scholarly journals POS1194 THE EFFECT OF SARS-COV-2 ON THE COURSE AND THE TREATMENT OF RHEUMATIC INFLAMMATORY DISEASES. EXPERIENCE FORM THE NORTHWESTERN GREECE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 879.1-879
Author(s):  
E. Pelechas ◽  
E. Kaltsonoudis ◽  
M. Migos ◽  
P. Karagianni ◽  
A. Kavvadias ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Hospital Stay ◽  
Rheumatic Diseases ◽  
Inflammatory Diseases ◽  
Immunosuppressive Treatment ◽  
Janus Kinase ◽  
Inflammatory Rheumatic Diseases ◽  
Low Grade ◽  
Low Oxygen ◽  
Mild Disease

Background:COVID-19 has been shown to significantly affect the vulnerable population [1,2]. Among them, patients suffering from inflammatory rheumatic diseases, and especially the immunosuppressed [3].Objectives:to assess the effect of SARS-CoV-2 on the course and the treatment of rheumatic inflammatory diseases.Methods:from February to December 2020, 46 patients with inflammatory rheumatic diseases were included (32 female) that got infected with the SARS-CoV-2. Mean age was 65 years old, 17 were smokers, 12 had arterial hypertension, 8 diabetes mellitus, and 3 hypothyroidism. Most of them had their comorbidities well-controlled and their rheumatic disease was in remission. More specifically, 24 patients had rheumatoid arthritis, 13 psoriatic arthritis, and 9 ankylosing spondylitis. All patients were under treatment with conventional synthetic (cs) and/or biological (b) disease-modifying anti-rheumatic drugs (DMARDs), while 7 of them were also on treatment with glucocorticoids (GC) (<5mg/day). Twenty-eight patients were on tumor necrosis alpha (TNF-α) inhibitors (19 as monotherapy), 4 on anti- interleukin (IL)-6 monotherapy, 3 on Janus Kinase (JAK) inhibitors plus on low dose methotrexate (MTX), and the rest (11 patients) were on a csDMARD with or without GCs.Results:positive patients with the SARS-CoV-2, instructed to discontinue their immunosuppressive treatment, except GCs that were adjusted for their disease. Most patients (37 out of 46) had a mild disease course and their symptomatology was nothing more than a simple flu-like syndrome. Furthermore, on 9 of them olfactory dysfunction and gastrointestinal manifestations as well as low grade fever were noted but without the need of a hospital admission. On the other hand, only 5 patients needed hospitalization (2 on MTX monotherapy and 3 on combination therapy) due to dyspnea with low oxygen saturation (hypoxemia) and high fever. From those 5, 3 had a short in-hospital stay, while 2 developed pneumonia and a longer in-hospital stay was required in order to get the appropriate treatment. None of the patients did not require an intensive care unit admission. Finally, in 14 patients that got infected from February to May 2020, viral antibodies had been measured. All patients had high titres of IgG antibodies in their serum for as long as six months after their infection. Of note, none of the infected patients were smokers.Conclusion:patients with rheumatic diseases that are in remission using low doses of GCs and DMARDs, have almost the same chances with the general population to have a serious course of their infection with the SARS-Cov-2. In addition, in these patients, the immune response appears to be adequate, both in the production and maintenance of antibodies, which appear to be maintained for at least 6 months after infection.References:[1]Patel JA, Nielsen FBH, Badiani AA, Assi S, Unadkat VA, Patel B, et al. Poverty, inequality and COVID-19: the forgotten vulnerable. Public Health. 2020;183:110-111. Doi: 10.1016/j.puhe.2020.05.006.[2]Poteat T, Millet GA, Nelson LE, Beyrer C. Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics. Ann Epidemiol. 2020;47:1-3. Doi: 10.1016/j.annepidem.2020.05.004.[3]Gianfrancesco MA, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Mateus EF, et al. Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registries. Lancet Rheumatol. 2020;2(5):e250-e253. Doi: 10.1016/S2665-9913(20)30095-3.Disclosure of Interests:None declared.

Comorbidities of rheumatic disease

2013 ◽  
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Physical Inactivity ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

BARICITINIB: NEW PHARMACOTHERAPY OPTIONS FOR RHEUMATOID ARTHRITIS AND OTHER IMMUNE-MEDIATED INFLAMMATORY RHEUMATIC DISEASES

2020 ◽  
Vol 58 (3) ◽  
pp. 304-316
Author(s):  
E. L. Nasonov ◽  
A. M. Lila
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatic Diseases ◽  
Janus Kinase ◽  
Inflammatory Rheumatic Diseases ◽  
Jak Inhibitors ◽  
Oral Medications ◽  
Immune Mediated ◽  
Wide Range ◽  
Promising Area ◽  
Medical Advances

Deciphering the mechanisms of the pathogenesis of immune-mediated inflammatory rheumatic diseases (IMIRDs) in conjunction with designing a wide range of biological agents is one of the major medical advances in the 21st century. A new promising area of pharmacotherapy for IMIRDs is associated with the design of the so-called targeted oral medications that primarily include Janus kinase (JAK) inhibitors. The review presents new data on the efficacy and safety of the new JAK inhibitor baricitinib in treating rheumatoid arthritis and other IMIRDs.

scholarly journals Favourable antibody responses to human coronaviruses in children and adolescents with autoimmune rheumatic diseases

2021 ◽  
Author(s):  
Claire T. Deakin ◽  
Georgina H. Cornish ◽  
Kevin W. Ng ◽  
Nikhil Faulkner ◽  
William Bolland ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Immunosuppressive Treatment ◽  
Immune Dysfunction ◽  
Inflammatory Rheumatic Diseases ◽  
Igg Antibodies ◽  
Autoimmune Rheumatic Diseases ◽  
Human Coronaviruses ◽  
The Impact

AbstractDifferences in humoral immunity to coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), between children and adults remain unexplained and the impact of underlying immune dysfunction or suppression unknown. Here, we examined the antibody immune competence of children and adolescents with prevalent inflammatory rheumatic diseases, juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM) and juvenile systemic lupus erythematosus (JSLE), against the seasonal human coronavirus (HCoV)-OC43 that frequently infects this age group. Despite immune dysfunction and immunosuppressive treatment, JIA, JDM and JSLE patients mounted comparable or stronger responses than healthier peers, dominated by IgG antibodies to HCoV-OC43 spike, and harboured IgG antibodies that cross-reacted with SARS-CoV-2 spike. In contrast, responses to HCoV-OC43 and SARS-CoV-2 nucleoproteins exhibited delayed age-dependent class-switching and were not elevated in JIA, JDM and JSLE patients, arguing against increased exposure. Consequently, autoimmune rheumatic diseases and their treatment were associated with a favourable ratio of spike to nucleoprotein antibodies.

scholarly journals Janus kinase inhibitors in immuno-inflammatory rheumatic diseases: new opportunities and prospects

2019 ◽  
Vol 57 (1) ◽  
pp. 8-16 ◽  
Author(s):  
E. L. Nasonov ◽  
A. M. Lila
Keyword(s):  
Rheumatic Diseases ◽  
Kinase Inhibitors ◽  
Population Level ◽  
Janus Kinase ◽  
Signal Molecules ◽  
Inflammatory Rheumatic Diseases ◽  
Great Success ◽  
Medical Problems ◽  
Synthetic Drugs ◽  
Reduction Of Mortality

Despite the great success in the diagnosis and treatment of immuno-inflammatory rheumatic diseases (IIRD), which led to a significant improvement in the prognosis in many patients, the fundamental medical problems of this pathology – the restoration of quality of life and reduction of mortality to the population level – are far from solution. This served as a powerful impetus to the study of new approaches to pharmacotherapy of IIRD, one of which is associated with the use of low-molecular synthetic drugs that inhibit intracellular "signal" molecules-Janus kinase (JAK), the socalled Jakinibs. The current achievements and trends concerning the use of JAK inhibitors in the treatment of IIRD are considered.

scholarly journals New directions of pharmacotherapy of immune - inflammatory rheumatic diseases

2019 ◽  
Vol 91 (8) ◽  
pp. 98-107 ◽  
Author(s):  
E L Nasonov
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Kinase Inhibitors ◽  
Systemic Vasculitis ◽  
Janus Kinase ◽  
Inflammatory Rheumatic Diseases ◽  
Dramatic Improvement ◽  
Janus Kinase Inhibitors ◽  
Autoimmune Pathology ◽  
Factor Α

Deciphering immunopathogenesis, expanding the scope of diagnostics and developing new methods for treating human autoimmune diseases are among the priority areas of XXI century medicine. Particularly widely autoimmune pathology is presented in immunoinflammatory rheumatic diseases (IIRD), such as rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, systemic vasculitis associated with the synthesis of antineutrophilic cytoplasmic antibodies, Sjogren's syndrome, idiopathic inflammatory myopathies and other other types of others. Deciphering the pathogenesis mechanisms of IIRD created the prerequisites for improving pharmacotherapy, which in the future should lead to a dramatic improvement in the prognosis for these diseases. The review discusses new approaches to IIRD pharmacotherapy associated with the inhibition of tumor necrosis factor-α, interleukin-6 (IL-6), IL-1β, IL-17, IL-23, and the prospects for using Janus kinase inhibitors, depending on the prevailing pathogenesis mechanisms - autoimmunity or autoinflammation.

Comorbidities of rheumatic disease

2015 ◽  
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Physical Inactivity ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

Comorbidities of rheumatic disease

2013 ◽  
pp. 243-250
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact ◽  
Index Disease

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. The concept of ‘multimorbidity’ is being used increasingly, shifting the focus from the index disease to two or more chronic diseases that exist in the same individual. In this chapter, we discuss the impact of multi/comorbidities. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

scholarly journals Reactivation of hepatitis B virus infection in rheumatic diseases: risk and management considerations

2020 ◽  
Vol 12 ◽  
pp. 1759720X2091264 ◽  
Author(s):  
Christos Koutsianas ◽  
Konstantinos Thomas ◽  
Dimitrios Vassilopoulos
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Rheumatic Diseases ◽  
Antiviral Treatment ◽  
Immunosuppressive Treatment ◽  
Immunosuppressive Drugs ◽  
Janus Kinase ◽  
Virus Reactivation ◽  
Specific Risk ◽  
B Virus

In patients with rheumatic diseases undergoing immunosuppressive treatment, hepatitis B virus reactivation (HBVr) has been long recognized as a major treatment-related adverse event with substantial morbidity and mortality. Because HBVr is easily preventable with appropriate screening and monitoring strategies, and, when indicated, prophylactic antiviral treatment, awareness of this complication is of the utmost importance, especially in the era of biologic treatments. As a condition, it continues to be topical, in view of the emergence of novel classes of immunosuppressive drugs (i.e. Janus kinase inhibitors) acquiring licenses for a variety of rheumatic diseases. The class-specific risk of these agents for HBVr has not yet been determined. Moreover, ambiguity still exists for the management of patients planned to be treated with traditional agents, such as cyclophosphamide and glucocorticoids, particularly in the setting of resolved HBV infection. Clinicians in the field of rheumatic diseases should be tailoring their practice according to the host’s profile and treatment-specific risk for HBVr. In this review, the authors attempt to critically review the existing literature and provide practical advice on these issues.

scholarly journals THE ASSESSMENT OF TUBERCULOSIS IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES TREATED WITH BLOCKERS OF THE TUMORAL NECROSIS ALPHA FACTOR: A RETROSPECTIVE OBSERVATIONAL MULTICENTRE STUDY

2015 ◽  
Vol 24 (3) ◽  
pp. 166-172
Author(s):  
Ileana Filipescu ◽  
◽  
Sorana D. Bolboaca ◽  
Doina Baltariu ◽  
Liana Chicea ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Rheumatic Diseases ◽  
Rural Areas ◽  
Inflammatory Diseases ◽  
Observational Research ◽  
Inflammatory Rheumatic Diseases ◽  
Tnf Inhibitor ◽  
Mycobacterium Tuberculosis Infection ◽  
Test Reaction ◽  
Psoriatic Arthropathy

Aim. To achieve extensive information (regional) in relation with the tuberculosis identified in current clinical practice in patients with inflammatory rheumatic diseases treated with biological agents. Patients and methods. Twenty seven rheumatologists from 11 Romanian medicale center agreed to participate voluntarily and provide required data on tuberculosis (TB) occurring between January 1999 and June 2011 in their patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthropathy (PsA) in relation with anti-TNFα agent. This observational research included 693 patients (RA n=492, SA n=137, AP n= 64). All patients were screen for latent Mycobacterium tuberculosis infection (LTBI) before they start anti-TNFα treatment. Chemoprophylaxis with isoniazid before anti-TNFα therapy is recommended if the diameter of tuberculin skin test reaction is more than 5 mm (before 2005 only if indurations was more than 10 mm). We recorded the demographic characteristics, and complex information about disease, treatment, tuberculosis diagnosis and the comorbidities. Incidence rate of TB are presented as events/1,000 person-years with associated 95% confidence interval [95%CI]. Results. Fifteen patients were diagnosed with TB, most (60%) were born in rural areas and 40% in areas with higher incidence (≥ 80%ooo) of TB. The incidence of TB was 1.65‰ (IC95% [11.54-34.63]). The extra pulmonary sites were present in 53.3% of the cases. Cultures were positive for Mycobacterium tuberculosis in 11 cases (73.3%). Suspicion of TB was confirmed histological in 6 cases (40%). The average duration of developing TB after initiation of TNF inhibitor was 23.26 months (range one month to 120 months). In 7/12 TB cases treated with IFX the incidence appeared in the first year of treatment. Any of known risk factors don’t have a significant influence in our cohort. Conclusions. The risk of reactivation of a latent TB during biologic therapy is greater in patients with rheumatic inflammatory diseases living in geographical areas with high endemicity of TB infection. Reduced compliance to chemoprophylaxis may be responsible for the occurrence of these cases.

scholarly journals Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001925
Author(s):  
Jose María Álvaro Gracia ◽  
Carlos Sanchez-Piedra ◽  
Javier Manero ◽  
María Ester Ruiz-Lucea ◽  
Laura López-Vives ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Targeted Therapies ◽  
Disease Diagnosis ◽  
Sociodemographic Factors ◽  
Inflammatory Rheumatic Diseases ◽  
Increased Risk ◽  
Related Hospitalisation ◽  
Observational Cohort ◽  
Synthetic Dmards

ObjectivesTo analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases.MethodsThe COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed.ResultsA total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients’ hospitalisation.ConclusionsThe use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.

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