[Vol 35] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 351. Increases diabetes risk associated with rheumatoid arthritis: Study

A new study shows that rheumatoid arthritis (RA) is associated with a 23 percent increased risk of type 2 diabetes (T2D), and may indicate that both diseases are linked to the body’s inflammatory response. Inflammation has emerged as a key factor in the onset and progression of T2D, and RA is an autoimmune and inflammatory disease. The team suggests that the systemic inflammation associated with RA might therefore contribute to the risk of individuals developing diabetes in the future. The team conducted a comprehensive search of a range of medical and scientific databases up to March 10, 2020, for cohort studies comparing the incidence of T2D among people with RA to the diabetes risk within the general population. The authors of the study said, “This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes. We suggest that more intensive screening and management of diabetes risk factors should be considered in people with rheumatoid arthritis. Agents that reduce systemic inflammatory marker levels may have a role in preventing type 2 diabetes. This may involve focussing on more than one pathway at a time.”

2. T cells of the immune system play a major role in reducing covid-19 severity: Study

Vaccine candidates for COVID-19 should elicit a broad immune response that includes antibodies, and the body’s helper and killer T cells, according to a study which says weak or uncoordinated immunity may lead to a poor disease outcome. Study senior author Shane Crotty from the La Jolla Institute for Immunology in the US said, “Our observations could also explain why older COVID-19 patients are much more vulnerable to the disease.” The research, published in the journal Cell, confirms that a multi-layered, virus-specific immune response is important for controlling the novel coronavirus during the acute phase of the infection and reducing COVID-19 disease severity. Shane Crotty further added, “With increasing age, the reservoir of T cells that can be activated against a specific virus declines and the body’s immune response becomes less coordinated, which looks to be one factor making older people drastically more susceptible to severe or fatal COVID-19.” The study’s co-author Sydney Ramirez further said, “It was particularly important to us to capture the whole range of disease manifestation from mild to critically ill so we could identify differentiating immunological factors.” Carolyn Moderbacher, another co-author of the study from La Jolla Institute for Immunology further added, “When we looked at a combination of all of our data across all 111 measured parameters we found that in general, people who mounted a broader and well-coordinated adaptive response tended to do better. A strong SARS-CoV-2 specific T cell response, in particular, was predictive of milder disease. Individuals whose immune response was less coordinated tended to have poorer outcomes.”

3. Targeted Treatment linked to longer survival in anaplastic thyroid cancer patients

According to a new report, with the introduction of targeted treatments for anaplastic thyroid carcinoma, patients have seen significant improvements in survival. Dr. Maria E. Cabanillas of The University of Texas MD Anderson Cancer Center, in Houston told a leading medical journal that, “Over the last 5 years, a greater understanding of the molecular genetics of anaplastic thyroid cancer has led to more personalized treatment strategies, which has greatly improved survival in these patients.” She and her colleagues examined data on 479 patients who were treated at their institution between 2000 and 2019. The patients’ median age was 65 years, and at presentation 11% were stage IVA, 36% were stage IVB and the remaining 53% were stage IVC. Overall survival at one year in the 227 patients treated between 2000 and 2013 was 35%, dropping to 18% at two years. For the 100 treated between 2014 and 2016, survival was 47% and 25%, respectively, and for those treated between 2017 and 2019, 59% and 42%. The researchers noted, “Recent work has demonstrated feasibility of complete resection and locoregional disease control when patients with BRAF V600E-variant tumors undergo surgical resection following neoadjuvant BRAF-directed therapy.” Dr. Cabanillas concluded by saying, “With this largest single-institution study, we have demonstrated that rapid molecular genetic tumor testing, personalized targeted therapies, immunotherapy, and surgery, can revolutionize the landscape of a disease that only a few years ago was considered untreatable and rapidly fatal.”

4. Severe stress linked to doubling the risk of dementia

New research shows that posttraumatic stress disorder (PTSD) is associated with up to a twofold increased risk of dementia. Researchers found that individuals with PTSD had a 61% higher risk of dementia, and pooled data from two particular studies showed that PTSD was associated with a doubling of dementia risk. Senior investigator Vasiliki Orgeta, PhD, associate professor, Division of Psychiatry, University College of London, UK, said, “These results provide important new evidence of how traumatic experience can impact brain health and how the long-term effects of trauma may impact the brain in many ways, increasing vulnerability to cognitive decline and dementia. Our study allows us to conclude for the first time that PTSD is a strong and potentially modifiable risk factor for dementia. Dementia is one of the greatest global health challenges and given that there is no cure for dementia, there’s an urgent need to identify modifiable risk factors to prevent or delay the onset of dementia.” To investigate whether a PTSD diagnosis was associated with an increased risk of dementia, the investigators analyzed findings from 13 studies conducted on four continents. Participants ranged in age from 51 to 73.6 years. A total of seven studies focused on veterans, five focused on the general population, and one study focused on refugees from war. Follow-up time ranged from 1 to 17 years. Dr Ortega further added, “This finding may point to a treatment effect since veterans are typically more likely to receive treatment for PTSD, at least in the countries where the studies were conducted, so the findings do suggest that treating PTSD may potentially reduce subsequent dementia risk. Concern about long-term consequences of PTSD might be relevant in patients hospitalized with COVID-19, which is a life-threatening condition.”

5. Aspirin may help for primary prevention of CVD in Rheumatic Diseases

Low-dose aspirin may be considered for the primary prevention of cardiovascular disease (CVD) in patients with autoimmune systemic rheumatic diseases who are at particularly high risk because of their individual cardiovascular risk profile, according to authors of a new review article in the journal Rheumatology. Secondary prevention with daily, low-dose aspirin is part of aggressive, comprehensive risk modification in patients who have experienced an MI or stroke or are considered at high risk for CVD. The authors stated that, “This review is devoted to reporting the present knowledge on the effectiveness of low-dose [aspirin] in primary CV prevention in a number of autoimmune systemic rheumatic diseases, not a systematic review or meta-analysis. We are not claiming to have covered more than a selection of the literature for each disease. Available data are not high-quality data and do not provide firm conclusions.” The authors focused primarily on accelerated, rather than spontaneous, atherosclerosis or buildup of plaque in artery walls, implicated in ischemic heart diseases such as MI and ischemic cerebrovascular diseases such as stroke. They looked at its association with autoimmune rheumatic diseases, primarily systemic lupus erythematosus (SLE) and RA, but also including antiphospholipid syndrome, systemic sclerosis, mixed connective tissue disease, dermatomyositis/polymyositis, primary Sjögren’s syndrome, and systemic vasculitis. Dr. Husni recommended keeping an open mind regarding individual approaches – for example, low-dose aspirin plus statins. She further added, “That kind of complexity in decision-making highlights the need for co management with a cardiologist. I’m a big believer in co management. At my multidisciplinary medical center, I am able to pick up the phone and talk to a cardiologist with whom our group has a relationship.”

6. Vitamin D may help lower risk for immunotherapy-induced colitis

A new study shows that taking vitamin D before starting immune checkpoint inhibitor (ICI) therapy may decrease the risk for treatment-related colitis. Senior author Osama Rahma, MD, said in a press release. Rahma is an assistant professor of medicine at Harvard Medical School, in Boston, Massachusetts said, “Our findings of a link between vitamin D intake and reduced risk for colitis could potentially impact practice if validated in future prospective studies. Vitamin D supplementation should be tested further to determine if it could be a safe, easily accessible, and cost-effective approach towards preventing immunotherapy’s gastrointestinal toxicity and extending the effectiveness of immune checkpoint inhibitor treatment in cancer patients.” They work by blocking either of two immune checkpoints, CTLA-4 or PD-1/PD-L1. This enhances the ability of the immune system to recognize and attack cancer cells. The problem is that blocking these checkpoints can unleash serious inflammatory reactions and immune-related adverse events, which can limit therapy. Patients who receive CTLA-4 blocking therapy or combined ICI therapy are more likely to develop colitis than those taking PD1/PD-L1 blockers alone. Jeffrey Weber, MD, PhD said, “The Harvard system is big enough to justify an inpatient hospital service dedicated to immune-related adverse events from checkpoint inhibitors. There are very few places in the US that could do a study like this. Most institutions wouldn’t have enough patients. These are preliminary data, but I think it’s good work that will provoke some serious thought. It provides grist for the mill for future research.”

Reference links:

  • https://health.economictimes.indiatimes.com/news/diagnostics/rheumatoid-arthritis-associated-with-23-pc-increased-risk-of-diabetes-study/78229088
  • https://health.economictimes.indiatimes.com/news/industry/immune-systems-t-cells-play-bigger-role-in-reducing-covid-19-severity-study/78179507
  • https://www.medscape.com/viewarticle/936044
  • https://www.medscape.com/viewarticle/937822#vp_2
  • https://www.medscape.com/viewarticle/937809
  • https://www.medscape.com/viewarticle/933301#vp_2

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