Heidi Splete

A significant 30% reduction in the number of sick leave days used per month was seen in adults with rheumatoid arthritis after using tumor necrosis factor antagonists for 6 months.

The finding was observed in a population-based study of 365 RA patients aged 18-85 years.

The study is among the first to address the quantitative impact of TNF inhibitors on sick leave and disability pension, said Dr. Tor Olofsson of Lund (Sweden) University, and colleagues.

They reviewed insurance database information on RA patients enrolled in the South Swedish Arthritis Treatment Group registry. Each patient was matched with four controls from the general population.

The study population averaged 9 sick days per month in the first month of anti-TNF treatment. The monthly rate dropped to an average of 6.5 days after 6 months and remained steady at an average of 6.6 days per month for months 6-12 (Ann. Rheum. Dis. 2010;69:2131-6).

Compared with the controls in the general population, the relative risk of being on sick leave in the RA group was 6.6 at the start of treatment, but dropped to 5.1 after 6 months, and remained at an average of 5.2 for the rest of the year. The relative risk of being on disability pension was 3.4 at the start of treatment and 3.2 after 1 year of treatment.

Approximately 98% of the patients had tried at least one disease-modifying antirheumatic drug (DMARD) before starting anti-TNF therapy. The average age of the patients was 46 years, and 82% were women. A total of 92 patients (25%) discontinued treatment, including 34 for adverse events, 32 for treatment failure, and 26 for other reasons.

"The reduction in sick leave during the first anti-TNF treatment year must be considered as a conservative measure in this cohort of patients who were severely ill, since there was a steady increase in sick leave prior to initiation of therapy," the researchers wrote. "Even a stabilization of the sick leave level could have been deemed as a successful outcome," they noted.

The results support findings from previous studies of the effects of TNF inhibitors on work outcomes, although the study was limited by the short follow-up period, the researchers noted. The findings conflict with data from a recent observational study that showed no difference in employment loss between RA patients using anti-TNF therapy and controls.

However, the average duration of RA in the observational study was 12 years, compared to an average duration of 4.5 years in the current study. This difference suggests a possible protective effect from anti-TNF therapy in a subset of patients with less than 11 years disease duration at the start of therapy, the researchers said.

The researchers said that they had no relevant financial conflicts to disclose. The study was funded by grants from multiple nonpharmaceutical organizations including the Swedish Research Council, Lund University, Region Skåne, the Swedish Social Insurance Agency, the Swedish Rheumatism Association, and the King Gustav V 80-Year Fund.

A significant 30% reduction in the number of sick leave days used per month was seen in adults with rheumatoid arthritis after using tumor necrosis factor antagonists for 6 months.

The finding was observed in a population-based study of 365 RA patients aged 18-85 years.

The study is among the first to address the quantitative impact of TNF inhibitors on sick leave and disability pension, said Dr. Tor Olofsson of Lund (Sweden) University, and colleagues.

They reviewed insurance database information on RA patients enrolled in the South Swedish Arthritis Treatment Group registry. Each patient was matched with four controls from the general population.

The study population averaged 9 sick days per month in the first month of anti-TNF treatment. The monthly rate dropped to an average of 6.5 days after 6 months and remained steady at an average of 6.6 days per month for months 6-12 (Ann. Rheum. Dis. 2010;69:2131-6).

Compared with the controls in the general population, the relative risk of being on sick leave in the RA group was 6.6 at the start of treatment, but dropped to 5.1 after 6 months, and remained at an average of 5.2 for the rest of the year. The relative risk of being on disability pension was 3.4 at the start of treatment and 3.2 after 1 year of treatment.

Approximately 98% of the patients had tried at least one disease-modifying antirheumatic drug (DMARD) before starting anti-TNF therapy. The average age of the patients was 46 years, and 82% were women. A total of 92 patients (25%) discontinued treatment, including 34 for adverse events, 32 for treatment failure, and 26 for other reasons.

"The reduction in sick leave during the first anti-TNF treatment year must be considered as a conservative measure in this cohort of patients who were severely ill, since there was a steady increase in sick leave prior to initiation of therapy," the researchers wrote. "Even a stabilization of the sick leave level could have been deemed as a successful outcome," they noted.

The results support findings from previous studies of the effects of TNF inhibitors on work outcomes, although the study was limited by the short follow-up period, the researchers noted. The findings conflict with data from a recent observational study that showed no difference in employment loss between RA patients using anti-TNF therapy and controls.

However, the average duration of RA in the observational study was 12 years, compared to an average duration of 4.5 years in the current study. This difference suggests a possible protective effect from anti-TNF therapy in a subset of patients with less than 11 years disease duration at the start of therapy, the researchers said.

The researchers said that they had no relevant financial conflicts to disclose. The study was funded by grants from multiple nonpharmaceutical organizations including the Swedish Research Council, Lund University, Region Skåne, the Swedish Social Insurance Agency, the Swedish Rheumatism Association, and the King Gustav V 80-Year Fund.

A significant 30% reduction in the number of sick leave days used per month was seen in adults with rheumatoid arthritis after using tumor necrosis factor antagonists for 6 months.

The finding was observed in a population-based study of 365 RA patients aged 18-85 years.

The study is among the first to address the quantitative impact of TNF inhibitors on sick leave and disability pension, said Dr. Tor Olofsson of Lund (Sweden) University, and colleagues.

They reviewed insurance database information on RA patients enrolled in the South Swedish Arthritis Treatment Group registry. Each patient was matched with four controls from the general population.

The study population averaged 9 sick days per month in the first month of anti-TNF treatment. The monthly rate dropped to an average of 6.5 days after 6 months and remained steady at an average of 6.6 days per month for months 6-12 (Ann. Rheum. Dis. 2010;69:2131-6).

Compared with the controls in the general population, the relative risk of being on sick leave in the RA group was 6.6 at the start of treatment, but dropped to 5.1 after 6 months, and remained at an average of 5.2 for the rest of the year. The relative risk of being on disability pension was 3.4 at the start of treatment and 3.2 after 1 year of treatment.

Approximately 98% of the patients had tried at least one disease-modifying antirheumatic drug (DMARD) before starting anti-TNF therapy. The average age of the patients was 46 years, and 82% were women. A total of 92 patients (25%) discontinued treatment, including 34 for adverse events, 32 for treatment failure, and 26 for other reasons.

"The reduction in sick leave during the first anti-TNF treatment year must be considered as a conservative measure in this cohort of patients who were severely ill, since there was a steady increase in sick leave prior to initiation of therapy," the researchers wrote. "Even a stabilization of the sick leave level could have been deemed as a successful outcome," they noted.

The results support findings from previous studies of the effects of TNF inhibitors on work outcomes, although the study was limited by the short follow-up period, the researchers noted. The findings conflict with data from a recent observational study that showed no difference in employment loss between RA patients using anti-TNF therapy and controls.

However, the average duration of RA in the observational study was 12 years, compared to an average duration of 4.5 years in the current study. This difference suggests a possible protective effect from anti-TNF therapy in a subset of patients with less than 11 years disease duration at the start of therapy, the researchers said.

The researchers said that they had no relevant financial conflicts to disclose. The study was funded by grants from multiple nonpharmaceutical organizations including the Swedish Research Council, Lund University, Region Skåne, the Swedish Social Insurance Agency, the Swedish Rheumatism Association, and the King Gustav V 80-Year Fund.

A significant 30% reduction in the number of sick leave days used per month was seen in adults with rheumatoid arthritis after using tumor necrosis factor antagonists for 6 months.

The finding was observed in a population-based study of 365 RA patients aged 18-85 years.

[TNF Inhibitors Appear to Reduce Diabetes Risk in RA]

The study is among the first to address the quantitative impact of TNF inhibitors on sick leave and disability pension, said Dr. Tor Olofsson of Lund (Sweden) University, and colleagues, whose study was published in the December issue of Annals of the Rheumatic Diseases.

They reviewed insurance database information on RA patients enrolled in the South Swedish Arthritis Treatment Group registry. Each patient was matched with four controls from the general population.

The study population averaged 9 sick days per month in the first month of anti-TNF treatment. The monthly rate dropped to an average of 6.5 days after 6 months and remained steady at an average of 6.6 days per month for months 6-12 (Ann. Rheum. Dis. 2010;69:2131-6).

Compared with the controls in the general population, the relative risk of being on sick leave in the RA group was 6.6 at the start of treatment, but dropped to 5.1 after 6 months, and remained at an average of 5.2 for the rest of the year. The relative risk of being on disability pension was 3.4 at the start of treatment and 3.2 after 1 year of treatment.

Approximately 98% of the patients had tried at least one disease-modifying antirheumatic drug (DMARD) before starting anti-TNF therapy. The average age of the patients was 46 years, and 82% were women. A total of 92 patients (25%) discontinued treatment, including 34 for adverse events, 32 for treatment failure, and 26 for other reasons.

[TNF Inhibitors Protect Against Plaque Buildup in RA Patients]

"The reduction in sick leave during the first anti-TNF treatment year must be considered as a conservative measure in this cohort of patients who were severely ill, since there was a steady increase in sick leave prior to initiation of therapy," the researchers wrote. "Even a stabilization of the sick leave level could have been deemed as a successful outcome," they noted.

The results support findings from previous studies of the effects of TNF inhibitors on work outcomes, although the study was limited by the short follow-up period, the researchers noted. The findings conflict with data from a recent observational study that showed no difference in employment loss between RA patients using anti-TNF therapy and controls. However, the average duration of RA in the observational study was 12 years, compared to an average duration of 4.5 years in the current study. This difference suggests a possible protective effect from anti-TNF therapy in a subset of patients with less than 11 years disease duration at the start of therapy, the researchers said.

[Switching TNF Inhibitors Does Not Increase Serious Infection Rate in RA]

The researchers said that they had no relevant financial conflicts to disclose. The study was funded by grants from multiple nonpharmaceutical organizations including the Swedish Research Council, Lund University, Region Skåne, the Swedish Social Insurance Agency, the Swedish Rheumatism Association, and the King Gustav V 80-Year Fund.

A significant 30% reduction in the number of sick leave days used per month was seen in adults with rheumatoid arthritis after using tumor necrosis factor antagonists for 6 months.

The finding was observed in a population-based study of 365 RA patients aged 18-85 years.

[TNF Inhibitors Appear to Reduce Diabetes Risk in RA]

The study is among the first to address the quantitative impact of TNF inhibitors on sick leave and disability pension, said Dr. Tor Olofsson of Lund (Sweden) University, and colleagues, whose study was published in the December issue of Annals of the Rheumatic Diseases.

They reviewed insurance database information on RA patients enrolled in the South Swedish Arthritis Treatment Group registry. Each patient was matched with four controls from the general population.

The study population averaged 9 sick days per month in the first month of anti-TNF treatment. The monthly rate dropped to an average of 6.5 days after 6 months and remained steady at an average of 6.6 days per month for months 6-12 (Ann. Rheum. Dis. 2010;69:2131-6).

Compared with the controls in the general population, the relative risk of being on sick leave in the RA group was 6.6 at the start of treatment, but dropped to 5.1 after 6 months, and remained at an average of 5.2 for the rest of the year. The relative risk of being on disability pension was 3.4 at the start of treatment and 3.2 after 1 year of treatment.

Approximately 98% of the patients had tried at least one disease-modifying antirheumatic drug (DMARD) before starting anti-TNF therapy. The average age of the patients was 46 years, and 82% were women. A total of 92 patients (25%) discontinued treatment, including 34 for adverse events, 32 for treatment failure, and 26 for other reasons.

[TNF Inhibitors Protect Against Plaque Buildup in RA Patients]

"The reduction in sick leave during the first anti-TNF treatment year must be considered as a conservative measure in this cohort of patients who were severely ill, since there was a steady increase in sick leave prior to initiation of therapy," the researchers wrote. "Even a stabilization of the sick leave level could have been deemed as a successful outcome," they noted.

The results support findings from previous studies of the effects of TNF inhibitors on work outcomes, although the study was limited by the short follow-up period, the researchers noted. The findings conflict with data from a recent observational study that showed no difference in employment loss between RA patients using anti-TNF therapy and controls. However, the average duration of RA in the observational study was 12 years, compared to an average duration of 4.5 years in the current study. This difference suggests a possible protective effect from anti-TNF therapy in a subset of patients with less than 11 years disease duration at the start of therapy, the researchers said.

[Switching TNF Inhibitors Does Not Increase Serious Infection Rate in RA]

The researchers said that they had no relevant financial conflicts to disclose. The study was funded by grants from multiple nonpharmaceutical organizations including the Swedish Research Council, Lund University, Region Skåne, the Swedish Social Insurance Agency, the Swedish Rheumatism Association, and the King Gustav V 80-Year Fund.

A significant 30% reduction in the number of sick leave days used per month was seen in adults with rheumatoid arthritis after using tumor necrosis factor antagonists for 6 months.

The finding was observed in a population-based study of 365 RA patients aged 18-85 years.

[TNF Inhibitors Appear to Reduce Diabetes Risk in RA]

The study is among the first to address the quantitative impact of TNF inhibitors on sick leave and disability pension, said Dr. Tor Olofsson of Lund (Sweden) University, and colleagues, whose study was published in the December issue of Annals of the Rheumatic Diseases.

They reviewed insurance database information on RA patients enrolled in the South Swedish Arthritis Treatment Group registry. Each patient was matched with four controls from the general population.

The study population averaged 9 sick days per month in the first month of anti-TNF treatment. The monthly rate dropped to an average of 6.5 days after 6 months and remained steady at an average of 6.6 days per month for months 6-12 (Ann. Rheum. Dis. 2010;69:2131-6).

Compared with the controls in the general population, the relative risk of being on sick leave in the RA group was 6.6 at the start of treatment, but dropped to 5.1 after 6 months, and remained at an average of 5.2 for the rest of the year. The relative risk of being on disability pension was 3.4 at the start of treatment and 3.2 after 1 year of treatment.

Approximately 98% of the patients had tried at least one disease-modifying antirheumatic drug (DMARD) before starting anti-TNF therapy. The average age of the patients was 46 years, and 82% were women. A total of 92 patients (25%) discontinued treatment, including 34 for adverse events, 32 for treatment failure, and 26 for other reasons.

[TNF Inhibitors Protect Against Plaque Buildup in RA Patients]

"The reduction in sick leave during the first anti-TNF treatment year must be considered as a conservative measure in this cohort of patients who were severely ill, since there was a steady increase in sick leave prior to initiation of therapy," the researchers wrote. "Even a stabilization of the sick leave level could have been deemed as a successful outcome," they noted.

The results support findings from previous studies of the effects of TNF inhibitors on work outcomes, although the study was limited by the short follow-up period, the researchers noted. The findings conflict with data from a recent observational study that showed no difference in employment loss between RA patients using anti-TNF therapy and controls. However, the average duration of RA in the observational study was 12 years, compared to an average duration of 4.5 years in the current study. This difference suggests a possible protective effect from anti-TNF therapy in a subset of patients with less than 11 years disease duration at the start of therapy, the researchers said.

[Switching TNF Inhibitors Does Not Increase Serious Infection Rate in RA]

The researchers said that they had no relevant financial conflicts to disclose. The study was funded by grants from multiple nonpharmaceutical organizations including the Swedish Research Council, Lund University, Region Skåne, the Swedish Social Insurance Agency, the Swedish Rheumatism Association, and the King Gustav V 80-Year Fund.

ATLANTA – Correcting for age can increase the diagnostic accuracy of some lab tests used to make the diagnosis of rheumatoid arthritis or other rheumatic disorders, according to Dr. Mark Wener and Dr. Robert Lightfoot.

Dr. Wener, director of the immunology division and a member of the rheumatology division at the University of Washington, Seattle, shared his clinical pearls for how to maximize the value of lab tests for inflammation.

A patient’s erythrocyte sedimentation rate (ESR) can be used to assess inflammation, but results can be deceiving, he said, because they are affected by factors including fibrinogen, globulins, albumin, and hematocrit.

In cases of acute inflammation, increased fibrinogen in turn increases the ESR, just as increased immunoglobulins that are present in chronic inflammation increase the ESR, Dr. Wener said. In addition, malnutrition, multiple myeloma, and malignancy and other noninflammatory conditions can raise the ESR.

The 2010 ACR/EULAR diagnostic criteria for rheumatoid arthritis (RA) recommend that clinicians take age and gender into account when using ESR. However, most labs don’t adjust for age, Dr. Wener said. For example, the incident inflammation asso ciated with age-related gingivitis can elevate the ESR even if no other inflammation is present.

[Check out our coverage of the American College of Rheumatology's annual meeting.]

Although most labs do not include age-adjusted reference ranges in their reports, clinicians can correct for age at the bedside by using a simple formula, said Dr. Wener. Use of a formula to determine the upper limit of the reference range for ESR can help physicians obtain an age-adjusted ESR (BMJ 1983;286:266):

• Men: Upper limit of normal ESR = age/2.

• Women: Upper limit of normal ESR = (age +10)/2.

Age and gender also play a role in the elevation of C-reactive protein levels, Dr. Wener said (J. Rheum. 2000;27:2351-9). He shared a similar formula to adjust for age and gender when considering CRP levels as an indicator of rheumatic disease.

• Men: Upper limit of normal CRP (mg/L) = age/5

• Women: Upper limit of normal CRP (mg/L) = (age + 30)/5

In general, ESR and CRP are elevated in patients with active RA, inflammatory RA, or polymyalgia rheumatica, Dr. Wener said. In contrast, patients with osteoarthritis and fibromyalgia rarely have elevated ESR and CRP levels, although age alone can increase both values, he emphasized. In addition, some patients with localized, noninflammatory disease or localized OA might have normal ESR and CRP values, and ESR and CRP levels vary in patients with chronic bursitis and in gout or other crystal diseases.

The most practical uses for ESR and CRP are for confirmation of inflammatory disease and for monitoring inflammation in cases of RA, although these tests are less reliable as measures of RA disease activity, said Dr. Wener. However, ESR and CRP have shown high sensitivity rates (92% and 100%, respectively) in identifying giant cell arteritis, he added.

Dr. Lightfoot, professor of medicine in the rheumatology division at the University of Kentucky, Lexington, added his clinical pearls for using the antinuclear antibody test (ANA) to diagnose rheumatic disease. "There are between 100 and 150 different antigens in the nucleus that can be detected in the indirect immunofluorescent ANA," said Dr. Lightfoot. "But we only know what about 10 of those antigens are."

The same ANA results might occur in both a healthy person and someone with confirmed RA, Dr. Lightfoot said. Make sure an IFA ANA is done as part of any ANA screening, especially if findings from an ANA panel show a negative ANA, or if an ANA is positive without a titer, he said.

In addition, it’s important to know the reliability of an anti-nDNA assay, because a positive anti-nDNA is often a false positive, said Dr. Lightfoot. "The biggest problem with all anti-nDNA assays is contamination of the antigen with single-stranded portions," he said. "Antibodies to single-stranded DNA are less specific than the ESR."

Dr. Wener has served as a consultant for Takeda Pharmaceuticals, and he has a contract for lab testing and imaging with Bio-Rad Laboratories. Dr. Lightfoot had no financial conflicts to disclose.

ATLANTA – Correcting for age can increase the diagnostic accuracy of some lab tests used to make the diagnosis of rheumatoid arthritis or other rheumatic disorders, according to Dr. Mark Wener and Dr. Robert Lightfoot.

Dr. Wener, director of the immunology division and a member of the rheumatology division at the University of Washington, Seattle, shared his clinical pearls for how to maximize the value of lab tests for inflammation.

A patient’s erythrocyte sedimentation rate (ESR) can be used to assess inflammation, but results can be deceiving, he said, because they are affected by factors including fibrinogen, globulins, albumin, and hematocrit.

In cases of acute inflammation, increased fibrinogen in turn increases the ESR, just as increased immunoglobulins that are present in chronic inflammation increase the ESR, Dr. Wener said. In addition, malnutrition, multiple myeloma, and malignancy and other noninflammatory conditions can raise the ESR.

The 2010 ACR/EULAR diagnostic criteria for rheumatoid arthritis (RA) recommend that clinicians take age and gender into account when using ESR. However, most labs don’t adjust for age, Dr. Wener said. For example, the incident inflammation asso ciated with age-related gingivitis can elevate the ESR even if no other inflammation is present.

[Check out our coverage of the American College of Rheumatology's annual meeting.]

Although most labs do not include age-adjusted reference ranges in their reports, clinicians can correct for age at the bedside by using a simple formula, said Dr. Wener. Use of a formula to determine the upper limit of the reference range for ESR can help physicians obtain an age-adjusted ESR (BMJ 1983;286:266):

• Men: Upper limit of normal ESR = age/2.

• Women: Upper limit of normal ESR = (age +10)/2.

Age and gender also play a role in the elevation of C-reactive protein levels, Dr. Wener said (J. Rheum. 2000;27:2351-9). He shared a similar formula to adjust for age and gender when considering CRP levels as an indicator of rheumatic disease.

• Men: Upper limit of normal CRP (mg/L) = age/5

• Women: Upper limit of normal CRP (mg/L) = (age + 30)/5

In general, ESR and CRP are elevated in patients with active RA, inflammatory RA, or polymyalgia rheumatica, Dr. Wener said. In contrast, patients with osteoarthritis and fibromyalgia rarely have elevated ESR and CRP levels, although age alone can increase both values, he emphasized. In addition, some patients with localized, noninflammatory disease or localized OA might have normal ESR and CRP values, and ESR and CRP levels vary in patients with chronic bursitis and in gout or other crystal diseases.

The most practical uses for ESR and CRP are for confirmation of inflammatory disease and for monitoring inflammation in cases of RA, although these tests are less reliable as measures of RA disease activity, said Dr. Wener. However, ESR and CRP have shown high sensitivity rates (92% and 100%, respectively) in identifying giant cell arteritis, he added.

Dr. Lightfoot, professor of medicine in the rheumatology division at the University of Kentucky, Lexington, added his clinical pearls for using the antinuclear antibody test (ANA) to diagnose rheumatic disease. "There are between 100 and 150 different antigens in the nucleus that can be detected in the indirect immunofluorescent ANA," said Dr. Lightfoot. "But we only know what about 10 of those antigens are."

The same ANA results might occur in both a healthy person and someone with confirmed RA, Dr. Lightfoot said. Make sure an IFA ANA is done as part of any ANA screening, especially if findings from an ANA panel show a negative ANA, or if an ANA is positive without a titer, he said.

In addition, it’s important to know the reliability of an anti-nDNA assay, because a positive anti-nDNA is often a false positive, said Dr. Lightfoot. "The biggest problem with all anti-nDNA assays is contamination of the antigen with single-stranded portions," he said. "Antibodies to single-stranded DNA are less specific than the ESR."

Dr. Wener has served as a consultant for Takeda Pharmaceuticals, and he has a contract for lab testing and imaging with Bio-Rad Laboratories. Dr. Lightfoot had no financial conflicts to disclose.

ATLANTA – Correcting for age can increase the diagnostic accuracy of some lab tests used to make the diagnosis of rheumatoid arthritis or other rheumatic disorders, according to Dr. Mark Wener and Dr. Robert Lightfoot.

Dr. Wener, director of the immunology division and a member of the rheumatology division at the University of Washington, Seattle, shared his clinical pearls for how to maximize the value of lab tests for inflammation.

A patient’s erythrocyte sedimentation rate (ESR) can be used to assess inflammation, but results can be deceiving, he said, because they are affected by factors including fibrinogen, globulins, albumin, and hematocrit.

In cases of acute inflammation, increased fibrinogen in turn increases the ESR, just as increased immunoglobulins that are present in chronic inflammation increase the ESR, Dr. Wener said. In addition, malnutrition, multiple myeloma, and malignancy and other noninflammatory conditions can raise the ESR.

The 2010 ACR/EULAR diagnostic criteria for rheumatoid arthritis (RA) recommend that clinicians take age and gender into account when using ESR. However, most labs don’t adjust for age, Dr. Wener said. For example, the incident inflammation asso ciated with age-related gingivitis can elevate the ESR even if no other inflammation is present.

[Check out our coverage of the American College of Rheumatology's annual meeting.]

Although most labs do not include age-adjusted reference ranges in their reports, clinicians can correct for age at the bedside by using a simple formula, said Dr. Wener. Use of a formula to determine the upper limit of the reference range for ESR can help physicians obtain an age-adjusted ESR (BMJ 1983;286:266):

• Men: Upper limit of normal ESR = age/2.

• Women: Upper limit of normal ESR = (age +10)/2.

Age and gender also play a role in the elevation of C-reactive protein levels, Dr. Wener said (J. Rheum. 2000;27:2351-9). He shared a similar formula to adjust for age and gender when considering CRP levels as an indicator of rheumatic disease.

• Men: Upper limit of normal CRP (mg/L) = age/5

• Women: Upper limit of normal CRP (mg/L) = (age + 30)/5

In general, ESR and CRP are elevated in patients with active RA, inflammatory RA, or polymyalgia rheumatica, Dr. Wener said. In contrast, patients with osteoarthritis and fibromyalgia rarely have elevated ESR and CRP levels, although age alone can increase both values, he emphasized. In addition, some patients with localized, noninflammatory disease or localized OA might have normal ESR and CRP values, and ESR and CRP levels vary in patients with chronic bursitis and in gout or other crystal diseases.

The most practical uses for ESR and CRP are for confirmation of inflammatory disease and for monitoring inflammation in cases of RA, although these tests are less reliable as measures of RA disease activity, said Dr. Wener. However, ESR and CRP have shown high sensitivity rates (92% and 100%, respectively) in identifying giant cell arteritis, he added.

Dr. Lightfoot, professor of medicine in the rheumatology division at the University of Kentucky, Lexington, added his clinical pearls for using the antinuclear antibody test (ANA) to diagnose rheumatic disease. "There are between 100 and 150 different antigens in the nucleus that can be detected in the indirect immunofluorescent ANA," said Dr. Lightfoot. "But we only know what about 10 of those antigens are."

The same ANA results might occur in both a healthy person and someone with confirmed RA, Dr. Lightfoot said. Make sure an IFA ANA is done as part of any ANA screening, especially if findings from an ANA panel show a negative ANA, or if an ANA is positive without a titer, he said.

In addition, it’s important to know the reliability of an anti-nDNA assay, because a positive anti-nDNA is often a false positive, said Dr. Lightfoot. "The biggest problem with all anti-nDNA assays is contamination of the antigen with single-stranded portions," he said. "Antibodies to single-stranded DNA are less specific than the ESR."

Dr. Wener has served as a consultant for Takeda Pharmaceuticals, and he has a contract for lab testing and imaging with Bio-Rad Laboratories. Dr. Lightfoot had no financial conflicts to disclose.

ATLANTA – The rate of cancer in children with juvenile idiopathic arthritis in the United States was at least twice as high as was the rate of cancer in children the same age without JIA, but no cancer cases were found among children with JIA who were exposed to TNF inhibitors, based on a review of a nationwide database.

The findings were presented at the annual meeting of the American College of Rheumatology.

[Check out our coverage of the American College of Rheumatology's annual meeting.]

"Since the introduction of TNF inhibitors in clinical practice, there has been concern about an increased risk of malignancy associated with them," Dr. Timothy Beukelman of the University of Alabama, Birmingham, said in an interview. This concern increased in 2009, when a report from the Food and Drug Administration found a possible association between TNF inhibitors and malignancy in children, he said. The report prompted the FDA to issue a black box warning about the risk of pediatric malignancy from anti-TNF drugs, he said.

But the FDA report compared cancer rates in children receiving TNF inhibitors with children in the general population, which did not account for exposure to other drugs, such as methotrexate, or for possible carcinogenic effects of the JIA disease process itself, said Dr. Beukelman.

"We attempted to fill in some of the gaps in our knowledge regarding a possible background or baseline increased rate of malignancy for children with JIA," he said.

Dr. Beukelman and colleagues reviewed National Medicaid Administrative Claims data for 2000-2005. They identified 7,321 children with JIA and compared them with non-JIA control groups who had diagnoses of asthma or attention-deficit hyperactivity disorder (ADHD). Among the JIA patients, 3,194 were taking methotrexate and 1,413 were exposed to TNF inhibitors.

The standardized rate of any cancer in children with JIA was 59 per 100,000 person-years, compared with 27 per 100,000 person-years and 23 per 100,000 person-years in the control groups with asthma and ADHD, respectively. The standardized rate of leukemia and lymphoma was 25 per 100,000 person-years in the JIA group, compared with 9 per 100,000 person-years in both control groups.

Of note, the researchers found no cases of cancer in more the 1,400 children with JIA who had been exposed to anti-TNF therapy, said Dr. Beukelman said.

More research is needed to determine how disease activity in children with JIA impacts their risk for cancer, but the study findings suggest that the potential cancer risk associated with TNF inhibitors appears to be less than expected, he said.

Dr. Beukelman said that he had no financial conflicts to disclose. Some of his coinvestigators have received research grants and consulting fees from multiple pharmaceutical companies including Amgen, Centocor, and Roche.

ATLANTA – The rate of cancer in children with juvenile idiopathic arthritis in the United States was at least twice as high as was the rate of cancer in children the same age without JIA, but no cancer cases were found among children with JIA who were exposed to TNF inhibitors, based on a review of a nationwide database.

The findings were presented at the annual meeting of the American College of Rheumatology.

[Check out our coverage of the American College of Rheumatology's annual meeting.]

"Since the introduction of TNF inhibitors in clinical practice, there has been concern about an increased risk of malignancy associated with them," Dr. Timothy Beukelman of the University of Alabama, Birmingham, said in an interview. This concern increased in 2009, when a report from the Food and Drug Administration found a possible association between TNF inhibitors and malignancy in children, he said. The report prompted the FDA to issue a black box warning about the risk of pediatric malignancy from anti-TNF drugs, he said.

But the FDA report compared cancer rates in children receiving TNF inhibitors with children in the general population, which did not account for exposure to other drugs, such as methotrexate, or for possible carcinogenic effects of the JIA disease process itself, said Dr. Beukelman.

"We attempted to fill in some of the gaps in our knowledge regarding a possible background or baseline increased rate of malignancy for children with JIA," he said.

Dr. Beukelman and colleagues reviewed National Medicaid Administrative Claims data for 2000-2005. They identified 7,321 children with JIA and compared them with non-JIA control groups who had diagnoses of asthma or attention-deficit hyperactivity disorder (ADHD). Among the JIA patients, 3,194 were taking methotrexate and 1,413 were exposed to TNF inhibitors.

The standardized rate of any cancer in children with JIA was 59 per 100,000 person-years, compared with 27 per 100,000 person-years and 23 per 100,000 person-years in the control groups with asthma and ADHD, respectively. The standardized rate of leukemia and lymphoma was 25 per 100,000 person-years in the JIA group, compared with 9 per 100,000 person-years in both control groups.

Of note, the researchers found no cases of cancer in more the 1,400 children with JIA who had been exposed to anti-TNF therapy, said Dr. Beukelman said.

More research is needed to determine how disease activity in children with JIA impacts their risk for cancer, but the study findings suggest that the potential cancer risk associated with TNF inhibitors appears to be less than expected, he said.

Dr. Beukelman said that he had no financial conflicts to disclose. Some of his coinvestigators have received research grants and consulting fees from multiple pharmaceutical companies including Amgen, Centocor, and Roche.

ATLANTA – The rate of cancer in children with juvenile idiopathic arthritis in the United States was at least twice as high as was the rate of cancer in children the same age without JIA, but no cancer cases were found among children with JIA who were exposed to TNF inhibitors, based on a review of a nationwide database.

The findings were presented at the annual meeting of the American College of Rheumatology.

[Check out our coverage of the American College of Rheumatology's annual meeting.]

"Since the introduction of TNF inhibitors in clinical practice, there has been concern about an increased risk of malignancy associated with them," Dr. Timothy Beukelman of the University of Alabama, Birmingham, said in an interview. This concern increased in 2009, when a report from the Food and Drug Administration found a possible association between TNF inhibitors and malignancy in children, he said. The report prompted the FDA to issue a black box warning about the risk of pediatric malignancy from anti-TNF drugs, he said.

But the FDA report compared cancer rates in children receiving TNF inhibitors with children in the general population, which did not account for exposure to other drugs, such as methotrexate, or for possible carcinogenic effects of the JIA disease process itself, said Dr. Beukelman.

"We attempted to fill in some of the gaps in our knowledge regarding a possible background or baseline increased rate of malignancy for children with JIA," he said.

Dr. Beukelman and colleagues reviewed National Medicaid Administrative Claims data for 2000-2005. They identified 7,321 children with JIA and compared them with non-JIA control groups who had diagnoses of asthma or attention-deficit hyperactivity disorder (ADHD). Among the JIA patients, 3,194 were taking methotrexate and 1,413 were exposed to TNF inhibitors.

The standardized rate of any cancer in children with JIA was 59 per 100,000 person-years, compared with 27 per 100,000 person-years and 23 per 100,000 person-years in the control groups with asthma and ADHD, respectively. The standardized rate of leukemia and lymphoma was 25 per 100,000 person-years in the JIA group, compared with 9 per 100,000 person-years in both control groups.

Of note, the researchers found no cases of cancer in more the 1,400 children with JIA who had been exposed to anti-TNF therapy, said Dr. Beukelman said.

More research is needed to determine how disease activity in children with JIA impacts their risk for cancer, but the study findings suggest that the potential cancer risk associated with TNF inhibitors appears to be less than expected, he said.

Dr. Beukelman said that he had no financial conflicts to disclose. Some of his coinvestigators have received research grants and consulting fees from multiple pharmaceutical companies including Amgen, Centocor, and Roche.

WASHINGTON – The percentage of American teenagers reporting daily marijuana use increased significantly from 2009 to 2010, according to findings from the 2010 Monitoring the Future survey. The results were presented at a press conference Dec. 14.

"We are seeing a decrease in the number of teenagers perceiving marijuana use as harmful," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. The survey is conducted for NIDA by the University of Michigan, Ann Arbor.

The percentage of 8th, 10th, and 12th graders reporting daily marijuana use increased from 1.0% to 1.2%, 2.8% to 3.3%, and 5.2% to 6.1%, respectively. In keeping with a gradual increase in use over the past 3 years, an increase was seen in all three grade levels measured in the survey. However, past-year and past-month reported use increased among 8th graders only.

In addition, Ecstasy appears to be gaining popularity after almost a decade of decline, said Lloyd D. Johnston, Ph.D., a research scientist at the University of Michigan and the principal investigator on the Monitoring the Future survey. In 2010, 2.4% of 8th graders and 4.7% of 10th graders reported past-year Ecstasy use, up from 1.3% and 3.7%, respectively, in the 2009 survey.

The decline in cigarette smoking appears to have stalled across all three grade levels, and nonmedical use of many prescription drugs, including OxyContin and Adderall, remained similar to last year’s levels among 12th graders.

On the positive side, past-year reports of alcohol consumption among 12th graders declined, from 43.5% to 41.2%, and binge drinking dropped from 25.2% to 23.2%, Dr. Johnston said. In addition, non-medical use of the prescription painkiller Vicodin decreased among 12th graders, he noted.

The changes in drug, cigarette, and alcohol use reflect changes in teens’ perceptions of the risks associated with these products, Dr. Volkow said. The 2010 results show a decline in the numbers of 8th graders who disapproved of marijuana use, and declines in the numbers of 10th and 12th graders who said they perceived a "great risk" of harm associated with smoking marijuana regularly. The mixed messages about the legalization of marijuana and its use as medicine might be contributing to the trend, Dr. Volkow noted.

It is important for doctors who treat teenagers to identify psychiatric problems, such as depression or anxiety, which could lead to the abuse of drugs if left untreated, Dr. Volkow said. In addition, physicians are in a unique position to help parents and teenagers understand the dangers of drugs, alcohol, and cigarette use, because they are neutral third parties, Dr. Johnston said. "I suspect that their advice would carry weight [with teens]," he said.

Monitoring the Future is an ongoing study of the opinions and beliefs of American adolescents. The 2010 survey included approximately 46,000 students in grades 8, 10, and 12. Monitoring the Future is funded by the National Institutes of Health. More detailed study results are available online.

WASHINGTON – The percentage of American teenagers reporting daily marijuana use increased significantly from 2009 to 2010, according to findings from the 2010 Monitoring the Future survey. The results were presented at a press conference Dec. 14.

"We are seeing a decrease in the number of teenagers perceiving marijuana use as harmful," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. The survey is conducted for NIDA by the University of Michigan, Ann Arbor.

The percentage of 8th, 10th, and 12th graders reporting daily marijuana use increased from 1.0% to 1.2%, 2.8% to 3.3%, and 5.2% to 6.1%, respectively. In keeping with a gradual increase in use over the past 3 years, an increase was seen in all three grade levels measured in the survey. However, past-year and past-month reported use increased among 8th graders only.

In addition, Ecstasy appears to be gaining popularity after almost a decade of decline, said Lloyd D. Johnston, Ph.D., a research scientist at the University of Michigan and the principal investigator on the Monitoring the Future survey. In 2010, 2.4% of 8th graders and 4.7% of 10th graders reported past-year Ecstasy use, up from 1.3% and 3.7%, respectively, in the 2009 survey.

The decline in cigarette smoking appears to have stalled across all three grade levels, and nonmedical use of many prescription drugs, including OxyContin and Adderall, remained similar to last year’s levels among 12th graders.

On the positive side, past-year reports of alcohol consumption among 12th graders declined, from 43.5% to 41.2%, and binge drinking dropped from 25.2% to 23.2%, Dr. Johnston said. In addition, non-medical use of the prescription painkiller Vicodin decreased among 12th graders, he noted.

The changes in drug, cigarette, and alcohol use reflect changes in teens’ perceptions of the risks associated with these products, Dr. Volkow said. The 2010 results show a decline in the numbers of 8th graders who disapproved of marijuana use, and declines in the numbers of 10th and 12th graders who said they perceived a "great risk" of harm associated with smoking marijuana regularly. The mixed messages about the legalization of marijuana and its use as medicine might be contributing to the trend, Dr. Volkow noted.

It is important for doctors who treat teenagers to identify psychiatric problems, such as depression or anxiety, which could lead to the abuse of drugs if left untreated, Dr. Volkow said. In addition, physicians are in a unique position to help parents and teenagers understand the dangers of drugs, alcohol, and cigarette use, because they are neutral third parties, Dr. Johnston said. "I suspect that their advice would carry weight [with teens]," he said.

Monitoring the Future is an ongoing study of the opinions and beliefs of American adolescents. The 2010 survey included approximately 46,000 students in grades 8, 10, and 12. Monitoring the Future is funded by the National Institutes of Health. More detailed study results are available online.

WASHINGTON – The percentage of American teenagers reporting daily marijuana use increased significantly from 2009 to 2010, according to findings from the 2010 Monitoring the Future survey. The results were presented at a press conference Dec. 14.

"We are seeing a decrease in the number of teenagers perceiving marijuana use as harmful," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. The survey is conducted for NIDA by the University of Michigan, Ann Arbor.

The percentage of 8th, 10th, and 12th graders reporting daily marijuana use increased from 1.0% to 1.2%, 2.8% to 3.3%, and 5.2% to 6.1%, respectively. In keeping with a gradual increase in use over the past 3 years, an increase was seen in all three grade levels measured in the survey. However, past-year and past-month reported use increased among 8th graders only.

In addition, Ecstasy appears to be gaining popularity after almost a decade of decline, said Lloyd D. Johnston, Ph.D., a research scientist at the University of Michigan and the principal investigator on the Monitoring the Future survey. In 2010, 2.4% of 8th graders and 4.7% of 10th graders reported past-year Ecstasy use, up from 1.3% and 3.7%, respectively, in the 2009 survey.

The decline in cigarette smoking appears to have stalled across all three grade levels, and nonmedical use of many prescription drugs, including OxyContin and Adderall, remained similar to last year’s levels among 12th graders.

On the positive side, past-year reports of alcohol consumption among 12th graders declined, from 43.5% to 41.2%, and binge drinking dropped from 25.2% to 23.2%, Dr. Johnston said. In addition, non-medical use of the prescription painkiller Vicodin decreased among 12th graders, he noted.

The changes in drug, cigarette, and alcohol use reflect changes in teens’ perceptions of the risks associated with these products, Dr. Volkow said. The 2010 results show a decline in the numbers of 8th graders who disapproved of marijuana use, and declines in the numbers of 10th and 12th graders who said they perceived a "great risk" of harm associated with smoking marijuana regularly. The mixed messages about the legalization of marijuana and its use as medicine might be contributing to the trend, Dr. Volkow noted.

It is important for doctors who treat teenagers to identify psychiatric problems, such as depression or anxiety, which could lead to the abuse of drugs if left untreated, Dr. Volkow said. In addition, physicians are in a unique position to help parents and teenagers understand the dangers of drugs, alcohol, and cigarette use, because they are neutral third parties, Dr. Johnston said. "I suspect that their advice would carry weight [with teens]," he said.

Monitoring the Future is an ongoing study of the opinions and beliefs of American adolescents. The 2010 survey included approximately 46,000 students in grades 8, 10, and 12. Monitoring the Future is funded by the National Institutes of Health. More detailed study results are available online.

WASHINGTON – The percentage of American teenagers reporting daily marijuana use increased significantly from 2009 to 2010, according to findings from the 2010 Monitoring the Future survey. The results were presented at a press conference Dec. 14.

"We are seeing a decrease in the number of teenagers perceiving marijuana use as harmful," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. The survey is conducted for NIDA by the University of Michigan, Ann Arbor.

The percentage of 8th, 10th, and 12th graders reporting daily marijuana use increased from 1.0% to 1.2%, 2.8% to 3.3%, and 5.2% to 6.1%, respectively. In keeping with a gradual increase in use over the past 3 years, an increase was seen in all three grade levels measured in the survey. However, past-year and past-month reported use increased among 8th graders only.

In addition, Ecstasy appears to be gaining popularity after almost a decade of decline, said Lloyd D. Johnston, Ph.D., a research scientist at the University of Michigan and the principal investigator on the Monitoring the Future survey. In 2010, 2.4% of 8th graders and 4.7% of 10th graders reported past-year Ecstasy use, up from 1.3% and 3.7%, respectively, in the 2009 survey.

The decline in cigarette smoking appears to have stalled across all three grade levels, and nonmedical use of many prescription drugs, including OxyContin and Adderall, remained similar to last year’s levels among 12th graders.

On the positive side, past-year reports of alcohol consumption among 12th graders declined, from 43.5% to 41.2%, and binge drinking dropped from 25.2% to 23.2%, Dr. Johnston said. In addition, non-medical use of the prescription painkiller Vicodin decreased among 12th graders, he noted.

The changes in drug, cigarette, and alcohol use reflect changes in teens’ perceptions of the risks associated with these products, Dr. Volkow said. The 2010 results show a decline in the numbers of 8th graders who disapproved of marijuana use, and declines in the numbers of 10th and 12th graders who said they perceived a "great risk" of harm associated with smoking marijuana regularly. The mixed messages about the legalization of marijuana and its use as medicine might be contributing to the trend, Dr. Volkow noted.

It is important for doctors who treat teenagers to identify psychiatric problems, such as depression or anxiety, which could lead to the abuse of drugs if left untreated, Dr. Volkow said. In addition, physicians are in a unique position to help parents and teenagers understand the dangers of drugs, alcohol, and cigarette use, because they are neutral third parties, Dr. Johnston said. "I suspect that their advice would carry weight [with teens]," he said.

Monitoring the Future is an ongoing study of the opinions and beliefs of American adolescents. The 2010 survey included approximately 46,000 students in grades 8, 10, and 12. Monitoring the Future is funded by the National Institutes of Health. More detailed study results are available online.

WASHINGTON – The percentage of American teenagers reporting daily marijuana use increased significantly from 2009 to 2010, according to findings from the 2010 Monitoring the Future survey. The results were presented at a press conference Dec. 14.

"We are seeing a decrease in the number of teenagers perceiving marijuana use as harmful," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. The survey is conducted for NIDA by the University of Michigan, Ann Arbor.

The percentage of 8th, 10th, and 12th graders reporting daily marijuana use increased from 1.0% to 1.2%, 2.8% to 3.3%, and 5.2% to 6.1%, respectively. In keeping with a gradual increase in use over the past 3 years, an increase was seen in all three grade levels measured in the survey. However, past-year and past-month reported use increased among 8th graders only.

In addition, Ecstasy appears to be gaining popularity after almost a decade of decline, said Lloyd D. Johnston, Ph.D., a research scientist at the University of Michigan and the principal investigator on the Monitoring the Future survey. In 2010, 2.4% of 8th graders and 4.7% of 10th graders reported past-year Ecstasy use, up from 1.3% and 3.7%, respectively, in the 2009 survey.

The decline in cigarette smoking appears to have stalled across all three grade levels, and nonmedical use of many prescription drugs, including OxyContin and Adderall, remained similar to last year’s levels among 12th graders.

On the positive side, past-year reports of alcohol consumption among 12th graders declined, from 43.5% to 41.2%, and binge drinking dropped from 25.2% to 23.2%, Dr. Johnston said. In addition, non-medical use of the prescription painkiller Vicodin decreased among 12th graders, he noted.

The changes in drug, cigarette, and alcohol use reflect changes in teens’ perceptions of the risks associated with these products, Dr. Volkow said. The 2010 results show a decline in the numbers of 8th graders who disapproved of marijuana use, and declines in the numbers of 10th and 12th graders who said they perceived a "great risk" of harm associated with smoking marijuana regularly. The mixed messages about the legalization of marijuana and its use as medicine might be contributing to the trend, Dr. Volkow noted.

It is important for doctors who treat teenagers to identify psychiatric problems, such as depression or anxiety, which could lead to the abuse of drugs if left untreated, Dr. Volkow said. In addition, physicians are in a unique position to help parents and teenagers understand the dangers of drugs, alcohol, and cigarette use, because they are neutral third parties, Dr. Johnston said. "I suspect that their advice would carry weight [with teens]," he said.

Monitoring the Future is an ongoing study of the opinions and beliefs of American adolescents. The 2010 survey included approximately 46,000 students in grades 8, 10, and 12. Monitoring the Future is funded by the National Institutes of Health. More detailed study results are available online.

WASHINGTON – The percentage of American teenagers reporting daily marijuana use increased significantly from 2009 to 2010, according to findings from the 2010 Monitoring the Future survey. The results were presented at a press conference Dec. 14.

"We are seeing a decrease in the number of teenagers perceiving marijuana use as harmful," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. The survey is conducted for NIDA by the University of Michigan, Ann Arbor.

The percentage of 8th, 10th, and 12th graders reporting daily marijuana use increased from 1.0% to 1.2%, 2.8% to 3.3%, and 5.2% to 6.1%, respectively. In keeping with a gradual increase in use over the past 3 years, an increase was seen in all three grade levels measured in the survey. However, past-year and past-month reported use increased among 8th graders only.

In addition, Ecstasy appears to be gaining popularity after almost a decade of decline, said Lloyd D. Johnston, Ph.D., a research scientist at the University of Michigan and the principal investigator on the Monitoring the Future survey. In 2010, 2.4% of 8th graders and 4.7% of 10th graders reported past-year Ecstasy use, up from 1.3% and 3.7%, respectively, in the 2009 survey.

The decline in cigarette smoking appears to have stalled across all three grade levels, and nonmedical use of many prescription drugs, including OxyContin and Adderall, remained similar to last year’s levels among 12th graders.

On the positive side, past-year reports of alcohol consumption among 12th graders declined, from 43.5% to 41.2%, and binge drinking dropped from 25.2% to 23.2%, Dr. Johnston said. In addition, non-medical use of the prescription painkiller Vicodin decreased among 12th graders, he noted.

The changes in drug, cigarette, and alcohol use reflect changes in teens’ perceptions of the risks associated with these products, Dr. Volkow said. The 2010 results show a decline in the numbers of 8th graders who disapproved of marijuana use, and declines in the numbers of 10th and 12th graders who said they perceived a "great risk" of harm associated with smoking marijuana regularly. The mixed messages about the legalization of marijuana and its use as medicine might be contributing to the trend, Dr. Volkow noted.

It is important for doctors who treat teenagers to identify psychiatric problems, such as depression or anxiety, which could lead to the abuse of drugs if left untreated, Dr. Volkow said. In addition, physicians are in a unique position to help parents and teenagers understand the dangers of drugs, alcohol, and cigarette use, because they are neutral third parties, Dr. Johnston said. "I suspect that their advice would carry weight [with teens]," he said.

Monitoring the Future is an ongoing study of the opinions and beliefs of American adolescents. The 2010 survey included approximately 46,000 students in grades 8, 10, and 12. Monitoring the Future is funded by the National Institutes of Health. More detailed study results are available online.

ATLANTA – Approximately 20% of cases of chronic low back pain in younger adults seen in primary care settings might be caused by spondyloarthritis, based on data from 364 patients aged 19-45 years. The findings were presented at the annual meeting of the American College of Rheumatology.

In the cross-sectional study, 77 of 364 patients (22%) met the diagnosis of axial spondyloarthritis on examination by a rheumatologist. The average age of the patients was 36 years, 43% were male, and the average duration of chronic low back pain was 9 years.

The diagnostic techniques included a detailed patient questionnaire about inflammatory back pain, physical examination and patient history; blood tests to assess C-reactive protein levels and the presence of HLA-B27 (a gene that has been linked to spondyloarthritis); and conventional and MRI images of sacroiliac joints. Two radiologists reviewed the images for the signs of inflammation and bone lesions that might indicate axial spondyloarthritis.

Fifty-two patients were diagnosed according to MRI criteria plus one additional spondyloarthritis feature. The other 12 patients were diagnosed according to a positive HLA-B27 test plus two additional spondyloarthritis features, Dr. Angelique Weel of Maasstad Ziekenhuis, Rotterdam, the Netherlands, said at a press conference.

In addition, 24 patients (6.6%) met the criteria for ankylosing spondylitis.

The results suggest that spondyloarthritis is underdiagnosed as a cause of chronic back pain in the general population. Dr. Weel recommended that primary care physicians suspect spondyloarthritis when they see younger adults with chronic back pain, and refer these patients to a rheumatologist if they suspect an inflammatory basis for the pain.

"We also tried to make a simple questionnaire for general practitioners, so they can determine which patient with chronic low back pain should be sent to a rheumatologist to investigate possible spondyloarthritis," she noted. Possible red flags from the standardized questionnaire include the response to NSAIDs and a family history of spondyloarthritis, Dr. Weel said.

"Of course, we need to validate these data in another population, and we also have to validate our referral tool [for general physicians]," she noted.

Dr. Weel said that she had no financial conflicts to disclose.

ATLANTA – Approximately 20% of cases of chronic low back pain in younger adults seen in primary care settings might be caused by spondyloarthritis, based on data from 364 patients aged 19-45 years. The findings were presented at the annual meeting of the American College of Rheumatology.

In the cross-sectional study, 77 of 364 patients (22%) met the diagnosis of axial spondyloarthritis on examination by a rheumatologist. The average age of the patients was 36 years, 43% were male, and the average duration of chronic low back pain was 9 years.

The diagnostic techniques included a detailed patient questionnaire about inflammatory back pain, physical examination and patient history; blood tests to assess C-reactive protein levels and the presence of HLA-B27 (a gene that has been linked to spondyloarthritis); and conventional and MRI images of sacroiliac joints. Two radiologists reviewed the images for the signs of inflammation and bone lesions that might indicate axial spondyloarthritis.

Fifty-two patients were diagnosed according to MRI criteria plus one additional spondyloarthritis feature. The other 12 patients were diagnosed according to a positive HLA-B27 test plus two additional spondyloarthritis features, Dr. Angelique Weel of Maasstad Ziekenhuis, Rotterdam, the Netherlands, said at a press conference.

In addition, 24 patients (6.6%) met the criteria for ankylosing spondylitis.

The results suggest that spondyloarthritis is underdiagnosed as a cause of chronic back pain in the general population. Dr. Weel recommended that primary care physicians suspect spondyloarthritis when they see younger adults with chronic back pain, and refer these patients to a rheumatologist if they suspect an inflammatory basis for the pain.

"We also tried to make a simple questionnaire for general practitioners, so they can determine which patient with chronic low back pain should be sent to a rheumatologist to investigate possible spondyloarthritis," she noted. Possible red flags from the standardized questionnaire include the response to NSAIDs and a family history of spondyloarthritis, Dr. Weel said.

"Of course, we need to validate these data in another population, and we also have to validate our referral tool [for general physicians]," she noted.

Dr. Weel said that she had no financial conflicts to disclose.

ATLANTA – Approximately 20% of cases of chronic low back pain in younger adults seen in primary care settings might be caused by spondyloarthritis, based on data from 364 patients aged 19-45 years. The findings were presented at the annual meeting of the American College of Rheumatology.

In the cross-sectional study, 77 of 364 patients (22%) met the diagnosis of axial spondyloarthritis on examination by a rheumatologist. The average age of the patients was 36 years, 43% were male, and the average duration of chronic low back pain was 9 years.

The diagnostic techniques included a detailed patient questionnaire about inflammatory back pain, physical examination and patient history; blood tests to assess C-reactive protein levels and the presence of HLA-B27 (a gene that has been linked to spondyloarthritis); and conventional and MRI images of sacroiliac joints. Two radiologists reviewed the images for the signs of inflammation and bone lesions that might indicate axial spondyloarthritis.

Fifty-two patients were diagnosed according to MRI criteria plus one additional spondyloarthritis feature. The other 12 patients were diagnosed according to a positive HLA-B27 test plus two additional spondyloarthritis features, Dr. Angelique Weel of Maasstad Ziekenhuis, Rotterdam, the Netherlands, said at a press conference.

In addition, 24 patients (6.6%) met the criteria for ankylosing spondylitis.

The results suggest that spondyloarthritis is underdiagnosed as a cause of chronic back pain in the general population. Dr. Weel recommended that primary care physicians suspect spondyloarthritis when they see younger adults with chronic back pain, and refer these patients to a rheumatologist if they suspect an inflammatory basis for the pain.

"We also tried to make a simple questionnaire for general practitioners, so they can determine which patient with chronic low back pain should be sent to a rheumatologist to investigate possible spondyloarthritis," she noted. Possible red flags from the standardized questionnaire include the response to NSAIDs and a family history of spondyloarthritis, Dr. Weel said.

"Of course, we need to validate these data in another population, and we also have to validate our referral tool [for general physicians]," she noted.

Dr. Weel said that she had no financial conflicts to disclose.

ATLANTA – Ultrasound guidance led to a significant increase in the number of noneffusive knees with osteoarthritis that responded to corticosteroid injections, based on data from a randomized trial of 94 knees. The findings were presented at the annual meeting of the American College of Rheumatology.

The accuracy rate for knee injections in OA varies widely, said Dr. Wilmer Sibbitt, professor of rheumatology and neurology at the University of New Mexico Health Sciences Center in Albuquerque.

Injections of medication or removal of fluid from the knee joints have historically been guided by the physician’s hands-on examination of the knee, but ultrasound guidance is becoming more common as a way to improve accuracy, said Dr. Sibbitt.

"Ultrasound is being used presently for injections, and there aren’t good outcome studies to determine whether this increased accuracy provides better results, and whether it increases or reduces costs," he said in an interview.

Dr. Sibbitt and colleagues randomized adults with knee OA to receive joint injections guided by ultrasound or with the conventional palpation guidance. For the sonographically guided injections, the researchers used a one-handed reciprocating procedure device syringe that enabled them to hold the ultrasound transducer in one hand and the dual chamber syringe in the other. The injection consisted of 80 mg of triamcinolone acetonide.

The researchers evaluated patients’ pain at baseline, during the injection, 2 weeks later, and 6 months later, using an established pain rating scale.

Compared with the conventional injection group, ultrasound-guided injections yielded a 48% reduction in pain during the injection, and a 42% reduction in pain scores at follow-up. In addition, significantly more knees in the ultrasound group than in the control group responded well to the injections and significantly fewer knees in the ultrasound group than in the control group did not respond well.

The researchers also evaluated the cost-effectiveness of ultrasound-guided injections. The ultrasound-guided injection was associated with a $48 reduction in patient costs per year, and a $593 reduction in outpatient costs per year.

The study was limited by its small size, and additional research is needed to confirm the results. But the findings suggest that sonographic needle guidance improves the performance, clinical outcomes, and effectiveness of knee injections for OA patients, Dr. Sibbitt said.

Dr. Sibbitt disclosed receiving consulting fees from multiple companies including Becton Dickinson, Ferring Pharmaceuticals, Avasca Medical, and Meditech Duopross. He also disclosed stock, stock options, or bond holdings in multiple companies including Celgene, Apple, Avasca, and Java Inc. He has received research grants from the National Institutes of Health.

ATLANTA – Ultrasound guidance led to a significant increase in the number of noneffusive knees with osteoarthritis that responded to corticosteroid injections, based on data from a randomized trial of 94 knees. The findings were presented at the annual meeting of the American College of Rheumatology.

The accuracy rate for knee injections in OA varies widely, said Dr. Wilmer Sibbitt, professor of rheumatology and neurology at the University of New Mexico Health Sciences Center in Albuquerque.

Injections of medication or removal of fluid from the knee joints have historically been guided by the physician’s hands-on examination of the knee, but ultrasound guidance is becoming more common as a way to improve accuracy, said Dr. Sibbitt.

"Ultrasound is being used presently for injections, and there aren’t good outcome studies to determine whether this increased accuracy provides better results, and whether it increases or reduces costs," he said in an interview.

Dr. Sibbitt and colleagues randomized adults with knee OA to receive joint injections guided by ultrasound or with the conventional palpation guidance. For the sonographically guided injections, the researchers used a one-handed reciprocating procedure device syringe that enabled them to hold the ultrasound transducer in one hand and the dual chamber syringe in the other. The injection consisted of 80 mg of triamcinolone acetonide.

The researchers evaluated patients’ pain at baseline, during the injection, 2 weeks later, and 6 months later, using an established pain rating scale.

Compared with the conventional injection group, ultrasound-guided injections yielded a 48% reduction in pain during the injection, and a 42% reduction in pain scores at follow-up. In addition, significantly more knees in the ultrasound group than in the control group responded well to the injections and significantly fewer knees in the ultrasound group than in the control group did not respond well.

The researchers also evaluated the cost-effectiveness of ultrasound-guided injections. The ultrasound-guided injection was associated with a $48 reduction in patient costs per year, and a $593 reduction in outpatient costs per year.

The study was limited by its small size, and additional research is needed to confirm the results. But the findings suggest that sonographic needle guidance improves the performance, clinical outcomes, and effectiveness of knee injections for OA patients, Dr. Sibbitt said.

Dr. Sibbitt disclosed receiving consulting fees from multiple companies including Becton Dickinson, Ferring Pharmaceuticals, Avasca Medical, and Meditech Duopross. He also disclosed stock, stock options, or bond holdings in multiple companies including Celgene, Apple, Avasca, and Java Inc. He has received research grants from the National Institutes of Health.

ATLANTA – Ultrasound guidance led to a significant increase in the number of noneffusive knees with osteoarthritis that responded to corticosteroid injections, based on data from a randomized trial of 94 knees. The findings were presented at the annual meeting of the American College of Rheumatology.

The accuracy rate for knee injections in OA varies widely, said Dr. Wilmer Sibbitt, professor of rheumatology and neurology at the University of New Mexico Health Sciences Center in Albuquerque.

Injections of medication or removal of fluid from the knee joints have historically been guided by the physician’s hands-on examination of the knee, but ultrasound guidance is becoming more common as a way to improve accuracy, said Dr. Sibbitt.

"Ultrasound is being used presently for injections, and there aren’t good outcome studies to determine whether this increased accuracy provides better results, and whether it increases or reduces costs," he said in an interview.

Dr. Sibbitt and colleagues randomized adults with knee OA to receive joint injections guided by ultrasound or with the conventional palpation guidance. For the sonographically guided injections, the researchers used a one-handed reciprocating procedure device syringe that enabled them to hold the ultrasound transducer in one hand and the dual chamber syringe in the other. The injection consisted of 80 mg of triamcinolone acetonide.

The researchers evaluated patients’ pain at baseline, during the injection, 2 weeks later, and 6 months later, using an established pain rating scale.

Compared with the conventional injection group, ultrasound-guided injections yielded a 48% reduction in pain during the injection, and a 42% reduction in pain scores at follow-up. In addition, significantly more knees in the ultrasound group than in the control group responded well to the injections and significantly fewer knees in the ultrasound group than in the control group did not respond well.

The researchers also evaluated the cost-effectiveness of ultrasound-guided injections. The ultrasound-guided injection was associated with a $48 reduction in patient costs per year, and a $593 reduction in outpatient costs per year.

The study was limited by its small size, and additional research is needed to confirm the results. But the findings suggest that sonographic needle guidance improves the performance, clinical outcomes, and effectiveness of knee injections for OA patients, Dr. Sibbitt said.

Dr. Sibbitt disclosed receiving consulting fees from multiple companies including Becton Dickinson, Ferring Pharmaceuticals, Avasca Medical, and Meditech Duopross. He also disclosed stock, stock options, or bond holdings in multiple companies including Celgene, Apple, Avasca, and Java Inc. He has received research grants from the National Institutes of Health.

ORLANDO – Hydroxyurea therapy was associated with an overall cumulative survival rate of 70% in children aged 3 to 18 years with sickle cell disease.

National Human Genome Research Institute

Hydroxyurea is routinely used to treat adults with sickle cell disease, but it has not been well studied in children, Dr. Clarisse Lobo of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti in Rio de Janeiro, Brazil, said at a press conference. Although deaths among children in the United States and Europe have decreased substantially, high mortality is still an issue in developing nations.

In a study presented Dec. 6 at the annual meeting of the American Society of Hematology, Dr. Lobo and her colleagues reviewed data from 224 children who met the criteria for hydroxyurea treatment over a 10-year period. No genotypes of sickle cell disease were excluded.

The cumulative survival rates at 10 years and 17.9 years of age were 99% and 97%, respectively, in hydroxyurea-treated children, compared with 97% and 66% in 965 untreated children (P = .027). A total of 46 deaths occurred during the study period. Only two of these occurred in hydroxyurea-treated children, and both were due to acute chest syndrome.

The treatment was significantly associated with a 68% reduction in hospitalizations, a 49% reduction in emergency department visits, and a 36% reduction in transfusions in children with sickle cell disease who were treated with hydroxyurea, compared with untreated children.

The starting dose of hydroxyurea was 15 mg/kg/day, escalated up to a maximum dose of 30 mg/kg/day. The median dose was 20 mg/kg/day, and the median treatment duration was 1.9 years.

Although the study was limited to children in Brazil, the results support the value of hydroxyurea for reducing mortality in children with sickle cell disease.

Dr. Lobo had no financial conflicts to disclose.

ORLANDO – Hydroxyurea therapy was associated with an overall cumulative survival rate of 70% in children aged 3 to 18 years with sickle cell disease.

National Human Genome Research Institute

Hydroxyurea is routinely used to treat adults with sickle cell disease, but it has not been well studied in children, Dr. Clarisse Lobo of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti in Rio de Janeiro, Brazil, said at a press conference. Although deaths among children in the United States and Europe have decreased substantially, high mortality is still an issue in developing nations.

In a study presented Dec. 6 at the annual meeting of the American Society of Hematology, Dr. Lobo and her colleagues reviewed data from 224 children who met the criteria for hydroxyurea treatment over a 10-year period. No genotypes of sickle cell disease were excluded.

The cumulative survival rates at 10 years and 17.9 years of age were 99% and 97%, respectively, in hydroxyurea-treated children, compared with 97% and 66% in 965 untreated children (P = .027). A total of 46 deaths occurred during the study period. Only two of these occurred in hydroxyurea-treated children, and both were due to acute chest syndrome.

The treatment was significantly associated with a 68% reduction in hospitalizations, a 49% reduction in emergency department visits, and a 36% reduction in transfusions in children with sickle cell disease who were treated with hydroxyurea, compared with untreated children.

The starting dose of hydroxyurea was 15 mg/kg/day, escalated up to a maximum dose of 30 mg/kg/day. The median dose was 20 mg/kg/day, and the median treatment duration was 1.9 years.

Although the study was limited to children in Brazil, the results support the value of hydroxyurea for reducing mortality in children with sickle cell disease.

Dr. Lobo had no financial conflicts to disclose.

ORLANDO – Hydroxyurea therapy was associated with an overall cumulative survival rate of 70% in children aged 3 to 18 years with sickle cell disease.

National Human Genome Research Institute

Hydroxyurea is routinely used to treat adults with sickle cell disease, but it has not been well studied in children, Dr. Clarisse Lobo of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti in Rio de Janeiro, Brazil, said at a press conference. Although deaths among children in the United States and Europe have decreased substantially, high mortality is still an issue in developing nations.

In a study presented Dec. 6 at the annual meeting of the American Society of Hematology, Dr. Lobo and her colleagues reviewed data from 224 children who met the criteria for hydroxyurea treatment over a 10-year period. No genotypes of sickle cell disease were excluded.

The cumulative survival rates at 10 years and 17.9 years of age were 99% and 97%, respectively, in hydroxyurea-treated children, compared with 97% and 66% in 965 untreated children (P = .027). A total of 46 deaths occurred during the study period. Only two of these occurred in hydroxyurea-treated children, and both were due to acute chest syndrome.

The treatment was significantly associated with a 68% reduction in hospitalizations, a 49% reduction in emergency department visits, and a 36% reduction in transfusions in children with sickle cell disease who were treated with hydroxyurea, compared with untreated children.

The starting dose of hydroxyurea was 15 mg/kg/day, escalated up to a maximum dose of 30 mg/kg/day. The median dose was 20 mg/kg/day, and the median treatment duration was 1.9 years.

Although the study was limited to children in Brazil, the results support the value of hydroxyurea for reducing mortality in children with sickle cell disease.

Dr. Lobo had no financial conflicts to disclose.

ORLANDO – Hydroxyurea therapy was associated with an overall cumulative survival rate of 70% in children aged 3 to 18 years with sickle cell disease.

National Human Genome Research Institute

Hydroxyurea is routinely used to treat adults with sickle cell disease, but it has not been well studied in children, Dr. Clarisse Lobo of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti in Rio de Janeiro, Brazil, said at a press conference. Although deaths among children in the United States and Europe have decreased substantially, high mortality is still an issue in developing nations.

In a study presented Dec. 6 at the annual meeting of the American Society of Hematology, Dr. Lobo and her colleagues reviewed data from 224 children who met the criteria for hydroxyurea treatment over a 10-year period. No genotypes of sickle cell disease were excluded.

The cumulative survival rates at 10 years and 17.9 years of age were 99% and 97%, respectively, in hydroxyurea-treated children, compared with 97% and 66% in 965 untreated children (P = .027). A total of 46 deaths occurred during the study period. Only two of these occurred in hydroxyurea-treated children, and both were due to acute chest syndrome.

The treatment was significantly associated with a 68% reduction in hospitalizations, a 49% reduction in emergency department visits, and a 36% reduction in transfusions in children with sickle cell disease who were treated with hydroxyurea, compared with untreated children.

The starting dose of hydroxyurea was 15 mg/kg/day, escalated up to a maximum dose of 30 mg/kg/day. The median dose was 20 mg/kg/day, and the median treatment duration was 1.9 years.

Although the study was limited to children in Brazil, the results support the value of hydroxyurea for reducing mortality in children with sickle cell disease.

Dr. Lobo had no financial conflicts to disclose.

ORLANDO – Hydroxyurea therapy was associated with an overall cumulative survival rate of 70% in children aged 3 to 18 years with sickle cell disease.

National Human Genome Research Institute

Hydroxyurea is routinely used to treat adults with sickle cell disease, but it has not been well studied in children, Dr. Clarisse Lobo of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti in Rio de Janeiro, Brazil, said at a press conference. Although deaths among children in the United States and Europe have decreased substantially, high mortality is still an issue in developing nations.

In a study presented Dec. 6 at the annual meeting of the American Society of Hematology, Dr. Lobo and her colleagues reviewed data from 224 children who met the criteria for hydroxyurea treatment over a 10-year period. No genotypes of sickle cell disease were excluded.

The cumulative survival rates at 10 years and 17.9 years of age were 99% and 97%, respectively, in hydroxyurea-treated children, compared with 97% and 66% in 965 untreated children (P = .027). A total of 46 deaths occurred during the study period. Only two of these occurred in hydroxyurea-treated children, and both were due to acute chest syndrome.

The treatment was significantly associated with a 68% reduction in hospitalizations, a 49% reduction in emergency department visits, and a 36% reduction in transfusions in children with sickle cell disease who were treated with hydroxyurea, compared with untreated children.

The starting dose of hydroxyurea was 15 mg/kg/day, escalated up to a maximum dose of 30 mg/kg/day. The median dose was 20 mg/kg/day, and the median treatment duration was 1.9 years.

Although the study was limited to children in Brazil, the results support the value of hydroxyurea for reducing mortality in children with sickle cell disease.

Dr. Lobo had no financial conflicts to disclose.

ORLANDO – Hydroxyurea therapy was associated with an overall cumulative survival rate of 70% in children aged 3 to 18 years with sickle cell disease.

National Human Genome Research Institute

Hydroxyurea is routinely used to treat adults with sickle cell disease, but it has not been well studied in children, Dr. Clarisse Lobo of the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti in Rio de Janeiro, Brazil, said at a press conference. Although deaths among children in the United States and Europe have decreased substantially, high mortality is still an issue in developing nations.

In a study presented Dec. 6 at the annual meeting of the American Society of Hematology, Dr. Lobo and her colleagues reviewed data from 224 children who met the criteria for hydroxyurea treatment over a 10-year period. No genotypes of sickle cell disease were excluded.

The cumulative survival rates at 10 years and 17.9 years of age were 99% and 97%, respectively, in hydroxyurea-treated children, compared with 97% and 66% in 965 untreated children (P = .027). A total of 46 deaths occurred during the study period. Only two of these occurred in hydroxyurea-treated children, and both were due to acute chest syndrome.

The treatment was significantly associated with a 68% reduction in hospitalizations, a 49% reduction in emergency department visits, and a 36% reduction in transfusions in children with sickle cell disease who were treated with hydroxyurea, compared with untreated children.

The starting dose of hydroxyurea was 15 mg/kg/day, escalated up to a maximum dose of 30 mg/kg/day. The median dose was 20 mg/kg/day, and the median treatment duration was 1.9 years.

Although the study was limited to children in Brazil, the results support the value of hydroxyurea for reducing mortality in children with sickle cell disease.

Dr. Lobo had no financial conflicts to disclose.