Objective
To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.
Methods
We developed clinically relevant population, intervention, comparator, and outcomes (PICO) ...questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Results
The guideline addresses treatment with disease‐modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high‐risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).
Conclusion
This clinical practice guideline is intended to serve as a tool to support clinician and patient decision‐making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision‐making process based on patients’ values, goals, preferences, and comorbidities.
Objective
To update the projected prevalence of arthritis and arthritis‐attributable activity limitations among US adults, using a newer baseline for estimates.
Methods
Baseline prevalence data were ...obtained from the 2010–2012 National Health Interview Survey. Arthritis was defined as an answer of “yes” to the question “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?” Arthritis‐attributable activity limitation was defined as an answer of “yes” to the question “Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?” The baseline prevalence of arthritis and arthritis‐attributable activity limitation was stratified according to age and sex and was statistically weighted to account for the complex survey design. The projected prevalence of doctor‐diagnosed arthritis and arthritis‐attributable activity limitation was calculated by multiplying the age‐ and sex‐stratified population estimates projected for 2015–2040 (in 5‐year intervals; provided by the US Census Bureau) by the baseline estimates. Age‐ and sex‐specific prevalences were summed to provide the total prevalence estimates for each year.
Results
In 2010–2012, 52.5 million adults in the US (22.7% of all adults) had doctor‐diagnosed arthritis, and 22.7 million (9.8%) had arthritis‐attributable activity limitation. By 2040, the number of US adults with doctor‐diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of all adults), and the number of adults with arthritis‐attributable activity limitation will increase 52% to 34.6 million (11.4% of all adults).
Conclusion
Updated projections suggest that arthritis and arthritis‐attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs.
Objective
Studies have suggested a potential link between traumatic experiences, psychological stress, and autoimmunity, but the impact of stress on disease activity and symptom severity in systemic ...lupus erythematosus (SLE) remains unclear. The present study was undertaken to examine whether increases in perceived stress independently associate with worse SLE disease outcomes over 3 years of follow‐up.
Methods
Participants were drawn from the California Lupus Epidemiology Study (CLUES). Stress was measured annually using the 4‐item Perceived Stress Scale (PSS). Participants with increases of ≥0.5 SD in PSS score were defined as having an increase in stress. Four outcomes were measured at the year 3 follow‐up visit: physician‐assessed disease activity (Systemic Lupus Erythematosus Disease Activity Index); patient‐reported disease activity (Systemic Lupus Activity Questionnaire); pain (Patient‐Reported Outcomes Measurement Information System PROMIS pain interference scale); and fatigue (PROMIS fatigue scale). Multivariable linear regression evaluated longitudinal associations of increase in stress with all 4 outcomes while controlling for potential confounders.
Results
The sample (n = 260) was 91% female, 36% Asian, 30% White, 22% Hispanic, and 11% African American; the mean ± SD age was 46 ± 14 years. In adjusted longitudinal analyses, increase in stress was independently associated with greater physician‐assessed disease activity (P = 0.015), greater self‐reported disease activity (P < 0.001), more pain (P = 0.019), and more fatigue (P < 0.001).
Conclusion
In a racially diverse sample of individuals with SLE, those who experienced an increase in stress had significantly worse disease activity and greater symptom burden at follow‐up compared to those with stress levels that remained stable or declined. Findings underscore the need for interventions to bolster stress resilience and support effective coping strategies among individuals living with lupus.
Objective
To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.
Methods
We developed clinically relevant population, intervention, comparator, and outcomes (PICO) ...questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Results
The guideline addresses treatment with disease‐modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high‐risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional).
Conclusion
This clinical practice guideline is intended to serve as a tool to support clinician and patient decision‐making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision‐making process based on patients’ values, goals, preferences, and comorbidities.
Vital Signs Barbour, Kamil E.; Helmick, Charles G.; Boring, Michael ...
MMWR. Morbidity and mortality weekly report,
03/2017, Letnik:
66, Številka:
9
Journal Article, Newsletter
Odprti dostop
In the United States, doctor-diagnosed arthritis is a common and disabling chronic condition. Arthritis can lead to severe joint pain and poor physical function, and it can negatively affect quality ...of life.
CDC analyzed 2013-2015 data from the National Health Interview Survey, an annual, nationally representative, in-person interview survey of the health status and behaviors of the noninstitutionalized civilian U.S. adult population, to update previous prevalence estimates of arthritis and arthritis-attributable activity limitations.
On average, during 2013-2015, 54.4 million (22.7%) adults had doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitations (an age-adjusted increase of approximately 20% in the proportion of adults with arthritis reporting activity limitations since 2002 p-trend <0.001). Among adults with heart disease, diabetes, and obesity, the prevalences of doctor-diagnosed arthritis were 49.3%, 47.1%, and 30.6%, respectively; the prevalences of arthritis-attributable activity limitations among adults with these conditions and arthritis were 54.5% (heart disease), 54.0% (diabetes), and 49.0% (obesity).
The prevalence of arthritis is high, particularly among adults with comorbid conditions, such as heart disease, diabetes, and obesity. Furthermore, the prevalence of arthritis-attributable activity limitations is high and increasing over time. Approximately half of adults with arthritis and heart disease, arthritis and diabetes, or arthritis and obesity are limited by their arthritis. Greater use of evidence-based physical activity and self-management education interventions can reduce pain and improve function and quality of life for adults with arthritis and also for adults with other chronic conditions who might be limited by their arthritis.
Abstract
Context
Adults with type 2 diabetes (T2D) have higher fracture risk compared with nondiabetics, despite having higher bone mineral density (BMD). Insulin resistance (IR) has been associated ...with increased BMD. It is not known if IR increases fracture risk.
Objective
We investigated the relationship among IR HOMA-IR, BMD, and incident nonspine fractures in nondiabetic individuals.
Design
Participants included 2398 community-dwelling, nondiabetic older adults (age 74 ± 3 years, 53% women, 38% black) in the Health, Aging and Body Composition Prospective Cohort Study median follow-up: 12 (interquartile range: 6) years.
Results
The cut-off values for the HOMA-IR quartiles were 1.05, 1.54, and 2.33. Total hip BMD was 0.104 g/cm2 higher in the fourth vs the first HOMA-IR quartile (P < 0.001). This difference was attenuated after adjustment for BMI (adjusted mean difference 0.007 g/cm2; P = 0.371). In unadjusted models, fracture risk was lower in those with higher HOMA-IR hazard ratio (HR) 0.86 (95% CI 0.73 to 1.01) and 0.65 (95% CI 0.47 to 0.89) for the third and fourth quartile, respectively, vs the first quartile. However, after adjustment for BMD and BMI, fracture risk was significantly higher in the third quartile (HR 1.19, 95% CI 1.00 to 1.41) and tended to be increased in the fourth quartile (HR 1.12, 95% CI 0.87 to 1.46) vs the first quartile.
Conclusions
Greater IR is associated with higher BMD in nondiabetic older adults. In contrast to the relationship between T2D and fracture risk, we did not find consistent evidence that greater IR is associated with increased fracture risk after adjustment for BMI and BMD.
We found lower risk of fracture with higher insulin resistance in older adults without diabetes. This inverse association was lost after adjustment for BMI and BMD.
In the United States, national ecological studies suggest a positive impact of COVID-19 vaccination coverage on outcomes in adults. However, the national impact of the vaccination program on COVID-19 ...in children remains unknown. To determine the association of COVID-19 vaccination with U.S. case incidence, emergency department visits, and hospital admissions for pediatric populations during the Delta and Omicron periods.
We conducted an ecological analysis among children aged 5-17 and compared incidence rate ratios (RRs) of COVID-19 cases, emergency department visits, and hospital admissions by pediatric vaccine coverage, with jurisdictions in the highest vaccine coverage quartile as the reference.
RRs comparing states with lowest pediatric vaccination coverage to the highest pediatric vaccination coverage were 2.00 and 0.64 for cases, 2.96 and 1.11 for emergency department visits, and 2.76 and 1.01 for hospital admissions among all children during the Delta and Omicron periods, respectively. During the 3-week peak period of the Omicron wave, only children aged 12-15 and 16-17 years in the states with the lowest versus highest coverage, had a significantly higher rate of emergency department visits (RR = 1.39 and RR = 1.34, respectively).
COVID-19 vaccines were associated with lower case incidence, emergency department visits and hospital admissions among children during the Delta period but the association was weaker during the Omicron period. Pediatric COVID-19 vaccination should be promoted as part of a program to decrease COVID-19 impact among children; however, vaccine effectiveness may be limited when available vaccines do not match circulating viral variants.
In the USA, COVID-19 vaccines became available in mid-December, 2020, with adults aged 65 years and older among the first groups prioritised for vaccination. We estimated the national-level impact of ...the initial phases of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older.
We analysed population-based data reported to US federal agencies on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 50 years and older during the period Nov 1, 2020, to April 10, 2021. We calculated the relative change in incidence among older age groups compared with a younger reference group for pre-vaccination and post-vaccination periods, defined by the week when vaccination coverage in a given age group first exceeded coverage in the reference age group by at least 1%; time lags for immune response and time to outcome were incorporated. We assessed whether the ratio of these relative changes differed when comparing the pre-vaccination and post-vaccination periods.
The ratio of relative changes comparing the change in the COVID-19 case incidence ratio over the post-vaccine versus pre-vaccine periods showed relative decreases of 53% (95% CI 50 to 55) and 62% (59 to 64) among adults aged 65 to 74 years and 75 years and older, respectively, compared with those aged 50 to 64 years. We found similar results for emergency department visits with relative decreases of 61% (52 to 68) for adults aged 65 to 74 years and 77% (71 to 78) for those aged 75 years and older compared with adults aged 50 to 64 years. Hospital admissions declined by 39% (29 to 48) among those aged 60 to 69 years, 60% (54 to 66) among those aged 70 to 79 years, and 68% (62 to 73), among those aged 80 years and older, compared with adults aged 50 to 59 years. COVID-19 deaths also declined (by 41%, 95% CI –14 to 69 among adults aged 65–74 years and by 30%, –47 to 66 among those aged ≥75 years, compared with adults aged 50 to 64 years), but the magnitude of the impact of vaccination roll-out on deaths was unclear.
The initial roll-out of the US COVID-19 vaccination programme was associated with reductions in COVID-19 cases, emergency department visits, and hospital admissions among older adults.
None.
Objective
Data on the onset of lupus manifestations across multiple organ domains and in diverse populations are limited. The objective was to analyze racial and ethnic differences in the risk of ...end‐organ lupus manifestations following systemic lupus erythematosus (SLE) diagnosis in a multiethnic cohort.
Methods
The California Lupus Epidemiology Study (CLUES) is a longitudinal study of SLE. Data on major end‐organ lupus manifestations were collected and categorized by organ system: renal, hematologic, neurologic, cardiovascular, and pulmonary. Multiorgan disease was defined as manifestations in ≥2 of these distinct organ systems. Kaplan‐Meier curves assessed end‐organ disease‐free survival, and Cox proportional hazards regression estimated the rate of end‐organ disease following SLE diagnosis, adjusting for age at diagnosis, sex, and self‐reported race and ethnicity (White, Hispanic, Black, and Asian).
Results
Of 326 participants, 89% were female; the mean age was 45 years. Self‐reported race and ethnicity were 30% White, 23% Hispanic, 11% Black, and 36% Asian. Multiorgan disease occurred in 29%. Compared to White participants, Hispanic and Asian participants had higher rates, respectively, of renal (hazard ratio HR 2.9 95% confidence interval (95% CI) 1.8–4.7, HR 2.9 95% CI 1.9–4.6); hematologic (HR 2.7 95% CI 1.3–5.7, HR 2.1 95% CI 1.0–4.2); and multiorgan disease (HR 3.3 95% CI 1.8–5.9, HR 2.5 95% CI 1.4–4.4) following SLE diagnosis.
Conclusion
We found heightened risks of developing renal, hematologic, and multiorgan disease following SLE diagnosis among Hispanic and Asian patients with SLE, as well as a high burden of multiorgan disease among CLUES participants.
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