Myocarditis and pericarditis following mRNA vaccination in autoimmune inflammatory rheumatic disease patients: A single-center experience.

Introduction: The mRNA vaccines Comirnaty (Pfizer/BioNTech) and Spikevax (Moderna) are considered safe and highly effective against SARS-COV2. However, they are also associated with a small increased risk of pericarditis and myocarditis. There is concern about an increased risk of these complications in patients with autoimmune inflammatory rheumatic diseases (AIRD). Case Report: We describe three patients with pre-existing AIRD who developed myocarditis or pericarditis shortly after receiving their first dose of the Pfizer-BioNTech vaccine. The first case is a 31-year-old female with systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APLS) who presented 7 days after receiving the Pfizer-BioNTech vaccine and was diagnosed with myopericarditis following a positive troponin and abnormal transthoracic echocardiogram (TTE). The second case is a 29-year-old man with seronegative inflammatory arthritis and APLS who presented 7 days after receiving the first dose of the Pfizer-BioNTech vaccine. His troponin and TTE were unremarkable however his ECG showed widespread ST elevation. Lastly, the third case is a 34-year-old man with Behcet's disease with a history of recurrent pericarditis. He developed a recurrence of symptoms approximately 7 days after his Pfizer-BioNTech vaccine and self-commenced prednisolone at home. He had normal laboratory and radiological findings. All patients received prednisolone resulting in a quick recovery and resolution of symptoms. Discussion: In this review we discuss the association between myocarditis, pericarditis and mRNA COVID-19 vaccines, those who are at greatest risk and current clinical considerations. We also discuss the possible increased risk in AIRD patients and the current research supporting this.

A multicentre validation study of a smartphone application to screen hand arthritis.

BACKGROUND: Arthritis is a common condition, and the prompt and accurate assessment of hand arthritis in primary care is an area of unmet clinical need. We have previously developed and tested a screening tool combining machine-learning algorithms, to help primary care physicians assess patients presenting with arthritis affecting the hands. The aim of this study was to assess the validity of the screening tool among a number of different Rheumatologists. METHODS: Two hundred and forty-eight consecutive new patients presenting to 7 private Rheumatology practices across Australia were enrolled. Using a smartphone application, each patient had photographs taken of their hands, completed a brief 9-part questionnaire, and had a single examination result (wrist irritability) recorded. The Rheumatologist diagnosis was entered following a 45-minute consultation. Multiple machine learning models were applied to both the photographic and survey/examination results, to generate a screening outcome for the primary diagnoses of osteoarthritis, rheumatoid and psoriatic arthritis. RESULTS: The combined algorithms in the application performed well in identifying and discriminating between different forms of hand arthritis. The algorithms were able to predict rheumatoid arthritis with accuracy, precision, recall and specificity of 85.1, 80.0, 88.1 and 82.7% respectively. The corresponding results for psoriatic arthritis were 95.2, 76.9, 90.9 and 95.8%, and for osteoarthritis were 77.4, 78.3, 80.6 and 73.7%. The results were maintained when each contributor was excluded from the analysis. The median time to capture all data across the group was 2 minutes and 59 seconds. CONCLUSIONS: This multicentre study confirms the results of the pilot study, and indicates that the performance of the screening tool is maintained across a group of different Rheumatologists. The smartphone application can provide a screening result from a combination of machine-learning algorithms applied to hand images and patient symptom responses. This could be used to assist primary care physicians in the assessment of patients presenting with hand arthritis, and has the potential to improve the clinical assessment and management of such patients.

Symptomatic elevation creatine kinase following treatment of rheumatoid arthritis with baricitinib.

The aim of RA treatment is to achieve reduction of disease activity and prevent joint damage and disability. Baricitinib is a synthetic small molecule which targets the JAK/STAT pathway which is implicated in the inflammatory response in RA. Baricitinib selectively targets JAK1 and JAK2 and has been shown to have efficacy in treating patients with RA. Common adverse effects reported during baricitinib therapy includes infection, asymptomatic changes in laboratory parameters including changes in neutrophil, lymphocyte, platelet counts, alanine aminotransferase, cholesterol, creatinine and creatine kinase (CK). We report the first two documented cases in Australia of baricitinib-induced symptomatic elevation of CK.

The effect of joint aspiration and corticosteroid injections in osteoarthritis of the knee.

AIM: To evaluate the benefits of knee joint aspiration and injection in knee osteoarthritis (OA). METHODS: A retrospective, pilot study involved 110 patients with knee OA from a dedicated OA clinic in a Melbourne tertiary hospital from 2007 to 2009. Only those who had completed two Multiple Attribute Prioritization Tool (MAPT) questionnaires within 6 months of the initial review were included. The MAPT was designed to help prioritise patients on orthopedic waiting lists. Three groups were analyzed: patients who had no corticosteroid injection or aspiration, patients who received corticosteroid injections, and patients who received both joint aspiration with corticosteroid injections. RESULTS: Patients who had both joint aspiration and injection reported an improvement in pain compared with those who had no injection (56.3%vs. 32.2%, P = 0.03). Those who had joint injections also did better than those without injection (62.7%vs. 32.2%, P = 0.001). Reduced analgesia use was noted in 12.5% of patients with aspiration and injection compared with 1.7% with no injection or aspiration (P = 0.03). Improved walking distance was noted in 22.4% of patients who had injections compared with 8.5% of patients with no injections (P = 0.03). No significant differences in MAPT scores among the different treatment groups were noted. CONCLUSION: This pilot study appears to show a beneficial trend in giving corticosteroid injections and to aspirate the knee in OA patients. Further studies are needed to address the mechanical benefits, quadriceps strengthening and pain reduction with knee aspiration, as well as the effects that different volumes of fluid may have on knee mechanics and symptoms.