Objective. Prediction of relapses inConclusion. Serial measurement of ANCA levels is valuable for the early prediction of relapses in patients with WG.
Research suggests that cannabis use affects negatively on onset and outcome of schizophrenia, but less is known about possible effects in mood disorders. Bipolar in- and outpatients (N = 3459) were enrolled in an observational study. The influence of cannabis exposure on clinical and social treatment outcome measures was examined over the course of 1 year, as well as the effects on these associations of third mediating variables. Over 12 months of treatment, cannabis users exhibited less compliance and higher levels of overall illness severity, mania, and psychosis compared with nonusers. Additionally, cannabis users experienced less satisfaction with life and had a lower probability of having a relationship compared with nonusers. There was little evidence that cannabis-outcome associations were mediated by third variables. An independent impact of cannabis use on psychopathologic outcomes in patients with bipolar disorder was apparent, whereas the impact on social outcomes was modest.
Objective. To analyze disease-free survival in patients with antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (AAV) treated with cyclophosphamide only or switched to azathioprine after 3 months of full remission while taking cyclophosphamide. Methods. We analyzed disease-free survival in all consecutive patients diagnosed with AAV between 1990 and 2000 at our center. Patients were treated with cyclophosphamide only (1990 -1996) or switched to azathioprine after 3 months of remission while taking cyclophosphamide (1997-2000). All patients received at least 12 months of followup. Results. Of the total 128 patients, 53 (41%) relapsed. Forty-four of the 128 patients (34%) had been switched to azathioprine therapy. Disease-free survival at 2 and 4 years was 76% and 65% in the cyclophosphamide group compared with 76% and 51% in the azathioprine group. In patients with proteinase 3 (PR3) classic ANCA (C-ANCA)-associated vasculitis who were switched to azathioprine (n ؍ 33), a positive C-ANCA titer at the moment of treatment switch (n ؍ 13) was significantly associated with relapse (RR 2.6, 95% confidence interval 1.1-8.0; P ؍ 0.04). In patients with a negative ANCA titer at the time of switch to azathioprine, disease-free survival at 2 and 4 years was 80% and 62%, which was identical to that for patients treated with cyclophosphamide only. In patients who were ANCA-positive at the time of treatment switch, disease-free survival at 2 and 4 years was only 58% and 17%. Conclusion. Switching cyclophosphamide to azathioprine after induction of remission in patients with PR3-ANCAassociated vasculitis who are still ANCA-positive at the time of treatment switch is associated with a high risk of relapse.
Objective. To describe the patients' perceptions of the effects of systemic lupus erythematosus (SLE) and Wegener's granulomatosis (WG) on health, function, income, and interpersonal relationships. Methods. 114 patients with SLE, and 79 patients with WG completed a self-administered questionnaire. Patients had been diagnosed with SLE or WG for a median period of 10 and 5 years, respectively. Results. All patients experienced substantial functional morbidity. Two-thirds of the patients with SLE or WG reported either a periodic or permanent inability to perform daily activities at home and/or at work. Furthermore, SLE as well as WG had a considerable impact upon the psychological and social life, affecting their happiness and altering relationships. Conclusion. Our study demonstrates that SLE and WG are associated with substantial medical morbidity resulting in physical and occupational disability. SLE has a profound impact on patients' lives, similar to that experienced in patients with WG.
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