Rheum Round-up: COVID-19 Vaccine Doctor Ousted over Hydroxychloroquine, Gout and Heart Failure, and more

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about the allegations that a federal doctor made regarding his termination, cardiac risks in older gout patients, vitamin D and high tibial osteotomy, and tranexamic acid use in total joint arthroplasty.

The doctor who was in charge of the agency doing research for a COVID-19 vaccine said he was dismissed because he challenged President Donald Trump’s claims that hydroxychloroquine was a proven promising treatment for the virus, according to a report. “Rick Bright was abruptly dismissed this week as the director of the Department of Health and Human Services’ Biomedical Advanced Research and Development Authority, or BARDA, and removed as the deputy assistant secretary for preparedness and response. He was given a narrower job at the National Institutes of Health,” The New York Times reported, noting that Dr. Bright obtained his PhD in immunology and molecular pathogenesis from Emory University.

Older adults with gout may be at risk for heart failure (HF), according to a study. Previous research has identified an increased risk for coronary heart disease (CHD) and stroke in this patient population, but fewer have assessed HF risk, the study authors observed. Median follow-up was 10 years, during which time incidence rates per 1,000 person-years among patients with and without gout were 13.1 and 4.4 for HF hospitalization, 16.0 and 9.3 for CHD, 9.3 and 8.2 for stroke, and 55.0 and 37.1 for all-cause mortality, respectively. When adjusting for sociodemographic variable and cardiovascular risk factors, the hazard ratio (HR) for patients with versus without gout for HF hospitalization was 1.97. The HR for CHD was 1.21, for stroke was 0.83, and for all-cause mortality was 1.08. Upon multivariable-adjusted analysis, the HR for HF hospitalization with reduced and preserved left ventricular ejection fraction in patients with versus without gout was 1.77 and 2.32, respectively. In the cohort of Medicare beneficiaries, the multivariable-adjusted HR for HF hospitalization associated with gout was 1.32.

High tibial osteotomy (HTO) patients with preoperative vitamin D deficiency may have poorer postoperative functional outcomes, according to new research. This retrospective study registered data on 209 HTO patients (327 knees) treated by a single surgeon; 94 patients (94 knees) were ultimately analyzed. Patients were stratified into two groups based on preoperative serum vitamin D level: deficiency, defined as 20 ng/mL (group D; n=48); and sufficient, defined as ≥20 ng/mL (group S; n=46). Mean postoperative mechanical alignment was valgus 3.3 degrees in group D and 2.7 degrees in group S, which the researchers said was not a statistically significant difference; angle correction was also not largely different between the groups. Preoperatively, groups S and D had similar International Knee Documentation Committee (IKDC) scores, but postoperatively, group S had a significantly higher IKDC score than group D (53.3 vs. 45.8; P=0.012); group S also had a much higher difference between pre- and postoperative IKDC scores than group D (21.4 vs. 14.0; P=0.006). There was not a large association between serum vitamin D level and preoperative IKDC score, and a weak relationship was observed between serum vitamin D level and postoperative IKDC score. Serum vitamin D level was weakly associated with postoperative improvement of IKDC score.

Patients with rheumatoid arthritis (RA) undergoing total joint arthroplasty (TJA) have a greater likelihood of requiring transfusion compared to osteoarthritis patients. Although tranexamic acid (TXA) is commonly used to reduce blood loss in TJA patients, transfusion rates in RA patients undergoing lower extremity TJA who receive TXA have not largely been studied. A retrospective study analyzed this correlation and found that TXA did not largely affect postoperative transfusion in this patient population. Final analysis included 252 patients; the majority of patients were women with longstanding disease and end-stage arthritis. Multivariate analysis identified the following factors correlated with greater transfusion risk: one g/dl decrease in baseline hemoglobin (odds ratio [OR]=0.394; 95% confidence interval [CI], 0.232t to 0.669; P=0.001), one-minute increase in surgical duration (OR=1.022; 95% CI, 1.008 to 1.037; P=0.003), and one-point increase in Clinical Disease Activity Index (OR=1.079; 95% CI, 1.001 to 1.162). TXA use did not decrease the risk of postoperative transfusion.