Rheumatology Rundown: Vaccinations in JIA; RA and T2D; SLE Quality of Life

The latest news in rheumatology includes the need for robust vaccinations in juvenile idiopathic arthritis; new findings about rheumatoid arthritis (RA) and type 2 diabetes; and quality of life in systemic lupus erythematosus.

Lower Vaccine Antibody Levels Seen in Juvenile Idiopathic Arthritis

A recent study of children with juvenile idiopathic arthritis (JIA) illustrates the pressing need for continued routine vaccinations. A report in Rheumatology Network found that these patients were more likely to have lower anti-vaccine antibody levels due in part to incomplete vaccination, arthritis, and immunosuppressive drugs like biologics and methotrexate; many patients stop the vaccinations at diagnosis despite their safety and efficacy. The study, published in Pediatric Rheumatology, analyzed 170 children, aged 2 to 17 years with JIA, who had received routine vaccinations, including measles, rubella, mumps (MMR), diphtheria, and hepatitis B. Patients were divided into 2 categories: complete and incomplete vaccination. Incomplete vaccination was defined as having fewer vaccines or doses by age. Post-vaccination antibodies (IgG) were measured using ELISA.

The study found that protective levels of antibodies for those with incomplete vaccinations ranged from 50% for hepatitis B, 52% for diphtheria, 58% for measles, 80% for mumps, and 98% for rubella.

Fifty patients did not achieve a complete vaccine dosing schedule against MMR. Among those, 39% were treated with biologics, 22% with methotrexate, and 14% with nonsteroidal anti-inflammatory drugs.

When comparing patients with complete and incomplete vaccinations, those with incomplete status had a lower level of antibodies against mumps and diphtheria; treatment with methotrexate and biologics were strong indicators of diphtheria revaccination omission. Incomplete vaccination was also a risk factor for nonprotective levels of antibodies against measles.

Study Highlights Need for Cardiovascular Disease Prevention in RA, T2D

In patients with rheumatoid arthritis (RA) with type 2 diabetes (T2D), the use of cardiovascular disease (CVD) medication and prevalence of atherosclerotic cardiovascular disease (ASCVD) were doubled compared with patients with RA who did not have T2D, according to a Rheumatology Network report.

Both RA and T2D are historically associated with increased risk of ASCVD. The findings of the global study suggested that increased awareness of ASCVD is needed as patients with both conditions more frequently reached lipid targets compared with patients with RA without T2D.

Patients With Lupus, Cardiovascular Autonomic Neuropathy Report Lower QOL

Patients with systemic lupus erythematosus (SLE) had more self-reported cardiovascular autonomic neuropathy, along with impaired health-related quality of life (QOL) and parasympathetic function, when compared with a control group that had cardiovascular autonomic neuropathy but not SLE, according to a report published in Rheumatology Network.

The relationship of autonomic dysfunction as it relates to QOL has been studied in other diseases but not in SLE, the report said. In this study, a bit more than half of patients with SLE presented with signs of autonomic dysfunction, characterized mostly by parasympathetic impairment and in more severe cases by sympathetic impairment. Even without cardiovascular autonomic neuropathy, patient with SLE had impaired parasympathetic function. The finding adds credence to evidence of autonomic dysfunction as a distinct disease mechanism in SLE that may suggest new targets for therapies.