In-Hospital Vasculitis-Associated Mortality Rates Declining

With few population-based studies assessing vasculitis-related mortality, most of which are limited to vasculitis subtypes, researchers examined time trends in in-hospital mortality in patients with vasculitis and compared these trends with those among the general US population using the U.S. National Inpatient Sample (NIS) from 1998-2014. The study team calculated unadjusted in-hospital mortality rates per 1,000 hospitalizations for people with versus without primary vasculitis hospitalizations. Unadjusted in-hospital mortality in primary vasculitis hospitalizations decreased by 43%, from 32.8 per 1,000 in 1998 to 18.7 per 1,000 in 2014, compared with a 24.5% reduction in deaths for all NIS claims without vasculitis, from 28.1 to 21.2 per 1,000. Age- and sex-adjusted in-hospital mortality decreased in primary vasculitis hospitalizations, from 27.3 per 1,000 claims in 1998 to 19.1 in 2014, as well as in non-vasculitis hospitalizations, from 15.1 to 13.2 per 1,000. These rates occurred despite primary vasculitis hospitalizations per year remaining fairly constant throughout the study period. The age- and sex-adjusted mortality rate gap between those with versus without vasculitis narrowed.

Osteoporosis in Men Often Overlooked, Rarely Treated

Current recommendations for testing of male patients with osteoporosis are rather inconsistent, leading to much ambiguity and a further increase in disease burden, according to the authors of a retrospective study that used a cohort of males aged 65 or older with Medicare enrolment who experienced a fracture to characterize this population and determine whether males who had a fracture had been effectively screened and treated. Before their fragility fracture, 62.8% of the men were known to suffer from musculoskeletal pain, with 48.5% receiving opioids, 22.4% medication for mobility impairment, 44.0% beta blockers, and 35.8% alpha blockers. However, bone mineral density tests had been performed in less than 6.0% within the previous 2 years. The vast majority of these patients (92.8%) were neither diagnosed with nor treated for osteoporosis before their fracture. Only 2.1% received treatment for osteoporosis, while 2.8% were diagnosed but did not receive therapy for osteoporosis and 2.3% were treated without an established diagnosis. Especially in male patients aged 75 or older, rates for undergoing bone density scans decreased between 2012 (6.0%) and 2014 (4.3%). “Better management of male osteoporosis, including earlier identification of at-risk individuals, is warranted,” said a study coauthor. “That way, they can be screened and identified as having high-risk conditions and low bone density and put on effective therapy to mitigate fracture risk and the subsequent morbidities and mortality that it ensues.”

Increased Long-Term Cardiovascular Event Risk in Children With Kawasaki Disease

Despite research showing Kawasaki disease (KD) is associated with coronary artery aneurysms (CAAs) and that the incidence of KD has significantly increased during the past 20 years, little is known regarding the risk of long-term cardiovascular events in children without large CAAs. To determine the risk and timing of such events (diagnoses and procedures) and the risk of allcause mortality in children with KD, study investigators analyzed data on patients aged 0-18 who survived hospitalization with a KD diagnosis from 1995-2018. Cases of KD were matched to 100 non-exposed controls by age, sex, and index year and followed until death or March 2019. Incidence rates and unadjusted hazard ratios were determined for cardiovascular events, major adverse events (MACE; cardiovascular death, myocardial infarction (MI) or stroke composite) and all-cause mortality, with the KD and non-exposed cohorts compared during the following time periods: 0-1, 1-5, 5-10, and more than 10 years. Among KD survivors, 16.2% experienced cardiovascular events, 1.7% MACE, and 0.2% mortality during a median 11.1-year follow-up. KD survivors were at increased risk of cardiovascular events and MACE compared with non-exposed children at 0-1, 1-5, and 5-10 years, and cardiovascular events at more than 10 years followup, and they experienced cardiovascular events sooner than non-exposed children.

Steroid Injections Do Not Advance the Need for Joint Replacement

A recent cohort study suggested a three-fold higher risk for knee osteoarthritis (OA) progression with the use of corticosteroid (CS) injections. Recipients of CS injections might have more advanced knee OA, which in itself is a risk factor for OA progression, making a comparison of those undergoing CS injections to those who do not report injections questionable, despite statistical adjustments. Therefore, researchers aimed to explore whether CS injections are associated with increased rates of knee OA progression compared with hyaluronic acid injections that have not been associated with cartilage loss. The study team used data from two large cohort studies of people with knee OA who received either corticosteroid or hyaluronic acid injections and reviewed the rates of radiographic progression and total knee replacement surgery. The rate of total knee replacement surgery was greater among patients with a single exam in which they reported hyaluronic acid injection compared with those with a single exam in which they reported CS injection. There was no difference between patients reporting injections at multiple exams. Multivariable analysis showed similar rates of X-ray progression for both kinds of injection treatment at either single or multiple medical exams. The authors concluded that CS injections for knee OA were not associated with a higher rate of radiographic progression or progression to a total knee replacement compared with hyaluronic acid injections.

Rheumatic Diseases Associated With Worse COVID-19-Related Outcomes

Data are lacking on whether patients with systemic autoimmune rheumatic diseases (SARDs) experience more severe complications from COVID-19 infection than the general population. To shed light in this area, researchers conducted a matched cohort study of COVID-19 infection outcomes of patients with SARDs from a network of real-time electronic health records data on more than 52 million patients across 32 healthcare organizations between January 20 and June 1. Patients with SARDs were matched 1:1 by age, sex, and race/ethnicity with patients without SARDs. Patients with SARDs had higher rates of comorbidities than comparators, including hypertension, asthma, chronic kidney disease, and heart failure. When compared with those without SARDs, those with SARDs had higher risks of hospitalization (relative risk [RR], 1.23), intensive care unit admission (RR, 1.75), mechanical ventilation (RR, 1.77), acute kidney injury (RR, 1.83), and congestive heart failure (RR, 3.06). Although the mortality rate was numerically higher in patients with SARDs than in comparators, it did not reach statistical significance.