Premature atherosclerosis in primary antiphospholipid syndrome: preliminary data.

OBJECTIVE: To investigate the atherosclerosis hypothesis in primary antiphospholipid syndrome (PAPS). METHODS: The intima media thickness (IMT) of carotid arteries and other cardiovascular risk factors was measured in 20 patients with PAPS (mean (SD) age 35 (12) years) and in 20 controls matched for age and sex (34 (12) years). RESULTS: The frequency of smoking, hypertension, and dyslipidaemia was similar in the two groups, but plasma homocysteine was higher in patients with PAPS (mean (SD) 11.9 (6.2) v 8.2 (3.4) micromol/l, p = 0.037). The IMT was slightly greater in patients with PAPS than in controls at the carotid bifurcation (mean (SD) 0.61 (0.24) v 0.48 (0.09) mm, p = 0.04) and internal carotid artery (0.52 (0.22) v 0.40 (0.08), p = 0.01). These differences were more evident in patients aged >40 years than in those aged <30 years at the carotid bifurcation (0.76 (0.25) v 0.55 (0.06), p = 0.0007) and internal carotid artery (0.63 (0.25) v 0.45 (0.09), p = 0.02); no differences were seen in the younger age group compared with controls. CONCLUSION: Atherosclerosis is a possibility in patients with PAPS in their fourth decade of life or older.

Bone loss in patients treated with pulses of methylprednisolone is not negligible: a short term prospective observational study.

OBJECTIVE: To examine the influence of intravenous pulsed methylprednisolone (MP) on bone mass. METHODS: 38 patients (30 women) with various rheumatic disorders requiring intravenous MP pulse treatment were examined at baseline and after 6 months with dual energy x ray absorptiometry (DXA), measuring hip and lumbar spine bone mineral density (BMD). Demographic and clinical data were collected. RESULTS: Demographics showed: mean (SD) age 48.4 (16.3) years, body mass index 24.9 (5.1) kg/m(2), and median (range) disease duration 3.2 (0.1-40.0) years. During follow up patients received a mean cumulative MP dose of 3.0 (1.6) g given as 5.7 (2.0) pulses over a median period of 5.7 (2.3-33.7) months. 34/38 (89%) patients were also pulsed with cyclophosphamide, 20 (53%) were taking oral corticosteroids, and 8 (21%) were using either bisphosphonates or oestrogen. At the end of the study mean BMD was reduced by -2.2% at the femoral neck, -1.1% at the total hip, and -1.0% at the spine L2-4. In subgroups BMD increased in patients treated with bisphosphonates or oestrogen (femoral neck +1.6%, total hip +3.2%, spine L2-4 +4.5%), whereas BMD decreased at all sites in patients not treated with antirersorptive treatment, both for users (femoral neck -4.4%, total hip -2.4%, spine L2-4 -2.1%) and non-users of concomitant oral prednisolone (femoral neck -1.7%, total hip -1.9%, spine L2-4 -2.6%). CONCLUSION: Treatment with intravenous pulses of MP leads to a high rate of bone loss. Prevention of bone loss in these patients with bisphosphonates and oestrogens should be considered.

Comparison of disability and quality of life in rheumatoid and psoriatic arthritis.

OBJECTIVE: There is controversy about the severity of peripheral psoriatic arthritis (PsA) compared to rheumatoid arthritis (RA). Early reports found PsA to be a milder disorder, excepting the mutilans form. Recent reports suggest that PsA can be as severe as RA. We compared severity, disability, and quality of life in patients with PsA and RA matched primarily for disease duration. METHODS: Data relating to the extent and severity of disease were recorded in a hospital clinic setting. Recent radiographs of hands and feet were read blinded to diagnosis, and information on function and quality of life was collected with the Health Assessment Questionnaire (HAQ) and EuroQol-5D, respectively. RESULTS: Forty-seven patients were matched for disease duration (median PsA 5 yrs, RA 7 yrs). The male/female ratio was 24/23 for PsA, 16/31 for RA, and median ages were 45 and 51 years, respectively. Patients with RA had significantly more joint involvement of metacarpophalangeal joints and wrists, whereas distal interphalangeal joints, spine, sternoclavicular joints, and sacroiliac joints were significantly more involved in PsA. No difference was found regarding Ritchie Articular Index, inflammatory markers, HAQ score, or EuroQol-5D. Patients with RA had significantly more damage on radiographs of hands and feet: median (range) Larsen score hands PsA 8 (0-91), RA 38 (0-125); feet PsA 4 (0-34), RA 11(0-56). Patients with RA were taking significantly more disease modifying drugs. CONCLUSION: Peripheral joint damage is significantly greater in RA than in PsA after equivalent disease duration, but function and quality of life scores are the same for both groups. The additional burden of skin disease in PsA may account for this.