News in brief: Pregnancy outcomes worse in PsA patients; Program to stop imaging for low back pain; Antivax beliefs increased by conservative media exposure

Thursday, 28 Oct 2021

Pregnancy outcomes worse in PsA patients

Psoriatic arthritis (PsA) patients with higher disease severity may have a greater risk of preterm birth and caesarean delivery than those without PsA, according to a Swedish study.

The study, which reviewed pregnancy outcomes in 921 PsA patients who were judged to have more severe disease based on drug prescriptions, versus 9,210 women without PsA, found PsA patients were more likely to be obese, smokers, and diagnosed with gestational hypertension and diabetes.

They also had increased risks of preterm birth (adjusted odds ratio [aOR]: 1.69) and caesarean delivery (aOR: elective, 1.77 vs emergency, 1.42).

While the study attempted to look at the effect of treatment and treatment timing on pregnancy outcomes, Redcliffe and Northside Rheumatology Consultant Rheumatologist Dr Laurel Young, who was not involved in the study, told the limbic readers can’t take much from the analysis, given the reliance on prescription data and lacking information about disease activity, which treatments were actually taken, when they were taken and for how long.

“[The study] just shows, like every other study in rheumatoid arthritis or lupus, that if you have bad activity in pregnancy, you potentially have a worse pregnancy outcomes,” Dr Young said.

“I don’t think you should take away from it that, say, if you’re on a biologic, you have a higher risk of preterm birth compared to other drugs, and therefore, don’t use biologics. You can’t make that conclusion from it.”

She stood by advice for rheumatoid arthritis and lupus, where patients should “have best controlled disease” and said it applied to PsA pregnancies.

“When you’ve got PsA pregnancies, you’re better off having a well controlled mother to have the best outcome for the baby,” she said.

The full study is available in Arthritis and Rheumatology.

Program aims to discourage imaging for low back pain

A feedback program for GPs to discourage the ordering of imaging for low back pain in primary care is being run NPS MedicineWise program supported by groups such as the Australian Rheumatology Association.

GPs are being sent letters showing how their rates of referrals for lumbosacral X-rays and CT scans have changed over time and how they compare with local peers.

The Practice Review program is based on Choosing Wisely campaign and evidence showing that 90–95% of low back pain presentations are non-specific and do not require imaging unless there are ‘red flags’.

The program includes educational resources that support GPs in advising patients that imaging is unlikely to find the reason for their ow back pain and to focus instead on keeping active.

A Low Back Pain Clinical Care Standard from the Australian Commission on Safety and Quality in Health Care will be launched in 2022 to support primary care management of low back pain.

Conservative media promote antivax and anti-mask beliefs: study

People who rely on conservative media outlets are more likely to accept conspiracy theories about the COVID-19 pandemic and less likely to accept pandemic mitigation measures such as mask-wearing and vaccination, a US study has found.

A national survey of 883 people running from March to November 2020 found that users of conservative media such as Fox News initially supported vaccination and trusted the Center for Disease Control (CDC) advice at the outset of the study, but continued exposure to conservative media reduced support for both. People who were exposed to conservative media displayed increasing belief in pandemic conspiracies which were associated with reduced support for pandemic prevention measures. In contrast, users of mainstream media sources showed enhanced trust in preventive behaviour and in public health authorities across the pandemic, and did not exhibit change in pandemic conspiracy beliefs over time, but heavy users of conservative media remain largely impervious to these influences.

“The selective use of these media enhances belief in conspiracies that pose challenges to the country’s ability to control a public health crisis such as the COVID pandemic,” the study authors concluded in Social Science and Medicine.

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