Ungprasert, Patompong

Background and Purpose— The association between hemorrhagic stroke and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established. We conducted a systematic review and meta-analysis of observation studies to further characterize this possible association. Methods— Case–control and cohort studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of hemorrhagic stroke among NSAIDs users versus nonusers were systematically searched. Point estimates from each study were extracted. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and individual NSAIDs were calculated using random-effect, generic inverse variance method. Results— Ten studies were identified and included in our data analysis. As a single group, NSAIDs use was associated with a small but insignificant risk of hemorrhagic stroke with the pooled RR of 1.09 (95% CI, 0.98–1.22). Individual NSAIDs analysis revealed a significantly increased risk among diclofenac and meloxicam users (RR 1.27; 95% CI, 1.02–1.59 and RR 1.27; 95% CI, 1.08–1.50, respectively). The risk estimate for rofecoxib users was higher, but statistically nonsignificant (RR 1.35; 95% CI, 0.88–2.06). Conclusions— Overall, the use of NSAIDs is not associated with an increased risk of hemorrhagic stroke, although this risk was modestly significantly elevated in diclofenac and meloxicam users.

Background— Patients with rheumatoid arthritis are more likely to have reduced kidney function develop over time. The aim of this study was to assess the clinical and safety outcomes of living kidney donors with rheumatoid arthritis. Methods— A retrospective cohort study at a tertiary referral hospital to assess the outcomes of living kidney donors with rheumatoid arthritis. All 6 adults with rheumatoid arthritis who underwent nephrectomy as living kidney donors between January 2000 and September 2014 were included. Eighteen nondonors with rheumatoid arthritis (3 nondonors per donor) were randomly selected for comparison by matching the year of birth and comorbidity score. Results— None of the donors with rheumatoid arthritis had a flare-up of arthritis at a median follow-up time of 5.9 years (interquartile range [IQR], 3.1–7.5 years), while 5 (27.8%) nondonors with rheumatoid arthritis had a flare-up at a median follow-up time of 4.7 years (IQR, 3.1–6.7 years). After nephrectomy, donors' estimated glomerular filtration rate decreased to a mean of 43.53 (SD, 4) mL/min per 1.73 m2 at 7 days after the index date. The estimated glomerular filtration rate of donors subsequently increased significantly at rate of 3.99 mL/min per 1.73 m2 ( P< .001). None of the donors with rheumatoid arthritis had end-stage renal disease develop or died at median follow-up times of 5.9 (IQR, 3.1–7.5) years and 8.2 (IQR, 5.8–9.7) years, respectively. Conclusion— Healthy kidney donors with rheumatoid arthritis have good outcomes, with no increased risk of decline in renal function, end-stage renal disease, or death.

Hematological abnormalities, such as anemia, leucopenia, and thrombocytopenia, secondary to peripheral destruction, are common in systemic lupus erythematosus (SLE). However, cytopenias from autoimmune myelofibrosis (AIMF) are extremely uncommon in SLE, with less than 40 reported cases in the literature. We report the case of a 33-year-old female who presented with bullous skin lesions and pancytopenia as the presenting manifestation of what was ultimately diagnosed as SLE with AIMF. She responded well to glucocorticoids and mycophenolate mofetil.

ObjectiveThe epidemiology and clinical characteristics of sarcoid arthropathy are not well described, as only referral‐based studies have been reported. This study aimed to use the data from a geographically well‐defined population to characterize the clinical characteristics of sarcoid arthropathy.MethodsAn inception cohort of patients with incident sarcoidosis in the years 1976–2013 in a geographically well‐defined population was identified based on comprehensive individual medical records review. Inclusion required physician diagnosis supported by histopathology and radiologic features of intrathoracic sarcoidosis, compatible clinical presentation, and exclusion of other granulomatous diseases. Patients with joint pain were then identified from this cohort.ResultsIn 1976–2013, all 345 incident cases of sarcoidosis were identified. Symptoms of joint pain occurred in 42 patients (mean age 41.2 years, 57.1% female, and 95% white), and 35 patients had swollen joint(s) on physical examination. Most patients had arthralgia prior to the diagnosis of sarcoidosis, with an average time to diagnosis of 21 days. Of the 35 cases, oligoarthritis (2 to 4 joints) was the most common pattern (88% of cases), followed by monoarthritis (6%) and polyarthritis (6%). Ankles were involved in 91% of cases. In the majority of patients (88%), the arthritis resolved within 6 weeks. Classic Lofgren's syndrome was observed in 11 patients (26%).ConclusionInflammatory arthritis occurs in a minority of patients with sarcoidosis. Acute oligoarthritis with bilateral ankle involvement was the most common pattern of sarcoid arthropathy. It should be noted that the generalizability of the results may be limited, as the cohort was predominantly white.

AbstractAimTo investigate the association between giant cell arteritis (GCA) and risk of peripheral arterial disease (PAD).MethodsWe conducted a systematic review and meta‐analysis of observational cohort studies that reported relative risks, hazard ratios or standardized incidence ratios with 95% confidence comparing PAD risk in patients with GCA versus non‐GCA subjects. Pooled risk ratios and 95% confidence intervals were calculated using a random‐effect, generic inverse variance of DerSimonian and Laird.ResultsFour studies with 9789 patients with GCA and 236 728 controls were identified and included in our data analysis. The pooled risk ratio of PAD among patients with GCA compared with controls was 1.88 (95% CI 1.04–3.41). The statistical heterogeneity was high with an I2 of 89%.ConclusionOur study demonstrated a statistically significant increased risk of PAD among patients with GCA.

AbstractAimThis study aimed to investigate how varied methods of determining baseline serum creatinine (SCr) would affect acute kidney injury (AKI) diagnosis and prediction of 60 day mortality in critically ill patients following an episode of AKI.MethodsThis is a single‐centre retrospective study conducted at a tertiary referral hospital. All adult intensive care unit (ICU) patients between January and December 2011, who had at least one SCr values measured between 7 days and 180 days before hospital admission and during ICU stay, were analyzed. The baseline SCr was calculated using either the most recent (SCrmost recent) or the minimum (SCrmin) value of SCr measurement over the specified assessment period before hospital admission. AKI was defined based on KDIGO SCr definition. The primary outcome was 60 day mortality after ICU admission.ResultsA total of 4020 patients were included in the analysis. AKI was detected in 1204 (30.0%) using the SCrmin and 945 (23.5%) using the SCrmost recent (P < 0.001). Compared with patients without AKI regardless of baseline SCr methodology, the 60 day mortality risk of patients who developed AKI using the SCrmin and SCrmost recent was significantly increased (odds ratio (OR) = 3.74; 95% confidence interval (CI) 2.98–4.70). Similarly, the risk of 60 day mortality in patients who met AKI criteria using the SCrmin but not the SCrmost recent was significant higher than in patients without AKI (OR = 2.04; 95% CI 1.36–3.00).ConclusionUsing the minimum value of preadmission SCr as a baseline kidney function not only can detect more AKI cases, but also provides the better predictive ability for 60 day mortality.