Elevated DAS28-ESR in patients with rheumatoid arthritis who have comorbid fibromyalgia is associated more with tender joint counts than with patient global assessment or swollen joint counts: implications for assessment of inflammatory activity.

OBJECTIVES: More than 20% of rheumatoid arthritis (RA) patients have comorbid fibromyalgia (FM+), which may elevate DAS28-ESR (disease activity score 28-erythrocyte sedimentation rate) and other indices, resulting in challenges to assess inflammatory disease activity. Although several reports indicate that elevated patient global assessment (PATGL) may elevate DAS28 in the absence of inflammatory activity, less information is available concerning the other three components, tender joint count (TJC), swollen joint count (SJC), and erythrocyte sedimentation rate (ESR), to possibly elevate DAS28 in FM+ vs. FM- RA patients. METHODS: A PubMed search identified 14 reports which presented comparisons of DAS28-ESR and its four components in RA FM+ vs. FM- groups. Median DAS28, component arithmetic differences, pooled effect sizes and 95% confidence intervals were analysed in the FM+ vs. FM- groups. RESULTS: In FM+ vs. FM- groups, median DAS28 was 5.3 vs. 4.2, SJC 4.0 vs. 3.0, TJC 13.2 vs. 5.3, PATGL 61.6 vs. 39.9, ESR 26.3 vs. 26.5. DAS28-ESR was classified as "high" (>5.1) in 11/14 FM+ groups and "moderate" (3.2-5.1) in all 14 FM- groups. Effect sizes in FM+ vs. FM- groups for DAS28-ESR, SJC, TJC, PATGL, and ESR were large (≥0.8) in 10/14, 1/13, 12/13, 7/13, and 1/13 comparisons, respectively, and pooled effect sizes 0.84 (0.3, 1.4), 0.33 (-0.4, 1.0), 1.27 (0.01, 2.5), 0.91 (-0.6, 2.4), and 0.07 (-0.6, 0.7), respectively. CONCLUSIONS: DAS28-ESR is elevated significantly in FM+ vs. FM- RA patients; pooled effect sizes were highest for TJC, followed by PATGL, SJC and ESR. The findings appear relevant to response and remission criteria, treat-to-target, and general management of RA.

Renal Involvement in Granulomatosis With Polyangiitis Increases Economic Health Care Burden: Insights From the National Inpatient Sample Database.

Background This study aims to compare outcomes of hospitalizations of granulomatosis with polyangiitis (GPA) with and without renal involvement. The primary outcome was inpatient mortality, whereas secondary outcomes were hospital length of stay (LOS) and total hospital charge. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS was searched for GPA hospitalizations with and without renal involvement as the principal or secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes. GPA hospitalizations for adult patients from the above groups were identified. Multivariate logistic and linear regression analyses were used to adjust for possible confounders for the primary and secondary outcomes, respectively. Results There were more than 71 million discharges included in the combined 2016 and 2017 NIS database, of which 23,670 were for adult patients who had either a principal or secondary ICD-10 code for GPA, and 8,265 (34.92%) of these GPA hospitalizations had renal involvement. Hospitalizations for GPA with renal involvement had similar inpatient mortality (3.8% vs. 3.7%; adjusted OR: 1.14; 95% CI: 0.84-1.56; p=0.406) compared to those without renal involvement. GPA with renal involvement hospitalizations had an increase in adjusted mean LOS of 1.36 days (95% CI: 0.82-1.91; p=0.0001) compared to those without renal involvement. GPA with renal involvement hospitalizations had an increase in adjusted total hospital charges of $18,723 (95% CI: 9,595-27,852; p=0.0001) compared to those without renal involvement. Conclusions GPA with renal involvement hospitalizations had similar inpatient mortality compared to those without renal involvement. However, LOS and total hospital charges were greater in those with renal involvement.

Psoriatic Arthritis Hospitalization Is Associated with Increased Health Care Charges: A Report from the National Inpatient Sample.

BACKGROUND: This study aims to compare the outcomes of psoriasis hospitalizations with and without joint involvement. The primary outcome was inpatient mortality, while secondary outcomes were hospital length of stay (LOS) and total hospital charges. METHODS: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS was searched for psoriasis hospitalizations with and without joint involvement as principal or secondary diagnosis using the International Classification of Diseases, tenth revision (ICD-10) codes. Psoriasis hospitalizations for adult patients (aged ≥18 years) from the above groups were identified. Multivariate logistic and linear regression analysis was used to adjust for confounders for the primary and secondary outcomes, respectively. RESULTS: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. A total of 323,405 hospitalizations were for adult patients with either a principal or secondary ICD-10 code for psoriasis. Of these hospitalizations, 77,980 (24.11%) had joint involvement. Psoriasis hospitalizations with joint involvement had similar inpatient mortality (1.42% vs. 1.78%, adjusted odds ratio (AOR): 0.89, 95% CI: 0.76-1.05, p=0.159) compared with those without joint involvement. Psoriasis with joint involvement hospitalizations had a decrease in adjusted mean LOS of 0.15 days (95% CI: 0.26-0.04, p=0.007) compared with the group without joint involvement. Psoriasis with joint involvement hospitalizations had an increase in adjusted mean total hospital charges of $3,655 (95% CI: 2,146-5,164; p<0.0001) compared with the group without joint involvement. CONCLUSIONS: Hospitalizations for psoriasis with and without joint involvement have similar inpatient mortality. However, joint involvement increases total hospital charges, which increases the burden to the health care system.

Reasons for Hospitalization of Psoriasis Patients: A Report From the National Inpatient Sample.

Background We used a large United States population-based database to analyze the reasons for hospitalization of psoriasis patients. Methods International Classification of Diseases, 10th revision (ICD-10) code was used to identify hospitalizations in National Inpatient Sample (NIS) 2017 with a principal or secondary diagnosis of psoriasis. The reasons for hospitalization were divided into 19 categories based on their principal discharge ICD-10 diagnosis code. We also ranked the five most common specific reasons for hospitalization of psoriasis patients. Results There were over 35 million discharges included in the 2017 NIS database. A total of 165215 hospitalizations had either a principal or secondary ICD 10 code for psoriasis. Based on ICD-10 code categories, the top five reasons for hospitalization in patients with history of psoriasis were: Cardiovascular (CV) (26605, 16.10%), rheumatologic (19555, 11.84%), digestive (18465, 11.18%), infection (16395, 9.92%), and respiratory (14865, 9.00%). Sepsis was the most common principal diagnosis of psoriasis hospitalizations. Conclusion CV diseases were the most common ICD category, and sepsis was the most common principal diagnosis for psoriasis hospitalization. Management of medical co-morbidities is important in reducing rates of hospitalization of psoriasis patients.

An Analysis of Rheumatoid Arthritis Hospitalizations.

Background We used a large United States (US) population-based database to analyze the reasons for hospitalization of rheumatoid arthritis (RA) patients. Methods The International Classification of Diseases, Tenth Revision (ICD-10) code was used to search for hospitalizations in 2017 in the National Inpatient Sample (NIS) database with RA as the principal or secondary diagnosis. The reasons for hospitalization were divided into 19 categories based on their principal discharge ICD-10 diagnosis code. We also ranked the five most common specific reasons for hospitalization. Results There were over 35 million discharges included in the 2017 NIS database; 565,440 hospitalizations had either a principal or secondary ICD-10 code for RA. The top five reasons for RA hospitalization by ICD-10 code categories were as follows: cardiovascular (CV): 93,825 (16.59%), rheumatologic: 82,785 (14.64%), respiratory: 66,895 (11.83%), infection: 62,660 (11.09%), and injury/poisoning: 56,460 (9.96%). Sepsis was the most common principal diagnosis for RA hospitalizations. Conclusion CV diseases were the most common ICD category, and sepsis was the most common principal diagnosis for RA hospitalizations. Management of medical comorbidities (such as CV) and prevention of infection is essential for reducing the rates of RA hospitalizations.