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Soontrapa P, Shahar S, Eauchai L, Ernste FC, Liewluck T. Disease spectrum of myopathies with elevated aldolase and normal creatine kinase. Eur J Neurol 2024; 31:e16117. [PMID: 37922500 DOI: 10.1111/ene.16117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND PURPOSE Elevation of serum creatine kinase (CK) or hyperCKemia is considered a biological marker of myopathies. However, selective elevation of serum aldolase with normal CK has been reported in a few myopathies, including dermatomyositis, immune-mediated myopathy with perimysial pathology and fasciitis with associated myopathy. The aim was to investigate the disease spectrum of myopathies with isolated aldolase elevation. METHODS Medical records were reviewed to identify patients >18 years old seen between December 1994 and June 2020 who had pathologically proven myopathies with elevated aldolase and normal CK level. Patients with alternative causes of aldolase elevation were excluded. RESULTS Thirty-four patients with various types of myopathies were identified. Myopathies were treatable in 27 patients. The three most common etiologies were dermatomyositis (n = 8), overlap myositis (n = 4) and nonspecific myopathy (n = 4). Perimysial pathology comprising inflammation, fragmentation, vasculitis, calcified perimysial vessels or extracellular amyloid deposition was found in 17/34 patients (50%). Eight dermatomyositis patients with selective elevated aldolase were compared to 24 sex- and age-matched patients with dermatomyositis and hyperCKemia. Dermatomyositis patients with normal CK significantly (p < 0.05) had less frequent cutaneous involvement (50.0% vs. 100.0%) and fibrillation potentials (50.0% vs. 90.5%) but higher median erythrocyte sedimentation rate (33.5 vs. 13.5 mm/h) and more common perifascicular mitochondrial pathology (37.5% vs. 4.2%). CONCLUSION Isolated aldolase elevation can be found in a greater variety of myopathies than initially thought and most were treatable. Dermatomyositis is the most common myopathy with selective elevation of aldolase in our cohort, which features some unique characteristics compared to dermatomyositis with hyperCKemia.
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Affiliation(s)
- Pannathat Soontrapa
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Division of Neurology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shelly Shahar
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lattawat Eauchai
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Anatomy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Floranne C Ernste
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teerin Liewluck
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Saketkoo LA, Paik JJ, Alexanderson H, Dimachkie MM, Ernste FC, Naddaf E, Shafranski B, Gupta L, Mecoli CA, Saygin D, Albayda J, Basharat P, Day JA, Valenzuela A, Bromley R, de Groot I, Edison SE, Lanis A, Lood C, Regardt M, Yi BY, Benitez AC, Chinoy H, Christopher-Stine L, Isenberg DA, Lang B, Oddis CV, van Royen A, Vencovsky J, Werth VP, Machado PM. Collaborative research in myositis-related disorders: MIHRA, a global shared community model. Clin Exp Rheumatol 2024; 42:207-212. [PMID: 38436382 DOI: 10.55563/clinexprheumatol/hc1lsf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
Myositis International Health and Research Collaborative Alliance (MIHRA) is a newly formed purpose-built non-profit charitable research organization dedicated to accelerating international clinical trial readiness, global professional and lay education, career development and rare disease advocacy in IIM-related disorders. In its long form, the name expresses the community's scope of engagement and intent. In its abbreviation, MIHRA, conveys linguistic roots across many languages, that reflects the IIM community's spirit with meanings such as kindness, community, goodness, and peace. MIHRA unites the global multi-disciplinary community of adult and pediatric healthcare professionals, researchers, patient advisors and networks focused on conducting research in and providing care for pediatric and adult IIM-related disorders to ultimately find a cure. MIHRA serves as a resourced platform for collaborative efforts in investigator-initiated projects, consensus guidelines for IIM assessment and treatment, and IIM-specific career development through connecting research networks.MIHRA's infrastructure, mission, programming and operations are designed to address challenges unique to rare disease communities and aspires to contribute toward transformative models of rare disease research such as global expansion and inclusivity, utilization of community resources, streamlining ethics and data-sharing policies to facilitate collaborative research. Herein, summarises MIHRA operational cores, missions, vision, programming and provision of community resources to sustain, accelerate and grow global collaborative research in myositis-related disorders.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Louisiana State University and Tulane University Schools of Medicine, New Orleans, LA, USA.
| | - Julie J Paik
- Johns Hopkins Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helene Alexanderson
- Karolinska Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, and Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, and Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Christopher A Mecoli
- Johns Hopkins Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Didem Saygin
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jemima Albayda
- Johns Hopkins Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jessica A Day
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Antonia Valenzuela
- Department of Rheumatology and Clinical Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Ingrid de Groot
- The Myositis Association, Columbia, MD, USA, and Spierziekten Nederland (Dutch patient association for NeuroMuscular Diseases), Dutch Myositis Network, TMA Medical Advisory Board, The Netherlands
| | | | - Aviya Lanis
- Seattle Children's Hospital, Seattle, WA, USA
| | - Christian Lood
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Malin Regardt
- Karolinska Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, and Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Belina Y Yi
- Johns Hopkins Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alejandro C Benitez
- Rheumatology Department at the National Hospital Alejandro Posadas, University of Buenos Aires, Argentina
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, and Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Lisa Christopher-Stine
- Johns Hopkins Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, UK
| | - Bianca Lang
- Department of Paediatrics and Medicine, Dalhousie University and IWK Health, Halifax, NS, Canada
| | - Chester V Oddis
- Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Pedro M Machado
- Department of Neuromuscular Diseases and Centre for Rheumatology, University College London; and Department of Rheumatology and Queen Square Centre for Neuromuscular Diseases, University College London Hospitals NHS Foundation Trust, London, UK
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Chompoopong P, Skolka MP, Ernste FC, Milone M, Liewluck T. Symptomatic myopathies in sarcoidosis: disease spectrum and myxovirus resistance protein A expression. Rheumatology (Oxford) 2023; 62:2556-2562. [PMID: 36440911 DOI: 10.1093/rheumatology/keac668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/19/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Symptomatic myopathy in sarcoidosis patients is not always due to sarcoid myopathy (ScM). We investigated the clinical and pathological spectrum including myxovirus resistance protein A (MxA) expression among sarcoidosis patients. METHODS We reviewed the Mayo Clinic database (May 1980-December 2020) to identify sarcoidosis patients with myopathic symptoms and pathological evidence of myopathy. RESULTS Among 5885 sarcoidosis patients, 21 had symptomatic myopathy. Eight carried a diagnosis of sarcoidosis 5.5 years (median) prior to myopathy onset. Eleven patients had ScM. The remaining had non-sarcoid myopathies (five IBM, one immune-mediated necrotizing myopathy, one non-specific myositis, two non-specific myopathy and one steroid myopathy). Estimated frequency of IBM is 85 per 100 000 sarcoidosis patients. The following features were associated with non-sarcoid myopathies (P < 0.05): (i) predominant finger flexor and quadriceps weakness, (ii) modified Rankin scale (mRS) >2 at time of diagnosis, (iii) creatine kinase >500 U/l, and (iv) absence of intramuscular granulomas. Sarcoplasmic MxA expression was observed in scattered myofibres in three patients, two of whom were tested for DM-specific autoantibodies and were negative. Immunosuppressive therapy led to improvement in mRS ≥1 in 5/10 ScM, none of the five IBM, and 3/3 remaining patients with non-sarcoid myopathies. DISCUSSION Symptomatic myopathy occurred in 0.36% of sarcoidosis. IBM was the second most common cause of myopathies after ScM. Frequency of IBM in sarcoidosis is higher than in the general population. Recognition of features suggestive of alternative aetiologies can guide proper treatment. Our findings of abnormal MxA expression warrant a larger study.
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Affiliation(s)
- Pitcha Chompoopong
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michael P Skolka
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Floranne C Ernste
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Margherita Milone
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Teerin Liewluck
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Eggleston RH, Baqir M, Varghese C, Pennington KM, Bekele DI, Hartman TE, Ernste FC. Clinical Outcomes With and Without Plasma Exchange in the Treatment of Rapidly Progressive Interstitial Lung Disease Associated With Idiopathic Inflammatory Myopathy. J Clin Rheumatol 2023; 29:151-158. [PMID: 36729874 DOI: 10.1097/rhu.0000000000001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE A subset of patients with idiopathic inflammatory myopathy (IIM) develops highly fatal, rapidly progressive interstitial lung disease (RP-ILD). Treatment strategies consist of glucocorticoid and adjunctive immunosuppressive therapies. Plasma exchange (PE) is an alternative therapy, but its benefit is unclear. In this study, we aimed to determine whether PE benefited outcomes for patients with RP-ILD. METHODS In this medical records review study, we compared baseline characteristics and clinical outcomes for 2 groups of patients with IIM-related RP-ILD: those who received and did not receive PE. RESULTS Our cohort consisted of 15 patients, 9 of whom received PE. Baseline demographic characteristics and severity of lung, skin, and musculoskeletal disease between the 2 groups of patients were not significantly different. Five patients required mechanical ventilation (2, PE; 3, no PE). Plasma exchange was generally a third-line adjunctive treatment option. The PE group had a longer median (interquartile range) hospitalization (27.0 [23.0-36.0] days) than the non-PE group (12.0 [8.0-14.0] days) ( p = 0.02). There was a potential benefit in 30-day mortality improvement in those receiving PE (0% vs 33%, p = 0.14), with a statistically significant improvement in 2 important composite end points including 30-day mortality or need for lung transplant (0% vs 50%, p = 0.04) and 1-year mortality or need for lung transplant or hospital readmission for RP-ILD in those receiving PE (22% vs 83%, p = 0.04). CONCLUSIONS Plasma exchange may be an underutilized, safe salvage therapy for patients with IIM-related RP-ILD when other immunosuppressive therapies fail.
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Affiliation(s)
- Reid H Eggleston
- From the Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester
| | | | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester
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Kronzer VL, Kimbrough BA, Crowson CS, Davis JM, Holmqvist M, Ernste FC. Incidence, Prevalence, and Mortality of Dermatomyositis: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:348-355. [PMID: 34549549 PMCID: PMC8934743 DOI: 10.1002/acr.24786] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to determine the population-based incidence, prevalence, and mortality of dermatomyositis (DM) using European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria. METHODS This population-based cohort study included incident DM from January 1, 1995 to December 31, 2019. We manually reviewed all individuals with at least 1 code for DM or polymyositis to determine if they met EULAR/ACR criteria, subspecialty physician diagnosis, and/or Bohan and Peter criteria. We age- and sex-adjusted incidence and prevalence estimates to the US non-Hispanic White year 2000 population and estimated prevalence on January 1, 2015. Standardized mortality ratios (SMRs) with 95% confidence intervals (95% CIs) compared observed to expected mortality adjusting for age, sex, and year. RESULTS We identified 40 cases of verified DM, with 29 cases incident in Olmsted County from 1995 to 2019. The mean age was 57 years, 26 (90%) were female, and 12 (41%) had clinically amyopathic DM (CADM). The median follow-up time was 8.2 years. The overall adjusted incidence of DM was 1.1 (95% CI 0.7-1.5) per 100,000 person-years, and prevalence was 13 (95% CI 6-19) per 100,000. The SMR was significantly elevated among the myopathic DM cases (3.1 [95% CI 1.1-6.8]) but not CADM cases (1.1 [95% CI 0.2-3.3]). The positive predictive value of ≥2 DM codes was only 40 of 82 (49%). CONCLUSION This population-based study found that DM incidence and prevalence were higher than previously reported. Mortality was significantly elevated for myopathic DM but not for CADM.
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Affiliation(s)
| | | | - Cynthia S. Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie Holmqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Naddaf E, Shelly S, Mandrekar J, Chamberlain AM, Hoffman EM, Ernste FC, Liewluck T. Survival and associated comorbidities in inclusion body myositis. Rheumatology (Oxford) 2022; 61:2016-2024. [PMID: 34534271 PMCID: PMC9071572 DOI: 10.1093/rheumatology/keab716] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/11/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate survival and associated comorbidities in inclusion body myositis (IBM) in a population-based, case-control study. METHODS We utilized the expanded Rochester Epidemiology Project medical records-linkage system, including 27 counties in Minnesota and Wisconsin, to identify patients with IBM, other inflammatory myopathies (IIM), and age/sex-matched population-controls. We compared the frequency of various comorbidities and survival among groups. RESULTS We identified 50 IBM patients, 65 IIM controls and 294 population controls. Dysphagia was most common in IBM (64%) patients. The frequency of neurodegenerative disorders (dementia/parkinsonism) and solid cancers was not different between groups. Rheumatoid arthritis was the most common rheumatic disease in all groups. A total of 36% of IBM patients had a peripheral neuropathy, 6% had Sjögren's syndrome and 10% had a haematologic malignancy. T-cell large granular lymphocytic leukaemia was only observed in the IBM group. None of the IBM patients had hepatitis B or C, or HIV. IBM patients were 2.7 times more likely to have peripheral neuropathy, 6.2 times more likely to have Sjögren's syndrome and 3.9 times more likely to have a haematologic malignancy than population controls. IBM was associated with increased mortality, with a 10-year survival of 36% from index, compared with 67% in IIM and 59% in population controls. Respiratory failure or pneumonia (44%) was the most common cause of death. CONCLUSIONS IBM is associated with lower survival, and higher frequency of peripheral neuropathy, Sjögren's syndrome and haematologic malignancies than the general population. Close monitoring of IBM-related complications is warranted.
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Affiliation(s)
| | | | | | | | | | - Floranne C Ernste
- Division of Rheumatology, Department of Medicine, Mayo Clinic,
Rochester, MN, USA
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7
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Karmacharya P, Wright K, Achenbach SJ, Crowson CS, Ogdie A, Bekele D, Duarte-García A, Ernste FC, Tollefson MM, Davis JM. Time to transition from psoriasis to psoriatic arthritis: A population-based study. Semin Arthritis Rheum 2022; 52:151949. [PMID: 35000786 PMCID: PMC8815433 DOI: 10.1016/j.semarthrit.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify demographic and clinical characteristics associated with time between psoriasis and psoriatic arthritis (PsA). METHODS A retrospective, population-based cohort of incident PsA patients ≥18 years (2000-17) from Olmsted County, MN was identified. PsA patients were divided into two groups: patients with concurrent psoriasis and PsA (within 1 year), and patients with psoriasis before PsA (>1 year). Patients with PsA prior to psoriasis were excluded. Age- and sex-adjusted logistic regression models were used to examine factors associated with the time between psoriasis and PsA diagnosis. RESULTS Among 164 patients with incident PsA, 158 had a current or personal history of psoriasis. The mean (SD) age at PsA diagnosis was 46.3 (12.0) years, and 46% were females. The median (interquartile range) time from psoriasis to PsA was 35.5 (0.8-153.4) months. 64 patients (41%) patients had concurrent psoriasis and PsA while 94 (59%) had onset of psoriasis before PsA. The estimated age at onset of psoriasis symptom (OR per 10-year decrease = 1.63, 95% CI: 1.26-2.11) and psoriasis severity (OR = 3.65, 95% CI: 1.18-11.32 for severe vs. mild) were associated with having a psoriasis diagnosis more than one year prior to incident PsA. CONCLUSION In this population-based study, approximately 60% of the patients had psoriasis before PsA, and the rest had concurrent psoriasis and PsA. Patients with lower age at psoriasis onset or severe psoriasis were more likely to have a longer time to transition from psoriasis to PsA.
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Affiliation(s)
- Paras Karmacharya
- Division of Rheumatology, Mayo Clinic, Rochester, MN,Division of Rheumatology &Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Kerry Wright
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Sara J. Achenbach
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Cynthia S. Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Delamo Bekele
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Megha M. Tollefson
- Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN
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Shakshouk H, Deschaine MA, Wetter DA, Drage LA, Ernste FC, Gibson LE, Lehman JS. Do histopathological features correlate with systemic manifestations in dermatomyositis? Analysis of 42 skin biopsy specimens from 22 patients. J Cutan Pathol 2022; 49:442-447. [PMID: 35080246 DOI: 10.1111/cup.14203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding whether specific histopathologic features on skin biopsy are predictive of systemic associations in dermatomyositis would be useful to guide clinical screening. METHODS Via retrospective medical record search, clinical and laboratory findings of patients with dermatomyositis were documented. Existing skin biopsy slides were re-reviewed blindly. RESULTS Of all biopsy specimens (n=42), the most frequent histopathological finding was vacuolar interface dermatitis (95%). Other features included perivascular lymphocytic infiltrate (71%), increased dermal mucin (40%), vessel wall thickening (12%), follicular plugging (9.5%) and dermal sclerosis (7%). Neutrophilic infiltrate was observed in 3 biopsies from a patient with adualimumab-associated DM. Vasculitis was not observed. There was no statistically significant difference in the presence of any histopathological feature and that of various systemic manifestations [i.e. myopathy, interstitial lung disease (ILD) and malignancy]. However, we observed that dense lichenoid infiltrate rather than pauci-inflammatory changes correlated with severe itching (p < 0.001) Patients with MDA-5 antibodies were significantly more likely to have vasculopathy than those without (p=0.029*). CONCLUSIONS No dermatopathological feature was reliably predictive of myopathy, ILD or malignancy. This finding implies that regardless of histopathologic findings, patients should be screened for associated conditions, as clinically indicated.
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Affiliation(s)
| | - Maria A Deschaine
- Department of Dermatology, Florida State University, Tallahassee, FL, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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9
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Shelly S, Mielke MM, Paul P, Milone M, Tracy JA, Mills JR, Klein CJ, Ernste FC, Mandrekar J, Liewluck T. Incidence and Prevalence of Immune-mediated Necrotizing Myopathy in Adults in Olmsted County, Minnesota. Muscle Nerve 2022; 65:541-546. [PMID: 35064938 PMCID: PMC9035036 DOI: 10.1002/mus.27504] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Immune-mediated necrotizing myopathy (IMNM) is considered a rare subtype of the immune-mediated myopathies, but its incidence and prevalence are unknown. This study aimed to determine the incidence and prevalence of IMNM in the adults in Olmsted County, Minnesota. METHODS We identified adult patients with IMNM defined by the 2016 European Neuromuscular Centre diagnostic criteria among Olmsted County, Minnesota, residents over a 20-year period RESULTS: Seven patients fulfilled the inclusion criteria. Six patients were tested for IMNM antibodies: 4 were anti 3-Hydroxy-3-Methylglutaryl-CoA Reductase (HMGCR)-positive, 1 was anti-signal recognition particle (SRP)-positive and 1 was seronegative. The incidence of IMNM during 2010-2019 was 8.3 per million person-years. The prevalence of IMNM in 2010 was 1.85 per 100,000 people ≥50 years. Median age at symptom onset was 64 years (range: 52-86) and median time from symptom onset to diagnosis was 3 months (range <1-156). Statin use among anti-HMGCR IMNM patients, but not the entire IMNM cohort, was higher than in controls (P=0.024). Two IMNM patients developed cancers. The incidence of malignancy in IMNM was not higher than that of the general population. Treatment outcome was favorable in all patients except for 1 with delayed treatment and one with insufficient therapy. Among 3 deceased patients, 1 died from cancer while 2 died from IMNM-related cardiorespiratory complications. DISCUSSION IMNM is a rare disease. Its prevalence is one tenth that of inclusion body myositis in Olmsted County, Minnesota. IMNM patients in our cohort were not at higher risk for developing cancer.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Neurology, Chaim Sheba Medical Center, Tel HaShomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Pritikanta Paul
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL
| | | | | | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Floranne C Ernste
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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10
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Colbenson GA, Rose CH, Ernste FC, Ryu JH. Successful Pregnancy Outcome With Connective Tissue Disease-Associated Interstitial Lung Disease: A Case Series. J Clin Rheumatol 2022; 28:e305-e307. [PMID: 33657592 DOI: 10.1097/rhu.0000000000001725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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11
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Sehgal R, Ernste FC, Eckloff S. Dr. Sehgal et al reply. J Rheumatol 2021; 49:547. [PMID: 34911806 DOI: 10.3899/jrheum.211190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We appreciate the interest of Wang et al1 in our case.2 We agree with several of their comments and would like to clarify a few details here.
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Affiliation(s)
- Rahul Sehgal
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA. R. Sehgal passed away on November 10, 2021. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Ernste, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Floranne C Ernste
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA. R. Sehgal passed away on November 10, 2021. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Ernste, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Sara Eckloff
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA. R. Sehgal passed away on November 10, 2021. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Ernste, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Shakshouk H, Deschaine MA, Wetter DA, Drage LA, Ernste FC, Lehman JS. Clinical and histopathological features of adult patients with dermatomyositis and MDA5 autoantibody seropositivity status, as determined by commercial-based testing: A retrospective, single-institution comparative cohort study. Clin Exp Dermatol 2021; 47:282-288. [PMID: 34342883 DOI: 10.1111/ced.14870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although MDA-5 autoantibodies are widely explored in dermatomyositis (DM), most studies relied on MDA-5 autoantibody testing performed in research settings and not with the now-available commercial laboratory tests. OBJECTIVE To characterize the clinical and histopathologic data in patients with DM and circulating MDA5-autoantibodies, as defined by commercial-based testing. METHODS Retrospective review of patients with DM who underwent MDA-5 antibody testing. All available skin biopsy slides were reviewed. RESULTS Cutaneous features more prevalent in MDA-5 positive DM included Raynaud syndrome (p <0.0001), cutaneous ulcerations (p=0.013), mechanic hands (p=0.0164), palmar papules (p=0.004), oral ulcers (p=0.024) and alopecia (p= 0.027). Joint and pulmonary involvement were more frequently in patients with MDA-5 positive DM (both p<0.0001) as was dysphagia (p=0.0029). Myopathy (p=0.404) and malignancy (p=0.342) were not statistically different between the cohorts. Vasculopathy was more frequent in MDA-5 positive DM (p=0.005), while spongiosis was less (p=0.016). CONCLUSIONS This study not only confirmed some known associations between disease manifestations and MDA-5 autoantibody status, as determined by commercially-available testing, but also identified new associations, including Raynaud syndrome and dysphagia.
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Affiliation(s)
- H Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - M A Deschaine
- Department of Dermatology, Florida State University, Tallahassee, FL, USA
| | - D A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - L A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - F C Ernste
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - J S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- Rahul Sehgal
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Floranne C Ernste
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara Eckloff
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Shelly S, Mielke MM, Mandrekar J, Milone M, Ernste FC, Naddaf E, Liewluck T. Epidemiology and Natural History of Inclusion Body Myositis: A 40-Year Population-Based Study. Neurology 2021; 96:e2653-e2661. [PMID: 33879596 DOI: 10.1212/wnl.0000000000012004] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine the prevalence and natural history of sporadic inclusion body myositis (sIBM) and to test the hypothesis that patients with sIBM have higher cancer or mortality rates than the general population. METHODS We sought patients with sIBM defined by the 2011 European Neuromuscular Centre (ENMC) diagnostic criteria among Olmsted County, Minnesota, residents in 40-year time period. RESULTS We identified 20 patients (10 clinicopathologically defined, 9 clinically defined, and 1 probable) according to the ENMC criteria and 1 patient with all features of clinicopathologically defined sIBM except for symptom onset at <45 years of age. The prevalence of sIBM in 2010 was 18.20 per 100,000 people ≥50 years old. Ten patients developed cancers. The incidence of cancers in sIBM did not differ from that observed in the general population (odds ratio 1.89, 95% confidence interval [CI] 0.639-5.613, p = 0.24). Two-thirds of patients developed dysphagia, and half required a feeding tube. Nine patients required a wheelchair. The median time from symptom onset to wheelchair dependence was 10.5 (range 1-29) years. Overall life expectancy was shorter in the sIBM group compared to the general population (84.1 [95% CI 78-88.4] vs 87.5 [95% CI 85.2-89.5] years, p = 0.03). Thirteen patients died; 9 deaths were sIBM related (7 respiratory and 2 unspecified sIBM complications). Female sex (p = 0.03) and dysphagia (p = 0.05) were independent predictors of death. CONCLUSION Olmsted County has the highest prevalence of sIBM reported to date. Patients with sIBM have similar risk of cancer, but slightly shorter life expectancy compared to matched patients without sIBM. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that patients with sIBM have similar risks of cancers and slightly shorter life expectancy compared to controls.
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Affiliation(s)
- Shahar Shelly
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN
| | - Margherita Milone
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN
| | - Floranne C Ernste
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN
| | - Elie Naddaf
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Teerin Liewluck
- From the Department of Neurology (S.S., M.M.M., J.M., M.M., E.N., T.L.), Department of Health Sciences Research (M.M.M., J.M.), and Division of Rheumatology (F.C.E.), Department of Medicine, Mayo Clinic, Rochester, MN.
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15
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Karmacharya P, Crowson CS, Bekele D, Achenbach SJ, Davis JM, Ogdie A, Duarte-García A, Ernste FC, Maradit-Kremers H, Tollefson MM, Wright K. The Epidemiology of Psoriatic Arthritis Over Five Decades: A Population-Based Study. Arthritis Rheumatol 2021; 73:1878-1885. [PMID: 33779070 DOI: 10.1002/art.41741] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the incidence of psoriatic arthritis (PsA) in a US population and describe trends in incidence and mortality over 5 decades. METHODS The previously identified population-based cohort that included Olmsted County, Minnesota residents ≥18 years of age who fulfilled PsA criteria during 1970-1999 was extended to include patients with incident PsA during 2000-2017. Age- and sex-specific incidence rates and point prevalence, adjusted to the 2010 US White population, were reported. RESULTS There were 164 incident cases of PsA in 2000-2017 (mean ± SD age 46.4 ± 12.0 years; 47% female). The overall age- and sex-adjusted annual incidence of PsA per 100,000 population was 8.5 (95% confidence interval [95% CI] 7.2-9.8) and was higher in men (9.3 [95% CI 7.4-11.3]) than women (7.7 [95% CI 5.9-9.4]) in 2000-2017. Overall incidence was highest in the 40-59 years age group. The incidence rate was relatively stable during 2000-2017, with no evidence of an overall increase or an increase in men only (but a modest increase of 3% per year in women), compared to 1970-1999 when a 4%-per-year increase in incidence was observed. Point prevalence was 181.8 per 100,000 population (95% CI 156.5-207.1) in 2015. The percentage of women among those with PsA increased from 39% in 1970-1999 and 41% in 2000-2009 to 54% in 2010-2017 (P = 0.08). Overall survival in PsA did not differ from the general population (standardized mortality ratio 0.85 [95% CI 0.61-1.15]). CONCLUSION The incidence of PsA in this predominantly White US population was stable in 2000-2017, in contrast to previous years. However, an increasing proportion of women with PsA was found in this study.
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Affiliation(s)
| | | | | | | | | | - Alexis Ogdie
- University of Pennsylvania Perelman School of Medicine, Philadelphia
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16
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Karmacharya P, Wright K, Achenbach SJ, Bekele D, Crowson CS, Ogdie A, Duarte-García A, Ernste FC, Tollefson MM, Davis JM. Diagnostic Delay in Psoriatic Arthritis: A Population-based Study. J Rheumatol 2021; 48:1410-1416. [PMID: 33589556 DOI: 10.3899/jrheum.201199] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine demographic and clinical characteristics associated with diagnostic delay in psoriatic arthritis (PsA). METHODS We characterized a retrospective, population-based cohort of incident adult (≥ 18 yrs) patients with PsA from Olmsted County, Minnesota, from 2000-2017. All patients met the classification criteria. Diagnostic delay was defined as the time from any patient-reported PsA-related joint symptom to a physician diagnosis of PsA. Factors associated with delay in PsA diagnosis were identified through logistic regression models. RESULTS Of the 164 incident PsA cases from 2000 to 2017, 162 had a physician or rheumatologist diagnosis. Mean (SD) age was 41.5 (12.6) years and 46% were female. Median time from symptom onset to physician diagnosis was 2.5 years (IQR 0.5-7.3). By 6 months, 38 (23%) received a diagnosis of PsA, 56 (35%) by 1 year, and 73 (45%) by 2 years after symptom onset. No significant trend in diagnostic delay was observed over calendar time. Earlier age at onset of PsA symptoms, higher BMI, and enthesitis were associated with a diagnostic delay of > 2 years, whereas sebopsoriasis was associated with a lower likelihood of delay. CONCLUSION In our study, more than half of PsA patients had a diagnostic delay of > 2 years, and no significant improvement in time to diagnosis was noted between 2000 and 2017. Patients with younger age at PsA symptom onset, higher BMI, or enthesitis before diagnosis were more likely to have a diagnostic delay of > 2 years, whereas patients with sebopsoriasis were less likely to have a diagnostic delay.
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Affiliation(s)
- Paras Karmacharya
- P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic;
| | - Kerry Wright
- P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic
| | - Sara J Achenbach
- S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic
| | - Delamo Bekele
- P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alí Duarte-García
- A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | - Floranne C Ernste
- P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic
| | - Megha M Tollefson
- M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - John M Davis
- P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic
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Paul P, Liewluck T, Ernste FC, Mandrekar J, Milone M. Anti-cN1A antibodies do not correlate with specific clinical, electromyographic, or pathological findings in sporadic inclusion body myositis. Muscle Nerve 2021; 63:490-496. [PMID: 33373040 DOI: 10.1002/mus.27157] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anti-cytosolic 5'-nucleotidase 1A (cN1A) antibodies are commonly detected in patients with sporadic inclusion body myositis (sIBM). However, their pathogenic role has not been established. Moreover, efforts toward identifying sIBM distinct clinicopathologic characteristics associated with these antibodies have yielded conflicting results. METHODS We first searched for patients, seen in our clinics, tested for anti-cN1A antibodies between December 2015 and December 2019. We identified 92 patients who were diagnosed with sIBM, according to the 2011 ENMC or Griggs et al criteria. Thereafter, we reviewed and compared the clinical and investigational findings of these patients in relation to their antibody status. RESULTS Anti-cN1A antibodies were present in 47/92 (51%) patients with sIBM. Comparison of seropositive and seronegative cohorts yielded no significant difference in clinical features, including facial weakness, oropharyngeal and respiratory involvement, or disease severity. The antibody titer did not correlate with the clinical phenotype, CK value, or presence of myotonic discharges on EMG. Anti-cN1A antibody positive patients appeared to have more frequent auto-aggressive inflammation on muscle biopsy but not as an isolated myopathological feature. CONCLUSIONS Our study showed that anti-cN1A antibody positive and negative sIBM patients have similar clinical features and disease severity. Anti-cN1A antibodies in our sIBM cohort did not correlate with any studied clinical or laboratory parameter and, therefore, were of limited value in the patient's assessment.
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Affiliation(s)
- Pritikanta Paul
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jay Mandrekar
- Biomedical Statistics and Bioinformatics, Mayo Clinic, Rochester, Minnesota, USA
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18
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Wilton KM, Achenbach SJ, Karmacharya P, Ernste FC, Matteson EL, Crowson CS. Erectile Dysfunction in Men With Psoriatic Arthritis: A Population-based Cohort Study. J Rheumatol 2020; 48:527-532. [PMID: 33060322 DOI: 10.3899/jrheum.200903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To define the incidence of erectile dysfunction (ED) in a population-based cohort of men with psoriatic arthritis (PsA). METHODS Data pertaining to demographics, ED, and potential confounding diagnosis were extracted from a comprehensive medical record system for a population-based cohort of men with PsA and an age-matched male comparator cohort. Cumulative incidence of ED adjusted for competing risk of death was compared between the 2 cohorts. RESULTS There were 128 age-matched pairs of men with PsA and without PsA in the described cohorts. At baseline, there was a 7% prevalence of ED in men with PsA prior to diagnosis compared to a 3% prevalence of ED in the comparator cohort (P = 0.16). After PsA diagnosis/index date, diagnosis with PsA was associated with an increased risk of ED (age-adjusted HR 1.45, 95% CI 0.79-2.68), but this association did not reach statistical significance. This was based on 24 cases of ED in the men with PsA and 18 cases within the comparator cohort. No confounding factors or ED treatment strategies differed significantly between men with PsA and ED and comparators with ED. CONCLUSION Men with PsA may have an increased risk of ED, which was detected but likely underpowered in this study. Whether this difference is secondary to higher prevalence of traditional risk factors of ED in men with PsA compared to the general population will require further study.
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Affiliation(s)
- Katelynn M Wilton
- K.M. Wilton, BS, Medical Scientist Training Program, Mayo Clinic College of Medicine and Science
| | - Sara J Achenbach
- S.J. Achenbach, MS, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science
| | - Paras Karmacharya
- P. Karmacharya, MBBS, F.C. Ernste, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Floranne C Ernste
- P. Karmacharya, MBBS, F.C. Ernste, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Eric L Matteson
- E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Biomedical Statistics and Informatics, and Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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19
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Ernste FC, Chong C, Crowson CS, Kermani TA, Mhuircheartaigh ON, Alexanderson H. Functional Index-3: A Valid and Reliable Functional Outcome Assessment Measure in Patients With Dermatomyositis and Polymyositis. J Rheumatol 2020; 48:94-100. [PMID: 32295854 DOI: 10.3899/jrheum.191374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with dermatomyositis (DM) and polymyositis (PM) have reduced muscle endurance.The aim of this study was to streamline the Functional Index-2 (FI-2) by developing the Functional Index-3 (FI-3) and to evaluate its measurement properties, content and construct validity, and intra- and interrater reliability. METHODS A dataset of the previously performed and validated FI-2 (n = 63) was analyzed for internal redundancy, floor, and ceiling effects. The content of the FI-2 was revised into the FI-3. Construct validity and intrarater reliability of FI-3 were tested on 43 DM and PM patients at 2 rheumatology centers. Interrater reliability was tested in 25 patients. The construct validity was compared with the Myositis Activities Profile (MAP), Health Assessment Questionnaire (HAQ), and Borg CR-10 using Spearman correlation coefficient. RESULTS Spearman correlation coefficients of 63 patients performing FI-3 revealed moderate to high correlations between shoulder flexion and hip flexion tasks and similar correlations with MAP and HAQ scores; there were lower correlations for neck flexion task. All FI-3 tasks had very low to moderate correlations with the Borg scale. Intraclass correlation coefficients (ICC) of FI-3 tasks for intrarater reliability (n = 25) were moderate to good (0.88-0.98). ICC of FI-3 tasks for interrater reliability (n = 17) were fair to good (range 0.83-0.96). CONCLUSION The FI-3 is an efficient and valid method for clinically assessing muscle endurance in DM and PM patients. FI-3 construct validity is supported by the significant correlations between functional tasks and the MAP, HAQ, and Borg CR-10 scores.
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Affiliation(s)
- Floranne C Ernste
- F.C. Ernste, MD, Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA;
| | - Christopher Chong
- C. Chong, MD, Arthritis Associates and Osteoporosis Center of Colorado Springs, Colorado Springs, Colorado, USA
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Department of Health Science Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanaz A Kermani
- T.A. Kermani, MD, University of California at Los Angeles, California, USA
| | - Orla Ni Mhuircheartaigh
- O. Ni Mhuircheartaigh, MBBCh, Division of Rheumatology, Department of Medicine, Beacon Hospital, Dublin, Ireland
| | - Helene Alexanderson
- H. Alexanderson, PhD, Department of Neurobiology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Division of Rheumatology Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Karolinska University Hospital, Solna, Stockholm, Sweden
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20
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Crowson CS, Hein MS, Pendegraft RS, Strausbauch MA, Niewold TB, Ernste FC, Dvergsten J, Amin S, Wampler Muskardin TL, Peterson E, Baechler EC, Reed AM. Interferon Chemokine Score and Other Cytokine Measures Track With Changes in Disease Activity in Patients With Juvenile and Adult Dermatomyositis. ACR Open Rheumatol 2019; 1:83-89. [PMID: 31777784 PMCID: PMC6857969 DOI: 10.1002/acr2.1011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective Our aim was to identify cytokines and chemokines in patients with adult dermatomyositis (DM) and juvenile dermatomyositis (JDM) that predict changes in disease activity. Methods Multiplexed immunoassays (Meso Scale Discovery) enabled simultaneous measurement of interferon (IFN)‐regulated chemokines and other pro‐ and anti‐inflammatory cytokines specific to differentiation of specific T‐cell and innate pathways. Cytokine scores were computed for IFNCK (IP‐10, MCP‐1), Th1 (IFNɣ, TNFα, and IL2), Th2 (IL4, IL10, IL12, and IL 13), Th17 (IL6, IL17, IL1β), macrophage (MIP‐1α, MIP‐1β, IL8), and regulatory (IL10, TNFα) factors. Spearman correlation and mixed models were used to examine whether cytokines at a previous visit predict change in disease activity at the next visit. Results The study included 36 patients (16 DM and 20 JDM) with at least two visits (87 patient intervals between two visits). Mean age (SD) at inclusion was 56.9 (18.4) years for DM and 10.8 (6.6) years in JDM, 67% of patients were female, 89% Caucasian. The mean (SD) physician global, muscle and extra‐muscular disease activity Visual Analog Scale scores at inclusion were 41 (26), 36 (30), and 34 (21) mm, respectively. The change in IFN score from one visit to the next was associated with the change in physician global (P = 0.010) and extramuscular (P < 0.001) disease activity scores. Preliminary results revealed significant correlations of previous IFNCK score and IL‐6 with subsequent disease activity measures, but after adjustment for multiple visits per patient, these associations did not reach statistical significance. Conclusion There is a potential relationship between IFNCK and other cytokine scores seen in adult and juvenile DM with future disease states.
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Affiliation(s)
| | - Molly S Hein
- Mayo Clinic College of Medicine Rochester Minnesota
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21
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George MP, Ernste FC, Tande A, Osmon D, Mabry T, Berbari EF. Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study. J Bone Jt Infect 2019; 4:20-26. [PMID: 30755844 PMCID: PMC6367192 DOI: 10.7150/jbji.29983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/06/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction: Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports. The purpose of this case series is to describe the demographics, presentation, management, and outcomes of a cohort of these patients seen at our academic medical center. Methods: Patients with post-implant pseudogout, who were evaluated at our medical center between January 1, 2000 and June 30, 2016, were identified from our EHR. Data pertaining to demographics, presentation, management, and outcomes were abstracted, and patients were categorized into two groups based on presence of concomitant infection along with positive CPDD findings in synovial fluid. Results: 22 patients were included. 90.9% of cases involved a TKA. The most common indication for arthroplasty was degenerative joint disease. Only four patients had a history of previous gout or pseudogout, three of which belonged to the group with no evidence of concomitant joint infection. Clinical features for patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). 45.5% of patients received antibiotics prior to joint aspiration (44.4% of patients with negative synovial fluid cultures, 46.2% of patients with concomitant infection). Conclusion: Our study suggests similar clinical presentation between post-implant pseudogout and PJI. Among patients with pseudogout as well as in those with PJI, the first dose of antibiotics should not be given before sampling for synovial culture. Unfortunately, many patients receive antibiotics prior to culture ascertainment, which raises concern for antibiotic overuse.
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Affiliation(s)
- Merit P George
- Mayo Clinic School of Medicine. 200 1st St SW, Rochester, MN 55905
| | - Floranne C Ernste
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Aaron Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Douglas Osmon
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Tad Mabry
- Division of Orthopedic Surgery, Department of Surgery, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
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Ma JE, Ernste FC, Davis MDP, Wetter DA. Topical sodium thiosulfate for calcinosis cutis associated with autoimmune connective tissue diseases: the Mayo Clinic experience, 2012-2017. Clin Exp Dermatol 2018; 44:e189-e192. [PMID: 30251264 DOI: 10.1111/ced.13782] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 11/29/2022]
Abstract
In this case series, we retrospectively identified all patients treated with topical sodium thiosulfate (TST) for calcinosis cutis (CC) associated with underlying autoimmune connective tissue diseases at Mayo Clinic (Rochester, MN, USA) during the period 1 January 2012 to 27 June 2017. Of 28 patients identified (mean age 57.0 years; 96% female), 19 (68%) had clinical improvement of their CC with TST, 7 (25%) had no response and 2 (7%) had unknown response. There were adverse events in three patients: two had skin irritation and the third, who had a zinc allergy, experienced pain with application. Overall, our findings support those of previous case reports that TST appears to be a relatively well-tolerated adjuvant treatment for CC, although future studies with a control group are warranted to assess the true efficacy of TST for the indication of CC.
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Affiliation(s)
- J E Ma
- Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - F C Ernste
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - M D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - D A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Ungprasert P, Wilton KM, Ernste FC, Kalra S, Crowson CS, Rajagopalan S, Bartholmai BJ. Novel Assessment of Interstitial Lung Disease Using the "Computer-Aided Lung Informatics for Pathology Evaluation and Rating" (CALIPER) Software System in Idiopathic Inflammatory Myopathies. Lung 2017; 195:545-552. [PMID: 28688028 DOI: 10.1007/s00408-017-0035-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the correlation between measurements from quantitative thoracic high-resolution CT (HRCT) analysis with "Computer-Aided Lung Informatics for Pathology Evaluation and Rating" (CALIPER) software and measurements from pulmonary function tests (PFTs) in patients with idiopathic inflammatory myopathies (IIM)-associated interstitial lung disease (ILD). METHODS A cohort of patients with IIM-associated ILD seen at Mayo Clinic was identified from medical record review. Retrospective analysis of HRCT data and PFTs at baseline and 1 year was performed. The abnormalities in HRCT were quantified using CALIPER software. RESULTS A total of 110 patients were identified. At baseline, total interstitial abnormalities as measured by CALIPER, both by absolute volume and by percentage of total lung volume, had a significant negative correlation with diffusing capacity for carbon monoxide (DLCO), total lung capacity (TLC), and oxygen saturation. Analysis by subtype of interstitial abnormality revealed significant negative correlations between ground glass opacities (GGO) and reticular density (RD) with DLCO and TLC. At one year, changes of total interstitial abnormalities compared with baseline had a significant negative correlation with changes of TLC and oxygen saturation. A negative correlation between changes of total interstitial abnormalities and DLCO was also observed, but it was not statistically significant. Analysis by subtype of interstitial abnormality revealed negative correlations between changes of GGO and RD and changes of DLCO, TLC, and oxygen saturation, but most of the correlations did not achieve statistical significance. CONCLUSION CALIPER measurements correlate well with functional measurements in patients with IIM-associated ILD.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Medicine, Mayo Clinic in Rochester, Mayo East15, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital in Bangkok, Bangkok, Thailand
| | - Katelynn M Wilton
- Mayo Medical Scientist Training Program, Mayo Clinic in Rochester, Rochester, MN, USA
| | - Floranne C Ernste
- Division of Rheumatology, Department of Medicine, Mayo Clinic in Rochester, Mayo East15, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Sanjay Kalra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic in Rochester, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic in Rochester, Mayo East15, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic in Rochester, Rochester, MN, USA
| | - Srinivasan Rajagopalan
- Department of Physiology and Biomedical Engineering, Biomedical Imaging Resource, Mayo Clinic in Rochester, Rochester, MN, USA
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López De Padilla CM, Crowson CS, Hein MS, Pendegraft RS, Strausbauch MA, Niewold TB, Ernste FC, Peterson E, Baechler EC, Reed AM. Gene Expression Profiling in Blood and Affected Muscle Tissues Reveals Differential Activation Pathways in Patients with New-onset Juvenile and Adult Dermatomyositis. J Rheumatol 2016; 44:117-124. [PMID: 27803134 DOI: 10.3899/jrheum.160293] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify shared and differential molecular pathways in blood and affected muscle between adult dermatomyositis (DM) and juvenile DM, and their association with clinical disease activity measures. METHODS Gene expression of transcription factors and cytokines involved in differentiation and effector function of T cell subsets, regulatory T cells and follicular Th cells, were analyzed in the blood from 21 newly diagnosed adult and 26 juvenile DM subjects and in 15 muscle specimens (7 adult and 8 juvenile DM) using a custom RT2 Profiler PCR Array. Disease activity was determined and measured by established disease activity tools. RESULTS The most prominent finding was the higher blood expression of Th17-related cytokines [retinoic acid-related orphan receptor-γ, interferon regulatory factor 4, interleukin (IL)-23A, IL-6, IL-17F, and IL-21] in juvenile DM at baseline. In contrast, adult patients with DM showed increased blood levels of STAT3 and BCL6 compared with juvenile DM. In muscle, GATA3, IL-13, and STAT5B were found at higher levels in juvenile patients with DM compared with adult DM. Among 25 patients (11 adult and 14 juvenile DM) who had blood samples at baseline and at 6 months, increased expression of IL-1β, STAT3, STAT6, STAT5B, and BCL6 was associated with an improvement in global extramuscular disease activity. CONCLUSION We observed differences in gene expression profiling in blood and muscle between new-onset adult and juvenile DM. Cytokine expression in the blood of juvenile patients with new-onset DM was dominated by Th17-related cytokines compared with adult patients with DM. This may reflect the activation of different Th pathways between muscle and blood.
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Affiliation(s)
- Consuelo M López De Padilla
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Cynthia S Crowson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Molly S Hein
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Richard S Pendegraft
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Michael A Strausbauch
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Timothy B Niewold
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Floranne C Ernste
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Erik Peterson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Emily C Baechler
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Ann M Reed
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA. .,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center.
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Ungprasert P, Crowson CS, Chowdhary VR, Ernste FC, Moder KG, Matteson EL. Epidemiology of Mixed Connective Tissue Disease, 1985-2014: A Population-Based Study. Arthritis Care Res (Hoboken) 2016; 68:1843-1848. [PMID: 26946215 DOI: 10.1002/acr.22872] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To characterize the epidemiology of mixed connective tissue disease (MCTD) from 1983 to 2014. METHODS An inception cohort of patients with incident MCTD in 1985-2014 in Olmsted County, Minnesota was identified based on comprehensive individual medical record review. Diagnosis of MCTD required fulfillment of at least 1 of the 4 widely accepted diagnostic criteria without fulfillment of classification criteria for other connective tissue diseases. Data were collected on demographic characteristics, clinical presentation, laboratory investigations, and mortality. RESULTS A total of 50 incident cases of MCTD were identified (mean age 48.1 years and 84% were female). The annual incidence of MCTD was 1.9 per 100,000 population. Raynaud's phenomenon was the most common initial symptoms (50%), followed by arthralgia (30%) and swollen hands (16%). The diagnosis was frequently delayed with the median time from first symptom to fulfillment of criteria of 3.6 years. At fulfillment of criteria, arthralgia was the most prevalent manifestation (86%), followed by Raynaud's phenomenon (80%), swollen hands (64%), leukopenia/lymphopenia (44%), and heartburn (38%). Evolution to other connective tissue occurred infrequently with a 10-year rate of evolution of 8.5% and 6.3% for systemic lupus erythematosus and systemic sclerosis, respectively. The overall mortality was not different from the general population with a standardized mortality ratio of 1.1 (95% confidence interval 0.4-2.6). CONCLUSION This study was the first population-based study of MCTD to provide a complete picture of epidemiology and clinical characteristics of MCTD. MCTD occurred in about 2 persons per 100,000 per year. Evolution to other connective diseases occurred infrequently and the mortality was not affected.
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Ungprasert P, Sagar V, Crowson CS, Amin S, Makol A, Ernste FC, Osborn TG, Moder KG, Niewold TB, Maradit-Kremers H, Ramsey-Goldman R, Chowdhary VR. Incidence of systemic lupus erythematosus in a population-based cohort using revised 1997 American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinics classification criteria. Lupus 2016; 26:240-247. [PMID: 27365370 DOI: 10.1177/0961203316657434] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2012, the Systemic Lupus International Collaborating Clinics (SLICC) group published a new set of classification criteria for systemic lupus erythematosus (SLE). Studies applying these criteria to real-life scenarios have found either equal or greater sensitivity and equal or lower specificity to the 1997 ACR classification criteria (ACR 97). Nonetheless, there are no studies that have used the SLICC 12 criteria to investigate the incidence of lupus. We used the resource of the Rochester Epidemiology Project to identify incident SLE patients in Olmsted County, Minnesota, from 1993 to 2005, who fulfilled the ACR 97 or SLICC 12 criteria. A total of 58 patients met criteria by SLICC 12 and 44 patients met criteria by ACR 97. The adjusted incidence of 4.9 per 100,000 person-years by SLICC 12 was higher than that by ACR 97 (3.7 per 100,000 person-years, p = 0.04). The median duration from the appearance of first criterion to fulfillment of the criteria was shorter for the SLICC 12 than for ACR 97 (3.9 months vs 8.1 months). The higher incidence by SLICC 12 criteria came primarily from the ability to classify patients with renal-limited disease, the expansion of the immunologic criteria and the expansion of neurologic criteria.
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Affiliation(s)
- P Ungprasert
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - V Sagar
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - C S Crowson
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S Amin
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,3 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - A Makol
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - F C Ernste
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T G Osborn
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K G Moder
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T B Niewold
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - H Maradit-Kremers
- 3 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,4 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - R Ramsey-Goldman
- 5 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - V R Chowdhary
- 1 Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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van der Stap DK, Rider LG, Alexanderson H, Huber AM, Gualano B, Gordon P, van der Net J, Mathiesen P, Johnson LG, Ernste FC, Feldman BM, Houghton KM, Singh-Grewal D, Kutzbach AG, Munters LA, Takken T. Proposal for a Candidate Core Set of Fitness and Strength Tests for Patients with Childhood or Adult Idiopathic Inflammatory Myopathies. J Rheumatol 2016; 43:169-76. [PMID: 26568594 PMCID: PMC4698199 DOI: 10.3899/jrheum.150270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Currently there are no evidence-based recommendations regarding fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies (IIM). This hinders clinicians and researchers in choosing the appropriate fitness- or muscle strength-related outcome measures for these patients. Through a Delphi survey, we aimed to identify a candidate core set of fitness and strength tests for children and adults with IIM. METHODS Fifteen experts participated in a Delphi survey that consisted of 5 stages to achieve a consensus. Using an extensive search of published literature and through the work of experts, a candidate core set based on expert opinion and clinimetrics properties was developed. Members of the International Myositis Assessment and Clinical Studies Group were invited to review this candidate core set during the final stage, which led to a final candidate core set. RESULTS A core set of fitness- and strength-related outcome measures was identified for children and adults with IIM. For both children and adults, different tests were identified and selected for maximal aerobic fitness, submaximal aerobic fitness, anaerobic fitness, muscle strength tests, and muscle function tests. CONCLUSION The core set of fitness- and strength-related outcome measures provided by this expert consensus process will assist practitioners and researchers in deciding which tests to use in patients with IIM. This will improve the uniformity of fitness and strength tests across studies, thereby facilitating the comparison of study results and therapeutic exercise program outcomes among patients with IIM.
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Affiliation(s)
- Djamilla K.D. van der Stap
- Faculty of Human Movement Sciences, Free University, Amsterdam, The Netherlands
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Helene Alexanderson
- Department of Neurobiology, Care Science and Society, Division of Physical Therapy, Karolinska Institutet and the Physical Therapy Clinic, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Patrick Gordon
- Department of rheumatology, King’s College Hospital, London, UK
| | - Janjaap van der Net
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pernille Mathiesen
- Paediatric Rheumatology Clinic, Paediatric Department, Rigshospitalet, Copenhagen, Denmark
| | - Liam G. Johnson
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Floranne C. Ernste
- Mayo Clinic in Rochester MN, Department of Internal Medicine, Division of Rheumatology
| | - Brian M. Feldman
- Departments of Pediatrics, Medicine and the Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | | | - Davinder Singh-Grewal
- The Sydney Children's Hospitals Network Randwick and Westmead Campuses
- The University of Sydney, School of Paediatrics and Child Health
- The University of New South Wales, Discipline of Child and Maternal Health
- The University of Western Sydney Department of Paediatrics, Sydney, Australia
- The John Hunter Children’s Hospital, Newcastle Australia
| | - Abraham Garcia Kutzbach
- Director of the postgraduate Program of Rheumatology AGAR, School of Medicine University Francisco Marroquin, Guatemala
- Professor of Medicine and History of Medicine, School of Medicine University Francisco Marroquin, Guatemala
- Member of the executive Committee Hospital Herrera Llerandi Guatemala
| | - Li Alemo Munters
- Physical Therapy Clinic, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University, Nashville, USA
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Kassardjian CD, Williamson ML, van Buskirk DJ, Ernste FC, Hunderfund ANL. Residency Training: Quality improvement projects in neurology residency and fellowship: applying DMAIC methodology. Neurology 2015; 85:e7-e10. [PMID: 26170406 DOI: 10.1212/wnl.0000000000001732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Teaching quality improvement (QI) is a priority for residency and fellowship training programs. However, many medical trainees have had little exposure to QI methods. The purpose of this study is to review a rigorous and simple QI methodology (define, measure, analyze, improve, and control [DMAIC]) and demonstrate its use in a fellow-driven QI project aimed at reducing the number of delayed and canceled muscle biopsies at our institution. METHODS DMAIC was utilized. The project aim was to reduce the number of delayed muscle biopsies to 10% or less within 24 months. Baseline data were collected for 12 months. These data were analyzed to identify root causes for muscle biopsy delays and cancellations. Interventions were developed to address the most common root causes. Performance was then remeasured for 9 months. RESULTS Baseline data were collected on 97 of 120 muscle biopsies during 2013. Twenty biopsies (20.6%) were delayed. The most common causes were scheduling too many tests on the same day and lack of fasting. Interventions aimed at patient education and biopsy scheduling were implemented. The effect was to reduce the number of delayed biopsies to 6.6% (6/91) over the next 9 months. CONCLUSIONS Familiarity with QI methodologies such as DMAIC is helpful to ensure valid results and conclusions. Utilizing DMAIC, we were able to implement simple changes and significantly reduce the number of delayed muscle biopsies at our institution.
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Affiliation(s)
- Charles D Kassardjian
- From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN
| | - Michelle L Williamson
- From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN
| | - Dorothy J van Buskirk
- From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN
| | - Floranne C Ernste
- From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN
| | - Andrea N Leep Hunderfund
- From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN.
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Ernste FC, Sánchez-Menéndez M, Wilton KM, Crowson CS, Matteson EL, Maradit Kremers H. Cardiovascular risk profile at the onset of psoriatic arthritis: a population-based cohort study. Arthritis Care Res (Hoboken) 2015; 67:1015-21. [PMID: 25581120 DOI: 10.1002/acr.22536] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 11/10/2014] [Accepted: 12/16/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The role of cardiovascular disease (CVD) risk factors in psoriatic arthritis (PsA) is poorly understood. We examined the prevalence of CVD risk factors at initial onset of PsA and compared the observed incidence of CVD events with that predicted by the Framingham Risk Score (FRS) to determine its applicability in this patient population. METHODS A population-based incidence cohort of 158 patients with PsA who fulfilled Classification of Psoriatic Arthritis criteria for PsA in 1989-2008 was assembled. Medical records were reviewed to ascertain CVD risk factors and CVD events. Future risk of CVD was estimated using the FRS algorithm. RESULTS Mean age was 43.4 years (range 19-74 years), 61% were men, and 44% were obese (body mass index ≥30 kg/m(2) ). Fifty-four patients (34%) presented with ≥2 CVD risk factors at PsA incidence. Among 126 patients ages ≥30 years at PsA incidence with no prior history of CVD, 33% had an FRS ≥10%, with 11% having an FRS ≥20%, and 18 experienced a CVD event in the first 10 years of disease duration. The 10-year cumulative incidence of CVD events was 17% (95% confidence interval [95% CI] 10%-24%), almost twice as high as the predicted incidence based on the FRS (standardized incidence ratio 1.80, 95% CI 1.14-2.86; P = 0.012). CONCLUSION The majority of newly diagnosed PsA patients have a >10% risk of CVD within 10 years of PsA incidence. The CVD risk in these patients is higher than expected and underestimated by the FRS.
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Affiliation(s)
| | | | - K M Wilton
- Mayo Medical School and Graduate School of Medicine, Rochester, Minnesota
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Rosenbaum AN, Anavekar NS, Ernste FC, Mankad SV, Le RJ, Manocha KK, Barsness GW. A case of catastrophic antiphospholipid syndrome: first report with advanced cardiac imaging using MRI. Lupus 2015; 24:1338-41. [DOI: 10.1177/0961203315587960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
This present case pertains to a 48-year-old woman with a history of antiphospholipid syndrome, who presented with progressive fatigue, generalized weakness, and orthopnea acutely. She had a prior diagnosis of antiphospholipid syndrome with recurrent deep vein thromboses (DVTs) and repeated demonstration of lupus anticoagulants. She presented in cardiogenic shock with markedly elevated troponin and global myocardial dysfunction on echocardiography, and cardiac catheterization revealed minimal disease. Cardiac magnetic resonance imaging was performed, which revealed findings of perfusion defects and microvascular obstruction, consistent with the pathophysiology of catastrophic antiphospholipid syndrome (CAPS). Diagnosis was made based on supportive imaging, including head magnetic resonance imaging (MRI) revealing multifocal, acute strokes; microvascular thrombosis in the dermis; and subacute renal infarctions. The patient was anticoagulated with intravenous unfractionated heparin and received high-dose methylprednisolone, plasmapheresis, intravenous immunoglobulin, and one dose each of rituximab and cyclophosphamide. She convalesced with eventual myocardial recovery after a complicated course. The diagnosis of CAPS relies on the presence of (1) antiphospholipid antibodies and (2) involvement of multiple organs in a microangiopathic thrombotic process with a close temporal association. The myocardium is frequently affected, and heart failure, either as the presenting symptom or cause of death, is common. Despite echocardiographic evidence of myocardial dysfunction in such patients, MRIs of CAPS have not previously been reported. This case highlights the utility in assessing the involvement of the myocardium by the microangiopathic process with MRI. Because the diagnosis of CAPS requires involvement in multiple organ systems, cardiac MRI is likely an underused tool that not only reaffirms the pathophysiology of CAPS, but could also clue clinicians in to the possibility of a diffuse thrombotic process.
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Affiliation(s)
- A N Rosenbaum
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - N S Anavekar
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - F C Ernste
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - S V Mankad
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - R J Le
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - K K Manocha
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - G W Barsness
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Abstract
INTRODUCTION Psoriasis is a T-cell-mediated skin disorder with uncommon extracutaneous manifestations. Rare patients with psoriasis and myopathy have been reported. METHODS We conducted a retrospective review of medical records of psoriasis patients seen at the Mayo Clinic during the period from January 1, 1996 to May 31, 2011. Patients who had pathologically confirmed myopathy or lymphocytic infiltrates in muscle were included. RESULTS Among 11,370 psoriasis patients, 13 had pathologically confirmed myopathies. Seventy percent were inflammatory myopathies, and 2 had focal inflammation in the muscle. Psoriasis preceded myopathy onset in two-thirds of the patients (median 14.7 years). Half of the patients had psoriatic arthritis; 60% had other autoimmune disorders. Patients who received anti-tumor necrosis factor-alpha (anti-TNF-α) therapy had a higher risk for developing myopathy or inflammation in muscle (odds ratio = 4.45). CONCLUSIONS Myopathy or inflammation in muscle affects an average of 1.32 of every 1000 psoriasis patients. Concomitant autoimmune disorders, psoriatic arthritis, and exposure to anti-TNF-α therapy may be associated with increased risk of developing myopathy in psoriasis patients.
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Affiliation(s)
- Teerin Liewluck
- Department of Neurology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, Colorado, 80045, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Maradit-Kremers H, Dierkhising RA, Crowson CS, Icen M, Ernste FC, McEvoy MT. Risk and predictors of cardiovascular disease in psoriasis: a population-based study. Int J Dermatol 2013; 52:32-40. [PMID: 23278607 DOI: 10.1111/j.1365-4632.2011.05430.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Emerging evidence suggests that severe psoriasis is associated with increased risk of cardiovascular disease. The goal of this study was to examine the risk and predictors of clinical cardiovascular events in psoriasis. METHODS We performed a historical cohort and a nested case-cohort study using the population-based resources in Olmsted County, Minnesota. The study population included a population-based incidence cohort of patients with psoriasis first diagnosed between January 1, 1970, and January 1, 2000, and 2678 age- and sex-matched non-psoriasis subjects. Cardiovascular events, including hospitalized myocardial infarction, coronary revascularization procedures, stroke, heart failure, and cardiovascular death. RESULTS Psoriasis was associated with an increased risk of myocardial infarction based on diagnostic codes (hazard ratio 1.26; 95% confidence intervals: 1.01, 1.58) but not when the analyses were restricted to validated myocardial infarction (hazard ratio 1.18; 95% confidence intervals: 0.80, 1.74). Psoriasis was not associated with an increased risk of heart failure or cardiovascular death. Traditional cardiovascular risk factors were significantly associated with cardiovascular risk in psoriasis. Each 1% increase in Framingham risk score at psoriasis incidence corresponded with a 5-10% increase in risk of cardiovascular events. CONCLUSION In this large incidence cohort of patients with psoriasis representing the full disease severity spectrum, psoriasis was not associated with an increased cardiovascular risk.
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Affiliation(s)
- Hilal Maradit-Kremers
- Department of Health Sciences, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Ernste FC, Crowson CS, de Padilla CL, Hein MS, Reed AM. Longitudinal Peripheral Blood Lymphocyte Subsets Correlate with Decreased Disease Activity in Juvenile Dermatomyositis. J Rheumatol 2013; 40:1200-11. [DOI: 10.3899/jrheum.121031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective:To determine the clinical characteristics and subsets of peripheral blood lymphocytes (PBL), which correlate with decreased disease activity in patients with juvenile dermatomyositis (JDM).Methods.Peripheral blood mononuclear cells from 24 patients with JDM were collected at Mayo Clinic Rochester between 2007 and 2011. These were analyzed using fluorescence-activated cell sorting and flow cytometry. Clinical disease activity was determined by visual analog scales (VAS) collected in 2 consecutive visits and correlated with PBL subsets.Results.The change in CD3+CD69+ T cells correlated with the change in global VAS scores. The change in HLA-DR- CD11c+ myeloid dendritic cells also correlated with the change in extramuscular VAS scores. There were trends toward decreased levels of HLA-DR- CD11c+ cells with decreased muscle and global VAS scores, but these did not reach significance. The change in HLA-DR- CD123+ plasmacytoid dendritic cells negatively correlated with the change in muscle VAS scores. Although not statistically significant, decreased levels of CD3-CD16- CD56+ natural killer (NK) cells and HLA-DR- CD86+ myeloid dendritic cells, and increased levels of CD16+CD56- NK cells, correlated with decreased VAS scores.Conclusion.Changes in CD3+CD69+ T cells, HLA-DR- CD11c+ myeloid dendritic cells, and HLA-DR- CD123+ plasmacytoid dendritic cells are associated with improved clinical course in JDM and could be used as markers for disease activity, but findings need to be verified in a larger, independent cohort. Lack of significant differences among most of our PBL subsets suggests that lymphocyte phenotyping may be difficult to definitively correlate with disease activity in JDM.
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Crowson CS, Matteson EL, Myasoedova E, Michet CJ, Ernste FC, Warrington KJ, Davis JM, Hunder GG, Therneau TM, Gabriel SE. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. ACTA ACUST UNITED AC 2013; 63:633-9. [PMID: 21360492 DOI: 10.1002/art.30155] [Citation(s) in RCA: 327] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Understanding of the personal risks for rheumatoid arthritis (RA) and other rheumatic diseases remains poor, despite advances in knowledge with regard to their pathogenesis, therapeutics, and clinical impact, in part because the personal lifetime risk of developing these diseases is unknown. This study was undertaken to estimate the lifetime risk of RA, as well as other inflammatory autoimmune rheumatic diseases, including systemic lupus erythematosus, psoriatic arthritis, polymyalgia rheumatica (PMR), giant cell arteritis, ankylosing spondylitis, and Sjögren's syndrome, and to provide an overall estimate of the risk of developing inflammatory autoimmune rheumatic disease over a lifetime. METHODS Using the incidence rates obtained from our population-based studies of rheumatic diseases among residents of Olmsted County, Minnesota, and mortality rates from life tables for the general population, we estimated the sex-specific lifetime risk of rheumatic disease. RESULTS The lifetime risk of RA developing in US adults was 3.6% for women and 1.7% for men, and the lifetime risk of rheumatoid factor-positive RA was 2.4% for women and 1.1% for men. The second most common inflammatory autoimmune rheumatic disease was PMR, with a lifetime risk of 2.4% for women and 1.7% for men. The overall lifetime risk of inflammatory autoimmune rheumatic disease was 8.4% for women and 5.1% for men. CONCLUSION One in 12 women and 1 in 20 men will develop an inflammatory autoimmune rheumatic disease during their lifetime. These results can serve as useful guides in counseling patients regarding their lifetime risk of these conditions and have important implications regarding disease awareness campaigns.
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Ernste FC, Reed AM. Idiopathic inflammatory myopathies: current trends in pathogenesis, clinical features, and up-to-date treatment recommendations. Mayo Clin Proc 2013; 88:83-105. [PMID: 23274022 DOI: 10.1016/j.mayocp.2012.10.017] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 01/13/2023]
Abstract
Recently, there have been important advances in the understanding of the pathophysiologic features, assessment, and management of patients with a newly diagnosed idiopathic inflammatory myopathy (IIM). Myositis-specific autoantibodies have been identified to define patient subgroups and offer prognostic implications. Similarly, proinflammatory cytokines, such as interleukin 6 and type 1 interferon-dependent genes, may serve as potential biomarkers of disease activity in adult and juvenile patients with dermatomyositis (DM). Moreover, magnetic resonance imaging has become an important modality for the assessment of muscle inflammation in adult IIM and juvenile DM. Immune-mediated necrotizing myopathies also are being recognized as a subset of IIM triggered by medications such as statins. However, confusion exists regarding effective management strategies for patients with IIM because of the lack of large-scale, randomized, controlled studies. This review focuses primarily on our current management and treatment algorithms for IIM including the care of pediatric patients with juvenile DM. For this review, we conducted a search of PubMed and MEDLINE for articles published from January 1, 1970, to December 1, 2011, using the following search terms: idiopathic inflammatory myopathies, dermatomyositis, polymyositis, juvenile dermatomyositis, sporadic inclusion body myositis, inclusion body myositis, inflammatory myositis, myositis, myopathies, pathogenesis, therapy, and treatment. Studies published in English were selected for inclusion in our review as well as additional articles identified from bibliographies.
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Maradit-Kremers H, Icen M, Ernste FC, Dierkhising RA, McEvoy MT. Disease severity and therapy as predictors of cardiovascular risk in psoriasis: a population-based cohort study. J Eur Acad Dermatol Venereol 2012; 26:336-43. [PMID: 22339785 DOI: 10.1111/j.1468-3083.2011.04071.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Previous studies suggest an increased risk of cardiovascular disease in psoriasis, but the relative contributions of traditional risk factors and markers of disease severity are unclear. We examined the effect of psoriasis disease characteristics on cardiovascular risk after adjusting for traditional cardiovascular risk factors. METHODS Study populations included (a) case-cohort sample of 771 patients nested within a population-based psoriasis incidence cohort, and (b) cohort of 1905 patients with incident and prevalent psoriasis patients. Both cohorts were followed-up to ascertain disease and treatment characteristics, traditional cardiovascular risk factors and cardiovascular outcomes. Cox proportional hazards regression models were used to identify predictors of cardiovascular outcomes. RESULTS After adjusting for traditional risk factors, increasing number of psoriasis-affected body sites at disease onset (HR: 1.53 per additional site, 95% CI: 1.20, 1.95) was significantly associated with an increased risk of cardiovascular outcomes. Phototherapy (HR: 3.76, 95% CI: 2.45, 5.77) and systemic therapy (HR: 2.17, 95% CI: 1.50, 3.13) were associated with a higher risk of cardiovascular outcomes in univariate analyses, but these relatively strong associations disappeared after adjusting for cardiovascular risk factors. CONCLUSIONS Increasing number of psoriasis-affected body sites may be a severity indicator in psoriasis and is associated with an increased cardiovascular risk. Due to low number of patients exposed to systemic therapy, this study had limited power to examine the effect of treatment on cardiovascular risk. Strong associations with phototherapy and systemic therapy suggest that the cardiovascular risk in psoriasis is confined to patients with severe disease.
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Affiliation(s)
- H Maradit-Kremers
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
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