CaseA 41-year-old woman has a 26-year history of psoriasis vulgaris and psoriatic arthritis (PsA). Initially, multiple erythematous to brownish thick scaly plaques and papules were observed over her limbs (Fig. 1). Subsequently, arthralgia developed bilaterally over the knees and progressed to the hands and feet. X-ray films revealed subluxation and deformity of the small hand joints (Fig. 2). Her past medical history was otherwise unremarkable.She received topical steroid, calcipotriol, and broadband ultraviolet B therapy, but the disease persisted with intermittent flare-ups. Methotrexate was prescribed, but active arthritis over the hands, elbows, and right ankle were persistent, hence rheumatologists switched to leflunomide for PsA treatment. Nevertheless, the progression of joint deformities and swelling continued. She was subsequently shifted to adalimumab subcutaneous injection (40 mg every other week).However, she experienced an intermittent cough for 7 months after adalimumab initiation. Three weeks after discontinuation of adalimumab, episodic fever up to 38°C with an intermittent sore throat occurred for 1 week. Subsequently, the symptoms worsened with anterior neck tenderness, low-grade fever, and submandibular lymphadenopathy in the next week.Restless hand tremors and palpitations were also observed.Laboratory data showed thyroid-stimulating hormone (TSH), 0.006 mU/l; T 3 , 3.9 nmol/l; T 4 , >308.9 nmol/l; free T 4 , 52.6 pmol/l; and erythrocyte sedimentation rate, 89 mm/h. The results of a serology survey for influenza infection were Figure 1 Multiple erythematous to brownish thick scaly plaques and papules over the patient's upper limbs ª
Background Osteoporosis is a recognized major threat to public health. Socioeconomic status (SES) is an important factors affecting health, and a confirmed predictor of various diseases and death. This study aimed to determine the relationship between survival and SES among osteoporotic women in Taiwan. Methods A cohort population-based study was conducted using the National Health Insurance Research Database of Taiwan from 2008 to 2013. The study subjects were women aged ≥ 50 years with osteoporosis identified from either a previously-documented diagnosis or osteoporosis-related fractures according to diagnostic codes. We designated individual SES and neighborhood SES by each patient’s job category and household income, characterizing each as advantaged or disadvantaged. Then, we compared the survival rates by SES group using Cox proportional hazards models adjusted for risk factors. Results This study included 21,546 women aged ≥ 50 years with osteoporosis. In terms of 5-year overall survival, osteoporotic patients with low individual SES living in disadvantaged neighborhoods were riskier of mortality than those with high SES living in disadvantaged neighborhoods, after adjustment for age and comorbidity. Osteoporotic women with low individual SES living in disadvantaged neighborhoods had no significant difference of mortality as those with low individual SES living in advantaged neighborhoods. Conclusions In this study, we found that individual SES, but not neighborhood SES, had worst survival rate and was associated with an increased mortality rate in osteoporotic women.
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