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Eades LE, Sines J, Hoi AY, Liddle R, Kandane-Rathnayake R, Morand EF, Brady S, Rischmueller M, Vincent FB. Autoimmune rheumatic disease in Australian Aboriginal and Torres Strait Islander Peoples: What do we know? Semin Arthritis Rheum 2024; 65:152354. [PMID: 38237231 DOI: 10.1016/j.semarthrit.2023.152354] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 03/22/2024]
Abstract
Autoimmune rheumatic disease (AIRD) is a collective term, which comprises a group of multisystem inflammatory autoimmune diseases, including connective tissue disease, chronic inflammatory arthritis, sarcoidosis and systemic vasculitis. Some AIRD are prevalent in the general population, and all can cause significant morbidity and reduced quality of life, with some increasing the risk of premature mortality, such as systemic lupus erythematosus (SLE), a connective tissue disease that is more prevalent and severe in Australian Aboriginal and Torres Strait Islander Peoples with high mortality rates. To ensure that management of AIRD can be optimised for all Australians, it is important that we understand the prevalence and potential phenotypic variations of AIRD across the Australian population. However, to date there have been few described cases of AIRD other than SLE in Aboriginal and Torres Strait Islander Peoples. In this review, we summarise what is known about AIRD other than SLE in Aboriginal and Torres Strait Islander Peoples, particularly with regards to prevalence, phenotype and disease outcomes, and highlight the current gaps in knowledge.
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Affiliation(s)
- Laura E Eades
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia; Rheumatology Department, Monash Health, Clayton, Victoria 3168, Australia
| | - Jason Sines
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney NSW 2001, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia; Rheumatology Department, Monash Health, Clayton, Victoria 3168, Australia
| | - Ruaidhri Liddle
- Primary and Public Health Care Central Australia, Alice Springs, Northern Territory 0870, Australia
| | | | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia; Rheumatology Department, Monash Health, Clayton, Victoria 3168, Australia
| | - Stephen Brady
- Rheumatology Department, Alice Springs Hospital, The Gap, Northern Territory 0870, Australia
| | - Maureen Rischmueller
- Rheumatology Department, Alice Springs Hospital, The Gap, Northern Territory 0870, Australia; Rheumatology Department, Royal Darwin Hospital, Tiwi, Northern Territory 0810, Australia; Discipline of Medicine, University of Adelaide, South Australia 5011, Australia; Rheumatology Department, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia.
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Luppi F, Manfredi A, Faverio P, Andersen MB, Bono F, Pagni F, Salvarani C, Bendstrup E, Sebastiani M. The usual Interstitial pneumonia pattern in autoimmune rheumatic diseases. BMC Pulm Med 2023; 23:501. [PMID: 38082233 PMCID: PMC10714466 DOI: 10.1186/s12890-023-02783-z] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Usual Interstitial Pneumonia (UIP) is characterized by progression of lung parenchyma that may be observed in various autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis and connective tissue diseases. From a diagnostic point of view, a UIP pattern related to ARDs may display imaging and pathological features able to distinguish it from that related to IPF, such as the "straight-edge" sign at HRCT and lymphoplasmacytic infiltrates at histologic specimens. Multidisciplinary approach (MDD), involving at least pulmonologist, rheumatologist and radiologist, is fundamental in the differential diagnosis process, but MDD is also required in the evaluation of severity, progression and response to treatment, that is based on the combination of changes in symptoms, pulmonary function trends, and, in selected patients, serial CT evaluation. Differently from IPF, in patients with ARDs both functional evaluation and patient-reported outcomes may be affected by systemic involvement and comorbidities, including musculoskeletal manifestations of disease. Finally, in regards to pharmacological treatment, immunosuppressants have been considered the cornerstone of therapy, despite the lack of solid evidence in most cases; recently, antifibrotic drugs were also proposed for the treatment of progressive fibrosing ILDs other than IPF. In ARD-ILD, the therapeutic choice should balance the need for the control of systemic and lung involvements with the risk of adverse events from multi-morbidities and -therapies. Purpose of this review is to summarize the definition, the radiological and morphological features of the UIP pattern in ARDs, together with risk factors, diagnostic criteria, prognostic evaluation, monitoring and management approaches of the UIP-ARDs.
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Affiliation(s)
- Fabrizio Luppi
- Respiratory Disease, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Paola Faverio
- Respiratory Disease, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michael Brun Andersen
- Copenhagen University Hospital Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Francesca Bono
- Pathology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Pagni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Pathology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Elisabeth Bendstrup
- Center for Rare Lung Disease, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
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Papagoras C, Zioga N, Papadopoulos V, Gerolymatou N, Kalavri E, Bounos C, Simopoulou T, Fragoulis GE, Panopoulos S, Fragiadaki K, Evangelatos G, Bournia VK, Arida A, Karamanakos A, Pappa M, Kravvariti E, Deftereou K, Kougkas N, Zampeli E, Kataxaki E, Melissaropoulos K, Barouta G, Panagiotopoulos A, Koutsianas C, Liossis SN, Georgiou P, Dimitroulas T, Tektonidou MG, Bogdanos DP, Elezoglou A, Voulgari PV, Sfikakis PP, Vassilopoulos D. Omicron variant dominance and anti-SARS-CoV-2 vaccination are key determinants for a milder course of COVID-19 in patients with systemic autoimmune rheumatic diseases. Clin Rheumatol 2023; 42:3375-3385. [PMID: 37731083 PMCID: PMC10640401 DOI: 10.1007/s10067-023-06769-4] [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: 06/02/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION This study aimed to determine whether the introduction of anti-SARS-CoV-2 vaccines and the dominance of the omicron variant had a significant impact on the outcome of COVID-19 in patients with systemic autoimmune rheumatic diseases (SAIRDs). METHODS Using data entered to the Greek Rheumatology Society COVID-19 registry, we investigated the incidence of hospitalization and death due to COVID-19, during the successive periods of the pandemic according to the prevalent strain (wild-type, Alpha, Delta, Omicron) in vaccinated and unvaccinated patients. Variables independently associated with hospitalization and death were explored using multivariate regression analyses, while Kaplan-Meier curves were used to depict survival data. RESULTS From August 2020 until June 30, 2022, 456 cases (70.2% females) of COVID-19 with a mean age (± SD) of 51.4 ± 14.0 years were reported. In unvaccinated patients, the proportions of hospitalization and death were 24.5% and 4%, compared to 12.5% and 0.8% in the vaccinated group (p < 0.001 for both comparisons). The rates of hospitalization for the wild-type, Alpha, Delta, and Omicron periods were 24.7%, 31.3%, 25.9%, and 8.1% respectively (p < 0.0001), while the case fatality rates were 2.7%, 4%, 7%, and 0%, respectively (p = 0.001). Using multivariable regression analysis, factors independently associated with hospitalization were infection by a non-Omicron variant, being non-vaccinated, exposure to rituximab, older age, and respiratory and cardiovascular disease. Independent predictors for death were contracting COVID-19 during the Alpha or Delta period, pulmonary disease, and older age, while being vaccinated was protective. CONCLUSIONS In this 2-year analysis, the rates of hospitalization and death among patients with SAIRDs have declined significantly. Vaccination and the dominance of the Omicron variant appear to be the major determinants for this shift. Key points • During the late phase of the pandemic, the proportion of severe COVID-19 cases, defined as requiring hospitalization or resulting in death, in patients with systemic autoimmune rheumatic diseases has declined. • Anti-SARS-CoV-2 vaccination and the dominance of the Omicron strain are the key factors that have independently contributed to this shift.
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Affiliation(s)
- Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikoleta Zioga
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Nafsika Gerolymatou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Kalavri
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Christos Bounos
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Theodora Simopoulou
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - George E Fragoulis
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Panopoulos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Evangelatos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Arida
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karamanakos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evrydiki Kravvariti
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleopatra Deftereou
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | | | | | - Alexandros Panagiotopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece
| | - Christos Koutsianas
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece
| | - Stamatis-Nick Liossis
- Division of Rheumatology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria G Tektonidou
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios P Bogdanos
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - Antonia Elezoglou
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Petros P Sfikakis
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece.
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Shi H, Wu H, Winkler MA, Belin de Chantemèle EJ, Lee R, Kim HW, Weintraub NL. Perivascular adipose tissue in autoimmune rheumatic diseases. Pharmacol Res 2022; 182:106354. [PMID: 35842184 PMCID: PMC10184774 DOI: 10.1016/j.phrs.2022.106354] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/27/2022] [Accepted: 07/11/2022] [Indexed: 01/14/2023]
Abstract
Perivascular adipose tissue (PVAT) resides at the outermost boundary of the vascular wall, surrounding most conduit blood vessels, except for the cerebral vessels, in humans. A growing body of evidence suggests that inflammation localized within PVAT may contribute to the pathogenesis of cardiovascular disease (CVD). Patients with autoimmune rheumatic diseases (ARDs), e.g., systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriasis, etc., exhibit heightened systemic inflammation and are at increased risk for CVD. Data from clinical studies in patients with ARDs support a linkage between dysfunctional adipose tissue, and PVAT in particular, in disease pathogenesis. Here, we review the data linking PVAT to the pathogenesis of CVD in patients with ARDs, focusing on the role of novel PVAT imaging techniques in defining disease risk and responses to biological therapies.
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Affiliation(s)
- Hong Shi
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA; Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Hanping Wu
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Michael A Winkler
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Eric J Belin de Chantemèle
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA; Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Richard Lee
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ha Won Kim
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA; Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Neal L Weintraub
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA; Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA.
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Leonardo H, Carrascosa M, Arreola R, Herrera-Méndez M. Causes of mortality associated with autoimmune rheumatic disease in a referral hospital. Reumatol Clin (Engl Ed) 2022; 18:304-308. [PMID: 34531169 DOI: 10.1016/j.reumae.2021.02.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/03/2021] [Indexed: 06/13/2023]
Abstract
The causes of mortality among rheumatic diseases vary widely between geographic areas and cannot be generalized, however, they are frequently associated with the aggressiveness of the clinical presentation and the secondary effects of the therapy used. The main purpose of this study was to characterize the causes of death in a group of patients with autoimmune rheumatic disease. For this purpose, a retrospective study was carried out over a period of 10 years (2009-2019), deceased patients were included from a referral centre in Guatemala City, the records were reviewed in search of demographic and clinical variables. In total, 185 deceased patients were identified from 898 admissions during that period, 85.9% were women and the main disease reported was systemic lupus erythematosus in 49.7% of the cases. Among the causes of mortality, infections were reported in 53% and those attributed to disease activity in 15% of cases. The main conclusion is that that most of the deaths were of infectious origin.
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Affiliation(s)
- Herberth Leonardo
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala
| | - Miriam Carrascosa
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala
| | - Ricardo Arreola
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala
| | - Maynor Herrera-Méndez
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala.
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Abstract
Until the etiopathogenic factor(s) of autoimmune and autoinflammatory rheumatic disorders will be identified, their classification into entities will continue. However, their similar clinical manifestations, overlapping syndromes, evolution from one entity into another, as well as common autoantibody responses, suggest that autoimmune and autoinflammatory disorders may constitute distinct pathophysiologic processes on the basis of a different genetic background. Prognosis and effective therapeutic regimens are mostly based on the clinico-pathologic severity of the involved tissues or organs and not on the disease label. Autoimmune rheumatic diseases (ARDs) can evolve from one into another disease. Different ARDs can appear in the same individual. Common humoral auto-reactivities appear in different ARDs. Therapy is based on the severity of ARDs expression.
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Affiliation(s)
- Haralampos M Moutsopoulos
- National and Kapodistrian University of Athens and Academy of Athens, Vournazou 29, Athens, 11521, Greece
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7
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Gamboa-Cárdenas RV, Barzola-Cerrón S, Toledo-Neira D, Reátegui-Sokolova C, Pimentel-Quiroz V, Zevallos-Miranda F, Alarcón GS, Ugarte-Gil M. Predictors of hospitalization for COVID-19 in patients with autoimmune rheumatic diseases: results from a community cohort follow-up. Clin Rheumatol 2021; 40:4725-4734. [PMID: 34189675 PMCID: PMC8241466 DOI: 10.1007/s10067-021-05833-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/23/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The identification of risk factors for COVID-19 adverse course in autoimmune rheumatic diseases (ARDs) is of the utmost importance when approaching patient management; however, data are scarce in relation to the Latin American population. The objective of this study was to determine predictors of hospitalization for COVID-19 patients from an ARD community cohort. METHODS A real setting longitudinal study (March to November 2020) in an ARD community cohort was carried out. Potential predictors of hospitalization for COVID-19 examined included (1) sociodemographic variables (age, gender, education, tobacco use, socioeconomic status, and co-inhabitants), (2) comorbidities, (3) time to COVID-19 diagnosis, and (4) ARD's features: clinical (disease type, disease duration, activity), treatment [corticosteroids use/doses, use of synthetic DMARDs (cDMARDs, tsDMARDs, and bDMARDs)], treatment schedule and non-adherence, and the Multidimensional Health Assessment Questionnaire (MDHAQ). Univariable and multivariable regression analysis were conducted; OR and 95% CI (p < 0.05) were determined. RESULTS One thousand and one hundred forty-eight patients with ARDs were included; 154 had COVID-19; of these 139 (90.3%) were women, aged 52.5 (13.7) years; 33.1% had hypertension and 61.0% an affected organ by ARD. Infection was detected 8.4 (10.1) days after symptoms started; there were 33 hospitalized patients (rate 21.4%). Predictors of hospitalization by multivariable analysis were age (OR: 1.06; CI: 1.01-1.10; p: 0.01), comorbidities: hypertension (OR: 3.95; 95% CI: 1.40-10.95, p: 0.01) and neoplasm (OR: 9.0; 95% CI: 1.6-52.3; p: 0.01), number of organs involved by ARD (OR: 2.26; 95% CI: 1.16-4.41; p: 0.02), and infection diagnosis delay (OR: 1.36; 95% CI: 1.03-1.80; p: 0.01). CONCLUSIONS In our ARD patients with COVID-19, older age, comorbidities (neoplasm and hypertension), and a delay in COVID-19 diagnosis were predictors of hospitalization. The only ARD-associated predictor feature was the number of organs involved. Key Points • Patients with ARD and COVID-19 have an adverse course in comparison to the general population. • Previous predictors of COVID-19 hospitalization, including known risk factors (such as older age and comorbidities) and systemic manifestations, should be taken into account in the management of these patients. • Delayed diagnosis of COVID-19 impacts negatively on prognosis. • Availability of diagnostic tests is of utmost importance.
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Affiliation(s)
- Rocío-V Gamboa-Cárdenas
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru. .,Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru.
| | - Silvia Barzola-Cerrón
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru
| | - Denisse Toledo-Neira
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru
| | - Cristina Reátegui-Sokolova
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru.,Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Víctor Pimentel-Quiroz
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru.,Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru
| | | | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama At Birmingham, Birmingham, AL, USA.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuel Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru.,Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru
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8
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Rodriguez-Pla A, Vikram HR, Khalid V, Wesselius LJ. COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review. Rheumatol Int 2021; 41:1509-1514. [PMID: 34091704 PMCID: PMC8180184 DOI: 10.1007/s00296-021-04905-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
A 77-year-old man with past medical history of granulomatosis with polyangiitis (GPA) on rituximab and prednisone, presented to the hospital with worsening cough and shortness of breath. He had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nasal swab polymerase chain reaction (PCR) while asymptomatic, 6 weeks earlier. He started with cough and shortness of breath 2 weeks after his initial positive test. After developing symptoms, he tested negative twice by nasal swab PCR, but the PCR of his bronchioloalveolar lavage was positive for SARS-CoV-2. He did not develop antibodies against coronavirus. Prednisone 15 mg daily was continued, and he received remdesivir, and convalescent plasma with quick recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma.
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Affiliation(s)
| | | | - Vanood Khalid
- Division of Hospital Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lewis J Wesselius
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
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Migkos MP, Kaltsonoudis E, Pelechas E, Drossou V, Karagianni PG, Kavvadias A, Voulgari PV, Drosos AA. Use of conventional synthetic and biologic disease-modifying anti-rheumatic drugs in patients with rheumatic diseases contracting COVID-19: a single-center experience. Rheumatol Int 2021; 41:903-909. [PMID: 33655421 PMCID: PMC7925256 DOI: 10.1007/s00296-021-04818-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022]
Abstract
To examine whether patients with inflammatory arthritis (IA) treated with conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) and/or biologic (b) DMARDs, could be affected from SARS-CoV-2 infection and to explore the COVID-19 disease course and outcome in this population. This is a prospective observational study. During the period February-December 2020, 443 patients with IA who were followed-up in the outpatient arthritis clinic were investigated. All patients were receiving cs and/or bDMARDs. During follow-up, the clinical, laboratory findings, comorbidities and drug side effects were all recorded and the treatment was adjusted or changed according to clinical manifestations and patient's needs. There were 251 patients with rheumatoid arthritis (RA), 101 with psoriatic arthritis (PsA) and 91 with ankylosing spondylitis (AS). We identified 32 patients who contracted COVID-19 (17 RA, 8 PsA, 7 AS). All were in remission and all drugs were discontinued. They presented mild COVID-19 symptoms, expressed mainly with systemic manifestations and sore throat, while six presented olfactory dysfunction and gastrointestinal disturbances, and all of them had a favorable disease course. However, three patients were admitted to the hospital, two of them with respiratory symptoms and pneumonia and were treated appropriately with excellent clinical response and outcome. Patients with IA treated with cs and/or bDMARDs have almost the same disease course with the general population when contract COVID-19.
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Affiliation(s)
- Michalis P. Migkos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Evripidis Kaltsonoudis
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Vassiliki Drossou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Panagiota G. Karagianni
- Laboratory Medicine, Department of Microbiology, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Athanasios Kavvadias
- Gastroenterology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Paraskevi V. Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Alexandros A. Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
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Leonardo H, Carrascosa M, Arreola R, Herrera-Méndez M. Causes of Mortality Associated with Autoimmune Rheumatic Disease in a Referral Hospital. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(21)00090-5. [PMID: 33875392 DOI: 10.1016/j.reuma.2021.02.010] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
The causes of mortality among rheumatic diseases vary widely between geographic areas and cannot be generalized, however, they are frequently associated with the aggressiveness of the clinical presentation and the secondary effects of the therapy used. The main purpose of this study was to characterize the causes of death in a group of patients with autoimmune rheumatic disease. For this purpose, a retrospective study was carried out over a period of 10 years (2009 to 2019), deceased patients were included from a referral centre in Guatemala City, the records were reviewed in search of demographic and clinical variables. In total, 185 deceased patients were identified from 898 admissions during that period, 85.9% were women and the main disease reported was systemic lupus erythematosus in 49.7% of the cases. Among the causes of mortality, infections were reported in 53% and those attributed to disease activity in 15% of cases. The main conclusion is that that most of the deaths were of infectious origin.
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Affiliation(s)
- Herberth Leonardo
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala
| | - Miriam Carrascosa
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala
| | - Ricardo Arreola
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala
| | - Maynor Herrera-Méndez
- Unidad de Reumatología, Departamento de Medicina Interna, Hospital Roosevelt, Ciudad de Guatemala, Guatemala; Facultad de Ciencias Médicas, Escuela de Estudios de Postgrado, Universidad de San Carlos de Guatemala, Ciudad de Guatemala, Guatemala.
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11
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Manolis AS, Tzioufas AG. Cardio-Rheumatology: Cardiovascular Complications in Systemic Autoimmune Rheumatic Diseases / Is Inflammation the Common Link and Target? Curr Vasc Pharmacol 2020; 18:425-430. [PMID: 32410564 DOI: 10.2174/1570161118666200514222236] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022]
Abstract
In the current Thematic Issue of Current Vascular Pharmacology (CVP), entitled "Systemic Autoimmune Rheumatic Diseases and Cardiology", presented in two parts, Part 1 and Part 2, review articles are included from specialists in cardiology, rheumatology, immunology and related fields. These reviews discuss the cardiovascular complications of the main systemic Autoimmune Rheumatic Diseases (ARDs). For example, the underlying pathogenetic mechanisms, the role of cardiovascular imaging and recommendations for prevention and management. These articles place inflammation as the key process, linking cardiovascular complications with ARDs. From all these reviews, the conclusion is the need for collaboration between the disciplines of Rheumatology and Cardiology to establish the emerging field of Cardio- Rheumatology. This will aid to fine-tune risk stratification and optimize preventive strategies and pharmacological therapies for patients with ARDs.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University, School of Medicine, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathopyhysiology, Athens University, School of Medicine, Athens, Greece
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12
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Manolis AS, Tzioufas AG. Cardio-Rheumatology: Two Collaborating Disciplines to Deal with the Enhanced Cardiovascular Risk in Autoimmune Rheumatic Diseases. Curr Vasc Pharmacol 2020; 18:533-537. [PMID: 32693768 DOI: 10.2174/1570161118666200721145718] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In Part 1 of this Thematic Issue entitled "Systemic Autoimmune Rheumatic Diseases and Cardiology", a panel of specialists and experts in cardiology, rheumatology, immunology and related fields discussed the cardiovascular complications of spondyloarthritides, rheumatoid arthritis, Sjogren's syndrome and vasculitides, as well as relevant cardiovascular issues related to non-biologic and biologic disease-modifying anti-rheumatic drugs (DMARDs), and provided their recommendations for prevention and management of these complications. In part 2 of this Thematic Issue, experts discuss the enhanced cardiovascular risk conferred by additional autoimmune rheumatic diseases (ARDs), including systemic lupus erythematosus, the antiphospholipid syndrome, psoriasis and psoriatic arthritis and juvenile idiopathic arthritis. These, and the previous articles, place inflammation as the key common link to explain the enhanced risk of cardiovascular complications in patients with ARDs. It follows that treatment should probably target inflammation. From all these contemporary reviews, the conclusion that is derived further supports the notion of the emerging field of Cardio- Rheumatology where physicians and experts from these two disciplines collaborate in risk stratification and optimization of preventive strategies and drug therapies in patients with ARDs.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Xiang L, Low AHL, Leung YY, Fong W, Gandhi M, Xin X, Uy EJ, Sparks JA, Karlson EW, Thumboo J. Improving sensitivity of the connective tissue disease screening questionnaire: A comparative study of various scoring methods. Lupus 2020; 30:35-44. [PMID: 33092467 DOI: 10.1177/0961203320966378] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Early detection of autoimmune rheumatic diseases is crucial given their high morbidity and mortality and short window of opportunity to improve patient outcomes. Self-administered screening questionnaires such as the connective tissue disease screening questionnaire (CSQ) have been shown to promote early detection of autoimmune rheumatic diseases. However, optimal scoring of screening questionnaires may differ with prevalence of clinical features and changes in classification criteria. We compared the performance of 3 scoring methods for the CSQ for early detection of autoimmune rheumatic diseases in a multi-ethnic Asian population. METHODS Patients who were newly referred for evaluation of possible autoimmune rheumatic diseases were invited to answer the cross-culturally adapted CSQ. Detection of autoimmune rheumatic diseases using 1) the original CSQ scoring, 2) a modified CSQ scoring and 3) a scoring based on current classification criteria, were compared to classification of autoimmune rheumatic diseases by classification criteria. RESULTS Of 819 participants, 85 were classified as having autoimmune rheumatic diseases screened for by the adapted CSQ. The original CSQ scoring yielded relatively lower sensitivities in detecting both any and individual autoimmune rheumatic diseases (67% and 20-57%, respectively) compared to the modified CSQ scoring (81% and 60-73%, respectively) and the scoring based on current classification criteria (89% and 50-88%, respectively). CONCLUSION The adapted CSQ with the classification criteria-based scoring achieved relatively high sensitivities in detecting autoimmune rheumatic diseases, suggesting this could be employed as the first step in population screening.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Xiaohui Xin
- Academic Clinical Program for Medicine, Singapore General Hospital, Singapore, Singapore
| | - Elenore Jb Uy
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Jeffrey A Sparks
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Elizabeth W Karlson
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Tsouris Z, Liaskos C, Dardiotis E, Scheper T, Tsimourtou V, Meyer W, Hadjigeorgiou G, Bogdanos DP. A comprehensive analysis of antigen-specific autoimmune liver disease related autoantibodies in patients with multiple sclerosis. Auto Immun Highlights 2020; 11:7. [PMID: 32308974 PMCID: PMC7147023 DOI: 10.1186/s13317-020-00130-4] [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] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/28/2020] [Indexed: 01/14/2023]
Abstract
Introduction Abnormal liver function tests are frequently seen in patients with multiple sclerosis (MS) and their origin at times is attributed to the possible co-occurrence or the de novo induction of autoimmune liver diseases (AILD), namely autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), but comprehensive analysis of AILD-related autoantibody has not been carried out. Aim To assess the presence of AILD-related autoantibodies in a well-defined cohort of MS patients, and to assess their clinical significance. Materials and methods 133 MS (93 female) patients (102 RRMS, 27 SPMS, and 5 PPMS), mean age 42.7 ± 11.9 SD years, mean duration of disease 11.2 ± 7.2 years were studied. 150 age and sex-matched healthy individuals were tested as normal controls (NCs).Autoantibody testing was performed by indirect immunofluorescence (IF) using triple tissue and HEp-2, a multiparametric line immunoassay detecting anti-LKM1(anti-CYP2D6), anti-LC1(anti-FTCD), soluble liver antigen/liver-pancreas(anti-SLA/LP), AMA-M2, and AMA-MIT3 (BPO), PBC-specific ANA (anti-gp210, anti-sp100 and anti-PML), and ELISA for anti-F-actin SMA and anti-dsDNA antibodies. Results Reactivity to at least one autoantibody was more frequent in MS patients compared to NCs (30/133, 22.6% vs 12/150, 8%) NCs (p = 0.00058). SMAs by IIF were more frequent in MS patients (18/133, 13.53%) compared to NCs (6/150, 4%, p = 0.002%). The AIH-1 related anti-F-actin SMA by ELISA were present in 21 (15.8%), at relatively low titres (all but three of the SMA-VG pattern by IF); anti-dsDNA in 3 (2.3%), and anti-SLA/LP in none; AIH-2 anti-LKM1 autoantibodies in 1 (0.8%, negative by IF), and anti-LC1 in none; PBC-specific AMA-M2 in 2 (1.5%, both negative for AMA-MIT3 and AMA by IF) and PBC-specific ANA anti-PML in 6 (4.5%), anti-sp100 in 1 (0.8%) and anti-gp210 in 1 (0.8%). Amongst the 30 MS patients with at least one autoantibody positivity, only 4 (3%) had overt AILD (2 AIH-1 and 2 PBC). Autoantibody positivity did not differ between naïve MS patients and patients under treatment. Conclusions Despite the relatively frequent presence of liver autoantibodies, tested either by IF or molecular assays, overt AILD is rather infrequent discouraging autoantibody screening strategies of MS patients in the absence of clinical suspicion.
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Affiliation(s)
- Zisis Tsouris
- 1Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Liaskos
- 2Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa 40500 Greece
| | - Efthymios Dardiotis
- 1Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Thomas Scheper
- Institute of Experimental Immunology, Affiliated to EUROIMMUN AG, Lubeck, Germany
| | - Vana Tsimourtou
- 1Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Wolfgang Meyer
- Institute of Experimental Immunology, Affiliated to EUROIMMUN AG, Lubeck, Germany
| | - George Hadjigeorgiou
- 1Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,4Department of Neurology, University of Nicosia, Nicosia, Cyprus
| | - Dimitrios P Bogdanos
- 2Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa 40500 Greece
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Ganapati A, Arunachal G, Arya S, Shanmugasundaram D, Jeyaseelan L, Kumar S, Danda S, Danda D. Study of familial aggregation of autoimmune rheumatic diseases in Asian Indian patients with systemic lupus erythematosus. Rheumatol Int 2019; 39:2053-60. [PMID: 31263994 DOI: 10.1007/s00296-019-04355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Systemic lupus erythematosus (SLE) and other autoimmune rheumatic diseases (AIRD) tend to co-aggregate in families, making positive familial history a risk factor. We aimed to estimate familial aggregation of AIRD in SLE patients and to compare between ones having a positive and negative family history of autoimmunity in our cohort. We included families of 157 consecutive SLE patients in a hospital-based, cross-sectional design for a three-generation pedigree study. Clinical and laboratory parameters of these patients were recorded. AIRD was seen in families of 39 SLE patients amounting to a familial prevalence of 24.8% [95% confidence interval (CI) 18.1, 31.6] with a relative risk (λ) of 4.3 for first-degree relatives (FDRs) and 1.1 for second-degree relatives (SDRs). SLE was the commonest AIRD seen in families of 19 patients with a familial prevalence of 12.1% (95% CI 7.0, 17.2) and λ of 78.2 for FDRs and 18.1 for SDRs. AIRD as a whole and SLE alone were seen more commonly with parental consanguinity (p < 0.05). Familial aggregation in SLE patients also showed a relatively higher percentage of affected males and lesser presentation with constitutional features (p < 0.05) than sporadic SLE patients. Rheumatoid arthritis (RA) was the second most common AIRD seen in 16/39 (41%) families with a RR of 3.1 in FDRs of SLE patients. In conclusion, Asian Indian SLE patients seem to have a high familial aggregation of AIRD, which is more pronounced in the background of parental consanguinity. SLE is the commonest AIRD seen amongst FDRs and SDRs of SLE patients, followed by RA, with FDRs being at highest risk.
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Williams D, Webber J, Pell B, Grant A, Sanders J, Choy E, Edwards A, Taylor A, Wu MC, Phillips R. "Nobody knows, or seems to know how rheumatology and breastfeeding works": Women's experiences of breastfeeding whilst managing a long-term limiting condition - A qualitative visual methods study. Midwifery 2019; 78:91-96. [PMID: 31404778 PMCID: PMC6750183 DOI: 10.1016/j.midw.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/21/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 11/30/2022]
Abstract
Background Only around 1% of babies in the UK are breastfed exclusively until six months of age as recommended by the World Health Organisation. One in ten women who have recently given birth in the UK have a long-term illness and they are at increased risk of stopping breastfeeding early. We considered women with autoimmune rheumatic diseases as an exemplar group of long term illnesses, to explore the barriers and enablers to breastfeeding Aim To understand the experiences of infant feeding among women with autoimmune rheumatic diseases and to identify potential barriers and enablers. Design Qualitative visual timeline-facilitated interviews. Participants and setting 128 women with autoimmune rheumatic diseases who were considering pregnancy, pregnant, or had young children took part in an online survey as part of the STAR Family Study. Of these, 13 women who had children were purposefully sampled to be interviewed. Interviews took place in person or on the telephone. Timeline-facilitated interviews were used to focus on lived experiences and topics important to the women, including early parenting. We conducted a focused thematic analysis of women's lived experiences of infant feeding. Results Three main themes were identified in relation to breastfeeding: lack of information about medication safety, lack of support in decision-making and maintaining breastfeeding, and maternal guilt. Conclusions Women with autoimmune rheumatic diseases found it difficult to access the information they needed about medications to make informed decisions about breastfeeding. They often also felt pressurised into breastfeeding and experienced feelings of guilt if they were unable, or did not wish to breastfeed. Tailored interventions are required that adopt a non-judgmental and person-centred approach to support decision-making in regard to infant feeding, providing women with information that can best enable them to make infant feeding choices.
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Affiliation(s)
- Denitza Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
| | - Jessica Webber
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Bethan Pell
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ernest Choy
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann Taylor
- Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Meng-Chieh Wu
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhiannon Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Phillips R, Pell B, Grant A, Bowen D, Sanders J, Taylor A, Edwards A, Choy E, Williams D. Identifying the unmet information and support needs of women with autoimmune rheumatic diseases during pregnancy planning, pregnancy and early parenting: mixed-methods study. BMC Rheumatol 2018; 2:21. [PMID: 30886972 PMCID: PMC6390539 DOI: 10.1186/s41927-018-0029-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 12/21/2017] [Accepted: 06/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background Autoimmune rheumatic diseases (ARDs) such as inflammatory arthritis and Lupus, and many of the treatments for these diseases, can have a detrimental impact on fertility and pregnancy outcomes. Disease activity and organ damage as a result of ARDs can affect maternal and foetal outcomes. The safety and acceptability of hormonal contraceptives can also be affected. The objective of this study was to identify the information and support needs of women with ARDs during pregnancy planning, pregnancy and early parenting. Methods This mixed methods study included a cross-sectional online survey and qualitative narrative interviews. The survey was completed by 128 women, aged 18–49 in the United Kingdom with an ARD who were thinking of getting pregnant in the next five years, who were pregnant, or had young children (< 5 years old). The survey assessed quality-of-life and information needs (Arthritis Impact Measurement Scale Short Form and Educational Needs Assessment Tool), support received, what women found challenging, what was helpful, and support women would have liked. From the survey participants, a maximum variation sample of 22 women were purposively recruited for qualitative interviews. Interviews used a person-centered participatory approach facilitated by visual methods, which enabled participants to reflect on their experiences. Interviews were also carried out with seven health professionals purposively sampled from primary care, secondary care, maternity, and health visiting services. Results Survey findings indicated an unmet need for information in this population (ENAT total mean 104.85, SD 30.18). Women at the pre-conception stage reported higher needs for information on pregnancy planning, fertility, giving birth, and breastfeeding, whereas those who had children already expressed a higher need for information on pain and mobility. The need for high quality information, and more holistic, multi-disciplinary, collaborative, and integrated care consistently emerged as themes in the survey open text responses and interviews with women and health professionals. Conclusions There is an urgent need to develop and evaluate interventions to better inform, support and empower women of reproductive age who have ARDs as they navigate the complex challenges that they face during pregnancy planning, pregnancy and early parenting. Electronic supplementary material The online version of this article (10.1186/s41927-018-0029-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rhiannon Phillips
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Bethan Pell
- 2Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Aimee Grant
- 2Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Daniel Bowen
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- 3School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Taylor
- 4Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ernest Choy
- 5Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Denitza Williams
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Dassouki T, Benatti FB, Pinto AJ, Roschel H, Lima FR, Augusto K, Pasoto S, Pereira RMR, Gualano B, de Sá Pinto AL. Objectively measured physical activity and its influence on physical capacity and clinical parameters in patients with primary Sjögren's syndrome. Lupus 2016; 26:690-697. [PMID: 27798360 DOI: 10.1177/0961203316674819] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective The objectives of this paper are to objectively measure habitual physical activity levels in patients with primary Sjögren's syndrome (pSS) with mild disease activity and to determine to which extent it may be associated with physical capacity and function and clinical features. Methods In this cross-sectional study, 29 women with pSS were objectively assessed for habitual physical activity levels (using accelerometry) and compared with 20 healthy women (CTRL) frequency-matched for physical activity levels, age, body mass index, and body fat percentage with regard to physical capacity and function, fatigue, depression, pain, and health-related quality of life. Results pSS showed 8.5 min/day of moderate-to-vigorous physical activity (MVPA) when only MVPA accumulated in bouts ≥ 10 min was considered; when considering total MVPA (including bouts < 10 min), average levels were 26.3 min/day, with 62% of pSS patients achieving the recommendation (≥ 21.4 min/day). Moreover, pSS showed lower VO2peak, lower muscle strength and function, higher fatigue, and poorer health-related quality of life when compared with CTRL ( p < 0.05). These differences (except for aerobic capacity) were sustained even when only individuals achieving the minimum of 21.4 min/day of total MVPA in both groups were compared. Finally, MVPA time was significantly correlated with aerobic conditioning, whereas total counts and sedentary time were associated with lower-body muscle strength and the bodily-pain domain of SF-36 in patients with pSS. Conclusion When compared to physical activity-matched healthy controls, pSS patients showed reduced physical capacity and function, increased fatigue and pain, and reduced health-related quality of life. Except for aerobic conditioning, these differences were sustained when only more physically active participants were compared, indicating that minimum recommended levels of physical activity for the general population may not be sufficient to counteract pSS comorbidities.
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Affiliation(s)
- T Dassouki
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - F B Benatti
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil.,2 Applied Physiology& Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - A J Pinto
- 2 Applied Physiology& Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - H Roschel
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil.,2 Applied Physiology& Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - F R Lima
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - K Augusto
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - S Pasoto
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - R M R Pereira
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - B Gualano
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil.,2 Applied Physiology& Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - A L de Sá Pinto
- 1 Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Abstract
The investigation of the patient with possible systemic autoimmune rheumatic disease is potentially one of the most challenging areas of rheumatology as the differential diagnosis is potentially very broad. The investigative approach should not only be directed at confirming the diagnosis of an autoimmune rheumatic disease but also at excluding as best as possible the major alternative diagnoses of malignancy and infection. A systematic approach should yield a positive diagnosis in the majority of cases based on excluding infection by appropriate cultures and serology, malignancy using imaging including 18-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT). The most important part of the assessment is the history, in particular covering systems that may not previously been assessed such as ears, nose, throat or eyes. The clue to the diagnosis of an autoimmune rheumatic disease often lies in detecting the multisystem nature of the condition and the cumulative effects of multiorgan involvement. Investigation may therefore need to cover different systems. Although stratified approaches have been described, they have not been subjected to a detailed investigation as to their effectiveness.
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Affiliation(s)
- Richard A Watts
- Ipswich Hospital NHS Trust, UK; Norwich Medical School, Norwich, UK.
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