Objective Patients with rheumatoid arthritis (RA) often suffer from bone complications due to persistent joint inflammation, especially incident fracture. Nowadays, Chinese herbal medicines (CHMs) have provided safe and effective therapy for treating skeletal conditions, but it is unclear whether CHMs can prevent fracture onset among RA individuals. This study aimed to determine the association between the use of CHMs and the risk of fracture among them. Methods This retrospective, population-based study retrieved administrative health data from the Taiwan National Health Insurance (NHI) database to identify patients with newly diagnosed RA between 2000 and 2009. Of the 6178 incident RA patients, 2495 matched pairs of CHMs users and non-CHMs users were identified by propensity score matching. Enrollees with hip fractures prior to RA onset were excluded. Included subjects were followed until the end of 2013. Incidence and adjusted hazard ratios (HR) of new-onset bone fracture in the multivariable Cox proportional hazard model were measured with 95% confidence interval (CI). Results Fracture incidence was lower in CHMs users than in the comparison cohort (26.91 vs 32.94 per 1000 person-years, respectively), with an adjusted HR of 0.82 (95% CI: 0.73–0.92). Subjects receiving CHMs for more than 2 years had a much lower risk of fracture onset by more than 50%. Some CHMs prescriptions (Yan Hu Suo, Bei Mu, Da Huang, Dang Shen, Fu-Zi, Shu-Jing-Huo-Xue-Tang, Dang-Gui-Nian-Tong-Tang, Jia-Wei-Xiao-Yao-San, Gan-Lu-Yin, and Gui-Zhi-Shao-Yao-Zhi-Mu-Tang) were associated with reduced fracture risk. Conclusion Adding CHMs to routine treatment was found to be related to lower fracture risk in RA patients.
Objective: Menopausal women appear to report a higher risk of Sjögren syndrome (SS). Although Chinese herbal medicines (CHMs) are proven to lower SS risk, the scientific evidence of whether it can lessen the occurrence of SS among menopausal women is limited. This longitudinal cohort study aimed to clarify the relationship between CHMs use and SS risk in menopausal women. Methods: Using a nationwide claims data, we enrolled 31,917 women with first-time diagnosed menopause who simultaneously were free of SS between 2000 and 2007. Among them, we randomly selected 12,757 CHMs users and 12,757 non-CHMs users using propensity scores matching. All participants were followed until the end of 2012 to record SS incidence. The hazard ratio of SS with regard to CHMs use was estimated using the Cox proportional hazards regression model. Results: In the follow-up period, 589 CHMs users and 644 non-CHMs users developed SS, representing incidence rates of 5.12 and 6.40, respectively, per 1,000 person-years. CHMs use was associated with a 21% lower subsequent risk of SS (adjusted hazard ratio, 0.79; 95% CI, 0.71-0.89). Six commonly prescribed CHMs were discovered to be associated with lower SS risk: Ge-Gen-Tang, Zhi-Gan-Cao-Tag, Da-Huang, Ye-Jiao-Teng, Tian-Hua-Fen, and Bo-Zi-Ren. Conclusions: A statistically significant association was found between CHMs use and lower risk of SS onset in menopausal women, suggesting that CHMs could be considered to integrate it into conventional therapy to reduce subsequent SS risk for menopausal women.
Background:ObjectivesTo study the relationship between the 2019 EULAR/ACR classification criteria and organ damage in patients with systemic lupus erythematosus (SLE)MethodsPatients involved in a cross-sectional validation study of the EULAR/ACR criteria and judged by a panel of rheumatologists to be clinical SLE were studied. Those who fulfilled the EULAR/ACR criteria at their last clinic visit were stratified into 2 groups based on a cut-off score of 20. The last SLE international collaborating clinic (SLICC) organ damage index (SDI) was compared between these two groups. Relationship among the domains of the EULAR/ACR criteria and SDI in all patients was studied by Spearman’s rank correlation.Results562 SLE patients were studied (93.6% women; age 36.5±14.1 years; follow-up duration 11.6±6.6 years). The mean and median EULAR/ACR criteria scores in those who fulfilled the EULAR/ACR criteria (N=542) was 24.6±7.3 and 24 (interquartile range 19-30), respectively. A total of 392 patients had EULAR/ACR scores of ≥20 (group 1) and 150 patients had scores of 10-19 (group 2). Group 1 patients had significantly higher prevalence of fever, alopecia, oral ulcers, acute lupus skin lesions, arthritis, serositis, seizure, hemolytic anemia, leukopenia and renal disease, and so were the anti-dsDNA, anti-Sm, antiphospholipid antibodies and low complement state. Organ damage (SDI score of ≥1) occurred in 232 (42.8%) patients. Patients in group 1 had significantly higher SDI scores in the renal, cardiovascular, dermatological and gonadal domains than group 2. The renal, neuropsychiatric and antiphospholipid antibodies domain scores of the EULAR/ACR criteria correlated positively with the total SDI. The renal domain of the EULAR/ACR criteria had the strongest correlation with renal damage (Rho 0.30; p<0.001). Patients who scored 10 points in the renal domain had significantly higher renal damage score than those scored 8 points or 4 points. Gonadal damage score was also significantly more common in the 10-point than 8-point group.ConclusionIn addition to disease classification, the EULAR/ACR SLE criteria may have a role in predicting organ damage and disease prognosis.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
Objectives:To validate the 2019 EULAR/ACR classification criteria for SLE in Hong Kong Chinese patients and compare its performance with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) and 1997 American college of rheumatology (ACR) criteria.Methods:We retrospectively reviewed the medical records of consecutive patients who attended the Rheumatology clinics in Tuen Mun and Pok Oi hospitals between May and September 2019. Patients with anti-nuclear antibody (ANA) ≥1:80 were included and patients with ANA <1:80 or no ANA results were excluded. Patients were evaluated and cross-checked for the fulfilment of the 1997 ACR, 2012 SLICC and 2019 EULAR/ACR criteria by two investigators (YKC,CL). Medical records were then reviewed by an expert panel consisting of 3 senior rheumatologists, who were blinded for the results of the criteria evaluation, for a diagnosis of SLE based on the clinical judgement and therapeutic decisions. Teleconferences were arranged by the panel to discuss the discrepancies of the final diagnosis and agreement was made by voting. The three SLE criteria were evaluated against the clinical diagnosis of SLE as judged by the expert panel on the sensitivity and specificity, which was calculated by 2x2 contingency tables (“condition positive” = clinical diagnosis of SLE; “test positive” = criteria positive for SLE) with standard formulas (sensitivity = true positive/[true positive + false negative]; specificity = true negative / [true negative + false positive]). Receiver operating characteristic (ROC) curve was used to study the optimal cut-off points from the EULAR/ACR criteria for the highest summation of specificity and sensitivity.Results:3967 patients were screened; 1542 patients who were positive for ANA (≥1:80) were included (88.3% women). The mean age of these patients at first rheumatology clinic attendance was 45.6±15.0 years and the duration of follow-up was 7.5±7.0 years. A total of 567 patients were judged to have SLE by the expert panel (discrepancy of clinical diagnosis in 135 patients resolved with voting). The sensitivity and specificity of the three SLE classification criteria in our patients are listed in Table 1. ROC analysis showed that the best cut-off for a clinical diagnosis of SLE using the EULAR/ACR criteria was 10 points (area under the curve [AUC] 0.977; sensitivity 89.2% and specificity 89.6%). Similar figures were obtained for subgroups of patients stratified by gender and different age ranges.Conclusion:In our cohort of Hong Kong Chinese patients, the 2019 EULAR/ACR criteria is more sensitive but less specific when compared with 1997 ACR criteria for classifying SLE. On the other hand, the EULAR/ACR criteria is less sensitive but more specific than the 2012 SLICC criteria. The specificity of the EULAR/ACR criteria for SLE is higher in male than female patients. In our patients older than 50 years, the EULAR/ACR criteria is less sensitive but more specific for a classification of SLE. Overall, the performance of the EULAR/ACR criteria for a diagnosis of SLE in our study is similar to that reported in recent Asian studies although the sensitivity is lower, which may be related to the inclusion of ANA+ patients only.References:Classification criteriaSensitivitySpecificity1997 ACR85.9%94.4%2012 SLICC97.5%86.4%2019 EULAR/ACR with 10 points as cut-off89.2%89.6%2019 EULAR/ACR with 9 points as cut-off93.6%68.7%2019 EULAR/ACR with 11 points as cut-off86.9%92.4%2019 EULAR/ACR with 10 points as cut-off (men)88.9%94.5%2019 EULAR/ACR with 10 points as cut-off (women)89.2%88.8%2019 EULAR/ACR with 10 points as cut-off (age >50 years)78.7%94.1%2019 EULAR/ACR with 10 points as cut-off (age ≤50 years)91.7%84.1%Disclosure of Interests:None declared
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