Clinical rheumatology
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Clinical rheumatology · Jun 2021
ReviewImpact of COVID-19 on rheumatology practice in the UK-a pan-regional rheumatology survey.
The COVID-19 pandemic has disrupted healthcare services and rheumatology staff were redeployed to the frontline. The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the provision of rheumatology services as viewed by rheumatologists in the UK. Survey monkey questionnaire weblink was sent to 804 clinicians including consultant rheumatologists, speciality trainees, nurse specialists, and allied health professionals in 4 regions of the UK to evaluate personal effects of COVID-19 and redeployment, impact on current out-patient clinic activity, immunosuppressive drug use, and future rheumatology care. ⋯ Underutilization of tele-rheumatology in this survey should be considered whilst planning the restoration of rheumatology services in the post-COVID era. Key points • COVID-19 has generated significant concerns among rheumatology community about their mental well-being. • In over 50% of cases, rheumatologists stopped IV biologic drugs as per patients' wishes during the first wave of the pandemic. • Tele-rheumatology has been used more widely during the pandemic, but the extent of its use in the post-COVID era is less clear. Evolving evidence will determine its future wider use.
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Clinical rheumatology · May 2021
Multicenter StudyRisk of serious infection, malignancy, or death in Japanese rheumatoid arthritis patients treated with a combination of abatacept and tacrolimus: a retrospective cohort study.
To evaluate whether combinatorial use of abatacept (ABT) and tacrolimus (Tac) increases the risk of adverse events compared to their individual use in Japanese rheumatoid arthritis (RA) patients. We conducted a retrospective cohort study of RA patients using the Japanese multicenter database and analyzed the data of RA patients registered from April 2010 to March 2019 by comparing three treatment groups who received Tac, ABT, or a combination of both. We included patients who had initiated treatment with ABT or Tac and excluded patients who used tumor necrosis factor inhibitors, IL-6 inhibitors, and Jak inhibitors in the first year of our study. ⋯ A Cox regression analysis which was adjusted for potential confounders such as age, disease activity, and concomitant use of prednisolone revealed no significant differences between groups. The combinatorial use of ABT and Tac, or ABT alone does not increase the risk of adverse events when compared to the use of Tac alone in RA patients in Japan. Key Points • This study included Japanese rheumatoid arthritis data and found that there was no significant risk when patients were treated with a combination of Tac and ABT or each drug alone.
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Clinical rheumatology · Apr 2021
Incidence of COVID-19 in patients with rheumatic disease: is prior health education more important than shielding advice during the pandemic?
The COVID-19 pandemic has led to major changes in clinical practice on a global scale in order to protect patients. This includes the identification of vulnerable patients who should "shield" in order to reduce the likelihood of contracting SARS-CoV2. We used national specialty guidance and an adapted screening tool to risk stratify patients identified from our prescribing and monitoring databases, and identify those needing to shield (score ≥ 3) using information from departmental letters, online general practice records and recent laboratory investigations. ⋯ The trend towards lower incidence in this cohort could be because of prior education regarding general infection risk and response to public health messages. While risk stratification and shielding could be effective, prior education regarding general infection risk and public health messages to enhance health protection behaviours during a pandemic may have equal or more important roles. Key Points • Patients on treatment for rheumatic disorders showed a trend for lower incidence of COVID-19 transmission irrespective of shielding letter status • This could potentially be because of prior education regarding infection risk received when starting on disease-modifying medication • Health education influencing health protection behaviours may be of equal or more importance than shielding information in reducing transmission of SARS-CoV-2.
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Clinical rheumatology · Apr 2021
The usefulness and validity of English-language videos on YouTube as an educational resource for spondyloarthritis.
YouTube is a popular online platform where patients often visit for information. However, the validity of the content on spondyloarthritis (SpA) on YouTube is not known. ⋯ Majority of YouTube videos have useful information on SpA and are important educational sources to patients. However, rheumatologists should be aware that misleading patient opinions on alternative therapies can contain inaccurate information and should hence actively correct these misinformation during their clinic consults Key Points • The majority of videos on Spondyloarthritis found on YouTube are deemed useful and are uploaded by healthcare professionals. • The majority of misleading videos were uploaded by patients and the main theme of misinformation was on clinical features and treatment of spondyloarthritis.
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Clinical rheumatology · Mar 2021
The influence of prior opioid use on healthcare utilization and recurrence rates for non-surgical patients seeking initial care for patellofemoral pain.
Prior opioid use can influence outcomes for patients with musculoskeletal disorders. The purpose of this study was to compare downstream medical utilization-based outcomes (costs, visits, recurrent episodes) after an initial diagnosis of patellofemoral pain based on pre-injury utilization of opioids. ⋯ Prior opioid utilization was associated with a greater number of recurrent episodes of knee pain and higher downstream medical costs compared with individuals without prior opioid use. For individuals with prior opioid utilization, opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes compared to the use of lower-risk opioids (Schedule IV). Key Points • Patients with prior opioid use had much greater knee-related medical costs compared to patients without prior opioid use. • Patients with prior opioid use were more likely to have additional episodes of knee pain in the following 2 years compared to patients without prior opioid use. • Prior opioid use has predicted higher costs and poor outcomes after surgery, but this is the first study to confirm similar findings in non-surgical patients.