108 research outputs found
Predictors of survival in a cohort of patients with polymyositis and dermatomyositis: effect of corticosteroids, methotrexate and azathioprine
Introduction: The idiopathic inflammatory myopathies are rare diseases for which data regarding the natural
history, response to therapies and factors affecting mortality are needed. We performed this study to examine the
effects of treatment and clinical features on survival in polymyositis and dermatomyositis patients.
Methods: A total of 160 consecutive patients (77 with polymyositis and 83 with dermatomyositis) seen at the
University of Michigan from 1997 to 2003 were included. Medical records were abstracted for clinical, laboratory
and therapeutic data, including initial steroid regimen and immunosuppressive use. State vital records were utilized
to derive mortality and cause of death data. Survival was modeled by left-truncated Kaplan-Meier estimation and
Cox regression.
Results: The 5- and 10-year survival estimates were 77% (95% CI = 66 to 85), and 62% (95% CI = 48 to 73),
respectively, and the rates were similar for polymyositis and dermatomyositis. Survival between the sexes was
similar through 5 years and significantly lower thereafter for males (10-year survival: 18% male, 73% female; P =
0.002 for 5- to 10-year interval). The sex disparity was restricted to the polymyositis group. Increased age at
diagnosis and non-Caucasian race were associated with lower survival. Intravenous versus oral corticosteroid use
was associated with a higher risk of death among Caucasians (HR = 10.6, 95% CI = 2.1 to 52.8). Early survival
between patients treated with methotrexate versus azathioprine was similar, but survival at 10 years was higher for
the methotrexate-treated group (76% vs 52%, P = 0.046 for 5- to 10-year interval).
Conclusions: Patients treated initially with intravenous corticosteroids had higher mortality, which was likely
related to disease severity. Both methotrexate and azathioprine showed similar early survival benefits as first-line
immunosuppressive drugs. Survival was higher between 5 and 10 years in the methotrexate-treated group, but
could not be confirmed in multivariable modeling for the full follow-up period. Other important predictors of longterm
survival included younger age, female sex and Caucasian race.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90025/1/IIM_ART2012.pdf1611
Prescription opioid use in patients with and without systemic lupus erythematosus — Michigan Lupus Epidemiology and Surveillance program, 2014–2015
Reply
No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58017/1/23350_ftp.pd
Ultrasound of the knee during voluntary quadriceps contraction: A technique for detecting otherwise occult effusions
Objective To describe 1) a technique that can detect synovial effusions not seen on static ultrasound (US) examination and 2) the characteristics of patients with knee osteoarthritis (OA) for whom this technique proved useful. Methods From reviewed records of 76 patients with knee OA (112 knees) that we had seen for US-guided injections over a defined period, we found 45 knees with no detectable effusion on static US, of which 18 (14 patients) showed fluid when scanned during voluntary quadriceps contraction. For all patients, we had recorded effusion features (physical examination, presence and size on US), and success of joint entry was determined by getting synovial fluid and/or seeing an air echo or inflow of injected material. Results The 14 patients we studied were obese (mean ± SEM body mass index 32.7 ± 2.3 kg/m 2 ; 3 morbidly obese), with moderate to severe OA by radiography in most (Kellgren/Lawrence class 3 or 4 in 10 of 14 knees for which radiographs were available). The suprapatellar synovial space seen by US was small (mean ± SEM depth 0.38 ± 0.04 cm). Arthrocentesis obtained 0.5–16 ml of synovial fluid (mean ± SEM 2.9 ± 0.6 ml), which correlated with the depth of effusion as seen on US with the quadriceps in maximum contraction (Spearman's Ρ = 0.5597, P = 0.0157). In 4 knees where arthrocentesis failed to retrieve fluid, we observed at injection the inflow of material and a linear air echo. Conclusion US of the knee during voluntary quadriceps contraction can find effusions not detectable on static US. Such effusions provide targets for accurate aspiration and injection that would not be appreciated with static US.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75770/1/20047_ftp.pd
Response to “Absence of Conclusive Evidence for the Safety and Efficacy of Gonadotropin‐Releasing Hormone Analogue Treatment in Protecting Against Chemotherapy‐Induced Gonadal Injury”
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139979/1/onco0613.pd
Predictors of survival in a cohort of patients with polymyositis and dermatomyositis: effect of corticosteroids, methotrexate and azathioprine
Abstract
Introduction
The idiopathic inflammatory myopathies are rare diseases for which data regarding the natural history, response to therapies and factors affecting mortality are needed. We performed this study to examine the effects of treatment and clinical features on survival in polymyositis and dermatomyositis patients.
Methods
A total of 160 consecutive patients (77 with polymyositis and 83 with dermatomyositis) seen at the University of Michigan from 1997 to 2003 were included. Medical records were abstracted for clinical, laboratory and therapeutic data, including initial steroid regimen and immunosuppressive use. State vital records were utilized to derive mortality and cause of death data. Survival was modeled by left-truncated Kaplan-Meier estimation and Cox regression.
Results
The 5- and 10-year survival estimates were 77% (95% CI = 66 to 85), and 62% (95% CI = 48 to 73), respectively, and the rates were similar for polymyositis and dermatomyositis. Survival between the sexes was similar through 5 years and significantly lower thereafter for males (10-year survival: 18% male, 73% female; P = 0.002 for 5- to 10-year interval). The sex disparity was restricted to the polymyositis group. Increased age at diagnosis and non-Caucasian race were associated with lower survival. Intravenous versus oral corticosteroid use was associated with a higher risk of death among Caucasians (HR = 10.6, 95% CI = 2.1 to 52.8). Early survival between patients treated with methotrexate versus azathioprine was similar, but survival at 10 years was higher for the methotrexate-treated group (76% vs 52%, P = 0.046 for 5- to 10-year interval).
Conclusions
Patients treated initially with intravenous corticosteroids had higher mortality, which was likely related to disease severity. Both methotrexate and azathioprine showed similar early survival benefits as first-line immunosuppressive drugs. Survival was higher between 5 and 10 years in the methotrexate-treated group, but could not be confirmed in multivariable modeling for the full follow-up period. Other important predictors of long-term survival included younger age, female sex and Caucasian race.http://deepblue.lib.umich.edu/bitstream/2027.42/112905/1/13075_2011_Article_3467.pd
Increased usage of special educational services by children born to mothers with systemic lupus erythematosus and antiphospholipid antibodies
Introduction: Surveys of long-term health and
developmental outcomes of children born to mothers
with systemic lupus erythematosus (SLE) have
suggested an increase in learning disabilities among
these children. We performed this observational study
to investigate the relationship between maternal
autoantibodies and antiphospholipid antibody
syndrome (APS) in maternal lupus patients and
neurocognitive development among their offspring.
Methods: SLE mothers with at least one live birth
postlupus diagnosis were enrolled. Data on maternal
medical/obstetric history and children’s perinatal/
medical history were collected by structured interview
and medical record reviews. The primary outcome was
requirement for special educational (SE) services,
a proxy for developmental delays. Multiple logistic
regression modelling was used to examine
associations between APS and autoantibodies with SE
usage, accounting for SLE disease severity and
potential confounders.
Results: Data on 38 mothers and 60 offspring were
analysed: SE service usage was reported for 15 of 60
(25%) offspring. Maternal APS history was
significantly associated with increased use of SE
services among offspring, including after adjustment
for lupus anticoagulant (LA) positivity and potential
confounders (OR 5.5–9.4 for delays age ≥2; p<0.05).
The presence of LA, but not other antiphospholipid
antibodies, was also associated with increased SE
services usage.
Conclusions: Maternal APS and LA were
independently associated with increased usage of
special educational services among offspring of
women with SLE.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108201/1/Lupus Sci Med-2014-Marder-.pdf5
Parental history of lupus and rheumatoid arthritis and risk in offspring in a nationwide cohort study: does sex matter?
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94406/1/Somers_2012_Parental_history_lupus_RA_does_sex_matter.pdf165
Type I Interferons Are Associated with Subclinical Markers of Cardiovascular Disease in a Cohort of Systemic Lupus Erythematosus Patients
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94405/1/Somers_2012_Type_I_Interferons_subclinical_markers.pdf165
Autoimmune diseases co-occurring within individuals and within families: a systematic review
BACKGROUND: Autoimmune diseases have been observed to coexist both within individuals and within families. It is unclear whether clinical reports of comorbid autoimmune diseases represent chance findings or true associations. This systematic review evaluates the current level of evidence on the coexistence of selected autoimmune diseases within individuals and families. We reviewed the associations among 4 TH1-associated autoimmune diseases: insulin-dependent diabetes mellitus, autoimmune (Hashimoto) thyroiditis, rheumatoid arthritis, and multiple sclerosis. METHODS: Studies quantifying the coexistence between the selected diseases, published through March 2004, were identified from Medline and Embase searches. Study eligibility was determined on the basis of preestablished criteria, and relevant data were extracted according to a fixed protocol. We determined the prevalence of comorbid autoimmune disease according to index disease and then compiled summary statistics. Heterogeneity among studies was assessed by exact likelihood ratio tests and Monte Carlo inference. RESULTS: We found 54 studies that met the eligibility criteria. Of these, 52 studies examined the coexistence of disease within individuals and 9 studies examined within-family associations. The majority of studies were uncontrolled and did not account for confounding factors. There was substantial evidence for heterogeneity among studies. Although inconclusive, the data appear to support an increased prevalence of autoimmune thyroiditis among patients with rheumatoid arthritis and those with insulin-dependent diabetes mellitus, and an inverse association between rheumatoid arthritis and multiple sclerosis. CONCLUSION: Although the available evidence does not permit firm conclusions regarding comorbidities among the selected autoimmune diseases, results are sufficiently suggestive to warrant further study.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60328/1/somers_autoimmune.pd
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