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Medscape
a day ago
- Health
- Medscape
‘Enormous Burden' Cataloged in Relapsing Polychondritis
A large multicenter prospective cohort study has expanded 'the understanding of the range of manifestations of disease in patients with relapsing polychondritis [RP]' — particularly involving the ear, nose, throat, and musculoskeletal systems — as well as a high prevalence of organ damage, near-universal use of glucocorticoids, and frequent use of additional nonbiologic or biologic immunomodulatory therapies. METHODOLOGY: Researchers conducted a multicenter cohort study between 2017 and 2023 to evaluate clinical manifestations, treatment approaches, and the association between them in 195 patients with RP (median age, 48 years; 85.6% women). A diagnosis of RP was confirmed using comprehensive laboratory, radiographic, and other tests; all participants tested negative for proteinase 3 and myeloperoxidase. Data on clinical manifestations, organ damage, and medication history were collected at baseline study visits using standardized case report forms. Patients were grouped by treatment: Group 1 received glucocorticoids or no drugs, group 2 received nonbiologic immunosuppressive drugs (excluding JAK inhibitors) with or without glucocorticoids, and group 3 received JAK inhibitors or biologic drugs with or without nonbiologic immunosuppressives or glucocorticoids. TAKEAWAY: All patients presented with at least three clinical manifestations of RP, with a median of 11 manifestations per patient; all showed ear, nose, or airway involvement, and 83% had musculoskeletal manifestations. A substantial portion of patients (41%) developed organ damage, including sensorineural hearing loss (25%), auricular and saddle nose deformities (12% each), and subglottic stenosis (9%); among those who underwent dynamic CT of the chest, 31% had tracheomalacia, and 20% had bronchomalacia. Treatment groups 1, 2, and 3 comprised 19%, 28%, and 53% of patients, respectively; most patients (95%) received glucocorticoids, and a substantial proportion (81%) received additional immunomodulatory treatments. Patients in treatment group 3 had the highest rate of organ damage (62% vs 22% in group 2 and 15% in group 1) and were more likely to have arthritis and stenosis, whereas those in group 1 were less likely to experience nose pain. IN PRACTICE: 'Standardized assessment of disease activity is warranted for patients with RP for early detection and timely initiation of treatment. These findings also highlight the absence of a consensus approach to treatment for patients with RP and underscore the need for clinical trials and treatment guidelines in this disease to help reduce the enormous burden of disease for patients,' the authors wrote. SOURCE: This study was led by Roger Yang, MD, University of Pennsylvania, Philadelphia, and University of Montreal, Montreal, Quebec, Canada. It was published online on May 20, 2025, in ACR Open Rheumatology . LIMITATIONS: This study did not capture data on dose and duration of immunomodulatory medications or clinical features at treatment decisions. Treatment choices were made independently by clinicians and may have been influenced by factors such as drug availability or insurance, introducing variability. Moreover, the academic referral setting may have contributed to selection bias. DISCLOSURES: Two authors reported receiving support from the Vasculitis Clinical Research Consortium, Association des médecins rhumatologues du Québec, Institute for Translational Medicine and Therapeutics, and other sources. This research was also supported by the Relapsing Polychondritis Foundation and other generous donors to the Penn Relapsing Polychondritis Program.
Medscape
16-05-2025
- Health
- Medscape
Age Matters in Gallbladder Surgery Success
Undergoing cholecystectomy at a younger age (< 40 years) was associated with higher long-term mortality, potentially influenced by higher alcohol use and smoking. METHODOLOGY: This nationwide Swedish cohort study examined the long-term mortality outcomes after cholecystectomy in 159,946 adults (62.2% men) aged 20-79 years who underwent the procedure between 1969 and 2016. The patients were matched with 764,681 (62% men) control individuals from the general population who did not have gallbladder disease or undergo cholecystectomy. Information on deaths and comorbidities was obtained from national registers. The participants were followed for a median of 12 years. TAKEAWAY: During the follow-up period, 38,401 deaths were reported in the cholecystectomy group, whereas 181,197 deaths occurred in the control group (adjusted hazard ratio [aHR], 0.91; 95% CI, 0.90-0.92), indicating a lower mortality risk after surgery. Cholecystectomy was associated with higher overall mortality in individuals aged 20-39 years (aHR, 1.42; 95% CI, 1.32-1.53) and those aged 40-49 years (aHR, 1.07; 95% CI, 1.02-1.13). Among the 1015 patients who underwent the surgery between the ages of 20 and 39 years and died during the follow-up period, alcohol-related diseases (12.2%) and smoking-related disorders (7.4%) were notably common. The risk for overall mortality was slightly reduced in patients older than 50 years at the time of cholecystectomy. IN PRACTICE: "Future studies are needed to investigate mechanisms of higher mortality among younger participants with cholecystectomy, and to identify measures to prevent these excess deaths in the population, our study suggests that obesity may be an important risk factor to target in this patient group," the authors wrote. SOURCE: This study was led by Louise Emilsson, Institute of Health and Society, University of Oslo, Oslo, Norway. It was published online on May 09, 2025, in Clinical Gastroenterology and Hepatology. LIMITATIONS: The study was limited by its inability to adjust for postmenopausal hormone use and potential residual confounding from factors such as body mass index, diet, and alcohol consumption. Additionally, it could not differentiate between gallstone types or classify surgeries as elective or acute. Furthermore, with a predominantly European ancestry among participants, the findings require validation in non-European populations. DISCLOSURES: The study was supported by grants from FORTE. One author disclosed receiving financial support, being involved in other research collaborations, and coordinating other studies, with ties to pharmaceutical companies. Another author declared being an employee and stockholder of a pharmaceutical company.
Medscape
14-05-2025
- Health
- Medscape
Study Links Pre-COVID Lung Health to Severe COVID-19 Risk
In a large US cohort study, pre-pandemic severe obstructive lung function, as measured by spirometry, was linked to more than a twofold increased risk for severe COVID-19. METHODOLOGY: Researchers analyzed the association of pre-pandemic measures of lung function and structure with the risk for severe COVID-19 using data from 11 prospective US population-based cohorts. Overall, 29,323 participants (mean age, 67.1 years) with valid pre-pandemic lung function and incident COVID-19 data were followed up for a median of 17.3 months from March 1, 2020. Pre-pandemic spirometry data were used to classify lung function: Normal physiology (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio ≥ 0.70 and FVC ≥ 80% of the predicted value). Obstructive physiology (FEV1/FVC ratio < 0.70) and severe obstruction (FEV1 < 50% of the predicted value). Restrictive physiology (FEV1/FVC ratio ≥ 0.70 and FVC < 80% of the predicted value). Structural abnormalities, including emphysema and interstitial lung abnormalities such as lung distortion, honeycombing, traction bronchiectasis, nonemphysematous cysts, and ground-glass or reticular opacities, were assessed on CT scans. The primary outcome was severe COVID-19 (COVID-19 leading to hospitalization or death), and the secondary outcome was nonsevere COVID-19 (SARS-CoV-2 infection not requiring hospitalization). TAKEAWAY: Severe obstructive physiology and restrictive physiology were associated with an increased risk for severe COVID-19 compared with normal spirometry, with adjusted hazard ratios (aHRs) of 2.11 (95% CI, 1.36-3.27) and 1.40 (95% CI, 1.12-1.76), respectively. The risk for severe COVID-19 was 1.64-fold higher risk among those in the highest quartile than among those in the lowest quartile of percent emphysema (95% CI, 1.03-2.61). Higher pre-pandemic FEV1 and FVC levels and being in the highest quartile of percent high attenuation areas (indicative of interstitial lung disease) were associated with an increased risk for nonsevere COVID-19. COVID-19 vaccination was associated with a reduced risk for severe disease across all lung function and structure categories (aHR, 0.19-0.50; P for interaction > .30). IN PRACTICE: 'These findings support enhanced COVID-19 risk mitigation, including COVID-19 vaccination, for individuals with impaired lung health,' the authors wrote. SOURCE: This study was led by Pallavi P. Balte, MBBS, PhD, Division of General Medicine, Columbia University Irving Medical Center, New York City. It was published online on April 16, 2025, in American Journal of Respiratory and Critical Care Medicine . LIMITATIONS: This study primarily collected data during the pre-Omicron period, limiting the generalizability of the findings to current variants. Additionally, some cohort studies recruited participants who were healthier than average, while others oversampled individuals with disease, affecting population representativeness. DISCLOSURES: This study was supported by a grant from the National Heart, Lung, and Blood Institute; reported receiving co-funding from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging; and reported receiving additional funding from the American Lung Association. Six authors reported having financial ties with various pharmaceutical companies and research organizations.
