Anti-survival motor neuron complex antibodies as a novel biomarker for pulmonary arterial hypertension and interstitial lung disease in mixed connective tissue disease

OBJECTIVE

The presence of anti-U1 RNP antibodies (Abs) is critical for diagnosing MCTD. The aim of this study is to evaluate the clinical relevance of anti-survival motor neuron (SMN) complex Abs, which often coexist with anti-U1 RNP Abs.

METHODS

A total of 158 newly diagnosed consecutive cases of SLE, SSc or MCTD with anti-U1 RNP Abs were enrolled in this multicentre observational study between April 2014 and August 2022. Serum anti-SMN complex Abs were screened by immunoprecipitation of 35S-methionine-labelled cell extracts, and associations between anti-SMN complex Abs positivity and clinical characteristics were analysed.

RESULTS

Anti-SMN complex Abs were detected in 36% of MCTD patients, which was significantly higher than that in SLE (8%) or SSc (12%). Among MCTD patients classified based on the combination of the clinical features of SLE, SSc and idiopathic inflammatory myopathies, anti-SMN complex Abs showed the highest prevalence in a subset with clinical features of all three components. Anti-SMN complex Abs-positive MCTD had a higher prevalence of pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), which are related to poor prognosis, than negative patients. Moreover, all three cases of death within 1 year of the treatment were positive for anti-SMN complex Abs.

CONCLUSIONS

Anti-SMN complex Abs is the first biomarker of a typical subset of MCTD which bears organ damages such as PAH and ILD.

The effects of telecommuting and family cohabiting situation on psychological distress in Japanese workers during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

This study aimed to determine whether telecommuting's impact on psychological distress differed depending on the status of workers' cohabiting family members during the COVID-19 pandemic.

METHODS

We collected data from 33 302 workers in Japan through an Internet survey, and included 27 036 valid responses in the analysis. The survey included items on family cohabitation and telecommuting status during the COVID-19 pandemic. We assessed workers' psychological distress using the Kessler 6.

RESULTS

The psychological distress odds ratios (ORs) were higher for participants who lived with family members requiring care (OR = 1.38, P < .001), and lower for participants living with preschool children (OR = 0.77, P < .001) or a spouse (OR = 0.80, P < .001). Furthermore, odds ratios were higher for participants who worked from home and lived with family members requiring care or preschool children (OR = 1.52, P = .002; OR = 1.28, P = .028). Stratified by the presence or absence of family members living with them, psychological distress was higher for telecommuters with family members requiring care, preschool children, or elementary school children.

CONCLUSION

The association between telecommuting and psychological distress varies, depending on workers' living situation with family members.

Prophylaxis against pneumocystis pneumonia in rheumatoid arthritis patients treated with b/tsDMARDs: insights from 3787 cases in the FIRST registry

OBJECTIVES

The use of biologic and targeted synthetic (b/ts) DMARDs in the treatment of RA is increasing. Therefore, prevention of b/tsDMARDs-induced infection is important. Here we describe a prophylaxis protocol for preventing pneumocystis pneumonia (PCP) in RA patients treated with b/tsDMARDs.

METHODS

The study subjects were 3787 RA patients from the FIRST registry. They were divided into cohort 1 (n = 807, requiring prophylaxis against PCP based on physicians' assessment at the point of new treatment with or switch to b/tsDMARDs) and cohort 2 (n = 2980, receiving strategic PCP prophylaxis). The incidence and risk factors for PCP were investigated.

RESULTS

Twenty-six PCP cases were observed throughout the study. After the introduction of strategic PCP prophylaxis, PCP incidence diminished from 0.51/100 person-years (PYs) to 0.21/100 PYs (risk ratio = 0.42). Sulfamethoxazole and trimethoprim in combination (SMX-TMP) showed greater efficacy in the prevention of PCP than pentamidine inhalation (P <0.0001). The prophylaxis rate increased chronologically despite the falls in the average SMX-TMP dose and in the incidence of PCP. Subanalysis of the data for 929 patients from both groups who did not receive prophylaxis showed that old age, high BMI, coexisting lung diseases, low lymphocyte count, and low serum IgG levels increased the risk of PCP development. Development of PCP could be predicted (using an equation based on these variables) in patients not treated with glucocorticoids [area under the curve (AUC) = 0.910)], but less accurately in those on glucocorticoids (AUC = 0.746).

CONCLUSIONS

Our study clarified the risk factors for PCP in RA patients on b/tsDMARDs treatment and highlighted and defined the criteria for effective prophylaxis against PCP.

Factors associated with occupational accidents during part-time work among international students in Japan

This study investigated the status of and risk factors for occupational accidents occurring during part-time work among international students in Japan. In total, 390 international students who had registered with an online survey company were invited to participate in a cross-sectional study using an online self-administered questionnaire in October 2020. Multiple regression analysis was performed to evaluate factors associated with accidents with absence from work. Among 311 participants, 126 (40.5%) had experienced an occupational accident at their part-time job in the past year, and 27 (8.7%) had lost working days because of accidents. The likelihood of accident with work absence was significantly higher among those with high income (adjusted odds ratio [OR] = 4.39, 95% confidence interval [CI]: 1.57-12.24) and language barrier (adjusted OR = 2.37, 95% CI: 1.03-5.47). International students experienced occupational accidents relatively frequently. These results provide insight to guide occupational safety measures for migrants.

A cross-sectional study of the association between frequency of telecommuting and unhealthy dietary habits among Japanese workers during the COVID-19 pandemic

OBJECTIVE

Due to the COVID-19 pandemic, telecommuting has become a new way of working that has not only changed individuals' work, but also their health and lifestyle. We examined the relationship between telecommuting frequency and unhealthy dietary habits among Japanese workers.

METHODS

A total of 33,302 workers completed an Internet survey about telecommuting and dietary habits. Data from 13,468 office workers who telecommuted were analyzed. Telecommuting frequency during the COVID-19 pandemic was extracted from a questionnaire. The odds ratios (ORs) of four types of dietary habits, namely, skipping breakfast, solitary eating, lower meal frequency, and meal substitution associated with telecommuting frequency were estimated using multilevel logistic regression nested in the prefecture of residence to control for differences in residential area.

RESULTS

The multivariate OR of skipping breakfast was 1.15 (95% CI: 1.03-1.29, p = .013) for participants who telecommuted in excess of four days per week compared to those who rarely telecommuted. Similarly, the OR of solitary eating, lower meal frequency and meal substitution were 1.44 (95% CI: 1.28-1.63, p < .001), 2.39 (95% CI: 1.66-3.44, p < .001), and 1.26 (95% CI: 1.04-1.51, p = .015) for those who telecommuted in excess of four days per week compared to those who rarely telecommuted. There was a statistically significant increase in the dose-response trend in ORs of solitary eating (p for trend <.001), lower meal frequency (p for trend <.001), and meal substitution (p for trend = .001) with increasing telecommuting frequency.

CONCLUSION

Telecommuters may develop unhealthy dietary habits, indicating the need for strategies to help telecommuters manage their nutrition and diet.

A cross-sectional study of infection control measures against COVID-19 and psychological distress among Japanese workers

OBJECTIVES

This study examined the relationship between the status of infection control efforts against COVID-19 in the workplace and workers' mental health using a large-scale Internet-based study.

METHODS

This cross-sectional study was based on an Internet monitoring survey conducted during the third wave of the COVID-19 epidemic in Japan. Of the 33 302 people who participated in the survey, 27 036 were included in the analyses. Participants answered whether or not each of 10 different infection control measures was in place at their workplace (eg, wearing masks at all times during working hours). A Kessler 6 (K6) score of ≥13 was defined as mild psychological distress. The odds ratios (ORs) of psychological distress associated with infection control measures at the workplace were estimated using a multilevel logistic model nested in the prefectures of residence.

RESULTS

The OR of subjects working at facilities with 4 or 5 infection control measures for psychological distress was 1.19 (95% confidence interval [CI]: 1.05-1.34, P = .010), that in facilities with 2 or 3 infection control measures was 1.43 (95% CI: 1.25-1.64, P < .001), and that in facilities with 1 or no infection control measures was 1.87 (95% CI: 1.63-2.14, P < .001) compared to subjects whose workplaces had ≥6 infection control measures.

CONCLUSION

Our findings suggest that proactive COVID-19 infection control measures can influence the mental health of workers.