Impact of first wave of SARS-CoV-2 infection in patients with Systemic Lupus Erythematosus: Weighting the risk of infection and flare.

INTRODUCTION: The aim of this study was to investigate the incidence and clinical presentation of SARS-CoV-2 infections in a Systemic Lupus Erythematosus (SLE) cohort; to assess correlations with disease characteristics and rheumatic therapy; and to evaluate the occurrence of treatment discontinuation and its impact on disease activity. MATERIALS AND METHODS: SLE patients monitored by a single Italian centre were interviewed between February and July 2020. Patients were considered to be positive for SARS-CoV-2 infections in case of 1) positive nasopharyngeal swab; 2) positive serology associated with COVID19 suggesting symptoms. The following data were also recorded: clinical symptoms, adoption of social distancing measures, disease activity and treatment discontinuation. RESULTS: 332 patients were enrolled in the study. Six patients (1.8%) tested positive for SARS-CoV-2 infection, with the incidence being significantly higher in the subgroup of patients treated with biological Disease-Modifying Anti-Rheumatic Drugs (p = 0.005), while no difference was observed for other therapies, age at enrollment, disease duration, type of cumulative organ involvement or adoption of social isolation. The course of the disease was mild. Thirty-six patients (11.1%) discontinued at least part of their therapy during this time period, and 27 (8.1%) cases of disease flare were recorded. Correlation between flare and discontinuation of therapy was statistically significant (p<0.001). No significant increase of rate of flare in a subgroup of the same patients during 2020 was observed. CONCLUSION: Treatment discontinuation seems to be an important cause of disease flare. Our findings suggest that abrupt drug withdrawal should be avoided or evaluated with caution on the basis of individual infection risk and comorbidities.

High rate of vertebral refracture after vertebroplasty in patients taking glucocorticoids: a prospective two-year study.

OBJECTIVES: To assess vertebral fracture (VFx) occurrence after percutaneous vertebroplasty (PVP) in patients with osteoporosis (OP), primary or secondary to chronic glucocorticoid (GC) therapy. METHODS: Prospective study of a 2-year follow-up. PRIMARY OUTCOME: proportion of patients with new VFx 24 months after PVP. Eligible patients were osteoporotic patients with VFx and pain resistant to conventional therapy, under GC therapy (n=70) or not (n=71), who underwent PVP. X-rays of dorso/lumbar spine were performed before PVP and 12 and 24 months after the procedure. All the patients were given secondary fractures prevention with oral bisphosphonates plus calcium and vitamin D. RESULTS: The two groups were comparable with respect to male to female ratio, age, BMI, pain score, number of prevalent VFx and their score according to Genant, time interval between VFx and PVP, number of VFx that were treated, vitamin D and PTH plasma levels, and bone mineral density at femur sites. The proportion of patients with new VFx was higher at 12 and 24 months in the group taking GC; at 24 months was 44.3% in GC group and 22.6% in non-GC group (RR 1.96; 95% CI 1.19-3.26, p=0.0087). All new VFx were clinically evident. GC-treated patients had more falls than the patients who were not on GC: 43 falls per 100 pts/y and 32 falls per 100 pts/y, respectively (p<0.05); however, only 4 and 6 falls, respectively, caused a VFx (p=NS). Finally, logistic regression model showed that the increased risk of new VFx was associated with GC use (OR 4.53; 95% CI 1.50-13.69, p=0.0073) and low femoral neck T-scores (OR 3.57; 95% CI 1.82-7.02, p=0.0002). CONCLUSIONS: Patients under treatment with GC show a two-fold increased risk of new VFx after PVP with respect to patients with primary OP. This should be weighed in the individual risk/benefit assessment of the procedure.

One year in review 2018: progress in osteoporosis treatment.

Osteoporosis is a generalised bone disease characterised by decreased bone mass and deterioration of bone microarchitecture predisposing to fragility fractures. Bone fractures are a remarkable social and economic health problem, and several studies have been carried out in order to reduce their occurrence. Inhibiting bone resorption and increasing bone formation are the mainstay of treatment, anti-catabolic and anabolic, respectively. This review highlights the most recent advances in osteoporosis and reports the evidence of efficacy and safety of anabolic treatment of osteoporosis, as evaluated by randomised, controlled trials published during 2017. As the most common form of secondary osteoporosis, we will also discuss the 2017 state-of-the-art on pathogenesis and treatment of glucocorticoid-induced osteoporosis.