Prognostic factors in short-term disability due to musculoskeletal disorders

OBJECTIVE: To identify factors associated with poor outcome in temporary work disability (TWD) due to musculoskeletal disorders (MSDs). METHODS: We conducted a secondary data analysis of a 2-year randomized controlled trial in which all patients with TWD due to MSDs in 3 health districts of Madrid (Spain) were included. Analyses refer to the patients in the intervention group. Primary outcome variables were duration of TWD and recurrence. Diagnoses, sociodemographic, work-related administrative, and occupational factors were analyzed by Cox proportional hazards models. RESULTS: We studied 3,311 patients with 4,424 TWD episodes. The following were independently associated with slower return to work: age (hazard ratio [HR] 0.99, 95% confidence interval [95% CI] 0.98-0.99), female sex (HR 0.84, 95% CI 0.78-0.90), married (HR 0.90, 95% CI 0.83-0.97), peripheral osteoarthritis (HR 0.77, 95% CI 0.6-0.9), sciatica (HR 0.59, 95% CI 0.54-0.65), self-employment (HR 0.56, 95% CI 0.48-0.65), unemployment (HR 0.41, 95% CI 0.28-0.58), manual worker (HR 0.86, 95% CI 0.79-0.94), and work position covered during sick leave (HR 0.84, 95% CI 0.77-0.92). The factors that better predicted recurrence were peripheral osteoarthritis (HR 1.75, 95% CI 1.14-2.6), inflammatory diseases (HR 1.66, 95% CI 1.009-2.72), sciatica (HR 1.30, 95% CI 1.08-1.56), indefinite work contract (HR 1.43, 95% CI 1.14-1.75), frequent kneeling (HR 1.39, 95% CI 1.15-1.69), manual worker (HR 1.19, 95% CI 1.003-1.42), and duration of previous episodes (HR 1.003, 95% CI 1.001-1.005). CONCLUSION: Sociodemographic, work-related administrative factors, diagnosis, and, to a lesser extent, occupational factors may explain the duration and recurrence of TWD related to MSD.     

Diagnostic concordance between primary care physicians and rheumatologists in patients with work disability related to musculoskeletal disorders

To assess the diagnostic correlation between primary care physicians and rheumatologists in patients with temporary work disability (TWD) related to musculoskeletal diseases (MSD). All patients with TWD related to MSDs in three health districts of Madrid, Spain, were randomized into standard care by primary care physicians (PCP) or the intervention group by rheumatologists. According to the cause, every TWD episode was classified into 11 syndrome categories. To examine the concordance between the rheumatologist and the referring PCP for each diagnosis, we used Kappa statistic (k) and 95% confidence interval (CI). A total of 3,311 (62.8%) were analyzed, 49.8% women, with a mean age of 41?years?±?12?years, 93.3% were general workers. The agreement between PCP and rheumatologists in all the diagnoses was moderated (k?=?0.62). The highest agreement was found in tendonitis (k?=?0.81, 95% CI 0.78?C0.84), and microcrystalline and undifferentiated arthritis (k?=?0.72, 95% CI 0.68?C0.77). Lowest agreements were found for peripheral osteoarthritis (k?=?0. 48 95% CI 0.38?C0.57), knee pain (k?=?0.40, 95% CI 0.29?C0.52), and muscular pain (k?=?0.15, 95% CI 0.10?C0.20) Although the global agreement on the musculoskeletal diagnosis between PCPs and rheumatologist in patients with TWD related to MSDs was reasonable, the correlation for peripheral osteoarthritis, knee pain, and muscular pain was low.     

Impact of lung‐function measures on cardiovascular disease events in older adults with metabolic syndrome and diabetes

Background

Individuals with metabolic syndrome (MetS) and diabetes (DM) are more likely to have decreased lung function and are at greater risk of cardiovascular disease (CVD).

Hypothesis.

Lung‐function measures can predict CVD events in older persons with MetS, DM, and neither condition.

Methods

We followed 4114 participants age ≥ 65 years with and without MetS or DM in the Cardiovascular Health Study. Cox regression examined the association of forced vital capacity (FVC) and 1‐second forced expiratory volume (FEV₁; percent of predicted values) with incident coronary heart disease and CVD events over 12.9 years.

Results

DM was present in 537 (13.1%) and MetS in 1277 (31.0%) participants. Comparing fourth vs first quartiles for FVC, risk of CVD events was 16% (HR: 0.84, 95% CI: 0.59–1.18), 23% (HR: 0.77, 95% CI: 0.60–0.99), and 30% (HR: 0.70, 95% CI: 0.58–0.84) lower in DM, MetS, and neither disease groups, respectively. For FEV₁, CVD risk was lower by 2% (HR: 0.98, 95% CI: 0.70–1.37), 26% (HR: 0.74, 95% CI: 0.59–0.93), and 31% (HR: 0.69, 95% CI: 0.57–0.82) in DM. Findings were strongest for predicting congestive heart failure (CHF) in all disease groups. C‐statistics increased significantly with addition of FEV₁ or FVC over risk factors for CVD and CHF among those with neither MetS nor DM.

Conclusions

FEV₁ and FVC are inversely related to CVD in older adults with and without MetS, but not DM (except for CHF); however, their value in incremental risk prediction beyond standard risk factors is limited mainly to metabolically healthier persons.     

Insecticide use and risk of rheumatoid arthritis and systemic lupus erythematosus in the Women's Health Initiative Observational Study

Objective

Farming and agricultural pesticide use has been associated with 2 autoimmune rheumatic diseases, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, risk associated with other residential or work place insecticide use is unknown.

Methods

We analyzed data from the Women's Health Initiative Observational Study (n = 76,861 postmenopausal women, ages 50–79 years). Incident cases (n = 213: 178 for RA, 27 for SLE, and 8 for both) were identified based on self‐report and use of disease‐modifying antirheumatic drugs at year 3 of followup. We examined self‐reported residential or work place insecticide use (personally mixing/applying by self and application by others) in relation to RA/SLE risk, overall and in relation to farm history. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were adjusted for age, race, region, education, occupation, smoking, reproductive factors, asthma, other autoimmune diseases, and comorbidities.

Results

Compared with never used, personal use of insecticides was associated with increased RA/SLE risk, with significant trends for greater frequency (HR 2.04, 95% CI 1.17–3.56 for ≥6 times/year) and duration (HR 1.97, 95% CI 1.20–3.23 for ≥20 years). Risk was also associated with long‐term insecticide application by others (HR 1.85, 95% CI 1.07–3.20 for ≥20 years) and frequent application by others among women with a farm history (HR 2.73, 95% CI 1.10–6.78 for ≥6 times/year).

Conclusion

These results suggest residential and work place insecticide exposure is associated with the risk of autoimmune rheumatic diseases in postmenopausal women. Although these findings require replication in other populations, they support a role for environmental pesticide exposure in the development of autoimmune rheumatic diseases.     

Immediate and medium-term outcomes of cryoballoon-based pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation: single-centre experience

Background

Pulmonary vein (PV) isolation with cryoballoon is a recently developed technique for the treatment of atrial fibrillation (AF) with acceptable mid-term results in terms of the success and safety. The purpose of our study is to identify the periprocedural complications, mid-term success rates and predictors of recurrence after AF ablation with cryoballoon.

Method

A total of 236 patients (54 % male, mean age 54.6?±?10.45 years and 79.6 % paroxysmal AF) with symptomatic AF underwent PV isolation with cryoballoon due to failure with ≥1 antiarrhythmic drug previously. Procedural success, complications and follow-up data were defined according to recent guidelines.

Results

Acute procedural success rate was 99.5 %. Mean procedural and fluoroscopy times were 72.5?±?5.3 and 14?±?3.5 min. At a median of 18 (6–27)?months follow-up, 80.8 % of paroxysmal AF patients and 50.0 % of persistent AF patients were free from AF recurrence. In multivariate regression analysis, body mass index (BMI) (hazard ratio (HR), 1.35; 95 % confidence interval (CI), 1.18–2.93, p?=?0.001), smoking (HR, 2.12; 95 % CI, 1.36–6.67, p?<?0.001), non-paroxysmal AF (HR, 1.26; 95 % CI, 1.12–2.56, p?=?0.024), duration of AF (HR, 1.42; 95 % CI, 1.18–2.61, p?=?0.015), left atrium (LA) diameter (HR, 2.42; 95 % CI, 1.64–5.88, p?<?0.001) and early AF recurrence (HR, 4.88; 95 % CI, 2.86–35.6, p?<?0.001) were independent predictors of AF recurrence following cryoablation.

Conclusion

Our results showed that AF ablation with cryoballoon is effective and safe. Non-paroxysmal AF, duration of AF, smoking, BMI, LA diameter and early recurrence were found to be the most powerful predictors and could be helpful to select patients for appropriate therapeutic strategy.     

Risk factors and impact of recurrent lupus nephritis in patients with systemic lupus erythematosus undergoing renal transplantation: Data from a single US institution

Objective

To determine the risk factors for recurrent lupus nephritis, allograft loss, and survival among patients with systemic lupus erythematosus (SLE) undergoing kidney transplantation.

Methods

The archival records of all kidney transplant recipients with a prior diagnosis of SLE (according to the American College of Rheumatology criteria) from June 1977 to June 2007 were reviewed. Patients who had died or lost the allograft within 90 days of engraftment were excluded. Time‐to‐event data were examined by univariable and multivariable Cox proportional hazards regression analyses.

Results

Two hundred twenty of nearly 7,000 renal transplantations were performed in 202 SLE patients during the 30‐year interval. Of the 177 patients who met the criteria for study entry, the majority were women (80%) and African American (65%), the mean age was 35.6 years, and the mean disease duration was 11.2 years. Recurrent lupus nephritis was noted in 20 patients (11%), allograft loss in 69 patients (39%), and death in 36 patients (20%). African American ethnicity was found to be associated with a shorter time‐to‐event for recurrent lupus nephritis (hazard ratio [HR] 4.63, 95% confidence interval [95% CI] 1.29–16.65) and death (HR 2.47, 95% CI 0.91–6.71), although, with the latter, the association was not statistically significant. Recurrent lupus nephritis and chronic rejection of the kidney transplant were found to be risk factors for allograft loss (HR 2.48, 95% CI 1.09–5.60 and HR 2.72, 95% CI 1.55–4.78, respectively). In patients with recurrent lupus nephritis, the lesion in the engrafted kidney was predominantly mesangial, compared with a predominance of proliferative or membranous lesions in the native kidneys.

Conclusion

African American ethnicity was independently associated with recurrent lupus nephritis. Allograft loss was associated with chronic transplant rejection and recurrence of lupus nephritis. Recurrent lupus nephritis is infrequent and relatively benign, without influence on a patient's survival.

     

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Aims/hypothesis

Sleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes (‘non-diabetes CHD’) but would hold true for cases of incident CHD following incident diabetes (‘diabetes-CHD’).

Methods

A total of 6966 men and 9378 women aged 45–73 years from the Malmö Diet Cancer Study, a population-based, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD.

Results

Mean follow-up times for incident diabetes (n = 1137/1016 [men/women]), incident CHD (n = 1170/578), non-diabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/77) were 14.2–15.2 years for men, and 15.8–16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.29, 95% CI 0.86, 1.93).

Conclusions/interpretation

The associations between sleep duration and incident CHD directly reflect the associations between sleep duration and incident diabetes. Incident diabetes may thus be the explanatory mechanism for the association between short and long sleep duration and incident CHD.

     

Association of a rheumatoid arthritis susceptibility variant at the CCL21 locus with premature mortality in inflammatory polyarthritis patients

Objective

To investigate whether recently identified rheumatoid arthritis (RA) susceptibility loci are also associated with disease severity, specifically all‐cause and cardiovascular disease (CVD) mortality, in patients with inflammatory polyarthritis (IP).

Methods

Subjects with recent‐onset IP were recruited from the Norfolk Arthritis Register. Seventeen RA susceptibility single‐nucleotide polymorphisms (SNPs) were tested using Sequenom MassArray iPLEX chemistry. Vital status was ascertained from central records. The association of SNP allele carriage with mortality risk was assessed using Cox proportional hazards models after adjusting by sex. The mortality risks of those SNP alleles found to be associated were then stratified by baseline anti–citrullinated peptide (anti‐CCP) antibody and shared epitope (SE) status.

Results

All SNPs were successfully genotyped in 2,324 IP subjects. The presence of 2 copies of the risk allele rs2812378 mapping to the CCL21 gene predicted all‐cause mortality (hazard ratio [HR] 1.40, 95% confidence interval [95% CI] 1.04–1.87), whereas risk allele carriage also predicted increased CVD mortality (HR 1.33, 95% CI 1.01–1.75). The highest mortality risks were seen in anti‐CCP antibody–positive subjects with 2 copies of the CCL21 risk alleles and 2 copies of the SE (all‐cause HR 3.20, 95% CI 1.52–6.72; CVD HR 3.73, 95% CI 1.30–10.72).

Conclusion

In this large study, we found that carriage of CCL21 risk alleles was associated with premature mortality in IP independently of anti‐CCP antibody and SE status. Interestingly, CCL21 expression has been reported in atherosclerotic plaques supporting the thesis that the increased CVD mortality in IP patients may be mediated by shared inflammatory mechanisms.     

Obesity is an independent risk factor for heart failure: Zona Franca Cohort study

Background:

Heart failure (HF) is a major problem in developed countries. However, its relationship with obesity remains unclear, especially in low‐risk populations. The objective of the study was to analyze the relationship between obesity and HF in a low‐risk Mediterranean population.

Hypothesis:

Obesity is an independent predictor for HF.

Methods:

A prospective community‐based population cohort study with 10 years' follow‐up was conducted at 2 healthcare centers in the city of Barcelona, Spain. From a registered population of 35 275, the study included 932 randomly selected patients without HF, age 35–84 years. Obesity was defined as body mass index (BMI) ≥30 and HF according to European Society of Cardiology guidelines, confirmed by echocardiography. Cox proportional hazards regression was used to examine the association between obesity and heart failure.

Results:

The difference in HF incidence between obese subjects (4.7%) and nonobese subjects (1.6%) was 3.1% (95% confidence interval [CI]: 0.7–5.5). In the unadjusted model, incident HF was significantly associated with BMI: the hazard ratio [HR] was 1.09 for every 1 kg/m² increase (95% CI: 1.05–1.14) and 3.01 for BMI ≥30 (95% CI: 1.34–6.77). After adjusting for age, sex, hypertension, ischemic heart disease, and diabetes mellitus, the results were similar: HR 1.06 (95% CI: 1.01–1.10) and HR 2.45 for BMI ≥30 (95% CI: 1.02–5.61). Overweight was not associated with HF in any of the models. The population‐attributable risk of HF due to obesity was 43.0% (95% CI: 13.9–74.9).

Conclusions:

High rate differences, HRs, and attributable risk indicate that obesity is an important risk factor for incident HF. Copyright © 2010 Wiley Periodicals, Inc. This work was supported by grants from Instituto de Salud Carlos III‐FEDER0 (PI080439), and by a joint contract of the Instituto de Salud Carlos III and the Health Department of the Catalan Government.     

No increased mortality in patients with rheumatoid arthritis treated with biologics: results from the biologics register of six rheumatology institutes in Japan

Objective

To investigate the influence of biologics on mortality and risk factors for death in rheumatoid arthritis (RA) patients.

Methods

RA patients treated with at least one dose of biologics in daily practice in six large rheumatology institutes (“biologics cohort”) were observed until 15 May 2010 or death, whichever occurred first. Mortality of the biologics cohort and the “comparator cohort” (comprising patients among the IORRA cohort who had never been treated with biologics) was compared to that of the Japanese general population. Factors associated with mortality were assessed by a Cox model.

Results

Among 2683 patients with 6913.0 patient-years of observation, 38 deaths were identified in the biologics cohort. The probability of death in patients lost to follow-up, calculated using the weighted standardized mortality ratio (SMR), was 1.08 [95 % confidence interval (CI) 0.77–1.47] in the biologics cohort and 1.28 (95 % CI 1.17–1.41) in the comparator cohort. Pulmonary involvement was the main cause of death (47.4 %), and the disease-specific SMR of pneumonia was 4.19 (95 % CI 1.81–8.25). Risk factors for death included male gender [hazard ratio (HR) 2.78 (95 % CI 1.24–6.22)], advanced age (HR 1.07, 95 % CI 1.03–1.11), and corticosteroid dose (HR 1.08, 95 % CI 1.01–1.17).

Conclusion

Mortality in RA patients exposed to biologics did not exceed that in patients not exposed to biologics, but death from pulmonary manifestations was proportionally increased in RA patients exposed to biologics.     

Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation

Background

Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored.

Possible protective effect of hydroxychloroquine on delaying the occurrence of integument damage in lupus: LXXI,data from a multiethnic cohort

Objective

To determine the features predictive of time to integument damage in patients with systemic lupus erythematosus (SLE) from a multiethnic cohort (LUpus in MInorities, NAture versus nurture [LUMINA]).

Methods

LUMINA SLE patients (n = 580) age ≥16 years, with a disease duration of ≤5 years at baseline (T0), of African American, Hispanic, and Caucasian ethnicity were studied. Integument damage was defined per the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (scarring alopecia, extensive skin scarring, and skin ulcers lasting at least 6 months); factors associated with time to its occurrence were examined by Cox proportional univariable and multivariable (main model) hazards regression analyses. Two alternative models were also examined: in model 1, all patients, regardless of when integument damage occurred (n = 94), were included; in model 2, a time‐varying approach (generalized estimating equation) was employed.

Results

Thirty‐nine (6.7%) of 580 patients developed integument damage over a mean ± SD total disease duration of 5.9 ± 3.7 years, and were included in the main multivariable regression model. After adjusting for discoid rash, nailfold infarcts, photosensitivity, and Raynaud's phenomenon (significant in the univariable analyses), disease activity over time (hazard ratio [HR] 1.17, 95% confidence interval [95% CI] 1.09–1.26) was associated with a shorter time to integument damage, whereas hydroxychloroquine use (HR 0.23, 95% CI 0.12–0.47) and Texan‐Hispanic (HR 0.35, 95% CI 0.14–0.87) and Caucasian ethnicities (HR 0.37, 95% CI 0.14–0.99) were associated with a longer time. Results of the alternative models were consistent with those of the main model, although in model 2, the association with hydroxychloroquine was not significant.

Conclusion

Our data indicate that hydroxychloroquine use is possibly associated with a delay in integument damage development in patients with SLE.     

Lifestyle Risk Factors Increase the Risk of Hospitalization for Sciatica: Findings of Four Prospective Cohort Studies

Background

The purpose of this study is to assess the effects of lifestyle risk factors on the risk of hospitalization for sciatica and to determine whether overweight or obesity modifies the effect of leisure-time physical activity on hospitalization for sciatica.

Lipid profile and incidence of atrial fibrillation: A prospective cohort study in China

Background

The association between dyslipidemia, a major risk factor for cardiovascular diseases, and atrial fibrillation (AF) is not clear because of limited evidence.

Hypothesis.

Dyslipidemia may be associated with increased risk of AF in a Chinese population.

Methods

A total of 88 785 participants free from AF at baseline (2006–2007) were identified from the Kailuan Study. Fasting levels of total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), and triglycerides (TG) were measured at baseline using standard procedures. The study population was stratified based on quartiles of lipid profile. Incident AF was ascertained from electrocardiograms at biennial follow‐up visits (2008–2015). The associations between incident AF and the different lipid parameters (TC, LDL‐C, HDL‐C, and TG) were assessed by Cox proportional hazards regression analysis.

Results

Over a mean follow‐up period of 7.12 years, 328 subjects developed AF. Higher TC (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.43‐0.84) and LDL‐C (HR: 0.60, 95% CI: 0.43‐0.83) levels were inversely associated with incident AF after multivariable adjustment. HDL‐C and TG levels showed no association with newly developed AF. The results remained consistent after exclusion of individuals with myocardial infarction or cerebral infarction, or those on lipid‐lowering therapy. Both TC/HDL‐C and LDL‐C/HDL‐C ratios were inversely associated with risk of AF (per unit increment, HR: 0.88, 95% CI: 0.79‐0.98 and HR: 0.77, 95% CI: 0.66‐0.91, respectively).

Conclusions

TC and LDL‐C levels were inversely associated with incident AF, whereas no significant association of AF with HDL‐C or TG levels was observed.     

The importance of proteinuria and prior cardiovascular disease in all major clinical outcomes of atherosclerotic renovascular disease – a single-center observational study

Background

Identification of patients at risk of developing adverse events would enable aggressive medical therapy and possibly targeted revascularization. The aim of this study is to characterize the determinants of long-term outcomes in atherosclerotic renovascular disease (ARVD).

Methods

Patients with a radiological diagnosis of ARVD were recruited into this single-center prospective cohort study between 1986 and 2014. Data collected included baseline co-morbid conditions, annualized prescribed medications and laboratory data (serum creatinine [υmol/L], proteinuria [g/24 h]). Multivariable Cox regression analysis was used to explore association with these end-points: death, end-stage kidney disease (ESKD), cardiovascular event (CVE) and the first of any of these events.

Results

A total of 872 patients were recruited into this study. However, 42 patients were excluded due to missing baseline data and hence case records for 830 patients were reviewed. Over median follow-up of 57.1 months (interquartile range: 21.7–96.9), incidence per 100 patient years of death, ESKD, CVE and any event was 13.5, 4.2, 8.9 and 21.0 respectively. Macrovascular disease (MVD), congestive heart failure (CHF), flash pulmonary oedema (FPE) and greater proteinuria at baseline were individually associated with increased risk for all end-points in multivariable analysis (Death: MVD –HR 1.24 [95% CI 1.02–1.50]; CHF –HR 1.33 [95% CI 1.08–1.64]; FPE – HR 2.10 [95% CI 1.50–2.92]; proteinuria – HR 1.14 [95% CI 1.08–1.20]). Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89–0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70–0.98]; statins: HR 0.79 [95% CI 0.66–.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71–1.00]; statins: HR 0.79 [95% CI 0.66–0.93]). Revascularization was associated with reduced risk of death (HR 0.65 [95% CI 0.51–0.83]) and ESKD (HR 0.59 [95% CI 0.46–0.76]).

Conclusion

All patients with ARVD require intensive vascular protection therapy to help mitigate systemic atherosclerosis, optimize cardiovascular risk and improve clinical outcomes. More effort is required to identify the minority of patients who may benefit from revascularization.

     

Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2‐year follow‐up

Background

Our previous study reported a modified endoscopic procedure for nonvalvular atrial fibrillation (AF) that requires only 3 ports in the left chest wall.

Hypothesis

Certain preoperative variables might be predictive risk factors for AF recurrence among patients who underwent this procedure.

Methods

From October 2010 to April 2014, 114 patients with either paroxysmal AF (PAF) or nonparoxysmal AF (non‐PAF) underwent the procedure and completed postoperative cardiac‐rhythm measurement via electrocardiography and Holter monitoring. Univariate and multivariate analyses of the possible AF‐related risk factors were conducted.

Results

During 2‐year follow‐up, 99 of 114 patients (86.8%) were free from atrial tachyarrhythmia. Results from univariate analyses showed that AF duration, left atrial diameter (LAD), left atrial minimum volume, left atrial empty fraction, left atrial expansion index, and left atrial active empty fraction (LAAEF) were significantly associated with postoperative AF recurrence. Results from multivariate analyses showed that AF duration (odds ratio [OR]: 1.194, 95% CI: 1.063‐1.340, P = 0.003), LAD (OR: 1.101, 95% CI: 1.005‐1.205, P = 0.039), and LAAEF (OR: 0.490, 95% CI: 0.277‐0.865, P = 0.014) were independent risk factors. There was no difference in AF recurrence between patients with PAF and non‐PAF (P = 0.250).

Conclusions

Our 2‐year follow‐up study suggested that low LAAEF, long AF duration, and large LAD might be potential predictive risk factors for AF recurrence. Patients with PAF and non‐PAF had a similar AF recurrence rate after modified endoscopic ablation.     

Presence of peripheral arthritis and male sex predicting continuation of anti–tumor necrosis factor therapy in ankylosing spondylitis: An observational prospective cohort study from the South Swedish arthritis treatment group register

Objective

To examine clinical characteristics as possible predictors of long‐term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice.

Methods

Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease‐modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years.

Results

The 2‐year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19–0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27–0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25–1.04], P = 0.062), whereas no differences were found comparing the 3 anti–tumor necrosis factor agents in other ways. Higher baseline C‐reactive protein level (HR 0.99 [95% CI 0.97–1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34–1.10], P = 0.10) also showed trends to entail better drug adherence.

Conclusion

AS patients in this study have an excellent 2‐year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.     

Childhood‐onset disease as a predictor of mortality in an adult cohort of patients with systemic lupus erythematosus

Objective

To examine childhood‐onset disease as a predictor of mortality in a cohort of adult patients with systemic lupus erythematosus (SLE).

Methods

Data were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 957 adult subjects with SLE that includes 98 subjects with childhood‐onset SLE. Baseline and followup data were obtained via telephone interviews conducted in 2002–2007. The number of deaths during 5 years of followup was determined and standardized mortality ratios (SMRs) for the cohort, and across age groups, were calculated. Kaplan‐Meier life table analysis was used to compare mortality rates between childhood‐ (defined as SLE diagnosis at <18 years of age) and adult‐onset SLE. Multivariate Cox proportional hazard models were used to determine predictors of mortality.

Results

During the median followup period of 48 months, 72 deaths (7.5% of subjects) occurred, including 9 deaths (12.5%) in subjects with childhood‐onset SLE. The overall SMR was 2.5 (95% confidence interval [95% CI] 2.0–3.2). In Kaplan‐Meier survival analysis, after adjusting for age, childhood‐onset subjects were at increased risk for mortality throughout the followup period (P< 0.0001). In a multivariate model adjusting for age, disease duration, and other covariates, childhood‐onset SLE was independently associated with an increased mortality risk (hazard ratio [HR] 3.1, 95% CI 1.3–7.3), as was low socioeconomic status measured by education (HR 1.9, 95% CI 1.1–3.2), and end stage renal disease (HR 2.1, 95% CI 1.1–4.0).

Conclusion

Childhood‐onset SLE was a strong predictor of mortality in this cohort. Interventions are needed to prevent early mortality in this population.     

Biomarkers of incident radiographic knee osteoarthritis: Do they vary by chronic knee symptoms?

Objective

To explore the ability of osteoarthritis (OA)–related biomarkers to predict incident radiographic knee OA in a large sample of African American and Caucasian men and women.

Methods

Baseline levels of serum cartilage oligomeric matrix protein (COMP), hyaluronan (HA), high‐sensitivity C‐reactive protein (hsCRP), and keratan sulfate (KS) and baseline and followup radiographs were available for 353 knees without baseline osteophyte formation and for 446 knees without baseline joint space narrowing (JSN). Cox models estimated the hazard ratio (HR) and 95% confidence interval (95% CI) for incident knee OA for a 1‐unit increase in the ln of each biomarker, with adjustment for age, race, sex, body mass index, and knee OA of the contralateral limb. Report of chronic knee symptoms was explored as a modifier of the association.

Results

The hazard of incident knee osteophytes (HR 2.16 [95% CI 1.39–3.37]) and incident JSN (HR 1.82 [95% CI 1.15–2.89]) increased with higher baseline ln(COMP) levels. The hazard of incident knee JSN increased with higher ln(HA) levels (HR 1.46 [95% CI 1.14–1.87]). Baseline ln(hsCRP) and ln(KS) did not predict incident knee outcomes. HRs per unit increase in ln(COMP), ln(HA), and ln(KS) were higher among knees with chronic symptoms than among those without symptoms.

Conclusion

Higher baseline ln(COMP) and ln(HA) levels were associated with incident knee OA over an average followup period of 6.3 years. These results represent detection of a molecular stage of OA prior to radiographic manifestations. Further exploration is needed to determine how chronic knee symptoms modify the biomarker–incident knee OA association.