Objective To identify and summarise the efficacy and safety of systemic glucocorticoids (GC) and local injections of GC in spondyloarthritis (SpA). Methods PubMed (Medline) and EMBASE were searched with predefined keywords and relevant articles in English reporting RCTs, non-randomized and observational studies on efficacy of GC in SpA, with 5 or more patients, were included in the systematic literature review (SLR). Local injections of GC included intra-articular (IA) and entheseal injections, but excluded sacroiliac joint injections. Results Out of 9657 records, there were 14 studies on use of systemic GC in SpA (364 patients); including two RCTs of oral prednisolone. On pooling data from two placebo-controlled RCTs (≤ 24 weeks), BASDAI50 was 4.2 times more likely (95% CI 1.5 to 11.5) and ASAS 20 twice more likely (95% CI 1.1 to 3.64) to occur in patients on high-dose oral prednisolone (± taper). Pulse GC led to dramatic improvements that lasted a few weeks to a few months. There were no deaths or major AEs. There were 10 studies (560 patients) on local GC in SpA. IA injection were effective with sustained response in 51.5 to 90% joints at 6 months. Entheseal injections led to reduced pain and improved ultrasound parameters. Conclusions There were limited studies on both systemic and local injections of GC in SpA. However, there was good evidence of efficacy with use of high-dose systemic GC in the short term (≤ 6 months) in SpA. Intra-articular or entheseal injections seemed safe and effective.

Protrusio acetabuli. Plain radiograph of the pelvis showing joint space narrowing in bilateral hip joints with deformity in medial wall of acetabulum and migration of the femoral head into the pelvic cavity on the left side, a deformity classically known as protrusio acetabuli.

The objective of the study is to report the outcomes of COVID-19 in ANCA-associated vasculitis (AAV) patients. This was a registry-based observational study conducted at a tertiary care center in north India. AAV patients with at least one follow-up visit between March 2020 and September 2021 were included. Demographic features, clinical manifestations, disease activity, and treatment details of underlying AAV were noted in all patients. Details of COVID-19 infection including severity, treatment, and outcomes were noted. Predictors of COVID-19 severity were determined using univariate analysis. A total of 33 (18.3%) out of 180 AAV patients contracted COVID-19 infection. Moderate COVID-19 infection was seen in 33.3% and severe or critical infection was seen in 36.3% of patients. Seventeen patients (51.5%) required supplemental oxygen therapy. Nine patients had active disease at the time of COVID-19 infection and three of them died due to COVID-19 infection. The risk of COVID-19 infection and its severity did not differ between patients receiving different immunosuppressants including rituximab induction. Hypothyroidism ( p = 0.046) and ocular ( p = 0.038) involvement due to AAV predicted the development of moderate to severe/critical COVID-19. Three (9.1%) patients died from COVID-19 and the rate of AAV flare after COVID-19 was similar to that in non-COVID-19 patients (15.3/100 person-year vs. 15.6/100 person-year, p = 0.95). Majority of the patients with AAV had moderate to severe or critical COVID-19 infection. The rate of death due to COVID-19 in AAV is higher than in general population. Use of standard remission induction regimens did not lead to increased risk of COVID-19 infection in our AAV cohort. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-022-05177-2.

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