Non-steroidal anti-inflammatory drugs and risk of pulmonary embolism in patients with inflammatory joint disease-results from the nationwide Norwegian Cardio-rheuma registry.

AIMS: Patients with inflammatory joint diseases (IJD), including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) have increased rates of pulmonary embolism (PE). Non-steroidal anti-inflammatory drugs (NSAIDs) use is associated with PE in the general population. Our aim was to evaluate the association between NSAIDs use and PE in IJD patients. METHODS AND RESULTS: Using individual-level registry data from the whole Norwegian population, including data from the Norwegian Patient Registry and the Norwegian Prescription Database, we: (1) evaluated PE risk in IJD compared to non-IJD individuals, (2) applied the self-controlled case series method to evaluate if PE risks were associated with use of traditional NSAIDs (tNSAIDs) and selective cox-2 inhibitors (coxibs). After a one-year wash-out period, we followed 4 660 475 adults, including 74 001 with IJD (RA: 39 050, PsA: 20 803, and axSpA: 18 591) for a median of 9.0 years. Crude PE incidence rates per 1000 patient years were 2.02 in IJD and 1.01 in non-IJD individuals. Age and sex adjusted hazard ratios for PE events were 1.57 for IJD patients compared to non-IJD. Incidence rate ratios (IRR) [95% confidence interval (CI)] for PE during tNSAIDs use were 0.78 (0.64-0.94, P = 0.010) in IJD and 1.68 (1.61-1.76, P < 0.001) in non-IJD. IRR (95% CI) for PE during coxibs use was 1.75 (1.10-2.79, P = 0.018) in IJD and 2.80 (2.47-3.18, P < 0.001) for non-IJD. CONCLUSION: Pulmonary embolism rates appeared to be higher in IJD than among non-IJD subjects in our study. Traditional NSAIDs may protect against PE in IJD patients, while coxibs may associated with increased PE risk.

All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study.

OBJECTIVES: To explore mortality and causes of death among Norwegian patients with RA, PsA and axial spondyloarthritis (axSpA) compared with the general population by conducting a nationwide registry-based cohort study. METHODS: Patients with RA, PsA and axSpA were identified from the Norwegian Patient Registry based on ICD-10 codes between 2008 and 2017. Using age as the time variable, all-cause and cause-specific mortality were estimated between 2010 and 2017 with the Kaplan-Meier estimator and the cumulative incidence competing risk method, respectively. Sex-, education level-, health region- and age group-adjusted hazard ratios (HRs) for mortality were estimated using Cox regression models. RESULTS: We identified 36 095 RA, 18 700 PsA and 16 524 axSpA patients (70%, 53% and 45% women, respectively). RA and axSpA were associated with increased all-cause mortality (HR 1.45 [95% CI: 1.41, 1.48] and HR 1.38 [95% CI: 1.28, 1.38], respectively). Women but not men with PsA had a slightly increased mortality rate (HR 1.10 [95% CI: 1.00, 1.21] among women and 1.02 [95% CI: 0.93, 1.11] among men). For all patient groups as well as for the general population, the three leading causes of death were cardiovascular diseases, neoplasms and respiratory diseases. RA patients had increased mortality from all of these causes, while axSpA patients had increased mortality from cardiovascular and respiratory diseases. CONCLUSION: Even in the era of modern treatments for IJDs, patients with RA and axSpA still have shortened life expectancy. Our findings warrant further attention to the prevention and management of comorbidities.

Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway.

OBJECTIVES: To evaluate nationwide incidence, sociodemographic associations and treatment penetration of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in Norway. METHODS: The study combined data from nationwide registries on the total Norwegian adult population (age ≥ 18). From the Norwegian Patient Registry, incident RA and PsA cases during 2011-2015 were identified with records of first and second healthcare episodes listing RA/PsA diagnostic codes, and ≥ 1 episode in an internal medicine or rheumatology unit with RA/PsA code during the two-year period after the first episode. Dispensed DMARD prescriptions were obtained from the Norwegian Prescription Database. Persons with dispensed DMARD prescriptions or biologic DMARDs given in hospitals > 12 months before the index date were excluded. RESULTS: Incidence of RA/PsA in Norway was 42/26 per 100,000 person-years (55/28 among women and 28/23 among men). RA peak incidence was observed at ages 70-79 in both sexes, whereas the peak incidence of PsA occurred at ages 50-59. Age- and sex-standardized incidences of RA and PsA were lower among persons with higher education levels. Within a year from the index date, 82.4/57.4% of RA/PsA patients used synthetic DMARDs while 9.4/9.5% used biologic DMARDs. CONCLUSIONS: Register-based incidence estimates for RA and PsA in Norway are similar to other Nordic countries, but slightly higher than in previous Norwegian studies. Furthermore, we found that higher socioeconomic status was associated with lower incidence of both RA and PsA. Although conventional synthetic DMARDs were less often used in early PsA than RA, frequency of biologic DMARD prescriptions was comparable.

Study of in vitro bioactivity and mechanical properties of diopside nano-bioceramic synthesized by a facile method using eggshell as raw material.

In this study, diopside bioceramic was synthesized using a mechanical milling process and subsequent heat treatment. The simplicity of experiments and also the high energy available in ball milling lead to rapid synthesis of the products in comparison with other synthesis methods. Magnesium oxide (MgO), silicon dioxide (SiO2) and eggshell (as the calcium source) powders were weighted in stoichiometric conditions and milled to initial activation of the surface of the powder's mixture. Then a sintering process was conducted to complete formation of diopside nanopowder and also evaluates its thermal stability. The mechanisms occurred during the synthesis of this bioceramic were carefully investigated. X-Ray diffraction analysis (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM), thermogravimetry (TG), differential thermal analysis (DTA), and inductive coupled plasma atomic emission spectroscopy (ICP-AES) were used for gathering and analyzing data. The ability and rate of apatite formation on the sample surface were evaluated by Simulated Body Fluid (SBF) test, a method that is well recognized to characterize the in vitro bioactivity of ceramic materials. According to the results obtained, the diopside samples had a significant potential to form apatite layer on their surface during soaking in the SBF solution. Besides, the bonding strength of this bioceramic was about 350±7MPa which was almost more than three times of that reported for hydroxyapatite. An excellent fracture toughness of 4±0.3MPam0.5 was also obtained for this ceramic which was higher than that of previously reported works.

A novel and economical route for synthesizing akermanite (Ca2MgSi2O7) nano-bioceramic.

Despite the benefits of akermanite, there are limited reports on making powder and dense bulk akermanite (Ca2MgSi2O7) and most articles have focused on building akermanite scaffolds. This study centers on a new and economical route for the synthesis of akermanite bioceramic via high energy ball milling and subsequent sintering of a mixed powders of eggshell (as calcium source), MgO, and SiO2. The mechanisms occurred during akermanite synthesis were carefully investigated. XRD, DTA, FTIR, TGA, SEM, TEM, ICP and EDS were used for analyzing the obtained results. Simulated body fluid (SBF) was also used for assessing in vitro bioactivity of the akermanite samples. According to the results, the method presented in this study can be introduced as a facile method for preparing akermanite samples with a good compressive strength of 210±7MPa. The XRD patterns also indicated that akermanite bioceramic was synthesized after heat treating at 900°C which is very low compared to previous researches. With increasing the sintering time of the akermanite samples and the reduction of the surface porosities, the amount of the formed apatite and also the rate of apatite formation decreased and the compressive strength of the samples increased.