Systematic review with meta-analysis: COVID-19 outcomes in patients receiving anti-TNF treatments.

BACKGROUND: Accumulating evidence suggests a beneficial effective of tumour necrosis factor-alpha (TNF-α) inhibitors on the outcomes of COVID-19 disease, which, however is not validated by all studies. AIMS: To perform a systematic review and meta-analysis of existing reports to investigate the impact of anti-TNF treatments on the clinical outcomes of COVID-19 patients. METHODS: A systematic search at PubMed and SCOPUS databases using specific keywords was performed. All reports of COVID-19 outcomes for patients receiving anti-TNF therapy by September 2021 were included. Pooled effect measures were calculated using a random-effects model. The Newcastle Ottawa Scale for observational studies was used to assess bias. Studies that were not eligible for meta-analysis were described qualitatively. RESULTS: In total, 84 studies were included in the systematic review, and 35 were included in the meta-analysis. Patients receiving anti-TNF treatment, compared to non-anti-TNF, among COVID-19 cases had a lower probability of hospitalisation (eight studies, 2555 patients, pooled OR = 0.53, 95% CI: 0.42-0.67, I2  = 0) and severe disease defined as intensive care unit admission or death (two studies, 1823 patients, pooled OR = 0.63, 95% CI: 0.41-0.96, I2  = 0), after adjustment for validated predictors of adverse disease outcomes. No difference was found for the risk for hospitalisation due to COVID-19 in populations without COVID-19 for patients receiving anti-TNF treatment compared to non-anti-TNF (three studies, 5 994 958 participants, pooled risk ratio = 0.97, 95% CI: 0.68-1.39, I2  = 20) adjusted for age, sex and comorbidities. CONCLUSIONS: TNF-α inhibitors are associated with a lower probability of hospitalisation and severe COVID-19 when compared to any other treatment for an underlying inflammatory disease.

Rheumatology: Necessary adjustments to the realities of the new era in Greece.

Rheumatic Diseases (RDs) are a serious, though often not sufficiently recognized, problem; strongly impacting not only patients' socio-economic activity but their quality of life in general. Yet, despite the tremendous progress made over the past few years, several questions, in regard to better management of people with rheumatic conditions, remain unanswered. Furthermore, many institutional problems and fixations in doctors' and patients' culture pose additional obstacles to the best treatment of these diseases. In Greece specifically, there are numerous and serious structural problems in the system of providing health services to people with rheumatic diseases; as well as in the education, professional training and development of Rheumatologists, which have been aggravated even more by the prolonged economic crisis. The scientific rheumatological community, and particularly its institutional representatives, need to implement a long-term plan for the correct and documented application of modern methods for the diagnosis, treatment and support of people with rheumatic diseases. They also need to lead the effort for the creation of a culture of cooperation between the parties concerned; namely the various professional groups of rheumatologists, other health professionals, patient associations and the state.

A survey to evaluate the implementation of vaccine recommendations among rheumatologists practicing in Greece.

OBJECTIVES: We sought to document the knowledge, perceptions and attitudes toward vaccinations among rheumatologists practicing in Greece. METHODS: Rheumatologists practicing in Greece in 2015 were surveyed by questionnaire during the Postgraduate Course of the Greek Rheumatology Society. Statistical analysis was carried out using SPSS software. RESULTS: One hundred and ten practicing rheumatologists in Greece were surveyed. Response rate was 63%. The majority of responders (82%) inquire patients about vaccination status during rheumatology medical history and most of them specifically advise patients for vaccination uptake (91%). Correct identification of all vaccine types was made by 11% of rheumatologists that took the survey. Ninety-three percent of responders were aware that influenza vaccine should be administered annually, and 94% acknowledged the need for pneumococcal vaccination. Some were not concerned about reduced immunogenicity in patients receiving treatment with methotrexate/TNF inhibitors and rituximab/abatacept (17% and 7%, respectively). A notable percentage overlook that live vaccines are contraindicated during treatment with TNF inhibitors (17%), conventional synthetic DMARDs (61%), or corticosteroids (30%). CONCLUSIONS: According to our results, the majority of Greek rheumatologists have implemented a vaccine strategy in their everyday practice. Still, there are several misconceptions that need to be addressed. A significant percentage cannot properly distinguish between inactivated and live vaccines, and many are not knowledgeable of the potential effect of specific DMARDs on the immunogenicity and safety of vaccination.

Biologic therapies and systemic bone loss in rheumatoid arthritis.

Chronic inflammation affects bone metabolism leading to disequilibrium in the rates of bone resorption and repair and subsequently to local and generalized bone loss. Osteoporosis represents an important co-morbidity of rheumatoid arthritis (RA) patients, which exhibit increased fracture risk. Osteoclasts play a pivotal role in the development and progression of bone loss, while resident synovial cells such as T cells, monocytes and synovial fibroblasts have been identified as sources of osteoclast differentiation signals in RA. This process is mainly mediated through the receptor activator of nuclear-kappa B ligand (RANKL) signalling system, which is upregulated by numerous proinflammatory cytokines involved in the pathogenesis of RA. Improved knowledge of the association between cells and cytokines of the immune system and their relationship to bone remodeling has revealed several promising targets for the treatment of inflammatory bone loss in RA. In this respect, initiation of biologic therapies targeting inflammatory cytokines and/or lymphocyte activation has modified RA therapy not only by blocking local and systemic inflammatory cascades but also by providing beneficial effects against bone and joint degradation. In this article we briefly present the modern view of the mechanisms that govern inflammatory bone loss, highlighting the role of cytokine-induced molecular pathways, and discuss in detail the effects of different biologic treatment strategies on bone mass in RA patients.

Type 2 diabetes mellitus is associated with obesity, smoking and low socioeconomic status in large and representative samples of rural, urban, and suburban adult Greek populations.

OBJECTIVE: In this cross-sectional epidemiologic study we examined the association between type 2 diabetes mellitus and demographic, clinical, and socioeconomic parameters in large rural, urban and suburban populations of adult Greeks. DESIGN: Of the total target adult population (≥19 years, n=14233) in nine selected geographical regions covering rural, suburban, and urban areas of Greece, 10,647 subjects were included in the study. Data were collected by physicians who interviewed subjects at their homes between 1996 and 1999. RESULTS: A total of 8740 subjects participated (response rate 82.1%). Among participants there were 360 subjects with type 2 diabetes. Multivariate logistic regression analysis after adjustment for factors associated with type 2 DM in univariate analyses including occupation, education level, place of residence, and number of persons living together demonstrated that advancing age, obesity-but not overweight status-and smoking in the past were associated with higher odds of type 2 diabetes. Moreover, low socioeconomic status was associated with type 2 diabetes independently of the effects of age, obesity, and smoking. CONCLUSIONS: In large representative rural, urban, and suburban populations of adult Greeks, type 2 Diabetes was associated with advancing age, obesity, exposure to smoke, and low socioeconomic status.

Prevalence of rheumatic diseases in Greece: a cross-sectional population based epidemiological study. The ESORDIG Study.

OBJECTIVE: To assess the prevalence of rheumatic diseases in Greek urban, suburban, and rural adult general populations. METHODS: This cross-sectional population based epidemiological study of rheumatic diseases in Greece (the ESORDIG Study) was conducted on the total adult population of 2 urban, one suburban, and 4 rural communities (8547 subjects), as well as on 2100 out of 5686 randomly selected subjects in one suburban and one rural community. The study, based on a standardized questionnaire and clinical evaluation and laboratory investigation when necessary, was carried out by rheumatologists who visited the target population at their homes. Either established classification criteria or criteria set for the purposes of the study were used for diagnosis. RESULTS: A total of 8740 subjects participated in the study (response rate 82.1%). The overall age and sex adjusted prevalence (prevalence(asa)) of rheumatic diseases in the total target adult population was 26.9% (95% CI 26.2-27.6), being significantly higher among women (33.7%) than men (19.9%) (p < 0.0005). Disease prevalence(asa) increased significantly with age (p < 0.0005). The most common disease group was low back pain, with a prevalence(asa) of 11.0%, followed by symptomatic peripheral osteoarthritis (7.9%), neck pain (4.8%), miscellaneous rheumatic disorders (4.4%), soft tissue rheumatism disorders (4.3%), and inflammatory rheumatic disease (2.1%). Logistic regression analysis showed a significant positive association of female or male sex, age >or= 50 years, high body mass index, low level of education, moderate or heavy alcohol consumption, and high socioeconomic level with particular diseases or disease groups. CONCLUSION: These findings indicate rheumatic diseases are very common in the general adult population of Greece; 26.9% of adults currently have active or chronic rheumatic disease in remission.