Work productivity loss and fatigue in psoriatic arthritis.

OBJECTIVE: To explore the relationship between fatigue and work productivity loss (WPL) in people with psoriatic arthritis (PsA). METHODS: Data were collected from participants in the Utah Psoriasis Initiative Arthritis registry between January 2010 and May 2013. WPL was measured with the 8-item Work Limitations Questionnaire. Fatigue was assessed with question 1 from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI#1), "How would you describe the overall level of fatigue/tiredness you have experienced?" and with question 1 from the Psoriatic Arthritis Quality of Life Questionnaire (PsAQOL#1) "I feel tired whatever I do." Psoriatic activity was evaluated with tender joint count (TJC), swollen joint count (SJC), dactylitis count, enthesitis count, inflammatory back pain (IBP), physician global assessment, body surface area, and psoriasis pain and itch. RESULTS: Among 107 participants, work productivity was reduced by 6.7%, compared to benchmark employees without limitations. Fatigue was reported by 54 patients (50.5%) on PsAQOL#1, and 64 (60.0%) were classified as high fatigue by BASDAI#1. TJC, SJC, enthesitis count, IBP, and depressed mood were highest or most frequent in participants reporting fatigue. After adjustments for psoriatic activity and depressed mood, WPL was associated with fatigue, as measured by PsAQOL#1 (p = 0.01) and BASDAI#1 (p = 0.002). CONCLUSION: WPL was associated with fatigue, and the association was not entirely explained by the evaluated musculoskeletal, cutaneous, or psychiatric manifestations of PsA.

Myocardial strain and strain rate in Kawasaki disease.

AIMS: We sought to determine whether velocity vector imaging (VVI)-derived left ventricular (LV) myocardial deformation indices could detect subtle myocardial abnormalities in acute Kawasaki disease (KD). METHODS AND RESULTS: The study cohort of children with KD was divided by coronary artery dilation (CAD, Z-score >2.5) and/or uncomplicated vs. treatment-resistant (persistent/recrudescent fever) cases and compared with age-matched controls. Peak systolic LV myocardial strain (ε) and strain rate (SR) were obtained using VVI on pre-treatment echocardiograms. Comparisons were made between controls and (i) the entire KD group, (ii) KD group subdivided by CAD, and (iii) KD group subdivided by treatment resistance. The KD group consisted of 32 children (66% male, 24 ± 20 months). Of these, 17 had CAD and 14 had resistant KD. The control group consisted of 22 children (55% male, 20 ± 17 months). Routine echo indices of LV systolic function were normal for both groups. Compared with controls, KD patients had lower global longitudinal ε (-15.29 vs. -12.94, P = 0.04) and SR (-1.12 vs. -0.87, P = 0.003). On subgroup analysis compared with controls, KD patients with CAD (n = 17) had lower longitudinal ε (-15.29 vs. -11.87, P = 0.02) and SR (-1.12 vs. -0.86, P = 0.005). Subdivided by treatment resistance, compared with controls, those with resistant KD had lower longitudinal ε (-15.29 vs. -11.8, P = 0.01) and SR (-1.12 vs. -0.82, P = 0.003). CONCLUSION: Despite normal LV systolic function by routine echocardiographic measurements, KD patients have reduced longitudinal LV ε and SR, which may be more sensitive indicators of myocardial inflammation and may provide supportive criteria to avoid delayed diagnosis of KD.