Heidi Splete

Performance of either biliary endoscopic sphincterotomy alone or dual biliary and pancreatic sphincterotomy similarly prevented approximately half of idiopathic recurrent acute pancreatitis cases in a trial in which 89 patients were randomized to treatments based on the presence or absence of sphincter of Oddi dysfunction.

The study is "the largest randomized clinical trial studying ERCP [endoscopic retrograde cholangiopancreatography] with SOM [sphincter of Oddi manometry] in this population" with long-term follow-up data, Dr. Gregory A. Coté of Indiana University in Indianapolis and his colleagues reported in the December issue of Gastroenterology (2012 [doi: 10.1053/j.gastro.2012.09.006]).

Source: American Gastroenterological Institute

Finding therapeutic equivalence between biliary endoscopic sphincterotomy (BES) and dual endoscopic sphincterotomy (DES) in preventing at least one episode of acute pancreatitis during follow-up is important, because the addition of pancreatic sphincterotomy to ERCP carries the risk of post-ERCP pancreatitis, bleeding, perforation, and sphincter restenosis, according to Dr. Coté and his associates.

To assess the therapeutic value of two types of sphincterotomy and the prognostic value of pancreatic SOD for patients with idiopathic recurrent acute pancreatitis (RAP), the researchers randomized 69 adults with SOD to BES or DES. The other 20 patients who did not have SOD were randomized to BES or a sham therapy. SOD was defined as basal pressure of 40 mm Hg or greater, "sustained for at least 30 seconds across two transducers," the researchers noted.

The patients were aged 18 years and older, and those with chronic pancreatitis or an identified cause of RAP were excluded from the study.

Of the 69 patients with SOD, RAP occurred in 49% of patients who underwent BES and 47% who underwent DES. There was no significant difference in rates of RAP between non-SOD patients who had BES and those who had a sham procedure (27% vs. 11%, respectively).

The risk of RAP was approximately four times higher in patients with SOD than in those without SOD, they added.

"Most RAP events occurred within 30 months of randomization in all subgroups," the researchers said.

Overall, chronic pancreatitis developed in 17% of all patients over a median of 78 months, and there was no difference in the probability of developing chronic pancreatitis in patients with and without SOD.

The study was limited by several factors, including its small sample size for the non-SOD population and the impact of environmental and genetic risk factors on idiopathic RAP, the researchers noted.

The small sample of patients with normal SOM meant that the researchers could draw no conclusions about the benefit of BES in these patients, but the results "represent preliminary data for estimating the sample size of a future definitive trial of ERCP with empiric biliary sphincterotomy," they noted.

In addition, the findings suggest that SOD "may be a secondary marker of more significant inflammation related to previous acute pancreatitis," and that pancreatic sphincterotomy "cannot be recommended as a curative treatment of unexplained RAP alone," they wrote.

None of the study authors had any financial conflicts to disclose.

Performance of either biliary endoscopic sphincterotomy alone or dual biliary and pancreatic sphincterotomy similarly prevented approximately half of idiopathic recurrent acute pancreatitis cases in a trial in which 89 patients were randomized to treatments based on the presence or absence of sphincter of Oddi dysfunction.

The study is "the largest randomized clinical trial studying ERCP [endoscopic retrograde cholangiopancreatography] with SOM [sphincter of Oddi manometry] in this population" with long-term follow-up data, Dr. Gregory A. Coté of Indiana University in Indianapolis and his colleagues reported in the December issue of Gastroenterology (2012 [doi: 10.1053/j.gastro.2012.09.006]).

Source: American Gastroenterological Institute

Finding therapeutic equivalence between biliary endoscopic sphincterotomy (BES) and dual endoscopic sphincterotomy (DES) in preventing at least one episode of acute pancreatitis during follow-up is important, because the addition of pancreatic sphincterotomy to ERCP carries the risk of post-ERCP pancreatitis, bleeding, perforation, and sphincter restenosis, according to Dr. Coté and his associates.

To assess the therapeutic value of two types of sphincterotomy and the prognostic value of pancreatic SOD for patients with idiopathic recurrent acute pancreatitis (RAP), the researchers randomized 69 adults with SOD to BES or DES. The other 20 patients who did not have SOD were randomized to BES or a sham therapy. SOD was defined as basal pressure of 40 mm Hg or greater, "sustained for at least 30 seconds across two transducers," the researchers noted.

The patients were aged 18 years and older, and those with chronic pancreatitis or an identified cause of RAP were excluded from the study.

Of the 69 patients with SOD, RAP occurred in 49% of patients who underwent BES and 47% who underwent DES. There was no significant difference in rates of RAP between non-SOD patients who had BES and those who had a sham procedure (27% vs. 11%, respectively).

The risk of RAP was approximately four times higher in patients with SOD than in those without SOD, they added.

"Most RAP events occurred within 30 months of randomization in all subgroups," the researchers said.

Overall, chronic pancreatitis developed in 17% of all patients over a median of 78 months, and there was no difference in the probability of developing chronic pancreatitis in patients with and without SOD.

The study was limited by several factors, including its small sample size for the non-SOD population and the impact of environmental and genetic risk factors on idiopathic RAP, the researchers noted.

The small sample of patients with normal SOM meant that the researchers could draw no conclusions about the benefit of BES in these patients, but the results "represent preliminary data for estimating the sample size of a future definitive trial of ERCP with empiric biliary sphincterotomy," they noted.

In addition, the findings suggest that SOD "may be a secondary marker of more significant inflammation related to previous acute pancreatitis," and that pancreatic sphincterotomy "cannot be recommended as a curative treatment of unexplained RAP alone," they wrote.

None of the study authors had any financial conflicts to disclose.

Performance of either biliary endoscopic sphincterotomy alone or dual biliary and pancreatic sphincterotomy similarly prevented approximately half of idiopathic recurrent acute pancreatitis cases in a trial in which 89 patients were randomized to treatments based on the presence or absence of sphincter of Oddi dysfunction.

The study is "the largest randomized clinical trial studying ERCP [endoscopic retrograde cholangiopancreatography] with SOM [sphincter of Oddi manometry] in this population" with long-term follow-up data, Dr. Gregory A. Coté of Indiana University in Indianapolis and his colleagues reported in the December issue of Gastroenterology (2012 [doi: 10.1053/j.gastro.2012.09.006]).

Source: American Gastroenterological Institute

Finding therapeutic equivalence between biliary endoscopic sphincterotomy (BES) and dual endoscopic sphincterotomy (DES) in preventing at least one episode of acute pancreatitis during follow-up is important, because the addition of pancreatic sphincterotomy to ERCP carries the risk of post-ERCP pancreatitis, bleeding, perforation, and sphincter restenosis, according to Dr. Coté and his associates.

To assess the therapeutic value of two types of sphincterotomy and the prognostic value of pancreatic SOD for patients with idiopathic recurrent acute pancreatitis (RAP), the researchers randomized 69 adults with SOD to BES or DES. The other 20 patients who did not have SOD were randomized to BES or a sham therapy. SOD was defined as basal pressure of 40 mm Hg or greater, "sustained for at least 30 seconds across two transducers," the researchers noted.

The patients were aged 18 years and older, and those with chronic pancreatitis or an identified cause of RAP were excluded from the study.

Of the 69 patients with SOD, RAP occurred in 49% of patients who underwent BES and 47% who underwent DES. There was no significant difference in rates of RAP between non-SOD patients who had BES and those who had a sham procedure (27% vs. 11%, respectively).

The risk of RAP was approximately four times higher in patients with SOD than in those without SOD, they added.

"Most RAP events occurred within 30 months of randomization in all subgroups," the researchers said.

Overall, chronic pancreatitis developed in 17% of all patients over a median of 78 months, and there was no difference in the probability of developing chronic pancreatitis in patients with and without SOD.

The study was limited by several factors, including its small sample size for the non-SOD population and the impact of environmental and genetic risk factors on idiopathic RAP, the researchers noted.

The small sample of patients with normal SOM meant that the researchers could draw no conclusions about the benefit of BES in these patients, but the results "represent preliminary data for estimating the sample size of a future definitive trial of ERCP with empiric biliary sphincterotomy," they noted.

In addition, the findings suggest that SOD "may be a secondary marker of more significant inflammation related to previous acute pancreatitis," and that pancreatic sphincterotomy "cannot be recommended as a curative treatment of unexplained RAP alone," they wrote.

None of the study authors had any financial conflicts to disclose.

The prevalence of chronic obstructive pulmonary disease is 6% nationwide, but varies from less than 4% in Washington and Minnesota to more than 9% in Alabama and Kentucky, according to data from the Centers for Disease Control and Prevention. The findings were published in the CDC’s Morbidity and Mortality Weekly Report on Nov. 23.

A total of 13,306 adults who reported having chronic obstructive pulmonary disease (COPD) in the national survey also responded to the COPD module. Of these, 76% reported undergoing a diagnostic breathing test, 64% reported that COPD symptoms (specifically shortness of breath) had an adverse effect on their quality of life, and 51% reported taking at least one COPD medication (MMWR 2012; 61:938-43).

In age-adjusted comparisons, women were more likely to report COPD compared with men (7% vs. 5%, respectively). COPD prevalence decreased from an average of 10% among individuals making less than $25,000 per year to 3% in those making more than $75,000 per year, and the prevalence was lower among employed individuals, homemakers, and students compared with those who were unemployed, retired, or otherwise unable to work. The prevalence of COPD was highest in current smokers (13%) compared with former smokers (7%) and never smokers (3%).

Data were taken from the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey. Additional COPD data were collected in an optional COPD module about COPD diagnosis and quality of life. This module was part of the BRFSS in 21 states, the District of Columbia, and Puerto Rico.

The 2011 BRFSS was conducted via telephone, either landline or mobile. The survey population included adults aged 18 years and older throughout the United States.

The findings were limited by several factors including the absence of data on individuals in institutions or nursing homes and by the use of self-reports for COPD diagnosis, the researchers said. However, the report is the first to analyze data on COPD prevalence in all 50 states, the District of Columbia, and Puerto Rico, they noted. State-level health officials should focus surveillance efforts, educational campaigns, and interventions on areas of highest COPD prevalence, they added.

The study was supported by the CDC and the National Heart, Lung, and Blood Institute of the National Institutes of Health.

The prevalence of chronic obstructive pulmonary disease is 6% nationwide, but varies from less than 4% in Washington and Minnesota to more than 9% in Alabama and Kentucky, according to data from the Centers for Disease Control and Prevention. The findings were published in the CDC’s Morbidity and Mortality Weekly Report on Nov. 23.

A total of 13,306 adults who reported having chronic obstructive pulmonary disease (COPD) in the national survey also responded to the COPD module. Of these, 76% reported undergoing a diagnostic breathing test, 64% reported that COPD symptoms (specifically shortness of breath) had an adverse effect on their quality of life, and 51% reported taking at least one COPD medication (MMWR 2012; 61:938-43).

In age-adjusted comparisons, women were more likely to report COPD compared with men (7% vs. 5%, respectively). COPD prevalence decreased from an average of 10% among individuals making less than $25,000 per year to 3% in those making more than $75,000 per year, and the prevalence was lower among employed individuals, homemakers, and students compared with those who were unemployed, retired, or otherwise unable to work. The prevalence of COPD was highest in current smokers (13%) compared with former smokers (7%) and never smokers (3%).

Data were taken from the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey. Additional COPD data were collected in an optional COPD module about COPD diagnosis and quality of life. This module was part of the BRFSS in 21 states, the District of Columbia, and Puerto Rico.

The 2011 BRFSS was conducted via telephone, either landline or mobile. The survey population included adults aged 18 years and older throughout the United States.

The findings were limited by several factors including the absence of data on individuals in institutions or nursing homes and by the use of self-reports for COPD diagnosis, the researchers said. However, the report is the first to analyze data on COPD prevalence in all 50 states, the District of Columbia, and Puerto Rico, they noted. State-level health officials should focus surveillance efforts, educational campaigns, and interventions on areas of highest COPD prevalence, they added.

The study was supported by the CDC and the National Heart, Lung, and Blood Institute of the National Institutes of Health.

The prevalence of chronic obstructive pulmonary disease is 6% nationwide, but varies from less than 4% in Washington and Minnesota to more than 9% in Alabama and Kentucky, according to data from the Centers for Disease Control and Prevention. The findings were published in the CDC’s Morbidity and Mortality Weekly Report on Nov. 23.

A total of 13,306 adults who reported having chronic obstructive pulmonary disease (COPD) in the national survey also responded to the COPD module. Of these, 76% reported undergoing a diagnostic breathing test, 64% reported that COPD symptoms (specifically shortness of breath) had an adverse effect on their quality of life, and 51% reported taking at least one COPD medication (MMWR 2012; 61:938-43).

In age-adjusted comparisons, women were more likely to report COPD compared with men (7% vs. 5%, respectively). COPD prevalence decreased from an average of 10% among individuals making less than $25,000 per year to 3% in those making more than $75,000 per year, and the prevalence was lower among employed individuals, homemakers, and students compared with those who were unemployed, retired, or otherwise unable to work. The prevalence of COPD was highest in current smokers (13%) compared with former smokers (7%) and never smokers (3%).

Data were taken from the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey. Additional COPD data were collected in an optional COPD module about COPD diagnosis and quality of life. This module was part of the BRFSS in 21 states, the District of Columbia, and Puerto Rico.

The 2011 BRFSS was conducted via telephone, either landline or mobile. The survey population included adults aged 18 years and older throughout the United States.

The findings were limited by several factors including the absence of data on individuals in institutions or nursing homes and by the use of self-reports for COPD diagnosis, the researchers said. However, the report is the first to analyze data on COPD prevalence in all 50 states, the District of Columbia, and Puerto Rico, they noted. State-level health officials should focus surveillance efforts, educational campaigns, and interventions on areas of highest COPD prevalence, they added.

The study was supported by the CDC and the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Ranbaxy Inc. voluntarily recalled 41 lots of Atorvastatin calcium tablets in 10-mg, 20-mg, and 40-mg doses because of potential contamination with ground glass, the company and the Food and Drug Administration announced Nov. 28.

The small size of the particles (less than 1 mm) makes safety concerns unlikely, according to the statement from MedWatch, the FDA Safety Information and Adverse Event Reporting Program.

"However, the possibility of adverse experiences arising primarily due to physical irritation cannot be ruled out," according to the statement.

The recall does not affect the 80-mg dosage of Atorvastatin calcium tablets, according to the Ranbaxy company press release, which lists the specific lots included in the recall.

Ranbaxy initiated the recall on Nov. 9. Distributors have ceased distribution of the affected lots and are in the process of returning these products to Ranbaxy, according to the statement. The affected tablet is white in color, with the imprint RX12 on 10-mg tablets, RX828 on 20-mg tablets, and RX829 on 40-mg tablets.

Atorvastatin is prescribed not only for lowering blood cholesterol, but also for the prevention of cardiovascular disease in patients at high risk for cardiovascular conditions, and for the prevention of cardiovascular events in patients with heart disease.

Adverse reactions or quality problems with the affected atorvastatin lots may be reported to the FDA online, by mail (use Form FDA 3500), or by fax (1-800-FDA-0178).

Ranbaxy Inc. voluntarily recalled 41 lots of Atorvastatin calcium tablets in 10-mg, 20-mg, and 40-mg doses because of potential contamination with ground glass, the company and the Food and Drug Administration announced Nov. 28.

The small size of the particles (less than 1 mm) makes safety concerns unlikely, according to the statement from MedWatch, the FDA Safety Information and Adverse Event Reporting Program.

"However, the possibility of adverse experiences arising primarily due to physical irritation cannot be ruled out," according to the statement.

The recall does not affect the 80-mg dosage of Atorvastatin calcium tablets, according to the Ranbaxy company press release, which lists the specific lots included in the recall.

Ranbaxy initiated the recall on Nov. 9. Distributors have ceased distribution of the affected lots and are in the process of returning these products to Ranbaxy, according to the statement. The affected tablet is white in color, with the imprint RX12 on 10-mg tablets, RX828 on 20-mg tablets, and RX829 on 40-mg tablets.

Atorvastatin is prescribed not only for lowering blood cholesterol, but also for the prevention of cardiovascular disease in patients at high risk for cardiovascular conditions, and for the prevention of cardiovascular events in patients with heart disease.

Adverse reactions or quality problems with the affected atorvastatin lots may be reported to the FDA online, by mail (use Form FDA 3500), or by fax (1-800-FDA-0178).

Ranbaxy Inc. voluntarily recalled 41 lots of Atorvastatin calcium tablets in 10-mg, 20-mg, and 40-mg doses because of potential contamination with ground glass, the company and the Food and Drug Administration announced Nov. 28.

The small size of the particles (less than 1 mm) makes safety concerns unlikely, according to the statement from MedWatch, the FDA Safety Information and Adverse Event Reporting Program.

"However, the possibility of adverse experiences arising primarily due to physical irritation cannot be ruled out," according to the statement.

The recall does not affect the 80-mg dosage of Atorvastatin calcium tablets, according to the Ranbaxy company press release, which lists the specific lots included in the recall.

Ranbaxy initiated the recall on Nov. 9. Distributors have ceased distribution of the affected lots and are in the process of returning these products to Ranbaxy, according to the statement. The affected tablet is white in color, with the imprint RX12 on 10-mg tablets, RX828 on 20-mg tablets, and RX829 on 40-mg tablets.

Atorvastatin is prescribed not only for lowering blood cholesterol, but also for the prevention of cardiovascular disease in patients at high risk for cardiovascular conditions, and for the prevention of cardiovascular events in patients with heart disease.

Adverse reactions or quality problems with the affected atorvastatin lots may be reported to the FDA online, by mail (use Form FDA 3500), or by fax (1-800-FDA-0178).

Approximately 1 in 4 new HIV infections in the United States in 2010 occurred in youth aged 13-24 years, according to data from the Centers for Disease Control and Prevention.

Nearly two-thirds (60%) of infected youth are unaware of their condition, according to a study published online Nov. 27 in Morbidity and Mortality Weekly Report.

"The bottom line is that every month, 1,000 youth are becoming infected with HIV," CDC director Dr. Thomas Frieden said in a telebriefing. "The cost of care of a single patient is approximately $400,000 over their lifetime," he said. "That means every month we are accruing about 400 million dollars of health care costs from preventable infections in youth."

Amanda Mills/CDC

"Reducing HIV among young people is a top priority for CDC," said Dr. Frieden. "This is about the health of a new generation, and protecting them from an entirely preventable disease."

In 2010, youth aged 13-24 years accounted for 12,200 new cases of HIV, which was 26% of the total estimated 45,700 new HIV infections. Of these 12,200, approximately 8,000 (72%) occurred in young men who have sex with men (MSM). Approximately 57% of the new cases among young MSM occurred in black youth, compared with 20% among both white and Hispanic youth, he noted.

An estimated 7,000 (57%) newly infected youths were black, 2,390 (20%) were Hispanic, and 2,380 (20%) were white. The report did not account for the ethnicity of the remaining 3% of the cohort. The majority of the newly infected youth were male (83%).

Although the CDC currently recommends routine HIV testing in medical settings, only 13% of high school students, 22% of sexually active high school students, and 35% of young adults aged 18-34 years have been tested, according to the report (MMWR 2012;61:1-6).

The researchers also reviewed data on risky behaviors among high school students in 12 states and 9 large urban school districts. Overall, young MSM were significantly less likely than their heterosexual peers to have used a condom during their most recent sexual encounters (44% vs. 70%), significantly more likely to have had four or more sexual partners (39% vs. 27%), and significantly less likely to report learning about HIV or AIDS in school (75% vs. 86%).

"We know there are many young people who are not routinely seeing health care providers," Dr. Frieden said. However, health care providers have a role to play in preventing the spread of HIV.

"The key for clinicians is to make it [HIV testing] routine," said Dr. Frieden. "Just as we screen adults for high cholesterol, we screen people for HIV infection. If someone refuses testing, that is their right," he said, but clinicians can have a policy of "this is what we do."

CDC researchers used data from the National HIV Surveillance System to estimate the incidence of new HIV infections in 2010. Data from the 2010 National Health Interview Survey and the Youth Risk Behavior Surveillance System were used to assess risk factors and testing rates.

The study was supported by the Centers for Disease Control and Prevention.

Approximately 1 in 4 new HIV infections in the United States in 2010 occurred in youth aged 13-24 years, according to data from the Centers for Disease Control and Prevention.

Nearly two-thirds (60%) of infected youth are unaware of their condition, according to a study published online Nov. 27 in Morbidity and Mortality Weekly Report.

"The bottom line is that every month, 1,000 youth are becoming infected with HIV," CDC director Dr. Thomas Frieden said in a telebriefing. "The cost of care of a single patient is approximately $400,000 over their lifetime," he said. "That means every month we are accruing about 400 million dollars of health care costs from preventable infections in youth."

Amanda Mills/CDC

"Reducing HIV among young people is a top priority for CDC," said Dr. Frieden. "This is about the health of a new generation, and protecting them from an entirely preventable disease."

In 2010, youth aged 13-24 years accounted for 12,200 new cases of HIV, which was 26% of the total estimated 45,700 new HIV infections. Of these 12,200, approximately 8,000 (72%) occurred in young men who have sex with men (MSM). Approximately 57% of the new cases among young MSM occurred in black youth, compared with 20% among both white and Hispanic youth, he noted.

An estimated 7,000 (57%) newly infected youths were black, 2,390 (20%) were Hispanic, and 2,380 (20%) were white. The report did not account for the ethnicity of the remaining 3% of the cohort. The majority of the newly infected youth were male (83%).

Although the CDC currently recommends routine HIV testing in medical settings, only 13% of high school students, 22% of sexually active high school students, and 35% of young adults aged 18-34 years have been tested, according to the report (MMWR 2012;61:1-6).

The researchers also reviewed data on risky behaviors among high school students in 12 states and 9 large urban school districts. Overall, young MSM were significantly less likely than their heterosexual peers to have used a condom during their most recent sexual encounters (44% vs. 70%), significantly more likely to have had four or more sexual partners (39% vs. 27%), and significantly less likely to report learning about HIV or AIDS in school (75% vs. 86%).

"We know there are many young people who are not routinely seeing health care providers," Dr. Frieden said. However, health care providers have a role to play in preventing the spread of HIV.

"The key for clinicians is to make it [HIV testing] routine," said Dr. Frieden. "Just as we screen adults for high cholesterol, we screen people for HIV infection. If someone refuses testing, that is their right," he said, but clinicians can have a policy of "this is what we do."

CDC researchers used data from the National HIV Surveillance System to estimate the incidence of new HIV infections in 2010. Data from the 2010 National Health Interview Survey and the Youth Risk Behavior Surveillance System were used to assess risk factors and testing rates.

The study was supported by the Centers for Disease Control and Prevention.

Approximately 1 in 4 new HIV infections in the United States in 2010 occurred in youth aged 13-24 years, according to data from the Centers for Disease Control and Prevention.

Nearly two-thirds (60%) of infected youth are unaware of their condition, according to a study published online Nov. 27 in Morbidity and Mortality Weekly Report.

"The bottom line is that every month, 1,000 youth are becoming infected with HIV," CDC director Dr. Thomas Frieden said in a telebriefing. "The cost of care of a single patient is approximately $400,000 over their lifetime," he said. "That means every month we are accruing about 400 million dollars of health care costs from preventable infections in youth."

Amanda Mills/CDC

"Reducing HIV among young people is a top priority for CDC," said Dr. Frieden. "This is about the health of a new generation, and protecting them from an entirely preventable disease."

In 2010, youth aged 13-24 years accounted for 12,200 new cases of HIV, which was 26% of the total estimated 45,700 new HIV infections. Of these 12,200, approximately 8,000 (72%) occurred in young men who have sex with men (MSM). Approximately 57% of the new cases among young MSM occurred in black youth, compared with 20% among both white and Hispanic youth, he noted.

An estimated 7,000 (57%) newly infected youths were black, 2,390 (20%) were Hispanic, and 2,380 (20%) were white. The report did not account for the ethnicity of the remaining 3% of the cohort. The majority of the newly infected youth were male (83%).

Although the CDC currently recommends routine HIV testing in medical settings, only 13% of high school students, 22% of sexually active high school students, and 35% of young adults aged 18-34 years have been tested, according to the report (MMWR 2012;61:1-6).

The researchers also reviewed data on risky behaviors among high school students in 12 states and 9 large urban school districts. Overall, young MSM were significantly less likely than their heterosexual peers to have used a condom during their most recent sexual encounters (44% vs. 70%), significantly more likely to have had four or more sexual partners (39% vs. 27%), and significantly less likely to report learning about HIV or AIDS in school (75% vs. 86%).

"We know there are many young people who are not routinely seeing health care providers," Dr. Frieden said. However, health care providers have a role to play in preventing the spread of HIV.

"The key for clinicians is to make it [HIV testing] routine," said Dr. Frieden. "Just as we screen adults for high cholesterol, we screen people for HIV infection. If someone refuses testing, that is their right," he said, but clinicians can have a policy of "this is what we do."

CDC researchers used data from the National HIV Surveillance System to estimate the incidence of new HIV infections in 2010. Data from the 2010 National Health Interview Survey and the Youth Risk Behavior Surveillance System were used to assess risk factors and testing rates.

The study was supported by the Centers for Disease Control and Prevention.

WASHINGTON – Younger age, lower baseline pain, and shorter time to remission were significant predictors of sustained remission for early rheumatoid arthritis patients, based on data from more than 1,000 patients older than 16 years.

The prevalence of and predictive factors for sustained remission in early rheumatoid arthritis (RA) is not well understood, "particularly in the context of new stringent definitions," said Dr. Vivian P. Bykerk, who is on the staff of the Inflammatory Arthritis Center of the Hospital for Special Surgery in New York.

Dr. Bykerk and her colleagues reviewed data from the Canadian Early Arthritis Cohort (CATCH) study. Their selected study population included 1,244 adults with probable or confirmed RA. The average age of the patients was 54 years, 83% were white, and 73% were women. The researchers presented the data at the annual American College of Rheumatology meeting.

Remission was defined using the Simple Disease Activity Index (SDAI) and the ACR/EULAR clinical practice and clinical trial definitions. The remission definition using SDAI was a score of 3.3 or less. The ACR/EULAR clinical practice remission definition included a tender joint count, swollen joint count, and patient global assessment scores of 1 or less; the clinical trial definition added a CRP level of 1 mg/dL or less to the clinical practice definition.

Overall, 40% of the patients achieved SDAI remission, 42% achieved ACR/EULAR clinical practice remission, and 35% achieved ACR/EULAR clinical trial remission. The median time to remission based on the three definitions was 10 months, 8 months, and 9 months, respectively.

Of the patients who achieved SDAI, ACR/EULAR clinical practice, and ACR/EULAR clinical trial remission, 56%, 59%, and 54%, respectively, achieved sustained remission (defined as remission lasting at least 12 months).

The average duration of symptoms was 6 months. Patients were either treatment naïve or in the early stages of treatment. In the first 3 months, 44% of the patients received combination therapy, 32% received methotrexate monotherapy, 30% received oral corticosteroids, and 2% received biologics.

The average SDAI score at baseline was 29, and the baseline number of tender and swollen joints was approximately 8. Patients were evaluated every 3 months for the first year, followed by evaluations every 6 months.

After researchers adjusted for confounding variables, they determined that younger age, lower baseline pain score, and shorter time to remission were significantly associated with sustained remission. The effect of shorter time to remission on sustained remission supports striving for early remission in early RA patients, Dr. Bykerk noted.

Variables that were not associated with sustained remission included smoking status, symptom duration, tender or swollen joint counts, morning stiffness, and initial treatment with oral corticosteroids or biologics.

Methotrexate monotherapy was associated with lower sustained remission, and the data could not prove an association between combination disease-modifying antirheumatic drugs (DMARD) therapy and sustained remission, said Dr. Bykerk.

In addition, laboratory values for erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anticitrullinated protein antibodies (ACPA) were not associated with sustained remission, she said.

The study findings were limited by several factors including a lack of data on medication changes and the limited follow-up times of 3- and 6-month intervals, Dr. Bykerk said. But the results are strengthened by the use of a real-world observational cohort and suggest that more work is needed to determine the best patient-specific treatment strategies, she said.

Dr. Bykerk disclosed financial relationships with multiple companies including Abbott, Amgen, Pfizer, and Roche.

WASHINGTON – Younger age, lower baseline pain, and shorter time to remission were significant predictors of sustained remission for early rheumatoid arthritis patients, based on data from more than 1,000 patients older than 16 years.

The prevalence of and predictive factors for sustained remission in early rheumatoid arthritis (RA) is not well understood, "particularly in the context of new stringent definitions," said Dr. Vivian P. Bykerk, who is on the staff of the Inflammatory Arthritis Center of the Hospital for Special Surgery in New York.

Dr. Bykerk and her colleagues reviewed data from the Canadian Early Arthritis Cohort (CATCH) study. Their selected study population included 1,244 adults with probable or confirmed RA. The average age of the patients was 54 years, 83% were white, and 73% were women. The researchers presented the data at the annual American College of Rheumatology meeting.

Remission was defined using the Simple Disease Activity Index (SDAI) and the ACR/EULAR clinical practice and clinical trial definitions. The remission definition using SDAI was a score of 3.3 or less. The ACR/EULAR clinical practice remission definition included a tender joint count, swollen joint count, and patient global assessment scores of 1 or less; the clinical trial definition added a CRP level of 1 mg/dL or less to the clinical practice definition.

Overall, 40% of the patients achieved SDAI remission, 42% achieved ACR/EULAR clinical practice remission, and 35% achieved ACR/EULAR clinical trial remission. The median time to remission based on the three definitions was 10 months, 8 months, and 9 months, respectively.

Of the patients who achieved SDAI, ACR/EULAR clinical practice, and ACR/EULAR clinical trial remission, 56%, 59%, and 54%, respectively, achieved sustained remission (defined as remission lasting at least 12 months).

The average duration of symptoms was 6 months. Patients were either treatment naïve or in the early stages of treatment. In the first 3 months, 44% of the patients received combination therapy, 32% received methotrexate monotherapy, 30% received oral corticosteroids, and 2% received biologics.

The average SDAI score at baseline was 29, and the baseline number of tender and swollen joints was approximately 8. Patients were evaluated every 3 months for the first year, followed by evaluations every 6 months.

After researchers adjusted for confounding variables, they determined that younger age, lower baseline pain score, and shorter time to remission were significantly associated with sustained remission. The effect of shorter time to remission on sustained remission supports striving for early remission in early RA patients, Dr. Bykerk noted.

Variables that were not associated with sustained remission included smoking status, symptom duration, tender or swollen joint counts, morning stiffness, and initial treatment with oral corticosteroids or biologics.

Methotrexate monotherapy was associated with lower sustained remission, and the data could not prove an association between combination disease-modifying antirheumatic drugs (DMARD) therapy and sustained remission, said Dr. Bykerk.

In addition, laboratory values for erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anticitrullinated protein antibodies (ACPA) were not associated with sustained remission, she said.

The study findings were limited by several factors including a lack of data on medication changes and the limited follow-up times of 3- and 6-month intervals, Dr. Bykerk said. But the results are strengthened by the use of a real-world observational cohort and suggest that more work is needed to determine the best patient-specific treatment strategies, she said.

Dr. Bykerk disclosed financial relationships with multiple companies including Abbott, Amgen, Pfizer, and Roche.

WASHINGTON – Younger age, lower baseline pain, and shorter time to remission were significant predictors of sustained remission for early rheumatoid arthritis patients, based on data from more than 1,000 patients older than 16 years.

The prevalence of and predictive factors for sustained remission in early rheumatoid arthritis (RA) is not well understood, "particularly in the context of new stringent definitions," said Dr. Vivian P. Bykerk, who is on the staff of the Inflammatory Arthritis Center of the Hospital for Special Surgery in New York.

Dr. Bykerk and her colleagues reviewed data from the Canadian Early Arthritis Cohort (CATCH) study. Their selected study population included 1,244 adults with probable or confirmed RA. The average age of the patients was 54 years, 83% were white, and 73% were women. The researchers presented the data at the annual American College of Rheumatology meeting.

Remission was defined using the Simple Disease Activity Index (SDAI) and the ACR/EULAR clinical practice and clinical trial definitions. The remission definition using SDAI was a score of 3.3 or less. The ACR/EULAR clinical practice remission definition included a tender joint count, swollen joint count, and patient global assessment scores of 1 or less; the clinical trial definition added a CRP level of 1 mg/dL or less to the clinical practice definition.

Overall, 40% of the patients achieved SDAI remission, 42% achieved ACR/EULAR clinical practice remission, and 35% achieved ACR/EULAR clinical trial remission. The median time to remission based on the three definitions was 10 months, 8 months, and 9 months, respectively.

Of the patients who achieved SDAI, ACR/EULAR clinical practice, and ACR/EULAR clinical trial remission, 56%, 59%, and 54%, respectively, achieved sustained remission (defined as remission lasting at least 12 months).

The average duration of symptoms was 6 months. Patients were either treatment naïve or in the early stages of treatment. In the first 3 months, 44% of the patients received combination therapy, 32% received methotrexate monotherapy, 30% received oral corticosteroids, and 2% received biologics.

The average SDAI score at baseline was 29, and the baseline number of tender and swollen joints was approximately 8. Patients were evaluated every 3 months for the first year, followed by evaluations every 6 months.

After researchers adjusted for confounding variables, they determined that younger age, lower baseline pain score, and shorter time to remission were significantly associated with sustained remission. The effect of shorter time to remission on sustained remission supports striving for early remission in early RA patients, Dr. Bykerk noted.

Variables that were not associated with sustained remission included smoking status, symptom duration, tender or swollen joint counts, morning stiffness, and initial treatment with oral corticosteroids or biologics.

Methotrexate monotherapy was associated with lower sustained remission, and the data could not prove an association between combination disease-modifying antirheumatic drugs (DMARD) therapy and sustained remission, said Dr. Bykerk.

In addition, laboratory values for erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anticitrullinated protein antibodies (ACPA) were not associated with sustained remission, she said.

The study findings were limited by several factors including a lack of data on medication changes and the limited follow-up times of 3- and 6-month intervals, Dr. Bykerk said. But the results are strengthened by the use of a real-world observational cohort and suggest that more work is needed to determine the best patient-specific treatment strategies, she said.

Dr. Bykerk disclosed financial relationships with multiple companies including Abbott, Amgen, Pfizer, and Roche.

CHICAGO – Approximately one-third of surgical complications were diagnosed after patients left the hospital, based on data from nearly 60,000 procedures performed at 112 hospitals.

Reporting postoperative complications, including surgical site infections, has become a mandatory quality reporting initiative for hospitals, and the Affordable Care Act requires reporting of readmissions, said Dr. Melanie Morris of the University of Alabama at Birmingham.

"Some postoperative complications may lead to readmissions, but this may not tell the whole story," she noted at the annual clinical congress of the American College of Surgeons.

To determine the timing of postoperative complications and the nature of readmissions, Dr. Morris and her colleagues reviewed Veterans Affairs data from the noncardiac Surgical Care Improvement Project (SCIP) cohort from 2005 to 2009 for 59,464 surgical procedures in which there was at least one complication.

Surgical cases were classified by specialty into gastrointestinal, gynecologic, orthopedic, and vascular. Complications were grouped into organ-based systems. For example, urinary complications included renal failure, renal insufficiency, and urinary tract infections; respiratory complications included failure to wean, pneumonia, and reintubation; and surgical site infections (SSIs) included both deep and superficial wounds.

The overall complication rate was approximately 15%, and 32% of complications were diagnosed after hospital discharge, Dr. Morris said. More than half (56%) of all SSIs were diagnosed after discharge, she added.

A statistically significant difference appeared in postdischarge complications by surgical specialty. The SSI rate was 5.4%, followed by respiratory complications (5.0%), urinary tract infection (4.9%), cardiac complications (3.2%), and venous thromboembolism (1.2%).

"Our GI surgical patients had the highest overall complication rate," Dr. Morris noted. Among GI patients, colectomy patients had the highest SSI rate (11%), and 23% of the GI complications were diagnosed after hospital discharge.

In addition, 78% of SSIs in orthopedic patients were diagnosed after discharge, as were 39% of SSIs in GI patients, 77% of SSIs in vascular surgery patients, and 95% of SSIs in gynecologic patients, said Dr. Morris.

There were no significant differences in length of hospital stay based on complications, Dr. Morris said.

The overall readmission rate was 11.9%, and 70% of these patients had no identifiable postoperative complication. Of those who did have an identifiable postop complication, 72% were diagnosed before discharge from the hospital.

The probability of being readmitted to the hospital over time was highest in patients with a postdischarge diagnosis of a complication. The overall length of stay was 5 days, and the average length of stay for patients with any complication was 9 days.

Patient-specific factors associated with an increased risk of readmission included a history of heart failure, renal failure, diabetes, weight loss, and smoking. Procedure-specific factors associated with an increased risk of readmission included a longer operating time, a more contaminated wound, and a higher ASA (American Society of Anesthesiologists) class.

Length of stay was slightly protective for readmission, and the presence of any complication was associated with a high risk of readmission.

"It’s very important that patients are accurately educated on the signs and symptoms of complications so they know to seek timely care after discharge," said Dr. Morris.

"Postoperative complications must be measured beyond hospital discharge to capture the whole story.

"Systematic collection of postoperative complications must include postdischarge data as well as readmissions to accurately measure quality," she said.

Dr. Morris said she had no relevant financial disclosures.

CHICAGO – Approximately one-third of surgical complications were diagnosed after patients left the hospital, based on data from nearly 60,000 procedures performed at 112 hospitals.

Reporting postoperative complications, including surgical site infections, has become a mandatory quality reporting initiative for hospitals, and the Affordable Care Act requires reporting of readmissions, said Dr. Melanie Morris of the University of Alabama at Birmingham.

"Some postoperative complications may lead to readmissions, but this may not tell the whole story," she noted at the annual clinical congress of the American College of Surgeons.

To determine the timing of postoperative complications and the nature of readmissions, Dr. Morris and her colleagues reviewed Veterans Affairs data from the noncardiac Surgical Care Improvement Project (SCIP) cohort from 2005 to 2009 for 59,464 surgical procedures in which there was at least one complication.

Surgical cases were classified by specialty into gastrointestinal, gynecologic, orthopedic, and vascular. Complications were grouped into organ-based systems. For example, urinary complications included renal failure, renal insufficiency, and urinary tract infections; respiratory complications included failure to wean, pneumonia, and reintubation; and surgical site infections (SSIs) included both deep and superficial wounds.

The overall complication rate was approximately 15%, and 32% of complications were diagnosed after hospital discharge, Dr. Morris said. More than half (56%) of all SSIs were diagnosed after discharge, she added.

A statistically significant difference appeared in postdischarge complications by surgical specialty. The SSI rate was 5.4%, followed by respiratory complications (5.0%), urinary tract infection (4.9%), cardiac complications (3.2%), and venous thromboembolism (1.2%).

"Our GI surgical patients had the highest overall complication rate," Dr. Morris noted. Among GI patients, colectomy patients had the highest SSI rate (11%), and 23% of the GI complications were diagnosed after hospital discharge.

In addition, 78% of SSIs in orthopedic patients were diagnosed after discharge, as were 39% of SSIs in GI patients, 77% of SSIs in vascular surgery patients, and 95% of SSIs in gynecologic patients, said Dr. Morris.

There were no significant differences in length of hospital stay based on complications, Dr. Morris said.

The overall readmission rate was 11.9%, and 70% of these patients had no identifiable postoperative complication. Of those who did have an identifiable postop complication, 72% were diagnosed before discharge from the hospital.

The probability of being readmitted to the hospital over time was highest in patients with a postdischarge diagnosis of a complication. The overall length of stay was 5 days, and the average length of stay for patients with any complication was 9 days.

Patient-specific factors associated with an increased risk of readmission included a history of heart failure, renal failure, diabetes, weight loss, and smoking. Procedure-specific factors associated with an increased risk of readmission included a longer operating time, a more contaminated wound, and a higher ASA (American Society of Anesthesiologists) class.

Length of stay was slightly protective for readmission, and the presence of any complication was associated with a high risk of readmission.

"It’s very important that patients are accurately educated on the signs and symptoms of complications so they know to seek timely care after discharge," said Dr. Morris.

"Postoperative complications must be measured beyond hospital discharge to capture the whole story.

"Systematic collection of postoperative complications must include postdischarge data as well as readmissions to accurately measure quality," she said.

Dr. Morris said she had no relevant financial disclosures.

CHICAGO – Approximately one-third of surgical complications were diagnosed after patients left the hospital, based on data from nearly 60,000 procedures performed at 112 hospitals.

Reporting postoperative complications, including surgical site infections, has become a mandatory quality reporting initiative for hospitals, and the Affordable Care Act requires reporting of readmissions, said Dr. Melanie Morris of the University of Alabama at Birmingham.

"Some postoperative complications may lead to readmissions, but this may not tell the whole story," she noted at the annual clinical congress of the American College of Surgeons.

To determine the timing of postoperative complications and the nature of readmissions, Dr. Morris and her colleagues reviewed Veterans Affairs data from the noncardiac Surgical Care Improvement Project (SCIP) cohort from 2005 to 2009 for 59,464 surgical procedures in which there was at least one complication.

Surgical cases were classified by specialty into gastrointestinal, gynecologic, orthopedic, and vascular. Complications were grouped into organ-based systems. For example, urinary complications included renal failure, renal insufficiency, and urinary tract infections; respiratory complications included failure to wean, pneumonia, and reintubation; and surgical site infections (SSIs) included both deep and superficial wounds.

The overall complication rate was approximately 15%, and 32% of complications were diagnosed after hospital discharge, Dr. Morris said. More than half (56%) of all SSIs were diagnosed after discharge, she added.

A statistically significant difference appeared in postdischarge complications by surgical specialty. The SSI rate was 5.4%, followed by respiratory complications (5.0%), urinary tract infection (4.9%), cardiac complications (3.2%), and venous thromboembolism (1.2%).

"Our GI surgical patients had the highest overall complication rate," Dr. Morris noted. Among GI patients, colectomy patients had the highest SSI rate (11%), and 23% of the GI complications were diagnosed after hospital discharge.

In addition, 78% of SSIs in orthopedic patients were diagnosed after discharge, as were 39% of SSIs in GI patients, 77% of SSIs in vascular surgery patients, and 95% of SSIs in gynecologic patients, said Dr. Morris.

There were no significant differences in length of hospital stay based on complications, Dr. Morris said.

The overall readmission rate was 11.9%, and 70% of these patients had no identifiable postoperative complication. Of those who did have an identifiable postop complication, 72% were diagnosed before discharge from the hospital.

The probability of being readmitted to the hospital over time was highest in patients with a postdischarge diagnosis of a complication. The overall length of stay was 5 days, and the average length of stay for patients with any complication was 9 days.

Patient-specific factors associated with an increased risk of readmission included a history of heart failure, renal failure, diabetes, weight loss, and smoking. Procedure-specific factors associated with an increased risk of readmission included a longer operating time, a more contaminated wound, and a higher ASA (American Society of Anesthesiologists) class.

Length of stay was slightly protective for readmission, and the presence of any complication was associated with a high risk of readmission.

"It’s very important that patients are accurately educated on the signs and symptoms of complications so they know to seek timely care after discharge," said Dr. Morris.

"Postoperative complications must be measured beyond hospital discharge to capture the whole story.

"Systematic collection of postoperative complications must include postdischarge data as well as readmissions to accurately measure quality," she said.

Dr. Morris said she had no relevant financial disclosures.

WASHINGTON – Men with rheumatoid arthritis who have depression or depressive symptoms were significantly more likely to die compared with RA patients who were not depressed, according to data from a longitudinal cohort study of 530 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

The deleterious effect of depression on early mortality also was seen in women with RA, but to a lesser extent.

"Depression is often underdiagnosed in RA," but the risk of mortality associated with depression in RA has not been well studied, said Patricia Katz, Ph.D., of the University of California, San Francisco.

Dr. Katz and colleagues conducted annual telephone surveys of 530 adults with RA over a 7-year period, with an average of 5 years’ follow-up. The average age of the patients was 60 years, 84% were women, the average disease duration was 19 years, and 46% reported at least one cardiovascular risk factor. Depression was defined as a score of 5 or higher on the 15-item Geriatric Depression Scale (GDS).

"Even though depression is very common in RA, it is not normal."

A total of 63 patients (12%) died during the study period. The risk of death in depressed men and women with RA was approximately three times that of RA patients who were not depressed (hazard ratio 3.5), according to the results of a bivariate analysis.

"People who were depressed at their last interview were more likely to die," Dr. Katz said. In a multivariate analysis, depression remained a significant predictor of mortality.

In particular, men with RA who met criteria for depression had the highest risk of mortality.

"Overall, men were two and half times more likely to die than women," Dr. Katz said, but men with depression had a risk that was six times higher than women with no depression (who served as a reference group), she added. Women with depression had a risk of death of two and half times that of women with no depression.

In addition, a change in depressive symptoms that did not meet the criteria for depression (defined as a worsening of GDS scores by at least 2 points) was associated with an approximately twofold increased risk of death in depressed women compared to women with no depression. Men with an increase in depressive symptom scores had an increase in risk five times that of women with no depression.

"Both depression and an increase in depressive symptoms are significant risk factors for all-cause mortality in RA," Dr. Katz noted.

"I think it is important to recognize that depression is a treatable condition," said Dr. Katz. "Even though depression is very common in RA, it is not normal. It needs to be treated, and to be treated it needs to be recognized," she said.

"This is the clinical challenge; there needs to be some sort of regular monitoring to recognize these changes early, so intervention can happen at an appropriate time," she added.

The study was funded in part by the National Institute for Arthritis, Musculoskeletal, and Skin Diseases of the National Institutes of Health. Dr. Katz had no financial conflicts to disclose.

WASHINGTON – Men with rheumatoid arthritis who have depression or depressive symptoms were significantly more likely to die compared with RA patients who were not depressed, according to data from a longitudinal cohort study of 530 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

The deleterious effect of depression on early mortality also was seen in women with RA, but to a lesser extent.

"Depression is often underdiagnosed in RA," but the risk of mortality associated with depression in RA has not been well studied, said Patricia Katz, Ph.D., of the University of California, San Francisco.

Dr. Katz and colleagues conducted annual telephone surveys of 530 adults with RA over a 7-year period, with an average of 5 years’ follow-up. The average age of the patients was 60 years, 84% were women, the average disease duration was 19 years, and 46% reported at least one cardiovascular risk factor. Depression was defined as a score of 5 or higher on the 15-item Geriatric Depression Scale (GDS).

"Even though depression is very common in RA, it is not normal."

A total of 63 patients (12%) died during the study period. The risk of death in depressed men and women with RA was approximately three times that of RA patients who were not depressed (hazard ratio 3.5), according to the results of a bivariate analysis.

"People who were depressed at their last interview were more likely to die," Dr. Katz said. In a multivariate analysis, depression remained a significant predictor of mortality.

In particular, men with RA who met criteria for depression had the highest risk of mortality.

"Overall, men were two and half times more likely to die than women," Dr. Katz said, but men with depression had a risk that was six times higher than women with no depression (who served as a reference group), she added. Women with depression had a risk of death of two and half times that of women with no depression.

In addition, a change in depressive symptoms that did not meet the criteria for depression (defined as a worsening of GDS scores by at least 2 points) was associated with an approximately twofold increased risk of death in depressed women compared to women with no depression. Men with an increase in depressive symptom scores had an increase in risk five times that of women with no depression.

"Both depression and an increase in depressive symptoms are significant risk factors for all-cause mortality in RA," Dr. Katz noted.

"I think it is important to recognize that depression is a treatable condition," said Dr. Katz. "Even though depression is very common in RA, it is not normal. It needs to be treated, and to be treated it needs to be recognized," she said.

"This is the clinical challenge; there needs to be some sort of regular monitoring to recognize these changes early, so intervention can happen at an appropriate time," she added.

The study was funded in part by the National Institute for Arthritis, Musculoskeletal, and Skin Diseases of the National Institutes of Health. Dr. Katz had no financial conflicts to disclose.

WASHINGTON – Men with rheumatoid arthritis who have depression or depressive symptoms were significantly more likely to die compared with RA patients who were not depressed, according to data from a longitudinal cohort study of 530 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

The deleterious effect of depression on early mortality also was seen in women with RA, but to a lesser extent.

"Depression is often underdiagnosed in RA," but the risk of mortality associated with depression in RA has not been well studied, said Patricia Katz, Ph.D., of the University of California, San Francisco.

Dr. Katz and colleagues conducted annual telephone surveys of 530 adults with RA over a 7-year period, with an average of 5 years’ follow-up. The average age of the patients was 60 years, 84% were women, the average disease duration was 19 years, and 46% reported at least one cardiovascular risk factor. Depression was defined as a score of 5 or higher on the 15-item Geriatric Depression Scale (GDS).

"Even though depression is very common in RA, it is not normal."

A total of 63 patients (12%) died during the study period. The risk of death in depressed men and women with RA was approximately three times that of RA patients who were not depressed (hazard ratio 3.5), according to the results of a bivariate analysis.

"People who were depressed at their last interview were more likely to die," Dr. Katz said. In a multivariate analysis, depression remained a significant predictor of mortality.

In particular, men with RA who met criteria for depression had the highest risk of mortality.

"Overall, men were two and half times more likely to die than women," Dr. Katz said, but men with depression had a risk that was six times higher than women with no depression (who served as a reference group), she added. Women with depression had a risk of death of two and half times that of women with no depression.

In addition, a change in depressive symptoms that did not meet the criteria for depression (defined as a worsening of GDS scores by at least 2 points) was associated with an approximately twofold increased risk of death in depressed women compared to women with no depression. Men with an increase in depressive symptom scores had an increase in risk five times that of women with no depression.

"Both depression and an increase in depressive symptoms are significant risk factors for all-cause mortality in RA," Dr. Katz noted.

"I think it is important to recognize that depression is a treatable condition," said Dr. Katz. "Even though depression is very common in RA, it is not normal. It needs to be treated, and to be treated it needs to be recognized," she said.

"This is the clinical challenge; there needs to be some sort of regular monitoring to recognize these changes early, so intervention can happen at an appropriate time," she added.

The study was funded in part by the National Institute for Arthritis, Musculoskeletal, and Skin Diseases of the National Institutes of Health. Dr. Katz had no financial conflicts to disclose.

WASHINGTON – Biologics use by rheumatoid arthritis patients was associated with a 25% reduction in the risk of premature death, compared with patients without exposure to biologics, based on data from a population-based study of more than 4,000 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

Rheumatoid arthritis (RA) is associated with a twofold increase in premature mortality risk, primarily caused by cardiovascular disease, said Dr. Diane Lacaille of the Arthritis Research Centre of Canada, in Vancouver. Previous research suggests that the increased risk is linked to inflammation that affects other organs beyond the RA-affected joints, she said. Biologic agents have shown effectiveness in controlling the inflammation associated with joint damage in RA, but the drugs’ impact on reducing early mortality has not been well studied, Dr. Lacaille said.

Dr. Lacaille and her colleagues reviewed data from the Canadian Ministry of Health to identify all RA cases that used a biologic agent (anti–tumor necrosis factor (anti-TNF), rituximab, anakinra, or abatacept) during follow-up. The study population included 2,156 patients who used biologics and 2,156 controls matched for age, sex, and calendar year. The average age of the patients was 56 years, and 75% were women. The researchers obtained data on all health services used by the study participants – including medications, lab tests, and hospitalizations – between January 1996 and March 2006, with follow-up to March 2010.

"Exposure to biologics was associated with a reduced risk of death, with a hazard ratio of 0.26 [(95% confidence interval, 0.18-0.36), P less than or equal to .0001)], which means that the risk of death in the biologics users was a quarter that of the nonbiologic users," Dr. Lacaille said. Approximately 90% of the biologics users were using anti-TNF therapy, but the findings were consistent for all biologics in a multivariate analysis, she noted.

Overall, 573 deaths were noted during the study period, including 247 in the biologics group and 326 in the control group. The use of three previous disease-modifying antirheumatic drugs or a change in DMARD did not affect the results, Dr. Lacaille noted.

"I think it wouldn’t be accurate from an epidemiological point of view to say that biologics lead to a 75% reduction" in the risk of premature death, she said.

"But we can be confident that there was an association with a reduction in the reduced risk of death," she added.

The study was limited by the lack of randomization, which may have led to some selection bias, said Dr. Lacaille. But given the increased risk of early mortality associated with RA, the data have "important implications for health policy makers, health care providers, and people with RA," she said.

Approximately 28% of the patients had used more than one biologic, but the number or course of prior biologics had no apparent impact on the risk of death, she added.

Dr. Lacaille had no financial conflicts to disclose.

WASHINGTON – Biologics use by rheumatoid arthritis patients was associated with a 25% reduction in the risk of premature death, compared with patients without exposure to biologics, based on data from a population-based study of more than 4,000 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

Rheumatoid arthritis (RA) is associated with a twofold increase in premature mortality risk, primarily caused by cardiovascular disease, said Dr. Diane Lacaille of the Arthritis Research Centre of Canada, in Vancouver. Previous research suggests that the increased risk is linked to inflammation that affects other organs beyond the RA-affected joints, she said. Biologic agents have shown effectiveness in controlling the inflammation associated with joint damage in RA, but the drugs’ impact on reducing early mortality has not been well studied, Dr. Lacaille said.

Dr. Lacaille and her colleagues reviewed data from the Canadian Ministry of Health to identify all RA cases that used a biologic agent (anti–tumor necrosis factor (anti-TNF), rituximab, anakinra, or abatacept) during follow-up. The study population included 2,156 patients who used biologics and 2,156 controls matched for age, sex, and calendar year. The average age of the patients was 56 years, and 75% were women. The researchers obtained data on all health services used by the study participants – including medications, lab tests, and hospitalizations – between January 1996 and March 2006, with follow-up to March 2010.

"Exposure to biologics was associated with a reduced risk of death, with a hazard ratio of 0.26 [(95% confidence interval, 0.18-0.36), P less than or equal to .0001)], which means that the risk of death in the biologics users was a quarter that of the nonbiologic users," Dr. Lacaille said. Approximately 90% of the biologics users were using anti-TNF therapy, but the findings were consistent for all biologics in a multivariate analysis, she noted.

Overall, 573 deaths were noted during the study period, including 247 in the biologics group and 326 in the control group. The use of three previous disease-modifying antirheumatic drugs or a change in DMARD did not affect the results, Dr. Lacaille noted.

"I think it wouldn’t be accurate from an epidemiological point of view to say that biologics lead to a 75% reduction" in the risk of premature death, she said.

"But we can be confident that there was an association with a reduction in the reduced risk of death," she added.

The study was limited by the lack of randomization, which may have led to some selection bias, said Dr. Lacaille. But given the increased risk of early mortality associated with RA, the data have "important implications for health policy makers, health care providers, and people with RA," she said.

Approximately 28% of the patients had used more than one biologic, but the number or course of prior biologics had no apparent impact on the risk of death, she added.

Dr. Lacaille had no financial conflicts to disclose.

WASHINGTON – Biologics use by rheumatoid arthritis patients was associated with a 25% reduction in the risk of premature death, compared with patients without exposure to biologics, based on data from a population-based study of more than 4,000 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

Rheumatoid arthritis (RA) is associated with a twofold increase in premature mortality risk, primarily caused by cardiovascular disease, said Dr. Diane Lacaille of the Arthritis Research Centre of Canada, in Vancouver. Previous research suggests that the increased risk is linked to inflammation that affects other organs beyond the RA-affected joints, she said. Biologic agents have shown effectiveness in controlling the inflammation associated with joint damage in RA, but the drugs’ impact on reducing early mortality has not been well studied, Dr. Lacaille said.

Dr. Lacaille and her colleagues reviewed data from the Canadian Ministry of Health to identify all RA cases that used a biologic agent (anti–tumor necrosis factor (anti-TNF), rituximab, anakinra, or abatacept) during follow-up. The study population included 2,156 patients who used biologics and 2,156 controls matched for age, sex, and calendar year. The average age of the patients was 56 years, and 75% were women. The researchers obtained data on all health services used by the study participants – including medications, lab tests, and hospitalizations – between January 1996 and March 2006, with follow-up to March 2010.

"Exposure to biologics was associated with a reduced risk of death, with a hazard ratio of 0.26 [(95% confidence interval, 0.18-0.36), P less than or equal to .0001)], which means that the risk of death in the biologics users was a quarter that of the nonbiologic users," Dr. Lacaille said. Approximately 90% of the biologics users were using anti-TNF therapy, but the findings were consistent for all biologics in a multivariate analysis, she noted.

Overall, 573 deaths were noted during the study period, including 247 in the biologics group and 326 in the control group. The use of three previous disease-modifying antirheumatic drugs or a change in DMARD did not affect the results, Dr. Lacaille noted.

"I think it wouldn’t be accurate from an epidemiological point of view to say that biologics lead to a 75% reduction" in the risk of premature death, she said.

"But we can be confident that there was an association with a reduction in the reduced risk of death," she added.

The study was limited by the lack of randomization, which may have led to some selection bias, said Dr. Lacaille. But given the increased risk of early mortality associated with RA, the data have "important implications for health policy makers, health care providers, and people with RA," she said.

Approximately 28% of the patients had used more than one biologic, but the number or course of prior biologics had no apparent impact on the risk of death, she added.

Dr. Lacaille had no financial conflicts to disclose.

WASHINGTON – A daily dose of strontium ranelate was associated with a significant delay in joint space narrowing in adults with symptomatic primary knee osteoarthritis, based on data from the phase III Strontium Ranelate Knee Osteoarthritis Trial (SEKOIA).

Strontium renalate currently is not approved in the United States, but it is approved in more than 100 countries for treating osteoporosis, said Dr. Jean-Yves Reginster, who is head of the Center for Investigation in Bone and Articular Cartilage Metabolism at the University of Liège (Belgium).

Data from nonclinical studies have shown that strontium’s bone-building activity has a positive impact on cartilage as well, he noted at the annual meeting of the American College of Rheumatology.

To examine the effectiveness of strontium ranelate on the progression of knee osteoarthritis (OA), Dr. Reginster and his colleagues randomized 1,683 adults with symptomatic primary knee OA to 1 g of strontium ranelate per day (566 patients), 2 g/day (558 patients), or a placebo (559 patients). Complete data were available for 1,371 patients. The average age of the patients was 63 years, and 69% were women.

Overall, treatment with either dose of strontium was associated with a significant delay in the radiographic progression of knee OA, which was assessed by measuring the radiological joint space narrowing (JSN) of the medial tibiofemoral compartment of the knee joint.

After 1 year, joint space width decreased by 0.27 mm in the 2-g/day group, 0.23 mm in the 1-g/day group, and 0.37 mm in the placebo group. The differences between the 2-g/day and 1-g/day groups and the placebo group were 0.10 mm and 0.14 mm, respectively.

Significantly less radiological progression was noted in both strontium groups, compared with the placebo group. The percentage of patients with radiological progression (defined as joint space narrowing of at least 0.5 mm) was 26% in the 2-g/day group, 22% in the 1-g/day group, and 33% in the placebo group.

"The structural effect is translated clinically into a lower number of patients having a radiological progression over thresholds predictive of OA-related surgery," Dr. Reginster said. The findings suggest that strontium ranelate could reduce the need for knee surgery in OA patients, he added.

In addition, significantly more patients in the 2-g/day group exceeded the minimally perceptible clinical improvement (MCPI) threshold, compared with the placebo patients, on subscores of pain, stiffness, and physical function. The percentage of patients in the 1-g/day group above this threshold was not significantly higher than in the placebo group.

No significant differences in adverse events were observed among the three groups, and the incidence of serious adverse events was 17% in all groups.

The study findings also appeared online on Nov. 9 (Ann. Rheum. Dis. 2012 [doi:10.1136/annrheumdis-2012-202231]).

The study was sponsored by Servier. Dr. Reginster disclosed financial relationships with multiple companies, including Servier.

WASHINGTON – A daily dose of strontium ranelate was associated with a significant delay in joint space narrowing in adults with symptomatic primary knee osteoarthritis, based on data from the phase III Strontium Ranelate Knee Osteoarthritis Trial (SEKOIA).

Strontium renalate currently is not approved in the United States, but it is approved in more than 100 countries for treating osteoporosis, said Dr. Jean-Yves Reginster, who is head of the Center for Investigation in Bone and Articular Cartilage Metabolism at the University of Liège (Belgium).

Data from nonclinical studies have shown that strontium’s bone-building activity has a positive impact on cartilage as well, he noted at the annual meeting of the American College of Rheumatology.

To examine the effectiveness of strontium ranelate on the progression of knee osteoarthritis (OA), Dr. Reginster and his colleagues randomized 1,683 adults with symptomatic primary knee OA to 1 g of strontium ranelate per day (566 patients), 2 g/day (558 patients), or a placebo (559 patients). Complete data were available for 1,371 patients. The average age of the patients was 63 years, and 69% were women.

Overall, treatment with either dose of strontium was associated with a significant delay in the radiographic progression of knee OA, which was assessed by measuring the radiological joint space narrowing (JSN) of the medial tibiofemoral compartment of the knee joint.

After 1 year, joint space width decreased by 0.27 mm in the 2-g/day group, 0.23 mm in the 1-g/day group, and 0.37 mm in the placebo group. The differences between the 2-g/day and 1-g/day groups and the placebo group were 0.10 mm and 0.14 mm, respectively.

Significantly less radiological progression was noted in both strontium groups, compared with the placebo group. The percentage of patients with radiological progression (defined as joint space narrowing of at least 0.5 mm) was 26% in the 2-g/day group, 22% in the 1-g/day group, and 33% in the placebo group.

"The structural effect is translated clinically into a lower number of patients having a radiological progression over thresholds predictive of OA-related surgery," Dr. Reginster said. The findings suggest that strontium ranelate could reduce the need for knee surgery in OA patients, he added.

In addition, significantly more patients in the 2-g/day group exceeded the minimally perceptible clinical improvement (MCPI) threshold, compared with the placebo patients, on subscores of pain, stiffness, and physical function. The percentage of patients in the 1-g/day group above this threshold was not significantly higher than in the placebo group.

No significant differences in adverse events were observed among the three groups, and the incidence of serious adverse events was 17% in all groups.

The study findings also appeared online on Nov. 9 (Ann. Rheum. Dis. 2012 [doi:10.1136/annrheumdis-2012-202231]).

The study was sponsored by Servier. Dr. Reginster disclosed financial relationships with multiple companies, including Servier.

WASHINGTON – A daily dose of strontium ranelate was associated with a significant delay in joint space narrowing in adults with symptomatic primary knee osteoarthritis, based on data from the phase III Strontium Ranelate Knee Osteoarthritis Trial (SEKOIA).

Strontium renalate currently is not approved in the United States, but it is approved in more than 100 countries for treating osteoporosis, said Dr. Jean-Yves Reginster, who is head of the Center for Investigation in Bone and Articular Cartilage Metabolism at the University of Liège (Belgium).

Data from nonclinical studies have shown that strontium’s bone-building activity has a positive impact on cartilage as well, he noted at the annual meeting of the American College of Rheumatology.

To examine the effectiveness of strontium ranelate on the progression of knee osteoarthritis (OA), Dr. Reginster and his colleagues randomized 1,683 adults with symptomatic primary knee OA to 1 g of strontium ranelate per day (566 patients), 2 g/day (558 patients), or a placebo (559 patients). Complete data were available for 1,371 patients. The average age of the patients was 63 years, and 69% were women.

Overall, treatment with either dose of strontium was associated with a significant delay in the radiographic progression of knee OA, which was assessed by measuring the radiological joint space narrowing (JSN) of the medial tibiofemoral compartment of the knee joint.

After 1 year, joint space width decreased by 0.27 mm in the 2-g/day group, 0.23 mm in the 1-g/day group, and 0.37 mm in the placebo group. The differences between the 2-g/day and 1-g/day groups and the placebo group were 0.10 mm and 0.14 mm, respectively.

Significantly less radiological progression was noted in both strontium groups, compared with the placebo group. The percentage of patients with radiological progression (defined as joint space narrowing of at least 0.5 mm) was 26% in the 2-g/day group, 22% in the 1-g/day group, and 33% in the placebo group.

"The structural effect is translated clinically into a lower number of patients having a radiological progression over thresholds predictive of OA-related surgery," Dr. Reginster said. The findings suggest that strontium ranelate could reduce the need for knee surgery in OA patients, he added.

In addition, significantly more patients in the 2-g/day group exceeded the minimally perceptible clinical improvement (MCPI) threshold, compared with the placebo patients, on subscores of pain, stiffness, and physical function. The percentage of patients in the 1-g/day group above this threshold was not significantly higher than in the placebo group.

No significant differences in adverse events were observed among the three groups, and the incidence of serious adverse events was 17% in all groups.

The study findings also appeared online on Nov. 9 (Ann. Rheum. Dis. 2012 [doi:10.1136/annrheumdis-2012-202231]).

The study was sponsored by Servier. Dr. Reginster disclosed financial relationships with multiple companies, including Servier.