Whitney McKnight

WASHINGTON ­– Congress should back better regulation of glucose-monitoring technologies and expanded access to continuous glucose monitoring for patients with either type 1 or insulin-dependent type 2 diabetes, according to two endocrinology organizations.

At a consensus conference on glucose monitoring, hosted by the American Association of Clinical Endocrinologists and the American College of Endocrinology, advocates pushed for federal legislation that would increase the role endocrinology experts play in setting policy and reimbursement for glucose monitoring.

Inaccurate glucose level readings can have devastating effects, ranging from seizures to coma or even death. Self-test glucose monitoring kits are currently considered the standard of care for people with type 1 diabetes or with insulin-dependent type-2 diabetes.

However, the reliability of the kits has come into question over the years – although knowing which kits are defective is difficult, endocrinology experts noted. That’s in part because adverse event reporting by manufacturers is voluntary, and any data that are collected are not well reviewed.

“What this impressed upon me is the inherent unfairness in the playing field right now,” said Dr. Daniel Einhorn, past president of the AACE and medical director for the Scripps Whittier Diabetes Institute in La Jolla, Calif. “It’s possible to be a company that is less ethical and yet still make it in the market once cleared [by the FDA], because it’s hard to remove it.”

Abbott, Dexcom, Johnson and Johnson, Medtronic, Merck, and several other medical manufacturers supported the conference. Dr. Einhorn disclosed financial relationships with Janssen, Lilly, and Sanofi.

WASHINGTON ­– Congress should back better regulation of glucose-monitoring technologies and expanded access to continuous glucose monitoring for patients with either type 1 or insulin-dependent type 2 diabetes, according to two endocrinology organizations.

At a consensus conference on glucose monitoring, hosted by the American Association of Clinical Endocrinologists and the American College of Endocrinology, advocates pushed for federal legislation that would increase the role endocrinology experts play in setting policy and reimbursement for glucose monitoring.

Inaccurate glucose level readings can have devastating effects, ranging from seizures to coma or even death. Self-test glucose monitoring kits are currently considered the standard of care for people with type 1 diabetes or with insulin-dependent type-2 diabetes.

However, the reliability of the kits has come into question over the years – although knowing which kits are defective is difficult, endocrinology experts noted. That’s in part because adverse event reporting by manufacturers is voluntary, and any data that are collected are not well reviewed.

“What this impressed upon me is the inherent unfairness in the playing field right now,” said Dr. Daniel Einhorn, past president of the AACE and medical director for the Scripps Whittier Diabetes Institute in La Jolla, Calif. “It’s possible to be a company that is less ethical and yet still make it in the market once cleared [by the FDA], because it’s hard to remove it.”

Abbott, Dexcom, Johnson and Johnson, Medtronic, Merck, and several other medical manufacturers supported the conference. Dr. Einhorn disclosed financial relationships with Janssen, Lilly, and Sanofi.

WASHINGTON ­– Congress should back better regulation of glucose-monitoring technologies and expanded access to continuous glucose monitoring for patients with either type 1 or insulin-dependent type 2 diabetes, according to two endocrinology organizations.

At a consensus conference on glucose monitoring, hosted by the American Association of Clinical Endocrinologists and the American College of Endocrinology, advocates pushed for federal legislation that would increase the role endocrinology experts play in setting policy and reimbursement for glucose monitoring.

Inaccurate glucose level readings can have devastating effects, ranging from seizures to coma or even death. Self-test glucose monitoring kits are currently considered the standard of care for people with type 1 diabetes or with insulin-dependent type-2 diabetes.

However, the reliability of the kits has come into question over the years – although knowing which kits are defective is difficult, endocrinology experts noted. That’s in part because adverse event reporting by manufacturers is voluntary, and any data that are collected are not well reviewed.

“What this impressed upon me is the inherent unfairness in the playing field right now,” said Dr. Daniel Einhorn, past president of the AACE and medical director for the Scripps Whittier Diabetes Institute in La Jolla, Calif. “It’s possible to be a company that is less ethical and yet still make it in the market once cleared [by the FDA], because it’s hard to remove it.”

Abbott, Dexcom, Johnson and Johnson, Medtronic, Merck, and several other medical manufacturers supported the conference. Dr. Einhorn disclosed financial relationships with Janssen, Lilly, and Sanofi.

WASHINGTON ­– Congress should back better regulation of glucose-monitoring technologies and expanded access to continuous glucose monitoring for patients with either type 1 or insulin-dependent type 2 diabetes, according to two endocrinology organizations.

At a consensus conference on glucose monitoring, hosted by the American Association of Clinical Endocrinologists and the American College of Endocrinology, advocates pushed for federal legislation that would increase the role endocrinology experts play in setting policy and reimbursement for glucose monitoring.

Inaccurate glucose level readings can have devastating effects, ranging from seizures to coma or even death. Self-test glucose monitoring kits are currently considered the standard of care for people with type 1 diabetes or with insulin-dependent type-2 diabetes.

However, the reliability of the kits has come into question over the years – although knowing which kits are defective is difficult, endocrinology experts noted. That’s in part because adverse event reporting by manufacturers is voluntary, and any data that are collected are not well reviewed.

“What this impressed upon me is the inherent unfairness in the playing field right now,” said Dr. Daniel Einhorn, past president of the AACE and medical director for the Scripps Whittier Diabetes Institute in La Jolla, Calif. “It’s possible to be a company that is less ethical and yet still make it in the market once cleared [by the FDA], because it’s hard to remove it.”

Abbott, Dexcom, Johnson and Johnson, Medtronic, Merck, and several other medical manufacturers supported the conference. Dr. Einhorn disclosed financial relationships with Janssen, Lilly, and Sanofi.

[email protected]

On Twitter @whitneymcknight

WASHINGTON ­– Congress should back better regulation of glucose-monitoring technologies and expanded access to continuous glucose monitoring for patients with either type 1 or insulin-dependent type 2 diabetes, according to two endocrinology organizations.

At a consensus conference on glucose monitoring, hosted by the American Association of Clinical Endocrinologists and the American College of Endocrinology, advocates pushed for federal legislation that would increase the role endocrinology experts play in setting policy and reimbursement for glucose monitoring.

Inaccurate glucose level readings can have devastating effects, ranging from seizures to coma or even death. Self-test glucose monitoring kits are currently considered the standard of care for people with type 1 diabetes or with insulin-dependent type-2 diabetes.

However, the reliability of the kits has come into question over the years – although knowing which kits are defective is difficult, endocrinology experts noted. That’s in part because adverse event reporting by manufacturers is voluntary, and any data that are collected are not well reviewed.

“What this impressed upon me is the inherent unfairness in the playing field right now,” said Dr. Daniel Einhorn, past president of the AACE and medical director for the Scripps Whittier Diabetes Institute in La Jolla, Calif. “It’s possible to be a company that is less ethical and yet still make it in the market once cleared [by the FDA], because it’s hard to remove it.”

Abbott, Dexcom, Johnson and Johnson, Medtronic, Merck, and several other medical manufacturers supported the conference. Dr. Einhorn disclosed financial relationships with Janssen, Lilly, and Sanofi.

[email protected]

On Twitter @whitneymcknight

WASHINGTON ­– Congress should back better regulation of glucose-monitoring technologies and expanded access to continuous glucose monitoring for patients with either type 1 or insulin-dependent type 2 diabetes, according to two endocrinology organizations.

At a consensus conference on glucose monitoring, hosted by the American Association of Clinical Endocrinologists and the American College of Endocrinology, advocates pushed for federal legislation that would increase the role endocrinology experts play in setting policy and reimbursement for glucose monitoring.

Inaccurate glucose level readings can have devastating effects, ranging from seizures to coma or even death. Self-test glucose monitoring kits are currently considered the standard of care for people with type 1 diabetes or with insulin-dependent type-2 diabetes.

However, the reliability of the kits has come into question over the years – although knowing which kits are defective is difficult, endocrinology experts noted. That’s in part because adverse event reporting by manufacturers is voluntary, and any data that are collected are not well reviewed.

“What this impressed upon me is the inherent unfairness in the playing field right now,” said Dr. Daniel Einhorn, past president of the AACE and medical director for the Scripps Whittier Diabetes Institute in La Jolla, Calif. “It’s possible to be a company that is less ethical and yet still make it in the market once cleared [by the FDA], because it’s hard to remove it.”

Abbott, Dexcom, Johnson and Johnson, Medtronic, Merck, and several other medical manufacturers supported the conference. Dr. Einhorn disclosed financial relationships with Janssen, Lilly, and Sanofi.

[email protected]

On Twitter @whitneymcknight

NATIONAL HARBOR, MD. – Menopausal women who experience vaginal dryness often find the resultant pain of sexual intercourse so prohibitive that, according to Dr. JoAnne Pinkerton, often these women go months or years without intimate relations.

There are many treatment options that can benefit patients with the condition, explained Dr. Pinkerton, medical director of the Midlife Health Center at the University of Virginia, Charlottesville, but physicians aren’t always aware of what’s available.

In a video interview at annual meeting of the North American Menopause Society, Dr. Pinkerton discussed the range of therapies physicians can offer menopausal patients with vaginal dryness.

[email protected]

On Twitter @whitneymcknight

NATIONAL HARBOR, MD. – Menopausal women who experience vaginal dryness often find the resultant pain of sexual intercourse so prohibitive that, according to Dr. JoAnne Pinkerton, often these women go months or years without intimate relations.

There are many treatment options that can benefit patients with the condition, explained Dr. Pinkerton, medical director of the Midlife Health Center at the University of Virginia, Charlottesville, but physicians aren’t always aware of what’s available.

In a video interview at annual meeting of the North American Menopause Society, Dr. Pinkerton discussed the range of therapies physicians can offer menopausal patients with vaginal dryness.

[email protected]

On Twitter @whitneymcknight

NATIONAL HARBOR, MD. – Menopausal women who experience vaginal dryness often find the resultant pain of sexual intercourse so prohibitive that, according to Dr. JoAnne Pinkerton, often these women go months or years without intimate relations.

There are many treatment options that can benefit patients with the condition, explained Dr. Pinkerton, medical director of the Midlife Health Center at the University of Virginia, Charlottesville, but physicians aren’t always aware of what’s available.

In a video interview at annual meeting of the North American Menopause Society, Dr. Pinkerton discussed the range of therapies physicians can offer menopausal patients with vaginal dryness.

[email protected]

On Twitter @whitneymcknight

NATIONAL HARBOR, MD. – Does the Food and Drug Administration’s black-box warning on estrogen contribute to noncompliance – or worse, to clinicians being unwilling to prescribe estrogen treatments – leaving many women to suffer untreated menopause symptoms?

The leadership of the North American Menopause Society thinks so, and the organization has started a campaign to get the FDA to reconsider how it labels estrogen.

“We would like the label for low-dose, vaginal estrogen to better reflect the true safety and risk profile,” said Dr. JoAnn Manson, chair of this year’s NAMS scientific committee.

In a video interview, Dr. Manson discusses how the current black-box labeling may impede effective treatment, and why revised, more-nuanced estrogen labeling could improve outcomes for many women.

NATIONAL HARBOR, MD. – Does the Food and Drug Administration’s black-box warning on estrogen contribute to noncompliance – or worse, to clinicians being unwilling to prescribe estrogen treatments – leaving many women to suffer untreated menopause symptoms?

The leadership of the North American Menopause Society thinks so, and the organization has started a campaign to get the FDA to reconsider how it labels estrogen.

“We would like the label for low-dose, vaginal estrogen to better reflect the true safety and risk profile,” said Dr. JoAnn Manson, chair of this year’s NAMS scientific committee.

In a video interview, Dr. Manson discusses how the current black-box labeling may impede effective treatment, and why revised, more-nuanced estrogen labeling could improve outcomes for many women.

NATIONAL HARBOR, MD. – Does the Food and Drug Administration’s black-box warning on estrogen contribute to noncompliance – or worse, to clinicians being unwilling to prescribe estrogen treatments – leaving many women to suffer untreated menopause symptoms?

The leadership of the North American Menopause Society thinks so, and the organization has started a campaign to get the FDA to reconsider how it labels estrogen.

“We would like the label for low-dose, vaginal estrogen to better reflect the true safety and risk profile,” said Dr. JoAnn Manson, chair of this year’s NAMS scientific committee.

In a video interview, Dr. Manson discusses how the current black-box labeling may impede effective treatment, and why revised, more-nuanced estrogen labeling could improve outcomes for many women.

NATIONAL HARBOR, MD. – Does the Food and Drug Administration’s black-box warning on estrogen contribute to noncompliance – or worse, to clinicians being unwilling to prescribe estrogen treatments – leaving many women to suffer untreated menopause symptoms?

The leadership of the North American Menopause Society thinks so, and the organization has started a campaign to get the FDA to reconsider how it labels estrogen.

“We would like the label for low-dose, vaginal estrogen to better reflect the true safety and risk profile,” said Dr. JoAnn Manson, chair of this year’s NAMS scientific committee.

In a video interview, Dr. Manson discusses how the current black-box labeling may impede effective treatment, and why revised, more-nuanced estrogen labeling could improve outcomes for many women.

[email protected] 


On Twitter @whitneymcknight

NATIONAL HARBOR, MD. – Does the Food and Drug Administration’s black-box warning on estrogen contribute to noncompliance – or worse, to clinicians being unwilling to prescribe estrogen treatments – leaving many women to suffer untreated menopause symptoms?

The leadership of the North American Menopause Society thinks so, and the organization has started a campaign to get the FDA to reconsider how it labels estrogen.

“We would like the label for low-dose, vaginal estrogen to better reflect the true safety and risk profile,” said Dr. JoAnn Manson, chair of this year’s NAMS scientific committee.

In a video interview, Dr. Manson discusses how the current black-box labeling may impede effective treatment, and why revised, more-nuanced estrogen labeling could improve outcomes for many women.

[email protected] 


On Twitter @whitneymcknight

NATIONAL HARBOR, MD. – Does the Food and Drug Administration’s black-box warning on estrogen contribute to noncompliance – or worse, to clinicians being unwilling to prescribe estrogen treatments – leaving many women to suffer untreated menopause symptoms?

The leadership of the North American Menopause Society thinks so, and the organization has started a campaign to get the FDA to reconsider how it labels estrogen.

“We would like the label for low-dose, vaginal estrogen to better reflect the true safety and risk profile,” said Dr. JoAnn Manson, chair of this year’s NAMS scientific committee.

In a video interview, Dr. Manson discusses how the current black-box labeling may impede effective treatment, and why revised, more-nuanced estrogen labeling could improve outcomes for many women.

[email protected] 


On Twitter @whitneymcknight

The more severe the psoriasis, the greater likelihood of uncontrolled hypertension, according to data from a population-based study. The findings were published online Oct. 15 in JAMA Dermatology.

In patients with diagnosed hypertension, those with moderate to severe psoriasis showed a positive dose-response relationship between their psoriasis activity and high blood pressure, wrote Dr. Junko Takeshita of the University of Pennsylvania, Philadelphia, and her associates (JAMA Dermatol. 2014 Oct. 15 [doi:10.1001/jamadermatol.2014.2094]).

The researchers compared a random sample of 1,322 adults aged 25-64 years with psoriasis and hypertension and 11,977 age- and practice-matched controls with hypertension. The data were taken from a population-based, cross-sectional study nested in a prospective cohort drawn from an electronic medical records database in the United Kingdom.

After investigators adjusted for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs, they found psoriasis activity and uncontrolled hypertension correlated, with adjusted odds ratios of 0.97 for mild psoriasis,1.20 for moderate psoriasis, and 1.48 for severe psoriasis (P = .01). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, but this increase was not statistically significant.

The study was limited by its cross-sectional design, which make the directionality of the two conditions hard to determine, the researchers noted.

However, the findings suggest that, among patients with hypertension, psoriasis “is independently associated with poorly controlled blood pressure,” and that more effective blood pressure management is warranted in psoriasis patients, especially those with more severe disease.

Dr. Takeshita reported receipt of payment for continuing medical education work related to psoriasis. Coauthor Dr. Joel Gelfand reported serving as a consultant for AbbVie, Amgen, Celgene, Eli Lilly, Janssen Biologics, and others. This study was supported in part by the National Heart, Lung, and Blood Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

[email protected]

On Twitter @whitneymcknight

The more severe the psoriasis, the greater likelihood of uncontrolled hypertension, according to data from a population-based study. The findings were published online Oct. 15 in JAMA Dermatology.

In patients with diagnosed hypertension, those with moderate to severe psoriasis showed a positive dose-response relationship between their psoriasis activity and high blood pressure, wrote Dr. Junko Takeshita of the University of Pennsylvania, Philadelphia, and her associates (JAMA Dermatol. 2014 Oct. 15 [doi:10.1001/jamadermatol.2014.2094]).

The researchers compared a random sample of 1,322 adults aged 25-64 years with psoriasis and hypertension and 11,977 age- and practice-matched controls with hypertension. The data were taken from a population-based, cross-sectional study nested in a prospective cohort drawn from an electronic medical records database in the United Kingdom.

After investigators adjusted for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs, they found psoriasis activity and uncontrolled hypertension correlated, with adjusted odds ratios of 0.97 for mild psoriasis,1.20 for moderate psoriasis, and 1.48 for severe psoriasis (P = .01). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, but this increase was not statistically significant.

The study was limited by its cross-sectional design, which make the directionality of the two conditions hard to determine, the researchers noted.

However, the findings suggest that, among patients with hypertension, psoriasis “is independently associated with poorly controlled blood pressure,” and that more effective blood pressure management is warranted in psoriasis patients, especially those with more severe disease.

Dr. Takeshita reported receipt of payment for continuing medical education work related to psoriasis. Coauthor Dr. Joel Gelfand reported serving as a consultant for AbbVie, Amgen, Celgene, Eli Lilly, Janssen Biologics, and others. This study was supported in part by the National Heart, Lung, and Blood Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

[email protected]

On Twitter @whitneymcknight

The more severe the psoriasis, the greater likelihood of uncontrolled hypertension, according to data from a population-based study. The findings were published online Oct. 15 in JAMA Dermatology.

In patients with diagnosed hypertension, those with moderate to severe psoriasis showed a positive dose-response relationship between their psoriasis activity and high blood pressure, wrote Dr. Junko Takeshita of the University of Pennsylvania, Philadelphia, and her associates (JAMA Dermatol. 2014 Oct. 15 [doi:10.1001/jamadermatol.2014.2094]).

The researchers compared a random sample of 1,322 adults aged 25-64 years with psoriasis and hypertension and 11,977 age- and practice-matched controls with hypertension. The data were taken from a population-based, cross-sectional study nested in a prospective cohort drawn from an electronic medical records database in the United Kingdom.

After investigators adjusted for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs, they found psoriasis activity and uncontrolled hypertension correlated, with adjusted odds ratios of 0.97 for mild psoriasis,1.20 for moderate psoriasis, and 1.48 for severe psoriasis (P = .01). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, but this increase was not statistically significant.

The study was limited by its cross-sectional design, which make the directionality of the two conditions hard to determine, the researchers noted.

However, the findings suggest that, among patients with hypertension, psoriasis “is independently associated with poorly controlled blood pressure,” and that more effective blood pressure management is warranted in psoriasis patients, especially those with more severe disease.

Dr. Takeshita reported receipt of payment for continuing medical education work related to psoriasis. Coauthor Dr. Joel Gelfand reported serving as a consultant for AbbVie, Amgen, Celgene, Eli Lilly, Janssen Biologics, and others. This study was supported in part by the National Heart, Lung, and Blood Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

[email protected]

On Twitter @whitneymcknight

Exercise in adulthood was associated with an almost 20% reduction in the odds of having depressive symptoms, according to a study published online Oct. 15 in JAMA Psychiatry. Conversely, the presence of depressive symptoms was found to be a barrier to increased physical activity.

Snehal M. Pinto Pereira, Ph.D., and her colleagues reported that adults who were physically active at age 23 years tended to experience fewer depressive symptoms as they aged, while those who engaged in less physical activity at that age were more likely to see their depressive symptoms increase throughout adulthood (JAMA Psychiatry 2014 Oct. 15 [doi:10.1001/jamapsychiatry.2014.1240]).

By analyzing data on depressive symptoms and physical activity frequency collected at ages 23, 33, 42, or 50 years in a British cohort study of 11,000 adults born during the same week in 1958, Dr. Pinto Pereira and her colleagues found a bidirectional effect between exercise and depression.

“At most ages, we found a trend of fewer depressive symptoms with more frequent activity,” wrote Dr. Pinto Pereira of the Population, Policy, and Practice program at the University College of London Institute of Child Health and her colleagues.

The more physical activity per week, the lower the mean number of depressive symptoms a person experienced by age 50 years (0.06; 95% confidence interval, –0.09 to –0.04), and the magnitude of association did not vary with age (P = .21).

If a person was inactive at 23 years of age and remained inactive 5 years later, there was no change in symptom level (mean difference, –0.01; 95% CI, –0.04 to 0.02). However, if the person increased physical activity to three times a week, there was a lower mean number of depressive symptoms (mean difference, −0.18; 95% CI, −0.22 to −0.15). Although the investigators noted that these differences equaled an estimated reduction for the odds of being depressed by as much as 19%, the relationship between symptoms and activity was seen to weaken with age (P < .001).

The average level of physical activity in asymptomatic adults at 23 years was higher 5 years later by 0.60 (95% CI, 0.57-0.64) times per week, whereas it was lower at 0.53 (95% CI, 0.49-0.56) times per week in the same age group 5 years later if the person had one additional depressive symptom. The frequency of physical activity did not differ in asymptomatic adults at 43 years who subsequently had zero or one symptom at age 48 years.

The results were based on self-reported data as analyzed with the psychological subscale of the Malaise Inventory, which cannot fully prevent confounding factors, such as misreported body mass index measurements. Still, Dr. Pinto Pereira and her colleagues wrote, their study indicated “activity may alleviate depressive symptoms in the general population and, in turn, depressive symptoms in early adulthood may be a barrier to activity.”

This study was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium, United Kingdom. The authors reported no conflict of interest.

[email protected]

On Twitter @whitneymcknight

Exercise in adulthood was associated with an almost 20% reduction in the odds of having depressive symptoms, according to a study published online Oct. 15 in JAMA Psychiatry. Conversely, the presence of depressive symptoms was found to be a barrier to increased physical activity.

Snehal M. Pinto Pereira, Ph.D., and her colleagues reported that adults who were physically active at age 23 years tended to experience fewer depressive symptoms as they aged, while those who engaged in less physical activity at that age were more likely to see their depressive symptoms increase throughout adulthood (JAMA Psychiatry 2014 Oct. 15 [doi:10.1001/jamapsychiatry.2014.1240]).

By analyzing data on depressive symptoms and physical activity frequency collected at ages 23, 33, 42, or 50 years in a British cohort study of 11,000 adults born during the same week in 1958, Dr. Pinto Pereira and her colleagues found a bidirectional effect between exercise and depression.

“At most ages, we found a trend of fewer depressive symptoms with more frequent activity,” wrote Dr. Pinto Pereira of the Population, Policy, and Practice program at the University College of London Institute of Child Health and her colleagues.

The more physical activity per week, the lower the mean number of depressive symptoms a person experienced by age 50 years (0.06; 95% confidence interval, –0.09 to –0.04), and the magnitude of association did not vary with age (P = .21).

If a person was inactive at 23 years of age and remained inactive 5 years later, there was no change in symptom level (mean difference, –0.01; 95% CI, –0.04 to 0.02). However, if the person increased physical activity to three times a week, there was a lower mean number of depressive symptoms (mean difference, −0.18; 95% CI, −0.22 to −0.15). Although the investigators noted that these differences equaled an estimated reduction for the odds of being depressed by as much as 19%, the relationship between symptoms and activity was seen to weaken with age (P < .001).

The average level of physical activity in asymptomatic adults at 23 years was higher 5 years later by 0.60 (95% CI, 0.57-0.64) times per week, whereas it was lower at 0.53 (95% CI, 0.49-0.56) times per week in the same age group 5 years later if the person had one additional depressive symptom. The frequency of physical activity did not differ in asymptomatic adults at 43 years who subsequently had zero or one symptom at age 48 years.

The results were based on self-reported data as analyzed with the psychological subscale of the Malaise Inventory, which cannot fully prevent confounding factors, such as misreported body mass index measurements. Still, Dr. Pinto Pereira and her colleagues wrote, their study indicated “activity may alleviate depressive symptoms in the general population and, in turn, depressive symptoms in early adulthood may be a barrier to activity.”

This study was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium, United Kingdom. The authors reported no conflict of interest.

[email protected]

On Twitter @whitneymcknight

Exercise in adulthood was associated with an almost 20% reduction in the odds of having depressive symptoms, according to a study published online Oct. 15 in JAMA Psychiatry. Conversely, the presence of depressive symptoms was found to be a barrier to increased physical activity.

Snehal M. Pinto Pereira, Ph.D., and her colleagues reported that adults who were physically active at age 23 years tended to experience fewer depressive symptoms as they aged, while those who engaged in less physical activity at that age were more likely to see their depressive symptoms increase throughout adulthood (JAMA Psychiatry 2014 Oct. 15 [doi:10.1001/jamapsychiatry.2014.1240]).

By analyzing data on depressive symptoms and physical activity frequency collected at ages 23, 33, 42, or 50 years in a British cohort study of 11,000 adults born during the same week in 1958, Dr. Pinto Pereira and her colleagues found a bidirectional effect between exercise and depression.

“At most ages, we found a trend of fewer depressive symptoms with more frequent activity,” wrote Dr. Pinto Pereira of the Population, Policy, and Practice program at the University College of London Institute of Child Health and her colleagues.

The more physical activity per week, the lower the mean number of depressive symptoms a person experienced by age 50 years (0.06; 95% confidence interval, –0.09 to –0.04), and the magnitude of association did not vary with age (P = .21).

If a person was inactive at 23 years of age and remained inactive 5 years later, there was no change in symptom level (mean difference, –0.01; 95% CI, –0.04 to 0.02). However, if the person increased physical activity to three times a week, there was a lower mean number of depressive symptoms (mean difference, −0.18; 95% CI, −0.22 to −0.15). Although the investigators noted that these differences equaled an estimated reduction for the odds of being depressed by as much as 19%, the relationship between symptoms and activity was seen to weaken with age (P < .001).

The average level of physical activity in asymptomatic adults at 23 years was higher 5 years later by 0.60 (95% CI, 0.57-0.64) times per week, whereas it was lower at 0.53 (95% CI, 0.49-0.56) times per week in the same age group 5 years later if the person had one additional depressive symptom. The frequency of physical activity did not differ in asymptomatic adults at 43 years who subsequently had zero or one symptom at age 48 years.

The results were based on self-reported data as analyzed with the psychological subscale of the Malaise Inventory, which cannot fully prevent confounding factors, such as misreported body mass index measurements. Still, Dr. Pinto Pereira and her colleagues wrote, their study indicated “activity may alleviate depressive symptoms in the general population and, in turn, depressive symptoms in early adulthood may be a barrier to activity.”

This study was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium, United Kingdom. The authors reported no conflict of interest.

[email protected]

On Twitter @whitneymcknight

Musculoskeletal ultrasound was associated with more than double gains in diagnostic certainty in a prospective cohort of consecutive patients referred for the evaluation of inflammatory arthritis.

Consistent with previous studies, “We found that musculoskeletal ultrasound greatly increased the diagnostic certainty for inflammatory arthritis in general and for RA [rheumatoid arthritis] in particular,” wrote Dr. Hamed Rezaei and coauthors at the Karolinska Institute in Stockholm.

When the investigators added musculoskeletal ultrasound (MSUS) to the assessment of 103 previously undiagnosed persons (mean age, 50 years; 74% female) who were referred to a single center for suspected inflammatory arthritis, the percentage of patients with a confirmed diagnosis rose from 33% before MSUS to 71.8% after (P < .001). Diagnostic confirmation specifically for RA went from 31.1% before MSUS to 61.2% after (P < .001). The imaging results were consistent with the final diagnosis in 95% of patients (Arthritis Res. Ther. 2014;16:448 [doi:10.1186/s13075-014-0448-6]).

The initial clinical assessments included joint examination, tests for acute-phase reactants, rheumatoid factor and anticitrullinated peptide antibody, and radiographs of hands and feet when indicated. A rheumatologist determined the probable presence of inflammatory arthritis generally, and rheumatoid arthritis specifically using a 5-point scale that assessed probability of the diagnosis with 1 point for less than a 20% probability, 2 points for greater than or equal to 20% but less than a 40% probability, and so on.

Following the initial assessment, the wrist, metacarpophalangeal, proximal interphalangeal joints 2-5 in both hands, metatarsophalangeal joints 2-5 in both feet, and any symptomatic joints, were imaged. The rheumatologist was then given the images and asked to use the same scale to once again assess the diagnostic probabilities.

Although the authors of the study pointed to the strength of their probabilistic approach to determining if musculoskeletal imaging improved diagnostic certainty on a 5-point scale, they acknowledged that the treating rheumatologist who performed the initial assessment was aware of her/his own scoring before the musculoskeletal imaging was done and may have felt either motivated to improve the result, or simply operated under the assumption that more information that may lead to increase posttest probability would be available later. However, when the cases were randomly rescored by another rheumatologist, results were reported to be almost identical.

“As expected, the likelihood of having any inflammatory arthritis and especially of having RA in patients with early arthritis symptoms increased with the presence of MSUS findings,” Dr. Rezaei and his colleagues wrote. “MSUS also improved diagnostic accuracy compared to clinical assessment alone, when analyzed in a classical (deterministic) manner; as also shown previously in more than 95% of patients there was agreement between MSUS finding and final diagnosis.”

[email protected]

On Twitter @whitneymcknight

Musculoskeletal ultrasound was associated with more than double gains in diagnostic certainty in a prospective cohort of consecutive patients referred for the evaluation of inflammatory arthritis.

Consistent with previous studies, “We found that musculoskeletal ultrasound greatly increased the diagnostic certainty for inflammatory arthritis in general and for RA [rheumatoid arthritis] in particular,” wrote Dr. Hamed Rezaei and coauthors at the Karolinska Institute in Stockholm.

When the investigators added musculoskeletal ultrasound (MSUS) to the assessment of 103 previously undiagnosed persons (mean age, 50 years; 74% female) who were referred to a single center for suspected inflammatory arthritis, the percentage of patients with a confirmed diagnosis rose from 33% before MSUS to 71.8% after (P < .001). Diagnostic confirmation specifically for RA went from 31.1% before MSUS to 61.2% after (P < .001). The imaging results were consistent with the final diagnosis in 95% of patients (Arthritis Res. Ther. 2014;16:448 [doi:10.1186/s13075-014-0448-6]).

The initial clinical assessments included joint examination, tests for acute-phase reactants, rheumatoid factor and anticitrullinated peptide antibody, and radiographs of hands and feet when indicated. A rheumatologist determined the probable presence of inflammatory arthritis generally, and rheumatoid arthritis specifically using a 5-point scale that assessed probability of the diagnosis with 1 point for less than a 20% probability, 2 points for greater than or equal to 20% but less than a 40% probability, and so on.

Following the initial assessment, the wrist, metacarpophalangeal, proximal interphalangeal joints 2-5 in both hands, metatarsophalangeal joints 2-5 in both feet, and any symptomatic joints, were imaged. The rheumatologist was then given the images and asked to use the same scale to once again assess the diagnostic probabilities.

Although the authors of the study pointed to the strength of their probabilistic approach to determining if musculoskeletal imaging improved diagnostic certainty on a 5-point scale, they acknowledged that the treating rheumatologist who performed the initial assessment was aware of her/his own scoring before the musculoskeletal imaging was done and may have felt either motivated to improve the result, or simply operated under the assumption that more information that may lead to increase posttest probability would be available later. However, when the cases were randomly rescored by another rheumatologist, results were reported to be almost identical.

“As expected, the likelihood of having any inflammatory arthritis and especially of having RA in patients with early arthritis symptoms increased with the presence of MSUS findings,” Dr. Rezaei and his colleagues wrote. “MSUS also improved diagnostic accuracy compared to clinical assessment alone, when analyzed in a classical (deterministic) manner; as also shown previously in more than 95% of patients there was agreement between MSUS finding and final diagnosis.”

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On Twitter @whitneymcknight

Musculoskeletal ultrasound was associated with more than double gains in diagnostic certainty in a prospective cohort of consecutive patients referred for the evaluation of inflammatory arthritis.

Consistent with previous studies, “We found that musculoskeletal ultrasound greatly increased the diagnostic certainty for inflammatory arthritis in general and for RA [rheumatoid arthritis] in particular,” wrote Dr. Hamed Rezaei and coauthors at the Karolinska Institute in Stockholm.

When the investigators added musculoskeletal ultrasound (MSUS) to the assessment of 103 previously undiagnosed persons (mean age, 50 years; 74% female) who were referred to a single center for suspected inflammatory arthritis, the percentage of patients with a confirmed diagnosis rose from 33% before MSUS to 71.8% after (P < .001). Diagnostic confirmation specifically for RA went from 31.1% before MSUS to 61.2% after (P < .001). The imaging results were consistent with the final diagnosis in 95% of patients (Arthritis Res. Ther. 2014;16:448 [doi:10.1186/s13075-014-0448-6]).

The initial clinical assessments included joint examination, tests for acute-phase reactants, rheumatoid factor and anticitrullinated peptide antibody, and radiographs of hands and feet when indicated. A rheumatologist determined the probable presence of inflammatory arthritis generally, and rheumatoid arthritis specifically using a 5-point scale that assessed probability of the diagnosis with 1 point for less than a 20% probability, 2 points for greater than or equal to 20% but less than a 40% probability, and so on.

Following the initial assessment, the wrist, metacarpophalangeal, proximal interphalangeal joints 2-5 in both hands, metatarsophalangeal joints 2-5 in both feet, and any symptomatic joints, were imaged. The rheumatologist was then given the images and asked to use the same scale to once again assess the diagnostic probabilities.

Although the authors of the study pointed to the strength of their probabilistic approach to determining if musculoskeletal imaging improved diagnostic certainty on a 5-point scale, they acknowledged that the treating rheumatologist who performed the initial assessment was aware of her/his own scoring before the musculoskeletal imaging was done and may have felt either motivated to improve the result, or simply operated under the assumption that more information that may lead to increase posttest probability would be available later. However, when the cases were randomly rescored by another rheumatologist, results were reported to be almost identical.

“As expected, the likelihood of having any inflammatory arthritis and especially of having RA in patients with early arthritis symptoms increased with the presence of MSUS findings,” Dr. Rezaei and his colleagues wrote. “MSUS also improved diagnostic accuracy compared to clinical assessment alone, when analyzed in a classical (deterministic) manner; as also shown previously in more than 95% of patients there was agreement between MSUS finding and final diagnosis.”

[email protected]

On Twitter @whitneymcknight