Adverse drug reactions are more common in geriatric patients than in younger patients, but there have been insufficient studies concerning the epidemiology or burden of drug allergy labels in geriatric patients. We prospectively investigated the prevalence and outcomes of geriatric patients with drug allergy labels in a cohort of hospitalised patients. Methods:Patients admitted to a regional hospital over a 6-month period were recruited for this study. All patients with drug allergy labels were prospectively followed until discharge; clinical data were anonymously extracted for analyses. Patients were categorised into either geriatric (aged ≥65 years) or non-geriatric (aged <65 years) groups. Demographic characteristics, clinical outcomes, and prevalences of drug allergy labels were compared between groups.Results: There were 4361 admissions involving 3641 patients during the 6-month study period. Overall, 492 patients (13.5%) had drug allergy labels, consisting of 151 non-geriatric patients (30.7%) and 341 geriatric patients (69.3%). The prevalence of drug allergy labels did not significantly differ between geriatric and non-geriatric patients (13.5% vs 13.5%,
BackgroundThe waiting time for newly referred patients to the rheumatology clinic is approximately 24 months. The Rheumatology Nurse Rapid Access Triage Clinic aims to shorten the waiting time of patients suspected to have rheumatoid arthritis (RA). It is hoped that patients with active RA can be fast-tracked to commence earlier treatment for better disease control.ObjectivesTo validate if Rheumatology Nurses (RhN) can screen out patients with active RA for earlier treatment and to evaluate the level of agreement in RA diagnosis between RhN and rheumatologists.MethodsNewly referred patients suspected to have RA were assessed by RhN from March 2012 to September 2015. Based on a protocol modelled upon the 2010 European League Against Rheumatism (EULAR)/American College of Rheumatologists (ACR) criteria for the classification of RA, RhN performed history taking, physical examination of joints, and ordered relevant blood and X-ray investigations. RhN then reviewed all results to discriminate between RA and non-RA. Paired t-tests and logistic regression were used to compare variables between RA and non-RA patients diagnosed by RhN. Correlation coefficient (CC) was used to compare the level of agreement between RhN's and rheumatologists' assessment.ResultsRhN assessed 102 patients (mean age =53.46 ± 12.59 years, 84.3% women). The group diagnosed to have RA by RhN had shortened waiting time for the rheumatology clinic when compared to the non-RA group. (11.5 vs 3.6 months; p<0.001) Agreement between RhN diagnosed RA and rheumatologist diagnosed RA was excellent (CC 90%; P<0.001). Comparing with the non-RA group, RhN diagnosed RA group also had greater chance of receiving disease modifying anti-rheumatic drugs (DMARDs) early (OR 43.08, p<0.001). The mean duration between onset of joint symptom and DMARDs commencement was 8.26 ± 11.52 months ranging from 3 to 52 months.ConclusionsThe Rheumatology Nurse Rapid Access Triage Clinic provides accurate diagnosis and shortens RA patient's waiting time. It also helps to screen out active patients to receive earlier treatment.ReferencesGormley GJ, Steele WK, Gilliland A, Leggett P, Wright GD, Bell AL, Matthew C, Meenagh G, Wylie E, Mulligan R, Stevenson M, Reilly DO and Taggart AJ (2003) Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics? Rheumatology 42:763–768.Disclosure of InterestNone declared
Background:Magnetic resonance imaging (MRI) is becoming increasingly important in axial spondyloarthritis (SpA) due to its unique role in early diagnosis, classification, and monitoring of disease (1, 2). It is the only disease assessment tool that has been validated with histological inflammatory cellularity in tissue biopsy of the sacroiliac (SI) joint (3). However, many MRI lesions are not exclusive to axial SpA and may occur in other conditions such as infection, degeneration and malignancy. Further characterization of these lesions may guide more targeted therapies.Objectives:The objective of this study was to describe, investigate associated factors, and to compare individual MRI lesions with age and sex matched controls.Methods:This was a cross-sectional observational study of MRI lesions of 431 participants with axial SpA compared with 53 age and sex matched participants with non-inflammatory back pain. Individual lesions identified included: discovertebral lesions (DVL), facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). Associated factors of the lesions were determined by regression analyses.Results:Compared to the control group, participants with axial SpA had more costovertebral lesions (12.5% vs 1.9%; p=0.02), CIL (46.6% vs 15.1%; p=0.03), and FCL (55.5% vs 39.6%; p=0.03). Multivariate regression showed that age (OR=1.02; p=0.03), regular alcohol use (OR=0.40; p=0.04) and radiographic axial SpA (OR=1.89; p=0.01) were associated with DVL; Chinese ethnicity (OR=0.06; p=0.01) and radiographic axial SpA (OR=3.63; p=0.01) were associated with facet joint lesion; radiographic axial SpA (OR=4.26; p<0.001) was associated with costovertebral joint lesion; male gender (ß=1.10; p=0.01), HLA B27 (ß=1.02; p=0.02), and radiographic axial SpA (ß=1.05; p=0.01) were associated with CIL; age (ß=0.10; p<0.01), male gender (ß=1.96; p=0.01), body weight (ß=0.11; p<0.01), HLA B27 (ß=3.23; p<0.001), and radiographic axial SpA (ß=1.77; p=0.02) were associated with FCL.Conclusion:The individual MRI lesions more specific to axial SpA when compared to non-inflammatory back pain were costovertebral joint lesions, CIL, and FCL.References:[1]Mandl P, Nacarro-Compan V, Terslev L, Aegerter P, van der Heijde D, D’Agpstino MA, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7): 1327-39.[2]Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskeletal Dis. 2012;4(4):301-11.[3]Bollow M, Fischer T, Reisshauer H, Backhaus M, Sieper J, Hamm B, et al. Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroillitis - cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis. 2000;59(2):135-40.Disclosure of Interests:None declared.
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