Heidi Splete

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.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

Many factors contribute to a child's perception of pain, including their age, past experiences, and cognitive development, according to Dr. Brandie J. Metz.

Dr. Metz shared tips and techniques to improve the pediatric dermatologic surgery experience for the doctor, patient, and parent at the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

Create a calm environment. When talking with a pediatric patient, get down on their level – sit at or below the child's height, and talk directly to him or her. Explain the procedure in a nonthreatening way, but do not leave anything out, and be honest about what is going to happen, noted Dr. Metz, the director of pediatric dermatology at the University of California, Irvine. "There should be no surprises."

Allow the child to have some control over the situation by allowing him or her to choose a radio station to play in the background or a DVD to watch if possible. Engage children in conversation, and let them choose the color for a surgical dressing, said Dr. Metz.

During the procedure, position the parent at the head of the table and strategically drape the surgical field so the parent and child cannot see the actual procedure. Take extra time to cover surgical trays or blood-soaked gauze that could increase the anxiety of the parent or child, she said.

When performing injections, slow infiltration is best; also, consider using a topical anesthetic and 30-gauge needles, she recommended. Dr. Metz prefers buffered, warmed lidocaine, with 1 cc 8.4% sodium bicarbonate/10 cc of 1% lidocaine.

The issue of anesthesia is an important one for pediatric surgery patients. There are no set rules or guidelines about the age at which surgical procedures can be performed with local vs. general anesthesia, Dr. Metz said. She recommended local anesthesia as an option for girls aged 8-9 years and older, and boys aged 9-10 years and older, but it ultimately depends on the maturity of the child. "Consider general anesthesia for larger procedures and in younger children," she said.

Remember that some elective dermatologic surgeries can be postponed until the preadolescent or adolescent years, she noted. Few data exist on the risks of general anesthesia for young children, but the risk appears highest during the first month of life, and complications are more common in emergency procedures, compared with elective procedures, she said. According to the American Society of Anesthesiologists, the risk of a complication from anesthesia in a healthy child ranges from 1:20,000 to 1:80,000 or less.

When performing excisions in children, 2-octyl cyanoacrylate (Dermabond) is an option, Dr. Metz reported. Several studies have shown the advantage of this skin glue over sutures or staples. However, studies of Dermabond have not controlled for confounding factors including excision location, patient ethnicity, and previous keloids.

Advantages of 2-octyl cyanoacrylate include speed of use, avoidance of a follow-up visit to remove sutures, and ability to withstand getting wet. Also, the antibacterial properties of the product might reduce the risk of post-surgery infections, Dr. Metz noted.

Disadvantages of 2-octyl cyanoacrylate include cost ($30/vial), the inability to place the product in the wound, and the lack of strength for use in high-tension areas, she reported.

Dr. Metz also shared tips for the staged excision of congenital nevi in children, which is an option when tissue expansion is not advisable and primary closure is not possible. Her recommendations for a successful excision include:

• Take as much of the lesion as possible during the first stage.

• Don't wait too long between stages. The timing should be about 6 to 8 weeks; long enough for the tension on the skin to relax, but not long enough for the scar to spread.

• Consider absorbable sutures to avoid the need for a suture removal visit.

Dr. Metz disclosed having no conflicts of interest. SDEF and this news organization are owned by Elsevier.

Many factors contribute to a child's perception of pain, including their age, past experiences, and cognitive development, according to Dr. Brandie J. Metz.

Dr. Metz shared tips and techniques to improve the pediatric dermatologic surgery experience for the doctor, patient, and parent at the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

Create a calm environment. When talking with a pediatric patient, get down on their level – sit at or below the child's height, and talk directly to him or her. Explain the procedure in a nonthreatening way, but do not leave anything out, and be honest about what is going to happen, noted Dr. Metz, the director of pediatric dermatology at the University of California, Irvine. "There should be no surprises."

Allow the child to have some control over the situation by allowing him or her to choose a radio station to play in the background or a DVD to watch if possible. Engage children in conversation, and let them choose the color for a surgical dressing, said Dr. Metz.

During the procedure, position the parent at the head of the table and strategically drape the surgical field so the parent and child cannot see the actual procedure. Take extra time to cover surgical trays or blood-soaked gauze that could increase the anxiety of the parent or child, she said.

When performing injections, slow infiltration is best; also, consider using a topical anesthetic and 30-gauge needles, she recommended. Dr. Metz prefers buffered, warmed lidocaine, with 1 cc 8.4% sodium bicarbonate/10 cc of 1% lidocaine.

The issue of anesthesia is an important one for pediatric surgery patients. There are no set rules or guidelines about the age at which surgical procedures can be performed with local vs. general anesthesia, Dr. Metz said. She recommended local anesthesia as an option for girls aged 8-9 years and older, and boys aged 9-10 years and older, but it ultimately depends on the maturity of the child. "Consider general anesthesia for larger procedures and in younger children," she said.

Remember that some elective dermatologic surgeries can be postponed until the preadolescent or adolescent years, she noted. Few data exist on the risks of general anesthesia for young children, but the risk appears highest during the first month of life, and complications are more common in emergency procedures, compared with elective procedures, she said. According to the American Society of Anesthesiologists, the risk of a complication from anesthesia in a healthy child ranges from 1:20,000 to 1:80,000 or less.

When performing excisions in children, 2-octyl cyanoacrylate (Dermabond) is an option, Dr. Metz reported. Several studies have shown the advantage of this skin glue over sutures or staples. However, studies of Dermabond have not controlled for confounding factors including excision location, patient ethnicity, and previous keloids.

Advantages of 2-octyl cyanoacrylate include speed of use, avoidance of a follow-up visit to remove sutures, and ability to withstand getting wet. Also, the antibacterial properties of the product might reduce the risk of post-surgery infections, Dr. Metz noted.

Disadvantages of 2-octyl cyanoacrylate include cost ($30/vial), the inability to place the product in the wound, and the lack of strength for use in high-tension areas, she reported.

Dr. Metz also shared tips for the staged excision of congenital nevi in children, which is an option when tissue expansion is not advisable and primary closure is not possible. Her recommendations for a successful excision include:

• Take as much of the lesion as possible during the first stage.

• Don't wait too long between stages. The timing should be about 6 to 8 weeks; long enough for the tension on the skin to relax, but not long enough for the scar to spread.

• Consider absorbable sutures to avoid the need for a suture removal visit.

Dr. Metz disclosed having no conflicts of interest. SDEF and this news organization are owned by Elsevier.

Many factors contribute to a child's perception of pain, including their age, past experiences, and cognitive development, according to Dr. Brandie J. Metz.

Dr. Metz shared tips and techniques to improve the pediatric dermatologic surgery experience for the doctor, patient, and parent at the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

Create a calm environment. When talking with a pediatric patient, get down on their level – sit at or below the child's height, and talk directly to him or her. Explain the procedure in a nonthreatening way, but do not leave anything out, and be honest about what is going to happen, noted Dr. Metz, the director of pediatric dermatology at the University of California, Irvine. "There should be no surprises."

Allow the child to have some control over the situation by allowing him or her to choose a radio station to play in the background or a DVD to watch if possible. Engage children in conversation, and let them choose the color for a surgical dressing, said Dr. Metz.

During the procedure, position the parent at the head of the table and strategically drape the surgical field so the parent and child cannot see the actual procedure. Take extra time to cover surgical trays or blood-soaked gauze that could increase the anxiety of the parent or child, she said.

When performing injections, slow infiltration is best; also, consider using a topical anesthetic and 30-gauge needles, she recommended. Dr. Metz prefers buffered, warmed lidocaine, with 1 cc 8.4% sodium bicarbonate/10 cc of 1% lidocaine.

The issue of anesthesia is an important one for pediatric surgery patients. There are no set rules or guidelines about the age at which surgical procedures can be performed with local vs. general anesthesia, Dr. Metz said. She recommended local anesthesia as an option for girls aged 8-9 years and older, and boys aged 9-10 years and older, but it ultimately depends on the maturity of the child. "Consider general anesthesia for larger procedures and in younger children," she said.

Remember that some elective dermatologic surgeries can be postponed until the preadolescent or adolescent years, she noted. Few data exist on the risks of general anesthesia for young children, but the risk appears highest during the first month of life, and complications are more common in emergency procedures, compared with elective procedures, she said. According to the American Society of Anesthesiologists, the risk of a complication from anesthesia in a healthy child ranges from 1:20,000 to 1:80,000 or less.

When performing excisions in children, 2-octyl cyanoacrylate (Dermabond) is an option, Dr. Metz reported. Several studies have shown the advantage of this skin glue over sutures or staples. However, studies of Dermabond have not controlled for confounding factors including excision location, patient ethnicity, and previous keloids.

Advantages of 2-octyl cyanoacrylate include speed of use, avoidance of a follow-up visit to remove sutures, and ability to withstand getting wet. Also, the antibacterial properties of the product might reduce the risk of post-surgery infections, Dr. Metz noted.

Disadvantages of 2-octyl cyanoacrylate include cost ($30/vial), the inability to place the product in the wound, and the lack of strength for use in high-tension areas, she reported.

Dr. Metz also shared tips for the staged excision of congenital nevi in children, which is an option when tissue expansion is not advisable and primary closure is not possible. Her recommendations for a successful excision include:

• Take as much of the lesion as possible during the first stage.

• Don't wait too long between stages. The timing should be about 6 to 8 weeks; long enough for the tension on the skin to relax, but not long enough for the scar to spread.

• Consider absorbable sutures to avoid the need for a suture removal visit.

Dr. Metz disclosed having no conflicts of interest. SDEF and this news organization are owned by Elsevier.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.