All-cause, cause-specific and age-specific standardised mortality ratios of patients with systemic lupus erythematosus in Ontario, Canada over 43 years (1971-2013).

Background: Survival in systemic lupus erythematosus (SLE) has improved substantially in the last 50 years. The aim of the present study was to assess the evolution of the all-cause, cause-specific and age-specific standardised mortality ratios (SMRs) of patients with lupus in Ontario, Canada.

Patients And Methods: Between 1971 and 2013, 1732 patients were followed in the Toronto Lupus Clinic.

Magnetic Resonance Imaging in Psoriatic Arthritis: A Descriptive Study of Indications, Features and Effect on Treatment Change.

Objective: The aims of this study were to describe the indications for, and features of, axial/peripheral joint magnetic resonance imaging (MRI) in psoriatic arthritis (PsA) and to examine the influence of MRI findings on clinical practice.

Methods: All axial and peripheral (hand and/or foot) MRI scans on patients attending the Toronto PsA clinic l between 2003 and 2014 were included. Scan details were garnered from the radiologist's official report.

Attainment of Minimal Disease Activity Using Methotrexate in Psoriatic Arthritis.

Objective: An international task force has recommended that disease remission or minimal disease activity (MDA) be the target of treatment for psoriatic arthritis (PsA) and that remission or MDA should be attained within 6 months of initiating medication. The aim of this study was to establish the proportion of patients with PsA who achieve MDA after 6 months of methotrexate (MTX) treatment.

Methods: Patients who initiated MTX and were naive to biologics between 2004 and 2014 were included.

Disease Outcomes in Glucocorticosteroid-Naive Patients With Systemic Lupus Erythematosus.

Objective: The phenotype of patients who remain naive of glucocorticosteroids has not been described, and the type and rate of their damage accrual remains largely unknown. The objective of this study was to compare the type, amount, rate, and nature of organ damage accrual, mortality, and atherosclerotic comorbidities in glucocorticosteroid-naive and glucocorticosteroid-exposed patients with systemic lupus erythematosus (SLE).

Methods: Inception patients from the University of Toronto Lupus Clinic who had never taken glucocorticosteroids and had a minimum of 3 years of followup were compared to patients who received glucocorticosteroids within the first 6 months of SLE diagnosis and for at least 3 years.

Optimal Monitoring For Coronary Heart Disease Risk in Patients with Systemic Lupus Erythematosus: A Systematic Review.

Objective: Premature coronary heart disease (CHD) significantly affects morbidity and mortality in systemic lupus erythematosus (SLE). Several studies have detected factors influencing the atherosclerotic process, as well as methods to quantify the atherosclerotic burden in subclinical stages. The aim of this systematic review was to identify the minimum investigations to optimally monitor CHD risk in SLE.

An Association between MicroRNA-21 Expression and Vitamin D Deficiency in Coronary Artery Disease.

Background: Atherosclerosis-related cardiovascular disease and osteoporosis (OP) occur concurrently and may share a common pathogenesis. Aberrant expression of miR-21 and vitamin D deficiency have been independently linked to the pathogenesis of atherosclerosis and OP.

Objectives: To examine the relationship between miR-21 expression and vitamin D in aorta and bone in atherosclerotic disease.

Investigational drugs for treating psoriatic arthritis.

Introduction: Psoriatic arthritis (PsA) is an inflammatory arthritis occurring in up to 30% of patients with psoriasis and can lead to progressive joint damage and disability. The emergence of 'biological' treatments, typified by the TNF inhibitors, has significantly advanced treatment of psoriatic disease over the last two decades and has led to an expanding field of drugs designed to target specific pathways identified in the pathogenesis of the disease.

Areas Covered: This review article describes current knowledge pertaining to genetic susceptibility and that gleaned from animal models.

Attitudes towards exercise in patients with chronic disease: the influence of comorbid factors on motivation and ability to exercise.

Background: Exercise is an integral part of a healthy lifestyle. It has a well defined role in maintaining health in chronic illness. This study was undertaken to determine attitudes towards exercise in patients admitted to hospital with medical illnesses.

Targeted ultrasound of the fifth metatarsophalangeal joint in an early inflammatory arthritis cohort.

Objective: To determine whether targeted ultrasonographic (US) imaging of the fifth metatarsophalangeal (MTP) joint, compared with radiographs, could aid in the early diagnosis of rheumatoid arthritis (RA) by identifying erosions sooner in early inflammatory arthritis. Radiographic erosion in RA is a late indication of poor prognosis. The earlier detection of erosion may facilitate the timely initiation of disease-modifying antirheumatic drug therapy, particularly in patients with undifferentiated synovitis.

Greater focus on clinical rheumatology is required for training in internal medicine.

Early intervention for rheumatic disease has been shown to improve prognosis, but is dependent on the recognition of pertinent symptoms and signs. This study was undertaken to identify the attitudes of junior doctors toward musculoskeletal assessment. The charts of 100 randomly selected medical patients admitted via the Emergency Department were reviewed for documentation of the musculoskeletal system.

Sub-optimal pain control in patients with rheumatic disease.

The visual analog scale (VAS) of pain is a ubiquitous clinical and research tool with widespread application in the rheumatic diseases. The objectives of this study were to assess if patients report pain differently to doctors or nurses, to determine reproducibility of this test for diagnosis, age, gender, and treatment, and to ascertain the level of pain in patients attending general rheumatology clinics. Using a standardized line of exactly 100 mm and instructions with identical wording, consecutive patients attending general rheumatology clinics were asked to score their perceived level of pain in the preceding week.