Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis.

OBJECTIVES A considerable proportion of patients with rheumatoid arthritis (RA) also suffer from hand osteoarthritis (OA). We here assess the association between conventional synthetic (cs) and biological (b) disease-modifying antirheumatic drugs (DMARDs) and radiographic distal interphalangeal-(DIP) OA in patients with RA. METHODS Adult RA patients from a longitudinal Swiss registry of rheumatic diseases who had ≥ 2 hand radiographs were included at the first radiograph and followed until the outcome or the last radiograph. Patients were grouped into two cohorts based on whether DIP OA was present or absent at cohort entry (cohorts 1 and 2, respectively). Modified Kellgren-Lawrence scores (KLS) were obtained by evaluating DIP joints for the severity of osteophytes, joint space narrowing, subchondral sclerosis, and erosions. KLS ≥ 2 in ≥ 1 DIP joint indicated incident or existing OA, and increase of ≥ 1 in KLS in ≥ 1 DIP joint indicated progression in existing DIP OA. Time-varying Cox regression and generalized estimating equation (GEE) analyses were performed. We estimated hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) of DIP OA incidence (cohort 2), or progression (cohort 1), in bDMARD monotherapy, bDMARD/csDMARD combination therapy, and past or never DMARD use, when compared to csDMARD use. In post hoc analyses, we descriptively and analytically assessed the individual KLS features in cohort 1. RESULTS Among 2234 RA patients with 5928 radiographs, 1340 patients had DIP OA at baseline (cohort 1). Radiographic progression of DIP OA was characterized by new or progressive osteophyte formation (666, 52.4%), joint space narrowing (379, 27.5%), subchondral sclerosis (238, 17.8%), or erosions (62, 4.3%). bDMARD monotherapy had an increased risk of radiographic DIP OA progression compared to csDMARD monotherapy (adjusted HR 1.34 [95% CI 1.07-1.69]). The risk was not significant in csDMARD/bDMARD combination users (HR 1.12 [95% CI 0.96-1.31]), absent in past DMARD users (HR 0.96 [95% CI 0.66-1.41]), and significantly lower among never DMARD users (HR 0.54 [95% CI 0.33-0.90]). Osteophyte progression (HR 1.74 [95% CI 1.11-2.74]) was the most significantly increased OA feature with bDMARD use compared to csDMARD use. In 894 patients without initial DIP OA (cohort 2), the risk of incident OA did not differ between the treatment groups. The results from GEE analyses corroborated all findings. CONCLUSIONS These real-world RA cohort data indicate that monotherapy with bDMARDs is associated with increased radiographic progression of existing DIP OA, but not with incident DIP OA

Entwicklung eines integrierten Energiekonzepts: Erfassung des Emissions-Reduktions-Potentials klimawirksamer Spurengase im Bereich rationeller Energienutzung fuer die alten Bundeslaender. Anhangsband II Sektor Industrie

The aim of this project is to image the demand flow for energy ranging from the energy service to the primary energy and to calculate the corresponding CO_2-emissions. Another aim is to specify different strategies in terms of energy and environmental policy which are investigated by three scenarios concerning their relevance to the climate taking the years 2005 and 2020 as reference. In the report part Industry first the system analysis of the sector demand for end energy ranging from the energy service to end energy use is presented as well as the model structures of the corresponding PROGRES model part. The main part includes the specification of the presuppositions and the results of the three scenarios (Business as usual, efficiency and ecological structure policy) where the future end energy use and the CO_2-emissions by the industry are explained. In this respect the end energy use of each sector is determined and assessed for all scenarios. In the following chapters the obtained results for the consumption of power and fuel are related to each energy carrier and investigated concerning their CO_2-emission. (orig./UA)Ziel dieses Projekts ist die Abbildung des Nachfrageflusses nach Energie von der Energiedienstleistung bis zur Primaerenergie und die Berechnung der damit verbundenen CO_2-Emissionen sowie die Formulierung unterschiedlicher energie-und umweltpolitischer Strategien die anhand von drei Szenarien mit den Stuetzjahren 2005 und 2020 bezueglich ihrer Klimarelevanz untersucht werden. Im Berichtsteil Industrie werden zunaechst die Systemanalyse des Endenergienachfragebereichs Industrie von der Energiedienstleistung bis zum Endenergieeinsatz und die Modellstrukturen des entsprechenden Progres-Modellteils dargestellt. Der folgende Hauptteil beinhaltet die Formulierung der Annahmen und die Ergebnisdarstellung der drei Szenarien (Business as usual, Effizienz und Oekologische Strukturpolitik) in denen der zukuenftige Endenergieeinsatz und die CO_2-Emissionen der Industrie dargestellt werden. Dabei wird zuerst der Endenergieeinsatz jeder einzelnen Branche ermittelt und fuer alle Szenarien abgeschaetzt. Die hierbei ermittelten Ergebnisse fuer den Strom- und den Brennstoffverbrauch werden in den anschliessenden Szenariokapiteln auf die einzelnen Energietraeger umgelegt und bezueglich ihrer CO_2-Emissionen betrachtet. (orig./UA)SIGLEAvailable from TIB Hannover: F95B295+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany); Ministerium fuer Wirtschaft, Mittelstand und Technologie des Landes Nordrhein-Westfalen, Duesseldorf (Germany)DEGerman

Brief Report: Influence of Disease Activity in Rheumatoid Arthritis on Radiographic Progression of Concomitant Interphalangeal Joint Osteoarthritis.

Distal interphalangeal (DIP) joints are commonly considered to be unaffected by rheumatoid arthritis (RA). Despite synovitis and bone marrow edema being associated with radiographic progression in hand osteoarthritis (OA) and hand RA, radiographic courses differ substantially. This study was undertaken to analyze incidence and progression of radiographically evident DIP joint OA in RA patients, in relation to RA activity and patient characteristics. In sequential radiographs of 1,988 RA patients in the Swiss Clinical Quality Management in Rheumatic Diseases registry, we evaluated and scored 15,904 DIP joints. Scoring was based on the presence of central erosions and subchondral sclerosis and on the severity of osteophytes and joint space narrowing, according to the modified Kellgren/Lawrence (K/L) grade. The presence of DIP joint OA was defined as ≥1 joint with a K/L grade of ≥2, and progression was defined as an increase in a summed K/L grade. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. The median follow-up time was 4.5 years (interquartile range 3.1-7.0), and the mean ± SD age was 56.1 ± 11.1 years. DIP joint OA was present in 60% of patients at baseline. Higher mean age (OR 1.09 [95% CI 1.08-1.10]), female sex (OR 1.37 [95% CI 1.08-1.74]), and higher mean body mass index (OR 1.03 [95% CI 1.00-1.06]) were associated with the presence of DIP joint OA, but neither the presence of anti-citrullinated protein antibodies (ACPAs) (OR 0.72 [95% CI 0.50-1.03]) nor the presence of rheumatoid factor (OR 1.01 [95% CI 0.74-1.38]) were associated with it. Disease Activity Score using the erythrocyte sedimentation rate and metacarpophalangeal (MCP) joint erosions were not associated with DIP joint OA progression. RA disease duration had no relevant effect size associated with DIP joint OA progression (OR 0.97 [95% CI 0.96-0.99]). Known risk factors for DIP joint OA were replicated in patients with RA. The observation that RA activity, the presence of ACPA, and MCP joint erosions were not associated with the prevalence or progression of DIP joint OA indicates that there are distinct roles of inflammation in the pathogenesis of RA and DIP joint OA

Detection and Grading of Radiographic Hand Osteoarthritis Using an Automated Machine Learning Platform.

Automated machine learning (autoML) platforms allow health care professionals to play an active role in the development of machine learning (ML) algorithms according to scientific or clinical needs. The aim of this study was to develop and evaluate such a model for automated detection and grading of distal hand osteoarthritis (OA). A total of 13,690 hand radiographs from 2,863 patients within the Swiss Cohort of Quality Management (SCQM) and an external control data set of 346 non-SCQM patients were collected and scored for distal interphalangeal OA (DIP-OA) using the modified Kellgren/Lawrence (K/L) score. Giotto (Learn to Forecast [L2F]) was used as an autoML platform for training two convolutional neural networks for DIP joint extraction and subsequent classification according to the K/L scores. A total of 48,892 DIP joints were extracted and then used to train the classification model. Heatmaps were generated independently of the platform. User experience of a web application as a provisional user interface was investigated by rheumatologists and radiologists. The sensitivity and specificity of this model for detecting DIP-OA were 79% and 86%, respectively. The accuracy for grading the correct K/L score was 75%, with a κ score of 0.76. The accuracy per DIP-OA class differed, with 86% for no OA (defined as K/L scores 0 and 1), 71% for a K/L score of 2, 46% for a K/L score of 3, and 67% for a K/L score of 4. Similar values were obtained in an independent external test set. Qualitative and quantitative user experience testing of the web application revealed a moderate to high demand for automated DIP-OA scoring among rheumatologists. Conversely, radiologists expressed a low demand, except for the use of heatmaps. AutoML platforms are an opportunity to develop clinical end-to-end ML algorithms. Here, automated radiographic DIP-OA detection is both feasible and usable, whereas grading among individual K/L scores (eg, for clinical trials) remains challenging

Entwicklung eines integrierten Energiekonzepts: Erfassung des Emissions-Reduktions-Potentials klimawirksamer Spurengase im Bereich rationeller Energienutzung fuer die alten Bundeslaender. Hauptband

The task of the research project was to develop an integrated energy concept for the Federal Republic of Germany (old Laender), that can be applied to quantify and depict the present energy use and the future potentials for the reduction of energy and emissions. As a basis for the energy concept an energy model had to be developed, that images the flow of energy demand from the energy service to the use of primary energy. Thus te energy model PROGRES (programme for the development of energy scenarios) that was developed by the researchers for this purpose, had to meet the requirement to model also thhe first step of the flow of energy demand, which as not been included in the models so far. This step lies between the energy service and the use of collectible energy necessary for the provision of this service. The energy model should image all sectors relevant to energy, i.e. the sectors households, small consumers, industry and traffic as well as the conversion sector. Apart from the elaboration of an energy model the central task of the research project was to find potentials for the energy conservation and reduction of emissions (CO_2) and describe solutions for teir realisation by means of scenarios. Three scenarios were set up for this task: ''Business as usual'', ''efficiency'' and ''ecological structure policy''. The period of the scenarios for the calculations in the frame of the research project should terminate in 2020. Since the project was approved before the reunification of Germany, all calculations only refer to the territory of the old Laender. (orig./UA)Aufgabe des Forschungsprojekts war es, ein integriertes Energiekonzept fuer die Bundesrepublik Deutschland (alte Bundeslaender) zu entwickeln, mit dessen Hilfe es moeglich ist, den heutigen Energieeinsatz und die zukuenftigen Energie-und Emissionsreduktionspotentiale quantifizieren und beschreiben zu koennen. Als Grundlage des Energiekonzepts war ein Energiemodell zu entwickeln, das den Energienachfragefluss von der Energiedienstleistung bis zum Primaerenergieeinsatz abbildet. Das von den Mitarbeitern des Forschungsprojekts fuer diesen Zweck erarbeitete Energiemodell PROGRES (Programm zur Entwicklung von Energie-Szenarien) hatte somit die Bedingung zu erfuellen, auch den in den Modellen bisher nicht erfassten ersten Schritt des Energienachfrageflusses zu modellieren - den zwischen der Energiedienstleistung und dem fuer ihre Bereitstellung notwendigen Nutzenergieeinsatz. Das Energiemodell sollte dabei alle energierelevanten Sektoren abbilden, d.h. die Sektoren Haushalte, Kleinverbraucher, Industrie und Verkehr sowie den Umwandlungsbereich. Neben der Erstellung eines Energiemodells war die zentrale Aufgabe des Forschungsprojekts, mittels Szenarien die zukuenftigen Energieeinspar- und Emissionsreduktionspotentiale (CO_2) zu ermitteln und Wege fuer ihre Realisierung zu beschreiben. Das Projekt ist diesem Auftrag mit den drei Szenarien ''Business as Usual'', ''Effizienz'' und ''Oekologische Strukturpolitik'' nachgekommen. Der Szenarienzeitraum der Berechnungen des Forschungsprojekts sollte sich bis zum Jahre 2020 erstrecken. Da das Projekt vor der Vereinigung Deutschlands genehmigt wurde, beziehen sich die Berechnungen nur auf das Gebiet der alten Bundeslaender. (orig./UA)Available from TIB Hannover: F95B293+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany); Ministerium fuer Wirtschaft, Mittelstand und Technologie des Landes Nordrhein-Westfalen, Duesseldorf (Germany)DEGerman

Association of nutritional risk and adverse medical outcomes across different medical inpatient populations

OBJECTIVE: The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. METHODS: We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index /=3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction > 0.05) based on age and main diagnosis groups. CONCLUSION: Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients

Association of nutritional risk and adverse medical outcomes across different medical inpatient populations

OBJECTIVE The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. METHODS We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index <95 points), hospital length of stay, hospital readmission rates, and quality of life (QoL; adapted from EQ5 D); all parameters were measured at 30 d. RESULTS Of 3186 patients (mean age 71 y, 44.7% women), 887 (27.8%) were at risk for malnutrition with an NRS ≥3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction < 0.05) based on age and main diagnosis groups. CONCLUSION Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients