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Diabetes mellitus and obesity are growing health concerns. New pharmacologic interventions have recently begun to play a more notable role in the treatment pathway of these separate but related conditions. In particular, glucagon-like peptide-1 receptor agonists, such as semaglutides (Ozempic, Wegovy) and tirzepatide (Mounjaro), and sodium glucose co-transporter 2 inhibitors, such as dapagliflozin (Farxiga) and empagliflozin (Jardiance), have emerged as treatment options. Multiple clinical trials have demonstrated their efficacy in regulating metabolism, improving glycemic control, and managing long-term weight reduction. However, glucagon-like peptide-1 receptor agonists have also been associated with gastrointestinal side effects, including delayed gastric emptying as well as regurgitation and aspiration during general anesthesia or deep sedation, and sodium glucose co-transporter 2 inhibitors have been associated with severe diabetic ketoacidosis. Therefore, discontinuation of these medications before surgery is imperative. Given the popularity of these medications among the general public, it is essential for hand surgeons, to understand how to appropriately manage them perioperatively. The objective of this article was to review these new diabetes mellitus and weight loss medications, including their mechanisms of action, indications for use, and perioperative management guidelines. Additionally, we will take this opportunity to review perioperative guidelines for other common medications relevant to patients undergoing procedures involving the hand and upper extremity such as antithrombotic medications and rheumatoid arthritis-related immunosuppressive medications. Finally, we will describe how the electronic medical record system can be used to optimize perioperative medication management in this population. [ABSTRACT FROM AUTHOR]

• This scoping review provides an up-to-date overview of published evidence regarding the frequency and severity of acute viral respiratory AEs related to antirheumatic disease therapies. • Glucocorticoid use was associated with a higher frequency of acute upper and lower respiratory viral events. • Mild viral respiratory infections occurred more frequently in several studies in which patients were treated with JAKi, most notably at higher doses. • TNFi and IL-17 inhibitors seemed to be associated with higher frequency of mild viral respiratory infections such as URTI and nasopharyngitis. • Our review identifies a knowledge gap for most antirheumatic medications and their acute respiratory viral complications; in the context of the COVID-19 pandemic, increased widespread respiratory viral PCR testing offers immediate research opportunities to clarify the safety of antirheumatic therapies in terms of viral respiratory complications. COVID-19 is an acute respiratory viral infection that threatens people worldwide, including people with rheumatic disease, although it remains unclear to what extent various antirheumatic disease therapies increase susceptibility to complications of viral respiratory infections. The present study undertakes a scoping review of available evidence regarding the frequency and severity of acute respiratory viral adverse events related to antirheumatic disease therapies. Online databases were used to identify, since database inception, studies reporting primary data on acute respiratory viral infections in patients utilizing antirheumatic disease therapies. Independent reviewer pairs charted data from eligible studies using a standardized data abstraction tool. A total of 180 studies were eligible for qualitative analysis. While acknowledging that the extant literature has a lack of specificity in reporting of acute viral infections or complications thereof, the data suggest that use of glucocorticoids, JAK inhibitors (especially high-dose), TNF inhibitors, and anti-IL-17 agents may be associated with an increased frequency of respiratory viral events. Available data suggest no increased frequency or risk of respiratory viral events with NSAIDs, hydroxychloroquine, sulfasalazine, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or apremilast. One large cohort study demonstrated an association with leflunomide use and increased risk of acute viral respiratory events compared to non-use. This scoping review identified that some medication classes may confer increased risk of acute respiratory viral infections. However, definitive data are lacking and future studies should address this knowledge gap. [ABSTRACT FROM AUTHOR]

• This scoping review provides insight into the effects of antirheumatic therapies during pregnancy and neurodevelopmental outcomes in exposed offspring amongst parents with chronic inflammatory arthritis. • Exposure to certain antirheumatic therapies during pregnancy did not seem to increase risk of adverse childhood neurodevelopmental outcomes. • Antenatal glucocorticoid use may increase risk of Attention Deficit Hyperactive Disorders in offspring of women with rheumatic diseases. • Our review is limited by scarce number of studies that met inclusion criteria and were of variable quality. • Our review revealed a knowledge gap and need to disentangle the factors influencing long-term child health outcomes of parents with rheumatic diseases. These factors include maternal co-morbidities, socioeconomic status, antenatal medication use and clinical disease activity. Most women with rheumatic diseases discontinue antirheumatic therapies in anticipation of, or during pregnancy due to concerns around medication safety and fetal wellbeing. We performed a scoping review of available evidence investigating the risks of adverse offspring neurodevelopmental outcomes amongst parents with chronic inflammatory arthritis, taking antirheumatic therapies during conception or pregnancy. We designed a scoping review protocol and search strategy a priori in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an exhaustive search in Cochrane Library, Embase, Google Scholar, Medline, and Web of Science for relevant literature in January 2023. Articles needed to include offspring neurodevelopmental outcomes born to parents with CIA who took antirheumatic therapies during conception or pregnancy. Independent reviewers extracted data from eligible articles using a standard abstraction tool and performed critical appraisal of study quality. Six studies were included for full data abstraction. Use of Nonsteroidal Anti-inflammatory Drugs, Tumor Necrosis Factor Alpha inhibitors, and exposure to methotrexate during early first trimester of pregnancy did not seem to increase risk for adverse offspring neurodevelopmental outcomes. Corticosteroid use during pregnancy seemed to pose an increased risk for attention deficit hyperactive disorders in offspring. Use of some antirheumatic therapies during pregnancy may not be associated with adverse offspring neurodevelopmental outcomes. Further investigations are needed to elucidate if other confounding factors affect long term offspring health outcomes born to parents with chronic inflammatory arthritis. [ABSTRACT FROM AUTHOR]

Aim: To reveal the commonly occurring important types of rheumatological disorders, as well as various clinico-epidemiological aspects, concurrent medical illnesses, and the ancillary medications used, along with their side-effects. Method: A total of 365 patients with various rheumatological disorders were studied at the Rheumatology Department of Manipal Teaching Hospital, Pokhara, Nepal from September 2001 to September 2004. The diagnosis was based on the criteria of the American College of Rheumatology (1988). A pro forma was prepared for 30 common rheumatological disorders, listing patient identification, clinical characteristics, disease duration, objective and subjective assessment of the progress of the diseases, monitoring the response of treatment and side-effects of medications. Patients aged 15–75 years, men and women suffering from various musculoskeletal disorders, fulfilling the ACR criteria, were studied. Each patient was followed up at 1–3 monthly interval and data recorded systematically to monitor the progress of joint function and evaluating the effects of medications. Results: Out of the 365 patients recorded, only 337 fulfilled the criteria laid down by ACR. Most common rheumatological disorders in order of frequency were soft tissue rheumatism (40.0%), inflammatory arthritis (21.36%) and bone and cartilage diseases (21.06%). Connective tissue disorders were only 4.74%. Seronegative spondyloarthritis group was only 2.67% and least common disease was gout at 3.85%. Rheumatoid arthritis was the most common inflammatory arthritis observed in 20.17% of total cases. Fibromyalgia was the most common soft tissue rheumatism seen in 19.88%. Osteoarthritis of knee, hand and hip were the most common degenerative disorder of the bone and cartilage, constituting 10.38%. Lumbago, lumbar spondylolisthesis and spinal canal stenosis together comprised 14.24% of patients with low back pain. Cervical spondylosis and all types of shoulder joint pain syndromes comprised 5.93% and 5.34%, respectively. Patients were mostly in the age group 20–60 years. The most common type of drug used in all rheumatic conditions was non-steroidal anti-inflammatory drugs in 81.6% of cases followed by steroids in 26.7%, disease-modifying and cytotoxic drugs in 18.6% and 17.2% of cases, respectively. Chronic obstructive airway disease and hypertension constituted the major concurrent illness in 23.63% and 18.78%, respectively. Conclusion: This unique type of clinico-epidemiological study on rheumatological disorders, the first in Nepal, will provide a rich database for future investigations into rheumatology and would plan for all levels of prevention and therapy in the future. [ABSTRACT FROM AUTHOR]