Objective. To examine the life expectancy, standardized mortality ratios (SMRs), and causes of death in 6 groups of patients from Hong Kong with different rheumatic diseases.Methods 7 years). In male patients, the loss in life expectancy was highest for SV (28.3 years), SLE (27 years), and SSc (16 years). There were 2,486 deaths during the study period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), and the principal causes were infections (28%), cardiovascular complications (18%), cancer (16%), and disease activity (7%). Infection was the leading cause of death in SLE, RA, AS, and PsA, whereas deaths from disease-related activity and cardiovascular complications were most frequent in SSc. Cancer was the most common cause of death in SV. Conclusion.Our findings indicate that patients with SLE, RA, AS, PsA, SV, and SSc have increased mortality rates and reduced life expectancy. SLE has the highest adjusted SMR, and female SSc patients have the greatest loss in life expectancy. Infection is the leading cause of death, followed by cardiovascular complications and malignancies.

Objective. To evaluate the prevalence of the metabolic syndrome in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). Methods. Consecutive patients with RA, AS, or PsA who attended our outpatient arthritis clinics between July and November 2009 were recruited for a study of atherosclerotic risk factors and the metabolic syndrome, defined according to the 2009 joint statements using the Asian criteria for central obesity. Results. Nine hundred thirty patients were studied (699 with RA, 122 with AS, and 109 with PsA; 70% women, mean ؎ SD age 51.1 ؎ 12.7 years). The mean ؎ SD disease duration for patients with RA, AS, and PsA was 5.3 ؎ 5.4, 6.0 ؎ 5.6, and 3.6 ؎ 3.1 years, respectively. The prevalence of metabolic syndrome was significantly higher in PsA (38%) than RA (20%) or AS (11%; P < 0.001). The odds ratios (ORs) for the metabolic syndrome compared to age-and sex-matched controls were 0.98 (95% confidence interval [95% CI] 0.78 -1.23, P ‫؍‬ 0.88), 0.59 (95% CI 0.30 -1.15, P ‫؍‬ 0.12), and 2.68 (95% CI 1.60 -4.50, P < 0.001), respectively, for RA, AS, and PsA. Patients with PsA had a significantly higher prevalence of impaired fasting glucose (30%; P < 0.001), low high-density lipoprotein (HDL) cholesterol (33%; P < 0.001), high triglycerides level (21%; P ‫؍‬ 0.008), central obesity (65%; P < 0.001), and high blood pressure (56%; P ‫؍‬ 0.045). In a logistic regression model, the adjusted OR for the metabolic syndrome in PsA was 2.44 (95% CI 1.48 -4.01, P < 0.001) relative to RA or AS. The adjusted ORs for central obesity, impaired fasting glucose, hypertriglyceridemia, and low HDL cholesterol were also significantly higher in PsA patients. Conclusion. Patients with PsA, but not RA or AS, have a significantly higher prevalence of the metabolic syndrome compared to the general population. Among the 3 diseases studied, PsA has the highest prevalence of the metabolic syndrome and is associated with the highest cardiovascular risk.

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Objective.To study the level of anti-müllerian hormone (AMH) and its relationship to age and previous exposure to cyclophosphamide (CYC) in patients with systemic lupus erythematosus (SLE).Methods. Consecutive female patients ages 18-52 years who had menses at least once during the preceding 12 months and fulfilled >4 American College of Rheumatology criteria for SLE were recruited. AMH was determined using an enzyme-linked immunosorbent assay (ELISA) kit. Serum AMH levels were compared in patients with and without previous use of immunosuppressive agents. The relationship of the AMH level to the patient's age and CYC exposure was studied by linear regression and receiver operating characteristic (ROC) curve analysis.Results. A total of 216 patients were studied (mean ؎ SD age 35.1 ؎ 10.1 years, mean ؎ SD SLE duration 7.6 ؎ 5.9 years). The mean ؎ SD AMH level was significantly lower in patients previously exposed to CYC therapy than in those who had not been exposed after adjustment for age (1.58 ؎ 2.92 versus 1.73 ؎ 2.11 ng/ml; P ‫؍‬ 0.04). The median time interval between the AMH assay and the last dose of CYC administered was 6.7 years (interquartile range 3.4-8.5). AMH levels in users versus nonusers of other immunosuppressive agents, including mycophenolate mofetil, azathioprine, and the calcineurin inhibitors, were not statistically different. Linear regression revealed increasing age (beta ؊0.32, P ‫؍‬ 0.02) and each 5 gm of CYC exposure (beta ؊0.28, P ‫؍‬ 0.047) were independently associated with a lower AMH level. In patients ages 30 years and younger, a cumulative CYC dose cutoff of 5.9 gm yielded a sensitivity of 0.75 and a specificity of 0.80 for the prediction of undetectable AMH level on ROC curve analysis.Conclusion. AMH is a sensitive marker for ovarian damage due to previous CYC exposure in women with SLE.

BMD of the spine and hip is significantly lower in patients with SSc than in healthy subjects, which is independent of age, sex, menopause, low BMI and altered body composition.