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1.
Arthritis Rheumatol ; 2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33779057

RESUMO

We thank Tang et al. for their interest in our study and correspondence on an important clinical question. In May of 2020 when our literature search was last updated, we did not identify any case series, cohort studies, or randomized controlled trials (RCTs) that evaluated the role of hydroxychloroquine as prophylaxis for COVID-19. Consequently, our analysis was unable to address this issue. The authors should be commended for their efforts to conduct an RCT during the early phases of the pandemic when there was widespread misinformation about antimalarials. We empathize with the difficulties they encountered, which highlight broader issues impacting the COVID-19 research agenda.

2.
Arthritis Rheumatol ; 2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33779070

RESUMO

OBJECTIVE: To determine the incidence of psoriatic arthritis (PsA) in a US population and describe trends in incidence and mortality over 5 decades. METHODS: The previously identified population-based cohort of Olmsted County, Minnesota residents ≥18 years of age who fulfilled PsA criteria during 1970-1999 was extended to include patients with incident PsA in 2000-2017. Age- and sex-specific incidence rates and point prevalence, adjusted to 2010 US white population, were reported. RESULTS: There were 164 incident cases of PsA in 2000-17, with a mean age of 46.4 (SD=12.0) years and 47% females. The overall age- and sex-adjusted annual incidence of PsA per 100,000 population was 8.5 (95% CI 7.2-9.8), and higher in males (9.3, 95% CI 7.4-11.3) than females (7.7, 95% CI 5.9-9.4) in 2000-2017. Overall incidence was highest in the age range 40-59 years. The incidence rate was relatively stable in 2000-2017 with no evidence of increase overall or in males, but a modest increase of 3% per year in females, compared to 1970-1999 where a 4%/yr rise in incidence was observed. Point prevalence was 181.8 per 100,000 (95% CI 156.5-207.1) in 2015. The percentage of females increased from 39% in 1970-1999 and 41% in 2000-2009 to 54% in 2010-2017 (p=0.08). Overall survival in PsA did not differ from general population (SMR= 0.85, 95% CI 0.61-1.15). CONCLUSION: The incidence of PsA in this predominantly white US population was stable in 2000-2017 in contrast to previous years. However, an increasing proportion of females was found in this study.

3.
Best Pract Res Clin Rheumatol ; 35(1): 101659, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33526326

RESUMO

Several immunosuppressive therapies have been investigated as potential treatments for patients with severe and critical coronavirus disease 2019 (COVID-19). Notable examples include corticosteroids, interleukin 6 (IL-6), interleukin 1 (IL-1), Janus kinase (JAK), and tumor necrosis factor alpha (TNF-α) inhibitors. The aim of this narrative review is to analyze the mechanistic rationale and available evidence for these selected anti-rheumatic drugs for the treatment of COVID-19. Currently, only corticosteroids have consistently proven to be effective in decreasing mortality and are recommended in clinical guidelines for the treatment of severe and critical COVID-19. Multiple randomized controlled trials (RCTs) are ongoing to determine the role of other immunosuppressants.


Assuntos
Antirreumáticos , Doenças Reumáticas , Antirreumáticos/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Doenças Reumáticas/tratamento farmacológico
4.
J Rheumatol ; 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589556

RESUMO

OBJECTIVE: To examine demographic and clinical characteristics associated with diagnostic delay in psoriatic arthritis (PsA). METHODS: We characterized a retrospective, population-based cohort of incident adult (≥18 years) PsA patients from Olmsted County, MN from 2000-17. All patients met classification criteria. Diagnostic delay was defined as the time from any patient-reported PsA-related joint symptom to a physician diagnosis of PsA. Factors associated with delay in PsA diagnosis were identified through logistic regression models. RESULTS: Of the 164 incident PsA cases from 2000-17, 162 had a physician or rheumatologist diagnosis. Mean (SD) age was 41.5 (12.6) and 46% were females. Median time from symptom onset to physician diagnosis was 2.5 years (interquartile range: 0.5 to 7.3). By six months, 38 (23%) received a diagnosis of PsA, 56 (35%) by one year and 73 (45%) by two years after symptom onset. No significant trend in diagnostic delay was observed over calendar time. Earlier age at onset of PsA symptoms, higher body mass index, and enthesitis were associated with a diagnostic delay of >2 years, while sebopsoriasis was associated with a lower likelihood of delay. CONCLUSION: In our study, more than half of PsA patients had a diagnostic delay of >2 years, and no significant improvement in time to diagnosis was noted between 2000-17. Patients with younger age at PsA symptom onset, higher BMI, or enthesitis before diagnosis were more likely to have a diagnostic delay of >2 year while patients with sebopsoriasis were less likely to have a diagnostic delay.

6.
Autoimmun Rev ; 19(12): 102688, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33131703

RESUMO

OBJECTIVE: Omega-3 fatty acids may decrease systemic lupus erythematosus (SLE) disease activity, however randomized controlled trials (RCT) have been small with conflicting findings. We conducted a systematic review and meta-analysis to estimate the effect of omega-3 fatty acids on SLE disease activity in adults. METHODS: A literature search was conducted from database inception to January 2020. RCTs of adults with SLE comparing omega-3 fatty acids supplementation to placebo or standard of care that evaluated SLE disease activity were included. Abstracts, full text reviews, data abstraction and statistical analysis were evaluated independently by two investigators. Study-specific standardized mean differences (SMD) were estimated and combined using random-effects model. RESULTS: Five RCTs with 136 patients in the comparison groups and 138 in the treatment groups, were included. All the studies used ≤3 g of omega-3 fatty acids. The trial follow-up time ranged from 12 to 52 weeks. The mean age of the patients was 43 years and 80% or more were female. Omega-3 fatty acids reduced SLE activity [SMD -0.33 (95CI: -0.57, -0.09), low certainty evidence, moderate effect size]. Transforming the SMD to the SLE Disease Activity Index (SLEDAI) scale, omega-3 fatty acids reduced disease activity by 0.9 (95CI: -1.6, -0.3, I2 = 0%) SLEDAI points compared to placebo. CONCLUSION: This meta-analysis suggests that omega-3 fatty acids could provide therapeutic benefit in addition to immunosuppressive regimens used for SLE.

7.
Lupus ; 29(12): 1571-1593, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33100166

RESUMO

Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.

10.
Semin Arthritis Rheum ; 50(5): 1191-1201, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32931985

RESUMO

INTRODUCTION: COVID-19 is an acute respiratory viral infection that threatens people worldwide, including people with rheumatic disease, although it remains unclear to what extent various antirheumatic disease therapies increase susceptibility to complications of viral respiratory infections. OBJECTIVE: The present study undertakes a scoping review of available evidence regarding the frequency and severity of acute respiratory viral adverse events related to antirheumatic disease therapies. METHODS: Online databases were used to identify, since database inception, studies reporting primary data on acute respiratory viral infections in patients utilizing antirheumatic disease therapies. Independent reviewer pairs charted data from eligible studies using a standardized data abstraction tool. RESULTS: A total of 180 studies were eligible for qualitative analysis. While acknowledging that the extant literature has a lack of specificity in reporting of acute viral infections or complications thereof, the data suggest that use of glucocorticoids, JAK inhibitors (especially high-dose), TNF inhibitors, and anti-IL-17 agents may be associated with an increased frequency of respiratory viral events. Available data suggest no increased frequency or risk of respiratory viral events with NSAIDs, hydroxychloroquine, sulfasalazine, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or apremilast. One large cohort study demonstrated an association with leflunomide use and increased risk of acute viral respiratory events compared to non-use. CONCLUSION: This scoping review identified that some medication classes may confer increased risk of acute respiratory viral infections. However, definitive data are lacking and future studies should address this knowledge gap.


Assuntos
Antirreumáticos/farmacologia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Doenças Reumáticas , Betacoronavirus , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/epidemiologia , Medição de Risco , Índice de Gravidade de Doença
11.
Arthritis Rheumatol ; 72(10): 1776, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32869535
12.
Arthritis Rheumatol ; 2020 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-32741139

RESUMO

OBJECTIVE: Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. We conducted a systematic review and meta-analysis to describe the current evidence. METHODS: A search of published and preprint databases in all languages was performed. Included studies described ≥1 relevant clinical outcome for ≥5 patients who were infected with severe acute respiratory syndrome coronavirus 2 and were treated with antirheumatic disease therapy between January 1, 2019 and May 29, 2020. Pairs of reviewers screened articles, extracted data, and assessed risk of bias. A meta-analysis of effect sizes using random-effects models was performed when possible. RESULTS: The search identified 3,935 articles, of which 45 were included (4 randomized controlled trials, 29 cohort studies, and 12 case series). All studies evaluated hospitalized patients, and 29 of the 45 studies had been published in a peer-reviewed journal. In a meta-analysis of 3 cohort studies with a low risk of bias, hydroxychloroquine use was not significantly associated with mortality (pooled hazard ratio [HR] 1.41 [95% confidence interval (95% CI) 0.83, 2.42]). In a meta-analysis of 2 cohort studies with some concerns/higher risk of bias, anakinra use was associated with lower mortality (pooled HR 0.25 [95% CI 0.12, 0.52]). Evidence was inconclusive with regard to other antirheumatic disease therapies, and the majority of other studies had a high risk of bias. CONCLUSION: In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm regarding COVID-19 mortality. The evidence supporting the effect of other antirheumatic disease therapies in COVID-19 is currently inconclusive.

14.
Expert Rev Clin Immunol ; 16(7): 659-666, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32620062

RESUMO

INTRODUCTION: Several months into the COVID-19 pandemic, safe and effective treatments against this global health disaster have yet to be identified. Clinical research trials around the world are underway testing a wide array of possible medications. In particular, the off-label use of hydroxychloroquine for COVID-19 prophylaxis and treatment has created many unprecedented challenges for the scientific community and the public. AREAS COVERED: We critically assessed major events from February - May 2020 that contributed to widespread use of hydroxychloroquine for the treatment and prophylaxis of COVID-19. We aimed to explore how opinions toward hydroxychloroquine may shift from early enthusiasm (based on in vitro and preliminary clinical data) to the hope for a miracle cure (through communication and promotion of questionable results) and, finally, to a rise of skepticism as more in-depth analyses are emerging. EXPERT OPINION: Mindful and rigorous acquisition of data, as well as its interpretation, are essential to an effective pandemic response. The rapid and premature promotion of results has had major implications for global crisis management, even creating distrust among the public. It is crucial for the medical and scientific community to incorporate the lessons learned from this situation.


Assuntos
Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Opinião Pública , Betacoronavirus/efeitos dos fármacos , Comunicação , Humanos , Pandemias , Resultado do Tratamento
16.
Semin Arthritis Rheum ; 50(6): 1348-1356, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32291099

RESUMO

OBJECTIVES: Anti-inflammatory and immune-modulating effects of statins suggest that they may play a role in the risk of rheumatoid arthritis (RA). We aimed to perform a systematic review and meta-analysis of studies assessing the risk of RA in statin-users versus non-users. METHODS: We searched Medline from inception to 01/22/2019 and Embase from 1988 to Week 03 2019 for studies that examined the association between statin use and RA without restrictions on language. RESULTS: We identified 1,161 references; of them 8 studies (5 cohort studies and 3 case-control studies) were included in the systematic review. Four cohort studies comparing statin-users versus non-users were included in the meta-analysis. The pooled risk ratio (RR) was 1.01; 95%CI 0.93-1.10; I2 = 17%. Case-control studies showed highly heterogeneous results (I2 = 92%) and were not included in the meta-analysis. One cohort study and one case-control study assessing persistence with or intensity of treatment with statins showed lower risk of RA with higher versus lower treatment persistence or intensity of statin use (pooled RR 0.66; 95%CI 0.5-0.87; I2 = 83%). The certainty in the evidence was low. CONCLUSION: In this systematic review and meta-analysis, we observed no difference in risk of RA in statin users vs non-users. Risk of RA may be lower in patients with higher versus lower statin treatment persistence or intensity. Future observational studies with guards against selection bias and confounding are needed to further elucidate the impact of statin use on the risk of RA, considering potential differences by dosage, duration of use, study population and other factors.

19.
Curr Opin Rheumatol ; 32(3): 215-227, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32187042

RESUMO

PURPOSE OF REVIEW: Antiphospholipid syndrome (APS), more common than once believed, is an autoimmune disease best known for its high risk of incident and recurrent thrombotic events. The approach to treatment potentially differs from treatment of thrombosis in the general population, and this article endeavors to review the latest updates on this topic. RECENT FINDINGS: The epidemiology of APS is being increasingly elucidated by large population-based studies, with APS perhaps affecting as many as 1 in 2000 individuals. Vitamin K antagonists, aspirin, and heparinoids continue to have obvious roles in the management of patients with APS. There has recently been intensive study of direct oral anticoagulants in APS, with the most recent randomized studies raising concerns about their inferiority to vitamin K antagonists, at least in some subgroups. Other approaches to treating APS beyond anticoagulants and antiaggregants are also receiving increased attention in mechanistic and preclinical studies with an eye toward future roles in patients with refractory and/or microvascular disease. Pediatric APS is identified as an area in desperate need of additional prospective research. SUMMARY: Progress continues to be made in pursuit of improving the lives of individuals afflicted with APS. The most important future directions would seem to involve leveraging modern molecular technologies in order to improve subphenotyping of antiphospholipid antibody-positive individuals. This will help personalize risk profiles and ideally define the optimal approach to therapy based on future risk, rather than past morbid events.

20.
Arthritis Rheumatol ; 72(5): 733-749, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31960614

RESUMO

OBJECTIVE: To investigate the effect of therapies on radiographic progression in patients with axial spondyloarthritis (SpA). METHODS: A comprehensive database search for studies assessing radiographic progression in axial SpA (particular treatment versus no treatment of interest) was performed. Study-specific standardized mean differences in treatment outcomes at 2 and ≥4 years were estimated and combined using random-effects models. RESULTS: Twenty-four studies in patients with axial SpA were identified, of which 18 involved tumor necrosis factor inhibitors (TNFi), 8 involved nonsteroidal antiinflammatory drugs (NSAIDs), and 1 involved secukinumab. Spinal radiographic progression, as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), was not significantly different between TNFi-treated and biologics-naive patients at 2 years (mSASSS difference -0.73 [95% confidence interval (95% CI) -1.52, 0.12], I2 = 28%) and ≥4 years (mSASSS difference -2.03 [95% CI -4.63, 0.72], I2 = 63%). Sensitivity analyses restricted to studies with a low risk of bias showed a significant difference in spinal radiographic progression between TNFi-treated and biologics-naive patients at ≥4 years (mSASSS difference -2.17 [95% CI -4.19, -0.15]). No significant difference in spinal radiographic progression was observed between NSAID-treated and control patients (mSASSS difference -0.30 [95% CI -2.62, 1.31], I2 = 71%) or between secukinumab-treated and biologics-naive patients (mSASSS difference -0.34 [95% CI -0.85, 0.17]). With regard to treatment differences in patients with nonradiographic axial SpA or in patients with radiographic progression measured using the sacroiliac joint score, an insufficient number of studies were available for analysis. CONCLUSION: Although no significant protective effect of TNFi treatment on spinal radiographic progression was seen over the course of 2 years or ≥4 years in patients with axial SpA, our analysis restricted to studies with a low risk of bias showed a protective effect of TNFi after ≥4 years. Therefore, long-term TNFi exposure might confer beneficial effects on spinal radiographic progression in axial SpA. No difference in radiographic progression at 2 years was seen in either the NSAID or secukinumab treatment groups compared to their controls. Future studies should explore the effects of biologic treatment on radiographic progression, as well as the effects of long-term biologics exposure, in patients with early axial SpA or those with nonradiographic axial SpA.


Assuntos
Espondilartrite/diagnóstico por imagem , Espondilartrite/terapia , Progressão da Doença , Humanos , Radiografia , Resultado do Tratamento
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