Holistic approach needed to address multimorbidity in RA
A greater multimorbidity burden in rheumatoid arthritis patients is not associated with the initiation of any new DMARD therapy, research shows.
However a US study found the multimorbidity burden was independently associated with lower odds of achieving target disease activity thresholds for those on a new therapy.
The retrospective study of more than 20,000 patients in the national Rheumatology Informatics System for Effectiveness (RISE) registry found hypertension and congestive heart failure were the most common coexisting conditions in patients with active RA.
“Recognising the rising prevalence of multimorbidity, these findings highlight the need for management strategies targeted at multimorbid patients with RA as well as comparative effectiveness and safety studies in multimorbid RA populations,” the study said.
“Risk-adjustment of quality measures that hold rheumatologists accountable for target disease activity measures in RA should also take multimorbidity into account.”
Hypertension and osteoarthritis link explored
A Review article in Nature Reviews Rheumatology has revisited the link between hypertension and osteoarthritis.
The Review notes that systemic hypertension leads to subchondral bone perfusion abnormalities and ischaemia, which disrupts angiogenic–osteogenic coupling and impairs the integrity of the bone–cartilage functional unit.
“At the molecular level, systemic activation of the renin–angiotensin, endothelin and Wnt–β-catenin signalling pathways induces a phenotypical change in articular chondrocytes and triggers cartilage degradation.”
The take-home message was that antihypertensive medications that exhibit chondroprotective effects in preclinical studies warrant further investigation in patients with osteoarthritis and systemic hypertension.
Specialists in isolation due to schools COVID-19 cluster
Hundreds of healthcare staff in Queensland including many senior doctors are being forced into isolation and unable to work because they are close contacts of their children attending schools affected by a COVID-19 cluster.
Chief Health Officer Jeannette Young said there were 400 Queensland Health employees now in isolation, including all cardiac surgeons at Queensland’s Children Hospital.
“Several senior doctors have confirmed the schools’ outbreak had potentially put about 50 per cent of surgeons in Brisbane into isolation as their children were attending schools associated with the COVID-19 cluster,” an ABC report said
Many of the healthcare staff are reported to have children among the 6,685 students at elite schools shut down as part of the so-called “Indooroopilly cluster” which includes Brisbane Grammar and Brisbane Girls Grammar School.
The isolation of healthcare staff and closure of hospital departments has forced patients to be diverted from Brisbane to Gold Coast hospitals.