scholarly journals Organ Manifestation and Systematic Organ Screening at the Onset of Inflammatory Rheumatic Diseases

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 67
Author(s):  
Tobias Hoffmann ◽  
Peter Oelzner ◽  
Martin Busch ◽  
Marcus Franz ◽  
Ulf Teichgräber ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Clinical Laboratory ◽  
Connective Tissue Diseases ◽  
Diagnostic Algorithm ◽  
Small Vessel Vasculitis ◽  
Inflammatory Rheumatic Diseases ◽  
Solid Organ ◽  
Newly Diagnosed ◽  
Cross Sectional ◽  
Organ Manifestations

Background: Inflammatory rheumatic diseases (IRD) are often associated with the involvement of various organs. However, data regarding organ manifestation and organ spread are rare. To close this knowledge gap, this cross-sectional study was initiated to evaluate the extent of solid organ manifestations in newly diagnosed IRD patients, and to present a structured systematic organ screening algorithm. Materials and Methods: The study included 84 patients (63 women, 21 men) with newly diagnosed IRD. None of the patients received any rheumatic therapy. All patients underwent a standardised organ screening programme encompassing a basic screening (including lungs, heart, kidneys, and gastrointestinal tract) and an additional systematic screening (nose and throat, central and peripheral nervous system) on the basis of clinical, laboratory, and immunological findings. Results: Represented were patients with connective tissue diseases (CTD) (72.6%), small-vessel vasculitis (16.7%), and myositis (10.7%). In total, 39 participants (46.5%) had one or more organ manifestation(s) (one organ, 29.7%; two organs, 10.7%; ≥three organs, 6.0%). The most frequently involved organs were the lungs (34.5%), heart (11.9%), and kidneys (8.3%). Lastly, a diagnostic algorithm for organ manifestation was applied. Conclusion: One-half of the patients presented with a solid organ involvement at initial diagnosis of IRD. Thus, in contrast to what has been described in the literature, organ manifestations were already present in a high proportion of patients at the time of diagnosis of IRD rather than after several years of disease. Therefore, in IRD patients, systematic organ screening is essential for treatment decisions.

scholarly journals The influence of the SARS-CoV-2 lockdown on patients with inflammatory rheumatic diseases on their adherence to immunomodulatory medication: a cross sectional study over 3 months in Germany

Rheumatology ◽  
2021 ◽  
Author(s):  
R Hasseli ◽  
U Müller-Ladner ◽  
F Keil ◽  
M Broll ◽  
A Dormann ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Immediate Release ◽  
Immunomodulatory Therapy ◽  
Inflammatory Rheumatic Diseases ◽  
University Hospitals ◽  
Physician Patient Relationship ◽  
Cross Sectional ◽  
Immunomodulating Therapy ◽  
Private Practices

Abstract Objectives To evaluate the influence of the SARS-CoV-2 pandemic on the adherence of patients with inflammatory rheumatic diseases (IRD) to their immunomodulatory medication during the three-month lockdown in Germany. Methods From 16th March until 15th June 2020, IRD patients from private practices and rheumatology departments were asked to answer a questionnaire addressing their behaviour with respect to their immunomodulating therapy. Eight private practices and nine rheumatology departments that included rheumatology primary care centres and university hospitals participated. A total of 4252 questionnaires were collected and evaluated. Results The majority of patients (54%) were diagnosed with RA, followed by psoriatic arthritis (14%), ankylosing spondylitis (10%), connective tissue diseases (12%) and vasculitides (6%). Most of the patients (84%) reported to continue their immunomodulatory therapy. Termination of therapy was reported by only 3% of the patients. The results were independent from the type of IRD, the respective immunomodulatory therapy and by whom the patients were treated (private practices vs rheumatology departments). Younger patients (<60 years) reported just as often as older patients to discontinue their therapy. Conclusion The data show that most of the patients continued their therapy in spite of the pandemic. A significant change in behaviour with regard to their immunomodulatory therapy was not observed during the three months of observation. The results support the idea that the immediate release of recommendations of the German Society of Rheumatology were well received, supporting the well-established physician–patient relationship in times of a crisis.

RARE RHEUMATIC DISEASES. RELAPSING POLYCHONDRITIS: A CLINICAL CASE

2019 ◽  
Vol 57 (4) ◽  
pp. 478-481
Author(s):  
I. V. Semizarova ◽  
L. N. Eliseeva ◽  
A. F. Davydova ◽  
Z. A. Baste ◽  
Zh. A. Kisian
Keyword(s):  
Rheumatic Diseases ◽  
Structural Changes ◽  
Clinical Laboratory ◽  
Systemic Vasculitis ◽  
Connective Tissue Diseases ◽  
Clinical Manifestations ◽  
Relapsing Polychondritis ◽  
Diagnostic Algorithm ◽  
Cartilage Tissue ◽  
Systemic Inflammatory Disease

The diagnosis of a disease accompanied by febrile syndrome presents special problems in clinical practice. The traditional diagnostic algorithm in this case involves the exclusion of infections, cancer, and rheumatic diseases. The causes of fever can be severe types of rheumatoid arthritis, systemic vasculitis, and diffuse connective tissue diseases, as well as rare diseases, the difficulty of diagnosis of which is due to low awareness of the disease and the absence of specific clinical, laboratory, and instrumental signs. These also include relapsing polychondritis (RPC) in particular. RPC is a rare systemic inflammatory disease of cartilage tissue, which leads to its structural changes resulting in complete destruction. Cartilages of the acoustic apparatus, nose, trachea, and joints are mainly affected. The severity of cardiovascular injury in RPC has recently been emphasized. This disease is observed with equal frequency in men and women, primarily at the age of 40–60 years, predominantly in white people, but it also occurs in other populations. The etiology of RPC is unknown. There are no pathognomonic laboratory and instrumental tests for the diagnosis of RPC. A unified approach to treating this condition has not been elaborated. The available data on the pathogenesis, various clinical manifestations and treatment options of the disease are analyzed. The authors’ own observations of RPC are depicted.

scholarly journals POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 914-914
Author(s):  
A. Boteanu ◽  
A. García Fernández ◽  
N. De la Torre ◽  
M. Pavia Pascual ◽  
O. Sanchez Pernaute ◽  
...  
Keyword(s):  
High Risk ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Infection ◽  
Pulmonary Involvement ◽  
Inflammatory Rheumatic Diseases ◽  
Factors Associated ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Male Sex

Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared

scholarly journals SAT0450 GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A MULTIVARIATE LINEAR REGRESSION ANALYSIS IDENTIFYING PREDICTIVE FACTORS FOR LOW BONE MASS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1182.2-1182
Author(s):  
E. Wiebe ◽  
D. Freier ◽  
D. Huscher ◽  
R. Biesen ◽  
S. Hermann ◽  
...  
Keyword(s):  
Bone Mass ◽  
Rheumatic Diseases ◽  
Positive Association ◽  
Fragility Fractures ◽  
Life Time ◽  
Inflammatory Rheumatic Diseases ◽  
Low Bone Mass ◽  
Cross Sectional ◽  
Chronic Inflammatory Rheumatic Diseases ◽  
Prevalence Of Osteoporosis

Background:Rheumatic diseases are associated with increased systemic bone loss and fracture risk related to chronic inflammation, disease-specific, general and demographic risk factors as well as treatment with glucocorticoids (GC). Yet, there is evidence that GCs may, by adequately suppressing systemic inflammation, also have a positive effect on bone mineral density (BMD) and fracture risk1.Objectives:The purpose of this study was to investigate the prevalence of osteoporosis and fragility fractures in patients with inflammatory rheumatic diseases and to analyze the impact that treatment with GCs, other known risk factors and preventive measures have on bone health in these patients.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic inflammatory rheumatic diseases and psoriasis treated with GCs. In this cross-sectional analysis, we evaluated the initial visit of 1091 patients. A multivariate linear regression model with known or potentially influential factors adjusted for age and sex was used to identify predictors of BMD as measured by dual-energy X-ray absorptiometry (DXA). Multiple imputation was applied for missing baseline covariate data.Results:In the total cohort of 1091 patients (75% female of which 87.5% were postmenopausal) with a mean age of 62.1 (±13.2) years, the prevalence of osteoporosis by DXA was 21.7%, while fragility fractures have occurred in 31.2% of the study population (6.7% vertebral, 27.7% non-vertebral). Current GC therapy was common (64.9%), with a median daily dose of 5.0mg [0.0;7.5], a mean life-time total GC dose of 17.7g (±24.6), and a mean GC therapy duration of 7.8 years (±8.5). Bisphosphonates were the most commonly used anti-osteoporotic drug (12.6%).Multivariate analysis showed that BMD as expressed by the minimum T-Score at all measured sites was negatively associated with higher age, female sex and menopause as well as Denosumab and Bisphosphonate treatment. A positive association with BMD was found for body mass index as well as current and life-time (cumulative) GC dose. While comedication with proton-pump-inhibitors significantly predicted low bone mass, concomitant use of non-steroidal anti-inflammatory drugs showed a positive association with BMD. Of the measured bone-specific laboratory parameters, higher alkaline phosphatase levels were determinants of low DXA-values, while the association was positive for gamma-glutamyltransferase.BMD was neither predicted by duration of GC treatment nor by treatment with disease modifying anti-rheumatic drugs.Predictive variables for BMD differed at the respective anatomical site. While treatment with Denosumab predicted low bone mass at the lumbar spine and not at the femoral neck, the opposite was true for health assessment questionnaire (HAQ) score. Current and life-time GC-dose as well as direct sun-exposure of more than 30 minutes daily were positively associated with bone mass at the femoral sites only.Conclusion:This cross-sectional analysis of a prospective cohort study quantified the prevalence of osteoporosis and identified predictive variables of BMD in patients with rheumatic diseases.Multivariate analyses corroborated low BMD to be predicted by traditional factors like age, female sex and menopause but showed current and well as life-time GC dose to be positively associated with BMD in our cohort of patients with chronic inflammatory rheumatic diseases. This suggests that optimal management of disease activity with GCs might be beneficial in order to avoid bone loss due to inflammation.References:[1]Güler-Yüksel et al. “Glucocorticoids, Inflammation and Bone.” Calcified Tissue International (January 08 2018).Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

Satisfaction and Adherence to Biological Treatment in Patients with Rheumatic Diseases

2021 ◽  
Vol 18 ◽  
Author(s):  
Marwa Hammad ◽  
Huny Bakry
Keyword(s):  
Rheumatic Diseases ◽  
Biological Treatment ◽  
Formal Education ◽  
Biological Therapy ◽  
Cross Sectional Study ◽  
P Value ◽  
Inflammatory Rheumatic Diseases ◽  
Cross Sectional ◽  
New Era ◽  
The Mean

Background: Autoimmune inflammatory rheumatic diseases have long been treated by conventional disease-modifying anti-rheumatic drugs. Biological therapy is a new era in the treatment of rheumatic diseases, but satisfaction and adherence to it is still not well tested. Aim: To assess the satisfaction and adherence to biological treatment among patients with autoimmune inflammatory rheumatic diseases. Methods: A cross sectional study was conducted among 56 patients suffering from inflammatory rheumatic diseases using Morisky 8 questionnaire and Treatment Satisfaction Questionnaire for Medication (TSQM) over a period of one month Results: About 76.8% of the patients had medium adherence and the underlying cause of missing doses was the unavailability of the drugs. The mean satisfaction with biological treatment was 62.7±6.9. Patients who did not receive formal education had significantly higher satisfaction with the biological treatment than others 64.94±5.01 at a P value 0.04 (<0.05). Conclusion: Patients with inflammatory rheumatic diseases in our study showed medium adherence and satisfaction. Authorities in the medical field are providing great help to these patients in need of biological therapy, but ensuring the availability of all doses of the biological treatment regimen is still necessary. Patient, family and nurse education programs are also necessary to maximize adherence and satisfaction.

scholarly journals Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000684 ◽  
Author(s):  
Matthieu Lavielle ◽  
Déborah Puyraimond-Zemmour ◽  
Xavier Romand ◽  
Laure Gossec ◽  
Eric Senbel ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Literature Review ◽  
Rheumatic Diseases ◽  
Systematic Literature Review ◽  
Lupus Erythematosus ◽  
Connective Tissue Diseases ◽  
Educational Interventions ◽  
Inflammatory Rheumatic Diseases ◽  
Improve Medication Adherence ◽  
Chronic Inflammatory Rheumatic Diseases

ObjectiveLack of adherence to treatment is frequent in chronic inflammatory rheumatic diseases and is associated with poorer outcomes. The objective of this study was to describe and evaluate interventions that have been proposed to enhance medication adherence in these conditions.MethodsA systematic literature review was performed in Pubmed, Cochrane, Embase and clinicaltrials.gov databases completed by the rheumatology meeting (ACR, EULAR and SFR) abstracts from last 2 years. All studies in English or French evaluating an intervention to improve medication adherence in chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal related diseases, connective tissue diseases, vasculitis and Still’s disease) were included. Interventions on adherence were collected and classified in five modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others).Results1325 abstracts were identified and 22 studies were finally included (18 studies in RA (72%), 4 studies in systemic lupus erythematosus (16%), 2 studies in SpA (8%) and 1 study in gout (4%)). On 13 randomised controlled trials (RCT) (1535 patients), only 5 were positive (774 patients). Educational interventions were the most represented and had the highest level of evidence: 8/13 RCT (62%, 1017 patients) and 4/8 were positive (50%). In these studies, each patient was individually informed or educated by different actors (physicians, pharmacists, nurses and so on). Supports and contents of these educational interventions were heterogenous.ConclusionDespite the importance of medication adherence in chronic inflammatory rheumatic disorders, evidence on interventions to improve medication adherence is scarce.

scholarly journals Mortality in Inflammatory Rheumatic Diseases: Lithuanian National Registry Data and Systematic Review

2021 ◽  
Vol 18 (23) ◽  
pp. 12338
Author(s):  
Jolanta Dadonienė ◽  
Greta Charukevič ◽  
Gabija Jasionytė ◽  
Karolina Staškuvienė ◽  
Dalia Miltinienė
Keyword(s):  
General Population ◽  
Life Expectancy ◽  
Literature Review ◽  
Rheumatic Diseases ◽  
Systematic Literature Review ◽  
Causes Of Death ◽  
Connective Tissue Diseases ◽  
Standardized Mortality Ratio ◽  
Inflammatory Rheumatic Diseases ◽  
Total Cohort

Despite significant improvement in survival, rheumatic diseases (RD) are associated with premature mortality rates comparable to cardiovascular and neoplastic disorders. The aim of our study was to assess mortality, causes of death, and life expectancy in an inflammatory RD retrospective cohort and compare those with the general population as well as with the results of previously published studies in a systematic literature review. Patients with the first-time diagnosis of inflammatory RD during 2012–2019 were identified and cross-checked for their vital status and the date of death. Sex- and age-standardized mortality ratios (SMR) as well as life expectancy for patients with inflammatory RDs were calculated. The results of a systematic literature review were included in meta-standardized mortality ratio calculations. 11,636 patients with newly diagnosed RD were identified. During a total of 43,064.34 person-years of follow-up, 950 death cases occurred. The prevailing causes of death for the total cohort were cardiovascular diseases and neoplasms. The age- and sex-adjusted SMR for the total cohort was calculated to be 1.32 (1.23; 1.40). Patients with rheumatoid arthritis if diagnosed at age 18–19 tend to live for 1.63 years less than the general population, patients with spondyloarthritis—for 2.7 years less, patients with connective tissue diseases—for almost nine years less than the general population. The findings of our study support the hypothesis that patients with RD have a higher risk of mortality and lower life expectancy than the general population.

scholarly journals Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in times of SARS-CoV-2 – methodology, key messages and justifying information

Rheumatology ◽  
2021 ◽  
Author(s):  
Hendrik Schulze-Koops ◽  
Klaus Krüger ◽  
Bimba Franziska Hoyer ◽  
Jan Leipe ◽  
Christof Iking-Konert ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Case Reports ◽  
Case Series ◽  
German Society ◽  
Immunosuppressive Drugs ◽  
Scientific Data ◽  
Inflammatory Rheumatic Diseases ◽  
Evidence Based ◽  
Cross Sectional ◽  
Hygiene Measures

Summary A few days after the SARS-CoV-2 infection was declared a pandemic, the German Society for Rheumatology (DGRh) has compiled a first group of recommendations for the care of patients with inflammatory rheumatic diseases in light of SARS-CoV-2/COVID-19. These first recommendations were based on an expert consensus and were largely "non-evidence-based". Now that the first scientific data from registries, cross-sectional studies, case reports and case series are available, the DGRh developed a timely update. This update is based on a literature search of publications available up to June 15th, 2020 and addresses preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. Driven by the commitment to let patients benefit from the new, first evidence-based recommendations as quickly as possible, the DGRh published the update in German on its homepage and in the Zeitschrift für Rheumatologie immediately after completion. Here, we report the key recommendations to make this recommendation available also for the international community, provide the scientific methodology used to develop the recommendations, give additional thoughts and advices for the management of patients with rheumatic diseases during the COVID-19 pandemic, and discuss our recommendations in the context of other international recommendations.

scholarly journals Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study

2020 ◽  
Vol 79 (12) ◽  
pp. 1544-1549 ◽  
Author(s):  
Jose L Pablos ◽  
María Galindo ◽  
Loreto Carmona ◽  
Ana Lledó ◽  
Miriam Retuerto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Illness ◽  
Inflammatory Rheumatic Diseases ◽  
Hospitalised Patients ◽  
Male Sex ◽  
The Impact ◽  
Rheumatic Patients

ObjectivesThe impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness.MethodsIn this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression.ResultsThe cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53–78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30).ConclusionIn hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

scholarly journals Are patients with rheumatic diseases on immunosuppressive therapies protected against preventable infections? A cross-sectional cohort study

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001499
Author(s):  
Uta Kiltz ◽  
Aylin Celik ◽  
Styliani Tsiami ◽  
Bjoern Buehring ◽  
Xenofon Baraliakos ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Pneumococcal Vaccination ◽  
Latent Tuberculosis ◽  
Cross Sectional Study ◽  
Study Data ◽  
Vaccination Status ◽  
Inflammatory Rheumatic Diseases ◽  
Cross Sectional ◽  
Vaccination Rates ◽  
Vaccination Recommendations

ObjectiveTo evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD).MethodsConsecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0–26) categorising patients into four immunisation states: low (0–6), moderate (7–13), good (14–20), high (21–26).ResultsAll patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score.ConclusionsThe majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result.

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