The edition · Rheumatology
RSV vaccination in rheumatic disease: effective in immunocompromised adults, but protection may wane sooner and rheumatic data are sparse
Also: early diagnosis of axial spondyloarthritis and spinal damage, imaging predictors in anti-CCP-positive people with symptoms, infection-related hospitalisation with lupus immunosuppressants, and avacopan in ANCA vasculitis.
The edition in brief
A systematic review of 49 studies found that only one reported RSV outcomes in people with systemic autoimmune rheumatic diseases, and none stratified vaccine effectiveness by DMARD class. Observational data suggested raised RSV hospitalisation with autoimmune and immunocompromising conditions, and first-season vaccine effectiveness of 60 to 73% in immunocompromised adults, with faster waning than in immunocompetent people. No consistent autoimmune safety signal was found. A Swiss registry analysis of 376 axSpA patients found lower long-term spinal radiographic damage with early diagnosis (mSASSS difference -3.85), becoming apparent 10 to 15 years after diagnosis. A prospective cohort of 130 anti-CCP-positive people with symptoms but no synovitis found that MRI hand tenosynovitis and ultrasound erosions independently predicted progression to inflammatory arthritis (37% progressed; combined hazard ratio 5.83). A target trial emulation in 6,168 people with non-renal lupus found that differences in infection-related hospitalisation between azathioprine, belimumab, methotrexate and mycophenolate were attenuated after accounting for glucocorticoid dose. A retrospective cohort of 387 patients with ANCA vasculitis linked avacopan to fewer severe infections (adjusted HR 0.22). The pearl covers infection screening before immunosuppression.
Early diagnosis of axial spondyloarthritis was linked to less spinal damage a decade later
Consider shortening diagnostic delay in axial spondyloarthritis; early diagnosis was linked to less spinal damage on a ten-year horizon.
In anti-CCP-positive people with symptoms, MRI tenosynovitis and ultrasound erosions predicted arthritis
Worth using imaging to decide how closely to follow anti-CCP-positive people with symptoms; it does not yet define who should be treated.
Infection hospitalisation differences between lupus immunosuppressants faded once glucocorticoid dose was counted
Consider glucocorticoid dose, more than the choice among these four drugs, as the modifiable infection risk in non-renal lupus.
Avacopan was linked to fewer severe infections in ANCA-associated vasculitis, in a small observational cohort
Worth noting: avacopan was linked to fewer severe infections and less steroid use in a small observational cohort; it needs confirmation.
Screen for infections and update vaccines before starting immunosuppression
Screen for tuberculosis and hepatitis, and update vaccines, before starting immunosuppression.
RSV vaccination in rheumatic disease: effective in immunocompromised adults, with sparse rheumatic-specific data
Consider RSV vaccination for eligible rheumatic disease patients using a personalised approach; evidence in this group is thin.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free