Nicola Garrett

Intravenous immunoglobulin may be an effective add-on therapy for patients with active diffuse cutaneous systemic sclerosis who are unresponsive to traditional immunosuppressive treatment, a single-center, observational study reports.

While intravenous immunoglobulin (IVIG) is commonly used to treat other autoimmune diseases, its effects on patients with systemic sclerosis is unclear, reported the authors led by Corrie L. Poelman and associates at Johns Hopkins University, Baltimore (J. Rheumatol. 2014 Nov. 29 [doi:10.3899/jrheum.140833]).

Their observational study involved 30 patients with refractory active diffuse cutaneous systemic sclerosis (dcSSc) who received treatment at the Johns Hopkins Scleroderma Center during 2004-2012.

The majority of patients (90%) had attempted other immunomodulatory or antifibrotic therapies without significant benefit.

Patients received IVIG 2 g/kg per month as part of routine clinical care. On average, patients completed 8.5 cycles of therapy along with concomitant therapy, which included mycophenolate mofetil (MMF, 70%), prednisolone (33.3%), cyclophosphamide (20%), methotrexate (10%), imatinib (3.3%), and hydroxychloroquine (3.3%).

Results showed a significant improvement in skin thickening over time, the researchers said.

The cohort’s mean baseline modified Rodnan skin score (mRSS) of 29.6 significantly decreased to 24.1 (n = 29; P = .0011) at 6 months, 22.5 (n = 25; P = .0001) at 12 months, 20.6 (n = 23; P= .0001) at 18 months, and 15.3 (n = 15; P < .0001) at 24 months.

Given the study’s retrospective nature, lack of a placebo control, and the frequent use of concomitant therapy, the researchers compared the changes in mRSS in the cohort with data from three large negative trials.

The comparison suggested that the improvement seen in their cohort “may be greater at 12 months than what would be expected by the natural history of the disease,” they said.

“In addition, the cohort treated with IVIG had a clinical improvement in mRSS that was similar to a group of patients treated with MMF who were typically deemed clinical responders, suggesting that addition of IVIG may stabilize previous refractory disease,” they added.

While the researchers did not see improvements in the Health Assessment Questionnaire-Disability Index (HAQ-DI) – a measure of activity and disease damage – patients’ assessments of disease severity significantly improved over time.

More than 70% discontinued IVIG because of improvement or stabilization as assessed by the treating physician, including one patient who developed an acute renal injury 15 months after discontinuing it because of improvement. Other discontinuations involved one who developed aseptic meningitis and stopped taking it because of severe side effects, one who stopped because of a transient ischemic attack, two who quit because of insurance coverage issues. One patient died of sudden cardiac arrest from a preexisting cardiomyopathy 16 months after initiating IVIG.

“IVIG may be an effective adjunctive therapy for active dcSSc in patients failing other therapies,” they concluded.

The study was supported by grants from the Scleroderma Research Foundation, he Catherine A. Keilty Memorial Fund for Scleroderma Research, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. No disclosures were given.

Intravenous immunoglobulin may be an effective add-on therapy for patients with active diffuse cutaneous systemic sclerosis who are unresponsive to traditional immunosuppressive treatment, a single-center, observational study reports.

While intravenous immunoglobulin (IVIG) is commonly used to treat other autoimmune diseases, its effects on patients with systemic sclerosis is unclear, reported the authors led by Corrie L. Poelman and associates at Johns Hopkins University, Baltimore (J. Rheumatol. 2014 Nov. 29 [doi:10.3899/jrheum.140833]).

Their observational study involved 30 patients with refractory active diffuse cutaneous systemic sclerosis (dcSSc) who received treatment at the Johns Hopkins Scleroderma Center during 2004-2012.

The majority of patients (90%) had attempted other immunomodulatory or antifibrotic therapies without significant benefit.

Patients received IVIG 2 g/kg per month as part of routine clinical care. On average, patients completed 8.5 cycles of therapy along with concomitant therapy, which included mycophenolate mofetil (MMF, 70%), prednisolone (33.3%), cyclophosphamide (20%), methotrexate (10%), imatinib (3.3%), and hydroxychloroquine (3.3%).

Results showed a significant improvement in skin thickening over time, the researchers said.

The cohort’s mean baseline modified Rodnan skin score (mRSS) of 29.6 significantly decreased to 24.1 (n = 29; P = .0011) at 6 months, 22.5 (n = 25; P = .0001) at 12 months, 20.6 (n = 23; P= .0001) at 18 months, and 15.3 (n = 15; P < .0001) at 24 months.

Given the study’s retrospective nature, lack of a placebo control, and the frequent use of concomitant therapy, the researchers compared the changes in mRSS in the cohort with data from three large negative trials.

The comparison suggested that the improvement seen in their cohort “may be greater at 12 months than what would be expected by the natural history of the disease,” they said.

“In addition, the cohort treated with IVIG had a clinical improvement in mRSS that was similar to a group of patients treated with MMF who were typically deemed clinical responders, suggesting that addition of IVIG may stabilize previous refractory disease,” they added.

While the researchers did not see improvements in the Health Assessment Questionnaire-Disability Index (HAQ-DI) – a measure of activity and disease damage – patients’ assessments of disease severity significantly improved over time.

More than 70% discontinued IVIG because of improvement or stabilization as assessed by the treating physician, including one patient who developed an acute renal injury 15 months after discontinuing it because of improvement. Other discontinuations involved one who developed aseptic meningitis and stopped taking it because of severe side effects, one who stopped because of a transient ischemic attack, two who quit because of insurance coverage issues. One patient died of sudden cardiac arrest from a preexisting cardiomyopathy 16 months after initiating IVIG.

“IVIG may be an effective adjunctive therapy for active dcSSc in patients failing other therapies,” they concluded.

The study was supported by grants from the Scleroderma Research Foundation, he Catherine A. Keilty Memorial Fund for Scleroderma Research, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. No disclosures were given.

Intravenous immunoglobulin may be an effective add-on therapy for patients with active diffuse cutaneous systemic sclerosis who are unresponsive to traditional immunosuppressive treatment, a single-center, observational study reports.

While intravenous immunoglobulin (IVIG) is commonly used to treat other autoimmune diseases, its effects on patients with systemic sclerosis is unclear, reported the authors led by Corrie L. Poelman and associates at Johns Hopkins University, Baltimore (J. Rheumatol. 2014 Nov. 29 [doi:10.3899/jrheum.140833]).

Their observational study involved 30 patients with refractory active diffuse cutaneous systemic sclerosis (dcSSc) who received treatment at the Johns Hopkins Scleroderma Center during 2004-2012.

The majority of patients (90%) had attempted other immunomodulatory or antifibrotic therapies without significant benefit.

Patients received IVIG 2 g/kg per month as part of routine clinical care. On average, patients completed 8.5 cycles of therapy along with concomitant therapy, which included mycophenolate mofetil (MMF, 70%), prednisolone (33.3%), cyclophosphamide (20%), methotrexate (10%), imatinib (3.3%), and hydroxychloroquine (3.3%).

Results showed a significant improvement in skin thickening over time, the researchers said.

The cohort’s mean baseline modified Rodnan skin score (mRSS) of 29.6 significantly decreased to 24.1 (n = 29; P = .0011) at 6 months, 22.5 (n = 25; P = .0001) at 12 months, 20.6 (n = 23; P= .0001) at 18 months, and 15.3 (n = 15; P < .0001) at 24 months.

Given the study’s retrospective nature, lack of a placebo control, and the frequent use of concomitant therapy, the researchers compared the changes in mRSS in the cohort with data from three large negative trials.

The comparison suggested that the improvement seen in their cohort “may be greater at 12 months than what would be expected by the natural history of the disease,” they said.

“In addition, the cohort treated with IVIG had a clinical improvement in mRSS that was similar to a group of patients treated with MMF who were typically deemed clinical responders, suggesting that addition of IVIG may stabilize previous refractory disease,” they added.

While the researchers did not see improvements in the Health Assessment Questionnaire-Disability Index (HAQ-DI) – a measure of activity and disease damage – patients’ assessments of disease severity significantly improved over time.

More than 70% discontinued IVIG because of improvement or stabilization as assessed by the treating physician, including one patient who developed an acute renal injury 15 months after discontinuing it because of improvement. Other discontinuations involved one who developed aseptic meningitis and stopped taking it because of severe side effects, one who stopped because of a transient ischemic attack, two who quit because of insurance coverage issues. One patient died of sudden cardiac arrest from a preexisting cardiomyopathy 16 months after initiating IVIG.

“IVIG may be an effective adjunctive therapy for active dcSSc in patients failing other therapies,” they concluded.

The study was supported by grants from the Scleroderma Research Foundation, he Catherine A. Keilty Memorial Fund for Scleroderma Research, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. No disclosures were given.

Immunogenicity to three TNF-alpha blocking agents seems to vary substantially among patients with psoriatic arthritis, and the use of methotrexate appears to attenuate the presence of antidrug antibodies, according to findings from a cross-sectional study.

Although researchers have looked at the immunogenicity of TNF-alpha blockers in patients with diseases such as rheumatoid arthritis (RA), ankylosing spondylitis, psoriasis, and inflammatory bowel disease, their immunogenicity in psoriatic arthritis (PsA) patients has not been fully investigated, noted the current study’s investigators, led by Dr. Michael Zisapel of the department of rheumatology at Tel Aviv University (J. Rheumatol. 2014 Nov. 15 [doi:10.3899/jrheum.140685]).

The prevalence of antidrug antibodies (ADAb) to TNF-alpha blockers has been reported to be 20%-40% in RA, 25%-64% in ankylosing spondylitis, and about 33% in psoriasis, and evidence has shown that this is significantly reduced by the use of methotrexate, they said.

The study involved 93 patients with PsA who were taking adalimumab (n = 48), infliximab (n = 24), and etanercept (n = 21). A quarter of the patients were taking methotrexate at an average dose of 13.3 mg/week.

Overall, 77% of the patients had therapeutic drug levels. The prevalence of immunogenicity in the entire group was 33.3%, and one-fifth of patients had high concentrations of antibodies.

High levels of ADAb were found in 29% of patients taking adalimumab and 21% of the patients taking infliximab. No ADAb levels were found in patients taking etanercept.

Interestingly, the patients taking adalimumab demonstrated an immunogenicity of 54%, but only half of them (29%) showed high concentrations of antibodies.

“This finding suggests that a variety of levels might be found that might affect the significance of immunogenicity differently among patients producing ADAb,” the investigators wrote.

Fewer methotrexate-treated patients had high ADAb concentrations, compared with patients not taking methotrexate (16.7% vs. 21.7%).

A clear correlation was found between the presence of immunogenicity, lower drug levels, and decreased clinical response in PsA patients, just as other studies have found in RA and ankylosing spondylitis patients, the authors noted.

“Our results suggest that the use of methotrexate should be strongly considered in addition to monoclonal antibodies,” they said.

Limitations of their study included the small number of patients and the use of a bridging ELISA test which is reliable but considered to be less accurate than radioimmunoassay.

No disclosure information was available.

Immunogenicity to three TNF-alpha blocking agents seems to vary substantially among patients with psoriatic arthritis, and the use of methotrexate appears to attenuate the presence of antidrug antibodies, according to findings from a cross-sectional study.

Although researchers have looked at the immunogenicity of TNF-alpha blockers in patients with diseases such as rheumatoid arthritis (RA), ankylosing spondylitis, psoriasis, and inflammatory bowel disease, their immunogenicity in psoriatic arthritis (PsA) patients has not been fully investigated, noted the current study’s investigators, led by Dr. Michael Zisapel of the department of rheumatology at Tel Aviv University (J. Rheumatol. 2014 Nov. 15 [doi:10.3899/jrheum.140685]).

The prevalence of antidrug antibodies (ADAb) to TNF-alpha blockers has been reported to be 20%-40% in RA, 25%-64% in ankylosing spondylitis, and about 33% in psoriasis, and evidence has shown that this is significantly reduced by the use of methotrexate, they said.

The study involved 93 patients with PsA who were taking adalimumab (n = 48), infliximab (n = 24), and etanercept (n = 21). A quarter of the patients were taking methotrexate at an average dose of 13.3 mg/week.

Overall, 77% of the patients had therapeutic drug levels. The prevalence of immunogenicity in the entire group was 33.3%, and one-fifth of patients had high concentrations of antibodies.

High levels of ADAb were found in 29% of patients taking adalimumab and 21% of the patients taking infliximab. No ADAb levels were found in patients taking etanercept.

Interestingly, the patients taking adalimumab demonstrated an immunogenicity of 54%, but only half of them (29%) showed high concentrations of antibodies.

“This finding suggests that a variety of levels might be found that might affect the significance of immunogenicity differently among patients producing ADAb,” the investigators wrote.

Fewer methotrexate-treated patients had high ADAb concentrations, compared with patients not taking methotrexate (16.7% vs. 21.7%).

A clear correlation was found between the presence of immunogenicity, lower drug levels, and decreased clinical response in PsA patients, just as other studies have found in RA and ankylosing spondylitis patients, the authors noted.

“Our results suggest that the use of methotrexate should be strongly considered in addition to monoclonal antibodies,” they said.

Limitations of their study included the small number of patients and the use of a bridging ELISA test which is reliable but considered to be less accurate than radioimmunoassay.

No disclosure information was available.

Immunogenicity to three TNF-alpha blocking agents seems to vary substantially among patients with psoriatic arthritis, and the use of methotrexate appears to attenuate the presence of antidrug antibodies, according to findings from a cross-sectional study.

Although researchers have looked at the immunogenicity of TNF-alpha blockers in patients with diseases such as rheumatoid arthritis (RA), ankylosing spondylitis, psoriasis, and inflammatory bowel disease, their immunogenicity in psoriatic arthritis (PsA) patients has not been fully investigated, noted the current study’s investigators, led by Dr. Michael Zisapel of the department of rheumatology at Tel Aviv University (J. Rheumatol. 2014 Nov. 15 [doi:10.3899/jrheum.140685]).

The prevalence of antidrug antibodies (ADAb) to TNF-alpha blockers has been reported to be 20%-40% in RA, 25%-64% in ankylosing spondylitis, and about 33% in psoriasis, and evidence has shown that this is significantly reduced by the use of methotrexate, they said.

The study involved 93 patients with PsA who were taking adalimumab (n = 48), infliximab (n = 24), and etanercept (n = 21). A quarter of the patients were taking methotrexate at an average dose of 13.3 mg/week.

Overall, 77% of the patients had therapeutic drug levels. The prevalence of immunogenicity in the entire group was 33.3%, and one-fifth of patients had high concentrations of antibodies.

High levels of ADAb were found in 29% of patients taking adalimumab and 21% of the patients taking infliximab. No ADAb levels were found in patients taking etanercept.

Interestingly, the patients taking adalimumab demonstrated an immunogenicity of 54%, but only half of them (29%) showed high concentrations of antibodies.

“This finding suggests that a variety of levels might be found that might affect the significance of immunogenicity differently among patients producing ADAb,” the investigators wrote.

Fewer methotrexate-treated patients had high ADAb concentrations, compared with patients not taking methotrexate (16.7% vs. 21.7%).

A clear correlation was found between the presence of immunogenicity, lower drug levels, and decreased clinical response in PsA patients, just as other studies have found in RA and ankylosing spondylitis patients, the authors noted.

“Our results suggest that the use of methotrexate should be strongly considered in addition to monoclonal antibodies,” they said.

Limitations of their study included the small number of patients and the use of a bridging ELISA test which is reliable but considered to be less accurate than radioimmunoassay.

No disclosure information was available.

Fixed-interval, repeat-dose rituximab is an effective maintenance therapy for patients with ANCA-associated vasculitis, a retrospective study reports.

The study helps to inform the ideal duration of maintenance treatment and the effects of cumulative treatment of ANCA (antineutrophil cytoplasmic antibody)–associated vasculitis (AAV) with the anti-CD20 monoclonal antibody rituximab, which is one of the currently unknown factors in the biologic’s use as an induction and maintenance treatment, according to the study authors, led by Dr. Federico Alberici from the University of Cambridge (England) (Rheumatology 2014 Dec. 3 [doi:10.1093/rheumatology/keu452]).

Current evidence suggests that maintenance therapy in AAV should be continued for 18-24 months, but the risk of relapse is high with standard maintenance treatment with first-line agents, they noted.

The researchers followed 69 AAV patients who received fixed-interval, repeat-dose rituximab for 2 years.

For initial remission induction, patients received rituximab 1 g every 2 weeks or 375 mg/m² weekly for 4 consecutive weeks. Remission maintenance was 1 g every 6 months for 24 months.

At the first rituximab dose, ongoing immunosuppressives were withdrawn and prednisolone was tapered during follow-up, with the aim of achieving complete withdrawal or 5 mg/day.

During the treatment protocol, nine patients (13%) relapsed at a median of 11 months after the first rituximab infusion, the researchers reported.

However, by the end of the maintenance phase, all 69 patients were in remission; 33 patients (48%) were not receiving steroids and 63 patients (91%) were not receiving other immunosuppressants.

During the posttreatment follow-up, 28 patients relapsed a median of 34.4 months after their last rituximab infusion.

Relapse risk was higher in patients who had a return of B cells within 12 months of the last rituximab dose (P = .0052), a switch from ANCA negativity to positivity (P = .0046), and PR3-associated disease (P = .039), the researchers reported.

“In order to allow early identification of major relapses in patients not on immunosuppression, we recommend monitoring B cells and ANCA after rituximab withdrawal,” they wrote.

“Better biomarkers are required to identify patients at relapse risk after rituximab maintenance therapy withdrawal,” they added.

The study was supported by the National Institute of Health Research Cambridge Biomedical Research Centre. Two authors reported receiving lecture fees and/or a research grant from Roche/Genentech, the manufacturer of rituximab. Another

Fixed-interval, repeat-dose rituximab is an effective maintenance therapy for patients with ANCA-associated vasculitis, a retrospective study reports.

The study helps to inform the ideal duration of maintenance treatment and the effects of cumulative treatment of ANCA (antineutrophil cytoplasmic antibody)–associated vasculitis (AAV) with the anti-CD20 monoclonal antibody rituximab, which is one of the currently unknown factors in the biologic’s use as an induction and maintenance treatment, according to the study authors, led by Dr. Federico Alberici from the University of Cambridge (England) (Rheumatology 2014 Dec. 3 [doi:10.1093/rheumatology/keu452]).

Current evidence suggests that maintenance therapy in AAV should be continued for 18-24 months, but the risk of relapse is high with standard maintenance treatment with first-line agents, they noted.

The researchers followed 69 AAV patients who received fixed-interval, repeat-dose rituximab for 2 years.

For initial remission induction, patients received rituximab 1 g every 2 weeks or 375 mg/m² weekly for 4 consecutive weeks. Remission maintenance was 1 g every 6 months for 24 months.

At the first rituximab dose, ongoing immunosuppressives were withdrawn and prednisolone was tapered during follow-up, with the aim of achieving complete withdrawal or 5 mg/day.

During the treatment protocol, nine patients (13%) relapsed at a median of 11 months after the first rituximab infusion, the researchers reported.

However, by the end of the maintenance phase, all 69 patients were in remission; 33 patients (48%) were not receiving steroids and 63 patients (91%) were not receiving other immunosuppressants.

During the posttreatment follow-up, 28 patients relapsed a median of 34.4 months after their last rituximab infusion.

Relapse risk was higher in patients who had a return of B cells within 12 months of the last rituximab dose (P = .0052), a switch from ANCA negativity to positivity (P = .0046), and PR3-associated disease (P = .039), the researchers reported.

“In order to allow early identification of major relapses in patients not on immunosuppression, we recommend monitoring B cells and ANCA after rituximab withdrawal,” they wrote.

“Better biomarkers are required to identify patients at relapse risk after rituximab maintenance therapy withdrawal,” they added.

The study was supported by the National Institute of Health Research Cambridge Biomedical Research Centre. Two authors reported receiving lecture fees and/or a research grant from Roche/Genentech, the manufacturer of rituximab. Another

Fixed-interval, repeat-dose rituximab is an effective maintenance therapy for patients with ANCA-associated vasculitis, a retrospective study reports.

The study helps to inform the ideal duration of maintenance treatment and the effects of cumulative treatment of ANCA (antineutrophil cytoplasmic antibody)–associated vasculitis (AAV) with the anti-CD20 monoclonal antibody rituximab, which is one of the currently unknown factors in the biologic’s use as an induction and maintenance treatment, according to the study authors, led by Dr. Federico Alberici from the University of Cambridge (England) (Rheumatology 2014 Dec. 3 [doi:10.1093/rheumatology/keu452]).

Current evidence suggests that maintenance therapy in AAV should be continued for 18-24 months, but the risk of relapse is high with standard maintenance treatment with first-line agents, they noted.

The researchers followed 69 AAV patients who received fixed-interval, repeat-dose rituximab for 2 years.

For initial remission induction, patients received rituximab 1 g every 2 weeks or 375 mg/m² weekly for 4 consecutive weeks. Remission maintenance was 1 g every 6 months for 24 months.

At the first rituximab dose, ongoing immunosuppressives were withdrawn and prednisolone was tapered during follow-up, with the aim of achieving complete withdrawal or 5 mg/day.

During the treatment protocol, nine patients (13%) relapsed at a median of 11 months after the first rituximab infusion, the researchers reported.

However, by the end of the maintenance phase, all 69 patients were in remission; 33 patients (48%) were not receiving steroids and 63 patients (91%) were not receiving other immunosuppressants.

During the posttreatment follow-up, 28 patients relapsed a median of 34.4 months after their last rituximab infusion.

Relapse risk was higher in patients who had a return of B cells within 12 months of the last rituximab dose (P = .0052), a switch from ANCA negativity to positivity (P = .0046), and PR3-associated disease (P = .039), the researchers reported.

“In order to allow early identification of major relapses in patients not on immunosuppression, we recommend monitoring B cells and ANCA after rituximab withdrawal,” they wrote.

“Better biomarkers are required to identify patients at relapse risk after rituximab maintenance therapy withdrawal,” they added.

The study was supported by the National Institute of Health Research Cambridge Biomedical Research Centre. Two authors reported receiving lecture fees and/or a research grant from Roche/Genentech, the manufacturer of rituximab. Another

The prevalence of low back pain appears to be higher in people with psoriasis than in the general population, according to an analysis of national survey data.

The findings may change the way psoriasis patients are managed when they present to primary care or specialty clinics with sudden-onset back and buttock pain, said first author of the study, Dr. Nicole Thom of the division of rheumatology at Cedars-Sinai Medical Center, Los Angeles, and her colleagues (Arthritis Care Res. 2014 Dec. 2 [doi:10.1002/acr.22528]).

Using data from the 2009-2010 U.S. National Health and Nutrition Examination Survey of 6,684 adults, the researchers identified 5,103 people who had answered questions on back pain. A total of 148 had psoriasis and 5 had psoriatic arthritis (PsA).

People with psoriasis/PsA had a significantly higher prevalence of axial pain as measured using the 3-month duration criteria, compared with people without the disease (31.1% vs. 18.9%; P = .04). They were also more likely to have alternating buttock pain (7.2% vs. 2.4%; P = .03) and meet Berlin 7b and 8a criteria for inflammatory back pain (P = .04 and P = .02, respectively). The prevalence of spondyloarthritis was significantly higher in the psoriasis/PsA group when using Amor or European Spondyloarthritis Study Group criteria (14.3% vs. 1.5%; P = .001). Sudden onset of axial pain was also higher in the psoriasis/PsA group (23.3% vs. 13.0%; P = .01), the researchers reported.

“The internist or family medicine physician should include inflammatory back pain in their differential diagnosis,” the study authors suggest.

With more and more research continuing to support multiple comorbidities in psoriasis, it also raises the question as to whether rheumatologists, dermatologists, and other health care professionals should be screening for them, they said.

The work was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and a National Center for Research Resources grant to the Clinical Translational Science Institute at the University of California, Los Angeles.

The prevalence of low back pain appears to be higher in people with psoriasis than in the general population, according to an analysis of national survey data.

The findings may change the way psoriasis patients are managed when they present to primary care or specialty clinics with sudden-onset back and buttock pain, said first author of the study, Dr. Nicole Thom of the division of rheumatology at Cedars-Sinai Medical Center, Los Angeles, and her colleagues (Arthritis Care Res. 2014 Dec. 2 [doi:10.1002/acr.22528]).

Using data from the 2009-2010 U.S. National Health and Nutrition Examination Survey of 6,684 adults, the researchers identified 5,103 people who had answered questions on back pain. A total of 148 had psoriasis and 5 had psoriatic arthritis (PsA).

People with psoriasis/PsA had a significantly higher prevalence of axial pain as measured using the 3-month duration criteria, compared with people without the disease (31.1% vs. 18.9%; P = .04). They were also more likely to have alternating buttock pain (7.2% vs. 2.4%; P = .03) and meet Berlin 7b and 8a criteria for inflammatory back pain (P = .04 and P = .02, respectively). The prevalence of spondyloarthritis was significantly higher in the psoriasis/PsA group when using Amor or European Spondyloarthritis Study Group criteria (14.3% vs. 1.5%; P = .001). Sudden onset of axial pain was also higher in the psoriasis/PsA group (23.3% vs. 13.0%; P = .01), the researchers reported.

“The internist or family medicine physician should include inflammatory back pain in their differential diagnosis,” the study authors suggest.

With more and more research continuing to support multiple comorbidities in psoriasis, it also raises the question as to whether rheumatologists, dermatologists, and other health care professionals should be screening for them, they said.

The work was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and a National Center for Research Resources grant to the Clinical Translational Science Institute at the University of California, Los Angeles.

The prevalence of low back pain appears to be higher in people with psoriasis than in the general population, according to an analysis of national survey data.

The findings may change the way psoriasis patients are managed when they present to primary care or specialty clinics with sudden-onset back and buttock pain, said first author of the study, Dr. Nicole Thom of the division of rheumatology at Cedars-Sinai Medical Center, Los Angeles, and her colleagues (Arthritis Care Res. 2014 Dec. 2 [doi:10.1002/acr.22528]).

Using data from the 2009-2010 U.S. National Health and Nutrition Examination Survey of 6,684 adults, the researchers identified 5,103 people who had answered questions on back pain. A total of 148 had psoriasis and 5 had psoriatic arthritis (PsA).

People with psoriasis/PsA had a significantly higher prevalence of axial pain as measured using the 3-month duration criteria, compared with people without the disease (31.1% vs. 18.9%; P = .04). They were also more likely to have alternating buttock pain (7.2% vs. 2.4%; P = .03) and meet Berlin 7b and 8a criteria for inflammatory back pain (P = .04 and P = .02, respectively). The prevalence of spondyloarthritis was significantly higher in the psoriasis/PsA group when using Amor or European Spondyloarthritis Study Group criteria (14.3% vs. 1.5%; P = .001). Sudden onset of axial pain was also higher in the psoriasis/PsA group (23.3% vs. 13.0%; P = .01), the researchers reported.

“The internist or family medicine physician should include inflammatory back pain in their differential diagnosis,” the study authors suggest.

With more and more research continuing to support multiple comorbidities in psoriasis, it also raises the question as to whether rheumatologists, dermatologists, and other health care professionals should be screening for them, they said.

The work was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and a National Center for Research Resources grant to the Clinical Translational Science Institute at the University of California, Los Angeles.

Women with lupus and a history of preeclampsia have almost fourfold higher odds of subsequent heart disease as measured by coronary artery calcium than do women with the disease who never had preeclampsia, according to findings from an exploratory study.

Women with systemic lupus erythematosus (SLE) are at an increased risk of pregnancy complications, including preeclampsia, preterm birth, and low birth weight, wrote Dr. Pin Lin of the division of rheumatology at Northwestern University, Chicago, and her colleagues (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000024]).

Using data from the longitudinal Study of Long-Term Vascular and Bone Outcomes in Lupus Erythematosus (SOLVABLE), the authors assessed the potential association between these adverse events and subsequent heart disease.

Of the 129 women included in the current study, there were 331 pregnancies, 66% of which occurred before the diagnosis of SLE.

Of the 56 women who reported an adverse event during pregnancy, 26 had at least one pregnancy complicated by preeclampsia, 36 had at least one pregnancy resulting in preterm birth, and 28 had at least one low-birth-weight infant. The women with or without complications had similar ages (44-45 years), SLE characteristics, and circulating markers of inflammation and endothelial activation. They also were similar with respect to many cardiovascular disease risk factors, except that hypertension occurred significantly more often among those with a history of complications (66% vs. 47%).

Results showed that women with a history of preeclampsia were more likely to have a coronary artery calcium (CAC) score greater than or equal to 10 (adjusted odds ratio, 3.7; 95% confidence interval, 1.2-11.9) than were women without a history of preeclampsia after adjustment for age and disease duration. However, the presence of plaque was not associated with this adverse pregnancy outcome, the authors reported.

Low birth weight and preterm birth were not associated with CAC or plaque.

In an accompanying editorial, Dr. Julia F. Simard of Stanford (Calif.) University and Dr. Jinoos Yazdany of the University of California, San Francisco, said that despite a clear question and the clinical significance, the study design and data only hint at an answer (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000035]).

The work should be viewed as exploratory, they said, building a scientific foundation for more definitive studies that will answer questions like:

• Should pregnancy complications alert clinicians caring for women with SLE about subsequent CVD risks necessitating more aggressive risk factor modification?

• Should preeclampsia be viewed as a ‘failed cardiac stress test?’ and

• Does the presence of SLE and preeclampsia together substantially increase CVD risk greater than expected with either risk factor alone?

“As the body of evidence between CVD and pregnancy morbidity grows, this line of study may unlock key risk factors to aid in the identification and management of early CVD in women with SLE,” they concluded.

The study was supported by grants from the National Institutes of Health, the Mary Kirkland Center for Lupus Research, and Rheuminations Inc. No relevant financial disclosures were declared.

Women with lupus and a history of preeclampsia have almost fourfold higher odds of subsequent heart disease as measured by coronary artery calcium than do women with the disease who never had preeclampsia, according to findings from an exploratory study.

Women with systemic lupus erythematosus (SLE) are at an increased risk of pregnancy complications, including preeclampsia, preterm birth, and low birth weight, wrote Dr. Pin Lin of the division of rheumatology at Northwestern University, Chicago, and her colleagues (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000024]).

Using data from the longitudinal Study of Long-Term Vascular and Bone Outcomes in Lupus Erythematosus (SOLVABLE), the authors assessed the potential association between these adverse events and subsequent heart disease.

Of the 129 women included in the current study, there were 331 pregnancies, 66% of which occurred before the diagnosis of SLE.

Of the 56 women who reported an adverse event during pregnancy, 26 had at least one pregnancy complicated by preeclampsia, 36 had at least one pregnancy resulting in preterm birth, and 28 had at least one low-birth-weight infant. The women with or without complications had similar ages (44-45 years), SLE characteristics, and circulating markers of inflammation and endothelial activation. They also were similar with respect to many cardiovascular disease risk factors, except that hypertension occurred significantly more often among those with a history of complications (66% vs. 47%).

Results showed that women with a history of preeclampsia were more likely to have a coronary artery calcium (CAC) score greater than or equal to 10 (adjusted odds ratio, 3.7; 95% confidence interval, 1.2-11.9) than were women without a history of preeclampsia after adjustment for age and disease duration. However, the presence of plaque was not associated with this adverse pregnancy outcome, the authors reported.

Low birth weight and preterm birth were not associated with CAC or plaque.

In an accompanying editorial, Dr. Julia F. Simard of Stanford (Calif.) University and Dr. Jinoos Yazdany of the University of California, San Francisco, said that despite a clear question and the clinical significance, the study design and data only hint at an answer (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000035]).

The work should be viewed as exploratory, they said, building a scientific foundation for more definitive studies that will answer questions like:

• Should pregnancy complications alert clinicians caring for women with SLE about subsequent CVD risks necessitating more aggressive risk factor modification?

• Should preeclampsia be viewed as a ‘failed cardiac stress test?’ and

• Does the presence of SLE and preeclampsia together substantially increase CVD risk greater than expected with either risk factor alone?

“As the body of evidence between CVD and pregnancy morbidity grows, this line of study may unlock key risk factors to aid in the identification and management of early CVD in women with SLE,” they concluded.

The study was supported by grants from the National Institutes of Health, the Mary Kirkland Center for Lupus Research, and Rheuminations Inc. No relevant financial disclosures were declared.

Women with lupus and a history of preeclampsia have almost fourfold higher odds of subsequent heart disease as measured by coronary artery calcium than do women with the disease who never had preeclampsia, according to findings from an exploratory study.

Women with systemic lupus erythematosus (SLE) are at an increased risk of pregnancy complications, including preeclampsia, preterm birth, and low birth weight, wrote Dr. Pin Lin of the division of rheumatology at Northwestern University, Chicago, and her colleagues (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000024]).

Using data from the longitudinal Study of Long-Term Vascular and Bone Outcomes in Lupus Erythematosus (SOLVABLE), the authors assessed the potential association between these adverse events and subsequent heart disease.

Of the 129 women included in the current study, there were 331 pregnancies, 66% of which occurred before the diagnosis of SLE.

Of the 56 women who reported an adverse event during pregnancy, 26 had at least one pregnancy complicated by preeclampsia, 36 had at least one pregnancy resulting in preterm birth, and 28 had at least one low-birth-weight infant. The women with or without complications had similar ages (44-45 years), SLE characteristics, and circulating markers of inflammation and endothelial activation. They also were similar with respect to many cardiovascular disease risk factors, except that hypertension occurred significantly more often among those with a history of complications (66% vs. 47%).

Results showed that women with a history of preeclampsia were more likely to have a coronary artery calcium (CAC) score greater than or equal to 10 (adjusted odds ratio, 3.7; 95% confidence interval, 1.2-11.9) than were women without a history of preeclampsia after adjustment for age and disease duration. However, the presence of plaque was not associated with this adverse pregnancy outcome, the authors reported.

Low birth weight and preterm birth were not associated with CAC or plaque.

In an accompanying editorial, Dr. Julia F. Simard of Stanford (Calif.) University and Dr. Jinoos Yazdany of the University of California, San Francisco, said that despite a clear question and the clinical significance, the study design and data only hint at an answer (Lupus Sci. Med. 2014 Dec. 12 [doi:10.1136/lupus-2014-000035]).

The work should be viewed as exploratory, they said, building a scientific foundation for more definitive studies that will answer questions like:

• Should pregnancy complications alert clinicians caring for women with SLE about subsequent CVD risks necessitating more aggressive risk factor modification?

• Should preeclampsia be viewed as a ‘failed cardiac stress test?’ and

• Does the presence of SLE and preeclampsia together substantially increase CVD risk greater than expected with either risk factor alone?

“As the body of evidence between CVD and pregnancy morbidity grows, this line of study may unlock key risk factors to aid in the identification and management of early CVD in women with SLE,” they concluded.

The study was supported by grants from the National Institutes of Health, the Mary Kirkland Center for Lupus Research, and Rheuminations Inc. No relevant financial disclosures were declared.

Skin burns, fainting, and eye injuries are the most common indoor tanning injuries requiring a trip to the local emergency department, according to a research letter published online Dec. 15 in JAMA Internal Medicine.

Indoor tanning exposes users to intense ultraviolet radiation, a known carcinogen, but little is known about the more immediate adverse events related to tanning, wrote Gery P. Guy Jr., Ph.D., of the Centers for Disease Control and Prevention, and coauthors.

After analyzing data from a nationally representative sample of hospital emergency departments from 2003 to 2012, the investigators estimated an average 3,234 indoor tanning–related injuries were treated each year in U.S. hospitals.

The most common injury was skin burns (79.5%), followed by syncope (9.5%) and eye injuries (5.8%).

Injuries occurred most commonly among younger adults and non-Hispanic white females, the populations with the highest rates of indoor tanning.

However, indoor tanning injuries were on the decline, decreasing from 6,487 in 2003 to 1,957 in 2012 (P < .001), a finding that was most likely due to a decline in the use of indoor sun beds, the researchers said.

Most patients did not require hospitalization, but burns severe enough to warrant a trip to the emergency department indicate an overexposure to ultraviolet radiation and an increased risk of skin cancer, the investigators added.

Although the Food and Drug Administration required tanning device manufacturers to install timers to limit exposure, several cases described patients falling asleep while tanning, raising concerns about timers malfunctioning or being intentionally overridden, the researchers noted.

The researchers said they had no relevant financial conflicts to disclose.

Skin burns, fainting, and eye injuries are the most common indoor tanning injuries requiring a trip to the local emergency department, according to a research letter published online Dec. 15 in JAMA Internal Medicine.

Indoor tanning exposes users to intense ultraviolet radiation, a known carcinogen, but little is known about the more immediate adverse events related to tanning, wrote Gery P. Guy Jr., Ph.D., of the Centers for Disease Control and Prevention, and coauthors.

After analyzing data from a nationally representative sample of hospital emergency departments from 2003 to 2012, the investigators estimated an average 3,234 indoor tanning–related injuries were treated each year in U.S. hospitals.

The most common injury was skin burns (79.5%), followed by syncope (9.5%) and eye injuries (5.8%).

Injuries occurred most commonly among younger adults and non-Hispanic white females, the populations with the highest rates of indoor tanning.

However, indoor tanning injuries were on the decline, decreasing from 6,487 in 2003 to 1,957 in 2012 (P < .001), a finding that was most likely due to a decline in the use of indoor sun beds, the researchers said.

Most patients did not require hospitalization, but burns severe enough to warrant a trip to the emergency department indicate an overexposure to ultraviolet radiation and an increased risk of skin cancer, the investigators added.

Although the Food and Drug Administration required tanning device manufacturers to install timers to limit exposure, several cases described patients falling asleep while tanning, raising concerns about timers malfunctioning or being intentionally overridden, the researchers noted.

The researchers said they had no relevant financial conflicts to disclose.

Skin burns, fainting, and eye injuries are the most common indoor tanning injuries requiring a trip to the local emergency department, according to a research letter published online Dec. 15 in JAMA Internal Medicine.

Indoor tanning exposes users to intense ultraviolet radiation, a known carcinogen, but little is known about the more immediate adverse events related to tanning, wrote Gery P. Guy Jr., Ph.D., of the Centers for Disease Control and Prevention, and coauthors.

After analyzing data from a nationally representative sample of hospital emergency departments from 2003 to 2012, the investigators estimated an average 3,234 indoor tanning–related injuries were treated each year in U.S. hospitals.

The most common injury was skin burns (79.5%), followed by syncope (9.5%) and eye injuries (5.8%).

Injuries occurred most commonly among younger adults and non-Hispanic white females, the populations with the highest rates of indoor tanning.

However, indoor tanning injuries were on the decline, decreasing from 6,487 in 2003 to 1,957 in 2012 (P < .001), a finding that was most likely due to a decline in the use of indoor sun beds, the researchers said.

Most patients did not require hospitalization, but burns severe enough to warrant a trip to the emergency department indicate an overexposure to ultraviolet radiation and an increased risk of skin cancer, the investigators added.

Although the Food and Drug Administration required tanning device manufacturers to install timers to limit exposure, several cases described patients falling asleep while tanning, raising concerns about timers malfunctioning or being intentionally overridden, the researchers noted.

The researchers said they had no relevant financial conflicts to disclose.

A large portion of young people using e-cigarettes are also smoking tobacco cigarettes, a cross-sectional study from Hawaii showed, raising concerns that the rise in the popularity of “vaping” may be renormalizing cigarette smoking.

Electronic cigarettes are a rising phenomenon in the United States, with projected sales in 2013 reaching $11.7 billion, Thomas A. Willis, Ph.D., and his associates at the University of Hawaii in Honolulu wrote in Pediatrics (2014 Feb. 15 [doi:10.1542/peds.2014-0760]).

There are two schools of thought on the use of e-cigarettes in adolescents, Dr. Willis and his colleagues wrote. One suggests that youth who try e-cigarettes are motivated by health values and concerns, making it unlikely that they also would try cigarettes or other substances.

However, the contrasting model argues that e-cigarettes appeal to young people wishing to rebel against conventional values, making it likely that they also would try tobacco and alcohol. “Although both formulations are plausible, there is little empirical evidence to support or reject either theory at this time,” the study authors wrote.

Conducting a school-based survey of 1,941 high school students living in Oahu, Hawaii, who were on average 14.6 years old, the researchers sought to determine what risk factors and conversely,which protective factors lead to a higher or lower likelihood of substance use. They found that 17% of respondents used e-cigarettes only, 12% used e-cigarettes and tobacco cigarettes (dual users), 3% used cigarettes only, and 68% were nonusers. The use of e-cigarettes in the student population was higher than seen in other data, although the authors noted that young people in Hawaii are particularly exposed to aggressive marketing.

According to the authors, some support for both schools of thought can be found in their data.

For example, people who used e-cigarettes only did not score high on rebelliousness and sensation seeking, compared with dual users. This finding supports the first model by showing that people who fall into this group are less prone to deviance, the investigators said. However, consistent with the model, dual users scored higher across several risk factors and lower on protective factors, compared with the other groups. “Dual users clearly represent people who are prone to problem behavior,” they wrote. “The fact that e-cigarette–only users were intermediate in risk status [between nonusers and dual users] raises the possibility that e-cigarettes are recruiting medium-risk adolescents who otherwise would be less susceptible to tobacco product use.”

Dr. Willis and his colleagues cited two limitations: The study was cross-sectional, and it was conducted in a single geographic area. “However, our findings on the association of e-cigarette use with current smoking status are consistent with those of other studies ... and our results on demographics are consistent with these and other studies,” the investigators wrote.

Attention should be given to the prominence of e-cigarette advertising and the perceived attractiveness of e-cigarettes, they added.

The study was funded by a grant from the National Cancer Institute. The authors said they had no relevant financial conflicts to disclose.

A large portion of young people using e-cigarettes are also smoking tobacco cigarettes, a cross-sectional study from Hawaii showed, raising concerns that the rise in the popularity of “vaping” may be renormalizing cigarette smoking.

Electronic cigarettes are a rising phenomenon in the United States, with projected sales in 2013 reaching $11.7 billion, Thomas A. Willis, Ph.D., and his associates at the University of Hawaii in Honolulu wrote in Pediatrics (2014 Feb. 15 [doi:10.1542/peds.2014-0760]).

There are two schools of thought on the use of e-cigarettes in adolescents, Dr. Willis and his colleagues wrote. One suggests that youth who try e-cigarettes are motivated by health values and concerns, making it unlikely that they also would try cigarettes or other substances.

However, the contrasting model argues that e-cigarettes appeal to young people wishing to rebel against conventional values, making it likely that they also would try tobacco and alcohol. “Although both formulations are plausible, there is little empirical evidence to support or reject either theory at this time,” the study authors wrote.

Conducting a school-based survey of 1,941 high school students living in Oahu, Hawaii, who were on average 14.6 years old, the researchers sought to determine what risk factors and conversely,which protective factors lead to a higher or lower likelihood of substance use. They found that 17% of respondents used e-cigarettes only, 12% used e-cigarettes and tobacco cigarettes (dual users), 3% used cigarettes only, and 68% were nonusers. The use of e-cigarettes in the student population was higher than seen in other data, although the authors noted that young people in Hawaii are particularly exposed to aggressive marketing.

According to the authors, some support for both schools of thought can be found in their data.

For example, people who used e-cigarettes only did not score high on rebelliousness and sensation seeking, compared with dual users. This finding supports the first model by showing that people who fall into this group are less prone to deviance, the investigators said. However, consistent with the model, dual users scored higher across several risk factors and lower on protective factors, compared with the other groups. “Dual users clearly represent people who are prone to problem behavior,” they wrote. “The fact that e-cigarette–only users were intermediate in risk status [between nonusers and dual users] raises the possibility that e-cigarettes are recruiting medium-risk adolescents who otherwise would be less susceptible to tobacco product use.”

Dr. Willis and his colleagues cited two limitations: The study was cross-sectional, and it was conducted in a single geographic area. “However, our findings on the association of e-cigarette use with current smoking status are consistent with those of other studies ... and our results on demographics are consistent with these and other studies,” the investigators wrote.

Attention should be given to the prominence of e-cigarette advertising and the perceived attractiveness of e-cigarettes, they added.

The study was funded by a grant from the National Cancer Institute. The authors said they had no relevant financial conflicts to disclose.

A large portion of young people using e-cigarettes are also smoking tobacco cigarettes, a cross-sectional study from Hawaii showed, raising concerns that the rise in the popularity of “vaping” may be renormalizing cigarette smoking.

Electronic cigarettes are a rising phenomenon in the United States, with projected sales in 2013 reaching $11.7 billion, Thomas A. Willis, Ph.D., and his associates at the University of Hawaii in Honolulu wrote in Pediatrics (2014 Feb. 15 [doi:10.1542/peds.2014-0760]).

There are two schools of thought on the use of e-cigarettes in adolescents, Dr. Willis and his colleagues wrote. One suggests that youth who try e-cigarettes are motivated by health values and concerns, making it unlikely that they also would try cigarettes or other substances.

However, the contrasting model argues that e-cigarettes appeal to young people wishing to rebel against conventional values, making it likely that they also would try tobacco and alcohol. “Although both formulations are plausible, there is little empirical evidence to support or reject either theory at this time,” the study authors wrote.

Conducting a school-based survey of 1,941 high school students living in Oahu, Hawaii, who were on average 14.6 years old, the researchers sought to determine what risk factors and conversely,which protective factors lead to a higher or lower likelihood of substance use. They found that 17% of respondents used e-cigarettes only, 12% used e-cigarettes and tobacco cigarettes (dual users), 3% used cigarettes only, and 68% were nonusers. The use of e-cigarettes in the student population was higher than seen in other data, although the authors noted that young people in Hawaii are particularly exposed to aggressive marketing.

According to the authors, some support for both schools of thought can be found in their data.

For example, people who used e-cigarettes only did not score high on rebelliousness and sensation seeking, compared with dual users. This finding supports the first model by showing that people who fall into this group are less prone to deviance, the investigators said. However, consistent with the model, dual users scored higher across several risk factors and lower on protective factors, compared with the other groups. “Dual users clearly represent people who are prone to problem behavior,” they wrote. “The fact that e-cigarette–only users were intermediate in risk status [between nonusers and dual users] raises the possibility that e-cigarettes are recruiting medium-risk adolescents who otherwise would be less susceptible to tobacco product use.”

Dr. Willis and his colleagues cited two limitations: The study was cross-sectional, and it was conducted in a single geographic area. “However, our findings on the association of e-cigarette use with current smoking status are consistent with those of other studies ... and our results on demographics are consistent with these and other studies,” the investigators wrote.

Attention should be given to the prominence of e-cigarette advertising and the perceived attractiveness of e-cigarettes, they added.

The study was funded by a grant from the National Cancer Institute. The authors said they had no relevant financial conflicts to disclose.

Children who are born prematurely have more than four times the risk of severe flu complications, despite not being considered a high-risk group by U.S., U.K., or World Health Organization guidelines, according to findings from a meta-analysis.

In keeping with existing guidelines, the systematic review and meta-analysis of 27 studies involving 14,086 children also identified children with neurologic disorders (odds ratio, 4.62; 95% confidence interval, 2.82-7.55), sickle cell disease (OR, 3.46; 95% CI, 1.63-7.37), immunosuppression (OR, 2.39; 95% CI, 1.24-4.61), and diabetes (OR, 2.34; 95% CI, 1.20-4.58) at increased risk of flu complications.

The presence of multiple medical conditions significantly increased the risk of hospital admission from 52% (one condition) to 74% (>1 condition), according to Peter J. Gill, D.Phil., of the University of Oxford (England), and associates (Lancet Respir. Med. 2014 Dec. 4 [doi:10.1016/S2213-2600(14)70252-8]).

There was no significant association between hospital admission for influenza and asthma or other respiratory conditions, obesity, heart conditions, or cancer, according to the investigators.

©Fuse/Thinkstockphotos.com

In a linked comment, however, Dr. Harish Nair of the University of Edinburgh (Scotland) and Dr. Marc-Alain Widdowson of the U.S. Centers for Disease Control and Prevention, Atlanta, said that this particular finding should be interpreted with caution, as the authors measured the risk of hospitalization among children already seeking care.

“If respiratory disease or asthma is already associated with seeking ambulatory care for influenza, then these characteristics might not have been identified as risk factors,” they wrote (Lancet Respir. Med 2014 Dec. 4 (doi:10.1016/S2213-2600(14)70285-1).

They also advised caution on the prematurity finding, as five of the seven studies in the analysis did not define prematurity by gestational age. If confirmed, however, it could have “major policy implications” as 11% (15 million) of the world’s babies are born preterm.

“Current WHO guidelines for seasonal influenza vaccination do not include preterm babies in the list of high-risk groups, but perhaps the new findings support their eventual inclusion,” Dr. Nair and Dr. Widdowson wrote.

Protection of these susceptible children, however, comes with challenges. “Children cannot be vaccinated before age 6 months; inactivated vaccines are poorly immunogenic in young children, necessitating two doses, and live, attenuated influenza vaccines are only recommended in children aged 2 years or older,” they noted.

Children who are born prematurely have more than four times the risk of severe flu complications, despite not being considered a high-risk group by U.S., U.K., or World Health Organization guidelines, according to findings from a meta-analysis.

In keeping with existing guidelines, the systematic review and meta-analysis of 27 studies involving 14,086 children also identified children with neurologic disorders (odds ratio, 4.62; 95% confidence interval, 2.82-7.55), sickle cell disease (OR, 3.46; 95% CI, 1.63-7.37), immunosuppression (OR, 2.39; 95% CI, 1.24-4.61), and diabetes (OR, 2.34; 95% CI, 1.20-4.58) at increased risk of flu complications.

The presence of multiple medical conditions significantly increased the risk of hospital admission from 52% (one condition) to 74% (>1 condition), according to Peter J. Gill, D.Phil., of the University of Oxford (England), and associates (Lancet Respir. Med. 2014 Dec. 4 [doi:10.1016/S2213-2600(14)70252-8]).

There was no significant association between hospital admission for influenza and asthma or other respiratory conditions, obesity, heart conditions, or cancer, according to the investigators.

©Fuse/Thinkstockphotos.com

In a linked comment, however, Dr. Harish Nair of the University of Edinburgh (Scotland) and Dr. Marc-Alain Widdowson of the U.S. Centers for Disease Control and Prevention, Atlanta, said that this particular finding should be interpreted with caution, as the authors measured the risk of hospitalization among children already seeking care.

“If respiratory disease or asthma is already associated with seeking ambulatory care for influenza, then these characteristics might not have been identified as risk factors,” they wrote (Lancet Respir. Med 2014 Dec. 4 (doi:10.1016/S2213-2600(14)70285-1).

They also advised caution on the prematurity finding, as five of the seven studies in the analysis did not define prematurity by gestational age. If confirmed, however, it could have “major policy implications” as 11% (15 million) of the world’s babies are born preterm.

“Current WHO guidelines for seasonal influenza vaccination do not include preterm babies in the list of high-risk groups, but perhaps the new findings support their eventual inclusion,” Dr. Nair and Dr. Widdowson wrote.

Protection of these susceptible children, however, comes with challenges. “Children cannot be vaccinated before age 6 months; inactivated vaccines are poorly immunogenic in young children, necessitating two doses, and live, attenuated influenza vaccines are only recommended in children aged 2 years or older,” they noted.

Children who are born prematurely have more than four times the risk of severe flu complications, despite not being considered a high-risk group by U.S., U.K., or World Health Organization guidelines, according to findings from a meta-analysis.

In keeping with existing guidelines, the systematic review and meta-analysis of 27 studies involving 14,086 children also identified children with neurologic disorders (odds ratio, 4.62; 95% confidence interval, 2.82-7.55), sickle cell disease (OR, 3.46; 95% CI, 1.63-7.37), immunosuppression (OR, 2.39; 95% CI, 1.24-4.61), and diabetes (OR, 2.34; 95% CI, 1.20-4.58) at increased risk of flu complications.

The presence of multiple medical conditions significantly increased the risk of hospital admission from 52% (one condition) to 74% (>1 condition), according to Peter J. Gill, D.Phil., of the University of Oxford (England), and associates (Lancet Respir. Med. 2014 Dec. 4 [doi:10.1016/S2213-2600(14)70252-8]).

There was no significant association between hospital admission for influenza and asthma or other respiratory conditions, obesity, heart conditions, or cancer, according to the investigators.

©Fuse/Thinkstockphotos.com

In a linked comment, however, Dr. Harish Nair of the University of Edinburgh (Scotland) and Dr. Marc-Alain Widdowson of the U.S. Centers for Disease Control and Prevention, Atlanta, said that this particular finding should be interpreted with caution, as the authors measured the risk of hospitalization among children already seeking care.

“If respiratory disease or asthma is already associated with seeking ambulatory care for influenza, then these characteristics might not have been identified as risk factors,” they wrote (Lancet Respir. Med 2014 Dec. 4 (doi:10.1016/S2213-2600(14)70285-1).

They also advised caution on the prematurity finding, as five of the seven studies in the analysis did not define prematurity by gestational age. If confirmed, however, it could have “major policy implications” as 11% (15 million) of the world’s babies are born preterm.

“Current WHO guidelines for seasonal influenza vaccination do not include preterm babies in the list of high-risk groups, but perhaps the new findings support their eventual inclusion,” Dr. Nair and Dr. Widdowson wrote.

Protection of these susceptible children, however, comes with challenges. “Children cannot be vaccinated before age 6 months; inactivated vaccines are poorly immunogenic in young children, necessitating two doses, and live, attenuated influenza vaccines are only recommended in children aged 2 years or older,” they noted.

Adults with type 2 diabetes or prediabetes in midlife had greater cognitive decline over the next 20 years than did people without diabetes, according to the findings from a large prospective cohort study.

The Atherosclerosis Risk in Communities (ARIC) study of 13,351 adults aged 48-67 years found those with diabetes in midlife had a 19% greater cognitive decline over a 20-year period than did people without diabetes (adjusted global z-score difference, –0.15 (95% confidence interval, –0.22 to –0.08]), according to the findings published online today in Annals of Internal Medicine (doi:10.7326/M14-0737).

The investigators used three neuropsychological tests to assess cognitive function: the delayed word recall test, the digit symbol substitution test of the Wechsler Adult Intelligence Scale–Revised, and the word fluency test.

Cognitive decline was significantly greater in people with prediabetes (HbA_1c level of 5.7%-6.4%), compared with those with an HbA_1c level lower than 5.7%, reported the study authors led by Andreea M. Rawlings of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

People with poorly controlled diabetes (HbA_1c≥7%) had greater cognitive decline than did people with better-controlled disease (adjusted global z-score difference, –0.16; P = .071). The association with cognitive decline was stronger for longer-duration diabetes (P<.001), and the findings were similar for black and white adults (P = .44). Maintaining cognitive function is a critical aspect of successful aging and ensuring a high quality of life, the study authors said.

“Diabetes and glucose control are potentially modifiable and may offer an important opportunity for the prevention of cognitive decline, thus delaying progression to dementia,” they wrote. At the population level, delaying the onset of dementia by even a couple of years could reduce its prevalence by more than 20% over the next 30 years, according to the investigators. Diabetes was assessed at baseline, and cognitive function was assessed at baseline and periodically during the 20-year follow-up.

The study was supported by the National Heart, Lung, and Blood Institute.

Adults with type 2 diabetes or prediabetes in midlife had greater cognitive decline over the next 20 years than did people without diabetes, according to the findings from a large prospective cohort study.

The Atherosclerosis Risk in Communities (ARIC) study of 13,351 adults aged 48-67 years found those with diabetes in midlife had a 19% greater cognitive decline over a 20-year period than did people without diabetes (adjusted global z-score difference, –0.15 (95% confidence interval, –0.22 to –0.08]), according to the findings published online today in Annals of Internal Medicine (doi:10.7326/M14-0737).

The investigators used three neuropsychological tests to assess cognitive function: the delayed word recall test, the digit symbol substitution test of the Wechsler Adult Intelligence Scale–Revised, and the word fluency test.

Cognitive decline was significantly greater in people with prediabetes (HbA_1c level of 5.7%-6.4%), compared with those with an HbA_1c level lower than 5.7%, reported the study authors led by Andreea M. Rawlings of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

People with poorly controlled diabetes (HbA_1c≥7%) had greater cognitive decline than did people with better-controlled disease (adjusted global z-score difference, –0.16; P = .071). The association with cognitive decline was stronger for longer-duration diabetes (P<.001), and the findings were similar for black and white adults (P = .44). Maintaining cognitive function is a critical aspect of successful aging and ensuring a high quality of life, the study authors said.

“Diabetes and glucose control are potentially modifiable and may offer an important opportunity for the prevention of cognitive decline, thus delaying progression to dementia,” they wrote. At the population level, delaying the onset of dementia by even a couple of years could reduce its prevalence by more than 20% over the next 30 years, according to the investigators. Diabetes was assessed at baseline, and cognitive function was assessed at baseline and periodically during the 20-year follow-up.

The study was supported by the National Heart, Lung, and Blood Institute.

Adults with type 2 diabetes or prediabetes in midlife had greater cognitive decline over the next 20 years than did people without diabetes, according to the findings from a large prospective cohort study.

The Atherosclerosis Risk in Communities (ARIC) study of 13,351 adults aged 48-67 years found those with diabetes in midlife had a 19% greater cognitive decline over a 20-year period than did people without diabetes (adjusted global z-score difference, –0.15 (95% confidence interval, –0.22 to –0.08]), according to the findings published online today in Annals of Internal Medicine (doi:10.7326/M14-0737).

The investigators used three neuropsychological tests to assess cognitive function: the delayed word recall test, the digit symbol substitution test of the Wechsler Adult Intelligence Scale–Revised, and the word fluency test.

Cognitive decline was significantly greater in people with prediabetes (HbA_1c level of 5.7%-6.4%), compared with those with an HbA_1c level lower than 5.7%, reported the study authors led by Andreea M. Rawlings of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

People with poorly controlled diabetes (HbA_1c≥7%) had greater cognitive decline than did people with better-controlled disease (adjusted global z-score difference, –0.16; P = .071). The association with cognitive decline was stronger for longer-duration diabetes (P<.001), and the findings were similar for black and white adults (P = .44). Maintaining cognitive function is a critical aspect of successful aging and ensuring a high quality of life, the study authors said.

“Diabetes and glucose control are potentially modifiable and may offer an important opportunity for the prevention of cognitive decline, thus delaying progression to dementia,” they wrote. At the population level, delaying the onset of dementia by even a couple of years could reduce its prevalence by more than 20% over the next 30 years, according to the investigators. Diabetes was assessed at baseline, and cognitive function was assessed at baseline and periodically during the 20-year follow-up.

The study was supported by the National Heart, Lung, and Blood Institute.