OBJECTIVE: To assess the therapeutic effects of cannabis, cannabis-derived products and synthetic cannabinoids for rheumatoid arthritis. DESIGN: This is the protocol of a systematic review. DATA SOURCES: Searches will be conducted in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, grey literature and in a centralized repository in L-OVE (Living OVerview of Evidence). L-OVE is a platform that maps PICO questions to evidence from Epistemonikos database. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We will include randomized controlled trials evaluating therapeutic use of cannabis, cannabis-derived products and synthetic cannabinoids for rheumatoid arthritis. Our primary interest will be in trials comparing the intervention with placebo or no treatment (intervention plus optimal treatment vs placebo plus optimal treatment or optimal treatment alone) in patients receiving optimal treatment for rheumatoid arthritis. Optimal treatment will be defined as disease modifying anti-rheumatic drugs. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will perform random-effects meta-analyses and use Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of the evidence for each outcome. ETHICS AND DISSEMINATION: The Scientific Ethics Committee of the Pontificia Universidad Católica de Chile granted ethical exemption for the realization of this study. Results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media and will be sent to relevant international organizations discussing this topic.

Background: Symptom management in rheumatoid arthritis (RA) remains a complex challenge. Widespread use of cannabis-based medicines for a myriad of symptoms has fostered rheumatology patients' interest. However, their safety and efficacy in RA remain unclear.Objective: The aim of this study was to perform a structured summary of the body of evidence in order to determine whether cannabis, cannabis-derived products, and synthetic cannabinoids are an effective treatment for rheumatoid arthritis.Methods: An electronic search in Epistemonikos database was performed to identify systematic reviews and their primary studies that addressed our clinical question. The body of evidence was collected in a pivot table in Epistemonikos. Information and data from the primary studies were extracted from the identified reviews. Finally, extracted data were reanalyzed, and a summary of findings table was generated using the Grading of Recommendations Assessment, Development and Evaluation approach.Results: Twenty-six systematic reviews were identified which included in total only 1 randomized trial assessing our clinical question.Conclusions: Cannabis, cannabis-derived products and synthetic cannabinoids may slightly reduce disease activity in patients with RA. Its use may result in little to no difference in pain reduction and may slightly increase nervous system adverse events. The evidence is very uncertain about the effect of cannabis, cannabis-derived products, and synthetic cannabinoids on serious adverse events risk.

Summary Background Obesity increases the severity of coronavirus disease 2019 illness in adults. The role of obesity in short‐term complications and post‐acute sequelae in children is not well defined. Objective To evaluate the relationship between obesity and short‐term complications and post‐acute sequelae of SARS‐CoV‐2 infection in hospitalized paediatric patients. Methods An observational study was conducted in three tertiary hospitals, including paediatric hospitalized patients with a confirmatory SARS‐CoV‐2 RT‐PCR from March 2020 to December 2021. Obesity was defined according to WHO 2006 (0–2 years) and CDC 2000 (2–20 years) growth references. Short‐term outcomes were intensive care unit admission, ventilatory support, superinfections, acute kidney injury, and mortality. Neurological, respiratory, and cardiological symptoms and/or delayed or long‐term complications beyond 4 weeks from the onset of symptoms were considered as post‐acute sequalae. Adjusted linear, logistic regression and generalized estimating equations models were performed. Results A total of 216 individuals were included, and 67 (31.02%) of them had obesity. Obesity was associated with intensive care unit admission (aOR = 5.63, CI95% 2.90–10.94), oxygen requirement (aOR = 2.77, CI95% 1.36–5.63), non‐invasive ventilatory support (aOR = 6.81, CI95% 2.11–22.04), overall superinfections (aOR = 3.02 CI95% 1.45–6.31), and suspected bacterial pneumonia (aOR = 3.00 CI95% 1.44–6.23). For post‐acute sequalae, obesity was associated with dyspnea (aOR = 9.91 CI95% 1.92–51.10) and muscle weakness (aOR = 20.04 CI95% 2.50–160.65). Conclusions In paediatric hospitalized patients with COVID‐19, severe short‐term outcomes and post‐acute sequelae are associated with obesity. Recognizing obesity as a key comorbidity is essential to develop targeted strategies for prevention of COVID‐19 complications in children.

Letters to the Editor age. The potential triggers for TE are an acute illness with fever, systemic diseases, severe emotional stress, major surgery, rapid weight loss, nutritional deficiency, endocrine disorders and drug exposure. Acute TE occurs within 2-3 months after the triggering event and usually resolves itself on its own or if the trigger is eliminated. 2 Hair loss due to TE has been reported in adult patients following COVID-19 infection, 3 and only 1 pediatric patient with MIS-C. 4 This case highlights that hair loss may occur as a late complication of MIS-C. Future studies are needed to define the long-term complications of MIS-C.