The COVID-19 pandemic has resulted in more than 2 million deaths globally. Two interconnected stages of disease are generally recognised; an initial viral stage and a subsequent immune response phase with the clinical characteristics of hyperinflammation associated with acute respiratory distress syndrome. Therefore, many immune modulators and immunosuppressive drugs, which are widely used in rheumatological practice, have been proposed as treatments for patients with moderate or severe COVID-19. In this Review, we provide an overview of what is currently known about the efficacy and safety of antirheumatic therapies for the treatment of patients with COVID-19. Dexamethasone has been shown to reduce COVID-19 related mortality, interleukin-6 inhibitors to reduce risk of cardiovascular or respiratory organ support, and baricitinib to reduce time to recovery in hospitalised patients requiring oxygen support. Further studies are needed to identify whether there is any role for glucocorticoids in patients with less severe COVID-19. Although evidence on the use of other antirheumatic drugs has suggested some benefits, results from adequately powered clinical trials are urgently needed. The heterogeneity in dosing and the absence of uniform inclusion criteria and defined stage of disease studied in many clinical trials have affected the conclusions and comparability of trial results. However, after the success of dexamethasone in proving the anti-inflammatory hypothesis, the next 12 months will undoubtedly bring further clarity about the clinical utility and optimal dose and timing of other anti-rheumatic drugs in the management of COVID-19.
The objective of the study was to investigate the frequency of traditional risk factors for the cardiovascular (CV) disease, to calculate the Systematic COronary Risk Evaluation (SCORE) for CV-related mortality in Danish patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS), and to compare with results from patients with rheumatoid arthritis (RA) from the same settlement. All PsA and AS patients aged 18-85 years from one outpatient clinic were invited. A rheumatology nurse conducted 30-min screening consultation, preceded by a lipid and glucose profile. High SCORE risk led to recommendation of follow-up by general practitioners. Multiple and logistic regression analyses, adjusted for age and gender, were performed, to compare risk factors and risk SCOREs. Participants were 116 AS (29.3% female) and 170 PsA (54.7% female). AS had opposed PsA patients' lower 10-year risk SCOREs of CV mortality than RA patients: AS versus RA coefficient -0.47 (confidence interval (CI) 95%: -0.84 to -0.) and PsA versus RA -0.14, (-0.43-0.16). Women with PsA and AS had increased waistline compared to women with RA [PsA vs. RA 7.94 (4.51-11.38); AS versus RA 6.67 (1.17-12.17)], and an increased prevalence of hypertension was seen in AS versus RA patients [1.87 (1.15-3.05)]. Traditional, modifiable CV risk factors were present in PsA and AS patients. AS but not PsA patients had an estimated lower 10-year risk of CV mortality than RA patients, according to the SCORE model adjusted for age and gender.
Background People with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) [1,2]. Although male gender is generally associated with a greater risk for cardiovascular related mortality and death, there is, as yet, little knowledge of the impact of gender on the risk factors for CVD in patients with RA. Objectives To explore gender differences in the distribution of risk factors and in the risk factors that exceed national recommended levels in outpatients with RA. Methods We used data from the first 836 outpatients in a hospital population with RA screened in 30-minute nursing consultations according to the EULAR recommendations [1,2]. Risk factors, such as history of CVD, hypertension or diabetes mellitus (DM), smoking, fasting glucose, total, LDL, HDL cholesterol and Triglycerides, exercise habits, alcohol use, Body Mass Index (BMI) and waist circumference were explored. Logistic regression analyses were used to test for gender differences. Results Fewer female than male patients were diagnosed with CVD (OR 0.662; CI 0.452, 0.965; p=0.032) and there were no gender differences in those diagnosed with DM. In the 644 patients without CVD or DM, male patients were more likely to smoke, drink more alcohol than recommended (p<0.001), and to have higher blood pressure (p=0.026) and lower total cholesterol (p=0.006), but to have a higher total-cholesterol/HDL-cholesterol ratio (p<0.001) than female patients. More male patients than female patients displayed too low HDL-cholesterol levels (p=0.014). When comparing female and male patients, and taking the deviations from the recommended levels for the different risk factors into account, female patients had a small but significantly lower risk for elevated blood pressure (OR 0.987) but a higher risk for an increase in waistline above the recommended limits than the male patients (OR 1.023). In addition, female patients had a lower odds ratio (OR 0.681) for an increase in fasting glucose compared to male patients. Conclusions In clinical practice, we need to be aware of gender differences in risk factors for development of CVD in order to target interventions. References Peters, M.J., et al., EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis, 2010. 69(2): p. 325-31. Primdahl J, Clausen J, Hørslev-Petersen K. Results from implementation of systematic screening for cardiovascular risk according to the EULAR recommendations in outpatients with rheumatoid arthritis. Ann Rheum Dis 2013; 72: 11:1771-6 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2828
Background EULAR 2010 recommendations advised attention on cardiovascular (CV) risk management in patients with psoriasis arthritis (PsA) or ankylosing spondylitis (AS) because of increased CV mortality [1]. Objectives To investigate the distribution of CV risk factors and estimate the risk of CV death in patients with AS or PsA Methods Outpatients with PsA or AS ≤85 years old were invited for a 30 min screening consultation with a nurse at a rheumatologic outpatient clinic. Risk factors for cardiovascular disease (total/HDL-cholesterol ratio, smoking habits, blood pressure, age and gender) were used to calculate absolute risk for CV death in 10 years according to the SCORE-system [2]. History of CV disease (CVD) and diabetes mellitus (DM), HbA1c, Body Mass Index (BMI), alcohol consumption and exercise habits were explored. Differences between diagnoses were explored by logistic regression analysis. Results From March 2012 through September 2013 286 patients were screened; 170 with PsA (54.7% female) and 116 with AS (29.3% female). Mean age were 54.3 (SD 12.9) and 51.6 (SD 14.0) years respectively. In total 37 (12.9%) were already diagnosed with CVD and 24 (8%) with DM. Among the 229 patients with no known DM or CVD, 26 (18.9%) PsA and 22 (23.9%) AS patients were smokers; 41 (29.9%) PsA and 21 (22.8%) AS patients had a systolic blood pressure ≥140; 89 (65.6%) PsA and 62 (67.4%) AS patients had a total cholesterol ≥5.0 mM; 20 (30.6%) PsA and 16 (33.3%) AS patients had low HDL-cholesterol (≤1.2mM for women and ≤1.0mM for men) and 2 (1.5%) with PsA and 2 (2.2%) with AS had HbA1C ≥48mM. Among the PsA patients 6 (8.9%) had an alcohol consumption above the national recommendations (max 7/14 units per week for women/men) versus 0 among AS patients (OR 1.28, p=0.012). Overall 50 (36.5%) PsA and 26 (28.3%) AS patients were obese (BMI>30) (OR 1.33; p=0.002). When adjusting for gender differences PsA patients still had an OR of 1.28, p=0.012 for obesity compared to AS patients. No significant differences between diagnoses were seen in any other risk factor. The risk SCORE (2) was ≥5 in 19 (14.1%) in PsA and 11 (12.0%) in AS patients. Patients with elevated risk for CVD were referred to follow-up by their general practitioner and community advice services. In a RA population previously screened (3) the risk SCORE was ≥5 in 12.6% and in 16.2% after adjusting the SCORE according to the EULAR recommendations (1). Conclusions Systematic screening revealed several risk factors in patients with PsA and AS which needed medical follow-up. PsA patients had higher risk for alcohol consumptions above recommendations and obesity than patients with AS. The risk for cardiovascular death within 10 years was lower than the modified scores seen in RA patients in the same clinic (3). References Peters, MJ et al., EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis, 2010. 69(2): p. 325-31. Conroy, RM et al., Estimat...
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