Aromatase inhibitors and fracture prevention - do 2017 guidelines work in real world?

Objectives: Aromatase inhibitor induced bone loss (AIBL) is a recognised adverse event with resultant increase in fracture risk. We aimed to determine the real-world impact of the 2017 consensus guidelines on AIBL and see if it is effective in fracture prevention.

Methods: Over a 7-year study period, 1001 women prescribed AI were split in two groups.

The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope.

Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies.

Should All Patients Trial Subcutaneous Methotrexate Prior to Commencing Biologic Therapy? A Real World Study.

Introduction: Methotrexate (MTX) is the bed rock of inflammatory arthritis management. However, intolerance is a limiting factor for drug optimisation and retention. There is data to suggest subcutaneous (SC) MTX is better tolerated.

Faculty perceptions on one-best MCQ development.

Objective: The aim of this study was to determine the perception of faculty of undergraduate medical and dental programmes in various private and public sector institutes regarding their Readiness, Attitude and Institutional support for developing high-quality one-best MCQs.

Methods: A validated questionnaire was designed for recording demographic data and responses related to Readiness, Attitude and Institutional support based on 5-point Likert scale and multiple options. Scores for items on Likert scale were categorised (Readiness: poor 0-12, good 13-24, Attitude: negative 0-12, positive 13-24, Institutional support: no support 0-12, highly supportive 13-24).

Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study.

Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19.

Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers.

Giant Cell Hepatitis - A Rare Association with Connective Tissue Disease.

A 68-year-old gentleman presented to hepatology department with asymptomatic year-long history of stably deranged liver function tests. His peak alkaline phosphatase (ALP), was 828 with alanine transaminase (ALT) of 141. Full liver workup was negative; hence, a liver biopsy was organised, which confirmed giant cell hepatitis (GCH).

Does biologic survival depend on co-prescribed methotrexate dose in established rheumatoid arthritis? A real-world study.

Objective: Several seminal studies have suggested that a combination therapy of biologics with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) improve disease outcomes in rheumatoid arthritis (RA). Hence, most guidelines reflect this practice. It has also been shown that methotrexate (MTX) at a dose of 8-10 mg/week is perhaps sufficient to achieve better outcomes in early RA.

Implications of genetic variation of common Drug Metabolizing Enzymes and ABC Transporters among the Pakistani Population.

Genetic polymorphism of drug metabolizing enzymes and transporters may influence drug response. The frequency varies substantially between ethnicities thus having implications on appropriate selection and dosage of various drugs in different populations. The distribution of genetic polymorphisms in healthy Pakistanis has so far not been described.

Crystallising the role of adrenocorticotrophic hormone in the management of acute gout: a review.

Objectives: Acute gout is traditionally treated with NSAIDs, corticosteroids, and colchicine. However, the presence of comorbid conditions and advancing age, often seen in hospitalised patients, may prevent their use. We reviewed the published data on the use of ACTH in the treatment of acute gouty arthritis.

Adherence to biologic therapy - Does it vary with ethnicity?

BackgroundPoor adherence to therapy remains a significant barrier to improving clinical outcomes in rheumatic diseases and carries a major financial burden. It has been linked to medication related patient beliefs, which were reported to differ between ethnic groups. Little is known about these variations in biologic therapies cohorts.

Biologic therapy for inflammatory arthritis and latent tuberculosis: real world experience from a high prevalence area in the United Kingdom.

Biologic therapies have resulted in a sea change in the management of inflammatory arthritis; however, a higher risk of opportunistic infection, particularly tuberculosis (TB), is well recognised. This has led to the development of TB screening guidelines. The aim of this study was to investigate the prevalence of latent TB in patients prescribed biologic therapy in an endemic area (prevalence of TB 50/100,000) and to assess the risk of subsequent reactivation.

Cupping (Hijama) Treatment: Benign or Sinister?

Cupping treatment is on the rise in the Western world as an alternative medicine modality.We present a hitherto unreported complication of bilateral subdural hemorrhage associated with this therapy, highlighting the need for vigilance in patients presenting with headache because they may get misdiagnosed unless history for such therapies is explored.

Pulmonary complications of biological therapies in children and adults with rheumatic diseases.

The management of rheumatic conditions, including those occurring in children, has improved dramatically over the last decade following the introduction of biologic disease-modifying anti-rheumatic drugs (bDMARDS) into the therapeutic arsenal. The benefits have been realised in multiple aspects of disease including signs and symptoms, bone and cartilage destruction, disability and quality of life. Overall, bDMARDS have an acceptable safety profile in the short to medium term in adults and children, however, that following longer term use remains unclear.

What do we know about juvenile idiopathic arthritis and vitamin D? A systematic literature review and meta-analysis of current evidence.

Over the last decade vitamin D (Vit D) has been the focus of considerable interest as a potential immunomodulator in a variety of conditions including autoimmune disease. Its influence in juvenile idiopathic arthritis (JIA) however is unclear. We therefore wished to clarify a possible link with the currently available evidence.

Same-day or historical ESR for disease activity score measurement: does it matter?

Several guidelines recommended routine use of Disease Activity Score-28 (DAS28) to monitor disease and the response to treatment for rheumatoid arthritis (RA). In practice, it may be appropriate to use historical erythrocyte sedimentation rate (ESR) values in place of same-day ESR, thereby preventing unnecessary delay in adjusting intervention. We asked whether ESR blood samples taken up to 3 months prior to the clinic appointment were adequate to accurately assess RA disease activity using the DAS28.

Does methotrexate increase the risk of varicella or herpes zoster infection in patients with rheumatoid arthritis? A systematic literature review.

Objectives: Methotrexate (MTX) has become the foundation disease-modifying anti-rheumatic drug (DMARD) for RA. However, concern exists regarding its possible association with infectious complications including varicella zoster virus (VZV) and herpes zoster (HZ). Furthermore, no consensus exists regarding pre-MTX VZV screening or the use of VZV vaccine.

Interleukin-6 and cytochrome-P450, reason for concern?

Interleukin 6 (IL-6) plays a central role in the immunopathogenesis of rheumatoid arthritis (RA) and tocilizumab [TCZ] (an anti-IL-6 receptor antibody) has been shown to be effective in the treatment of the condition. As up-regulation of IL-6 reduces the activity of cytochrome P450 (CYP) enzymes, blockade of this cytokine may enhance CYP function. This may lead to reduced bioavailability of CYP-metabolized drugs.