bluuebunny/crossref_metadata_2025_split huggingface dataset:
Klinefelter's syndrome (47,XXY) in male systemic lupus erythematosus patients: Support for the notion of a gene‐dose effect from the X chromosome
Authors: Scofield R. Hal , Bruner Gail R. , Namjou Bahram , Kimberly Robert P. , Ramsey‐Goldman Rosalind , Petri Michelle , Reveille John D. , Alarcón Graciela S. , Vilá Luis M. , Reid Jeff , Harris Bryan , Li Shibo , Kelly Jennifer A. , Harley John B. 
Published: August 2008

AbstractObjectiveSystemic lupus erythematosus (SLE) is a systemic autoimmune disease that predominantly affects women. Despite isolated reports of patients with coexisting Klinefelter's syndrome (47,XXY) and SLE, no association of Klinefelter's syndrome with SLE or any other autoimmune disease has been established. The present study was undertaken to investigate the prevalence of Klinefelter's syndrome in a large population of patients with SLE.MethodsSex chromosome genotyping was performed in 981 SLE patients, of whom 213 were men. A first group of 844 SLE patients from 378 multiplex families and a second group of 137 men with nonfamilial SLE were evaluated. In selected cases, chromosomes were enumerated by fluorescence in situ hybridization (FISH) and karyotyping in transformed B cell lines.ResultsOf 213 men with SLE, 5 had Klinefelter's syndrome (1 in 43). Four of them were heterozygous at X markers, and Klinefelter's syndrome was confirmed by FISH and karyotyping in the fifth. An overall rate of 47,XXY of 235 per 10,000 male SLE patients was found (95% confidence interval 77–539), a dramatic increase over the known prevalence of Klinefelter's syndrome in an unselected population (17 per 10,000 live male births). Asking men with SLE about fertility was highly sensitive (100%) for Klinefelter's syndrome. All 768 women with SLE were heterozygous at X.ConclusionThe frequency of Klinefelter's syndrome (47,XXY), often subclinical, is increased in men with SLE by ∼14‐fold compared with its prevalence in men without SLE. Diagnostic vigilance for 47,XXY in male patients with SLE is warranted. These data are the first to show an association of Klinefelter's syndrome with an autoimmune disease found predominantly in women. The risk of SLE in men with Klinefelter's syndrome is predicted to be similar to the risk in normal women with 46,XX and ∼14‐fold higher than in men with 46,XY, consistent with the notion that SLE susceptibility is partly explained by an X chromosome gene‐dose effect.
Trends in out‐of‐pocket medical care expenditures for medicare‐age adults with arthritis between 1998 and 2004
Authors: Lurie Ithai Z. , Dunlop Dorothy D. , Manheim Larry M. 
Published: August 2008

AbstractObjectiveTo provide estimates of the growth in out‐of‐pocket (OOP) medical expenditures for persons with arthritis.MethodsOOP medical expenditures were estimated for 1998–2004 based on 7 panels of the Medical Expenditures Panel Survey, which provide nationally representative data. A simple simulation then extrapolated the data through 2006, for which the potential effects of Medicare Part D drug coverage were computed.ResultsMedian total OOP expenditures for persons with arthritis showed an increase of 52.4% between 1998 and 2004 (7.3% annually beyond inflation). Median OOP expenditures for prescription medication showed larger growth, at 72.0%. Medicare Part D was predicted to lower both total and prescription OOP expenditures and return them close to 2003 levels. Simulation limitations included exclusive use of the standard Medicare Part D benefit structure and the assumption of stable prescribing trends during this period.ConclusionHigh prescription drug expenditures are likely to continue to be an issue, both for individuals faced with increasing OOP burden and for policy makers faced with increasing budgetary shortfalls to fund increasing Medicare expenses.
Subgroup analyses to determine cardiovascular risk associated with nonsteroidal antiinflammatory drugs and coxibs in specific patient groups
Authors: Solomon Daniel H. , Glynn Robert J. , Rothman Kenneth J. , Schneeweiss Sebastian , Setoguchi Soko , Mogun Helen , Avorn Jerry , Stürmer Til 
Published: August 2008

AbstractObjectiveTo explore the extent to which clinical characteristics influence the association between cyclooxygenase 2 inhibitors (coxibs) and/or nonselective nonsteroidal antiinflammatory drugs (NSAIDs) and increased cardiovascular disease (CVD) risk in specific patient subgroups. There is substantial concern regarding the potential cardiovascular adverse effects of selective coxibs and nonselective NSAIDs, but many patients with arthritis experience important clinical benefits from these agents.MethodsThe study population consisted of Medicare beneficiaries also eligible for a drug benefits program for older adults during the years 1999–2004. We calculated the relative risk (RR) for CVD events (myocardial infarction [MI], stroke, congestive heart failure, and cardiovascular death) among users of coxibs or nonselective NSAIDs in the prior 6 months compared with nonusers. We assessed biologic interaction between these medication exposures and important patient characteristics.ResultsIn the primary cohort, we identified 76,082 new users of coxibs, 53,014 new users of nonselective NSAIDs, and 46,558 nonusers. Compared with nonusers, the adjusted RR of CVD events for new users of each agent increased for rofecoxib (RR 1.22, 95% confidence interval [95% CI] 1.14, 1.30) and decreased for naproxen (RR 0.79, 95% CI 0.67, 0.93). Several patient characteristics were found to increase the risk of CVD events among users of some agents in both the primary and secondary cohorts, including age ≥80 years, hypertension, prior MI, prior CVD, rheumatoid arthritis, chronic renal disease, and chronic obstructive pulmonary disease. Rofecoxib and ibuprofen appeared to confer an increased risk in multiple patient subgroups.ConclusionMany nonselective NSAIDs and coxibs are not associated with an increased risk of CVD events. However, several patient characteristics identify important subgroups that may be at an increased risk when using specific agents.
Validation of the Childhood Health Assessment Questionnaire in active juvenile systemic lupus erythematosus
Authors: Meiorin Silvia , Pistorio Angela , Ravelli Angelo , Iusan Silvia M. , Filocamo Giovanni , Trail Lucia , Oliveira Sheila , Cuttica Ruben , Espada Graciela , Alessio Maria , Mihaylova Dimitrina , Cortis Elisabetta , Martini Alberto , Ruperto Nicolino ,   Paediatric Rheumatology International Trials Organisation (PRINTO)
Published: August 2008

AbstractObjectiveTo validate the Childhood Health Assessment Questionnaire (C‐HAQ) as a measure of disability in patients with active juvenile systemic lupus erythematosus (SLE).MethodsOf 557 patients with juvenile SLE included in the Paediatric Rheumatology International Trials Organisation (PRINTO) database, 504 (90.5%) were included in the present study and underwent C‐HAQ assessment at the time of a major therapeutic intervention and then after 6 months. Validation procedures, according to the Outcome Measures in Rheumatology Clinical Trials filter for outcome measures in rheumatology, included assessment of responsiveness, feasibility, internal consistency, construct validity, collinearity, and discriminative ability. Response to therapy was evaluated with the PRINTO/American College of Rheumatology (ACR) juvenile SLE definition of improvement.ResultsAt baseline, patients showed a high level of disease activity (mean physician global 5.8) and moderate disability (mean C‐HAQ 0.83); both disease activity and disability improved after 6 months of treatment. The change in C‐HAQ score correlated moderately with the Systemic Lupus Activity Measure (rs = 0.42), parent's global assessment of pain and well‐being (rs = 0.55 and 0.53, respectively), and the physical summary score of the Child Health Questionnaire (rs = −0.61), and poorly with other clinical and laboratory parameters. The absolute change in C‐HAQ demonstrated a significant ability to discriminate between patients who improved and those who did not improve based on the PRINTO/ACR definition of improvement. Responsiveness of the C‐HAQ was moderate (standardized response mean 0.74). Internal consistency was excellent (Cronbach's α = 0.96).ConclusionThe C‐HAQ showed moderate responsiveness to clinical change, construct validity, good feasibility, internal consistency, and discriminative ability. These findings demonstrate that the C‐HAQ represents a good measure to capture disability in patients with active juvenile SLE.
Use of nonbiologic disease‐modifying antirheumatic drugs and risk of infection in patients with rheumatoid arthritis
Authors: Lacaille Diane , Guh Daphne P. , Abrahamowicz Michal , Anis Aslam H. , Esdaile John M. 
Published: August 2008

AbstractObjectiveRheumatoid arthritis (RA) is associated with increased frequency of and mortality from infections, which may be related to host factors, RA itself, inflammation, or medication side effects. This study was undertaken to determine the effect of nonbiologic disease‐modifying antirheumatic drugs (DMARDs) on infection risk in RA.MethodsWe performed a retrospective, longitudinal study of a population‐based RA cohort in British Columbia, Canada, followed from January 1996 to March 2003 using administrative data. We evaluated mild infections (requiring a physician visit or antibiotics) and serious infections (requiring or complicating hospitalization). Adjusted risk of mild and serious infections associated with DMARD exposure was estimated using generalized estimating equation extension of multivariate Poisson regression models, after adjusting for baseline covariates (age, sex, RA duration, socioeconomic status) and time‐dependent covariates (corticosteroids, comorbidity, prior infections).ResultsA total of 27,710 individuals with RA provided 162,710 person‐years of followup. Of these, 25,608 (92%) had at least 1 mild infection and 4,941 (18%) had at least 1 serious infection. Use of DMARDs without corticosteroids was associated with a small decrease in mild infection risk of statistical significance but unclear clinical significance (adjusted rate ratio [RR] 0.90, 95% confidence interval [95% CI] 0.88–0.93 relative to no corticosteroid or DMARD use). Use of DMARDs without corticosteroids was not associated with increased serious infection risk (adjusted RR 0.92, 95% CI 0.85–1.0). Use of corticosteroids increased the risk of mild and serious infections.ConclusionOur results indicate that use of nonbiologic DMARDs, including methotrexate, does not increase the risk of infection in RA, whereas use of corticosteroids does. This has important implications for counseling individuals with RA concerning risks and benefits of DMARDs.
Arthritis prevalence and associations in American Indian and Alaska native people
Authors: Ferucci Elizabeth D. , Schumacher M. Catherine , Lanier Anne P. , Murtaugh Maureen A. , Edwards Sandra , Helzer Laurie J. , Tom‐Orme Lillian , Slattery Martha L. 
Published: August 2008

AbstractObjectiveTo investigate the prevalence of arthritis and associations with arthritis in American Indian and Alaska Native populations.MethodsData on self‐reported, doctor‐diagnosed arthritis from the baseline visit of 9,968 American Indian and Alaska Native adults from Alaska and the Southwest US were included. The prevalence of arthritis and univariate and multivariate associations between arthritis and demographic characteristics, health‐related factors, and treatment are described.ResultsThe prevalence of self‐reported arthritis increased with age. The age‐sex adjusted prevalence was high in Alaska (26.1%) and low in the Southwest US (16.5%) as compared with the US population (21.5%). In both centers, arthritis was associated with age, lack of employment, chronic medical conditions, and poorer self‐reported overall health. Arthritis was associated with female sex in Alaska only, whereas education, marital status, and urban residency were associated with arthritis in the Southwest US. In both centers, self‐reported physical health measured by the Short Form 12 Health Survey was lower in people with arthritis, and mental health was not associated with arthritis. More frequent use of antiinflammatory medications was reported with arthritis in both centers, but increased use of traditional medicine and healers were associated with arthritis only in Alaska.ConclusionCompared with US rates, the prevalence of self‐reported arthritis was higher among Alaska Native people and lower in a Southwest American Indian population. Some factors associated with arthritis differ between the 2 populations.
Increased angiogenesis and cellular proliferation as hallmarks of the synovium in chronic septic arthritis
Authors: Pessler F. , Dai L. , Diaz‐Torne C. , Ogdie A. , Gomez‐Vaquero C. , Paessler M. E. , Einhorn E. , Chen L. X. , Schumacher H. R. 
Published: August 2008

AbstractObjectiveTo characterize histologic alterations and inflammatory infiltrates in the synovium of patients with chronic septic arthritis (SeA).MethodsSynovial membranes from patients with SeA (9 specimens; disease duration >4 weeks) were compared with specimens from patients with septic joint prosthesis loosening (septic total arthroplasty [SeTA]; 9 specimens), rheumatoid arthritis (RA; 25 specimens), osteoarthritis (25 specimens), and normal histology (10 specimens). Sections were stained with hematoxylin and eosin, tissue gram stain, and immunostains for von Willebrand factor (vWF; blood vessels), Ki‐67 (dividing cells), CD15 (neutrophils), CD3 (T cells), CD20 (B cells), CD38 (plasma cells), and CD68 (macrophages).ResultsGram stains were positive in all SeA and SeTA specimens. Mixed polymorphonuclear and mononuclear infiltrates predominated in SeA and SeTA. SeA could be differentiated from RA by higher densities of CD15+ cells (SeA:RA ratio 6.5:1; P < 0.001) or Ki‐67+ cells (ratio 2.1:1; P = 0.012). The inflammatory infiltrate of SeTA was similar to SeA but contained fewer CD3+ cells (SeTA versus SeA 0.26:1; P = 0.009) and a tendency toward fewer CD20+ cells. Mean vascular density was strikingly increased in SeA (SeA:normal ratio 3.0:1; P < 0.001) and, to a lesser extent, in the vascularized areas of the SeTA specimens (SeTA:normal ratio 1.9:1). Ki‐67/CD31 double immunostains demonstrated proliferating endothelial cells in small subintimal blood vessels, suggesting angiogenesis. Receiver operating characteristic curve analysis identified higher densities of CD15+ and Ki‐67+ cells and vWF‐positive vessels as histologic markers that differentiated SeA from RA.ConclusionThis first analysis of the synovium in patients with chronic pyogenic arthritis identified dramatic neovascularization and cell proliferation, accompanied by persistent bacterial colonization and heterogeneous inflammatory infiltrates rich in CD15+ neutrophils, as histopathologic hallmarks.
Development and validation of a preliminary definition of minimal disease activity in patients with juvenile idiopathic arthritis
Authors: Magni‐Manzoni Silvia , Ruperto Nicolino , Pistorio Angela , Sala Elena , Solari Nicoletta , Palmisani Elena , Cugno Chiara , Bozzola Elena , Martini Alberto , Ravelli Angelo 
Published: August 2008

AbstractObjectiveTo develop and validate a definition of minimal disease activity (MDA) in patients with juvenile idiopathic arthritis (JIA).MethodsThe clinical charts of JIA patients followed over a 16‐year period were reviewed to identify visits with high disease activity and MDA, defined on the basis of therapeutic decisions made by the attending physician. For each JIA activity measure recorded at the time of the visit, the cutoff value that best identified states of MDA was calculated by means of the area under the receiver operating characteristic curve analysis. A definition of MDA for oligoarthritis and polyarthritis was set up after testing the relative power of each variable in a multivariate analysis. Validation procedures included assessment of discriminant and construct validity.ResultsThe definition that resulted from the analyses led to establish that a state of MDA could be defined as the presence of a physician global assessment ≤2.5 cm and a swollen joint count of 0 in patients with oligoarthritis; and as the presence of a physician global assessment ≤3.4 cm, a parent global assessment ≤2.1 cm, and a swollen joint count ≤1 in patients with polyarthritis. Validation procedures demonstrated that the MDA definition had good discriminant and construct validity in the context of both observational studies and controlled trials.ConclusionWe developed a preliminary definition of MDA in patients with JIA that represents a useful treatment target state and is proposed for inclusion as an outcome measure in future observational studies and clinical trials in patients with JIA.
Evaluation of the effect of anti–tumor necrosis factor agent use on rheumatoid arthritis work disability: The jury is still out
Authors: Allaire Saralynn , Wolfe Frederick , Niu Jingbo , Zhang Yuqing , Zhang Bin , LaValley Michael 
Published: August 2008

AbstractObjectiveTo examine the role of anti–tumor necrosis factor (anti‐TNF) agents in predicting work disability in subjects with rheumatoid arthritis (RA).MethodsWe studied 953 subjects with rheumatologist‐diagnosed RA from a US cohort using a nested, matched, case–control approach. Subjects provided data on medication usage and employment every 6 months for 18 months, were employed at baseline, and were age <65 years at last followup. Cases were subjects who were not employed at followup (n = 231) and were matched ∼3:1 by time of entry into the cohort to 722 controls who were employed at followup. Risk of any employment loss, or loss attributed to RA, at followup as predicted by use of an anti‐TNF agent at baseline was computed using conditional logistic regression. Stratification on possible confounding factors and recursive partitioning analyses were also conducted.ResultsSubjects' mean age was 51 years, 82% were female, 92% were white, and 72% had more than a high school education. Nearly half (48%) used an anti‐TNF agent at baseline; characteristics of anti‐TNF agent users were similar to nonusers. In the main analyses, anti‐TNF use did not protect against any or RA‐attributed employment loss (odds ratio [95% confidence interval] 1.1 [0.7–1.6] versus 0.9 [0.5–1.5]). However, a protective effect was found for users with disease duration <11 years (odds ratio [95% confidence interval] 0.5 [0.2–0.9]). In recursive partitioning analyses, age, RA global severity, and functional limitation played a much greater role in determining employment loss than anti‐TNF agent use.ConclusionAnti‐TNF agent use did not protect against work disability in the main analyses. In stratified analyses, their use was protective among subjects with shorter RA duration, whereas in nonparametric analyses, age and disease factors were the prominent predictors of work disability.
Serum interleukin‐6 receptor in polymyalgia rheumatica: A potential marker of relapse/recurrence risk
Authors: Pulsatelli Lia , Boiardi Luigi , Pignotti Elettra , Dolzani Paolo , Silvestri Tania , Macchioni Pierluigi , Cantini Fabrizio , Salvarani Carlo , Facchini Andrea , Meliconi Riccardo 
Published: August 2008

AbstractObjectiveTo investigate the modulation of systemic levels of soluble interleukin‐6 receptor (sIL‐6R) and soluble gp130 (sgp130) in untreated and treated polymyalgia rheumatica (PMR) patients during a followup period of at least 24 months in order to evaluate the relationship of these molecules with clinical outcome and their feasibility to provide a prognostic tool in clinical practice.MethodsWe analyzed sIL‐6R and sgp130 serum levels in 93 PMR patients, and 46 age‐matched normal controls, at disease onset and at 1, 3, 6, 12, and 24 months of followup during corticosteroid therapy by enzyme‐linked immunosorbent assay.ResultsNo difference in sIL‐6R and sgp130 levels was observed between PMR patients and normal controls at disease onset or during followup. A significant correlation was found between the number of relapses and sIL‐6R concentrations at baseline and after 1, 3, and 12 months of therapy. No correlation was found between sgp130 levels and the number of relapses. Cox multivariate analysis indicated that the best model for predicting relapses was identified by sIL‐6R levels and the hemoglobin value at baseline. We found that high sIL‐6R levels combined with low hemoglobin values resulted in a 10.1‐fold increased risk of relapse.ConclusionOur data support the identification of a potential prognostic marker of PMR outcome that might have important implications in clinical practice. Because targeting sIL‐6R with blocking antibodies has proven useful in other rheumatic disorders, our results could suggest the opportunity to evaluate sIL‐6R–blocking treatment in patients with PMR and elevated levels of sIL‐6R at disease onset.
Changes in the characteristics of patients prescribed selective cyclooxygenase 2 inhibitors after the 2004 withdrawal of rofecoxib
Authors: Setakis E. , Leufkens H. G. M. , van Staa T. P. 
Published: August 2008

AbstractObjectiveTo evaluate the impact of rofecoxib withdrawal on the characteristics of patients prescribed selective cyclooxygenase 2 (COX‐2) inhibitors.MethodsThe General Practice Research Database was used to identify patients age ≥18 years who were prescribed a selective COX‐2 inhibitor. Various patient characteristics were noted at the start of therapy: age, sex, nonsteroidal antiinflammatory drug–related risk factors for upper gastrointestinal (GI) events, and the Framingham risk score for cardiovascular disease. Logistic regression was used to compare patients using selective COX‐2 inhibitors before and after September 2004.ResultThe study population included 171,645 patients receiving selective COX‐2 inhibitors. The number of users substantially increased over time until September 2004 and sharply declined thereafter. Approximately 80% stopped selective COX‐2 inhibitor therapy within 6 months. Patients receiving selective COX‐2 inhibitors after September 2004 were younger and included more men compared with those receiving therapy before September 2004. There was no change before and after September 2004 in the proportion of patients with GI risk factors or high Framingham risk scores, after adjustment for age and sex. A correlation was found between presence of GI risk factors and high Framingham risk scores. Only 20% of patients receiving selective COX‐2 inhibitors had GI risk factors but low Framingham risk score, which did not change after September 2004.ConclusionThere was no channeling in the usage of selective COX‐2 inhibitors toward patients with a high risk of GI and low risk of cardiovascular disease following the withdrawal of rofecoxib.