scholarly journals Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001987
Author(s):  
Hannah Bower ◽  
Thomas Frisell ◽  
Daniela di Giuseppe ◽  
Bénédicte Delcoigne ◽  
Gerd-Marfie Ahlenius ◽  
...  
Keyword(s):  
Joint Diseases ◽  
Care Provision ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Inflammatory Joint Diseases ◽  
Relative Risks ◽  
Increased Risk ◽  
Related Hospitalisation ◽  
Cohort Study Design ◽  
Disease Modifying

ObjectivesTo compare risks for COVID-19-related outcomes in inflammatory joint diseases (IJDs) and across disease-modifying antirheumatic drugs (DMARDs) during the first two waves of the pandemic and to assess effects of the pandemic on rheumatology care provision.MethodsThrough nationwide multiregister linkages and cohort study design, we defined IJD and DMARD use annually in 2015–2020. We assessed absolute and relative risks of hospitalisation or death listing COVID-19. We also assessed the incidence of IJD and among individuals with IJD, rheumatologist visits, DMARD use and incidence of selected comorbidities.ResultsBased on 115 317 patients with IJD in 2020, crude risks of hospitalisation and death listing COVID-19 (0.94% and 0.33% across both waves, respectively) were similar during both waves (adjusted HR versus the general population 1.33, 95% CI 1.23 to 1.43, for hospitalisation listing COVID-19; 1.23, 95% CI 1.08 to 1.40 for death listing COVID-19). Overall, biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) did not increase risks of COVID-19 related hospitalisation (with the exception of a potential signal for JAK inhibitors) or death. During the pandemic, decreases were observed for IJD incidence (−7%), visits to rheumatology units (−16%), DMARD dispensations (+6.5% for bDMARD/tsDMARDs and −8.5% for conventional synthetic DMARDs compared with previous years) and for new comorbid conditions, but several of these changes were part of underlying secular trends.ConclusionsPatients with IJD are at increased risk of serious COVID-19 outcomes, which may partially be explained by medical conditions other than IJD per se. The SARS-CoV-2 pandemic has exerted measurable effects on aspects of rheumatology care provision demonstrated, the future impact of which will need to be assessed.

scholarly journals Influenza outcomes in patients with inflammatory joint diseases and DMARDs: how do they compare to those of COVID-19?

2021 ◽  
pp. annrheumdis-2021-221461
Author(s):  
Hannah Bower ◽  
Thomas Frisell ◽  
Daniela Di Giuseppe ◽  
Bénédicte Delcoigne ◽  
Johan Askling
Keyword(s):  
General Population ◽  
Seasonal Influenza ◽  
Cox Regression ◽  
Joint Diseases ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Inflammatory Joint Diseases ◽  
Relative Risks ◽  
Synthetic Dmards ◽  
Disease Modifying

ObjectivesTo estimate absolute and relative risks for seasonal influenza outcomes in patients with inflammatory joint diseases (IJDs) and disease-modifying antirheumatic drugs (DMARDs). To contextualise recent findings on corresponding COVID-19 risks.MethodsUsing Swedish nationwide registers for this cohort study, we followed 116 989 patients with IJD and matched population comparators across four influenza seasons (2015–2019). We quantified absolute risks of hospitalisation and death due to influenza, and compared IJD to comparators via Cox regression. We identified 71 556 patients with IJD on active treatment with conventional synthetic DMARDs and biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drug (tsDMARDs) at the start of each influenza season, estimated risks for the same outcomes and compared these risks across DMARDs via Cox regression.ResultsPer season, average risks for hospitalisation listing influenza were 0.25% in IJD and 0.1% in the general population, corresponding to a crude HR of 2.38 (95% CI 2.21 to 2.56) that decreased to 1.44 (95% CI 1.33 to 1.56) following adjustments for comorbidities. For death listing influenza, the corresponding numbers were 0.015% and 0.006% (HR=2.63, 95% CI 1.93 to 3.58, and HR=1.46, 95% CI 1.07 to 2.01). Absolute risks for influenza outcomes were half (hospitalisation) and one-tenth (death) of those for COVID-19, but relative estimates comparing IJD to the general population were similar.ConclusionsIn absolute terms, COVID-19 in IJD outnumbers that of average seasonal influenza, but IJD entails a 50%–100% increase in risk for hospitalisation and death for both types of infections, which is largely dependent on associated comorbidities. Overall, bDMARDs/tsDMARDs do not seem to confer additional risk for hospitalisation or death related to seasonal influenza.

scholarly journals Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study

2021 ◽  
pp. annrheumdis-2021-219845
Author(s):  
Hannah Bower ◽  
Thomas Frisell ◽  
Daniela Di Giuseppe ◽  
Bénédicte Delcoigne ◽  
Gerd-Marie Ahlenius ◽  
...  
Keyword(s):  
Intensive Care ◽  
General Population ◽  
Cox Regression ◽  
Joint Diseases ◽  
Antirheumatic Drugs ◽  
Inflammatory Joint Diseases ◽  
Relative Risks ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Swedish Cohort

ObjectivesTo estimate absolute and relative risks for all-cause mortality and for severe COVID-19 in inflammatory joint diseases (IJDs) and with antirheumatic therapies.MethodsThrough Swedish nationwide multiregister linkages, we selected all adult patients with rheumatoid arthritis (RA, n=53 455 in March 2020), other IJDs (here: spondyloarthropathies, psoriatic arthritis and juvenile idiopathic arthritis, n=57 112), their antirheumatic drug use, and individually matched population referents. We compared annual all-cause mortality March–September 2015 through 2020 within and across cohorts, and assessed absolute and relative risks for hospitalisation, admission to intensive care and death due to COVID-19 March–September 2020, using Cox regression.ResultsDuring March–September 2020, the absolute all-cause mortality in RA and in other IJDs was higher than 2015–2019, but relative risks versus the general population (around 2 and 1.5) remained similar during 2020 compared with 2015–2019. Among patients with IJD, the risks of hospitalisation (0.5% vs 0.3% in their population referents), admission to intensive care (0.04% vs 0.03%) and death (0.10% vs 0.07%) due to COVID-19 were low. Antirheumatic drugs were not associated with increased risk of serious COVID-19 outcomes, although for certain drugs, precision was limited.ConclusionsRisks of severe COVID-19-related outcomes were increased among patients with IJDs, but risk increases were also seen for non-COVID-19 morbidity. Overall absolute and excess risks are low and the level of risk increases are largely proportionate to those in the general population, and explained by comorbidities. With possible exceptions, antirheumatic drugs do not have a major impact on these risks.

scholarly journals Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry

2021 ◽  
pp. annrheumdis-2021-221490
Author(s):  
Pedro M Machado ◽  
Saskia Lawson-Tovey ◽  
Anja Strangfeld ◽  
Elsa F Mateus ◽  
Kimme L Hyrich ◽  
...  
Keyword(s):  
Musculoskeletal Diseases ◽  
Connective Tissue Diseases ◽  
Vaccine Safety ◽  
Joint Diseases ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Biological Dmards ◽  
Inflammatory Joint Diseases ◽  
Disease Modifying ◽  
Medication Changes

ObjectivesTo describe the safety of vaccines against SARS-CoV-2 in people with inflammatory/autoimmune rheumatic and musculoskeletal disease (I-RMD).MethodsPhysician-reported registry of I-RMD and non-inflammatory RMD (NI-RMDs) patients vaccinated against SARS-CoV-2. From 5 February 2021 to 27 July 2021, we collected data on demographics, vaccination, RMD diagnosis, disease activity, immunomodulatory/immunosuppressive treatments, flares, adverse events (AEs) and SARS-CoV-2 breakthrough infections. Data were analysed descriptively.ResultsThe study included 5121 participants from 30 countries, 90% with I-RMDs (n=4604, 68% female, mean age 60.5 years) and 10% with NI-RMDs (n=517, 77% female, mean age 71.4). Inflammatory joint diseases (58%), connective tissue diseases (18%) and vasculitis (12%) were the most frequent diagnostic groups; 54% received conventional synthetic disease-modifying antirheumatic drugs (DMARDs), 42% biological DMARDs and 35% immunosuppressants. Most patients received the Pfizer/BioNTech vaccine (70%), 17% AstraZeneca/Oxford and 8% Moderna. In fully vaccinated cases, breakthrough infections were reported in 0.7% of I-RMD patients and 1.1% of NI-RMD patients. I-RMD flares were reported in 4.4% of cases (0.6% severe), 1.5% resulting in medication changes. AEs were reported in 37% of cases (37% I-RMD, 40% NI-RMD), serious AEs in 0.5% (0.4% I-RMD, 1.9% NI-RMD).ConclusionThe safety profiles of SARS-CoV-2 vaccines in patients with I-RMD was reassuring and comparable with patients with NI-RMDs. The majority of patients tolerated their vaccination well with rare reports of I-RMD flare and very rare reports of serious AEs. These findings should provide reassurance to rheumatologists and vaccine recipients and promote confidence in SARS-CoV-2 vaccine safety in I-RMD patients.

scholarly journals Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity in patients with inflammatory rheumatic and musculoskeletal diseases

2021 ◽  
Vol 80 (10) ◽  
pp. 1255-1265 ◽  
Author(s):  
Marcia A Friedman ◽  
Jeffrey R Curtis ◽  
Kevin L Winthrop
Keyword(s):  
Musculoskeletal Diseases ◽  
Janus Kinase ◽  
Vaccine Response ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Substantial Impact ◽  
Vaccination Recommendations ◽  
Increased Risk ◽  
Disease Modifying ◽  
Vaccine Immunogenicity

Patients with rheumatic diseases are at increased risk of infectious complications; vaccinations are a critical component of their care. Disease-modifying antirheumatic drugs may reduce the immunogenicity of common vaccines. We will review here available data regarding the effect of these medications on influenza, pneumococcal, herpes zoster, SARS-CoV-2, hepatitis B, human papilloma virus and yellow fever vaccines. Rituximab has the most substantial impact on vaccine immunogenicity, which is most profound when vaccinations are given at shorter intervals after rituximab dosing. Methotrexate has less substantial effect but appears to adversely impact most vaccine immunogenicity. Abatacept likely decrease vaccine immunogenicity, although these studies are limited by the lack of adequate control groups. Janus kinase and tumour necrosis factor inhibitors decrease absolute antibody titres for many vaccines, but do not seem to significantly impact the proportions of patients achieving seroprotection. Other biologics (interleukin-6R (IL-6R), IL-12/IL-23 and IL-17 inhibitors) have little observed impact on vaccine immunogenicity. Data regarding the effect of these medications on the SARS-CoV-2 vaccine immunogenicity are just now emerging, and early glimpses appear similar to our experience with other vaccines. In this review, we summarise the most recent data regarding vaccine response and efficacy in this setting, particularly in light of current vaccination recommendations for immunocompromised patients.

High Levels of Polypharmacy in Rheumatoid Arthritis—A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study

2019 ◽  
pp. 089719001986915 ◽  
Author(s):  
Ana Paula M. Gomides ◽  
Cleandro P. Albuquerque ◽  
Ana B.V. Santos ◽  
Rodrigo B. C. Amorim ◽  
Manoel B. Bértolo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Real Life ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Cross Sectional ◽  
Rheumatic Arthritis ◽  
Increased Risk ◽  
Disease Modifying

Background: Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. Objective: To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. Methods: A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. Results: We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). Conclusion: We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.

scholarly journals A Case of Diverticular Perforation in a Young Patient with Rheumatoid Arthritis on Methotrexate

2015 ◽  
Vol 2015 ◽  
pp. 1-2 ◽  
Author(s):  
Ian Chang ◽  
Carla Guggenheim ◽  
Heather Laird-Fick
Keyword(s):  
Rheumatoid Arthritis ◽  
Dihydrofolate Reductase ◽  
Methylenetetrahydrofolate Reductase ◽  
Gastrointestinal Disease ◽  
Gastrointestinal Toxicity ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Increased Risk ◽  
Disease Modifying ◽  
Concomitant Exposure

Background. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), are associated with gastrointestinal toxicity. MTX inhibits dihydrofolate reductase, but it is unclear if polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene predict toxicity.Case. We describe a 33-year-old male with polyarticular rheumatoid arthritis who developed sigmoid diverticular perforation while receiving methotrexate, folic acid, prednisone, and naproxen. He tested heterozygous for the C677T alleleMTHFRgene.Discussion. Rheumatoid arthritis and its treatments are associated with increased risk of gastrointestinal disease. In one study, perforation was highest among individuals with concomitant exposure to NSAIDs, nonbiologic DMARDs, and glucocorticoids. Multiple mutations of theMTHFRgene have been identified, but their association with MTX toxicity is unclear. This case adds to a growing body of literature that could help inform the treatment of others in the future.

Incidence and factors related to SARS-CoV-2 infection in a cohort of patients with rheumatoid arthritis in Colombia during the COVID-19 pandemic v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Treatment Strategies ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Biological Dmards ◽  
Increased Risk ◽  
Systemic Glucocorticoids ◽  
Synthetic Dmards ◽  
Disease Modifying

Introduction:Patients with rheumatoid arthritis (RA) have an increased risk of SARS-CoV-2 infection due to intrinsic characteristics of the pathology and the medications used to treat it. Objective: To evaluate the incidence of and factors related to SARS-CoV-2 infection in patients with RA in Colombia. Materials and methods: This was an observational study of patients diagnosed with RA who were treated at a health care institution in Colombia. The study evaluated whether the patients presented SARS-CoV-2 infection and other clinical variables. Variables associated with the risk of SARS-CoV-2 infection were identified. Results: A total of 2,566 patients with RA were identified. They had a median age of 61.9 years, and 81.1% were women. They were mainly treated with synthetic disease-modifying antirheumatic drugs (DMARDs) (85.3%), glucocorticoids (52.2%) and biological DMARDs (26.8%). The incidence of SARS-CoV-2 infection was 5.1%, and the factors that increased the risk included treatment with synthetic DMARDs with or without biological DMARDs but with concomitant systemic glucocorticoids (OR: 2.18, 95% CI: 1.21-3.93 and OR: 1.69, 95% CI: 1.05-2.74, respectively) and receiving antidiabetic drugs (OR: 2.24, 95% CI: 1.27-3.94). A total of 20.8% of patients with COVID-19 required hospitalization, and 3.8% died. Conclusions: The incidence of COVID-19 is higher among patients with RA who receive DMARDs and glucocorticoids simultaneously or who have diabetes mellitus than among RA patients not receiving these drug combinations, which should guide treatment strategies.

scholarly journals FRI0112 RISK OF MALIGNANCY WITH NON-TNFI BIOLOGIC OR TOFACITINIB THERAPY IN RHEUMATOID ARTHRITIS: A META-ANALYSIS OF OBSERVATIONAL STUDIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 636.1-637
Author(s):  
W. Xie ◽  
X. Yang ◽  
Z. Zhang
Keyword(s):  
Rheumatoid Arthritis ◽  
Relative Risk ◽  
Observational Studies ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Non Melanoma Skin Cancer ◽  
Increased Risk ◽  
Cancer Types ◽  
Disease Modifying ◽  
Melanoma Skin

Background:With an increasing usage of non-TNFi biologics and tofacitinib, it is crucial to understand the comparative safety of these agents regarding malignancies risk.Objectives:We aim to assess the risk of developing cancer in patients with RA exposed to non- TNF inhibitors (TNFi) biologics or tofacitinib therapy.Methods:Systematical search of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed for observational studies that reported cancer incidence in patients with RA treated with biologics or tofacitinib with active comparator of conventional DMARDs (csDMARDs) or TNFi. The pooled relative risk (RR) and 95% confidence interval (CI) were calculated with fix-effects or random-effects model.Results:Of 2,819 identified articles, a total of 10 studies involving over 323,361 patients and 1,179,263 patient-years of follow-up were included. Pooled analysis showed there was no increased risk of developing cancer in general or specific cancer types in RA patients receiving treatment with rituximab (pooled RR 1.13, 95% CI 0.80-1.59), tocilizumab (pooled RR 0.96, 95% CI 0.83-1.11), or tofacitinib (pooled RR 0.97, 95% CI 0.66-1.43), compared with those receiving csDMARDs or TNFi. However, abatacept usage in RA was associated with a slightly increased overall cancer risk (pooled RR 1.13, 95% CI 1.02-1.24) and non-melanoma skin cancer (pooled RR 1.26, 95% CI 1.09-1.45), relative to csDMARDs or TNFi.Conclusion:Compared with csDMARDs or TNFi, there was no increased risk of malignancies among RA patients treated with non-TNFi biologics or tofacitinib, with exception of abatacept associated with slightly increased total cancer and specific caner types. Extended researches are required to confirm the findings in a real-world context.References:[1]Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76:960-977.Figure 1.Relative risk of developing cancer between rituximab and csDMARDs. (A) any cancer; (B) all cancer types excluding NMSC; (C) solid tumors; (D) hematological cancer; (E) NMSC; or (F) melanoma. csDMARDs: conventional synthetic disease-modifying antirheumatic drugs. NMSC: non-melanoma skin cancer.Disclosure of Interests:None declared

scholarly journals Obesity and Clinical Activity in Psoriatic Arthritis Patients Treated with Synthetic Disease-Modifying Antirheumatic Drugs

2021 ◽  
Vol 3 (9) ◽  
pp. 01-09
Author(s):  
Jose A. Pinto Tasende ◽  
Jose M. Lorenzo Alvarez ◽  
Carlota Iñiguez Ubiaga ◽  
Luis Fernández Dominguez ◽  
Carlos García Porrúa ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Corticosteroid Treatment ◽  
Response To Therapy ◽  
Clinical Activity ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Low Disease Activity ◽  
Increased Risk ◽  
Disease Modifying

Introduction: Comorbidities are prevalent in psoriatic arthritis (PsA) and which may affect disease activity and response to therapy. Aims: To evaluate comorbidities among patients with PsA naïve to biologics, and their association with basal inflammatory activity status, before starting them. Methods: We performed a retrospective cross-sectional a study of cohort of patients with PsA (CASPAR criteria), treated with synthetic disease-modifying antirheumatic drugs. Patients were managed according to EULAR/GRAPPA recommendations, and the collected variables included demographics, clinical, serological, classical CV risk factors, and treatment. Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis and clinical DAPSA scores. The tests were two-tailed, with a significance level of <0.05. Results: A total of 416 patients were included in the study: 222 maintained remission or low disease activity being treated without biologics, and 194 who needed to be treated with bDMARD because they did not response well to csDMARD. From patients who were waiting to start biologics, 38.1% had obesity and had increased risk of MetS for age > 50 years old (OR 3.287 [95%CI: 1.258-8.591], p 0.015) and CRP > 0.5 mgr/dL (OR 2.684 [95%CI: 1.141-6.313], p 0.024) but not for cDAPSA>13 (OR 1.539 [95%CI: 0.695-3.409], p 0.288). DAPSA score was higher in patients with obesity, 20.3 (14.4) vs 13.8 (8.5), p0.010 and these patients had an OR for cDAPSA>13 of 3.15 [95%CI: 1.07-9.25], p 0.037). Patients with obesity had a higher frequency of DAPSA and cDAPSA MoDA-HDA (p = 0.022; p = 0.032). In the linear logistic regression analysis, a high-moderate DAPSA score was associated with obesity (p = 0.017), CRP (p <0.0001), and cDAPSA score with obesity (0.029) but not with CRP (p = 0.748). Obesity and corticosteroid treatment were independent factors for cDAPSA>13 and the presence of enthesitis for cDAPSA≤13. Conclusion: PsA patients who did not respond well to csDMARD had a higher prevalence of MetS, associated with age > 50 years and CRP higher than normal values. The DAPSA score was higher in patients with obesity and corticosteroid treatment. Enthesitis was more frequent in patients with low disease activity by DAPSA score.

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