Patient perceptions of health-related quality of life in giant cell arteritis: international development of a disease-specific patient-reported outcome measure.

OBJECTIVES: GCA is a large vessel vasculitis (LVV) presenting with headache, jaw claudication, musculoskeletal and visual involvement. Current treatment is glucocorticoids and anti-IL-6 tocilizumab in refractory disease. The objective of this study was to explore the impact of GCA and its treatment on people's health-related quality of life (HRQoL), to inform the development of a disease-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. METHODS: Participants from the UK and Australia, with biopsy- or imaging-confirmed GCA, were interviewed to identify salient aspects of HRQoL in relation to GCA and its treatment. Purposive sampling included a range of demographic and disease features (cranial, LVV-GCA and visual involvement). Inductive analysis identified individual themes of importance, then domains. Candidate questionnaire items were developed from the individual themes, refined by piloting, cognitive interviews and a linguistic translatability assessment. RESULTS: Thirty-six interviews were conducted to saturation with participants with GCA from the UK (25) and Australia (11). Mean age was 74 years, 23 (63.9%) were female, 13 (36.1%) had visual loss and 5 (13.9%) had LVV-GCA. Thirty-nine individual themes within five domains were identified: physical symptoms; activity of daily living and function; participation; psychological impact; and impact on sense of self and perception of health. Sixty-nine candidate items were developed from individual themes; piloting and refinement resulted in a 40-item draft questionnaire. CONCLUSION: This international qualitative study underpins the development of candidate items for a disease-specific PROM for GCA. The draft questionnaire is now ready for psychometric testing.

Association between histological features and clinical features of patients with biopsy positive giant cell arteritis.

OBJECTIVES: The aim of this study was to investigate the association between histological biopsy features and clinical features, such as blindness, in patients with biopsy positive giant cell arteritis (GCA). METHODS: Positive temporal artery biopsies registered on the South Australian Giant Cell Arteritis Registry were identified between 1991 and 2013 (n=186). Clinical and serological data was recorded using both patient questionnaire and case note review. Patients without clinical data were excluded from the analysis (n=42). Statistical analysis was performed using chi-squared and Wilcoxon's tests. RESULTS: 144 biopsy positive GCA cases were analysed. The mean age at biopsy was 77 years; 71% were female. In total 25% experienced blindness. Although not individually significant, transmural inflammation (p=0.11), luminal thrombus (p=0.17) and giant cells (p=0.20) were more frequent in patients who suffered blindness, whereas fragmentation of the internal elastic lamina (p=0.04), and intimal thickening (p=0.02) were more frequent in patients without blindness. The presence of giant cells was associated with transmural inflammation (p=0.06), jaw claudication (p=0.02), and higher inflammatory markers. In contrast, characteristics of patients with intimal thickening included a lower frequency of giant cells (0.01) and jaw claudication (p=0.01), and lower inflammatory markers. CONCLUSIONS: Giant cells are strongly associated with jaw claudication and systemic markers of inflammation, perhaps reflecting more acute and aggressive disease. We did not find any histological features that were individually significantly associated with an increased risk of blindness in GCA patients.

Jaw claudication and jaw stiffness in giant cell arteritis: secondary analysis of a qualitative research dataset.

Objective: Jaw symptoms can be a vital clue to the diagnosis of GCA. Guidelines recommend more intensive treatment if jaw claudication is present. We sought to explore how patients with GCA described their jaw symptoms. Methods: We carried out a secondary, qualitative analysis of interview data from 36 participants from the UK (n = 25) and Australia (n = 11), originally collected in order to develop a patient-reported outcome measure for GCA. In all cases, GCA had been confirmed by biopsy/imaging. Interview transcripts were organized within QSR NVivo 12 software and analysed using template analysis. Themes were refined through discussion among the research team, including a patient partner. Results: Twenty of 36 participants reported jaw symptoms associated with GCA. The median age of these 20 participants was 76.5 years; 60% were female. Five themes were identified: physical sensations; impact on function; impact on diet; symptom response with CSs; and attribution to other causes. Physical sensations included ache, cramp, stiffness and 'lockjaw'. Functional impacts included difficulty in eating/chewing, cleaning teeth, speaking or opening the mouth. Dietary impacts included switching to softer food. Response to CSs was not always immediate. Jaw symptoms were initially mis-attributed by some participants to arthritis, age or viral illnesses; or by health-care professionals to a dental cavity, ear infection or teeth-grinding. Conclusion: Jaw symptoms in GCA are diverse and can lead to diagnostic confusion with primary temporomandibular joint disorder, potentially contributing to delay in GCA diagnosis. Further research is needed to determine the relationship of jaw stiffness to jaw claudication.

[The frequency of cancer in France]. / La fréquence des cancers en France.

Several indicators are available to measure the frequency of cancers, the main being incidence and mortality indicators. If one controls for the effects of population increase and population aging, the incidence of cancer is increasing in France; in the male population the increase is entirely explained by an increase in prostate cancer incidence due to screening, widely used despite not being recommended by the authorities; in the female population most of the increase s explained by increase in breast and lung cancer incidence. Overall cancer mortality decreases both in the male and the female population. The largest variation is a decrease in male mouth, pharynx, larynx and esophageal cancer mortality, due to decreases in the consumption of alcohol and tobacco in this population. One observes also important reductions in prostate and lung cancer mortality, this last reduction being the result of a decrease in tobacco consumption In the female population the largest variation is an increase in lung cancer mortality which is the consequence of increasing tobacco consumption. These results show the importance of individual behavior on the risk of cancer.

Giant cell arteritis: A population-based retrospective cohort study exploring incidence and clinical presentation in Canterbury, Aotearoa New Zealand.

Background/aim: To determine the epidemiology and clinical features of giant cell arteritis (GCA) in Canterbury, Aotearoa New Zealand, with a particular focus on extra-cranial large vessel disease. Methods: Patients with GCA were identified from radiology and pathology reports, outpatient letters and inpatient hospital admissions in the Canterbury New Zealand from 1 June 2011 to 31 May 2016. Data was collected retrospectively based on review of electronic medical records. Results: There were 142 cases of GCA identified. 65.5% of cases were female with a mean age of 74.2 years. The estimated population incidence for biopsy-proven GCA was 10.5 per 100,000 people over the age of 50 and incidence peaked between 80 and 84 years of age. 10/142 (7%) people were diagnosed with large vessel GCA, often presenting with non-specific symptoms and evidence of vascular insufficiency including limb claudication, vascular bruits, blood pressure and pulse discrepancy, or cerebrovascular accident. Those with limited cranial GCA were more likely to present with the cardinal clinical features of headache and jaw claudication. Patients across the two groups were treated similarly, but those with large vessel disease had greater long-term steroid burden. Rates of aortic complication were low across both groups, although available follow-up data was limited. Conclusion: This study is the first of its kind to describe the clinical characteristics of large vessel GCA in a New Zealand cohort. Despite small case numbers, two distinct subsets of disease were recognized, differentiating patients with cranial and large vessel disease. Our results suggest that utilization of an alternative diagnostic and therapeutic approach may be needed to manage patients with large vessel disease.

Screening for SARS-CoV-2 by RT-PCR: Saliva or nasopharyngeal swab? Rapid review and meta-analysis.

BACKGROUND: Diagnosis of COVID-19 in symptomatic patients and screening of populations for SARS-CoV-2 infection require access to straightforward, low-cost and high-throughput testing. The recommended nasopharyngeal swab tests are limited by the need of trained professionals and specific consumables and this procedure is poorly accepted as a screening method In contrast, saliva sampling can be self-administered. METHODS: In order to compare saliva and nasopharyngeal/oropharyngeal samples for the detection of SARS-CoV-2, we designed a meta-analysis searching in PubMed up to December 29th, 2020 with the key words "(SARS-CoV-2 OR COVID-19 OR COVID19) AND (salivary OR saliva OR oral fluid)) NOT (review[Publication Type]) NOT (PrePrint[Publication Type])" applying the following criteria: records published in peer reviewed scientific journals, in English, with at least 15 nasopharyngeal/orapharyngeal swabs and saliva paired samples tested by RT-PCR, studies with available raw data including numbers of positive and negative tests with the two sampling methods. For all studies, concordance and sensitivity were calculated and then pooled in a random-effects model. FINDINGS: A total of 377 studies were retrieved, of which 50 were eligible, reporting on 16,473 pairs of nasopharyngeal/oropharyngeal and saliva samples. Meta-analysis showed high concordance, 92.5% (95%CI: 89.5-94.7), across studies and pooled sensitivities of 86.5% (95%CI: 83.4-89.1) and 92.0% (95%CI: 89.1-94.2) from saliva and nasopharyngeal/oropharyngeal swabs respectively. Heterogeneity across studies was 72.0% for saliva and 85.0% for nasopharyngeal/oropharyngeal swabs. INTERPRETATION: Our meta-analysis strongly suggests that saliva could be used for frequent testing of COVID-19 patients and "en masse" screening of populations.

Cross syndrome comparison of sleep problems in children with Down syndrome and Williams syndrome.

Based on previous findings of frequent sleep problems in children with Down syndrome (DS) and Williams syndrome (WS), the present study aimed to expand our knowledge by using parent report and actigraphy to define sleep problems more precisely in these groups. Twenty-two school-aged children with DS, 24 with WS and 52 typically developing (TD) children took part in the study. Each child wore an actiwatch for a minimum of four nights and parents completed the Children's Sleep Habits Questionnaire (CSHQ). Sleep problems were common in both developmental disorders. Children with DS had the greatest sleep disruption, with frequent and longer night wakings as well as restlessness. Parents reported symptoms of sleep-disordered breathing and a range of other problems including grinding teeth, bedtime resistance and sleep anxiety. Children with WS had problems initiating sleep and parents also reported bed-wetting and body pain. Despite these problems, the mean actual sleep time, as measured by actigraphy, did not differ between the three groups. CSHQ reports were in agreement with actigraphy for children's sleep duration, but this was not the case for sleep latency, restlessness and the night wakings variables. Sleep problems in DS and WS are common and appear to be syndrome-specific. Due to the inaccuracy of parent report, it is recommended that children at risk undergo objective measures of sleep assessment.

[The frequency of cancer in France in year 2002, and trends since 1968]. / La fréquence des cancers en France en 2002 et son évolution depuis 1968.

The estimated number of cancers diagnosed in 2002 is 150,000 in the male population and 120,000 in the female population and there were close to 88,000 cancer deaths among men and 59,000 cancer deaths among women in France. The most frequent cancer sites in the male population are prostate, lung, colon, intestine and head & neck (mouth, pharynx, larynx). In the female population, breast cancer is by far the most frequent cancer, followed by colorectal cancer. Between 1968 and 2002, cancer mortality decreased by 5% for men and by 19% for women. Cancer mortality reached a maximum in 1987 in the male population and in the last 15 years the decrease is larger among men than among women.

[The frequency of cancer in France in year 2000, and trends since 1950]. / La fréquence des cancers en France en 2000 et son évolution depuis 1950.

In 2000, there were 87,000 cancer deaths among men and 57,000 cancer deaths among women in France. Cancer mortality is decreasing since 1987 in the male population and since the mid 1960s in the female population. The decrease is larger among men than among women. The estimated number of cancers diagnosed in 2000 is 160,000 in the male population and 120,000 in the female population. The most frequent cancer sites in the male population are prostate, lung, colon, intestine and mouth, pharynx plus larynx. In the female population, breast cancer is by far the most frequent cancer, followed by colorectal cancer. Between 1980 and 2000, cancer incidence increased by 30%, whereas cancer mortality decreased by 10%, these results are observed for each sex.