BMC Rheumatology最新文献

Background: Immune checkpoint inhibitors (ICIs) have been associated with immune-related adverse events (irAEs), including ICI associated vasculitis (ICI-vasculitis) and ICI associated PMR (ICI-polymyalgia rheumatica (PMR)-like syndromes). We sought to describe the characteristics of ICI-vasculitis and ICI-PMR in individuals treated with ICIs through a systematic review and local case series.

Methods: We searched MEDLINE and Embase from inception to July 2023 for cases of ICI-vasculitis and ICI-PMR in ICI-treated individuals. Our series included cases obtained from clinicians at the Universities of Toronto, McMaster, and Western in Ontario, Canada.

Results: One hundred and forty-four patients were identified: 130 from the systematic review in 76 articles and 14 from our case series. This included 73 patients with ICI-vasculitis (14 large vessel, 7 ANCA-associated, 52 other) and 71 with ICI-PMR. Ninety-five per cent of patients were treated with glucocorticoids and 17% received disease-modifying antirheumatic drugs (DMARDs). Among 4 individuals with vasculitis who continued the ICI, two remitted. Of five who paused and restarted ICIs, one experienced a recurrence. Among four individuals with vasculitis who continued ICIs, two remitted. All 11 ICI-PMR cases that continued ICIs remitted; among 3 patients who paused and restarted two did not relapse and one had a relapse that improved with an increase in their dose of prednisone.

Conclusion: ICI-vasculitis and ICI-PMR are underrecognized complications of ICIs. Glucocorticoids are effective for ICI-vasculitis and ICI-PMR. It is unclear if ICIs can be safely continued or restarted after remission of ICI-vasculitis or ICI-PMR. Limited data suggests ICIs may be resumed in individuals with non-severe ICI-vasculitis or ICI-PMR.

Background: Chronic inflammatory arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), poses unique challenges during pregnancy due to potential maternal and fetal complications. This study aimed to compare pregnancy outcomes among women with these conditions in Qatar.

Methods: A retrospective cohort study was conducted at Hamad General Hospital from 2016 to 2022. Data on sociodemographic characteristics, disease features (e.g., disease duration, serological markers), treatments, and pregnancy outcomes were extracted from electronic medical records. Pregnancy outcomes included miscarriage, live birth, and intrauterine fetal demise (IUFD); delivery data such as term, weeks of gestation, and mode of delivery; and neonatal data including birth weight, low birth weight (LBW), congenital anomalies, and NICU admissions. Multivariable logistic regression was used to identify associations between disease subtype, medication use, and pregnancy outcomes.

Results: A total of 189 pregnant women were included (RA = 131, SpA = 29, and PsA = 29). Pregnancy outcomes were compared across the three patient groups: SpA was associated with the highest live birth rate (89.7%), while PsA had the highest rate of NICU admissions (13.8%) and lowest preterm birth rate (6.9%). Intrauterine growth restriction (IUGR) occurred only in RA (31%). Multivariable analyses showed that SpA was linked to significantly higher odds of live birth and lower risks of miscarriage, peripartum complications, and low birth weight compared to RA. PsA was associated with a reduced risk of preterm birth. Advanced maternal age increases the risk of any complication taken together. Sulfasalazine use was associated with lower miscarriage risk and higher likelihood of live birth, but also increased NICU admissions, as did anti-TNF therapy. Hydroxychloroquine use was associated with a protective effect against NICU admissions and low birth weight.

Conclusion: Pregnancy outcomes vary significantly across chronic inflammatory arthritis subtypes. Our findings underscore the need for individualized, multidisciplinary care and further prospective studies to guide clinical management.

Background: Women with systemic lupus erythematosus (SLE) are at risk for body image (BI) disturbances and its resultant psychological distress (PD). The aim of this study was to examine the effects of self-compassion (SC)-based writing on BI and PD among women with SLE.

Methods: In this randomized clinical trial, which was done in 2022-2023, 86 women with SLE were selected and randomly allocated to an intervention group (IG) and a control group (CG). Participants in the IG were instructed to engage in SC-based writing that emphasized the concepts of common humanity, mindfulness, and self-kindness. Six blank pages were provided, each featuring a question related to self-compassion for participants to address. Conversely, the CG was also provided with papers and asked to respond to questions that were unrelated to SC. Data were collected before, immediately after, and one month after the intervention (T1-T3) using a demographic and clinical characteristics questionnaire, the SLE Disease Activity Index, the Body Image Lupus Scale(BILS), the Depression Anxiety Stress Scale, the Self-Compassion Scale, and the Body Image Quality of Life Inventory(BIQLI). The SPSS software (v. 22.0) was employed for data analysis.

Results: Groups did not significantly differ from each other respecting baseline demographic and clinical characteristics and baseline mean scores of the main study outcomes. However, there were significant between-group differences respecting the mean scores of BI (P = 0.028), stress (P = 0.003), anxiety (P = 0.003), and SC (P < 0.001) at T2 and the mean scores of stress (P = 0.023), anxiety (P = 0.029), and SC (P < 0.001) at T3. Moreover, between-group differences respecting the other study outcomes at T2 and T3 were insignificant (P > 0.05).

Conclusions: SC-based writing significantly increases SC among women with SLE. Patients may be encouraged to engage in SC-based writing through education about this technique. Investigating alternative strategies or implementing the intervention at different time intervals may be beneficial for improving the BILS, PD, and BIQLI.

Trial registration: This study was registered in the Iranian Registry of Clinical Trials in February 14, 2022 (code: IRCT20220107053656N1).