Occurrence Of Flares Research Articles

A Rapid Sequence of Solar Energetic Particle Events Associated with a Series of Extreme-ultraviolet Jets: Solar Orbiter, STEREO-A, and Near-Earth Spacecraft Observations

A series of solar energetic electron (SEE) events was observed from 2022 November 9 to November 15 by Solar Orbiter, STEREO-A, and near-Earth spacecraft. At least 32 SEE intensity enhancements at energies >10 keV were clearly distinguishable in Solar Orbiter particle data, with 13 of them occurring on November 11. Several of these events were accompanied by ≲10 MeV proton and ≲2 MeV nucleon−1 heavy-ion intensity enhancements. By combining remote-sensing and in situ data from the three viewpoints (Solar Orbiter and STEREO-A were ∼20° and ∼15° east of Earth, respectively), we determine that the origin of this rapid succession of events was a series of brightenings and jetlike eruptions detected in extreme ultraviolet (EUV) observations from the vicinity of two active regions. We find a close association between these EUV phenomena, the occurrence of hard X-ray flares, type III radio bursts, and the release of SEEs. For the most intense events, usually associated with extended EUV jets, the distance between the site of these solar eruptions and the estimated magnetic connectivity regions of each spacecraft with the Sun did not prevent the arrival of electrons at the three locations. The capability of jets to drive coronal fronts does not necessarily imply the observation of an SEE event. Two peculiar SEE events on November 9 and 14, observed only at electron energies ≲50 keV but rich in ≲1 MeV nucleon−1 heavy ions, originated from slow-rising confined EUV emissions, for which the process resulting in energetic particle release to interplanetary space is unclear.

Dual-energy computed tomography-based radiomics for differentiating patients with and without gout flares.

There is a current lack of data pertaining to the potential link between gout flares and dual-energy computed tomography radiomic features. This study aimed to construct and validate a comprehensive dual-energy computed tomography-based radiomics model for differentiating patients with and without gout flares. The analysis included 200 patients, of whom 150 were confirmed to have experienced at least one flare in the past 12months; the remaining 50 patients did not experience flares. The radiomic features of the tophi at the bilateral first metatarsophalangeal joints were extracted and analyzed. Optimal radiomic features were selected using the least absolute shrinkage and selection operator method, and logistic regression analysis was used to screen clinical characteristics and establish a clinical model. The optimal radiomic features were then combined with the identified independent clinical variables to develop a comprehensive model. The performances of the radiomic, clinical, and comprehensive models were evaluated using receiver operating characteristic curve analysis, calibration curves, and decision curve analysis. Four radiomic features distinguished patients with at least one flare from those without flares and were used to establish the radiomic model. Disease duration and hypertension were independent factors that differentiated flare occurrences. The radiomic, clinical, and comprehensive models showed favorable discrimination, with areas under the receiver operating characteristic curves of 0.76 (95% CI, 0.69-0.83), 0.72(95% CI, 0.63-0.80), and 0.79(95% CI, 0.73-0.86), respectively. The calibration curves (P > 0.05) showed that the differentiated values of the comprehensive model agreed well with the actual values. Decision curve analysis demonstrated that the comprehensive model achieved higher net clinical benefits than the use of either the radiomic or clinical model alone. The results of this study suggest that a radiomics model can distinguish patients with and without gout flares. Our proposed clinical radiomics nomogram can increase the efficacy of differentiating flare occurrence, which may facilitate the clinical decision-making process.

Case Studies on Pre-eruptive X-class Flares using R-value in the Lower Solar Atmosphere

The R-value is a measure of the strength of photospheric magnetic polarity inversion lines in active regions (ARs). This work investigates the possibility of a relation between R-value variations and the occurrence of X-class flares in ARs, not in the solar photosphere, as usual, but above it in regions closer to where flares occur. The modus operandi is to extrapolate the Solar Dynamic Observatory’s Helioseismic and Magnetic Imager magnetogram data up to a height of 3.24 Mm above the photosphere and then compute the R-value based on the extrapolated magnetic field. Recent studies have shown that certain flare-predictive parameters such as the horizontal gradient of the vertical magnetic field and magnetic helicity may improve flare prediction lead times significantly if studied at a specific height range above the photosphere, called the optimal height range (OHR). Here, we define the OHR as a collection of heights where a sudden but sustained increase in R-value is found. For the eight case studies discussed in this paper, our results indicate that it is possible for OHRs to exist in the low solar atmosphere (between 0.36 and 3.24 Mm), where R-value spikes occur 48–68 hr before the first X-class flare of an emerging AR. The temporal evolution of R-value before the first X-class flare for an emerging AR is also found to be distinct from that of nonflaring ARs. For X-class flares associated with nonemerging ARs, an OHR could not be found.

Evolution of Characteristics of Vertical Electric Current and Magnetic Field in Active Regions of the Sun and their Relation to Powerful Flares

The study of evolution of magnetic field and electric currents in active regions of the Sun over a long-time interval is of interest for understanding the processes of accumulation and release of energy in them, leading to various phenomena that affect space weather. In this work, based on the photospheric vector magnetograms of the Helioseismic and Magnetic Imager instrument aboard the Solar Dynamics Observatory, an analysis was made of the evolution of a number of characteristics of the magnetic field and vertical electric current in three active regions 11158, 11675, and 12673 that produced class M and X flares, during the time from their origin in the Eastern hemisphere, during the passage through the solar disk, and until the disappearance near the Western limb with a step of 2 hours. The characteristics under consideration included: the power-law exponent of the probability density function of the absolute value of the vertical electric current density, the maximum of the absolute value of the vertical current density, the signed and unsigned total vertical currents and the unsigned total vertical and horizontal magnetic fluxes, the energy of the nonlinear force-free and potential magnetic fields, the free magnetic energy, and the number of islands with strong vertical current. Some regularities in the behaviour of the characteristics under consideration are found, in particular regarding the occurrence of solar flares. The correlation coefficients between pairs of these characteristics are calculated. Additionally, M. Aschwanden’s approach is shown to be promising for predicting the maximum X-ray class of a flare based on the calculation of the energy of the potential magnetic field in active regions. The results obtained can be used to predict powerful solar flares.

Urate lowering therapy in patients starting hemodialysis limit gout flares occurrence: ten years retrospective study

BackgroundUncontrolled gout can cause articular impairment but is also associated with a global and cardiovascular excess mortality, especially in dialysis population.Data documented within existing research is not conclusive regarding gout flares evolution during hemodialysis and their control by urate lowering therapy (ULT).Without clear guidelines concerning hemodialysis patients management with chronic gout, this study proposes to investigate whether gout flare incidence reduction could be observed on this population treated by urate lowering therapy versus patients without treatment.MethodsWe performed a retrospective cohort study in two hemodialysis centers in France. Were selected patients over 18 years old with a gout history who started hemodialysis between January 2005 and September 2015.Demographics and clinicals data were recorded at hemodialysis start and throughout 5 years of follow up. Gout flare was defined as presence of uric acid crystal in joint punction or clinically diagnosed as such with a colchicine prescription.All statistical analysis were performed in SAS® version 9.4 (SAS Institute Inc., Cary, NC).ResultsOne hundred eighty-one patients have been included, mean age at dialysis initiation was 68.6 years (± 12.4) with 72% of men, 54% were treated by ULT: 89.7% by allopurinol and 9.3% by febuxostat. One patient received both treatments successively. After hemodialysis initiation, 35.36% patients had experienced at least one gout flare. The appearance of at least one gout flare concerned 50% of patients in no ULT group and 22.68% patients in ULT group (p = 0.0002).Dialysis efficiency was measured at regular interval during follow-up and was similar in both groups.To study the association strength between clinical factors and gout flares occurrences, a Cox model was performed; ULT is a protector factor of gout flare (HR:0,42, CI 95: 0,25-0,71).The proportion of serum urate values within the target (median 53% vs 29.3%, p < 0.0001) was significantly higher in ULT group versus no ULT group (median 53% vs 29.3%, p < 0.0001).ConclusionUrate lowering therapy limit new gout flares occurrence in hemodialysis patients with gout historyCollaboration between rheumatologists and nephrologists may help to update guidelines for urate-lowering therapies in patients on dialysis.

Association between COVID-19 infection and uveitis flare in patients with Behcet's disease, a retrospective multicenter cohort study.

To explore if COVID-19 infection and its subsequent immunosuppressant adjustment as well as previous vaccination status are associated with higher risks of uveitis flare in patients with Behcet's disease. This retrospective multicenter cohort study was conducted in January 2023 among patients with Behcet's uveitis, during the second wave of the COVID-19 pandemic in China, with an anticipated sample size of 250. The primary objective was to examine the association between COVID-19 infection and the occurrence of uveitis flare. The potential impact of other exposures, including the patient's vaccination status and treatment adjustments to the risk of uveitis flare and the course of COVID-19 infection were also analyzed. 207 patients with COVID-19 infection and 47 patients without COVID-19 infection were included. A total of 127 uveitis flares occurred in the observational period (14.29 events per 100 person-month). COVID-19 infection was found to be significantly associated with a higher rate of uveitis flare (adjusted rate ratio = 4.8, 95% CI 3.7 to 6.3, P < 0.001). However, neither systemic immunosuppressive adjustment nor COVID-19 vaccination status showed a significant association with uveitis flare or the course of COVID-19 infection. This study provides evidence of an association between COVID-19 infection and an increased risk of uveitis flare in patients with Behcet's disease. However, there was no significant evidence to support that baseline immunosuppressive therapy regimens, treatment adjustment after COVID-19 infection, or vaccination status were associated with higher risks of uveitis flare or prolonged COVID-19 course.

Comparison of Gout Flares With the Initiation of Treat-to-Target Allopurinol and Febuxostat: A Post-Hoc Analysis of a Randomized Multicenter Trial.

Initiating urate-lowering therapy (ULT) in gout can precipitate arthritis flares. There have been limited comparisons of flare risk during the initiation and escalation of allopurinol and febuxostat, administered as a treat-to-target strategy with optimal anti-inflammatory prophylaxis. This was a post-hoc analysis of a 72-week randomized, double-blind, placebo-controlled, noninferiority trial comparing the efficacy of allopurinol and febuxostat. For this analysis, the occurrence of flares was examined during weeks 0 to 24 when ULT was initiated and titrated to a serum urate (sUA) goal of less than 6 mg/dl (<5 mg/dl if tophi). Flares were assessed at regular intervals through structured participant interviews. Predictors of flare, including treatment assignment, were examined using multivariable Cox proportional hazards regression. Study participants (n = 940) were predominantly male (98.4%) and had a mean age of 62.1 years with approximately equal proportions receiving allopurinol or febuxostat. Mean baseline sUA was 8.5 mg/dl and all participants received anti-inflammatory prophylaxis (90% colchicine). In a multivariable model, there were no significant associations of ULT treatment (hazard ratio [HR] 1.17; febuxostat vs allopurinol), ULT-dose escalation (HR 1.18 vs no escalation), prophylaxis type, or individual comorbidity with flare and no evidence of ULT-dose escalation interaction. Factors independently associated with flare risk during ULT initiation/escalation included younger age, higher baseline sUA, and absence of tophi. These results demonstrate that gout flare risk during the initiation and titration of allopurinol is similar to febuxostat when these agents are administered according to a treat-to-target strategy using gradual ULT-dose titration and best practice gout flare prophylaxis.

Intercurrent infection as a risk factor for disease flares in patients with systemic lupus erythematosus

ObjectiveTo determine whether intercurrent infections are a risk factor for subsequent disease flares in systemic lupus erythematosus (SLE).MethodsDemographic and clinical characteristics of 203 patients with SLE participating in the Amsterdam...

Impact of cancer treatment in patients with inflammatory bowel disease: A systematic review and meta analysis.

e23084 Background: The association between cancer treatments and impact of inflammatory bowel diseases (IBD) remains uncertain. Given the growing prevalence of IBD globally, it is crucial to understand the impact of various cancer treatments in this patient population to make informed decisions and optimize outcomes. Thus, the objective of our systematic review is to assess how cancer treatments impact the activity of underlying IBD. Methods: We performed a systematic review of the literature on cancer therapy in patients with pre-existing IBD. Various databases like PubMed, Cochrane, Embase and Google Scholar were searched for studies reporting effects of cancer treatment in patients with IBD, till February 1, 2024. Studies without relevant data were excluded. The outcomes studied were the flares of IBD following cancer treatment and initiation of systemic steroids or biologics for management of IBD flares. Results: In total, 36 studies were included which comprised 1,443 patients with IBD who received cancer treatment. The overall occurrence of IBD flares in patients with IBD receiving cancer treatment was 28% (CI 22.9%-33.8%, I2= 68%) out of which 35.9% (CI 27.5% - 45.3%, I2= 40) had received immune checkpoint inhibitor therapy. The flares resulted in the utilization of systemic steroids and biologics in 27% and 10% respectively. Conclusions: While the data suggests a high proportion of patients with IBD experience flares during cancer treatment, all of the reported episodes were manageable with steroids and/or biologics. However, the population studied only included 1443 patients, and larger population studies are required to optimize individual outcomes, and to explore methods to minimize severity and frequency of flares, when possible.

Positive relationship between plant diversity dietary patterns and disease activity in Australian adults with Inflammatory Bowel Disease

Diet is implicated in the development of Inflammatory Bowel Disease (IBD). However, the role of diet in reducing inflammation and managing prevalent disease is unclear (1–3). Previous studies have analysed the relationship between dietary patterns and occurrence of flares or symptoms, but not disease activity or inflammation (4–5). It is important to explore the role of habitual diet in management of IBD to provide targeted dietary recommendations. We explored the relationship between dietary intake with disease activity and inflammation in an Australian adult cohort with and without IBD. We analysed dietary and clinical data from the Australian IBD Microbiome (AIM) study. AIM is a prospective longitudinal cohort study of adults and children with Crohn’s Disease (CD), Ulcerative colitis (UC) and healthy controls (HC). Habitual dietary intake of food groups, fibre, polyphenols and fermented foods was collected by merging dietary data from 3-day food records and food frequency questionnaires with PhenolExplorer and the Australian Fibre Categories Database. Dietary patterns were explored using Principal Component Analysis (PCA) and cluster analysis (CA) in IBM SPSS Statistics (V29). Associations between dietary intake, clinical disease activity categorised as remission or active, and faecal calprotectin (FCAL) were explored in adult participants. A total of 412 participants (IBD = 223, HC = 189) were included. FCAL data was available for 211 participants (HC = 100, CD = 49, UC = 62). Median (IQR) FCAL at baseline was 20 (20) mg/kg for HC and 33 (127) mg/kg for IBD, indicating clinically irrelevant inflammation (FCAL &gt;50mg/kg = clinical inflammation). PCA identified 7 distinct dietary patterns for adults with IBD. A dietary pattern of high plant diversity was associated with active CD. In the total IBD cohort, low association to a 'Prudent’ pattern was positively associated with low FCAL, and high association to a 'Meat-eaters’ dietary pattern was positively associated with moderate FCAL. CA revealed 3 distinct clusters amongst participants with IBD. No significant difference between diet cluster and disease activity or FCAL was seen. There were no significant differences in intake of fibre or polyphenols between remission vs active disease in participants with IBD. A significant difference between total, soluble and insoluble fibre and FCAL categories was seen with a higher fibre intake associated with lower FCAL. Higher plant-diversity and 'Prudent’ dietary patterns are associated with active disease and higher FCAL in Australian adults with IBD. Reverse causality cannot be ruled out, with analysis of larger cohorts and clinical trial data needed to clarify this.

3D Magnetic Free Energy and Flaring Activity Using 83 Major Solar Flares

In this Letter, we examine the relationship between 3D magnetic free energy (MFE) and flaring activity using 83 major solar flares (M-class and X-class) in nine solar active regions (ARs). For this, we use 998 nonlinear force-free field extrapolations compiled by the “Institute for Space-Earth Environmental Research Database” at Nagoya University. These ARs produced at least three major flares with distinct rising and peak phases of 3D MFE. For each phase, the solar flare occurrence rate (FOR) is calculated as a ratio of the number of flares to the duration. The major results from this study are summarized as follows. First, there is no clear linear correlation (CC = 0.15) between 3D MFE and flare peak flux. Second, the FOR (3.4 day−1) of the rising phase is a little higher than that (3.1 day−1) of the peak phase, depending on AR. Third, for several flares, there are noticeable decreases in 3D MFE, which correspond to the typical energy of a major flare (about 1032 erg). Fourth, it is interesting to note that there are noticeable enhancements in FORs at several local maxima of 3D MFE, which may be associated with flux emergence and/or shearing motions. Fifth, the flare index rates, which are defined as the summation of flaring activity divided by the duration, of rising and peak phases are 151 day−1 and 314 day−1, respectively. Our results imply that the traditional and simple “storage and release” model does not apply to flare activities, and the random perturbation may be important for triggering flares.

Magnetic activity of radio stars based on TESS and LAMOST surveys

Aims. Stellar flares serve as crucial indicators stellar magnetic activity. Radio emissions were detectable across all stages of stellar evolution. We define radio stars in our paper as stars with radio continuum emission in the frequency region of about 1.4 - 375 GHz from the catalog published by Wendker (1995, 2015). We also include detected radio stars from the LOFAR Two-metre Sky Survey (LoTSS) and the Australian Square Kilometre Array Pathfinder (ASKAP), and VLA Sky Survey (VLASS) surveys, and present comparative discussions. We used the light curves from the Transiting Exoplanet Survey Satellite (TESS) survey coupled with low- and medium-resolution spectra from the Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST) survey to investigate the magnetic activity and statistical properties of radio stars. Methods. We cross-matched the radio stars from the radio star catalog and the LoTSS, ASKAP, and VLASS surveys with the TESS survey. For the stars from the radio star catalog, we obtained a matched sample of 1,537 stars (hereafter Sample 1) and downloaded their TESS light curves, which include 4,001 light curves at a 120s cadence. For the stars from the LoTSS, ASKAP, and VLASS surveys, we obtain a matched sample of 98 stars (hereafter Sample 2) and downloaded their 120s TESS light curves, totaling 260. Subsequently, we employed repeated fitting techniques to distinguish stellar background light curves from flare events. For Sample 1, we successfully identify 12,155 flare events occurring on 856 stars. For Sample 2, we identify a total of 3,992 flare events on 86 stars. Furthermore, by cross-referencing our samples with the Gaia survey, the TESS Input Catalog, and the LAMOST survey, we obtain additional stellar parameters, facilitating the determination of relationships between stellar and flare parameters. Results. For stars in Sample 1, within the 12,155 flare events observed on the 856 flare-active radio stars, a majority of more than 97$&lt;!PCT!&gt;$ have durations of less than 2 hours, while for stars in Sample 2, all 3,992 flare events have a duration of less than 2 hours. We calculated the flare occurrence percentage for each flare-active radio star, observing a decrease as effective temperature increased for both Sample 1 and Sample 2. We derived values of the power-law index (for Sample 1, the alpha value is approximately 1.50pm 0.11 for single stars and 1.38pm 0.09 for binary stars, for Sample 2, the alpha value is about 1.47pm 0.11 for single stars and 1.42pm 0.09 for binary stars) for the cumulative flare frequency distribution. In both Sample 1 and Sample 2, stars with lower effective temperatures tend to exhibit increased activity. Using LAMOST spectra and the Gaia DR3 chromospheric activity index, we note that the Halpha equivalent width and Gaia Ca II IRT activity index of flare-active radio stars is significantly larger than that of nonflaring stars. An intriguing finding is our potential identification of a coronal rain candidate through asymmetry observed in the Halpha line.

Superflare rate variability on M dwarfs

ABSTRACT M dwarfs are often highly flare productive, and changes in the rate of flaring can potentially affect the radiation and energetic particles an exoplanet is exposed to. Rate variability has been found to be rare on G-type stars, and there has been limited study of the variability of flaring on M dwarfs. Using data from the TESS mission up to Observation Sector 66, we analyse 658 stars ranging from K7 to M5 to test for superflare rate variability by calculating an optimal piecewise constant-rate model for flare occurrence using a Bayesian algorithm and identify 66 stars with rate changes, a larger proportion than our previous study into G-type stars (7 out of 270 stars). We find that rate variability does not depend on the stellar parameters for our sample. We investigate how the flare-frequency distribution for these stars varies and whether this variation affects exoplanet habitability. No stars in our sample provide sufficient UV flux to support prebiotic chemistry. We investigate the phase distributions on the rate variable stars, finding 11 cases of potential phase dependence in flaring across seven stars. We also compare the Bayesian method to another measure of activity, the fraction of flux emitted through flares, and do not observe a consistent relationship between this flaring activity metric and the optimal Bayesian model. We discuss the possible reasons for the discrepancy and identify a problem with the flaring activity metric due to the power-law distribution of the flare events.

Flare prediction after tapering the dose of tumour necrosis factor inhibitors in patients with axial spondyloarthritis: A nationwide cohort study.

To develop a model for predicting flares after tapering the dose of tumour necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA). Data were obtained from the Korean College of Rheumatology Biologics and Targeted Therapy Registry. In total, 526 patients who received the standard-dose TNFi for at least 1 year and tapered their dose were included in the derivation cohort. The main outcome was a flare occurrence defined as an Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) score of ≥ 2.1 after 1 year of TNFi tapering. The final prediction model was validated using an independent cohort. Among 526 patients, 127 (24.1%) experienced flares. The final prediction model included negative human leucocyte antigen B27 (β = 1.088), inflammatory back pain (β = 1.072), psoriasis (β = 1.567), family history of SpA (β = 0.623), diabetes mellitus (β = 1.092), TNFi tapering by ≥ 50% of the standard-dose (β = 0.435), ASDAS-CRP at tapering (β = 1.029), and Bath Ankylosing Spondylitis Functional Index score at tapering (β = 0.194) as covariates. It showed an excellent discrimination performance (AUC = 0.828). According to the predictive risk, patients were classified into three groups (low-, intermediate-, and high-risk). The probabilities of flares in these groups were 4.5%, 18.1%, and 61.8%, respectively. The performance of the model in the validation cohort was also comparable. The established prediction model accurately predicted the risk of flares after TNFi dose tapering in patients with axSpA using eight simple clinical parameters, which could be helpful to select appropriate patients for tapering their TNFi without flare in daily clinical practice.

Tenofovir alafenamide or tenofovir disoproxil fumarate in pregnancy to prevent HBV transmission: Maternal ALT trajectory and infant outcomes.

The use of antiviral agents, specifically tenofovir disoproxil fumarate (TDF), in pregnant women to prevent mother-to-child HBV transmission is a key step towards hepatitis elimination. However, data on using tenofovir alafenamide (TAF) is insufficient. The frequent occurrence of postpartum ALT flares may impact the clinical implementation. The maternal and infant outcomes were compared in multi-centre trials of high viral load HBsAg/HBeAg+ pregnant women receiving TAF or TDF from the third trimester until 2 weeks postpartum with intensive follow-ups. To explore the dynamic pre- and postpartum changes in ALT levels, we used a group-based trajectory model for analysing data of 332 women from three prospective studies. After treatment, the maternal HBV DNA levels significantly decreased from baseline to delivery: 7.87 ± 0.59 to 3.99 ± 1.07 Log10 IU/mL TAF (n = 78) and 8.30 ± 0.36 to 4.47 ± 0.86 Log10 IU/mL (TDF, n = 53), with viral load reductions of 3.87 versus 3.83 Log10 IU/mL. The HBsAg-positive rates among 12-month-old infants were 1.28% (1/78) versus 1.82% (1/55) respectively (p = 1.00). Of the TAF or TDF-treated mothers, 25.64% versus 16.98% experienced ALT > 2X ULN, and 11.54% versus 1.89% received extended antiviral treatment. Our model revealed four distinct ALT patterns: stable ALT (87.2%), moderate (8.0%) or marked (2.4%) postpartum flares, or prepartum elevations (2.4%). TAF effectively reduces mother-to-child HBV transmission, but prophylaxis failure still occurred in few cases. Postpartum ALT flares are common in women receiving TAF or TDF during pregnancy. Approximately 12.8% of mothers may require extended postpartum antiviral treatment. NCT03695029 (ClinicalTrials.gov).

Clinical and economic burden of systemic lupus erythematosus in Colombia

Aims Our cost-of-illness (COI) model adopted payer and societal perspectives over five years to measure the economic burden of Systemic Lupus Erythematosus (SLE) in Colombia. Materials and methods A prevalence-based model was constructed to estimate costs and economic consequences for SLE patients in Colombia. The model included four health states: three phenotypes of SLE representing mild, moderate, and severe states and death. The clinical inputs were captured from the published literature and validated by the Delphi panel. Our model measured direct medical and indirect costs, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. Results The number of Colombian SLE patients was 37,498. The number of SLE patients with mild, moderate, and severe phenotypes was 5343, 28757 and 3,397, respectively. SLE-patients with moderate (Colombian pesos; COP 146 billion) and severe phenotypes (COP276 billion) incurred higher costs than those with mild phenotypes (COP2 billion), over 5 years. The total SLE cost in Colombia over five years from the payer and societal perspectives was estimated to be COP 915 billion and 8 trillion, respectively. The costs per patient per year from the payer and societal perspectives were COP 4,881,902 ($3,510) and COP 46,637,054 ($33,528), respectively. Conclusion The burden of SLE in Colombia over five years is substantially high, mainly due to the consequences of economic loss because it affects women and men of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI indicated that disease management costs among patients with moderate and severe SLE were substantially higher than those among patients with a mild phenotype. Therefore, more attention should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatment strategies that help in disease control.

Economic burden of systemic lupus erythematosus in Malaysia

Introduction Our cost-of-illness (COI) model adopted the perspective of both payer and society over a time horizon of 5 years to measure the economic burden of systemic lupus erythematosus (SLE) in Malaysia. Methodology Our COI model utilized a prevalence-based model to estimate the costs and economic consequences of SLE in Malaysia. The clinical parameters were obtained from published literature and validated using the Delphi panel. Direct and indirect medical costs were measured, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. Results The number of target Malaysian patients with SLE in the COI model was 18,121. At diagnosis, the numbers of SLE patients with mild, moderate, and severe phenotypes were 2,582, 13,897, and 1,642, respectively. The total SLE cost in Malaysia over 5 years from both payer and society perspectives was estimated at MYR 678 million and 2 billion, respectively. The results showed a considerable cost burden due to productivity losses resulting from SLE-related morbidity and mortality. Over a 5-year time horizon, the costs per patient per year from the payer and society perspectives were MYR 7,484 ($4766) and 24,281($15,465), respectively. Conclusion Our study demonstrated the substantial economic burden of SLE in Malaysia over a time horizon of 5 years. It affects adults of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI model indicated that disease management costs among patients with higher disease severity were higher than those among patients with a mild phenotype. Hence, more attetion should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatments that could lead to better outcomes.

The economic burden of systemic lupus erythematosus in Taiwan

Background Our cost-of-illness (COI) model adopted both payer and societal perspectives over a time horizon of 5 years to measure the economic burden of systemic lupus erythematosus (SLE) in Taiwan. Methodology A prevalence-based model was established to estimate the economic consequences of SLE after diagnosis in Taiwan. The model included four health states: (i) the three phenotypes representing mild, moderate, and severe SLE, and (ii) death. The inputs were obtained from a literature review of all the clinical trials and validated using a Delphi panel. The Delphi panel’s insights included commonly used treatment strategies for patients with SLE within the Taiwanese healthcare system. The costs mentioned in this model are disease management, monitoring, transient event, and indirect costs. One-way sensitivity analyses were conducted to assess the model uncertainty. Results The number of patients with SLE in our COI model was 20,189. At diagnosis, the number of SLE patients with mild, moderate, and severe phenotypes was 5,916, 12,255, and 2019, respectively. The total SLE cost in Taiwan over 5 years from both payer and societal perspectives was estimated at TWD 3.9 and 47 billion, respectively. The costs per patient per year from the payer and societal perspective were TWD 38,775 ($2,758) and TWD 466,119 ($33,152), respectively. Conclusion The findings demonstrated that the burden of SLE in Taiwan over a time horizon of 5 years is substantially high, mainly due to the consequences of economic loss as it affects women and men during their working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Therefore, more attention should be paid to limiting the progression of SLE and the occurrence of flares, and further economic evaluations are necessary to assess novel treatment strategies that could control the disease.

The economic burden of systemic lupus erythematosus in United Arab Emirates

Aims Our study aims to provide an enhanced comprehension of systemic lupus erythematosus (SLE) burden in United Arab Emirates (UAE), over a five-year period from payer and societal perspective. Materials and methods A Markov model was established to simulate the economic consequences of SLE among UAE population. It included four health states: i) the three phenotypes of SLE, representing mild, moderate, and severe states, and ii) death. Clinical parameters were retrieved from previous literature and validated using the Delphi panel—the most common clinical practice within the Emirati healthcare system. We calculated the disease management, transient events, and indirect costs by macro costing. One-way sensitivity analysis was conducted. Results The estimated number of SLE patients in our study was 13,359. The number of SLE patients with mild, moderate, and severe phenotypes was 3,914, 8,109, and 1,336, respectively. Disease management costs, including treatment of each phenotype and disease follow-up, were AED 2 billion ($0.89 billion), whereas the costs of transient events (infections, flares, and consequences of SLE-related organ damage) were AED 1 billion ($0.44 billion). The productivity loss costs among adult-employed patients with SLE in the UAE were estimated at AED 7 billion ($3.1 billion). The total SLE cost over five years from payer and societal perspectives is estimated at AED 3 ($1.3 billion) and 10 billion ($4.4 billion), respectively. Additionally, the costs per patient per year from the payer and societal perspectives were AED 45,960 ($20,610) and AED 148,468 ($66,578), respectively. Conclusion Our findings demonstrate that the burden of SLE in the UAE is enormous, mainly because of the costly complications and productivity loss. More awareness should be created to limit the progression of SLE and reduce the occurrence of flares, necessitating further economic evaluations of novel treatments that could help reduce the economic consequences of SLE in the UAE.

Oral fusidic acid for the treatment of mild-to-moderate hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a debilitating inflammatory skin disease. Tetracyclines are one of the few therapeutic options recommended for mild-to-moderate disease. This study aimed to investigate the efficacy of systemic fusidic acid's (FA) effectiveness in treating HS. This retrospective study analyzed 55 FA therapy cycles (TC, average weekly dose: 6409 mg; range: 5250-9800 mg; 2-12 weeks) in 49 patients. The outcome was evaluated using the Physician's Global Assessment (PGA) scale. Therapy response was defined as any reduction of inflammatory activity without the occurrence of flares. We also characterized adverse events and investigated predictors for treatment success. Results were compared to a matched control group receiving doxycycline. FA treatment (55 treatment cycles (TC); male: 45.5%; female: 54.5%) showed an overall response rate of 70.9% (39 TC). No worsening was observed. Significantly higher response rates were observed in females (83.3%, P = 0.026) and Hurley I (90.9%, P = 0.008). After multivariate adjustment, higher response rates were associated with the Hurley grade (P = 0.046) but not with gender (P = 0.0174). Adverse reactions (21.8% gastrointestinal symptoms) occurred in 27.3% (15 TC) and 46.7% within the first 4 weeks. Similar results were observed in the doxycycline control group (overall response rate: 76.4%). Oral FA is safe and improves symptoms in most patients. HS patients could benefit from oral FA treatment, especially in case of contraindications or resistance to tetracyclines.