Evaluation of Adjunctive Mycophenolate for Large Vessel Giant Cell Arteritis

Funding: We are grateful to Versus Arthritis (grant 22088) and PMR/GCA Scotland for supporting our workPeer reviewedPublisher PD

Myocardial infarction risk is increased by periodontal pathobionts : a cross-sectional study

Acknowledgements The authors thank the laboratory and administrative staff at the Institute of Dentistry and the Institute of Medical Sciences of the University of Aberdeen for their help. We are grateful to Dr Pirkko Pussinen (Institute of Dentistry, University of Turku, Finland) for sharing the P. gingivalis-antibody positive serum samples and a detailed ELISA protocol. We would like to thank all Consultant Cardiologists at Aberdeen Royal Infirmary for identifying suitable patients during the acute on-call: Dr Andrew Hannah, Dr Andrew Stewart, Dr Adelle Dawson, Dr Deepak Garg, Dr Paul Broadhurst, Dr Nicola Ryan. Lastly, we are grateful to all the participating patients. Funding “Periodontal health in patients acutely admitted for myocardial infarction study” was funded by the Elphinstone Award to Dr Hijazi. Dr Dawson is supported by the British Heart Foundation (FS/RTF/20/30009, NH/19/1/34595, PG/18/35/33786, CS/17/4/32960, PG/15/88/31780, ), Chest Heart and Stroke Scotland (19/53), Tenovus Scotland (G.18.01), Friends of Anchor and Grampian NHS-Endowments.Peer reviewedPublisher PD

Fatigue: a principal contributor to impaired quality of life in ANCA-associated vasculitis

Objectives: To describe quality of life (QoL) in an ANCA-associated vasculitis (AAV) cohort and make comparisons with a general population sample. In addition, we aimed to take preliminary steps to identify potential disease and psycho-social factors which may determine QoL impairment. Methods: A population-based case–control study was designed. All AAV patients resident in Grampian, Scotland, were invited to participate as cases. Controls were identified from a random sample of persons registered with four local general practices. Participants completed a questionnaire comprising validated generic and symptom-specific tools in the assessment of QoL. In addition, all cases were clinically assessed and putative disease factors recorded. Cases and controls were compared and, in addition, disease and psycho-social associations were explored for identified QoL impairments. Results: In total, 74/90 (82%) cases and 781/2000 (39%) controls participated. Cases reported a significant impairment in physical health (P < 0.0001), but not mental health (P = 0.85), compared with controls, as measured by Short Form-8 (SF-8). Following adjustment for age and sex, persons with AAV were more than twice as likely to report mild/moderate fatigue [odds ratio (OR) 2.0; 95% CI 1.1, 3.8] or severe fatigue (OR 2.5; 95% CI 1.4, 4.5) compared with controls. Furthermore, among cases, fatigue was found to be strongly associated with impaired physical health (P < 0.0001), while disease factors such as disease activity and damage were not (P = 0.60 and 0.27, respectively). Conclusions: Patients with AAV report impaired physical but not mental health. Specifically, fatigue is a principal complaint and appears to be a major determinant of impaired QoL

Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study.

BACKGROUND Intravenous pulse methylprednisolone (MP) is commonly included in the management of severe ANCA associated vasculitis (AAV) despite limited evidence of benefit. We aimed to evaluate outcomes in patients who had, or had not received MP, along with standard therapy for remission induction in severe AAV. METHODS We retrospectively studied 114 consecutive patients from five centres in Europe and the United States with a new diagnosis of severe AAV (creatinine > 500 μmol/L or dialysis dependency) and that received standard therapy (plasma exchange, cyclophosphamide and high-dose oral corticosteroids) for remission induction with or without pulse MP between 2000 and 2013. We evaluated survival, renal recovery, relapses, and adverse events over the first 12 months. RESULTS Fifty-two patients received pulse MP in addition to standard therapy compared to 62 patients that did not. There was no difference in survival, renal recovery or relapses. Treatment with MP associated with higher risk of infection during the first 3 months (hazard ratio (HR) 2.7, 95%CI [1.4-5.3], p = 0.004) and higher incidence of diabetes (HR 6.33 [1.94-20.63], p = 0.002), after adjustment for confounding factors. CONCLUSIONS The results of this study suggest that addition of pulse intravenous MP to standard therapy for remission induction in severe AAV may not confer clinical benefit and may be associated with more episodes of infection and higher incidence of diabetes