April 2023 to July 2023
Authors: Olivier Fakih and Clementina López-Medina
Fibromyalgia and mortality: a systematic review and meta-analysis
Treister-Goltzman et al.(doi:10.1136/rmdopen-2023-003005)carried out a systematic review and meta-analysis including 8 articles corresponding to 188751 patients on mortality in fibromyalgia. An increased HR was found for all-cause mortality (HR 1.27, 95% CI 1.04 to 1.51), but not for the subgroup diagnosed by the 1990 ACR criteria. There was an increased risk for mortality from infections (SMR 1.66, 95% CI 1.15 to 2.38), and suicide (SMR 3.37, 95% CI 1.52 to 7.50), and a decreased mortality rate for cancer (SMR 0.82, 95% CI 0.69 to 0.97). There was considerable heterogeneity in the studies selected.
New pro-inflammatory cytokine IL-40 plays a role in the early stages of seropositive rheumatoid arthritis
Navratilova et al. (doi:10.1136/rmdopen-2022-002894) investigated IL-40 levels in early rheumatoid arthritis (ERA). 60 treatment-naive ERA patients and 60 age- and sex-matched care controls (HC) were included. IL-40 levels were elevated in the serum of ERA patients vs. HCs (4.51 (0.91) vs. 1.47 (0.09) ng/mL, p<0.0001) and normalized after 3 months of conventional treatment. At baseline, the levels of IL-40 correlated with peripheral blood neutrophil count (r=0.351, p<0.05) and with the surrogate NETosis markers. In vitro experiments showed an abundant release of IL-40 by artificially stimulated ERA neutrophils undergoing NETosis (n=11) compared with untreated neutrophils (3873 (677) vs 1361 (286) pg/mL, p<0.001), thus suggesting NETosis being a trigger for IL-40 release. Other proinflammatory cytokines such as IL-1β, IL-8 and TNF, but not IL-6, increased IL-40 secretion compared with untreated cells.
Facilitators and barriers for vaccination in patients with inflammatory rheumatic musculoskeletal diseases
Andreica et al. (doi:10.1136/rmdopen-2022-002875)tried to identify facilitators and barriers towards vaccination in general and specifically against pneumococci, influenza and SARS-CoV-2 in patients with RMD, using a questionnaire answered by 441 patients attending a German tertiary rheumatology hospital. Vaccination willingness, confidence and safety concerns towards SARS-CoV-2 vaccines were assessed with a Numerical Rating Scale (NRS) ranging from 0 to 10 (fully agree). The willingness to be vaccinated against SARS-CoV-2 was high (NRS 8.6 (2.5)). Self-reported vaccine uptake against pneumococci and seasonal influenza was present in 225 (51.0%) and 279 (63.3%). 38.6% of patients were open to receive more detailed information on vaccines. Protection of high-risk patients was the most frequently cited facilitator towards vaccination. Many patients worried about worsening of their disease after vaccination. Concerns about safety were more prominent for vaccinations against SARS-CoV-2.
Outcomes during and after long-term tocilizumab treatment in patients with giant cell arteritis
Matza et al(doi:10.1136/rmdopen-2022-002923) studied outcomes in giant cell arteritis (GCA) patients during and after long-term tocilizumab (TCZ) treatment, with a retrospective analysis of 65 patients at a single centre from 2010 to 2022. The mean duration of the initial TCZ course was 1.9 (1.1) years. The Kaplan-Meier (KM)-estimated relapse rate at 18 months on TCZ was 15.5%. The first TCZ course was discontinued due to satisfactory remission achievement in 45 (69.2%) patients and adverse events in 6 (9.2%) patients. KM-estimated relapse rate at 18 months after TCZ discontinuation was 47.3%. 13 serious adverse events occurred during 204.1 patient-years of follow-up, of which 6 possibly were related or possibly related to TCZ.
Olivier is a rheumatology resident at the Department of Rheumatology of Besançon University Hospital in France. His research interests include the epidemiology of inflammatory rheumatic diseases, in particular mortality and comorbidities in spondyloarthritis. Olivier is a member of the French Society of Rheumatology and the society’s young rheumatologists section (REF). He is a member of the EMEUNET Social Media sub-committee, in the podcast team.
Clementina López-Medina is a Rheumatologist and postdoctoral researcher at the Spondyloarthritis Unit of the Reina Sofia University Hospital in Cordoba, Spain. Her work focuses on the epidemiology and clinical phenotypes of Spondyloarthritis. Clementina is a member of the Social Media Sub-Committee.