Heidi Splete

CHICAGO – Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, data on nearly 2,000 adults show.

Previous studies have suggested that metabolic syndrome is associated with “a state of chronic, low-grade inflammation,” said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York. “Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA,” she said at the meeting.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort of 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. Also, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The study was limited by the small sample of PsA patients, and by the modified metabolic syndrome criteria that may have underestimated the prevalence of metabolic syndrome in both groups, said Dr. Bahce-Altuntas. However, the results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. “High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA,” she noted.

The combination of skin and joint inflammation in PsA may contribute to the increased frequency of metabolic syndrome in these patients, but more research is needed, Dr. Bahce-Altuntas said. “More intensive interventions to modify these risk factors are warranted in PsA patients in order to reduce cardiovascular morbidity and mortality.”

These companies have supported CORRONA over the past 2 years: Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Centocor, Genentech, Lilly, Pfizer, and Roche. Dr. Bahce-Altuntas had no disclosures.

CHICAGO – Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, data on nearly 2,000 adults show.

Previous studies have suggested that metabolic syndrome is associated with “a state of chronic, low-grade inflammation,” said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York. “Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA,” she said at the meeting.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort of 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. Also, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The study was limited by the small sample of PsA patients, and by the modified metabolic syndrome criteria that may have underestimated the prevalence of metabolic syndrome in both groups, said Dr. Bahce-Altuntas. However, the results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. “High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA,” she noted.

The combination of skin and joint inflammation in PsA may contribute to the increased frequency of metabolic syndrome in these patients, but more research is needed, Dr. Bahce-Altuntas said. “More intensive interventions to modify these risk factors are warranted in PsA patients in order to reduce cardiovascular morbidity and mortality.”

These companies have supported CORRONA over the past 2 years: Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Centocor, Genentech, Lilly, Pfizer, and Roche. Dr. Bahce-Altuntas had no disclosures.

CHICAGO – Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, data on nearly 2,000 adults show.

Previous studies have suggested that metabolic syndrome is associated with “a state of chronic, low-grade inflammation,” said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York. “Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA,” she said at the meeting.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort of 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. Also, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The study was limited by the small sample of PsA patients, and by the modified metabolic syndrome criteria that may have underestimated the prevalence of metabolic syndrome in both groups, said Dr. Bahce-Altuntas. However, the results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. “High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA,” she noted.

The combination of skin and joint inflammation in PsA may contribute to the increased frequency of metabolic syndrome in these patients, but more research is needed, Dr. Bahce-Altuntas said. “More intensive interventions to modify these risk factors are warranted in PsA patients in order to reduce cardiovascular morbidity and mortality.”

These companies have supported CORRONA over the past 2 years: Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Centocor, Genentech, Lilly, Pfizer, and Roche. Dr. Bahce-Altuntas had no disclosures.

Lyme disease can create confusion for clinicians, especially when patients think it is causing their chronic, nonspecific symptoms, said Dr. Eugene Shapiro.

Patients with genuine Lyme disease may indeed have nonspecific symptoms, but – given that the disease does not cause chronic, nonspecific symptoms in the absence of objective signs of the illness – patients must also have an objective sign of Lyme disease, he explained.

Lyme disease can be classified into the following three categories:

• Early localized disease. This is "simply erythema migrans," said Dr. Shapiro, professor of pediatrics and of epidemiology and public health at Yale University, New Haven, Conn. It starts at the site of the tick bite, and expands for a few weeks if left untreated. Many people associate Lyme disease with a bull’s-eye, but it is more common to see uniform erythema, he said. "Don’t think that it is not erythema migrans just because there is no target lesion." Also, it is typical for the area of erythema not to be perfectly round, he added.

• Early disseminated disease. Signs of Lyme disease at this stage include multiple erythema migrans, symptoms of a flulike illness, aseptic meningitis, neuritis, and carditis. Meningitis is relatively uncommon in cases of Lyme disease, but it does occur, Dr. Shapiro noted. Neuritis (seventh-nerve palsy) is more common, but it is unaffected by treatment and usually resolves, he said.

• Late Lyme disease. Late disease is characterized by arthritis, and more than 90% of those cases of arthritis involve the knee, Dr. Shapiro said. The arthritis may be monoarticular or pauciarticular, and the duration of the arthritis varies, but it usually resolves with treatment, he said.

The question of "chronic" Lyme disease poses a different conundrum for clinicians. Although medically unexplained symptoms are common in these patients, most who complain of "chronic" Lyme disease have no evidence of ever having had the disease, based on history or serologic tests, he said. "We doctors are very good at treating diseases, but we are very poor at managing symptoms without a diagnosis," he added. His advice for managing such patients is to focus on treating the symptoms with a combination of counseling, increased exercise, improved sleep, cognitive-behavioral therapy, and in some cases, medication.

"Associated pathology is rare and rarely missed, whereas psychiatric diagnoses are common and often missed" in these patients, he said.

When it comes to prevention, be selective in ordering serologic tests, Dr. Shapiro emphasized. "Positive serologic test results without objective signs are very likely false-positive results," he said.

Dr. Shapiro made his remarks in Cambridge, Mass., at a conference on pediatric infectious diseases that was sponsored by Boston University, Pediatric News, and Family Practice News. Pediatric News and Family Practice News are owned by Elsevier. He disclosed that he is the official media spokesperson on Lyme disease for the Infectious Diseases Society of America.

Lyme disease can create confusion for clinicians, especially when patients think it is causing their chronic, nonspecific symptoms, said Dr. Eugene Shapiro.

Patients with genuine Lyme disease may indeed have nonspecific symptoms, but – given that the disease does not cause chronic, nonspecific symptoms in the absence of objective signs of the illness – patients must also have an objective sign of Lyme disease, he explained.

Lyme disease can be classified into the following three categories:

• Early localized disease. This is "simply erythema migrans," said Dr. Shapiro, professor of pediatrics and of epidemiology and public health at Yale University, New Haven, Conn. It starts at the site of the tick bite, and expands for a few weeks if left untreated. Many people associate Lyme disease with a bull’s-eye, but it is more common to see uniform erythema, he said. "Don’t think that it is not erythema migrans just because there is no target lesion." Also, it is typical for the area of erythema not to be perfectly round, he added.

• Early disseminated disease. Signs of Lyme disease at this stage include multiple erythema migrans, symptoms of a flulike illness, aseptic meningitis, neuritis, and carditis. Meningitis is relatively uncommon in cases of Lyme disease, but it does occur, Dr. Shapiro noted. Neuritis (seventh-nerve palsy) is more common, but it is unaffected by treatment and usually resolves, he said.

• Late Lyme disease. Late disease is characterized by arthritis, and more than 90% of those cases of arthritis involve the knee, Dr. Shapiro said. The arthritis may be monoarticular or pauciarticular, and the duration of the arthritis varies, but it usually resolves with treatment, he said.

The question of "chronic" Lyme disease poses a different conundrum for clinicians. Although medically unexplained symptoms are common in these patients, most who complain of "chronic" Lyme disease have no evidence of ever having had the disease, based on history or serologic tests, he said. "We doctors are very good at treating diseases, but we are very poor at managing symptoms without a diagnosis," he added. His advice for managing such patients is to focus on treating the symptoms with a combination of counseling, increased exercise, improved sleep, cognitive-behavioral therapy, and in some cases, medication.

"Associated pathology is rare and rarely missed, whereas psychiatric diagnoses are common and often missed" in these patients, he said.

When it comes to prevention, be selective in ordering serologic tests, Dr. Shapiro emphasized. "Positive serologic test results without objective signs are very likely false-positive results," he said.

Dr. Shapiro made his remarks in Cambridge, Mass., at a conference on pediatric infectious diseases that was sponsored by Boston University, Pediatric News, and Family Practice News. Pediatric News and Family Practice News are owned by Elsevier. He disclosed that he is the official media spokesperson on Lyme disease for the Infectious Diseases Society of America.

Lyme disease can create confusion for clinicians, especially when patients think it is causing their chronic, nonspecific symptoms, said Dr. Eugene Shapiro.

Patients with genuine Lyme disease may indeed have nonspecific symptoms, but – given that the disease does not cause chronic, nonspecific symptoms in the absence of objective signs of the illness – patients must also have an objective sign of Lyme disease, he explained.

Lyme disease can be classified into the following three categories:

• Early localized disease. This is "simply erythema migrans," said Dr. Shapiro, professor of pediatrics and of epidemiology and public health at Yale University, New Haven, Conn. It starts at the site of the tick bite, and expands for a few weeks if left untreated. Many people associate Lyme disease with a bull’s-eye, but it is more common to see uniform erythema, he said. "Don’t think that it is not erythema migrans just because there is no target lesion." Also, it is typical for the area of erythema not to be perfectly round, he added.

• Early disseminated disease. Signs of Lyme disease at this stage include multiple erythema migrans, symptoms of a flulike illness, aseptic meningitis, neuritis, and carditis. Meningitis is relatively uncommon in cases of Lyme disease, but it does occur, Dr. Shapiro noted. Neuritis (seventh-nerve palsy) is more common, but it is unaffected by treatment and usually resolves, he said.

• Late Lyme disease. Late disease is characterized by arthritis, and more than 90% of those cases of arthritis involve the knee, Dr. Shapiro said. The arthritis may be monoarticular or pauciarticular, and the duration of the arthritis varies, but it usually resolves with treatment, he said.

The question of "chronic" Lyme disease poses a different conundrum for clinicians. Although medically unexplained symptoms are common in these patients, most who complain of "chronic" Lyme disease have no evidence of ever having had the disease, based on history or serologic tests, he said. "We doctors are very good at treating diseases, but we are very poor at managing symptoms without a diagnosis," he added. His advice for managing such patients is to focus on treating the symptoms with a combination of counseling, increased exercise, improved sleep, cognitive-behavioral therapy, and in some cases, medication.

"Associated pathology is rare and rarely missed, whereas psychiatric diagnoses are common and often missed" in these patients, he said.

When it comes to prevention, be selective in ordering serologic tests, Dr. Shapiro emphasized. "Positive serologic test results without objective signs are very likely false-positive results," he said.

Dr. Shapiro made his remarks in Cambridge, Mass., at a conference on pediatric infectious diseases that was sponsored by Boston University, Pediatric News, and Family Practice News. Pediatric News and Family Practice News are owned by Elsevier. He disclosed that he is the official media spokesperson on Lyme disease for the Infectious Diseases Society of America.

BALTIMORE – Comorbid attention-deficit/hyperactivity disorder persistently affected the cognitive development of children with epilepsy up to 5 or 6 years after the onset of seizures in a prospective case-control study.

In a previous study of the same group of children, Connie Sung and her colleagues found that children with new-onset epilepsy and comorbid ADHD (with or without academic problems) had poorer cognitive performance at baseline and abnormal cognitive development after 2 years, compared with healthy control children and children with new-onset epilepsy but without ADHD.

In the current study, Ms. Sung, a doctoral student in the department of rehabilitation psychology and special education at the University of Wisconsin, Madison, and her colleagues conducted cognitive assessments of 75 children with epilepsy and 62 of their healthy first-degree cousins who served as controls. They gave the children a comprehensive battery of neurologic tests to assess academic achievement, intelligence, language, memory, executive function, and motor function at baseline and at 2 years’ and 5-6 years’ follow-up. The children’s average age at last follow-up was 13 years.

At baseline, ADHD and academic performance were significantly associated with neuropsychological impairment across all cognitive domains. However, children with epilepsy who did not have either ADHD or academic performance problems had "entirely normal" cognition, compared with controls, Ms. Sung reported in a poster at the annual meeting of the American Epilepsy Society.

"This effect at baseline suggests an antecedent neurobiological effect," Ms. Sung wrote.

These trends persisted after 2 years and 5-6 years. Full-scale raw IQ scores after 2 years were approximately 88 for healthy controls and for children with epilepsy without comorbidities, compared with 76 in children with epilepsy and academic performance problems and 68 in children with epilepsy and comorbid ADHD.

At 5-6 years after onset, children with epilepsy and either ADHD or academic problems had significantly worse cognitive trajectories than did controls, but children with epilepsy who did not have these comorbidities had normal cognitive trajectories.

The researchers said that their findings were limited by the study’s relatively small sample size, but the results suggest that specific neurobehavioral comorbidities at the time of the onset of epilepsy appear to be markers for abnormal cognitive development before and after epilepsy.

"These effects are strong and consistent [and] affect all cognitive domains," Ms. Sung wrote.

The researchers are now studying the effects of the presence or absence of ADHD and learning disorders on real-life outcomes such as employment, education, and income, as their study population ages. "These comorbidities may represent early risk factors for later life span complications [in children with epilepsy], opening the possibility for early intervention," Ms. Sung reported.

The study was supported in part by a grant from the National Institute of Neurological Disorders and Stroke. The researchers said they had no relevant financial disclosures.

BALTIMORE – Comorbid attention-deficit/hyperactivity disorder persistently affected the cognitive development of children with epilepsy up to 5 or 6 years after the onset of seizures in a prospective case-control study.

In a previous study of the same group of children, Connie Sung and her colleagues found that children with new-onset epilepsy and comorbid ADHD (with or without academic problems) had poorer cognitive performance at baseline and abnormal cognitive development after 2 years, compared with healthy control children and children with new-onset epilepsy but without ADHD.

In the current study, Ms. Sung, a doctoral student in the department of rehabilitation psychology and special education at the University of Wisconsin, Madison, and her colleagues conducted cognitive assessments of 75 children with epilepsy and 62 of their healthy first-degree cousins who served as controls. They gave the children a comprehensive battery of neurologic tests to assess academic achievement, intelligence, language, memory, executive function, and motor function at baseline and at 2 years’ and 5-6 years’ follow-up. The children’s average age at last follow-up was 13 years.

At baseline, ADHD and academic performance were significantly associated with neuropsychological impairment across all cognitive domains. However, children with epilepsy who did not have either ADHD or academic performance problems had "entirely normal" cognition, compared with controls, Ms. Sung reported in a poster at the annual meeting of the American Epilepsy Society.

"This effect at baseline suggests an antecedent neurobiological effect," Ms. Sung wrote.

These trends persisted after 2 years and 5-6 years. Full-scale raw IQ scores after 2 years were approximately 88 for healthy controls and for children with epilepsy without comorbidities, compared with 76 in children with epilepsy and academic performance problems and 68 in children with epilepsy and comorbid ADHD.

At 5-6 years after onset, children with epilepsy and either ADHD or academic problems had significantly worse cognitive trajectories than did controls, but children with epilepsy who did not have these comorbidities had normal cognitive trajectories.

The researchers said that their findings were limited by the study’s relatively small sample size, but the results suggest that specific neurobehavioral comorbidities at the time of the onset of epilepsy appear to be markers for abnormal cognitive development before and after epilepsy.

"These effects are strong and consistent [and] affect all cognitive domains," Ms. Sung wrote.

The researchers are now studying the effects of the presence or absence of ADHD and learning disorders on real-life outcomes such as employment, education, and income, as their study population ages. "These comorbidities may represent early risk factors for later life span complications [in children with epilepsy], opening the possibility for early intervention," Ms. Sung reported.

The study was supported in part by a grant from the National Institute of Neurological Disorders and Stroke. The researchers said they had no relevant financial disclosures.

BALTIMORE – Comorbid attention-deficit/hyperactivity disorder persistently affected the cognitive development of children with epilepsy up to 5 or 6 years after the onset of seizures in a prospective case-control study.

In a previous study of the same group of children, Connie Sung and her colleagues found that children with new-onset epilepsy and comorbid ADHD (with or without academic problems) had poorer cognitive performance at baseline and abnormal cognitive development after 2 years, compared with healthy control children and children with new-onset epilepsy but without ADHD.

In the current study, Ms. Sung, a doctoral student in the department of rehabilitation psychology and special education at the University of Wisconsin, Madison, and her colleagues conducted cognitive assessments of 75 children with epilepsy and 62 of their healthy first-degree cousins who served as controls. They gave the children a comprehensive battery of neurologic tests to assess academic achievement, intelligence, language, memory, executive function, and motor function at baseline and at 2 years’ and 5-6 years’ follow-up. The children’s average age at last follow-up was 13 years.

At baseline, ADHD and academic performance were significantly associated with neuropsychological impairment across all cognitive domains. However, children with epilepsy who did not have either ADHD or academic performance problems had "entirely normal" cognition, compared with controls, Ms. Sung reported in a poster at the annual meeting of the American Epilepsy Society.

"This effect at baseline suggests an antecedent neurobiological effect," Ms. Sung wrote.

These trends persisted after 2 years and 5-6 years. Full-scale raw IQ scores after 2 years were approximately 88 for healthy controls and for children with epilepsy without comorbidities, compared with 76 in children with epilepsy and academic performance problems and 68 in children with epilepsy and comorbid ADHD.

At 5-6 years after onset, children with epilepsy and either ADHD or academic problems had significantly worse cognitive trajectories than did controls, but children with epilepsy who did not have these comorbidities had normal cognitive trajectories.

The researchers said that their findings were limited by the study’s relatively small sample size, but the results suggest that specific neurobehavioral comorbidities at the time of the onset of epilepsy appear to be markers for abnormal cognitive development before and after epilepsy.

"These effects are strong and consistent [and] affect all cognitive domains," Ms. Sung wrote.

The researchers are now studying the effects of the presence or absence of ADHD and learning disorders on real-life outcomes such as employment, education, and income, as their study population ages. "These comorbidities may represent early risk factors for later life span complications [in children with epilepsy], opening the possibility for early intervention," Ms. Sung reported.

The study was supported in part by a grant from the National Institute of Neurological Disorders and Stroke. The researchers said they had no relevant financial disclosures.

BALTIMORE – The risk for children with febrile seizures to develop epilepsy decreased with time in an analysis of the prospective U.K. National General Practice Study of Epilepsy.

Short-term studies have shown that 1%-3% of children with febrile seizures develop afebrile seizures later in life, said Dr. Gail S. Bell of University College London Institute of Neurology.

Dr. Bell and her colleagues sought to determine if the risk of newly developing epilepsy in children with febrile seizures would decrease over time despite a continual increase in the cumulative incidence of epilepsy over time. They presented their findings in a poster at the annual meeting of the American Epilepsy Society.

They reviewed data from a cohort of 220 individuals with febrile seizures (aside from neonatal seizures) who were enrolled in the study in 1984-1987.

Overall, 68% of the children had no further seizures after their initial seizure. Of 181 individuals who were followed through 2009-2010, 175 had been free of seizures for the past 5 years, including 171 who were not taking antiepileptic drugs, the researchers noted.

However, the risk of recurrent seizures was slightly higher among children for whom the index seizure was not the first febrile seizure (hazard ratio, 1.76).

A total of 14 patients (6%) developed epilepsy and 17 (8%) developed afebrile seizures, the researchers said. Overall, "the probability of developing epilepsy by 20 years after the index seizure was 6.7%," they noted. The standardized incidence ratio for developing epilepsy was 9.7; this was highest among children aged 0-10 years with up to 10 years of follow-up, and it decreased with age until it was no longer significant in individuals aged 15-20 years with 10-20 years of follow-up.

The findings were limited by the relatively small study population, but the results suggest that epilepsy risk decreases with time in most cases, the researchers said. "Larger studies, ideally stratified by ethnic group, are required to establish whether the risk of developing epilepsy decreases to the population rate."

The study was funded by the U.K. Brain Research Trust and the U.K. Epilepsy Society. The researchers had no financial conflicts to disclose.

BALTIMORE – The risk for children with febrile seizures to develop epilepsy decreased with time in an analysis of the prospective U.K. National General Practice Study of Epilepsy.

Short-term studies have shown that 1%-3% of children with febrile seizures develop afebrile seizures later in life, said Dr. Gail S. Bell of University College London Institute of Neurology.

Dr. Bell and her colleagues sought to determine if the risk of newly developing epilepsy in children with febrile seizures would decrease over time despite a continual increase in the cumulative incidence of epilepsy over time. They presented their findings in a poster at the annual meeting of the American Epilepsy Society.

They reviewed data from a cohort of 220 individuals with febrile seizures (aside from neonatal seizures) who were enrolled in the study in 1984-1987.

Overall, 68% of the children had no further seizures after their initial seizure. Of 181 individuals who were followed through 2009-2010, 175 had been free of seizures for the past 5 years, including 171 who were not taking antiepileptic drugs, the researchers noted.

However, the risk of recurrent seizures was slightly higher among children for whom the index seizure was not the first febrile seizure (hazard ratio, 1.76).

A total of 14 patients (6%) developed epilepsy and 17 (8%) developed afebrile seizures, the researchers said. Overall, "the probability of developing epilepsy by 20 years after the index seizure was 6.7%," they noted. The standardized incidence ratio for developing epilepsy was 9.7; this was highest among children aged 0-10 years with up to 10 years of follow-up, and it decreased with age until it was no longer significant in individuals aged 15-20 years with 10-20 years of follow-up.

The findings were limited by the relatively small study population, but the results suggest that epilepsy risk decreases with time in most cases, the researchers said. "Larger studies, ideally stratified by ethnic group, are required to establish whether the risk of developing epilepsy decreases to the population rate."

The study was funded by the U.K. Brain Research Trust and the U.K. Epilepsy Society. The researchers had no financial conflicts to disclose.

BALTIMORE – The risk for children with febrile seizures to develop epilepsy decreased with time in an analysis of the prospective U.K. National General Practice Study of Epilepsy.

Short-term studies have shown that 1%-3% of children with febrile seizures develop afebrile seizures later in life, said Dr. Gail S. Bell of University College London Institute of Neurology.

Dr. Bell and her colleagues sought to determine if the risk of newly developing epilepsy in children with febrile seizures would decrease over time despite a continual increase in the cumulative incidence of epilepsy over time. They presented their findings in a poster at the annual meeting of the American Epilepsy Society.

They reviewed data from a cohort of 220 individuals with febrile seizures (aside from neonatal seizures) who were enrolled in the study in 1984-1987.

Overall, 68% of the children had no further seizures after their initial seizure. Of 181 individuals who were followed through 2009-2010, 175 had been free of seizures for the past 5 years, including 171 who were not taking antiepileptic drugs, the researchers noted.

However, the risk of recurrent seizures was slightly higher among children for whom the index seizure was not the first febrile seizure (hazard ratio, 1.76).

A total of 14 patients (6%) developed epilepsy and 17 (8%) developed afebrile seizures, the researchers said. Overall, "the probability of developing epilepsy by 20 years after the index seizure was 6.7%," they noted. The standardized incidence ratio for developing epilepsy was 9.7; this was highest among children aged 0-10 years with up to 10 years of follow-up, and it decreased with age until it was no longer significant in individuals aged 15-20 years with 10-20 years of follow-up.

The findings were limited by the relatively small study population, but the results suggest that epilepsy risk decreases with time in most cases, the researchers said. "Larger studies, ideally stratified by ethnic group, are required to establish whether the risk of developing epilepsy decreases to the population rate."

The study was funded by the U.K. Brain Research Trust and the U.K. Epilepsy Society. The researchers had no financial conflicts to disclose.

CHICAGO – Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, based on data from nearly 2,000 adults.

Previous studies have suggested that metabolic syndrome is associated with "a state of chronic, low-grade inflammation," said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York.

"Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA," she said at the annual meeting of the American College of Rheumatology.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort including 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. In addition, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m² and any two of the following criteria: triglycerides greater than 150 mg/dL, HDL less than 40 mg/dL for men or less than 50 mg/dL for women, a diagnosis of hypertension, or a diagnosis of diabetes.

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The study was limited by the relatively small sample of PsA patients, and by the modified metabolic syndrome criteria that may have underestimated the prevalence of metabolic syndrome in both groups, said Dr. Bahce-Altuntas.

However, the results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. "High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA," she noted.

The combination of skin and joint inflammation in PsA may contribute to the increased frequency of metabolic syndrome in these patients, but more research is needed, Dr. Bahce-Altuntas said.

Meanwhile, "more intensive interventions to modify these risk factors are warranted in PsA patients in order to reduce cardiovascular morbidity and mortality," she said.

The following companies have supported CORRONA through contracted subscriptions over the past 2 years: Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Centocor, Genentech, Lilly, Pfizer, and Roche. Dr. Bahce-Altuntas had no financial conflicts to disclose.

CHICAGO – Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, based on data from nearly 2,000 adults.

Previous studies have suggested that metabolic syndrome is associated with "a state of chronic, low-grade inflammation," said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York.

"Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA," she said at the annual meeting of the American College of Rheumatology.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort including 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. In addition, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m² and any two of the following criteria: triglycerides greater than 150 mg/dL, HDL less than 40 mg/dL for men or less than 50 mg/dL for women, a diagnosis of hypertension, or a diagnosis of diabetes.

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The study was limited by the relatively small sample of PsA patients, and by the modified metabolic syndrome criteria that may have underestimated the prevalence of metabolic syndrome in both groups, said Dr. Bahce-Altuntas.

However, the results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. "High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA," she noted.

The combination of skin and joint inflammation in PsA may contribute to the increased frequency of metabolic syndrome in these patients, but more research is needed, Dr. Bahce-Altuntas said.

Meanwhile, "more intensive interventions to modify these risk factors are warranted in PsA patients in order to reduce cardiovascular morbidity and mortality," she said.

The following companies have supported CORRONA through contracted subscriptions over the past 2 years: Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Centocor, Genentech, Lilly, Pfizer, and Roche. Dr. Bahce-Altuntas had no financial conflicts to disclose.

CHICAGO – Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, based on data from nearly 2,000 adults.

Previous studies have suggested that metabolic syndrome is associated with "a state of chronic, low-grade inflammation," said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York.

"Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA," she said at the annual meeting of the American College of Rheumatology.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort including 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. In addition, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m² and any two of the following criteria: triglycerides greater than 150 mg/dL, HDL less than 40 mg/dL for men or less than 50 mg/dL for women, a diagnosis of hypertension, or a diagnosis of diabetes.

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The study was limited by the relatively small sample of PsA patients, and by the modified metabolic syndrome criteria that may have underestimated the prevalence of metabolic syndrome in both groups, said Dr. Bahce-Altuntas.

However, the results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. "High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA," she noted.

The combination of skin and joint inflammation in PsA may contribute to the increased frequency of metabolic syndrome in these patients, but more research is needed, Dr. Bahce-Altuntas said.

Meanwhile, "more intensive interventions to modify these risk factors are warranted in PsA patients in order to reduce cardiovascular morbidity and mortality," she said.

The following companies have supported CORRONA through contracted subscriptions over the past 2 years: Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Centocor, Genentech, Lilly, Pfizer, and Roche. Dr. Bahce-Altuntas had no financial conflicts to disclose.

CHICAGO – Adding disease-modifying antirheumatic drugs to anti-TNF therapy failed to enhance drug retention in a study involving 1,630 adults with spondyloarthritis.

Current ankylosing spondylitis recommendations from the Assessment of SpondyloArthritis international Society (ASAS) and the European League Against Rheumatism do not support adding disease-modifying antirheumatic drugs (DMARDs) to anti-TNF therapy, said Dr. Michael Nissen of University Hospital Geneva (Switzerland).

Yet, in practice, cotherapy often is prescribed, and the impact of this addition has not been well studied, he said at the annual meeting of the American College of Rheumatology.

"Utilization of a DMARD with an anti-TNF agent is of no additional benefit in SpA [spondyloarthritis] patients in terms of drug survival," and the study findings support the current treatment recommendations, he added.

Dr. Nissen and his colleagues reviewed data from patient registries that included 1,060 adults with axial spondyloarthritis, 535 with psoriatic arthritis, and 35 with undifferentiated spondyloarthritis.

A total of 1,123 patients (69%) had anti-TNF monotherapy and 507 (31%) had DMARD/anti-TNF cotherapy. Among the cotherapy patients, 72% received methotrexate, 21% received sulfasalazine, and 14% received leflunomide. The mean ages in the monotherapy and cotherapy groups were 43 years and 46 years, respectively, and slightly more than half of patients in each group were male.

After a median follow-up period of 4 years, overall drug retention rates were not significantly different between the monotherapy and cotherapy groups, regardless of the type of anti-TNF treatment. The overall median drug retention was 2.8 years. Significant predictors of drug retention after controlling for confounding variables included male sex, longer disease duration, older age, prior anti-TNF use, steroid use, and baseline scores on the Health Assessment Questionnaire and Bath Ankylosing Spondylitis Disease Activity Index.

In addition, there was no significant effect of DMARDs on anti-TNF retention relating to the type of anti-TNF therapy, clinical manifestations of disease (peripheral vs. axial), or diagnosis (axial spondyloarthritis vs. psoriatic arthritis), Dr. Nissen said.

The study was sponsored by unrestricted research grants from Abbott and Pfizer.

CHICAGO – Adding disease-modifying antirheumatic drugs to anti-TNF therapy failed to enhance drug retention in a study involving 1,630 adults with spondyloarthritis.

Current ankylosing spondylitis recommendations from the Assessment of SpondyloArthritis international Society (ASAS) and the European League Against Rheumatism do not support adding disease-modifying antirheumatic drugs (DMARDs) to anti-TNF therapy, said Dr. Michael Nissen of University Hospital Geneva (Switzerland).

Yet, in practice, cotherapy often is prescribed, and the impact of this addition has not been well studied, he said at the annual meeting of the American College of Rheumatology.

"Utilization of a DMARD with an anti-TNF agent is of no additional benefit in SpA [spondyloarthritis] patients in terms of drug survival," and the study findings support the current treatment recommendations, he added.

Dr. Nissen and his colleagues reviewed data from patient registries that included 1,060 adults with axial spondyloarthritis, 535 with psoriatic arthritis, and 35 with undifferentiated spondyloarthritis.

A total of 1,123 patients (69%) had anti-TNF monotherapy and 507 (31%) had DMARD/anti-TNF cotherapy. Among the cotherapy patients, 72% received methotrexate, 21% received sulfasalazine, and 14% received leflunomide. The mean ages in the monotherapy and cotherapy groups were 43 years and 46 years, respectively, and slightly more than half of patients in each group were male.

After a median follow-up period of 4 years, overall drug retention rates were not significantly different between the monotherapy and cotherapy groups, regardless of the type of anti-TNF treatment. The overall median drug retention was 2.8 years. Significant predictors of drug retention after controlling for confounding variables included male sex, longer disease duration, older age, prior anti-TNF use, steroid use, and baseline scores on the Health Assessment Questionnaire and Bath Ankylosing Spondylitis Disease Activity Index.

In addition, there was no significant effect of DMARDs on anti-TNF retention relating to the type of anti-TNF therapy, clinical manifestations of disease (peripheral vs. axial), or diagnosis (axial spondyloarthritis vs. psoriatic arthritis), Dr. Nissen said.

The study was sponsored by unrestricted research grants from Abbott and Pfizer.

CHICAGO – Adding disease-modifying antirheumatic drugs to anti-TNF therapy failed to enhance drug retention in a study involving 1,630 adults with spondyloarthritis.

Current ankylosing spondylitis recommendations from the Assessment of SpondyloArthritis international Society (ASAS) and the European League Against Rheumatism do not support adding disease-modifying antirheumatic drugs (DMARDs) to anti-TNF therapy, said Dr. Michael Nissen of University Hospital Geneva (Switzerland).

Yet, in practice, cotherapy often is prescribed, and the impact of this addition has not been well studied, he said at the annual meeting of the American College of Rheumatology.

"Utilization of a DMARD with an anti-TNF agent is of no additional benefit in SpA [spondyloarthritis] patients in terms of drug survival," and the study findings support the current treatment recommendations, he added.

Dr. Nissen and his colleagues reviewed data from patient registries that included 1,060 adults with axial spondyloarthritis, 535 with psoriatic arthritis, and 35 with undifferentiated spondyloarthritis.

A total of 1,123 patients (69%) had anti-TNF monotherapy and 507 (31%) had DMARD/anti-TNF cotherapy. Among the cotherapy patients, 72% received methotrexate, 21% received sulfasalazine, and 14% received leflunomide. The mean ages in the monotherapy and cotherapy groups were 43 years and 46 years, respectively, and slightly more than half of patients in each group were male.

After a median follow-up period of 4 years, overall drug retention rates were not significantly different between the monotherapy and cotherapy groups, regardless of the type of anti-TNF treatment. The overall median drug retention was 2.8 years. Significant predictors of drug retention after controlling for confounding variables included male sex, longer disease duration, older age, prior anti-TNF use, steroid use, and baseline scores on the Health Assessment Questionnaire and Bath Ankylosing Spondylitis Disease Activity Index.

In addition, there was no significant effect of DMARDs on anti-TNF retention relating to the type of anti-TNF therapy, clinical manifestations of disease (peripheral vs. axial), or diagnosis (axial spondyloarthritis vs. psoriatic arthritis), Dr. Nissen said.

The study was sponsored by unrestricted research grants from Abbott and Pfizer.

BALTIMORE – The use of hormonal contraception among women with epilepsy may significantly increase their rate of seizure activity, according to the findings of a Web-based survey of women aged 18 to 47 years with the neurological condition.

Seizures while using contraceptives were reported by 18% of women using hormonal contraceptives, compared with 3% of those using nonhormonal contraceptives, according to the study’s lead investigator Kristen M. Fowler, R.N., of Beth Israel Deaconess Medical Center, Boston.

When antiepileptic drugs (AEDs) were not used, 24% of women using hormonal contraceptives reported an increase in seizure frequency, compared with 7% of women using nonhormonal contraceptives.

Seizure exacerbation with hormonal contraceptives differed among the AEDs used, Ms. Fowler said at the annual meeting of the American Epilepsy Society, where she presented her findings from the first 300 women who responded to a Web-based survey, called the Epilepsy Birth Control Registry.

Valproate showed the greatest seizure exacerbation when used in conjunction with hormonal contraceptives. Seizure exacerbation while taking valproate occurred in 44% of women using hormonal contraceptives, compared with 8% of women who were using nonhormonal contraceptives.

In general, glucuronidated AEDs and enzyme-inducing AEDs were associated with significantly greater seizure exacerbation than nonenzyme-inducing AEDs, especially when women were using hormonal contraception, Ms. Fowler found.

In a related analysis that looked more broadly at contraceptive choices among the same group of surveyed women, 72% of the women reported using contraception. Among those women, the most common choices were oral contraceptives (23%), male condoms (23%), intrauterine devices (12%), and withdrawal (10%).

"Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy," said Kaitlyn Cahill, also at Beth Israel Deaconess Medical Center.

The top three considerations when making contraceptive choices were AED interaction (57%), efficacy (53%), and convenience (45%). Only about 3% of the women mentioned cost as a most important consideration in choosing contraception.

A subgroup of 178 women was considered high risk because they were potentially fertile and sexually active. Of these women, 68% used highly effective contraceptive methods: 44% used hormonal contraception, 16% used IUDs, and 8% relied on a tubal ligation or vasectomy.

Hormonal contraception varied according to insurance coverage status (53% with insurance used it vs. 29% without).

Only 28% of the women reported consulting their neurologist before selecting a contraceptive method.

The retrospective design of both studies limited the conclusion that could be drawn. "Prospective investigations are needed to determine whether these findings represent important seizure safety issues or reporting biases," they concluded.

The studies were supported in part by the Epilepsy Foundation. The researchers had no financial conflicts to disclose.

BALTIMORE – The use of hormonal contraception among women with epilepsy may significantly increase their rate of seizure activity, according to the findings of a Web-based survey of women aged 18 to 47 years with the neurological condition.

Seizures while using contraceptives were reported by 18% of women using hormonal contraceptives, compared with 3% of those using nonhormonal contraceptives, according to the study’s lead investigator Kristen M. Fowler, R.N., of Beth Israel Deaconess Medical Center, Boston.

When antiepileptic drugs (AEDs) were not used, 24% of women using hormonal contraceptives reported an increase in seizure frequency, compared with 7% of women using nonhormonal contraceptives.

Seizure exacerbation with hormonal contraceptives differed among the AEDs used, Ms. Fowler said at the annual meeting of the American Epilepsy Society, where she presented her findings from the first 300 women who responded to a Web-based survey, called the Epilepsy Birth Control Registry.

Valproate showed the greatest seizure exacerbation when used in conjunction with hormonal contraceptives. Seizure exacerbation while taking valproate occurred in 44% of women using hormonal contraceptives, compared with 8% of women who were using nonhormonal contraceptives.

In general, glucuronidated AEDs and enzyme-inducing AEDs were associated with significantly greater seizure exacerbation than nonenzyme-inducing AEDs, especially when women were using hormonal contraception, Ms. Fowler found.

In a related analysis that looked more broadly at contraceptive choices among the same group of surveyed women, 72% of the women reported using contraception. Among those women, the most common choices were oral contraceptives (23%), male condoms (23%), intrauterine devices (12%), and withdrawal (10%).

"Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy," said Kaitlyn Cahill, also at Beth Israel Deaconess Medical Center.

The top three considerations when making contraceptive choices were AED interaction (57%), efficacy (53%), and convenience (45%). Only about 3% of the women mentioned cost as a most important consideration in choosing contraception.

A subgroup of 178 women was considered high risk because they were potentially fertile and sexually active. Of these women, 68% used highly effective contraceptive methods: 44% used hormonal contraception, 16% used IUDs, and 8% relied on a tubal ligation or vasectomy.

Hormonal contraception varied according to insurance coverage status (53% with insurance used it vs. 29% without).

Only 28% of the women reported consulting their neurologist before selecting a contraceptive method.

The retrospective design of both studies limited the conclusion that could be drawn. "Prospective investigations are needed to determine whether these findings represent important seizure safety issues or reporting biases," they concluded.

The studies were supported in part by the Epilepsy Foundation. The researchers had no financial conflicts to disclose.

BALTIMORE – The use of hormonal contraception among women with epilepsy may significantly increase their rate of seizure activity, according to the findings of a Web-based survey of women aged 18 to 47 years with the neurological condition.

Seizures while using contraceptives were reported by 18% of women using hormonal contraceptives, compared with 3% of those using nonhormonal contraceptives, according to the study’s lead investigator Kristen M. Fowler, R.N., of Beth Israel Deaconess Medical Center, Boston.

When antiepileptic drugs (AEDs) were not used, 24% of women using hormonal contraceptives reported an increase in seizure frequency, compared with 7% of women using nonhormonal contraceptives.

Seizure exacerbation with hormonal contraceptives differed among the AEDs used, Ms. Fowler said at the annual meeting of the American Epilepsy Society, where she presented her findings from the first 300 women who responded to a Web-based survey, called the Epilepsy Birth Control Registry.

Valproate showed the greatest seizure exacerbation when used in conjunction with hormonal contraceptives. Seizure exacerbation while taking valproate occurred in 44% of women using hormonal contraceptives, compared with 8% of women who were using nonhormonal contraceptives.

In general, glucuronidated AEDs and enzyme-inducing AEDs were associated with significantly greater seizure exacerbation than nonenzyme-inducing AEDs, especially when women were using hormonal contraception, Ms. Fowler found.

In a related analysis that looked more broadly at contraceptive choices among the same group of surveyed women, 72% of the women reported using contraception. Among those women, the most common choices were oral contraceptives (23%), male condoms (23%), intrauterine devices (12%), and withdrawal (10%).

"Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy," said Kaitlyn Cahill, also at Beth Israel Deaconess Medical Center.

The top three considerations when making contraceptive choices were AED interaction (57%), efficacy (53%), and convenience (45%). Only about 3% of the women mentioned cost as a most important consideration in choosing contraception.

A subgroup of 178 women was considered high risk because they were potentially fertile and sexually active. Of these women, 68% used highly effective contraceptive methods: 44% used hormonal contraception, 16% used IUDs, and 8% relied on a tubal ligation or vasectomy.

Hormonal contraception varied according to insurance coverage status (53% with insurance used it vs. 29% without).

Only 28% of the women reported consulting their neurologist before selecting a contraceptive method.

The retrospective design of both studies limited the conclusion that could be drawn. "Prospective investigations are needed to determine whether these findings represent important seizure safety issues or reporting biases," they concluded.

The studies were supported in part by the Epilepsy Foundation. The researchers had no financial conflicts to disclose.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Information about the relative risks of knee OA as a result of sports participation is essential to help develop prevention strategies and shape public health messages, said Jeffrey Driban, Ph.D., who presented the findings at the annual meeting of the American College of Rheumatology.

Dr. Driban and his colleagues at Tufts Medical Center in Boston analyzed 16 studies that identified OA rates in elite and recreational athletes participating in a range of sports including running, soccer, and wrestling. In general, the prevalence of knee OA was 8.4% among the 3,192 athletes of any level, compared with 9.1% among the 3,485 nonathletes, Dr. Driban said.

However, the risk of knee OA is sport-specific, Dr. Driban said. Compared with nonathletes, soccer players at elite and nonelite levels were at increased risk of knee OA (relative risk, 4.4), as were elite athletes competing in distance running (3.2), weight lifting (6.4), and wrestling (3.7). Elite athletes were defined as those competing at the national, Olympic, or professional level; nonelite athletes were those competing at the recreational or scholastic level.

The results were limited by the lack of adequate data on women and injury histories for the study participants. However, the data are encouraging and suggest that knee OA risk generally is not elevated for most recreational athletes, said Dr. Driban.

"For individuals who are interested in pursuing the health benefits of physical activity, sports participation can be a healthy way of getting those benefits," Dr. Driban emphasized.

However, anyone who is especially concerned about reducing their risk for OA should opt for low-impact, noncontact sports, he said. Elite athletes in high-risk sports can take steps to reduce their risk, such as treating injuries promptly and maintaining a healthy weight and lifestyle when they retire from competition, he added.

Dr. Driban reported having no financial conflicts of interest.

Information about the relative risks of knee OA as a result of sports participation is essential to help develop prevention strategies and shape public health messages, said Jeffrey Driban, Ph.D., who presented the findings at the annual meeting of the American College of Rheumatology.

Dr. Driban and his colleagues at Tufts Medical Center in Boston analyzed 16 studies that identified OA rates in elite and recreational athletes participating in a range of sports including running, soccer, and wrestling. In general, the prevalence of knee OA was 8.4% among the 3,192 athletes of any level, compared with 9.1% among the 3,485 nonathletes, Dr. Driban said.

However, the risk of knee OA is sport-specific, Dr. Driban said. Compared with nonathletes, soccer players at elite and nonelite levels were at increased risk of knee OA (relative risk, 4.4), as were elite athletes competing in distance running (3.2), weight lifting (6.4), and wrestling (3.7). Elite athletes were defined as those competing at the national, Olympic, or professional level; nonelite athletes were those competing at the recreational or scholastic level.

The results were limited by the lack of adequate data on women and injury histories for the study participants. However, the data are encouraging and suggest that knee OA risk generally is not elevated for most recreational athletes, said Dr. Driban.

"For individuals who are interested in pursuing the health benefits of physical activity, sports participation can be a healthy way of getting those benefits," Dr. Driban emphasized.

However, anyone who is especially concerned about reducing their risk for OA should opt for low-impact, noncontact sports, he said. Elite athletes in high-risk sports can take steps to reduce their risk, such as treating injuries promptly and maintaining a healthy weight and lifestyle when they retire from competition, he added.

Dr. Driban reported having no financial conflicts of interest.

Information about the relative risks of knee OA as a result of sports participation is essential to help develop prevention strategies and shape public health messages, said Jeffrey Driban, Ph.D., who presented the findings at the annual meeting of the American College of Rheumatology.

Dr. Driban and his colleagues at Tufts Medical Center in Boston analyzed 16 studies that identified OA rates in elite and recreational athletes participating in a range of sports including running, soccer, and wrestling. In general, the prevalence of knee OA was 8.4% among the 3,192 athletes of any level, compared with 9.1% among the 3,485 nonathletes, Dr. Driban said.

However, the risk of knee OA is sport-specific, Dr. Driban said. Compared with nonathletes, soccer players at elite and nonelite levels were at increased risk of knee OA (relative risk, 4.4), as were elite athletes competing in distance running (3.2), weight lifting (6.4), and wrestling (3.7). Elite athletes were defined as those competing at the national, Olympic, or professional level; nonelite athletes were those competing at the recreational or scholastic level.

The results were limited by the lack of adequate data on women and injury histories for the study participants. However, the data are encouraging and suggest that knee OA risk generally is not elevated for most recreational athletes, said Dr. Driban.

"For individuals who are interested in pursuing the health benefits of physical activity, sports participation can be a healthy way of getting those benefits," Dr. Driban emphasized.

However, anyone who is especially concerned about reducing their risk for OA should opt for low-impact, noncontact sports, he said. Elite athletes in high-risk sports can take steps to reduce their risk, such as treating injuries promptly and maintaining a healthy weight and lifestyle when they retire from competition, he added.

Dr. Driban reported having no financial conflicts of interest.

In 2009, the prevalence of no physical activity was 53% higher in adults with arthritis than those without, based on the latest data from the Behavioral Risk Factor Surveillance System. The findings were published online in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on Dec. 8.

From 2002 to 2008, the percentage of all adults in the United States who reported no physical activity stagnated at 25%, regardless of their arthritis status. The growing subset of adults with arthritis who tend to be sedentary because of their barriers to activity may have contributed to that stagnation, according to the CDC researchers.

"Further reduction in the prevalence of no leisure-time physical activity (LTPA) among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis," the researchers noted.

The researchers reviewed data from 432,607 adults aged 18 years and older who responded to telephone surveys. The study population included respondents from all 50 states, the District of Columbia, and all U.S. territories (MMWR 2011;60:1641-45).

Adults with arthritis accounted for at least 20% of all adults reporting no LTPA in each state, ranging from 21% in Minnesota to 43% in Tennessee.

Survey respondents were defined as "no LTPA" if they answered no to the question, "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"

Survey respondents were defined as having arthritis if they answered yes to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

© Diana Hirsch/iStockphoto.com

The findings are not surprising, given the disease-specific barriers to physical activity experienced by people with arthritis, the researchers wrote.

"However, these barriers can be addressed through targeted health communication messages; increased access to arthritis-appropriate, individually adapted behavior change programs; and relevant policy and environmental changes," they added.

The study results were limited by several factors, included the use of self-reports and the lack of including household, occupational, or transportation-related activities as LTPA.

The findings, however, support data from previous studies showing increased rates of physical inactivity in adults with arthritis, and they highlight the need to target these individuals with physical activity promotion initiatives that are arthritis specific, the researchers noted.

"Health care providers and public health physical activity practitioners should counsel arthritis patients regarding the benefits of physical activity and refer them to physical or occupational therapy if indicated or to locally available arthritis-appropriate physical activity programs," they said.

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

In 2009, the prevalence of no physical activity was 53% higher in adults with arthritis than those without, based on the latest data from the Behavioral Risk Factor Surveillance System. The findings were published online in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on Dec. 8.

From 2002 to 2008, the percentage of all adults in the United States who reported no physical activity stagnated at 25%, regardless of their arthritis status. The growing subset of adults with arthritis who tend to be sedentary because of their barriers to activity may have contributed to that stagnation, according to the CDC researchers.

"Further reduction in the prevalence of no leisure-time physical activity (LTPA) among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis," the researchers noted.

The researchers reviewed data from 432,607 adults aged 18 years and older who responded to telephone surveys. The study population included respondents from all 50 states, the District of Columbia, and all U.S. territories (MMWR 2011;60:1641-45).

Adults with arthritis accounted for at least 20% of all adults reporting no LTPA in each state, ranging from 21% in Minnesota to 43% in Tennessee.

Survey respondents were defined as "no LTPA" if they answered no to the question, "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"

Survey respondents were defined as having arthritis if they answered yes to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

© Diana Hirsch/iStockphoto.com

The findings are not surprising, given the disease-specific barriers to physical activity experienced by people with arthritis, the researchers wrote.

"However, these barriers can be addressed through targeted health communication messages; increased access to arthritis-appropriate, individually adapted behavior change programs; and relevant policy and environmental changes," they added.

The study results were limited by several factors, included the use of self-reports and the lack of including household, occupational, or transportation-related activities as LTPA.

The findings, however, support data from previous studies showing increased rates of physical inactivity in adults with arthritis, and they highlight the need to target these individuals with physical activity promotion initiatives that are arthritis specific, the researchers noted.

"Health care providers and public health physical activity practitioners should counsel arthritis patients regarding the benefits of physical activity and refer them to physical or occupational therapy if indicated or to locally available arthritis-appropriate physical activity programs," they said.

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

In 2009, the prevalence of no physical activity was 53% higher in adults with arthritis than those without, based on the latest data from the Behavioral Risk Factor Surveillance System. The findings were published online in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on Dec. 8.

From 2002 to 2008, the percentage of all adults in the United States who reported no physical activity stagnated at 25%, regardless of their arthritis status. The growing subset of adults with arthritis who tend to be sedentary because of their barriers to activity may have contributed to that stagnation, according to the CDC researchers.

"Further reduction in the prevalence of no leisure-time physical activity (LTPA) among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis," the researchers noted.

The researchers reviewed data from 432,607 adults aged 18 years and older who responded to telephone surveys. The study population included respondents from all 50 states, the District of Columbia, and all U.S. territories (MMWR 2011;60:1641-45).

Adults with arthritis accounted for at least 20% of all adults reporting no LTPA in each state, ranging from 21% in Minnesota to 43% in Tennessee.

Survey respondents were defined as "no LTPA" if they answered no to the question, "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"

Survey respondents were defined as having arthritis if they answered yes to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

© Diana Hirsch/iStockphoto.com

The findings are not surprising, given the disease-specific barriers to physical activity experienced by people with arthritis, the researchers wrote.

"However, these barriers can be addressed through targeted health communication messages; increased access to arthritis-appropriate, individually adapted behavior change programs; and relevant policy and environmental changes," they added.

The study results were limited by several factors, included the use of self-reports and the lack of including household, occupational, or transportation-related activities as LTPA.

The findings, however, support data from previous studies showing increased rates of physical inactivity in adults with arthritis, and they highlight the need to target these individuals with physical activity promotion initiatives that are arthritis specific, the researchers noted.

"Health care providers and public health physical activity practitioners should counsel arthritis patients regarding the benefits of physical activity and refer them to physical or occupational therapy if indicated or to locally available arthritis-appropriate physical activity programs," they said.

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