News in brief: Paradigm shift needed in assessment of PMR patients; Anakinra repurposed to prevent chemo-induced inflammation; Medical acronyms mystify patients

19 May 2022

Paradigm shift needed in assessment of PMR patients

More than a quarter of patients with polymyalgia rheumatica (PMR) may have subclinical giant cell arteritis (GCA) at diagnosis, a study suggests.

A Swiss-led meta-analysis of data from 566 patients with PMR that included contributions from rheumatologists at Austin Health, Melbourne, found a pooled prevalence of subclinical GCA of 23% for any screening method and 29% in studies using PET.

The dataset could not identify a marker for subclinical GCA, and classical inflammatory parameters such as ESR and CRP were not associated with subclinical GCA, the review found.

The study authors said the findings showed that “a paradigm shift in the assessment of PMR patients in favour of implementing imaging studies should be discussed.”

“Due to the high prevalence of subclinical GCA at PMR diagnosis, the role of routine imaging for GCA warrants discussion. Although PET/CT has been most often used, other modalities such as CT, ultrasound, or MRI, each with its specific advantages and disadvantages, are available for this purpose,” they wrote in the journal Seminars in Arthritis and Rheumatism

Anakinra repurposed to prevent chemotherapy-induced inflammation

The arthritis drug anakinra could be repurposed to prevent the intestinal mucositis that leads to infections and fever in patients receiving blood cancer therapies, Australian researchers say.

A team at the Supportive Oncology Research Group at the South Australian Health and Medical Research Institute (SAHMRI), Adelaide, says the interleukin (IL-1) receptor antagonist may have a role in reducing antibiotic use in haematology patients in whom chemotherapy causes intestinal inflammation and subsequent breakdown of the mucosal barrier, permitting translocation of enteric pathogens.

In animal studies they showed that mucosal barrier injury induced by the mucotoxic chemotherapeutic agent, high-dose melphalan (HDM) was characterised by hyper-active IL-1b/CXCL1/neutrophil signalling. Inhibition of this pathway with anakinra minimised the duration and intensity of mucosal barrier injury and accompanying clinical symptoms, including diarrhoea, weight loss and fever.

Co-author and consultant haematologist Professor Nicole Blijlevens, said a greater understanding of where infections originated led to finding alternative solutions to controlling bacteria.

“While we used to think infections predominantly came from external sources like hospital surfaces and equipment, we now know that they mainly come from inside the person’s gut,” she said.

“This has refocused our attention to how we can prevent these bacteria from moving from the gut to the blood.

“We showed that this drug – which is usually used to control rheumatoid arthritis – was not associated with any adverse events in people undergoing high dose chemotherapy.

“For decades, we have relied on antibiotics to prevent infection, but this new work suggests there may be alternatives to minimise our reliance on antibiotics.

Their study has been published in Scientific Reports.

Medical acronyms mystify patients

As more patients are accessing their electronic medical records, many fail to comprehend basic medical abbreviations and acronyms, a study has found.

Comprehension of common abbreviations such as ‘HTN’ (hypertension) and ‘MI’ (myocardial infarction) remained below 40%, much lower than clinicians estimated, a survey conducted at three US hospitals found.

The survey of 60 patients found that most understood terms such as hrs (hours) and BP (blood pressure) but only two thirds knew what ED meant and as few as 20% comprehended terms such as hx (history) and HF (heart failure).

Researchers at the Department of Biomedical Informatics, Columbia University, New York, said clinicians should not assume that patients will understand even the most basic medical abbreviations. Automated text programs that convert and spell out acronyms in notes may help overcome misunderstanding of some medical abbreviations, they suggested.

The findings are published in JAMA Network Open.

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