Multimorbidity in Psoriasis as a Risk Factor for Psoriatic Arthritis: A Population-Based Study.

OBJECTIVES: To examine multimorbidity in psoriasis and its association with the development of PsA. METHODS: A retrospective cohort study was performed using the Rochester Epidemiology Project. Population-based incidence (2000-2009) and prevalence (Jan 1, 2010) cohorts of psoriasis were identified by manual chart review. A cohort of individuals without psoriasis (comparators) were identified (1:1 matched on age, sex, and county). Morbidities were defined using ≥2 Clinical Classification Software codes ≥30 days apart within prior five years. PsA was defined using ClASsification of Psoriatic ARthritis (CASPAR) criteria. χ2 and rank-sum tests were used to compare morbidities, and age-, sex-, and race-adjusted Cox models to examine the association of baseline morbidities in psoriasis with development of PsA. RESULTS: Among 817 incident psoriasis patients, the mean age was 45.2 years with 52.0% females, and 82.0% moderate/severe psoriasis. No multimorbidity differences were found between incident psoriasis patients and comparators. However, in the 1,088 prevalent psoriasis patients, multimorbidity was significantly more common compared with 1,086 comparators (OR : 1.35 and OR : 1.48 for ≥2 and ≥5 morbidities, respectively). Over a median 13.3-year follow-up, 23 patients (cumulative incidence: 2.9% by 15 years) developed PsA. Multimorbidity (≥2 morbidities) was associated with a 3-fold higher risk of developing PsA. CONCLUSION: Multimorbidity was more common in the prevalent but not incident cohort of psoriasis compared with the general population, suggesting patients with psoriasis may experience accelerated development of multimorbidity. Moreover, multimorbidity at psoriasis onset significantly increased the risk of developing PsA, highlighting the importance of monitoring multimorbid psoriasis patients for the development of PsA.

The epidemiology of psoriatic arthritis: A literature review.

Psoriatic arthritis (PsA) is a chronic, progressive musculoskeletal disease that affects 0.1%-1% of the general population and ~20% of patients with psoriasis. Significant differences exist in epidemiological estimates between studies, likely related to methodological and geographic differences. While most studies show an increase in prevalence over recent years, the underdiagnosis of PsA persists. Studies suggest that a complex interaction of multiple factors is involved in the development of PsA in patients with psoriasis and a single factor may not be able to effectively define at-risk patients with PsA. Modification of some risk factors such as weight loss may help in the prevention of the disease and improved outcomes.

Socioeconomic and racial disparities in the prevalence of congenital heart disease in infants of diabetic mothers.

Infants of diabetic mothers (IDM) are at increased risk for congenital heart disease (CHD). There is little information in the literature about the impact of economic status and race/ethnicity on the prevalence of CHD in IDM. Using the KID national database collected from 2003 to 2012, we studied over 180,000 IDM to compare the prevalence of CHD according to family income and race/ethnicity. There were 9214 (5.02%) CHDs out of 183 453 IDM. We found significant impact of family income and race/ethnicity on the prevalence of CHD. Specifically, compared to IDM born in a family with highest 25th quartile family income, infants in the lowest 25th quartile family income had higher odds of CHD with unadjusted odds ratio (OR) of 1.6 [(95% confidence interval (CI): 1.4-1.7), p < .001]. In terms of racial/ethnic differences, Black [unadjusted OR = 1.4 (95% CI: 1.3-1.5), p < .001] and Hispanic [unadjusted OR 1.26 (95% CI: 1.2-1.4), p < .001] IDM are more likely, and Asians [0.69 (95% CI: 0.59-0.81), p < .001] were less likely to have CHD when compared to whites. When adjusting race/ethnicity for family income quartile and vice versa, we did not observe changes in the estimates, suggesting that family income and race/ethnicity impact on the odds of CHD independently. Our report of higher prevalence of CHD among IDM in ethnic minorities and lower socioeconomic status would warrant more studies to further dissect causes of higher prevalence in these subpopulations.

Effects of Therapies on Cardiovascular Events in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis.

INTRODUCTION: Non-steroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor inhibitors (TNFi) are the most common therapies used in AS, however, the associated long-term cardiovascular risk is unclear. We performed a systematic review and meta-analysis on the association of therapies used for ankylosing spondylitis (AS) such as NSAIDs and TNFi on cardiovascular events (CVE) in AS. METHODS: A comprehensive search was performed from database inception to May 29, 2020 to include controlled studies of AS treated with NSAIDs, oral small molecules, or biologics reporting CVE. Study-specific risk ratios (RR) were pooled using a random effects model. RESULTS: Nine non-randomized studies from 1570 studies screened fulfilled inclusion criteria. Among NSAID users as a whole versus no NSAIDs, no increased risk of CVE (composite outcome) was observed; however, the risk of cerebrovascular accident was significantly lower (RR 0.58, 95% CI 0.37-0.93, I2 = 66%). Cox-2 inhibitor use was associated with reduced risk of all CVE (RR 0.48, 95% CI 0.33-0.70, I2 = 0%). Non-selective NSAIDs were not associated with any increased/decreased risk of any CVE. Meta-analysis of three studies of MI did not show a significant association with TNFi (RR 0.88, 95% CI 0.57-1.35, I2 = 76%). CONCLUSIONS: In this meta-analysis of non-randomized studies, NSAID users as a whole and users of non-selective NSAIDs did not seem to have a higher risk of any CVE. Limited data suggest a lower risk of composite CVE outcome with Cox-2 inhibitors, unlike the increased risk reported in the general population. No significant association between TNFi and MI was observed. The certainty in evidence was very low due to all studies being observational. More studies are needed to study the association between TNFi use and CVE in general to evaluate a possible protective role in AS.

Effectiveness of intravenous immunoglobulin use in heparin-induced thrombocytopenia.

: Heparin-induced thrombocytopenia (HIT) syndrome is an immune-mediated disorder producing thrombocytopenia and thrombosis, with or without prior exposure to heparin. Although avoidance of heparin products and nonheparin anticoagulants are used, immune-based therapies including intravenous immunoglobulin (IVIg) have been tried when the thrombocytopenia persists or there is breakthrough thrombosis. We sought to systematically review and analyze the published literature on use of IVIg in the treatment of HIT. A systematic search of PubMed, Google Scholar, EMBASE and SCOPUS for all study designs and reports were carried out from inception until April 2019. Statistical analysis was done using Microsoft Excel and Stata version 13. In 34 patients with HIT, the mean age was 60 years. About 70% cases were by unfractionated heparin exposure and 30% by low-molecular weight heparin. The most common precipitant in the patients without heparin exposure was recent surgery. Average nadir platelet count for which IVIg was used was 28 000/µl. Time from resolution of the thrombocytopenia after IVIg treatment was 3 days with average platelet count recovery to 159 000/µl. Mean time from diagnosis to administration of IVIg was day 18. Thrombosis was identified in 32% of patients. About 77% patients improved (platelet count >100 000/µl or cessation of thrombosis) following use of IVIg. Logistic regression did not identify any factors that predicted IVIg response (P > 0.05). No thrombotic events or other adverse events were noted with use of IVIg. IVIg appears to be a safe and effective treatment option for HIT-related thrombocytopenia and for refractory thrombosis.