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Arthritis, general [keywords]
- Work disability is related to the presence of arthritis and not to a specific diagnosis. Results from a large early arthritis cohort in Argentina. [JOURNAL ARTICLE]
- Clin Rheumatol 2014 Nov 27.
The objective of the study was to evaluate work disability and its main associated factors in patients with early arthritis. Argentine Consortium for Early Arthritis (CONAART) is the first early arthritis cohort in Argentina. Patients with one or more swollen joints and less than 2 years of symptoms duration were followed up prospectively in 13 departments of rheumatology. Social, demographic, familiar, clinical, and laboratory data were recollected. At first year and every year, X-rays of hands and feet were performed and working status and pharmaco-economic data were recollected. Work status (employed, unemployed, retired) and type of work were assessed by direct interview using a predesigned questionnaire. Eight hundred forty-eight patients were included, rheumatoid arthritis (RA) = 483 (57 %)and undifferentiated arthritis (UA) = 365 (43 %), 694 (81.8 %) were women, median age was 46 years (interquartile range (IQR) 35-55.7) and median symptoms duration 7 months (IQR 3-12). Patients with RA had significantly higher disease activity, worse functional capacity and quality of life, and more severe radiological damage compared to UA patients. However work disability (unemployed patient) was comparable between groups (RA = 21 % versus UA = 18.6 % p = NS). In both groups, unemployed patients had higher disease activity score of 28 joints (DAS28), worse Health Assessment Questionnaire (HAQ) values, and less years of formal education (p value <0.005 in all comparisons). Radiological damage was greater in unemployed patients but this difference did not reach statistical significance. In multivariate analysis, disease activity was the main variable associated with unemployment in both groups. Joint involvement was the main cause of work disability in this cohort of patients with early arthritis, independently of the final diagnosis.1. Work disability is higher in patients with inflammatory arthritis as compared to the general population. 2. Prevalence of work disability is comparable among patients with undifferentiated and rheumatoid arthritis. 3. Disease activity is the main disease variable associated with work disability.
- No male predominance in offspring of women with rheumatoid arthritis or systemic lupus erythematosus. [JOURNAL ARTICLE]
- Immunol Res 2014 Nov 26.
To assess the proportion of male versus female offspring of women diagnosed with SLE or RA, disorders in which female predominance is well known and PsA a disease in which female dominance is less established. The study population encompassed all females aged 16-46, who were members of the Maccabi Health Services (MHS) throughout the period of 2000-2011 and had at least one pregnancy. Data were retrieved from the computerized database of MHS, a 2-million enrollee health maintenance organization operating in Israel. The database was also used to collect data on patients with RA, SLE, and PsA. A total of 182,073 women had at least one indication of pregnancy during the study period. Among them, 546, 270, and 170 were diagnosed with RA, SLE, and PsA, respectively. The proportion of live-born males in 380,472 offspring of women free of these diseases was 51.5 % (95 % CI 51.4-51.7 %). The proportion (95 % CIs) of male offspring born to mothers diagnosed with of RA, SLE, and PsA were 46.3 % (42.3-50.3 %), 51.8 % (46.6-57.0 %), and 50.6 % (42.8-58.5 %), respectively. Our findings support the primary contribution of the hormonal phenotype rather than the genetic phenotype on autoimmunity. Neither patients with SLE or RA differ from the general population by the sex of their offspring.
- Sexual dysfunction in psoriasis: a systematic review. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2014 Nov 26.
Psoriasis has been associated with numerous psychological disorders such as low self-esteem, depression, anxiety, sexual dysfunction or suicidal ideation. Recently, there has been a progressive increase in studies examining the impact of psoriasis on sexual function. This alteration seems to be considerable and can cause significant changes in quality of life.The aim of this study was to elaborate recommendations for psoriasis and sexual function supported by a systematic review, to facilitate the application of new scientific findings into clinical practice and to serve as a basis for conducting future research.We performed a systematic review of the available studies on psoriasis and sexual dysfunction.Scientific evidence shows that psoriasis patients have a higher risk of sexual dysfunction as compared to the general population. The risk of erectile dysfunction is also higher in psoriasis patients. The risk factors associated with sexual dysfunction in psoriasis patients are disease severity, female gender, psoriatic arthritis and age.
- Anal tuberculosis complicating anti-TNFα therapy. [Journal Article]
- BMJ Case Rep 2014.
A 42-year-old man receiving anti-tumour necrosis factor α (anti-TNFα) therapy with adalimumab due to psoriatic arthritis presented with a 2-month-old anal ulcer. An apical right lung infiltrate was found in his chest X-ray, although he had no pulmonary symptoms. Two biopsies of the ulcer were taken and reported as granulomatous, necrotising, with chronic inflammation (first), and as hyperplasic epidermis with linfocitary infiltrate and the presence of plenty of plasmatic cells (second). Histochemical techniques, including Ziehl-Neelsen, Grocott and periodic acid-Schiff stains, and PCR for Mycobacterium tuberculosis on both biopsies were negative. Serology for HIV, syphilis and hepatitis were also negative. In the second biopsy culture, moderate colonies of M. tuberculosis finally grew. The patient started a four-drug antituberculosis regimen. Adalimumab was discontinued and etanercept introduced after 2 months of antituberculosis therapy. The patient remained on therapy for 9 months with complete ulcer resolution.
- Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study. [JOURNAL ARTICLE]
- BMC Fam Pract 2014 Nov 25; 15(1):185.
BackgroundThe prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated health in a middle-aged and older population in England, and to determine whether any association is mediated by depression and other psychosocial factors.Methods25 268 individuals aged 39 to 79 years recruited from general practice registers in the European Prospective Investigation of Cancer (EPIC-Norfolk) study, completed a survey including self-rated health, psychosocial function and presence of common physical chronic conditions (cancer, stroke, heart attack, diabetes, asthma/bronchitis and arthritis). Logistic regression models determined odds of ¿moderate/poor¿ compared to ¿good/excellent¿ health by condition and number of conditions adjusting for psychosocial measures.ResultsOne-third (8252) reported one, around 7.5% (1899) two, and around 1% (194) three or more conditions. Odds of ¿moderate/poor¿ self-rated health worsened with increasing number of conditions (one (OR¿=¿1.3(1.2¿1.4)) versus three or more (OR¿=¿3.4(2.3¿5.1)), and were highest where there was comorbidity with stroke (OR¿=¿8.7(4.6¿16.7)) or heart attack (OR¿=¿8.5(5.3¿13.6)). Psychosocial measures did not explain the association between chronic diseases and multimorbidity with self-rated health.The relationship of multimorbidity with self-rated health was particularly strong in men compared to women (three or more conditions: men (OR¿=¿5.2(3.0¿8.9)), women OR¿=¿2.1 (1.1¿3.9)).ConclusionsSelf-rated health provides a simple, integrative patient-centred assessment for evaluation of illness in the context of multiple chronic disease diagnoses. Those registering in general practice in particular men with three or more diseases or those with cardiovascular comorbidities and with poorer self-rated health may warrant further assessment and intervention to improve their physical and subjective health.
- No excess risks in offspring with paternal preconception exposure to disease modifying anti-rheumatic drugs. [JOURNAL ARTICLE]
- Arthritis Rheumatol 2014 Nov 24.
Background: The risk of poor pregnancy outcomes including congenital malformations in offspring of men with inflammatory joint diseases (IJD) treated with disease modifying antirheumatic drugs (DMARDs) before conception is largely unknown. Objective: To examine outcomes of pregnancy in partners of male patients with IJD, one paternal group exposed and another group never exposed to DMARDs before conception, compared with references from the general population. Methods: Linkage of data from a longitudinal observational study of IJD patients (NOR-DMARD) and the Medical Birth Registry of Norway (MBRN) enabled to study pregnancy outcomes in partners of men diagnosed with IJD. Outcomes of pregnancies with paternal exposure to DMARDs within 12 weeks of conception and pregnancies without paternal DMARD exposure ever were analyzed separately and compared with references from the general population. Potential associations between DMARD exposure and adverse pregnancy outcomes were assessed by logistic regression analysis. Results: Totally 1796 males with IJD were connected with 2777 births in MBRN. Among these 110 births were paternal DMARD-exposed births within 12 weeks before conception, and in 230 births the father had never been exposed to DMARDs before conception. Most frequently used DMARDs (mono- or combination treatment) within 12 weeks of conception were methotrexate (n = 49), sulfasalazine (n = 17) and TNF-inhibitors (n = 57). Neither adverse pregnancy outcomes nor congenital malformations differed between patients and references in either group. Conclusion: Preconception paternal exposure to DMARD was not associated with increase in adverse outcomes of pregnancy. Importantly, no increased risk of congenital malformations was observed. © 2014 American College of Rheumatology.
- [Management of skin necrosis around incision following total knee arthroplasty]. [English Abstract, Journal Article]
- Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014 Aug; 28(8):985-7.
To investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA), and explore the measures of prevention and treatment.Between June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated. There were 5 males and 2 females with an average age of 69 years (range, 59-78 years), including osteoarthritis in 4 cases, traumatic arthritis in 2 cases, and rheumatoid arthritis in 1 case. Two cases complicated by diabetes, and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking. Scar was seen near knee joint in 2 cases. The skin necrosis ranged from 10 cm x 2 cm to 13 cm x 8 cm. The time from TKA to debridement was 7-15 days (mean, 12 days). After thorough debridement, the saphenous artery skin flap, medial head of gastrocnemius muscle flap, lateral head of gastrocnemius muscle flap were used in 4 cases, 2 cases, and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases. Donor sites were repaired by split-thickness skin graft.All the flaps and myocutaneous flaps survived well, and all wounds healed by first intention. At donor site, the grafted skins survived and wounds healed by first intention. No early complication occurred. All cases were followed up 6-12 months (mean, 7.8 months). The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened, no secondary infection was observed after operation. The knee range of motion was 45-110 degrees (mean, 85 degrees) at 6 months after operation. According to the Knee Society Score (KSS), the results were excellent in 3 cases, good in 2 cases, general in 1 case, and poor in 1 case at 6 months after operation.Early discovery, thoroughly debridement, and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.
- Interleukin 10 hampers endothelial cell differentiation and enhances the effects of interferon α on lupus endothelial cell progenitors. [JOURNAL ARTICLE]
- Rheumatology (Oxford) 2014 Nov 20.
SLE is an autoimmune disease characterized by autoantibody generation, organ damage and an increased risk of cardiovascular disease. Generally considered an anti-inflammatory cytokine, IL-10 is increased in SLE and correlates with poor cardiovascular outcomes in the general population. The aim of this study was to explore the putative role of IL-10 in modulating endothelial function in SLE by examining the effects of this cytokine on endothelial progenitor cell/circulating angiogenic cell (EPC/CAC) differentiation.Human and murine control and lupus EPCs/CACs were differentiated into mature endothelial cells (ECs) in the presence or absence of graded concentrations of recombinant IL-10 with or without recombinant IFN-α or a neutralizing antibody to IL-10. IL-10-deficient mice were examined to assess the role of this cytokine in type I IFN-mediated inhibition of EC differentiation and neo-angiogenesis using an in vivo Matrigel plug assay. Serum IL-10 concentrations were measured via ELISA.IL-10 hampers EC differentiation in a dose-dependent manner. In murine EPC cultures, IL-10 is required to observe the inhibitory effects of type I IFNs on EPC function and neo-angiogenesis. In human SLE EPC/CAC cultures, neutralization of IL-10 significantly improved the differentiation of EPCs, and IL-10 enhanced type I IFN-mediated EPC/CAC dysfunction. The presence of IL-10 in serum inversely correlated with EPC/CAC function in SLE but not in control cells.IL-10 interferes with endothelial differentiation and may enhance the effects of type I IFN on vascular repair in SLE. IL-10 may be a relevant target for improving cardiovascular risk in SLE.
- Surgical Treatment for Thumb CMC Joint Arthritis. [Journal Article]
- Curr Rheumatol Rev 2013 Jul 31; 9(2):113-8.
Thumb carpometacarpal (CMC) joint arthritis is a common and debilitating condition. The mainstay of treatment is conservative management. Surgery is only indicated following failure of a prolonged and comprehensive trial of nonoperative treatment. Once surgery has been designated, an array of surgical alternatives exist, all of which provide specific benefits and disadvantages. The different surgical options and their results are reviewed. The specific surgery will vary depending on the surgeon`s experience and preference taking into account the patient`s specific needs. The most commonly performed operative management at this time consists of trapeziectomy with ligament reconstruction, but most procedures can produce high patient satisfaction and in general, the results of surgical treatment are good.
- Factors associated with poor self-reported health status after aortic valve replacement with or without concomitant bypass surgery. [JOURNAL ARTICLE]
- Eur J Cardiothorac Surg 2014 Nov 19.
Improving patients' health status is a central goal for cardiac surgery. Knowledge remains sparse on how combined CABG or other factors influence long-term, self-reported health status after aortic valve replacement (AVR). The aims of this study were (i) to identify significant factors influencing self-reported health status of patients assessed up to 13 years after AVR; and (ii) to compare their health with the age- and gender-matched general population.A survey questionnaire was sent to 1191 patients who had undergone AVR with or without concomitant CABG between 2000 and 12. Physical and mental sum scores of Short Form 12 were used as dependent variables and 34 independent variables including the Minnesota living with Heart Failure Questionnaire (MLHFQ) were evaluated by hierarchical linear regression. A comparison was made with the Norwegian general population. Clinical data were obtained from the local cardiac surgery database.In all, 912 patients (77%) responded (mean age: 73 years; 63% men). Of these, 59% had an isolated AVR. The mean assessment interval since surgery was 6 years. Several factors significantly predicted worse physical health: low education level (b: -2.8, P = 0.005), higher preoperative EuroSCORE (b: -0.88, P = 0.007), high NYHA class (b: -4.5, P < 0.001), depression (b: -5.62, P = 0.012), worse MLHFQ physical scores (b: -0.70, P < 0.001), arthritis (b: -5.13, P = 0.003), osteoporosis (b: -6.96, P = 0.010) and cancer (b: -4.48, P = 0.047) accounting for 60% of the variation (P < 0.001). Living alone (b: -3.60, P < 0.001), anxiety (b: -12.99, P < 0.001), depression (b: -6.82, P < 0.001) and worse MLHFQ emotional score (b: -0.50, P < 0.001) predicted poor mental health status, and explained 58% of the variation among AVR patients (P < 0.001). Both genders had poorer physical and mental health than their age-matched general population peers, particularly those in older age groups.AVR patients, regardless of gender, had worse physical and mental health than the general population. Living alone, educational level, physical symptom status, anxiety and depression were the most important predictors of physical and mental health status after AVR. Implementing new screening protocols for psychosocial risk factors and individualized rehabilitation programmes may contribute to improved health in AVR patients.