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IVIG has been widely used for dermatomyositis but with limited evidence-based support. In a 16-week randomized trial, the percentage of patients with improvement was greater with IVIG than with placebo.

Adult-onset idiopathic inflammatory myopathy (IIM) is associated with an increased cancer risk within the 3 years preceding and following IIM onset. Evidence- and consensus-based recommendations for IIM-associated cancer screening can potentially improve outcomes. This International Guideline for IIM-Associated Cancer Screening provides recommendations addressing IIM-associated cancer risk stratification, cancer screening modalities and screening frequency. The international Expert Group formed a total of 18 recommendations via a modified Delphi approach using a series of online surveys. First, the recommendations enable an individual patient’s IIM-associated cancer risk to be stratified into standard, moderate or high risk according to the IIM subtype, autoantibody status and clinical features. Second, the recommendations outline a ‘basic’ screening panel (including chest radiography and preliminary laboratory tests) and an ‘enhanced’ screening panel (including CT and tumour markers). Third, the recommendations advise on the timing and frequency of screening via basic and enhanced panels, according to risk status. The recommendations also advise consideration of upper or lower gastrointestinal endoscopy, nasoendoscopy and 18F-FDG PET–CT scanning in specific patient populations. These recommendations are aimed at facilitating earlier IIM-associated cancer detection, especially in those who are at a high risk, thus potentially improving outcomes, including survival.In this Evidence-Based Guideline article, an international, multidisciplinary group of experts presents evidence-based consensus recommendations on screening for cancer in patients with adult-onset idiopathic inflammatory myopathy, addressing cancer risk stratification, screening modalities and screening frequency.

The authors developed four variants of the qNMR technique (1H or 13C nucleus, DMSO-d6 or CDCl3 solvent) for identification and quantification by NMR of 22R and 22S epimers in budesonide active pharmaceutical ingredient and budesonide drugs (sprays, capsules, tablets). The choice of the qNMR technique version depends on the drug excipients. The correlation of 1H and 13C spectra signals to molecules of different budesonide epimers was carried out on the basis of a comprehensive analysis of experimental spectral NMR data (1H-1H gCOSY, 1H-13C gHSQC, 1H-13C gHMBC, 1H-1H ROESY). This technique makes it possible to identify budesonide epimers and determine their weight ratio directly, without constructing a calibration curve and using any standards. The results of measuring the 22S epimer content by qNMR are comparable with the results of measurements using the reference HPLC method.

[...]TAB should still be a preferred diagnostic test in the settings where expertise with imaging in GCA is questionable. [...]rheumatologists can choose the optimum first-line diagnostic strategy (ultrasound-guided or TAB-based) taking into account the available resources and expertise. The GiACTA trial led to the approval of tocilizumab for the treatment of GCA in the USA, the European Community and the UK. [...]the regulatory authorities have recognised the role of imaging modalities in the diagnosis of GCA. Furthermore, the results of several studies suggest that TAB does not affect management in the majority of patients with suspected GCA,5 that is, in one series, 87% of biopsy-negative patients continued prednisolone therapy on clinical grounds.6 In our centre, we prefer to use PET as a second-line imaging modality in ultrasound-negative patients with suspected GCA.7 This method allows both to identify vasculitis of the large arteries and to rule out infections or tumours that can be associated with constitutional symptoms and laboratory findings typical for GCA. [...]PET may be helpful for monitoring of disease activity, though it is still unclear whether ongoing tracer uptake despite immunosuppressive treatment reflects low-grade inflammation or remodelling.1 Disadvantages of PET that include high costs, radiation exposure and possible diagnostic errors in the elderly patients with atherosclerosis should also be appreciated.

The authors developed a 1H qNMR test procedure for identification and quantification of impurity A present in gabapentin active pharmaceutical ingredient (API) and gabapentin products. The validation studies helped to determine the limit of quantitation and assess linearity, accuracy, repeatability, intermediate precision, specificity, and robustness of the procedure. Spike-and-recovery assays were used to calculate standard deviations, coefficients of variation, confidence intervals, bias, Fisher’s F test, and Student’s t-test for assay results. The obtained statistical values satisfy the acceptance criteria for the validation parameters. The authors compared the results of impurity A quantification in gabapentin APIs and capsules by using the 1H qNMR and HPLC test methods.

Acute kidney injury (AKI) is associated with increased mortality in most critical settings. However, it is unclear whether its mild form (i.e. AKI stage 1) is associated with increased mortality also in non-critical settings. Here we conducted an international study in patients hospitalized with SARS-CoV-2 infection aiming 1. to estimate the incidence of AKI at each stage and its impact on mortality 2. to identify AKI risk factors at admission (susceptibility) and during hospitalization (exposures) and factors contributing to AKI-associated mortality. We included 939 patients from medical departments in Moscow (Russia) and Padua (Italy). In-hospital AKI onset was identified in 140 (14.9%) patients, mainly with stage 1 (65%). Mortality was remarkably higher in patients with AKI compared to those without AKI (55 [39.3%] vs. 34 [4.3%], respectively). Such association remained significant after adjustment for other clinical conditions at admission (relative risk [RR] 5.6; CI 3.5- 8.8) or restricting to AKI stage 1 (RR 3.2; CI 1.8–5.5) or to subjects with AKI onset preceding deterioration of clinical conditions. After hospital admission, worsening of hypoxic damage, inflammation, hyperglycemia, and coagulopathy were identified as hospital-acquired risk factors predicting AKI onset. Following AKI onset, the AKI-associated worsening of respiratory function was identified as the main contributor to AKI-induced increase in mortality risk. In conclusion, AKI is a common complication of Sars-CoV2 infection in non-intensive care settings where it markedly increases mortality risk also at stage 1. The identification of hospital-acquired risk factors and exposures might help prevention of AKI onset and of its complications.

Heat shock proteins play an important role in immune inflammation and the formation and restoration of proteins. In recent years, the importance of heat shock protein 90 (Hsp90) in the activation of immune inflammation through nuclear factor kB (NFkB) has been discussed. To assess the activation of the Hsp90-NFkB system by measuring serum and urinary levels in patients with chronic glomerulonephritis (CGN). This study included 32 patients with active forms of CGN and 14 patients with Fabry nephropathy. The control group included 10 healthy individuals. Twenty-one out of 32 CGN patients had nephrotic syndrome (NS). Eleven out of 32 CGN patients had proteinuria levels from 1 to 3 g/day without nephrotic syndrome. A total of 17 patients had renal dysfunction (estimated glomerular filtration rate < 60 ml/min/1.73m²). Fourteen patients with Fabry nephropathy had proteinuria without nephrotic syndrome. Serum and urine HSP-90 and NFkB p65 levels were determined using an enzyme-linked immunosorbent assay. The levels of HSP-90 and NFkB in the serum of patients with CGN were significantly higher than in healthy individuals and patients with Fabry nephropathy. In patients with Fabry nephropathy, the HSP-90 and NFkB levels in the urine and serum did not significantly differ from those in the control subjects. Serum Hsp90 levels were significantly higher in the CGN patients with NS than in patients without NS, as well as in patients with normal renal function compared with patients with an eGFR < 60 ml/min/1.73 m 2 and patients with tubulo-interstitial fibrosis. Higher levels of HSP-90 and NFkB in serum were observed in patients with nephrotic forms of CGN, including focal segmental glomerulosclerosis, minimal change disease and membranous nephropathy. There were no correlations between the clinical signs of CGN and urinary HSP90/NFkB levels. Activation of the HSP-90-NFkB system, which is directly involved in the development of immune inflammation in CGN, was found in patients with an active course of CGN, especially in those with nephrotic syndrome.

Unlike methotrexate, MMF can be used in patients with moderate or severe renal disease. [...]remission induction treatment with MMF was similar in efficacy to pulsed cyclophosphamide in patients with lupus nephritis.2 It seems that MPO-ANCA associated renal vasculitis may be a primary indication for administration of MMF. Only patients with newly diagnosed AAV participated in the MYCYC study. [...]the efficacy of MMF as compared with cyclophosphamide in patients with relapsing AAV is not established. In the IMPROVE trial, MMF was also inferior to azathioprine for maintaining disease remission in 156 patients with AAV.4 Currently, rituximab is increasingly used for initial induction remission treatment in patients with both de novo and relapsing AAV. [...]in the USA, rituximab label has been recently updated to include information for maintenance therapy in adult patients with GPA and MPA who have achieved remission with induction treatment.

EGF is a specific biomarker of tubular compartment injury. [...]a pioneering study conducted by Wu et al 3 provided further insight into the basic mechanisms involved in the progression of ANCA-associated glomerulonephritis and could lead to new achievements in this field. Noteworthy, Zhao et al 11 detected KIM-1 expression in the hyperplastic parietal epithelium of the Bowman’s capsule and glomerular tuft in a rat model of diabetic nephropathy. [...]KIM-1 was not a selective biomarker of tubulointerstitial damage. Furthermore, the degree of tubular atrophy correlated with the expression of complement regulatory protein CD46 and alternative complement pathway marker Bb.12 13 In summary, the Wu et al 3 study suggested that urinary EGF/creatinine, which negatively correlated with the degree of interstitial fibrosis and tubular atrophy in renal histology, might be a useful predictor of adverse outcomes in patients with AAV. [...]a lower urinary EGF/creatinine was associated with renal resistance to induction-remission therapy.