Heidi Splete

ATLANTA – Lupus patients were more than 2.5 times as likely as the general population to develop blood cancers, based on data from 13,492 adults with lupus.

The risk for hematologic cancers was significantly elevated among patients with lupus. Specifically, lupus patients were more than three times as likely as the general population to develop any type of lymphoma, and more than three times as likely to develop non-Hodgkin’s lymphoma. In addition, lupus patients were 1.15 times more likely than the general population to develop any cancer, said Dr. Sasha R. Bernatsky of the divisions of clinical epidemiology and rheumatology at McGill University in Montreal.

Previous studies have shown an association between systemic lupus erythematosus (SLE) and cancer, due largely to the increased risk for lymphoma. In this study, Dr. Bernatsky and her colleagues aimed for a more precise estimate of cancer rates in lupus patients, as well as stratification by age. This global effort included researchers from the Systemic Lupus International Collaborating Clinics, the Canadian Network for Improved Outcomes in SLE, and other sites around the world.

Dr. Bernatsky and her colleagues reviewed data on patients from 24 centers worldwide for an average follow-up period of 9 years, and a total of 118,359 patient-years. They identified 632 cancers during the study period.

The researchers also found a significantly increased risk of lung cancer, vulvovaginal cancer, and hepatic cancer in lupus patients, compared with the general population.

However, there was a significant decrease in the risk of hormone-sensitive cancers, including breast cancer, endometrial cancer, and ovarian cancer.

Altered clearance of viruses such as human papillomavirus might be behind the increased risk for cervical and vulvovaginal cancers in lupus patients, suggested Dr. Bernatsky. Changes in estrogen metabolism might be behind the decreased risk for hormone-sensitive cancers, although more research is needed to study these possible associations.

When the results were stratified by age, patients in the youngest age group (younger than 40 years) were significantly (1.7 times) more likely to develop any cancer, compared with the general population.

Despite the increased risk, blood cancers remain rare in lupus patients, Dr. Bernatsky noted. But the study results highlight the overall risk of cancer in lupus patients. The findings remind clinicians to counsel smoking cessation to reduce the risk of lung cancer, and to emphasize regular Pap testing for female patients to catch precancerous changes as soon as possible.

The decreased risk of certain cancers such as breast cancer is good news for women with SLE "and will be an area of keen research interest in the future," Dr. Bernatsky said at the annual meeting of the American College of Rheumatology.

She disclosed that she has received funding from the National Institutes of Health and research grants from the Arthritis Society of Canada.

ATLANTA – Lupus patients were more than 2.5 times as likely as the general population to develop blood cancers, based on data from 13,492 adults with lupus.

The risk for hematologic cancers was significantly elevated among patients with lupus. Specifically, lupus patients were more than three times as likely as the general population to develop any type of lymphoma, and more than three times as likely to develop non-Hodgkin’s lymphoma. In addition, lupus patients were 1.15 times more likely than the general population to develop any cancer, said Dr. Sasha R. Bernatsky of the divisions of clinical epidemiology and rheumatology at McGill University in Montreal.

Previous studies have shown an association between systemic lupus erythematosus (SLE) and cancer, due largely to the increased risk for lymphoma. In this study, Dr. Bernatsky and her colleagues aimed for a more precise estimate of cancer rates in lupus patients, as well as stratification by age. This global effort included researchers from the Systemic Lupus International Collaborating Clinics, the Canadian Network for Improved Outcomes in SLE, and other sites around the world.

Dr. Bernatsky and her colleagues reviewed data on patients from 24 centers worldwide for an average follow-up period of 9 years, and a total of 118,359 patient-years. They identified 632 cancers during the study period.

The researchers also found a significantly increased risk of lung cancer, vulvovaginal cancer, and hepatic cancer in lupus patients, compared with the general population.

However, there was a significant decrease in the risk of hormone-sensitive cancers, including breast cancer, endometrial cancer, and ovarian cancer.

Altered clearance of viruses such as human papillomavirus might be behind the increased risk for cervical and vulvovaginal cancers in lupus patients, suggested Dr. Bernatsky. Changes in estrogen metabolism might be behind the decreased risk for hormone-sensitive cancers, although more research is needed to study these possible associations.

When the results were stratified by age, patients in the youngest age group (younger than 40 years) were significantly (1.7 times) more likely to develop any cancer, compared with the general population.

Despite the increased risk, blood cancers remain rare in lupus patients, Dr. Bernatsky noted. But the study results highlight the overall risk of cancer in lupus patients. The findings remind clinicians to counsel smoking cessation to reduce the risk of lung cancer, and to emphasize regular Pap testing for female patients to catch precancerous changes as soon as possible.

The decreased risk of certain cancers such as breast cancer is good news for women with SLE "and will be an area of keen research interest in the future," Dr. Bernatsky said at the annual meeting of the American College of Rheumatology.

She disclosed that she has received funding from the National Institutes of Health and research grants from the Arthritis Society of Canada.

ATLANTA – Lupus patients were more than 2.5 times as likely as the general population to develop blood cancers, based on data from 13,492 adults with lupus.

The risk for hematologic cancers was significantly elevated among patients with lupus. Specifically, lupus patients were more than three times as likely as the general population to develop any type of lymphoma, and more than three times as likely to develop non-Hodgkin’s lymphoma. In addition, lupus patients were 1.15 times more likely than the general population to develop any cancer, said Dr. Sasha R. Bernatsky of the divisions of clinical epidemiology and rheumatology at McGill University in Montreal.

Previous studies have shown an association between systemic lupus erythematosus (SLE) and cancer, due largely to the increased risk for lymphoma. In this study, Dr. Bernatsky and her colleagues aimed for a more precise estimate of cancer rates in lupus patients, as well as stratification by age. This global effort included researchers from the Systemic Lupus International Collaborating Clinics, the Canadian Network for Improved Outcomes in SLE, and other sites around the world.

Dr. Bernatsky and her colleagues reviewed data on patients from 24 centers worldwide for an average follow-up period of 9 years, and a total of 118,359 patient-years. They identified 632 cancers during the study period.

The researchers also found a significantly increased risk of lung cancer, vulvovaginal cancer, and hepatic cancer in lupus patients, compared with the general population.

However, there was a significant decrease in the risk of hormone-sensitive cancers, including breast cancer, endometrial cancer, and ovarian cancer.

Altered clearance of viruses such as human papillomavirus might be behind the increased risk for cervical and vulvovaginal cancers in lupus patients, suggested Dr. Bernatsky. Changes in estrogen metabolism might be behind the decreased risk for hormone-sensitive cancers, although more research is needed to study these possible associations.

When the results were stratified by age, patients in the youngest age group (younger than 40 years) were significantly (1.7 times) more likely to develop any cancer, compared with the general population.

Despite the increased risk, blood cancers remain rare in lupus patients, Dr. Bernatsky noted. But the study results highlight the overall risk of cancer in lupus patients. The findings remind clinicians to counsel smoking cessation to reduce the risk of lung cancer, and to emphasize regular Pap testing for female patients to catch precancerous changes as soon as possible.

The decreased risk of certain cancers such as breast cancer is good news for women with SLE "and will be an area of keen research interest in the future," Dr. Bernatsky said at the annual meeting of the American College of Rheumatology.

She disclosed that she has received funding from the National Institutes of Health and research grants from the Arthritis Society of Canada.

SAN ANTONIO – Fifty percent of adults with nonalcoholic steatohepatitis improved their disease scores by at least two points with pentoxifylline therapy, compared with 15% of the placebo group, in a randomized, double-blind trial of 55 patients.

Pentoxifylline is known to increase the flexibility of red blood cells and reduce platelet aggregation. Preliminary work in mice and rats has prompted studies of pentoxifylline in patients with nonalcoholic steatohepatitis (NASH), but most of these studies have been small and lacking in control groups or histologic follow-up, said Dr. Claudia Zein, who presented the results at the annual scientific meeting of the American College of Gastroenterology.

Effective therapies are important because a significant number of patients with NASH will go on to develop cirrhosis, said Dr. Zein of the Cleveland Clinic. One recent study showed some benefits of vitamin E in some patients, but "there is still a great need for effective and safe therapies for NASH," Dr. Zein said.

In this study, 55 adults who were recruited from two medical centers in Cleveland were randomized to receive either 400-mg pentoxifylline three times daily (26 patients) or placebo (29 patients) for 1 year. The baseline histologic characteristics were similar between the two groups. The mean age of the patients was 50 years, and most were men.

Treatment success was defined as an improvement of 2 or more points in the NAS (NAFLD [Nonalcoholic Fatty Liver Disease] Activity Score), a validated scoring system that combines several histologic features, namely steatosis, lobular inflammation, and intracellular ballooning.

In the per protocol analysis of 49 patients, 50% of the pentoxifylline group improved their NAS scores by at least 2 points after 1 year, compared with 15% of the placebo group; this difference was statistically significant. Three patients in each group dropped out because of reasons unrelated to the study drug.

Patients in the pentoxifylline group were significantly more likely than the placebo patients to have improved steatosis (80% vs. 20%) and inflammation (55% vs. 23%). However, hepatocellular ballooning results did not differ significantly between the two groups.

In addition, no differences in progression of fibrosis were seen between the two groups. "But in future studies, we think we will see a lack of progression of fibrosis," Dr. Zein said.

In addition, 57% of the pentoxifylline patients met the secondary end point of an improvement of 30% or more in ALT (alanine aminotransferase) levels, compared with 25% of the placebo patients.

No serious adverse events were reported in either group, and the incidence of adverse events was similar between the two groups. Nausea and vomiting appeared to be more prominent in the pentoxifylline group, but the difference fell short of statistical significance.

"Pentoxifylline appeared to be safe and well tolerated in patients with NASH," said Dr. Zein. "We feel that further trials with larger numbers of patients are warranted."

This study was a 2010 Governor’s Award Recipient for Excellence in Clinical Research from the American College of Gastroenterology, which involved a monetary grant.

SAN ANTONIO – Fifty percent of adults with nonalcoholic steatohepatitis improved their disease scores by at least two points with pentoxifylline therapy, compared with 15% of the placebo group, in a randomized, double-blind trial of 55 patients.

Pentoxifylline is known to increase the flexibility of red blood cells and reduce platelet aggregation. Preliminary work in mice and rats has prompted studies of pentoxifylline in patients with nonalcoholic steatohepatitis (NASH), but most of these studies have been small and lacking in control groups or histologic follow-up, said Dr. Claudia Zein, who presented the results at the annual scientific meeting of the American College of Gastroenterology.

Effective therapies are important because a significant number of patients with NASH will go on to develop cirrhosis, said Dr. Zein of the Cleveland Clinic. One recent study showed some benefits of vitamin E in some patients, but "there is still a great need for effective and safe therapies for NASH," Dr. Zein said.

In this study, 55 adults who were recruited from two medical centers in Cleveland were randomized to receive either 400-mg pentoxifylline three times daily (26 patients) or placebo (29 patients) for 1 year. The baseline histologic characteristics were similar between the two groups. The mean age of the patients was 50 years, and most were men.

Treatment success was defined as an improvement of 2 or more points in the NAS (NAFLD [Nonalcoholic Fatty Liver Disease] Activity Score), a validated scoring system that combines several histologic features, namely steatosis, lobular inflammation, and intracellular ballooning.

In the per protocol analysis of 49 patients, 50% of the pentoxifylline group improved their NAS scores by at least 2 points after 1 year, compared with 15% of the placebo group; this difference was statistically significant. Three patients in each group dropped out because of reasons unrelated to the study drug.

Patients in the pentoxifylline group were significantly more likely than the placebo patients to have improved steatosis (80% vs. 20%) and inflammation (55% vs. 23%). However, hepatocellular ballooning results did not differ significantly between the two groups.

In addition, no differences in progression of fibrosis were seen between the two groups. "But in future studies, we think we will see a lack of progression of fibrosis," Dr. Zein said.

In addition, 57% of the pentoxifylline patients met the secondary end point of an improvement of 30% or more in ALT (alanine aminotransferase) levels, compared with 25% of the placebo patients.

No serious adverse events were reported in either group, and the incidence of adverse events was similar between the two groups. Nausea and vomiting appeared to be more prominent in the pentoxifylline group, but the difference fell short of statistical significance.

"Pentoxifylline appeared to be safe and well tolerated in patients with NASH," said Dr. Zein. "We feel that further trials with larger numbers of patients are warranted."

This study was a 2010 Governor’s Award Recipient for Excellence in Clinical Research from the American College of Gastroenterology, which involved a monetary grant.

SAN ANTONIO – Fifty percent of adults with nonalcoholic steatohepatitis improved their disease scores by at least two points with pentoxifylline therapy, compared with 15% of the placebo group, in a randomized, double-blind trial of 55 patients.

Pentoxifylline is known to increase the flexibility of red blood cells and reduce platelet aggregation. Preliminary work in mice and rats has prompted studies of pentoxifylline in patients with nonalcoholic steatohepatitis (NASH), but most of these studies have been small and lacking in control groups or histologic follow-up, said Dr. Claudia Zein, who presented the results at the annual scientific meeting of the American College of Gastroenterology.

Effective therapies are important because a significant number of patients with NASH will go on to develop cirrhosis, said Dr. Zein of the Cleveland Clinic. One recent study showed some benefits of vitamin E in some patients, but "there is still a great need for effective and safe therapies for NASH," Dr. Zein said.

In this study, 55 adults who were recruited from two medical centers in Cleveland were randomized to receive either 400-mg pentoxifylline three times daily (26 patients) or placebo (29 patients) for 1 year. The baseline histologic characteristics were similar between the two groups. The mean age of the patients was 50 years, and most were men.

Treatment success was defined as an improvement of 2 or more points in the NAS (NAFLD [Nonalcoholic Fatty Liver Disease] Activity Score), a validated scoring system that combines several histologic features, namely steatosis, lobular inflammation, and intracellular ballooning.

In the per protocol analysis of 49 patients, 50% of the pentoxifylline group improved their NAS scores by at least 2 points after 1 year, compared with 15% of the placebo group; this difference was statistically significant. Three patients in each group dropped out because of reasons unrelated to the study drug.

Patients in the pentoxifylline group were significantly more likely than the placebo patients to have improved steatosis (80% vs. 20%) and inflammation (55% vs. 23%). However, hepatocellular ballooning results did not differ significantly between the two groups.

In addition, no differences in progression of fibrosis were seen between the two groups. "But in future studies, we think we will see a lack of progression of fibrosis," Dr. Zein said.

In addition, 57% of the pentoxifylline patients met the secondary end point of an improvement of 30% or more in ALT (alanine aminotransferase) levels, compared with 25% of the placebo patients.

No serious adverse events were reported in either group, and the incidence of adverse events was similar between the two groups. Nausea and vomiting appeared to be more prominent in the pentoxifylline group, but the difference fell short of statistical significance.

"Pentoxifylline appeared to be safe and well tolerated in patients with NASH," said Dr. Zein. "We feel that further trials with larger numbers of patients are warranted."

This study was a 2010 Governor’s Award Recipient for Excellence in Clinical Research from the American College of Gastroenterology, which involved a monetary grant.

SAN ANTONIO – Fifty percent of adults with nonalcoholic steatohepatitis improved their disease scores by at least two points with pentoxifylline therapy, compared with 15% of the placebo group, in a randomized, double-blind trial of 55 patients.

Pentoxifylline is known to increase the flexibility of red blood cells and reduce platelet aggregation. Preliminary work in mice and rats has prompted studies of pentoxifylline in patients with nonalcoholic steatohepatitis (NASH), but most of these studies have been small and lacking in control groups or histologic follow-up, said Dr. Claudia Zein, who presented the results at the annual scientific meeting of the American College of Gastroenterology.

Effective therapies are important because a significant number of patients with NASH will go on to develop cirrhosis, said Dr. Zein of the Cleveland Clinic. One recent study showed some benefits of vitamin E in some patients, but "there is still a great need for effective and safe therapies for NASH," Dr. Zein said.

In this study, 55 adults who were recruited from two medical centers in Cleveland were randomized to receive either 400-mg pentoxifylline three times daily (26 patients) or placebo (29 patients) for 1 year. The baseline histologic characteristics were similar between the two groups. The mean age of the patients was 50 years, and most were men.

Treatment success was defined as an improvement of 2 or more points in the NAS (NAFLD [Nonalcoholic Fatty Liver Disease] Activity Score), a validated scoring system that combines several histologic features, namely steatosis, lobular inflammation, and intracellular ballooning.

In the per protocol analysis of 49 patients, 50% of the pentoxifylline group improved their NAS scores by at least 2 points after 1 year, compared with 15% of the placebo group; this difference was statistically significant. Three patients in each group dropped out because of reasons unrelated to the study drug.

Patients in the pentoxifylline group were significantly more likely than the placebo patients to have improved steatosis (80% vs. 20%) and inflammation (55% vs. 23%). However, hepatocellular ballooning results did not differ significantly between the two groups.

In addition, no differences in progression of fibrosis were seen between the two groups. "But in future studies, we think we will see a lack of progression of fibrosis," Dr. Zein said.

In addition, 57% of the pentoxifylline patients met the secondary end point of an improvement of 30% or more in ALT (alanine aminotransferase) levels, compared with 25% of the placebo patients.

No serious adverse events were reported in either group, and the incidence of adverse events was similar between the two groups. Nausea and vomiting appeared to be more prominent in the pentoxifylline group, but the difference fell short of statistical significance.

"Pentoxifylline appeared to be safe and well tolerated in patients with NASH," said Dr. Zein. "We feel that further trials with larger numbers of patients are warranted."

This study was a 2010 Governor’s Award Recipient for Excellence in Clinical Research from the American College of Gastroenterology, which involved a monetary grant.

SAN ANTONIO – Fifty percent of adults with nonalcoholic steatohepatitis improved their disease scores by at least two points with pentoxifylline therapy, compared with 15% of the placebo group, in a randomized, double-blind trial of 55 patients.

Pentoxifylline is known to increase the flexibility of red blood cells and reduce platelet aggregation. Preliminary work in mice and rats has prompted studies of pentoxifylline in patients with nonalcoholic steatohepatitis (NASH), but most of these studies have been small and lacking in control groups or histologic follow-up, said Dr. Claudia Zein, who presented the results at the annual scientific meeting of the American College of Gastroenterology.

Effective therapies are important because a significant number of patients with NASH will go on to develop cirrhosis, said Dr. Zein of the Cleveland Clinic. One recent study showed some benefits of vitamin E in some patients, but "there is still a great need for effective and safe therapies for NASH," Dr. Zein said.

In this study, 55 adults who were recruited from two medical centers in Cleveland were randomized to receive either 400-mg pentoxifylline three times daily (26 patients) or placebo (29 patients) for 1 year. The baseline histologic characteristics were similar between the two groups. The mean age of the patients was 50 years, and most were men.

Treatment success was defined as an improvement of 2 or more points in the NAS (NAFLD [Nonalcoholic Fatty Liver Disease] Activity Score), a validated scoring system that combines several histologic features, namely steatosis, lobular inflammation, and intracellular ballooning.

In the per protocol analysis of 49 patients, 50% of the pentoxifylline group improved their NAS scores by at least 2 points after 1 year, compared with 15% of the placebo group; this difference was statistically significant. Three patients in each group dropped out because of reasons unrelated to the study drug.

Patients in the pentoxifylline group were significantly more likely than the placebo patients to have improved steatosis (80% vs. 20%) and inflammation (55% vs. 23%). However, hepatocellular ballooning results did not differ significantly between the two groups.

In addition, no differences in progression of fibrosis were seen between the two groups. "But in future studies, we think we will see a lack of progression of fibrosis," Dr. Zein said.

In addition, 57% of the pentoxifylline patients met the secondary end point of an improvement of 30% or more in ALT (alanine aminotransferase) levels, compared with 25% of the placebo patients.

No serious adverse events were reported in either group, and the incidence of adverse events was similar between the two groups. Nausea and vomiting appeared to be more prominent in the pentoxifylline group, but the difference fell short of statistical significance.

"Pentoxifylline appeared to be safe and well tolerated in patients with NASH," said Dr. Zein. "We feel that further trials with larger numbers of patients are warranted."

This study was a 2010 Governor’s Award Recipient for Excellence in Clinical Research from the American College of Gastroenterology, which involved a monetary grant.

SAN ANTONIO – Fifty percent of adults with nonalcoholic steatohepatitis improved their disease scores by at least two points with pentoxifylline therapy, compared with 15% of the placebo group, in a randomized, double-blind trial of 55 patients.

Pentoxifylline is known to increase the flexibility of red blood cells and reduce platelet aggregation. Preliminary work in mice and rats has prompted studies of pentoxifylline in patients with nonalcoholic steatohepatitis (NASH), but most of these studies have been small and lacking in control groups or histologic follow-up, said Dr. Claudia Zein, who presented the results at the annual scientific meeting of the American College of Gastroenterology.

Effective therapies are important because a significant number of patients with NASH will go on to develop cirrhosis, said Dr. Zein of the Cleveland Clinic. One recent study showed some benefits of vitamin E in some patients, but "there is still a great need for effective and safe therapies for NASH," Dr. Zein said.

In this study, 55 adults who were recruited from two medical centers in Cleveland were randomized to receive either 400-mg pentoxifylline three times daily (26 patients) or placebo (29 patients) for 1 year. The baseline histologic characteristics were similar between the two groups. The mean age of the patients was 50 years, and most were men.

Treatment success was defined as an improvement of 2 or more points in the NAS (NAFLD [Nonalcoholic Fatty Liver Disease] Activity Score), a validated scoring system that combines several histologic features, namely steatosis, lobular inflammation, and intracellular ballooning.

In the per protocol analysis of 49 patients, 50% of the pentoxifylline group improved their NAS scores by at least 2 points after 1 year, compared with 15% of the placebo group; this difference was statistically significant. Three patients in each group dropped out because of reasons unrelated to the study drug.

Patients in the pentoxifylline group were significantly more likely than the placebo patients to have improved steatosis (80% vs. 20%) and inflammation (55% vs. 23%). However, hepatocellular ballooning results did not differ significantly between the two groups.

In addition, no differences in progression of fibrosis were seen between the two groups. "But in future studies, we think we will see a lack of progression of fibrosis," Dr. Zein said.

In addition, 57% of the pentoxifylline patients met the secondary end point of an improvement of 30% or more in ALT (alanine aminotransferase) levels, compared with 25% of the placebo patients.

No serious adverse events were reported in either group, and the incidence of adverse events was similar between the two groups. Nausea and vomiting appeared to be more prominent in the pentoxifylline group, but the difference fell short of statistical significance.

"Pentoxifylline appeared to be safe and well tolerated in patients with NASH," said Dr. Zein. "We feel that further trials with larger numbers of patients are warranted."

This study was a 2010 Governor’s Award Recipient for Excellence in Clinical Research from the American College of Gastroenterology, which involved a monetary grant.

SAN ANTONIO – Overweight and obese adults had an increased risk of recurrent adenomas during short-term and long-term follow-up, based on data from patients with colorectal adenomas at baseline.

Previous studies have shown a short-term association between obesity and increased risk of adenoma recurrence, said Dr. Adeyinka Laiyemo of Howard University in Washington. To assess the long-term impact of overweight and obesity on adenoma risk, Dr. Laiyemo and colleagues reviewed data from participants in the Polyp Prevention Trial, a multicenter study of the effect of a low-fat, high-fiber diet on adenoma recurrence. The results were presented at the annual scientific meeting of the American College of Gastroenterology.

Upon completion of the 4-year (short-term) study, a subset of 760 participants agreed to continue in an extended, passive long-term follow-up without dietary restrictions. Their colonoscopy reports were analyzed for up to 12 years, with an average follow-up period of 8.4 years.

During the long-term follow-up, obese patients had a significant 20% increase in risk for any adenoma and a 25% nonsignificant increase in risk for an advanced adenoma, compared with patients of normal weight. Overweight patients had an 18% significant increase in risk of any adenoma and a 14% nonsignificant increase in risk of advanced adenoma, compared with normal-weight patients.

Analysis of the initial 4-year follow-up period also showed increased risk for participants with excess body weight. Obese patients had a 19% increase in risk for any adenoma and a 23% increase in risk for advanced adenoma compared with normal-weight patients, although neither of these were statistically significant. Overweight patients had a 23% significant increase in risk for any adenoma and a 18% nonsignificant increase in risk for advanced adenomas compared with normal-weight patients during the 4-year period.

The average age of the participants was 60 years, and 66% were men. Approximately 25% of the participants were of normal weight (body mass index less than 25 kg/m2), 50% were overweight (BMI of 25-29), and 25% were obese (BMI of 30 or higher).

"This suggests that lifestyle modification should be encouraged," Dr. Laiyemo said. The study was strengthened by the inclusion of patients from eight different centers, but was limited by the lack of data on morbidly obese patients, he added.

More research is needed to determine whether overweight or obese patients with baseline polyps should be reexamined more frequently than normal-weight patients. For now, however, if these patients have baseline polyps, they need to know that their risk for recurrent adenomas is increased, Dr. Amy E. Foxx-Orenstein of the Mayo Clinic, Scottsdale, Ariz., said at a press conference.

Another message that patients need to hear is that a good prep is important, to get the best possible information from each colonoscopy, Dr. David A. Johnson of Eastern Virginia School of Medicine, Norfolk, said at the press conference.

Dr. Laiyemo had no financial conflicts to disclose.

SAN ANTONIO – Overweight and obese adults had an increased risk of recurrent adenomas during short-term and long-term follow-up, based on data from patients with colorectal adenomas at baseline.

Previous studies have shown a short-term association between obesity and increased risk of adenoma recurrence, said Dr. Adeyinka Laiyemo of Howard University in Washington. To assess the long-term impact of overweight and obesity on adenoma risk, Dr. Laiyemo and colleagues reviewed data from participants in the Polyp Prevention Trial, a multicenter study of the effect of a low-fat, high-fiber diet on adenoma recurrence. The results were presented at the annual scientific meeting of the American College of Gastroenterology.

Upon completion of the 4-year (short-term) study, a subset of 760 participants agreed to continue in an extended, passive long-term follow-up without dietary restrictions. Their colonoscopy reports were analyzed for up to 12 years, with an average follow-up period of 8.4 years.

During the long-term follow-up, obese patients had a significant 20% increase in risk for any adenoma and a 25% nonsignificant increase in risk for an advanced adenoma, compared with patients of normal weight. Overweight patients had an 18% significant increase in risk of any adenoma and a 14% nonsignificant increase in risk of advanced adenoma, compared with normal-weight patients.

Analysis of the initial 4-year follow-up period also showed increased risk for participants with excess body weight. Obese patients had a 19% increase in risk for any adenoma and a 23% increase in risk for advanced adenoma compared with normal-weight patients, although neither of these were statistically significant. Overweight patients had a 23% significant increase in risk for any adenoma and a 18% nonsignificant increase in risk for advanced adenomas compared with normal-weight patients during the 4-year period.

The average age of the participants was 60 years, and 66% were men. Approximately 25% of the participants were of normal weight (body mass index less than 25 kg/m2), 50% were overweight (BMI of 25-29), and 25% were obese (BMI of 30 or higher).

"This suggests that lifestyle modification should be encouraged," Dr. Laiyemo said. The study was strengthened by the inclusion of patients from eight different centers, but was limited by the lack of data on morbidly obese patients, he added.

More research is needed to determine whether overweight or obese patients with baseline polyps should be reexamined more frequently than normal-weight patients. For now, however, if these patients have baseline polyps, they need to know that their risk for recurrent adenomas is increased, Dr. Amy E. Foxx-Orenstein of the Mayo Clinic, Scottsdale, Ariz., said at a press conference.

Another message that patients need to hear is that a good prep is important, to get the best possible information from each colonoscopy, Dr. David A. Johnson of Eastern Virginia School of Medicine, Norfolk, said at the press conference.

Dr. Laiyemo had no financial conflicts to disclose.

SAN ANTONIO – Overweight and obese adults had an increased risk of recurrent adenomas during short-term and long-term follow-up, based on data from patients with colorectal adenomas at baseline.

Previous studies have shown a short-term association between obesity and increased risk of adenoma recurrence, said Dr. Adeyinka Laiyemo of Howard University in Washington. To assess the long-term impact of overweight and obesity on adenoma risk, Dr. Laiyemo and colleagues reviewed data from participants in the Polyp Prevention Trial, a multicenter study of the effect of a low-fat, high-fiber diet on adenoma recurrence. The results were presented at the annual scientific meeting of the American College of Gastroenterology.

Upon completion of the 4-year (short-term) study, a subset of 760 participants agreed to continue in an extended, passive long-term follow-up without dietary restrictions. Their colonoscopy reports were analyzed for up to 12 years, with an average follow-up period of 8.4 years.

During the long-term follow-up, obese patients had a significant 20% increase in risk for any adenoma and a 25% nonsignificant increase in risk for an advanced adenoma, compared with patients of normal weight. Overweight patients had an 18% significant increase in risk of any adenoma and a 14% nonsignificant increase in risk of advanced adenoma, compared with normal-weight patients.

Analysis of the initial 4-year follow-up period also showed increased risk for participants with excess body weight. Obese patients had a 19% increase in risk for any adenoma and a 23% increase in risk for advanced adenoma compared with normal-weight patients, although neither of these were statistically significant. Overweight patients had a 23% significant increase in risk for any adenoma and a 18% nonsignificant increase in risk for advanced adenomas compared with normal-weight patients during the 4-year period.

The average age of the participants was 60 years, and 66% were men. Approximately 25% of the participants were of normal weight (body mass index less than 25 kg/m2), 50% were overweight (BMI of 25-29), and 25% were obese (BMI of 30 or higher).

"This suggests that lifestyle modification should be encouraged," Dr. Laiyemo said. The study was strengthened by the inclusion of patients from eight different centers, but was limited by the lack of data on morbidly obese patients, he added.

More research is needed to determine whether overweight or obese patients with baseline polyps should be reexamined more frequently than normal-weight patients. For now, however, if these patients have baseline polyps, they need to know that their risk for recurrent adenomas is increased, Dr. Amy E. Foxx-Orenstein of the Mayo Clinic, Scottsdale, Ariz., said at a press conference.

Another message that patients need to hear is that a good prep is important, to get the best possible information from each colonoscopy, Dr. David A. Johnson of Eastern Virginia School of Medicine, Norfolk, said at the press conference.

Dr. Laiyemo had no financial conflicts to disclose.

SAN ANTONIO – Overweight and obese adults had an increased risk of recurrent adenomas during short-term and long-term follow-up, based on data from patients with colorectal adenomas at baseline.

Previous studies have shown a short-term association between obesity and increased risk of adenoma recurrence, said Dr. Adeyinka Laiyemo of Howard University in Washington. To assess the long-term impact of overweight and obesity on adenoma risk, Dr. Laiyemo and colleagues reviewed data from participants in the Polyp Prevention Trial, a multicenter study of the effect of a low-fat, high-fiber diet on adenoma recurrence. The results were presented at the annual scientific meeting of the American College of Gastroenterology.

Upon completion of the 4-year (short-term) study, a subset of 760 participants agreed to continue in an extended, passive long-term follow-up without dietary restrictions. Their colonoscopy reports were analyzed for up to 12 years, with an average follow-up period of 8.4 years.

During the long-term follow-up, obese patients had a significant 20% increase in risk for any adenoma and a 25% nonsignificant increase in risk for an advanced adenoma, compared with patients of normal weight. Overweight patients had an 18% significant increase in risk of any adenoma and a 14% nonsignificant increase in risk of advanced adenoma, compared with normal-weight patients.

Analysis of the initial 4-year follow-up period also showed increased risk for participants with excess body weight. Obese patients had a 19% increase in risk for any adenoma and a 23% increase in risk for advanced adenoma compared with normal-weight patients, although neither of these were statistically significant. Overweight patients had a 23% significant increase in risk for any adenoma and a 18% nonsignificant increase in risk for advanced adenomas compared with normal-weight patients during the 4-year period.

The average age of the participants was 60 years, and 66% were men. Approximately 25% of the participants were of normal weight (body mass index less than 25 kg/m2), 50% were overweight (BMI of 25-29), and 25% were obese (BMI of 30 or higher).

"This suggests that lifestyle modification should be encouraged," Dr. Laiyemo said. The study was strengthened by the inclusion of patients from eight different centers, but was limited by the lack of data on morbidly obese patients, he added.

More research is needed to determine whether overweight or obese patients with baseline polyps should be reexamined more frequently than normal-weight patients. For now, however, if these patients have baseline polyps, they need to know that their risk for recurrent adenomas is increased, Dr. Amy E. Foxx-Orenstein of the Mayo Clinic, Scottsdale, Ariz., said at a press conference.

Another message that patients need to hear is that a good prep is important, to get the best possible information from each colonoscopy, Dr. David A. Johnson of Eastern Virginia School of Medicine, Norfolk, said at the press conference.

Dr. Laiyemo had no financial conflicts to disclose.

SAN ANTONIO – Overweight and obese adults had an increased risk of recurrent adenomas during short-term and long-term follow-up, based on data from patients with colorectal adenomas at baseline.

Previous studies have shown a short-term association between obesity and increased risk of adenoma recurrence, said Dr. Adeyinka Laiyemo of Howard University in Washington. To assess the long-term impact of overweight and obesity on adenoma risk, Dr. Laiyemo and colleagues reviewed data from participants in the Polyp Prevention Trial, a multicenter study of the effect of a low-fat, high-fiber diet on adenoma recurrence. The results were presented at the annual scientific meeting of the American College of Gastroenterology.

Upon completion of the 4-year (short-term) study, a subset of 760 participants agreed to continue in an extended, passive long-term follow-up without dietary restrictions. Their colonoscopy reports were analyzed for up to 12 years, with an average follow-up period of 8.4 years.

During the long-term follow-up, obese patients had a significant 20% increase in risk for any adenoma and a 25% nonsignificant increase in risk for an advanced adenoma, compared with patients of normal weight. Overweight patients had an 18% significant increase in risk of any adenoma and a 14% nonsignificant increase in risk of advanced adenoma, compared with normal-weight patients.

Analysis of the initial 4-year follow-up period also showed increased risk for participants with excess body weight. Obese patients had a 19% increase in risk for any adenoma and a 23% increase in risk for advanced adenoma compared with normal-weight patients, although neither of these were statistically significant. Overweight patients had a 23% significant increase in risk for any adenoma and a 18% nonsignificant increase in risk for advanced adenomas compared with normal-weight patients during the 4-year period.

The average age of the participants was 60 years, and 66% were men. Approximately 25% of the participants were of normal weight (body mass index less than 25 kg/m2), 50% were overweight (BMI of 25-29), and 25% were obese (BMI of 30 or higher).

"This suggests that lifestyle modification should be encouraged," Dr. Laiyemo said. The study was strengthened by the inclusion of patients from eight different centers, but was limited by the lack of data on morbidly obese patients, he added.

More research is needed to determine whether overweight or obese patients with baseline polyps should be reexamined more frequently than normal-weight patients. For now, however, if these patients have baseline polyps, they need to know that their risk for recurrent adenomas is increased, Dr. Amy E. Foxx-Orenstein of the Mayo Clinic, Scottsdale, Ariz., said at a press conference.

Another message that patients need to hear is that a good prep is important, to get the best possible information from each colonoscopy, Dr. David A. Johnson of Eastern Virginia School of Medicine, Norfolk, said at the press conference.

Dr. Laiyemo had no financial conflicts to disclose.

SAN ANTONIO – Overweight and obese adults had an increased risk of recurrent adenomas during short-term and long-term follow-up, based on data from patients with colorectal adenomas at baseline.

Previous studies have shown a short-term association between obesity and increased risk of adenoma recurrence, said Dr. Adeyinka Laiyemo of Howard University in Washington. To assess the long-term impact of overweight and obesity on adenoma risk, Dr. Laiyemo and colleagues reviewed data from participants in the Polyp Prevention Trial, a multicenter study of the effect of a low-fat, high-fiber diet on adenoma recurrence. The results were presented at the annual scientific meeting of the American College of Gastroenterology.

Upon completion of the 4-year (short-term) study, a subset of 760 participants agreed to continue in an extended, passive long-term follow-up without dietary restrictions. Their colonoscopy reports were analyzed for up to 12 years, with an average follow-up period of 8.4 years.

During the long-term follow-up, obese patients had a significant 20% increase in risk for any adenoma and a 25% nonsignificant increase in risk for an advanced adenoma, compared with patients of normal weight. Overweight patients had an 18% significant increase in risk of any adenoma and a 14% nonsignificant increase in risk of advanced adenoma, compared with normal-weight patients.

Analysis of the initial 4-year follow-up period also showed increased risk for participants with excess body weight. Obese patients had a 19% increase in risk for any adenoma and a 23% increase in risk for advanced adenoma compared with normal-weight patients, although neither of these were statistically significant. Overweight patients had a 23% significant increase in risk for any adenoma and a 18% nonsignificant increase in risk for advanced adenomas compared with normal-weight patients during the 4-year period.

The average age of the participants was 60 years, and 66% were men. Approximately 25% of the participants were of normal weight (body mass index less than 25 kg/m2), 50% were overweight (BMI of 25-29), and 25% were obese (BMI of 30 or higher).

"This suggests that lifestyle modification should be encouraged," Dr. Laiyemo said. The study was strengthened by the inclusion of patients from eight different centers, but was limited by the lack of data on morbidly obese patients, he added.

More research is needed to determine whether overweight or obese patients with baseline polyps should be reexamined more frequently than normal-weight patients. For now, however, if these patients have baseline polyps, they need to know that their risk for recurrent adenomas is increased, Dr. Amy E. Foxx-Orenstein of the Mayo Clinic, Scottsdale, Ariz., said at a press conference.

Another message that patients need to hear is that a good prep is important, to get the best possible information from each colonoscopy, Dr. David A. Johnson of Eastern Virginia School of Medicine, Norfolk, said at the press conference.

Dr. Laiyemo had no financial conflicts to disclose.

ATLANTA – An estimated 32 million adults in the United States have hyperuricemia, which often precedes gout, based on data from the National Health and Nutrition Examination Survey.

The results were presented during a press conference Nov. 10 at the annual meeting of the American College of Rheumatology.

Previous studies have suggested that the prevalence of gout and hyperuricemia are on the rise in the United States, possibly because of factors including obesity, the metabolic syndrome, and hypertension, said Yanyan Zhu, Ph.D., of Boston University.

Dr. Zhu and colleagues reviewed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2008 on 24,693 individuals aged 20 years and older. The group included 11,816 men and 12,877 women. The data were compared with U.S. population estimates from the U.S. Census Bureau.

Hyperuricemia was defined using the standard NHANES definition of serum urate levels greater than 7.0 mg/dL for men, and greater than 5.7 mg/dL for women.

The results suggest a substantial potential burden from gout, especially in older adults, said Dr. Zhu. The prevalence of hyperuricemia was 31% in adults aged 65 years and older, vs. 18% in those aged 20-64 years. Overall, the prevalence of hyperuricemia increased with age, ranging from 16% in individuals aged 20-29 years to 37% among those aged 80 years and older. The estimates for hyperuricemia were similar for men and women (16.1 million vs. 15.8 million, respectively).

Gout rates in U.S. adults are rising, based on data from a related study also presented at the meeting. Dr. Zhu and her colleagues used NHANES data to estimate 8.3 million cases of gout in U.S. adults aged 20 years and older during 2007-2008.

In this study, the researchers compared NHANES data from 1988 through 1994 with NHANES data from 2007 through 2008. They found a 1.2% increase in gout among U.S. adults, from 2.7% during 1988-1994 to 3.9% during 2007-2008.

The increase was largely due to the significant rise in gout among men and older adults, the researchers noted. The prevalence of gout in men increased from 3.8% to 5.9% between the two time periods, and the prevalence in adults aged 80 years and older increased from 5.9% to 12.6%.

The NHANES data in the second study included 18,825 individuals from 1988 through 1994 and 5,707 from 2007 through 2008. These numbers also were compared with U.S. Census Bureau data.

Most physicians in the United States don’t regularly check patients’ uric acid levels, and fewer than 5% of adults with gout receive treatment, noted Dr. John Sundy of Duke University Medical Center, Durham, N.C. Dr. Sundy served as moderator when the study findings were presented at the press conference. More education is needed for doctors and patients so the available therapies can be used more effectively, he said.

Dr. Zhu said she had no financial conflicts to disclose. Her study coauthors are employed by or have received consulting fees from Takeda Pharmaceuticals International. Dr. Sundy has served as a consultant for multiple companies including Array Biopharma, Savient Pharmaceuticals, and Takeda Pharmaceuticals.

ATLANTA – An estimated 32 million adults in the United States have hyperuricemia, which often precedes gout, based on data from the National Health and Nutrition Examination Survey.

The results were presented during a press conference Nov. 10 at the annual meeting of the American College of Rheumatology.

Previous studies have suggested that the prevalence of gout and hyperuricemia are on the rise in the United States, possibly because of factors including obesity, the metabolic syndrome, and hypertension, said Yanyan Zhu, Ph.D., of Boston University.

Dr. Zhu and colleagues reviewed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2008 on 24,693 individuals aged 20 years and older. The group included 11,816 men and 12,877 women. The data were compared with U.S. population estimates from the U.S. Census Bureau.

Hyperuricemia was defined using the standard NHANES definition of serum urate levels greater than 7.0 mg/dL for men, and greater than 5.7 mg/dL for women.

The results suggest a substantial potential burden from gout, especially in older adults, said Dr. Zhu. The prevalence of hyperuricemia was 31% in adults aged 65 years and older, vs. 18% in those aged 20-64 years. Overall, the prevalence of hyperuricemia increased with age, ranging from 16% in individuals aged 20-29 years to 37% among those aged 80 years and older. The estimates for hyperuricemia were similar for men and women (16.1 million vs. 15.8 million, respectively).

Gout rates in U.S. adults are rising, based on data from a related study also presented at the meeting. Dr. Zhu and her colleagues used NHANES data to estimate 8.3 million cases of gout in U.S. adults aged 20 years and older during 2007-2008.

In this study, the researchers compared NHANES data from 1988 through 1994 with NHANES data from 2007 through 2008. They found a 1.2% increase in gout among U.S. adults, from 2.7% during 1988-1994 to 3.9% during 2007-2008.

The increase was largely due to the significant rise in gout among men and older adults, the researchers noted. The prevalence of gout in men increased from 3.8% to 5.9% between the two time periods, and the prevalence in adults aged 80 years and older increased from 5.9% to 12.6%.

The NHANES data in the second study included 18,825 individuals from 1988 through 1994 and 5,707 from 2007 through 2008. These numbers also were compared with U.S. Census Bureau data.

Most physicians in the United States don’t regularly check patients’ uric acid levels, and fewer than 5% of adults with gout receive treatment, noted Dr. John Sundy of Duke University Medical Center, Durham, N.C. Dr. Sundy served as moderator when the study findings were presented at the press conference. More education is needed for doctors and patients so the available therapies can be used more effectively, he said.

Dr. Zhu said she had no financial conflicts to disclose. Her study coauthors are employed by or have received consulting fees from Takeda Pharmaceuticals International. Dr. Sundy has served as a consultant for multiple companies including Array Biopharma, Savient Pharmaceuticals, and Takeda Pharmaceuticals.

ATLANTA – An estimated 32 million adults in the United States have hyperuricemia, which often precedes gout, based on data from the National Health and Nutrition Examination Survey.

The results were presented during a press conference Nov. 10 at the annual meeting of the American College of Rheumatology.

Previous studies have suggested that the prevalence of gout and hyperuricemia are on the rise in the United States, possibly because of factors including obesity, the metabolic syndrome, and hypertension, said Yanyan Zhu, Ph.D., of Boston University.

Dr. Zhu and colleagues reviewed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2008 on 24,693 individuals aged 20 years and older. The group included 11,816 men and 12,877 women. The data were compared with U.S. population estimates from the U.S. Census Bureau.

Hyperuricemia was defined using the standard NHANES definition of serum urate levels greater than 7.0 mg/dL for men, and greater than 5.7 mg/dL for women.

The results suggest a substantial potential burden from gout, especially in older adults, said Dr. Zhu. The prevalence of hyperuricemia was 31% in adults aged 65 years and older, vs. 18% in those aged 20-64 years. Overall, the prevalence of hyperuricemia increased with age, ranging from 16% in individuals aged 20-29 years to 37% among those aged 80 years and older. The estimates for hyperuricemia were similar for men and women (16.1 million vs. 15.8 million, respectively).

Gout rates in U.S. adults are rising, based on data from a related study also presented at the meeting. Dr. Zhu and her colleagues used NHANES data to estimate 8.3 million cases of gout in U.S. adults aged 20 years and older during 2007-2008.

In this study, the researchers compared NHANES data from 1988 through 1994 with NHANES data from 2007 through 2008. They found a 1.2% increase in gout among U.S. adults, from 2.7% during 1988-1994 to 3.9% during 2007-2008.

The increase was largely due to the significant rise in gout among men and older adults, the researchers noted. The prevalence of gout in men increased from 3.8% to 5.9% between the two time periods, and the prevalence in adults aged 80 years and older increased from 5.9% to 12.6%.

The NHANES data in the second study included 18,825 individuals from 1988 through 1994 and 5,707 from 2007 through 2008. These numbers also were compared with U.S. Census Bureau data.

Most physicians in the United States don’t regularly check patients’ uric acid levels, and fewer than 5% of adults with gout receive treatment, noted Dr. John Sundy of Duke University Medical Center, Durham, N.C. Dr. Sundy served as moderator when the study findings were presented at the press conference. More education is needed for doctors and patients so the available therapies can be used more effectively, he said.

Dr. Zhu said she had no financial conflicts to disclose. Her study coauthors are employed by or have received consulting fees from Takeda Pharmaceuticals International. Dr. Sundy has served as a consultant for multiple companies including Array Biopharma, Savient Pharmaceuticals, and Takeda Pharmaceuticals.

ATLANTA – Atorvastatin did prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10-21 years. The results were presented at the annual scientific meeting of the American College of Rheumatology.

"This is a landmark study in the pediatric rheumatology community," said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, the progression of thickening in the arteries was not significantly different between the statin and placebo groups.

"This was a surprise to us," Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0024 mm/year in the statin group, vs. 0.0010 mm/year in the placebo group (P =.24).

However, the statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

"We wanted to see whether there was a way to decrease the long-term risk" of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled children and adolescents from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, said Dr. Schanberg. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well-tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

ATLANTA – Atorvastatin did prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10-21 years. The results were presented at the annual scientific meeting of the American College of Rheumatology.

"This is a landmark study in the pediatric rheumatology community," said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, the progression of thickening in the arteries was not significantly different between the statin and placebo groups.

"This was a surprise to us," Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0024 mm/year in the statin group, vs. 0.0010 mm/year in the placebo group (P =.24).

However, the statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

"We wanted to see whether there was a way to decrease the long-term risk" of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled children and adolescents from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, said Dr. Schanberg. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well-tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

ATLANTA – Atorvastatin did prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10-21 years. The results were presented at the annual scientific meeting of the American College of Rheumatology.

"This is a landmark study in the pediatric rheumatology community," said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, the progression of thickening in the arteries was not significantly different between the statin and placebo groups.

"This was a surprise to us," Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0024 mm/year in the statin group, vs. 0.0010 mm/year in the placebo group (P =.24).

However, the statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

"We wanted to see whether there was a way to decrease the long-term risk" of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled children and adolescents from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, said Dr. Schanberg. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well-tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

ATLANTA – Atorvastatin did prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10-21 years. The results were presented at the annual scientific meeting of the American College of Rheumatology.

"This is a landmark study in the pediatric rheumatology community," said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, the progression of thickening in the arteries was not significantly different between the statin and placebo groups.

"This was a surprise to us," Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0024 mm/year in the statin group, vs. 0.0010 mm/year in the placebo group (P =.24).

However, the statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

"We wanted to see whether there was a way to decrease the long-term risk" of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled children and adolescents from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, said Dr. Schanberg. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well-tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

ATLANTA – Atorvastatin did prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10-21 years. The results were presented at the annual scientific meeting of the American College of Rheumatology.

"This is a landmark study in the pediatric rheumatology community," said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, the progression of thickening in the arteries was not significantly different between the statin and placebo groups.

"This was a surprise to us," Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0024 mm/year in the statin group, vs. 0.0010 mm/year in the placebo group (P =.24).

However, the statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

"We wanted to see whether there was a way to decrease the long-term risk" of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled children and adolescents from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, said Dr. Schanberg. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well-tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

ATLANTA – Atorvastatin did prevent early atherosclerosis in children and adolescents with lupus, based on data from 221 patients aged 10-21 years. The results were presented at the annual scientific meeting of the American College of Rheumatology.

"This is a landmark study in the pediatric rheumatology community," said Dr. Laura Schanberg, co-chief of the division of pediatric rheumatology at Duke University Medical Center in Durham, N.C.

To assess the risk of cardiovascular problems, the researchers used an accepted surrogate marker: an ultrasound measurement of the thickening of the carotid arteries. The study participants underwent ultrasound examinations seven times during the 3-year study period.

Overall, the progression of thickening in the arteries was not significantly different between the statin and placebo groups.

"This was a surprise to us," Dr. Schanberg said. The researchers had expected significantly less carotid intima-media thickening (CIMT) in the statin group.

The data were trending toward a positive effect, but the findings did not show enough benefit to recommend routine statin treatment for most children and adolescents with lupus. The difference in CIMT was 0.0024 mm/year in the statin group, vs. 0.0010 mm/year in the placebo group (P =.24).

However, the statin group did achieve statistically significant reductions in high-sensitivity C-reactive protein levels, total cholesterol, and low-density lipoprotein. Changes in lupus disease activity and damage, quality of life measures, and measures of muscle, liver, and neurotoxicity were similar between the two groups.

Previous studies have shown that lupus is a strong risk factor for cardiovascular problems. Pediatric lupus patients are considered at increased risk because they typically live with the disease for a longer period of time. Statins have not previously been studied as a way to reduce cardiovascular risk in children with lupus, but some clinicians already prescribe statins to children with lupus at especially high risk from factors such as high cholesterol, Dr. Schanberg said.

"We wanted to see whether there was a way to decrease the long-term risk" of cardiovascular problems in children with lupus, she said. In this study, the researchers enrolled children and adolescents from 21 sites through the Childhood Arthritis and Rheumatology Research Alliance.

All the children received standard lupus care including aspirin, a multivitamin, hydroxychloroquine, and counseling about a low-cholesterol diet and other cardiovascular risk factors. They were randomized to receive atorvastatin or a placebo.

Of note, the study did not include children at especially high risk for cardiovascular problems, such as those with high cholesterol, said Dr. Schanberg. In fact, a subgroup analysis may reveal certain groups that would benefit from statin use in childhood and adolescence, she said.

Despite the lack of clinical significance, the results showed that atorvastatin was safe and well-tolerated in the study population, and Dr. Schanberg advised clinicians to continue prescribing statins for pediatric lupus patients with abnormal cholesterol or lipid levels.

Dr. Schanberg has served on the advisory board for Bristol-Myers Squibb, and Pfizer provided the drugs used in the study.

ATLANTA – Preliminary data suggest naturally occurring bacteria in the mouth and intestine might trigger the inflammation that causes rheumatoid arthritis, according to findings presented in a press conference at the annual meeting of the American College of Rheumatology on Nov. 8.

"We are testing an old hypothesis with new technology," said Dr. Jose Scher of New York University. The ongoing study is the first to use DNA technology to bypass the cumbersome bacterial culture process. Dr. Scher and his colleagues used DNA sequencing to identify all the bacteria present in the mouths and intestines of study participants. This technology finally allows researchers to explore a long-standing theory that oral and intestinal bacteria might trigger rheumatoid arthritis (RA) by activating Th17 cells.

To date, 90 patients have been enrolled in the study, including 55 adults with RA and 45 healthy controls, Dr. Scher said in an interview. Of these, 22 RA patients and 14 controls have undergone DNA sequencing.

When the researchers examined oral microbiota, patients with early-onset RA had three to four times more Porphyromonas gingivalis bacteria (implicated in gum disease) than did healthy controls. In general, gum disease is present in approximately 82% of chronic RA patients and 75% of new-onset RA patients, Dr. Scher noted.

In addition, intestinal bacteria associated with inflammation were more prevalent in RA patients, compared with controls. The Prevotellaceae species of bacteria was identified in approximately 80% of the RA patients, compared with the 20% usually found in healthy individuals, he said.

The results are preliminary, but the findings support data from previous studies showing a high prevalence of oral disease in RA patients, said Dr. Scher. The study is ongoing, and the next steps for research include using antibiotics to modify the microflora in the body and identify how the bacteria cause inflammation, he added, noting that, ideally, researchers would then develop strategies to reduce or prevent the inflammation before it caused RA.

The study was supported in part by funding from the National Institutes of Health. Dr. Scher said he had no financial conflicts to disclose.

ATLANTA – Preliminary data suggest naturally occurring bacteria in the mouth and intestine might trigger the inflammation that causes rheumatoid arthritis, according to findings presented in a press conference at the annual meeting of the American College of Rheumatology on Nov. 8.

"We are testing an old hypothesis with new technology," said Dr. Jose Scher of New York University. The ongoing study is the first to use DNA technology to bypass the cumbersome bacterial culture process. Dr. Scher and his colleagues used DNA sequencing to identify all the bacteria present in the mouths and intestines of study participants. This technology finally allows researchers to explore a long-standing theory that oral and intestinal bacteria might trigger rheumatoid arthritis (RA) by activating Th17 cells.

To date, 90 patients have been enrolled in the study, including 55 adults with RA and 45 healthy controls, Dr. Scher said in an interview. Of these, 22 RA patients and 14 controls have undergone DNA sequencing.

When the researchers examined oral microbiota, patients with early-onset RA had three to four times more Porphyromonas gingivalis bacteria (implicated in gum disease) than did healthy controls. In general, gum disease is present in approximately 82% of chronic RA patients and 75% of new-onset RA patients, Dr. Scher noted.

In addition, intestinal bacteria associated with inflammation were more prevalent in RA patients, compared with controls. The Prevotellaceae species of bacteria was identified in approximately 80% of the RA patients, compared with the 20% usually found in healthy individuals, he said.

The results are preliminary, but the findings support data from previous studies showing a high prevalence of oral disease in RA patients, said Dr. Scher. The study is ongoing, and the next steps for research include using antibiotics to modify the microflora in the body and identify how the bacteria cause inflammation, he added, noting that, ideally, researchers would then develop strategies to reduce or prevent the inflammation before it caused RA.

The study was supported in part by funding from the National Institutes of Health. Dr. Scher said he had no financial conflicts to disclose.

ATLANTA – Preliminary data suggest naturally occurring bacteria in the mouth and intestine might trigger the inflammation that causes rheumatoid arthritis, according to findings presented in a press conference at the annual meeting of the American College of Rheumatology on Nov. 8.

"We are testing an old hypothesis with new technology," said Dr. Jose Scher of New York University. The ongoing study is the first to use DNA technology to bypass the cumbersome bacterial culture process. Dr. Scher and his colleagues used DNA sequencing to identify all the bacteria present in the mouths and intestines of study participants. This technology finally allows researchers to explore a long-standing theory that oral and intestinal bacteria might trigger rheumatoid arthritis (RA) by activating Th17 cells.

To date, 90 patients have been enrolled in the study, including 55 adults with RA and 45 healthy controls, Dr. Scher said in an interview. Of these, 22 RA patients and 14 controls have undergone DNA sequencing.

When the researchers examined oral microbiota, patients with early-onset RA had three to four times more Porphyromonas gingivalis bacteria (implicated in gum disease) than did healthy controls. In general, gum disease is present in approximately 82% of chronic RA patients and 75% of new-onset RA patients, Dr. Scher noted.

In addition, intestinal bacteria associated with inflammation were more prevalent in RA patients, compared with controls. The Prevotellaceae species of bacteria was identified in approximately 80% of the RA patients, compared with the 20% usually found in healthy individuals, he said.

The results are preliminary, but the findings support data from previous studies showing a high prevalence of oral disease in RA patients, said Dr. Scher. The study is ongoing, and the next steps for research include using antibiotics to modify the microflora in the body and identify how the bacteria cause inflammation, he added, noting that, ideally, researchers would then develop strategies to reduce or prevent the inflammation before it caused RA.

The study was supported in part by funding from the National Institutes of Health. Dr. Scher said he had no financial conflicts to disclose.

ATLANTA – Preliminary data suggest naturally occurring bacteria in the mouth and intestine might trigger the inflammation that causes rheumatoid arthritis, according to findings presented in a press conference at the annual meeting of the American College of Rheumatology on Nov. 8.

"We are testing an old hypothesis with new technology," said Dr. Jose Scher of New York University. The ongoing study is the first to use DNA technology to bypass the cumbersome bacterial culture process. Dr. Scher and his colleagues used DNA sequencing to identify all the bacteria present in the mouths and intestines of study participants. This technology finally allows researchers to explore a long-standing theory that oral and intestinal bacteria might trigger rheumatoid arthritis (RA) by activating Th17 cells.

To date, 90 patients have been enrolled in the study, including 55 adults with RA and 45 healthy controls, Dr. Scher said in an interview. Of these, 22 RA patients and 14 controls have undergone DNA sequencing.

When the researchers examined oral microbiota, patients with early-onset RA had three to four times more Porphyromonas gingivalis bacteria (implicated in gum disease) than did healthy controls. In general, gum disease is present in approximately 82% of chronic RA patients and 75% of new-onset RA patients, Dr. Scher noted.

In addition, intestinal bacteria associated with inflammation were more prevalent in RA patients, compared with controls. The Prevotellaceae species of bacteria was identified in approximately 80% of the RA patients, compared with the 20% usually found in healthy individuals, he said.

The results are preliminary, but the findings support data from previous studies showing a high prevalence of oral disease in RA patients, said Dr. Scher. The study is ongoing, and the next steps for research include using antibiotics to modify the microflora in the body and identify how the bacteria cause inflammation, he added, noting that, ideally, researchers would then develop strategies to reduce or prevent the inflammation before it caused RA.

The study was supported in part by funding from the National Institutes of Health. Dr. Scher said he had no financial conflicts to disclose.

ATLANTA – Preliminary data suggest naturally occurring bacteria in the mouth and intestine might trigger the inflammation that causes rheumatoid arthritis, according to findings presented in a press conference at the annual meeting of the American College of Rheumatology on Nov. 8.

"We are testing an old hypothesis with new technology," said Dr. Jose Scher of New York University. The ongoing study is the first to use DNA technology to bypass the cumbersome bacterial culture process. Dr. Scher and his colleagues used DNA sequencing to identify all the bacteria present in the mouths and intestines of study participants. This technology finally allows researchers to explore a long-standing theory that oral and intestinal bacteria might trigger rheumatoid arthritis (RA) by activating Th17 cells.

To date, 90 patients have been enrolled in the study, including 55 adults with RA and 45 healthy controls, Dr. Scher said in an interview. Of these, 22 RA patients and 14 controls have undergone DNA sequencing.

When the researchers examined oral microbiota, patients with early-onset RA had three to four times more Porphyromonas gingivalis bacteria (implicated in gum disease) than did healthy controls. In general, gum disease is present in approximately 82% of chronic RA patients and 75% of new-onset RA patients, Dr. Scher noted.

In addition, intestinal bacteria associated with inflammation were more prevalent in RA patients, compared with controls. The Prevotellaceae species of bacteria was identified in approximately 80% of the RA patients, compared with the 20% usually found in healthy individuals, he said.

The results are preliminary, but the findings support data from previous studies showing a high prevalence of oral disease in RA patients, said Dr. Scher. The study is ongoing, and the next steps for research include using antibiotics to modify the microflora in the body and identify how the bacteria cause inflammation, he added, noting that, ideally, researchers would then develop strategies to reduce or prevent the inflammation before it caused RA.

The study was supported in part by funding from the National Institutes of Health. Dr. Scher said he had no financial conflicts to disclose.

ATLANTA – Preliminary data suggest naturally occurring bacteria in the mouth and intestine might trigger the inflammation that causes rheumatoid arthritis, according to findings presented in a press conference at the annual meeting of the American College of Rheumatology on Nov. 8.

"We are testing an old hypothesis with new technology," said Dr. Jose Scher of New York University. The ongoing study is the first to use DNA technology to bypass the cumbersome bacterial culture process. Dr. Scher and his colleagues used DNA sequencing to identify all the bacteria present in the mouths and intestines of study participants. This technology finally allows researchers to explore a long-standing theory that oral and intestinal bacteria might trigger rheumatoid arthritis (RA) by activating Th17 cells.

To date, 90 patients have been enrolled in the study, including 55 adults with RA and 45 healthy controls, Dr. Scher said in an interview. Of these, 22 RA patients and 14 controls have undergone DNA sequencing.

When the researchers examined oral microbiota, patients with early-onset RA had three to four times more Porphyromonas gingivalis bacteria (implicated in gum disease) than did healthy controls. In general, gum disease is present in approximately 82% of chronic RA patients and 75% of new-onset RA patients, Dr. Scher noted.

In addition, intestinal bacteria associated with inflammation were more prevalent in RA patients, compared with controls. The Prevotellaceae species of bacteria was identified in approximately 80% of the RA patients, compared with the 20% usually found in healthy individuals, he said.

The results are preliminary, but the findings support data from previous studies showing a high prevalence of oral disease in RA patients, said Dr. Scher. The study is ongoing, and the next steps for research include using antibiotics to modify the microflora in the body and identify how the bacteria cause inflammation, he added, noting that, ideally, researchers would then develop strategies to reduce or prevent the inflammation before it caused RA.

The study was supported in part by funding from the National Institutes of Health. Dr. Scher said he had no financial conflicts to disclose.