scholarly journals Juvenile idiopathic arthritis and risk of cancer before and after the introduction of biological therapies

RMD Open ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e001055
Author(s):  
AnnaCarin Horne ◽  
Bénédicte Delcoigne ◽  
Karin Palmblad ◽  
Johan Askling
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Group Level ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Increased Risk ◽  
Before And After ◽  
Risk Of Cancer ◽  
Excess Incidence ◽  
Swedish Patient

BackgroundThe risk of cancer, including any secular trends in risk, in patients with juvenile idiopathic arthritis (JIA) is incompletely understood.MethodsWe performed a register-based cohort study of patients with JIA from 2001 until 2017, identified via the Swedish Patient Register. Patients with JIA were matched to five population reference subjects. Patients and referents were followed up for incident cancers (via linkage to the Swedish Cancer Register) until 18 years of age or 31 December 2016.ResultsAmong the 6721 patients with JIA, we observed 10 incident malignancies (5 lymphoproliferative cancers) during 34 951 person-years of follow-up, corresponding to an excess incidence of 0.09 cancers per 1000 person-years (one extra case per 11 000 patients per year), an HR for cancer (all sites) of 1.4 (95% CI 0.7 to 2.9) and an HR for lymphoproliferative malignancies of 3.6 (95% CI 1.1 to 11.2). The rates of cancer in JIA did not increase over the study period. We noted no differences in the excess risk comparing periods before and after the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs).DiscussionChildren and adolescents with JIA are at a slightly increased risk of lymphoproliferative (but not of other) malignancies. At the group level, there is no sign that this risk has increased further after the introduction of bDMARDs.

scholarly journals Venous thrombotic events are not increased in patients with rheumatoid arthritis treated with anti‑TNF therapy: results from the British Society for Rheumatology Biologics Register

2011 ◽  
Vol 70 (10) ◽  
pp. 1831-1834 ◽  
Author(s):  
Rebecca Davies ◽  
James B Galloway ◽  
Kath D Watson ◽  
Mark Lunt ◽  
Deborah P M Symmons ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
British Society ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Increased Risk ◽  
Observational Cohort ◽  
Using Data ◽  
Necrosis Factor ◽  
Biologics Register

ObjectivesPast studies have reported conflicting rates of venous thrombotic events (VTEs) in rheumatoid arthritis (RA). The current study aimed to compare (1) the rates of VTEs in patients with RA treated with anti-tumour necrosis factor (anti-TNF) therapy versus those treated with non-biological disease-modifying antirheumatic drugs (nbDMARDs) alone and (2) the rates between each individual anti-TNF agent and nbDMARDs.MethodsUsing data from the British Society for Rheumatology Biologics Register, a national prospective observational cohort study of biological safety in patients with RA, the authors compared the incidence of VTEs between 11 881 anti-TNF- and 3673 nbDMARD-treated patients. Analysis was limited to the first VTE per person. HRs were calculated using Cox modelling. Adjustment was made for potential confounders including surgery performed during follow-up.ResultsA total of 196 first VTEs were reported (151 anti-TNF, 45 nbDMARD). Overall there was no difference in the rates of VTEs between anti-TNF- and nbDMARD-treated patients (adjusted HR 0.8 (95% CI 0.5 to 1.5)). The risk was similar across all anti-TNF agents. Rates of postoperative VTEs did not significantly differ between groups.ConclusionsThese data suggest that anti-TNF therapy is not associated with an increased risk of VTEs in RA patients.

scholarly journals Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor?

2018 ◽  
Vol 128 (2) ◽  
pp. 617-626 ◽  
Author(s):  
Ajay Niranjan ◽  
Sudesh S. Raju ◽  
Edward A. Monaco ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Median Time ◽  
Rating Scale ◽  
Maximum Dose ◽  
Karnofsky Performance Status ◽  
Dominant Hand ◽  
Complete Restoration ◽  
Increased Risk ◽  
Before And After ◽  
Median Maximum

OBJECTIVEUnilateral Gamma Knife thalamotomy (GKT) is a well-established treatment for patients with medically refractory tremor who are not eligible for invasive procedures due to increased risk of compications. The purpose of this study was to evaluate whether staged bilateral GKT provides benefit with acceptable risk to patients suffering from disabling medically refractory bilateral tremor.METHODSEleven patients underwent staged bilateral GKT during a 17-year period (1999–2016). Eight patients had essential tremor (ET), 2 had Parkinson's disease (PD)–related tremor, and 1 had multiple-sclerosis (MS)–related tremor. For the first GKT, a median maximum dose of 140 Gy was delivered to the posterior-inferior region of the nucleus ventralis intermedius (VIM) through a single isocenter with 4-mm collimators. Patients who benefitted from unilateral GKT were eligible for a contralateral GKT 1–2 years later (median 22 months). For the second GKT, a median maximum dose of 130 Gy was delivered to the opposite VIM nucleus to a single 4-mm isocenter. The Fahn-Tolosa-Marin (FTM) clinical tremor rating scale was used to score tremor, drawing, and drinking before and after each GKT. The FTM writing score was assessed only for the dominant hand before and after the first GKT. The Karnofsky Performance Status (KPS) was used to assess quality of life and activities of daily living before and after the first and second GKT.RESULTSThe median time to last follow-up after the first GKT was 35 months (range 11–70 months). All patients had improvement in at least 1 FTM score after the first GKT. Three patients (27.3%) had tremor arrest and complete restoration of function (noted via FTM tremor, writing, drawing, and drinking scores equaling zero). No patient had tremor recurrence or diminished tremor relief after the first GKT. One patient experienced new temporary neurological deficit (contralateral lower-extremity hemiparesis) from the first GKT. The median time to last follow-up after the second GKT was 12 months (range 2–70 months). Nine patients had improvement in at least 1 FTM score after the second GKT. Two patients had tremor arrest and complete restoration of function. No patient experienced tremor recurrence or diminished tremor relief after the second GKT. No patient experienced new neurological or radiological adverse effect from the second GKT. Statistically significant improvements were noted in the KPS score following the first and second GKT.CONCLUSIONSStaged bilateral GKT provided effective relief for medically refractory, disabling, bilateral tremor without increased risk of neurological complications. It is an appropriate strategy for carefully selected patients with medically refractory bilateral tremor who are not eligible for deep brain stimulation.

Relationship between alcohol consumption and cancer in rural Chinese adults: 1 5- year follow-up cohort study

2020 ◽  
Author(s):  
Yue Zhang ◽  
Jingyi Li ◽  
Nannan Cheng ◽  
Jie Yang ◽  
Lijing Ye ◽  
...  
Keyword(s):  
Cohort Study ◽  
Alcohol Consumption ◽  
Cancer Incidence ◽  
Rural China ◽  
Density Lipoprotein ◽  
Estimating Equation ◽  
Chinese Adults ◽  
Increased Risk ◽  
Risk Of Cancer

Abstract Background：We aimed to evaluate the association between alcohol consumption and risk of cancer incidence among rural Chinese adults. Methods: We utilized data from a community-based cohort study in rural China enrolled in 2003 and followed up prospectively up to 2018. Generalized estimating equation models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) to analyze the relationship between alcohol consumption and cancer incidence. Results: After an average of 15 years of follow-up, a total of 9870 adult participants were included in this study. The results of the regression analysis for males showed that former drinkers had a significantly increased risk of cancer compared to never drinkers ([OR]2.46,95%[CI](1.43-4.23)). The cancer risk for current drinkers with heavy alcohol consumption(>400g/week) significantly increased ([OR]1.66,95% [CI] (1.18-2.34))compared to never drinkers. Among current drinkers, for every 100g of alcohol consumed per week, the risk of cancer increased by 15%. Among current drinkers, those aged 53.5 years or older , had a significant increase in the risk of cancer ([OR]1.26,95% [CI](1.12-1.42), for those with triglycerides ≥150 mg/dL, the risk of cancer was even higher ([OR]1.50,95%[CI](1.20-1.88), P for interaction 0.018), and for those with high density lipoprotein cholesterol (HDLC)<40 mg/dL, the risk of cancer increased the greatest ([OR]2.03,95%[CI](1.36-3.04), P for interaction 0.005). Conclusions: Among middle-aged and elderly males in rural China, the risk of cancer significantly increased among former and heavy current drinkers compared with never drinkers. Age, triglycerides, and HDLC may increase the risk of cancer along with alcohol consumption.

Attitudes, knowledge and sexual behavior among Finnish adolescents before and after an intervention

2019 ◽  
Vol 35 (4) ◽  
pp. 821-830
Author(s):  
Marja Pakarinen ◽  
Jari Kylmä ◽  
Mika Helminen ◽  
Tarja Suominen
Keyword(s):  
Health Promotion ◽  
Sexual Behavior ◽  
Sexual Health ◽  
First Year Students ◽  
Sexually Transmitted ◽  
Increased Risk ◽  
Before And After ◽  
Class Room ◽  
Information Materials

Abstract Adolescents are an important target group for sexual health promotion, and there are numerous programs and interventions carried out in this field. The aim of this study is to describe adolescents’ attitudes, knowledge and sexual behavior before and after a sexual health promotion intervention. The intervention was developed in the study and consisted of three elements: (i) class-room session, (ii) information materials and (iii) free condom distribution. The study was carried out in eight randomly selected vocational schools in Finland. The participants were first year students aged 15–19 years. The data were collected using an electronic questionnaire before intervention (intervention baseline n = 500, control baseline n = 183) and two times after the intervention (intervention first follow-up n = 173/second follow-up n = 202, control first follow-up n = 115/second follow-up n = 46). There were significant differences before and after the intervention concerning better knowledge and more frequent testing for sexually transmitted infections (STIs). Schools are an important environment to reach adolescents during the phase where their sexual health is developing and there is an increased risk of STI transmission. More school-based interventions are therefore needed, and the results of this study can be utilized when developing sexual health promotion interventions among adolescents.

scholarly journals Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

2020 ◽  
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E. Machado-Duque ◽  
Andres Gaviria-Mendoza ◽  
Juan Manuel Reyes ◽  
Natalia Castaño Gamboa
Keyword(s):  
Rheumatoid Arthritis ◽  
Pharmacological Treatment ◽  
Healthcare Costs ◽  
Cost Of Care ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Healthcare Resources ◽  
Conventional Dmards ◽  
Disease Modifying

Abstract Introduction/objectives The objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib. Method This is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider. Results We evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4–17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377. Conclusions In the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs. Key Points• Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs.• The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission.• Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.

scholarly journals Mortality among persons experiencing musculoskeletal pain: a prospective study among Danish men and women

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Teresa Holmberg ◽  
Michael Davidsen ◽  
Lau Caspar Thygesen ◽  
Mikala Josefine Krøll ◽  
Janne Schurmann Tolstrup
Keyword(s):  
Pain Intensity ◽  
Cox Regression ◽  
Widespread Pain ◽  
Men And Women ◽  
Respiratory Mortality ◽  
Discriminatory Accuracy ◽  
Increased Risk ◽  
A Prospective Study ◽  
Risk Of Cancer

Abstract Background Musculoskeletal (MSK) pain affects many people worldwide and has a great impact on general health and quality of life. However, the relationship between MSK pain and mortality is not clear. This study aimed to investigate all-cause and cause-specific mortality in relation to self-reported MSK pain within the last 14 days, including spread of pain and pain intensity. Methods This prospective cohort study included a representative cohort of 4806 men and women aged 16+ years, who participated in a Danish MSK survey 1990–1991. The survey comprised questions on MSK pain, including spread of pain and pain intensity. These data were linked with the Danish Register of Causes of Death to obtain information on cause of death. Mean follow-up was 19.1 years. Cox regression analyses were performed with adjustment for potential confounders. Results In the study population (mean age 44.5 years; 47.9% men), 41.0% had experienced MSK pain within the last 14 days and 1372 persons died during follow-up. For both sexes, increased all-cause mortality with higher spread and intensity of MSK pain was observed; a high risk was observed especially for men with strong pain (HR = 1.66; 95% CI:1.09–2.53) and women with widespread pain (HR = 1.49; 95% CI:1.16–1.92). MSK pain within last 14 days yielded c-statistics of 0.544 and 0.887 with age added. Moreover, persons with strong MSK pain had an increased cardiovascular mortality, persons with moderate pain and pain in two areas had an increased risk of cancer mortality, and persons with widespread pain had an increased risk of respiratory mortality. Conclusions Overall, persons experiencing MSK pain had a higher risk of mortality. The increased mortality was not accounted for by potential confounders. However, when evaluating these results, it is important to take the possibility of unmeasured confounders into account as we had no information on e.g. BMI etc. Significance The present study provides new insights into the long-term consequences of MSK pain. However, the discriminatory accuracy of MSK pain was low, which indicates that this information cannot stand alone when predicting mortality risk.

scholarly journals A rare case of tuberculosis-induced hypercalcemia

2020 ◽  
Vol 30 (3) ◽  
pp. 471-474
Author(s):  
Loris Wauthier ◽  
Xavier Theunssens ◽  
Patrick Durez ◽  
Catherine Fillée ◽  
Diane Maisin ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Rare Case ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Atypical Case ◽  
Severe Hypercalcemia ◽  
Laboratory Investigations ◽  
Disease Modifying ◽  
25 Oh Vitamin D

Laboratory investigations of hypercalcemia involve testing of various biochemical parameters such as parathyroid hormone (PTH), 25-(OH) Vitamin D (25-(OH) VitD), 1,25-(OH)2 Vitamin D3 (calcitriol) and PTH related peptide (PTHrp). We herein present an atypical case of severe hypercalcemia in a patient with rheumatoid arthritis who has been treated for years by various biological disease-modifying antirheumatic drugs (DMARDs) and suddenly presented with general state alteration, oedema and ulceration of her right ankle. We illustrate how tuberculosis (TB) can cause high calcitriol concentration and subsequently lead to potentially severe hypercalcemia. Moreover, we highlight the importance of TB testing and follow-up in patients treated with biological DMARDs.

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