BackgroundInflammatory joint diseases (IJD) such as psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD) since inflammation plays a pivotal role in the pathogenesis of coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (Afib)1. Ischemic heart disease and HF are the main causes of the increased and premature mortality among patients with IJD2.Additionally, patients with PsA have a prevalence of hyperuricemia (HUC) of 32%, 3 times greater as compared with the general population, which may be related to increased cell turnover as well as the release of pro-inflammatory cytokines and tumor necrosis factor3.Prolonged exposure to high levels of uric acid (UA) has been shown to result in oxidative stress causing endothelial dysfunction, ionic channel changes, atrial and ventricular remodeling4. There is experimental evidence indicating that uric acid stimulates renin-angiotensin-aldosterone system (RAAS), and it is associated with an increase in cardiac tissue xanthine oxidase activity, all of which induce cardiomyocyte hypertrophy, myocardial oxidative stress, interstitial fibrosis and impaired diastolic relaxation5.ObjectivesThe aim of this study is to assess the correlation of HUC and the clinical expression of CVD in patients with PsA.MethodsThis is a retrospective cohort study using the 2016 National Inpatient Sample (NIS) of adults diagnosed with PsA based on ICD-10 codes, to detect the prevalence of cardiovascular (CV) conditions such as CAD, Afib, and HF with preserved ejection fraction (HFpEF) in patients with concomitant HUC or gout versus age matched controls. Chi square was used for point prevalence and multivariate linear regression adjusted for age, gender, race, CAD, diabetes mellitus, HTN, hyperlipidemia (HLD), smoking, chronic kidney disease (CKD) and Charlson comorbidity index for prevalence odds ratio (POR). We used STATA-15 for statistical analysis.ResultsWe identified 37,315 patients with PsA, of whom 2,165 had concomitant HUC or gout (5.80%). Mean age was 61 years, 57% were females. Our results showed that PsA with concomitant HUC or gout compared to PsA without HUC or gout was associated with a higher rate of Afib (17.8% vs 6.1%, p < 0.001), CAD (35.1% vs 19.4%, p < 0.001) and HFpEF (7.2% vs 3.1%, p < 0.001). Furthermore, patients with PsA and HUC/gout appeared to have more risk of developing Afib (POR 1.79; 95%-CI 1.31-2.45; p < 0.001) and HFpEF (POR 1.56; 95%-CI 1.08-2.26; p=0.018), compared to patients with normal uric acid after multivariate-adjustment for risk factors. No statistical difference in CAD was identified between the two groups (POR 1.21; 95%-CI 0.94-1.55; p=0.131) after multivariate linear regression adjustment for confounders.ConclusionThis study showed that HUC is independently associated with CVD, mainly with Afib and HFpEF in patients with PsA. It remains to be seen if a treat to target approach with normalization of UA in patients with PsA will result in improved CV outcomes. We believe that our findings merit further investig...
Background. Rowell’s syndrome is comprised of the presentation of erythema multiforme- (EM-) like lesions in association with lupus erythematosus (LE), along with serologies of speckled antinuclear antibodies (ANAs), positive rheumatoid factor (RF), positive anti-La/anti-Ro, and the clinical finding of chilblains. As per the redefined criteria by Zeitouni et al., three major criteria in addition to at least 1 minor criterion are necessary for diagnosis. Case Presentation. A 20-year-old male presented with a one-week history of worsening nonpruritic erythematous maculopapular skin rash (resembling EM) which appeared on the face and subsequently spread to the trunk, arms, legs, palms, and soles. There was no mucosal involvement. At the onset of rash, the patient reported headaches, associated with photosensitivity and intermittent fevers. Workup for viral meningitis yielded negative results. Laboratory investigation revealed mild anemia, elevated inflammatory markers, a positive ANA with speckled pattern, a positive anti-Ro/SSA, anti-La/SSB antibodies, and a positive rheumatoid factor (RF). Lupus anticoagulant antibody was positive along with a low-positive anticardiolipin IgM antibody and a negative beta-2 glycoprotein antibody. Anti-dsDNA, anti-Smith, anti-Jo-1, anti-centromere, and anti-Scl-70 antibodies were negative. Hepatitis serologies, herpes simplex virus 1 and 2, mycoplasma, Epstein–Barr virus, HIV, and parvovirus B19 were negative. Left arm skin biopsy demonstrated vacuolar interface dermatitis and positive colloidal iron stain suggestive of dermal mucin deposition, favoring the diagnosis of cutaneous collagen vascular disease. Cutaneous lesions improved with administration of oral prednisolone. Conclusion. Rowell’s syndrome should be considered in patients who present with cutaneous LE and lesions resembling EM. Further serological markers should be pursued in the absence of obvious EM-precipitating factors.
Background It has been shown that gout is associated with left atrium remodeling and a pro‐inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF. Methods This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD‐10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre‐existing AF and gout. Results In 2016, we identified 3 844 057 patients admitted to the hospitals in NIS with history of AF, of which 240 875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97‐2.19], P < .001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01‐1.11], P = .041). However, presence of gout in patients with AF was not associated with all‐cause in‐hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility. Conclusion Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.
Contrast-enhanced chest computed tomography (CT) is not considered part of the evaluation of myocardial infarction. However, acute myocardial infarction has been detected on contrast-enhanced chest CT as areas of decreased myocardial enhancement in patients evaluated for other indications, such as pulmonary embolism and aortic dissection. We present a case of acute myocardial infarction on a nongated chest CT in a 67-year-old male who presented with atypical chest pain and initial nondiagnostic electrocardiogram. This case highlights that acute myocardial infarction may be detectable on contrast-enhanced CT. When evaluating contrast-enhanced chest CT's for other etiologies of chest pain, radiologists should look for potential myocardial perfusion abnormalities that can provide clues to the presence of myocardial infarction.
Background:Multiple studies have been done assessing the “weekend effect” and outcomes for hospitalized patients1,2,3,4, however, there is no data evaluating the outcome of patients with septic arthritis of a native joint (SANJ) who are admitted on the weekend compared to the rest of the week.Objectives:To evaluate whether important outcomes in SANJ, including in-hospital mortality, differ between patients admitted on weekends versus weekdays and the time to diagnostic arthrocentesis.Methods:The National Inpatient Sample (NIS) database of the year 2016 was utilized for patients admitted to the hospital with a principal discharge diagnosis of SANJ. This was a retrospective cohort study of patients hospitalized in 2016 with SANJ in hospitals across the US. Patients were included if they were adults with a principal diagnosis of SANJ based on ICD-10 codes. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. The proportion of patients with SANJ admitted over weekends versus weekdays was determined. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length of stay and total hospital charges, These results were compared after multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis.Results:The study included 12819 patients with SANJ. Compared with patients admitted on weekdays, patients with SANJ admitted on weekends had increased in-hospital mortality rates (adjusted odds ratio[aOR] 3.67; 95% [CI] 1.52 – 8.86, p<.005), but similar early arthrocentesis rates ([aOR] 1.14; 95%, [CI] 0.90 – 1.45 p>0.05), length of stay (p>0.05) and hospital charges ($ 2751.11; 95% [CI] -4449.6 – 9951.8; P>0.05). However, regardless of the day of admission those who received an early arthrocentesis had lower length of stay (-1.46, p<0.05), and lower total hospital charges ($ -6527 $; p<0.05).Conclusion:This study showed that compared with patients admitted on weekdays, patients with SANJ admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had significantly lower length of stay and hospital charges regardless of the day of admission. This results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis.References:[1] Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med2001;345:663-8.[2] Pauls LA, et al. The Weekend Effect in Hospitalized Patients: A Meta-Analysis. J Hosp Med. 2017Sep;12(...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.