scholarly journals AB0576 BONE EROSION IN PSORIATIC ARTHRITIS ASSOCIATED WITH PSORIASIS DURATION, SKIN, NAIL AND JOINT DISEASE SEVERITY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1325.2-1326
Author(s):  
M. Chamurlieva ◽  
E. Loginova ◽  
T. Korotaeva ◽  
Y. Korsakova ◽  
E. Gubar ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Severity ◽  
Bone Erosion ◽  
Joint Disease ◽  
Practice Research ◽  
Forest Plot ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
Nail Disease

Background:Psoriatic arthritis (PsA) is heterogeneous in its clinical presentation and disease course, but many patients (pts) develop a destructive form of arthritis. Psoriasis (PsO) precedes arthritis by an average of 7 years. [1]. Theory of transition from PsO to PsA has been proposed recently [2]. But association between skin disease severity and joint disease are still unclear.Objectives:to evaluate association between bone erosion, PsO duration, skin and nail disease severity in PsA pts based on data from clinical practice (RU-PsART cohort).Methods:737 (M/F=350/387) PsA pts fulfilling the CASPAR criteria were included. Mean age 47.4±12.7 years (yrs), PsA duration 55[17;120] mos., PsO duration 165[74.5;292] mos., mean DAPSA 23.3[14;36.9] mos., HAQ-DI - 0.98 [0.5;1.38], CRP - 7.4 [2.1;18] mg/l. All pts underwent standard clinical examination (tender joins count (TJC)/68, swelling joints count (SJC)/66, CRP (mg/l), DAPSA, dactylitis, enthesitis by LEI + Plantar Facia (PF), HAQ-DI. Mild disease was defined as body surface area (BSA)≤10%, moderate to severe as BSA>10%. The presence/absent of nail PsO was evaluated. X-ray of feet and hand were done in 622 out of 737 pts. The one-factor model of logistic regression was used to identify a group of features that are associated with achievement MDA. M±SD, Me [Q25; Q75], Min-Max, %, t-test, Pierson-χ2, Manna-Whitney tests, ORs with 95% CI were performed. All p<0.05 were considered to indicate statistical significance.Results:PsO precedes of PsA by an average of 9.2 years. BSA≤10% was found in 615 out of 672 pts (91.5%), BSA>10% - in 57 out of 672 pts (8.5%). Nail PsO were seen in 230 out of 737 (31.2%). Bone erosion was found in 237 out of 622 of pts (38.1%). Among these pts nail PsO were seen in 67 out of 237 pts (28.3%). Enthesitis found in 236 out of 737 pts (42.1%), dactylitis – in 197 out 731 pts (27%), axial PsA – in 315 out of 731 pts (43.1%). Bone erosion significantly associated with PsO duration more than 5 yrs., skin and nail PsO severity, high PsA activity by DAPSA, axial manifestation and duration of PsA > 36 mos. (Figure 1).Figure 1Forest plot of factors associated with bone erosion in PsA pts.Conclusion:In our cohort the majority of PsA pts had mild PsO preceded PsA on average of 9.2 yrs. Bone erosion was found in 30% of PsA pts which associated with PsO duration, skin and nail disease severity as well as with PsA activity. Early diagnosis and therapeutic intervention within a “window of opportunity” are very important for improving outcomes and prevent structural damage in PsA.References:[1]Tillett W, et al. Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort. Rheumatol. 2017; 56, 2109–2113[2]Scher JU, et al. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol. 2019;15(3):153-166. doi: 10.1038/s41584-019-0175-0. PMID: 30742092.Disclosure of Interests:None declared.

scholarly journals Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort

Rheumatology ◽  
2017 ◽  
Vol 56 (12) ◽  
pp. 2109-2113 ◽  
Author(s):  
William Tillett ◽  
Rachel Charlton ◽  
Alison Nightingale ◽  
Julia Snowball ◽  
Amelia Green ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

Comparative effect of statins on the risk of incident Alzheimer disease

Neurology ◽  
2017 ◽  
Vol 90 (3) ◽  
pp. e179-e187 ◽  
Author(s):  
Liliya Sinyavskaya ◽  
Serge Gauthier ◽  
Christel Renoux ◽  
Sophie Dell'Aniello ◽  
Samy Suissa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Alzheimer Disease ◽  
Proportional Hazards ◽  
Neuroprotective Effect ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Increased Risk

ObjectiveTo investigate whether fungus-derived statins are associated with a lower risk of incident Alzheimer disease (AD) compared with synthetic statins using real-world clinical practice data.MethodsWe identified a population-based retrospective cohort of patients aged ≥60 years newly prescribed a statin between January 1, 1994, and December 31, 2012, and followed until March 31, 2015, using the UK Clinical Practice Research Datalink. Statins were consecutively classified according to their type, lipophilicity, and potency. For each group, we calculated the crude AD incidence rates per 1,000 person-years. Time-dependent Cox proportional hazards models adjusted for propensity score deciles were used to estimate hazard ratios (HRs) with 95% confidence interval (CIs) of incident AD associated with different statin categories.ResultsOver the 18-year study period, we identified 465,085 statin users, including 7,669 patients who developed AD during 2,891,268 person-years of follow-up (incidence rate 2.65 [95% CI 2.59–2.71] per 1,000 person-years). Compared to synthetic, fungus-derived statins were associated with an increased risk of AD (HR 1.09, 95% CI 1.03–1.15). Lipophilic statins also were associated with higher AD risk (HR 1.18, 95% CI 1.09–1.27) compared to hydrophilic statins, while statin potency did not modify the risk of AD (adjusted HR 1.03, 95% CI 0.98–1.08). The risk was further reduced in sensitivity analyses.ConclusionFungus-derived and lipophilic statins were not associated with decreased incidence of AD compared to synthetic and hydrophilic statins. The modest variations in the risk of incident AD observed between statin characteristics needs to be evaluated in future studies on their possible heterogeneous neuroprotective effect.

scholarly journals Association of lipid-regulating drugs with dementia and related conditions: an observational study of data from the Clinical Practice Research Datalink

2021 ◽  
Author(s):  
Luke A McGuinness ◽  
Julian PT Higgins ◽  
Venexia M Walker ◽  
Neil M Davies ◽  
Richard M Martin ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Practice ◽  
Disease Risk ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Confounding By Indication ◽  
Drug Classes ◽  
Increased Risk ◽  
Residual Confounding

Background: There is some evidence that circulating blood lipids play a role in the development of Alzheimer's disease (AD) and dementia. These modifiable risk factors could be targeted by existing lipid-regulating agents, including statins, for dementia prevention. Here, we test the association between lipid-regulating agents and incidence of dementia and related conditions in the Clinical Practice Research Datalink (CPRD), an United Kingdom-based electronic health record database. Methods: A retrospective cohort study was performed using routinely collected CPRD data (January 1995 and March 2016). Multivariable Cox proportional hazard models, allowing for a time-varying treatment indicator, were used to estimate the association between seven lipid-regulating drug classes (vs. no drug) and five dementia outcomes (all-cause, vascular and other dementias, and probable and possible Alzheimer's disease). Results: We analyzed 1,684,564 participants with a total follow-up of 10,835,685 patient-years (median: 5.9 years (IQR:2.7-9.7)). We found little evidence that lipid-regulating agents were associated with incidence of Alzheimer's disease (probable HR:0.98, 95%CI:0.94-1.01; possible HR:0.97, 95%CI:0.93-1.01), but there was evidence of an increased risk of all-cause (HR:1.17, 95%CI:1.14-1.19), vascular (HR:1.81, 95%CI:1.73-1.89) and other dementias (HR:1.19, 95%CI:1.15-1.24). Evidence from a number of control outcomes indicated the presence of substantial residual confounding by indication (ischaemic heart disease HR: 1.62, 95%CI: 1.59-1.64; backpain HR: 1.04, 95%CI: 1.03-1.05; and Type 2 diabetes HR: 1.50, 95%CI: 1.48-1.51). Conclusion: Lipid-regulating agents were not associated with reduced Alzheimer's disease risk. There was some evidence of an increased the risk of all-cause, vascular and other dementias, likely due to residual confounding by indication.

scholarly journals Which Patients with Giant Cell Arteritis Will Develop Cardiovascular or Cerebrovascular Disease? A Clinical Practice Research Datalink Study

2016 ◽  
Vol 43 (6) ◽  
pp. 1085-1092 ◽  
Author(s):  
Joanna C. Robson ◽  
Amit Kiran ◽  
Joe Maskell ◽  
Andrew Hutchings ◽  
Nigel Arden ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cerebrovascular Disease ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Risk Model ◽  
Competing Risk ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
The Uk

Objective.To evaluate the risk of cerebrovascular disease and cardiovascular disease (CVD) in patients with giant cell arteritis (GCA), and to identify predictors.Methods.The UK Clinical Practice Research Datalink 1991–2010 was used for a parallel cohort study of 5827 patients with GCA and 37,090 age-, sex-, and location-matched controls. A multivariable competing risk model (non-cerebrovascular/CV-related death as the competing risk) determined the relative risk [subhazard ratio (SHR)] between patients with GCA compared with background controls for cerebrovascular disease, CVD, or either. Each cohort (GCA and controls) was then analyzed individually using the same multivariable model, with age and sex now present, to identify predictors of CVD or cerebrovascular disease.Results.Patients with GCA, compared with controls, had an increased risk SHR (95% CI) of cerebrovascular disease (1.45, 1.31–1.60), CVD (1.49, 1.37–1.62), or either (1.47, 1.37–1.57). In the GCA cohort, predictors of “cerebrovascular disease or CVD” included increasing age, > 80 years versus < 65 years (1.98, 1.62–2.42), male sex (1.20, 1.05–1.38), and socioeconomic status, most deprived quintile versus least deprived (1.34, 1.01–1.78). These predictors were also present within the non-GCA cohort.Conclusion.Patients with GCA are more likely to develop cerebrovascular disease or CVD than age-, sex-, and location-matched controls. In common with the non-GCA cohort, patients who are older, male, and from the most deprived compared with least deprived areas have a higher risk of cerebrovascular disease or CVD. Further work is needed to understand how this risk may be mediated by specific behavioral, social, and economic factors.

Risk of osteoarthritis in an incident cohort of people with psoriatic arthritis: a population-based cohort study

2020 ◽  
pp. jrheum.200564
Author(s):  
Rachel Charlton ◽  
Amelia Green ◽  
Gavin Shaddick ◽  
Julia Snowball ◽  
Alison Nightingale ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
General Population ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Study Cohort ◽  
Relative Risks ◽  
Population Cohort ◽  
Increased Risk ◽  
General Population Cohort

Objective To determine the risk of a diagnosis of osteoarthritis (OA) in psoriatic arthritis (PsA) patients compared to patients with psoriasis and a general population cohort. Methods Incident PsA patients aged 18-89 years at diagnosis were identified from the UK Clinical Practice Research Datalink between 1998 and 2014. All PsA patients were matched to two cohorts of patients both at a 1:4 ratio. The first cohort included patients with psoriasis (and no PsA) and the second was a general population cohort (with no psoriasis or PsA). The baseline prevalence of OA was calculated for each study cohort. The incidence of OA was calculated and adjusted relative risks (RRadj) were calculated using conditional Poisson regression. Results We identified 6,783 incident PsA patients. The baseline prevalence of OA ranged from 22.1% (CI9521.1-23.1) in the PsA cohort to 12.6% (CI9512.2-13.0) and 11.0% (CI9510.6- 11.3) in the psoriasis and general population cohorts respectively. The incidence of OA was significantly higher in the PsA cohort compared to the psoriasis and general population cohorts after adjusting for BMI (RRadj 1.68 CI951.46-1.93 and RRadj 1.86 CI951.62-2.14 respectively). Conclusion An increased risk of OA was observed in patients with PsA compared to patients with psoriasis alone and those in the general population. Further work is needed to determine whether this reflects a true increase in OA risk or misdiagnosed PsA and the extent to which it can be explained by differences in the opportunity for OA diagnosis between cohorts.

scholarly journals wEight chanGes, caRdio-mEtabolic risks and morTality in patients with hyperthyroidism (EGRET): a protocol for a CPRD–HES linked cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e055219
Author(s):  
Barbara Torlinska ◽  
Jonathan M Hazlehurst ◽  
Krishnarajah Nirantharakumar ◽  
G Neil Thomas ◽  
Julia R Priestley ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Weight Change ◽  
Practice Research ◽  
Antithyroid Drugs ◽  
Clinical Practice Research Datalink ◽  
Common Symptom ◽  
Weight Changes ◽  
Time To Event ◽  
Increased Risk ◽  
The Impact

IntroductionHyperthyroidism is a common condition affecting up to 3% of the UK population. Treatment improves symptoms and reduces the risk of atrial fibrillation and stroke that contribute to increased mortality. The most common symptom is weight loss, which is reversed during treatment. However, the weight regain may be excessive, contributing to increased risk of obesity. Current treatment options include antithyroid drugs, radioiodine and thyroidectomy. Whether there are differences in either weight change or the long-term cardiometabolic risk between the three treatments is unclear.Methods and analysisThe study will establish the natural history of weight change in hyperthyroidism, investigate the risk of obesity and risks of cardiometabolic conditions and death relative to the treatment. The data on patients diagnosed with hyperthyroidism between 1 January 1996 and 31 December 2015 will come from Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office of National Statistics Death Registry. The weight changes will be modelled using a flexible joint modelling, accounting for mortality. Obesity prevalence in the general population will be sourced from Health Survey for England and compared with the post-treatment prevalence of obesity in patients with hyperthyroidism. The incidence and time-to-event of major adverse cardiovascular events, other cardiometabolic outcomes and mortality will be compared between the treatments using the inverse propensity weighting model. Incidence rate ratios of outcomes will be modelled with Poisson regression. Time to event will be analysed using Cox proportional hazards model. A competing risks approach will be adopted to estimate comparative incidences to allow for the impact of mortality.Ethics and disseminationThe study will bring new knowledge on the risk of developing obesity, cardiometabolic morbidity and mortality following treatment for hyperthyroidism to inform clinical practice and public health policies. The results will be disseminated via open-access peer-reviewed publications and directly to the patients and public groups (Independent Scientific Advisory Committee protocol approval #20_000185).

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