Co-morbidity burden for kids with JIA
A novel study involving over eight-thousand children and young people (CYP) with juvenile idiopathic arthritis (JIA) has found similar rates of comorbidities across Europe.
The study, published in Rheumatology, carried out a parallel analysis in three of the largest JIA registries in Europe to determine the occurrence of uveitis, macrophage activation syndrome (MAS), varicella (and herpes zoster) infection, and tuberculosis (TB).
The three registries – the UK JIA Biologic Registers, the German Biologic Registers BiKeR (biologics in pediatric rheumatology) and JuMBO (Juvenile Arthritis Methotrexate/Biologics Long-Term Observation, and Pharmacovigilance in JIA (Pharmachild) – all report history of comorbidities at registration.
Patients with a history of uveitis, MAS, or TB when they joined the registers were excluded from incidence analyses. Separate rates were recorded for varicella infection and herpes zoster infections, and all patients were included regardless of varicella vaccination (VZV) history or a well-noted history of varicella infection.
Reassuringly, the prevalence of most comorbidities at registration were similar across the studies: 13%-19% had a history of uveitis, while 0-1.5% had ever had TB.
However, there were differences in the proportion of systemic-JIA patients who had a history of MAS (4%-24%).
Shingles risk with upadacitinib
Upadacitinib patients have a greater risk of developing shingles than those on adalimumab and/or methotrexate, a review of clinical trial data has found.
The study, which reviewed 5,306 patients across six randomised phase III trial trials, found the herpes zoster (HZ) incidence rate per 100 patient-years was 3.0 and 5.3 in 15 mg and 30 mg upadacitinib users respectively. It was only 0.8 and 1.1 in those on methotrexate alone or with adalimumab, however, the authors wrote in Annals of the Rheumatic Diseases.
Patients from Asia and those with a history of HZ may also be at increased shingles risk while on upadacitinib, they found.
As with other JAK inhibitors, the majority of shingles cases in upadacitinib patients were “non-serious and involved a single dermatome”, the authors wrote.
The study “provides further support for the need for continued vigilance and monitoring for signs of HZ in patients receiving UPA, particularly in Asian populations and those with a history of HZ”, they concluded.
Patient communication suffers if physicians can’t mentally multitask
Patient communication tends to be less satisfactory in specialties in which physicians must use diagnostic reasoning during patient encounters, an Australian study has found.
Physicians have more ‘cognitive busyness’ and must mentally multitask more than specialists such as surgeons whose encounters are more focused on procedures, according to according to Queensland researchers who analysed communication ratings for 67 doctors across various specialties.
They said their findings suggested that patient communication may be relegated to a secondary task and the news of an adverse finding may be less well accepted from physicians than from a procedural specialist who was not distracted by cognitive multitasking.
Possible solutions included having separate consultations for making and conveying a diagnosis or taking a break during a consultation before delivering the diagnosis, they suggested in Internal Medicine Journal.