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R N, Sen P, Griger Z, Day J, Joshi M, Nune A, Nikiphorou E, Saha S, Tan AL, Shinjo SK, Ziade N, Velikova T, Milchert M, Jagtap K, Parodis I, Gracia-Ramos AE, Cavagna L, Kuwana M, Knitza J, Chen YM, Makol A, Agarwal V, Patel A, Pauling JD, Wincup C, Barman B, Zamora Tehozol EA, Rojas Serrano J, García-De La Torre I, Colunga-Pedraza IJ, Merayo-Chalico J, Chibuzo OC, Katchamart W, Akarawatcharangura Goo P, Shumnalieva R, Hoff LS, El Kibbi L, Halabi H, Vaidya B, Shaharir SS, Hasan ATMT, Dey D, Toro Gutiérrez CE, Caballero-Uribe CV, Lilleker JB, Salim B, Gheita T, Chatterjee T, Distler O, Saavedra MA, Chinoy H, Agarwal V, Aggarwal R, Gupta L. Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys. Rheumatology (Oxford) 2024; 63:127-139. [PMID: 37084267 DOI: 10.1093/rheumatology/kead180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES Disease flares in the post-coronavirus disease 2019 (COVID-19) vaccination period represent a prominent concern, though risk factors are poorly understood. We studied these flares among patients with idiopathic inflammatory myopathies (IIMs) and other autoimmune rheumatic diseases (AIRDs). METHODS The COVAD-1 and -2 global surveys were circulated in early 2021 and 2022, respectively, and we captured demographics, comorbidities, AIRDs details, COVID-19 infection history and vaccination details. Flares of IIMs were defined as (a) patient self-reported, (b) immunosuppression (IS) denoted, (c) clinical sign directed and (d) with >7.9-point minimal clinically significant improvement difference worsening of Patient-Reported Outcomes Measurement Information System (PROMIS) PROMISPF10a score. Risk factors of flares were analysed using regression models. RESULTS Of 15 165 total respondents, 1278 IIMs (age 63 years, 70.3% female, 80.8% Caucasians) and 3453 AIRDs were included. Flares of IIM were seen in 9.6%, 12.7%, 8.7% and 19.6% patients by definitions (a) to (d), respectively, with a median time to flare of 71.5 (10.7-235) days, similar to AIRDs. Patients with active IIMs pre-vaccination (OR 1.2; 95% CI 1.03, 1.6, P = 0.025) were prone to flares, while those receiving rituximab (OR 0.3; 95% CI 0.1, 0.7, P = 0.010) and AZA (OR 0.3, 95% CI 0.1, 0.8, P = 0.016) were at lower risk. Female gender and comorbidities predisposed to flares requiring changes in IS. Asthma (OR 1.62; 95% CI 1.05, 2.50, P = 0.028) and higher pain visual analogue score (OR 1.19; 95% CI 1.11, 1.27, P < 0.001) were associated with disparity between self-reported and IS-denoted flares. CONCLUSION A diagnosis of IIMs confers an equal risk of flares in the post-COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.
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Affiliation(s)
- Naveen R
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Parikshit Sen
- Maulana Azad Medical College, New Delhi, Delhi, India
| | - Zoltán Griger
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College, and Sassoon General Hospitals, Pune, India
| | - Arvind Nune
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | | | - Marcin Milchert
- Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Kshitij Jagtap
- Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center, "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Lombardy, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Johannes Knitza
- Medizinische Klinik 3-Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yi Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - Aarat Patel
- Bon Secours Rheumatology Center, and Division of Pediatric Rheumatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John D Pauling
- Bristol Medical School Translational Health Sciences, University of Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Chris Wincup
- Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH, GOSH, London, UK
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Erick Adrian Zamora Tehozol
- Rheumatology, Medical Care & Research, Centro Medico Pensiones Hospital, Instituto Mexicano del Seguro Social Delegación Yucatán, Yucatán, Mexico
| | - Jorge Rojas Serrano
- Rheumatologist and Clinical Investigator, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ignacio García-De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente and Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Okwara Celestine Chibuzo
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu, Nigeria
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Russka Shumnalieva
- Department of Rheumatology, Clinic of Rheumatology, University Hospital "St Ivan Rilski", Medical University-Sofia, Sofia, Bulgaria
| | | | - Lina El Kibbi
- Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Internal Medicine, Section of rheumatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Binit Vaidya
- National Center for Rheumatic Diseases (NCRD), Ratopul, Kathmandu, Nepal
| | | | - A T M Tanveer Hasan
- Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
| | - Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Carlos Enrique Toro Gutiérrez
- General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Cali, Colombia
| | | | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miguel A Saavedra
- Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret IMSS, Centro Médico Nacional La Raza, Mexico City, Mexico
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Reid MR, Danguecan AN, Colindres I, Witherspoon D, Rubinstein TB, Drenkard C, Knight AM, Cunningham NR. An ecological approach to understanding and addressing health inequities of systemic lupus erythematosus. Lupus 2023; 32:612-624. [PMID: 36922154 DOI: 10.1177/09612033231164637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease disproportionally afflicting women and, in particular, American Indian/Alaska Native, Black, and Hispanic women. These groups of women have significantly worse SLE-related health outcomes which are partially attributable to their exposure to marginalizing and interconnecting social issues like racism, sexism, economic inequality, and more. Although these groups of women have higher rates of SLE and though it is well known that they are at risk of exposure to marginalizing social phenomena, relatively little SLE literature explicitly links and addresses the relationship between marginalizing social issues and poor SLE-health outcomes among these women. Therefore, we developed a community-engaged partnership with two childhood-SLE diagnosed women of color to identify their perspectives on which systemic issues impacted on their SLE health-related outcomes. Afterward, we used Cochrane guidelines to conduct a rapid review associated with these identified issues and original SLE research. Then, we adapted an ecological model to illustrate the connection between systems issues and SLE health outcomes. Finally, we provided recommendations for ways to research and clinically mitigate SLE health inequities.
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Affiliation(s)
- Mallet R Reid
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
| | - Ashley N Danguecan
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Tamar B Rubinstein
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY, USA
| | | | - Andrea M Knight
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | - Natoshia R Cunningham
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
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Allemang B, Dimitropoulos G, Patten SB, Sitter KC, Brobbey A, Mackie AS, Samuel S. Association between transition readiness and mental health comorbidity in youth with chronic health conditions. J Pediatr Nurs 2022; 67:161-167. [PMID: 36152476 DOI: 10.1016/j.pedn.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Between 33 and 59% of youth with chronic health conditions experience mental health conditions. Transition readiness, or the acquisition of knowledge and self-management skills, facilitates successful transition to adult care. Transition readiness among youth with co-occurring chronic health and mental health conditions has not been explored. DESIGN AND METHODS This study used a sample of 201 patients (aged 16-21) with chronic conditions. All patients completed the Transition Readiness Assessment Questionniare (TRAQ) and were grouped into Cohort A: chronic health conditions only (n = 140), and Cohort B: co-occurring chronic health and mental health conditions (n = 61). A quantile regression at the 50th percentile was conducted to examine associations between TRAQ score and mental health comorbidity, age, gender and immigration status. RESULTS The median TRAQ score for Cohort A was 3.87 (IQR 0.84) versus 4.00 (IQR 0.87) for Cohort B. Our analysis revealed that having a mental health comorbidity (b = 0.402, p = 0.034), being older in age (b = 0.540, p = 0.004) and being female (b = 0.388, p = 0.001) were associated with higher overall TRAQ score. CONCLUSIONS The presence of a mental health comorbidity was associated with greater transition readiness as measured by the TRAQ in our sample. Future research should explore why youth with co-occurring chronic health and mental health conditions exhibit greater transition readiness. PRACTICE IMPLICATIONS Youth with co-occurring chronic health and mental health conditions may develop transition readiness as a result of coping with mental health challenges. Practitioners could invite them to reflect on how their physical and mental health are related and affect their level of preparedness for adult care.
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Affiliation(s)
- Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen C Sitter
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Anita Brobbey
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew S Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Samuel
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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