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Axis I psychiatric disorders high in skin-restricted lupus patients
The prevalence of psychiatric disorders is high among people with skin-restricted lupus (SRL), compared with the general population, yet most do not receive specialist mental health care or appropriate psychotropic treatment, researchers report.
Investigators led by psychiatrist Isabelle Jalenques of the Clermont-Ferrand (France) University Hospital noted that psychiatric disorders had been extensively reported in patients with systemic lupus erythematosus (SLE), but no data existed on patients with skin-restricted disease (Br J Dermatol. 2016. doi: 10.1111/bjd.14392).
A previous exploratory study by the research group had shown that 60% of the 20 patients with subacute cutaneous lupus erythematosus and discoid lupus erythematosus studied had at least one psychiatric disorder. However the study was limited by its size and lack of a control group.
In the current multicenter study, the researchers compared 75 outpatients with SRL with 150 controls. Mean age of patients was 46 years and mean duration of disease was 10 years. They discovered that almost 49% of the patients with SRL fulfilled criteria for at least one current Axis I psychiatric disorder, compared with 13% of controls (OR, 5.0; P less than .001). Furthermore, 73% of patients fulfilled criteria for at least one lifetime Axis I psychiatric disorder, compared with 43% of controls (OR, 4.4; P less than .001).
The rates were close to that of patients with SLE for both current (42.2 and 46.7%) and lifetime psychiatric disorders (72%), Dr. Jalenques and her associates noted.
Patients with SRL were at a particularly high risk of the following psychiatric disorders, compared with controls:
• Major depressive disorder: current (9% vs. 0%; P = .0007) and lifetime (44% vs. 26%; P = .01).
• Generalized anxiety disorder: current (23% vs. 3%; P less than .001) and lifetime (35% vs. 19%; P = .03).
• Panic disorder: current (7% vs. 0%; P = .004) and lifetime (21 % vs. 3 %; P less than .001).
• Suicide risk: current (24% vs. 7%; P = .003).
• Alcohol dependence: current (7% vs. 0%; P = .004).
• Lifetime agoraphobia: (20% vs. 9%; P = .01).
Many patients were not receiving specialist mental health care or appropriate psychotropic treatment despite psychiatric disorders being a well-known cause of psychological distress, excess mortality, impaired global functioning, and poor compliance with medical treatment, Dr. Jalenques and her associates noted.
“Clinicians should be aware of the high prevalence of these disorders among SRL patients and not hesitate to refer such patients for psychiatric evaluation,” they concluded.
This study was supported by a grant from the French Ministry of Health and from Société Française de Dermatologie. The authors declared they have no conflicts of interest.
The prevalence of psychiatric disorders is high among people with skin-restricted lupus (SRL), compared with the general population, yet most do not receive specialist mental health care or appropriate psychotropic treatment, researchers report.
Investigators led by psychiatrist Isabelle Jalenques of the Clermont-Ferrand (France) University Hospital noted that psychiatric disorders had been extensively reported in patients with systemic lupus erythematosus (SLE), but no data existed on patients with skin-restricted disease (Br J Dermatol. 2016. doi: 10.1111/bjd.14392).
A previous exploratory study by the research group had shown that 60% of the 20 patients with subacute cutaneous lupus erythematosus and discoid lupus erythematosus studied had at least one psychiatric disorder. However the study was limited by its size and lack of a control group.
In the current multicenter study, the researchers compared 75 outpatients with SRL with 150 controls. Mean age of patients was 46 years and mean duration of disease was 10 years. They discovered that almost 49% of the patients with SRL fulfilled criteria for at least one current Axis I psychiatric disorder, compared with 13% of controls (OR, 5.0; P less than .001). Furthermore, 73% of patients fulfilled criteria for at least one lifetime Axis I psychiatric disorder, compared with 43% of controls (OR, 4.4; P less than .001).
The rates were close to that of patients with SLE for both current (42.2 and 46.7%) and lifetime psychiatric disorders (72%), Dr. Jalenques and her associates noted.
Patients with SRL were at a particularly high risk of the following psychiatric disorders, compared with controls:
• Major depressive disorder: current (9% vs. 0%; P = .0007) and lifetime (44% vs. 26%; P = .01).
• Generalized anxiety disorder: current (23% vs. 3%; P less than .001) and lifetime (35% vs. 19%; P = .03).
• Panic disorder: current (7% vs. 0%; P = .004) and lifetime (21 % vs. 3 %; P less than .001).
• Suicide risk: current (24% vs. 7%; P = .003).
• Alcohol dependence: current (7% vs. 0%; P = .004).
• Lifetime agoraphobia: (20% vs. 9%; P = .01).
Many patients were not receiving specialist mental health care or appropriate psychotropic treatment despite psychiatric disorders being a well-known cause of psychological distress, excess mortality, impaired global functioning, and poor compliance with medical treatment, Dr. Jalenques and her associates noted.
“Clinicians should be aware of the high prevalence of these disorders among SRL patients and not hesitate to refer such patients for psychiatric evaluation,” they concluded.
This study was supported by a grant from the French Ministry of Health and from Société Française de Dermatologie. The authors declared they have no conflicts of interest.
The prevalence of psychiatric disorders is high among people with skin-restricted lupus (SRL), compared with the general population, yet most do not receive specialist mental health care or appropriate psychotropic treatment, researchers report.
Investigators led by psychiatrist Isabelle Jalenques of the Clermont-Ferrand (France) University Hospital noted that psychiatric disorders had been extensively reported in patients with systemic lupus erythematosus (SLE), but no data existed on patients with skin-restricted disease (Br J Dermatol. 2016. doi: 10.1111/bjd.14392).
A previous exploratory study by the research group had shown that 60% of the 20 patients with subacute cutaneous lupus erythematosus and discoid lupus erythematosus studied had at least one psychiatric disorder. However the study was limited by its size and lack of a control group.
In the current multicenter study, the researchers compared 75 outpatients with SRL with 150 controls. Mean age of patients was 46 years and mean duration of disease was 10 years. They discovered that almost 49% of the patients with SRL fulfilled criteria for at least one current Axis I psychiatric disorder, compared with 13% of controls (OR, 5.0; P less than .001). Furthermore, 73% of patients fulfilled criteria for at least one lifetime Axis I psychiatric disorder, compared with 43% of controls (OR, 4.4; P less than .001).
The rates were close to that of patients with SLE for both current (42.2 and 46.7%) and lifetime psychiatric disorders (72%), Dr. Jalenques and her associates noted.
Patients with SRL were at a particularly high risk of the following psychiatric disorders, compared with controls:
• Major depressive disorder: current (9% vs. 0%; P = .0007) and lifetime (44% vs. 26%; P = .01).
• Generalized anxiety disorder: current (23% vs. 3%; P less than .001) and lifetime (35% vs. 19%; P = .03).
• Panic disorder: current (7% vs. 0%; P = .004) and lifetime (21 % vs. 3 %; P less than .001).
• Suicide risk: current (24% vs. 7%; P = .003).
• Alcohol dependence: current (7% vs. 0%; P = .004).
• Lifetime agoraphobia: (20% vs. 9%; P = .01).
Many patients were not receiving specialist mental health care or appropriate psychotropic treatment despite psychiatric disorders being a well-known cause of psychological distress, excess mortality, impaired global functioning, and poor compliance with medical treatment, Dr. Jalenques and her associates noted.
“Clinicians should be aware of the high prevalence of these disorders among SRL patients and not hesitate to refer such patients for psychiatric evaluation,” they concluded.
This study was supported by a grant from the French Ministry of Health and from Société Française de Dermatologie. The authors declared they have no conflicts of interest.
FROM BRITISH JOURNAL OF DERMATOLOGY
Key clinical point: The prevalence of psychiatric disorders is high among people with skin-restricted lupus, yet many do not receive specialist mental health care or appropriate psychotropic treatment.
Major finding: Almost half of the patients with SRL fulfilled criteria for at least one current Axis I psychiatric disorder, compared with 13% of controls (OR 5.0 [95% CI, 2.4-10.7], P less than .001).
Data source: A multicenter study of 75 outpatients with SRL and 150 control subjects.
Disclosures: This study was supported by a grant from the French Ministry of Health and from Société Française de Dermatologie. The authors declared they have no conflicts of interest.
HIV infection an independent risk factor for AECOPD
HIV infection is an independent risk factor for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), particularly in those with severe immune suppression, new research shows.
The longitudinal study, led by Dr. Kristina Crothers, a pulmonary and critical care specialist at Harborview Medical Center in Seattle, compared the incidence of AECOPD in 43,618 HIV-infected patients with 86,492 uninfected patients participating in the Veterans Aging Cohort Study (AIDS. 2016 Jan 28;30[3]:455-63).
Over 234,099 person-years of follow-up, the research team found that HIV-infected individuals had an increased rate of AECOPD compared with uninfected individuals (18.8 vs. 13.3 per 1,000 person-years, P less than .001).
Adjusted models showed that AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44-1.65), particularly in those with more severe immune suppression when stratified by CD4+ cell count (cells/mcL) compared with uninfected individuals (HIV-infected CD4+ <200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4+ ≥ 200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4+ ≥350: IRR 0.99, 95% CI 0.88-1.10).
“These findings support that severity of immune suppression increases risk for AECOPD, likely through greater risk of infection,” Dr. Crothers and her coauthors wrote.
The researchers also found a significant interaction between HIV infection and current smoking and alcohol use, with both conferring a substantially greater risk for AECOPD. This suggests that the increased risk of AECOPD in HIV may be related to enhanced susceptibility to harms from the modifiable risk factors of smoking and unhealthy alcohol use.
Infection with HIV coupled with alcohol use could serve as a ‘double hit’ to increase susceptibility to exacerbations of lung disease, the authors suggested.
“Intervening on these contributing factors may decrease morbidity and costs associated with COPD, particularly in a vulnerable HIV-infected population,” they concluded.
The authors declared no conflicts of interest.
HIV infection is an independent risk factor for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), particularly in those with severe immune suppression, new research shows.
The longitudinal study, led by Dr. Kristina Crothers, a pulmonary and critical care specialist at Harborview Medical Center in Seattle, compared the incidence of AECOPD in 43,618 HIV-infected patients with 86,492 uninfected patients participating in the Veterans Aging Cohort Study (AIDS. 2016 Jan 28;30[3]:455-63).
Over 234,099 person-years of follow-up, the research team found that HIV-infected individuals had an increased rate of AECOPD compared with uninfected individuals (18.8 vs. 13.3 per 1,000 person-years, P less than .001).
Adjusted models showed that AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44-1.65), particularly in those with more severe immune suppression when stratified by CD4+ cell count (cells/mcL) compared with uninfected individuals (HIV-infected CD4+ <200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4+ ≥ 200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4+ ≥350: IRR 0.99, 95% CI 0.88-1.10).
“These findings support that severity of immune suppression increases risk for AECOPD, likely through greater risk of infection,” Dr. Crothers and her coauthors wrote.
The researchers also found a significant interaction between HIV infection and current smoking and alcohol use, with both conferring a substantially greater risk for AECOPD. This suggests that the increased risk of AECOPD in HIV may be related to enhanced susceptibility to harms from the modifiable risk factors of smoking and unhealthy alcohol use.
Infection with HIV coupled with alcohol use could serve as a ‘double hit’ to increase susceptibility to exacerbations of lung disease, the authors suggested.
“Intervening on these contributing factors may decrease morbidity and costs associated with COPD, particularly in a vulnerable HIV-infected population,” they concluded.
The authors declared no conflicts of interest.
HIV infection is an independent risk factor for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), particularly in those with severe immune suppression, new research shows.
The longitudinal study, led by Dr. Kristina Crothers, a pulmonary and critical care specialist at Harborview Medical Center in Seattle, compared the incidence of AECOPD in 43,618 HIV-infected patients with 86,492 uninfected patients participating in the Veterans Aging Cohort Study (AIDS. 2016 Jan 28;30[3]:455-63).
Over 234,099 person-years of follow-up, the research team found that HIV-infected individuals had an increased rate of AECOPD compared with uninfected individuals (18.8 vs. 13.3 per 1,000 person-years, P less than .001).
Adjusted models showed that AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44-1.65), particularly in those with more severe immune suppression when stratified by CD4+ cell count (cells/mcL) compared with uninfected individuals (HIV-infected CD4+ <200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4+ ≥ 200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4+ ≥350: IRR 0.99, 95% CI 0.88-1.10).
“These findings support that severity of immune suppression increases risk for AECOPD, likely through greater risk of infection,” Dr. Crothers and her coauthors wrote.
The researchers also found a significant interaction between HIV infection and current smoking and alcohol use, with both conferring a substantially greater risk for AECOPD. This suggests that the increased risk of AECOPD in HIV may be related to enhanced susceptibility to harms from the modifiable risk factors of smoking and unhealthy alcohol use.
Infection with HIV coupled with alcohol use could serve as a ‘double hit’ to increase susceptibility to exacerbations of lung disease, the authors suggested.
“Intervening on these contributing factors may decrease morbidity and costs associated with COPD, particularly in a vulnerable HIV-infected population,” they concluded.
The authors declared no conflicts of interest.
FROM AIDS
Key clinical point: HIV-infected individuals are at a higher risk of AECOPD if they have severe immune suppression, and/or smoke cigarettes and drink alcohol.
Major finding: HIV-infected individuals had an increased rate of AECOPD compared with uninfected individuals (18.8 vs. 13.3 per 1,000 person-years, P less than .001).
Data source: Longitudinal study involving 43,618 HIV-infected individuals and 86,492 uninfected individuals participating in the Veterans Aging Cohort Study.
Disclosures: No conflicts of interest are declared.
Methotrexate has a role in treating articular manifestations of psoriatic arthritis
Patients with psoriatic arthritis taking methotrexate demonstrated an improvement in peripheral joint disease, skin disease, enthesitis, dactylitis, and nail disease over 12 weeks in a subanalysis of methotrexate users in the TICOPA (Tight Control of Psoriatic Arthritis) study.
Out of the original 206 patients in the open-label, randomized, controlled TICOPA study, the subanalysis involved 188 who received methotrexate in its first 12 weeks. Substudy authors Dr. Laura C. Coates and Dr. Philip S. Helliwell of the Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds (England) verified a maximum dose at 12 weeks of at least 15 mg/week in 175, 20 mg/week in 122, and 25 mg/week in 86 (J Rheumatol. Dec 15. doi: 10.3899/jrheum.150614).
The proportions of patients achieving American College of Rheumatology (ACR) outcomes at 12 weeks were 40.8% for ACR20, 18.8% for ACR50, and 8.6% for ACR70. A total of 22.4% achieved minimal disease activity, defined as meeting five of these seven criteria: 0-1 tender joints, 0-1 swollen joints, Psoriasis Area and Severity Index (PASI) of 1 or less or body surface area involvement of 3 or less, patient pain visual analog score (VAS) of 15 or less, patient global disease activity VAS of 20 or less, health assessment questionnaire of 0.5 or less, and 0-1 tender entheseal points.
Other improvements that occurred at 12 weeks included 27.2% reaching a PASI75, a 62.7% drop in dactylitis incidence, a significant drop of –59.7 in Leeds dactylitis instrument median score, and a significant decrease in the proportion of patients with enthesitis (25.7%). However, the median change in enthesitis score was 0.
Response rates did not differ between patients receiving methotrexate 15 mg/week or higher doses, although there was generally a higher proportion who met various response criteria among those taking greater than 15 mg/week. However, the authors noted that there could be an underestimation of the dose effect because the design of the TICOPA study, which randomized patients to a protocol for tight control of psoriatic arthritis disease activity or standard care, introduced a bias by intentionally escalating treatment doses in patients who continue to have active disease.
The investigators advised that the study results be interpreted in the context of the open-label design of the study, and placed alongside the other observational studies that support its use in psoriatic arthritis.
No relevant conflicts of interest were disclosed.
Patients with psoriatic arthritis taking methotrexate demonstrated an improvement in peripheral joint disease, skin disease, enthesitis, dactylitis, and nail disease over 12 weeks in a subanalysis of methotrexate users in the TICOPA (Tight Control of Psoriatic Arthritis) study.
Out of the original 206 patients in the open-label, randomized, controlled TICOPA study, the subanalysis involved 188 who received methotrexate in its first 12 weeks. Substudy authors Dr. Laura C. Coates and Dr. Philip S. Helliwell of the Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds (England) verified a maximum dose at 12 weeks of at least 15 mg/week in 175, 20 mg/week in 122, and 25 mg/week in 86 (J Rheumatol. Dec 15. doi: 10.3899/jrheum.150614).
The proportions of patients achieving American College of Rheumatology (ACR) outcomes at 12 weeks were 40.8% for ACR20, 18.8% for ACR50, and 8.6% for ACR70. A total of 22.4% achieved minimal disease activity, defined as meeting five of these seven criteria: 0-1 tender joints, 0-1 swollen joints, Psoriasis Area and Severity Index (PASI) of 1 or less or body surface area involvement of 3 or less, patient pain visual analog score (VAS) of 15 or less, patient global disease activity VAS of 20 or less, health assessment questionnaire of 0.5 or less, and 0-1 tender entheseal points.
Other improvements that occurred at 12 weeks included 27.2% reaching a PASI75, a 62.7% drop in dactylitis incidence, a significant drop of –59.7 in Leeds dactylitis instrument median score, and a significant decrease in the proportion of patients with enthesitis (25.7%). However, the median change in enthesitis score was 0.
Response rates did not differ between patients receiving methotrexate 15 mg/week or higher doses, although there was generally a higher proportion who met various response criteria among those taking greater than 15 mg/week. However, the authors noted that there could be an underestimation of the dose effect because the design of the TICOPA study, which randomized patients to a protocol for tight control of psoriatic arthritis disease activity or standard care, introduced a bias by intentionally escalating treatment doses in patients who continue to have active disease.
The investigators advised that the study results be interpreted in the context of the open-label design of the study, and placed alongside the other observational studies that support its use in psoriatic arthritis.
No relevant conflicts of interest were disclosed.
Patients with psoriatic arthritis taking methotrexate demonstrated an improvement in peripheral joint disease, skin disease, enthesitis, dactylitis, and nail disease over 12 weeks in a subanalysis of methotrexate users in the TICOPA (Tight Control of Psoriatic Arthritis) study.
Out of the original 206 patients in the open-label, randomized, controlled TICOPA study, the subanalysis involved 188 who received methotrexate in its first 12 weeks. Substudy authors Dr. Laura C. Coates and Dr. Philip S. Helliwell of the Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds (England) verified a maximum dose at 12 weeks of at least 15 mg/week in 175, 20 mg/week in 122, and 25 mg/week in 86 (J Rheumatol. Dec 15. doi: 10.3899/jrheum.150614).
The proportions of patients achieving American College of Rheumatology (ACR) outcomes at 12 weeks were 40.8% for ACR20, 18.8% for ACR50, and 8.6% for ACR70. A total of 22.4% achieved minimal disease activity, defined as meeting five of these seven criteria: 0-1 tender joints, 0-1 swollen joints, Psoriasis Area and Severity Index (PASI) of 1 or less or body surface area involvement of 3 or less, patient pain visual analog score (VAS) of 15 or less, patient global disease activity VAS of 20 or less, health assessment questionnaire of 0.5 or less, and 0-1 tender entheseal points.
Other improvements that occurred at 12 weeks included 27.2% reaching a PASI75, a 62.7% drop in dactylitis incidence, a significant drop of –59.7 in Leeds dactylitis instrument median score, and a significant decrease in the proportion of patients with enthesitis (25.7%). However, the median change in enthesitis score was 0.
Response rates did not differ between patients receiving methotrexate 15 mg/week or higher doses, although there was generally a higher proportion who met various response criteria among those taking greater than 15 mg/week. However, the authors noted that there could be an underestimation of the dose effect because the design of the TICOPA study, which randomized patients to a protocol for tight control of psoriatic arthritis disease activity or standard care, introduced a bias by intentionally escalating treatment doses in patients who continue to have active disease.
The investigators advised that the study results be interpreted in the context of the open-label design of the study, and placed alongside the other observational studies that support its use in psoriatic arthritis.
No relevant conflicts of interest were disclosed.
FROM JOURNAL OF RHEUMATOLOGY
Key clinical point: Methotrexate is a commonly prescribed drug in psoriatic arthritis, and while it may not be effective for all patients, it does have a role in the treatment of articular manifestations.
Major finding: The proportions of patients achieving American College of Rheumatology (ACR) outcomes at 12 weeks were 40.8% for ACR20, 18.8% for ACR50, and 8.6% for ACR70.
Data source: Open-label, observational study of 188 patients participating in the Tight Control of Psoriatic Arthritis (TICOPA) study.
Disclosures: No relevant conflicts of interest were disclosed.
More comorbidity with PsA form of spondyloarthritis
Psoriatic arthritis in patients with spondyloarthritis conveys an increased risk of comorbidities, especially cardiovascular and metabolic diseases, as compared with spondyloarthritis alone.
The association persisted even after adjusting for demographic factors, disease duration, and length of treatment, Dr. Naba Haque of the University of Leuven (Belgium) and associates wrote in the Journal of Rheumatology (2015 Dec 15. doi: 10.3899/jrheum.141359).
In an analysis of 518 patients in the spondyloarthritis database at the university, over half (54%) had comorbidities, and those with psoriatic spondyloarthropathy had significantly more comorbidities than those without psoriatic arthropathy (P less than .001). Cardiovascular comorbidities were most common, with an increased prevalence of hypertension, coronary artery disease, and hyperlipidemia in the patients with psoriatic spondyloarthropathy (odds ratios, 1.81, 1.39, and 1.60, respectively; P less than .001). The differences persisted after adjusting for confounders such as age, sex, disease duration, and treatment.
Twice as many patients with spondyloarthritis and psoriatic arthropathy met the criteria for metabolic syndrome as did patients without psoriatric arthropathy (10% vs. 5%, P = .03). The regression model showed a significant difference in the prevalence of diabetes in the PsA patients (OR, 1.35; 95% confidence interval, 1.17-1.56; P less than .001). Psoriatic arthropathy also was linked to an increased risk of cancer (12% vs. 6%; P less than .05); however, the authors wrote that “we can only state a possible positive association … this observation needs to be studied in further detail.”
The study was supported by an unrestricted grant from the Abbvie Chair for psoriatic arthritis research (Dr. Rik J. Lories and Dr. Kurt de Vlam).
Psoriatic arthritis in patients with spondyloarthritis conveys an increased risk of comorbidities, especially cardiovascular and metabolic diseases, as compared with spondyloarthritis alone.
The association persisted even after adjusting for demographic factors, disease duration, and length of treatment, Dr. Naba Haque of the University of Leuven (Belgium) and associates wrote in the Journal of Rheumatology (2015 Dec 15. doi: 10.3899/jrheum.141359).
In an analysis of 518 patients in the spondyloarthritis database at the university, over half (54%) had comorbidities, and those with psoriatic spondyloarthropathy had significantly more comorbidities than those without psoriatic arthropathy (P less than .001). Cardiovascular comorbidities were most common, with an increased prevalence of hypertension, coronary artery disease, and hyperlipidemia in the patients with psoriatic spondyloarthropathy (odds ratios, 1.81, 1.39, and 1.60, respectively; P less than .001). The differences persisted after adjusting for confounders such as age, sex, disease duration, and treatment.
Twice as many patients with spondyloarthritis and psoriatic arthropathy met the criteria for metabolic syndrome as did patients without psoriatric arthropathy (10% vs. 5%, P = .03). The regression model showed a significant difference in the prevalence of diabetes in the PsA patients (OR, 1.35; 95% confidence interval, 1.17-1.56; P less than .001). Psoriatic arthropathy also was linked to an increased risk of cancer (12% vs. 6%; P less than .05); however, the authors wrote that “we can only state a possible positive association … this observation needs to be studied in further detail.”
The study was supported by an unrestricted grant from the Abbvie Chair for psoriatic arthritis research (Dr. Rik J. Lories and Dr. Kurt de Vlam).
Psoriatic arthritis in patients with spondyloarthritis conveys an increased risk of comorbidities, especially cardiovascular and metabolic diseases, as compared with spondyloarthritis alone.
The association persisted even after adjusting for demographic factors, disease duration, and length of treatment, Dr. Naba Haque of the University of Leuven (Belgium) and associates wrote in the Journal of Rheumatology (2015 Dec 15. doi: 10.3899/jrheum.141359).
In an analysis of 518 patients in the spondyloarthritis database at the university, over half (54%) had comorbidities, and those with psoriatic spondyloarthropathy had significantly more comorbidities than those without psoriatic arthropathy (P less than .001). Cardiovascular comorbidities were most common, with an increased prevalence of hypertension, coronary artery disease, and hyperlipidemia in the patients with psoriatic spondyloarthropathy (odds ratios, 1.81, 1.39, and 1.60, respectively; P less than .001). The differences persisted after adjusting for confounders such as age, sex, disease duration, and treatment.
Twice as many patients with spondyloarthritis and psoriatic arthropathy met the criteria for metabolic syndrome as did patients without psoriatric arthropathy (10% vs. 5%, P = .03). The regression model showed a significant difference in the prevalence of diabetes in the PsA patients (OR, 1.35; 95% confidence interval, 1.17-1.56; P less than .001). Psoriatic arthropathy also was linked to an increased risk of cancer (12% vs. 6%; P less than .05); however, the authors wrote that “we can only state a possible positive association … this observation needs to be studied in further detail.”
The study was supported by an unrestricted grant from the Abbvie Chair for psoriatic arthritis research (Dr. Rik J. Lories and Dr. Kurt de Vlam).
FROM THE JOURNAL OF RHEUMATOLOGY
Key clinical point: People with psoriatic arthritis (PsA) have a significantly increased risk of cardiovascular and metabolic diseases, compared with people with non-PsA forms of spondyloarthritis (SpA).
Major finding: After correcting for risk factors, spondyloarthritis plus psoriatic arthritis was linked with an increased prevalence of hypertension, coronary artery disease, and hyperlipidemia (OR, 1.81, 1.39, and 1.60 respectively, P less than .001).
Data source: Cross-sectional study of 518 spondyloarthritis patients in a database at a university rheumatology department.
Disclosures: The study was supported by an unrestricted grant from the Abbvie Chair for psoriatic arthritis research (Dr. Lories and Dr. de Vlam).
Secukinumab cut ankylosing spondylitis symptoms in MEASURE trials
Secukinumab, an interleukin 17-A inhibitor approved for the treatment of moderate to severe psoriasis, significantly reduced the signs and symptoms of ankylosing spondylitis in two phase III trials, researchers reported Dec. 23 in the New England Journal of Medicine.
The results of the double-blind MEASURE 1 and MEASURE 2 trials extend the positive results of the phase II study, according to Dr. Dominique Baeten of the Academic Medical Center at the University of Amsterdam and his colleagues (N Engl J Med. 2015 Dec 23. doi: 10.1056/NEJMoa1505066).
“Although head-to-head trials would be required to fully assess the efficacy and safety of secukinumab versus TNF-inhibitors, the [20% improvement in Assessment of Spondyloarthritis International Society (ASAS20) response criteria] response rates achieved with secukinumab at week 16 in our studies were similar to those reported in phase III studies of anti-TNF agents in which most of the patients had not received previous anti-TNF therapy (response rates of 58% to 64% at weeks 12 to 24), even though 30% to 40% of the patients in our studies had had no response to previous anti-TNF treatment,” the authors wrote.
“Thus, secukinumab not only is effective in patients who have not received TNF agents previously but also may be effective in patients in whom previous anti-TNF treatment failed,” they added.
In MEASURE 1, 371 patients received intravenous secukinumab (10 mg/kg of body weight) or matched placebo at weeks 0, 2, and 4, followed by subcutaneous secukinumab (150 mg or 75 mg) or matched placebo every 4 weeks starting at week 8.
The study’s primary endpoint of ASAS20 response rates at week 16 were 61%, 60%, and 29% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively, (P less than .001 for both comparisons with placebo).
In MEASURE 2, 219 patients received subcutaneous secukinumab (150 mg or 75 mg) or matched placebo at baseline; at weeks 1, 2, and 3; and every 4 weeks starting at week 4.
At week 16, patients in the placebo group were randomly reassigned to subcutaneous secukinumab at a dose of 150 mg or 75 mg.
In this trial, ASAS20 rates were 61%, 41%, and 28% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P less than .001 for the 150-mg dose and P = .10 for the 75-mg dose).
The researchers noted that the ineffectiveness of the 75-mg dose in MEASURE 2 suggests that the efficacy of secukinumab at the 75-mg dose in MEASURE 1 may have been due to the greater exposure at week 16 as a result of the intravenous loading regimen, not to the 75-mg subcutaneous maintenance dose.
The safety profile of secukinumab in the present studies was consistent with previous studies of secukinumab for ankylosing spondylitis and moderate-to-severe plaque psoriasis, Dr. Baeten and his associates said.
During the entire treatment period, pooled exposure-adjusted incidence rates of grade 3 or 4 neutropenia, candida infections, and Crohn’s disease were 0.7, 0.9, and 0.7 cases per 100 patient-years, respectively, in secukinumab-treated patients.
Overall, the results suggest that interleukin-17A plays a role in the pathogenesis of ankylosing spondylitis, and they validate inhibition of this cytokine as a potential therapeutic approach, the study authors concluded.
The study was sponsored by Novartis Pharma. Dr. Baeten has received a grant from Novartis to study the impact of IL-17A blockade in experimental models of spondyloarthritis. He also has been a consultant for Novartis for the design and conduct of the secukinumab program in ankylosing spondylitis and psoriatic arthritis.
Secukinumab, an interleukin 17-A inhibitor approved for the treatment of moderate to severe psoriasis, significantly reduced the signs and symptoms of ankylosing spondylitis in two phase III trials, researchers reported Dec. 23 in the New England Journal of Medicine.
The results of the double-blind MEASURE 1 and MEASURE 2 trials extend the positive results of the phase II study, according to Dr. Dominique Baeten of the Academic Medical Center at the University of Amsterdam and his colleagues (N Engl J Med. 2015 Dec 23. doi: 10.1056/NEJMoa1505066).
“Although head-to-head trials would be required to fully assess the efficacy and safety of secukinumab versus TNF-inhibitors, the [20% improvement in Assessment of Spondyloarthritis International Society (ASAS20) response criteria] response rates achieved with secukinumab at week 16 in our studies were similar to those reported in phase III studies of anti-TNF agents in which most of the patients had not received previous anti-TNF therapy (response rates of 58% to 64% at weeks 12 to 24), even though 30% to 40% of the patients in our studies had had no response to previous anti-TNF treatment,” the authors wrote.
“Thus, secukinumab not only is effective in patients who have not received TNF agents previously but also may be effective in patients in whom previous anti-TNF treatment failed,” they added.
In MEASURE 1, 371 patients received intravenous secukinumab (10 mg/kg of body weight) or matched placebo at weeks 0, 2, and 4, followed by subcutaneous secukinumab (150 mg or 75 mg) or matched placebo every 4 weeks starting at week 8.
The study’s primary endpoint of ASAS20 response rates at week 16 were 61%, 60%, and 29% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively, (P less than .001 for both comparisons with placebo).
In MEASURE 2, 219 patients received subcutaneous secukinumab (150 mg or 75 mg) or matched placebo at baseline; at weeks 1, 2, and 3; and every 4 weeks starting at week 4.
At week 16, patients in the placebo group were randomly reassigned to subcutaneous secukinumab at a dose of 150 mg or 75 mg.
In this trial, ASAS20 rates were 61%, 41%, and 28% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P less than .001 for the 150-mg dose and P = .10 for the 75-mg dose).
The researchers noted that the ineffectiveness of the 75-mg dose in MEASURE 2 suggests that the efficacy of secukinumab at the 75-mg dose in MEASURE 1 may have been due to the greater exposure at week 16 as a result of the intravenous loading regimen, not to the 75-mg subcutaneous maintenance dose.
The safety profile of secukinumab in the present studies was consistent with previous studies of secukinumab for ankylosing spondylitis and moderate-to-severe plaque psoriasis, Dr. Baeten and his associates said.
During the entire treatment period, pooled exposure-adjusted incidence rates of grade 3 or 4 neutropenia, candida infections, and Crohn’s disease were 0.7, 0.9, and 0.7 cases per 100 patient-years, respectively, in secukinumab-treated patients.
Overall, the results suggest that interleukin-17A plays a role in the pathogenesis of ankylosing spondylitis, and they validate inhibition of this cytokine as a potential therapeutic approach, the study authors concluded.
The study was sponsored by Novartis Pharma. Dr. Baeten has received a grant from Novartis to study the impact of IL-17A blockade in experimental models of spondyloarthritis. He also has been a consultant for Novartis for the design and conduct of the secukinumab program in ankylosing spondylitis and psoriatic arthritis.
Secukinumab, an interleukin 17-A inhibitor approved for the treatment of moderate to severe psoriasis, significantly reduced the signs and symptoms of ankylosing spondylitis in two phase III trials, researchers reported Dec. 23 in the New England Journal of Medicine.
The results of the double-blind MEASURE 1 and MEASURE 2 trials extend the positive results of the phase II study, according to Dr. Dominique Baeten of the Academic Medical Center at the University of Amsterdam and his colleagues (N Engl J Med. 2015 Dec 23. doi: 10.1056/NEJMoa1505066).
“Although head-to-head trials would be required to fully assess the efficacy and safety of secukinumab versus TNF-inhibitors, the [20% improvement in Assessment of Spondyloarthritis International Society (ASAS20) response criteria] response rates achieved with secukinumab at week 16 in our studies were similar to those reported in phase III studies of anti-TNF agents in which most of the patients had not received previous anti-TNF therapy (response rates of 58% to 64% at weeks 12 to 24), even though 30% to 40% of the patients in our studies had had no response to previous anti-TNF treatment,” the authors wrote.
“Thus, secukinumab not only is effective in patients who have not received TNF agents previously but also may be effective in patients in whom previous anti-TNF treatment failed,” they added.
In MEASURE 1, 371 patients received intravenous secukinumab (10 mg/kg of body weight) or matched placebo at weeks 0, 2, and 4, followed by subcutaneous secukinumab (150 mg or 75 mg) or matched placebo every 4 weeks starting at week 8.
The study’s primary endpoint of ASAS20 response rates at week 16 were 61%, 60%, and 29% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively, (P less than .001 for both comparisons with placebo).
In MEASURE 2, 219 patients received subcutaneous secukinumab (150 mg or 75 mg) or matched placebo at baseline; at weeks 1, 2, and 3; and every 4 weeks starting at week 4.
At week 16, patients in the placebo group were randomly reassigned to subcutaneous secukinumab at a dose of 150 mg or 75 mg.
In this trial, ASAS20 rates were 61%, 41%, and 28% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P less than .001 for the 150-mg dose and P = .10 for the 75-mg dose).
The researchers noted that the ineffectiveness of the 75-mg dose in MEASURE 2 suggests that the efficacy of secukinumab at the 75-mg dose in MEASURE 1 may have been due to the greater exposure at week 16 as a result of the intravenous loading regimen, not to the 75-mg subcutaneous maintenance dose.
The safety profile of secukinumab in the present studies was consistent with previous studies of secukinumab for ankylosing spondylitis and moderate-to-severe plaque psoriasis, Dr. Baeten and his associates said.
During the entire treatment period, pooled exposure-adjusted incidence rates of grade 3 or 4 neutropenia, candida infections, and Crohn’s disease were 0.7, 0.9, and 0.7 cases per 100 patient-years, respectively, in secukinumab-treated patients.
Overall, the results suggest that interleukin-17A plays a role in the pathogenesis of ankylosing spondylitis, and they validate inhibition of this cytokine as a potential therapeutic approach, the study authors concluded.
The study was sponsored by Novartis Pharma. Dr. Baeten has received a grant from Novartis to study the impact of IL-17A blockade in experimental models of spondyloarthritis. He also has been a consultant for Novartis for the design and conduct of the secukinumab program in ankylosing spondylitis and psoriatic arthritis.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Interleukin-17A may play a role in ankylosing spondylitis, and secukinumab may prove to be an effective therapy for these patients.
Major finding: The primary endpoint of Assessment of Spondyloarthritis International Society (ASAS20) response rates at week 16 was met in both secukinumab groups in MEASURE 1 and in the group that received 150 mg of secukinumab subcutaneously in MEASURE 2.
Data source: Two double-blind, phase III studies: MEASURE 1 involving 371 patients with AS and MEASURE 2 involving 371 patients.
Disclosures: The studies were funded by Novartis Pharma. Dr. Baeten has received a grant from Novartis to study the impact of IL-17A blockade in experimental models of spondyloarthritis. He also has been a consultant for Novartis for the design and conduct of the secukinumab program in ankylosing spondylitis and psoriatic arthritis.
‘Hot’ Joints May Predict RA Joint Damage
Recording the temperature of skin over an inflamed joint may identify rheumatoid arthritis patients at high risk of joint damage, an exploratory study suggested.
Dermal joint temperature could become a screening test to “quickly and accurately” identify individual RA patients at high risk for radiographic damage and those who may benefit from biologic therapy, said Dr. Maria Greenwald, a rheumatologist in group practice in Palm Desert, Calif., and her colleagues.
During 2009-2014, the investigators enrolled seropositive RA patients who were on stable doses of methotrexate (20-25 mg/wk) for the past 3 months and did not use biologics or other disease-modifying antirheumatic drugs. It took 9 months to enroll 104 patients with cool joints and 42 months to enroll 104 patients with hot joints, suggesting “that at a single office visit, RA patients on methotrexate are five times more likely to have cool joints than hot joints,” the researchers reported.
The results showed that patients in the hot-joint cohort had a nearly fourfold higher risk of x-ray damage at 1-year follow-up, compared with those with cool joints (change in modified van der Heijde total Sharp score [mTSS]: 8.7 vs. 2.5; P less than .001). Patients with hot joints had an average joint temperature exceeding central forehead body temperature by 1.1° F, whereas those with cool joints had an average joint temperature of 4.3° F below central forehead body temperature.
In the cohort of patients with hot joints, 74% had clear x-ray evidence of new joint damage (mTSS of 5 or greater), compared with 7% of cold-joint cohort patients at 1-year follow-up. Joint temperature at the hand or wrist predicted x-ray damage in the next year with 92% sensitivity and 78% specificity(Arthritis Care Res. 2015 Dec 14. doi: 10.1002/acr.22813).
Patients in the hot-joint cohort were younger, had more recent onset of RA, and had a significantly higher Westergren erythrocyte sedimentation rate than patients in the cool-joint cohort, the investigators noted.
They suggested a future study might define a hot-joint cohort as RA patients with a joint that measures over a set point such as 98° F. “Such a cutoff would make assessment very simple and would maintain the specificity and sensitivity of the model,” they said.
No conflicts of interest were disclosed.
Recording the temperature of skin over an inflamed joint may identify rheumatoid arthritis patients at high risk of joint damage, an exploratory study suggested.
Dermal joint temperature could become a screening test to “quickly and accurately” identify individual RA patients at high risk for radiographic damage and those who may benefit from biologic therapy, said Dr. Maria Greenwald, a rheumatologist in group practice in Palm Desert, Calif., and her colleagues.
During 2009-2014, the investigators enrolled seropositive RA patients who were on stable doses of methotrexate (20-25 mg/wk) for the past 3 months and did not use biologics or other disease-modifying antirheumatic drugs. It took 9 months to enroll 104 patients with cool joints and 42 months to enroll 104 patients with hot joints, suggesting “that at a single office visit, RA patients on methotrexate are five times more likely to have cool joints than hot joints,” the researchers reported.
The results showed that patients in the hot-joint cohort had a nearly fourfold higher risk of x-ray damage at 1-year follow-up, compared with those with cool joints (change in modified van der Heijde total Sharp score [mTSS]: 8.7 vs. 2.5; P less than .001). Patients with hot joints had an average joint temperature exceeding central forehead body temperature by 1.1° F, whereas those with cool joints had an average joint temperature of 4.3° F below central forehead body temperature.
In the cohort of patients with hot joints, 74% had clear x-ray evidence of new joint damage (mTSS of 5 or greater), compared with 7% of cold-joint cohort patients at 1-year follow-up. Joint temperature at the hand or wrist predicted x-ray damage in the next year with 92% sensitivity and 78% specificity(Arthritis Care Res. 2015 Dec 14. doi: 10.1002/acr.22813).
Patients in the hot-joint cohort were younger, had more recent onset of RA, and had a significantly higher Westergren erythrocyte sedimentation rate than patients in the cool-joint cohort, the investigators noted.
They suggested a future study might define a hot-joint cohort as RA patients with a joint that measures over a set point such as 98° F. “Such a cutoff would make assessment very simple and would maintain the specificity and sensitivity of the model,” they said.
No conflicts of interest were disclosed.
Recording the temperature of skin over an inflamed joint may identify rheumatoid arthritis patients at high risk of joint damage, an exploratory study suggested.
Dermal joint temperature could become a screening test to “quickly and accurately” identify individual RA patients at high risk for radiographic damage and those who may benefit from biologic therapy, said Dr. Maria Greenwald, a rheumatologist in group practice in Palm Desert, Calif., and her colleagues.
During 2009-2014, the investigators enrolled seropositive RA patients who were on stable doses of methotrexate (20-25 mg/wk) for the past 3 months and did not use biologics or other disease-modifying antirheumatic drugs. It took 9 months to enroll 104 patients with cool joints and 42 months to enroll 104 patients with hot joints, suggesting “that at a single office visit, RA patients on methotrexate are five times more likely to have cool joints than hot joints,” the researchers reported.
The results showed that patients in the hot-joint cohort had a nearly fourfold higher risk of x-ray damage at 1-year follow-up, compared with those with cool joints (change in modified van der Heijde total Sharp score [mTSS]: 8.7 vs. 2.5; P less than .001). Patients with hot joints had an average joint temperature exceeding central forehead body temperature by 1.1° F, whereas those with cool joints had an average joint temperature of 4.3° F below central forehead body temperature.
In the cohort of patients with hot joints, 74% had clear x-ray evidence of new joint damage (mTSS of 5 or greater), compared with 7% of cold-joint cohort patients at 1-year follow-up. Joint temperature at the hand or wrist predicted x-ray damage in the next year with 92% sensitivity and 78% specificity(Arthritis Care Res. 2015 Dec 14. doi: 10.1002/acr.22813).
Patients in the hot-joint cohort were younger, had more recent onset of RA, and had a significantly higher Westergren erythrocyte sedimentation rate than patients in the cool-joint cohort, the investigators noted.
They suggested a future study might define a hot-joint cohort as RA patients with a joint that measures over a set point such as 98° F. “Such a cutoff would make assessment very simple and would maintain the specificity and sensitivity of the model,” they said.
No conflicts of interest were disclosed.
FROM ARTHRITIS CARE & RESEARCH
‘Hot’ joints may predict RA joint damage
Recording the temperature of skin over an inflamed joint may identify rheumatoid arthritis patients at high risk of joint damage, an exploratory study suggested.
Dermal joint temperature could become a screening test to “quickly and accurately” identify individual RA patients at high risk for radiographic damage and those who may benefit from biologic therapy, said Dr. Maria Greenwald, a rheumatologist in group practice in Palm Desert, Calif., and her colleagues.
During 2009-2014, the investigators enrolled seropositive RA patients who were on stable doses of methotrexate (20-25 mg/wk) for the past 3 months and did not use biologics or other disease-modifying antirheumatic drugs. It took 9 months to enroll 104 patients with cool joints and 42 months to enroll 104 patients with hot joints, suggesting “that at a single office visit, RA patients on methotrexate are five times more likely to have cool joints than hot joints,” the researchers reported.
The results showed that patients in the hot-joint cohort had a nearly fourfold higher risk of x-ray damage at 1-year follow-up, compared with those with cool joints (change in modified van der Heijde total Sharp score [mTSS]: 8.7 vs. 2.5; P less than .001). Patients with hot joints had an average joint temperature exceeding central forehead body temperature by 1.1° F, whereas those with cool joints had an average joint temperature of 4.3° F below central forehead body temperature.
In the cohort of patients with hot joints, 74% had clear x-ray evidence of new joint damage (mTSS of 5 or greater), compared with 7% of cold-joint cohort patients at 1-year follow-up. Joint temperature at the hand or wrist predicted x-ray damage in the next year with 92% sensitivity and 78% specificity(Arthritis Care Res. 2015 Dec 14. doi: 10.1002/acr.22813).
Patients in the hot-joint cohort were younger, had more recent onset of RA, and had a significantly higher Westergren erythrocyte sedimentation rate than patients in the cool-joint cohort, the investigators noted.
They suggested a future study might define a hot-joint cohort as RA patients with a joint that measures over a set point such as 98° F. “Such a cutoff would make assessment very simple and would maintain the specificity and sensitivity of the model,” they said.
No conflicts of interest were disclosed.
Recording the temperature of skin over an inflamed joint may identify rheumatoid arthritis patients at high risk of joint damage, an exploratory study suggested.
Dermal joint temperature could become a screening test to “quickly and accurately” identify individual RA patients at high risk for radiographic damage and those who may benefit from biologic therapy, said Dr. Maria Greenwald, a rheumatologist in group practice in Palm Desert, Calif., and her colleagues.
During 2009-2014, the investigators enrolled seropositive RA patients who were on stable doses of methotrexate (20-25 mg/wk) for the past 3 months and did not use biologics or other disease-modifying antirheumatic drugs. It took 9 months to enroll 104 patients with cool joints and 42 months to enroll 104 patients with hot joints, suggesting “that at a single office visit, RA patients on methotrexate are five times more likely to have cool joints than hot joints,” the researchers reported.
The results showed that patients in the hot-joint cohort had a nearly fourfold higher risk of x-ray damage at 1-year follow-up, compared with those with cool joints (change in modified van der Heijde total Sharp score [mTSS]: 8.7 vs. 2.5; P less than .001). Patients with hot joints had an average joint temperature exceeding central forehead body temperature by 1.1° F, whereas those with cool joints had an average joint temperature of 4.3° F below central forehead body temperature.
In the cohort of patients with hot joints, 74% had clear x-ray evidence of new joint damage (mTSS of 5 or greater), compared with 7% of cold-joint cohort patients at 1-year follow-up. Joint temperature at the hand or wrist predicted x-ray damage in the next year with 92% sensitivity and 78% specificity(Arthritis Care Res. 2015 Dec 14. doi: 10.1002/acr.22813).
Patients in the hot-joint cohort were younger, had more recent onset of RA, and had a significantly higher Westergren erythrocyte sedimentation rate than patients in the cool-joint cohort, the investigators noted.
They suggested a future study might define a hot-joint cohort as RA patients with a joint that measures over a set point such as 98° F. “Such a cutoff would make assessment very simple and would maintain the specificity and sensitivity of the model,” they said.
No conflicts of interest were disclosed.
Recording the temperature of skin over an inflamed joint may identify rheumatoid arthritis patients at high risk of joint damage, an exploratory study suggested.
Dermal joint temperature could become a screening test to “quickly and accurately” identify individual RA patients at high risk for radiographic damage and those who may benefit from biologic therapy, said Dr. Maria Greenwald, a rheumatologist in group practice in Palm Desert, Calif., and her colleagues.
During 2009-2014, the investigators enrolled seropositive RA patients who were on stable doses of methotrexate (20-25 mg/wk) for the past 3 months and did not use biologics or other disease-modifying antirheumatic drugs. It took 9 months to enroll 104 patients with cool joints and 42 months to enroll 104 patients with hot joints, suggesting “that at a single office visit, RA patients on methotrexate are five times more likely to have cool joints than hot joints,” the researchers reported.
The results showed that patients in the hot-joint cohort had a nearly fourfold higher risk of x-ray damage at 1-year follow-up, compared with those with cool joints (change in modified van der Heijde total Sharp score [mTSS]: 8.7 vs. 2.5; P less than .001). Patients with hot joints had an average joint temperature exceeding central forehead body temperature by 1.1° F, whereas those with cool joints had an average joint temperature of 4.3° F below central forehead body temperature.
In the cohort of patients with hot joints, 74% had clear x-ray evidence of new joint damage (mTSS of 5 or greater), compared with 7% of cold-joint cohort patients at 1-year follow-up. Joint temperature at the hand or wrist predicted x-ray damage in the next year with 92% sensitivity and 78% specificity(Arthritis Care Res. 2015 Dec 14. doi: 10.1002/acr.22813).
Patients in the hot-joint cohort were younger, had more recent onset of RA, and had a significantly higher Westergren erythrocyte sedimentation rate than patients in the cool-joint cohort, the investigators noted.
They suggested a future study might define a hot-joint cohort as RA patients with a joint that measures over a set point such as 98° F. “Such a cutoff would make assessment very simple and would maintain the specificity and sensitivity of the model,” they said.
No conflicts of interest were disclosed.
FROM ARTHRITIS CARE & RESEARCH
Key clinical point: A raised skin temperature over an inflamed joint may identify RA patients at risk of joint damage.
Major finding: Patients with hot joints had a nearly fourfold higher risk of x-ray damage at follow-up, compared with those with cool joints.
Data source: An observational pilot study involving 208 RA patients.
Disclosures: No conflicts of interest were declared.
Thigh muscle weakness a risk factor for knee replacement in women
Women with knee osteoarthritis who had low thigh muscle strength were more likely to need a knee replacement in a case-control study of participants in the Osteoarthritis Initiative (OAI).
In particular, predictors of knee replacement included knee extensor weakness in the year prior to knee replacement and longitudinal deterioration in knee extensor strength over a 2-year observation period prior to surgery. Measurement of knee extensor strength in women with knee osteoarthritis may then indicate who could benefit from weight training exercises to potentially delay or prevent the need for knee replacement surgery, said the researchers, led by Dr. Adam Culvenor of Paracelsus Medical University in Salzburg, Austria (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39540).
The optimal knee extensor strength threshold for differentiating those with and without knee replacement risk was approximately 200 N or 0.9 Nm/kg; or prevention of any loss of knee extensor strength over 2 years.
“There appears to be a considerable window for women below this threshold to obtain realistic strength gains and potentially lower the risk of knee replacement,” the study authors concluded.
In the multicenter, longitudinal, case-control study of 4,796 participants in the OAI (60% of whom were women), the investigators identified 136 participants who had received a knee replacement and matched them with controls who had not received a knee replacement and were similar in age, body mass index (BMI), and radiographic stage. The mean age of the women was 65 years and the mean BMI was 29 kg/m2.
The results showed that knee extensor strength at the examination prior to knee replacement (time T0), which occurred 2 years or less before surgery, was significantly lower in females who had received a knee replacement than in matched controls (pain-adjusted odds ratio, 1.72; 95% confidence interval, 1.16-2.56; P = .007). Measurement of the longitudinal change in knee extensor and flexor strength between T0 and 2 years prior to T0 (T-2) also provided similar results (pain-adjusted OR, 4.30; 95% CI, 1.34-13.79; P = .014). The findings were independent of age, BMI, and radiographic disease severity, the researchers noted.
The investigators found no relationship between knee extensor or flexor muscle strength in men and subsequent need for knee replacement surgery. The relationship between thigh muscle strength and knee replacement for women did not extend to measurements made at T-2 or T-4 or the change in thigh muscle strength between T-2 and T-4.
The OAI receives funding from the National Institutes of Health, Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. The work was also funded by a grant from the European Union Seventh Framework Programme. One author disclosed consulting or preparing educational sessions for pharmaceutical companies and for receiving research support. Two authors reported being employees of Chondrometrics GmbH, a company providing MR image analysis services to academic researchers and to industry.
Women with knee osteoarthritis who had low thigh muscle strength were more likely to need a knee replacement in a case-control study of participants in the Osteoarthritis Initiative (OAI).
In particular, predictors of knee replacement included knee extensor weakness in the year prior to knee replacement and longitudinal deterioration in knee extensor strength over a 2-year observation period prior to surgery. Measurement of knee extensor strength in women with knee osteoarthritis may then indicate who could benefit from weight training exercises to potentially delay or prevent the need for knee replacement surgery, said the researchers, led by Dr. Adam Culvenor of Paracelsus Medical University in Salzburg, Austria (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39540).
The optimal knee extensor strength threshold for differentiating those with and without knee replacement risk was approximately 200 N or 0.9 Nm/kg; or prevention of any loss of knee extensor strength over 2 years.
“There appears to be a considerable window for women below this threshold to obtain realistic strength gains and potentially lower the risk of knee replacement,” the study authors concluded.
In the multicenter, longitudinal, case-control study of 4,796 participants in the OAI (60% of whom were women), the investigators identified 136 participants who had received a knee replacement and matched them with controls who had not received a knee replacement and were similar in age, body mass index (BMI), and radiographic stage. The mean age of the women was 65 years and the mean BMI was 29 kg/m2.
The results showed that knee extensor strength at the examination prior to knee replacement (time T0), which occurred 2 years or less before surgery, was significantly lower in females who had received a knee replacement than in matched controls (pain-adjusted odds ratio, 1.72; 95% confidence interval, 1.16-2.56; P = .007). Measurement of the longitudinal change in knee extensor and flexor strength between T0 and 2 years prior to T0 (T-2) also provided similar results (pain-adjusted OR, 4.30; 95% CI, 1.34-13.79; P = .014). The findings were independent of age, BMI, and radiographic disease severity, the researchers noted.
The investigators found no relationship between knee extensor or flexor muscle strength in men and subsequent need for knee replacement surgery. The relationship between thigh muscle strength and knee replacement for women did not extend to measurements made at T-2 or T-4 or the change in thigh muscle strength between T-2 and T-4.
The OAI receives funding from the National Institutes of Health, Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. The work was also funded by a grant from the European Union Seventh Framework Programme. One author disclosed consulting or preparing educational sessions for pharmaceutical companies and for receiving research support. Two authors reported being employees of Chondrometrics GmbH, a company providing MR image analysis services to academic researchers and to industry.
Women with knee osteoarthritis who had low thigh muscle strength were more likely to need a knee replacement in a case-control study of participants in the Osteoarthritis Initiative (OAI).
In particular, predictors of knee replacement included knee extensor weakness in the year prior to knee replacement and longitudinal deterioration in knee extensor strength over a 2-year observation period prior to surgery. Measurement of knee extensor strength in women with knee osteoarthritis may then indicate who could benefit from weight training exercises to potentially delay or prevent the need for knee replacement surgery, said the researchers, led by Dr. Adam Culvenor of Paracelsus Medical University in Salzburg, Austria (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39540).
The optimal knee extensor strength threshold for differentiating those with and without knee replacement risk was approximately 200 N or 0.9 Nm/kg; or prevention of any loss of knee extensor strength over 2 years.
“There appears to be a considerable window for women below this threshold to obtain realistic strength gains and potentially lower the risk of knee replacement,” the study authors concluded.
In the multicenter, longitudinal, case-control study of 4,796 participants in the OAI (60% of whom were women), the investigators identified 136 participants who had received a knee replacement and matched them with controls who had not received a knee replacement and were similar in age, body mass index (BMI), and radiographic stage. The mean age of the women was 65 years and the mean BMI was 29 kg/m2.
The results showed that knee extensor strength at the examination prior to knee replacement (time T0), which occurred 2 years or less before surgery, was significantly lower in females who had received a knee replacement than in matched controls (pain-adjusted odds ratio, 1.72; 95% confidence interval, 1.16-2.56; P = .007). Measurement of the longitudinal change in knee extensor and flexor strength between T0 and 2 years prior to T0 (T-2) also provided similar results (pain-adjusted OR, 4.30; 95% CI, 1.34-13.79; P = .014). The findings were independent of age, BMI, and radiographic disease severity, the researchers noted.
The investigators found no relationship between knee extensor or flexor muscle strength in men and subsequent need for knee replacement surgery. The relationship between thigh muscle strength and knee replacement for women did not extend to measurements made at T-2 or T-4 or the change in thigh muscle strength between T-2 and T-4.
The OAI receives funding from the National Institutes of Health, Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. The work was also funded by a grant from the European Union Seventh Framework Programme. One author disclosed consulting or preparing educational sessions for pharmaceutical companies and for receiving research support. Two authors reported being employees of Chondrometrics GmbH, a company providing MR image analysis services to academic researchers and to industry.
FROM ARTHRITIS & RHEUMATOLOGY
Key clinical point: A window of opportunity exists for women with knee osteoarthritis and low thigh muscle strength to potentially lower their risk of knee replacement.
Major finding: Women who underwent knee replacement had significantly lower thigh muscle strength compared to matched controls who had not had knee surgery.
Data source: A multicenter longitudinal case control study involving 4,796 participants in the Osteoarthritis Initiative (OAI).
Disclosures: The OAI receives funding from the National Institutes of Health, Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. The work was also funded by a grant from the European Union Seventh Framework Programme. One author disclosed consulting or preparing educational sessions for pharmaceutical companies and for receiving research support. Two authors reported being employees of Chondrometrics GmbH, a company providing MR image analysis services to academic researchers and to industry.
Oral steroid dose, duration affect diabetes risk for people with RA
People with rheumatoid arthritis who take oral glucocorticoids have an increased risk of diabetes, the magnitude of which is dependent on dose and treatment duration, based on an analysis of two databases.
Dr. Mohammad Movahedi of the Arthritis Research UK Centre for Epidemiology at the University of Manchester (England) led researchers conducting the observational study using the U.K. primary care database (CPRD) of 21,962 RA patients and the U.S. National Data Bank for Rheumatic Diseases (NDB) involving 12,657 RA patients (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39537).
The hazard ratio (HR) for developing diabetes was 1.30 (95% confidence interval, 1.17-1.45) for patients taking oral glucocorticoids in the CPRD cohort and 1.61 (95% CI, 1.37-1.89) for people in the NDB cohort.
While doses taken more than 6 months ago did not influence current risk, each 5-mg increase of current oral glucocorticoid dose was associated with a 25% and 30% increased risk of diabetes in the CPRD and NDB cohorts, respectively.
According to the researchers, identifying the risk of diabetes with various doses and durations of therapy allows clinicians and patients to make informed decisions about treatment as well as balance the benefits and harms.
The research team plans to examine the threshold for cost-effective diabetes screening in patients receiving steroids for RA.
Individual investigators reported support for their work from the Medical Research Council, the Canadian Institute for Health Research, the Rheumatology Research Foundation, and the NIHR Manchester Musculoskeletal Biomedical Research Unit.
People with rheumatoid arthritis who take oral glucocorticoids have an increased risk of diabetes, the magnitude of which is dependent on dose and treatment duration, based on an analysis of two databases.
Dr. Mohammad Movahedi of the Arthritis Research UK Centre for Epidemiology at the University of Manchester (England) led researchers conducting the observational study using the U.K. primary care database (CPRD) of 21,962 RA patients and the U.S. National Data Bank for Rheumatic Diseases (NDB) involving 12,657 RA patients (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39537).
The hazard ratio (HR) for developing diabetes was 1.30 (95% confidence interval, 1.17-1.45) for patients taking oral glucocorticoids in the CPRD cohort and 1.61 (95% CI, 1.37-1.89) for people in the NDB cohort.
While doses taken more than 6 months ago did not influence current risk, each 5-mg increase of current oral glucocorticoid dose was associated with a 25% and 30% increased risk of diabetes in the CPRD and NDB cohorts, respectively.
According to the researchers, identifying the risk of diabetes with various doses and durations of therapy allows clinicians and patients to make informed decisions about treatment as well as balance the benefits and harms.
The research team plans to examine the threshold for cost-effective diabetes screening in patients receiving steroids for RA.
Individual investigators reported support for their work from the Medical Research Council, the Canadian Institute for Health Research, the Rheumatology Research Foundation, and the NIHR Manchester Musculoskeletal Biomedical Research Unit.
People with rheumatoid arthritis who take oral glucocorticoids have an increased risk of diabetes, the magnitude of which is dependent on dose and treatment duration, based on an analysis of two databases.
Dr. Mohammad Movahedi of the Arthritis Research UK Centre for Epidemiology at the University of Manchester (England) led researchers conducting the observational study using the U.K. primary care database (CPRD) of 21,962 RA patients and the U.S. National Data Bank for Rheumatic Diseases (NDB) involving 12,657 RA patients (Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39537).
The hazard ratio (HR) for developing diabetes was 1.30 (95% confidence interval, 1.17-1.45) for patients taking oral glucocorticoids in the CPRD cohort and 1.61 (95% CI, 1.37-1.89) for people in the NDB cohort.
While doses taken more than 6 months ago did not influence current risk, each 5-mg increase of current oral glucocorticoid dose was associated with a 25% and 30% increased risk of diabetes in the CPRD and NDB cohorts, respectively.
According to the researchers, identifying the risk of diabetes with various doses and durations of therapy allows clinicians and patients to make informed decisions about treatment as well as balance the benefits and harms.
The research team plans to examine the threshold for cost-effective diabetes screening in patients receiving steroids for RA.
Individual investigators reported support for their work from the Medical Research Council, the Canadian Institute for Health Research, the Rheumatology Research Foundation, and the NIHR Manchester Musculoskeletal Biomedical Research Unit.
FROM ARTHRITIS & RHEUMATOLOGY
Key clinical point: The magnitude of increased diabetes risk associated with oral glucocorticoids is dependent on duration of treatment and dose.
Major finding: People with RA who were taking oral corticosteroids had up to 60% higher risk of developing diabetes, compared with nonusers.
Data source: An observational study using two databases: the U.K. primary care database of 21,962 RA patients and the U.S. National Data Bank for Rheumatic Diseases involving 12,657 RA patients.
Disclosures: Individual investigators reported support for their work from the Medical Research Council, the Canadian Institute for Health Research, the Rheumatology Research Foundation, and the NIHR Manchester Musculoskeletal Biomedical Research Unit.
Dactylitis warns of future damage in psoriatic arthritis
Baseline radiographic damage and the presence of dactylitis at 5 years are independent predictors of further joint destruction in people with psoriatic arthritis, according to follow-up data from a psoriatic arthritis registry.
The analysis of hand and foot radiographic findings from 72 patients (29 men, 43 women) participating in the Swedish Early Psoriatic Arthritis Registry (SwePsA) registry found that radiographic progression in early PsA was generally slow but was substantial in men. At entry to the registry, the patients had a mean age of about 48 years and had symptoms for a median of 12 months. Most had polyarticular disease as a result of the registry’s protocol, and none had arthritis mutilans or axial disease only. Three men and none of the women had combined axial and peripheral disease, reported Dr. Mats Geijer of the Center for Medical Imaging and Physiology at Skåne University Hospital, Lund, Sweden, and his colleagues (J Rheumatol. 2015 Oct 15. doi: 10.3899/jrheum.150165).
Only 4 (14%) of the men did not have radiographic changes at 5 years, compared with 17 (40%) women, making male sex a risk factor for structural abnormality (odds ratio, 4.09; 95% confidence interval, 1.2-13.8; P = .024). Most of the radiographic changes in men occurred in the feet. Baseline radiographic changes also were a significant predictor of additional radiographic damage at 5 years (OR, 3.4; 95% CI, 2.2-5.2; P less than .001).
In a multivariate linear regression analysis, only baseline radiographic score and the presence of dactylitis at 5 years were independent predictors of a high radiographic score at 5-year follow-up.
The findings suggested that men improve clinically but develop radiographic changes, whereas women show less clinical improvement but do not develop joint damage to the same extent as men. This gender-divergent behavior could be taken into consideration when planning treatment and care for patients, the authors said.
For example, women may require more interventions against functional deterioration and help coping with pain and men may need follow-up radiography, especially in the presence of dactylitis, high disease activity, and a known propensity for radiographic destruction, they suggested.
“Radiography and scoring the hands and feet at baseline are important and cannot be substituted with clinical signs, especially in men,” they concluded.
The study was supported by independent grants from the Swedish Psoriasis Foundation, Skåne University Hospital (SUS Fonder) and Pfizer.
Baseline radiographic damage and the presence of dactylitis at 5 years are independent predictors of further joint destruction in people with psoriatic arthritis, according to follow-up data from a psoriatic arthritis registry.
The analysis of hand and foot radiographic findings from 72 patients (29 men, 43 women) participating in the Swedish Early Psoriatic Arthritis Registry (SwePsA) registry found that radiographic progression in early PsA was generally slow but was substantial in men. At entry to the registry, the patients had a mean age of about 48 years and had symptoms for a median of 12 months. Most had polyarticular disease as a result of the registry’s protocol, and none had arthritis mutilans or axial disease only. Three men and none of the women had combined axial and peripheral disease, reported Dr. Mats Geijer of the Center for Medical Imaging and Physiology at Skåne University Hospital, Lund, Sweden, and his colleagues (J Rheumatol. 2015 Oct 15. doi: 10.3899/jrheum.150165).
Only 4 (14%) of the men did not have radiographic changes at 5 years, compared with 17 (40%) women, making male sex a risk factor for structural abnormality (odds ratio, 4.09; 95% confidence interval, 1.2-13.8; P = .024). Most of the radiographic changes in men occurred in the feet. Baseline radiographic changes also were a significant predictor of additional radiographic damage at 5 years (OR, 3.4; 95% CI, 2.2-5.2; P less than .001).
In a multivariate linear regression analysis, only baseline radiographic score and the presence of dactylitis at 5 years were independent predictors of a high radiographic score at 5-year follow-up.
The findings suggested that men improve clinically but develop radiographic changes, whereas women show less clinical improvement but do not develop joint damage to the same extent as men. This gender-divergent behavior could be taken into consideration when planning treatment and care for patients, the authors said.
For example, women may require more interventions against functional deterioration and help coping with pain and men may need follow-up radiography, especially in the presence of dactylitis, high disease activity, and a known propensity for radiographic destruction, they suggested.
“Radiography and scoring the hands and feet at baseline are important and cannot be substituted with clinical signs, especially in men,” they concluded.
The study was supported by independent grants from the Swedish Psoriasis Foundation, Skåne University Hospital (SUS Fonder) and Pfizer.
Baseline radiographic damage and the presence of dactylitis at 5 years are independent predictors of further joint destruction in people with psoriatic arthritis, according to follow-up data from a psoriatic arthritis registry.
The analysis of hand and foot radiographic findings from 72 patients (29 men, 43 women) participating in the Swedish Early Psoriatic Arthritis Registry (SwePsA) registry found that radiographic progression in early PsA was generally slow but was substantial in men. At entry to the registry, the patients had a mean age of about 48 years and had symptoms for a median of 12 months. Most had polyarticular disease as a result of the registry’s protocol, and none had arthritis mutilans or axial disease only. Three men and none of the women had combined axial and peripheral disease, reported Dr. Mats Geijer of the Center for Medical Imaging and Physiology at Skåne University Hospital, Lund, Sweden, and his colleagues (J Rheumatol. 2015 Oct 15. doi: 10.3899/jrheum.150165).
Only 4 (14%) of the men did not have radiographic changes at 5 years, compared with 17 (40%) women, making male sex a risk factor for structural abnormality (odds ratio, 4.09; 95% confidence interval, 1.2-13.8; P = .024). Most of the radiographic changes in men occurred in the feet. Baseline radiographic changes also were a significant predictor of additional radiographic damage at 5 years (OR, 3.4; 95% CI, 2.2-5.2; P less than .001).
In a multivariate linear regression analysis, only baseline radiographic score and the presence of dactylitis at 5 years were independent predictors of a high radiographic score at 5-year follow-up.
The findings suggested that men improve clinically but develop radiographic changes, whereas women show less clinical improvement but do not develop joint damage to the same extent as men. This gender-divergent behavior could be taken into consideration when planning treatment and care for patients, the authors said.
For example, women may require more interventions against functional deterioration and help coping with pain and men may need follow-up radiography, especially in the presence of dactylitis, high disease activity, and a known propensity for radiographic destruction, they suggested.
“Radiography and scoring the hands and feet at baseline are important and cannot be substituted with clinical signs, especially in men,” they concluded.
The study was supported by independent grants from the Swedish Psoriasis Foundation, Skåne University Hospital (SUS Fonder) and Pfizer.
FROM JOURNAL OF RHEUMATOLOGY
Key clinical point: Men with early psoriatic arthritis tend to improve clinically but develop radiographic changes over a 5-year period, whereas women show less clinical improvement but do not develop joint damage to the same extent as men.
Major finding: Only 4 (14%) of the men did not have radiographic changes at 5 years, compared with 17 (40%) women, making male sex a risk factor for structural abnormality (OR, 4.09; 95% CI, 1.2-13.8; P = .024).
Data source: A longitudinal cohort study of 72 patients with psoriatic arthritis from the Swedish Early Psoriatic Arthritis Registry.
Disclosures: The study was supported by independent grants from the Swedish Psoriasis Foundation, Skåne University Hospital (SUS Fonder) and Pfizer.
