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.

• Available in full text at Rheumatology (Oxford, England) from Unpaywall

Author(s) Marago I.; Roberts M.; Lilleker J.B.; Roncaroli F.; DuPlessis D. et al.
Source Rheumatology (Oxford, England); Jul 2021
Language English
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. 

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. 

• Available in full text at Annals of the Rheumatic Diseases from BMJ Journals - NHS

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. 

• Available in full text at Musculoskeletal care from Wiley Online Library Medicine and Nursing Collection 2013

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. 

• Available in full text at Annals of the Rheumatic Diseases from BMJ Journals - NHS