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

More concordance in terminology and care is needed for better management and 

 of preschool wheeze, according to a new qualitative study of parents’ views and experiences.

“This research demonstrates an urgent need for preschool wheeze management policies and treatment pathways that are evidence-based and co-developed with parents. We have shown that use of investigations such as blood or allergy tests would be acceptable to parents, if they were shown to be helpful in guiding more effective and timely treatments,” senior investigator Gemma Heath, PhD, health psychologist and senior lecturer, Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom, said in a statement.

Preschool wheeze often resembles asthma and affects approximately 30–40% of children under 6 years of age. The episodes of wheezing or breathlessness are often triggered by viral infections or allergies and do not necessarily indicate asthma.

Heath and colleagues team interviewed affected parents and carers about their experiences with navigating preschool wheeze, as there is currently no diagnostic pathway or definitive management guidelines for preschool wheeze. They found multiple concerns and problems at different levels of management.

One source of confusion was inconsistent terminology used by doctors and differing diagnoses of asthma, suspected asthma, viral wheeze and allergy. Parents reported frustration at the lack of definitive diagnosis or “mystery” causes, apparent lacks of general practitioner knowledge, and sometimes false reassurance that the wheeze was viral rather than asthma.

“Preschool wheeze has significant impact on young children’s and their parents’ lives. Our research, involving parents with lived experience, will inform future studies to improve the care and reduce the impact of preschool wheeze on the already-stretched emergency health services in the UK” investigator Prasad Nagakumar, MBBS, MD, Consultant Respiratory Pediatrician, Birmingham Children’s Hospital, and Honorary Associate Professor, Department of Inflammation and Ageing, University of Birmingham, added.

Investigators also found that investigative tests would not be performed until after multiple hospitalizations, delaying identification of what caused the wheeze and appropriate treatment.

 In the study, parents welcomed the idea of timely tests but did not want to subject children to repeated testing. Concerning treatment with steroid and salbutamol inhalers, similarly to asthma, parents were amenable to the medications although they had concerns about short and long-term adverse events.

Parents reported significant psychological impacts of children being admitted to hospitals, with some missing work or giving up work to care for their child while experiencing high levels of anxiety. Others felt unable to go on international family vacations due to concerns about healthcare access in the case oof a wheeze attack. Overall, parents reported being “terrified” while observing preschool wheeze attacks.

In accordance with a lack of confidence in general practitioner knowledge, most parents preferred hospital care than at private clinics. However, this care can be expensive and burdensome for the family as a whole.

“Parents’ views highlight the problem of diagnosing and treating preschool wheeze at multiple system levels. To improve management and ensure that services for children with preschool wheeze are effective, there is an urgent need for consistent terminology, a unified approach to guide investigations and treatments and for upskilling healthcare professionals in primary and secondary care,” Heath and colleagues wrote.

Wajid LMA, Saglani S, Nagakumar P, Heath G. Managing preschool wheeze: a qualitative study of parents’ views and experiences. 

 Published online December 11, 2024. doi: 10.1136/archdischild-2024-327781

Aston University and Birmingham Children’s Hospital study shows diagnosis and treatment of preschool wheeze needs improvement. News release. Aston University. January 13, 2025. https://www.eurekalert.org/news-releases/1070311

Articles

Preschool wheeze, affecting 30-40% of children under six, often mimics asthma but lacks clear diagnostic pathways and management guidelines. A qualitative study highlights parents' frustrations with inconsistent terminology and diagnoses, and the delayed use of investigative tests. Parents are open to tests and treatments if they improve outcomes but express concerns about adverse effects and psychological impacts. The study underscores the need for evidence-based management policies, consistent terminology, and enhanced healthcare professional training to improve care and reduce the burden on emergency health services.

Among multiple issues were confusing and conflicting misdiagnoses of asthma.

Better Management Needed for Childhood Wheeze

Patients with inflammatory bowel disease (IBD) have

 (FM) than the general population and in previous literature, according to new research.

Notably, this population experienced higher rates of fatigue and reduced quality of life.

"IBD patients often experience extraintestinal manifestations, which significantly impact their quality of life, contribute to disability, and impose substantial costs on healthcare systems. Osteoarticular manifestations are the most common type of extraintestinal manifestations (EIMs). FM, the second most common rheumatic disease, affects an estimated 2% to 8% of the global population, with a higher prevalence among females. FM is characterized by widespread pain, frequently accompanied by fatigue, cognitive difficulties, and sleep disturbances. Evidence indicates a strong association between FM and IBD, with numerous studies reporting a higher prevalence of FM among IBD patients compared to the general population

,” lead investigator RDCP Prado, University of São Paulo School of Medicine, Department of Gastroenterology and Nutrology, São Paulo, Brazil, and colleagues wrote.

Prado and colleagues conducted a cross-sectional analysis from adult patients seen at the IBD outpatient clinic at the University of São Paulo from July 2023 to July 2024. FM diagnoses were made based on the 2016 American College of Rheumatology criteria. The investigators collected data on demographics, IBD phenotype, clinical and endoscopic activity, quality of life (IBDQ) and fatigue (FACIT) measurements.

Prado and colleagues included 250 patients in the study. These participants had an overall prevalence of FM of 15.2%, predominantly in female participants (53.6%; 

<.001). At the time of inclusion, participants had a mean age of 34.5 years (standard deviation [SD], 15.3) and a mean disease duration of10.9 years (SD, 8.1). Most participants were White (55.7%) and non-smokers (65.3%).

The investigators found no significant differences in C-reactive protein levels between IBD-FM patients and IBD-only patients (5.1 vs. 8.6 mg/dL; 

= .324). Patients with ulcerative colitis had higher rates of FM compared to those with Crohn disease (22 vs 16, 

= .041). Patients with FM were statistically significantly older (40.7 years vs. 33.4 years; 

= .008) and had a higher BMI (27.8 vs. 24.8; 

= .001) compared to those without FM. Prado and colleagues also found that patients with FM had a significantly longer mean disease duration (14 years vs 10.3, 

= .015) and reported notably lower mean scores of IBDQ (147.4 vs 183.1; 

< .001) and lower mean FACIT scores (31.5 vs 42.1; 

“The association between FM and IBD was substantial in the studied cohort, with a prevalence exceeding that reported in the general population and in previous literature. There was a slight predominance of FM among female patients diagnosed with UC. The co-occurrence of IBD and FM was associated with a significantly reduced quality of life and elevated levels of fatigue,” Prado and colleagues concluded.

Prado RDCP, Domiciano DS, Mattos PSLD, et al. Fibromyalgia as a predictive factor of fatigue and reduced quality of life in patients with inflammatory bowel disease. 

 2025(19):1: i859. doi: 10.1093/ecco-jcc/jjae190.0549

Kocyigit BF, Akyol A. Fibromyalgia syndrome: epidemiology, diagnosis and treatment. 

. 2022;60(6):413-421. doi: 10.5114/reum.2022.123671

Patients with inflammatory bowel disease (IBD) exhibit a higher prevalence of fibromyalgia (FM) compared to the general population, with significant impacts on fatigue and quality of life. A study conducted at the University of São Paulo found a 15.2% prevalence of FM among IBD patients, predominantly affecting females. FM was associated with older age, higher BMI, longer disease duration, and lower quality of life and fatigue scores. The study highlights the substantial co-occurrence of FM and IBD, emphasizing the need for comprehensive management strategies for these patients.

People with inflammatory bowel disease and FM tended to have a higher disease duration and reported higher rates of fatigue and lower QoL. 

Fibromyalgia Common in People With IBD 

Clinicians have called on the United States Preventive Services Task Force (USPSTF) to clarify its recommendations for and to advocate for universal screening of 

in pregnant women in a letter published today in 

“In view of the simple treatment option, we recommend early detection and treatment of iron deficiency in pregnancy, including the use of intravenously administered iron when necessary, to prevent adverse maternal and fetal outcomes,” Peter Kranke, MD, MBA, MME, University Hospital Würzburg, Germany, and colleagues wrote in the letter.

The letter comes after the USPSTF published its final recommendation statement for iron deficiency screening in pregnancy in August 2024.

 Its recommendation stated that the current evidence is insufficient to evaluate the benefits and harms of screening and routine iron supplementation for iron deficiency and iron deficiency anemia during pregnancy to prevent adverse maternal and infant health outcomes.

The Grade I statement recommendations apply to asymptomatic pregnant adolescents and adults but do not apply to those who are severely malnourished, have symptoms of iron deficiency or anemia, or have specific hematologic conditions or nutritional deficiencies that may increase the need for iron intake.

“This recommendation is consistent with the 2015 recommendation statement on screening and supplementation for iron deficiency anemia in pregnancy,” wrote Wanda K. Nicholson, MD, MPH, MBA, Milken Institute of Public Health, George Washington University.

“In 2015, the USPSTF concluded that the current evidence was insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women to prevent adverse maternal health and birth outcomes (I statement).”

To search for evidence supporting iron deficiency screening in pregnant women, the USPSTF performed a search in the Ovid MEDLINE and Cochrane databases through May 2023 and surveillance through May 2024, which yielded 17 trials (n = 24,023) on maternal iron supplementation.

While data showed that iron supplementation was linked to a lower risk of maternal iron deficiency anemia and iron deficiency at term, compared with placebo or no iron supplementation, no statistically significant differences in maternal quality of life, gestational diabetes, maternal hemorrhage, hypertensive disorders of pregnancy, cesarean delivery, preterm birth, infant low birth weight, or infants small for gestational age were observed. Thus, the USPSTF could not make a conclusive recommendation but urged clinicians to use their clinical judgment when screening for iron deficiency and anemia or providing routine iron supplementation during pregnancy.

In the new letter Kranke and colleagues stressed that while no randomized trials gave conclusive evidence of routine screening’s benefit, the real-world impact of not screening could be significant.

They point out that clinician judgment may leave pregnant women with iron deficiency undetected, as the symptoms of iron deficiency and iron deficiency anemia, including fatigue, muscle weakness, and cognitive disturbances, often overlap with over pregnancy symptoms. Notably, they point out that the JAMA Patient Page defines anemia as having symptoms including fatigue, weakness, and shortness of breath, and this definition includes almost all pregnant patients.

In view of the adverse effects of iron deficiency anemia and the natural history of untreated iron deficiency to progressing anemia, we are convinced that virtually all pregnant individuals would benefit from screening,” Kranke and colleagues wrote.

Kranke P, Surbek D, Achebe MO. USPSTF Recommendation Statement About Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy. 

. Published online January 27, 2025. doi:10.1001/jama.2024.26286

US Preventive Services Task Force. Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy: US Preventive Services Task Force Recommendation Statement. 

. Published online August 20, 2024. doi:10.1001/jama.2024.15196

Cantor AG, Holmes R, Bougatsos C, Atchison C, DeLoughery T, Chou R. Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. 

. Published online August 20, 2024. doi:10.1001/jama.2024.13546

Clinicians are urging the USPSTF to advocate for universal iron deficiency screening in pregnant women, emphasizing the importance of early detection and treatment to prevent adverse outcomes. Despite the USPSTF's 2024 recommendation stating insufficient evidence to assess the benefits and harms of screening, clinicians argue that the real-world impact of not screening could be significant. They highlight the overlap of iron deficiency symptoms with pregnancy symptoms, which may lead to undetected cases. The USPSTF encourages clinicians to use their judgment in screening and supplementation decisions.

Peter Kranke, MD, MBA, MME, and colleagues call for clarifications to the August 2024 recommendations with more real-world considerations. 

Clinicians Challenge USPSTF Iron Deficiency Screening Recommendations in Pregnancy 

New research has confirmed low response rates and higher infusion reaction (IR) rates of 

 plus methotrexate (MTX) in patients with gout following failed monotherapy, highlighting the importance of initiating immunomodulation prior to first pegloticase exposure.

“Pegloticase is often the last treatment option for patients with uncontrolled or refractory gout. However, antidrug antibody development (ADA) can lead to loss of serum urate (SU)–lowering response and put patients at risk for IRs. Evidence from both real-world and clinical trial data support the use of immunomodulation as cotherapy to pegloticase to increase urate-lowering response rate and minimize IR risk

,” lead investigator Orrin M. Troum, MD, Division of Rheumatology, University of Southern California Keck School of Medicine and Providence Saint John’s Health Center, and colleagues wrote.

The small open-label ADVANCE trial enrolled patients with uncontrolled gout (SU levels ≥6 mg/dL, oral urate–lowering therapy failure or intolerance, and ≥1 gout sign or symptom) whose disease previously stopped responding to pegloticase monotherapy. Patients with moderate-to-severe IR or anaphylaxis to pegloticase, MTX contraindication, immunosuppressant administration, glucose-6-phosphate dehydrogenase deficiency, and estimated glomerular filtration rate <30 mL/min/1.73m2 were excluded from the trial. Participants first completed a 6-week subcutaneous MTX run-in (25 mg per week) then entered a 24-week pegloticase (at 8 mg biweekly) plus MTX treatment period. The trial’s primary end point was SU-lowering response rate during month 6 (SU levels <6 mg/dL for ≥80% of weeks 20–24). Investigators assessed adverse events (AEs) and completed laboratory monitoring for safety.

Troum and colleagues followed 11 participants with gout who began pegloticase plus MTX treatment. These participants were mostly male (91%), had a mean age of 58.6 years (standard deviation [SD], 11.3), mean SU levels of 8.5 mg/dL (SD, 3.2), and 91% had tophaceous gout. Participants had received previous pegloticase courses ranging from 2 to 27 infusion, with the last infusion administered at a mean of 3.7 years (SD, 2.4) prior to the trial.

The investigators found that 1 patient (9%) maintained their response during month 6. On the other hand, the other 10 patients prematurely discontinued treatment due to loss of SU lowering (n = 8) and IRs (n = 2). Eight patients (73%) experienced at least 1 AE, most commonly gout flare. All AEs were mild or moderate.

“In conclusion, ADA attenuation with MTX has emerged as an important advancement for improving both the efficacy and safety of pegloticase. These results of the ADVANCE open-label trial demonstrate the challenge of overcoming established ADAs against pegloticase in patients with previous loss of urate-lowering response. Given that pegloticase is often the last treatment option for patients with uncontrolled gout, maximizing treatment benefit is of the utmost importance in this patient population. The current study supports the importance of MTX coadministration during initial pegloticase treatment course in achieving this in patients without contraindication to MTX,” Troum and colleagues concluded.

Troum OM, Botson JK, Obermeyer K, et al. Pegloticase and Methotrexate Cotherapy in Patients With Uncontrolled Gout With Prior Pegloticase Monotherapy Failure: Findings of an Open-Label Trial. 

Published online January 23, 2025. doi.org/10.1002/acr2.11789

Botson JK, Saag K, Peterson J, et al. A randomized, placebo-controlled study of methotrexate to increase response rates in patients with uncontrolled gout receiving pegloticase: primary efficacy and safety findings. 

New research highlights the challenges of treating uncontrolled gout with pegloticase following monotherapy failure, emphasizing the role of methotrexate (MTX) in improving outcomes. Pegloticase, often a last resort, faces issues with antidrug antibodies (ADA) leading to reduced efficacy and increased infusion reactions (IRs). The ADVANCE trial demonstrated that MTX coadministration can enhance urate-lowering response and safety, although overcoming established ADAs remains difficult. The study underscores the importance of initiating immunomodulation with MTX during initial pegloticase treatment to maximize benefits for patients without MTX contraindications.

New research highlights the importance of immunomodulation before pegloticase exposure.