BMC Rheumatology最新文献

Objectives: Allogeneic blood transfusion is a common therapeutic intervention for patients with rheumatoid arthritis (RA) undergoing lower extremity joint replacement (LEJR). Despite the potential for adverse outcomes associated with blood transfusion, the risks related to this procedure in RA patients remain underexplored, particularly within the framework of a large-scale national dataset.

Methods: This study analyzed data from the National Inpatient Sample (NIS) database from 2010 to 2019, identifying 66,674 patients diagnosed with RA who underwent LEJR. These cases were subsequently divided into two groups based on whether they received blood transfusion. Univariate and multivariate logistic regression analyses were conducted on patient demographics, the prevalence of comorbidities, hospital-level characteristics, total financial charges, insurance coverage, and in-hospital mortality rates.

Results: The cumulative blood transfusion rate among RA patients undergoing LEJR was 10.9%, showing a declining trend over the study period (from 23.79% in 2010 to 3.67% in 2019). Several factors were associated with an increased likelihood of receiving blood transfusion, including advanced age (≥ 65 years), female sex, deficiency anemia, chronic blood loss anemia, weight loss, coagulopathy, fluid and electrolyte imbalances, neurological disorders, pulmonary circulatory disturbances, congestive heart failure, chronic kidney disease, and uncomplicated diabetes. Moreover, patients who received blood transfusion demonstrated a higher risk of specific complications, including wound infection, acute myocardial infarction, pneumonia, acute kidney injury, urinary tract infection, postoperative delirium, deep vein thrombosis, lower limb nerve injury, sepsis, and respiratory failure.

Conclusion: Thorough preoperative assessment is essential for identifying RA patients who were more likely to receive blood transfusion and be subjected to adverse outcomes. Proactive interventions during the perioperative period, coupled with the implementation of a comprehensive blood management strategy, can optimize blood transfusion in RA patients after LEJR.

Background: Avacopan, a selective oral C5a receptor antagonist, was approved for the treatment of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) in 2021. However, there are still limited reports on its efficacy and safety in real-world settings, specifically regarding its impact on the Vasculitis Damage Index (VDI), and its effects on serum biomarkers are poorly understood. This study aimed to evaluate the efficacy and safety of avacopan in remission induction therapy for MPA/GPA in a real-world setting, as well as its effect on serum C5a levels.

Methods: This retrospective study investigated patients with MPA/GPA who received remission induction therapy with a 6-month follow-up at our institution, comparing those who received avacopan with those who did not. Efficacy and safety were evaluated by comparing the remission rate, changes in Birmingham Vasculitis Activity Score (BVAS) and VDI score after 6 months, daily glucocorticoid (GC) dose, and incidence of adverse events (AEs). Changes in serum C5a levels, measured using ELISA, were compared between both groups at baseline and 3 months.

Results: A total of 66 patients with MPA/GPA were included, with 14 and 52 patients in the avacopan and non-avacopan groups, respectively. The remission rate and decrease in BVAS was comparable between both groups. However, those who received avacopan had a significantly smaller increase in VDI score, significantly lower daily GC dose at 1, 3, and 6 months, and significantly lower incidence of GC-related AEs within 6 months. Serum C5a levels did not significantly change in the avacopan group but significantly decreased in the non-avacopan group. Remission was achieved in the avacopan group regardless of whether serum C5a decreased or increased.

Conclusions: Treatment with avacopan appears to effectively suppress the increase in VDI score, enable reduced GC dosage, and lower the incidence of GC-related AEs during remission induction therapy for MPA/GPA in a real-world setting. Furthermore, avacopan may suppress disease activity regardless of serum C5a levels.

Clinical trial number: Not applicable.

Background: This study was conducted to describe differences in self-reported health-related quality of life (HRQoL) for patients with inflammatory joint disease (IJD) related to sociodemographic factors.

Methods: The data were collected through an anonymous survey in a cross-sectional study of 261 patients with IJD- rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). The patients' health status was assessed using a standard questionnaire [EQ-5D-3L].

Results: The results showed no significant differences related to the type of JDC in any domain of patients' quality of life. Among the demographic factors, social status showed a significant association with all aspects of patients' HRQoL: mobility ratings (p = 0.002), self-care ratings (p < 0.001), usual activities (p < 0.001), pain or discomfort (p = 0.039), anxiety or depression (p = 0.001). Anxiety and depression were more common among women than men (p = 0.033). Men rated their health higher on the EQ-VAS scale (p = 0.036). Working patients reported better health than retirees (p = 0.008), and disability pensioners (p < 0.001). Better health was associated with higher levels of education (p < 0.001). Patients with elementary education provided the lowest ratings while patients with higher degrees gave the highest ratings. Patients living in villages reported better health than those from urban areas (p = 0.019). Social class, education, and place of residence accounted for 17.9% of the variance in EQ-VAS scores.

Conclusion: Understanding the role of sociodemographic factors is crucial to promote improved patient care and better healthcare resources. The results of our study can serve as a benchmark for future studies to assess the influence of sociodemographic factors among patients with other subtypes of IJD.

Introduction: Rheumatoid arthritis (RA) in adult patients, there is contradictory evidence regarding Abatacept's safety profile (ABA). This study aims to assess the safety and efficacy of ABA in adult patients in Saudi Arabia.

Methods: This retrospective cohort study analyzed adult patients aged 18 and above with RA who received ABA at King Fahad Armed Forces Hospital, and King Fahad General Hospital, and Al-Noor Specialist Hospital in Saudi Arabia. Data was collected from electronic medical records, and analyzed using the statistical analyses (IBM's SPSS Software, version 29.0).

Results: The study included 236 RA patients (88.6% female), with a mean age of 55.7 years. Comorbidities were present in 64.6%, and the average disease duration was 127.1 months. Joint erosion was the most common feature (49.6%), while 25% had extra-articular manifestations. Abnormal labs included elevated liver enzymes and leukocytosis. After 6 months of ABA, DAS-28 scores significantly decreased to a mean of 3.07 (SD = 1.31; p < 0.001). The mean treatment duration was 28.0 months, with a 31.8% discontinuation rate-mainly due to secondary failure (41.1%), primary failure (17.9%), and non-compliance (10.7%). Discontinuation was more frequent in females (p = 0.049). ADRs (Adverse drug reactions) included cytopenia in 8.6% (n = 18), mainly anemia. liver enzyme elevations, GI upset, HBV reactivation, and one malignancy, but none were statistically significant (all p > 0.05). tuberculosis (TB) reactivation occurred in 2 patients (0.8%), neither discontinued the drug (p = 0.565). Notably, 45.3% were biologic-naïve and showed better outcomes: greater DAS-28 reduction (2.1 vs. 1.5; p = 0.015) and lower discontinuation rates (24.3% vs. 38.8%; p = 0.028) than biologic-switch patients.

Conclusion: The study confirms the safety and efficacy of ABA in treating RA in Saudi Arabian adults. It found significant improvements in disease activity, but with high discontinuation rates though aligning with previous studies. We recommend measures targeting identified possible causes and extensive research to explore the safety and efficacy of ABA.

Clinical trial number: Not applicable.