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Dehsarvi A, Al-Wasity S, Stefanov K, Wiseman SJ, Ralston SH, Wardlaw JM, Emsley R, Bachmair EM, Cavanagh J, Waiter GD, Basu N. Characterizing the Neurobiological Mechanisms of Action of Exercise and Cognitive-Behavioral Interventions for Rheumatoid Arthritis Fatigue: A Magnetic Resonance Imaging Brain Study. Arthritis Rheumatol 2024; 76:522-530. [PMID: 37975154 DOI: 10.1002/art.42755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Chronic fatigue is a major clinical unmet need among patients with rheumatoid arthritis (RA). Current therapies are limited to nonpharmacological interventions, such as personalized exercise programs (PEPs) and cognitive-behavioral approaches (CBAs); however, most patients still continue to report severe fatigue. To inform more effective therapies, we conducted a magnetic resonance imaging (MRI) brain study of PEPs and CBAs, nested within a randomized controlled trial (RCT), to identify their neurobiological mechanisms of fatigue reduction in RA. METHODS A subgroup of patients with RA (n = 90), participating in an RCT of PEPs and CBAs for fatigue, undertook a multimodal MRI brain scan following randomization to either usual care (UC) alone or in addition to PEPs and CBAs and again after the intervention (six months). Brain regional volumetric, functional, and structural connectivity indices were curated and then computed employing a causal analysis framework. The primary outcome was fatigue improvement (Chalder fatigue scale). RESULTS Several structural and functional connections were identified as mediators of fatigue improvement in both PEPs and CBAs compared to UC. PEPs had a more pronounced effect on functional connectivity than CBAs; however, structural connectivity between the left isthmus cingulate cortex (L-ICC) and left paracentral lobule (L-PCL) was shared, and the size of mediation effect ranked highly for both PEPs and CBAs (ßAverage = -0.46, SD 0.61; ßAverage = -0.32, SD 0.47, respectively). CONCLUSION The structural connection between the L-ICC and L-PCL appears to be a dominant mechanism for how both PEPs and CBAs reduce fatigue among patients with RA. This supports its potential as a substrate of fatigue neurobiology and a putative candidate for future targeting.
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Affiliation(s)
- Amir Dehsarvi
- The Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Salim Al-Wasity
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- College of Engineering, University of Wasit, Wasit, Iraq
| | - Kristian Stefanov
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Stewart J Wiseman
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stuart H Ralston
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Jonathan Cavanagh
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Gordon D Waiter
- The Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Kidder D, Basu N. The Extinction of Primary Polyarteritis Nodosa: A Modern Science Success Story? Arthritis Rheumatol 2024. [PMID: 38556926 DOI: 10.1002/art.42851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Dana Kidder
- University of Aberdeen, Aberdeen, United Kingdom
| | - Neil Basu
- University of Glasgow, Glasgow, United Kingdom
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Gisslander K, Rutherford M, Aslett L, Basu N, Dradin F, Hederman L, Hruskova Z, Kardaoui H, Lamprecht P, Lichołai S, Musial J, O'Sullivan D, Puechal X, Scott J, Segelmark M, Straka R, Terrier B, Tesar V, Tesi M, Vaglio A, Wandrei D, White A, Wójcik K, Yaman B, Little MA, Mohammad AJ. Data quality and patient characteristics in European ANCA-associated vasculitis registries: data retrieval by federated querying. Ann Rheum Dis 2024; 83:112-120. [PMID: 37907255 PMCID: PMC10804071 DOI: 10.1136/ard-2023-224571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/13/2023] [Accepted: 09/16/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study aims to describe the data structure and harmonisation process, explore data quality and define characteristics, treatment, and outcomes of patients across six federated antineutrophil cytoplasmic antibody-associated vasculitis (AAV) registries. METHODS Through creation of the vasculitis-specific Findable, Accessible, Interoperable, Reusable, VASCulitis ontology, we harmonised the registries and enabled semantic interoperability. We assessed data quality across the domains of uniqueness, consistency, completeness and correctness. Aggregated data were retrieved using the semantic query language SPARQL Protocol and Resource Description Framework Query Language (SPARQL) and outcome rates were assessed through random effects meta-analysis. RESULTS A total of 5282 cases of AAV were identified. Uniqueness and data-type consistency were 100% across all assessed variables. Completeness and correctness varied from 49%-100% to 60%-100%, respectively. There were 2754 (52.1%) cases classified as granulomatosis with polyangiitis (GPA), 1580 (29.9%) as microscopic polyangiitis and 937 (17.7%) as eosinophilic GPA. The pattern of organ involvement included: lung in 3281 (65.1%), ear-nose-throat in 2860 (56.7%) and kidney in 2534 (50.2%). Intravenous cyclophosphamide was used as remission induction therapy in 982 (50.7%), rituximab in 505 (17.7%) and pulsed intravenous glucocorticoid use was highly variable (11%-91%). Overall mortality and incidence rates of end-stage kidney disease were 28.8 (95% CI 19.7 to 42.2) and 24.8 (95% CI 19.7 to 31.1) per 1000 patient-years, respectively. CONCLUSIONS In the largest reported AAV cohort-study, we federated patient registries using semantic web technologies and highlighted concerns about data quality. The comparison of patient characteristics, treatment and outcomes was hampered by heterogeneous recruitment settings.
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Affiliation(s)
- Karl Gisslander
- Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | | | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | | | - Lucy Hederman
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Zdenka Hruskova
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hicham Kardaoui
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, Universitat zu Lubeck, Lubeck, Germany
| | - Sabina Lichołai
- Division of Molecular Biology and Clinical Genetics, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Musial
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Declan O'Sullivan
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Xavier Puechal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- French Vasculitis Study Group, Paris, France
| | - Jennifer Scott
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Mårten Segelmark
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Richard Straka
- General University Hospital in Prague, Praha, Czech Republic
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- French Vasculitis Study Group, Paris, France
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michelangelo Tesi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Dagmar Wandrei
- Clinical Trials Unit, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Arthur White
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Beyza Yaman
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Aladdin J Mohammad
- Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Brock J, Basu N, Schlachetzki JCM, Schett G, McInnes IB, Cavanagh J. Immune mechanisms of depression in rheumatoid arthritis. Nat Rev Rheumatol 2023; 19:790-804. [PMID: 37923863 DOI: 10.1038/s41584-023-01037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/06/2023]
Abstract
Depression is a common and disabling comorbidity in rheumatoid arthritis that not only decreases the likelihood of remission and treatment adherence but also increases the risk of disability and mortality in patients with rheumatoid arthritis. Compelling data that link immune mechanisms to major depressive disorder indicate possible common mechanisms that drive the pathology of the two conditions. Preclinical evidence suggests that pro-inflammatory cytokines, which are prevalent in rheumatoid arthritis, have various effects on monoaminergic neurotransmission, neurotrophic factors and measures of synaptic plasticity. Neuroimaging studies provide insight into the consequences of inflammation on the brain (for example, on neural connectivity), and clinical trial data highlight the beneficial effects of immune modulation on comorbid depression. Major depressive disorder occurs more frequently in patients with rheumatoid arthritis than in the general population, and major depressive disorder also increases the risk of a future diagnosis of rheumatoid arthritis, further highlighting the link between rheumatoid arthritis and major depressive disorder. This Review focuses on interactions between peripheral and central immunobiological mechanisms in the context of both rheumatoid arthritis and major depressive disorder. Understanding these mechanisms will provide a basis for future therapeutic development, not least in depression.
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Affiliation(s)
- James Brock
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Universitätsklinikum Erlangen, Erlangen, Germany
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Jonathan Cavanagh
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
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Chong HY, McNamee P, Bachmair EM, Martin K, Aucott L, Dhaun N, Dures E, Emsley R, Gray SR, Kidd E, Kumar V, Lovell K, MacLennan G, Norrie J, Paul L, Packham J, Ralston SH, Siebert S, Wearden A, Macfarlane G, Basu N. Cost-effectiveness of cognitive behavioural and personalized exercise interventions for reducing fatigue in inflammatory rheumatic diseases. Rheumatology (Oxford) 2023; 62:3819-3827. [PMID: 37018151 PMCID: PMC10691924 DOI: 10.1093/rheumatology/kead157] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of a cognitive behavioural approach (CBA) or a personalized exercise programme (PEP), alongside usual care (UC), in patients with inflammatory rheumatic diseases who report chronic, moderate to severe fatigue. METHODS A within-trial cost-utility analysis was conducted using individual patient data collected within a multicentre, three-arm randomized controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis. RESULTS Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95% CI: £464, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (QALY) difference: PEP 0.043 (95% CI: 0.019, 0.068); CBA 0.001 (95% CI: -0.022, 0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs UC, and £793 777 for CBA vs UC. Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI: £324, £511) and a non-significant QALY gain of 0.016 (95% CI: -0.003, 0.035), leading to an ICER of £26 822 vs UC. The estimates from sensitivity analyses were consistent with these results. CONCLUSION The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
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Affiliation(s)
- Huey Yi Chong
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Eva-Maria Bachmair
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Kathryn Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh/British Heart Foundation Centre of Research Excellence, Edinburgh, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Elizabeth Kidd
- Department of Rheumatology, Freeman’s Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vinod Kumar
- Department of Rheumatology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Karina Lovell
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Packham
- Physiotherapy and Paramedicine, Haywood Rheumatology Centre, Stoke-on-Trent, UK
| | - Stuart H Ralston
- Rheumatology and Bone Disease, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Alison Wearden
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Gary Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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7
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Barnes E, Goodyear CS, Willicombe M, Gaskell C, Siebert S, I de Silva T, Murray SM, Rea D, Snowden JA, Carroll M, Pirrie S, Bowden SJ, Dunachie SJ, Richter A, Lim Z, Satsangi J, Cook G, Pope A, Hughes A, Harrison M, Lim SH, Miller P, Klenerman P, Basu N, Gilmour A, Irwin S, Meacham G, Marjot T, Dimitriadis S, Kelleher P, Prendecki M, Clarke C, Mortimer P, McIntyre S, Selby R, Meardon N, Nguyen D, Tipton T, Longet S, Laidlaw S, Orchard K, Ireland G, Thomas D, Kearns P, Kirkham A, McInnes IB. SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease. Nat Med 2023; 29:1760-1774. [PMID: 37414897 PMCID: PMC10353927 DOI: 10.1038/s41591-023-02414-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [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: 08/05/2022] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 of 2,204 (12%) patients failed to develop anti-spike antibodies, with an additional 600 of 2,204 (27%) patients generating low levels (<380 AU ml-1). Vaccine failure rates were highest in ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis on immunosuppressive therapy (6/30, 20%) and solid organ transplant recipients (20/81, 25% and 141/458, 31%). SARS-CoV-2-specific T cell responses were detected in 513 of 580 (88%) patients, with lower T cell magnitude or proportion in hemodialysis, allogeneic hematopoietic stem cell transplantation and liver transplant recipients (versus healthy controls). Humoral responses against Omicron (BA.1) were reduced, although cross-reactive T cell responses were sustained in all participants for whom these data were available. BNT162b2 was associated with higher antibody but lower cellular responses compared to ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 infection episodes, including 48 individuals with hospitalization or death from COVID-19. Decreased magnitude of both the serological and the T cell response was associated with severe COVID-19. Overall, we identified clinical phenotypes that may benefit from targeted COVID-19 therapeutic strategies.
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Affiliation(s)
- Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl S Goodyear
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Stefan Siebert
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Sam M Murray
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Miles Carroll
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sarah J Bowden
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Susanna J Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Richter
- Clinical Immunology Service, University of Birmingham, Edgbaston, Birmingham, UK
| | - Zixiang Lim
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jack Satsangi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gordon Cook
- National Institute for Health Research, Leeds MIC, University of Leeds, Leeds, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Ana Hughes
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Molly Harrison
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sean H Lim
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Paul Miller
- British Society of Blood and Marrow Transplantation and Cellular Therapy, Guy's Hospital, London, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Basu
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Ashley Gilmour
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Sophie Irwin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina Meacham
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas Marjot
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Peter Kelleher
- Department of Infectious Diseases, Imperial College London, School of Medicine Chelsea and Westminster Hospital, London, UK
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Candice Clarke
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Paige Mortimer
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Stacey McIntyre
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Rachael Selby
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Naomi Meardon
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Dung Nguyen
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tom Tipton
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stephen Laidlaw
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Kim Orchard
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Georgina Ireland
- UK Health Security Agency (UKHSA), Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - David Thomas
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Iain B McInnes
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
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Clauw DJ, Choy EHS, Napadow V, Soni A, Boehnke KF, Naliboff B, Hassett AL, Arewasikporn A, Schrepf A, Kaplan CM, Williams D, Basu N, Bergmans RS, Harris RE, Harte SE, Chadwick A, Macfarlane GJ. Hypothetical model ignores many important pathophysiologic mechanisms in fibromyalgia. Nat Rev Rheumatol 2023; 19:321. [PMID: 36964334 PMCID: PMC10878028 DOI: 10.1038/s41584-023-00951-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA.
| | - Ernest H S Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - Vitaly Napadow
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Anushka Soni
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Bruce Naliboff
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Afton L Hassett
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Anne Arewasikporn
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Chelsea M Kaplan
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - David Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Rachel S Bergmans
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Chadwick
- Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gary J Macfarlane
- Department of Public Health, School of Medicine, University of Aberdeen, Aberdeen, UK
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9
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Sunzini F, Schrepf A, Clauw DJ, Basu N. The Biology of Pain: Through the Rheumatology Lens. Arthritis Rheumatol 2023; 75:650-660. [PMID: 36599071 DOI: 10.1002/art.42429] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
Chronic pain is a major socioeconomic burden globally. The most frequent origin of chronic pain is musculoskeletal. In inflammatory musculoskeletal diseases such as rheumatoid arthritis (RA), chronic pain is a primary determinant of deleterious quality of life. The pivotal role of peripheral inflammation in the initiation and perpetuation of nociceptive pain is well-established among patients with musculoskeletal diseases. However, the persistence of pain, even after the apparent resolution of peripheral inflammation, alludes to the coexistence of different pain states. Recent advances in neurobiology have highlighted the importance of nociplastic pain mechanisms. In this review we aimed to explore the biology of pain with a particular focus on nociplastic pain in RA.
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Affiliation(s)
- Flavia Sunzini
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
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10
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Stefanov K, Al-Wasity S, Parkinson JT, Waiter GD, Cavanagh J, Basu N. Brain mapping inflammatory-arthritis-related fatigue in the pursuit of novel therapeutics. Lancet Rheumatol 2023; 5:e99-e109. [PMID: 38251542 DOI: 10.1016/s2665-9913(23)00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023]
Abstract
Despite developments in pharmacological treatments, chronic fatigue is an unresolved issue for most people with inflammatory arthritis that severely disrupts their personal and working lives. Fatigue in these patients is not strongly linked with peripheral disease activity but is associated with CNS-derived symptoms such as chronic pain, sleep disturbance, and depression. Therefore, a neurobiological basis should be considered when pursuing novel fatigue-specific therapeutics. In this Review, we focus on clinical imaging biomarkers that map candidate brain regions and are crucial in fatigue pathophysiology. We then evaluate neuromodulation techniques that could affect these candidate brain regions and are potential treatment strategies for fatigue in patients with inflammatory arthritis. We delineate work that is still required for neuroimaging and neuromodulation to eventually become part of a clinical pathway to treat and manage fatigue.
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Affiliation(s)
- Kristian Stefanov
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | - Salim Al-Wasity
- School of Infection and Immunity, University of Glasgow, Glasgow, UK; College of Engineering, University of Wasit, Al Kūt, Iraq
| | - Joel T Parkinson
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Gordon D Waiter
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jonathan Cavanagh
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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11
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Winthrop KL, Isaacs JD, Mease PJ, Boumpas DT, Baraliakos X, Gottenberg JE, Siebert S, Mosca M, Basu N, Orange D, Lories R, Aletaha D, McInnes IB, Huizinga TWJ, Voll RE, Gravallese EM, Breedveld FC, Smolen JS. Unmet need in rheumatology: reports from the Advances in Targeted Therapies meeting, 2022. Ann Rheum Dis 2023; 82:594-598. [PMID: 36702529 DOI: 10.1136/ard-2022-223528] [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: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023]
Abstract
To detail the unmet clinical and scientific needs in the field of rheumatology. After a 2-year hiatus due to the SARS-CoV-2 pandemic, the 22nd annual international Advances in Targeted Therapies meeting brought together more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. Breakout sessions were convened with experts in five rheumatological disease-specific groups including: rheumatoid arthritis (RA), psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus and connective tissue diseases (CTDs). In each group, experts were asked to identify and prioritise current unmet needs in clinical and translational research, as well as highlight recent progress in meeting formerly identified unmet needs. Clinical trial design innovation was emphasised across all disease states. Within RA, developing therapies and trials for refractory disease patients remained among the most important identified unmet needs and within lupus and spondyloarthritis the need to account for disease endotypes was highlighted. The RA group also identified the need to better understand the natural history of RA, pre-RA states and the need ultimately for precision medicine. In CTD generally, experts focused on the need to better identify molecular, cellular and clinical signals of early and undifferentiated disease in order to identify novel drug targets. There remains a strong need to develop therapies and therapeutic strategies for those with treatment-refractory disease. Increasingly it is clear that we need to better understand the natural history of these diseases, including their 'predisease' states, and identify molecular signatures, including at a tissue level, which can facilitate disease diagnosis and treatment. As these unmet needs in the field of rheumatic diseases have been identified based on consensus of expert clinicians and scientists in the field, this document may serve individual researchers, institutions and industry to help prioritise their scientific activities.
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Affiliation(s)
- Kevin L Winthrop
- Department of Medicine, Oregon Health and Sciences University (OHSU), Portland, Oregon, USA
| | - John D Isaacs
- Department of Clinical Rheumatology, Newcastle University, Newcastle upon Tyne, UK
| | - Philip J Mease
- Swedish Medical Center; University of Washington, Seattle, Washington, USA
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, Rheumatology and Clinical Immunology Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Jacques-Eric Gottenberg
- Centre National de Référence des Maladies AutoImmunes Systémiques Rares CHU Strasbourg-Hautepierre, Strasbourg, France
| | - Stefan Siebert
- College of Medical, Veterinary & Life Sciences; University of Glasgow, Glasgow, UK
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Neil Basu
- College of Medical, Veterinary & Life Sciences; University of Glasgow, Glasgow, UK
| | - Dana Orange
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Lories
- Division of Rheumatology Hospital for Special Surgery, New York, NY, USA
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
| | - Iain B McInnes
- College of Medical, Veterinary & Life Sciences; University of Glasgow, Glasgow, UK
| | - Tom W J Huizinga
- Division of Rheumatology, University of Leuven, Leuven, The Netherlands
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University of Freiburg, Freiburg, Germany
| | - Ellen M Gravallese
- Brigham and Women‟s Hospital, Harvard University, Boston, Massachusetts, USA
| | - Ferry C Breedveld
- Department of Rheumatology, University of Leiden, Leiden, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
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Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA, Hill C, Ranganathan D, Kronbichler A, Blockmans D, Barra L, Carette S, Pagnoux C, Dhindsa N, Fifi‐Mah A, Khalidi N, Liang P, Milman N, Pineau C, Tian X, Wang G, Wang T, Zhao M, Tesar V, Baslund B, Hammam N, Shahin A, Pirila L, Putaala J, Hellmich B, Henes J, Holle J, Lamprecht P, Moosig F, Neumann T, Schmidt W, Sunderkoettey C, Szekanecz Z, Danda D, Das S, Gupta R, Rajasekhar L, Sharma A, Wagh S, Clarkson M, Molloy E, Salvarani C, Schiavon F, Tombetti E, Vaglio A, Amano K, Arimura Y, Dobashi H, Fujimoto S, Harigai M, Hirano F, Hirahashi J, Honma S, Kawakami T, Kobayashi S, Kono H, Makino H, Matsui K, Muso E, Suzuki K, Ikeda K, Takeuchi T, Tsukamoto T, Uchida S, Wada T, Yamada H, Yamagata K, Yumura W, Lai KS, Flores‐Suarez LF, Hinojosa‐Azaola A, Rutgers B, Tak P, Grainger R, Quincey V, Stamp L, Suppiah R, Besada E, Diamantopoulos A, Sznajd J, Azevedo E, Geraldes R, Rodrigues M, Santos E, Song Y, Moiseev S, Hočevar A, Cid MC, Moreno XS, Atukorala I, Berglin E, Mohammed A, Segelmark M, Daikeler T, Direskeneli H, Hatemi G, Kamali S, Karadağ Ö, Pehlevan S, Adler M, Basu N, Bruce I, Chakravarty K, Dasgupta B, Flossmann O, Gendi N, Hassan A, Hoyles R, Jayne D, Jones C, Klocke R, Lanyon P, Laversuch C, Luqmani R, Robson J, Magliano M, Mason J, Maw WW, McInnes I, Mclaren J, Morgan M, Morgan A, Mukhtyar C, O'Riordan E, Patel S, Peall A, Robson J, Venkatachalam S, Vermaak E, Menon A, Watts R, Yee C, Albert D, Calabrese L, Chung S, Forbess L, Gaffo A, Gewurz‐Singer O, Grayson P, Liang K, Matteson E, Merkel PA, Rhee R, Springer J, Sreih A. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis. Arthritis Rheumatol 2022; 74:1872-1880. [PMID: 36349501 DOI: 10.1002/art.42324] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 07/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for Takayasu arteritis (TAK). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based classification score in a development data set, and 6) validation in an independent data set. RESULTS The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94-0.99) with a sensitivity of 93.8% (95% CI 88.6-97.1%) and specificity of 99.2% (95% CI 96.7-100.0%). CONCLUSION The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
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Affiliation(s)
- Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Acadámico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
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Bennett SE, Almeida C, Bachmair EM, Gray SR, Lovell K, Paul L, Wearden A, Macfarlane GJ, Basu N, Dures E. Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation. Rheumatol Adv Pract 2022; 6:rkac083. [PMID: 36340509 PMCID: PMC9629972 DOI: 10.1093/rap/rkac083] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to understand rheumatology health professionals' (therapists') perspectives of delivering the interventions in the LIFT trial. METHODS A subgroup of therapists who had delivered the personalized exercise programme (PEP) and cognitive-behavioural approach (CBA) interventions took part in semi-structured telephone interviews. RESULTS Seventeen therapists (13 women and 4 men) who delivered PEP (n = 8) or CBA (n = 9) interventions participated. Five themes were identified. In 'The benefits of informative, structured training', therapists described how they were able to practice their skills, and the convenience of having the LIFT manual for reference. When 'Getting into the swing of it', supporting patients gave therapists the confidence to tailor the content of the manual to each patient. Clinical supervision supported therapists to gain feedback and request assistance when required. In 'Delivering the intervention', therapists reported that patients valued the opportunity to talk about their fatigue and challenge their beliefs. In 'Challenges in delivering the LIFT intervention', therapists struggled to work in partnership with patients who lacked motivation or stopped engaging. Finally, in 'LIFT developing clinical skills', therapists gained confidence and professional satisfaction, seeing patients' fatigue improve over time. CONCLUSION The findings support the provision of training for rheumatology health professionals to remotely deliver fatigue-management interventions. Insights from these trials can be used to better improve clinical practice and service provision.
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Affiliation(s)
- Sarah E Bennett
- Correspondence to: Sarah E. Bennett, Translational Health Sciences, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK. E-mail:
| | - Celia Almeida
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Eva-Maria Bachmair
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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15
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Basu N. Maintaining Confidence in Police Use of Force in Western Liberal Democracies. Camb J Evid Based Polic 2022. [PMCID: PMC9281269 DOI: 10.1007/s41887-022-00076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In a liberal democracy, the police cannot have the power to use force without accountability and transparency. Operational independence to make hard policing decisions should be matched by operational responsibility and willingness to account for that decision. Political and societal pressure can result in over- or under-reaction in the use of hard police tactics. We are not making decisions based on rigorous evidence and research, so we cannot explain why we use certain tactics and whether they are disproportionate. The evidence concerning our need for more self-protection and greater force is poor and may affect our judgement. Public confidence requires both better evidence and better communication of that evidence to communities in which police use force with greatest consequence.
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Abstract
Background Fatigue is a common and burdensome symptom in Rheumatoid Arthritis (RA), yet is poorly understood. Currently, clinicians rely solely on fatigue questionnaires, which are inherently subjective measures. For the effective development of future therapies and stratification, it is of vital importance to identify biomarkers of fatigue. In this study, we identify brain differences between RA patients who improved and did not improve their levels of fatigue based on Chalder Fatigue Scale variation (ΔCFS≥ 2), and we compared the performance of different classifiers to distinguish between these samples at baseline. Methods Fifty-four fatigued RA patients underwent a magnetic resonance (MR) scan at baseline and 6 months later. At 6 months we identified those whose fatigue levels improved and those for whom it did not. More than 900 brain features across three data sets were assessed as potential predictors of fatigue improvement. These data sets included clinical, structural MRI (sMRI) and diffusion tensor imaging (DTI) data. A genetic algorithm was used for feature selection. Three classifiers were employed in the discrimination of improvers and non-improvers of fatigue: a Least Square Linear Discriminant (LSLD), a linear Support Vector Machine (SVM) and a SVM with Radial Basis Function kernel. Results The highest accuracy (67.9%) was achieved with the sMRI set, followed by the DTI set (63.8%), whereas classification performance using clinical features was at the chance level. The mean curvature of the left superior temporal sulcus was most strongly selected during the feature selection step, followed by the surface are of the right frontal pole and the surface area of the left banks of the superior temporal sulcus. Conclusions The results presented evidence a superiority of brain metrics over clinical metrics in predicting fatigue changes. Further exploration of these methods may support clinicians to triage patients towards the most appropriate fatigue alleviating therapies.
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Affiliation(s)
- María Goñi
- Aberdeen Biomedical Imaging Centre (ABIC), Lilian Sutton Building, Foresterhill, University of Aberdeen, Aberdeen, United Kingdom
- * E-mail:
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Alison D. Murray
- Aberdeen Biomedical Imaging Centre (ABIC), Lilian Sutton Building, Foresterhill, University of Aberdeen, Aberdeen, United Kingdom
| | - Gordon D. Waiter
- Aberdeen Biomedical Imaging Centre (ABIC), Lilian Sutton Building, Foresterhill, University of Aberdeen, Aberdeen, United Kingdom
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Scott J, Havyarimana E, Navarro-Gallinad A, White A, Wyse J, van Geffen J, van Weele M, Buettner A, Wanigasekera T, Walsh C, Aslett L, Kelleher JD, Power J, Ng J, O'Sullivan D, Hederman L, Basu N, Little MA, Zgaga L. The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset. Arthritis Res Ther 2022; 24:147. [PMID: 35717248 PMCID: PMC9206351 DOI: 10.1186/s13075-022-02834-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background The aetiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n = 439) and UKIVAS (n = 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine the relapse risk using only the RKD dataset. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse risk, phenotype and serotype. Results Residential latitude was positively correlated (OR 1.41, 95% CI 1.14–1.74, p = 0.002) and average vitD-UVB negatively correlated (0.82, 0.70–0.99, p = 0.04) with relapse risk, with a stronger effect when restricting to winter measurements (0.71, 0.57–0.89, p = 0.002). However, these associations were not restricted to granulomatous phenotypes. We observed no clear relationship between latitude, vitD-UVB or CW-D-UVB and AAV phenotype or serotype. Conclusion Our findings suggest that low winter ambient UVB and prolonged vitD status contribute to AAV relapse risk across all phenotypes. However, the development of a granulomatous phenotype does not appear to be directly vitD-mediated. Further research is needed to determine whether sufficient vitD status would reduce relapse propensity in AAV. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02834-6.
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Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Enock Havyarimana
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Arthur White
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jason Wyse
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jos van Geffen
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Michiel van Weele
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Antonia Buettner
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Tamara Wanigasekera
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | - John D Kelleher
- School of Computer Science, Technological University Dublin, Dublin, Ireland
| | - Julie Power
- Vasculitis Ireland Awareness, Galway, Ireland
| | - James Ng
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Declan O'Sullivan
- ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland
| | - Lucy Hederman
- ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland. .,ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland.
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Goebel A, Andersson D, Barker C, Basu N, Bullock C, Bevan S, Bashford-Rogers RJM, Choy E, Clauw D, Dulake D, Dulake R, Flor H, Glanvill M, Helyes Z, Irani S, Kosek E, Laird J, MacFarlane G, McCullough H, Marshall A, Moots R, Perrot S, Shenker N, Sher E, Sommer C, Svensson CI, Williams A, Wood G, Dorris ER. Research Recommendations Following the Discovery of Pain Sensitizing IgG Autoantibodies in Fibromyalgia Syndrome. Pain Med 2022; 23:1084-1094. [PMID: 34850195 PMCID: PMC9157149 DOI: 10.1093/pm/pnab338] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is the most common chronic widespread pain condition in rheumatology. Until recently, no clear pathophysiological mechanism for fibromyalgia had been established, resulting in management challenges. Recent research has indicated that serum immunoglobulin Gs (IgGs) may play a role in FMS. We undertook a research prioritisation exercise to identify the most pertinent research approaches that may lead to clinically implementable outputs. METHODS Research priority setting was conducted in five phases: situation analysis; design; expert group consultation; interim recommendations; consultation and revision. A dialogue model was used, and an international multi-stakeholder expert group was invited. Clinical, patient, industry, funder, and scientific expertise was represented throughout. Recommendation-consensus was determined via a voluntary closed eSurvey. Reporting guideline for priority setting of health research were employed to support implementation and maximise impact. RESULTS Arising from the expert group consultation (n = 29 participants), 39 interim recommendations were defined. A response rate of 81.5% was achieved in the consensus survey. Six recommendations were identified as high priority- and 15 as medium level priority. The recommendations range from aspects of fibromyalgia features that should be considered in future autoantibody research, to specific immunological investigations, suggestions for trial design in FMS, and therapeutic interventions that should be assessed in trials. CONCLUSIONS By applying the principles of strategic priority setting we directed research towards that which is implementable, thereby expediating the benefit to the FMS patient population. These recommendations are intended for patients, international professionals and grant-giving bodies concerned with research into causes and management of patients with fibromyalgia syndrome.
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Affiliation(s)
- Andreas Goebel
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David Andersson
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | - Chris Barker
- Lancashire and South Cumbria NHS Foundation Trust, UK
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Craig Bullock
- Versus Arthritis, Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, UK
| | - Stuart Bevan
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | | | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, UK
| | - David Clauw
- Anesthesiology, Medicine (Rheumatology) and Psychiatry University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School & Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Laird
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | | | - Hayley McCullough
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, Liverpool, UK
| | - Andrew Marshall
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Robert Moots
- Faculty of Health Social Care and Medicine, Edge Hill University, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Nick Shenker
- Rheumatology Research Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Emanuele Sher
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Germany
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Williams
- Health Psychology, UCL Research Department of Clinical, Educational & Health Psychology, University College London, UK
| | - Geoff Wood
- Cambridge Institute for Medical Research, Cambridge, UK
| | - Emma R Dorris
- School of Medicine, University College Dublin, Ireland
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Bennett SE, Almeida C, Bachmair EM, Gray SR, Lovell K, Paul L, Wearden A, Macfarlane GJ, Basu N, Dures E, Aucott L, Martin K, Dhaun N, Emsley R, Kidd E, Kumar V, MacLennan G, Paul M, Norrie J, Packham J, Ralston SH, Siebert S, Nicol A, Norris K, Mann S, Van Lierop L, Gomez E, McCurdy F, Findlay V, Hastie N, Morgan E, Emmanuel R, Whibley D, Urquart A, MacPerson L, Rowland J, Kiddie G, Pankhurst D, Paul J, Nicholson H, Dunsmore A, Knight A, Ellis J, Maclean C, Crighton L, Shearer C, Coyle J, Begg S, Ackerman L, Carnevale J, Arbuthnot S, Watters H, Dockrell D, Hamilton D, Salutous D, Cathcart S, Rimmer D, Hughes E, Harvey J, Gillies M, Webster S, Milne L, Semple G, Duffy K, Turner L, Alexander J, Innes J, Clark C, Meek C, McKenna E, Routledge C, Hinchcliffe-Hume H, Traianos E, Dibnah B, Storey D, O'Callaghan G, Baron JY, Hunt S, Wheat N, Smith P, Barcroft EA, Thompson A, Tomlinson J, Barber J, MacPerson G, White P, Hewlett S. Remotely delivered cognitive-behavioural and personalized exercise interventions to lessen the impact of fatigue: a qualitative evaluation. Rheumatol Adv Pract 2022; 6:rkac051. [PMID: 35795008 PMCID: PMC9252174 DOI: 10.1093/rap/rkac051] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/13/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Fatigue can be a disabling symptom of inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) is a randomized trial of remotely delivered cognitive-behavioural approach or personalized exercise programme interventions, compared with usual care. The aim of this nested qualitative study was to evaluate participants’ experiences of taking part in the intervention, including their ideas about future service delivery.
Methods
Semi-structured telephone interviews were conducted with a subgroup of LIFT participants to discuss their views and experiences of the interventions.
Results
Forty-three participants (30 women) from six sites who had participated in the cognitive-behavioural approach (n = 22) or personalized exercise programme (n = 21) interventions took part. Five themes were identified in the thematic analysis. In the theme ‘not a miracle cure, but a way to better manage fatigue’, LIFT could not cure fatigue; however, most felt better able to manage after participating. Participants valued ‘building a therapeutic relationship’ with the same therapist throughout the intervention. In ‘structure, self-monitoring and being accountable’, participants liked the inclusion of goal-setting techniques and were motivated by reporting back to the therapist.
After taking part in the interventions, participants felt ‘better equipped to cope with fatigue’; more confident and empowered. Lastly, participants shared ideas for ‘a tailored programme delivered remotely’, including follow-up sessions, video calling, and group-based sessions for social support.
Conclusion
Many participants engaged with the LIFT interventions and reported benefits of taking part. This suggests an important future role for the remote delivery of fatigue self-management.
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Affiliation(s)
- Sarah E Bennett
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol
| | - Celia Almeida
- School of Health and Social Wellbeing, University of the West of England
- Academic Rheumatology, Bristol Royal Infirmary , Bristol
| | - Eva-Maria Bachmair
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen , Aberdeen
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester , Manchester
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University , Glasgow
| | - Alison Wearden
- Division of Psychology and Mental Health, University of Manchester , Manchester
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen , Aberdeen
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow , Glasgow, UK
| | - Emma Dures
- School of Health and Social Wellbeing, University of the West of England
- Academic Rheumatology, Bristol Royal Infirmary , Bristol
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Barton-Maclaren TS, Wade M, Basu N, Bayen S, Grundy J, Marlatt V, Moore R, Parent L, Parrott J, Grigorova P, Pinsonnault-Cooper J, Langlois VS. Innovation in regulatory approaches for endocrine disrupting chemicals: The journey to risk assessment modernization in Canada. Environ Res 2022; 204:112225. [PMID: 34666016 DOI: 10.1016/j.envres.2021.112225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
Globally, regulatory authorities grapple with the challenge of assessing the hazards and risks to human and ecosystem health that may result from exposure to chemicals that disrupt the normal functioning of endocrine systems. Rapidly increasing number of chemicals in commerce, coupled with the reliance on traditional, costly animal experiments for hazard characterization - often with limited sensitivity to many important mechanisms of endocrine disruption -, presents ongoing challenges for chemical regulation. The consequence is a limited number of chemicals for which there is sufficient data to assess if there is endocrine toxicity and hence few chemicals with thorough hazard characterization. To address this challenge, regulatory assessment of endocrine disrupting chemicals (EDCs) is benefiting from a revolution in toxicology that focuses on New Approach Methodologies (NAMs) to more rapidly identify, prioritize, and assess the potential risks from exposure to chemicals using novel, more efficient, and more mechanistically driven methodologies and tools. Incorporated into Integrated Approaches to Testing and Assessment (IATA) and guided by conceptual frameworks such as Adverse Outcome Pathways (AOPs), emerging approaches focus initially on molecular interactions between the test chemical and potentially vulnerable biological systems instead of the need for animal toxicity data. These new toxicity testing methods can be complemented with in silico and computational toxicology approaches, including those that predict chemical kinetics. Coupled with exposure data, these will inform risk-based decision-making approaches. Canada is part of a global network collaborating on building confidence in the use of NAMs for regulatory assessment of EDCs. Herein, we review the current approaches to EDC regulation globally (mainly from the perspective of human health), and provide a perspective on how the advances for regulatory testing and assessment can be applied and discuss the promises and challenges faced in adopting these novel approaches to minimize risks due to EDC exposure in Canada, and our world.
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Affiliation(s)
- T S Barton-Maclaren
- Existing Substances Risk Assessment Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Canada.
| | - M Wade
- Environmental Health Centre, Environmental Health, Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - N Basu
- Faculty of Agricultural and Environmental Sciences, McGill University, Ste Anne de Bellevue, QC, Canada
| | - S Bayen
- Faculty of Agricultural and Environmental Sciences, McGill University, Ste Anne de Bellevue, QC, Canada
| | - J Grundy
- New Substances Assessment and Control Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Canada
| | - V Marlatt
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - R Moore
- New Substances Assessment and Control Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Canada
| | - L Parent
- Département Science et Technologie, Université TÉLUQ, Montréal, QC, Canada
| | - J Parrott
- Water Science and Technology Directorate, Environment and Climate Change Canada, Burlington, ON, Canada
| | - P Grigorova
- Département Science et Technologie, Université TÉLUQ, Montréal, QC, Canada
| | - J Pinsonnault-Cooper
- New Substances Assessment and Control Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Canada
| | - V S Langlois
- Institut National de la Recherche Scientifique (INRS), Centre Eau Terre Environnement, Quebec City, QC, Canada
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Rutherford M, Basu N. Reply to Riza and Hamit comment on 'Factors influencing severe COVID-19 in systemic vasculitis patients'. Arthritis Rheumatol 2021; 74:725-726. [PMID: 34783446 PMCID: PMC8652784 DOI: 10.1002/art.42024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 11/13/2022]
Affiliation(s)
- M Rutherford
- Institute of Infection, Immunology & Inflammation, University of Glasgow, UK
| | - N Basu
- Institute of Infection, Immunology & Inflammation, University of Glasgow, UK
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Philobos M, Perkins A, Karabayas M, Dospinescu P, Fluck N, Kidder D, Chapman FA, Dhaun N, Basu N. A real-world assessment of mycophenolate mofetil for remission induction in eosinophilic granulomatosis with polyangiitis. Rheumatol Int 2021; 41:1811-1814. [PMID: 34350491 PMCID: PMC8390413 DOI: 10.1007/s00296-021-04961-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/27/2021] [Indexed: 10/30/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of ANCA-associated vasculitis (AAV). Clinical trials demonstrating the efficacy of mycophenolate mofetil (MMF) for remission induction in AAV excluded patients with EGPA. Despite this, MMF is commonly used in these patients. The objective of this study was to evaluate, for the first time, the effectiveness and tolerance of MMF in EGPA remission induction. A retrospective, two-center, real-world study was conducted in patients with EGPA who received MMF in addition to prednisolone for newly diagnosed or relapsing disease between 2009 and 2019. Baseline, 3-, 6- and 12-month outcome data were extracted from electronic health records. The primary outcome was disease remission, defined as a Birmingham Vasculitis Activity Score of 0 at 6 months. Secondary outcomes included disease relapse, median prednisolone dose at 12 months and drug tolerance. In total, 15 patients (73% male, median age 57) with EGPA (11 newly diagnosed/4 relapsing) were identified. At 6 months, 67% had achieved disease remission. At 12 months, this was maintained (66.7%) and 4 patients had relapsed. All but one patient remained on MMF at study completion and all patients tolerated MMF. Our real-world data suggest that MMF is an effective and well-tolerated agent for achieving disease remission in EGPA. A future randomized controlled trial of MMF in this neglected orphan disease is now warranted.
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Affiliation(s)
| | - Amy Perkins
- Rheumatology Unit, NHS Grampian, Aberdeen, UK
| | | | | | - Nick Fluck
- Renal Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Fiona A Chapman
- Renal Unit, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh, UK
| | - Neeraj Dhaun
- Renal Unit, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
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King C, Druce KL, Nightingale P, Kay E, Basu N, Salama AD, Harper L. Predicting relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis: a Systematic review and meta-analysis. Rheumatol Adv Pract 2021; 5:rkab018. [PMID: 34476335 PMCID: PMC8407598 DOI: 10.1093/rap/rkab018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/03/2020] [Revised: 02/16/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives Relapses affect 30–50% of patients with ANCA-associated vasculitis (AAV) over 5 years, necessitating long-term treatment. Although there have been studies looking at predictors of relapse in AAV, this research has yet to translate clinically into guidance on tailored therapy. The aim of this systematic review was to identify and meta-analyse existing risk factors from the literature and produce a model to calculate individualised patient risk of relapse. Method A search strategy was developed to include all studies identifying predictors of AAV relapse using multivariate analysis. Individual risk factors were extracted and pooled hazard ratios (HRs) calculated. A model to predict the time to first relapse based on identified risk factors was tested retrospectively using a cohort of patients with AAV. Results The review of 2674 abstracts identified 117 papers for full text review, with 16 eligible for inclusion. Pooled HRs were calculated from significant risk factors, including anti-PR3 ANCA positivity [HR 1.69 (95% CI 1.46, 1.94)], cardiovascular involvement [HR 1.78 (95% CI 1.26, 2.53)], creatinine >200 µmol/l (relative to creatinine ≤100) [HR 0.39 (95% CI 0.22, 0.69)] and creatinine 101–200 µmol/l [HR 0.81 (95% CI 0.77, 0.85)]. Using data from 182 AAV patients to validate the model gave a C-statistic of 0.61. Conclusion Anti-PR3 ANCA positivity, lower serum creatinine and cardiovascular system involvement are all associated with an increased risk of relapse, and a combination of these risk factors can be used to predict the individualised risk of relapse. In order to produce a clinically useful model to stratify risk, we need to identify more risk factors, with a focus on robust biomarkers.
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Affiliation(s)
- Catherine King
- Centre for Translational Inflammation Research, University of Birmingham.,Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham
| | - Katie L Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester.,Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - Peter Nightingale
- Centre for Translational Inflammation Research, University of Birmingham
| | - Ellen Kay
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham
| | - Neil Basu
- Institution of Infection, Immunity and Inflammation, University of Glasgow, Glasgow
| | - Alan D Salama
- Department of Renal Medicine, University College London, London, UK
| | - Lorraine Harper
- Centre for Translational Inflammation Research, University of Birmingham.,Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham
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Rutherford MA, Scott J, Karabayas M, Antonelou M, Gopaluni S, Gray D, Barrett J, Brix SR, Dhaun N, McAdoo SP, Smith RM, Geddes C, Jayne D, Luqmani R, Salama AD, Little MA, Basu N. Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study. Arthritis Rheumatol 2021; 73:1713-1719. [PMID: 33750043 PMCID: PMC8251299 DOI: 10.1002/art.41728] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies. METHODS A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death. RESULTS The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes. CONCLUSION In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.
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Affiliation(s)
| | | | | | | | | | | | | | - Silke R. Brix
- Manchester University NHS Foundation Trust and University of ManchesterManchesterUK
| | | | | | | | | | | | | | - Alan D. Salama
- University College London and Royal Free HospitalLondonUK
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Fragoulis GE, Brock J, Basu N, McInnes IB, Siebert S. The role for JAK inhibitors in the treatment of immune-mediated rheumatic and related conditions. J Allergy Clin Immunol 2021; 148:941-952. [PMID: 34450118 DOI: 10.1016/j.jaci.2021.08.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/30/2022]
Abstract
JAK inhibitors (JAKIs) are a new class of targeted therapy that have entered clinical practice for the treatment of immune-mediated rheumatic conditions. JAKIs can block the signaling activity of a variety of proinflammatory cytokines and therefore have the potential to mediate therapeutic benefits across a wide range of immune-mediated conditions. Several JAKIs are licensed, and many more are undergoing clinical trials. Here we provide a narrative review of the current and upcoming JAKIs for adult immune-mediated rheumatic and related conditions, with a specific focus on efficacy in rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, psoriasis, and inflammatory bowel disease. The overall safety profile of JAKIs appears largely comparable to that of existing biologic cytokine-targeting agents, particularly, TNF inhibitors, apart from risk of herpes zoster, which is increased for JAKIs. Importantly however, unresolved safety concerns remain, particularly relating to increased venous thromboembolism.
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Affiliation(s)
- George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom; First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - James Brock
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
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26
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Kelly CA, Nisar M, Arthanari S, Carty S, Woodhead FA, Price-Forbes A, Middleton D, Dempsey O, Miller D, Basu N, Dawson J, Sathi N, Ahmad Y, Palmer E, Iqbal K, Janakiraman G, Koduri G, Young A. Rheumatoid arthritis related interstitial lung disease - improving outcomes over 25 years: a large multicentre UK study. Rheumatology (Oxford) 2021; 60:1882-1890. [PMID: 33150434 DOI: 10.1093/rheumatology/keaa577] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/25/2020] [Revised: 06/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study explores whether the prognosis of interstitial lung disease in rheumatoid arthritis (RA-ILD) has improved over time and assesses the potential influence of drug therapy in a large multicentre UK network. METHODS We analysed data from 18 UK centres on patients meeting criteria for both RA and ILD diagnosed over a 25-year period. Data included age, disease duration, outcome and cause of death. We compared all cause and respiratory mortality between RA controls and RA-ILD patients, assessing the influence of specific drugs on mortality in four quartiles based on year of diagnosis. RESULTS A total of 290 RA-ILD patients were identified. All cause (respiratory) mortality was increased at 30% (18%) compared with controls 21% (7%) (P =0.02). Overall, prognosis improved over quartiles with median age at death rising from 63 years to 78 years (P =0.01). No effect on mortality was detected as a result of DMARD use in RA-ILD. Relative risk (RR) of death from any cause was increased among patients who had received anti-TNF therapy [2.09 (1.1-4.0)] P =0.03, while RR was lower in those treated with rituximab [0.52(0.1-2.1)] or mycophenolate [0.65 (0.2-2.0)]. Patients receiving rituximab as their first biologic had longer three (92%), five (82%) and seven year (80%) survival than those whose first biologic was an anti-TNF agent (82%, 76% and 64%, respectively) (P =0.037). DISCUSSION This large retrospective multicentre study demonstrates survival of patients with RA-ILD has improved. This may relate to the increasing use of specific immunosuppressive and biologic agents.
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Affiliation(s)
- Clive A Kelly
- Department of Cellular Medicine, University of Newcastle upon Tyne, Gateshead, UK
| | - Mohamed Nisar
- Rheumatology, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Suba Arthanari
- Rheumatology, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Sarah Carty
- Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Felix A Woodhead
- Chest Medicine, University Hospital Leicester NHS Foundation Trust, Leicester, UK
| | - Alex Price-Forbes
- Chest Medicine, University Hospital Leicester NHS Foundation Trust, Leicester, UK
| | | | | | | | - Neil Basu
- Rheumatology, Royal Hospital, Aberdeen, UK
| | - Julie Dawson
- Rheumatology, St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, UK
| | - Nav Sathi
- Rheumatology, St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, UK
| | - Yasmin Ahmad
- Rheumatology, North Wales Hospitals Trust, Betsy-Coed, UK
| | - Evelyn Palmer
- Medicine, Northern Deanery, Health Education North East, Newcastle, UK
| | - Kundan Iqbal
- Medicine, Northern Deanery, Health Education North East, Newcastle, UK
| | | | - Gouri Koduri
- Rheumatology, Southend Hospital, Westcliff-on-Sea, UK
| | - Adam Young
- Rheumatology, St Albans City Hospital, St Albans, UK
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Derakhshan MH, Morton F, Fragoulis GE, Paterson C, Dale J, Basu N, Mcinnes I, Porter D, Siebert S. AB0265 OPIOIDS AND ANALGESIC USE IN EARLY RHEUMATOID ARTHRITIS: A LONGITUDINAL ANALYSIS OF LINKED REAL-WORLD PRESCRIPTION DATA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Large numbers of patients with rheumatoid arthritis (RA) receive regular opioids despite significant toxicity and a lack of evidence supporting their use in non-cancer pain. In order to address this situation, we need to understand when opioids are started in early RA where this has not been studied.Objectives:To examine the temporal trend of opioid prescriptions before and after RA symptom onset and to compare this with DMARD and NSAID prescriptions.Methods:RA participants (cases) were recruited as part of the Scottish Early Rheumatoid Arthritis (SERA) inception cohort1. Controls without RA (five per case), matched for sex, age and post code over the same time period, were obtained through routine data linkage. Prescription data between Jan 2009 to Nov 2019 of cases and matched controls were compared using date of RA symptom onset as reference point. The Prescriptions Per Participant (PPP) for each three-month block was estimated by dividing the number of prescribed drugs in the selected drug classes (assigned using the British National Formulary) in that time block by the number of participants in each group. The differences between mean PPP of the RA cases and controls in each time block were tested by t-test for independent groups and subsequent adjustment for multiple testing.Results:1,720,335 prescriptions were available for analysis with 421,961 items for 950 RA cases and 1,299,374 items for 4,558 matched controls. As expected, DMARD prescriptions in the SERA cases increased after the symptom onset period and were then sustained (Figure 1: top left panel). NSAID prescriptions in RA cases peaked during the 3 months after symptom onset and then reduced progressively (top right panel). Opioid analgesic prescriptions for the RA cases increased two-fold during the reference period and then reduced 6-9 months post-symptom onset. However, unlike NSAIDs, after this there was no further significant reduction in opioid prescriptions in the RA cases, which remained stable and significantly higher than in the controls for the remaining study period. The non-opioid analgesic mean PPP increased sharply at the time of symptom onset, with a steady gradual upward trend over time (lower right panel).Conclusion:Opioid prescriptions increase significantly at the time of RA symptoms onset. Despite rapid introduction of DMARDs and resultant reductions in NSAIDs, analgesic use remains significantly higher than in controls. Further research is required to identify the factors associated with persistent opioid use in early RA with interventions aimed at the first 6 months.References:[1]Dale et al. BMC Musculoskelet Disord. 2016;17:461.Acknowledgements:The work was supported by Health Data Research UK which receives its funding from HDR UK Ltd funded by the UKRI MRC, EPSRC, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientists Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust.The SERA study was jointly funded by the Chief Scientists Office Scotland and Pfizer Ltd.Disclosure of Interests:None declared
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Bennett SE, Dures E, Almeida C, Bachmair EM, Lovell K, Paul L, Wearden A, Macfarlane GJ, Basu N. P201 Therapists' experiences of remotely delivered cognitive-behavioural and graded-exercise interventions to lessen the impact of fatigue in inflammatory rheumatic diseases: a qualitative evaluation. Rheumatology (Oxford) 2021. [PMCID: PMC8135464 DOI: 10.1093/rheumatology/keab247.196] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background/Aims There is evidence for non-pharmacological interventions to support patients to self-manage fatigue, however implementation in clinical practice is a challenge. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomised Trial) is a multi-centre three-arm randomised trial using a remotely delivered cognitive-behavioural approach (CBA) or personalized exercise programme (PEP) interventions, in addition to usual care, compared to normal care alone. Interventions were delivered to patients by rheumatology health professionals using a manual, after training. The aim of this nested qualitative evaluation was to understand their perspectives of delivering the interventions. Methods A subgroup of rheumatology healthcare professionals who had delivered the CBA and PEP interventions took part in semi-structured telephone interviews to explore their experiences of training and delivery, the challenges and benefits of learning new skills, and the barriers and facilitators to supporting patients remotely (mainly by telephone) using the LIFT manual. Results A total of 17 rheumatology healthcare professionals (13 women, 4 men) from the CBA (n = 9) and PEP (n = 8) arms contributed. SB conducted an inductive thematic analysis of the data set. ED, CA, AW and KL reviewed a sub-set of transcripts. Five main themes were identified: The benefits of informative, structured training: Rheumatology healthcare professionals reflected how training, including role-play, helped them to practice their skills, even though this could feel uncomfortable. Those allocated shorter four-hour training sessions would have liked more time to practice. Many felt anxious before meeting patients for the first time but liked the manual to refer to. Getting into the swing of it: Practice gave rheumatology healthcare professionals the confidence to tailor content to individual patients’ requirements. Clinical supervision in the PEP and CBA arm supported rheumatology healthcare professionals to query their own practice, gain valuable feedback, and request assistance where needed. Benefits of telephone delivery: The initial face-to-face session enabled rheumatology healthcare professionals to build rapport with patients. Thereafter, patients seemed engaged and valued the opportunity to address their fatigue and challenge their own beliefs via the telephone. Some patients not ready to change: Rheumatology healthcare professionals struggled to work collaboratively with a minority of patients who were not willing to make changes, lacked motivation to complete tasks or stopped engaging with the intervention. LIFT developing clinical skills: Rheumatology healthcare professionals were confident that they were doing the ‘right thing’ for patients with fatigue and gained professional satisfaction seeing patients’ fatigue improve. Many felt that the skills they acquired and their experiences of remote delivery were helping them to respond to the current COVID-19 related changes in service provision. Conclusion Findings support the value of skills training for rheumatology health professionals to deliver fatigue management interventions remotely. These insights can inform service provision and clinical practice. Disclosure S.E. Bennett: None. E. Dures: None. C. Almeida: None. E. Bachmair: None. K. Lovell: None. L. Paul: None. A. Wearden: None. G.J. Macfarlane: None. N. Basu: None.
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Affiliation(s)
- Sarah E Bennett
- Department of Nursing and Midwifery, The University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Emma Dures
- Department of Nursing and Midwifery, The University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Celia Almeida
- Department of Nursing and Midwifery, The University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Eva-Maria Bachmair
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Karina Lovell
- School of Health Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Alison Wearden
- School of Health Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
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Karabayas M, Brock J, Fordyce G, Basu N. P052 Leflunomide and severe COVID-19 outcome: a cautionary observation from the COVID-19 Scottish Registry of Autoimmune Rheumatic Diseases (SCAR-19). Rheumatology (Oxford) 2021. [PMCID: PMC8135409 DOI: 10.1093/rheumatology/keab247.049] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Leflunomide, a conventional disease modifying drug (csDMARD), is used in a variety of autoimmune rheumatic diseases (ARD) due to its immunomodulating, immunosuppressive and antiproliferative properties. This agent does however confer a greater infection risk and, due to its long half-life, drug washout procedures are often advised in the context of serious infections. Interestingly, Leflunomide is currently being tested as a potential therapy for COVID-19 in the general population. It is unknown whether leflunomide therapy is associated with a poor or favourable outcome among ARD patients infected with COVID-19.
Methods
A Scottish-wide registry was rapidly developed in March 2020. Clinical characteristics and outcomes of infected cases were collated across all Scottish health boards. Eligible patients included any adult leflunomide treated ARD patients with a confirmed (clinically or PCR) diagnosis of COVID-19.
Results
Of the 69 cases included in the registry, n = 4 were treated with leflunomide (75% female; mean age 61, SD 4.2). N = 2 were treated with combination baricitinib or hydroxychloroquine respectively, whilst n = 1 received recent corticosteroid therapy (intramuscular Kenalog). Comorbidities observed in this sub-cohort include diabetes mellitus n = 3, hypertension n = 2, cardiovascular disease n = 1, lung disease n = 1 and latent TB n = 1. At presentation, all patients (n = 4) experienced the established COVID-19 related symptom triad of dyspnoea, cough and fever and promptly developed acute respiratory syndrome. Diarrhoea was also recorded in n = 2 and constitutional upset n = 3. All patients suffered a serious COVID-19 disease outcome (defined as a requirement of invasive or non-invasive ventilation (n = 4) and/ or death (n = 2). P052 Table 1:Patient demographics, clinical characteristics and outcomesPatient 1Patient 2Patient 3Patient 4Age58635766SexFemaleFemaleMaleFemaleRheumatic diagnosisRheumatoid arthritisPsoriatic arthritisPsoriatic arthritisRheumatoid ArthritisComorbiditiesDiabetesHypertension Diabetes COPDNilIschaemic heart disease Hypertension Diabetes Latent TBClinical presentationDyspnoea Cough Fever Confusion Constitutional upsetDyspnoea Cough Fever Diarrhoea Constitutional upsetDyspnoea Cough Fever Constitutional upsetDyspnoea Cough Fever Diarrhoea Constitutional upsetAdditional csDMARD*NilNilNilHydroxychloroquinebDMARD**/ tsDMARD***BaricitinibNilNilNilSteroid therapyNilNilNilIM KenalogInvasive or non-invasive ventilationYesYesYesYesDeathNoNoYesYes* conventional disease modifying drug,**biologic disease modifying drug,***targeted synthetic disease modifying drug.
Conclusion
Preliminary data from this Scotland-wide registry has identified only a small number of leflunomide treated ARD patients infected with COVID-19. However, it is concerning that all cases experienced a serious outcome. Given the relatively infrequent prescription of this drug, combining similar national registry data is necessary to ensure this observation is not spurious. If confirmed, leflunomide washout procedures should be encouraged among such patients when they first present with COVID-19.
Disclosure
M. Karabayas: None. J. Brock: None. G. Fordyce: None. N. Basu: None.
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Affiliation(s)
- Maira Karabayas
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
- Department of Rheumatology, NHS Grampian, Aberdeen, UNITED KINGDOM
| | - James Brock
- Department of Rheumatology, NHS Greater Glasgow & Clyde, Glasgow, UNITED KINGDOM
| | - Gillian Fordyce
- Department of Rheumatology, NHS Grampian, Aberdeen, UNITED KINGDOM
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
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Bennett SE, Dures E, Almeida C, Bachmair EM, Lovell K, Paul L, Wearden A, Macfarlane GJ, Basu N. O04 Patient engagement with remotely delivered cognitive-behavioural and graded-exercise interventions to lessen the impact of fatigue in inflammatory rheumatic diseases: a qualitative evaluation. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab246.003] [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: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Fatigue is a substantial, disabling symptom of inflammatory rheumatic diseases (IRDs). LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomised Trial) is a multi-centre three-arm randomised trial using remotely delivered cognitive-behavioral approach (CBA) and personalised exercise programme (PEP) interventions, compared to normal care alone, with the aim to lessen the impact of fatigue in patients with IRDs. Most sessions were delivered by telephone. This nested qualitative study explored patients’ experiences of taking part in the interventions.
Methods
A subgroup of patients who had completed follow-up after the LIFT trial took part in semi-structured telephone interviews to discuss their views and experiences of the interventions and subsequent impact on their lives.
Results
Participants were purposively sampled from six UK research sites to include variation in gender, age and IRDs. A total of 47 participants (33 women, 14 men) from the PEP (n = 22) and CBA (n = 25) arms took part. SB conducted an inductive thematic analysis of the data set. ED, CA, AW and KL reviewed a sub-set of the data. Five main themes were agreed after group discussion: There is no miracle cure, but LIFT is a way to manage fatigue: participants had disabling fatigue, with substantial impact on their work and social lives. Many were keen to understand the link between their IRD and fatigue. Participants reflected that LIFT could not offer a miracle cure, but most felt that they were better able to cope with their fatigue after taking part.
Building a therapeutic relationship: participants reported feeling validated by LIFT therapists who understood the impact of IRD-fatigue. They valued the continuity of interacting with the same therapist throughout the intervention.
The advantages of structure, self-monitoring and being accountable: many participants liked the structured format of the interventions and the inclusion of techniques such as goal setting because self-monitoring and being accountable to the therapist were helpful. Some felt guilty if they did not meet their goals but used this as an incentive to set more realistic objectives.
A new toolbox: many participants described feeling more confident and empowered after the interventions, with a new ‘toolbox’ of coping mechanisms; more motivated to socialise, exercise and better able to pace activity. PEP participants who were physically active prior to LIFT saw less benefit.
LIFT going forward - a tailored remotely delivered programme: participants’ ideas included follow-up sessions at six and twelve months; the option for video calling; and group-based sessions to boost engagement and receive social support from other patients with fatigue.
Conclusion
Many patients engaged with the LIFT interventions and reported benefits of taking part. This suggests an important role for the remote delivery of fatigue self-management as services respond and adapt to the current pandemic.
Disclosure
S.E. Bennett: None. E. Dures: None. C. Almeida: None. E. Bachmair: None. K. Lovell: None. L. Paul: None. A. Wearden: None. G.J. Macfarlane: None. N. Basu: None.
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Affiliation(s)
- Sarah E Bennett
- Department of Nursing and Midwifery, The University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Emma Dures
- Department of Nursing and Midwifery, The University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Celia Almeida
- Department of Nursing and Midwifery, The University of the West of England, Bristol, UNITED KINGDOM
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Eva-Maria Bachmair
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Karina Lovell
- School of Health Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Alison Wearden
- School of Health Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
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Karabayas M, Brock J, Rutherford M, Fordyce G, Fluck N, Kardash S, Moran L, Richmond R, Tan A, Sznajd J, Lambie S, Khalid M, Else S, Davies CA, Duncan M, Mclaren J, Duncan S, Murphy5 S, Hasan F, Basu N. O30 Variation in immunosuppressant impact on severe COVID-19 outcome: preliminary results from the COVID-19 Scottish Registry of Autoimmune Rheumatic Diseases (SCAR-19). Rheumatology (Oxford) 2021. [PMCID: PMC8135447 DOI: 10.1093/rheumatology/keab246.029] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background/Aims The novel infectious disease COVID-19 is associated with a wide spectrum of clinical severity amongst the general population. Patients with autoimmune rheumatic diseases (ARD) are more likely to experience serious COVID-19 related events, although risk factors for such outcomes have yet to be established. In particular, the risk profiles of specific ARD therapies are unknown. Methods A Scottish wide registry was rapidly developed in March 2020. Clinical characteristics and outcomes of infected cases were collated across all Scottish health boards, leveraging the Scottish Systemic Vasculitis Network and Scottish Society for Rheumatology. Eligible patients included any adult ARD patients with a confirmed (clinically or PCR) diagnosis of COVID-19. Simple descriptive statistics were employed to evaluate associations between ARD therapies and a serious COVID-19 disease outcome, as defined by a requirement of invasive or non-invasive ventilation, and/or death. Results A total of 69 patients (59% female; mean age 65.6, SD15.5) were recruited to the registry ,92% of which required hospitalisation. Cases were most commonly diagnosed with rheumatoid arthritis (n = 32, 46.4%) followed by spondyloarthritis (n = 19, 27.5%) and systemic vasculitis (n = 9, 13.0%). Anti-TNF therapy (n = 8, 11.6%) and methotrexate (n = 31, 44.9%) were the commonest biologic and conventional disease modifying drug (bDMARD and csDMARD) used respectively. N = 20 (29%) received background corticosteroid therapy (15.9% prednisolone >5mg, 13% prednisolone ≤5mg). A severe outcome was observed in n = 25(31.9%); n = 11 required assisted ventilation and n = 19 died. With the exception of Leflunomide, conventional and biologic DMARDs did not appear to confer a higher risk for severe outcome (table 1). Of note, anti-TNF therapy was associated with a non-serious outcome (p = 0.04) and prednisolone>5mg with a serious outcome (p = 0.08). Conclusion Preliminary data from this Scotland-wide ARD COVID-19 registry evidences variation in the impact of standard ARD therapies on the severity of COVID-19 outcome. In general, background csDMARD and bDMARD use does not appear to be a risk factor for severe outcomes. However, anti-TNF therapy may confer a favourable outcome, while leflunomide and corticosteroids may have the opposite effect. Rheumatologists should be aware of these possible risk factors and continue to contribute to registries to help establish whether these putative signals are clinically relevant. Disclosure M. Karabayas: None. J. Brock: None. M. Rutherford: None. G. Fordyce: None. N. Fluck: None. S. Kardash: None. L. Moran: None. R. Richmond: None. A. Tan: None. J. Sznajd: None. S. Lambie: None. M. Khalid: None. S. Else: None. C.A. Davies: None. M. Duncan: None. J. Mclaren: None. S. Duncan: None. S. Murphy5: None. F. Hasan: None. N. Basu: None.
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Affiliation(s)
- Maira Karabayas
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
- Department of Rheumatology, NHS Grampian, Aberdeen, UNITED KINGDOM
| | - James Brock
- Department of Rheumatology, NHS Greater Glasgow & Clyde, Glasgow, UNITED KINGDOM
| | - Matthew Rutherford
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Gillian Fordyce
- Department of Rheumatology, NHS Grampian, Aberdeen, UNITED KINGDOM
| | - Nick Fluck
- Renal Unit, NHS Grampian, Aberdeen, UNITED KINGDOM
| | - Sally Kardash
- Department of Rheumatology, NHS Lanarkshire, Lanarkshire, UNITED KINGDOM
| | - Lucy Moran
- Department of Rheumatology, NHS Dumfries and Galloway, Dumfries and Gal, UNITED KINGDOM
| | - Ruth Richmond
- Department of Rheumatology, NHS Borders, Borders, UNITED KINGDOM
| | - Adrian Tan
- Department of Rheumatology, NHS Borders, Borders, UNITED KINGDOM
| | - Jan Sznajd
- Department of Rheumatology, NHS Highlands, Inverness, UNITED KINGDOM
| | - Stewart Lambie
- Department of Rheumatology, NHS Highlands, Inverness, UNITED KINGDOM
| | - Mohmmed Khalid
- Department of Rheumatology, NHS Lothian, Edinburgh, UNITED KINGDOM
| | - Sara Else
- Department of Rheumatology, NHS Forth Valley, Forth Valley, UNITED KINGDOM
| | - Carol A Davies
- Department of Rheumatology, NHS Forth Valley, Forth Valley, UNITED KINGDOM
| | - Margaret Duncan
- Department of Rheumatology, NHS Ayrshire and Arran, Ayrshire, UNITED KINGDOM
| | - John Mclaren
- Department of Rheumatology, NHS Fife, Fife, UNITED KINGDOM
| | - Sean Duncan
- Department of Rheumatology, NHS Fife, Fife, UNITED KINGDOM
| | - Sean Murphy5
- Department of Rheumatology, NHS Tayside, Dundee, UNITED KINGDOM
| | - Fuad Hasan
- Department of Rheumatology, NHS Tayside, Dundee, UNITED KINGDOM
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
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Desforges JP, Mikkelsen B, Dam M, Rigét F, Sveegaard S, Sonne C, Dietz R, Basu N. Mercury and neurochemical biomarkers in multiple brain regions of five Arctic marine mammals. Neurotoxicology 2021; 84:136-145. [PMID: 33774067 DOI: 10.1016/j.neuro.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/02/2021] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
Mercury is a neurotoxic chemical that represents one of the greatest pollution threats to Arctic ecosystem health. Evaluating the direct neurotoxic effects of mercury in free ranging wildlife is challenging, necessitating the use of neurochemical biomarkers to assess potential sub-clinical neurological changes. The objective of this study was to characterize the distribution and speciation of mercury, as well as exposure-associated changes in neurochemistry, across multiple brain regions (n = 10) and marine mammal species (n = 5) that each occupy a trophic niche in the Arctic ecosystem. We found consistent species differences in mean brain and brain region-specific concentrations of total mercury (THg) and methyl mercury (MeHg), with higher concentrations in toothed whales (narwhal, pilot whales and harbour porpoise) compared to fur-bearing mammals (polar bear and ringed seal). Mean THg (μg/g dw) in decreasing rank order was: pilot whale (11.9) > narwhal (7.7) > harbour porpoise (3.6) > polar bear (0.6) > ringed seal (0.2). The higher THg concentrations in toothed whales was associated with a marked reduction in the percentage of MeHg (<40 %) compared to polar bears (>70 %) that had lower brain THg concentrations. This pattern in mercury concentration and speciation corresponded broadly to an overall higher number of mercury-associated neurochemical biomarker correlations in toothed whales. Of the 226 correlations between mercury and neurochemical biomarkers across brain regions, we found 60 (27 %) meaningful relationships (r>0.60 or p < 0.10). We add to the growing weight of evidence that wildlife accumulate mercury in their brains and demonstrate that there is variance in accumulation across species as well as across distinct brain regions, and that some of these exposures may be associated with sub-clinical changes in neurochemistry.
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Affiliation(s)
- J P Desforges
- Department of Natural Resource Sciences, McGill University, Ste-Anne-de-Bellevue, QC, Canada.
| | - B Mikkelsen
- Faroe Marine Research Institute, Nóatún 1, FO-100, Tórshavn, Faroe Islands
| | - M Dam
- Environment Agency, Research, Traðagøta 38, P.O. Box 2048, FO-165, Argir, Faroe Islands
| | - F Rigét
- Department of Bioscience, Aarhus University, DK-4000, Denmark
| | - S Sveegaard
- Department of Bioscience, Aarhus University, DK-4000, Denmark
| | - C Sonne
- Department of Bioscience, Aarhus University, DK-4000, Denmark
| | - R Dietz
- Department of Bioscience, Aarhus University, DK-4000, Denmark
| | - N Basu
- Department of Natural Resource Sciences, McGill University, Ste-Anne-de-Bellevue, QC, Canada.
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Sarica SH, Gallacher PJ, Dhaun N, Sznajd J, Harvie J, McLaren J, McGeoch L, Kumar V, Amft N, Erwig L, Marks A, Bruno L, Zöllner Y, Black C, Basu N. Multimorbidity in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results From a Longitudinal, Multicenter Data Linkage Study. Arthritis Rheumatol 2021; 73:651-659. [PMID: 33058567 DOI: 10.1002/art.41557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/08/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is considered a chronic, relapsing condition. To date, no studies have investigated multimorbidity in AAV nationally. This study was undertaken to characterize temporal trends in multimorbidity and report excess health care expenditures associated with multimorbidities in a national AAV cohort from Scotland. METHODS Eligible patients with AAV were diagnosed between 1997 and 2017. Each patient was matched with up to 5 general population controls. Linked morbidity and health care expenditure data were retrieved from a Scottish national hospitalization repository and from published national cost data. Multimorbidity was defined as the development of ≥2 disorders. Prespecified morbidities, individually and together, were analyzed for risks and associations over time using modified Poisson regression, discrete interval analysis, and chi-square test for trend. The relationship between multimorbidities and health care expenditure was investigated using multivariate linear regression. RESULTS In total, 543 patients with AAV (median age 58.7 years [range 48.9-68.0 years]; 53.6% male) and 2,672 general population controls (median age 58.7 years [range 48.9-68.0 years]; 53.7% male) were matched and followed up for a median of 5.1 years. AAV patients were more likely to develop individual morbidities at all time points, but especially <2 years after diagnosis. The highest proportional risk observed was for osteoporosis (adjusted incidence rate ratio 8.0, 95% confidence interval [95% CI] 4.5-14.2). After 1 year, 23.0% of AAV patients and 9.3% of controls had developed multimorbidity (P < 0.0001). After 10 years, 37.0% of AAV patients and 17.3% of controls were reported to have multimorbidity (P < 0.0001). Multimorbidity was associated with disproportionate increases in health care expenditures in AAV patients. Health care expenditure was highest for AAV patients with ≥3 morbidities (3.89-fold increase in costs, 95% CI 2.83-5.31; P < 0.001 versus no morbidities). CONCLUSION These findings emphasize the importance of holistic care in patients with AAV, and may identify a potentially critical opportunity to consider early screening.
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Affiliation(s)
| | - Peter J Gallacher
- University of Edinburgh British Heart Foundation Center of Research Excellence, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University of Edinburgh British Heart Foundation Center of Research Excellence, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Nicole Amft
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Angharad Marks
- Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Laura Bruno
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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Pugh D, Grayson P, Basu N, Dhaun N. Aortitis: recent advances, current concepts and future possibilities. Heart 2021; 107:1620-1629. [PMID: 33593995 DOI: 10.1136/heartjnl-2020-318085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
Broadly defined, aortitis refers to inflammation of the aorta and incorporates both infectious and non-infectious aetiologies. As advanced imaging modalities are increasingly incorporated into clinical practice, the phenotypic spectrum associated with aortitis has widened. The primary large vessel vasculitides, giant cell arteritis and Takayasu arteritis, are the most common causes of non-infectious aortitis. Aortitis without systemic disease or involvement of other vascular territories is classified as clinically isolated aortitis. Periaortitis, where inflammation spreads beyond the aortic wall, is an important disease subset with a distinct group of aetiologies. Infectious aortitis can involve bacterial, viral or fungal pathogens and, while uncommon, can be devastating. Importantly, optimal management strategies and patient outcomes differ between aortitis subgroups highlighting the need for a thorough diagnostic workup. Monitoring disease activity over time is also challenging as normal inflammatory markers do not exclude significant vascular inflammation, particularly after starting treatment. Additional areas of unmet clinical need include clear disease classifications and improved short-term and long-term management strategies. Some of these calls are now being answered, particularly with regard to large vessel vasculitis where our understanding has advanced significantly in recent years. Work extrapolated from temporal artery histology has paved the way for targeted biological agents and, although glucocorticoids remain central to the management of non-infectious aortitis, these may allow reduced glucocorticoid reliance. Future work should seek to clarify disease definitions, improve diagnostic pathways and ultimately allow a more stratified approach to patient management.
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Affiliation(s)
- Dan Pugh
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Peter Grayson
- National Institute of Arthritis & Musculoskeletal & Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Macfarlane GJ, Beasley M, Scott N, Chong H, McNamee P, McBeth J, Basu N, Hannaford PC, Jones GT, Keeley P, Prescott GJ, Lovell K. Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study). Ann Rheum Dis 2021; 80:903-911. [PMID: 33526434 PMCID: PMC8237175 DOI: 10.1136/annrheumdis-2020-219091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
Objective Cognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk. Methods A population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment. Results 996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention. Conclusions A short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP. Trial registration number ClinicalTrials.gov Registry (NCT02668003).
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Affiliation(s)
- Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Huey Chong
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - John McBeth
- Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Phil Keeley
- School of Nursing and Midwifery, University of Keele, Stoke-on-Trent, Staffordshire, UK
| | - Gordon J Prescott
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Karabayas M, Dospinescu P, Fluck N, Kidder D, Fordyce G, Hollick RJ, De Bari C, Basu N. Evaluation of adjunctive mycophenolate for large vessel giant cell arteritis. Rheumatol Adv Pract 2020; 4:rkaa069. [PMID: 33381680 PMCID: PMC7756006 DOI: 10.1093/rap/rkaa069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/11/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives GCA patients with large vessel involvement (LV-GCA) experience greater CS requirements and higher relapse rates compared with classical cranial GCA. Despite the distinct disease course, interventions in LV-GCA have yet to be investigated specifically. This study aimed to evaluate the CS-sparing effect and tolerability of first-line mycophenolate in LV-GCA. Methods A retrospective cohort study was conducted in patients with LV-GCA identified from a regional clinical database between 2005 and 2019. All cases were prescribed mycophenolate derivatives (MYC; MMF or mycophenolic acid) at diagnosis and were followed up for ≥2 years. The primary outcome was the cumulative CS dose at 1 year. Secondary outcomes included MYC tolerance, relapse rates and CRP levels at 1 and 2 years. Results A total of 37 patients (65% female; mean age 69.4 years, SD 7.9 years) were identified. All cases demonstrated large vessel involvement via CT/PET (n = 34), CT angiography (n = 5) or magnetic resonance angiography (n = 2). After 2 years, 31 patients remained on MYC, whereas 6 had switched to MTX or tocilizumab owing to significant disease relapse. The mean (±SD) cumulative prednisolone dose at 1 year was 4960 (±1621) mg. Relapse rates at 1 and 2 years were 16.2 and 27%, respectively, and CRP levels at 1 and 2 years were 4 [interquartile range (IQR) 4–6] and 4 (IQR 4–4) mg/l, respectively. Conclusion To our knowledge, this is the first attempt to assess the effectiveness of any specific agent in LV-GCA. MYC might be both effective in reducing CS exposure and well tolerated in this subpopulation. A future randomized controlled trial is warranted.
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Affiliation(s)
- Maira Karabayas
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Rheumatology Service, NHS Grampian
| | | | - Nick Fluck
- Renal Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen
| | - Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen
| | | | - Rosemary J Hollick
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Rheumatology Service, NHS Grampian
| | - Cosimo De Bari
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Rheumatology Service, NHS Grampian
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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Shim J, Dean LE, Karabayas M, Jones GT, Macfarlane GJ, Basu N. Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis. Rheumatology (Oxford) 2020; 59:3408-3414. [PMID: 32337555 PMCID: PMC7590410 DOI: 10.1093/rheumatology/keaa132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/02/2019] [Revised: 02/24/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Effective management of axial spondyloarthritis (axSpA)-related fatigue is a major unmet clinical need. Anti-TNF therapy may reduce fatigue levels, although any effect has yet to be definitively quantified and predictors of any such improvements are unknown. METHODS The British Society of Rheumatology Register in Axial Spondyloarthritis (BSRBR-AS) prospectively recruited axSpA patients across the UK. Changes in fatigue levels (measured using the Chalder Fatigue Scale) >1 year were compared between those starting anti-TNF therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results were meta-analysed with the extant literature to calculate pooled estimates. Then, among those BSRBR-AS anti-TNF commencers with clinically relevant fatigue, baseline predictors of response were investigated. RESULTS Of the 998 BSRBR-AS recruits with complete fatigue data, 310 were anti-TNF commencers. At 1-year follow-up, the former group reported a mean fatigue change of -2.6 (95% CI -4.1, -1.9) points while the latter reported a mean worsening of fatigue by 0.2 points. Following propensity score adjustment, those commencing anti-TNF therapy reduced fatigue by 3.0 points compared with those not. Of those with significant fatigue and commencing anti-TNF, poor sleep quality at baseline predicted fatigue improvement. In the meta-analysis, including 1109 subjects, treatment with anti-TNF therapy resulted in a significant improvement in fatigue [Standardized mean difference (SMD) = 0.36, 95% CI 0.15, 1.56]. CONCLUSION Anti-TNF therapy results in a significant but modest reduction in fatigue amongst axSpA patients, with those reporting poor sleep quality most likely to report improvement. Effective management will likely require additional approaches.
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Affiliation(s)
- Joanna Shim
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Aberdeen Centre for Arthritis and Musculoskeletal Health.,Medical Research Council/Versus Arthrtis Centre for Musculoskeletal Health and Work, University of Aberdeen.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Linda E Dean
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Aberdeen Centre for Arthritis and Musculoskeletal Health.,Medical Research Council/Versus Arthrtis Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Maira Karabayas
- Department of Rheumatology, Aberdeen Royal Infirmary, Aberdeen
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Aberdeen Centre for Arthritis and Musculoskeletal Health.,Medical Research Council/Versus Arthrtis Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Aberdeen Centre for Arthritis and Musculoskeletal Health.,Medical Research Council/Versus Arthrtis Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Sarica SH, Dhaun N, Sznajd J, Harvie J, McLaren J, McGeoch L, Kumar V, Amft N, Erwig L, Marks A, Black C, Basu N. Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study. Rheumatology (Oxford) 2020; 59:3014-3022. [PMID: 32159801 PMCID: PMC7516107 DOI: 10.1093/rheumatology/keaa070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Infection exerts a major burden in ANCA-associated vasculitis (AAV), however, its precise extent and nature remains unclear. In this national study we aimed to longitudinally quantify, characterize and contextualize infection risk in AAV. METHODS We conducted a multicentre matched cohort study of AAV. Complementary data on infections were retrieved via data linkage with the population-based Scottish microbiological laboratory, hospitalization and primary care prescribing registries. RESULTS A total of 379 AAV patients and 1859 controls were followed up for a median of 3.5 years (interquartile range 1.9-5.7). During follow-up, the proportions of AAV patients with at least one laboratory-confirmed infection, severe infection and primary care antibiotic prescription were 55.4%, 35.6% and 74.6%, respectively. The risk of infection was higher in AAV than in matched controls {laboratory-confirmed infections: incidence rate ratio [IRR] 7.3 [95% confidence interval (CI) 5.6, 9.6]; severe infections: IRR 4.4 [95% CI 3.3, 5.7]; antibiotic prescriptions: IRR 2.2 [95% CI 1.9, 2.6]}. Temporal trend analysis showed that AAV patients remained at a higher risk of infections throughout the follow-up period, especially year 1. Although the Escherichia genus was the most commonly identified pathogen (16.6% of AAV, 5.5% of controls; P < 0.0001), AAV patients had the highest risk for Herpes [IRR 12.5 (95% CI 3.7, 42.6)] and Candida [IRR 11.4 (95% CI 2.4, 55.4)]. CONCLUSION AAV patients have up to seven times higher risk of infection than the general population and the overall risk remains significant after 8 years of follow-up. The testing of enhanced short- to medium-term prophylactic antibiotic regimes should be considered.
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Affiliation(s)
- Shifa H Sarica
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Neeraj Dhaun
- Queen’s Medical Research Institute, University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Edinburgh, UK
| | - Jan Sznajd
- Department of Rheumatology, Raigmore Hospital, Inverness, UK
| | - John Harvie
- Department of Rheumatology, Raigmore Hospital, Inverness, UK
| | - John McLaren
- Fife Rheumatic Diseases Unit, Whyteman’s Brae Hospital, Kirkcaldy, UK
| | - Lucy McGeoch
- Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
| | - Vinod Kumar
- Rheumatology Department, Ninewells Hospital, Dundee, UK
| | - Nicole Amft
- GlaxoSmithKline, Medicines Research Centre, Stevenage, UK
| | - Lars Erwig
- GlaxoSmithKline, Medicines Research Centre, Stevenage, UK
| | - Angharad Marks
- Morriston Hospital Renal Unit, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Kitching AR, Anders HJ, Basu N, Brouwer E, Gordon J, Jayne DR, Kullman J, Lyons PA, Merkel PA, Savage COS, Specks U, Kain R. ANCA-associated vasculitis. Nat Rev Dis Primers 2020; 6:71. [PMID: 32855422 DOI: 10.1038/s41572-020-0204-y] [Citation(s) in RCA: 360] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are a group of disorders involving severe, systemic, small-vessel vasculitis and are characterized by the development of autoantibodies to the neutrophil proteins leukocyte proteinase 3 (PR3-ANCA) or myeloperoxidase (MPO-ANCA). The three AAV subgroups, namely granulomatosis with polyangiitis (GPA), microscopic polyangiitis and eosinophilic GPA (EGPA), are defined according to clinical features. However, genetic and other clinical findings suggest that these clinical syndromes may be better classified as PR3-positive AAV (PR3-AAV), MPO-positive AAV (MPO-AAV) and, for EGPA, by the presence or absence of ANCA (ANCA+ or ANCA-, respectively). Although any tissue can be involved in AAV, the upper and lower respiratory tract and kidneys are most commonly and severely affected. AAVs have a complex and unique pathogenesis, with evidence for a loss of tolerance to neutrophil proteins, which leads to ANCA-mediated neutrophil activation, recruitment and injury, with effector T cells also involved. Without therapy, prognosis is poor but treatments, typically immunosuppressants, have improved survival, albeit with considerable morbidity from glucocorticoids and other immunosuppressive medications. Current challenges include improving the measures of disease activity and risk of relapse, uncertainty about optimal therapy duration and a need for targeted therapies with fewer adverse effects. Meeting these challenges requires a more detailed knowledge of the fundamental biology of AAV as well as cooperative international research and clinical trials with meaningful input from patients.
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Affiliation(s)
- A Richard Kitching
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia. .,Departments of Nephrology and Paediatric Nephrology, Monash Health, Clayton, Victoria, Australia.
| | - Hans-Joachim Anders
- Renal Division, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians University, Munich, Germany
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Elisabeth Brouwer
- Vasculitis Expertise Centre Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Jennifer Gordon
- Department of Neuroscience and Center for Neurovirology, Temple University School of Medicine, Philadelphia, PA, USA
| | - David R Jayne
- Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Paul A Lyons
- Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.,Cambridge Institute for Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine and Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline O S Savage
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Renate Kain
- Department of Pathology, Medical University Vienna, Vienna, Austria
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Tieu J, Smith R, Basu N, Brogan P, D'Cruz D, Dhaun N, Flossmann O, Harper L, Jones RB, Lanyon PC, Luqmani RA, McAdoo SP, Mukhtyar C, Pearce FA, Pusey CD, Robson JC, Salama AD, Smyth L, Watts RA, Willcocks LC, Jayne DRW. Rituximab for maintenance of remission in ANCA-associated vasculitis: expert consensus guidelines. Rheumatology (Oxford) 2020; 59:e24-e32. [PMID: 32096545 DOI: 10.1093/rheumatology/kez640] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/31/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
- Joanna Tieu
- Department of Medicine, University of Cambridge, Cambridge, UK.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Rona Smith
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow
| | - Paul Brogan
- University College London Great Ormond Institute of Child Health.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David D'Cruz
- Guy's and St Thomas' NHS Foundation Trust, London
| | - Neeraj Dhaun
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh.,Royal Infirmary of Edinburgh, Edinburgh
| | | | - Lorraine Harper
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Rachel B Jones
- Department of Medicine, University of Cambridge, Cambridge, UK.,Department of Renal Medicine, Cambridge University Hospitals Trust, Cambridge
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, University of Oxford, Oxford
| | | | - Chetan Mukhtyar
- Norfolk and Norwich University Hospital.,University of East Anglia, Norwich
| | - Fiona A Pearce
- University of Nottingham.,Nottingham University Hospitals NHS Trust, Nottingham
| | | | - Joanna C Robson
- Faculty of Health and Applied Sciences, University of West of England.,Department of Rheumatology, University Hospitals Bristol NHS Trust, Bristol
| | - Alan D Salama
- University College London.,Department of Renal Medicine, Royal Free Hospital, London
| | - Lucy Smyth
- Exeter Kidney Unit, Royal Devon and Exeter Hospital, Exeter
| | - Richard A Watts
- Ipswich Hospital, Ipswich.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa C Willcocks
- Department of Renal Medicine, Cambridge University Hospitals Trust, Cambridge
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK.,Vasculitis and Lupus Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Metraiah EH, Olisaka N, Philobos M, Walbaum D, Dospinescu P, Fluck N, Basu N, Kidder D. Correction to: Late-onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA-associated vasculitis. Clin Rheumatol 2020; 39:2499. [DOI: 10.1007/s10067-020-05242-w] [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: 12/01/2022]
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Porter D, Basu N, Siebert S. Classification criteria: time for a rethink? Ann Rheum Dis 2020; 79:1264-1266. [PMID: 32699035 DOI: 10.1136/annrheumdis-2020-217769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/25/2020] [Accepted: 06/22/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Duncan Porter
- Institute of Infection Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Neil Basu
- Institute of Infection Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
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43
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Stefanov K, McLean J, McColl A, Basu N, Cavanagh J, Krishnadas R. Mild Inflammation in Healthy Males Induces Fatigue Mediated by Changes in Effective Connectivity Within the Insula. Biol Psychiatry Cogn Neurosci Neuroimaging 2020; 5:865-874. [PMID: 32532687 DOI: 10.1016/j.bpsc.2020.04.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Systemic inflammation is associated with sickness behaviors such as low mood and fatigue. Activity patterns within the insula are suggested to coordinate these behaviors but have not been modeled. We hypothesized that mild systemic inflammation would result in changes in effective connectivity between the viscerosensory and the visceromotor regions of the insula. METHODS We used a double-blind, crossover design to randomize 20 male subjects to receive either a Salmonella typhi vaccine or a placebo saline injection at two separate sessions. All participants underwent a resting-state functional magnetic resonance scan 3 hours after injection. We determined behavioral and inflammatory changes, using the Profile of Mood States questionnaire and interleukin-6 levels. We extracted effective connectivity matrices between bilateral mid/posterior (viscerosensory) and anterior (visceromotor) insular cortices using spectral dynamic causal modeling. We applied parametric empirical Bayes and mediation analysis to determine a vaccination effect on effective connectivity and whether this mediated behavioral changes. RESULTS The vaccine condition was associated with greater interleukin-6 levels and greater fatigue 3 hours after the injection. Activity within the right mid/posterior insula increased the activity within the bilateral anterior insular regions. This connectivity was augmented by vaccination over a 99% posterior confidence threshold. The right mid/posterior insula-to-left anterior insula connectivity was significantly associated with fatigue and mediated the association between inflammation and increased fatigue scores. CONCLUSIONS These results demonstrate that increased effective connectivity between specific nodes of the insula can model and mediate the association between inflammation and fatigue in males.
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Affiliation(s)
- Kristian Stefanov
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
| | - John McLean
- Institute for Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alison McColl
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Cavanagh
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom; Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.
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Karabayas M, Dospinescu P, Locherty M, Moulindu P, Sobti M, Hollick R, De Bari C, Robinson S, Olson J, Basu N. Stratified glucocorticoid monotherapy is safe and effective for most cases of giant cell arteritis. Rheumatol Adv Pract 2020; 4:rkaa024. [PMID: 32914048 PMCID: PMC7474854 DOI: 10.1093/rap/rkaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/22/2019] [Accepted: 05/27/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives High-dose glucocorticoids anchor standard care in GCA but are associated with significant toxicity. We aimed to evaluate the safety and effectiveness of a stratified approach to glucocorticoid tapering. The strategy aggressively reduced glucocorticoid doses in those manifesting an adequate early response to treatment, with a view to minimizing glucocorticoid complications. Methods A retrospective, population-based study of GCA was performed. All cases were confirmed by temporal artery biopsy between November 2010 and November 2015. Baseline and outcome data were extracted from secondary and primary care records at diagnosis and 1 year follow-up. The primary outcome was loss of vision. Secondary outcomes included remission and relapse rates and CS-related complications. Results The cohort consisted of 73 patients (76% female; mean age 73.5 years, s.d. 7.6 years). At presentation, a reduction in visual acuity was recorded in 17 patients (22.3%). The median CRP at diagnosis was 69.5 mg/l [interquartile range (IQR) 40.5–101 mg/l], with a median ESR of 80 mm/h (IQR 60–91 mm/h). At 1 year, remission was achieved in 64 patients (87.7%), whereas 10 patients (13.7%) relapsed. A single patient sustained visual loss after initiation of therapy. The median CRP at 1 year was 4 mg/l (IQR 4–9.5 mg/l) and the mean prednisolone dose was 5.4 mg (0–15 mg). CS-related complications were observed in 10 patients (13.7%). Conclusion A stratified approach to CS tapering appeared safe and effective in GCA. It was associated with a high rate of remission and promisingly low rates of relapse at 1 year follow-up. These real-world data indicate that glucocorticoid exposure can be minimized safely in some patients with GCA.
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Affiliation(s)
- Maira Karabayas
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Department of Rheumatology
| | | | | | | | | | - Rosemary Hollick
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Department of Rheumatology
| | - Cosimo De Bari
- Aberdeen Centre for Arthritis & Musculoskeletal Health, University of Aberdeen.,Department of Rheumatology
| | | | | | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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45
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Zurowski J, Wright C, Basu N, Poyade M, Bennett L. OP0255-PARE USING AN EDUCATIONAL APPLICATION TO FACILITATE UNDERSTANDING OF THE ANATOMY AND FUNCTION OF THE BRAIN AND TO EXPLORE THE EFFECTS OF CLINICAL FATIGUE FROM A PATIENT PERSPECTIVE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Rheumatic and musculoskeletal diseases are a group of devastating autoimmune disorders that all commonly share the debilitating symptom of fatigue. Despite the fact that fatigue can often cause some of the greatest impairments to quality of life, it is frequently reported by patients as the least successfully managed symptom of these conditions.Fatigue is routinely misunderstood within the general population, with many people using the word fatigue as a synonym for tired. Fatigue is not the same as tiredness, which is a normal state that is experienced by most of the population, therefore it is important to help the general public understand what fatigue actually is and how it imposes consequences and limitations on those who suffer from it. To aid this understanding an educational application has been created to reinforce the patient perspective of living with fatigue. Furthermore, this application will also aid the understanding of brain anatomy and function, using Augmented Reality (AR), as research has now shown that brain function may be altered in the state of fatigue.Currently, educational AR applications show great potential for increasing comprehension and understanding of complex concepts. AR expands user engagement by enhancing the learner’s enjoyment and enriching their learning environment. We hope to utilise this technology in the education of fatigue.Objectives:We aimed to create an AR application that has informative content designed to educate users on the topics of basic brain anatomy and function. Furthermore, we aimed to increase the users understanding of the complete impairment of fatigue by creating a short video that describes living with fatigue from the patient’s perspective.Methods:The application was created using medical scan dataset, a variety of 3D modelling software, and a game engine to create a functional and interactive augmented application. The short video regarding a patient’s perspective on living with fatigue was developed in collaboration with the Glasgow Arthritis Involvement Network patient partners. In order to determine if the application met its primary objectives a pilot test was conducted on 14 participants. After consenting to taking part in the study, individuals were guided through a pre-application test, the use of the application itself and finally a post-application test.Results:Initial results from the pilot test showed promise in the educational potential of the application. With regards to the questions pertaining to the brain anatomy, the percentage of questions answered correctly increased from 36% in the pre-test to 60% in the post-test. Furthermore, after using the application the participants reported a significant increase in their confidence for their answers. An additional six questions ascertained a participants perceptions of fatigue. From these questions, the answer that was most significantly changed after use of the application, was in relation to the impact that fatigue has on a patient’s quality of life (t-Test p=0.02). After use of the application participants’ opinions changed to reflect the fact that fatigue can completely impair a person’s quality of life, showing an increase in their understanding of the debilitating nature of fatigue.Conclusion:This research explored the development and effectiveness of an AR application that was centered around fatigue and basic neuroanatomy education within the general population. From the pilot test conducted we are able to report that the application was successful in delivering educational material about brain anatomy and was successful in increasing awareness about the impact that fatigue can have on an individual’s quality of life.Figure 1.Augmented brain model scene using brain model as triggerFigure 2.Example of material change upon selection of Occipital Lobe optionAcknowledgments:The Glasgow Arthritis Involvement Network (GAIN)Disclosure of Interests:None declared
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Metraiah EH, Dospinescu P, Fluck N, Basu N, Kidder D. P0381THE UTILITY OF LOW DOSE RITUXIMAB FOR INDUCTION AND MAINTENANCE TREATMENT IN ELDERLY PATIENTS WITH ANCA-ASSOCIATED VASCULITIS: A SINGLE CENTRE EXPERIENCE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0381] [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: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Elderly patients with Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) tend to have higher rates of mortality and treatment-related adverse events. Rituximab is now widely used in the treatment of patients with AAV based on the results of remission induction (RITUXVAS and RAVE) and remission maintenance (MAINRITSAN) randomized controlled trials. Elderly patients were relatively under-represented in these trials. In this observational study we aimed to examine the outcome of elderly patients who received Rituximab (either as low dose Rituximab (LDR) or standard dose Rituximab (SDR)) for remission induction and maintenance.
Method
We investigated the outcome of three treatment strategies in elderly (age>65 years) patients who presented with AAV to our Vasculitis clinic from 1 July 2007 to 9 of July 2017. These strategies included: LDR (17 patients), SDR (14 patients) and Cyclophosphamide/Azathioprine (Cyc/A) 26 patients. LDR patients received two dose of 500mg Rituximab fortnightly followed by six monthly 500mg doses for 2 years. SDR patients received 1g Rituximab fortnightly followed by six monthly 1g doses for 2 years. Cyc/A patients received 1.5mg/kg oral Cyclophosphamide for 3 months followed by 18 months of Azathioprine.
Results
Among 57 AAV patients, 56% were females and mean age of 79.6 +/- 4 (LDR), 72.4 +/- 7.2 (SDR), and 71.1 +/- 5 (Cyc/A) (p=0.001). The distribution of MPA and GPA was 11/6 in LDR, 7/7 in SDR and 18/8 in Cyc, respectively. Relapsing GPA was significantly higher in SDR 12/2 compared to LDR 3/14, and Cyc/A 0/26 (p=0.0001). There were no significant differences in serum creatinine, BVAS scores or CRP between groups at initiation of treatment. Patients survival at 24 months was 88% (LDR), 92% (SDR), and 77% (Cyc), p=0.3. The mean corticosteroids dose at 3 months from onset of treatment was significantly lower in the LDR (7.6 +/- 1.7) and SDR (8.6 +/- 3.1) compared with Cyc/A (12.5 +/- 3.6), p=0.001. 1 patients relapsed in the SDR group and 4 patients in the Cyc/A group. Hospitalization for infections were significantly lower in the LDR (3 episodes) compared to Cyc/A (17 episodes), p=0.004. The number of patients with hypogammaglobulinemia was not significantly different between LDR and SDR.
Conclusion
In this single centre observational study, we found that low dose Rituximab for remission induction and maintenance associated with similar patient outcome to SDR. The findings of this study needs to be replicated with longer duration of follow-up.
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Affiliation(s)
- El Hakem Metraiah
- Aberdeen Royal Infirmary, Aberdeen Renal Unit, Aberdeen, United Kingdom
| | - Paula Dospinescu
- Department of Rheumatology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | | | - Neil Basu
- Institution of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Dana Kidder
- Aberdeen Royal Infirmary, Aberdeen Renal Unit, Aberdeen, United Kingdom
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Abstract
Systemic vasculitis are a complex cluster of diseases with high associated morbidity. As disease-related mortality diminishes, the cumulative impact of poor health-related quality of life becomes more pertinent to patients than the initial pathological insult. In this article we explore health-related quality of life in ANCA-associated vasculitis, large-vessel vasculitis and therapeutic strategies that may enhance this critical outcome.
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Affiliation(s)
- M Aitken
- Department of Rheumatology, NHS Greater Glasgow & Clyde
| | - N Basu
- Department of Rheumatology, NHS Greater Glasgow & Clyde.,Institute of Infection, Immunology & Inflammation, University of Glasgow, Glasgow, UK
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48
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Cheung SM, Keenan K, Senn N, Hutcheon G, Chan K, Erwig L, Schrepf A, Dospinescu P, Gray S, Waiter G, He J, Basu N. Metabolic and Structural Skeletal Muscle Health in Systemic Lupus Erythematosus-Related Fatigue: A Multimodal Magnetic Resonance Imaging Study. Arthritis Care Res (Hoboken) 2020; 71:1640-1646. [PMID: 30629805 DOI: 10.1002/acr.23833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the potential structural and metabolic role of skeletal muscle in systemic lupus erythematosus (SLE)-related fatigue. METHODS A case-control, multimodal magnetic resonance imaging (MRI) study was conducted. Cases were patients with inactive SLE who reported chronic fatigue. Controls were age- and sex-matched healthy members of the general population. Patients were clinically characterized and then underwent a 3T whole-body MRI scan. Resting and dynamic 31 P MRI spectroscopy of the calf muscles was applied, from which phosphocreatine (PCr) recovery halftime, a marker of mitochondrial dysfunction, was computed. In addition, microstructural sequences (T1-weighted anatomic images, T2 mapping, and diffusion tensor imaging) were acquired. Descriptive statistics evaluated group differences and within-case physical fatigue correlations were explored. RESULTS Of the 37 recruits (mean age 43.8 years, 89.2% female), cases (n = 19) reported higher levels of physical fatigue, pain, depression, and sleep disturbance compared to the control group (P < 0.0001). PCr was greater (P = 0.045) among cases (mean ± SD 33.0 ± 9.0 seconds) compared to controls (mean ± SD 27.1 ± 6.6 seconds). No microstructural group differences were observed. Within cases, physical fatigue did not correlate with PCr (r = -0.28, P = 0.25). CONCLUSION We report preliminary data demonstrating greater skeletal muscle mitochondrial dysfunction among fatigued patients with SLE compared to healthy controls.
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Affiliation(s)
| | | | | | | | | | - Lars Erwig
- University of Aberdeen, Aberdeen, and GlaxoSmithKline, Stevenage, UK
| | | | | | | | | | - Jiabao He
- University of Aberdeen, Aberdeen, UK
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Abstract
People with RA commonly experience fatigue. Fatigue is a key contributor to increased clinical care costs, primary care consultations and employment loss. Despite this, our understanding of the prognostic of factors of poor fatigue outcomes is lacking and fatigue is poorly managed. Examining longitudinal predictors of fatigue can identify both individuals ‘at risk’ of poor prognosis, and candidate mechanisms that are worthy of greater inspection. This review discusses the factors most commonly investigated as being implicated in the prognosis of RA fatigue. The available data appears to implicate generic factors such as pain, mental health, disability and sleep as consistent predictors of fatigue outcome, while the role of disease activity and inflammation seems less clear. However, the existing data are not without methodological limitations and there have been no specific studies primarily designed to investigate the inflammatory biomarkers of fatigue. Future studies are required to more comprehensively and robustly determine the mechanisms of fatigue.
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Affiliation(s)
- Katie L Druce
- Centre for Epidemiology Versus Arthritis, Faculty of Biology Medicine and Health, The University of Manchester, Manchester
| | - Neil Basu
- Institution of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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50
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Macfarlane GJ, Beasley M, Scott N, McNamee P, McBeth J, Prescott G, Jones GT, Hannaford P, Basu N, Keeley P, Lovell K. O15 Maintaining musculoskeletal health: a randomised controlled trial of cognitive behaviour therapy among people at high risk of developing chronic widespread pain. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa110.014] [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: 11/14/2022] Open
Abstract
Abstract
Background
Cognitive behaviour therapy (CBT) is effective in the management of fibromyalgia (and its characteristic feature chronic widespread pain (CWP). CBT is recommended in all recent major fibromyalgia management guidelines. From large-scale epidemiological studies, prediction models are available which identify groups at high-risk of developing CWP. We now test whether it is possible to prevent onset of CWP and/or change factors associated with its onset.
Methods
A randomised controlled trial of CBT delivered by telephone plus usual care (tCBT) was tested against usual care alone (UC). Eligible adults aged at least 25 years were identified by a survey of persons registered with sixteen general practices across Scotland. Respondents reporting regional pain (not CWP) for which they had recently consulted their GP and at least 2 items from a previously validated ‘high risk’ profile (Somatic Symptom Scale, Sleep Problem Scale, Illness Behaviour Scale) were invited to participate. tCBT was delivered across 6 sessions over 8 weeks with booster sessions 3 and 6 months after treatment start. Primary outcome was CWP at 12 months. Secondary outcomes were risk profile measures: fatigue (Chalder Fatigue Scale), Patient Global Impression of Change (PGIC: 7 categories), psychological distress (General Health Questionnaire) and quality of life (EQ-5D-5L) also at 12 months. Analysis used logistic, ordinal logistic or linear regression depending on outcome variable type; expressed as an effect size with 95% confidence interval.
Results
1,002 people were randomised, with equal numbers assigned to each arm of the trial: 59% of participants were female, with a median age of 59 (range 25-91) years. 66% of tCBT participants completed treatment and 83% of all participants provided follow-up data at 12 months. There was no difference in the proportion with CWP at 12 months (tCBT 18.0% v. UC 17.5%). There were improvements (all favouring tCBT) in Illness Behaviour Score (mean difference (md) -0.83; -1.55,-0.11), Sleep Problem Scale (md -0.90; -1.45,-0.36), psychological distress (Odds Ratio (OR) per category 0.65; 0.50, 0.85), EQ-5D-5L (md 0.024; 0.009, 0.039), Chalder Fatigue Scale (md -1.05; -1.66,-0.44) and PGIC (OR per category 0.51;0.39,0.67). Specifically 30.2% of those receiving tCBT reported their health as much or very much better, compared to 17.3% of those receiving UC.
Conclusion
This first-ever large-scale trial of prevention, aimed at persons at high risk, has shown tCBT does not change the likelihood of CWP onset but does improve the underlying risk profile for developing the condition as well as improving distress , fatigue and quality of life. Those receiving tCBT were, 12 months later, significantly more like to consider their health was better. This trial provides evidence for extending the group of people considered to benefit from CBT.
Disclosures
G.J. Macfarlane None. M. Beasley None. N. Scott None. P. McNamee None. J. McBeth None. G. Prescott None. G.T. Jones None. P. Hannaford None. N. Basu None. P. Keeley None. K. Lovell None.
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Affiliation(s)
- Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - John McBeth
- Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
| | - Gordon Prescott
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UNITED KINGDOM
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Phil Hannaford
- Primary Care, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Neil Basu
- Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Phil Keeley
- Human and Health Sciences, University of Huddersfield, Huddersfield, UNITED KINGDOM
| | - Karina Lovell
- Nursery, Midwifery and Social Work, University of Manchester, Manchester, UNITED KINGDOM
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