COVID-19 Vaccination Uptake among individuals with Immune-Mediated Inflammatory Diseases in Ontario, Canada between December 2020 and October 2021: A population-based analysis

Objective We assessed COVID-19 vaccine uptake among individuals with immune-mediated inflammatory diseases (IMID) and the Ontario general population. Methods We studied all residents 16 years and older who were alive and enrolled in Ontario's universal health insurance plan as of December 14, 2020 when vaccination commenced (n=12,435,914). Individuals with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), psoriasis (PsO), and inflammatory bowel disease (IBD) were identified using established disease-specific case definitions applied to health administrative data. Vaccination status was extracted from the provincial COVaxON registry. Weekly cumulative proportions of first and second doses up until October 3, 2021 were expressed as the vaccinated percentage of each disease group, and compared to the general Ontario population, and stratified by age. Results By October 3, 2021, the cumulative percentage with at least one dose was 82.1% for the general population, 88.9% for RA, 87.4% for AS, 90.6% for PsA, 87.3% for PsO, and 87.0% for IBD. There was also a higher total cumulative percentage with two doses among IMIDs (83.8-88.2%) vs the general population (78.0%). The difference was also evident when stratifying by age. Individuals with IMIDs in the youngest age group initially had earlier uptake than the general population but remain the lowest age group with two doses (70.6% in the general population vs. 73.7-79.2% across IMID groups). Conclusion While implementation of COVID-19 vaccination programs has differed globally, these Canadian estimates are the first to reassuringly show higher COVID-19 vaccine uptake among individuals with IMIDs.

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Even low doses of steroids increase the risk of cardiovascular disease in people with inflammatory diseases

BMJ ◽

10.1136/bmj.n2599 ◽

2021 ◽

pp. n2599

Author(s):

Helen Saul ◽

Deniz Gursul

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Inflammatory Diseases ◽

Population Based ◽

Low Doses ◽

Cardiovascular Risks ◽

Oral Glucocorticoid ◽

Link Type ◽

Immune Mediated ◽

Dose Dependent

The study Pujades-Rodríguez M, Morgan AW, Cubbon RM, Wu J. Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: a population-based cohort study. PLoS Med 2020;17:e1003432. To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/low-doses-steroids-increase-cardiovascular-risks-in-inflammatory-diseases/

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COVID-19 and rheumatology: A year later

Rheumatology Science and Practice ◽

10.47360/1995-4484-2021-31-36 ◽

2021 ◽

Vol 59 (1) ◽

pp. 31-36

Author(s):

B. S. Belov ◽

A. M. Lila

Keyword(s):

Clinical Trials ◽

General Population ◽

Severe Acute Respiratory Syndrome ◽

Inflammatory Diseases ◽

Controlled Clinical Trials ◽

Antirheumatic Drugs ◽

The Past ◽

Immune Mediated ◽

Great Hope ◽

Blind Spots

An enormous body of evidence on various aspects of the coronavirus disease 2019, COVID-19 associated with the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2) has been accumulated over the past year. Meanwhile, investigated relationship between COVID-19 and rheumatic immune-mediated inflammatory diseases (IMIDs) and certain identified similarities were of paramount importance. It was shown that the incidence of COVID-19 in patients with rheumatic diseases does not significantly differ from that in general population. The risk of severe course and unfavorable COVID-19 outcomes in patients with rheumatic IMIDs is significantly associated with older age and comorbidities – as in general population, and is not aggravated by preceding use of the majority of antirheumatic drugs. Gaining better insights into pathogenesis of COVID-19 provided sound prerequisites for anti-rheumatic drugs repurposing and substantiated their use for treatment of COVID-19 infection. Under current COVID-19 pandemic circumstances, accelerated development and invention of various COVID-19 vaccines offers a great hope to curb the tide of pandemic. However, the efficacy, immunogenicity, and safety of these vaccines in patients with rheumatic IMIDs must be studied in controlled clinical trials. Generally speaking, there are still numerous blind spots in our knowledge of rheumatological aspects of such a versatile and polymorphous condition as COVID-19 infection.

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Existing comorbidities in people with osteoarthritis: a retrospective analysis of a population-based cohort in Alberta, Canada

BMJ Open ◽

10.1136/bmjopen-2019-033334 ◽

2019 ◽

Vol 9 (11) ◽

pp. e033334 ◽

Cited By ~ 4

Author(s):

Deborah A Marshall ◽

Xiaoxiao Liu ◽

Cheryl Barnabe ◽

Karen Yee ◽

Peter D Faris ◽

...

Keyword(s):

Cohort Analysis ◽

Age Groups ◽

Population Based ◽

Case Definition ◽

Chronic Obstructive ◽

Age Group ◽

Case Definitions ◽

Obstructive Pulmonary Disease ◽

Physician Visits ◽

Significant Difference

ObjectivesThe purpose of this study is to estimate the prevalence of comorbidities among people with osteoarthritis (OA) using administrative health data.DesignRetrospective cohort analysis.SettingAll residents in the province of Alberta, Canada registered with the Alberta Health Care Insurance Plan population registry.Participants497 362 people with OA as defined by ‘having at least one OA-related hospitalization, or at least two OA-related physician visits or two ambulatory care visits within two years’.Primary outcome measuresWe selected eight comorbidities based on literature review, clinical consultation and the availability of validated case definitions to estimate their frequencies at the time of diagnosis of OA. Sex-stratified age-standardised prevalence rates per 1000 population of eight clinically relevant comorbidities were calculated using direct standardisation with 95% CIs. We applied χ2 tests of independence with a Bonferroni correction to compare the percentage of comorbid conditions in each age group.Results54.6% (n=2 71 794) of people meeting the OA case definition had at least one of the eight selected comorbidities. Females had a significantly higher rate of comorbidities compared with males (standardised rates ratio=1.26, 95% CI 1.25 to 1.28). Depression, chronic obstructive pulmonary disease (COPD) and hypertension were the most prevalent in both females and males after age-standardisation, with 40% of all cases having any combination of these comorbidities. We observed a significant difference in the percentage of comorbidities among age groups, illustrated by the youngest age group (<45 years) having the highest percentage of cases with depression (24.6%), compared with a frequency of 16.1% in those >65 years.ConclusionsOur findings highlight the high frequency of comorbidity in people with OA, with depression having the highest age-standardised prevalence rate. Comorbidities differentially affect females, and vary by age. These factors should inform healthcare programme and delivery.

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Incidence of atrial fibrillation in different major cancer subtypes: a Nationwide population-based 12 year follow up study

BMC Cancer ◽

10.1186/s12885-019-6314-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Christina Boegh Jakobsen ◽

Morten Lamberts ◽

Nicholas Carlson ◽

Morten Lock-Hansen ◽

Christian Torp-Pedersen ◽

...

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

The Elderly ◽

Population Based ◽

Incidence Rates ◽

Cancer Subtypes ◽

History Of ◽

The Difference ◽

Rate Ratios ◽

New Onset

Abstract Background The prevalence of both atrial fibrillation (AF) and malignancies are increasing in the elderly, but incidences of new onset AF in different cancer subtypes are not well described.The objectives of this study were therefore to determine the incidence of AF in different cancer subtypes and to examine the association of cancer and future AF. Methods Using national databases, the Danish general population was followed from 2000 until 2012. Every individual aged > 18 years and with no history of cancer or AF prior to study start was included. Incidence rates of new onset AF were identified and incidence rate ratios (IRRs) of AF in cancer patients were calculated in an adjusted Poisson regression model. Results A total of 4,324,545 individuals were included in the study. Cancer was diagnosed in 316,040 patients. The median age of the cancer population was 67.0 year and 51.5% were females. Incidences of AF were increased in all subtypes of cancer. For overall cancer, the incidence was 17.4 per 1000 person years (PY) vs 3.7 per 1000 PY in the general population and the difference increased with age. The covariate adjusted IRR for AF in overall cancer was 1.46 (95% confidence interval (CI) 1.44–1.48). The strength of the association declined with time from cancer diagnosis (IRR0-90days = 3.41 (3.29–3.54), (IRR-180 days-1 year = 1.57 (CI 1.50–1.64) and (IRR2–5 years = 1.12 (CI 1.09–1.15). Conclusions In this nationwide cohort study we observed that all major cancer subtypes were associated with an increased incidence of AF. Further, cancer and AF might be independently associated.

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Rates of Chronic Medical Conditions in 1991 Gulf War Veterans Compared to the General Population

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16060949 ◽

2019 ◽

Vol 16 (6) ◽

pp. 949 ◽

Cited By ~ 25

Author(s):

Clara Zundel ◽

Maxine Krengel ◽

Timothy Heeren ◽

Megan Yee ◽

Claudia Grasso ◽

...

Keyword(s):

Blood Pressure ◽

General Population ◽

High Blood Pressure ◽

Population Based ◽

Chronic Medical Conditions ◽

Medical Conditions ◽

Gulf War Veterans ◽

Increased Risk ◽

Prevalence Estimates ◽

The Difference

Prevalence of nine chronic medical conditions in the population-based Ft. Devens Cohort (FDC) of GW veterans were compared with the population-based 2013–2014 National Health and Nutrition Examination Survey (NHANES) cohort. Excess prevalence was calculated as the difference in prevalence estimates from the Ft. Devens and NHANES cohorts; and confidence intervals and p-values are based on the standard errors for the two prevalence estimates. FDC males were at increased risk for reporting seven chronic medical conditions compared with NHANES males. FDC females were at decreased risk for high blood pressure and increased risk for diabetes when compared with NHANES females. FDC veterans reporting war-related chemical weapons exposure showed higher risk of high blood pressure; diabetes; arthritis and chronic bronchitis while those reporting taking anti-nerve gas pills had increased risk of heart attack and diabetes. GW veterans are at higher risk of chronic conditions than the general population and these risks are associated with self-reported toxicant exposures.

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Incidence of Guillain–Barre's Syndrome in Children under 15 Years of Age in Oman

Journal of Pediatric Neurology ◽

10.1055/s-0038-1660838 ◽

2018 ◽

Vol 17 (06) ◽

pp. 206-209

Author(s):

Roshan Koul ◽

Amna Al-Fuitaisi ◽

Nabil Macki ◽

Prakash Kurubarahalli Patel ◽

Haleema Al-Balushi ◽

...

Keyword(s):

Adult Population ◽

Intravenous Immunoglobulins ◽

Population Based ◽

Age Group ◽

Microsoft Excel ◽

Female Ratio ◽

Immune Mediated ◽

Gulf Country ◽

Male To Female ◽

Excel Format

Objective Guillain–Barre's syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy seen in all ages but mostly in the adult population. We aim to report the incidence of GBS in children under 15 years of age in Oman, a Gulf country. Materials and Methods All children with GBS under 15 years of age were included in the study from January 2002 to December 2016. The data were compiled in Microsoft Excel format and analysis was performed using SPSS, version 17.0. Population-based age- and sex-specific rates of GBS were calculated using the estimated population for each 5-year period based on 2004, 2009, and 2014 mid-year population, respectively. Relative risk and 95% confidence intervals of GBS at different age categories were calculated using the overall incidence of GBS in those under 15 years as reference. Results The average annual incidence in those under 15 years was 3.1/100,000. Age-specific incidence was 4.0/100,000 in the age group 0 to 9 years and 4.7/100,000 in age group 0 to 4 years. Sixty percent had evidence of preceding infections, and the male to female ratio was 1.8:1. Fifty percent had cranial nerve involvement and 18% needed mechanical ventilation. Five percent had residual weakness. Intravenous immunoglobulins (IVIGs) were used in all, and 3.3% required plasmapheresis when they did not improve with IVIG. Clinical profile of the GBS was not different from the rest reported in the literature. Conclusion The incidence of GBS in Oman was 3.1/100,000 (range: 2.7–3.5 cases/100,000) in children under 15 years of age. The GBS is a smaller proportion among the total acute flaccid paralysis cases.

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Serosurveillance among COVID-19 Cases in Ahmedabad Using SARS-COV2 IgG Antibodies

Indian Journal of Community Health ◽

10.47203/ijch.2021.v33i02.022 ◽

2021 ◽

Vol 33 (2) ◽

pp. 351-356

Author(s):

Om Prakash ◽

Bhavin Solanki ◽

Jay Sheth ◽

Daxa Maitrak ◽

Mina Kadam ◽

...

Keyword(s):

Clinical Symptoms ◽

Close Correlation ◽

Population Based ◽

Age Group ◽

Igg Antibodies ◽

Factors Affecting ◽

Increasing Trend ◽

Duration Of Hospitalization ◽

The Difference ◽

Clinical Illness

Background: Serosurveillance study focusing on antibodies against SARS-CoV2 among the Covid19 cases can add value in the scientific knowledge & help in formulating valid predictions regarding immunity status in the post-covid period. Objectives: To estimate seropositivity among covid19 cases and to identify various factors affecting seropositivity. Methods: During second half of October 2020, a population based serosurvey on Covid19 cases was carried out in Ahmedabad. Covid-Kavach test kits were used and estimated seroprevalence was compared with available demographic and covid19 case related parameters to identify factors affecting seropositivity in the post-covid period. Simple proportions and Z-test were used as appropriate. Results: As on October 2020, the sero-positivity among Covid19 cases in Ahmedabad was 54.51% [95% Confidence Interval (CI) 52.14-56.86%]. Females have higher positivity (54.78%) as compared to males (54.30%) but the difference was statistically not significant (Z=0.19, P=0.84). Among children and elderly, the positivity is high and from young adults to elderly the seropositivity has an increasing trend. Severity of clinical illness and longer duration of hospitalization are associated with higher seropositivity. Conclusion: With 54.51% seropositivity among covid19 cases, it is clear that all the covid19 cases may not have developed IgG antibodies, have undetectable level or might have disappeared during the post-covid period. Comparison of seropositivity with age group and clinical case details clearly suggest close correlation with the severity of clinical symptoms. The seronegative cases indicate the need for further in-depth scientific research to identify the factors affecting immunity and to uncover the reasons behind the same.

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Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003432 ◽

2020 ◽

Vol 17 (12) ◽

pp. e1003432 ◽

Cited By ~ 1

Author(s):

Mar Pujades-Rodriguez ◽

Ann W. Morgan ◽

Richard M. Cubbon ◽

Jianhua Wu

Keyword(s):

Cardiovascular Risk ◽

Disease Activity ◽

Lupus Erythematosus ◽

Inflammatory Diseases ◽

Population Based ◽

Equivalent Dose ◽

Systemic Lupus ◽

Immune Mediated ◽

Cumulative Risks ◽

Dose Dependent

Background Glucocorticoids are widely used to reduce disease activity and inflammation in patients with a range of immune-mediated inflammatory diseases. It is uncertain whether or not low to moderate glucocorticoid dose increases cardiovascular risk. We aimed to quantify glucocorticoid dose-dependent cardiovascular risk in people with 6 immune-mediated inflammatory diseases. Methods and findings We conducted a population-based cohort analysis of medical records from 389 primary care practices contributing data to the United Kingdom Clinical Practice Research Datalink (CPRD), linked to hospital admissions and deaths in 1998–2017. We estimated time-variant daily and cumulative glucocorticoid prednisolone-equivalent dose-related risks and hazard ratios (HRs) of first all-cause and type-specific cardiovascular diseases (CVDs). There were 87,794 patients with giant cell arteritis and/or polymyalgia rheumatica (n = 25,581), inflammatory bowel disease (n = 27,739), rheumatoid arthritis (n = 25,324), systemic lupus erythematosus (n = 3,951), and/or vasculitis (n = 5,199), and no prior CVD. Mean age was 56 years and 34.1% were men. The median follow-up time was 5.0 years, and the proportions of person–years spent at each level of glucocorticoid daily exposure were 80% for non-use, 6.0% for <5 mg, 11.2% for 5.0–14.9 mg, 1.6% for 15.0–24.9 mg, and 1.2% for ≥25.0 mg. Incident CVD occurred in 13,426 (15.3%) people, including 6,013 atrial fibrillation, 7,727 heart failure, and 2,809 acute myocardial infarction events. One-year cumulative risks of all-cause CVD increased from 1.4% in periods of non-use to 8.9% for a daily prednisolone-equivalent dose of ≥25.0 mg. Five-year cumulative risks increased from 7.1% to 28.0%, respectively. Compared to periods of non-glucocorticoid use, those with <5.0 mg daily prednisolone-equivalent dose had increased all-cause CVD risk (HR = 1.74; 95% confidence interval [CI] 1.64–1.84; range 1.52 for polymyalgia rheumatica and/or giant cell arteritis to 2.82 for systemic lupus erythematosus). Increased dose-dependent risk ratios were found regardless of disease activity level and for all type-specific CVDs. HRs for type-specific CVDs and <5.0-mg daily dose use were: 1.69 (95% CI 1.54–1.85) for atrial fibrillation, 1.75 (95% CI 1.56–1.97) for heart failure, 1.76 (95% CI 1.51–2.05) for acute myocardial infarction, 1.78 (95% CI 1.53–2.07) for peripheral arterial disease, 1.32 (95% CI 1.15–1.50) for cerebrovascular disease, and 1.93 (95% CI 1.47–2.53) for abdominal aortic aneurysm. The lack of hospital medication records and drug adherence data might have led to underestimation of the dose prescribed when specialists provided care and overestimation of the dose taken during periods of low disease activity. The resulting dose misclassification in some patients is likely to have reduced the size of dose–response estimates. Conclusions In this study, we observed an increased risk of CVDs associated with glucocorticoid dose intake even at lower doses (<5 mg) in 6 immune-mediated diseases. These results highlight the importance of prompt and regular monitoring of cardiovascular risk and use of primary prevention treatment at all glucocorticoid doses.

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IBD considerations in spondyloarthritis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x20939410 ◽

2020 ◽

Vol 12 ◽

pp. 1759720X2093941

Author(s):

Caroline Di Jiang ◽

Tim Raine

Keyword(s):

Inflammatory Diseases ◽

Drug Dosing ◽

Inflammatory Conditions ◽

Gastrointestinal Pathology ◽

Immune Mediated ◽

Form Part ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Gastrointestinal Inflammation ◽

The Difference

Spondyloarthritis (SpA) may be regarded a family of auto-inflammatory conditions with inflammation focused on the joints. These form part of a wider family of immune-mediated inflammatory diseases, which include inflammatory bowel diseases (IBD). These conditions share common elements of pathophysiology and it is perhaps unsurprising, therefore, that individuals with SpA frequently manifest gastrointestinal inflammation, to which the physician managing the patient with SpA must be alert. In this article, we review the shared epidemiology and pathophysiology of these conditions, before discussing approaches to diagnosis and management of inflammatory gastrointestinal pathology in patients seen in rheumatology clinics. In particular, we discuss the difference between non-specific gastrointestinal inflammation commonly described in this patient group and the more specific diagnosis of Crohn’s disease or ulcerative colitis. We describe the appropriate diagnostic workup for patients suspected of having IBD. In addition, we discuss how a diagnosis of IBD can inform treatment selection, highlighting important differences in treatment choice, drug dosing, monitoring and drug safety for this particular comorbid patient population.

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Risk of tuberculosis in patients with immune-mediated diseases on biological therapies: a population-based study in a tuberculosis endemic region

Rheumatology ◽

10.1093/rheumatology/key364 ◽

2018 ◽

Vol 58 (5) ◽

pp. 803-810 ◽

Cited By ~ 3

Author(s):

Xing Wang ◽

Sunny H Wong ◽

Xian-Song Wang ◽

Whitney Tang ◽

Chang-Qin Liu ◽

...

Keyword(s):

General Population ◽

Population Based ◽

Hazard Ratio ◽

Tnf Inhibitor ◽

Biological Therapies ◽

Standardized Incidence Ratio ◽

Endemic Region ◽

Immune Mediated ◽

Increased Risk

Abstract Objective Real-world epidemiological data on the risk of tuberculosis (TB) in patients with immune-mediated diseases treated with biologics are scarce in TB endemic areas. We investigated the incidence of TB in a population-based setting and stratified the risk of TB among different biological therapies. Methods We collected medical data from a territory-wide computerized database in Hong Kong. We reported the incidence of TB in patients treated with various classes of biologics, and calculated standardized incidence ratio by comparing with the general population. Subgroup analyses were performed based on disease subtypes and biological drugs. Results Among 2485 subjects with immune-mediated diseases (82.5% rheumatology diseases; 10.6% IBD; 6.9% dermatology diseases), 54 subjects developed active TB during 6921 person-years of follow-up. The mean age (±s.d.) was 43 (14) years, and the median follow-up duration was 24.9 months (interquartile range 4.9–45.0). The overall standardized incidence ratio of TB was 10.91 (95% CI 8.00–13.82), and patients treated with infliximab had a nearly 26 times increased risk of TB compared with the general population (standardized incidence ratio 25.95; 95% CI 17.23–34.67). The risk of TB with TNF inhibitor was higher than with a non-TNF biologic (hazard ratio 4.34; 95% CI 1.31–14.39), while the risk of infliximab was higher than etanercept and adalimumab (hazard ratio: 4.10 and 2.08, respectively). Conclusion The risk of TB is much higher in patients with immune-mediated diseases on biological therapy compared with the general population, and infliximab is associated with the highest risk of TB among the biologics analysed.

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