Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies.

OBJECTIVES: Knowledge of cardiac involvement in idiopathic inflammatory myopathies (IIM) is limited, especially in the early stage of disease. The objective of the present study was to perform a controlled evaluation of cardiac abnormalities in newly diagnosed, untreated patients with idiopathic inflammatory myopathies (IIM) by means of non-invasive techniques. METHODS: Fourteen patients with IIM (8 polymyositis, 4 dermatomyositis, 2 cancer-associated dermatomyositis) and 14 gender- and age- matched healthy control subjects were investigated. Participant assessments included a cardiac questionnaire, cardiac troponin-I (TnI), electrocardiogram (standard 12-lead and 48-h Holter monitoring), echocardiography with tissue Doppler measures, cardiac magnetic resonance (CMR) imaging with T2 mapping and semi-quantitative (99m)technetium pyrophosphate ((99m)Tc-PYP) scintigraphy. RESULTS: Dyspnoea was present in 8 (57%) of the patients compared to none of the controls (p<0.01). Median levels of TnI in patients and controls were 20 ng/L and 6 ng/L, respectively (p=0.06). QTc intervals were prolonged in the patient group (p=0.01). Two patients had systolic dysfunction, and one diastolic dysfunction. The myocardial (99m)Tc-PYP uptake and CMR results differed between patients and controls, albeit not with statistical significance. Overall, cardiac abnormalities were demonstrated in 9 (64%) of the patients versus 2 (14%) of the controls (p=0.02). CONCLUSIONS: Cardiac abnormalities assessed by TnI, ECG or imaging modalities were significantly more common in newly diagnosed, treatment naïve patients with IIM compared to healthy control subjects. These abnormalities, although subclinical, may indicate that myocardial involvement is common in patients and calls for larger controlled studies and further investigations of the prognostic implications of this finding.

Self-reported physical activity in Danish patients with systemic lupus erythematosus.

INTRODUCTION: Physical activity is acknowledged as an important factor for enhancing health, and the WHO recommends performing physical activity weekly. The aim of this study was to describe self-reported physical activity in a population of patients with systemic lupus erythematosus. METHODS: The patients were enrolled at outpatient consultations where patient and disease characteristics such as age, gender, disease damage (SLICC/ACR-DI), disease activity (SLEDAI-2K) and medication were registered. Self-reported physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ), and a continuous variable on energy requirement in the form of the metabolic equivalent (MET) was calculated. Depression was evaluated with the Major Depression Inventory (MDI) questionnaire. RESULTS: A total of 210 patients reported a mean total MET score of 5,319 ± 3,650 (mean ± standard deviation) MET-min./week, and they spent an average of 194 ± 118 min./day being physically active. 70.5% of the patients reported a high level of physical activity and 89.5% met the WHO recommendations. The MDI questionnaire found that 10.5% were depressed. Severely depressed patients had lower MET scores, but this group only included six patients. Physical activity was inversely associated with time spent sitting according to the IPAQ (p = 0.001), disease duration (p = 0.02) and the SLICC/ACR DI score (p = 0.01), but not with the MDI (p = 0.26). CONCLUSION: A large share of the patients reported a high level of physical activity and met the WHO recommendations. FUNDING: Odense University Hospital Fund for Pre-graduate Scholarships (A 3478). TRIAL REGISTRATION: not relevant.

Coronary, Carotid, and Lower-extremity Atherosclerosis and Their Interrelationship in Danish Patients with Systemic Lupus Erythematosus.

OBJECTIVE: Atherosclerosis is highly prevalent among patients with systemic lupus erythematosus (SLE), but has been demonstrated predominantly in non-European SLE cohorts and few investigations have included more than 1 imaging modality. We aimed to investigate the prevalence of atherosclerosis in 3 frequently affected vascular territories, the coronary, carotid, and lower-extremity arteries, in a Danish, predominantly population-based SLE cohort. METHODS: Patients with SLE without prior cardiovascular disease (CVD; n = 103) were screened for coronary artery calcification, carotid intima-media thickening and plaque, and abnormal ankle-brachial index by means of cardiac computed tomography, ultrasound of the carotid arteries, and ankle systolic blood pressure. RESULTS: In patients with SLE, the prevalence of atherosclerosis in any vascular territory was 41%. The distribution of the atherosclerotic manifestations showed an overlap with 45% of the patients having involvement in more than 1 vascular territory. However, more than one-third of the patients with SLE with coronary, carotid, or lower-extremity atherosclerosis exclusively demonstrated this particular manifestation. Based on a multiple logistic regression model, age (p < 0.001), current smoking (p = 0.009), and the Systemic Lupus International Collaborating Clinics (SLICC; p = 0.008) were significant independent risk factors for atherosclerosis at any vascular territory. CONCLUSION: Atherosclerosis is highly prevalent among Danish patients with SLE without prior CVD. Screening for atherosclerosis in 1 vascular territory is insufficient in diagnosing atherosclerosis in patients with SLE. In Danish patients with SLE, the presence of atherosclerosis was not only assigned to traditional CV risk factors, but also associated with SLICC.

Validation of the Fatigue Severity Scale in Danish patients with systemic lupus erythematosus.

INTRODUCTION: Fatigue is a symptom of systemic lupus erythematosus (SLE), which has a substantial effect on the patients' quality of life and is a parameter that is difficult to quantify. The Fatigue Severity Scale (FSS) is a validated and reliable tool for quantifying fatigue. However, no Danish translation has yet been developed or validated. The aim of this study was to translate the FSS from English into Danish and subsequently to test and describe its validity and reliability in Danish SLE patients. MATERIAL AND METHODS: The FSS was translated from English into Danish and then back-translated. The translation agreed upon by medical professionals was tested for construct validity in an unselected group of SLE patients. The final version was tested for content validity, internal consistency and test-retest reliability in a second unselected group of SLE patients using the Danish version of the Short-Form Health Survey (SF-36). All patients included were outpatients with SLE of low to moderate disease activity, and low to moderate organ damage. RESULTS: Correlations were found between the Danish FSS and the main component scores of the SF-36. We found a high Cronbach's alpha as well as acceptable results of the intraclass correlation coefficient and the Bland-Altman plot. CONCLUSION: The Danish FSS translation is a valid and reliable measure of fatigue in the Danish SLE patients included in this study. FUNDING: Anne Voss reported a grant from The Danish Rheumatism Association (R33-A1836) and grants from The A.P. Møller Foundation for the Advancement of Medical Science and finally grants from the Region of South Denmark during the conduct of the study. TRIAL REGISTRATION: not relevant.