Changes in bone mineral density over 10 years in patients with early rheumatoid arthritis

Objectives To investigate changes in bone mineral density (BMD) in patients with early rheumatoid arthritis (RA) over a 10-year period. Methods Consecutive patients with early RA (symptom duration <12 months) were followed according to a structured programme and examined with dual-energy X-ray absorptiometry (DXA) at inclusion and after 2, 5 and 10 years. Mean Z-scores over the study period were estimated using mixed linear effect models. Changes in Z-scores between follow-up visits were analysed using paired T-tests. Results At inclusion, 220 patients were examined with DXA. At the femoral neck, the mean Z-score over 10 years was -0.33 (95 % CI -0.57 to -0.08) in men and -0.07 (-0.22 to 0.08) in women. Men had significantly lower BMD at the femoral neck than expected by age at inclusion (intercept Z-score value -0.35; 95 % CI -0.61 to -0.09), whereas there was no such difference in women. At the lumbar spine, the mean Z-score over the study period for men was -0.05 (-0.29 to 0.19) and for women 0.06 (-0.10 to 0.21). In paired comparisons of BMD at different follow-up visits, femoral neck Z-scores for men decreased significantly from inclusion to the 5-year follow-up. After 5 years, no further reduction was seen. Conclusions In this observational study of a limited sample, men with early RA had reduced femoral neck BMD at diagnosis, with a further significant but marginal decline during the first 5 years. Lumbar spine BMD Z-scores were not reduced in men or women with early RA. Data on 10-year follow-up were limited

Association Between Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Global Registry of Acute Coronary Events Risk Score in Acute Myocardial Infarction

Background. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory markers in cardiovascular diseases. Global Registry of Acute Coronary Events (GRACE) risk score is a scoring system to predict risk of mortality in acute coronary syndrome. Objective. To investigate the association between NLR and PLR with GRACE risk score in acute myocardial infarction (AMI) patients. Method. A cross-sectional study using data from medical records of AMI patients. Spectrum of AMI includes ST-segment elevation myocardial infarction (STEMI) or non-STEMI. Data analysis was performed using SPSS 20. Results. A total of 136 patients were included, 72.1% male with mean age 56.1 ± 10.5 years. NLR (p&lt;0.001) and PLR (p&lt;0.001) among GRACE risk score groups were significantly different. Mean NLR in low, intermediate, and high GRACE risk score groups were 3.5 ± 2.4, 6.0 ± 4.8, and 7.9 ± 3.9, respectively. Mean PLR in low, intermediate, and high GRACE risk score groups were 117.2 ± 62.3, 183.7 ± 95.8, and 209.9 ± 83.4, respectively. NLR (r=0.527; p&lt;0.001) and also PLR (r=0.496; p&lt;0.001) was significantly positively correlated with GRACE risk score. Conclusion. NLR and PLR are simple and cost effective inflammatory markers to predict GRACE risk score and an additional prognostic tool in AMI.Pendahuluan. Rasio neutrofil-limfosit (RNL) dan rasio platelet-limfosit (RPL) merupakan petanda inflamasi penyakit kardiovaskular baru. Skor risiko Global Registry of Acute Coronary Events (GRACE) digunakan untuk prediksi risiko mortalitas sindrom koroner akut. Tujuan. Menyelidiki hubungan antara RNL dan RPL dengan skor risiko GRACE pada pasien infark miokard akut (IMA). Metode. Studi potong lintang atas data rekam medis pasien IMA. Spektrum IMA meliputi IMA dengan Elevasi Segmen ST (IMA-EST) dan IMA Non-elevasi Segmen ST (IMA-NEST). Analisis data menggunakan SPSS 20. Hasil. Sebanyak 136 pasien diteliti, 72.1% laki-laki dengan usia rerata 56.1 ± 10.5 tahun. Terdapat perbedaan signifikan nilai RNL (p&lt;0.001) dan RPL (p&lt;0.001) di antara kelompok skor risiko GRACE. Rerata RNL kelompok skor risiko GRACE rendah, sedang, dan tinggi adalah masing-masing 3.5 ± 2.4, 6.0 ± 4.8, dan 7.9 ± 3.9. Rerata RPL kelompok skor risiko GRACE rendah, sedang, dan tinggi adalah masing-masing 117.2 ± 62.3, 183.7 ± 95.8, dan 209.9 ± 83.4. RNL memiliki korelasi positif signifikan dengan skor risiko GRACE (r=0.527; p&lt;0.001). RPL juga memiliki korelasi positif signifikan dengan skor risiko GRACE (r=0.496; p&lt;0.001). Simpulan. RNL dan RPL merupakan petanda inflamasi sederhana dan hemat biaya yang dapat memprediksi skor risiko GRACE dan memberikan nilai prognostik tambahan pada IMA

A Critical Analysis of Prognostic Factors in North American Patients With Human T-Cell Lymphotropic Virus Type-1-Associated Adult T-Cell Leukemia/Lymphoma A Multicenter Clinicopathologic Experience and New Prognostic Score

BACKGROUND: To define the clinicopathologic and prognostic features of patients with human T-cell lymphotropic virus type-1 (HTLV-1)-associated adult T-cell leukemia/lymphoma (ATLL) in North America, standard criteria were used to identify patients with ATLL. METHODS: Statistical analyses used included descriptive statistics, Kaplan-Meir survival analysis, and recursive partitioning. RESULTS: Eighty-nine patients were identified between August 1992 and May 2007, including 37 (41.6%) males and 52 (58.4%) females with a median age of 50 years (range, 22-82 years). All but 6 patients had immigrated to the United States from the Caribbean, Latin America, or Africa. The acute subtype predominated (68.5%). The majority of patients received a combination-alkylator-based chemotherapy regimen in the front-line setting (72.6%). The most common regimen was cyclophosphamide, doxorubicin, vincristine, and prednisone at standard doses or attenuated and/or with methotrexate (CHOP-like), which produced an overall response rate of 64.1%. Despite initial responses to therapy, the median overall survival for all subtypes was 24 weeks (range, 0.9-315 weeks). Although the International Prognostic Index and Prognostic Index for peripheral T-cell lymphoma unspecified identified subsets of patients, these models were not completely predictive. A recursive partitioning analysis was performed on the data, which successfully identified 3 prognostic categories based on Eastern Cooperative Oncology Group performance status, stage, age, and calcium level at diagnosis. CONCLUSIONS: This series proposed a new prognostic model for patients with HTLV-1-associated ATLL and confirmed a poor outcome for these patients in North America. Cancer 2010;116:3438-46. (C) 2010 American Cancer Society

Association Between Bone Mineral Density and Autoantibodies in Patients With Rheumatoid Arthritis

Objective: Autoantibodies, such as anti–citrullinated protein antibodies (ACPAs), have been described as inducing bone loss in rheumatoid arthritis (RA), which can also be reflected by bone mineral density (BMD). We therefore examined the association between osteoporosis and autoantibodies in two independent RA cohorts. Methods: Dual x-ray absorptiometry (DXA) of the lumbar spine and left hip was performed in 408 Dutch patients with early RA during 5 years of follow-up and in 198 Swedish patients with early RA during 10 years of follow-up. The longitudinal effect of ACPAs and other autoantibodies on several BMD measures was assessed using generalized estimating equations. Results: In the Dutch cohort, significantly lower BMD at baseline was observed in ACPA-positive patients compared to ACPA-negative patients, with an estimated marginal mean BMD in the left hip of 0.92 g/cm2 (95% confidence interval [95% CI] 0.91–0.93) versus 0.95 g/cm2 (95% CI 0.93–0.97) (P = 0.01). In line with this, significantly lower Z scores at baseline were noted in the ACPA-positive group compared to the ACPA-negative group (estimated marginal mean Z score in the left hip of 0.18 [95% CI 0.08–0.29] versus 0.48 [95% CI 0.33–0.63]) (P < 0.01). However, despite clear differences at baseline, ACPA positivity was not associated with greater decrease in absolute BMD or Z scores over time. Furthermore, there was no association between BMD and higher levels of ACPAs or other autoantibodies (rheumatoid factor and anti–carbamylated protein antibodies). In the Swedish cohort, ACPA-positive patients tended to have a higher prevalence of osteopenia at baseline (P = 0.04), but again, ACPA positivity was not associated with an increased prevalence of osteopenia or osteoporosis over time. Conclusion: The presence of ACPAs is associated with significantly lower BMD at baseline, but not with greater BMD loss over time in treated RA patients. These results suggest that ACPAs alone do not appear to contribute to bone loss after disease onset when disease activity is well-managed

Association Between Bone Mineral Density and Autoantibodies in Patients With Rheumatoid Arthritis

Objective: Autoantibodies, such as anti–citrullinated protein antibodies (ACPAs), have been described as inducing bone loss in rheumatoid arthritis (RA), which can also be reflected by bone mineral density (BMD). We therefore examined the association between osteoporosis and autoantibodies in two independent RA cohorts. Methods: Dual x-ray absorptiometry (DXA) of the lumbar spine and left hip was performed in 408 Dutch patients with early RA during 5 years of follow-up and in 198 Swedish patients with early RA during 10 years of follow-up. The longitudinal effect of ACPAs and other autoantibodies on several BMD measures was assessed using generalized estimating equations. Results: In the Dutch cohort, significantly lower BMD at baseline was observed in ACPA-positive patients compared to ACPA-negative patients, with an estimated marginal mean BMD in the left hip of 0.92 g/cm2 (95% confidence interval [95% CI] 0.91–0.93) versus 0.95 g/cm2 (95% CI 0.93–0.97) (P = 0.01). In line with this, significantly lower Z scores at baseline were noted in the ACPA-positive group compared to the ACPA-negative group (estimated marginal mean Z score in the left hip of 0.18 [95% CI 0.08–0.29] versus 0.48 [95% CI 0.33–0.63]) (P < 0.01). However, despite clear differences at baseline, ACPA positivity was not associated with greater decrease in absolute BMD or Z scores over time. Furthermore, there was no association between BMD and higher levels of ACPAs or other autoantibodies (rheumatoid factor and anti–carbamylated protein antibodies). In the Swedish cohort, ACPA-positive patients tended to have a higher prevalence of osteopenia at baseline (P = 0.04), but again, ACPA positivity was not associated with an increased prevalence of osteopenia or osteoporosis over time. Conclusion: The presence of ACPAs is associated with significantly lower BMD at baseline, but not with greater BMD loss over time in treated RA patients. These results suggest that ACPAs alone do not appear to contribute to bone loss after disease onset when disease activity is well-managed