Spring 2024 Press Review – Seminars in Arthritis and Rheumatism

December 2023 to March 2024

Author: Halbert Hernández-Negrin

Seminars in Arthritis and Rheumatism

Assessment of cardiovascular risk in ankylosing spondylitis

Polo et al.’s (doi: 10.1016/j.semarthrit.2024.152442) study on 684 ankylosing spondylitis (AS) patients from the CARMA project found that the QRISK3 algorithm, with a follow-up of 4,907 person-years, identified lower and higher CV risk groups, resulting in 33 CV events (rate=6.73 per 1000 person-years). When QRISK3 was combined with SCORE2, the model’s predictive value improved, as shown by the lowest Akaike Information Criterium (406.70) and Bayesian Information Criterium (415.66), suggesting this as the best approach for assessing CV risk in the Spanish AS population.

Cardiac involvement in catastrophic antiphospholipid syndrom

Pons et al.’s (doi: 10.1016/j.semarthrit.2024.152439) analysis of the “CAPS Registry” involved 749 CAPS patients, where 52% (404 events) had cardiac involvement. Heart failure was present in 55% (185/377), valvular disease in 31% (116/377), and acute myocardial infarction in 28% (104/378) of the cases. Notably, 83% (48/58) of patients with histological analysis had cardiac thrombotic microangiopathy. Significantly more frequent in events with cardiac involvement were stroke, pulmonary and renal infarction, acute kidney injury, and livedo reticularis. Multivariate analysis identified acute kidney injury as independently associated with cardiac involvement (OR 1.068, 95% CI: 1.8–4.8, p<0.001). Cardiac involvement was not related to increased mortality, emphasizing the need for cardiac vigilance in CAPS without impacting survival predictions.

Impact of air pollution on gout

Liu et al. (doi: 10.1016/j.semarthrit.2024.152445) utilized the UK Biobank data, involving over 458,884 participants, to investigate the link between long-term air pollution exposure and gout risk. Significant associations were observed between the risk of gout and a IQR increase in NO2, NOx and PM_2.5 levels. An IQR increase in the air pollution score was associated with an elevated risk of gout (p = 0.005). Biomarkers like serum urate, vitamin D, LDL cholesterol, gamma-glutamyl transferase, and aspartate aminotransferase were found to mediate this relationship, indicating a biological pathway that connects environmental factors to the development of gout.

Immune checkpoint inhibitor-induced vasculitis

Lee et al. (doi: 10.1016/j.semarthrit.2024.152440) explored vasculitis as an immune-related adverse event (irAE) from checkpoint inhibitor (ICI) therapy for cancer in a scoping review. Analyzing 29 cases, the average patient age was 62.1, with a male majority (58.6%). The most common cancers were lung (41.4%) and melanoma (41.4%). Vasculitis typically manifested 7.2 months after starting ICI, with 86.2% of patients improving upon discontinuation of the therapy. This review highlights the need for standardized irAE reporting to better understand vasculitis in the context of ICI therapy.

Orbital and ocular involvement in VEXAS syndrome

Vitale et al. (doi: 10.1016/j.semarthrit.2024.152430) conducted a study in which 27 out of 59 patients with VEXAS syndrome exhibited orbital/ocular inflammation, with periorbital edema (13.6%), episcleritis, and scleritis (each 8.5%) being the most frequent. Significantly, relapsing polychondritis was diagnosed in 12 patients and was associated with orbital/ocular involvement (Relative Risk: 2.37, 95% CI: 1.03–5.46, p = 0.048). The study, observing a high mortality rate where 5 out of 6 deceased patients had orbital/ocular involvement, suggesting that these manifestations may indicate a need for increased clinical vigilance.