Axillary lymph-node metabolic activity assessment on 18F-FDG-PET/CT in rheumatoid arthritis patients treated with biologic therapies.

Objective: Recent studies have provided new insights into the role of lymph nodes (LNs) in rheumatoid arthritis (RA). The aim of this study was to evaluate the metabolic activity of the axillary LNs in relation to that of the upper limb joints and the clinical assessment of disease activity in RA patients treated with biologic therapies.Method: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) scans were acquired for 64 patients with RA at baseline and after 6 months of biologic therapy, and the patients' clinical status was evaluated. The maximum standardized uptake value (SUVmax), metabolic active volume, and total lesion glycolysis (TLG) were used to assess glucose metabolism in the LNs and 12 joints. Clinical evaluations included serum markers and the Disease Activity Score based on 28-joint count-erythrocyte sedimentation rate (DAS28-ESR).Results: Changes in the SUVmax and TLG for the axillary LNs correlated significantly with those of the ipsilateral wrist joints. There was a positive correlation between the changes in the three metabolic parameters of the axillary LNs and the changes in disease activity after treatment. After 6 months of biologic therapy, all metabolic parameters for the axillary LNs in patients with a DAS28-ESR < 3.2 were significantly lower than those of patients with a DAS28-ESR ≥ 3.2.Conclusion: A relationship between the glucose metabolism of the axillary LNs and the ipsilateral wrist joints was demonstrated by the 18F-FDG-PET/CT parameters. The metabolic activity and active volume of axillary LNs may reflect the therapeutic response to the biologic treatment of RA.

Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma.

SUMMARY: In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD. INTRODUCTION: It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures. METHODS: In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained. RESULTS: Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15-3.93 oral steroids; OR 2.05, 95% CI 1.27-3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively. CONCLUSION: Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis.

Sex-specific association of serum vitamin D levels with physical function in older adults.

UNLABELLED: In women, but not men, lower 25-hydroxyvitamin D [25(OH)D] levels were associated with impaired performance on two lower extremity function tests in both cross-sectional and prospective analyses. INTRODUCTION: Preserved physical function may explain how 25(OH)D supplementation reduces falls and fractures. METHODS: A total of 1,065 community-dwelling men and women (mean age 74.6 years) with 25(OH)D levels and performance on timed up and go (TUG) and timed chair stand (TCS) were seen in 1997-1999; 769 (72%) participants returned for follow-up. Associations were examined using generalized linear models. RESULTS: 25(OH)D levels were higher in men than women, but the prevalence of vitamin D insufficiency defined as 25(OH)D <75 nmol/L was 14%. There were no baseline sex differences in TUG or TCS. However, after 2.5 years, decline in TCS and TUG was greater in women than men (11% vs. 3%; p < 0.001). Women in the lowest 25(OH)D quartile (<80 nmol/L) compared to the highest quartile had an accelerated rate of functional decline on the TUG and TCS independent of covariates. No significant associations were seen in men. CONCLUSION: In women, but not men, lower 25(OH)D levels were associated with impaired performance on two lower extremity function tests in both cross-sectional and prospective analyses. These results provide additional evidence that 25(OH)D is associated with physical function, which may explain how vitamin D supplementation reduces falls and fractures.