Restless Leg Syndrome in CKD Patients Strongly Linked to Iron Deficiency, reveals study

Researchers have discovered that Restless Leg Syndrome (RLS), a painful neurological disorder characterized by an irresistible craving for movement of the legs, is far more prevalent among patients with chronic kidney disease (CKD), especially those who are on dialysis. The research, carried out at Madras Medical College, Chennai, showed that iron deficiency is a significant etiology of RLS in these patients, even with normal ferritin levels, suggesting functional iron deficiency. The results underscore the importance of early detection and specific iron therapy to control the symptoms and enhance quality of life. The study was published in Cureus journal by Parimala E. and colleagues.

The present study was a cross-sectional observational study that was conducted over a period of six months on 150 adult patients suffering from Stage 3 to Stage 5 CKD. Participants were divided into four treatment groups: those on hemodialysis (HD), peritoneal dialysis (PD), conservative management (non-dialysis), and post-renal transplant patients. Exclusion criteria included any history of non-CKD neurological or psychiatric disorders, or use of medications known to cause RLS.

The diagnosis of RLS was confirmed using the standardized criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Clinical interviews, case record review, and detailed laboratory tests — including iron tests like serum ferritin, transferrin saturation (TSAT), serum iron, and total iron-binding capacity (TIBC), were employed for data collection. SPSS software was used for statistical analysis, and a p-value below 0.05 was considered significant.

Key Findings

  • The participants’ mean age was 51.6 years (±12.3) and 58% were male.

  • The distribution of treatment modalities revealed that 40% of patients were on hemodialysis, 28% were conservatively managed, 18% were on peritoneal dialysis, and 14% were transplant recipients.

  • In total, 42% of patients were diagnosed with RLS (63 out of 150).

  • The highest prevalence was in the hemodialysis group (51.7%), followed by the peritoneal dialysis group (40.7%), conservative treatment group (26.2%), and transplant group (23.8%).

  • Older patients over the age of 60 and women presented with a greater frequency of RLS (46.7% and 47.6%, respectively).

  • Moreover, RLS was more frequent in diabetic patients (47.8%) compared to non-diabetics (37%).

  • RLS patients were found to have significantly lower levels of iron on various parameters.

  • The average serum ferritin was 88.4 ng/mL in RLS patients, whereas it was 126.7 ng/mL in non-RLS patients.

  • Transferrin saturation (TSAT) was 16.3% in RLS and 22.1% in non-RLS patients.

  • The serum iron concentration was 48.2 µg/dL in RLS, which was statistically lower than 64.7 µg/dL in non-RLS.

  • Conversely, TIBC levels were elevated at 295 µg/dL in RLS as opposed to 273 µg/dL in the non-RLS group.

  • All the differences were statistically relevant with p-values below 0.01.

This research supports the fact that movement disorder Restless Leg Syndrome is quite common among CKD patients, particularly those undergoing dialysis, and has a close relationship with iron deficiency. These results imply that early identification and management of iron deficiency, including functional iron deficiency, are necessary to counteract RLS symptoms and enhance the quality of life in CKD patients.

Reference:

Elangovan P, Murugadhandayuthapany A, S D, et al. (June 17, 2025) Prevalence of Restless Leg Syndrome and Its Association With Iron Deficiency in Patients With Chronic Kidney Disease: A Cross-Sectional Observational Study. Cureus 17(6): e86188. doi:10.7759/cureus.86188

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Single Dose of Psilocybin Reduces Anxiety and Depression in Cancer Patients for 2 Years, suggests study

USA: A phase II trial published in the Cancer Journal has revealed that a single dose of psilocybin, when combined with psychological support, significantly reduced anxiety and depression for up to two years in patients with cancer and major depressive disorder.

Depression is a common and often debilitating challenge for many individuals coping with cancer, and managing these symptoms is frequently complex. Traditional antidepressants may take weeks to be effective and are sometimes poorly tolerated in this patient population. In light of these challenges, researchers are exploring alternative treatments.

Dr. Manish Agrawal and colleagues from Aquilino Cancer Center in Rockville, Maryland, conducted a phase II study to investigate the safety, feasibility, and long-term efficacy of psilocybin—a psychoactive compound derived from certain mushrooms—paired with psychological support. The trial included 30 cancer patients diagnosed with major depressive disorder who received a single 25 mg dose of psilocybin alongside therapy.

The study findings were as follows:

  • Two years after treatment, the study showed notable and lasting benefits.
  • Among the 28 patients who completed follow-up, 53.6% experienced a significant reduction in depression symptoms.
  • The average improvement in depression symptoms was 15 points on the Montgomery-Asberg Depression Rating Scale (MADRS).
  • Half of the patients (50%) maintained this reduction in depression symptoms over the two years.
  • Anxiety symptoms also improved, with 46.4% of participants reporting significant reductions.
  • The average improvement in anxiety symptoms was nearly 14 points on the Hamilton Anxiety Rating Scale.
  • Sustained anxiety relief was observed in approximately 43% of patients.

These findings highlight psilocybin’s potential as a powerful therapeutic option for depression and anxiety in individuals with cancer. “The results demonstrate robust and lasting antidepressant effects from just a single psilocybin dose combined with psychotherapy,” noted the authors. They suggest this approach may offer a groundbreaking alternative to traditional antidepressants, which typically require ongoing use and may carry side effects.

While these results are encouraging, the researchers emphasize the need for larger studies to confirm psilocybin’s role in clinical practice. Future research should also explore the mechanisms by which psilocybin, in combination with psychological support, leads to such long-term mood improvements.

The authors concluded, “With growing interest in psychedelic-assisted therapy, the study adds to the emerging evidence that psilocybin could potentially reshape how clinicians approach the treatment of depression and anxiety in cancer patients, offering hope for a faster-acting and longer-lasting solution to an often difficult-to-treat problem.”

Reference:

Agrawal, M., Roddy, K., Jenkins, B., Leeks, C., & Emanuel, E. (2025). Long-term benefits of single-dose psilocybin in depressed patients with cancer. Cancer, 131(12), e35889. https://doi.org/10.1002/cncr.35889

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High Systemic Immune-Inflammation Index in Early Pregnancy tied to risk of Preeclampsia and Preterm Birth: Study

A study published in Journal of Inflammation Research has revealed that women with a high systemic immune-inflammation index (SII) in early pregnancy had a greater risk of preeclampsia and preterm birth. The association was particularly strong in women aged 35 and older, highlighting SII as a potential early marker for identifying at-risk pregnancies.

The systemic immune-inflammation index (SII) is an effective indicator for evaluating systemic immune-inflammatory responses. The development of preeclampsia (PE) may be attributed to an excessive systemic inflammatory response in pregnant women, however, the relationship between systemic immune-inflammation index and preeclampsia remains unclear. This study included 47,480 singleton pregnant women from three hospitals, comprising 2489 PE patients and 34,835 healthy controls. The gestational age for SII detection is 11.59 ± 3.98 weeks. Participants were divided into four groups based on the quartiles of SII calculated at baseline. Multivariable logistic regression and smooth fitting curves were used to analyze the relationship between SII and preeclampsia. Subgroup analyses based on age, BMI, and parity were conducted, and interaction tests were performed to assess the impact of different subgroups on the outcomes.

Results: After adjusting for relevant confounding factors, we observed that compared to SII Q1, participants in SII Q4 had a 21% increased risk of PE (OR = 1.21, 95% CI: 1.05– 1.39, P = 0.0078) and a 12% increased risk of preterm birth (OR = 1.12, 95% CI: 1.00– 1.26, P = 0.0488). Smooth fitting curves indicate that the risk of preeclampsia increases as SII rises. In subgroups of women aged ≥ 35 years and those with a BMI > 24, SII Q4 was significantly associated with an increased risk of preeclampsia compared to systemic immune-inflammation index Q1. Interaction tests showed that BMI and parity did not significantly influence this positive correlation (interaction P > 0.05). Age may affect the association between SII and preeclampsia (interaction P < 0.05), with a more pronounced positive correlation observed in women aged ≥ 35 years. The results indicate that elevated systemic immune-inflammation index in early pregnancy is a potential marker associated with an increased risk of preeclampsia.

Reference:

Li Q, Li M, Zhao C, Chen X, Zhang C, Li Y, Chen Y, Yue C. Association Between Systemic Immune-Inflammation Index in Early Pregnancy and Preeclampsia: A Multicenter Cohort Study. J Inflamm Res. 2025;18:8107-8118

https://doi.org/10.2147/JIR.S523131

Keywords:

High, Systemic, Immune-Inflammation, Index, Early, Pregnancy, tied, risk, Preeclampsia, Preterm Birth, Study, systemic immune-inflammation index, preeclampsia, multicenter cohort study, Li Q, Li M, Zhao C, Chen X, Zhang C, Li Y, Chen Y, Yue C.

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New drug for diabetes and obesity shows promising results

Lower blood sugar and increased fat burning – without negatively affecting appetite or muscle mass. These are some of the most promising effects of a new potential drug treatment for people with type 2 diabetes and obesity, according to a new study published in the journal Cell by researchers from Karolinska Institutet and Stockholm University.

The new drug, which is taken in tablet form, has a completely different mechanism of action than the well-known GLP-1-based drugs, such as Ozempic, which is administered via injections. GLP-1 drugs affect hunger via signals between the gut and the brain, but often have side effects such as loss of appetite, reduced muscle mass, and gastrointestinal problems.

The new substance instead activates metabolism in skeletal muscle. In animal studies, the treatment has shown good effects on both blood sugar control and body composition, but without the side effects associated with today’s GLP-1-based drugs.

An initial phase I clinical trial involving 48 healthy subjects and 25 people with type 2 diabetes shows that humans also tolerate the treatment well.

“Our results point to a future where we can improve metabolic health without losing muscle mass. Muscles are important in both type 2 diabetes and obesity, and muscle mass is also directly correlated with life expectancy,” says one of the researchers behind the study, Tore Bengtsson, professor at the Department of Molecular Bioscience, Wenner-Gren Institute, Stockholm University.

The drug substance is based on a molecule—a type of β2 agonist that the researchers have developed in a laboratory. The molecule can activate important signaling pathways in the body in a new way, which has a positive effect on the muscles without overstimulating the heart, which is a known problem with β2 agonists.

“This drug represents a completely new type of treatment and has the potential to be of great importance for patients with type 2 diabetes and obesity. Our substance appears to promote healthy weight loss and, in addition, patients do not have to take injections,” says Shane C. Wright, assistant professor at the Department of Physiology and Pharmacology at Karolinska Institutet, who is one of the researchers behind the study.

This new type of drug not only works on its own, but can also work in combination with GLP-1, thanks to their different mechanisms of action.

“This makes them valuable both as a stand-alone treatment and in combination with GLP-1 drugs,” says Shane C. Wright.

The next step is a larger, clinical phase II study planned by Atrogi AB, the company developing the treatment. The aim of the study is to see whether the same positive effects seen in preclinical models also occur in people with type 2 diabetes or obesity.

Reference:

Motso, Aikaterini et al. GRK-biased adrenergic agonists for the treatment of type 2 diabetes and obesity, Cell, DOI:10.1016/j.cell.2025.05.042 

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Low FODMAP diet can ease GI symptoms of those with endometriosis: Study

A low FODMAP diet developed by Monash University researchers for irritable bowel syndrome (IBS) has been shown to improve gastrointestinal symptoms in women with endometriosis.

Sixty percent of study participants responded to the Low FODMAP Diet (LFD), compared to 26 per cent who responded to a control diet based on Australian Dietary Guidelines.

The majority of those on the LFD experienced a clinically significant improvement in gastrointestinal symptoms, and overall symptom severity was 40 per cent lower on the LFD than on the control diet.

Published in Alimentary Pharmacology and Therapeutics, researchers found that the LFD also eased abdominal pain and bloating, and normalised stool consistency.

Dr Jane Varney, a Senior Research Dietitian in Monash University’s School of Translational Medicine Department of Gastroenterology, and Alfred Health, said this research showed for the first time that the Low FODMAP Diet reduced gastrointestinal symptom severity in women with endometriosis.

Dr Varney said more than 75 per cent of women with endometriosis experienced gastrointestinal symptoms, which mimic those experienced by people with IBS. She said that while many women with endometriosis attempted to modify their diet to help manage their symptoms, until now there was limited evidence to suggest any particular dietary approach worked.

“Six out of 10 patients responded to the Low FODMAP Diet and reported clinically significant improvements in gastrointestinal symptoms,” Dr Varney said.

“Abdominal pain and bloating improved, stool form normalised and quality of life improved. Given the high prevalence of gastrointestinal symptoms among women with endometriosis, and the absence of targeted treatments, this study highlights a diet therapy that will bring symptom relief to many women.”

Developed in the mid-2000s, The Monash University Low FODMAP Diet revolutionised IBS treatment. Monash dietitians, scientists and gastroenterologists established the FODMAP diet’s effectiveness then released the FODMAP Diet App in 2012 and a cookbook in 2023.

This study involved 35 women aged over 18 with diagnosed endometriosis and gastrointestinal symptoms such as abdominal pain, bloating, altered bowel habits and pain during/after bowel movements.

After eating their usual diet for seven days, participants were randomised to one of two diets that were supplied by the researchers for 28 days. Both diets were based on Australian Healthy Eating Guidelines, but only one was low in FODMAPs. Participants then returned to their regular diet for 28 days, before crossing over to the alternate dietary intervention. The two study diets were matched for macronutrients, micronutrients and fibre, so they only differed in FODMAP content.

Senior author Associate Professor Rebecca Burgell, who is Head of the Functional Gut Service at Alfred Health, and an Adjunct Associate Professor at the Monash University School of Translational Medicine, said that despite the high prevalence of gastrointestinal symptoms in endometriosis, few treatments specifically targeted those symptoms, and some made them worse.

“Gastrointestinal symptoms associated with endometriosis are largely ignored in clinical guidelines,” Associate Professor Burgell said. “Most endometriosis guidelines fail to mention gastrointestinal symptoms and none offer advice about identification or management. Nor do IBS guidelines mention screening for endometriosis.”

Reference:

Jane E. Varney, Daniel So, Peter R. Gibson, Dakota Rhys-Jones, Yuet Sang Jimmy Lee, Jane Fisher, Judith S. Moore, Roni Ratner, Mark Morrison, Rebecca E. Burgell, Jane G. Muir, Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated With Endometriosis (EndoFOD)—A Randomised, Controlled Crossover Feeding Study, Alimentary Pharmacology & Therapeutics, https://doi.org/10.1111/apt.70161

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Paternal Mental Distress Linked to Child Development, suggests study

A new study published in the Journal of American Medical Association showed that paternal mental distress during the perinatal period is a modifiable risk factor affecting child development. Further addressing fathers’ mental health during the transition to parenthood could play a crucial role in improving outcomes for both parents and their children.

To reduce the effects of mental strain on the growing fetus and newborn, the perinatal period, from conception to 24 months after delivery, is especially crucial. Thus, this study was to present a meta-analytic synthesis of the literature on the relationship between the development of the children during the first 18 years of life and the paternal prenatal depression, anxiety, and stress.

For this analysis, studies published up until November 2024 were found using MEDLINE Complete, PsycINFO, Embase, CINAHL Complete, and the gray literature. English-language accessibility, a human sample, quantitative data, a longitudinal design, and the possession of a measure of the emotional discomfort experienced by the father during pregnancy and the development of his kids were among the requirements for inclusion.

A total of 48 cohorts with 674 effect sizes (including 286 unpublished associations) met the requirements for quantitative synthesis out of the 9572 studies that were found. To statistically summarize the relationships between father prenatal mental distress and child development, univariate random-effects models were employed.

The US National Institutes of Health’s quality evaluation method for cross-sectional, cohort, and observational studies was used to evaluate the study’s quality. The examination of the data was finished in January 2025. Global, adaptive, social-emotional, cognitive, physical, linguistic, and motor development in children over the first 18 years of life were the main results.

Poorer global (r = -0.12; 95% CI, -0.22 to -0.01), social-emotional (r = 0.09; 95% CI, 0.07-0.11), cognitive (r = -0.07; 95% CI, -0.13 to -0.01), language (r = -0.15; 95% CI, -0.25 to -0.05), and physical (r = 0.04; 95% CI, 0.00-0.08) development in offspring were all linked to paternal perinatal mental distress.

There was no proof of motor or adaptive results. Thus, associations were stronger for postnatal mental anguish than for prenatal mental distress, indicating that a father’s mental health may have a greater direct impact on the growing kid after birth.

Overall, based on the data from this comprehensive review, father mental anguish may be able to be changed to predict a child’s growth. Preventative treatments that support dads during the transition to parenting and advance the health and well-being of next-generation kids should focus on reducing mental distress in fathers during pregnancy.

Source:

Le Bas, G., Aarsman, S. R., Rogers, A., Macdonald, J. A., Misuraca, G., Khor, S., Spry, E. A., Rossen, L., Weller, E., Mansour, K., Youssef, G., Olsson, C. A., Teague, S. J., & Hutchinson, D. (2025). Paternal perinatal depression, anxiety, and stress and child development: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2025.0880

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Stellate Ganglion Block Fails to Improve COVID-Related Smell Distortion: JAMA

A new study published in the Journal of American Medical Association showed that stellate ganglion block did not reduce COVID-19-induced odor distortion.

A persistent symptom of the post-COVID-19 syndrome that has an incalculable negative impact on quality of life is smell distortion, or parosmia. There is currently no accepted standard for treating this annoying illness. Thus, to ascertain if stellate ganglion block (SGB) is safe and successful in resolving olfactory impairment in individuals with chronic COVID-19-induced parosmia, Nyssa Fox Farrell and colleagues undertook this investigation.

The trial took place at Barnes Jewish Hospital and Washington University in St. Louis between October 2023 and September 2024. A total of 192 volunteers were screened, where 57 were included after fulfilling the eligibility requirements, which included being between the ages of 18 and 70, having self-reported parosmia that occurred at least 6 months following COVID-19 infection, and having a screening score of at least 40 on the Parosmia Olfactory Dysfunction Outcomes Rating [DisODOR] scale. The most frequent explanations for the exclusion of 135 were previous SGB (n = 42) and parosmia resolution or non-COVID-19-induced parosmia (n = 28). 

A board-certified anesthesiologist and pain medicine expert administered 6 to 8 mL of active mepivacaine, 1%, or saline, 0.9%, by ultrasound-guided injection at the right or left (randomized 1:1) stellate ganglion. 25% difference between subjects in the percentage of respondents who dropped their DisODOR score by 15 points from the baseline was considered as the primary outcome.

32 people were randomly assigned to SGB (median [range] age, 45 [19-64] years; 25 [81%] female) and 16 were assigned to placebo (median [SD] age, 45 [26-64] years; 13 [81%] female) out of the 48 persons examined in the research. Both groups had comparable times after COVID-19 infection (SGB, 35.3 vs. placebo, 30.6 months; MD = -3.1 months; 95% CI, -10.9 to 3.7).

For SGB, the 3-month response rate was 43% (n = 13), while for the placebo, it was 38% (n = 6; difference, −5%; 95% CI, −32% to 33%). There was no difference in the clinical overall perception of improvement across the groups. Overall, in accordance with the results of this research, SGB is not a better therapy for COVID-19-induced parosmia than a placebo, and as such, it should not be suggested.

Source:

Farrell, N. F., Crock, L. W., Islam, A., Adkins, D., Peterson, A. M., Kallogjeri, D., & Piccirillo, J. F. (2025). Stellate ganglion block for the treatment of COVID-19-induced parosmia: A randomized clinical trial. JAMA Otolaryngology-Head & Neck Surgery. https://doi.org/10.1001/jamaoto.2025.1304

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New PET tracer may identify diverse invasive mold infections behind life-threatening illnesses in cancer and transplant patients: Study

A novel PET radiotracer can accurately detect a wide range of mold species that are linked to dangerous infections, according to new research presented at the Society of Nuclear Medicine and Molecular Imaging 2025 Annual Meeting. The imaging agent has the potential to dramatically enhance the diagnosis and monitoring of invasive mold infections in patients.

Advances in cancer and immunosuppressive treatments have helped many patients live longer, but they also leave more people with weakened immune systems, making invasive mold infections increasingly common. With mortality rates of invasive mold infections reaching up to 85 percent, early and accurate diagnosis followed by timely treatment is critical to improving patient outcomes.

“Currently it’s very difficult to detect invasive mold infections,” said Carlos Ruiz-Gonzalez, MD, a postdoctoral research fellow at Johns Hopkins University Medical School in Baltimore, Maryland. “Definitive diagnosis often depends on invasive procedures or on biomarkers that lack sensitivity for many mold species. In this study, we aimed to develop a PET tracer capable of detecting a broad range of mold infections and distinguishing them from inflammation with high sensitivity and specificity.”

The imaging agent, 18F-FDS, was first evaluated in vitro to determine its ability to detect 30 different strains of disease-causing molds collected from infected patients. 18F-FDS PET/CT was then performed to identify fungal infections in mice with weakened immune systems, as well as in four human patients with confirmed invasive mold infections, and five control patients with inflammatory diseases or cancer, but no infections.

18F-FDS was found to quickly and specifically accumulate inside a wide range of disease-causing molds (including drug-resistant strains) while showing no uptake in heat-killed molds or human cells. Among mice, it accurately identified fungal infections in the lungs, brain, and sinuses, and was able to distinguish these from non-infectious inflammation. In patient studies, 18F-FDS PET safely detected and localized mold infections-including one missed by a previous brain MRI.

“This research demonstrates that 18F-FDS PET is a promising, noninvasive diagnostic tool to detect mold-related invasive fungal diseases,” noted Ruiz-Gonzalez. “What’s more, since 18F-FDS can be easily produced from 18F-FDG, it can be synthesized on demand and made available globally. This can have a real impact for patients around the world.”

Reference:

Carlos Ruiz-gonzalez, Oscar Nino-meza, Medha Singh, Yuderleys Masias-leon, Amy Kronenberg, Madelynn Shambles, Xueyi Chen, Mona Sarhan, Elizabeth Tucker, Laurence Carroll, Kenneth Cooke, Olivia Kates, Shmuel Shoham, 18F-Fluorodeoxysorbitol PET for noninvasive detection of invasive mold infections in patients, Journal of Nuclear Medicine. 

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Atopic Dermatitis Linked to Shorter Stature in Young Children, Finds Research

USA: Researchers have discovered in a new study that young children with moderate-to-severe atopic dermatitis (AD) tend to be shorter than their peers. They suggest that factors such as poor sleep quality and extended use of topical or systemic glucocorticoids and immunosuppressants could contribute to this impaired growth.

The study, published in the Journal of the American Academy of Dermatology, was led by Dr. Amy Paller of Northwestern University Feinberg School of Medicine, along with her colleagues. The research highlights the potential influence of chronic skin inflammation on growth patterns in children under 12 years of age.

Atopic dermatitis is widely known to affect the quality of life in children, leading to discomfort, disturbed sleep, and emotional stress. However, its potential effects on physical growth, particularly in the context of long-term treatments such as corticosteroids or immunosuppressants, have not been fully understood. Given that childhood growth is a critical marker of general health, investigating this relationship is essential.

To address this knowledge gap, the researchers analysed data from 1,329 children enrolled in PEDISTAD (NCT03687359), an ongoing international, observational study focusing on patients younger than 12 years with moderate-to-severe AD. The analysis compared the children’s height, weight, and Body Mass Index (BMI) against the CDC Learning Management System reference population, offering insights into how these growth parameters align with healthy norms.

The study revealed several key findings:

  • Only 38% of boys with AD were taller than the 50th percentile for height, although 50% exceeded the 50th percentile for weight.
  • Among girls, 52% were taller than the 50th percentile for height, while 51% surpassed the 50th percentile for weight.
  • The height disparity became even more evident in older children: in the 5- to 12-year age group, just 28% of boys and 47% of girls were taller than the 50th percentile for height.
  • For BMI, 69% of boys and 71% of girls exceeded the 50th percentile.
  • The overall average percentiles across all ages for boys were 46th for height, 51st for weight, and 58th for BMI.
  • Among girls, these averages were 50th for height, 50th for weight, and 59th for BMI.

Based on these findings, the authors suggest that moderate-to-severe AD may hinder linear growth in children, possibly due to chronic inflammation, poor sleep, or long-term effects of corticosteroid and immunosuppressant therapy.

“The study emphasizes the importance of monitoring growth parameters in children with AD and considering these factors when selecting treatment strategies,” the authors noted. “Further research is needed to understand better the long-term effects of AD and its treatments on child development.”

Reference: https://www.jaad.org/article/S0190-9622(24)01056-9/fulltext

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Rheumatoid Arthritis Significantly Increases Pulmonary TB Risk, Regardless of Treatment Status: Study Suggests

South Korea: In a large-scale, longitudinal study published in ERJ Open Research, researchers have found that individuals with rheumatoid arthritis (RA) remain significantly more vulnerable to active pulmonary tuberculosis (TB), even in clinical settings where TB screening is routinely conducted before initiating biologic therapies.

The research, led by Dr. Hayoung Choi from the Division of Pulmonary, Allergy, and Critical Care Medicine at Hallym University Kangnam Sacred Heart Hospital, underscores the continued need for vigilant TB surveillance in RA populations.

The nationwide study followed over 59,000 RA patients—subdivided into seropositive (SPRA) and seronegative (SNRA) groups—alongside nearly 298,000 matched controls without RA, over a period spanning up to nine years. Participants were tracked between 2010 and 2019, with a median follow-up duration of 4.4 years.

The key findings include the following:

  • Individuals with rheumatoid arthritis (RA) had a 3.2-fold higher risk of developing active pulmonary tuberculosis (TB) compared to those without RA, even after adjusting for potential confounders.
  • Seropositive RA patients exhibited a 3.2-fold increased TB risk compared to the general population.
  • Seronegative RA patients showed a 2.5-fold higher risk of active pulmonary TB than matched controls.
  • RA patients treated with biological or targeted synthetic DMARDs had a nearly 4.7-fold increased risk of developing active TB.
  • RA patients not receiving these advanced therapies still had a 2.9-fold higher TB risk than the general population.
  • The elevated TB risk in RA patients persisted regardless of exposure to DMARDs.
  • Additional factors linked to increased TB susceptibility among RA patients included male sex, being underweight, and having comorbid conditions such as diabetes mellitus.

While the study stands out for its robust national dataset and comprehensive analysis of confounding variables, the authors acknowledged several limitations. For instance, data on individual TB infection screening outcomes and treatment completion were not available. Additionally, because the study population included individuals who had undergone health screenings, selection bias might have contributed to a relatively lower observed TB incidence. Moreover, the findings, derived from a country with an intermediate TB burden like South Korea, may not be directly generalizable to nations with lower or higher TB prevalence.

Despite these limitations, the research highlights a critical gap in TB prevention among RA patients. According to the authors, current TB infection screening and treatment protocols may not be sufficient to eliminate the risk of active disease, particularly in those on immunosuppressive therapies.

The authors concluded, “Given these insights, the study advocates for more tailored and intensified TB screening strategies in RA care—especially for patients with seropositive RA or those receiving biologics or targeted DMARDs.”

Reference:

Choi H, Eun Y, Han K, Jung JH, Jung W, Kim H, Shin DW, Lee H. Impact of seropositivity and disease-modifying antirheumatic drugs on pulmonary tuberculosis risk in rheumatoid arthritis. ERJ Open Res. 2025 May 27;11(3):00957-2024. doi: 10.1183/23120541.00957-2024. PMID: 40432816; PMCID: PMC12107382.

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