Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Victoria Johnson

New research has revealed that patients with 

 syndrome (FMS) had higher rates of astigmatism, meibomian gland dysfunction (MGD), and dry eye disease (DED) than those without, emphasizing the importance of routine anterior segment assessments in this population.

“In recent years, there has been a growing interest in the ophthalmologic involvement of FMS as research has begun to reveal ocular manifestations in these patients. Among the most common complaints are dry eye symptoms, photophobia, and vision problems, all of which are hypothesized to be associated with immunological alterations and autonomic nervous system dysfunctions… Patients with chronic pain syndrome have dry eye symptoms, even when their clinical grade of ocular surface illness is comparable to or less severe than that of dry eye patients without chronic pain. Ocular manifestations may contribute to the overall burden of the disease; nevertheless, the comprehensive level of ocular involvement in FMS is still not completely understood,” lead investigator Duygu Topaktaş Emekli, Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey, and colleagues wrote.

In this cross-sectional and comparative analysis, Emekli and colleagues collected data at a tertiary care education and research hospital from August 2024 to November 2024. They evaluated participants’ central corneal thickness, uncorrected and best-corrected visual acuities, refraction parameters, intraocular pressure, MGD, and DED.

The investigators did not find any significant differences in visual acuity, spherical equivalent, intraocular pressure, or central corneal thickness between FMS and healthy controls (all 

 >.05). They did find differences in astigmatism, MGD, and DED. Specifically, the FMS group had median astigmatism of − 0.50 (range, -8.25–0) in the right eye (diopter) compared with − 0.12 (range, -1.75–0.50) in the control group (

= .012); and − 0.50 (range, -2–1.50) in the left eye compared with and 0 (range, -1.75–0.75) in the control group.

Furthermore, 36.6% (n = 26) of the FMS group had MGD and 60.6% (n = 43) had DED, compared with 4.3% (n = 3; 

<.001) in the control group, respectively.

“These data show that FMS may predispose to these issues. The increased frequency of dry eye disease and meibomian gland dysfunction in FMS patients underscores the necessity for regular ocular assessments in this patient group. Future research should prioritize longitudinal studies with larger sample sizes to ascertain causal links and investigate the temporal dynamics of ocular alterations in FMS. Furthermore, assessments of drug effects, autonomic function, and psychiatric abnormalities (such as depression, anxiety, and sleep issues) are crucial for clarifying the underlying mechanisms and pinpointing prospective treatment strategies,” Emekli and colleagues concluded.

Emekli and colleagues previously conducted a similar study evaluating ophthalmic vascular and neuroretinal alterations in people with FMS and found only slight differences in retinal parafoveal thickness and foveal density in FMS patients, with no substantial vascular or neurodegenerative alterations compared to healthy controls.

Emekli DT, Sahutoglu E, Öztürk GY, Kocyigit BF. Anterior segment alterations in fibromyalgia syndrome: a cross-sectional study on dry eye disease, meibomian gland dysfunction, and astigmatism. 

2025;45(5):120. Published 2025 Apr 25. doi:10.1007/s00296-025-05872-w

Öztürk GY, Emekli DT, Sahutoglu E, Kocyigit BF. Evaluation of ophthalmic vascular and neuroretinal alterations in fibromyalgia syndrome: a cross-sectional comparative study. 

 2024;44(9):1757-1765. doi:10.1007/s00296-024-05662-w

Articles

Recent research indicates that fibromyalgia syndrome (FMS) patients exhibit higher rates of astigmatism, meibomian gland dysfunction (MGD), and dry eye disease (DED) compared to healthy individuals. This underscores the need for routine ocular assessments in FMS patients. The study found no significant differences in visual acuity or intraocular pressure between FMS patients and controls, but highlighted the prevalence of MGD and DED in the FMS group. Future research should focus on longitudinal studies to explore causal relationships and the impact of various factors on ocular health in FMS.

New findings highlight the link between fibromyalgia syndrome and increased rates of astigmatism, dry eye disease, and meibomian gland dysfunction.

People With Fibromyalgia Have Higher Rates of Astigmatism, Dry Eye, MGD

Patients with end-stage renal disease (ESRD) have a high prevalence of 

“We review the current literature to discuss the possibility of using uric acid as an indicator of renal impairment. A lot of research has been done for years to prove the relationship between chronic kidney disease (CKD) and gout. The association between gout and CKD is described as mutual, and CKD is an independent risk factor for gout,” lead investigator Heba Abuhelala, Department of Medical Laboratory Sciences, Faculty of Medical Technology, University of Tripoli, Libya, and colleagues wrote.

Abuhelala and colleagues evaluated 121 samples from patients with ESRD from at the Tripoli Kidney Services Center between April and July 2022. They analyzed the samples, which came from females with a mean age of 54.2 and males with a mean age of 56.4, for urea, creatinine, and uric acid.

They found that all urea and creatinine results were high, with male urea results having a mean of 146.984 mg/dL and the female urea results having a mean of 146.982 mg/dL. For creatinine levels, females had a mean of 8.63 mg/dL and males had a mean of 8.48 mg/dL. The investigators found that uric acid clearance had no relationship with urea and creatinine clearance during dialysis.

The investigators also found that males had slightly higher uric acid levels (mean, 7.04 mg/dL) than females (mean, 6.87 mg/dL), although this was not statistically significant. Overall, the prevalence of gout among patients with ESRD in the study was 46.3% (

< .000) and was specifically 46% in males and 47% in females.

“The study was conducted on patients with ESRD stage 5 of chronic kidney disease to study the prevalence of gout, which was originally a disorder in the metabolism of purine, but in the case of patients with renal failure, the main cause is an impairment in the secretion of uric acid by the kidneys. The other problem is that uric acid does not decrease after a dialysis session, such as urea and creatinine, and it needs special treatments,” Abuhelala and colleagues wrote.

 “We aspire to link the mutual relationship between gout and chronic kidney diseases for gout sufferers and non-infected people and to study the impact of gout on the kidneys and kidney impairment on the development of gout, on a larger number of cases and over a longer period of time.”

In other recent research on gout in people with CKD, results were reported last month from the phase 4 PROTECT trial that demonstrated that pegloticase properly managed serum urate levels and provided clinical and quality of life (QOL) benefits in 

kidney transplant (KT) recipients with gout

Investigators found that found that 89% of patients reached and maintained a SU of less than 6 mg/dL during Month 6. QOL measures also meaningfully improved over the 24 weeks of treatment, with a mean change of -0.3 (95% CI, -0.6 to 0.1) on HAQ-DI from baseline, a mean change of -35.5 (95% CI, -54.5 to -16.5) on HAQ-Pain, a mean change of -22.4 (95% CI, -39.5 to -5.2) on HAQ-Health, and a mean change of -2.4 (95% CI, -3.7 to -1.1) on PhGA from baseline. Furthermore, mean arterial BP fell by an average of -6.8 (95% CI, -12.5 to -1.0) from baseline and 3 of 7 participants (42.9%) with tophi at baseline had at least 1 tophus resolve.

Abuhelala H, Alsharif H, Abdulatif A, Abukel I, Elyounsi N. Prevalence of Gout in End-Stage Renal Disease Patients. 

2025;8(2):679-689. doi: 10.54361/ajmas.258221

Abdellatif A, Zhao L, Obermeyer K, Vranic Z, Marder BA, Scandling JD. Quality of life improvements and clinical assessments in kidney transplant recipients undergoing pegloticase treatment for uncontrolled gout: findings of the phase 4 PROTECT clinical trial. 

2025;16:1516146. Published 2025 Mar 13. doi:10.3389/fimmu.2025.1516146

Patients with end-stage renal disease (ESRD) exhibit a high prevalence of gout, with a study showing a 46.3% occurrence rate. The study analyzed uric acid, urea, and creatinine levels in ESRD patients, revealing no correlation between uric acid clearance and dialysis. Uric acid levels remained elevated post-dialysis, necessitating special treatments. The mutual relationship between gout and chronic kidney disease (CKD) was emphasized. Additionally, the PROTECT trial demonstrated that pegloticase effectively managed serum urate levels and improved quality of life in kidney transplant recipients with gout.

A recent study reveals a significant prevalence of gout in end-stage renal disease patients, highlighting the complex relationship between kidney function and uric acid levels.

Gout Prevalence High Among Patients With End-Stage Real Disease 

The FDA has approved Upadacitinib 15 mg once daily for the treatment of adults with giant cell arteritis (GCA), under the name Rinvoq.

"Glucocorticoids remain a mainstay of treatment of GCA but lead to substantial drug-associated toxicities. Additionally, relapse remains common for patients with this disease," investigator Peter A. Merkel, MD, MPH, chief of rheumatology at the University of Pennsylvania, said in a statement.

 "We now have a new option to treat GCA. The results of this clinical trial show that upadacitinib offers patients the chance to reach sustained remission."

The approval was based off of data from the phase 3 SELECT-GCA clinical trial in which 46.4% (95% CI, 39.6-53.2) of patients receiving upadacitinib 15 mg in combination with a 26-week steroid taper regimen achieving sustained remission from week 12 to week 52, compared with 29.0% (95% CI, 20.6-37.5) of patients receiving placebo in combination with a 52-week steroid taper regimen (

“The primary endpoint was the proportion of patients in the different treatment arms in sustained remission. And this turned out to be positive. Upadacitinib 15 milligrams was significantly better than placebo… it also met 9 out of 11 multiplicity-controlled secondary end points. It was a positive study. It couldn't be more positive,” lead investigator Daniel Blockmans, MD, PhD, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium, previously told HCPLive at the 

2024 European Congress of Rheumatology (EULAR)

 conference during which he presented interim data from SELECT-GCA.

In the trial, a total of 209 patients received upadacitinib at a dose of 15 mg, 107 received upadacitinib at a dose of 7.5 mg, and 112 received placebo. Most participants (70%) had new-onset GCA. SELECT-GCA also evaluated a 7.5 mg dose, which did not show statistical significance compared with the placebo group (41.1% [95% CI, 31.8-50.4]). Importantly, safety outcomes over the 52 weeks were similar in the upadacitinib and placebo groups, and no major adverse cardiovascular events occurred in the upadacitinib groups, although cardiovascular risk is a potential concern with a JAK inhibitor.

"This FDA approval will now provide an alternative treatment option that can offer patients with GCA the possibility of tapering off steroids and achieving sustained remission," said Roopal Thakkar, MD, executive vice president, research and development, chief scientific officer, AbbVie, added to the statement.

 "With this new indication for RINVOQ, we are underscoring AbbVie's commitment to exploring how we can identify and address unmet needs for patients with immune-mediated diseases."

RINVOQ® (upadacitinib) Receives U.S. FDA Approval for Giant Cell Arteritis (GCA). News release. AbbVie. April 29, 2025. 

https://news.abbvie.com/2025-04-29-RINVOQ-R-upadacitinib-Receives-U-S-FDA-Approval-for-Giant-Cell-Arteritis-GCA

Blockmans D, Penn SK, Setty AR, et al. A Phase 3 Trial of Upadacitinib for Giant-Cell Arteritis. 

Published online April 2, 2025. DOI: 10.1056/NEJMoa2413449

The FDA has approved Upadacitinib 15 mg, marketed as Rinvoq, for treating adults with giant cell arteritis (GCA). This approval offers a new treatment option beyond glucocorticoids, which are associated with significant toxicities and frequent relapses. The decision was based on the SELECT-GCA phase 3 trial, where 46.4% of patients on Upadacitinib achieved sustained remission compared to 29% on placebo. The trial's primary endpoint was met, and the drug showed superiority over placebo in multiple secondary endpoints, providing an alternative for steroid tapering and sustained remission.

Upadacitinib joins tocilizumab as the second therapy to be approved for treating GCA.

FDA Approves Upadacitinib, Expanding Treatment for Adults With Giant Cell Arteritis

In a recent study, patients with hereditary α-tryptasemia (HαT) had a 13% prevalence of drug-induced 

“This is the first report investigating HαT and α-tryptase genotypes as a risk factor for potentially life-threatening reactions in patients with drug allergy or hypersensitivity to biological agents,” wrote investigators, led by Peter Korošec, MD, from the University Clinic of Respiratory and Allergic Diseases in Slovenia.

HαT, caused by extra copies of the TPSAB1 gene that increases α-tryptase and leads to high tryptase levels, occurs in approximately 5% of people in Western Europe and in the United States.

 Those with this genetic trait have a 50% chance of passing it down to their child, and 90% of people in the general population with increased baseline serum tryptase have HαT.

Studies have yet to show what function pro-tryptases serve in human health or disease in this patient population. Many symptoms are associated with HαT, including chronic skin flushing, itching, hives, bee sting allergy, dizziness, difficulty maintaining a normal pulse, chronic head, back, or joint pain, skeletal abnormalities, heartburn, IBS, food and drug reactions or intolerances, and sleep disturbances.

 However, it can be challenging to prove what symptoms caused HαT because of how common it is.

Investigators sought to determine the impact of tryptase genotypes on drug-induced anaphylaxis.

 They also examined inciting agents causing the anaphylaxis and the severity of reactions.

“Our study suggests that increased germline copies of α-tryptase-encoding sequences at TPSAB1 are more prevalent among patients with anaphylaxis to drugs, and in both a discovery and validation cohort, the presence of HαT was associated with anaphylaxis to antibiotic and/or mAb,” investigators wrote.

The prospective discovery cohort included 99 patients, from a referral center in Slovenia, with drug-induced anaphylaxis who underwent tryptase genotyping by droplet digital PCR. The validation cohort included 26 patients from the Czech Republic.

HαT was associated with drug-induced anaphylaxis in 13% (n = 13) of the discovery cohort and 15% in the validation cohort (n = 4). Everyone with increased BST levels (11.6 to 21.9 ng/mL; n=14) in the discovery and validation cohort had HαT.

The study showed HαT had a greater prevalence in individuals with antibiotic- or mAb-induced anaphylaxis from both cohorts (26%) compared to those with anaphylaxis induced by NMBAs (n = 23), NSAIDs (n = 18), contrast (n = 3), chlorhexidine (n = 7), or other drugs (n = 10) (7%) odds ratio [OR] 4.1; 95% confidence interval [CI], 1.3 – 11.1; 

 = .02). Reactions were mostly severe (68%) grade 3 or 4, followed by grade 2 (17%) and grade 1 (15%).

“We found that the number of subjects with drug-induced anaphylaxis and H⍺T was more than twice that of the general population, and these findings are remarkably similar to previous data on adult patients with idiopathic anaphylaxis (17%) and severe Hymenoptera venom-triggered anaphylaxis (8.6%),” investigators wrote.

Additionally, patients with no α-tryptase had fewer HαT traits than in the general population, and those with more ⍺-tryptase copies had more severe reactions. Participants with 3 ⍺-tryptase copies had the greatest prevalence of severe anaphylaxis (73%), compared with 59% in participants with 1 to 2 copies and 58% in those without any copies.

“These initial data are interesting and justify looking at tryptase genotyping in other cohorts to evaluate any potential role for genotyping in clinical evaluation,” investigators wrote. “While the understanding of HαT as a modifier of mast cell-mediated reactions is currently nascent, our evolving data suggests that in patients with antibiotics or mAb-induced anaphylaxis, HαT may be more common…further studies are needed to evaluate if individuals with HαT are at higher risk of developing drug-induced anaphylaxis.

Korošec P, Lyons JJ, Svetina M, Koudová M, Bittóová M, Zidarn M, Sedláčková L, Rijavec M, Kopač P. Hereditary α-tryptasemia is associated with anaphylaxis to antibiotics and monoclonal antibodies. J Allergy Clin Immunol Pract. 2025 Apr 14:S2213-2198(25)00369-1. doi: 10.1016/j.jaip.2025.04.013. Epub ahead of print. PMID: 40239920.

https://tmsforacure.org/hereditary-alpha-tryptasemia/

Hereditary Alpha Tryptasemia and Hereditary Alpha Tryptasemia Syndrome FAQ. National Institute of Allergy and Infectious Diseases. 

https://www.niaid.nih.gov/research/hereditary-alpha-tryptasemia-faq

Hereditary α-tryptasemia (HαT) is linked to a higher prevalence of drug-induced anaphylaxis, particularly with antibiotics and monoclonal antibodies (mAb). This genetic condition, caused by extra copies of the TPSAB1 gene, results in elevated α-tryptase levels and affects approximately 5% of people in Western Europe and the U.S. The study found that individuals with HαT had more severe anaphylactic reactions, with a significant association between increased α-tryptase copies and reaction severity. Further research is needed to explore the clinical implications of tryptase genotyping in drug-induced anaphylaxis.

Patients with HαT showed a 13% prevalence of drug-induced anaphylaxis, with greater risk tied to antibiotic- and monoclonal antibody-triggered reactions.