/MCTD) had lupus nephritis. The average time from COVID-19 to ACTD diagnosis was 23.7 days. A third of patients were admitted to critical care, one for treatment of haemophagocytic lymphohistiocytosis in SLE (14 sessions of plasmapheresis, rituximab and intravenous corticosteroids) and nine due to COVID-19. 80% of patients went into remission of ACTD following treatment, while three (10%) patients died-one due to macrophage activation syndrome with anti-synthetase syndrome and two from unreported causes. Our results suggest a potential association between COVID-19 and new-onset ACTDs, notably in young females, reflecting more comprehensive CTD epidemiology. The most common diagnosis in our cohort was IIM. The aetiology and mechanisms by which ACTDs emerge following COVID-19 remain unknown and require further research.
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Affiliation(s)
- Koushan Kouranloo
- School of Medicine, University of Liverpool, Ashon St., Liverpool, L69 3GE, UK.
- Royal Liverpool University NHS Foundation Trust, Prescot St., Liverpool, L7 8XP, UK.
| | - Mrinalini Dey
- Department of Rheumatology, Queen Elizabeth Hospital, Stadium Rd., London, SE18 4QH, UK
- Institute of Life Health Sciences, University of Liverpool, Liverpool, L7 8TX, UK
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London, WC1H 9JP, UK
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk NHS Foundation Trust, Southport, PR8 6PN, UK
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Dey M, Busby A, Elwell H, Lempp H, Pratt A, Isaacs JD, Nikiphorou E. P186 The association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
It is clear that physical and mental illnesses are driven by ethnicity, social, environmental and economic determinants. Novel theoretical frameworks in RA focus on links between biological and non-biological (social) factors and adverse interactions within specific social contexts. This review aimed to summarise the existing evidence on associations between social deprivation and RA disease activity, and implications for research going forward.
Methods
Articles studying the association between socioeconomic status (SES) and RA disease activity were included, published from 1946 until March 2021. Initial scoping reviews were performed to optimise the search strategy, especially with regards to the exposure and outcome variables. The focus of the review was on the effect of “socioeconomic status” or similar database indexing terms, on disease activity (and similar indexing terms). The databases Medline, Embase, International Network of Agencies for Health Technology Assessment, PsychInfo and Cochrane Databases were searched. The research question, using the ‘Patients, Intervention, Comparator or Control, Outcome, Type of study’ format was as follows: Is there an association between social deprivation and disease activity in people with rheumatoid arthritis? The search was restricted to English-language articles only. Articles deemed eligible were: observational studies, qualitative studies and randomised controlled trials. Titles and abstracts were screened to assess eligibility. The full articles which met inclusion criteria were then examined in detail by one author. For validation, 10% of articles were screened at the abstract and full paper stage by a second author. Disagreements were resolved through discussion and input from a third reviewer. Information was extracted on definition/measure of SES, ethnicity, education, employment comorbidities, disease activity and the presence/absence of association between social deprivation and disease activity.
Results
In the initial search, 1750 articles and 797 conference abstracts were identified. After deduplication, this was reduced to 1299 full papers. After screening title and abstract, 1268 papers were excluded, with 31 proceeding to full-text screening. Ultimately, 30 articles (all observational studies) were included in the review. There was marked variation in definition of SES, with ten articles using a formal scale or measure, the majority using educational attainment as a proxy. Most studies controlled for lifestyle factors including smoking and BMI, as well as comorbidities. 25 articles concluded an association between SES and RA disease activity, two articles were unclear, and three found no association.
Conclusion
Our review highlights the association between low SES and worse disease outcomes in patients with RA, consistent with previous work in this area. We have demonstrated the complex multifaceted relationships giving rise to this association. There is a need for increased application of mixed-methods methodology and consideration of syndemic frameworks to understand bio-bio and bio-social interactions, to examine drivers of disease and poor clinical outcomes more holistically.
Disclosure
M. Dey: None. A. Busby: None. H. Elwell: None. H. Lempp: None. A. Pratt: None. J.D. Isaacs: None. E. Nikiphorou: None.
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Affiliation(s)
- Mrinalini Dey
- University of Liverpool, Institute of Life Course & Medical Sciences, Liverpool, UNITED KINGDOM
- Department of Rheumatology, Countess of Chester Hospital NHS Foundation Trust, Liverpool Road, Chester, UNITED KINGDOM
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, UNITED KINGDOM
| | - Helen Elwell
- BMA Library, British Medical Association, BMA House, Tavistock Square, London, UNITED KINGDOM
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UNITED KINGDOM
| | - Arthur Pratt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UNITED KINGDOM
| | - John D Isaacs
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UNITED KINGDOM
| | - Elena Nikiphorou
- Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UNITED KINGDOM
- Rheumatology Department, King's College Hospital, London, UNITED KINGDOM
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Dey M, Busby A, Elwell H, Lempp H, Pratt A, Young A, Isaacs J, Nikiphorou E. Association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review. RMD Open 2022; 8:rmdopen-2021-002058. [PMID: 35450954 PMCID: PMC9024227 DOI: 10.1136/rmdopen-2021-002058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Physical and mental illnesses are driven by ethnicity, social, environmental and economic determinants. Novel theoretical frameworks in rheumatoid arthritis (RA) focus on links and adverse interactions between and within biological and social factors. This review aimed to summarise associations between socioeconomic status (SES) and RA disease activity, and implications for future research. Articles studying the association between SES and RA disease activity were identified, from 1946 until March 2021. The research question was: Is there an association between social deprivation and disease activity in people with RA? Articles meeting inclusion criteria were examined by one author, with 10% screened at abstract and full paper stage by a second author. Disagreements were resolved with input from a third reviewer. Information was extracted on definition/measure of SES, ethnicity, education, employment, comorbidities, disease activity and presence/absence of association between SES and disease activity. Initially, 1750 articles were identified, with 30 articles ultimately included. SES definition varied markedly—10 articles used a formal scale and most used educational attainment as a proxy. Most studies controlled for lifestyle factors including smoking and body mass index, and comorbidities. Twenty-five articles concluded an association between SES and RA disease activity; two were unclear; three found no association. We have demonstrated the association between low SES and worse RA outcomes. There is a need for further research into the mechanisms underpinning this, including application of mixed-methods methodology and consideration of syndemic frameworks to understand bio–bio and bio–social interactions, to examine disease drivers and outcomes holistically.
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Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, Brownlow Hill, University of Liverpool, Liverpool, UK .,Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London, UK
| | - Heidi Lempp
- Academic Department of Rheumatology, Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Arthur Pratt
- Translational and Clinical Research Institute, Framlington Place, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - John Isaacs
- Translational and Clinical Research Institute, Framlington Place, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Elena Nikiphorou
- Academic Department of Rheumatology, Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UK.,Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
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Dey M, Busby A, Elwell H, Pratt A, Young A, Isaacs J, Nikiphorou E. The use and context of the term 'multimorbidity' in rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 2021; 60:3058-3071. [PMID: 33682885 DOI: 10.1093/rheumatology/keab214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/14/2022] Open
Abstract
This systematic literature review aimed to analyse terms describing coexisting conditions in the RA literature, informing the need for an operationalized definition of multimorbidity. Articles discussing RA with multimorbidity, published 1946 until August 2020, were identified. The primary outcome was the use and/or definition of 'multimorbidity' in RA. Information extracted included terms defining coexisting conditions, the use of a comorbidity/multimorbidity score and the use of 'index disease' to describe RA (more applicable to comorbidity than multimorbidity). Thirty-nine articles were included. Eight articles used the term 'multimorbidity', 18 used 'comorbidity' and 12 used both terms, 7 synonymously. One used no term. Fourteen articles fully defined the term. The number of co-existing conditions described in included studies was one-121. Twelve articles used a comorbidity/multimorbidity score. Four articles described RA as the 'index disease'. Our results demonstrate inconsistent use of the term multimorbidity. Improved assessment of multimorbidity is indicated in RA patients, including an operationalized use and definition.
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Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield
| | - Helen Elwell
- British Medical Association Library, BMA House, Tavistock Square, London
| | - Arthur Pratt
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield
| | - John Isaacs
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
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Elwell H. Making the best use of medical librarians. Assoc Med J 2006. [DOI: 10.1136/bmj.333.7568.s108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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