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1.
Annals of the Rheumatic Diseases ; 82(Suppl 1):2147, 2023.
Article in English | ProQuest Central | ID: covidwho-20245420

ABSTRACT

BackgroundCOVID-19 infection has revealed a considerable number of extra-pulmonary manifestations, especially rheumatological. The detection of these manifestations, which herald the infection, is of great value in the early diagnosis of the disease, especially in health care workers (HCWs) who are at considerable risk of infection. Although myalgia is a common clinical feature of COVID-19, other musculoskeletal disorders (MSDs) have been rarely described.ObjectivesTo describe MSDs during SARS-COV2 infection in HCWs.MethodsProspective descriptive study conducted at the department of occupational pathology and fitness for work of Charles Nicolle Hospital in Tunis, having included the HCWs affected by COVID-19 during the period from 01 September 2020 to 28 February 2021. Data collection was carried out by regular telephone follow-up during the containment period using a pre-established form.ResultsDuring the study period, 656 HCWs were infected with SARS COV 2, of whom 134 (20.4%) had at least one musculoskeletal event. The mean age was 42±9 years with a sex ratio (M/F) of 0.2. The most represented occupational category was nurses (33.6%) followed by health technicians (23.1%). The median professional length of service was 12 [7;20] years. The presence of comorbidity was noted in 58.2% of HCWs. A pre-existing osteoarticular disease was found in 8.2% of cases. Obesity was noted in 25.4% of the population. Active smoking was reported by 14.3% of respondents. A known vitamin D deficiency was noted in 16.5% of patients. Spinal pain was the most reported MSD, present in 87.3% of cases. Low back pain was the most frequent spinal pain (56.7%) followed by back pain (37.4%) and neck pain (5.9%). MSDs of the lower limbs were found in 12.7% of patients. They were represented by gonalgia in 11.9% of cases, ankle pain in 5.2% of cases and hip pain in 4.3% of cases. MSDs of the upper limbs were described by 7.5% of the patients, 92.5% of whom presented with shoulder pain. The median duration of MSDs during COVID-19 was 5 [3;8] days. These manifestations were persistent on return to work in 21.1% of cases.ConclusionKnowledge of the frequency and consequences of musculoskeletal manifestations related to COVID-19 infection is of great importance, particularly in HCWs, in order to optimise management and ensure a rapid return to work.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

2.
Turkish Journal of Physiotherapy and Rehabilitation ; 33(2):23-31, 2022.
Article in Turkish | EMBASE | ID: covidwho-20242652

ABSTRACT

Purpose: The aim of this study was to investigate the relationship between the functionality of disabled children and its effects on parents during the Covid-19 pandemic. Method(s): A total of 168 people, including 84 disabled children and 84 mothers, were included in the study. The Pediatric Disability Assessment Inventory (PEDI) and Gross Motor Function Classification System (GMFCS) were used for children with disabilities. The Zarit Burden Scale (ZBS), Fatigue Severity Scale (FSS) and The Nordic Musculoskeletal Questionnaire (NMQ) were applied to the mothers to question musculoskeletal disorders. Result(s): There was no correlation between care burden score and PEDI, total score, self-care and mobility scores (p>0.05). A moderately negative (r=-0.306;p<0.01) significant linear relationship was found between care burden score and social function score. There was no significant linear relationship between the fatigue severity score and PEDI total score, self-care, mobility and social function scores (p>0.05). No correlation was found between care burden score and fatigue severity score (p>0.05). For the last 12 months, only the pain in the lumbar region of the parents prevented them from doing their usual work. It was determined that the most aching body parts of the parents who complained of musculoskeletal pain during the last 12 months were in the waist, neck, shoulder, back, and knee regions. Conclusion(s): As a result, no relationship was found between the functionality of disabled children and their parents' influences during the Covid-19 pandemic.Copyright © 2022 Turkish Physiotherapy Association. All rights reserved.

3.
National Journal of Physiology, Pharmacy and Pharmacology ; 13(5):1050-1054, 2023.
Article in English | EMBASE | ID: covidwho-20241104

ABSTRACT

Background: COVID-19 made many changes in life of persons and even after post COVID era these changes are integral to our life. Some of the changes were online classes, work from home, and online gaming. Computer work leads to static position of neck, shoulders, and upper limbs for extended hours. This leads to higher risk of developing visual, musculoskeletal and psychological problems. Aims and Objectives: The present study was carried out to determine prevalence of musculoskeletal health disorders, assess work distribution, and their probable interaction with musculoskeletal health problems in computer users of Ahmedabad city. Material(s) and Method(s): A cross-sectional study was carried out over a period of 1-year time among 800 participants to study the musculoskeletal problems among computer users. Result(s): Out of 800 participants, 76.75% of participants had any computer related musculoskeletal problem. If participants work more than 4 h in a single spell prevalence of musculoskeletal problems was 82.95%. Regular exercise has significant role in preventing computer-related musculoskeletal problems. Conclusion(s): Computer-related musculoskeletal problems have relation with number of hours spent in single spell, total daily working hours, and years of computer-related work.Copyright © 2023, Mr Bhawani Singh. All rights reserved.

4.
Current Nutrition and Food Science ; 19(6):602-614, 2023.
Article in English | EMBASE | ID: covidwho-20241090

ABSTRACT

In addition to the classical functions of the musculoskeletal system and calcium homeostasis, the function of vitamin D as an immune modulator is well established. The vitamin D receptors and enzymes that metabolize vitamin D are ubiquitously expressed in most cells in the body, including T and B lymphocytes, antigen-presenting cells, monocytes, macrophages and natural killer cells that trigger immune and antimicrobial responses. Many in vitro and in vivo studies revealed that vitamin D promotes tolerogenic immunological action and immune modulation. Vitamin D adequacy positively influences the expression and release of antimicrobial peptides, such as cathelicidin, defensin, and anti-inflammatory cytokines, and reduces the expression of proinflammatory cytokines. Evidence suggestss that vitamin D's protective immunogenic actions reduce the risk, complications, and death from COVID-19. On the contrary, vitamin D deficiency worsened the clinical outcomes of viral respiratory diseases and the COVID-19-related cytokine storm, acute respiratory distress syndrome, and death. The study revealed the need for more preclinical studies and focused on well-designed clinical trials with adequate sizes to understand the role of vitamin D on the pathophysiology of immune disorders and mechanisms of subduing microbial infections, including COVID-19.Copyright © 2023 Bentham Science Publishers.

5.
Annals of the Rheumatic Diseases ; 82(Suppl 1):1889-1890, 2023.
Article in English | ProQuest Central | ID: covidwho-20239950

ABSTRACT

BackgroundIt is known that rheumatologic patients often present a course of COVID-19 similar to that of the general population. Some factors are linked to a worse COVID-19 outcome, such as moderate glucocorticoid (GC) dose, high body mass index (BMI), and comorbidities.ObjectivesTo describe the outcome of COVID-19 in patients with rheumatoid arthritis (RA) in terms of symptoms, therapy and need for hospitalization compared to a control group. Also, to evaluate the variation in disease activity before and after COVID-19.MethodsIn this monocentric prospective study, we recruited consecutive adult patients with RA classified according to ACR-EULAR 2010 criteria who received a diagnosis of COVID-19 through molecular or rapid antigen swab tests between September 2020 and December 2022. Demographic and clinical data, including age, BMI, smoking habit, comorbidities, treatment at the diagnosis of COVID-19, duration of COVID-19, symptoms related to the infection and therapy required, together with the vaccination status were collected through a self-administered questionnaire. We compared DAS28-CRP before the infection and at the first visit after the resolution. As controls (Cs), individuals with COVID-19 but with no referred diagnosis of rheumatic/autoimmune disease were recruited.ResultsWe enrolled 111 patients affected by RA (males 15%, median age 56 years, IQR 25) and 89 Cs (males 44%, median age 47 years, IQR 43), whose demographic and clinical characteristics are reported in Table 1. The median RA disease duration was 108 months (IQR 201). At the COVID-19 diagnosis, 62 patients (56%) were assuming csDMARDs, 67 (60%) bDMARDs, and 18 (16%) GC with a median prednisone equivalent dose of 4 mg/day (IQR 1). DAS28-CRP was available for 62 patients, with a median value of 1.67 (IQR 2.71);42 patients (60%) were in remission (Figure 1). Before developing COVID-19, only 35 (32%) RA patients and 42 (47%) Cs had completed the vaccinal cycle, which was performed by mRNA vaccine in all the patients and 87% of Cs. The median COVID-19 duration was 18 days (IQR 18) for RA patients and 14 days (IQR 13.5) for Cs (p>0.7). Cs reported a significantly higher frequency of constitutional symptoms (headache and asthenia) compared to RA patients (p<0.00001). When hospitalization was required, RA patients received heparin more frequently than Cs (p<0.039). Once COVID-19 was resolved, RA patients were evaluated after a median of 2 months (IQR 2). DAS28-CRP was available for 68 patients, with a median value of 1.61 (IQR 1.77);42 patients (68%) were in remission (Figure 1).No differences in terms of COVID-19 duration, clinical manifestations, and therapy emerged comparing RA patients in remission (40;58%) with patients with the active disease before COVID-19 (29;42%). Also, in vaccinated subjects, the outcome of COVID-19 was similar in RA patients and Cs, irrespective of RA activity.ConclusionCOVID-19's impact on patients with RA was not significantly different from the general population, even for patients with active RA. Patients did not suffer from reactivation of RA because of COVID-19. In our opinion, these positive results could be ascribed to the massive vaccination campaign.References[1]Conway R et al, Ir J Med Sci. 2023[2]Andersen KM et al, Lancet Rheumatol. 2022Table 1.Clinical characteristics, COVID-19 symptoms, and therapy of the two groups. Values in brackets are expressed as percentages unless specified. Musculoskeletal diseases: osteoarthritis and osteoporosis.Rheumatoid arthritis N=111Controls N=89P value*ACTIVE SMOKERS13 (12)20 (22)BMI (IQR)24 (7)23(6)COMORBIDITIES64 (58)44 (49)Cardiovascular26 (23)18 (20)Endocrine24 (22)14 (16)Musculoskeletal11 (10)6 (7)Neoplastic12 (11)3 (3)CLINICAL MANIFESTATIONS96 (86)74 (83)Fever50 (45)47 (53)Constitutional symptoms52 (47)75 (84)p <0.00001Respiratory symptoms100 (90)86 (97)Gastrointestinal symptoms12 (11)13 (15)THERAPY88 (79)74 (67)NSAIDs41 (37)31 (35)Glucocorticoids24 (22)21 (30)Antibiotics33 (30)27 (24)Oxygen6 (5)5 (6)Heparin8 (7)0 (0)p <0.039HOSPITALIZATION10 (9)6 (9)*Where not indi ated, p value >0.5Acknowledgements:NIL.Disclosure of InterestsNone Declared.

6.
Annals of the Rheumatic Diseases ; 82(Suppl 1):2105, 2023.
Article in English | ProQuest Central | ID: covidwho-20239301

ABSTRACT

BackgroundThe Covid-19 pandemic has put patients with rheumatic diseases in front of a number of obstacles that had to be solved together with Bulgarian rheumatologists. The lockdowns and restrictive measures have made it difficult for people with rheumatic diseases to have access to timely hospital and pre-hospital care. A number of digital solutions have been implemented to address these issues.ObjectivesTo highlight the problems that patients with rheumatic diseases had during the Covid-19 pandemic;access to rheumatologists and the effectiveness of hospital and pre-hospital care during the pandemic, access to treatment, changes of treatment;communication between physicians and patients, the impact of the pandemic on work, social contacts, hobbies.MethodsAn anonymous survey was conducted online and by telephone. The survey was developed by Medical university, Plovdiv, University hospital "Kaspela”:, Plovdiv, Bulgarian Association for Musculoskeletal Ultrasound, Bulgarian organization for people with rheumatic diseases;Association for patients with autoimmune diseases.Number of participants: 1205 patients with RMD's.Age range: 18-82ResultsFace to face meetings with doctors have been limited during the pandemic.Visits to the rheumatologist's office are significantly reduced and phone, email, text messaging, online consultations were preferred as communication channels.Before the pandemic, 76% of respondents most often communicated with their physicians by visiting their practice, during the pandemic their relative share decreased to 46%, with a significant difference of 30%Phone consultations: patients using this type of communication increasing from 38% before the pandemic to 56% during the pandemic, a significant difference of 18%The percentage of patients who communicated via text or email rises from 10% to 17 %.It has become apparent that Digital transformation is needed and patients and physicians should work together to achieve it and to be established in Bulgaria.245 patients reported a change in their treatment. Of these: (30%) reduced the dose of their medications, 119 (49%) increased the dose and the remaining 55 (21%) stopped their therapy.From the responses of the respondents, it is clear that 71% have not experienced a change in their work during the COVID-19 pandemic, 17% have worked from home.From the responses of the respondents, it is clear that 71% have not experienced a change in their work during the COVID-19 pandemic, 17% have worked from home, 4% have been fired, 3% have left their jobs due to the risk of their health and 5% left their jobs for other reasons.ConclusionThe Covid-19 pandemic has shown that the digital transformation in rheumatology care can be an efficient alternative to some of the services offered to patients with rheumatic diseases in Bulgaria (especially secondary examinations and therapy monitoring examinations). The results of the conducted survey could be used to support digitization in healthcare in Bulgaria.Very important was the collaboration between the patient organizations and the Bulgarian Association for Musculoskeletal Ultrasound, Medical University, Plovdiv and the rheumatologists from University hospital "Kaspela” Plovdiv.References[1]Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79: 859–66.[2]Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis 2020;79: 667–68.[3]Dejaco, C.;Alunno, A.;Bijlsma, J.W.;Boonen, A.;Combe, B.;Finckh, A.;Machado, P.M.;Padjen, I.;Sivera, F.;Stamm, T.A.;et al. Influence of COVID-19 pandemic on decisions for the management of people with inflammatory rheumatic and musculoskeletal diseases: A survey among EULAR countries. Ann. Rheum. Dis. 2020AcknowledgementsBul arian organization for people with rheumatic diseases.Association for patients with autoimmune diseases.Bulgarian Association for Musculoskeletal Ultrasound.Disclosure of InterestsNone Declared.

7.
Annals of the Rheumatic Diseases ; 82(Suppl 1):2088, 2023.
Article in English | ProQuest Central | ID: covidwho-20238768

ABSTRACT

BackgroundThe use of interactive patient scenarios has long been a valuable component of medical school curricula, as this type of learning facilitates empathy, comprehensive understanding, and cultural sensitivity.[1] The COVID-19 pandemic, however, has precipitated a shift to more virtual strategies to keep students, faculty, and patients safe.[2]ObjectivesTo evaluate second year medical students' (MS2s) perceptions on the use of live patient encounters during the teaching of the skin and rheumatology course (BMS 6635) using different teaching formats due to changes from the COVID-19 pandemic.MethodsFour to five patients with dermatologic, autoimmune, and musculoskeletal diseases volunteered to participate in an interactive teaching session with MS2s at the University of Central Florida College of Medicine. MS2s enrolled in BMS 6635 were asked to voluntarily complete a survey about their learning experiences using these patient cases. Students who did not respond to the survey were excluded. Data analysis using Chi Square testing was performed on survey responses obtained pre-pandemic as compared to those collected in academic years 2020-2021 and 2021-2022 during the COVID-19 pandemic.Results700 surveys were obtained after patient cases given in different formats. When the interactive patient cases were given in person before COVID-19, 93% of students enjoyed the cases and 95% of students believed that the cases were an appropriate learning experience in their education. When these cases were delivered virtually beginning in the academic year 2020-2021, however, students' enjoyment of these cases decreased to 86%, with 92% of students believing that the cases were an appropriate learning experience. This is a 7% and 9% decrease, respectively, from pre-pandemic years. During the academic year 2021-2022, use of a hybrid model, with students and faculty in-person and patients participating virtually, resulted in 81% of students enjoying the interactive patient cases and 83% of students believing that the cases were an appropriate learning experience. This was a 12% decrease from before the COVID-19 pandemic (p <.001) and a 5% and 9% decrease, respectively, from the previous year (p <.001) (Figure 1). 37% of students who had their cases in a completely virtual format preferred the interactive patient sessions to stay completely virtual, while 51% of students who participated in hybrid sessions during COVID-19 preferred the sessions to be completely virtual (p<.029) (Table 1).Table 1.Medical student survey responses comparing live patient encounters given in person, completely virtually, and a hybrid formatIn person pre-Covid (2016-2020)Completely virtual-Covid (2020-2021)Hybrid Format-Covid (2021-2022)Totalp-valueI enjoyed the Live Patient cases43993%9186%9881%628<.001*The Live Patient cases were an appropriate learning experience at this stage in my education44895%9792%10183%646<.001*The Live Patient cases helped me remember the diseases well for the exam9583%8075%8671%261.111Would you prefer the Live Patient sessions to be on Zoom?3937%6251%49.029** = Statistical significance defined as p<0.05Figure 1.Medical students' feedback on live patient cases given in different platforms before COVID-19 and during the COVID-19 pandemic.[Figure omitted. See PDF]ConclusionThe use of interactive patient cases in medical education has been met with positive feedback over the years and should continue to be used in medical education. This study showed that MS2s enjoyed the patient encounters more when delivered in-person vs a virtual or hybrid format. Careful consideration should be given to delivery format to optimize student learning and enjoyment.References[1] Spencer J, Blackmore D, Heard S, et al. Patient-oriented learning: a review of the role of the patient in the education of medical students. Med Educ. 2000;34(10):851-857. doi: 10.1046/j.1365-2923.2000.00779.x.[2] Rose S. Medical Student Education in the Time of COVID-19. JAMA. 2020;323(21):2131-2132. doi: 10.1001/jama.2020.5227.Acknowledgements:NIL.Disclosure of I terestsNone Declared.

8.
Annals of the Rheumatic Diseases ; 82(Suppl 1):2110-2111, 2023.
Article in English | ProQuest Central | ID: covidwho-20238341

ABSTRACT

BackgroundIn Tunisia, during the last decade, the number of MSDs declared as compensable occupational diseases has been increasing. So, what is the impact of the COVID-19 pandemic on the MSD reporting rate.ObjectivesTo describe the socio-professional characteristics of workers with musculoskeletal disorders (MSDs) and to determine the reporting rate of MSDs as occupational diseases.MethodsA descriptive cross-sectional study among workers with work-related MSDs who consulted the occupational medicine department of the Charles Nicolle Hospital for medical advice between January 2021 and September 2022.ResultsA total of 109 workers with MSDs were included in this study. The workers were 64.2% female. The average age was 46 ± [21-61 years]. The sectors most prone to MSDs were the health sector (27.5%), food processing (16.5%) and textiles (15.6%). The workers reported MSDs of the upper limb in 31.2%, MSDs of the lower limb in 33.9% and of the spine in 69.7%. These MSDs reported included 5/13 cases of rotator cuff tendinopathy, 6/13 cases of carpal tunnel syndrome, one case of achilles tendonitis and one case of Dequervain's tenosynovitis.ConclusionDuring the COVID-19 pandemic, the reporting of MSDs as occupational diseases has declined considerably. This decline can be explained by the difficult access to hospital facilities.References[1]https://www.emro.who.int/emhj-volume-23-2017/volume-23-issue-11/prevalence-et-determinants-des-troubles-musculo-squelettiques-des-membres-superieurs-chez-les-artisans-tunisiens.html.[2]http://medecinetravail.canalblog.com/archives/2011/10/04/22196851.htmlAcknowledgements:NIL.Disclosure of InterestsNone Declared.

9.
Annals of the Rheumatic Diseases ; 82(Suppl 1):1869, 2023.
Article in English | ProQuest Central | ID: covidwho-20238086

ABSTRACT

BackgroundAmid the coronavirus disease 2019 (COVID-19) crisis, two messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have benefited most people worldwide. While healthy people can acquire sufficient humoral immunity against COVID-19 even in the elderly by vaccination with three doses of vaccine., recent studies have shown that complex factors other than age, including the type of vaccines and immunosuppressive drugs, are associated with immunogenicity in patients with rheumatic musculoskeletal disease (RMD). Identifying factors that contribute to the vulnerability of those patients to acquire not only humoral but also cellular immunity to SARS-CoV-2 despite multiple vaccinations is crucial for establishing an appropriate booster vaccine strategy.ObjectivesTo assess humoral,and T cell immune responses after third doses of mRNA vaccines against SARS-CoV-2.MethodsThis prospective observational study included consecutive RMD patients treated with immunosuppressant who received three doses of mRNA vaccines including BNT162b2 and mRNA-1273. Blood samples were obtained 2-6 weeks after second and third dose of mRNA vaccines. We measured neutralizing antibody titres, which against the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2 and seroconversion rates to evaluate the humoral responses. We also assessed T-cell immunity responses using interferon releasing assay against SARS-CoV-2.ResultsA total of 586 patients with RMD treated with mmunosuppressive treatments were enrolled. The mean age was 54 years, and 70% of the patients were female. Seroconversion rates and neutralizing antibody titres after third vaccination of SARS-CoV-2 were significantly higher compared to those after second vaccination (seroconversion rate, 94.5% vs 83.6%, p<0.001;titres of neutralizing antibody, 48.2 IU/mL vs 11.0 IU/mL, p<0.001, respectively). Interferon releasing assay after third vaccinations demonstrated that T cell reaction against SARS-CoV-2 was also increased from that of second vaccination (interferon for antigen 1, 1.11.9 vs 0.61.9, p=0.004,interferon for antigen 2, 1.72.6 vs 0.82.3, p=0.004). Humoral and cellular immunogenicity did not differ between the types of third vaccination including full dose of BNT162 and half dose of mRNA1273.(neutralizing antibody titers, 47.8±76.1 IU/mL vs 49.0±60.1 IU/mL, p<0.001;interferon for antigen 1, 1.12.0 vs 1.01.5, p=0.004, respectively). Attenuated humoral response to third vaccination was associated with BNT162b2 as second vaccination age (>60 years old), glucocorticoid (equivalent to prednisolone > 7.5 mg/day), and immunosuppressant use including mycophenolate, and rituximab. On another front, use of mycophenolate and abatacept or tacrolimus but not rituximab were identified as negative factors for T-cell reactions against SARS-CoV-2. Although 53 patients (9.0%) who had been immunised with third-vaccination contracted COVID-19 during Omicron pandemic phase, no one developed severe pulmonary disease that required corticosteroid therapy.ConclusionOur results demonstrated third mRNA vaccination booster of SARS-CoV-2 contributed to restore both humeral and cellular immunity in RMD patients with immunosuppressants. We also identified that certain immunosuppressive therapy with older RMD patients having BNT162b2 as a second vaccination may need additional booster vaccination.Reference[1]Furer V, Eviatar T, Freund T, et al. Ann Rheum Dis. 2022 Nov;81(11):1594-1602. doi: 10.1136/ard-2022-222550.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

10.
Annals of the Rheumatic Diseases ; 82(Suppl 1):1895-1896, 2023.
Article in English | ProQuest Central | ID: covidwho-20238064

ABSTRACT

BackgroundAmid the coronavirus disease 2019 (COVID-19) crisis, two messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have benefitted most people worldwide. However, the safety of vaccine has not been established in patients with rheumatic arthritis (RA). Previous studies reported that flares of underlying RA following SARS–CoV-2 vaccination were not so frequent, and there was no report of severe flare. However, those reports did not assess patients' disease activity with validated disease activity measures and described only simple self-reported questionnaires. Hence, the effect of vaccination on disease activity in patients with RA is still unclear. Understanding the association between arthritis flare in patients in RA and vaccination is important to overcome vaccine hesitancy.ObjectivesTo clarify the effect of SARS-CoV-2 vaccination on disease activity in patients with RA and identify risk factors associated with RA flares following the vaccination.MethodsThis is a prospective cohort study in patients with rheumatic musculoskeletal disease including RA who received the SARS-CoV-2 mRNA vaccines BNT162b2 or mRNA-1273 from March 16, 2021, at Keio University Hospital. The disease activity was evaluated with disease activity score for 28 joints using C-reactive protein (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI) before vaccination and after second vaccination (within two months). RA flare was defined as ΔDAS28-CRP>0.6with requirement of treatment intensification. All analysis in this study was carried out with JMP.ResultsWe enrolled 318 patients with RA in this analysis. The mean age was 61 years old, and 283 (89%) were female. The mean DAS28-CRP before vaccination and after 2nd dose of vaccination were 1.70±0.71 and 1.78±0.81, respectively (p=0.84). The increase in DAS28-CPR after vaccination > 0.6 was observed in 53 patients (16.7%), and among them, 23 patients (8.2%) needed treatment intensification. The types of SARS-CoV-2 vaccine, humoral immunogenicity including neutralizing antibody titer and its adverse effects including systemic reaction (fever or general fatigue) were not different between the flare and non-flare groups (9.8 vs 9.1 IU/mL, p=0.88;31.2% vs 18.7%, p=0.32, respectively). In the flare group, swollen joint counts (SJC), hourly erythrocyte sedimentation rates, DAS28-CRP, and SDAI were significantly higher than those in the non-flare group (0.5 vs 0.0, p<0.000;13 vs 11 mm/h, p=0.01;1.57 vs 1.45, p<0.001;3.9 vs 2.4, p=0.02, respectively). Multivariable logistic regression analysis revealed that the number of swollen joints before vaccination contributed RA exacerbation after SARS-CoV-2 vaccination significantly (odds ratio 1.3, 95% confidence interval 1.06-1.65, p=0.01). The receiver operating curve analysis identified that having two or more swollen joint counts predicts RA flares after vaccination with an area under the curve of 0.64, a sensitivity of 42.3%, and a specificity of 86.9%.ConclusionDisease flare with requirement of treatment intensification is observed in 8.2% of patients with RA. Patients with higher disease activity, especially having two or more swollen joint counts are at high risk of flare following mRNA SARS-CoV-2 vaccination.Reference[1]Connolly CM, Ruddy JA, Boyarsky BJ, et al. Disease Flare and Reactogenicity in Patients With Rheumatic and Musculoskeletal Diseases Following Two-Dose SARS-CoV-2 Messenger RNA Vaccination. Arthritis Rheumatol. 2022;74(1):28-32. doi: 10.1002/art.41924. Epub 2021 Dec 3.Figure 1.Risk factors associated with RA flares after vaccination[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsNone Declared.

11.
Annals of the Rheumatic Diseases ; 82(Suppl 1):1912, 2023.
Article in English | ProQuest Central | ID: covidwho-20236893

ABSTRACT

BackgroundVaccine-induced immunity is very important for controlling the COVID-19 infection. The vaccination supports humoral and cellular immunity, and this is one of the main strategy for us. Various vaccines approved in the countries have been shown to reduce infection rates, severity, and mortality.ObjectivesWe aimed to compare humoral and cellular immune responses after homologous or heterologous vaccination among patients with aiRMDs at their third vaccination with BNT162b2 or with two vaccinations followed by COVID-19 infection. We detected the anti-SARS-CoV2 antibody levels and measured the SARS-CoV-2 reactive B-, or T-cell mediated immunity in aiRMDs receiving homologous (Hom.), heterologous (Het.) vaccines or became infected (Inf.).MethodsA single center observational study evaluated immunogenicity and safety of the third dose vaccines or after two-dose regimen of vaccine and COVID infection in patients with aiRMDs. Neutralizing anti-RBD antibodies and specific T-cell response were measured.ResultsWe showed that following 4 months of the booster vaccination with the third dose of mRNA-based vaccine or after COVID infection, the positive (>21.8 BAU/mL) neutralizing anti-RBD IgG antibody response was outstanding in all three patient groups, 95.5%, 100% and 100% of the homologous and heterologous as well as the SARS-CoV-2 infected groups. Taken together booster vaccinations or SARS-CoV-2 infection after completing 2 doses of the vaccination can lead to the production of neutralizing antibodies still protective in RMD cases after 4 months of the third antigen exposition. The booster vaccination reduces the frequency of hospital admissions and mortality with ai RMDs. The vaccinations are effective independently from the type of vaccine, the SARS-CoV-2 specific memory B-cell populations showed a statistically not significant but lower frequency in the infection group. Clinical activity of aiRMDs was not increased following booster vaccination.ConclusionPatients, who received a heterologous booster vaccine had a higher level of peripheral memory B-cells compared to those who had COVID-19 infection. Biologic therapy decreased the level of B-cells. Patients with a disease duration of more than 10 years had higher level of CD8+TNF-α+ and CD8+IFN-γ+ T-cells compared to patients who were diagnosed less than 10 years ago. The third booster mRNA-based vaccine was as much effective as in the homologous and heterologous patients groups compared who had COVID infection.References[1] Szebeni, G.J.;Gemes, N.;Honfi, D.;Szabo, E.;Neuperger, P.;Balog, J.A.;Nagy, L.I.;Szekanecz, Z.;Puskas, L.G.;Toldi, G.;et al. Humoral and Cellular Immunogenicity and Safety of Five Different SARS-CoV-2 Vaccines in Patients With Autoimmune Rheumatic and Musculoskeletal Diseases in Remission or With Low Disease Activity and in Healthy Controls: A Single Center Study. Front. Immunol. 2022, 13, 846248.[2]Honfi, D.;Gémes, N.;Szabó, E.;Neuperger, P.;Balog, J.Á.;Nagy, L.I.;Toldi, G.;Puskás, L.G.;Szebeni, G.J.;Balog, A. Comparison of Homologous and Heterologous Booster SARS-CoV-2 Vaccination in Autoimmune Rheumatic and Musculoskeletal Patients. Int. J. Mol. Sci. 2022, 23, 11411Acknowledgements:NIL.Disclosure of InterestsNone Declared.

12.
Annals of the Rheumatic Diseases ; 82(Suppl 1):27, 2023.
Article in English | ProQuest Central | ID: covidwho-20236817

ABSTRACT

BackgroundThe first coronavirus infection was confirmed in Wuhan City, People's Republic of China, in December 2019. On January 30, 2020, the World Health Organization declared the novel coronavirus disease a public health emergency of international concern. On March 11, 2020, World Health Organization announced that the new coronavirus infection can be regarded as a pandemic because of the global spread of the infection. The world's first authorization for a coronavirus disease 2019 vaccine (CV) in the UK was in December 2020. The first authorization for a CV in Japan was in February 2021. A maximum of five times of vaccination had been performed in Japanese people until January 2023. Patients with rheumatoid arthritis (RA) are generally immunocompromised because of the drugs used for RA treatment. Patients with RA are recommended to receive a CV in the 2021 update of the EULAR recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2 [1]. However, some patients with RA rejected CV for various reasons or reports of adverse reactions (ARs) in clinical practice. Real-world clinical information on CV is necessary for better relationships between patients with RA and their physicians.ObjectivesThis retrospective study aimed to determine the vaccination rate, ARs, and reasons for nonvaccination of CV in patients with RA in clinical practice.MethodsThe vaccination rate, ARs, and reasons for nonvaccination of CV in patients with RA on clinical records of our institute were investigated up to the third vaccination. Patients were divided into three age groups: 0–64 years old (YG), 65–74 years old (OG), and >75 years old (VOG). The association between age groups and vaccination rates was also investigated. The Cochran–Armitage test was used for statistical analysis.ResultsRegarding patient background (n = 610), the mean age was 67.8 years (YG, n = 207;OG, n = 196;VOG, n = 207;female, 75.1%;mean RA duration, 14.1 years). The vaccination rate among all patients was 8.4% for nonvaccination;91.6% for the first dose;91.3%, second dose;and 86.6%, third dose. A significant decrease over time was observed (p < 0.01). Nonvaccination was observed in 13.0%, 9.2%, and 2.9% of those in YG, OG, and VOG, respectively. A higher rate of nonvaccination was observed in the YG (p < 0.01). The results of the analysis by age group were 87.0%/90.8%/97.1% (first dose), 87.0%/90.3%/96.6% (second dose), and 77.8%/86.7%/95.2% (third dose) among the YG/OG/VOG, respectively (Figure 1). No statistically significant decrease in the vaccination rate was found over time in OG (p = 0.19) and VOG (p = 0.30) but not in VOG (p = 0.01). ARs occurred in 8.2%, 14.5%, and 16.1% of the patients receiving the first, second, and third doses, respectively. Among the reasons for nonvaccination, 35 (68.6%) patients were concerned about ARs to CV and 6 (11.8%) thought that CV was unnecessary.ConclusionCV rate in our cohort was higher than that of whole nation in Japan (81.4% for the first dose, 80.4% for the second dose, 67.8% for the third dose). CV rate has been declining steadily in patients with RA, with a stronger trend in younger age groups. Fear of ARs was the most frequent reason for nonvaccination.Reference[1]Landewé RBM et al. Ann Rheum Dis 2022.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

13.
Annals of the Rheumatic Diseases ; 82(Suppl 1):536-537, 2023.
Article in English | ProQuest Central | ID: covidwho-20236222

ABSTRACT

BackgroundThe COVID-19 pandemic caused concerns whether patients with rheumatic musculoskeletal disease (RMD) treated with conventional (cs) or biologic (b) disease modifying drugs (DMARDs) and/or prednisolone exhibit an adequate immune response to the applied SARS-CoV2 vaccines.ObjectivesWe established the DECODIR study to assess and compare the efficacy of the SARS-CoV2 vaccines administered as part of the national vaccine roll-out: BNT162b2 vaccine (Pfizer/BioNTech) and mRNA-1273 vaccine (Moderna). The vaccines were offered as two doses four weeks apart;followed by a booster vaccination six months later. This national regimen included inflammatory rheumatic patients regardless of their respective anti-inflammatory treatment. We used patients' SARS-CoV2 IgG serum level as proxy for vaccination response (1).MethodsThe study was conducted as a longitudinal prospective cohort study. Patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA) or psoriatic arthritis (PsA) receiving their outpatient treatment at the Danish Hospital for Rheumatic Diseases, Sonderborg, and monitored in the Danish DANBIO registry, were included.Blood samples, Disease activity and treatment information (cs/bDMARD, prednisolone) were collected at baseline (i.e. prior to vaccination), after six weeks, six and twelve months. SARS-CoV-2 IgG levels in serum were assessed by ELISA (Thermo-Fischer), and manufacturer's cut-off (>=10 EliA U/mL) selected as definition of sufficient IgG response. Antibody response was measured and compared at all four time points.Associations between antibody response, age, gender, disease (RA/PsA/SpA), treatment (none, cs/bDMARD or prednisolone) and disease activity were tested using proportional odds regression and bootstrapped tests of medians. Results were reported using mean, median (IqR) and bootstrapped 95% confidence interval (CI) of the median.ResultsA total of 243 patients were included at baseline and all were followed-up after six weeks;data from 233 patients were available at six months and for 229 patients at twelve months' follow-up. Those 229 patients had completed the national vaccination programme.The measurements performed 6 months after baseline demonstrated a per se decrease of IgG levels for the whole study population (median of 2.08 EliA U/mL at 6 months vs. 16 EliA U/mL at 6 weeks). The final measurements performed after twelve months demonstrated a significant increase of IgG levels. Thus, the completed vaccination programme, was followed by a significant increase in IgG levels (median of 100 EliA U/mL at twelve months vs. 16.5 EliA U/mL at six months, p < 0.001).Sufficient response rates were now recorded in all treatment scenarios, also in patients treated with prednisolone or combination of csDMARD and bDMARD. These two groups were at 6 months characterized by significant lower response rates, when compared with patients without any DMARD treatment.ConclusionCompleted vaccination programme defined as two doses plus booster vaccination resulted in a sufficient vaccination response as measured by IgG levels regardless of RA treatment.It is noteworthy that IgG levels increased markedly in patients treated with a combination of cs/bDMARD or oral prednisolone, who had low IgG levels (below manufacturer's cut-off >=10 EliA U/mL) after 6 months. Our results strongly support the efficacy of the complete vaccination programme including the 3rd booster vaccine in patients with inflammatory rheumatic diseases.Figure 1.Serum IgG-levels at baseline, 6 weeks, 6 months and 12 months;stratified by antirheumatic treatment. (Box plot showing median and interquartile range).[Figure omitted. See PDF]Reference[1]Schreiber K. et al. Reduced Humoral Response of SARS-CoV-2 Antibodies following Vaccination in Patients with Inflammatory Rheumatic Diseases— an Interim Report from a Danish Prospective Cohort Study. Vaccines 2022, 10(1), 35;https://doi.org/10.3390/vaccines10010035AcknowledgementsWe acknowledge all patients contributing to the DANBIO registry.The Danish Rheumatologic Biobank is a knowledged for handling and storage of biological material.Lab chieftechnician Charlotte Drachmann is acknowledged for her assistance.Disclosure of InterestsChristine Graversgaard: None declared, Karen Schreiber Speakers bureau: Lilly, UCB, Henning Jakobsen: None declared, Randi Petersen: None declared, Anders Bo Bojesen: None declared, Niels Steen Krogh: None declared, Bente Glintborg Grant/research support from: Pfizer, AbbVie, BMS, Sandoz, Merete Lund Hetland: None declared, Oliver Hendricks Speakers bureau: Pfizer, Lilly, Novartis.

14.
Annals of the Rheumatic Diseases ; 82(Suppl 1):1887-1888, 2023.
Article in English | ProQuest Central | ID: covidwho-20234468

ABSTRACT

BackgroundPatients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with comorbidities associated. However, few studies in the literature assessed the safety and immunogenicity of the COVID-19 heterologous vaccine schedules in patients with RA.ObjectivesEvaluate the safety and immunogenicity of two heterologous vaccine schedules against SARS-CoV-2 in patients with RA.MethodsThese data are from the study "SAFER - Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases,” a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Immunogenicity and adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 plus additional dose of BNT162b2 or after two doses of inactivated SARS-CoV-2 vaccine CoronaVac plus additional dose of BNT162b2. The titers of neutralizing antibodies against the receptor-biding domain of protein spike (S) of SARS-CoV-2 (anti-RBD) were measured by chemiluminescence test after each dose of immunizers. Proportions between groups were compared using the chi-square and Fisher's exact tests for categorical variables. Clinical Disease Activity Index (CDAI) before and after vaccination was assessed using the McNemar test.ResultsA total of 107 patients with RA were include in the study, most of them female, with a mean age of 46 years. Biological disease modifying anti-rheumatic drugs (DMARDs) were used by 50 % of the patients and conventional synthetics DMARDs in 48 %. Two doses of CoronaVac plus additional dose of BNT162b2 was used in 66 patients and two doses of ChAdOx1 plus additional dose of BNT162b2 in 41. Only mild AEs were observed, mainly after the first dose. The most common AEs after all doses, regardless of the immunizer type, were pain at the injection, headache, arthralgia and myalgia. ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0,001) and arthralgia (68% vs 15%, p < 0,001) compared to CoronaVac. No patients had flare after the vaccination. The titers of anti-RBD after two doses of ChAdOx1 were higher compared to two doses of CoronaVac (6,03 BAU/mL vs 4,67 BAU/mL, p < 0,001). However, after the additional dose of BNT162b2, the anti-RBD titers were similar in both groups (7.28 BAU/mL vs 7.06 BAU/mL, p = 0.56). Only two cases of COVID 19, with mild symptoms, were reported, one in each group.Figure 1.ConclusionChAdOx1, CoronaVac, and BNT162b2 vaccines are safe in RA patients. The frequency of local adverse effects, particularly pain at the injection site, is high. AEs are more frequent with ChAdOx1, especially after the first dose. The use of the immunizers does not change the degree of inflammatory activity of the disease. The immunogenicity of the two heterologous regimens analyzed was similar.References[1]Marques C, Kakehasi AM, Gomides APM, Paiva EDS, Dos Reis Neto ET, Pileggi GCS, et al. A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study. JMIR Res Protoc.[2]Medeiros-Ribeiro AC, Aikawa NE, Saad CGS, Yuki EFN, Pedrosa T, Fusco SRG, et al. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat Med. 2021;27(10):1744-1751.[3]Machado PM, Lawson-Tovey S, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, et al. Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry. Ann Rheum Dis. 2022;81(5):695-709.[4]Tavares ACFMG, Melo AKG, Cruz VA, Souza VA, Carvalho JS, Machado KLLL, et al. Guidelines on COVID-19 vaccination in patients with immunemediated rheumatic diseases: a Brazilian Society of Rheumatology task force. Adv Rheumatol. 2022;62:3.Acknowledg ments:NIL.Disclosure of InterestsNone Declared.

15.
JCSM Rapid Communications ; 6(1):26-32, 2023.
Article in English | ProQuest Central | ID: covidwho-20233327

ABSTRACT

BackgroundRestrictions on outdoor movements due to the coronavirus disease (COVID-19) pandemic have led to a decreased physical activity;this can lead to sarcopenia and frailty in older adults. Our recent study has demonstrated a significant decrease in the trunk muscle mass immediately after the pandemic's first wave (April–May 2020) among Japanese community-dwelling older women. In the present study, we further examined whether muscle mass recovery or deterioration occurs after 1 year of the pandemic's first wave by comparing physical measurements among the following assessment periods: before the first wave, immediately after the first wave, and at 1-year follow-up thereafter.MethodsThis study included 77 women (78.0 ± 5.7 years) who underwent physical measurements for muscle mass, grip strength, one-leg stand-up ability (3 s), and oral motor skills and answered questionnaires on sociality (social network, participation, and support) in the three assessment periods.ResultsThe frequency of going out and the subjective vitality were significantly decreased immediately after the first wave;these recovered at the 1-year follow-up (P < 0.001). When comparing muscular measures, the trunk muscle mass index preferentially decreased immediately after the first wave but recovered significantly at the 1-year follow-up (P < 0.001). Conversely, the appendicular skeletal muscle mass index (ASMI) and grip strength continued to decrease until the 1-year follow-up (P < 0.001 and P = 0.03, respectively). The ability to perform a one-leg stand-up for 3 s and the oral motor skills did not change significantly across the assessment periods. The prevalence of pre-sarcopenia and sarcopenia tended to increase during these periods (P = 0.068). The reduction and subsequent recovery patterns for sociality were similar to those observed for the trunk muscle mass.ConclusionsOur findings demonstrated differences in the reversibility of skeletal muscle mass and strength at 1 year after the first wave of the COVID-19 pandemic: the trunk muscle mass declined acutely and recovered rapidly, whereas the ASMI and grip strength declined continuously. These differences in the skeletal muscle recovery and deterioration might help formulate short-term or long-term strategies for COVID-19-related sarcopenia prevention in community-dwelling older adults.

16.
Annals of the Rheumatic Diseases ; 82(Suppl 1):815-816, 2023.
Article in English | ProQuest Central | ID: covidwho-20232827

ABSTRACT

BackgroundInflammatory rheumatic and musculoskeletal diseases (iRMDs), including rheumatoid arthritis (RA) and juveneille inflammatory arthritsi (JIA), are common and cause a high disease burden globally. Early diagnosis of iRMDs and subsequent timely access to disease modifying therapies is associated with improved health and socio-economic outcomes. However, the COVID-19 pandemic meant that the way healthcare was delivered changed abruptly as all consultations were ‘remote by default' was widely implemented, replacing traditional ‘face-to-face' healthcare.ObjectivesTo describe the impact of the COVID-19 pandemic upon referral patterns and incident diagnosis of iRMDs.MethodsData from the Clinical Practice Research Datalink Aurum were analysed from 01/04/17 to 01/10/2021 to describe episodes of care for patients with musculoskeletal (MSK) conditions, in a primary care setting, for pre-COVID-19 (01/04/2017–31/03/2020), early-COVID-19 (01/04/2020–31/07/2021), and late-COVID-19 pandemic (01/08/2020–31/10/2021) periods. Prevalent and incident MSK consultations were determined. Referrals were matched to these consultations. Trends in referrals to MSK services and further incident diagnoses of iRMDs were described using Joinpoint regression and comparisons made between time-periods. Negative binomial regression was used to compare incident rates between time-periods: first MSK consultation to RA/JIA/iRMD diagnosis;first MSK consultation to first referral;first referral to RA/JIA/iRMD diagnosis. The number of consultations between first MSK consultation and referral/diagnosis were described. Results were adjusted for age and sex and further stratified by geographical region and deprivation.ResultsThe incidence of RA and JIA reduced by -13.3% (from 32.0 to 17.2 per 100,000) and -17.4% (from 1.8 to 0.97 per 1,000,000) per month respectively between January 2020 and April 2020, and then increased by 1.9% (from 17.2 to 25.2 per 100,000) and 3.7% (from 0.97 to 1.3 per 1,000,000) per month respectively between April 2020 and October 2021. The incidence of all diagnosed iRMDs was stable until October 2021. Referral incidence decreased between February 2020 and May 2020 by -16.8% (from 4.8 to 2.4 per 100) per month in patients presenting with a MSK condition. After May 2020, referrals increased significantly (16.8% per month from 2.4 to 4.5 per 100) to July 2020. Time from first MSK consultation to RA diagnosis, and referral to RA diagnosis increased in the early-pandemic period (rate ratio (RR) 1.11, 95% confidence interval (CI) 1.07-1.15;RR 1.23, 95%CI 1.17-1.30) and remained consistently higher in the late-pandemic (RR 1.13, 95%CI 1.11-1.16;RR 1.27, 95%CI 1.23-1.32) periods respectively, compared to the pre-COVID-19 period.ConclusionPatients with underlying RA/JIA that developed during the pandemic may be yet to present, or in the process of being referred and/or diagnosed. Primary care clinicians should remain alert to this possibility and consider the use of fast-track referral pathways where indicated. It is apparent that patients developing incident episodes of inflammatory arthropathies may display a prodrome of other MSK symptoms and conditions, which alone may not warrant referral but in combination require further investigation. Commissioners should be alert to these findings to allow for the appropriate planning and commissioning of services.References[1]Jordan KP, Kadam UT, Hayward R, et al. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskeletal Disorders 2010;11:144.[2]NHS England and NHS Improvement. Important and urgent - Next steps on NHS response to COVID-19 2020. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0098-total-triage-blueprint-september-2020-v3.pdf Accessed Oct 2, 2021.AcknowledgementsWe wish to acknowledge: members of our PPIE group who helped to formulate the research question and provide insight into the implications of our results;and to Prof Edward Roddy, Prof Sa antha Hider and Dr Lorna Clarson for their insights as consultant rheumatologists and commissioners of healthcare services.Disclosure of InterestsNone Declared.

17.
Annals of the Rheumatic Diseases ; 82(Suppl 1):1886, 2023.
Article in English | ProQuest Central | ID: covidwho-20232222

ABSTRACT

BackgroundAs the third year of the pandemic begins, over 13 billion doses of anti-SARS-CoV-2 vaccines have been administrated worldwide and growing evidence on their efficacy and safety in people with RMDs has accrued.ObjectivesTo update our previous systematic literature review (SLR)[1] on efficacy and safety of anti-SARS-CoV-2 vaccination in people with rheumatic and musculoskeletal diseases (RMDs)MethodsA literature search according to the PICO framework was conducted on July 22, 2022 to identify references in seven databases published after June 1, 2021 (end date of previous SLR). Title and s were independently screened by 3 investigators (AA, AN and FK). Eligibility criteria were stricter in terms of requirement of the inclusion of control group or undertaking a multivariable analysis. However, for some outcomes (e.g., RMD flares), descriptive studies were also included due to the paucity of data. Data extraction and risk of bias (RoB) assessment were performed as in the previous SLR.ResultsOf 1583 references, 219 were included for full text assessment and 30 fulfilled the eligibility criteria. Recent studies confirmed that a full vaccination cycle was generally immunogenic, though the seroconversion rate and the anti-spike antibody (Ab) titre were lower in patients with RMDs compared to healthy controls. Vaccination was also able to induce neutralising antibodies (NAb) but the seroconversion rate and the neutralising activity were lower than in controls. Glucocorticoids, mycophenolate mofetil, rituximab and abatacept were negatively associated with Ab and NAb seroconversion. Two studies specifically investigating RTX-treated RMD patients identified an association between lower dose and longer period of time after the last RTX infusion before vaccination and higher likelihood of Ab seroconversion. The majority of breakthrough infections (B-INFs) were asymptomatic and, if symptomatic, mild to moderate. A higher number of vaccine doses was associated with a lower incidence and severity of B-INFs, although B-INF incidence rate was generally higher in the post-delta variant period. Higher disease activity was associated with higher likelihood of severe/critical B-INFs. Regarding safety, in general, patients with RMDs showed higher rates of mild AEs compared to the general population, however severe AEs were rare, if any. Disease flares have been observed in/reported by less than 10% of patients in the various cohorts and although often requiring treatment with glucocorticoids or change of the ongoing immunosuppressive therapy, hospitalization was generally not needed. Pre-vaccination colchicine prophylaxis seemed useful to prevent gout flares in the post-vaccination trimester.ConclusionOverall anti-SARS-CoV-2 vaccination is immunogenic and safe in patients with RMDs. However, careful and individualised assessment of the ongoing therapy and disease activity when planning the vaccination schedule is necessary to minimise the risk of reduced immunogenicity, post-vaccination disease flares and breakthrough infections.Reference[1]Kroon FPB, Najm A, Alunno A, Schoones JW, Landewé RBM, Machado PM, Navarro Compán V. Ann Rheum Dis. 2022;81(3):422-432Acknowledgements:NIL.Disclosure of InterestsNone Declared.

18.
BMJ Case Rep ; 16(6)2023 Jun 01.
Article in English | MEDLINE | ID: covidwho-20241613

ABSTRACT

Vaccination against mRNA SARS-CoV-2 has been administered on a very large scale and various side effects have been described. The increased risk of myopericarditis is known, and only a few cases of shoulder capsulitis have been reported after vaccination. These two pathologies have never been reported in the same patient after vaccination. Our article presents the history of a man in his 40s who presented with myopericarditis a few days after vaccination against SARS-CoV-2 with mRNA(Messenger RNA) Moderna® vaccine and who at the same time developed shoulder capsulitis. His cardiovascular symptoms resolved rapidly, and his shoulder symptoms improved/resolved within 1 year. This case should make physicians aware of the possibility of several concomitant side effects following vaccination against SARS-CoV-2.


Subject(s)
Bursitis , COVID-19 , Drug-Related Side Effects and Adverse Reactions , Myocarditis , Pericarditis , Male , Humans , SARS-CoV-2 , Shoulder , Pericarditis/etiology , Myocarditis/diagnosis , Myocarditis/etiology , Vaccination/adverse effects , RNA, Messenger
19.
J Pak Med Assoc ; 72(12): 2463-2467, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-20239239

ABSTRACT

OBJECTIVE: To determine the frequency and risk factors of musculoskeletal disorders in high-risk occupation workers in an urban setting. METHODS: The analytical cross-sectional study was conducted in Karachi from July to December 2020, and comprised office workers, operation theatre technicians and coolies. The presence of musculoskeletal disorders was assessed using the Nordic Musculoskeletal Questionnaire to determine factors associated with moderate to severe condition. Data was analysed using SPSS 20. RESULTS: Of the 300 male subjects, 100(33.3%) each were office workers, operation theatre technicians and coolies. The overall mean age was 33.25±6.8 years (range: 18-50 years). The overall prevalence of musculoskeletal disorders was 179(59.7%). Besides, 117(65.4%) patients with musculoskeletal disorders had intermediate stage of the disease. The lower back and neck were the most common site of trouble involved in preceding 12 months 111(43.6%) each. CONCLUSIONS: Prevalence of musculoskeletal disorders was found to be a common problem affecting high-risk occupational workers.


Subject(s)
Musculoskeletal Diseases , Occupational Diseases , Humans , Male , Adult , Cross-Sectional Studies , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Musculoskeletal Diseases/epidemiology , Musculoskeletal Diseases/complications , Risk Factors , Occupations , Surveys and Questionnaires , Prevalence
20.
BMJ Case Rep ; 16(6)2023 Jun 05.
Article in English | MEDLINE | ID: covidwho-20238760

ABSTRACT

Anti-synthetase syndrome (ASS) is a rare inflammatory myopathy with a wide variety of clinical presentations. ASS-related interstitial lung disease (ASS-ILD) presents with rapid onset and progression, which could often be confused with other more common acute processes such as pneumonia, especially when ILD can be the sole manifestation. A woman in her 50s presented with recurrent dyspnoea for 2 months requiring multiple hospital admissions, and each time, she was diagnosed with multifocal pneumonia and treated with antibiotics. On admission, the evaluation revealed a markedly elevated creatine kinase level at 3258 U/L and a CT scan of the chest revealed worsening scattered ground-glass opacities. Given the concern for ILD as the cause of antibiotic failure, she underwent bronchoscopy with bronchoalveolar lavage which revealed non-specific interstitial pneumonia. A subsequent myositis panel revealed a positive anti-Jo-1 antibody, and she was diagnosed with ASS-ILD. She completed a course of intravenous immunoglobulin and methylprednisolone and experienced significant clinical improvement with the resolution of hypoxaemia and improved polyarthralgia.ASS could often be misdiagnosed as other more common acute lung processes, as a clinically subtle course can escape detection given its rarity, as well as its non-specific and highly variable presentations. This case highlights the importance of early suspicion and consideration of performing specific autoantibody testing when evaluating patients with a suspicion of undifferentiated autoimmune condition.


Subject(s)
Lung Diseases, Interstitial , Myositis , Pneumonia , Female , Humans , Animals , Ligases , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/etiology , Lung , Myositis/diagnosis , Myositis/drug therapy , Myositis/complications , Autoantibodies , Pneumonia/complications , Equidae
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