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Ziegler L, Fuehner S, Kessel C, Hinze C, Klotsche J, Niewerth M, Minden K, Foell D. Soluble interleukin-2 receptor serum levels facilitate prediction of relapses in subgroups of patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2022; 61:4975-4984. [PMID: 35325053 DOI: 10.1093/rheumatology/keac178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/11/2021] [Revised: 03/15/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES JIA is characterised by a chronic disease course. Once patients achieve a state of inactive disease, there are no established biomarkers to predict the further course of inflammation for these patients. Therefore, the purpose of this study was to quantify serum biomarkers during quiescent disease to evaluate their use in identifying JIA patients at risk for future disease flare. METHODS Patients with non-systemic JIA reaching inactive disease status were divided into two groups: 92 patients with future active disease after a median period of 6 months (range 3-9) and 80 patients with persistent inactive disease for the following period (median 11 months, range 7-16) according to the juvenile arthritis DAS (JADAS). Clinical parameters and serum levels of various biomarkers were measured in the state of inactive disease using immunoassays in both groups and were analysed for their potential to predict the further course of disease. RESULTS Soluble interleukin-2 receptor (sIL-2R) serum levels were significantly higher in patients with future active disease (P = 0.021), which especially applied to patients with RF-negative polyarticular and extended oligoarticular JIA (P < 0.001). Higher sIL-2R serum levels during inactive disease were associated with a greater number of active joints at future active disease. CONCLUSION Patients without clinical signs of disease activity already presented with increased sIL-2R serum levels several months before disease relapses, whereas conventional inflammation parameters were not elevated. Determination of sIL-2R serum levels during inactive disease may facilitate identifying patients with subclinical disease activity at risk for future active disease.
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Affiliation(s)
- Linda Ziegler
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster
| | - Sabrina Fuehner
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster
| | - Claas Hinze
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Martina Niewerth
- Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster
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Goren I, Sharar Fischler T, Yanai H, Pal P, Adigopula B, Pendyala S, Ganesh G, Vishnubhotla R, Rabinowitz KM, Shaham Barda E, Yadamreddy D, Godny L, Peleg N, Banerjee R, Dotan I. Newly Diagnosed Crohn's Disease Patients in India and Israel Display Distinct Presentations and Serological Markers: Insights from Prospective Cohorts. J Clin Med 2022; 11:jcm11236899. [PMID: 36498474 PMCID: PMC9737641 DOI: 10.3390/jcm11236899] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Crohn’s disease (CD) incidence is rising in India. However, features of newly diagnosed patients with CD in this population are largely unknown. The Indo-Israeli IBD GastroEnterology paRtnership (TiiiGER) aimed to investigate differences in presentation among patients with newly diagnosed CD in India and Israel, and to explore phenotype−serotype correlations. Methods: A prospective observational cohort study of consecutive adults (>18 years) conducted in two large referral centers in India and Israel (2014−2018). Clinical data, an antiglycan serological panel, and 20 CD-associated genetic variants were analyzed. Outcomes: complicated phenotype at diagnosis and early complicated course (hospitalizations/surgeries) within 2 years of diagnosis. Results: We included 260 patients (104, Indian (65.4%, male; age, 37.8); 156 Israeli (49.4%, male; 31.8, age)). Median lag time from symptoms onset to diagnosis was 10.5 (IQR 3−38) vs. 3 (IQR 1−8) months in Indian vs. Israeli patients (p < 0.001). Complicated phenotype at diagnosis was observed in 48% of Indian and 30% of Israeli patients (p = 0.003). Complicated phenotype was associated with higher anti-Saccharomyces cerevisiae antibody (ASCA) seropositivity rate among Israeli patients (p < 0.001), but not among Indian patients. Antiglycan serology did not correlate with the tested genetic variants. Early complicated course occurred in 28 (18%) Israeli and 13 (12.5%) Indian patients. The time from diagnosis to complication was comparable (log rank p = 0.152). Antiglycan serology did not correlate with a complicated early course in either cohort. Conclusions: There are significant differences in patients presenting with newly diagnosed CD in India and Israel, including phenotype and distinct biomarkers at diagnosis. These differences suggest different genetic and environmental disease modifiers.
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Affiliation(s)
- Idan Goren
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Correspondence:
| | - Tali Sharar Fischler
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Henit Yanai
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Partha Pal
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Bhargavi Adigopula
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Sushmitha Pendyala
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Girish Ganesh
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Ravikanth Vishnubhotla
- Department of Genomics and Molecular Biology, Institute of Translational Research, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad 500032, India
| | - Keren Masha Rabinowitz
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49414, Israel
| | - Efrat Shaham Barda
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49414, Israel
| | - Durga Yadamreddy
- Department of Genomics and Molecular Biology, Institute of Translational Research, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad 500032, India
| | - Lihi Godny
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Noam Peleg
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
| | - Rupa Banerjee
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 501301, India
| | - Iris Dotan
- IBD Center, Division of Gastroenterology, Rabin Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
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Sterling M, Ritchie C, Rebbeck T, Cameron ID, Griffin A, Jagnoor J, Nicholas M, Nguyen H, Warren J. Comparison of the Accuracy of WhipPredict to That of a Modified Version of the Short-Form Örebro Musculoskeletal Pain Screening Questionnaire to Predict Poor Recovery After Whiplash Injury. J Orthop Sports Phys Ther 2021; 51:207-15. [PMID: 33607916 DOI: 10.2519/jospt.2021.9987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the accuracy of a whiplash-specific risk screening tool (WhipPredict) with that of the modified generic short-form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPSQ) for predicting poor recovery in patients following whiplash injury. STUDY DESIGN Inception cohort study. METHODS Two hundred two participants with acute whiplash completed the WhipPredict and modified SF-ÖMPSQ at baseline. Poor recovery was measured at 6 and 12 months using the Neck Disability Index (greater than 10%), numeric pain-rating scale (greater than 3/10), global perceived recovery (less than +4), and inability to return to preinjury work level. Accuracy statistics were calculated to predict poor recovery. RESULTS Seventy-one percent (n = 143) of participants completed the 6-month assessment and 56% (n = 113) completed the 12-month assessment. At baseline, agreement between the WhipPredict and modified SF-ÖMPSQ was fair (prevalence-adjusted and bias-adjusted κ = 0.26; 95% confidence interval: 0.12, 0.39). Depending on the outcome, 20% to 72% of people had not recovered at 6 months and 12% to 71% had not recovered at 12 months. At 6 and 12 months, the WhipPredict tool showed high sensitivity (88%-96%) and low specificity (all outcomes less than 31%) on all 4 separate outcomes. The modified SF-ÖMPSQ showed moderate sensitivity (67%-75%) for the Neck Disability Index, numeric pain-rating scale, and global perceived recovery, high sensitivity for return to work (81%-90%), and moderate specificity (54%-77%) for all 4 outcomes. CONCLUSION Both tools showed acceptable accuracy in predicting poor recovery. The WhipPredict tool is recommended to correctly identify patients who will not recover but may falsely classify those who recover well. Using the modified SF-ÖMPSQ will result in fewer patients falsely categorized as being at risk of poor recovery and may result in some people being undertreated. J Orthop Sports Phys Ther 2021;51(5):207-215. Epub 19 Feb 2021. doi:10.2519/jospt.2021.9987.
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Ayan G, Aydin SZ, Kimyon G, Ozisler C, Tinazzi I, Dogru A, Omma A, Kilic L, Yılmaz S, Kucuksahin O, Gönüllü E, Yıldız F, Can M, Balkarlı A, Solmaz D, Dalkılıc E, Bayindir O, Yıldırım Çetin G, Ergulu Esmen S, Ersozlu ED, Duruoz MT, Akyol L, Kucuk A, Bes C, Cınar M, Erden A, Mercan R, Bakirci S, Kasifoglu T, Yazısız V, Kalyoncu U. PsART-ID inception cohort: clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis. Rheumatology (Oxford) 2021; 60:1755-1762. [PMID: 33097960 DOI: 10.1093/rheumatology/keaa663] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts. METHODS PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5-10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts. RESULTS The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months. CONCLUSION The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.
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Affiliation(s)
- Gizem Ayan
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada.,Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
| | - Sibel Zehra Aydin
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gezmis Kimyon
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Mustafa Kemal University, Hatay, Turkey
| | - Cem Ozisler
- Department of Internal Medicine, Division of Rheumatology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Ilaria Tinazzi
- Sacro Cuore Don Calabria Hospital, Unit of Rheumatology, Negrar-Verona, VR, Italy
| | - Atalay Dogru
- Department of Internal Medicine, Division of Rheumatology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Ahmet Omma
- Department of Internal Medicine, Division of Rheumatology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Levent Kilic
- Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
| | - Sema Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Orhan Kucuksahin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Emel Gönüllü
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Sakarya University, Sakarya, Turkey
| | - Fatih Yıldız
- Department of Internal Medicine, Division of Rheumatology, Van Training and Research Hospital, University of Health Sciences, Turkey
| | - Meryem Can
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Ayşe Balkarlı
- Department of Internal Medicine, Division of Rheumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Dilek Solmaz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Izmir, Turkey
| | - Ediz Dalkılıc
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Uludag University, Bursa, Turkey
| | - Ozun Bayindir
- Department of Internal Medicine, Division of Rheumatology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Gözde Yıldırım Çetin
- Department of Internal Medicine, Division of Rheumatology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Serpil Ergulu Esmen
- Department of Internal Medicine, Division of Rheumatology, Konya Education and Research Hospital, Konya, Turkey
| | - Emine Duygu Ersozlu
- Department of Internal Medicine, Division of Rheumatology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Tuncay Duruoz
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University, Istanbul, Turkey
| | - Lütfi Akyol
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayis University, Samsun, Turkey
| | - Adem Kucuk
- Meram Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Necmettin Erbakan Univeristy, Konya, Turkey
| | - Cemal Bes
- Department of Internal Medicine, Division of Rheumatology, and Research Hospital, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Muhammet Cınar
- Department of Internal Medicine, Division of Rheumatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Abdulsamet Erden
- Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
| | - Rıdvan Mercan
- Department of Internal Medicine, Division of Rheumatology Tekirdag, Faculty of Medicine, Namık Kemal University, Turkey
| | - Sibel Bakirci
- Department of Internal Medicine, Division of Rheumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Timucin Kasifoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Veli Yazısız
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
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Fekete C, Gurtner B, Kunz S, Gemperli A, Gmünder HP, Hund-Georgiadis M, Jordan X, Schubert M, Stoyanov J, Stucki G. Inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI): Design, participant characteristics, response rates and non-response. J Rehabil Med 2021; 53:jrm00159. [PMID: 33569608 PMCID: PMC8814861 DOI: 10.2340/16501977-2795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To provide a methodological reference paper for the inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), by detailing its methodological features and reporting on participant characteristics, response rates and non-response bias. Design Prospective cohort study starting in 2013 in all 4 specialized rehabilitation centres in Switzerland. Subjects Included are 655 newly diagnosed first rehabilitation patients aged ≥16 years with traumatic or non-traumatic spinal cord injury (TSCI, NTSCI). Methods Descriptive statistics were used to depict participant characteristics and to compare characteristics of responders and non-responders. Logistic regressions were conducted to estimate non-response bias. RESULTS The sample consisted of 69% males, with mean age 53.5 years, 57.9% TSCI, 60.7% paraplegia and 78.8% incomplete SCI. Males and younger persons more often sustained TSCI and more severe SCI, resulting in longer duration of rehabilitation. Complete lesions were more prevalent in TSCI compared to NTSCI. The response rate was 47.5% and study participation was less likely in females, older persons, persons with lower functional independence and those with NTSCI. Conclusion SwiSCI inception cohort data enable the estimation of epidemiological figures of SCI in Switzerland, and prognostic and trajectory modelling of outcomes after SCI to guide policy, service provision and clinical practice.
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Affiliation(s)
- Christine Fekete
- SwiSCI, Swiss Paraplegic Research, Nottwil, Switzerland. E-mail:
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da Silva T, Mills K, Kongsted A, Maher CG, Hancock M. What Is the Personal Impact of Recurrences of Low Back Pain? Subanalysis of an Inception Cohort Study. J Orthop Sports Phys Ther 2020; 50:294-300. [PMID: 32295461 DOI: 10.2519/jospt.2020.9345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate (1) the impact of low back pain (LBP) over the course of 1 year in people recently recovered from an episode of LBP, (2) whether the impact differs in people who do and do not experience a recurrence, and (3) the impact of LBP based on 3 definitions of a recurrence of LBP. DESIGN Cohort study. METHODS In 250 individuals recently recovered from LBP, the impact of LBP over the previous 3 months was assessed with the impact score, a multidimensional measure (range, 8-50), at 3, 6, 9, and 12 months. Recurrence of LBP was assessed monthly and defined as a recurrence of an episode of LBP, a recurrence of activity-limiting LBP, or a recurrence of LBP causing patients to seek care. RESULTS The median impact over 1 year was 11.5 points (interquartile range, 9.5-14.8). The impact was 15.2 points (95% confidence interval [CI]: 13.9, 16.3) for those who reported any recurrence and 11.1 points (95% CI: 10.6, 11.5) for those who did not. When comparing definitions of recurrence, those who had a recurrence that did not cause moderate activity limitation or result in care seeking had an overall impact of 12.7 points (95% CI: 11.6, 13.8). Participants who had recurrences of activity-limiting LBP but did not seek care, had an overall impact of 15.5 points (95% CI: 13.5, 17.6), and those who had recurrences of LBP for which health care was sought had an overall impact of 16.9 points (95% CI: 15.3, 18.4). CONCLUSION The average impact due to recurrence of LBP was low and dependent on the definition of recurrence. J Orthop Sports Phys Ther 2020;50(6):294-300. Epub 16 Apr 2020. doi:10.2519/jospt.2020.9345.
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Pagé GM, Lacasse A, Beaudet N, Choinière M, Deslauriers S, Diatchenko L, Dupuis L, Grégoire S, Hovey R, Leclair E, Leonard G, Meloto CB, Montagna F, Parent A, Rainville P, Roy JS, Roy M, Ware MA, Wideman TH, Stone LS; Quebec Back Pain Consortium (in alphabetical order). The Quebec Low Back Pain Study: a protocol for an innovative 2-tier provincial cohort. Pain Rep 2020; 5:e799. [PMID: 32072095 DOI: 10.1097/PR9.0000000000000799] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Introduction: The neurobiological mechanisms underlying recovery from or persistence of low back pain (LBP) remain misunderstood, limiting progress toward effective management. We have developed an innovative two-tier design to study the transition from acute to chronic LBP. The objective of the first tier is to create a provincial web-based infrastructure to recruit and monitor the trajectory of individuals with acute LBP. The objective of the second tier is to fuel hypothesis-driven satellite data collection centers with specialized expertise to study the role of biomechanical, epigenetic, genetic, neuroanatomical, ontological, physiological, psychological, and socioeconomic factors in LBP chronicity. Methods: This article describes the first tier of the protocol: establishment of the Core Dataset and Cohort. Adults with acute LBP will be recruited through networks, media, and health care settings. A web-based interface will be used to collect self-reported variables at baseline and at 3, 6, 12, and 24 months. Acute LBP will be defined according to the Dionne 2008 consensus. Measurements will include the Canadian minimum data set for chronic LBP research, DN4 for neuropathic pain, comorbidities, EQ-5D-5L for quality of life, and linkage with provincial medico-administrative databases. The primary outcome will be the transition to chronic LBP, as defined by Deyo 2014. Secondary outcomes include health care resource utilization, disability, sick leave, mood, and quality of life. Perspective: This study brings together diverse research expertise to investigate the transition from acute to chronic LBP, characterize the progression to recovery or chronicity, and identify patterns associated with that progression.
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Fragoulis GE, Paterson C, Gilmour A, Derakhshan MH, McInnes IB, Porter D, Siebert S. Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome. RMD Open 2018; 4:e000739. [PMID: 30402267 PMCID: PMC6203094 DOI: 10.1136/rmdopen-2018-000739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 12/30/2022] Open
Abstract
Objectives To determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management. Methods The Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades. Results 77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6-48) months. Neutropaenia occurred at a median (range) of 12 (0-120) months after RA diagnosis. The majority had mild neutropaenia (grade 1: n=42; grade 2: n=14; grade 3: n=1; grade 4: n=1). Neutropaenia was transient (single episode) in the majority (44; 75.8%) of cases but led to treatment discontinuation in 14 (24.1%) patients. Patients who developed neutropaenia were more likely to be female (p=0.01) and non-smokers (p=0.007) and had lower baseline neutrophil levels (p<0.0001). Binomial regression analysis confirmed the latter (p<0.0001, B: -0.491) as neutropaenia predictor. The rate of infections did not differ between patients who developed neutropaenia and those who did not (p=0.878). Conclusion Neutropaenia was a common finding in this cohort. It was usually mild, transient and not associated with increased infection rates. Neutropaenia occurrence was associated with non-smoking, female gender and lower baseline neutrophil levels.
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Affiliation(s)
- George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Caron Paterson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Ashley Gilmour
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Mohammad H Derakhshan
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Duncan Porter
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Moon NC, Zeng L, Cook RJ. Tracing studies in cohorts with attrition: Selection models for efficient sampling. Stat Med 2018; 37:2354-2366. [PMID: 29682774 DOI: 10.1002/sim.7646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 01/06/2018] [Accepted: 02/04/2018] [Indexed: 11/08/2022]
Abstract
Cohort studies of chronic diseases involve recruitment and longitudinal follow-up of affected individuals with a view to studying the effect of risk factors on disease progression and death. When the time to withdrawal from the cohort is conditionally independent of the disease process the primary consequence is a loss of information on the parameters of interest. This loss can sometimes be mitigated through the conduct of tracing studies in which a subsample of those lost to follow up are contacted and some information is obtained on their disease and survival status. We describe the use of selection models to sample individuals for tracing who will yield more efficient estimators than those obtained by simple random sampling. Efficient sampling schemes featuring cost constraints are also developed and shown to perform well. An application to data from the University of Toronto Psoriatic Arthritis Cohort illustrates how to apply the method in a real setting.
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Affiliation(s)
- Nathalie C Moon
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Leilei Zeng
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
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Burisch J, Ungaro R, Vind I, Prosberg MV, Bendtsen F, Colombel JF, Vester-Andersen MK. Proximal Disease Extension in Patients With Limited Ulcerative Colitis: A Danish Population-based Inception Cohort. J Crohns Colitis 2017; 11:1200-1204. [PMID: 28486626 PMCID: PMC6279091 DOI: 10.1093/ecco-jcc/jjx066] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Disease extent in ulcerative colitis [UC] is dynamic and can progress over time. Little is known about risk factors for UC extension in the era of biologics. We investigated the risk of UC extension and subsequent risk of surgery in a Danish population-based cohort. METHODS All incident UC cases in a strictly defined Copenhagen area between 2003 and 2004 were followed prospectively through 2011. Disease extension was defined as patients with limited UC [E1 or E2] at diagnosis having progressed from the initial extent by colonoscopy or surgery to E2 or extensive colitis [E3]. Associations between progression or colectomy and multiple covariates were analysed by Cox regression analysis. RESULTS Of 300 UC patients, 220 [73%] had E1 or E2 at diagnosis. During follow-up, 50 [23%] patients with E1/E2 progressed to E3, and 22 [10%] with E1 progressed to E2. Disease extent at diagnosis was the sole predictor of extension to E3. A total of 18 [8%] patients with E1/E2 at diagnosis had a colectomy. Progression from E1/E2 to E3, female gender and a history of smoking were risk factors for colectomy. CONCLUSION After 7 years of follow-up, 33% of patients with limited UC experienced disease extension. Only extent at diagnosis was a clinical predictor for disease extension. The risk of colectomy was increased in former smokers and patients who progressed to extensive colitis. This highlights the need to prevent disease progression in patients with limited UC, and to identify new histological or molecular markers that might help stratify risks for disease progression.
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Affiliation(s)
- Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,Corresponding author: Johan Burisch, MD, PhD, Gastrounit, Medical Division, Copenhagen University Hospital, Hvidovre, Kettegård Allé 30, 2750 Hvidovre, Denmark.
| | - Ryan Ungaro
- Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Michelle V Prosberg
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jean-Frederic Colombel
- Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marianne K. Vester-Andersen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,Department of Internal Medicine, Zealand University Hospital, Køge, Denmark
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Abstract
Study Design Systematic review. Background While most people with acute low back pain (LBP) recover quickly, recurrences are believed to be common. To our knowledge, no published high-quality systematic review has assessed the risk of recurrent LBP or the factors that would predict LBP recurrence. Objectives The aim of this study was to investigate the risk of, and prognostic factors for, a recurrence of LBP in patients who have recovered from a previous episode of LBP within the last year. Methods Systematic searches were conducted in the MEDLINE, Embase, and CINAHL databases. We included longitudinal studies of adults who had recovered from a previous episode of LBP within 12 months. The primary outcome was a new episode of LBP. Secondary outcomes were other types of recurrence (eg, episodes causing care seeking). Results Eight studies were included in the review: 7 observational studies and 1 randomized trial (2 publications). Six studies reported recurrence proportions for the primary outcome of an episode of LBP. Meta-analysis was not conducted due to the low quality and heterogeneity of studies. Only 1 study was considered an inception cohort study; it reported a 1-year recurrence proportion of 33%. A history of previous episodes of LBP prior to the most recent episode was the only factor that consistently predicted recurrence of LBP. Conclusion The available research does not provide robust estimates of the risk of LBP recurrence and provides little information about factors that predict recurrence in people recently recovered from an episode of LBP. Level of Evidence Prognosis, 1a-. Prospectively registered in PROSPERO on February 9, 2016 (CRD42016030220). J Orthop Sports Phys Ther 2017;47(5):305-313. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7415.
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Hanly JG, O'Keeffe AG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Clarke AE, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Fortin P, Gladman DD, Sanchez-Guerrero J, Petri M, Bruce IN, Dooley MA, Ramsey-Goldman R, Aranow C, Alarcón GS, Fessler BJ, Steinsson K, Nived O, Sturfelt GK, Manzi S, Khamashta MA, van Vollenhoven RF, Zoma AA, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Stoll T, Inanc M, Kalunian KC, Kamen DL, Maddison P, Peschken CA, Jacobsen S, Askanase A, Theriault C, Thompson K, Farewell V. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford) 2015; 55:252-62. [PMID: 26342222 DOI: 10.1093/rheumatology/kev311] [Citation(s) in RCA: 322] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort. METHODS Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores. RESULTS There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values. CONCLUSION LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.
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Affiliation(s)
- John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada,
| | - Aidan G O'Keeffe
- Department of Statistical Science, University College London, London
| | - Li Su
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Caroline Gordon
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre
| | - Ann E Clarke
- Division of Rheumatology, University of Calgary, Alberta, Canada
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, UK
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Paul Fortin
- Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
| | | | | | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barri J Fessler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristjan Steinsson
- Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Ola Nived
- Department of Rheumatology, University Hospital Lund, Lund, Sweden
| | | | - Susan Manzi
- Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | | | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Thomas Stoll
- Kantonsspital Geissbergstr, Schaffhausen, Switzerland
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Diane L Kamen
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Soren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA and
| | - Chris Theriault
- Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kara Thompson
- Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vernon Farewell
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK
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Jönsen A, Bengtsson AA, Hjalte F, Petersson IF, Willim M, Nived O. Total cost and cost predictors in systemic lupus erythematosus - 8-years follow-up of a Swedish inception cohort. Lupus 2015; 24:1248-56. [PMID: 25957301 DOI: 10.1177/0961203315584812] [Citation(s) in RCA: 18] [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: 09/17/2014] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the annual direct and indirect costs in systemic lupus erythematosus (SLE) and how age, disease manifestations, disease activity, and organ damage influence total costs and predicted costs for SLE. METHODS Clinical data on all patients with a diagnosis of SLE living in a defined area in southern Sweden during eight years were linked to health authority registries and the social insurance system which contain data on cost. Cost data on four matched population controls for each patient were also extracted. The controls were matched for age, sex, and area of residence. RESULTS Data from 127 patients with SLE and 508 population controls were extracted. The mean annual total cost for SLE patients was SEK 180,520 ($30,093); the highest costs were found in the subgroup with nephritis SEK 229,423 ($38,246). The total costs for the patient group were significantly higher (p < 0.05) compared to the population controls of SEK 59,985 ($10,000). Of the total costs, 72% were due to indirect costs, 3% to SLE-specific pharmaceuticals, and the remaining 25% were in- and outpatient related costs. During the study period, inpatient days decreased by 60%, while outpatient contacts increased by 25%. Age (inverse relation), increasing disease activity, and acquired organ damage were significant predictors of total costs (all p < 0.05). CONCLUSION The total annual costs for unselected SLE patients were found to be three times those for matched population controls. Important predictors of total costs were found.
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Affiliation(s)
- A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden
| | - A A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden
| | - F Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | - I F Petersson
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden
| | - M Willim
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden
| | - O Nived
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden
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Melloh M, Elfering A, Stanton TR, Barz T, Aghayev E, Röder C, Theis JC. Low back pain risk factors associated with persistence, recurrence and delayed presentation. J Back Musculoskelet Rehabil 2015; 27:281-9. [PMID: 24284275 DOI: 10.3233/bmr-130445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is little knowledge in the literature on the role of time-related variables for the prognosis of acute and subacute low back pain (LBP). OBJECTIVE The aim of this study was to estimate the relationship between time-related LBP characteristics and prognostic factors for acute/subacute LBP. METHODS We performed a prospective inception cohort study of 315 patients attending a health practitioner for acute/subacute LBP or recurrent LBP. One-tailed correlations were conducted between patient characteristics and time-related variables. RESULTS The pattern of correlation between risk factors for and resources against persistent LBP differed between three time-related variables. 'Subacute LBP' and 'delayed presentation' were positively associated with psychological factors. Both indicators were negatively correlated with resources against development of persistent LBP. Moreover, 'delayed presentation' was related positively with occupational stressors. In contrast, 'recurrent LBP' was only related to more impaired health-related factors. CONCLUSIONS Patients with current LBP waiting longer until seeking help in primary care have a more disadvantageous profile of occupational and psychological risk factors and lower resource levels. A similar but less pronounced pattern occurred in those with subacute LBP compared to those with acute LBP. Consideration of time characteristics of LBP may help to better understand LBP.
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Affiliation(s)
- Markus Melloh
- Centre for Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Achim Elfering
- Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Berne, Switzerland
| | - Tasha R Stanton
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia Neuroscience Research Australia, Sydney, NSW, Australia
| | - Thomas Barz
- Department of Orthopaedic Surgery, Asklepios Klinikum Uckermark, Schwedt/Oder, Germany
| | - Emin Aghayev
- Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Center, University of Berne, Berne, Switzerland
| | - Christoph Röder
- Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Center, University of Berne, Berne, Switzerland
| | - Jean-Claude Theis
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Gui W, Wisnewski AV, Neamtiu I, Gurzau E, Sparer JA, Stowe MH, Liu J, Slade MD, Rusu OA, Redlich CA. Inception cohort study of workers exposed to toluene diisocyanate at a polyurethane foam factory: initial one-year follow-up. Am J Ind Med 2014; 57:1207-15. [PMID: 25266741 DOI: 10.1002/ajim.22385] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 07/29/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Isocyanates are one of the most commonly reported causes of occupational asthma; however, the risks of developing isocyanate asthma in modern production facilities remain poorly defined. We evaluated TDI exposure and respiratory health among an inception cohort of workers during their first year of employment at a new polyurethane foam production factory. METHODS Forty-nine newly hired workers were evaluated pre-employment, 6-months, and 12-months post-employment through questionnaire, spirometry, and TDI-specific serology. Airborne TDI levels were monitored by fixed-point air sampling and limited personal sampling. Qualitative surface SWYPE™ tests were performed to evaluate potential sources of skin exposure. RESULTS Airborne TDI levels overall were low; over 90% of fixed-point air measurements were below the limit of detection (0.1 ppb). Over the first year of employment, 12 of the 49 original workers (24.5%) were lost to follow-up, no additional workers were enrolled, and seven of the 49 original workers (14.2%) developed either new asthma symptoms (N = 3), TDI-specific IgG (N = 1), new airflow obstruction (N = 1) and/or a decline in FEV1 ≥ 15% (N = 3), findings that could indicate TDI-related health effects. The prevalence of current asthma symptoms was significantly higher in the workers lost to follow-up compared to those who completed the 12-month follow-up (25% vs. 2.7%; P = 0.04). CONCLUSIONS The findings suggest possible early TDI-related health effects in a modern polyurethane production plant. These findings also highlight the need for further longitudinal evaluation of these workers and the challenges of studying workers at risk for isocyanate asthma.
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Affiliation(s)
- Wei Gui
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Adam V. Wisnewski
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Iulia Neamtiu
- The Environmental Health Center; Cluj-Napoca Romania
| | - Eugen Gurzau
- The Environmental Health Center; Cluj-Napoca Romania
| | - Judith A. Sparer
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Meredith H. Stowe
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Jian Liu
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Martin D. Slade
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | | | - Carrie A. Redlich
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
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Kievit W, Fransen J, de Waal Malefijt MC, den Broeder AA, van Riel PLCM. Treatment changes and improved outcomes in RA: an overview of a large inception cohort from 1989 to 2009. Rheumatology (Oxford) 2013; 52:1500-8. [PMID: 23657913 DOI: 10.1093/rheumatology/ket166] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 12/21/2022] Open
Abstract
OBJECTIVE The introduction of effective treatment strategies in the past two decades has changed the management of RA dramatically. The objective was to analyse the changes in disease activity, function, joint damage and incidence of orthopaedic surgery over a period of 20 years (1989-2009) for patients with RA. METHODS Data acquired from 1989 to 2008 inclusive from the Nijmegen RA inception cohort were studied. By repeated measures analysis the course of the population mean disease activity score (DAS28) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) corrected for age, gender, RF and disease duration was determined. Orthopaedic interventions were analysed as incidence rates with a Poisson distribution. We calculated the prevalence of the various therapies that patients were receiving. RESULTS By 2009, 992 patients with RA had been included and 273 had been excluded. From 1989 onwards, the proportion of patients using MTX increased from 5% (8 of 164) to 62% (486 of 780), and biologic response modifiers from 0% to 22% (168 of 780) in 2008. The average MTX dosage increased to 16.1 ± 5.5 mg/week in 2008. The mean DAS28 (3.1) and HAQ-DI (0.47) were least (P < 0.008) in 2008 compared with previous years. There was a significant trend towards lower incidence rates of orthopaedic intervention in the period 2006-2008 than in almost all previous years. CONCLUSION Treatment strategy changed in a large inception cohort of patients with RA which coincided with decreased disease activity, increased functional ability and fewer orthopaedic interventions since the early 1990s.
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Affiliation(s)
- Wietske Kievit
- Department of Rheumatic Diseases (470), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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