Outcomes and Safety of Tumor Necrosis Factor Inhibitors in Reactive Arthritis: A Nationwide Experience from Iceland.

To access publisher's full text version of this article click on the hyperlink belowObjective: Reactive arthritis (ReA) is a spondyloarthritis triggered by a bacterial infection. In cases where nonsteroidal antiinflammatory drugs and conventional synthetic disease-modifying antirheumatic drugs have failed, biologics such as tumor necrosis factor inhibitors (TNFi) have been used. However, limited evidence exists of the efficacy and safety of these drugs in ReA. We report on Icelandic patients with ReA who have been treated with TNFi, their characteristics, outcomes, and safety. Methods: We conducted an observational cohort study using the Icelandic nationwide database of biologic therapy (ICEBIO) supplemented with a retrospective study of electronic health record (EHR) data. Drug efficacy was assessed using disease activity scores and standardized questionnaires within ICEBIO; safety was assessed using ICEBIO and EHR data. Results: Thirty-eight patients with ReA were registered in the database. Eight were given TNFi within 1 year of symptom onset. At 6 and 18 months, there was a significant reduction in C-reactive protein (CRP), tender and swollen joints, visual analog scale for pain and fatigue, 28-joint count Disease Activity Score 28 based on CRP, Clinical Disease Activity Index, and Health Assessment Questionnaire scores. Seventy-one to 90% of patients were considered treatment responders. Two patients were able to stop biologics owing to remission. During the 303 patient-years (mean 8, range 1-15) biologics were given, 6 hospital admissions for infections were noted. Conclusion: TNFi are safe and effective in ReA, but treatment tends to be prolonged. Further clinical trials are urgently needed in ReA. Keywords: TNF-α; biologics; reactive arthritis; registry; safety

Genetic propensities for verbal and spatial ability have opposite effects on body mass index and risk of schizophrenia

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadWe generated two polygenic scores, one capturing verbal and the other spatial aspects of cognitive ability, using UK Biobank data and studied their effects on various diseases and other traits in the Icelandic population. The score tagging spatial ability associated with higher body mass index (β = 0.032, p = 3.2 × 10−13), but lower risk of schizophrenia (OR = 0.82, p = 8.8 × 10−9) and other mental disorders. Furthermore, it associated with less openness, a personality trait reflecting curiosity and creativity (β = −0.023, p = 1.3 × 10−4). Conversely, the score tagging verbal ability associated with lower body mass index (β = −0.023, p = 1.6 × 10−7) and more openness (β = 0.045, p = 3.5 × 10−14), but did not associate with risk of schizophrenia (OR = 0.97, p = 0.42). Furthermore, applying genomic structural equation modeling, we observed that the genetic component of verbal ability associated positively with the genetic component of schizophrenia after conditioning on the g factor (bg = 0.193, p = 5.4 × 10−4). Thus, at the genetic level, verbal and spatial ability exhibit contrasting associations with indicators of mental and physical health, as well as with personality.Horizon 202