Presence Of Rheumatic Disease Research Articles

Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy.

Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 [3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women] were suffering from rheumatic diseases. A total of 20 deaths were reported [case fatality rate 31%, 95% confidence interval (CI): 19-42] compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.

1490-P: Levels of Specific Antibodies (Ab) for Sars Cov2 after Vaccination and Its Relationship with Clinical and Metabolic Variables in People with Type 2 Diabetes vs. Controls without Diabetes

Introduction: The COVID-19 pandemic has affected people all over the world, and even more seriously people with chronic pathologies. Objectives: Primary: To evaluate the humoral immune response (IgG Ab specific for SARS CoV-2) in adults with DM2 versus controls. Secondary: To evaluate the relationship between Ab IgG levels and the presence of other clinical variables and comorbidities. Materials and Methods: The study was carried out in January 2022 in Argentina. Adults with DM2 and controls who had received first and second doses of any SARS Cov-2 vaccines were included. Titers of Ac IgG were performed through the assay of IgG anti RBD (receptor binding domain in the host cell). Multiple Logistic Regression and Multiple Linear Regression were used. p value <0.05 was considered statistically significant. Results: N 144 participants (91 with DM2 and 53 controls). Median from the second dose of a vaccine to the measurement of Ab: 141 days in controls and 144 in diabetics (p=0.451). The logarithm of the Ab titers were significantly lower in patients with DM2 vs. controls (p<0.01). Univariate analysis: Ab levels were positively and significantly related to BMI (p<0.01). They were also significantly associated with age (p<0.001) and with the presence of rheumatic diseases (p= 0.02). Multivariate analysis: Ab levels were only significantly and negatively associated with age (p<0.01) and the presence of rheumatologic bone disease (p=0.02). No differences were found between the type of vaccines used. Conclusion: Although the Ab titers registered in DM2 were significantly lower vs. controls, the adjustment for various covariates have not allowed to sustain the significance of this association in multivariate analysis. The role of age, BMI, the presence of rheumatic diseases and other factors should be explored in other studies in order to evaluate their potential role as confounders. Disclosure M.L.Pomares: None. A.Figuerero: None. C.Gomez martin: None. S.Gorban de lapertosa: None. G.Cuzziol: None. C.E.Lopez: None. S.Kremer sendros: None. D.Pomares: None. M.Ojeda: None. V.Wolffenbuttel carloto: None. R.M.Tejada: None. G.A.Ojeda: None.

Association between short-term systemic use of glucocorticoids and prognosis of cardiogenic shock: a retrospective analysis

ObjectiveTo investigate the prescription rate of short-term systemic use of glucocorticoids during hospitalization in patients with cardiogenic shock (CS), and outcomes related with glucocorticoid use.MethodsWe extracted patients' information from the Medical Information Mart for Intensive Care IV version 2.0 (MIMIC-IV v2.0) database. The primary endpoint was 90-day all-cause mortality. Secondary safety endpoints were infection identified by bacterial culture and at least one episode of hyperglycemia after ICU admission. Propensity score matching (PSM) was used to balance baseline characteristics. The difference in cumulative mortality rate between these treated with and without glucocorticoids was assessed by Kaplan–Meier curve with log-rank test. Independent risk factors for endpoints were identified by Cox or Logistic regression analysis.ResultsA total of 1528 patients were enrolled, and one-sixth of these patients received short-term systemic therapy of glucocorticoids during hospitalization. These conditions, including rapid heart rate, the presence of rheumatic disease, chronic pulmonary disease and septic shock, high lactate level, the requirements of mechanical ventilation and continuous renal replacement therapy, were associated with an increase in glucocorticoid administration (all P ≤ 0.024). During a follow-up of 90 days, the cumulative mortality rate in patients treated with glucocorticoids was significantly higher than that in these untreated with glucocorticoids (log-rank test, P < 0.001). Multivariable Cox regression analysis showed that glucocorticoid use (hazard ratio 1.48, 95% confidence interval [CI] 1.22–1.81; P < 0.001) was independently associated with an increased risk for 90-day all-cause mortality. This result was consistent irrespective of age, gender, the presence of myocardial infarction, acute decompensated heart failure and septic shock, and inotrope therapy, but was more evident in low-risk patients as assessed by ICU scoring systems. Additionally, multivariable Logistic regression analysis showed that glucocorticoid exposure was an independent predictor of hyperglycemia (odds ratio 2.14, 95% CI 1.48–3.10; P < 0.001), but not infection (odds ratio 1.23, 95% CI 0.88–1.73; P = 0.221). After PSM, glucocorticoid therapy was also significantly related with increased risks of 90-day mortality and hyperglycemia.ConclusionsReal-world data showed that short-term systemic use of glucocorticoids was common in CS patients. Importantly, these prescriptions were associated with increased risks of adverse events.

Long-term persistence of antibodies after diphtheria/tetanus vaccination in immunosuppressed patients with inflammatory rheumatic diseases and healthy controls

Many vaccines demonstrate high effectiveness for years. This prospective multicentre study was conducted in Switzerland to assess the long-term persistence of antibodies to the diphtheria/tetanus (dT)-vaccine in adult patients with rheumatic diseases (PRDs). 163 PRDs and 169 controls were included in the study. The median age of all participants was 50 years (range: 18–83 years) and 56% were female. After a median time interval of 16 years after vaccination, the median anti-vaccine antibody concentrations were lower in PRDs than in controls for tetanus (1.68 vs 2.01; p = 0.049) and diphtheria (0.05 vs 0.22; p = 0.002). Based on the currently accepted seroprotection threshold (antibody concentration ≥ 0.1 IU/ml), PRDs had lower proportions of short-term tetanus and diphtheria protection as demonstrated by crude odds ratios (OR) of 0.30 (p = 0.017) and OR: 0.52 (p = 0.004), respectively. After adjusting for ‘age’ and ‘time since last dT vaccination’, the strength of associations became weaker; for tetanus, borderline evidence remained for a true difference between PRDs and controls (OR: 0.36 [p = 0.098]), however, not for diphtheria (OR: 0.86 [p = 0.58]). We hypothesize that in the presence of rheumatic diseases and its immunosuppressive treatment, vaccine-specific long-lived plasma cells (LLPCs) may be diminished or competitively displaced by rheumatism-specific LLPCs, a process which may decrease the persistence of vaccine-specific antibodies. Novel studies should be designed by incorporating methodologies allowing to determine the attributable fraction of immunosuppressive/immunomodulatory medications and rheumatic disease itself on long-lasting vaccine-specific antibody persistence, as well as, further study the role of LLPCs.

Properties of Uncommon Indirect Immunofluorescence Staining Patterns Determined during Antinuclear Antibody Detection on HEp-2 Cells.

In this study, we aimed to assess the prevalence of uncommon staining patterns found during testing for the presence of antinuclear antibodies (ANA) and to determine their association with certain antibodies and clinical diagnoses. Presence of ANA and the staining pattern was determined in 10955 samples using indirect immunofluorescence (IIF) on HEp-2 cells. ANA-positive samples were assessed for presence of 14 specific antibody types using a microbead based system. Demographic data (age, sex) and clinical diagnoses were collected from the referral documentation. Particular staining patterns were then compared with a representative comparison group comprised of samples with common staining patterns using these criteria. There were 22 patterns present in less than 3% of samples each and these were jointly present in 42.43% of ANA-positive samples. Specific antibodies were found in proportions similar to the comparison group (46.06%) and varied significantly between patterns. Likewise, there were significant differences in antibody distribution in particular patterns. Some patterns were associated with presence of rheumatic diseases or inflammatory arthropathies, while in others there was a concurrent diagnosis of liver disease, or a neoplastic process. Many of the uncommon IIF patterns have distinctive characteristics that warrant further investigation in order to determine their role in diagnosing various diseases, not limited only to the illnesses of the rheumatic spectrum. IIF on HEp-2 cells remains an irreplaceable method because of the diversity of ANA, only a number of which can be detected using other standardised methods.

POS1267 CLINICAL COURSE OF NEW SARS-COV-2 INFECTION IN CHILDREN WITH RHEUMATIC DISEASES: RETROSPECTIVE STUDY OF SINGLE PEDIATRIC RHEUMATOLOGY CENTER

Background:About one year ago at the beginning of the new SARS-CoV-2 infection pandemic, it was expected, that rheumatic disease (RD) and immunosuppressive therapy could predispose to a more severe course of the Covid-19 infection. At that time, it was unspeakable how this infection would occur in children with RВ in compare to adults. Now it’s time to draw preliminary conclusions.Objectives:to analyze all features of COVID19 infection in children with RDMethods:The retrospective single center study of all patients with pediatric RD who had the COVID19 infection up to the end of January 2021. It was analyzed all variety of clinical manifestations, changing in therapy at the time of COVID-19 and after it, the dynamics of the RD and consequences of the new viral disease.Results:The study included 66 patients under the age of 18 with various RS, including autoinflammatory disease (AIDs). The diagnostic distribution, sex ratio, age and previous therapy present in the Table 1. There were patients treated with DMARDS (methotrexate -47, hydroxychloroquine -3, mycophenolate mofetil -2, colchicine -1), NSAID monotherapy -6, systemic steroids -10; 29 patients recived Biologics, including combination with methotrexate. None of our patients had a severe course of the COVID-19, none of 66 patients was hospitalized for emergency indications in the intensive care unit or in other specialized departments. The diagnosis of Covid-19 infection was based on different evidences: positive PCR in 15 (23%) cases, high levels of immunoglobulins G and M - in 64 (97%) and 7 (11%) respectively, viral pneumonia was confirmed by CT in 2 (10%) cases. A manifest clinical picture presented just in 21 (32 %) of patients, the others were carried the disease asymptomatically. Among the clinical manifestations of SARS-CoV-2 that were observed in our patients were the following: fever, as the most frequent symptom - 19 (90%), rhinitis - 12 (57%), anosmia - 10 (48%), sore throat - 3 (14%), arthralgia/myalgia in 4 (19%), rash - 1 (5%) case, cough - 4 (19%) cases. it is important to note that until July 2020, only 4 patients were registered, and in the next 6 months – 62. The treatment against Covid-19 in our patients with clinical symptoms included: NSAID monotherapy -4 (19%), Systemic steroids -2 (10%), Hydroxychloroquine -2(10%), Antibiotics-5 (24%).Table 1.Clinical characteristics of children with RD according to presence of symptoms of Covid-19ParameterCovid-19 symptomatic course (n=21)Covid-19 asymptomatic course (n=45)p-valuesSex ratio (F/M)9/1230/15nsDuration of RD (Me. Years)4 (2;6)4 (2;7)nsAge(years)Me&lt;10 yrs&gt;10 yrs15 (13; 17)12011 (8;13.5)1926&lt;0,001&lt;0,05&lt;0,001Covid-19 evidencesIgG Covid-19 +1945nsIgM Covid-19 +34nsPCR Covid-19 +110nsDiagnosis of RDJIA non-systemic1431nssJIA13nsSLE41nsJDM11nsScleroderma6nsAIDs (CAPS, FMF, FOP)13nsPrevious therapyNSAID monotherapy36nsDMARDs1633nsSystemic steroids47nsTNF-inhibitors512nsAbatacept13nsIL6-inhibitors (Tocilizumab, Sarilumab)02nsJAK-kinase inhibitors12nsWorsening/flare of RD after Covid-19 infection50p&lt;0,05Conclusion:Our study suggests that the presence of RD and immunosuppression therapy does not lead to an increased frequency or severe course of Covid-19 infection in children. The final conclusion will be drawn as the data accumulates.Disclosure of Interests:None declared

Presence of anti-TIF-1γ, anti-Ro52, anti-SSA/Ro60 and anti-Su/Ago2 antibodies in breast cancer: a cross-sectional study

Objectives The presence of myositis-specific antibodies (MSA), was recently reported in healthy individuals, cancer patients without myopathy and paraneoplastic rheumatic syndromes. We sought to analyze the frequency of MSA, myositis-associated antibodies (MAA) and autoantibodies related to systemic autoimmune rheumatic diseases (SARD) in breast cancer patients. Methods One hundred fifty-two breast cancer patients were enrolled in a cross-sectional study. Clinical information was collected, and autoantibodies tested by immunoprecipitation of an 35S-methionine-labeled K562 cell extract, enzyme-linked immunosorbent assay (ELISA) and Western blot when indicated. All statistical tests were performed using the software statistical package for the social science (SPSS) ver. 19.0 (IBM Inc., NYSE, USA). Results Autoantibodies associated with SARD: anti-52 kD ribonucleoprotein/tripartite motif-containing 21 (anti-Ro52/TRIM21) was found in 5.9% (9/152), anti-Sjögren syndrome-related antigen A/60 kD ribonucleoprotein antibody (anti-SSA/Ro60) in 3.9% (6/152) and anti-Su antigen/Argonaute 2 antibody (anti-Su/Ago2) in 2.6% (4/152). Meanwhile, anti-transcription intermediary factor-1γ (anti-TIF-1γ, p155/140) antibody was positive in 2 cases and anti-polymyositis/scleroderma antibody was detected in one case. As a whole, 14.47% (22/152) of breast cancer patients showed autoantibodies associated with SARD. These specific autoantibodies were not associated with the presence of rheumatic diseases except one rheumatoid arthritis patient positive for anti-Ro52/TRIM21. Conclusions Autoantibodies to TIF-1γ were found in two patients with breast cancer without dermatomyositis (DM). More common specificities were autoantibodies anti-SSA/Ro60, anti-Ro52/TRIM21 and anti-Su/Ago2. More studies are needed in order to establish the biological meaning of the presence of SARD-associated autoantibodies in breast cancer.

Risk of coronavirus disease 2019 hospitalization and mortality in rheumatic patients treated with hydroxychloroquine or other conventional disease-modifying anti-rheumatic drugs in Italy.

ObjectivesTo ascertain if hydroxychloroquine (HCQ)/chloroquine (CLQ) and other conventional disease-modifying anti-rheumatic drugs (cDMARDs) use, and rheumatic diseases per se, may be associated with COVID-19-related risk of hospitalization and mortality.MethodsThis case-control study nested within a cohort of cDMARD users was conducted in the Lombardy, Veneto, Tuscany and Lazio regions and Reggio Emilia province. Claims databases were linked to COVID-19 surveillance registries. Risk of COVID-19-related outcomes was estimated using a multivariate conditional logistic regression analysis, comparing HCQ/CLQ vs methotrexate, vs other cDMARDs and vs non-use of these drugs. Presence of rheumatic diseases vs their absence in a non-nested population was investigated.Results1275 cases hospitalized due to COVID-19 were matched to 12 734 controls. Compared with recent use of methotrexate, no association between HCQ/CLQ monotherapy and COVID-19 hospitalization (OR 0.83 [95%CI, 0.69–1.00]) or mortality (OR 1.19 [95%CI, 0.85–1.67]) was observed. A lower risk was found when comparing HCQ/CLQ use to the concomitant use of other cDMARDs and glucocorticoids. HCQ/CLQ was not associated with COVID-19 hospitalization as compared with non-use. An increased risk for recent use of either methotrexate monotherapy (OR 1.19 [95% CI, 1.05–1.34]) or other cDMARDs (OR 1.21 [95% CI, 1.08–1.36]) vs non-use was found. Rheumatic diseases were not associated with COVID-19-related outcomes.ConclusionHCQ/CLQ use in rheumatic patients was not associated with a protective effect against COVID-19-related outcomes. Use of other cDMARDs was associated with an increased risk when compared with non-use, and, if concomitantly used with glucocorticoids, also vs HCQ/CLQ, probably to be ascribed to immunosuppressive action.

РЕВМАТИЧЕСКИЕ ЗАБОЛЕВАНИЯ И БЕРЕМЕННОСТЬ

. The problem of pregnancy in rheumatic diseases does not lose its relevance. The most studied is the course of pregnancy in patients with rheumatoid arthritis, systemic lupus erythematosus and axial spondyloarthritis. Observations in other systemic connective tissue diseases are episodic and do not allow us to draw reliable conclusions. The course of the disease itself, as well as the therapy received by patients, can affect pregnancy, starting with the possibility of conception and ending with unfavorable pregnancy outcomes for the mother and fetus. The onset of pregnancy should be planned at the time of remission or minimal activity of the disease. Of particular interest is drug therapy in patients with rheumatic diseases during gestation. This issue has been and remains complex and has not been fully studied due to the fact that any conclusions about the effect of drugs on the fetus are made retrospectively and cannot be the result of a deliberately initiated study. Currently allowed, though with some reservations, during pregnancy drugs are glucocorticoids, non-steroidal anti-inflammatory drugs, hydroxychloroquine and sulfasalazine. The development of genetic engineering has raised the question of the possibility of using genetic engineering basic therapy during gestation. Currently, the largest number of observations is available for TNF-α inhibitors, the use of which is recognized as possible during pregnancy. The presence of rheumatic disease in itself is not an absolute indication for a caesarean section. The question of the method of delivery is decided individually. Pregnant patients with rheumatic diseases should be under regular joint supervision of an obstetrician-gynecologist, rheumatologist and neonatologist

Вакцинация детей с аутоиммунными ревматическими заболеваниями. Современное состояние проблемы

Vaccination of children with autoimmune rheumatic diseases is a significant problem since infectious diseases remain the main cause of complications of anti-rheumatic therapy and one of the leading causes of death in this category of patients. This review presents current information on the frequency of comorbid infections, the accumulated experience of vaccination in children with autoimmune rheumatic diseases. The recommendations of The European League Against Rheumatism (EULAR) for vaccination in paediatric patients with rheumatic diseases are presented in detail. The presence of rheumatic disease is not an exception for vaccination, it is recommended for all children following national guidelines. Non-live vaccines are effective and safe in paediatric patients with rheumatic diseases. Live vaccines are not recommended for patients receiving high doses of glucocorticoids, immunosuppressive and biologics therapy due to the risk of infectious complications. Vaccination against pneumococcal infection and seasonal influenzais are hihgly recommended. Key words: vaccination, children, autoimmune rheumatic diseases, guidelines, review

Hypogonadotropic Hypogonadism and Juvenile Idiopathic Arthritis in an African Boy: What is the Pathophysiological Link?

The association between hypogonadotropic hypogonadism and juvenile chronic arthritis has rarely been reported in the literature. We report an untreated case of systemic juvenile idiopathic arthritis in a young African male with co-presentation of hypogonadotropic hypogonadism. Possible pathophysiological and etiological links are discussed.A 16-year-old boy was received in our outpatient department for chronic arthritis with temporomandibular involvement and fever. There was no family history of rheumatic diseases or psoriasis. Body temperature was 39.5°C at admission. The clinical examination found synovitis of wrists and knees and inflammatory lymphadenopathy. This polyarthritis occurred in a context of hypogonadism marked by impuberism of Tanner classification stage P2G2. Laboratory tests showed biological inflammatory syndrome and hyperferritinemia with collapsed glycosylated ferritin at 11%. Hormonal testing found low blood testosterone (0.08 mg/L) and pituitary hormone levels attesting to hypogonadotropic hypogonadism. Screening for infections was negative. The immunological assessment for antinuclear antibodies, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies were negative. Standard radiography showed bilateral wrist carpitis. The olfactory bulb was present and normal by cerebral magnetic resonance imaging. The diagnosis of systemic juvenile idiopathic arthritis associated with hypogonadotropic hypogonadism, probably related to delayed puberty, was retained. A therapy combining corticosteroid, methotrexate for arthritis, and hormone replacement with testosterone led to regression of arthritis, biological inflammatory syndrome, and hypogonadism.The presence of rheumatic disease in this context of hypogonadism, regardless of its cause, is mainly associated with very low testosterone levels and the presentation of arthritis in these patients tends to be more severe.

Patient Characteristics of Possible Responders and Nonresponders to Total Ankle Arthroplasty

Characteristics of responders, or those who achieve a clinical improvement above the level of a minimal clinically important difference, have not been defined for total ankle arthroplasty (TAA). The purpose of this study was to determine patient characteristics that distinguish possible responders from possible nonresponders after TAA using criteria established for other arthroplasty surgeries. Patients undergoing TAA who were enrolled into a prospective study at a single academic center evaluating patient-reported outcomes were included. Patients were characterized as possible responders if the relative or absolute improvement in their 2-year follow-up Short Musculoskeletal Function Assessment (SMFA) function score was at least 50% or 20, respectively, compared with their preoperative score, consistent with Outcome Measures in Rheumatoid Arthritis Clinical Trials and the Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Patient factors were then associated with possible responder or nonresponder status and a multivariable analysis was performed. A total of 491 patients with complete data and 2-year follow-up were included in this study. Multivariable analysis demonstrated that a higher baseline 36-Item Short-Form Survey (SF-36) mental component summary (MCS) score (OR [95% CI], 1.02 [1.01, 1.04]; P = .003), indicating better mental health, was associated with being a possible responder to TAA. The presence of rheumatic disease (OR [95% CI], 0.38 [0.22, 0.67]; P = .001) was a significant predictor of being a possible nonresponder. Our data reveal that a higher baseline SF-36 MCS score was associated with increased improvement in SMFA function scores, while rheumatic disease was associated with worse improvement in SMFA function scores after TAA. Patients with rheumatic disease or poor mental health may not achieve as favorable results after TAA and should be counseled appropriately. Level III, retrospective comparative study.

Factors related to chronic pain in institutionalized elderly

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain is one of the main problems arising from the aging process. It may be related to multiple physical and even psychosocial causes, influencing quality of life and well-being of the elderly, especially those living in long-term care facilities. The objective of this study was to evaluate the prevalence of chronic pain and related factors in institutionalized elderly. METHODS: Cross-sectional population-based study, carried out with 125 elderly individuals living in long-term care facilities. Data collection was carried out through an interview with a structured questionnaire, investigating, in addition to the presence of chronic pain, sociodemographic aspects, health conditions, subjective self-rated health, cognitive status, basic activities of daily life, risk of sarcopenia and presence of depressive symptoms. RESULTS: The sample consisted of 125 elderly people with 78.20±9.10 years old, of whom 64% were women. The prevalence of chronic pain in the population was 44%, and the factors related to it were the presence of rheumatic disease (p=0.000), low back pain (p=0.003), the use of polypharmacy (p=0.018) and being dependent when performing basic activities of daily living (p=0.029). CONCLUSION: The factors related to chronic pain in institutionalized elderly people were rheumatic disease, low back pain, polypharmacy and dependence to perform basic activities of daily living.

Coronary flow reserve in systemic rheumatic diseases: a systematic review and meta-analysis.

Coronary flow reserve (CFR), a measure of both obstructive coronary artery disease and microvascular dysfunction, has been evaluated in systemic rheumatic diseases (RDs), but a comprehensive critical appraisal of the available evidence is lacking. The objective of this study is to conduct a systematic review and meta-analysis of studies with small sample size investigating the associations between the presence of RDs and CFR to increase statistical power and accuracy. PubMed, Web of Science, Scopus, and Google Scholar, from inception to March 2018, were searched for studies reporting on CFR in RDs in comparison to healthy subjects. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Meta-regressions and sensitivity analyses assessed study heterogeneity by type of RDs, age, traditional cardiovascular risk factors, systemic inflammation, and methodology used to evaluate CFR. Twenty-one studies (709 RDs patients and 650 healthy controls) were included in the meta-analysis. Pooled results showed that CFR values were significantly lower in patients with RDs than in healthy controls (SMD=- 1.51, 95% CI - 1.91, - 1.11; p < 0.001; I2 = 90.1%, p < 0.001). The between-group differences in CFR were not associated with inflammatory burden, age, lipids, body mass index, blood pressure, or assessment methods. Patients with prevalent autoimmune features (e.g., systemic lupus erythematosus) showed a significantly lower CFR when compared to patients with mixed autoimmune and autoinflammatory features (e.g., psoriatic arthritis). This meta-analysis showed a significant impairment in CFR in patients with RDs with respect to the general population. Differences in pathogenetic mechanisms may influence the severity of CFR impairment in RDs.

New horizons in the use of biological agents during pregnancy in patients with rheumatic disease

Pregnancy in the presence of rheumatic diseases (RD) and adequate therapy before planned conception, during gestation, and after delivery during lactation is challenging. Advances in the treatment of RD are largely due to the clinical introduction of a new class of biological agents (BAs). There are less than two decades of experience in using BAs in rheumatology and to date there are no unified standards and accepted rules governing their use during pregnancy. According to the current requirements, information on a medicine should be given in three sections: 1) pregnancy; 2) lactation, and 3) use in men and women who are planning concept (the latter section has appeared for the first time). The present article summarizes data on the possible use of BAs in patients with RD during pregnancy planning, pregnancy, and breastfeeding.

The place of intravenous immunoglobulin in rheumatic diseases

Therapy with intravenous human immunoglobulin (IVIG) was and continues to remain essential for a number of diseases. At the same time the evidence base for IVIG use is extremely small in rheumatology. Clinical experience shows that IVIG is effective in treating thrombocytopenic purpura, Guillain–Barre syndrome, and chronic inflammatory demyelinating polyneuropathy, which develop in the presence of rheumatic diseases, such as systemic lupus erythematosus, inflammatory myopathies, and antineutrophil cytoplasmic antibody-associated vasculitides. The review considers indications for the use of IVIG, its dosage regimen, benefits, and adverse reactions and analyzes the Russian and foreign literature on this issue.

Rheumatic diseases and multimorbidity

In the past decade, investigators' undeniable and justified interest has not been fading in comorbidities in the presence of rheumatic diseases. The terms "comorbidity" and "multimorbidity" are frequently and not always consciously used as interinterchangeable, confusing the terminology and accordingly the elaboration of strategies for further researches. The concepts "(co-occurring disease" and "multimodality" are not mutually exclusive or contradictory, but these should be considered from another point of view than "comorbidity". The problem of multimorbid disease is the rule rather than the exception for clinicians treating primarily "typical" rheumatic patients. Recent researches could outline a few key areas for further study of the concept of multimorbidity in rheumatologic practice, which will be able to turn the international research community from rheumatic disease to the patient as a whole.

Retinal Toxicity Due to Antimalarials: Frequency and Risk Factors

ObjectiveTo study the frequency of retinal toxicity and associated risk factors in a cohort of patients treated with antimalarials and seen at a tertiary level hospital. Material and methodsRetrospective study of 40 patients treated with antimalarials, who were referred to ophthalmology for the study of retinal toxicity during 2011. Data collection included type of antimalarial prescribed, daily and cumulative doses, presence of rheumatic disease, corticosteroid use, associated diseases and ophthalmologic examination. Retinal toxicity was confirmed if two of the following tests were altered: fundus examination, visual field with a macular pattern, changes in spectral domain optical coherence tomography (SD-OCT) and full-field electroretinography (ERG). ResultsToxic retinopathy was detected in 13.1% of patients (95% confidence interval 5%–21%) and a trend for a higher risk was observed in case of chloroquine (CQ) treatment. Among the patients with retinopathy, the mean cumulative dose was 229g for CQ and 111g for Hydroxychloroquine (HCQ), and the mean daily dose of CQ was 250mg and 333mg for HCQ. Arterial hypertension had a statistically significant effect on retinopathy development. ConclusionsToxic retinopathy defined by ophthalmological evaluation was detected in 13.1% of patients. A trend for a higher risk was observed in case of chloroquine treatment.

Toxicidad retiniana por antipalúdicos: frecuencia y factores de riesgo

ObjectiveTo study the frequency of retinal toxicity and associated risk factors in a cohort of patients treated with antimalarials and seen at a tertiary level hospital. Material and methodsRetrospective study of 40 patients treated with antimalarials, who were referred to ophthalmology for the study of retinal toxicity during 2011. Data collection included type of antimalarial prescribed, daily and cumulative doses, presence of rheumatic disease, corticosteroid use, associated diseases and ophthalmologic examination. Retinal toxicity was confirmed if two of the following tests were altered: fundus examination, visual field with a macular pattern, changes in spectral domain optical coherence tomography and full-field electroretinography. ResultsToxic retinopathy was detected in 13.1% of patients (95% confidence interval 5-21%) and a trend for a higher risk was observed in case of chloroquine (CQ) treatment. Among the patients with retinopathy, the mean cumulative dose was 229g for CQ and 111g for Hydroxychloroquine (HCQ), and the mean daily dose of CQ was 250mg and 333mg for HCQ. Arterial hypertension had a statistically significant effect on retinopathy development. ConclusionsToxic retinopathy defined by ophthalmological evaluation was detected in 13.1% of patients. A trend for a higher risk was observed in case of chloroquine treatment.

The study of the prevalence of articular syndrome and pathology of the musculoskeletal system through a telephone questionnaire survey

Aim. To establish the prevalence of complaints of joint swelling and arthralgia among the population of Smolensk city, to assess their correlation with the presence of rheumatic diseases. Methods. A cross-sectional telephone questionnaire survey of residents of six therapeutic districts of two municipal polyclinics of Smolensk city was conducted. Interviewed were 2737 people (64.8% females and 35.2% males). The average age of respondents was 49.1±17.6 years. Results. Swelling of the joints at the time of the survey was revealed in 665 (24.3%) of respondents, in the majority of which (583 people, 21.3%) the symptoms persisted for more than the last 12 months. Pain in the knee joints was observed in 1141 (41.7%) residents, including arthralgia lasting more than a year - in 1012 (37.0%) people. The relationship between both of the symptoms and the gender (the predominance of women) and age (an increasing linear nature of the frequency of complaints in males and non-linear with a peak in the group of 70-80-year-olds - in females) was revealed. It was established that only 41.3% of respondents with joints swelling and 30.9% with arthralgia had a previously established diagnosis of rheumatic disease. Conclusion. The study results suggest that there is high prevalence of rheumatic complaints among residents of Smolensk city with a predominance of articular disease in women and individuals of older age groups; revealed was the fact of low awareness of the population of the existing rheumatic disease.