The Effect of Leflunomide on Cold and Vibratory Sensation in Patients with Rheumatoid Arthritis

Objective To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with lefl unomide (LEF) by quantitative sensory testing (QST). Method A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory fi ndings, concomitant diseases, and medication history were evaluated at the time of QST. Th e cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured. Results Age, gender, RA duration, ESR, and CRP did not show any signifi cant diff erences between the two groups. VDT did not demonstrate any signifi cant diff erence in both groups. However, CDT in LEF group was signifi cantly higher than that of the control group (8.6±2.7 in LEF vs. 5.6±3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these fi ndings were not statistically signifi cant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show signifi cant correlation with CDT in both groups. VDT signifi cantly correlated with age in both groups. Conclusion LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not aff ected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF

Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management

The Cardiovascular Autonomic Neuropathy (CAN) Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy worked to update CAN guidelines, with regard to epidemiology, clinical impact, diagnosis, usefulness of CAN testing, and management. CAN is the impairment of cardiovascular autonomic control in the setting of diabetes after exclusion of other causes. The prevalence of confirmed CAN is around 20%, and increases up to 65% with age and diabetes duration. Established risk factors for CAN are glycaemic control in type 1 and a combination of hypertension, dyslipidaemia, obesity, and glycaemic control in type 2 diabetes. CAN is a risk marker of mortality and cardiovascular morbidity, and possibly a progression promoter of diabetic nephropathy. Criteria for CAN diagnosis and staging are: (1) one abnormal cardiovagal test result identifies possible or early CAN; (2) at least two abnormal cardiovagal test results are required for definite or confirmed CAN; and (3) the presence of orthostatic hypotension in addition to abnormal heart rate test results identifies severe or advanced CAN. Progressive stages of CAN are associated with increasingly worse prognosis. CAN assessment is relevant in clinical practice for (1) diagnosis of CAN clinical forms, (2) detection and tailored treatment of CAN clinical correlates (e.g. tachycardia, orthostatic hypotension, non‐dipping, QT interval prolongation), (3) risk stratification for diabetic complications and cardiovascular morbidity and mortality, and (4) modulation of targets of diabetes therapy. Evidence on the cost‐effectiveness of CAN testing is lacking. Apart from the preventive role of intensive glycaemic control in type 1 diabetes, recommendations cannot be made for most therapeutic approaches to CAN. Copyright © 2011 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86954/1/1239_ftp.pd

Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis

Objectives: Osteoarthritis (OA) is a leading cause of disability, but the relationship with premature mortality remains uncertain. We aimed to investigate the relationship between OA and mortality from any cause and from cardiovascular disease (CVD). Methods: Electronic literature databases searches were conducted to identify prospective studies comparing mortality in a sample of people with and without OA. Risk of all-cause and CVD mortality were summarized using adjusted hazard ratios (HRs) for joint specific (hand, hip, and knee) and joint non-specific OA. New data from the Progetto Veneto Anziani (PRO.V.A.) study were also included. Results: From the PRO.V.A. study (N 1⁄4 2927), there was no significant increase in mortality risk for participants with any joint OA (N 1⁄4 1858) compared to non-OA (all-cause, HR 1⁄4 0.95, 95% CI: 0.77–1.15 and CVD, HR 1⁄4 1.12, 95% CI: 0.82–1.54). On meta-analysis, seven studies (OA 1⁄4 10,018/non-OA 1⁄4 18,541), with a median 12-year follow-up, reported no increased risk of any-cause mortality in those with OA (HR 1⁄4 1.10, 95% CI: 0.97–1.25). After removing data on hand OA, a significant association between OA and mortality was observed (HR 1⁄4 1.18, 95% CI: 1.08–1.28). There was a significant higher risk of overall mortality for (1) studies conducted in Europe, (2) patients with multi-joint OA; and (3) a radiological diagnosis of OA. OA was associated with significantly higher CVD mortality (HR 1⁄4 1.21, 95% CI: 1.10–1.34). Conclusions: People with OA are at increased risk of death due to CVD. The relationship with overall mortality is less clear and may be moderated by the presence of hand OA