Outcomes of children born to mothers with systemic lupus erythematosus exposed to hydroxychloroquine or azathioprine.
Authors: Teh LS et al
Source: Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2022 Jun 29. Date of Electronic Publication: 2022 Jun 29.
Objectives: Hydroxychloroquine (HCQ) and azathioprine (AZA) are used to control disease activity and reduce risk of flare during pregnancy in patients with SLE. The aim of this study was to determine outcomes of children born to mothers with SLE exposed to HCQ or AZA during pregnancy and breast-feeding.
Methods: Women attending UK specialist lupus clinics with children ≤17 years old, born after SLE diagnosis, were recruited to this retrospective study. Data were collected using questionnaires and from clinical record review. Factors associated with the outcomes of low birth weight and childhood infection were determined using multivariable mixed effects logistic regression models.
Results: We analysed 284 live births of 199 mothers from 10 UK centres. The first pregnancies of 147/199 (73.9%) mothers was captured in the study. 150/248 (60.4%) and 87 (31.1%) children were exposed to HCQ and AZA respectively. There were no significant differences in the frequency of congenital malformations or intrauterine growth restriction (IUGR) between children exposed or not to HCQ or AZA. AZA use was increased in women with a history of hypertension or renal disease. Although AZA was associated with low birth weight in univariate models, there was no significant association in multivariable models. In adjusted models, exposure to AZA was associated with increased reports of childhood infection requiring hospital management (OR 2.283 [1.003, 5.198], p= 0.049).
Conclusions: There were no significant negative outcomes in children exposed to HCQ in pregnancy. AZA use was associated with increased reporting of childhood infection which warrants further study.
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Ultrasound to identify systemic lupus erythematosus patients with musculoskeletal symptoms who respond best to therapy: the US Evaluation for Musculoskeletal Lupus longitudinal multicentre study.
Author(s) Mahmoud; Zayat, Ahmed S; Yusof, Md Yuzaiful Md; Dutton, Katherine; Teh, Lee Suan; Yee, Chee-Seng; D'Cruz, David; Ng, Nora; Isenberg, David; Ciurtin, Coziana; Conaghan, Philip G; Emery, Paul; Edwards, Christopher J; Hensor, Elizabeth M A; Vital, Edward M
Source Rheumatology; Nov 2021; vol. 60 (no. 11); p. 5194-5204
AbstractObjectives To determine whether SLE patients with inflammatory joint symptoms and US synovitis/tenosyovitis achieve better clinical responses to glucocorticoids compared with patients with normal scans. Secondary objectives included identification of clinical features predicting US synovitis/tenosynovitis. Methods In a longitudinal multicentre study, SLE patients with physician-diagnosed inflammatory joint pain received intramuscular methylprednisolone 120 mg once. Clinical assessments, patient-reported outcomes and bilateral hand/wrist USs were collected at 0, 2 and 6 weeks. The primary outcome (determined via internal pilot) was the early morning stiffness visual analogue scale (EMS-VAS) at 2 weeks, adjusted for baseline, comparing patients with positive (greyscale ≥2 and/or power Doppler ≥1) and negative US. Post hoc analyses excluded FM. Results Of 133 patients, 78 had a positive US. Only 53 (68%) of these had one or more swollen joint. Of 66 patients with one or more swollen joint, 20% had a negative US. A positive US was associated with joint swelling, symmetrical small joint distribution and serology. The primary endpoint was not met: in the full analysis set (N = 133) there was no difference in baseline-adjusted EMS-VAS at week 2 [−7.7 mm (95% CI −19.0, 3.5); P = 0.178]. After excluding 32 patients with FM, response was significantly better in patients with a positive US at baseline [baseline-adjusted EMS-VAS at 2 weeks −12.1 mm (95% CI −22.2, −0.1); P = 0.049]. This difference was greater when adjusted for treatment [−12.8 mm (95% CI −22, −3); P = 0.007]. BILAG and SLEDAI responses were higher in US-positive patients. Conclusion In SLE patients without FM, those with a positive US had a better clinical response to therapy. Imaging-detected synovitis/tenosynovitis may be considered to decide on therapy and enrich clinical trials.
Bimekizumab: a dual IL-17A and IL-17F inhibitor for the treatment of psoriasis and psoriatic arthritis
Author(s) Ali Z.; Al-Janabi A.; Warren R.B.; Matthews R.
Source Expert Review of Clinical Immunology; 2021; vol. 17 (no. 10); p. 1073-1081
Publication Date 2021
Introduction: Interleukin (IL)-17 is critical in the pathogenesis of psoriasis and psoriatic arthritis (PsA) with most data suggesting that IL-17A alone was the key cytokine. However, in vitro and in vivo studies have suggested dual blockade of IL-17A and IL-17 F may be more effective than IL-17 A blockade alone. Bimekizumab is the first human monoclonal antibody to exert simultaneous specific inhibition of IL-17A and IL-17 F, and has been studied in several phase II/III trials for psoriasis and PsA. Areas covered: Bimekizumab is not currently licensed for use. A literature search identified clinical trials examining the efficacy and safety of bimekizumab for psoriasis and PsA, and these were critically appraised. Expert opinion: Clinical trials of bimekizumab have been promising, demonstrating a rapid onset of response and superior efficacy compared to three currently licensed biologics: secukinumab, ustekinumab, and adalimumab. Bimekizumab maintains a high level of efficacy with maintenance dosing intervals of 8 weeks, compared with 4 weeks for currently licensed IL-17A antagonists. No unexpected adverse events have been identified, although mild-to-moderate fungal infections occur in approximately 10%. Studies over longer time periods involving additional active comparators would be valuable in further defining the role of bimekizumab amongst currently available treatments.
Author(s) McElhone ; Abbott, Janice; Hurley, Margaret; Burnell, Jane; Lanyon, Peter et al.
Source Rheumatology; Jul 2021; vol. 60 (no. 7); p. 3262-3267
Objective SLE is characterized by relapses and remissions. We aimed to describe the frequency, type and time to flare in a cohort of SLE patients. Methods SLE patients with one or more 'A' or 'B' BILAG-2004 systems meeting flare criteria ('new' or 'worse' items) and requiring an increase in immunosuppression were recruited from nine UK centres and assessed at baseline and monthly for 9 months. Subsequent flares were defined as: severe (any 'A' irrespective of number of 'B' flares), moderate (two or more 'B' without any 'A' flares) and mild (one 'B'). Results Of the 100 patients, 94% were female, 61% White Caucasians, mean age (s. d.) was 40.7 years (12.7) and mean disease duration (s. d.) was 9.3 years (8.1). A total of 195 flares re-occurred in 76 patients over 781 monthly assessments (flare rate of 0.25/patient-month). There were 37 severe flares, 32 moderate flares and 126 mild flares. By 1 month, 22% had a mild/moderate/severe flare and 22% had a severe flare by 7 months. The median time to any 'A' or 'B' flare was 4 months. Severe/moderate flares tended to be in the system(s) affected at baseline, whereas mild flares could affect any system. Conclusion. In a population with active SLE we observed an ongoing rate of flares from early in the follow-up period with moderate–severe flares being due to an inability to fully control the disease. This real-world population study demonstrates the limitations of current treatments and provides a useful reference population from which to inform future clinical trial design.
Limb girdle muscular dystrophy R12 (LGMD 2L, anoctaminopathy) mimicking idiopathic inflammatory myopathy: key points to prevent misdiagnosis
Author(s) Marago I.; Roberts M.; Lilleker J.B.; Roncaroli F.; DuPlessis D. et al.
Source Rheumatology (Oxford, England); Jul 2021
OBJECTIVES: Diagnosing the idiopathic inflammatory myopathies (IIMs) can be challenging as several conditions, including genetic myopathies such as limb girdle muscular dystrophy type R12 (LGMD 2l, anoctaminopathy), mimic the presentation. Here we describe learning points identified from review of four patients with LGMD 2l who were initially incorrectly diagnosed with IIM. Our aim is to provide clinicians working in adult rheumatology services with a toolkit to help identify non-inflammatory presentations of myopathy.
The arthritis component of the sledai should only be scored if there is joint swelling
Author(s) Mahmoud K.; Md Yusof M.Y.; Dutton K.; Conaghan P.G.; Emery P. et al.
Source Annals of the Rheumatic Diseases; Jun 2021; vol. 80 ; p. 625
Background: SLE disease activity tools do not optimally define disease activity and response. The SLEDAI arthritis item is common, and sufficient to define SRI response. Lupus patients with arthralgia often have no swelling. Glossary definitions of arthritis in different versions of the SLEDAI have included: swelling, swelling between visits, effusion, tenderness, warmth and erythema. MSK ultrasound in SLE can identify synovitis without swelling, ultrasound synovitis is associated with worse symptoms and serology, predicts response to therapy, and is more responsive to therapy than clinical variables. Objective(s): To validate different glossary definitions for SLEDAI arthritis using musculoskeletal ultrasound.
Rehabilitation following proximal humeral fracture in the UK National Health Service: A survey of publicly facing information
Author(s) Rohun J.; May P.; Littlewood C.
Source Musculoskeletal care; Jun 2021; vol. 19 (no. 2); p. 193-198
INTRODUCTION: Proximal humeral fractures (PHF) are a common injury in the older population but there is limited research evaluating rehabilitation following PHF. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following PHF as a platform for conducting future research.
Author(s) Yee C.S.; Stevens R.; Farewell V.; Akil M.; Lanyon P. et al.
Source Annals of the Rheumatic Diseases; Jun 2021; vol. 80 ; p. 602
Background: BILAG-2004 Index (BILAG-2004) has undergone construct and criterion validity and is used to assess disease activity in SLE. However, its predictive validity has yet to be established. Objective(s): This study was to determine if disease activity according to BILAG-2004 was predictive of development of damage in an inception cohort.
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