The Impact of Social Media on Vaccination: A Narrative Review.

Vaccine hesitancy poses a significant global health challenge, fueled by misinformation and anti-vaccination campaigns on social media platforms (SMPs). This study examines the influence of social media on coronavirus disease 2019 (COVID-19) and non-COVID-19 vaccination in Asia during the peri-pandemic period. Through a comprehensive analysis of available literature, we aim to elucidate the role of SMPs in shaping vaccination attitudes and behaviors. The findings highlight the detrimental impact of social media on vaccination efforts and provide insights into addressing vaccine hesitancy during this critical period. A narrative review was conducted by searching the PubMed, Scopus, and Google Scholar databases from inception to May 26, 2022. Only English-language articles involving human participants from Asian countries were included in this review. Out of the 228 articles identified through the database search, 14 articles were included in the final analysis. The prevalence of COVID-19 vaccine hesitancy or negative attitudes towards COVID-19 vaccines in Asian countries was found to be high, ranging from 20% to 55% across countries. Notably, reliance on SMPs for vaccine-related information was associated with a higher likelihood of COVID-19 vaccine hesitancy. This trend coincided with the proliferation of misinformation and conspiracy theories that portrayed COVID-19 vaccines as harmful during the pandemic. Similar patterns were observed for other types of vaccines, including polio, measles mumps and rubella, and diphtheria-tetanus-pertussis vaccines. The use of SMPs was also found to be associated with increased fear among caregivers in Asian countries, as well as a 3-4 times higher likelihood of delayed immunization. SMPs negatively impact vaccine intent in Asia due to misinformation and anti-vaccination campaigns during the pandemic. However, they can be a powerful tool for healthcare providers and policymakers to promote informed decision-making. Efforts should focus on leveraging SMPs to disseminate reliable information and combat hesitancy, fostering a well-informed and vaccinated population in Asia.

Correlation between Cumulative Methotrexate Dose, Metabolic Syndrome and Hepatic Fibrosis Detected by FibroScan in Rheumatoid Arthritis Patients.

Background and Objectives: Methotrexate (MTX) is routinely prescribed for rheumatoid arthritis (RA) patients, but high cumulative doses may lead to hepatic fibrosis. Additionally, a high proportion of RA patients suffer from metabolic syndrome, which also increases the risk of hepatic fibrosis. This cross-sectional study aimed to explore the association between a cumulative MTX dose, metabolic syndrome, and hepatic fibrosis in patients diagnosed with RA. Materials and Methods: RA patients undergoing treatment with MTX were examined using transient elastography (TE). All patients, regardless of having hepatic fibrosis, were compared to identify the risk factors. Results: Two hundred and ninety-five rheumatoid arthritis patients were examined using FibroScan. One hundred and seven patients (36.27%) were found to have hepatic fibrosis (TE > 7 kPa). After multivariate analysis, only BMI (OR = 14.73; 95% CI 2.90-74.79; p = 0.001), insulin resistance (OR = 312.07; 95% CI 6.19-15732.13; p = 0.04), and cumulative MTX dosage (OR 1.03; 95% CI 1.01-1.10; p = 0.002) were associated with hepatic fibrosis. Conclusions: While the cumulative MTX dose and metabolic syndrome are both the risk factors of hepatic fibrosis, metabolic syndrome, including a high BMI and insulin resistance, poses a greater risk. Therefore, MTX-prescribed RA patients with metabolic syndrome factors should be attentively monitored for signs of liver fibrosis.

Prevalence, Risk Factors, and Outcomes of Gout Flare in Patients Hospitalized for PCR-Confirmed COVID-19: A Multicenter Retrospective Cohort Study.

OBJECTIVE: The study aimed to describe the prevalence and outcomes of gout flare in patients with comorbid gout hospitalized for coronavirus disease 2019 (COVID-19). Factors associated with gout flare and hospital length of stay were explored. METHODS: This retrospective cohort study included adults with comorbid gout who were hospitalized for PCR-confirmed COVID-19 between March 2020 and December 2021 in 3 hospitals in Thailand. Prevalence, characteristics, and outcomes of gout flare were described. Factors associated with gout flare were explored using least absolute shrinkage and selection operator selection and multivariate logistic regression. The association between gout flare and hospital length of stay was explored using multivariate linear regression. RESULTS: Among 8697 patients hospitalized for COVID-19, 146 patients with comorbid gout were identified and gout flare occurred in 26 (18%). Compared to those without flare, patients with gout flare had higher baseline serum urate and lower prevalence of use of urate-lowering therapy (ULT) and gout flare prophylaxis medications. One-third of gout flare episodes were treated with ≥ 2 antiinflammatory medications. Logistic regression identified GOUT-36 rule ≥ 2, a predictive index for inpatient gout flare, as the only factor associated with gout flare (odds ratio 5.46, 95% CI 1.18-25.37). Gout flare was found to be independently associated with hospital length of stay and added 3 days to hospital course. CONCLUSION: Gout flare occurred in 18% of patients with comorbid gout hospitalized for COVID-19 and added up to 3 days to hospital length of stay. Patients with suboptimal ULT appeared to be at high risk for gout flare during COVID-19 hospitalization.

Characteristics and Outcomes of People With Gout Hospitalized Due to COVID-19: Data From the COVID-19 Global Rheumatology Alliance Physician-Reported Registry.

OBJECTIVE: To describe people with gout who were diagnosed with coronavirus disease 2019 (COVID-19) and hospitalized and to characterize their outcomes. METHODS: Data on patients with gout hospitalized for COVID-19 between March 12, 2020, and October 25, 2021, were extracted from the COVID-19 Global Rheumatology Alliance registry. Descriptive statistics were used to describe the demographics, comorbidities, medication exposures, and COVID-19 outcomes including oxygenation or ventilation support and death. RESULTS: One hundred sixty-three patients with gout who developed COVID-19 and were hospitalized were included. The mean age was 63 years, and 85% were male. The majority of the group lived in the Western Pacific Region (35%) and North America (18%). Nearly half (46%) had two or more comorbidities, with hypertension (56%), cardiovascular disease (28%), diabetes mellitus (26%), chronic kidney disease (25%), and obesity (23%) being the most common. Glucocorticoids and colchicine were used pre-COVID-19 in 11% and 12% of the cohort, respectively. Over two thirds (68%) of the cohort required supplemental oxygen or ventilatory support during hospitalization. COVID-19-related death was reported in 16% of the overall cohort, with 73% of deaths documented in people with two or more comorbidities. CONCLUSION: This cohort of people with gout and COVID-19 who were hospitalized had high frequencies of ventilatory support and death. This suggests that patients with gout who were hospitalized for COVID-19 may be at risk of poor outcomes, perhaps related to known risk factors for poor outcomes, such as age and presence of comorbidity.

The GOUT-36 prediction rule for inpatient gout flare in people with comorbid gout: derivation and external validation.

OBJECTIVES: To develop and validate a gout flare risk stratification tool for people with gout hospitalized for non-gout conditions. METHODS: The prediction rule for inpatient gout flare was derived from a cohort of 625 hospitalized people with comorbid gout from New Zealand. The rule had four items: no pre-admission gout flare prophylaxis, no pre-admission urate-lowering therapy, tophus and pre-admission serum urate >0.36 mmol/l within the previous year (GOUT-36 rule). Two or more items are required for the classification of high risk for developing inpatient gout flares. The GOUT-36 rule was validated in a prospective cohort of 284 hospitalized people with comorbid gout from Thailand and China. RESULTS: The GOUT-36 rule had a sensitivity of 75%, specificity of 67% and area under the curve of 0.71 for classifying people at high risk for developing inpatient gout flares. Four risk groups were developed: low (no items), moderate (one item), high (two items) and very high risk (three or four items). In a population with frequent (overall 34%) in-hospital gout flares, 80% of people with very high risk developed inpatient flares while 11% with low risk had inpatient flares. CONCLUSION: The GOUT-36 rule is simple and sensitive for classifying people with high risk for inpatient gout flares. The rule may help inform clinical decisions and future research on the prevention of inpatient gout flares.

Regular pre-admission urate-lowering therapy and serum urate testing are associated with a shorter hospital length of stay in people with gout: A nation-wide population-based cohort study.

OBJECTIVE: This study aims to explore the association between inpatient gout flare-related variables and the length of stay (LOS) in hospitalized people with comorbid gout. METHODS: Using data from the Aotearoa/New Zealand national data collections, this cohort study included adults with comorbid gout who were admitted to publicly funded hospitals during 2017 for reasons other than gout. The primary outcome was LOS. Association between 20 variables and the LOS was explored using two generalized linear models. Directed acyclic graph (DAG) was constructed to evaluate the causal relationship between pre-admission urate lowering therapy (ULT) and LOS. RESULTS: The cohort included 36 047 admissions. We identified five variables associated with shorter LOS (pre-admission regular urate-lowering therapy (ULT), serum urate testing, male gender, Maori ethnicity and low-dose aspirin) and seven variables associated with longer LOS (M3 multimorbidity index, acute admission, operation, loop diuretics, potassium-sparing diuretics, NSAIDs, and age). Regular ULT had the strongest impact on shorter LOS (10% shorter). The model estimated an additional four days of hospitalization if the patient had multiple variables associated with longer LOS. DAG suggested a causal relationship between regular ULT and LOS under the condition that all unobserved confounders affected only ULT use, with no impact on in-hospital gout flares and/or LOS except through its influence on ULT use or as mediator of confounders that were observed. CONCLUSION: We have identified a set of gout flare-related variables found to be associated with LOS in hospitalized people with comorbid gout. Pre-admission ULT may help reduce the LOS in such patients.

Adult-onset Still's disease preceded by influenza vaccination: Coincidence or true association?

BACKGROUND: Influenza vaccine has rarely been associated with the occurrence of systemic inflammatory diseases. OBJECTIVE: To present a case of adult-onset Still's disease (AOSD) following influenza vaccination, and subsequently explore the possible association between AOSD and influenza vaccination, as well as implications for clinical practice. METHODS: Case report. RESULTS: We report a case of 20-year-old woman who developed typical AOSD, characterized by spiking fever, arthritis and salmon-pink rash, one week after influenza vaccination. She responded well to systemic corticosteroids therapy. This is the first case report of influenza vaccination-associated AOSD from Thailand. CONCLUSIONS: Influenza vaccination may be a trigger of AOSD but more data are needed to confirm the association. History of recent vaccination should be explored in patients suspected of having systemic inflammatory diseases including AOSD.

Efficacy of febuxostat versus allopurinol and the predictors of achieving target serum urate in a cohort of Thai people with gout.

OBJECTIVE: The objectives of our study were to compare the efficacy of febuxostat with allopurinol in Thai subjects with gout, as well as to determine the predictive factors of responsiveness to urate-lowering agents and to evaluate the safety of febuxostat in a real-world setting. METHODS: The study was a retrospective cohort study; a total of 354 gout patients were recruited from February 2015 to November 2018. The patients were categorized according to prescription of allopurinol or febuxostat. Demographic data, comorbidities, concomitant medications, gout-related clinical parameters, and the laboratory results were collected. The serial serum urate (sUA) levels were recorded at the beginning of the treatment (baseline), and after treatment at 12 weeks, 18 weeks, and 27 weeks. The primary efficacy endpoint was the achievement of target urate of < 6 mg/dl in people taking febuxostat, compared with those taking allopurinol. The secondary endpoints were the predictive factors of achieving target urate level and adverse drug reactions in patients taking febuxostat. Multivariable regression analysis was used to determine factors associated with achieving target serum urate. RESULTS: After the treatment, the febuxostat groups had significantly lower mean sUA compared with the allopurinol groups across all follow-up periods. The proportion of people who achieved target serum urate was also higher in the febuxostat groups compared with the allopurinol groups throughout the follow-up periods. The multivariable regression analysis showed that febuxostat 40 mg (OR = 10.96 (95% CI 4.32-27.80); p value < 0.001), febuxostat 80 mg (OR = 9.54 (95% CI 3.91-23.28), smoking (OR = 2.35 (95% CI 1.13-4.91); p value = 0.023), and low baseline serum urate (OR = 0.62 (95% CI 0.52-0.74); p value < 0.001) were associated with the achievement of target serum urate. No adverse drug reaction from febuxostat was observed even among people with renal insufficiency. CONCLUSION: In a Thai cohort, people receiving febuxostat are more likely to achieve target serum urate level, compared with people receiving allopurinol. Febuxostat (40 or 80 mg), smoking, and low baseline serum urate were associated with the achievement of target serum urate. KEY POINTS: • Febuxostat showed superior urate-lowering efficacy compared with allopurinol in an Asian population. • In addition to febuxostat, lower baseline serum urate level and history of smoking were associated with achieving target serum urate in gout patients.