Use of a sensitive enzyme immunoassay for human thyrotropin in the diagnosis of hyperthyroidism

A sensitive, simultaneous sandwich enzyme immunoassay for TSH was evaluated especially for its ability to distinguish hyperthyroid patients from the euthyroid population. A total of 140 patient samples was analzyed by this assay as well as with a two-step sandwich radioimmunoassay. The diagnostic sensitivity of the thyrotropin assay was 92.5% and the specificity was 88%. False negatives by thyrotropin assay included two patients with Graves' disease who were being treated with propranolol at the time of testing and one patient who was considered hyperthyroid while receiving synthroid. Twelve patients with elevated free thyroxine index levels were considered euthyroid and 50% of these had thyrotropin values that were undetectable; most were elderly patients with nonthyroidal illnesses. Although the thyrotropin enzyme immunoassay had good sensitivity and precision for the detection of hyperthyroidism, our data suggest the limitation of a single thyrotropin determination in establishing the euthyroid state, especially in elderly patients with associated nonthyroidal illnesses and hyperthyroxinemia.     

Aeromonas spp. and their association with human diarrheal disease.

Between January 1988 and December 1989 Aeromonas species were isolated from 45 (1.8%) of 2,480 patients with acute gastroenteritis. No other bacterial enteric pathogens were found in any of these 45 patients. Of the 45 Aeromonas isolates, 35 strains (77.8%) were Aeromonas hydrophila, 7 (15.5%) were Aeromonas sobria, and 3 (6.7%) were Aeromonas caviae. Most of the patients were under 5 years of age. No bacterial enteric pathogens, including Aeromonas species, were isolated from 512 age- and sex-matched control subjects. Examination of the Aeromonas isolates for exotoxin production (enterotoxin and hemolysin) indicated that all strains, irrespective of species, were enterotoxin positive (rabbit ileal loop model) and hemolysin positive (rabbit erythrocyte model). These results suggest that Aeromonas species are potential enteric pathogens in our geographical region.     

Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay

This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR]?=?0.986; p?<?0.0001), male (HR?=?1.15; p?=?0.0163), diagnosed with uveitis (HR?=?1.49; p?=?0.0050), referred by primary care physicians (HR?=?1.96; p?<?0.0001), prescribed non-steroidal anti-inflammatory drugs (HR?=?1.55; p?<?0.0001), disease-modifying antirheumatic drugs (HR?=?1.33; p?<?0.0001), and tumor necrosis factor inhibitors (HR?=?1.40; p?=?0.0036), and to have had spinal/pelvic X-ray prior to referral (HR?=?1.28; p?=?0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.     

2007 annual research and education meeting of the Spondyloarthritis Research and Therapy Network (SPARTAN)

OBJECTIVE: The Spondyloarthritis Research and Therapy Network (SPARTAN; www.spartangroup.org) was founded in 2003 by a group of North American clinicians and researchers to promote research, education, and treatment of spondyloarthritis (SpA). In past years, it has produced and disseminated United States-specific modifications of the ASsessments in Ankylosing Spondylitis (ASAS) guidelines for the use of anti-tumor necrosis factor (TNF) therapy in AS1,2. SPARTAN held its fifth annual research meeting in September 2007 in Cleveland, Ohio. Highlights of the meeting included updates on current research in SpA, including epidemiology and genetics, bone formation and inflammation, biomarkers, activation of the IL-23/IL-17 axis, and animal models. A presentation was made on basic and clinical science of inflammatory bowel disease, and an educational pre-meeting conference was specifically designed for rheumatology fellows.     

Efficacy and safety of ixekizumab in patients with active psoriatic arthritis with and without concomitant conventional disease-modifying antirheumatic drugs: SPIRIT-P1 and SPIRIT-P2 3-year results

Clinical Rheumatology - To evaluate the three-year efficacy and safety of ixekizumab with and without concomitant conventional synthetic disease-modifying antirheumatic drug (csDMARD) use in...