Difference in clinical profile between juvenile onset and adult-onset systemic lupus erythematosus: a meta-analysis

The aim was to systematically review the studies that compared clinical and serological variation between adult-onset systematic lupus erythematosus (aSLE) andjuvenile-onset systematic lupus erythematosus (jSLE). A comprehensive literature search was done, in various available electronic databases for relevant publication that compared juvenile onset SLE and adult onset SLE. The data of adverse clinical features, serological profile and mortality were extracted. Juvenile onset was defined as 18 years. The methodological quality of study was assessed by Newcastle Ottawa scale (NOS) criteria and R version 3.3.1 was used for analysis and ORs and 95% CIs, were used as statistical parameter. A total of 14,920 patients; (12,230: aSLE, and 2,690: jSLE) were included. Renal involvement especially nephritis was significantly more in j-SLE OR: 2.18, 95% CI: [1.81;2.62]; I2=10.8% whereas musculoskeletal was significant in aSLE O.R: 0.64; C.I: [0.44; 0.93]; I2=83.4%. Seizure and malar rash were significantly higher in J-SLE OR:1.69, CI: [1.31; 2.18]; I2=31.1%,1.43; C.I [1.04; 1.97]; I2=82%, respectively. Raynaud’s phenomenon and pleuritis were significantly higher in adult onset SLE. Anemia and thrombocytopenia were significantly higher in juvenile onset SLE. Anti-ds DNA, anti-histone, and anti-ribosomal-P were more frequent in juvenile-onset SLE while, anti-Ro was more common in adult-onset disease. The cause of mortality was not significantly different in both groups. Renal biopsy of class III and IV combined and class V were significantly more in adult-onset SLE. SLEDAI was higher in j-SLE. Meta-analysis indicated that, regardless of many similar clinical and serological manifestations, there is still some variation between adult-onset SLE and juvenile-onset SLE. Although, SLE disease is continuum from juvenile to adult but disease aggressive in juvenile onset SLE

Impact of COVID-19 on rheumatic diseases in india: Determinants of mortality and adverse outcome: A retrospective, cross-sectional cohort study

Introduction: There is varying impact of COVID19 on world population depending on ethnicity, age and underlying co-morbidities. However, the lack of data regarding the effect of COVID on patients with rheumatological disorders (RDs) from different nations adds to uncertainty on disease outcome. Across the world, many rheumatology associations have joined hands to collate-related information. A national database under Indian Rheumatology Associations (IRAs) was developed to understand the impact of underlying RD and immunosuppressants during the COVID pandemic on its severity and outcome in our country. Methods: All registered members of IRA were invited to participate in this registry and provide information of reverse transcription–polymerase chain reaction confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-infected RD patients using an online platform https://iradatabaseard.in/iracovid/index.php. The results of the data were analyzed using the appropriate statistics. Multivariate logistic regression was used to analyze the impact of different variables on mortality. Odds ratio and 95% confidence interval were used to define risk of death. Results: In this retrospective cross-sectional study, data for 447 RD patients who were infected with SARS-CoV2 data were available as of December 1, 2020. The mean age was 47.9 ± 14.4 years, including two children and 93 (20.8%) geriatric age group patients, male: female ratio was 0.4:1 and mean disease duration was 79.3 ± 77.1 months. Rheumatoid arthritis was the most common RD. Underlying disease was quiescent in 54.7% and active in 18.4% patients. Most common medications at the time of COVID diagnosis were steroids (57.76%) and hydroxychloroquine (67.34%). Fever and cough were the most common symptoms. More than half of the patients (54.4%) needed hospitalization. Oxygen requirement was noted in 18.8%, intensive care unit admission, and invasive ventilation was needed in 6.0%, and 2.9% patients, respectively. Complete recovery was seen in 95.5% of patients and 4.47% (n = 20) expired due to COVID. The presence of comorbidity, dyspnea, and a higher neutrophil count was statistically significantly associated with death (P < 0.05). None of the other factors affected COVID-19 outcome. Conclusion: This is the largest cohort from a single nation looking at the interface between RD and COVID. The results indicate that patients with RD do not show increased mortality despite current use of disease-modifying anti-rheumatic drugs/immunosuppressants

Bevezetés: Norbert Elias és a folyamatszociológia

2014 júniusában fontos konferencia került megrendezésre a Leicesteri Egyetemen Elias munkásságáról, amelynek apropóját az életművet bemutató összkiadás (Th e Collected Works of Norbert Elias) kötetsorozatának befejezése szolgáltatta. Az összkiadást a University College Dublin Press adta ki Stephen Mennell szerkesztésében [az ezzel kapcsolatos információkat lásd a hasznos oldalak között a kötet végén]. A konferencia főszervezői John Goodwin és Jason Hughes voltak, a szervezésben aktívan részt vett Plugor Réka, és – a mintegy kéttucatnyi országból érkezett konferencia-résztvevő között – jelen volt Hadas Miklós is. Itt merült föl annak ötlete, hogy elkészüljön ez a különszám

COVID-19 vaccination in autoimmune disease (COVAD) survey protocol

The coronavirus disease-2019 (COVID-19) pandemic continues to be a cause of unprecedented global morbidity and mortality. Whilst COVID-19 vaccination has emerged as the only tangible solution to reducing poor clinical outcomes, vaccine hesitancy continues to be an obstacle to achieving high levels of vaccine uptake. This represents particular risk to patients with autoimmune diseases, a group already at increased risk of hospitalization and poor clinical outcomes related to COVID-19 infection. Whilst there is a paucity of long-term safety and efficacy data of COVID-19 vaccination in patients with autoimmune diseases, the current evidence strongly suggests that the benefits of vaccination outweigh the risks of adverse effects and disease flares. Herein, we report the protocol of the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an ongoing international collaborative study involving 29 countries and over 110 investigators

High fatigue scores in patients with idiopathic inflammatory myopathies: a multigroup comparative study from the COVAD e-survey

Idiopathic inflammatory myopathies (IIMs) confer a significant risk of disability and poor quality of life, though fatigue, an important contributing factor, remains under-reported in these individuals. We aimed to compare and analyze differences in visual analog scale (VAS) scores (0-10 cm) for fatigue (VAS-F) in patients with IIMs, non-IIM systemic autoimmune diseases (SAIDs), and healthy controls (HCs). We performed a cross-sectional analysis of the data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) international patient self-reported e-survey. The COVAD survey was circulated from December 2020 to August 2021, and details including demographics, COVID-19 history, vaccination details, SAID details, global health, and functional status were collected from adult patients having received at least one COVID-19 vaccine dose. Fatigue experienced 1 week prior to survey completion was assessed using a single-item 10 cm VAS. Determinants of fatigue were analyzed in regression models. Six thousand nine hundred and eighty-eight respondents (mean age 43.8 years, 72% female; 55% White) were included in the analysis. The overall VAS-F score was 3 (IQR 1-6). Patients with IIMs had similar fatigue scores (5, IQR 3-7) to non-IIM SAIDs [5 (IQR 2-7)], but higher compared to HCs (2, IQR 1-5; P < 0.001), regardless of disease activity. In adjusted analysis, higher VAS-F scores were seen in females (reference female; coefficient -0.17; 95%CI -0.21 to -13; P < 0.001) and Caucasians (reference Caucasians; coefficient -0.22; 95%CI -0.30 to -0.14; P < 0.001 for Asians and coefficient -0.08; 95%CI -0.13 to 0.30; P = 0.003 for Hispanics) in our cohort. Our study found that patients with IIMs exhibit considerable fatigue, similar to other SAIDs and higher than healthy individuals. Women and Caucasians experience greater fatigue scores, allowing identification of stratified groups for optimized multidisciplinary care and improve outcomes such as quality of life

High fatigue scores in patients with idiopathic inflammatory myopathies: a multigroup comparative study from the COVAD e-survey

Idiopathic inflammatory myopathies (IIMs) confer a significant risk of disability and poor quality of life, though fatigue, an important contributing factor, remains under-reported in these individuals. We aimed to compare and analyze differences in visual analog scale (VAS) scores (0-10 cm) for fatigue (VAS-F) in patients with IIMs, non-IIM systemic autoimmune diseases (SAIDs), and healthy controls (HCs). We performed a cross-sectional analysis of the data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) international patient self-reported e-survey. The COVAD survey was circulated from December 2020 to August 2021, and details including demographics, COVID-19 history, vaccination details, SAID details, global health, and functional status were collected from adult patients having received at least one COVID-19 vaccine dose. Fatigue experienced 1 week prior to survey completion was assessed using a single-item 10 cm VAS. Determinants of fatigue were analyzed in regression models. Six thousand nine hundred and eighty-eight respondents (mean age 43.8 years, 72% female; 55% White) were included in the analysis. The overall VAS-F score was 3 (IQR 1-6). Patients with IIMs had similar fatigue scores (5, IQR 3-7) to non-IIM SAIDs [5 (IQR 2-7)], but higher compared to HCs (2, IQR 1-5; P < 0.001), regardless of disease activity. In adjusted analysis, higher VAS-F scores were seen in females (reference female; coefficient -0.17; 95%CI -0.21 to -13; P < 0.001) and Caucasians (reference Caucasians; coefficient -0.22; 95%CI -0.30 to -0.14; P < 0.001 for Asians and coefficient -0.08; 95%CI -0.13 to 0.30; P = 0.003 for Hispanics) in our cohort. Our study found that patients with IIMs exhibit considerable fatigue, similar to other SAIDs and higher than healthy individuals. Women and Caucasians experience greater fatigue scores, allowing identification of stratified groups for optimized multidisciplinary care and improve outcomes such as quality of life

COVID-19 vaccination-related adverse events among autoimmune disease patients: results from the COVAD study

Objectives COVID-19 vaccines have been proven to be safe in the healthy population. However, gaps remain in the evidence of their safety in patients with systemic autoimmune and inflammatory disorders (SAIDs). COVID-19 vaccination-related adverse events (AEs) in patients with SAIDs and healthy controls (HC) seven days post-vaccination were assessed in the COVAD study, a patient self-reported cross-sectional survey. Methods The survey was circulated in early 2021 by >110 collaborators (94 countries) to collect SAID details, COVID-19 vaccination details and 7-day vaccine AEs, irrespective of respondent vaccination status. Analysis was performed based on data distribution and variable type. Results Ten thousand nine hundred respondents [median (interquartile range) age 42 (30-55) years, 74% females and 45% Caucasians] were analysed; 5867 patients (54%) with SAIDs were compared with 5033 HCs. Seventy-nine percent had minor and only 3% had major vaccine AEs requiring urgent medical attention (but not hospital admission) overall. Headache [SAIDs = 26%, HCs = 24%; odds ratio (OR) = 1.1 (95% CI: 1.03, 1.3); P = 0.014], abdominal pain [SAIDs = 2.6%, HCs = 1.4%; OR = 1.5 (95% CI: 1.1, 2.3); P = 0.011], and dizziness [SAIDs = 6%, HCs = 4%; OR = 1.3 (95% CI: 1.07, 1.6); P = 0.011], were slightly more frequent in SAIDs. Overall, major AEs [SAIDs = 4%, HCs = 2%; OR = 1.9 (95% CI: 1.6, 2.2); P < 0.001] and, specifically, throat closure [SAIDs = 0.5%, HCs = 0.3%; OR = 5.7 (95% CI: 2.9, 11); P = 0.010] were more frequent in SAIDs though absolute risk was small (0-4%). Major AEs and hospitalizations (<2%) were comparable across vaccine types in SAIDs. Conclusion Vaccination against COVID-19 is safe in SAID patients. SAIDs were at a higher risk of major AEs than HCs, though absolute risk was small. There are small differences in minor AEs between vaccine types in SAID patients