scholarly journals Acute Coronary Syndrome in Idiopathic Inflammatory Myopathies: A Population-based Study

2019 ◽  
Vol 46 (11) ◽  
pp. 1509-1514 ◽  
Author(s):  
Valérie Leclair ◽  
John Svensson ◽  
Ingrid E. Lundberg ◽  
Marie Holmqvist
Keyword(s):  
Acute Coronary Syndrome ◽  
General Population ◽  
Incidence Rate ◽  
Competing Risk ◽  
First Year ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk

Objective.Evidence suggests an increased risk of cardiovascular (CV) diseases, including acute coronary syndrome (ACS), in idiopathic inflammatory myopathies (IIM). The aim of this study was to investigate the risk of ACS in an incident IIM cohort compared to the general Swedish population.Methods.A cohort of 655 individuals with incident IIM and 6813 general population comparators were identified from national registries. IIM subjects were diagnosed from 2002 to 2011. Followup started at IIM diagnosis and corresponding date in the general population. ACS, CV comorbidities, and CV risk factors were defined using International Classification of Diseases codes. Incidence rates including 95% CI were calculated. Cox proportional hazards models were used to compare the risk of ACS in patients with IIM and the general population. The competing risk of death was accounted for using competing risk regression models.Results.The incidence rate of ACS in IIM was higher than in the general population, particularly within the first year of diagnosis and in older individuals. The overall ACS incidence rate in IIM was 15.6 (95% CI 11.7–20.4) per 1000 person-years, with an HR of 2.4 (95% CI 1.8–3.2) compared with the general population. When accounting for the competing risk of death, the risk of ACS in IIM remained increased with a cumulative incidence of 7% at 5 years compared to 3.3% in the general population.Conclusion.IIM individuals are at higher risk of ACS, particularly within the first year after diagnosis.

Abstract P353: Survival after Acute Coronary Syndrome in the Community

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Sheila M McNallan ◽  
Yariv Gerber ◽  
Susan A Weston ◽  
Jill Killian ◽  
Shannon M Dunlay ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Survival Estimate ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Over Time

Background: Contemporary data on survival after incident acute coronary syndrome (ACS), including both myocardial infarction (MI) and unstable angina (UA), are limited. Objective: To describe survival after incident ACS, to determine if it differs by ACS type (MI or UA) and to determine whether it has improved over time. Methods: Olmsted County, MN residents hospitalized between 1/1/2005-12/31/2010 were screened for incident ACS. ACS was defined as either MI validated by standard epidemiological criteria or UA validated by the Braunwald classification. Patients were followed for death from any cause. Cox proportional hazards regression was used to determine whether survival differed by ACS type, while adjusting for year of diagnosis, age, sex and comorbidities. Results: Among 1,160 incident ACS cases (mean±SD age 66.9±14.8, 60% male), 35% were UA and 65% were MI. After a mean (SD) follow up of 3.7 (2.1) years, 274 deaths occurred. The 3-year Kaplan-Meier survival estimate for MI was 79.6% (95% CI: 76.7%-82.6%) and for UA was 84.9% (95% CI: 81.3%-88.6%) (log-rank p=0.011). The association of ACS type with survival differed by age (p=0.056). After adjustment for year of diagnosis, sex and comorbidities, no difference in survival was observed between ACS types among those aged <60 (HR for MI vs. UA: 0.64, 95% 0.29-1.42). By contrast, among patients aged 60-79, those with an MI had 2 times the risk of death compared to those with UA (HR: 2.04, 95% CI: 1.24-3.37). Patients aged 80 or older who had an MI had a 40% increased risk of death compared to patients of the same age who had UA (HR: 1.42, 95% CI: 1.02-1.98). There was no difference in survival over time (HR for 2010 vs. 2005: 0.91, 95% CI: 0.61-1.36). Conclusions: Survival did not differ between UA and MI patients younger than 60, however among patients 60 or older, survival was worse among those with an MI. Survival after ACS did not change over the study period.

Congestive heart failure complicating non-ST segment elevation acute coronary syndrome: incidence, predictors, and clinical outcomes

2005 ◽  
Vol 83 (1) ◽  
pp. 98-103 ◽  
Author(s):  
Shamir R Mehta ◽  
John W Eikelboom ◽  
Catherine Demers ◽  
Aldo P Maggioni ◽  
Patrick J Commerford ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Clinical Outcomes ◽  
St Segment Elevation ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
St Segment ◽  
Increased Risk

There are limited data regarding the incidence and clinical significance of congestive heart failure (CHF) in patients with non-ST segment elevation acute coronary syndromes (ACS). The objectives of this study were to examine the incidence, predictors, and clinical outcomes in patients with ACS without ST elevation who develop CHF. We studied patients with unstable angina or non-ST segment elevation myocardial infarction (NSTEMI) randomized to hirudin or unfractionated heparin in the Organisation to Assess Strategies for Ischemic Syndromes (OASIS-2) trial. The diagnosis of CHF was based on a combination of clinical and radiographic features. Patients were followed for 6 months. Of 10 141 randomized patients, 501 (4.9%) developed CHF within the first week and 643 (6.3%) during 6 months of followup. Independent predictors for the development of CHF were older age, female sex, diabetes, prior MI, prior CHF, and NSTEMI at presentation. Compared with patients who did not develop CHF, patients who developed CHF were at increased risk of death (odds ratio (OR) 3.4, 95% CI 2.7–4.3), new MI (OR 2.8, 95% CI 2.2–3.6), and the need for intra-aortic balloon pump insertion (OR 5.4, 95% CI 3.5–8.4) at 7 days and 6 months. There was no increase in use of cardiac catheterization (OR 0.8, 95% CI 0.7–1.0) or revascularization (OR 0.9, 95% CI 0.7–1.1) in patients who developed CHF. CHF is a common complication in patients presenting with non-ST segment elevation ACS and is strongly associated with adverse clinical outcomes including new MI and death. Despite this worse prognosis, patients with ACS developing CHF are less likely to be referred for invasive management.Key words: unstable angina, acute coronary syndrome, congestive heart failure, prognosis.

scholarly journals POS0796 SURVIVAL OF GIANT CELL ARTERITIS PATIENTS IN SLOVENIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 650.1-650
Author(s):  
A. Hočevar ◽  
A. Viršček ◽  
R. Jese ◽  
M. Tomsic ◽  
Z. Rotar
Keyword(s):  
General Population ◽  
Survival Curve ◽  
Standardized Mortality Ratio ◽  
First Year ◽  
Risk Of Death ◽  
Slovenian Population ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Standardized Mortality Ratios

Background:Recent meta-analysis reported no difference in the long-term mortality of GCA patients at a population level, but an increased mortality in hospital-based cohorts1.Objectives:The aim of our study was to evaluate for the first time the survival of GCA patients in Slovenia.Methods:We included patients with clinical diagnosis of GCA supported by histology or imaging diagnosed between September 2011 and December 2019 and prospectively followed at our secondary/tertiary rheumatology center. To evaluate mortality the censor date of 24. June 2020 was used. Kaplan–Meier analysis was used to analyze mortality. Standardized mortality ratio (SMR) was calculated using data of age matched Slovenian population as the reference.Results:Between September 2011 and December 2019 we identified 309 new GCA patients (203 (65.7%) females, median (IQR) age 74.9 (67.7–80.1.7), range 53.7 to 97.5 years). Patients were followed (until death or censor date) of a median (IQR) 33.3 (17.5-60.8) months. Until the censor date 51 (16.5%) GCA patients died (24 females, 27 males). We found no significant sex related differences in the net survival estimates during the first five years of follow up (p=0.68). Figure 1 shows the survival curve of GCA patients and general population as a comparator according to Kaplan–Meier analysis. In the first year following GCA diagnosis the mortality rate was 1.9 times higher compared to general Slovenian population (95% CI 1.19 - 2.88, p=0.03). For patients who survived the first year after diagnosis the mortality was comparable to the general population (Table 1).Figure 1.Survival curve according to Kaplan–Meier analysis in GCATable 1.Standardized mortality ratios of patients who survived the first year after diagnosing GCA (ie. were followed at least one year) compared to the general populationYearsof FUObserved deathsExpected deathsSMR (95%CI)P-value2119.71.14 (0.57-2.03)0.75331416.50.85 (0.46-1.43)0.62642121.60.97 (0.60-1.49)0.98752525.01.00 (0.65-1.48)0.92162627.60.94 (0.61-1.38)0.831Legend: FU follow up; SMR Standardized mortality ratios; CI confidence intervalConclusion:GCA patients had an increased risk of death in the first year from the GCA diagnosis.References:[1]Hill CL, et al. Semin Arthritis Rheum. 2017;46(4):513-9.Disclosure of Interests:None declared

scholarly journals The Association between Nutritional Status and In-Hospital Mortality among Patients with Acute Coronary Syndrome—A Result of the Retrospective Nutritional Status Heart Study (NSHS)

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3091
Author(s):  
Michał Czapla ◽  
Piotr Karniej ◽  
Raúl Juárez-Vela ◽  
Katarzyna Łokieć
Keyword(s):  
Acute Coronary Syndrome ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Nutrition Risk ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Heart Study ◽  
Increased Risk

Background: Nutritional status is related to the prognosis and the length of hospitalization of individuals with myocardial infarction. This study aimed to assess the effects of nutritional status on in-hospital mortality in patients with acute coronary syndrome. Methods: We performed a retrospective study of 1623 medical records of patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland) between 2017 and 2019. Results: It was found that, of those who died in the sample, 50% had a BMI within the normal range, 29% were in the overweight range and 18% were in the obese range. Patients who died had significantly more frequent occurrences of the following: Nutrition Risk Screening (NRS) ≥ 3 (20% vs. 6%; p < 0.001); heart failure (53% vs. 25%; p < 0.001); or a history of stroke (22% vs. 9%; p < 0.001), arterial hypertension (66% vs. 19%; p < 0001) or diabetes (41% vs. 19%; p < 0.001). Statistically significant differences were found when considering the type of infarction, diabetes or people with low-density lipoprotein greater than or equal to 70 mg/dL. Conclusions: This study shows that malnutrition correlates with an increased risk of death during hospitalization.

scholarly journals Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Magnus O. Wijkman ◽  
Brian Claggett ◽  
Rafael Diaz ◽  
Hertzel C. Gerstein ◽  
Lars Køber ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Coronary Event ◽  
Hazard Ratio ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
The Relationship

Abstract Background The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. Methods We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. Results Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99–1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04–1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86–1.04) P = 0.26; P for interaction 0.005). Conclusions The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010

Endothelial dysfunction and cardiovascular mortality in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yoshii ◽  
T Matsuzawa ◽  
H Nakahashi ◽  
R Satou ◽  
E Akiyama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Cardiovascular Mortality ◽  
Causes Of Death ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Abstract Background Although the prognostic value of non-invasive endothelial function test has been reported in several populations including heart failure patients and angina pectoris patients, it is unknown in patients with acute coronary syndrome (ACS). Furthermore, the role of endothelial dysfunction in increased risk for specific causes of death has not been investigated. Purpose To study the relation between endothelial dysfunction and the risk of death in ACS patients, both overall and with regard to the main causes of death. Method Six hundred and ninety-two patients who were hospitalized for ACS from 2010 to 2014 were enrolled. Reactive hyoeremia index (RHI) was measured to assess endothelial function non-invasively in all patients using the peripheral arterial tonometry. RHI values below 1.67 were interpreted as signs of endothelial dysfunction in accordance with the manufacturer. Patients were followed up for a median of 6.5 years. Result A mean age (standard deviation) was 66 (12) years, and 542 patients (78%) were male. The patients in this study consist of 377 ST-elevation myocardial infarction (54%), and 263 non ST-elevation myocardial infarction (38%), and 52 unstable angina (8%). Endothelial dysfunction was detected in 276 patients (40%). During the follow-up period, 84 patients (12%) died (48 from cardiovascular disease, 36 from other causes). Patients with endothelial dysfunction had an increased risk of death (hazard ratio (HR) 1.83, 95% confidence interval (95% CI): 1.19–2.83, p=0.006) compared with those without endothelial dysfunction. Analyses for specific causes of death showed that patients with endothelial dysfunction had a 2.4-fold higher increased risk of cardiovascular death (HR: 2.44, 95% CI: 1.35 ro 4.59, p=0.003) after multivariate adjustment. However there was no significant relation between endothelial dysfunction and non-cardiovascular mortality (HR: 0.69, 95% CI: 0.34 to 1.36, p=0.29). Conclusion Endothelial dysfunction is strongly associated with an increased risk of cardiovascular mortality in ACS patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals The effectiveness of clopidogrel in the prevention of thrombotic complications in patients with acute coronary syndrome and genetic factors

2012 ◽  
Vol 93 (2) ◽  
pp. 294-297
Author(s):  
A S Galyavich ◽  
D D Valeeva
Keyword(s):  
Acute Coronary Syndrome ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Antiplatelet Drug ◽  
C3435t Polymorphism ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
P Glycoprotein ◽  
Cyp2c19 Polymorphism ◽  
Increased Risk

This review article presents the current views on genotyping during administration of clopidogrel - an antiplatelet drug from the class of thienopyridines, for patients with acute coronary syndrome. Highlighted were the data on genetic disorders affecting the absorption and metabolism of clopidogrel. The gene ABCB1 (MDR1) encodes the intestinal transporter P-glycoprotein. The variability of this gene may affect the bioavailability of clopidogrel. However, data on the relationship between C3435T polymorphism of ABCB1 gene and the expression of P-glycoprotein still remain controversial. Differences in the effects of C3435T may reflect the differences in the frequency of ABCB1 polymorphism among ethnic groups and the complex of effects of different polymorphisms in the same gene within a haplotype, or confounding factors of the environment. The most important role in the metabolism of clopidogrel is played by cytochrome P-450 (iso-enzyme CYP2C19). Several large studies have confirmed the prognostic significance of CYP2C19 polymorphism in patients receiving clopidogrel. In a recent meta-analysis of nine pharmacogenetic studies of clopidogrel, which included 9685 patients with acute coronary syndrome, revealed was a significant association between the homozygous and heterozygous alleles with reduced CYP2C19 function and an increased risk of death due to cardiovascular disease, myocardial infarction or stroke. Two large randomized studies of CYP2C19 genotyping did not reveal any relationship between its variants and the occurrence of cardiovascular events in patients with acute coronary syndrome or atrial fibrillation. Thus, in genetic studies of the antiplatelet effectiveness of clopidogrel, there are many uncertainties; domestic data on this subject is extremely scarce.

scholarly journals Clinical profile of patients with acute coronary syndrome and its association with biomarker troponin I

2018 ◽  
Vol 5 (2) ◽  
pp. 433
Author(s):  
Hemant S. Joshi ◽  
Samil Sajal ◽  
Nirmit V. Yagnik ◽  
Y. K. Bolya
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Clinical Profile ◽  
Prognostic Information ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Acute Mi ◽  
Coronary Syndromes

Background: In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. Author studied the clinical profile of patients with Acute MI and its relation with troponin I level.Methods: In this prospective study, 65 patients admitted with Acute MI were studied. Study patients were divided in Troponin I positive and Troponin I negative group. Patients were followed up to discharge or death in the hospital.Results: Most common symptom present in the patients with Acute Coronary Syndrome was chest pain (94%) and most common risk factor was dyslipidaemia (72.3%). Most common complication was recurrent angina (72.3%). Out of total patients with significant CAD, almost 70 % belong to Troponin I positive group and it is statistically highly significant (p<0.05). Total 30 patients (46.2%) have more than 10 episodes of angina in our study. There is statistically significant association between number of angina episode and Troponin I positivity (p<0.05). Out of total deaths, 73.3% have occurred among Troponin I positive study patients and it is statistically significant (p<0.05).Conclusions: In patients with acute coronary syndromes, cardiac troponin I levels provide useful prognostic information and permit the early identification of patients with an increased risk of death.  

Venous thromboembolism in 9,489 patients with glioma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1538-1538
Author(s):  
T. J. Semrad ◽  
R. O’Donnell ◽  
H. Zhou ◽  
T. Wun ◽  
R. White
Keyword(s):  
Risk Factors ◽  
Incidence Rate ◽  
Cancer Diagnosis ◽  
Lower Risk ◽  
First Year ◽  
Cox Models ◽  
Neurosurgical Procedure ◽  
Risk Of Death ◽  
Increased Risk ◽  
Venous Thromboembolic Events

1538 Background: Venous thromboembolic events (VTE) are a commonly reported complication of brain tumors. The objective of this study was to define the incidence, risk factors, and outcomes associated with VTE in a population-based cohort. Methods: This was a retrospective analysis of all glioma cases diagnosed in California between 1993–1995 and 1997–1999. Glioma cases in the California Cancer Registry were linked to the California Patient Discharge Database to identify incident VTE. Cox models were generated to analyze the association of pre-specified risk factors with VTE or death within one year of the cancer diagnosis. Results: There were 9489 cases: 76% were Caucasians and 56% were men. The 1-year cumulative incidence of VTE was 663 (7%) with an incidence rate during the first year of 11.1 events per 100 person-years. Sixty-six percent of all VTE diagnosed in the first year occurred within 3 months of the cancer diagnosis with a corresponding incidence rate of 21.6 events per 100 person-years. Of 663 first year VTE, 405 (61%) occurred <2 months after an invasive neurosurgical procedure. Glioblastoma multiforme (GBM) was associated with an increased risk of VTE (HR=1.6, CI: 1.3–2.0) compared to other gliomas. The risk of VTE was strongly associated with the number of chronic co-morbidities (HR=4.0, CI: 3.1–5.0 for ≥3 chronic co-morbidities). Asian race was associated with significantly lower risk of VTE (HR=0.3, CI: 0.2–0.6) and female gender conferred a modestly lower risk (HR=0.8, CI: 0.7–0.9). A VTE in the first year was associated with slightly lower risk of death (HR = 0.8; CI: 0.8–0.9), whereas increasing age (HR=6.3, CI: 5.6–7.0 for age≥75), number of co-morbidities (HR=1.9, CI: 1.7–2.0 for ≥3 chronic co-morbidities), and GBM (HR=2.2, CI: 2.0–2.4) or anaplastic astrocytoma (HR=1.5, CI: 1.3–1.7) histology were associated with a higher risk of death within 1 year. Conclusions: In this large glioma cohort, the incidence of symptomatic VTE was very high. Two-thirds of all VTE occurred early after the diagnosis of glioma, and most of these occurred within 2 months of an invasive neurosurgical procedure. The presence of chronic medical co-morbidities and GBM histology were strong predictors of VTE. A diagnosis of VTE was not associated with an increased risk of death within 1 year. No significant financial relationships to disclose.

Siblings of patients with rheumatoid arthritis are at increased risk of acute coronary syndrome

2019 ◽  
Vol 78 (5) ◽  
pp. 683-687 ◽  
Author(s):  
Helga Westerlind ◽  
Marie Holmqvist ◽  
Lotta Ljung ◽  
Thomas Frisell ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
General Population ◽  
Cox Regression ◽  
Significant Risk ◽  
Coronary Syndrome ◽  
Risk Increase ◽  
Increased Risk ◽  
The Impact

ObjectivesTo investigate a potential shared susceptibility between rheumatoid arthritis (RA) and acute coronary syndrome (ACS) by estimation of the risk of ACS among full siblings of patients with RA.MethodsBy linking nation-wide Swedish registers, we identified a cohort of patients with new-onset RA 1996–2016, age- and sex-matched (5:1) general population comparator subjects, full siblings of RA and comparator subjects, and incident ACS events through 31 December 2016. We used Cox regression to estimate the HR of ACS among patients with RA and the siblings of patients with RA versus the general population, overall and stratified by RA serostatus. We explored the impact of traditional cardiovascular (CV) risk factors on the observed associations.ResultsWe identified 8109 patients with incident RA, and 11 562 full siblings of these. Compared with the general population, the HR of ACS in RA was 1.46 (95% CI 1.28 to 1.67) and 1.22 (95% CI 1.09 to 1.38) among their siblings. The increased risks seemed confined to seropositive RA (patients: 1.52 [1.30 to 1.79], their siblings: 1.27 [1.10 to 1.46]); no significant risk increase was observed among siblings of patients with seronegative RA (HR 1.13 [95% CI 0.92 to 1.39]). Adjustment for 19 traditional CV risk factors did not appreciably alter these associations.ConclusionSiblings of patients with RA are at increased risk of ACS, suggesting shared susceptibility between RA and ACS, indicating the need and potential for additional cardio-preventive measures in RA (and their siblings).

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