Rheumatology Clinic Research Articles

Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study

BackgroundSystemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members).MethodsCaregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis.ResultsFour barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient.ConclusionThese findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don’t receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.

#2775 ERCOS multicenter Spanish study: clinical profile of patients with chronic kidney disease G3a-G5D and osteoporosis

Abstract Background and Aims Fracture risk evaluation has recently been integrated into the 2017 KDIGO CKD-MBD (Chronic Kidney Disease- Mineral and Bone Disorder) guideline and its 2021 Spanish endorsement. It is now suggested to test bone mineral density (BMD) to assess fracture risk “if results will impact treatment decisions”. In fact, multiple new prospective studies have now documented that lower BMD predicts incident fractures in patients with CKD G3a–G5D. However, we scarcely know current real clinical practice in this population. Thus, the aim of the ERCOS (“Enfermedad Renal Crónica OSteoporosis”) study was to describe the clinical profile of patients with CKD who had been diagnosed of osteoporosis in outpatient Nephrology and Rheumatology clinics in Spain. Method ERCOS is a descriptive, observational, and multicenter Spanish study. Patients were recruited by consecutive sampling from 15 different Spanish hospitals. Osteoporosis characteristics (history of fragility fracture, BMD and other fracture risk factors), associated comorbidities, biochemical parameters and treatment were analyzed. Results A total of 163 patients (median age 77 years old) were included. Most were women (71.2%) and 98.3% of them were postmenopausal. Hypertension was the most frequent comorbidity (87.1%) and “attributed” cause of CKD (43.2%). Diabetes mellitus and cardiovascular disease were present in 35.6% and 29.4% of patients, respectively. Median estimated glomerular filtration rate was 36 ml/min/1.73 m2 [creatinine 1.48 mg/dl (95% CI 1,2-2)]. 38% of patients were G5D CKD patients (95.2% undergoing hemodialysis). 37.7% of patients had had a fragility fracture after the diagnosis of CKD (vertebral 52.5%, hip 24.6%, wrist 21.3%, humerus 16.4%, among others). Importantly, despite the diagnosis of osteoporosis, only 60.1% of the patients received specific treatment (mainly bisphosphonates or denosumab). Moreover, antiosteoporotic treatment was much more frequently prescribed by rheumatologists (46.9%), internal medicine physicians (23.5%), and only 13.3% was prescribed by nephrologists. 19.4% of patients suffered from fragility fractures even after initiating specific treatment. Conclusion Most patients with moderate and severe CKD with osteoporosis were old postmenopausal women with a high prevalence of diabetes or cardiovascular disease. Although about 40% had even suffered a fragility fracture, there is a high treatment gap, especially relevant among nephrologists. A call to action and to avoid existing therapeutic nihilism seems necessary, expanding the knowledge of the new more proactive guidelines and homogenizing the care and therapeutic approach in these patients.

Rheumatology nurses’ knowledge and practices on pain management

Objective: Nurses have important responsibilities in providing effective pain management. This study was conducted to determine the level of knowledge and practices of rheumatology nurses regarding pain management. Methods: A descriptive study sample was 64 nurses in the rheumatology clinic. Data were collected using the Nurse Introduction Form and Questionnaire on Knowledge and Practices Regarding Pain Management. The data were evaluated in the SPSS. Results: It was determined that 73.4% of the rheumatology nurses did not receive training on pain management. The pain management knowledge score was moderate, and the knowledge of non-pharmacological pain management was insufficient. The mean pain management self-confidence score was 6.03±2.01 (0-10), and a positive correlation was found between the graduation year, working years in rheumatology, and pain management knowledge score (P

Adalimumab in the Treatment of Complex Sarcoidosis-related Inflammatory Eye Disease: A Case Series

Background: Sarcoidosis is a systemic granulomatous inflammatory disease that is associated with inflammatory eye manifestations such as uveitis, cystoid macular edema, and retinal vasculitis. Although Corticosteroids (CS) have traditionally been the mainstay of treatment, there is a clinical need and growing interest in exploring alternative therapeutic options for patients who are refractory to or intolerant of CS or require long-term steroid-sparing agents. Purpose: This case series aims to describe the effectiveness of adalimumab, an anti-tumor necrosis factor (TNF)-α monoclonal antibody, in the management of complex sarcoidosis-related inflammatory eye disease via reduction in CS dosage and ocular exam findings before and after initiation of adalimumab therapy. Method: A retrospective chart review of patients between 2010 and 2023 seen at our academic center’s rheumatology and eye clinics was conducted, with 5 patients meeting the inclusion criteria. Results: Most patients were able to lower, discontinue, or remain off oral CS, while all 5 patients demonstrated a reduction in uveitis activity, Cystoid Macular Edema (CME), and/or retinal vasculitis. Conclusion: These findings suggest a potential role for adalimumab as an effective and safe therapeutic option in the management of complex sarcoidosis-related inflammatory eye disease.

A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria

Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.

False-positive Findings of Large Vessel Vasculitis on FDG-PET in Patients Treated With Immune Checkpoint Inhibitors.

Fluorine-18 fluorodeoxygluocose positron emission tomography (FDG-PET) is increasingly used in the evaluation of response to immune checkpoint inhibitor (ICI) therapy. Incidental findings of increased vessel wall uptake may prompt the concern for ICI-induced large vessel vasculitis (LVV). Precise radiographic and clinical evaluation is required to determine if this represents true vasculitis, as use of immune suppression and ICI discontinuation can have significant impacts on patient outcomes. We performed a retrospective case analysis of 4 consecutive patients referred to 2 rheumatology clinics treated with ICI with incidental findings of LVV on FDG-PET, reviewing their clinical course and radiographic findings. All 4 cases had FDG-PET scans for routine oncology indications and had no associated clinical features of LVV. One patient was treated with corticosteroids and no patients developed any clinical evidence of vasculitis during a mean follow-up period of 17 months (range: 7-33mo). All FDG-PET images reporting LVV underwent a standardized analysis to identify any technical issues or concerns with interpretation. In review of imaging, 3 of the cases may have been due to delayed tracer to scan interval leading to misinterpretation of vascular uptake as suspected LVV. Recognition of technical pitfalls in FDG-PET interpretation is crucial to inform the need for immunosuppression and the safety of continued ICI therapy.

The transition process for paediatric rheumatology clinic patients at a single tertiary paediatric rheumatology centre in Australia.

This study aimed to examine the transition process of paediatric rheumatology patients from the Monash Children's Hospital (MCH) in Melbourne in order to identify areas that could be improved. Retrospective review of clinical data from the rheumatology database of paediatric rheumatology patients eligible for transition between January 2015 and September 2020. One hundred and sixty-five patients were included; 57 patients were transitioned. Of patients transitioned to an adult service, 38 (88%) were on medication and 14 (33%) had active disease. All patients transitioned to the general practitioner (GP) had inactive disease off medication. Juvenile idiopathic arthritis (JIA) (non-systemic) was the most common diagnosis in patients transitioned. The mean age at which transition was first discussed was 18.0 years; the first referral was made at a mean of 18.3 years. The mean age at the first adult appointment was 18.5 years. Thirty-nine (91%) patients had a referral completed and 8 (19%) had a transfer letter. Thirteen (93%) patients transferred to the GP had a transfer letter. Transfer documents to an adult public rheumatology service rated 4.3 for quality, compared to 5.5 to the GP. Transfer of care was confirmed in 40 (93%) patients transitioned to an adult service; however, correspondence was available for only 3 (7%). Although the transition process at MCH was adequate, it could be improved through earlier discussion of the process and improved referrals and documentation. A readiness-to-transfer checklist and a young adult clinic have the potential to improve the process of transition to adult rheumatology care.

Patient Perspectives on a Decision Aid for Systemic Lupus Erythematosus: Insights and Future Considerations.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide spectrum of clinical manifestations. A decision aid (DA) for SLE was developed and implemented in 15 rheumatology clinics throughout the United States. This study explored the experiences of patients who viewed the DA to understand how patients engage with and respond to the SLE DA. We conducted a qualitative descriptive study using semistructured interviews with a convenience sample of 24 patients during May to July 2022. Patients recognized the value of the SLE DA in providing general knowledge about SLE and different treatment options. However, patients expressed a desire for more comprehensive lifestyle information to better manage their condition. Another theme was the importance of having multiple formats available to cater to their different needs, as well as tailoring the DA to different stages of SLE. This study contributes to a broader understanding of how to provide patient-centered care for patients with SLE by offering practical insights that can inform the development of more effective, patient-centric health information technologies for managing chronic diseases, ultimately improving patient outcomes. Overall, this study underscores the significance of optimizing both the information content and determining the appropriate delivery of the tool for its future sustainability.

Chronic Nonbacterial Osteomyelitis, Hidradenitis Suppurativa, and SAPHO Syndrome

Introduction: Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome may represent one side of a spectrum of disease that also includes chronic nonbacterial osteomyelitis. Case: A 23-year-old male with bone pain in the anterior chest, shoulder, clavicles, left elbow, and left ankle presented to rheumatology clinic after multiple evaluations for infectious osteomyelitis. Imaging and deep bone biopsies of affected areas were consistent with chronic osteomyelitis, with labs notable for elevated erythrocyte sedimentation rate, C-reactive protein, and positivity for HLA-B27. A full skin exam was consistent with hidradenitis suppurativa, and he was started on infliximab and methotrexate with improvement in both his osteoarticular and skin symptoms. Conclusions: Patients presenting with features of follicular occlusion or neutrophilic dermatoses in conjunction with bone pain should be evaluated for SAPHO/CNO. In patients with SAPHO/CNO with vertebral involvement, bisphosphonates in addition to anti-inflammatory medications (such as methotrexate and TNF-inhibitors) can be effective.

Clinical and laboratory profiles of systemic lupus erythematosus patients in a new rheumatology clinic in southwestern Nigeria.

The aims were to study the sociodemographic characteristics of patients presenting to the clinic and to study the clinical and serological pattern of systemic lupus erythematosus (SLE) in a new rheumatology clinic of a predominantly Yoruba population. This was a retrospective, cross-sectional study conducted over 7 years (January 2017 - December 2023). Patients who satisfied the 1997 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were enrolled using their medical records. Patients with overlap syndromes and other inflammatory or noninflammatory rheumatic diseases were excluded from the study. Their sociodemographic, clinical, laboratory, and treatment data were retrieved from their medical records and analysed using IBM SPSS version 23.0 software. A total of 65 patients were diagnosed with SLE with a frequency of 15.8%. The mean age ±SD of the patients at presentation was 33.85 years ±11.01 and the female to male ratio was 9.8 : 1. The median (IQR) duration of symptoms at presentation was 7.0 months (3-24). The common clinical presentations included synovitis (86.2%), acute cutaneous rash (53.8%), oral ulcers (52.3%), nonscarring alopecia (50.8%), and serositis (47.7%). Proteinuria was seen in 37.7% of the patients and the predominant renal histopathological feature was Class IV. Antinuclear antibody was 100% positive with 50.94% of the patients having a titre of 1 : 5,120 and above. Anti-double-stranded deoxyribonucleic acid and anti-Smith antibodies each had 50% prevalence. Dyslipidaemia was found in 76.7% of the patients. The study's findings are largely consistent with similar studies done in Africa. Further prospective multi-centred studies are needed to further determine the epidemiological characteristics of the disease in Nigeria with a multi-ethnic population.

The effects of vitamin D supplementation on disease activity and fatigue in Libyan rheumatoid arthritis patients.

This study aimed to investigate the effect of vitamin D supplementation therapy on disease activity and fatigue in rheumatoid arthritis (RA) patients. A prospective randomized clinical trial was conducted at rheumatology clinics in Tripoli Central Hospital, Libya. The eligible patients received disease-modifying antirheumatic drugs (DMARDs) and were divided into two groups: group A received 50,000 IU of vitamin D once a week; while group B received conventional DMARDs without vitamin D supplementation. The groups were monitored for 12 weeks. The study included 68 RA patients, with the majority being female (75%). There were no significant differences in parameters such as age, sex, duration of illness, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), calcium, and vitamin D levels, as well as DAS28 (Disease Activity Score with 28-joint count) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) levels between these two groups at baseline. After 12 weeks, group A showed a significant improvement in mean vitamin D levels and FACIT-F scores compared to group B. The increase in vitamin D levels in group A (24.21 ±4.81 nmol/l) was higher than that in group B (5.76 ±3.36 nmol/l). Furthermore, the FACIT-F score in group A was in the normal range (mean: 39.36 ±6.15), whereas group B still exhibited "abnormal" FACIT-F < 27.75 ±4.41. Correlation analysis indicated a positive correlation between FACIT-F and vitamin D levels, suggesting that higher vitamin D levels were associated with improved fatigue. Additionally, a weak inverse correlation was observed between DAS28 and vitamin D levels though the difference was not statistically significant (p > 0.05). Finally, the correlation between DAS28 and FACIT-F was positive (R = 0.557, p = 0.000). The results of the recent study indicated that vitamin D3 (50,000 IU of cholecalciferol) supplementation had a positive impact in RA patients compared to conventional DMARDs drugs, as was clear from the significant FACIT-F.

Lupus Journey: The Challenge of Obstructıve Hydrocephalus

Systemic lupus erythematosus (SLE) is a complex autoimmune condition known for its diverse clinical presentations. Neuropsychiatric SLE refers to neurological or psychiatric symptoms that arise once other potential causes have been ruled out. While hydrocephalus occurring in the context of SLE is exceedingly rare and its underlying mechanism remains elusive, its recognition is crucial for informed management decisions. A 20-year-old female patient, diagnosed with SLE, had been under our rheumatology clinic's care for two years. She recently presented with confusion, which emerged a year after her initial diagnosis. Brain tomography revealed obstructive hydrocephalus, and subsequent investigations ruled out other potential causes, linking the condition to her clinical SLE. After consulting with a neurosurgeon, a ventricular drainage catheter was inserted. In response to this hydrocephalus development, a regimen of pulse steroid therapy was administered. Following this, mycophenolate mofetil was prescribed as an immunosuppressant agent and her clinical condition was successfully stabilized.

Skin and ophthalmic complications of chloroquine and hydroxychloroquine in patients with rheumatoid arthritis and systemic lupus erythematous

ABSTRACT Immunosuppressive agents are routinely used to control autoimmunity. However, some adverse events are correlated to their clinical applications. The aim of this study was to study the clinical findings and ocular and cutaneous side effects of chloroquine (CQ) and hydroxychloroquine (HCQ), as current immunomodulators, in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This descriptive study was performed on 360 individuals referred to the Rheumatology clinic during 2003–2020. Demographic characteristics and other information were collected from patients with RA and SLE. Skin and ocular complications were evaluated in patients who were on treatment with CQ and HCQ. Study populations consisted of 199 subjects with RA and 161 cases with SLE. The frequencies of skin and ocular complications in all patients treated with CQ and HCQ were 32 (17.65%) and 94 (51.9%), respectively. The prevalence of skin complications in patients with RA and SLE was 20 (10.05%) and 22 (13.66%), respectively. The frequencies of ocular complications in patients with RA and SLE were, respectively, 58 (29.4%) and 36 (22.5%). Multiple logistic regression analysis revealed that ophthalmic complications of CQ and HCQ in all patients were dependent on the effects of the duration of drug uses, disease duration, and cumulative doses (p < 0.05), unlike skin complications. Disease types had no effect on ocular complications. Based on these findings, treatment with CQ and HCQ participates in some skin and ocular complications in patients with RA and SLE which are largely associated with the duration of disease and treatment.

Prevalence of polypharmacy and drug interaction in older adults with rheumatic disease

Introduction/AimOlder people with rheumatic diseases tend to have a greater number of associated comorbidities, which will require the use of more drugs, increasing the risk of hospitalizations, complications, and drug interactions. In Mexico, there has been an estimated prevalence of polypharmacy of up to 55%, however there are scarce reports on the topic in our elderly population with rheumatic diseases. We aimed to determine the prevalence of polypharmacy and the association of drug interactions in patients treated for rheumatic disease. MethodsA retrospective observational study was conducted on patients undergoing treatment for rheumatic diseases who were treated in geriatrics and rheumatology clinics from January to December 2021. The presence of polypharmacy and drug interactions was evaluated using the BOT Plus Pharmacological Surveillance System. The prevalence of polypharmacy and the association of drug interactions were estimated. ResultsWe evaluated 320 patients, with a mean age of 67.05±5.8 years, predominantly female (85%). The prevalence of polypharmacy was 68.1% (n=218), of which 214 (98.1%) patients had related drug interactions; 27.1% were severe and 53.2% as moderate interactions. Factors related with increased risk of drug interactions were being exposed to hypertension increased the risk of drug interactions (POR 1.75, 95% CI 1.44–2.14; P<0.001), having osteoarthritis (POR 1.21, 95% CI 1.04–1.42; P=0.032) and thyroid disease (POR 1.45, 95% CI 1.28–1.65; P=0.001). The most prevalent serious interactions were leflunomide–methotrexate in 27 (46.5%) patients and buprenorphine–tramadol in 8 (13.7%). ConclusionsA high prevalence of polypharmacy and drug interactions was observed in elderly patients with rheumatic diseases. The main associated factors were comorbidities, particularly high blood pressure, osteoarthritis and thyroid diseases.

Assessment of pain in children with juvenile idiopathic arthritis using the pediatric pain questionnaire

Background Juvenile idiopathic arthritis (JIA) is a chronic autoinflammatory disease of unknown etiology and is the most common cause of autoimmune musculoskeletal disease in children. Pain is a commonly reported symptom in JIA. There are levels of pain that interfere with physical, educational, emotional, and social activity, even when disease activity is controlled. Assessment of pain at each office visit is the cornerstone of effective pain management. Pediatric Pain Questionnaire (PPQ) uses a 100-mm horizontal visual analog score (VAS) anchored with happy and sad faces to assess the present pain intensity and the worst pain intensity in the past week. Patients are also asked to choose from a list of 46 word descriptors to express sensory (e.g., cutting), affective (e.g., horrible), and evaluative (e.g., sad) qualities of their pain. Aim The aim of the study was to assess pain in children with JIA attending the Rheumatology Clinic in Alexandria University Children’s Hospital and to determine its relation to disease activity. Patients and methods Fifty-eight patients and their parents who attended the Pediatric Rheumatology Clinic of Alexandria University Children Hospital were asked to fill out the questionnaire. Of the patients 58.6% were females and 41.4% patients were males; the mean age of the patients was 10.36±3.34 (months). Results According to pain and emotion, most parents in this study answered that the pain seemed worse when their children are tired. Distribution of the studied cases for present pain on VAS in this study showed that no significant differences were found between the children and parent scorings of present pain on VAS. All correlations were highly significant for present pain (P&lt;0.001*). The distribution of the studied cases for worst pain last week on the VAS showed no significant differences between the children and parents scorings of worst pain on the VAS. All correlations were highly significant for worst pain (P&lt;0.001*). Distribution of the studied cases according to the relationship between pain intensity on VAS and disease activity score showed no significant difference between pain intensity reported by children, parents, and physicians on VAS and disease activity score. Conclusion This work should be viewed in the light of some potential limitations. The results of this study revealed that the PPQ questionnaire was valid, reliable, and sensitive to the assessment of pain. Integrating patient-reported outcome measures of pain severity and responsiveness to standard clinical practice is feasible and applicable in the follow-up of patients and monitoring the treatment effectiveness.

Immunogenicity of Covishield vaccine in patients with autoimmune rheumatic diseases.

The Coronavirus disease 2019 (COVID-19) pandemic has been the biggest threat to humankind during the last 3 years. It has caused the loss of more than 6.9 million precious lives across the world. The only method by which the massacre could be stopped was by mass vaccination or mass immunization. The patients suffering from autoimmune rheumatic disorders (AIRDs) and treated with immunosuppressants were the high-priority candidates for vaccination. However, the data regarding the efficacy of COVID-19 vaccines in this group of patients are very less. Hence, this study was planned to study the immunogenicity of Covishield in patients with AIRDs attending the rheumatology OPD at DMCH, Ludhiana. It was a prospective cohort study and was planned by the Department of Biochemistry and Department of Clinical Immunology and Rheumatology at Dayanand Medical College and Hospital, Ludhiana. Fifty patients with AIRDs attending the DMCH rheumatology OPD and 52 age and sex-matched healthy controls who had received two doses of Covishield vaccine were included in this study. Patients having any other immunosuppressive conditions like uncontrolled diabetes, hepatitis, malignancy or HIV were excluded. Patients who had suffered from previous laboratory-confirmed COVID-19 infection (by RT-PCR) were also excluded. Blood samples were collected following all aseptic precautions from patients and controls on the 28th day after administration of a second dose of Covishield vaccine and total antibodies to the severe acute respiratory syndrome coronavirus 2 spike (S) protein receptor binding domain was measured using Elecsys Anti-SARS-CoV-2 S kit from Roche. It was observed that no significant difference was there in antibody titre between cases and controls (6213 ± 4418 vs. 8331 ± 7979, P = 0.1022). It was also observed that no statistically significant difference in antibody titre in cases without prednisolone and those taking treatment with prednisolone was found (P = 0.7058). A similar observation was found in terms of methotrexate also (P = 0.457). No significant difference in antibody titres was there when compared with controls (for prednisolone, P = 0.169, for methotrexate, P = 0.078). We found that only the patients receiving mycophenolate mofetil showed a statistically significant decrease in antibody titre in comparison to healthy controls (P = 0.03). Our study showed no statistically significant difference in antibody titres between patients suffering from different AIRDs. Our study supplements the fact that patients with AIRDs in India can receive Covishield as the primary vaccine against COVID-19 without concerns regarding decreased immunogenicity or increased adverse effects.

Equine-assisted service’s effect on cartilage and skeletal biomarkers for adults and older adults with arthritis: A pilot study

ObjectiveThe object of this study was to determine the effect of EAS (Equine-Assisted Services) on arthritis conditions, as measured by the sTnT (Skeletal troponin) and COMP (cartilage oligomeric matrix proteins) biomarkers, compared to an exercise attention control intervention. DesignThis was a secondary analysis of a randomized clinical trial comparing equine-assisted therapy to exercise education attention-control on cartilage and skeletal biomarkers in adults with arthritis. Twenty-one adults (Mage = 64 years) with arthritis who attended rheumatology clinics in the midwestern United States participated. ResultsNo changes were found in sTnT from baseline to week six within either intervention nor were there differences in changes between the two groups (p = 0.91). COMP increased from baseline to week six for both conditions, suggesting increased deterioration of cartilage and joints. Although the attention-control condition demonstrated larger increases in cartilage oligomeric matrix proteins level, compared to the EAS condition, these differences were not statistically (p = 0.58) or clinically significant (i.e., trivial effect, d = −0.16). When 3 outliers were removed, the differences in changes between EAT and attention-control group could be arguably of clinical significance (d = - 0.33), suggesting that the attention-control group demonstrated larger increases in levels of COMP than those in the EAS condition, though this difference was not statistically significant (p = 0.28). ConclusionAlthough equine-assisted therapy may reduce pain and improve quality of life for adults with arthritis, findings here are not fully corroborated with biomarkers.

Prevalence of thyroid dysfunctions and thyroid autoantibodies in Thai patients with systemic lupus erythematosus: An age- and sex-matched controlled study.

To determine the prevalence of thyroid dysfunctions and thyroid autoantibodies in Thai systemic lupus erythematosus (SLE) patients, and compare them with age- and sex-matched healthy controls (HCs). Associations between thyroid dysfunctions and SLE disease activity, and associated factors for thyroid dysfunctions in SLE also were determined. One hundred SLE patients, without apparent clinical thyroid disease, attended the Rheumatology Clinic between November 2021 and October 2022, were enrolled into this study. HCs were matched to SLE cases by age and sex (ratio of 1:1). Clinical manifestations, SLE disease activity and medication received were collected in all SLE patients. Thyroid function tests and thyroid autoantibodies (anti-thyroglobulin: anti-TG and anti-thyroid peroxidase: anti-TPO) were collected from all participants. When compared with HCs, SLE patients had higher prevalence of thyroid dysfunctions, hypothyroidism and euthyroid sick syndrome (28% vs. 7%, p < .001, and 12% vs. 2%, p = .010, and 6% vs. 0%, p = .013, respectively). Prevalence of isolated hypothyroxinemia was higher numerically in SLE patients (9% vs. 3%, p = .074). Prevalence of anti-TG or anti-TPO was no different between SLE patients and HCs (16% vs. 18%, p = .707). There was no association between SLE disease activity and abnormal thyroid functions or thyroid autoantibodies. Family history of thyroid disease and prednisolone use (>10 mg/day) were associated factors for thyroid abnormalities with adjusted OR (95% CI) of 6.13 (1.58-23.75), p = .009 and 4.00 (1.37-11.70), p = .011, respectively. Thyroid dysfunctions were more prevalent in SLE patients. Family history of thyroid disease and prednisolone use (>10 mg/day) were independent associated factors of thyroid abnormalities.

The relationship of vitamin D to the MHAQ index, activity disease, and inflammation in a sample of Syrian rheumatoid disease patients

Background: Vitamin D has an immunomodulatory and anti-inflammatory role, and its deficiency has been linked with many autoimmune disorders, including rheumatoid arthritis (RA). The correlation ship between the severity of RA and serum levels of vitamin D is a subject of immense interest and therapeutic implications. Patients and Methods: A total of 100 patients previously diagnosed with RA were collected from visitors to the rheumatology clinic at the university hospital and their ages were over 18 years. The serum vitamin D value and the C-reactive protein (CRP) value were measured, and the Disease Activity Score CRP28 (DAS28CRP) and Modified Health Assessment Questionnaire (MHAQ) score were calculated to determine the severity and effectiveness of the disease and its relationship to vitamin D deficiency. Results: The average age of the patients ranged according to the patient’s age (46.03±11.291), we note that individuals whose ages ranged from 26 to 65 accounted for the largest percentage (94%), 83% of women (83) and 17% men (17), and the mean score for sun exposure was 15.80±5.446. Patients were individuals diagnosed with the disease between 5 and 10 years were the highest group, with a percentage of 31%. A total of 72% of the patients were not treated with corticosteroids, and 43% of the patients were treated with vitamin D. We found that the number of patients using biologic medications was 18%, and the number of patients using disease-modifying anti-rheumatic drugs was 88%. The mean of DAS28 was moderate in 63% of patients, and the average of the MHAQ score was 0.80±0.334. We found that there is no statically significant correlation between the serum vitamin D level and DAS28/CRP (P=0.733), and there is also no statically significant correlation between the serum value of vitamin D and the medications used, whether biological or disease-modifying anti-rheumatic drugs (P=0.361). In addition, there is also no significant correlation between the serum vitamin D level and MHAQ score (P=0.100). Conclusion: There was no significant relationship between vitamin D deficiency and the disease activity or severity in a sample of patients with RA.

Telemedicine Usability and Satisfaction among Pediatric Rheumatology Patients and their Caregivers during COVID-19 Pandemic.

The 2019 coronavirus disease pandemic opened an opportunity to explore the role of telemedicine in pediatric rheumatology clinic as well as patient satisfaction with virtual visits. To determine the usability and satisfaction rate of telemedicine among pediatric rheumatology patients and their caregivers. A cross-sectional online survey was conducted among patients and caregivers consulting via telemedicine at a pediatric rheumatology clinic of University of the Philippines - Philippine General Hospital (UP - PGH), a tertiary government hospital. Collected data included socio-demographics and the validated Telehealth Usability Questionnaire (TUQ). There were 39 (55.7%) patients and 31 (44.3%) primary caregivers included in the study. Across all usability factors, the response of primary caregivers did not significantly differ from those of patients. The average scores across all questions for both patients and primary caregivers were 5.96±1.19 and 6.04±1.34, respectively. This showed a high level of agreement that they were highly satisfied with telemedicine experience. Among the different usability factors, questions related to usefulness obtained the highest mean score for both patients (6.11±1.17) and primary caregivers (6.12±1.38). While the lowest mean score was observed on questions related to reliability, 5.65±1.33 for patients and 5.89±1.31 for primary caregivers. Pediatric rheumatology patients as well as their caregivers are generally highly satisfied with telemedicine during this time of pandemic. With high patient and caregiver satisfaction, telemedicine could be an option for ambulatory patient care even after pandemic.