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 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 Endocrine and Metabolic Diseases Among Colorectal Cancer Survivors in a Population-Based Cohort

2019 ◽  
Vol 112 (1) ◽  
pp. 78-86
Author(s):  
Makenzie L Hawkins ◽  
Brenna E Blackburn ◽  
Kerry Rowe ◽  
John Snyder ◽  
Vikrant G Deshmukh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factor ◽  
General Population ◽  
Metabolic Diseases ◽  
The United States ◽  
Population Cohort ◽  
Increased Risk ◽  
General Population Cohort ◽  
Time Periods

Abstract Background There are an estimated 1.4 million colorectal cancer (CRC) survivors in the United States. Research on endocrine and metabolic diseases over the long term in CRC survivors is limited. Obesity is a risk factor for CRC; thus it is of interest to investigate diseases that may share this risk factor, such as diabetes, for long-term health outcomes among CRC survivors. Methods A total of 7114 CRC patients were identified from the Utah Population Database and matched to a general population cohort of 25 979 individuals on birth year, sex, and birth state. Disease diagnoses (assessed over three time periods of 1–5 years, 5–10 years, and &gt;10 years) were identified using electronic medical records and statewide ambulatory and inpatient discharge data. Cox proportional hazard models were used to estimate the risk of endocrine and metabolic disease. Results Across all three time periods, risks for endocrine and metabolic diseases were statistically significantly greater for CRC survivors compared with the general population cohort. At 1–5 years postdiagnosis, CRC survivors’ risk for diabetes mellitus with complications was statistically significantly elevated (hazard ratio [HR] = 1.36, 99% confidence interval [CI] = 1.09 to 1.70). CRC survivors also experienced a 40% increased risk of obesity at 1–5 years postcancer diagnosis (HR= 1.40, 99% CI= 1.66 to 2.18) and a 50% increased risk at 5–10 years postdiagnosis (HR = 1.50, 99% CI= 1.16 to 1.95). Conclusions Endocrine and metabolic diseases were statistically significantly higher in CRC survivors throughout the follow-up periods of 1–5 years, 5–10 years, and more than 10 years postdiagnosis. As the number of CRC survivors increases, understanding the long-term trajectory is critical for improved survivorship care.

scholarly journals Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study

2021 ◽  
pp. 1-8
Author(s):  
Rebecca Musgrove ◽  
Matthew J. Carr ◽  
Nav Kapur ◽  
Carolyn A. Chew-Graham ◽  
Faraz Mughal ◽  
...  
Keyword(s):  
Older Adults ◽  
General Population ◽  
Cumulative Incidence ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Close Monitoring ◽  
Post Discharge ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Working Age

Background Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. Aims To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge. Method Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001–2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18–64 and ≥65 years with additional stratification by gender and practice-level deprivation. Results The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0–2.3) and 14.1% (95% CI 13.6–14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0–292.0) among working-age adults and 125.4 (95% CI 52.6–298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation. Conclusions Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.

scholarly journals The Risk of Deep Venous Thrombosis and Pulmonary Embolism in Primary Sjögren Syndrome: A General Population-based Study

2017 ◽  
Vol 44 (8) ◽  
pp. 1184-1189 ◽  
Author(s):  
J. Antonio Aviña-Zubieta ◽  
Michael Jansz ◽  
Eric C. Sayre ◽  
Hyon K. Choi
Keyword(s):  
Pulmonary Embolism ◽  
General Population ◽  
Population Based ◽  
Sjögren Syndrome ◽  
First Year ◽  
Study Cohort ◽  
Sjogren Syndrome ◽  
Primary Sjögren Syndrome ◽  
Entry Time ◽  
Increased Risk

Objective.To estimate the future risk and time trends of venous thromboembolism (VTE) in individuals with newly diagnosed primary Sjögren syndrome (pSS) in the general population.Methods.Using a population database that includes all residents of British Columbia, Canada, we created a study cohort of all patients with incident SS and up to 10 controls from the general population matched for age, sex, and entry time. We compared incidence rates (IR) of pulmonary embolism (PE), deep vein thrombosis (DVT), and VTE between the 2 groups according to SS disease duration. We calculated HR, adjusting for confounders.Results.Among 1175 incident pSS cases (mean age 56.7 yrs, 87.6% women), the IR of PE, DVT, and VTE were 3.9, 2.8, and 5.2 per 1000 person-years (PY), respectively; the corresponding rates in the comparison cohort were 0.9, 0.8, and 1.4 per 1000 PY. Compared with non-SS individuals, the multivariable HR for PE, DVT, and VTE among SS cases were 4.07 (95% CI 2.04–8.09), 2.80 (95% CI 1.27–6.17), and 2.92 (95% CI 1.66–5.16), respectively. The HR matched for age, sex, and entry time for VTE, PE, and DVT were highest during the first year after SS diagnosis (8.29, 95% CI 2.57–26.77; 4.72, 95% CI 1.13–19.73; and 7.34, 95% CI 2.80–19.25, respectively).Conclusion.These findings provide population-based evidence that patients with pSS have a substantially increased risk of VTE, especially within the first year after SS diagnosis. Further research into the involvement of monitoring and prevention of VTE in SS may be warranted.

scholarly journals Antihypertensive Medications and COVID-19 Diagnosis and Mortality: Population-based Case-Control Analysis in the United Kingdom

2020 ◽  
Author(s):  
Emma Rezel-Potts ◽  
Abdel Douiri ◽  
Phil J Chowienczyk ◽  
Martin C Gulliford
Keyword(s):  
Antihypertensive Therapy ◽  
Population Based ◽  
Case Control ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Control Analysis ◽  
Antihypertensive Medications ◽  
Lower Odds ◽  
Healthcare Seeking ◽  
Increased Risk

Objectives: To evaluate antihypertensive medications and COVID-19 diagnosis and mortality, accounting for healthcare seeking behaviour. Design: A population-based case control study with additional cohort analysis. Setting: Primary care patients from the UK Clinical Practice Research Datalink (CPRD). Participants: 16 866 patients with COVID-19 events in the CPRD from 29th January to June 25th 2020 and 70 137 matched controls. Main outcome measures: We explored associations between COVID-19 diagnosis and prescriptions for angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (B), calcium-channel blockers (C), thiazide diuretics (D) and other antihypertensive drugs (O). We evaluated all-cause mortality among COVID-19 cases. Analyses were adjusted for covariates and consultation frequency. Results: In covariate adjusted analyses, ACEIs were associated with lower odds of COVID-19 diagnosis (0.82, 95% confidence interval 0.77 to 0.88) as were ARBs, 0.87 (0.80 to 0.95) with little attenuation from adjustment for consultation frequency. In fully adjusted analyses, C and D were also associated with lower odds of COVID-19. Increased odds of COVID-19 for B (1.19, 1.12 to 1.26), were attenuated after adjustment for consultation frequency (1.01, 0.95 to 1.08). In adjusted analyses, patients treated with ACEIs or ARBs had similar mortality to patients treated with classes B, C, D or O (1.00, 0.83 to 1.20) or patients receiving no antihypertensive therapy (0.99, 0.83 to 1.18). Conclusions: Associations were sensitive to adjustment for confounding and healthcare seeking, but there was no evidence that antihypertensive therapy is associated with increased risk of COVID-19 diagnosis or mortality; most classes of antihypertensive therapy showed negative associations with COVID-19 diagnosis.

scholarly journals The risk of psoriasis in patients with uveitis: A nationwide population-based cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255492
Author(s):  
Yu-Yen Chen ◽  
Hsin-Hua Chen ◽  
Tzu-Chen Lo ◽  
Pesus Chou
Keyword(s):  
Cohort Study ◽  
Psoriatic Arthritis ◽  
Cox Regression ◽  
Population Based ◽  
Severe Psoriasis ◽  
Study Cohort ◽  
Research Database ◽  
Insurance Cost ◽  
Hazard Ratios ◽  
Increased Risk

Objective To evaluate whether the risk of subsequent psoriasis and psoriatic arthritis development is increased in patients with uveitis. Methods In Taiwan’s national health insurance research database, we identified 195,125 patients with new-onset uveitis between 2001 and 2013. We randomly selected 390,250 individuals without uveitis who were matched 2:1 to uveitis cases based on age, sex and year of enrolment. The characteristics of the two groups were compared. Using multivariate Cox regression, hazard ratios (HRs) for psoriasis or psoriatic arthritis corresponding to uveitis were computed after adjustment for age, sex, insurance cost and comorbidities. In subgroup analyses, separate HRs for mild psoriasis, severe psoriasis and psoriatic arthritis were calculated. Results The mean age of the study cohort was 50.2 ± 17.2 years. Hypertension, diabetes, hyperlipidaemia and obesity were more prevalent in the uveitis group (all p < 0.0001). The hazard of psoriasis or psoriatic arthritis development was significantly greater in the uveitis group than in the non-uveitis group (p < 0.0001); this increased risk persisted after adjustment for confounders [adjusted HR = 1.41; 95% confidence interval (CI), 1.33–1.48]. Adjusted HRs showed an increasing trend from mild psoriasis (1.35; 95% CI, 1.28–1.44) to severe psoriasis (1.59; 95% CI, 1.30–1.94) and psoriatic arthritis (1.97; 95% CI, 1.60–2.42). Conclusions This nationwide population-based cohort study revealed that patients with uveitis have an increased risk of subsequent psoriasis or psoriatic arthritis development.

scholarly journals Infectious Disease Burden and the Risk of Alzheimer’s Disease: A Population-Based Study

2021 ◽  
pp. 1-10
Author(s):  
Antonios Douros ◽  
Christina Santella ◽  
Sophie Dell’Aniello ◽  
Laurent Azoulay ◽  
Christel Renoux ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Disease Burden ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Cumulative Number ◽  
Increased Risk

Background: Previous studies suggested a link between various infectious pathogens and the development of Alzheimer’s disease (AD), posing the question whether infectious disease could present a novel modifiable risk factor. Objective: To assess whether infectious disease burden due to clinically apparent infections is associated with an increased risk of AD. Methods: We conducted a population-based nested case-control study using the United Kingdom Clinical Practice Research Datalink. We included all dementia-free subjects ≥50 years of age enrolling in the database between January 1988 and December 2017. Each case of AD identified during follow-up was matched with up to 40 controls. Conditional logistic regression estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of AD associated with ≥1 infection diagnosed >  2 years before the index date compared with no infection during the study period. We further stratified by time since first infection and cumulative number of infections. Results: The cohort included overall 4,262,092 individuals (mean age at cohort entry 60.4 years; 52% female). During a median follow-up of 10.5 years, 40,455 cases of AD were matched to 1,610,502 controls. Compared with having no burden of infectious disease, having a burden of infectious disease was associated with an increase in the risk of AD (OR, 1.05; 95% CI, 1.02 to 1.08). The risk increased with longer time since first infection, peaking after 12–30 years (OR, 1.11; 95% CI, 1.05–1.17). The risk did not increase with cumulative number of infections. Conclusion: The overall risk of AD associated with infectious disease burden was small but increased gradually with longer time since first infection.

Long-Term Mortality of Patients with Primary Immune Thrombocytopenia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 619-619
Author(s):  
Henrik Frederiksen ◽  
Merete Lund Maegbaek ◽  
Henrik Toft Sorensen
Keyword(s):  
Platelet Count ◽  
General Population ◽  
Index Date ◽  
Population Based ◽  
Ongoing Treatment ◽  
Remission Status ◽  
Population Cohort ◽  
Comparison Cohort ◽  
General Population Cohort

Abstract Abstract 619 Introduction Morbidity and mortality are higher among patients with primary immune thrombocytopenia (ITP) than in the general population. In 1999 we reported on a population-based cohort of patients with incident primary ITP, with long and complete follow-up1. Here we report on mortality within this cohort according to remission status. We also compare mortality in this cohort with that in the general population. Methods ITP cohort A population-based cohort of all incident ITP patients was identified, consisting of patients aged > 14 years, diagnosed in any Danish hospital or outpatient clinic during the 23-year period from 1973 through 19951. The date of last follow-up was the last date on which the patient was both present at the hospital and had his/her platelet count measured. The index date was defined as the last follow-up date. General population comparison cohort For each ITP patient, we randomly identified 10 comparison cohort members matched on age, sex, and calendar year. Members of the comparison cohort were assigned the index date according to the ITP patient of which they were matched. Remission Remission criteria for ITP patients at last follow-up were defined before data were collected. Criteria for Complete Remission (CR) were ITP treatment discontinued and platelet count > 149 × 109/l. Criteria for Partial Remission (PR) were ITP treatment discontinued, increased platelet count since diagnosis, and one of the following: 1) platelet count of 100–149 × 109/l; 2) platelet count increased by at least 50% to 50–99 × 109/l; 3) platelet count increased by at least 100% to 20–49 × 109/l; or 4) platelet count increased to at least 20 × 109/l, if initial platelet count was < 10 × 109/l. All other patients, including those who were still on ITP medical treatment at last follow-up, were in the No Remission (NR) group. For the survival analyses, patients in the NR category were stratified into the following three subgroups on the basis of treatment and platelet count at last follow-up: A. No remission due to ongoing treatment, with a platelet count > 149 × 109/l; B. No remission due to ongoing treatment, with a platelet count < 150 × 109/l; or C. No remission and no current treatment. Statistical analysis We assessed survival in the ITP cohort and compared it to the general population cohort. Participants in the two cohorts were followed from the index date until emigration, death, or 1 January 2012, whichever event came first. We used the Kaplan-Meier Method to compare survival between the ITP and the general population cohorts. We used Cox regression to compare rates of mortality among ITP patients and members of the general population cohort. We estimated mortality rate ratios (MRRs) and associated 95% confidence intervals (CIs). The MRRs were adjusted for age, sex, calendar year, comorbidity, and remission status at last follow-up. Results Since diagnosis, 116 (52%) of the ITP patients died. The mortality in the ITP cohort was consistently higher than the in the general population cohort (Figure 1), with an adjusted MRR of 1.4 (95% CI: 1.2–1.8). When remission status was taken into account, ITP patients who were in the NR category due to ongoing treatment and decreased platelet counts at last follow-up had the highest mortality (Figure 2). This subgroup had adjusted MRRs of 6.3 (95% CI: 3.7–10.7) after 5 years, 9.1 (95% CI: 5.1–16.4) after 10 years, and 9.9 (95% CI: 5.4–18.1) after 20 years, compared to the general population cohort. In contrast, patients who were in the CR category at last follow-up had 5-year,10-year, and 20-year MRRs comparable to those of the general population cohort. Conclusion Both short-term and long-term mortality among adult ITP patients are elevated compared to the general population. Mortality rates are highest among patients who are on ITP treatment and remain thrombocytopenic. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Occurrence, thromboembolic risk, and mortality in Danish patients with cold agglutinin disease

2019 ◽  
Vol 3 (20) ◽  
pp. 2980-2985 ◽  
Author(s):  
Lauren C. Bylsma ◽  
Anne Gulbech Ording ◽  
Adam Rosenthal ◽  
Buket Öztürk ◽  
Jon P. Fryzek ◽  
...  
Keyword(s):  
General Population ◽  
Mortality Risk ◽  
Cold Agglutinin ◽  
Cold Agglutinin Disease ◽  
Thromboembolic Risk ◽  
Risk Of Death ◽  
Population Cohort ◽  
Increased Risk ◽  
Key Points ◽  
General Population Cohort

Key Points This is the first study to compare thromboembolism and mortality risk in CAD against a general population cohort. Patients with CAD were at a significantly increased risk of death, especially during the first 5 years after diagnosis.

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