Publications by authors named "Philip C Robinson"

102 Publications

Predictors of hospitalization in patients with rheumatic disease and COVID-19 in Ireland: data from the COVID-19 global rheumatology alliance registry.

Rheumatol Adv Pract 2021 13;5(2):rkab031. Epub 2021 May 13.

Department of Rheumatology, Mater Misericordiae Hospital, Dublin.

Objectives: Given the limited data regarding the risk of hospitalization in patients with rheumatic disease and coronavirus disease 2019 (COVID-19) in Ireland, we used the COVID-19 Global Rheumatology Alliance (GRA) registry data to study outcomes and their predictors. The primary objective was to explore potential predictors of hospitalization.

Methods: We examined data on patients and their disease-related characteristics entered in the COVID-19 GRA provider registry from Ireland (from 24 March 2020 to 31 August 2020). Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with hospitalization.

Results: Of 105 patients, 47 (45.6%) were hospitalized and 10 (9.5%) died. Multivariable logistic regression analysis showed that age [odds ratio (OR) = 1.06, 95% CI 1.01, 1.10], number of co-morbidities (OR = 1.93, 95% CI 1.11, 3.35) and glucocorticoid use (OR = 15.01, 95% CI 1.77, 127.16) were significantly associated with hospitalization. A diagnosis of inflammatory arthritis was associated with lower odds of hospitalization (OR = 0.09, 95% CI 0.02, 0.32).

Conclusion: Increasing age, co-morbidity burden and glucocorticoid use were associated with hospitalization, whereas a diagnosis of inflammatory arthritis was associated with lower odds of hospitalization.
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http://dx.doi.org/10.1093/rap/rkab031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244588PMC
May 2021

Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey.

RMD Open 2021 09;7(3)

Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA.

Background: We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine.

Methods: From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination.

Results: We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%.

Conclusion: Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.
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http://dx.doi.org/10.1136/rmdopen-2021-001814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424419PMC
September 2021

COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance.

J Rheumatol 2021 Sep 1. Epub 2021 Sep 1.

The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance, and do not necessarily represent the views of the American College of Rheumatology (ACR), the European Alliance of Associations for Rheumatology (EULAR), the (UK) National Health Service (NHS), the National Institute for Health Research (NIHR), or the (UK) Department of Health, or any other organization. B.L. Bermas, MD, UTSouthwestern Medical Center, Dallas, Texas, USA; M. Gianfrancesco, MPH, PhD, A.M. Seet, MPH, J. Yazdany, MPH, MD, Division of Rheumatology, School of Medicine, University of California, San Francisco, California, USA; H.L. Tanner, MBChB, FRACP, University of Queensland School of Clinical Medicine, Faculty of Medicine, Queensland, Australia; M.C. Aguiar, MD, Hospital General Agustin O'Horan, Merida, Mexico; N.K. Al Adhoubi, MD, FRCP, Rheumatology Unit, Royal Hospital, Muscat, Oman; S. Al Emadi, MBBS, FRCPC, Hamad Medical Corporation, Doha, Qatar; B.M. Cunha, MD, PhD, Sarah Network of Rehabilitation Hospitals, Brasília, Brazil; R. Flood, MB, BCh, BAO, Tallaght University Hospital, Tallaght, Dublin, Ireland; D.A. Kusevich, MD,PhD, V.A. Nasonova Research Institute of Rheumatology, Moscow, and Anikina Clinic, Vidnoe, Russia; E.M. McCarthy, MB, MRCPI, Manchester University Foundation Trust, Manchester, UK; N.J. Patel, MD, Massachusetts General Hospital, Boston, Massachusetts, USA; E.M. Ruderman, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; S.E. Sattui, MD, MS, Hospital for Special Surgery, New York, New York, USA; S. Sciascia, MD, PhD, Center of Research of Immunopathology and Rare Diseases/Nephrology and Dialysis Unit, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital, Turin, Italy; F. Siddique, MD, Loyola University Medical Center, Maywood, Illinois, USA; M.O. Valenzuela-Almada, MBBS, A. Duarte-Garcia, MD, MS, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; L.M. Wise, MD, University of Southern California, Los Angeles, California, USA; A.B. Worthing, MD, Arthritis & Rheumatism Associates, PC, and Georgetown University Medical Center, Washington, DC, USA; J. Zell, MD, University of Colorado, Aurora, Colorado, USA; S. Bhana, MD, Crystal Run Healthcare, Middletown, New York, USA; W. Costello, Irish Children's arthritis network (iCan), Tipperary, Ireland; R. Grainger, MBChB, PhD, FRACP, Department of Medicine, University of Otago, Wellington, New Zealand; L. Gossec, MD, PhD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Rheumatology Department, Paris, France; J.S. Hausmann, MD, Program in Rheumatology, Division of Immunology, Boston Children's Hospital, and Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; K. Hyrich, MD, PhD, FRCPC, Centre for Epidemiology Versus Arthritis, The University of Manchester, and National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK; S. Lawson-Tovey, BA, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK; J.W. Liew, MS, MD, Boston University School of Medicine, Boston, Massachusetts, USA; E. Sirotich, BSc, Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; P. Sufka, MD, Healthpartners, St. Paul, Minnesota, USA; Z.S. Wallace, MD, MSc, Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; P.M. Machado, MD, PhD, Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, and National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK; A. Strangfeld, MD, Epidemiology Unit, German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany; M.E.B. Clowse, MD, MPH, Duke University School of Medicine, Durham, North Carolina, USA; P.C. Robinson, MBChB, PhD, FRACP, Associate Professor, University of Queensland School of Clinical Medicine, Faculty of Medicine, Queensland, Australia, and Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia. EMR declares consulting for AbbVie, Amgen, BMS, Horizon, Janssen, Lilly, Novartis, and Pfizer; and research grants from Corrona and Pfizer, all unrelated to this work. SES declares funding from the Vasculitis Clinical Research Consortium and Vasculitis Foundation outside the submitted work. LMW declares consulting for Aurinia outside the submitted work. SB declares nonbranded consulting for AbbVie, Horizon, Pfizer, and Novartis. ADG declares grants from the Centers for Disease Control and Prevention, the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award, and the Eaton Family Career Development Award. RG declares AbbVie, Cornerstones, Janssen, and Pfizer, all outside the submitted work. LG declares research grants from Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, Sanofi; and consulting fees from AbbVie, Amgen, BMS, Biogen, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB, all outside the submitted work. JSH declares grants from the Rheumatology Research Foundation and salary support from the Childhood Arthritis and Rheumatology Research Alliance (CARRA); and consulting for Novartis, Biogen, and Pfizer (< $10,000), all unrelated to this work. KH declares honoraria from AbbVie, and grants from BMS, Pfizer, and UCB. JWL declares research funding from Pfizer unrelated to this work. JAS declares research support from Amgen and BMS, and performed consultancy for BMS, Gilead, Inova, Janssen, and Optum, unrelated to this work. ZSW declares grant support from BMS and Principia, and has received consulting fees from MedPace and Viela Bio for unrelated work. PMM declares consulting/speaker's fees from AbbVie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche, and UCB, all unrelated to this manuscript, and is supported by the NIHR, University College London Hospitals, Biomedical Research Centre. AS declares lecture honoraria from AbbVie, BMS, Celltrion, MSD, Pfizer, Roche, and UCB, outside the submitted work. MEBC declares consulting for GSK, AstraZeneca, and UCB; and grants from GSK and Pfizer, outside the submitted work. JY declares personal fees from AstraZeneca, personal fees from Eli Lilly, and grants from Pfizer and Gilead, outside the submitted work. PCR declares personal feesAbbVie, Atom Bioscience, Gilead, Eli Lilly, Novartis, Roche, UCB, BMS, Janssen, and Pfizer, all outside the submitted work. The remaining authors declare no competing interests relevant to this article. Address correspondence to Assoc. Prof. P.C. Robinson, University of Queensland School of Clinical Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland 4006, Australia. Email: Accepted for publication August 11, 2021.

Objective: To describe coronavirus disease 2019 (COVID-19) and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of infection.

Methods: Since March 2020, the COVID-19 Global Rheumatology Alliance has collected cases of patients with rheumatic disease with COVID-19. We report details of pregnant women at the time of COVID-19 infection, including obstetric details separately ascertained from providers.

Results: We report on 39 patients, including 22 with obstetric detail available. The mean and median age was 33 years, range 24-45 years. Rheumatic disease diagnoses included rheumatoid arthritis (n = 9), systemic lupus erythematosus (n = 9), psoriatic arthritis/other inflammatory arthritides (n = 8), and antiphospholipid syndrome (n = 6). Most had a term birth (16/22), with 3 preterm births, 1 termination, and 1 miscarriage; 1 woman had yet to deliver at the time of report. One-quarter (n = 10/39) of pregnant women were hospitalized following COVID-19 diagnosis. Two of 39 (5%) required supplemental oxygen (both hospitalized); no patients died. The majority did not receive specific medication treatment for their COVID-19 (n = 32/39, 82%), and 7 patients received some combination of antimalarials, colchicine, anti-interleukin 1β, azithromycin, glucocorticoids, and lopinavir/ritonavir.

Conclusion: Women with rheumatic diseases who were pregnant at the time of COVID-19 had favorable outcomes. These data have limitations due to the small size and methodology; however, they provide cautious optimism for pregnancy outcomes for women with rheumatic disease particularly in comparison to the increased risk of poor outcomes that have been reported in other series of pregnant women with COVID-19.
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http://dx.doi.org/10.3899/jrheum.210480DOI Listing
September 2021

Longitudinal development of incident gout from low-normal baseline serum urate concentrations: individual participant data analysis.

BMC Rheumatol 2021 Aug 28;5(1):33. Epub 2021 Aug 28.

Department of Medicine, University of Auckland, Auckland, New Zealand.

Introduction: Elevated serum urate (SU) concentration is the central risk factor for the development of gout. The aim of this study was to examine the incidence of gout in people with low and normal SU levels (< 7.00 mg/dL).

Methods: Longitudinal cohort data from the Atherosclerosis Risk in Communities Study (ARIC), Coronary Artery Risk Development in Young Adults Study (CARDIA), and both the Original and Offspring cohorts of the Framingham Heart Study (FHS) were used to determine incident gout by baseline SU over 3, 5, 10, 12 and 15 year periods. A Cox proportional hazards model with covariables of age, gender, ethnicity, and cohort was calculated to report the hazard ratios (HR) for incident gout.

Results: The incidence of gout at 15 years for a baseline SU < 4.00 mg/dL was 0.59%, 4.00-4.49 mg/dL was 1.28%, 4.50-4.99 mg/dL was 0.86%, 5.00-5.49 mg/dL was 0.94%, 5.50-5.99 mg/dL was 1.52%, 6.00-6.49 mg/dL was 2.91%, 6.50-6.99 mg/dL was 3.2%, and > 7.00 mg/dL was 12.2%. In an adjusted Cox proportional hazards model, compared to the referent baseline SU < 4.00 mg/dL, there was a non-significant increase in incident gout for baseline SU bands between 4.00-5.49 mg/dL, whereas incident gout was significantly increased for SU 5.50-5.99 mg/dL (HR 2.60), 6.00-6.49 mg/dL (HR 3.70), 6.50-6.99 mg/dL (HR 5.24) and > 7.00 mg/dL (HR 18.62).

Conclusion: A baseline SU of 5.50 mg/dL or more is a risk factor for development of gout over 15 years. However, incident gout does occur over time in a small proportion of people with lower baseline SU levels.
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http://dx.doi.org/10.1186/s41927-021-00204-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399746PMC
August 2021

Systematic Review and Meta-Analysis of Inflammatory Bowel Disease Adverse Events with Anti-Interleukin 17A Agents and Tumor Necrosis Factor Inhibitors in Rheumatic Disease and Skin Psoriasis.

Rheumatol Ther 2021 Aug 26. Epub 2021 Aug 26.

Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.

Introduction: The aim of this work is to perform a systematic review and meta-analysis of anti-tumor necrosis factor (anti-TNF) and anti-interleukin-17 (anti-IL-17) trials for spondyloarthritis, psoriatic arthritis, and psoriasis comparing rates of inflammatory bowel disease (IBD) events compared to placebo.

Methods: MEDLINE, EMBASE, and The Cochrane Library were searched for double-blind, randomized placebo-controlled anti-TNF and anti-IL-17 trials of included diseases. Inflammatory bowel disease events from the RCT period were pooled and meta-analyzed using statistical methods suitable for low-event-rate meta-analysis (Peto's, Mantel-Haenszel, hypergeometric-normal model, and Shuster-Guo-Skyler). When observed data were insufficient, we performed an exploratory sensitivity analysis to compare methods.

Results: We identified 9551 original papers, and included 96 publications: 65 anti-TNF and 31 anti-IL-17 trials, containing 21 new and 12 flare IBD events in 28,209 participants. New IBD on anti-IL-17 occurred 0.23/100 patient-years (PY) in psoriasis, 0.61/100 PY in PsA and 1.63/100 PY in spondyloarthritis, rates similar to observational cohorts, and less commonly on anti-TNF (0/100 PY, 0/100 PY, 0.32/100 PY, respectively). No evidence of difference between groups was found, with wide CI from many pooled counts of zero, especially in placebo arms.

Conclusions: IBD events were rare, occurring at rates similar to biologic-naive groups. We could not find statistically significant differences in risk of new or recurrent IBD between treatment and control groups using selected meta-analytical methods for low event rate scenarios. Meta-analyses of this topic require more IBD events, ideally without pooling heterogeneous groups. Larger, thoroughly reported trials with systematic and detailed safety reporting are required to improve risk estimation and to make accurate inferences.
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http://dx.doi.org/10.1007/s40744-021-00360-6DOI Listing
August 2021

Consensus Statement Regarding the Efficacy and Safety of Long-Term Low-Dose Colchicine in Gout and Cardiovascular Disease.

Am J Med 2021 Aug 18. Epub 2021 Aug 18.

GenesisCare, Perth, WA, Australia.

Over the last decade, evidence has demonstrated that long-term, low-dose colchicine (0.5 mg daily) is effective for preventing gout flare and cardiovascular (CV) events in a wide range of patients. Given the potentially expanding use of colchicine in CV disease, we here review and update the biologic effects and safety of colchicine based on recent data gathered from bench and pharmacodynamic studies, clinical reports, controlled clinical trials, and meta-analyses, integrated with important studies over the last 50 years, to offer a consensus perspective by experts from multiple specialties familiar with colchicine's long-term use. We conclude that the clinical benefits of colchicine in gout and CV disease achieved at low dose do not sustain serum levels above the upper limit of safety when used in patients without advanced renal or liver disease or when used concomitantly with most medications. Further, data accrued over the last 50 years strongly suggest that the biologic effects of long-term colchicine do not increase the risk of cancer, sepsis, cytopenia, or myotoxicity.
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http://dx.doi.org/10.1016/j.amjmed.2021.07.025DOI Listing
August 2021

The Effect of Etanercept in Nonradiographic Axial Spondyloarthritis by Stratified C-Reactive Protein Levels.

ACR Open Rheumatol 2021 Oct 18;3(10):699-706. Epub 2021 Aug 18.

University of Queensland, Brisbane, Queensland, Australia.

Objective: Biological agents have shown markedly different response rates by baseline C-reactive protein (CRP). Here, we determine the response of patients with nonradiographic axial spondyloarthritis (nr-axSpA) to etanercept stratified by their baseline CRP level.

Methods: The EMBARK trial was a phase 3, randomized, double-blind, placebo-controlled study of etanercept in nr-axSpA. The primary endpoint was Assessment of Spondyloarthritis International Society (ASAS) 40 at Week 12, the conclusion of the double-blind phase. It recruited patients who met the ASAS criteria for axial spondyloarthritis, and sacroiliac joint magnetic resonance scans were completed on all patients. In this post hoc analysis, we analyzed outcomes by baseline C-reactive protein (CRP) level of less than 5 mg/L, 5 mg/L to 10 mg/L, and greater than 10 mg/L. The clinical trial outcome data were accessed via the Vivli platform.

Results: In the less than 5 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP), and ASDAS-ESR (erythrocyte sedimentation rate) outcomes were 49% (P = 0.84), 26% (P = 0.14), 42% (P = 0.002), and 44% (P = 0.006), respectively. In the 5 to 10 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, ASDAS-CRP, and ASDAS-ESR outcomes were 56% (P = 0.99), 31% (P = 0.40), 56% (P = 0.16), and 50% (P = 0.11), respectively. In the greater than10 mg/L CRP group treated with etanercept, the ASAS20 response, ASAS40 response, ASDAS-CRP, and ASDAS-ESR outcomes were 74% (P = 0.02), 68% (P = 0.003), 82% (P = 0.005), and 50% (P = 0.001), respectively.

Conclusion: Although there are reduced ASAS20 and ASAS40 response rates in the groups with baseline CRP less than 10 mg/L, there remain clinically relevant responses when the composite outcome measures ASDAS-CRP or ASDAS-ESR were used, and this should be considered when deciding on thresholds for reimbursement.
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http://dx.doi.org/10.1002/acr2.11312DOI Listing
October 2021

The COVID-19 Pandemic and Rheumatology: Impact on Providing Care in Latin America and Around the World.

J Rheumatol 2021 10 1;48(10):1501-1503. Epub 2021 Aug 1.

P.C. Robinson, MB ChB, PhD, Associate Professor, University of Queensland School of Clinical Medicine, Faculty of Medicine, and Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia.

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http://dx.doi.org/10.3899/jrheum.210774DOI Listing
October 2021

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases.

Lancet Rheumatol 2021 Oct 22;3(10):e707-e714. Epub 2021 Jul 22.

Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Background: The impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide.

Methods: Survey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis.

Findings: 12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren's syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514).

Interpretation: People with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity.

Funding: American College of Rheumatology.
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http://dx.doi.org/10.1016/S2665-9913(21)00175-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298011PMC
October 2021

Coronavirus disease 2019: update on coronavirus disease 2019 outcomes and vaccine efficacy in patients with immune-mediated inflammatory disease.

Curr Opin Rheumatol 2021 09;33(5):412-418

University of Queensland School of Clinical Medicine, Faculty of Medicine.

Purpose Of Review: Although the literature to date on COVID-19 outcomes in those with immune-mediated inflammatory disease has been largely reassuring there remain many unanswered questions. These include the impact of specific medications on outcomes and the antibody response after COVID-19 vaccination.

Recent Findings: We summarized the current literature related to COVID-19 outcomes in immune-mediated inflammatory diseases in rheumatology, gastroenterology, dermatology, and neurology. Overall, we found either no difference or modest differences in risk for severe COVID-19 for people with immune-mediated diseases compared with the general population. When considering disease-specific factors, glucocorticoid use and underlying immune-mediated disease activity were generally associated with worse outcomes. Specific medications varied in associations: tumor necrosis factor inhibitors generally had lower odds for severe COVID-19 outcomes, whereas rituximab use generally had higher odds for severe outcomes. We also detailed the recent reports of antibody response to COVID-19 vaccination in people with immune-mediated inflammatory diseases.

Summary: Investigations of immune-mediated inflammatory diseases across several organ systems have offered important insight into the COVID-19 disease course. Overall, these studies have provided reassurance to patients and clinicians while also identifying groups who may be at higher risk for poor outcomes.
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http://dx.doi.org/10.1097/BOR.0000000000000812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373387PMC
September 2021

COVID-19 in immunocompromised populations: implications for prognosis and repurposing of immunotherapies.

J Immunother Cancer 2021 06;9(6)

Department. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Comprehensive Cancer Center, Stockholm, Sweden.

SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. COVID-19 has highly variable disease severity and a bimodal course characterized by acute respiratory viral infection followed by hyperinflammation in a subset of patients with severe disease. This immune dysregulation is characterized by lymphocytopenia, elevated levels of plasma cytokines and proliferative and exhausted T cells, among other dysfunctional cell types. Immunocompromised persons often fare worse in the context of acute respiratory infections, but preliminary data suggest this may not hold true for COVID-19. In this review, we explore the effect of SARS-CoV-2 infection on mortality in four populations with distinct forms of immunocompromise: (1) persons with hematological malignancies (HM) and hematopoietic stem cell transplant (HCT) recipients; (2) solid organ transplant recipients (SOTRs); (3) persons with rheumatological diseases; and (4) persons living with HIV (PLWH). For each population, key immunological defects are described and how these relate to the immune dysregulation in COVID-19. Next, outcomes including mortality after SARS-CoV-2 infection are described for each population, giving comparisons to the general population of age-matched and comorbidity-matched controls. In these four populations, iatrogenic or disease-related immunosuppression is not clearly associated with poor prognosis in HM, HCT, SOTR, rheumatological diseases, or HIV. However, certain individual immunosuppressants or disease states may be associated with harmful or beneficial effects, including harm from severe CD4 lymphocytopenia in PLWH and possible benefit to the calcineurin inhibitor ciclosporin in SOTRs, or tumor necrosis factor-α inhibitors in persons with rheumatic diseases. Lastly, insights gained from clinical and translational studies are explored as to the relevance for repurposing of immunosuppressive host-directed therapies for the treatment of hyperinflammation in COVID-19 in the general population.
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http://dx.doi.org/10.1136/jitc-2021-002630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206176PMC
June 2021

Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry.

Ann Rheum Dis 2021 09 28;80(9):1137-1146. Epub 2021 May 28.

Rheumatology Department, Hamad Medical Corporation, Doha, Qatar.

Objective: To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA).

Methods: We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders.

Results: Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity.

Conclusions: People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.
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http://dx.doi.org/10.1136/annrheumdis-2021-220418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172266PMC
September 2021

Healthcare access and attitudes towards telehealth during the early phase of the COVID-19 pandemic among an Australian cohort with inflammatory arthritis.

Intern Med J 2021 05;51(5):788-792

Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.

Community restrictions due to COVID-19 have changed healthcare, including increased telehealth use. During the early pandemic phase, a cohort of Australian patients with inflammatory arthritis was surveyed. Self-reported access to healthcare was maintained and physical health was more likely to be self-rated poorly than mental health. There was a high level of support for telehealth during and after the pandemic.
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http://dx.doi.org/10.1111/imj.15309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207000PMC
May 2021

Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID-19 pandemic.

Int J Rheum Dis 2021 Jun 4;24(6):733-745. Epub 2021 May 4.

Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh.

Aim: To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID-19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID-19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process.

Results: Agreement was obtained around key aspects of screening for or diagnosis of COVID-19; management of patients with RMD without confirmed COVID-19; and management of patients with RMD with confirmed COVID-19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID-19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence.

Conclusions: Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID-19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID-19 vaccination in patients with RMD.
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http://dx.doi.org/10.1111/1756-185X.14124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206920PMC
June 2021

Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond.

Curr Rheumatol Rep 2021 04 28;23(6):36. Epub 2021 Apr 28.

Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, 4006, Australia.

Purpose Of Review: This review examines axial spondyloarthritis (axSpA) and the wider field of rheumatology through a value-based healthcare (VBHC) lens. VBHC is focused on ensuring patients receive high quality care to improve outcomes and reduce unnecessary costs.

Recent Findings: There are many opportunities to apply the principles of VBHC in axSpA. These include the appropriate utilization of diagnostic investigations, such as HLA-B27 and magnetic resonance imaging, assessing outcomes meaningful to patients, and optimizing care pathways. Multidisciplinary care may improve value, and reduced specialist review and medication tapering may be appropriate. Increasing the value of the care we provide to patients can occur across domains and directly and indirectly improves patient outcomes. Taking the time to integrate principles of VBHC into our practice will allow us to justifiably gain and maintain access to diagnostic and therapeutic advances for the benefit of all our patients.
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http://dx.doi.org/10.1007/s11926-021-01003-zDOI Listing
April 2021

Patients with gout: an under-recognised group at high risk of COVID-19.

Lancet Rheumatol 2021 May 9;3(5):e317-e318. Epub 2021 Mar 9.

University of Queensland Faculty of Medicine, Brisbane, QLD, Australia.

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http://dx.doi.org/10.1016/S2665-9913(21)00073-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062083PMC
May 2021

Gout, Rheumatoid Arthritis, and the Risk of Death Related to Coronavirus Disease 2019: An Analysis of the UK Biobank.

ACR Open Rheumatol 2021 May 15;3(5):333-340. Epub 2021 Apr 15.

University of Otago, Dunedin, New Zealand, and University of Alabama at Birmingham.

Objectives: The objectives for this study were to assess whether gout and/or rheumatoid arthritis (RA) are risk factors for coronavirus disease 2019 (COVID-19) diagnosis and to assess whether gout and/or RA are risk factors for death from COVID-19.

Methods: We used data from the UK Biobank. Multivariable-adjusted logistic regression was employed in the following analyses: analysis A, to test for association between gout and/or RA and COVID-19 diagnosis (n = 473,139); analysis B, to test for association between gout and/or RA and death from COVID-19 in a case-control cohort of people who died of or survived COVID-19 (n = 2059); analysis C, to test for association between gout and/or RA and death from COVID-19 in the entire UK Biobank cohort (n = 473,139).

Results: RA, but not gout, was associated with COVID-19 diagnosis in analysis A. Neither RA nor gout was associated with risk of death in the group diagnosed with COVID-19 in analysis B. However, RA was associated with risk of death related to COVID-19 by using the UK Biobank cohort in analysis C, independent of comorbidities and other measured risk factors (odds ratio [OR] 1.9; 95% confidence interval CI 1.2-3.0). Gout was not associated with death related to COVID-19 in the same UK Biobank analysis (OR 1.2; 95% CI 0.8-1.7).

Conclusion: RA is a risk factor for death from COVID-19 by using the UK Biobank cohort. These findings require replication in larger data sets that also allow for inclusion of a wider range of factors.
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http://dx.doi.org/10.1002/acr2.11252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126763PMC
May 2021

Changing COVID-19 outcomes in patients with rheumatic disease-are we really getting better at this?

Lancet Rheumatol 2021 Feb 28;3(2):e88-e90. Epub 2021 Jan 28.

University of Queensland Faculty of Medicine, Herston, Australia.

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http://dx.doi.org/10.1016/S2665-9913(21)00008-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906652PMC
February 2021

Addressing the challenges of the SARS-CoV-2 pandemic in patients affected by autoimmune and rheumatic disease.

Best Pract Res Clin Rheumatol 2021 03 17;35(1):101664. Epub 2021 Feb 17.

Washington University School of Medicine, St. Louis, Missouri, USA.

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http://dx.doi.org/10.1016/j.berh.2021.101664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888248PMC
March 2021

Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective.

Lancet Rheumatol 2021 Jan 8;3(1):e71-e82. Epub 2020 Dec 8.

Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA.

Giant cell arteritis, a common primary systemic vasculitis affecting older people, presents acutely as a medical emergency and requires rapid specialist assessment and treatment to prevent irreversible vision loss. Disruption of the health-care system caused by the COVID-19 pandemic exposed weak points in clinical pathways for diagnosis and treatment of giant cell arteritis, but has also permitted innovative solutions. The essential roles played by all professionals, including general practitioners and surgeons, in treating these patients have become evident. Patients must also be involved in the reshaping of clinical services. As an international group of authors involved in the care of patients with giant cell arteritis, we reflect in this Viewpoint on rapid service adaptations during the first peak of COVID-19, evaluate challenges, and consider implications for the future.
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http://dx.doi.org/10.1016/S2665-9913(20)30386-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834492PMC
January 2021

Accumulating evidence suggests anti-TNF therapy needs to be given trial priority in COVID-19 treatment.

Lancet Rheumatol 2020 Nov 5;2(11):e653-e655. Epub 2020 Sep 5.

Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK.

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http://dx.doi.org/10.1016/S2665-9913(20)30309-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832144PMC
November 2020

Divergent effects of acute versus chronic glucocorticoids in COVID-19.

Lancet Rheumatol 2021 Mar 18;3(3):e168-e170. Epub 2021 Jan 18.

Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1016/S2665-9913(21)00005-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833899PMC
March 2021

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.

Ann Rheum Dis 2021 07 27;80(7):930-942. Epub 2021 Jan 27.

National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.

Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases.

Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
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http://dx.doi.org/10.1136/annrheumdis-2020-219498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843211PMC
July 2021

Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes.

Best Pract Res Clin Rheumatol 2021 03 23;35(1):101657. Epub 2020 Dec 23.

University of Queensland School of Clinical Medicine, HERSTON, QLD, Australia; Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, HERSTON, QLD, Australia.

There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at an increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with the risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to the risk of infection and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune-mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.
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http://dx.doi.org/10.1016/j.berh.2020.101657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756169PMC
March 2021

Gout models of care: The next step is to facilitate implementation.

Int J Rheum Dis 2020 Sep;23(9):1115-1116

University of Queensland Faculty of Medicine, Brisbane, Qld, Australia.

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http://dx.doi.org/10.1111/1756-185X.13900DOI Listing
September 2020
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