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Karmacharya P, Chakradhar R, Hulshizer CA, Gunderson TM, Ogdie A, Davis JM, Wright K, Tollefson MM, Duarte-García A, Bekele D, Maradit-Kremers H, Crowson CS. Multimorbidity in Psoriasis as a Risk Factor for Psoriatic Arthritis: A Population-Based Study. Rheumatology (Oxford) 2024:keae040. [PMID: 38291896 DOI: 10.1093/rheumatology/keae040] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES To examine multimorbidity in psoriasis and its association with the development of PsA. METHODS A retrospective cohort study was performed using the Rochester Epidemiology Project. Population-based incidence (2000-2009) and prevalence (Jan 1, 2010) cohorts of psoriasis were identified by manual chart review. A cohort of individuals without psoriasis (comparators) were identified (1:1 matched on age, sex, and county). Morbidities were defined using ≥2 Clinical Classification Software codes ≥30 days apart within prior five years. PsA was defined using ClASsification of Psoriatic ARthritis (CASPAR) criteria. χ2 and rank-sum tests were used to compare morbidities, and age-, sex-, and race-adjusted Cox models to examine the association of baseline morbidities in psoriasis with development of PsA. RESULTS Among 817 incident psoriasis patients, the mean age was 45.2 years with 52.0% females, and 82.0% moderate/severe psoriasis. No multimorbidity differences were found between incident psoriasis patients and comparators. However, in the 1,088 prevalent psoriasis patients, multimorbidity was significantly more common compared with 1,086 comparators (OR : 1.35 and OR : 1.48 for ≥2 and ≥5 morbidities, respectively). Over a median 13.3-year follow-up, 23 patients (cumulative incidence: 2.9% by 15 years) developed PsA. Multimorbidity (≥2 morbidities) was associated with a 3-fold higher risk of developing PsA. CONCLUSION Multimorbidity was more common in the prevalent but not incident cohort of psoriasis compared with the general population, suggesting patients with psoriasis may experience accelerated development of multimorbidity. Moreover, multimorbidity at psoriasis onset significantly increased the risk of developing PsA, highlighting the importance of monitoring multimorbid psoriasis patients for the development of PsA.
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Affiliation(s)
- Paras Karmacharya
- Division of Rheumatology & Immunology, Vanderbilt University Medical Center, Nashville, TN
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Rikesh Chakradhar
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Department of Psychiatry, MetroHealth Medical Center, Psychiatry, Cleveland, OH
| | | | - Tina M Gunderson
- 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
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Kerry Wright
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Megha M Tollefson
- Departments of Dermatology and Pediatric and Adolescent Medicine, 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
| | - Delamo Bekele
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | | | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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Wyles CC, Fu S, Odum SL, Rowe T, Habet NA, Berry DJ, Lewallen DG, Maradit-Kremers H, Sohn S, Springer BD. External Validation of Natural Language Processing Algorithms to Extract Common Data Elements in THA Operative Notes. J Arthroplasty 2023; 38:2081-2084. [PMID: 36280160 PMCID: PMC10121967 DOI: 10.1016/j.arth.2022.10.031] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Natural language processing (NLP) systems are distinctive in their ability to extract critical information from raw text in electronic health records (EHR). We previously developed three algorithms for total hip arthroplasty (THA) operative notes with rules aimed at capturing (1) operative approach, (2) fixation method, and (3) bearing surface using inputs from a single institution. The purpose of this study was to externally validate and improve these algorithms as a prerequisite for broader adoption in automated registry data curation. METHODS The previous NLP algorithms developed at Mayo Clinic were deployed and refined on EHRs from OrthoCarolina, evaluating 39 randomly selected primary THA operative reports from 2018 to 2021. Operative reports were available only in PDF format, requiring conversion to "readable" text with Adobe software. Accuracy statistics were calculated against manual chart review. RESULTS The operative approach, fixation technique, and bearing surface algorithms all demonstrated perfect accuracy of 100%. By comparison, validated performance at the developing center yielded an accuracy of 99.2% for operative approach, 90.7% for fixation technique, and 95.8% for bearing surface. CONCLUSION NLP algorithms applied to data from an external center demonstrated excellent accuracy in delineating common elements in THA operative notes. Notably, the algorithms had no functional problems evaluating scanned PDFs that were converted to "readable" text by common software. Taken together, these findings provide promise for NLP applied to scanned PDFs as a source to develop large registries by reliably extracting data of interest from very large unstructured data sets in an expeditious and cost-effective manner.
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Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Sunyang Fu
- Department of AI and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Susan L Odum
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Taylor Rowe
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Nahir A Habet
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit-Kremers
- Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Department of AI and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sunghwan Sohn
- Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Department of AI and Informatics, Mayo Clinic, Rochester, Minnesota
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Harmer JR, Wyles CC, Duong SQ, Morgan Iii RJ, Maradit-Kremers H, Abdel MP. Depression and anxiety are associated with an increased risk of infection, revision, and reoperation following total hip or knee arthroplasty. Bone Joint J 2023; 105-B:526-533. [PMID: 37121583 DOI: 10.1302/0301-620x.105b5.bjj-2022-1123.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation. Between January 2000 and March 2019, 21,469 primary and revision arthroplasties (10,011 THAs; 11,458 TKAs), which were undertaken in 15,504 patients at a single academic medical centre, were identified from a 27-county linked electronic medical record (EMR) system. Depressive and anxiety disorders were identified by diagnoses in the EMR or by using a natural language processing program with subsequent validation from review of the medical records. Patients with mental health diagnoses other than anxiety or depression were excluded. Depressive and/or anxiety disorders were common before THA and TKA, with a prevalence of 30% in those who underwent primary THA, 33% in those who underwent revision THA, 32% in those who underwent primary TKA, and 35% in those who underwent revision TKA. The presence of depressive or anxiety disorders was associated with a significantly increased risk of any infection (primary THA, hazard ratio (HR) 1.5; revision THA, HR 1.9; primary TKA, HR 1.6; revision TKA, HR 1.8), revision (THA, HR 1.7; TKA, HR 1.6), re-revision (THA, HR 2.0; TKA, HR 1.6), and reoperation (primary THA, HR 1.6; revision THA, HR 2.2; primary TKA, HR 1.4; revision TKA, HR 1.9; p < 0.03 for all). Patients with preoperative depressive and/or anxiety disorders were significantly less likely to report "much better" joint function after primary THA (78% vs 87%) and primary TKA (86% vs 90%) compared with those without these disorders at two years postoperatively (p < 0.001 for all). The presence of depressive or anxiety disorders prior to primary or revision THA and TKA is common, and associated with a significantly higher risk of infection, revision, reoperation, and dissatisfaction. This topic deserves further study, and surgeons may consider mental health optimization to be of similar importance to preoperative variables such as diabetic control, prior to arthroplasty.
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Affiliation(s)
- Joshua R Harmer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie Q Duong
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Robert J Morgan Iii
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hilal Maradit-Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Wilson JM, Maradit-Kremers H, Abdel MP, Berry DJ, Mabry TM, Pagnano MW, Perry KI, Sierra RJ, Taunton MJ, Trousdale RT, Lewallen DG. Comparative Survival of Contemporary Cementless Acetabular Components Following Revision Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00343-1. [PMID: 37028772 DOI: 10.1016/j.arth.2023.03.093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The advent of highly porous ingrowth surfaces and highly crosslinked polyethylene (HXLPE) has been expected to improve implant survivorship in revision total hip arthroplasty (THA). Therefore, we sought to evaluate the survival of several contemporary acetabular designs following revision THA. METHODS Acetabular revisions performed from 2000 to 2019 were identified from our institutional total joint registry. We studied 3,348 revision hips, implanted with one of 7 cementless acetabular designs. These were paired with HXLPE or dual-mobility liners. A historical series of 258 Harris-Galante-1 (HG-1) components, paired with conventional polyethylene, was used as reference. Survivorship analyses were performed. For the 2,976 hips with minimum 2-year follow-up, the median follow-up was 8 years (range, 2 to 35 years). RESULTS Contemporary components with adequate follow-up had survivorship free of acetabular re-revision of ≥95% at 10-year follow-up. Relative to HG-1 components, 10-year survivorship free of all-cause acetabular cup re-revision was significantly higher in Zimmer TM Revision (Hazard Ratio (HR) 0.3, 95% Confidence Interval (CI) 0.2-0.45), Zimmer TM Modular (HR 0.34, 95%CI 0.13-0.89), Zimmer Trilogy (HR 0.4, 95%CI 0.24-0.69), Depuy Pinnacle Porocoat (HR 0.24, 95%CI 0.11-0.51), and Stryker Tritanium Revision (HR 0.46, 95%CI 0.24-0.91) shells. Among contemporary components, there were only 23 re-revisions for acetabular aseptic loosening and no re-revisions for polyethylene wear. CONCLUSIONS Contemporary acetabular ingrowth and bearing surfaces were associated with no re-revisions for wear and aseptic loosening was uncommon, particularly with highly porous designs. Therefore, it appears that contemporary revision acetabular components have dramatically improved upon historical results at available follow-up.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Hilal Maradit-Kremers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905.
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Wyles CC, Maradit-Kremers H, Larson DR, Lewallen DG, Taunton MJ, Trousdale RT, Pagnano MW, Berry DJ, Sierra RJ. Creation of a Total Hip Arthroplasty Patient-Specific Dislocation Risk Calculator. J Bone Joint Surg Am 2022; 104:1068-1080. [PMID: 36149242 PMCID: PMC9587736 DOI: 10.2106/jbjs.21.01171] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many risk factors have been described for dislocation following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions. METHODS In this study, 29,349 THAs, including 21,978 primary and 7371 revision cases, performed between 1998 and 2018 were evaluated. During a mean 6-year follow-up, 1521 THAs were followed by a dislocation. Patients were characterized, through individual-chart review, according to non-modifiable factors (demographics, indication for THA, spine disease, prior spine surgery, and neurologic disease) and modifiable operative decisions (operative approach, femoral head diameter, and type of acetabular liner [standard, elevated, constrained, or dual-mobility]). Multivariable regression models and nomograms were developed with dislocation as a binary outcome at 1 year and 5 years postoperatively. RESULTS Dislocation risk, based on patient-specific comorbidities and operative decisions, was wide-ranging-from 0.3% to 13% at 1 year and from 0.4% to 19% at 5 years after primary THA, and from 2% to 32% at 1 year and from 3% to 42% at 5 years after revision THA. In the primary-THA group, the direct anterior approach (hazard ratio [HR] = 0.27) and lateral approach (HR = 0.58) decreased the dislocation risk compared with the posterior approach. After adjusting for the approach in that group, the combination of a ≥36-mm-diameter femoral head and an elevated liner yielded the largest decrease in dislocation risk (HR = 0.28), followed by dual-mobility constructs (HR = 0.48). In the patients who underwent revision THA, the adjusted risk of dislocation was most markedly decreased by the use of a dual-mobility construct (HR = 0.40), followed by a ≥36-mm femoral head and an elevated liner (HR = 0.88). The adjusted risk of dislocation after revision THA was decreased by acetabular revision (HR = 0.58), irrespective of whether other components were revised. CONCLUSIONS Our patient-specific dislocation risk calculator, which was strengthened by our use of a robust multivariable model that accounted for comorbidities associated with instability, demonstrated wide-ranging patient-specific risks based on comorbidity profiles. The resultant nomograms can be used as a screening tool to identify patients at high risk for dislocation following THA and to individualize operative decisions for evidence-based risk mitigation. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Cody C. Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Dirk R. Larson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Mark W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Rafael J. Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Han P, Fu S, Kolis J, Hughes R, Hallstrom BR, Carvour M, Maradit-Kremers H, Sohn S, Vydiswaran VGV. Multi-Center Validation of Natural Language Processing Algorithms for Detection of Common Data Elements in Operative Notes for Total Hip Arthroplasty (Preprint). JMIR Med Inform 2022; 10:e38155. [PMID: 36044253 PMCID: PMC9475406 DOI: 10.2196/38155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background Natural language processing (NLP) methods are powerful tools for extracting and analyzing critical information from free-text data. MedTaggerIE, an open-source NLP pipeline for information extraction based on text patterns, has been widely used in the annotation of clinical notes. A rule-based system, MedTagger-total hip arthroplasty (THA), developed based on MedTaggerIE, was previously shown to correctly identify the surgical approach, fixation, and bearing surface from the THA operative notes at Mayo Clinic. Objective This study aimed to assess the implementability, usability, and portability of MedTagger-THA at two external institutions, Michigan Medicine and the University of Iowa, and provide lessons learned for best practices. Methods We conducted iterative test-apply-refinement processes with three involved sites—the development site (Mayo Clinic) and two deployment sites (Michigan Medicine and the University of Iowa). Mayo Clinic was the primary NLP development site, with the THA registry as the gold standard. The activities at the two deployment sites included the extraction of the operative notes, gold standard development (Michigan: registry data; Iowa: manual chart review), the refinement of NLP algorithms on training data, and the evaluation of test data. Error analyses were conducted to understand language variations across sites. To further assess the model specificity for approach and fixation, we applied the refined MedTagger-THA to arthroscopic hip procedures and periacetabular osteotomy cases, as neither of these operative notes should contain any approach or fixation keywords. Results MedTagger-THA algorithms were implemented and refined independently for both sites. At Michigan, the study comprised THA-related notes for 2569 patient-date pairs. Before model refinement, MedTagger-THA algorithms demonstrated excellent accuracy for approach (96.6%, 95% CI 94.6%-97.9%) and fixation (95.7%, 95% CI 92.4%-97.6%). These results were comparable with internal accuracy at the development site (99.2% for approach and 90.7% for fixation). Model refinement improved accuracies slightly for both approach (99%, 95% CI 97.6%-99.6%) and fixation (98%, 95% CI 95.3%-99.3%). The specificity of approach identification was 88.9% for arthroscopy cases, and the specificity of fixation identification was 100% for both periacetabular osteotomy and arthroscopy cases. At the Iowa site, the study comprised an overall data set of 100 operative notes (50 training notes and 50 test notes). MedTagger-THA algorithms achieved moderate-high performance on the training data. After model refinement, the model achieved high performance for approach (100%, 95% CI 91.3%-100%), fixation (98%, 95% CI 88.3%-100%), and bearing surface (92%, 95% CI 80.5%-97.3%). Conclusions High performance across centers was achieved for the MedTagger-THA algorithms, demonstrating that they were sufficiently implementable, usable, and portable to different deployment sites. This study provided important lessons learned during the model deployment and validation processes, and it can serve as a reference for transferring rule-based electronic health record models.
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Affiliation(s)
- Peijin Han
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Sunyang Fu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Julie Kolis
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Richard Hughes
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Brian R Hallstrom
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Martha Carvour
- Department of Internal Medicine and Epidemiology, University of Iowa, Iowa City, IA, United States
| | - Hilal Maradit-Kremers
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
- Departments of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, United States
- School of Information, University of Michigan, Ann Arbor, MI, United States
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Hevesi M, Wyles CC, Rouzrokh P, Erickson BJ, Maradit-Kremers H, Lewallen DG, Taunton MJ, Trousdale RT, Berry DJ. Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability. J Bone Joint Surg Am 2022; 104:239-245. [PMID: 34958643 DOI: 10.2106/jbjs.21.00406] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular "safe zone" to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation. METHODS Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach. RESULTS We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02). CONCLUSIONS Optimal acetabular positioning differs significantly from historic values, with increased anteversion providing decreased dislocation risk. Additionally, surgical approach and patient sex demonstrated clear effects on 3D safe-zone topography. Further study is needed to characterize the 3D interaction between acetabular positioning and spinopelvic as well as femoral-sided parameters. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Pouria Rouzrokh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Radiology Informatics Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Erickson
- Radiology Informatics Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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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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9
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Hassebrock JD, Wyles CC, Hevesi M, Maradit-Kremers H, Christensen AL, Levey BA, Trousdale RT, Sierra RJ, Bingham JS. Costs of open, arthroscopic and combined surgery for developmental dysplasia of the hip. J Hip Preserv Surg 2020; 7:570-574. [PMID: 33948212 PMCID: PMC8081411 DOI: 10.1093/jhps/hnaa048] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 11/14/2022] Open
Abstract
A variety of options exist for management of patients with developmental dysplasia of the hip (DDH). Most studies to date have focused on clinical outcomes; however, there are currently no data on comparative cost of these techniques. The purpose of this study was to evaluate in-hospital costs between patients managed with periacetabular osteotomy, hip arthroscopy or a combination for DDH. One hundred and nine patients were included: 35 PAO + HA, 32 PAO and 42 HA. There were no significant differences in the demographic parameters. Operative times were significantly different between groups with a mean of 52 min for PAO, 100 min for HA and 155 min for PAO + HA, (P < 0.001). Total direct medical costs were calculated and adjusted to nationally representative unit costs in 2017 inflation-adjusted dollars. Total in-hospital costs were significantly different between each of the three treatment groups. PAO + HA was the most expensive with a median of $21 852, followed by PAO with a median of $15 124, followed by HA with a median of $11 582 (P < 0.001). There was a significant difference between outpatient median costs of $11 385 compared with $24 320 for inpatients (P < 0.001). Procedures with greater complexity were more expensive. However, a change from outpatient to inpatient status with HA moved that group from the least expensive to similar to PAO and PAO + HA. These data provide an important complement to clinical outcomes reports as surgeons and policymakers aim to provide optimal value.
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Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Hilal Maradit-Kremers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Austin L Christensen
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Bruce A Levey
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Joshua S Bingham
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
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Karmacharya P, Crowson CS, Bekele D, Achenbach S, Davis III JM, Ogdie A, Duarte-Garcia A, Maradit-Kremers H, Tollefson M, Ernste FC, Wright K. SAT0404 INCIDENCE OF PSORIATIC ARTHRITIS FROM 2000-2017: A POPULATION-BASED STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease with an estimated prevalence of 0.05% to 0.25% in the population and 6% to 41% in psoriasis patients. There is disparity in the reported incidence patterns in the general population in more recent years, with increasing incidence seen in Denmark, but relatively stable rates seen in Canada. However, no studies in the US have looked at the recent incidence patterns, and it would be important to see how newer therapies for psoriasis have impacted the incidence of PsA. Variability in the estimates of incidence and prevalence across different studies has been attributed to differences in case ascertainment and most studies have used ICD codes to identify PsA patients.Objectives:To determine the annual incidence of PsA (2000-17) and compare it to incidence of PsA in previous years (1970-1999)1in the Olmsted County, Minnesota, USA population.Methods:A retrospective, population-based cohort of PsA patients ≥18 years of age from Olmsted County, MN meeting ClASsification of Psoriatic ARthritis (CASPAR) criteria for PsA (2000-17) was identified from the Rochester Epidemiology Project (REP). REP ensures virtually complete ascertainment and follow-up of all clinically diagnosed cases of PsA in a geographically-defined area. The date of fulfillment of CASPAR criteria was taken as the PsA incidence date. Age- and sex-specific incidence rates, adjusted to 2010 US white population, were reported. Our previously reported cohort from REP (1970-1999)1also used the same CASPAR criteria, and trends from the current study were compared to the previous years.Results:There were 170 incident cases of PsA, with a mean age of 46.7 (SD=12.3) years and 47% females from 2000-17. The overall age and sex adjusted annual incidence of PsA per 100,000 population was 8.8 (95% CI 7.5-10.1), and higher in males (9.7, 95% CI 7.7-11.7) than females (8.0, 95% CI 6.2-9.8). Overall incidence was highest in the age range 40-59 years (Table 1). The incidence rate was relatively stable in the recent years 2000-2017 compared to 1970-19991where a rise in incidence was observed (3.6 to 9.8 per 100,000 persons from 1970-79 to 1990-99, p<0.001) (Figure 1).Table 1.Annual incidence rate, IR (per 100,000) of psoriatic arthritis by age and sex between 2000-17 in Olmsted County, MN.MaleFemaleTotalAge Group, yrsNIRNIRNRate18-2994.141.6132.830-392413.4147.33810.240-492413.92614.05014.050-592113.52816.24914.960-6976.987.1157.070-7935.000.032.280+26.000.022.2Total (95% CI)909.7 (7.7-11.7)†808.0 (6.2-9.8)†1708.8 (7.5-10.1)††† Age-adjusted to the 2010 US White population. †† Age- and sex-adjusted to the 2010 US White populationConclusion:In the Olmsted County population, the increasing PsA incidence seen in previous years 1970-19991seems to have leveled off after 2000. This is in contrast to increasing incidence in recent years reported from Denmark, Taiwan and Israel. However, similar to our study, incidence rates for PsA from 2008-2015 were reported to be stable in Canada.References:[1]Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study.J Rheumatol. 2009;36(2):361-367.Acknowledgments:This project was supported by CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Science (NCATS).Disclosure of Interests:Paras Karmacharya: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Delamo Bekele: None declared, Sara Achenbach: None declared, John M Davis III Grant/research support from: Research grants from Pfizer, Consultant of: Served on advisory boards for Abbvie and Sanofi-Genzyme, Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis, Ali Duarte-Garcia: None declared, Hilal Maradit-Kremers: None declared, Megha Tollefson: None declared, Floranne C. Ernste: None declared, Kerry Wright: None declared
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Wyles CC, Tibbo ME, Fu S, Wang Y, Sohn S, Kremers WK, Berry DJ, Lewallen DG, Maradit-Kremers H. Use of Natural Language Processing Algorithms to Identify Common Data Elements in Operative Notes for Total Hip Arthroplasty. J Bone Joint Surg Am 2019; 101:1931-1938. [PMID: 31567670 PMCID: PMC7406139 DOI: 10.2106/jbjs.19.00071] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Manual chart review is labor-intensive and requires specialized knowledge possessed by highly trained medical professionals. Natural language processing (NLP) tools are distinctive in their ability to extract critical information from raw text in electronic health records (EHRs). As a proof of concept for the potential application of this technology, we examined the ability of NLP to correctly identify common elements described by surgeons in operative notes for total hip arthroplasty (THA). METHODS We evaluated primary THAs that had been performed at a single academic institution from 2000 to 2015. A training sample of operative reports was randomly selected to develop prototype NLP algorithms, and additional operative reports were randomly selected as the test sample. Three separate algorithms were created with rules aimed at capturing (1) the operative approach, (2) the fixation method, and (3) the bearing surface category. The algorithms were applied to operative notes to evaluate the language used by 29 different surgeons at our center and were applied to EHR data from outside facilities to determine external validity. Accuracy statistics were calculated with use of manual chart review as the gold standard. RESULTS The operative approach algorithm demonstrated an accuracy of 99.2% (95% confidence interval [CI], 97.1% to 99.9%). The fixation technique algorithm demonstrated an accuracy of 90.7% (95% CI, 86.8% to 93.8%). The bearing surface algorithm demonstrated an accuracy of 95.8% (95% CI, 92.7% to 97.8%). Additionally, the NLP algorithms applied to operative reports from other institutions yielded comparable performance, demonstrating external validity. CONCLUSIONS NLP-enabled algorithms are a promising alternative to the current gold standard of manual chart review for identifying common data elements from orthopaedic operative notes. The present study provides a proof of concept for use of NLP techniques in clinical research studies and registry-development endeavors to reliably extract data of interest in an expeditious and cost-effective manner.
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Affiliation(s)
- Cody C. Wyles
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Meagan E. Tibbo
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Sunyang Fu
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Yanshan Wang
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Sunghwan Sohn
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Walter K. Kremers
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Daniel J. Berry
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - David G. Lewallen
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit-Kremers
- Departments of Orthopedic Surgery (C.C.W., M.E.T., D.J.B., D.G.L., and H.M.-K.) and Health Sciences Research (S.F., Y.W., S.S., W.K.K., and H.M.-K.), Mayo Clinic, Rochester, Minnesota
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12
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Hevesi M, Wyles CC, Yao JJ, Maradit-Kremers H, Habermann EB, Glasgow AE, Bews KA, Ransom JE, Visscher SL, Lewallen DG, Berry DJ. Revision Total Hip Arthroplasty for the Treatment of Fracture: More Expensive, More Complications, Same Diagnosis-Related Groups: A Local and National Cohort Study. J Bone Joint Surg Am 2019; 101:912-919. [PMID: 31094983 DOI: 10.2106/jbjs.18.00523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision total hip arthroplasty (revision THA) occurs for a wide variety of indications and in the United States it is coded under Diagnosis-Related Groups (DRGs) 466, 467, and 468, which do not account for revision etiology, a potentially substantial driver of cost. This study investigates revision THA costs and 30-day complications by indication, both locally and nationally. METHODS Hospitalization costs and complication rates for 1,422 aseptic revision THAs performed at a high-volume center between 2009 and 2014 were retrospectively reviewed. Additionally, charges for 28,133 revision THAs in the National Inpatient Sample (NIS) were converted to costs using the Healthcare Cost and Utilization Project cost-to-charge ratios, and 30-day complication rates for 3,224 revision THAs were obtained with use of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Costs and complications were compared between revision THAs performed for fracture, wear/loosening, and dislocation/instability with use of simultaneous and pairwise comparisons and a multivariable model accounting for American Society of Anesthesiologists (ASA) score, age, and sex. RESULTS Local hospitalization costs for fracture (median, $25,672) were significantly higher than those for wear/loosening ($20,228; p < 0.001) or dislocation/instability ($17,911; p < 0.001), with differences remaining significant even after adjusting for patient comorbidities (p < 0.001). NIS costs for fracture (median, $27,596) were higher than those for other aseptic indications (wear/loosening: $21,176, p < 0.001; dislocation/instability: $16,891, p< 0.001). Local 30-day orthopaedic complication rates for fracture (20.7%) were higher those than for dislocation/instability (9.0%; p = 0.007) and similar to those for wear/loosening (17.6%; p = 0.434). Nationally, combined medical and surgical complication rates for fracture (71.3% of patients with ≥1 complication) were significantly higher than those for wear/loosening (35.2%; p < 0.001) or dislocation/instability (35.1%; p < 0.001). CONCLUSIONS Hospitalization costs for revision THA for fracture were 33% to 48% higher than for all other aseptic revision THAs, both locally and nationally. This increased cost persisted even after multivariable comorbidity adjustment, the current DRG basis for stratifying revision THA reimbursement. Additionally, 30-day complication rates suggest that increased resource utilization for fracture patients continues even after discharge. Indication-specific coding and reimbursement systems are necessary to maintain sustainable access to revision THA for all patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Jie J Yao
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit-Kremers
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Amy E Glasgow
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Katherine A Bews
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Jeanine E Ransom
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Sue L Visscher
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota
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Wyles CC, Robinson WA, Maradit-Kremers H, Houdek MT, Trousdale RT, Mabry TM. Cost and Patient Outcomes Associated With Bilateral Total Knee Arthroplasty Performed by 2-Surgeon Teams vs a Single Surgeon. J Arthroplasty 2019; 34:671-675. [PMID: 30661905 DOI: 10.1016/j.arth.2018.12.029] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a 2-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. METHODS All primary TKAs performed from 2007 to 2017 by the 2 participating surgeons for each of the 3 groups of interest were identified: team SA (N = 42 patients; 84 knees), single-surgeon SA (N = 146 patients; 292 knees), single-surgeon TA (N = 242 patients; 484 knees). No patients were lost to follow-up. RESULTS Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (P < .001 overall; P = .0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4% for team SA, 11.0% for single-surgeon SA, and 8.3% for single-surgeon TA (P = .2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31%, single-surgeon SA 53%, and single-surgeon TA after the second operation 34% (P < .001). CONCLUSION This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient operating room utilization may further enhance the financial benefits.
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Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Singh AG, Crowson CS, Singh S, Denis M, Davis P, Maradit-Kremers H, Matteson EL, Chowdhary VR. Risk of Cerebrovascular Accidents and Ischemic Heart Disease in Cutaneous Lupus Erythematosus: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2017; 68:1664-1670. [PMID: 27015109 DOI: 10.1002/acr.22892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/10/2016] [Accepted: 03/22/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE It is unclear whether isolated cutaneous lupus erythematosus (CLE) affects cardiovascular risk. We estimated the cumulative incidence and mortality of cardiovascular diseases in a population-based CLE cohort and compared the risk with a matched non-CLE cohort. METHODS All incident cases of CLE in Olmsted County, Minnesota, between 1965 and 2005 were followed until December 2013. The cumulative incidence of cerebrovascular accidents (CVAs [including stroke and transient ischemic attack]), ischemic heart disease (IHD [including coronary artery disease, myocardial infarction, and angina pectoris]), heart failure, and peripheral arterial disease (PAD) was derived and compared to an age-, sex-, and calendar year-matched non-CLE cohort using Cox models. RESULTS There were 155 patients with CLE (mean ± SD age at diagnosis 48 ± 16 years, 65% female, mean ± SD BMI 26.3 ± 7.1 kg/m2 , 40% smokers, 9% with diabetes mellitus). During a median followup of 14.6 years, 41 CLE patients had cardiovascular events (15 patients with CVAs, 32 patients with IHD), with a 20-year cumulative incidence of 31.6%. As compared to non-CLE subjects, the risk of CVAs (smoking-adjusted hazard ratio [HR] 2.97 [95% confidence interval (95% CI) 1.13-7.78]) and PAD (HR 2.06 [95% CI 0.99-4.32]) was increased in patients with CLE, but the risk of IHD was not increased (HR 0.94 [95% CI 0.57-1.54]). There was no increase in cardiovascular mortality (HR 1.68 [95% CI 0.76-3.75]). The magnitude of risk for any cardiovascular outcome was not significantly influenced by the extent of cutaneous involvement. CONCLUSION CLE may be associated with an increased risk of CVAs and PAD, but not IHD. Factors contributing to increased CVA risk in patients with CLE merit evaluation.
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Affiliation(s)
- Abha G Singh
- Mayo Clinic, Rochester, Minnesota, and University of California, San Diego
| | | | | | | | - P Davis
- Mayo Clinic, Rochester, Minnesota
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Koster MJ, Achenbach SJ, Crowson CS, Maradit-Kremers H, Matteson EL, Warrington KJ. Healthcare Use and Direct Cost of Giant Cell Arteritis: A Population-based Study. J Rheumatol 2017; 44:1044-1050. [PMID: 28461641 DOI: 10.3899/jrheum.161516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the healthcare use and direct medical cost of giant cell arteritis (GCA) in a population-based cohort. METHODS A well-defined, retrospective population-based cohort of Olmsted County, Minnesota, USA, residents diagnosed with GCA from 1982-2009 was compared to a matched referent cohort from the same population. Standardized cost data (inflation-adjusted to 2014 US dollars) for 1987-2014 and outpatient use data for 1995-2014 were obtained. Use and costs were compared between cohorts through signed-rank paired tests, McNemar's tests, and quantile regression models. RESULTS Significant annual differences in outpatient costs were observed for patients with GCA in each of the first 4 years (median differences: $2085, $437, $382, $388, respectively). In adjusted analyses, median incremental cost attributed to GCA over a 5-year period was $4662. Compared with matched referent subjects, patients with GCA had higher use of laboratory visit-days annually for each of the first 3 years following incidence/index date, and increased outpatient physician visits for years 0-1, 1-2, and 3-4. Patients with GCA had significantly more radiology visit-days in years 0-1, 3-4, and 4-5, and more ophthalmologic procedures/surgery in years 0-1, 1-2, 2-3, and 4-5 compared to non-GCA. Emergency medicine visits, musculoskeletal, and cardiovascular procedures/surgery were similar between GCA and non-GCA groups throughout the study period. CONCLUSION Direct medical outpatient costs were increased in the month preceding and in the first 4 years following GCA diagnosis. Higher use of outpatient physician, laboratory, and radiology visits, and ophthalmologic procedures among these patients accounts for the increased cost of care.
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Affiliation(s)
- Matthew J Koster
- From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA. .,M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic.
| | - Sara J Achenbach
- From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA.,M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
| | - Cynthia S Crowson
- From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA.,M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
| | - Hilal Maradit-Kremers
- From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA.,M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
| | - Eric L Matteson
- From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA.,M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
| | - Kenneth J Warrington
- From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA.,M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
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16
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Baghdadi YMK, Maradit-Kremers H, Dennison T, Ransom JE, Sperling JW, Cofield RH, Sánchez-Sotelo J. The hospital cost of two-stage reimplantation for deep infection after shoulder arthroplasty. JSES Open Access 2017; 1:15-18. [PMID: 30675533 PMCID: PMC6340834 DOI: 10.1016/j.jses.2017.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The cost of treating infection after hip and knee arthroplasty is well documented in the literature. The purpose of this study was to determine the cost of two-stage reimplantation for deep infection after shoulder arthroplasty. Methods Between 2003 and 2012, 57 shoulders (56 patients) underwent a two-stage reimplantation for deep periprosthetic shoulder infection; implants placed at reimplantation included anatomic total shoulder arthroplasty (a-TSA) in 58%, reverse total shoulder arthroplasty (r-TSA) in 40%, and hemiarthroplasty (HA) in 2%. During the same timeframe, 2953 primary shoulder arthroplasties (2589 patients) were performed at the same institution (a-TSA in 55%, r-TSA in 28%, and HA in 17%). Total direct medical costs were calculated by using standardized, inflation-adjusted costs for services and procedures billed during hospitalization and were adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Results The mean hospital cost (per shoulder) for two-stage reimplantation was $35,824 (95% CI: 33,363 to 38,285) and was significantly higher than for primary procedures (mean: $16,068; 95% CI: 15,823 to 16,314). Both Part A and Part B costs were significantly higher in two-stage reimplantation (p < 0.001). For part A (hospital services), the mean cost for two-stage reimplantation was $29,851 (95% CI: 27,741 to 31,960), compared to $13,508 (95% CI: 13,302 to 13,715) for primaries. For part B (professional costs), mean costs were $5973 (95% CI: 5493 to 6453) versus 2560 (95% CI: 2512 to 2608) respectively. Conclusions The hospital cost of two-stage reimplantation for the treatment of an infected shoulder arthroplasty is about two times higher than the cost of a primary shoulder arthroplasty.
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Affiliation(s)
| | | | - Taylor Dennison
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeanine E Ransom
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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17
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Michet CJ, Schleck CD, Larson DR, Maradit-Kremers H, Berry DJ, Lewallen DG. Cause-Specific Mortality Trends Following Total Hip and Knee Arthroplasty. J Arthroplasty 2017; 32:1292-1297. [PMID: 27866950 PMCID: PMC5362336 DOI: 10.1016/j.arth.2016.10.009] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/13/2016] [Accepted: 10/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND While studies have demonstrated that mortality after total hip (THA) and total knee (TKA) arthroplasty is better than the general population, the causes of death are not well established. We evaluated cause-specific mortality after THA and TKA. METHODS The study included population-based cohorts of patients who underwent THA (N = 2019) and TKA (N = 2259) between 1969 and 2008. Causes of death were classified using the International Classification of Diseases 9th and 10th editions. Cause-specific standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated by comparing observed and expected mortality. Expected mortality was derived from mortality rates in the United States white population of similar calendar year, age, and sex characteristics. RESULTS All-cause mortality was lower than expected following both THA and TKA. However, there was excess mortality due to mental diseases such as dementia following both THA (SMR 1.40, 95% CI 1.08, 1.80) and TKA (SMR 1.49, 95% CI 1.19, 1.85). There was also excess mortality from inflammatory musculoskeletal diseases in THA (SMR 3.50, 95% CI 2.11, 5.46) and TKA (SMR 4.85, 95% CI 3.29, 6.88). When the cohorts were restricted to patients with osteoarthritis as the surgical indication, the excess risk of death from mental diseases still persisted in THA (SMR 1.36, 95% CI 1.02, 1.78) and TKA (SMR 1.52, 95% CI 1.20, 1.91). CONCLUSION THA and TKA patients experience a higher risk of death from mental and inflammatory musculoskeletal diseases. These findings warrant further research to identify drivers of mortality and prevention strategies in arthroplasty patients.
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Affiliation(s)
- CJ Michet
- Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW,
Rochester, MN, 55905
| | - CD Schleck
- Departments of Health Sciences Research, Mayo Clinic, 200 First
Street SW, Rochester, MN, 55905
| | - DR Larson
- Departments of Health Sciences Research, Mayo Clinic, 200 First
Street SW, Rochester, MN, 55905
| | - H Maradit-Kremers
- Departments of Health Sciences Research, Mayo Clinic, 200 First
Street SW, Rochester, MN, 55905
| | - DJ Berry
- Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW,
Rochester, MN, 55905
| | - DG Lewallen
- Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW,
Rochester, MN, 55905
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18
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Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty? J Arthroplasty 2017; 32:1143-1147. [PMID: 27876254 DOI: 10.1016/j.arth.2016.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To resurface or not to resurface the patella remains a controversy in total knee arthroplasty (TKA). The purpose of this study was to assess the long-term outcomes associated with selectively not resurfacing the patella. METHODS This was a historical cohort study of 15,497 patients with 21,371 primary TKA procedures performed at a single institution between 1985 and 2010. The cohort included 402 (2%) knees with unresurfaced patellae and 20,969 knees with all-polyethylene patellae designs. Reasons for not resurfacing the patella were documented. Multivariable Cox regression analyses were used to estimate the risk of complications and revisions among procedures with unresurfaced patellae. RESULTS According to the surgeon, reasons for not resurfacing were normal cartilage (226, 56%), young patient (30, 8%), thin patella (53, 13%), and surgeons' choice (93, 23%). In age, sex, and calendar year-adjusted analyses, the risk of complications (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.06, 1.46) and all-cause revisions (HR: 1.39, 95% CI: 1.02, 1.89) were significantly higher after TKA with unresurfaced patellae. However, after adjusting for femoral component types and operative diagnoses, these associations were no longer significant. The only group with significantly worse outcomes were those with a thin patellae with increased risk of complications (HR: 2.66, 95% CI: 1.70, 4.17) and revisions (HR: 5.94, 95% CI: 2.35, 15.02). Yet, the excess risk in the thin patellae group was mainly due to infections, and not related to unresurfaced patellae. CONCLUSION Selectively not resurfacing the patella seemed to provide similar results compared with routine resurfacing.
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Affiliation(s)
| | - Omar J Haque
- Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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19
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Singh AG, Crowson CS, Singh S, Davis MDP, Maradit-Kremers H, Matteson EL, Chowdhary VR. Cancer risk in cutaneous lupus erythematosus: a population-based cohort study. Rheumatology (Oxford) 2016; 55:2009-2013. [PMID: 27520797 DOI: 10.1093/rheumatology/kew291] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 06/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Immune dysregulation associated with chronic autoimmune diseases, such as SLE, has been associated with increased cancer risk. It is unclear whether isolated cutaneous lupus erythematosus (CLE) modifies cancer risk. We estimated the cumulative incidence of cancer in a population-based CLE cohort and compared the risk with a matched non-CLE cohort. METHODS All incident cases of CLE in Olmsted County, MN, USA between 1965 and 2005 were identified and followed to December 2013. Estimates for the cumulative incidence of any cancer and skin cancer in patients with CLE were derived and compared with an age-, sex- and calendar-year-matched non-CLE cohort using Cox models. RESULTS There were a total of 155 patients with CLE [age at diagnosis, 48 (sd 16) years; 65% females; BMI, 26.3 (sd 7.1) kg/m2; 40% smokers, 9% with diabetes]. During a median follow-up of 14.6 years, we observed 35 cases of incident cancer (including 10 cases of skin cancer). The cumulative 1-, 5- and 10-year incidence of any cancer after diagnosis of CLE was 1.4, 7.5 and 11.6%, respectively. Compared with matched non-CLE controls, the overall risk of malignancies was not increased in patients with CLE (smoking-adjusted hazard ratio = 1.29; 95% CI: 0.78, 2.13; P = 0.31). There was also no significant increase in risk of any skin cancer in patients with CLE (hazard ratio = 2.51; 95% CI: 0.91, 6.96; P = 0.16). CONCLUSION CLE is not associated with an increased risk of any cancers, including skin cancers, compared with the general population. However, the number of events was small, limiting the power of the study.
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Affiliation(s)
- Abha G Singh
- Division of Rheumatology, Mayo Clinic, Rochester, MN.,Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, CA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Siddharth Singh
- Division of Biomedical Informatics, University of California San Diego, La Jolla, CA
| | | | - Hilal Maradit-Kremers
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic, Rochester, MN.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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20
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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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21
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Koster M, Achenbach S, Crowson C, Maradit-Kremers H, Matteson E, Warrington K. FRI0384 Healthcare Utilization and Direct Medical Costs of Giant Cell Arteritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Singh A, Crowson C, Davis M, Maradit-Kremers H, Matteson E, Chowdhary V. THU0329 Risk of Cancer is not Increased in Patients with Cutaneous Lupus Erythematosus: A Population-Based Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Singh A, Crowson C, Davis M, Maradit-Kremers H, Matteson E, Chowdhary V. AB0539 Risk of Cardiovascular Events in Patients with Cutaneous Lupus Erythematosus: A Population-Based Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Sagar V, Crowson C, Amin S, Makol A, Ernste F, Osborn T, Moder K, Niewold T, Maradit-Kremers H, Chowdhary V. THU0372 Incidence of Systemic Lupus Erythematosus (SLE) in a Population Based Cohort Using 1982, Revised 1997 ACR and 2012 SLICC Criteria. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Chowdhary V, Crowson C, Maradit-Kremers H, Davis M. SAT0100 Incidence of Systemic Lupus Erythematosus and Cutaneous Lupus Erythematosuis in A Population Based Cohort from 1993-2005. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Fenstad ER, Le RJ, Sinak LJ, Maradit-Kremers H, Ammash NM, Ayalew AM, Villarraga HR, Oh JK, Frantz RP, McCully RB, McGoon MD, Kane GC. Pericardial effusions in pulmonary arterial hypertension: characteristics, prognosis, and role of drainage. Chest 2014; 144:1530-1538. [PMID: 23949692 DOI: 10.1378/chest.12-3033] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The presence and size of a pericardial effusion in pulmonary arterial hypertension (PAH) and its association with outcome is unclear. METHODS In this single-center cohort study of 577 patients with group 1 PAH seen between January 1, 1995, and December 31, 2005, all patients underwent transthoracic echocardiography and were followed for ≥ 5 years. Echocardiography-guided pericardiocentesis was performed as needed. RESULTS Pericardial effusions on index echocardiography occurred in 150 patients (26%); 128 patients had small and 22 had moderate-sized or larger effusions. Most of the moderate or greater effusions occurred in patients who had connective tissue disease (82%). Mean right atrial pressure was 13.4 ± 4.4 mm Hg (no effusion), 15.1 ± 4.4 mm Hg (small effusion), and 17.0 ± 4.0 mm Hg (moderate or greater effusion) (P < .0001). Median survival for patients with moderate or greater effusion, mild effusion, or no effusion was 11.3 months, 42.3 months, and 76.5 months, respectively. Four of the 22 patients with moderate or greater pericardial effusions eventually required echocardiography-guided pericardiocentesis because of clinical and echocardiographic evidence of hemodynamic impact. When drained, the effusions were large (858 ± 469 mL) and generally serous. All pericardiocenteses were performed cautiously under echocardiographic guidance by a highly experienced echocardiologist, with low immediate morbidity and mortality. CONCLUSIONS Pericardial effusions are relatively common but rarely of hemodynamic significance in patients with PAH. However, even modest degrees of pericardial fluid are associated with a significant increase in mortality and appear to reflect the presence of associated collagen vascular disease and high right atrial pressure.
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Affiliation(s)
- Eric R Fenstad
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rachel J Le
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Lawrence J Sinak
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Hilal Maradit-Kremers
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Assefa M Ayalew
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Hector R Villarraga
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jae K Oh
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Robert P Frantz
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Robert B McCully
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael D McGoon
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
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27
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Zhong W, Maradit-Kremers H, St Sauver JL, Yawn BP, Ebbert JO, Roger VL, Jacobson DJ, McGree ME, Brue SM, Rocca WA. Age and sex patterns of drug prescribing in a defined American population. Mayo Clin Proc 2013; 88:697-707. [PMID: 23790544 PMCID: PMC3754826 DOI: 10.1016/j.mayocp.2013.04.021] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the age and sex patterns of drug prescribing in Olmsted County, Minnesota. PATIENTS AND METHODS Population-based drug prescription records for the Olmsted County population in 2009 were obtained using the Rochester Epidemiology Project medical records linkage system (n=142,377). Drug prescriptions were classified using RxNorm codes and were grouped using the National Drug File-Reference Terminology. RESULTS Overall, 68.1% of the population (n=96,953) received a prescription from at least 1 drug group, 51.6% (n=73,501) received prescriptions from 2 or more groups, and 21.2% (n=30,218) received prescriptions from 5 or more groups. The most commonly prescribed drug groups in the entire population were penicillins and β-lactam antimicrobials (17%; n=23,734), antidepressants (13%; n=18,028), opioid analgesics (12%; n=16,954), antilipemic agents (11%; n=16,082), and vaccines/toxoids (11%; n=15,918). However, prescribing patterns differed by age and sex. Vaccines/toxoids, penicillins and β-lactam antimicrobials, and antiasthmatic drugs were most commonly prescribed in persons younger than 19 years. Antidepressants and opioid analgesics were most commonly prescribed in young and middle-aged adults. Cardiovascular drugs were most commonly prescribed in older adults. Women received more prescriptions than men for several drug groups, in particular for antidepressants. For several drug groups, use increased with advancing age. CONCLUSION This study provides valuable baseline information for future studies of drug utilization and drug-related outcomes in this population.
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Affiliation(s)
- Wenjun Zhong
- Division of Epidemiology, Mayo Clinic, Rochester, MN
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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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McCoy SS, Crowson CS, Maradit-Kremers H, Therneau TM, Roger VL, Matteson EL, Gabriel SE. Longterm outcomes and treatment after myocardial infarction in patients with rheumatoid arthritis. J Rheumatol 2013; 40:605-10. [PMID: 23418388 DOI: 10.3899/jrheum.120941] [Citation(s) in RCA: 39] [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] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the risk profiles, treatment, and outcomes of patients with rheumatoid arthritis (RA) with myocardial infarction (MI) and matched MI patients without RA. METHODS We used a population-based cohort of Olmsted County, Minnesota, residents with MI from the period 1979-2009. We identified 77 patients who fulfilled the American College of Rheumatology 1987 criteria for RA and 154 MI patients without RA matched for age, sex, and calendar year. Data collection from medical records included RA and MI characteristics, antirheumatic and cardioprotective medications, reperfusion therapy, and outcomes (mortality, heart failure, and recurrent ischemia). RESULTS The mean age at MI was 72.4 years and 55% of patients were female in both cohorts. Cardiovascular risk factor profiles, MI characteristics, and treatment with reperfusion therapy or cardioprotective medications were similar in MI patients with and those without RA. Patients with RA experienced poorer longterm outcomes compared to patients without RA--for mortality: hazard ratio (HR) 1.47; 95% CI 1.04, 2.08; and for recurrent ischemia: HR 1.51; 95% CI 1.04, 2.18. CONCLUSION MI patients with RA received similar treatment with reperfusion therapy and cardioprotective medications and had similar short-term outcomes compared to patients without RA. Patients with RA had poorer longterm outcomes. Despite similar treatment, MI patients with RA had worse longterm outcomes than MI patients without RA.
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Affiliation(s)
- Sara S McCoy
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Akkara Veetil BM, Matteson EL, Maradit-Kremers H, McEvoy MT, Crowson CS. Trends in lipid profiles in patients with psoriasis: a population-based analysis. BMC Dermatol 2012; 12:20. [PMID: 23110323 PMCID: PMC3520693 DOI: 10.1186/1471-5945-12-20] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 10/08/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Psoriasis is associated with an atherogenic lipid profile but longitudinal changes in lipids around disease onset are unknown. The purpose of our study is to examine the effect of psoriasis onset on serum lipid profiles. METHODS We compared changes in lipid profiles in a population based incident cohort of 689 patients with psoriasis and 717 non-psoriasis subjects. All lipid measures performed 5 years before and after psoriasis incidence/index date were abstracted. Random-effects models adjusting for age, sex and calendar year were used to examine trends in lipid profiles. RESULTS There were significant declines in total cholesterol (TC) and low-density lipoprotein (LDL) levels during the 5 years before and after psoriasis incidence/index date in both the psoriasis and the non-psoriasis cohorts, with a greater decrease noted in the TC levels (p=0.022) and LDL (p=0.054) in the non-psoriasis cohort. High-density lipoprotein (HDL) levels increased significantly both before and after psoriasis incidence date in the psoriasis cohort. Triglyceride (TG) levels were significantly higher (p<0.001), and HDL levels significantly lower (p=0.013) in patients with psoriasis compared to non-psoriasis subjects. There were no differences in prescriptions for lipid lowering drugs between the two cohorts. CONCLUSIONS Patients with psoriasis had a significant decrease in TC and LDL levels during the 5 years before psoriasis incidence. Higher mean TG and lower mean HDL levels were noted in the 5 years before psoriasis incidence. These changes are unlikely to be caused by lipid lowering treatment alone and require further exploration.
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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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Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, Amo MD, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71:484-92. [PMID: 22388996 PMCID: PMC3298664 DOI: 10.1136/annrheumdis-2011-200329] [Citation(s) in RCA: 302] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness>45 minutes, elevated CRP and/or ESR and new hip pain. These criteria are not meant for diagnostic purposes.
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Affiliation(s)
- Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Marco A Cimmino
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Wolfgang A Schmidt
- Department of Rheumatology, Immanuel Krankenhaus Berlin: Medical Center for Rheumatology Berlin–Buch Berlin, Berlin, Germany
| | - Michael Schirmer
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | - Carlo Salvarani
- Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Artur Bachta
- Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria
| | - Christina Duftner
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
- Department of Internal Medicine, General Hospital of Kufstein, Kufstein, Austria
| | | | | | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Novák Pál Kaposi
- Radiology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Peter Mandl
- General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Peter V Balint
- General and Pediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Zsuzsa Schmidt
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Annamaria Iagnocco
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | | | | | | | - Nicolò Pipitone
- Department of Rheumatology, Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | | | - Georgina Espígol-Frigolé
- Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maria C Cid
- Department of Systemic Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Víctor M Martínez-Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - Elisabeth Nordborg
- Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
| | - Sibel Zehra Aydin
- Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
| | - Khalid Ahmed
- Department of Rheumatology, Princess Alexandra Hospital, Harlow, UK
| | - Brian Hazleman
- Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK
| | | | - Colin Pease
- Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
| | - Richard J Wakefield
- Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds, UK
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Andy Abril
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Clement J Michet
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ralph Marcus
- Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
| | - Neil J Gonter
- Rheumatology Associates of North Jersey, Teaneck, New Jersey, USA
| | - Mehrdad Maz
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric L Matteson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Matteson EL, Maradit-Kremers H, Cimmino MA, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Slott Jensen H, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Cantini F, Nannini C, Macchioni P, Pipitone N, Del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazelman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Marcus R, Gonter NJ, Maz M, Crowson CS, Dasgupta B. Patient-reported outcomes in polymyalgia rheumatica. J Rheumatol 2012; 39:795-803. [PMID: 22422492 DOI: 10.3899/jrheum.110977] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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
OBJECTIVE To prospectively evaluate the disease course and the performance of clinical, patient-reported outcome (PRO) and musculoskeletal ultrasound measures in patients with polymyalgia rheumatica (PMR). METHODS The study population included 85 patients with new-onset PMR who were initially treated with prednisone equivalent dose of 15 mg daily tapered gradually, and followed for 26 weeks. Data collection included physical examination findings, laboratory measures of acute-phase reactants, and PRO measures. Ultrasound evaluation was performed at baseline and Week 26 to assess for features previously reported to be associated with PMR. Response to corticosteroid treatment was defined as 70% improvement in PMR on visual analog scale (VAS). RESULTS At baseline, 77% had hip pain in addition to shoulder pain and 100% had abnormal C-reactive protein or erythrocyte sedimentation rate. On ultrasound, 84% had shoulder findings and 32% had both shoulder and hip findings. Response to corticosteroid treatment occurred in 73% of patients by Week 4 and was highly correlated with percentage improvement in other VAS measures. Presence of ultrasound findings at baseline predicted response to corticosteroids at 4 weeks. Factor analysis revealed 6 domains that sufficiently represented all the outcome measures: PMR-related pain and physical function, an elevated inflammatory marker, hip pain, global pain, mental function, and morning stiffness. CONCLUSION PRO measures and inflammatory markers performed well in assessing disease activity in patients with PMR. A minimum set of outcome measures consisting of PRO measures of pain and function and an inflammatory marker should be used in practice and in clinical trials in PMR.
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Affiliation(s)
- Eric L Matteson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Le RJ, Fenstad ER, Maradit-Kremers H, McCully RB, Frantz RP, McGoon MD, Kane GC. RETRACTED: Syncope in Adults With Pulmonary Arterial Hypertension. J Am Coll Cardiol 2011; 58:863-7. [DOI: 10.1016/j.jacc.2011.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/03/2011] [Accepted: 04/13/2011] [Indexed: 11/29/2022]
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Myasoedova E, Crowson CS, Nicola PJ, Maradit-Kremers H, Davis JM, Roger VL, Therneau TM, Gabriel SE. The influence of rheumatoid arthritis disease characteristics on heart failure. J Rheumatol 2011; 38:1601-6. [PMID: 21572155 DOI: 10.3899/jrheum.100979] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA. METHODS A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data. RESULTS The study included 795 RA patients [mean age 55.3 yrs, 69% women, 66% rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95% CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95% CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95% CI 1.2, 3.5), severe extraarticular manifestations (HR 3.1, 95% CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95% CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95% CI 0.3, 0.9). CONCLUSION Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment.
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Ionescu RA, Daha IC, Sisiroi M, Tanasescu C, Dasgupta B, Crowson C, Maradit-Kremers H, Matteson E, Youngstein T, Mehta P, Mason J, Suppiah R, Hadden RD, Batra R, Arden N, Collins MP, Guillevin L, Jayne D, Luqmani R, Mukherjee J, Youngstein T, Pyne D, Hughes E, Nash J, Andrews J, Mason JC, Atzeni F, Boiardi L, Casali B, Farnetti E, Nicoli D, Sarzi-Puttini P, Pipitone N, Olivieri I, Cantini F, Salvi F, La Corte R, Triolo G, Filippini D, Paolazzi G, Salvarani C, Suppiah R, Batra R, Robson J, Arden N, Flossmann O, Harper L, Hoglund P, Jayne D, Judge A, Mukhtyar C, Westman K, Luqmani R, Suppiah R, Judge A, Batra R, Flossmann O, Harper L, Hoglund P, Kassim Javaid M, Jayne D, Mukhtyar C, Westman K, Davis JC, Hoffman GS, Joseph McCune W, Merkel PA, William St. Clair E, Seo P, Specks U, Spiera R, Stone JH, Luqmani R. Vasculitis: 265. Cryoglobulinemic Vasculitis Secondary to Hepatitis C Infection: Is Prediction of Disease Severity Feasible? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dejaco C, Duftner C, Cimmino MA, Dasgupta B, Salvarani C, Crowson CS, Maradit-Kremers H, Hutchings A, Matteson EL, Schirmer M. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis 2010; 70:447-53. [PMID: 21097803 PMCID: PMC3033531 DOI: 10.1136/ard.2010.133850] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus. Methods Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%. Results Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms. Conclusions Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR.
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Affiliation(s)
- Christian Dejaco
- Correspondence to Professor Michael Schirmer, Department of Internal Medicine I, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Kane GC, Maradit-Kremers H, Slusser JP, Scott CG, Frantz RP, McGoon MD. Integration of clinical and hemodynamic parameters in the prediction of long-term survival in patients with pulmonary arterial hypertension. Chest 2010; 139:1285-1293. [PMID: 21071530 DOI: 10.1378/chest.10-1293] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Current management guidelines for pulmonary arterial hypertension (PAH) recommend a treatment choice based primarily on World Health Organization (WHO) functional class. This study was designed to assess how the incorporation of readily obtained clinical and test-based information may significantly improve the prediction of outcomes over functional class alone. METHODS Clinical and hemodynamic variables were assessed in 484 consecutive patients presenting with WHO group 1 PAH. The primary outcome measure was time to all-cause mortality over 5 years from the index presentation (data available in all). Follow-up was censored at the time of lung or heart/lung transplant in 21 patients or at 5 years. Predictors of mortality were assessed sequentially using Cox models, with the step-wise incorporation of clinical variables, echocardiographic, and catheterization findings. Results were further compared with the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management) prediction score. RESULTS Overall median survival was 237 weeks (95% CI, 196-266), corresponding to 1-year, 3-year, and 5-year survival rates of 81.1% (77.0, 84.7), 61.1% (56.5, 65.3), and 47.9% (43.2, 52.4), respectively. The prediction of mortality was improved incrementally by incorporating clinical and echocardiographic measures with a concordance index (c-index) of 0.84 compared with that of 0.60 with functional class alone. The REVEAL prediction score was validated independently in this cohort to predict both 1-year and 5-year mortality. It had a prediction c-index of 0.71. CONCLUSIONS The integration of routine PAH clinical (predominantly noninvasive) parameters predicts long-term outcome better than functional class and, hence, should be incorporated into medical management decisions.
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Affiliation(s)
- Garvan C Kane
- Pulmonary Hypertension Clinic, Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
| | | | - Josh P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Chris G Scott
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Robert P Frantz
- Pulmonary Hypertension Clinic, Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael D McGoon
- Pulmonary Hypertension Clinic, Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
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Le RJ, Fenstad E, Maradit-Kremers H, McCully RB, Frantz RP, McGoon MD, Kane GC. Syncope in Adults With Pulmonary Arterial Hypertension: Characterization and Prognostic Implications. Chest 2010. [DOI: 10.1378/chest.10008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have an increased risk for developing cardiovascular disease (CVD) compared to subjects in the general population. The development of CVD has also been linked to chronic sleep apnea. The purpose of this study was to examine the risk for sleep apnea in patients with RA compared to subjects without RA. METHODS We recruited RA patients and non-RA subjects who were age and sex matched from the same population. These persons completed the Berlin Sleep Questionnaire, which evaluated their level of risk (high or low) for sleep apnea. In addition, there were 3 subscales evaluating snoring, fatigue, and relevant comorbidities [i.e., high blood pressure and obesity [body mass index (BMI) > or = 30 kg/m(2))]. Chi-squared tests were used for comparisons. RESULTS The study population consisted of 164 patients with RA and 328 patients without RA. Age, sex and BMI were similar for both groups. There was no difference in snoring (p = 0.31) or in the comorbidities subscale (p = 0.37). However, RA patients reported more fatigue (38%) than subjects without RA (13%; p < 0.001). Overall, the risk for sleep apnea was significantly higher for the RA patients (50%) than the non-RA subjects (31%; p < 0.001). CONCLUSION Patients with RA may be at a higher risk for sleep apnea compared to non-RA subjects. This apparent risk difference may be attributed to reports of fatigue in RA patients, which may be associated with sleep apnea or RA disease itself.
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Affiliation(s)
- Stephanie R. Reading
- Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Cynthia S. Crowson
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Richard J. Rodeheffer
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Patrick D. Fitz-Gibbon
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Hilal Maradit-Kremers
- Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Sherine E. Gabriel
- Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
- Department of Medicine, Division of Rheumatology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
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Icen M, Nicola PJ, Maradit-Kremers H, Crowson CS, Therneau TM, Matteson EL, Gabriel SE. Systemic lupus erythematosus features in rheumatoid arthritis and their effect on overall mortality. J Rheumatol 2009; 36:50-7. [PMID: 19004043 PMCID: PMC2836232 DOI: 10.3899/jrheum.080091] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Features of systemic lupus erythematosus (SLE) are commonly observed in patients with rheumatoid arthritis (RA). However, their frequency and clinical significance are uncertain. We examined the frequency of SLE features in RA and their effect on overall mortality. METHODS We assembled a population-based incidence cohort of subjects aged >or=18 years first diagnosed with RA [1987 American College of Rheumatology (ACR) criteria] between 1955 and 1995. Information regarding disease characteristics, therapy, comorbidities, and SLE features (1982 ACR criteria) were collected from the complete inpatient and outpatient medical records. Cox regression models were used to estimate the mortality risk associated with lupus features. RESULTS The study population comprised 603 subjects with incident RA (mean age 58 yrs, 73% women) with a mean followup time of 15 years. By 25 years after RA incidence, >or=4 SLE features were observed in 15.5% of the subjects with RA. After adjustment for age and sex, occurrence of >or=4 SLE features was associated with increased overall mortality [hazard ratio (HR) 5.54, 95% confidence interval (CI) 3.59-8.53].With further adjustment for RA characteristics, therapy, and comorbidities, the association weakened but remained statistically significant (HR 2.56, 95% CI 1.60-4.08). After adjustment for age, sex, RA characteristics, therapy, and comorbidities, thrombocytopenia (2.0, 95% CI 1.2, 3.1) and proteinuria (1.8, 95% CI 1.3, 2.6) were significantly associated with mortality. CONCLUSION SLE features were common in RA, given sufficient observation time. Subjects with RA who developed >or=4 SLE features had an increased risk of death. Proteinuria and thrombocytopenia were individually associated with an increased mortality risk.
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Affiliation(s)
- Murat Icen
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Paulo J. Nicola
- Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Hilal Maradit-Kremers
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Cynthia S. Crowson
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Terry M. Therneau
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Eric L. Matteson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sherine E. Gabriel
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Kane GC, Slusser JP, Scott CG, Maradit-Kremers H, McGoon MD. CLINICAL AND HEMODYNAMIC PREDICTORS OF SURVIVAL: A SINGLE CENTER STUDY OF 657 PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.s63003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Dasgupta B, Salvarani C, Schirmer M, Crowson CS, Maradit-Kremers H, Hutchings A, Matteson EL. Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey. J Rheumatol 2008; 35:270-277. [PMID: 18050370] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This report summarizes the findings from a consensus process to identify potential classification criteria for polymyalgia rheumatica (PMR). METHODS A 3-stage hybrid consensus approach was used to develop potential PMR classification criteria. The first stage consisted of a facilitated meeting of 27 international experts who anonymously rated the importance of 68 potential criteria. The second stage involved a meeting of the experts, who were provided with the results of the first round of ratings and were then asked to re-rate the criteria. In the third stage, the wider acceptance of the 43 criteria that received > 50% support at round 2 was evaluated using an extended mailed survey of 111 rheumatologists and 53 nonrheumatologists in the United States, Canada, and Northern and Western Europe. RESULTS A total of 68 and 50 criteria were identified and rated in round 1 and round 2, respectively. In round 2, 43 of the 50 items achieved at least 50% support, including 10 core criteria achieving 100% support. In round 3, over 70% of survey respondents agreed on the importance of 7 core criteria. These were age >or=50 years, duration >or=2 weeks, bilateral shoulder and/or pelvic girdle aching, duration of morning stiffness > 45 min, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and rapid steroid response (> 75% global response within 1 wk to prednisolone/prednisone 15 20 mg daily). Among physical signs, more than 70% of survey respondents agreed on the importance of assessing pain and limitation of shoulder (84%) and/or hip (76%) on motion, but agreement was low for peripheral signs like carpal tunnel, tenosynovitis, and peripheral arthritis. CONCLUSION There are differences in opinion as to what PMR is and how it should be treated. These findings make it important to develop classification criteria for PMR. The next step is to perform an international prospective study to evaluate the utility of candidate classification criteria for PMR in patients presenting with the polymyalgic syndrome.
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Affiliation(s)
- Bhaskar Dasgupta
- Department of Rheumatology, Southend Hospital, Westcliff, Essex SS0 0RY, UK.
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Dasgupta B, Matteson EL, Maradit-Kremers H. Management guidelines and outcome measures in polymyalgia rheumatica (PMR). Clin Exp Rheumatol 2007; 25:130-136. [PMID: 18021518] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease of the elderly that is subject to wide variations in clinical practice and is managed both in the primary and secondary care settings by general practitioners, rheumatologists and non-rheumatologists. Considerable uncertainty exists relating to diagnosis, management and outcome in patients with PMR. The guidelines presented here seek to improve outcomes for PMR patients by outlining a process to ensure more accurate diagnosis and timely specialist referral. The guidelines are directed to promote more conservative treatment and to ensure early bone protection in order to reduce the common morbidity of osteoporotic fractures. Furthermore, these guidelines specify the goals of treatment, including clinical and patient-based outcomes, and provide advice concerning monitoring for disease activity and complications.
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Affiliation(s)
- B Dasgupta
- Department of Rheumatology, Southend University Hospital, Essex, UK.
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Agirbasli M, Tanrikulu B, Arikan S, Izci E, Ozguven S, Besimoglu B, Ciliv G, Maradit-Kremers H. Trends in body mass index, blood pressure and parental smoking habits in middle socio-economic level Turkish adolescents. J Hum Hypertens 2007; 22:12-7. [PMID: 17611546 DOI: 10.1038/sj.jhh.1002262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/09/2022]
Abstract
Patterns of cardiovascular risk factors in populations are not static over time. We examined trends in body mass index (BMI), parental smoking and blood pressure over a 15-year period in Turkish children aged 15-17 years. Two cross-sectional studies were performed in secondary schools in Turkey in 1989-1990 and 2004-2005. Study participants were 673 children in 1989-1990 and 640 adolescents in 2004-2005. Main outcome measures were weight, height, BMI, presence and amount of parental smoking, systolic and diastolic blood pressure. Age and sex matched comparisons were performed to assess temporal trends in these measures. Children in 2004-2005 had increased weight, height, BMI and decreased systolic and diastolic blood pressure in all age groups compared with children in 1989-1990. According to the international criteria, 3.4% of children were obese and 15.8% were overweight in 2005, compared to 0.7% obese and 4.2% overweight in 1990 (P<0.001). However, a decrease was noted in blood pressure; 16% were classified as hypertensive in 1989-1990 versus 8% in 2004-2005 (P<0.001). The prevalence and amount of parental smoking also decreased over the last 15 years. We observed significant changes in BMI and blood pressure in Turkish children over the last 15 years. Temporal trends in these parameters may indicate a change in the pattern of cardiovascular disease in this population.
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Affiliation(s)
- M Agirbasli
- Department of Cardiology, Marmara University Medical School, Altunizade, Istanbul, Turkey.
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Aubry MC, Maradit-Kremers H, Reinalda MS, Crowson CS, Edwards WD, Gabriel SE. Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis. J Rheumatol 2007; 34:937-42. [PMID: 17361987] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular diseases (CVD). We compared the histologic features of coronary artery disease in patients with RA and non-RA controls. METHODS Forty-one RA patients who died and underwent autopsy between 1985 and 2003 were matched to 82 non-RA controls of the same age and sex with similar history of CVD and autopsy date. Coronary arteries were submitted for histologic evaluation. The grade of stenosis was evaluated in each artery. The numbers of vulnerable plaques and acute coronary lesions were counted. The composition of a representative stable and vulnerable plaque from each vessel was evaluated. Chi-square tests were used to compare differences between groups. RESULTS Patients and controls had similar age at death (mean 79 yrs) and 61% were female in both groups. Overall, there was no significant difference in grade of stenosis or number of acute coronary lesions. Among subjects with CVD, 54% of controls had grade 3-4 lesions in left main artery versus only 7% of patients (p = 0.023). Vulnerable plaques in left anterior descending (LAD) artery were significantly more common in patients than controls (p = 0.018). Inflammation was observed more frequently in patients, in both the media of left circumflex (p = 0.005) and adventitia of LAD artery (p = 0.024). Similar trends were seen for subjects with heart failure. CONCLUSION There was less histologic evidence of atherosclerosis but greater evidence of inflammation and instability in RA patients compared to controls. These differences suggest that the mechanisms responsible for cardiovascular morbidity and mortality may be different in patients with RA.
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Affiliation(s)
- Marie-Christine Aubry
- Divisions of Anatomic Pathology, Health Science Research, Biostatistics, and Rheumatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Maradit-Kremers H, Nicola PJ, Crowson CS, Ballman KV, Jacobsen SJ, Roger VL, Gabriel SE. Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis. Ann Rheum Dis 2006; 66:76-80. [PMID: 16818462 PMCID: PMC1798392 DOI: 10.1136/ard.2006.053710] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Inflammatory markers are associated with heart failure. Patients with rheumatoid arthritis have twice the risk of heart failure compared with people without rheumatoid arthritis. OBJECTIVE To assess whether heart failure in patients with rheumatoid arthritis is preceded by an inflammatory activation as shown by erythrocyte sedimentation rate (ESR), a systemic marker of inflammation. METHODS A population-based inception cohort of 575 patients with rheumatoid arthritis, free of heart failure at their rheumatoid arthritis incidence date, was followed up longitudinally until death or 2001. During 15 years of follow-up, they had a median of 15 ESR tests, and 172 patients had new-onset heart failure (Framingham Heart Study criteria). The follow-up period, beginning with the rheumatoid arthritis incidence date and ending with date of the last follow-up, was divided into 6-month intervals. The proportions of patients with at least one ESR value >/=40 mm/h and with anaemia (haemoglobin <11 g/dl) within each 6-month interval were plotted against time from fulfilment of heart failure criteria. A binomial test was used to compare proportions. RESULTS In patients with rheumatoid arthritis who developed heart failure, the proportion with ESR >/=40 mm/h was highest (23%) during the 6-month period immediately preceding the new-onset heart failure, as compared with the average ESR during the entire remaining follow-up period, both before and after heart failure (10.6%; p<0.01). The proportion of patients with anaemia peaked (54%) during the 6-month period after heart failure. CONCLUSIONS Inflammatory stimuli may be involved in the initiation of heart failure among patients with rheumatoid arthritis.
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Affiliation(s)
- H Maradit-Kremers
- Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Gulec S, Ozdemir AO, Maradit-Kremers H, Dincer I, Atmaca Y, Erol C. Elevated levels of C-reactive protein are associated with impaired coronary collateral development. Eur J Clin Invest 2006; 36:369-75. [PMID: 16684119 DOI: 10.1111/j.1365-2362.2006.01641.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND In vitro studies have shown that C-reactive protein (CRP) attenuates nitric oxide production and inhibits angiogenesis, which may result in impaired collateral development. The aim of this study was to investigate the association between high sensitivity CRP (hsCRP) levels and the extent of coronary collaterals. MATERIALS AND METHODS We investigated the association between hsCRP levels and the extent of coronary collaterals according to the Rentrop classification in a cohort of 185 patients who had high-grade coronary stenosis or occlusion on their angiograms. RESULTS Mean age was 62 years and 80% were males. Subjects with a higher grade of collaterals were significantly less likely to have diabetes mellitus (OR; 0.48, 95% and CI; 0.28, 0.83) or acute coronary syndrome (OR; 0.58, 95% and CI; 0.33, 0.99), but they were more likely to have higher number of vessels with significant stenosis (OR; 1.41, 95% and CI; 1.03, 1.93) and to have received statins (OR; 1.84, 1.09, 3.13). The mean hsCRP values reduced significantly as the Rentrop grades increased (trend, P = 0.0006). After adjusting for age, gender, statin use, clinical presentation with acute coronary syndrome, diabetes mellitus and the number of vessels with significant stenosis, each 10-unit increase in hsCRP values corresponded to a 31% reduced odds of having a higher collateral score (OR; 0.69, 95% and CI; 0.53, 0.90). CONCLUSIONS Our findings indicate that elevated hsCRP levels are associated with a significant impairment in coronary collateralization. These data suggest a previously unrecognized mechanism through which inflammation may worsen cardiovascular outcomes.
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Affiliation(s)
- S Gulec
- Department of Cardiology, School of Medicine, Ankara University, Ankara, Turkey.
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Nicola PJ, Crowson CS, Maradit-Kremers H, Ballman KV, Roger VL, Jacobsen SJ, Gabriel SE. Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis. ACTA ACUST UNITED AC 2006; 54:60-7. [PMID: 16385496 DOI: 10.1002/art.21560] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although mortality among patients with rheumatoid arthritis (RA) is higher than in the general population, the relative contribution of comorbid diseases to this mortality difference is not known. This study was undertaken to evaluate the contribution of congestive heart failure (CHF) and ischemic heart disease (IHD), including myocardial infarction, to the excess mortality in patients with RA, compared with that in individuals without RA. METHODS We assembled a population-based inception cohort of individuals living in Rochester, Minnesota, in whom RA (defined according to the criteria of the American College of Rheumatology [formerly, the American Rheumatism Association]) first developed between 1955 and 1995, and an age- and sex-matched non-RA cohort. All subjects were followed up until either death, migration from the county, or until 2001. Detailed information from the complete medical records was collected. Statistical analyses included the person-years method, cumulative incidence, and Cox regression modeling. Attributable risk analysis techniques were used to estimate the number of RA deaths that would be prevented if the incidence of CHF was the same in patients with RA and non-RA subjects. RESULTS The study population included 603 patients with RA and 603 subjects without RA. During followup, there was an excess of 123 deaths among patients with RA (345 RA deaths occurred, although only 222 such deaths were expected). The mortality rates among patients with RA and non-RA subjects were 39.0 and 29.2 per 1,000 person-years, respectively. There was a significantly higher cumulative incidence of CHF (but not IHD) in patients with RA compared with non-RA subjects (37.1% versus 27.7% at 30 years of followup, respectively; P < 0.001). The risk of death associated with either CHF or IHD was not significantly different between patients with RA and non-RA subjects. If the risk of developing CHF was the same in patients with RA and individuals without RA, the overall mortality rate difference between RA and non-RA hypothetically would be reduced from 9.8 to 8.0 excess deaths per 1,000 person-years; that is, 16 (13%) of the 123 excess deaths could be prevented. CONCLUSION CHF, rather than IHD, appears to be an important contributor to the excess overall mortality among patients with RA. CHF contributes to this excess mortality primarily through the increased incidence of CHF in RA, rather than increased mortality associated with CHF in patients with RA compared with non-RA subjects. Eliminating the excess risk of CHF in patients with RA could significantly improve their survival.
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Affiliation(s)
- Paulo J Nicola
- Dept. of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Maradit-Kremers H, Nicola PJ, Crowson CS, O'Fallon WM, Gabriel SE. Patient, disease, and therapy-related factors that influence discontinuation of disease-modifying antirheumatic drugs: a population-based incidence cohort of patients with rheumatoid arthritis. J Rheumatol 2006; 33:248-55. [PMID: 16358365] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE A major challenge in management of rheumatoid arthritis (RA) is prediction of longterm response to disease-modifying antirheumatic drug (DMARD) treatment. Our objective was to identify the predictors of DMARD discontinuation in an incidence cohort of patients with RA followed continuously from their incidence date. METHODS Members of a population-based incidence cohort of Rochester, Minnesota, residents aged > or = 18 years diagnosed with RA (by 1987 American College of Rheumatology criteria) from January 1, 1955, to January 1, 1995, were followed longitudinally through their complete medical records until January 1, 2001. Detailed drug exposure data were collected on all DMARD and glucocorticoid regimens. Subjects were considered exposed to a DMARD if duration of use was > or = 30 days. Time to discontinuation of DMARD was estimated using survival analysis techniques. Andersen-Gill models with multiple events per patient were used to assess the influence of demographics, calendar time, comorbidities, disease characteristics [disease duration, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), joint counts, radiographic changes, nodules, RA complications], and therapy characteristics (DMARD use, singly or in combination, glucocorticoid use, first or subsequent regimen, effect of previous therapy) on time from DMARD initiation to discontinuation. RESULTS The study population comprised 345 DMARD-treated patients (73% female) with mean age of 53.1 years and mean followup 15.4 years. Median time taking any DMARD was 16.0 months for the first, and 17.9 months for all regimens. Methotrexate (MTX) had the longest time to discontinuation, with a median of 30.3 months without folate, and 61.7 months with folate supplementation. Among the various disease characteristics examined, only higher ESR at DMARD initiation was significantly associated with a shorter time taking DMARD [hazard ratio (HR) 1.05 per 10 mm/h increase, 95% CI 1.02, 1.08]. In multivariable Andersen-Gill models considering all DMARD regimens, hydroxychloroquine use (HR 0.77, 95% CI 0.64, 0.92) and MTX use (HR with folate 0.39, 95% CI 0.30, 0.51; HR without folate 0.51, 95% CI 0.39, 0.67) were significantly associated with longer time to DMARD discontinuation, whereas prior MTX use (HR 1.96, 95% CI 1.57, 2.45) was associated with shorter time to DMARD discontinuation, after adjusting for age, sex, calendar year, Charlson comorbidity index, disease duration, and ESR at DMARD initiation. Disease duration was negatively associated with time to DMARD discontinuation; each 10 year increase in disease duration corresponded to a 14% decrease in the risk of discontinuation (HR 0.86, 95% CI 0.75, 0.98). CONCLUSION Longer RA disease duration does not appear to increase the risk of DMARD discontinuation. However, high disease activity (as assessed by ESR) is associated with a higher likelihood of discontinuing DMARD. MTX failure may identify a subgroup of patients who are less likely to respond to other DMARD and therefore could be considered as candidates for biological therapies.
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