To estimate the prevalence of the metabolic syndrome among individuals with psoriasis and to examine the association between these 2 conditions in the general US population.Cross-sectional health survey of a nationally representative random sample of the noninstitutionalized civilian US population.The National Health and Nutrition Examination Survey, 2003-2006.The study included 6549 participants aged 20 to 59 years.Prevalence of the metabolic syndrome defined by the revised National Cholesterol Education Program Adult Treatment Panel III definition and odds ratios for associations after adjustment for age, sex, race/ethnicity, smoking status, and C-reactive protein levels.The prevalence of the metabolic syndrome was 40% among psoriasis cases and 23% among controls. According to 2008 US census data, the projected number of patients with psoriasis aged 20 to 59 years with the metabolic syndrome was 2.7 million. The univariate and multivariate odds ratios for patients with psoriasis and the metabolic syndrome were 2.16 (95% confidence interval, 1.16 to 4.03) and 1.96 (1.01 to 3.77), respectively. The most common feature of the metabolic syndrome among patients with psoriasis was abdominal obesity, followed by hypertriglyceridemia and low levels of high-density lipoprotein cholesterol.The prevalence of the metabolic syndrome is high among individuals with psoriasis. Given the serious complications associated with the metabolic syndrome, this frequent comorbidity should be recognized and taken into account in the long-term treatment of individuals with psoriasis.
To develop a Glucocorticoid Toxicity Index (GTI) to assess glucocorticoid (GC)-related morbidity and GC-sparing ability of other therapies.Nineteen experts on GC use and outcome measures from 11 subspecialties participated. Ten experts were from the USA; nine from Canada, Europe or Australia. Group consensus methods and multicriteria decision analysis (MCDA) were used. A Composite GTI and Specific List comprise the overall GTI. The Composite GTI reflects toxicity likely to change during a clinical trial. The Composite GTI toxicities occur commonly, vary with GC exposure, and are weighted and scored. Relative weights for items in the Composite GTI were derived by group consensus and MCDA. The Specific List is designed to capture GC toxicity not included in the Composite GTI. The Composite GTI was evaluated by application to paper cases by the investigators and an external group of 17 subspecialists.Thirty-one toxicity items were included in the Composite GTI and 23 in the Specific List. Composite GTI evaluation showed high inter-rater agreement (investigators κ 0.88, external raters κ 0.90). To assess the degree to which the Composite GTI corresponds to expert clinical judgement, participants ranked 15 cases by clinical judgement in order of highest to lowest GC toxicity. Expert rankings were then compared with case ranking by the Composite GTI, yielding excellent agreement (investigators weighted κ 0.87, external raters weighted κ 0.77).We describe the development and initial evaluation of a comprehensive instrument for the assessment of GC toxicity.
To evaluate the independent association between psoriasis and risk of diabetes and hypertension.
Design
A prospective study of female nurses who were followed up from 1991 to 2005.
Setting
Nurses' Health Study II, a cohort of 116 671 US women aged 27 to 44 years in 1991.
Participants
The study included 78 061 women who responded to a question about a lifetime history of physician-diagnosed psoriasis in 2005. Women who reported a diagnosis of diabetes or hypertension at baseline were excluded.
Main Outcome Measure
New diagnosis of diabetes or hypertension, obtained from biennial questionnaires.
Results
Of the 78 061 women, 1813 (2.3%) reported a diagnosis of psoriasis. During the 14 years of follow-up, a total of 1560 incident cases (2%) of diabetes and 15 724 incident cases (20%) of hypertension were documented. The multivariate-adjusted relative risk of diabetes in women with psoriasis compared with women without psoriasis was 1.63 (95% confidence interval, 1.25-2.12). Women with psoriasis were also at an increased risk for the development of hypertension (multivariate relative risk, 1.17; 95% confidence interval, 1.06-1.30). Age, body mass index, and smoking status did not significantly modify the association between psoriasis and risk of diabetes or hypertension (Pvalues for interaction, ≥.07).
Conclusions
In this prospective analysis, psoriasis was independently associated with an increased risk of diabetes and hypertension. Future studies are needed to find out whether psoriasis treatment will reduce the risk of diabetes and hypertension.
Calcium pyrophosphate ( CPP ) crystal deposition ( CPPD ) is prevalent and can be associated with synovitis and joint damage. The population of elderly persons predominantly affected by CPPD is growing rapidly. Since shortfalls exist in many aspects of CPPD , we conducted an anonymous survey of CPPD unmet needs, prioritized by experts from the Gout, Hyperuricemia and Crystal‐Associated Disease Network. We provide our perspectives on the survey results, and we propose several CPPD basic and clinical translational research pathways. Chondrocyte and cartilage culture systems for generating CPP crystals in vitro and transgenic small animal CPPD models are needed to better define CPPD mechanism paradigms and help guide new therapies. CPPD recognition, clinical research, and care would be improved by international consensus on CPPD nomenclature and disease phenotype classification, better exploitation of advanced imaging, and pragmatic new point‐of‐care crystal analytic approaches for detecting CPP crystals. Clinical impacts of CPP crystals in osteoarthritis and in asymptomatic joints in elderly persons remain major unanswered questions that are rendered more difficult by current inability to therapeutically limit or dissolve the crystal deposits and assess the consequent clinical outcome. Going forward, CPPD clinical research studies should define clinical settings in which articular CPPD does substantial harm and should include analyses of diverse clinical phenotypes and populations. Clinical trials should identify the best therapeutic targets to limit CPP crystal deposition and associated inflammation and should include assessment of intraarticular agents. Our perspective is that such advances in basic and clinical science in CPPD are now within reach and can lead to better treatments for this disorder.
We wish to thank Zhou and colleagues for their letter.1 As outlined in the published paper,2 the myocardial infarction (MI) case definition was based on the diagnosis being recorded as a MI Read code in The Health Improvement Network (THIN), a validated means of identifying MI in pharmacoepidemiological studies.3 Because THIN is based on general practitioner’s coded records, the …
Background and purpose Elevated plasma uric acid has been inconsistently associated with an increased risk of total stroke; however, data are sparse amongst women. The association between plasma uric acid concentrations and ischaemic stroke amongst women was examined and the effect modification by key cardiovascular risk factors was evaluated. Methods A nested case−control design with matching by age, race/ethnicity, smoking status, menopausal status, postmenopausal hormone therapy use, date of blood draw and fasting status was utilized amongst female participants of the Nurses' Health Study who provided blood samples between 1989 and 1990. Plasma uric acid was measured on stored blood samples. The National Survey of Stroke criteria were utilized to confirm 460 incident cases of ischaemic stroke by medical records from 1990 to 2006. Multivariable conditional logistic regression models were estimated. Results In matched analysis, risk of ischaemic stroke increased by 15% for each 1 mg/dl increase in plasma uric acid [95% confidence interval ( CI ) 3%–28%], but was no longer significant after adjustment for cardiovascular risk factors, particularly history of hypertension. The highest quartile of uric acid was significantly associated with greater risk of ischaemic stroke (relative risk 1.56; 95% CI 1.06–2.29, extreme quartiles) in matched analysis, but estimates were no longer significant after adjustment for cardiovascular risk factors (relative risk 1.43; 95% CI 0.93–2.18). Significant effect modification by key cardiovascular risk factors was not observed. Conclusions Plasma uric acid levels were not independently associated with increased risk of ischaemic stroke in this cohort of women. Whilst plasma uric acid was associated with stroke risk factors, it was not independently associated with stroke risk.
