Psoriatic arthritis (PsA) is a chronic T cell-mediated inflammatory spondyloarthropathy affecting 10-40 % of psoriasis (PSO) patients (0.3-1.0 % of the general population). Recent epidemiological studies have shown an increased prevalence of cardiovascular (CV) risk factors and/or morbidity among PSO or PsA patients as compared to control individuals. The aim of this study is to describe the CV profile of PsA patients in Newfoundland, Canada. The possible impact of duration of chronic inflammation on CV variables was also explored. PsA patients were selected from a registry of PSO and PsA patients in Newfoundland. PsA patients diagnosed as per the CASPAR criteria are entered in the registry at the time of diagnosis, questioned on their medical history, and are followed indefinitely. Based on the duration since PsA diagnosis patients were classified as having early (<2 years) or established (≥2 years) PsA. CV risk was assessed using both conventional (hypertension, hypercholesterolemia, diabetes, obesity) and non-conventional (markers of chronic inflammation) factors. A total of 196 PsA patients were included; 42.9 % had early PsA and 57.1 % had established PsA. The prevalence of hypercholesterolemia, obesity, hypertension, diabetes mellitus, anxiety/depression, and coronary heart disease was 61.6, 59.7, 32.7, 13.8, 13.8, and 8.7 %, respectively. The prevalence of comorbidities was generally comparable between cohorts with exception of anxiety/depression, which was considerably higher in patients with established PsA compared to early PsA and obesity which was more common among male patients with established PsA. However, upon adjusting for age and gender differences, no statistically significant between-group differences were observed. Overall, these results suggest that PsA, even at early stages, is associated with significant CV comorbidity. These conditions should be taken into consideration when assessing the PsA burden of illness in epidemiological and health outcomes studies. Furthermore, early detection and management of these conditions could improve the patients' disability and quality of life.
ObjectiveTo determine the association between drinking water quality and rates of type 1 diabetes in the Newfoundland and Labrador (NL) population, which has one of the highest incidences of type 1 diabetes reported globally.Research design and methodsThe study used a community-based, case-control design. We first calculated incidence rates of type 1 diabetes at the provincial, regional and community levels. The connection between incidence rates and components in public water supplies were then analyzed in three ways: to evaluate differences in water quality between communities with and without incident cases of type 1 diabetes, and to analyze the relationship between water quality and incidence rates of type 1 diabetes at both the community and regional levels.ResultsThe provincial incidence of type 1 diabetes was 51.7/100 000 (0-14 year age group) for the period studied. In the community-based analysis, there were significant associations found between higher concentrations of arsenic (β=0.268, P=0.013) and fluoride (β=0.202, P=0.005) in drinking water and higher incidence of type 1 diabetes. In the regional analysis, barium (β=−0.478, P=0.009) and nickel (β=−0.354, P=0.050) concentrations were negatively associated with incidence of type 1 diabetes.ConclusionsWe confirmed the high incidence of type 1 diabetes in NL. We also found that concentrations of some components in drinking water were associated with higher incidence of type 1 diabetes, but no component was found to have a significant association across the three different levels of analysis performed.
Background The pathogenic mechanisms involved in increased CV complications in RA patients are multifactorial due to RA-related inflammation as well as the traditional risk factors affecting the general population. Objectives To assess 10-year CV event risk in patients with RA at the baseline, 12 and 18 months after the initiation of treatment with Biologic DMARDs (BDMARDs). Methods 215 patients with RA receiving biologic therapy (Etanercept, Adalimumab, Rituximab, Tocilizumab and Abatacept) were included in this study. The FRS was used for the assessment of the 10-year CV risk. The presence of CV risk factors was ascertained by a medical records review throughout the study. Paired t-test and Regression analyses before and after treatment with biologics were performed. The mean age was 55.6 (12) years. The mean age at RA diagnosis was 41.6 (13.2) years with mean duration of RA 14.6 (8.6) years. 7 patients had MI and 5 TIA/Stroke prior to the study. 41 patients smoked at the baseline. 61 patients were on Lipid-lowering treatment, of them 31 (45%) started it after the initiation of the treatment with biologics. TJC and SJC were significantly reduced after 12 and 18 months of treatment. The mean TC not significantly increased from the baseline measures. HDL significantly increased at 12-month and not significantly at 18-month period. The AI was significantly reduced during the two follow-up periods. CRP, ESR and DAS28 were also significantly reduced from the baseline levels. Patients were grouped by their 10-year CVD risk level: 5.2% of men and 3.8% of women in an 18-month period lowered their risk from the high to the moderate/low. The overall risk of CVD was slightly reduced at 12-month but significantly at 18-month (from 11.5±9.4 to 10.7±8.9, p=0.011; 95%CI 0.18-1.36). 10-year CV event risk was significantly improved at 18-month in Tocilizumab (14.2±10.0 vs. 12.7±9.1; p=0.026; 95%CI 0.20-2.85) and Abatacept (12.7±10.3 vs. 10.6±9.8; p=0.011; 95%CI 0.53-3.64) cohorts. Conclusions Our findings showed a trend in reducing a 10-year CV event risk over 18-month period. No CV event was observed during the study period. The results demonstrated a favorable effect of BDMARDs on the levels of atheroprotective HDL-C. Good control of the chronic inflammation by biologic DMARDs effectively decreased the intermittent disease activity and possibly played a pivotal role in reducing the risk for CV event in patients with RA. Disclosure of Interest M. Khraishi Grant/research support from: Dr. Khraishi received non restricted educational grants from Hoffman-La Roche Canada, Amgen and Pfizer Canada, and Abbott Canada, R. Aslanov: None Declared
Background Psoriatic arthritis (PSA) is a chronic condition that affects up to 1% of the general population and is associated with progressive joint damage, disability, and serious co-morbidities. Objectives To assess and compare utilization of healthcare services by patients with Early (EPsA) and Established (EstPsA) PsA To assess patients’ Quality of Life over 12 months Methods 151 patients with PsA were recruited from a rheumatology clinic and followed prospectively for a 12-month period. Fifty eight patients had EPsA and 93 had EstPsA (defined as <2 and ≥2 years from onset of arthritis symptoms, respectively). The HCU was examined using “Health Care Utilization Resource Use” form. The QoL was evaluated using EUROQOL-5D and SF36 tools. The association of disease severity with patients’ utilization of health care services and their QoL were also analyzed and compared between two cohorts. Results At baseline, patients with EPsA utilized more health care services for arthritis and co-morbidities (e.g. CHD, Diabetes and Infections) than those with EstPsA: “ER” (0.12 vs. 0.09), “Doctor’s Office Visit” (0.91 vs. 0.72), “Specialist Visit” (0.86 vs.0.73), “Psychologist/Counsellor”(0.07vs.0.05) and “Physiotherapy/Rehabilitation” (0.26 vs. 0.19). Patients with EstPsA used more “Walk in Clinic” (0.12 vs. 0.09) and “Hospital Admittance” (0.05 vs. 0.02) services. DAS28 was strongly associated with HCU in both cohorts (EPsA: OR=1.3, p=0.049, 95%CI 1.0-1.7; EstPsA: OR=1.6, p=0.001, 95%CI 1.2-2.1). DAS28 and HAQ significantly correlated with QoL in both cohorts: EPsA: r=-0.28, p=0.002 and r=-0.41, p<0.001, respectively; EstPsA: r=-0.35, p<0.001 and r=-0.43, p<0.001, respectively. By 12 months, EPsA patients non-significantly improved their Physical Health, while EstPsA patients showed significant improvement in both Physical (48.3 vs. 56.4, p=0.021) and Mental (61.1 vs. 68.2, p=0.026) components of SF36. EQ-5D Visual Analog Scale also showed significant improvement for EstPsA patients. Conclusions PsA causes considerable disability and affects the QoL of patients even at early stages of the disease. Traditionally, it was felt that longer disease duration leads to greater health care utilization. However, our findings showed that patients with EPsA seem to utilize more health care services. Early initiation of treatment with DMARDs may reduce the burden of PsA on the health care system and improve patients’ well-being and quality of life. Disclosure of Interest M. Khraishi Grant/research support from: Dr. Khraishi received non restricted research grants from Hoffman-La Roche Canada, Amgen and Pfizer Canada, and Abbott Canada, R. Aslanov: None Declared, S. Khraishi: None Declared, H. Zurel: None Declared
Background Multiple studies suggest that patients with Psoriatic Arthritis (PsA) are at increased risk of cardiovascular diseases than the general population. This risk seems to be strongly associated with subclinical atherosclerosis and high prevalence of comorbidities. Objectives To assess the prevalence of comorbidities in patients with PsA and their impact on patients' 10-year cardiovascular risk and quality of life (QoL) Methods A cohort of 280 PsA patients has been followed prospectively between January 2009 and December 2013. Clinical, laboratory and quality of life data were collected every six months. The frequency of 25 comorbidities was ascertained. Paired t-test was conducted to compare variables at the baseline and 24 months. Regression analyses were performed to estimate the magnitude of the association between number and type of comorbidities and variables of interest. Ten-year CV risk was assessed using the Framingham Risk Score and 2009 Canadian Cardiovascular Society guidelines; SF-36 and EQ-5D forms were used for patients' quality QoL. Results A total of 200 patients (50.5% males) were included in this analysis with mean (SD) age 50.2 (10.5) and mean (SD) of PsA duration 4.4 (5.8) years. Prevalence of comorbidity was high with 58% of patients having 4 or more of coexisting conditions. The most prevalent were Obesity (60.5%), non-PSA musculoskeletal diseases (59.5%), HTN (27.5%), Anxiety/Depression (23.5%), DM (15%) and IHD (14.5%). Polyarthritis was the most common pattern (57%), followed by DIP (50%), olygoarthritis, axial, and both axial and peripheral joints involvement. Ten-year CV risk was associated with patients' age at PsA diagnosis (p<0.001; 95%CI 0.29-0.57), duration of PsA (p<0.001; 95%CI 0.27-0.45), and traditional CV comorbidities such as dyslipidemia (p<0.001), hypertension (p=0.019), diabetes (p<0.001), CHD (p=0.015), cerebrovascular disease (p0.003), smoking (p=0.011), and peripheral vascular disease (p<0.001). Other comorbidities in the model failed to achieve significant association. In 24 months, the 10-year risk for CV event improved non-significantly. Disease activity improved significantly (CRP (p<0.001), ESR (p=0.030), DAS28 (p<0.001). Also improvement was evident in the PASQ (p<0.001) and PASI (p<0.001)) scores. Treatment of 31.5% of patients with statins reduced the values of TC, LDL-C and Atherogenic Index (p=0.050, p=0.019 & p<0.001). General Health (GH) and its Physical (PCS) and Mental (MCS) component scores of the SF-36 were significantly and negatively associated with axial involvement, polyarthritis, and axial with peripheral joints involvement. Those three parameters of QoL were also significantly affected by Anxiety/Depression (p=0.002, p=0.012 & p<0.001), Obesity (p=0.012, p=0.023 & p=0.030), and total number of comorbidities (p=0.008, p=0.033 & p=0.035). EQ-5D VAS (p=0.007) and PCS (p=0.001) improved in 24 months without significant changes in patients' MCS and GH. Conclusions There was a high prevalence of cardiovascular comorbidities with their sig...
BACKGROUND:Human Papillomavirus (HPV) is the most common sexually transmitted agent. These small DNA viruses target the basal cells of the epithelium. While the HPV family is comprised of more than 100 genotypes, only about 40 or so types are associated with human anogenital infections. Infection s with oncogenic HPV 53,66,6 8,73,18,31,33,35,39,45 ,51,52,56,58,59) OBJECTIVES:Primary: To determine the prevalence and distribution of high risk (HR) oncogenic HPV-types in HIV-positive adult s in Atlantic Canada.Secondary: To correlate the prevalence of HR HPV genotyp es with underl ying pre-malign ant lesions and maligna ncy through a cross-sectiona l study.To corre late pre-ma lignant lesions and malignancy with patient s' demographics and underlying risk factor s.This thesis is part of a larger prospective cohort study designed to follow consenting persons with Hl'V infection in Atlantic Canada over a 3-year period subsequent to baseline screening in year one. The data in this thesis are limited to that obtained at baseline in all four Atlantic Provinces during the first year of the study. All Hlv-positive adults treated through the participating infectious disease clinics were approached by the clinic physicians or nurses to request participation in the study. Atlantic Canada has approximately 800 routinely followed HlV-positive adults and we expected to enroll approximately 400 of them. This study was approved by ethic committees of all participating institutions as well as the Public Health Agency of Canada, the funding agency for the study.Recruitment commenced in June, 2009. All procedures were performed after obtaining informed consent. Consenting participants were required to comp lete a confidential questionnaire to obtain demographic and risk factor data. Participants' identifiers were retained to permit questionnaire data to be correlated with HPV related disease outcomes. SurePath (Becton Dickinson) liquid cytology medium was used in the collection of oropharyngeal and anal swab specimens from all males and females, and an additional cervical specimen was obtained from females. All specimens were tested for cytologic abnormalities , HPV DNA and genotyping . The study cohort will be followed up with the above protocol for a period of 3 years. These results will be subsequently used to assess any HPV related disease outcome and genotypic specific information. Consent also gives access to patients' medical files for information on viral load, CD4+T cell count and treatment regimens in order to correlate these factors with disease outcome.The study analysis is based on a total of 300 patients; of these 91.7% were males. The population and gender distribution among the provinces were: Nova Scotia, Halifax (NSH) -total 150 patients, of these 142 (94.7%) were males; New Brunswick, Moncton (NBM) -total 90 patients, of these 85 (94.4%) were males; Newfoundland and Labrador, St. John's (NLSJ) -total 44 patients, of these 34 (77.3%) were males; and New Brunswick, Saint John (NBSJ) -total 16 patients, of ...
Background Rheumatoid Arthritis (RA) is a systemic autoimmune disease affecting up to 1% of the general population. Continuous measurement of RA activity facilitates clinical decision-making and treatment to target strategy. The CDAI measurement provides a sensitive and accurate reflection of disease activity. Objectives We aimed to validate the accuracy of the assessment of RA disease activity by a healthcare professional (nurse) trained in joint examination using an electronic version of CDAI as compared to rheumatologist assessments. Methods Thirty-eight consecutive patients with RA attending a biologic therapy infusion centre were included in this study. The CDAI scores were obtained for the same patients by rheumatology nurses trained in joint counting and a rheumatologist. Both the nurse and rheumatologist were blinded to the other's assessment results. The order of the assessments by examiners was changed every second patient. The total score, Swollen and Tender Joint Counts (SJC & TJC) and the Global Assessment (GA) of disease activity were compared between evaluators using student t-test and Mann-Whitney U test. All scores were assessed based on CDAI Disease Activity State levels: Remission-0 (<2.8); Low-1 (2.8-9.9); Moderate-2 (10-22); and High-3 (>22). The Pearson's correlation (r) and the level of agreement between evaluators were also investigated using Kappa (Chi-square) statistics. The HAQdas iPad app V4.0 (NLRT) was used in all cases. Results Thirty-eight RA patients (84.2% females) with mean (SD) age of 43.1 (19.2) years and mean (SD) duration of disease 14.6 (9.4) were assessed during the study. All measurements taken by nurses were strongly correlated with measurements provided by the physician: SJC (r=0.86, p<0.001); TJC (r=0.97, p<0.001); GA of disease activity (r=0.94, p<0.001); CDAI scores (r=0.98, p<0.001); and Disease Activity State (r=0.95, p<0.001). Nurses tended to count less swollen joints (5.2 (4.7) vs. 5.4 (5.1), p=0.63) and more tender joints (11.6 (9.8) vs. 11.1 (9.5), p=0.78) compared to the physician. The mean CDAI score obtained by nurses and the physician did not differ significantly (24.6±17.8 vs. 24.9±17.6, p=0.579; 95%CI -1.42-0.80). Even though, nurses tended to rate the Disease Activity State significantly lower than rheumatologist (2.1±1.0 vs. 2.2±1.0; p=0.023; 95%CI -0.24-(-0.02)), the agreement between evaluators was high with approximately 80% (p<0.001) of patients concordantly classified by Disease Activity State. Conclusions There was strong agreement between evaluators of different backgrounds in their assessment of RA patients' disease activity (CDAI). The study results suggest that measuring and following disease activity in RA utilizing the CDAI can be employed effectively by a trained Health Care Professional (HCP), independently and probably in different locations and settings. The electronic versions of the CDAI seem to be useful in treating to target strategy, as a clinical index of RA disease activity and planning adjustments of therapy. This appro...
Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with variable manifestations. New developments in the understanding and treatment of SLE mandated closer monitoring of the disease activity and its response to treatment. Current disease activity indices (e.g. SLEDAI SELENA, BILAG & SLAM) have their own limitations. Two new disease activity evaluation tools (the SLE Activity Scoring Tool (LAST) and the Clinical LAST (C-LAST)) were designed to simplify the approach in quantifying SLE activity while maintaining high sensitivity. An easy to use electronic application of these tools was also developed. Objectives Primary: To validate two SLE activity tools with their correlation to the SLEDAI SELENA modification. Secondary: To test the usability and the accuracy of electronic applications of the same tools in clinical settings. Methods The new disease activity tracking and evaluating tools included patient global assessment of disease activity (PGA), physician global assessment of disease activity (PHGA), and a formula incorporating the current immunomodulating medication used as an indication of SLE activity. The LAST included C3, C4 and Anti-ds Anti-DNA titer abnormalities as activity indicators. Patients who met the SLE ACR 1997 criteria update were seen in a rheumatology clinic during the last 12 months. The laboratory investigations were done within 2 weeks of their visit and the SLEDAI was evaluated for each visit. Five different algorithms of weighting the disease activity through different variables were calculated. Apple iPad and Windows web-based applications were developed for the LAST and C-LAST. Descriptive statistics and correlation bivariates (Pearson’s & Spearman’s) were conducted. Each algorithm result and multiple assessments of the disease activity were compared to the SLEDAI SELENA. Results Twenty patients (90% females) with 38 assessments were included. Scores from 5 algorithms of the variables in addition to the SLEDAI SELENA scores were obtained at each visit. The mean (SD) age was 48.25 (15.17) years and the mean (SD) of disease duration was 12.35 (6.80) years. The mean (SD) SLEDAI score was 5.97 (4.12). The mean (SD) C-LAST and LAST (with C3, C4 and Anti-ds DNA) scores were 38.19 (19.27) and 35.32 (19.15), respectively. The correlation between the two new indices was very high: 0.925 with p=0.011. The correlation of the SLEDAI with both the LAST and the C-LAST was also significant (0.903 (p<0.001) and 0.766 (p<0.001), respectively). The SLEDAI scores were consistent with the LAST and C-LAST scores at the baseline and follow-up visits: from 0 to 4 corresponded up to 30; from 8 and higher were up to 50 and higher, respectively. The electronic applications of the LAST and C-LAST were easy to use and there were no errors detected in their results. Conclusions The new disease activity tools correlated well with the SLEDAI SELENA modification. The use of simple clinical variables as a measure of SLE activity seemed to be valid. The development of easy to use electronic...
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