Objective. To evaluate the course of glucocorticoid (GC) therapy and associated adverse events in a population-based cohort of patients with giant cell arteritis (GCA). Methods. We identified 125 Olmsted County residents with GCA diagnosed between 1950 and 1991 and obtained followup information on the 120 patients who were diagnosed antemortem and agreed to participate in this study. Clinical variables, GC doses, and GC adverse events on each patient were recorded. The relationship between GC therapy and the development of adverse events was studied by the Cox and Anderson-Gill proportional hazards models. Results. All patients were treated with GCs and responded rapidly (median initial dosage 60 mg prednisone/day). The dosage was later reduced according to the treating physicians' judgment. The median duration required to reach 7.5 mg/day was 6.5 months and the median duration required to reach 5 mg/day was 7.5 months. Relapses or recurrences occurred in 57 patients. For the 87 patients followed to discontinuation of GC therapy and permanent remission of GCA (median of 22 months), the total median dose of prednisone was 6.47 gm. Adverse events associated with GCs were recorded in 103 (86%) patients and 2 or more events occurred in 70 patients (58%). Age and higher cumulative dose of GCs were associated with the development of adverse GC side effects. Conclusion. GCs are therapeutically effective in GCA and the prednisone dosage was reduced to physiologic levels in three-fourths of the patients within 1 year. However, most patients developed serious adverse side effects related to GCs, indicating that less toxic therapeutic measures are needed.

The present study based on a nationally representative sample of older adults living in the Andes mountains and coastal region of the country indicates that 34.7% of older adults had fallen in the previous year in Ecuador. Among fallers, 30.6% reported a fall-related injury. The prevalence of falls was higher in women and among older adults residing in the rural Andes mountains. In the multivariate model, women, subjects with cognitive impairment, those reporting urinary incontinence, and those being physically active during the previous year were variables found independently associated with increased risk of falling among older adults in Ecuador. Moreover, a gradual and linear increase in the prevalence of falls was seen as the number of risk factors increased. Falls represent a major public health problem among older adults in Ecuador. The present findings may assist public health authorities to implement programs of awareness and fall prevention among older adults at higher risk of falls.

To examine national trends in fall-related injuries among older adults treated in emergency departments (ED) and project these injuries until the year 2030. The Web-based Injury Statistics Query and Reporting System was used to generate data on fall-related injuries treated in ED. Joinpoint regression analysis was used to examine the average annual change in injury rates over time. Fall-related injury and hospitalisation rates increased on average by 2% (95% CI 1.5% to 2.7%) and by 4% (95% CI 2.9% to 5.0%) per year, respectively. Assuming the increase in fall-related injury rates remains unchanged, the number of fall-related injuries may increase to 5.7 million by the year 2030. Fall-related injuries among older adults treated in ED increased in the USA during the study period. Moreover, a marked increase in the number of these injuries may occur over the next decades.

Objectives. To estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and its determinants among older adults in Ecuador. Methods. 25(OH)D deficiency and insufficiency prevalence rates were examined among participants in the National Survey of Health, Wellbeing, and Aging. Logistic regression models were used to evaluate demographic characteristics associated with 25(OH)D deficiency. Results. Of 2,374 participants with a mean age of 71.0 (8.3) years, 25(OH)D insufficiency and deficiency were present in 67.8% (95% CI, 65.3–70.2) and 21.6% (95% CI, 19.5–23.7) of older adults in Ecuador, respectively. Women (OR, 3.19; 95% CI, 3.15–3.22), self-reported race as Indigenous (OR, 2.75; 95% CI, 2.70–2.80), and residents in rural (OR, 4.49; 95% CI, 4.40–4.58) and urban (OR, 2.74; 95% CI, 2.69–2.80) areas of the Andes Mountains region were variables significantly associated with 25(OH)D deficiency among older adults. Conclusions. Despite abundant sunlight throughout the year in Ecuador, 25(OH)D deficiency was significantly prevalent among older women, Indigenous subjects, and subjects residing in the Andes Mountains region of the country. The present findings may assist public health authorities to implement policies of vitamin D supplementation among older adults at risk for this condition.

Objective. To evaluate the reliability and validity of the number of deformed joints (NDJ) as a surrogate measure of joint damage in rheumatoid arthritis (RA). Methods. We tested interrater reliability and validity in determining the NDJ as a surrogate for joint damage in consecutive patients with RA. We rated each of 48 joints as normal or abnormal in terms of alignment and range of motion, and expressed the results as the total number of deformed joints. We compared the NDJ with the severity of damage on a plain radiograph of the hands, scored using Sharp's technique, as the gold standard measure of joint damage. We also compared the correlation between the NDJ and radiographic joint damage, on the one hand, and disease duration, performance-based measures of physical function, and the self-reported level of disability. Results. The interrater reliability of the NDJ was excellent, with an intraclass correlation among four examiners of 0.94. To assess validity of the NDJ, we studied 273 RA patients from 5 clinical settings. Their average NDJ was 14 (range 0 -43), and their average Sharp's score for joint space narrowing and erosions combined was 106 (range 4 -309). The NDJ and the total Sharp's score were highly correlated (r ‫؍‬ 0.83). Both measures were correlated to a similar degree with disease duration (r ‫؍‬ 0.51 for each measure), grip strength (r ‫؍‬ ؊0.49 for NDJ, and r ‫؍‬ ؊0.51 for Sharp's score), walking velocity (r ‫؍‬ ؊0.44 for NDJ, and r ‫؍‬ ؊0.45 for Sharp's score), the timed button test (r ‫؍‬ ؊0.62 for NDJ, and r ‫؍‬ ؊0.57 for Sharp's score), and the Modified Health Assessment Questionnaire (r ‫؍‬ 0.38 for NDJ, and r ‫؍‬ 0.38 for Sharp's score). Both the Sharp's score and the NDJ worsened significantly in 38 patients for whom 1-2 year followup data were available. Conclusion. The NDJ is reliable and is strongly associated with the standard measure of joint damage in RA. Because it is easily performed in a clinical setting, it could be used as an economical surrogate of joint damage in studies of the long-term outcome of RA.