An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists

Objectives: To explore current management practices for PMR by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment.Methods: An English language questionnaire was constructed by a working group of rheumatologists and GPs from six countries. The questionnaire focused on: 1: Respondent characteristics; 2: Referral practices; 3: Treatment with glucocorticoids; 4: Diagnostics; 5: Comorbidities; and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/Giant Cell Arteritis Study Group.Results: In total, 394 GPs and 937 rheumatologists responded to the survey. GPs referred a median of 25% of their suspected PMR patients for diagnosis and 50% of these were returned to their GP for management. In general, 39% of rheumatologists evaluated patients with suspected PMR &gt;2 weeks after referral, and a median of 50% of patients had started prednisolone before rheumatologist evaluation. Direct comparison of initial treatment showed that the percentage prescribing &gt;25 mg prednisolone daily for patients was 30% for GPs and 12% for rheumatologists. Diagnostic imaging was rarely used. More than half (56%) of rheumatologists experienced difficulties recruiting people with PMR to clinical trials.Conclusion: This large international survey indicates that a large proportion of people with PMR are not referred for diagnosis, and that the proportion of treatment-naive patients declined with increasing time from referral to assessment. Strategies are needed to change referral and management of people with PMR, to improve clinical practice and facilitate recruitment to clinical trials.</p

Clinical and Serological Features in Latin American IgG4-Related Disease Patients Differ According to Sex, Ethnicity, and Clinical Phenotype

Background/Objective Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD. Methods We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation. Results The mean age was 50.8 ± 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance. Conclusions Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype.Fil: Martín-Nares, Eduardo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Department of Immunology and Rheumatology; MéxicoFil: Baenas, Diego Federico. Hospital Privado Universitario de Córdoba. Servicio de Reumatología; ArgentinaFil: Cuellar Gutiérrez, María Carolina. Hospital Del Salvador. Departamento de Medicina Interna. Servicio de Reumatología; ChileFil: Hernández-Molina, Gabriela. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Department of Immunology and Rheumatology; MéxicoFil: Ortiz, Alberto Christian. Hospital José María Cullen. Sección de Reumatología; ArgentinaFil: Neira, Oscar. Universidad de Chile. Hospital Del Salvador. Sección Reumatología; ChileFil: Neira, Oscar. Clínica Alemana de Santiago-Universidad Del Desarrollo. Unidad Reumatología; ChileFil: Gutiérrez, Miguel A. Universidad de Valparaíso. Hospital Naval Almirante Nef. Departamento de Reumatologia; ChileFil: Calvo, Romina. Hospital José María Cullen. Sección de Reumatología; ArgentinaFil: Saad, Emanuel José. Hospital Privado Universitario de Córdoba. Departamento de Clínica Médica; ArgentinaFil: Elgueta Pinochet, Sergio. Hospital Clínico de la Universidad de Chile. Sección Reumatología. Departamento de Medicina; ChileFil: Gallo, Jesica. Hospital Central de Reconquista. Sección de Reumatología; ArgentinaFil: Herrera Moya, Alejandra. Pontificia Universidad Católica de Chile. Departamento de Inmunología Clínica y Reumatología; ChileFil: Mansilla Aravena, Bellanides Agustina. Hospital Clínico Magallanes; ArgentinaFil: Crespo Espíndola, María Elena. Hospital Señor Del Milagro; ArgentinaFil: Cairoli, Ernesto. Hospital Evangélico. Unidad de Enfermedades Autoinmunes; BrasilFil: Cairoli, Ernesto. Centro Asistencial Del Sindicato Médico Del Uruguay. Unidad de Enfermedades Autoinmunes; UruguayFil: Cairoli, Ernesto. Institut Pasteur. Laboratorio de Inmunorregulación e Inflamación; UruguayFil: Bertoli, Ana María. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Servicio de Reumatología; ArgentinaFil: Córdoba, Mercedes. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Servicio de Reumatología; ArgentinaFil: Wurmann Kiblisky, Pamela. Hospital Clínico Universidad de Chile.Fil: Basualdo Arancibia, Washington Javier. Departamento de Medicina. Sección Reumatología; ChileFil: Badilla Piñeiro, María Natalia. Hospital Del Salvador, Universidad de Chile. Sección Reumatología; ChileFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Hospital Córdoba; ArgentinaFil: Berbotto, Guillermo Ariel. Sanatorio Británico. Servicio de Reumatología; ArgentinaFil: Pisoni, Cecilia N. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno. Sección Reumatología e Inmunología; ArgentinaFil: Juárez, Vicente. Hospital Señor Del Milagro; ArgentinaFil: Cosatti, Micaela Ana. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno. Sección Reumatología e Inmunología; ArgentinaFil: Aste, Nora María. Reumatología; ArgentinaFil: Airoldi, Carla. Hospital Provincial. Reumatología; ArgentinaFil: Llanos, Carolina. Pontificia Universidad Católica de Chile. Departamento de Inmunología Clínica y Reumatología; ArgentinaFil: Vergara Melian, Cristian Fabián. Hospital San Martin de Quillota; ChileFil: Vergara Melian, Cristian Fabián. Clinica Ciudad Del Mar; ChileFil: Erlij Opazo, Daniel. Universidad de Chile. Hospital Del Salvador. Departamento de Medicina Oriente; ChileFil: Goecke, Annelise. Hospital Clínico Universidad de Chile. Departamento de Medicina. Servicio de Reumatología; ChileFil: Pastenes Montaño, Paula Andrea. Hospital Carlos Van Buren. Servicio de Medicina. Departamento de Reumatología; ChileFil: Tate, Patricio. Organización Médica de Investigación; ArgentinaFil: Pirola, Juan Pablo. Sanatorio Argentino; ArgentinaFil: Stange Núñez, Lilith. Clínica Ciudad Del Mar. Centro de Artritis Reumatoide; ChileFil: Burgos, Paula I. Pontificia Universidad Católica de Chile. Departamento de Inmunología Clínica y Reumatología; ChileFil: Mezzano Robinson, María Verónica. Hospital Del Salvador. Clínica Las Condes; ChileFil: Michalland H, Susana. Universidad de Chile. Hospital Del Salvador. Sección Reumatología; ChileFil: Silva Labra, Francisco. Hospital Padre Hurtado. Facultad de Medicina Clínica Alemana-Universidad Del Desarrollo; ChileFil: Labarca Solar, Cristián Humberto. Hospital Padre Hurtado. Facultad de Medicina Clínica Alemana-Universidad Del Desarrollo; ChileFil: Lencina, María Verónica. Hospital Señor Del Milagro; ArgentinaFil: Izquierdo Loaiza, Jorge Hernán. Clínica de Occidente S.A. Grupo de Reumatología; ColombiaFil: Del Castillo Gil, David Julián. Clínica de Occidente S.A. Grupo de Reumatología; ColombiaFil: Caeiro, Francisco. Hospital Privado Universitario de Córdoba. Servicio de Reumatología; ArgentinaFil: Paira, Sergio. Hospital José María Cullen. Sección de Reumatología; Argentin

An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists

ObjectivesTo explore current management practices for PMR by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment.MethodsAn English language questionnaire was constructed by a working group of rheumatologists and GPs from six countries. The questionnaire focused on: 1: Respondent characteristics; 2: Referral practices; 3: Treatment with glucocorticoids; 4: Diagnostics; 5: Comorbidities; and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/Giant Cell Arteritis Study Group

Impact of genetic ancestry and sociodemographic status on the clinical expression of systemic lupus erythematosus in American Indian-European populations

Objective American Indian-Europeans, Asians, and African Americans have an excess morbidity from systemic lupus erythematosus (SLE) and a higher prevalence of lupus nephritis than do Caucasians. The aim of this study was to analyze the relationship between genetic ancestry and sociodemographic characteristics and clinical features in a large cohort of American Indian-European SLE patients. Methods A total of 2,116 SLE patients of American Indian-European origin and 4,001 SLE patients of European descent for whom we had clinical data were included in the study. Genotyping of 253 continental ancestry-informative markers was performed on the Illumina platform. Structure and Admixture software were used to determine genetic ancestry proportions of each individual. Logistic regression was used to test the association between genetic ancestry and sociodemographic and clinical characteristics. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). Results The average American Indian genetic ancestry of 2,116 SLE patients was 40.7%. American Indian genetic ancestry conferred increased risks of renal involvement (P less than 0.0001, OR 3.50 [95% CI 2.63- 4.63]) and early age at onset (P less than 0.0001). American Indian ancestry protected against photosensitivity (P less than 0.0001, OR 0.58 [95% CI 0.44-0.76]), oral ulcers (P less than 0.0001, OR 0.55 [95% CI 0.42-0.72]), and serositis (P less than 0.0001, OR 0.56 [95% CI 0.41-0.75]) after adjustment for age, sex, and age at onset. However, age and sex had stronger effects than genetic ancestry on malar rash, discoid rash, arthritis, and neurologic involvement. Conclusion In general, American Indian genetic ancestry correlates with lower sociodemographic status and increases the risk of developing renal involvement and SLE at an earlier age. Copyright © 2012 by the American College of Rheumatology

Impact of genetic ancestry and sociodemographic status on the clinical expression of systemic lupus erythematosus in American Indian-European populations

Objective American Indian-Europeans, Asians, and African Americans have an excess morbidity from systemic lupus erythematosus (SLE) and a higher prevalence of lupus nephritis than do Caucasians. The aim of this study was to analyze the relationship between genetic ancestry and sociodemographic characteristics and clinical features in a large cohort of American Indian-European SLE patients. Methods A total of 2,116 SLE patients of American Indian-European origin and 4,001 SLE patients of European descent for whom we had clinical data were included in the study. Genotyping of 253 continental ancestry-informative markers was performed on the Illumina platform. Structure and Admixture software were used to determine genetic ancestry proportions of each individual. Logistic regression was used to test the association between genetic ancestry and sociodemographic and clinical characteristics. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). Results The average American Indian genetic ancestry of 2,116 SLE patients was 40.7%. American Indian genetic ancestry conferred increased risks of renal involvement (P less than 0.0001, OR 3.50 [95% CI 2.63- 4.63]) and early age at onset (P less than 0.0001). American Indian ancestry protected against photosensitivity (P less than 0.0001, OR 0.58 [95% CI 0.44-0.76]), oral ulcers (P less than 0.0001, OR 0.55 [95% CI 0.42-0.72]), and serositis (P less than 0.0001, OR 0.56 [95% CI 0.41-0.75]) after adjustment for age, sex, and age at onset. However, age and sex had stronger effects than genetic ancestry on malar rash, discoid rash, arthritis, and neurologic involvement. Conclusion In general, American Indian genetic ancestry correlates with lower sociodemographic status and increases the risk of developing renal involvement and SLE at an earlier age. Copyright © 2012 by the American College of Rheumatology

Impact of genetic ancestry and sociodemographic status on the clinical expression of systemic lupus erythematosus in American Indian-European populations

Artículo de publicación ISIObjective American Indian-Europeans, Asians, and African Americans have an excess morbidity from systemic lupus erythematosus (SLE) and a higher prevalence of lupus nephritis than do Caucasians. The aim of this study was to analyze the relationship between genetic ancestry and sociodemographic characteristics and clinical features in a large cohort of American Indian-European SLE patients. Methods A total of 2,116 SLE patients of American Indian-European origin and 4,001 SLE patients of European descent for whom we had clinical data were included in the study. Genotyping of 253 continental ancestry-informative markers was performed on the Illumina platform. Structure and Admixture software were used to determine genetic ancestry proportions of each individual. Logistic regression was used to test the association between genetic ancestry and sociodemographic and clinical characteristics. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). Results The average American Indian genetic ancestry of 2,116 SLE patients was 40.7%. American Indian genetic ancestry conferred increased risks of renal involvement (P < 0.0001, OR 3.50 [95% CI 2.63- 4.63]) and early age at onset (P < 0.0001). American Indian ancestry protected against photosensitivity (P < 0.0001, OR 0.58 [95% CI 0.44-0.76]), oral ulcers (P < 0.0001, OR 0.55 [95% CI 0.42-0.72]), and serositis (P < 0.0001, OR 0.56 [95% CI 0.41-0.75]) after adjustment for age, sex, and age at onset. However, age and sex had stronger effects than genetic ancestry on malar rash, discoid rash, arthritis, and neurologic involvement. Conclusion In general, American Indian genetic ancestry correlates with lower sociodemographic status and increases the risk of developing renal involvement and SLE at an earlier age.NIH P01-AR-49084 P60-AR-053308 R01-AR-052300 R21-AI-070304 K24-AR-002138 P60 2-AR-30692 UL1-RR-025741 P30-AR-053483 P30-RR-031152 P01-AI-083194 AR-43727 American Recovery and Reinvestment Act grant AR-058621 Centers of Biomedical Research Excellence (COBRE) grant 8 P20-GM-103456-09 National Center for Research Resources UL1-RR-025005 Alliance for Lupus Research Kirkland Scholar Award Federico Wilhelm Agricola Foundatio