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Background and Aims

The association between environmental air pollution and osteoporosis is unclear. The aim of the present study is to determine the association between osteoporosis and air pollution.

Methods

We conducted a retrospective analysis of a nation-wide cohort (DeFRACalc79 database). DeFRACalc79 is a tool that estimates the fracture risk considering clinical and densitometric risk factors. Data on daily air pollution concentrations were retrieved from the ISPRA Institute (Italian institute for air quality). Associations between continuous variables were tested using Pearson correlation coefficients for normally distributed variables or Spearmen rank test for non-normally distributed tests and binary logistic regressions.

Results

59,950 women (mean age 65.1 years, SD 10.9 years) were included in the study. Exposure to pollutants (particulate matter [PM] less than 10 μm and PM less than 2.5 μm) was estimated based on more than 3,000,000 daily measurements (urban, industrial, and rural zones) from 2013 to 2019. We found a significant negative association between femoral neck BMD and air pollution exposure (unadjusted ρ -0.032 for PM 10 and ρ-0.056 for PM 2.5, p<0.0001). The adjusted model (binary logistic regression including covariates such as age, BMI, glucocorticoid intake and comorbidities) showed that every 1 μg/m3 increase in PM 10 the risk of osteoporosis at any site increased by 0.05% and every 1 μg/m3 increase in PM 2.5 the risk of osteoporosis at any site increased by 1.0% Patients exposed to PM10 >30 μg/m3 had a 15% increased risk of having osteoporosis (aOR 1.15 95%CI 1.14-1.19).

Conclusions

Air pollution is associated with an increased risk of osteoporosis.

Background and Aims

With the rapid spread of the SARS-COV2 virus, the government of Singapore is pushing for mass vaccination.

During the last 2 months, we have been seeing an increasing number of patients with arthritis flares after the Pfizer BioTech COVID-19 vaccine. Vaccine-induced arthritis is part of the ASIA syndrome.

We report our experience with 22 patients who developed arthritis flares after the COVID-19 vaccination.

Methods

We collated all our patients who developed inflammatory arthritis after COVID-19 vaccination from March to May 2021.

The patients were selected if they developed arthritis after the first or second dose of the vaccine within 4 weeks of the dosing, and the patients had no previous arthritis history or were in remission or stable disease for at least 3 months prior to receiving the COVID-19 vaccination.

Results

Racial distribution: 18 Chinese, 2 Indian, 1 Filipino 1 British..

Age ranged from 45-85 years, mean age of 59 years.

Diagnosis: Rheumatoid arthritis (RA) flare – 10, Osteoarthritis flare – 5, Gouty arthritis flare -4, Pseudogout flare - 1 De novo oligoarthritis – 2.

Flare Characteristics::Mild – 4, Moderate – 12, Severe – 6

Monoarticular – 12 Oligoarticular – 4 Polyarticular – 4

Flare after 1st dose: 10 Flare after 2nd dose: 10 Recurrent Flare after Both doses: 2

Time to Onset of flares: 1- 27 days.

Conclusions

With widespread COVID-19 vaccination, ours is the largest series of series of post-vaccination rthritis flares. The BNT162b2 mRNA vaccine seems to reprogram both the body’s adaptative and innate immune responses, More observational studies are needed.

Background and Aims

Concerns were raised whether patients with connective tissue diseases (CTD) can mount a protective immune response to mRNA vaccines against SARS CoV2 and whether the vaccination may trigger a flare up of the CTD.

Our aims were to assess the impact on CTD activity and the humoral response to 2 doses of mRNA vaccine against SARS CoV2, in CTD patients treated with immunomodulating drugs.

Methods

Consecutive 90 CTD patients treated at our rheumatology institute who received their first SARS-CoV-2 (Pfizer) vaccine were recruited to the study. They were reassessed 4-6 weeks after receiving the second dose of vaccine and blood samples were obtained for serology. CTD activity assessment and the vaccine side effects were documented during both visits. Neutralizing IgG Antibodies (Ab) against the spike receptor-binding domain of SARS COV2 virus were detected using the SARS-Cov-2 IgG II Quant (Abbott) assay.

Results

The cohort included 51systemic sclerosis patients, 24 with lupus, 9 with myositis, 3 with Sjogren and 3 with mixed CTD ((mean age(SD) 55(14), disease duration 9.4(5.7)). The immunomodulatory treatment was continued. 69 % received csDMARDs, 35% biological DMARDs, 18% combined therapy (csDMARDs+bDMARDs) and 42% steroids. 72 patients (80%) mounted a significant humoral response (median(IQR) 3738.5(80-40000)AU/ml). The humoral response was influenced only by the type of treatment (especially rituximab). The CTD remained stable.

Conclusions

The vast majority of CTD patients developed a significant humoral response to 2 doses of the Pfizer mRNA vaccine against SARS CoV2 virus. Only minor side effects were reported, no apparent impact on CTD activity was noted.