Rheumatoid arthritis raises risk for shingles
People with rheumatoid arthritis are at increased risk of herpes zoster, or shingles, a painful skin condition caused by a reactivation of the chickenpox virus, according to research on more than 160,000 individuals with rheumatoid arthritis.
Medications used to treat rheumatoid arthritis appear to increase vulnerability to shingles, Allison L. Smitten, from the Harvard School of Public Health, Boston, and colleagues report in the medical journal, Arthritis Care and Research.
It is "biologically plausible" that having rheumatoid arthritis may result in an increased risk of shingles due to the dysregulation of the immune system in patients with rheumatoid arthritis, they write.
By studying the US PharMetrics claims database for the period 1998-2002, which included 122,000 rheumatoid arthritis patients and one million randomly selected controls, the researchers found that the rate of shingles was significantly higher in rheumatoid arthritis patients than in controls - 9.83 versus 3.71 per 1,000 "person-years". This translates into a 91 per cent higher adjusted risk of shingles in patients with rheumatoid arthritis relative to those without rheumatoid arthritis.
A look at the UK General Practice Research Database for the period 1990-2001, which included 38,000 rheumatoid arthritis patients and 500,000 randomly selected controls, revealed rates of shingles of 10.6 per 1,000 person-years in patients with rheumatoid arthritis versus only 4.1 per 1,000 person-years, in controls - a 65 per cent increased risk in the setting of rheumatoid arthritis.
Dr Smitten and colleagues also found evidence that a variety of anti-rheumatoid arthritis drugs were associated with greater likelihood of developing shingles.
They were unable to tell if the medications themselves increased risk, or if they were simply markers for more severe disease that made patients more susceptible to reactivation of the chickenpox virus.
"Given that many of the drugs used to treat rheumatoid arthritis have been associated with substantial benefit in terms of disease improvement and quality of life, any increase in the risk of herpes zoster must be considered in the context of the benefits expected from the medications," Dr Smitten and her associates conclude.
Teen risk factors for schizophrenia identified
Five key factors can help predict whether at-risk young people will go on to develop schizophrenia, researchers have found.
The findings show that it is "feasible" to identify a person's risk of schizophrenia as accurately as gauging his or her risk of heart disease or diabetes, and raise the possibility of preventing psychotic illness, Tyrone D. Cannon of the University of California, Los Angeles and colleagues say.
The earlier schizophrenia is identified and treated, the less damaging its course, they note in the Archives of General Psychiatry. However, current methods designed to predict schizophrenia risk are imprecise, they point out.
Dr Cannon and his team followed 291 teenagers considered to be at high risk for developing schizophrenia for two-and-a-half years to look for a more accurate predictive technique. All of the study participants had been diagnosed with prodromal syndrome for schizophrenia, meaning they had non-specific symptoms such as paranoia, disorganised communication, and unusual thoughts that could signal the onset of full-blown disease.
Thirty-five per cent of the study participants developed schizophrenia during the study. Five characteristics identified at the study's outset sharply increased the likelihood that a teen would develop the disease: A genetic risk for schizophrenia combined with recent decline in function; higher levels of unusual thought content; more suspicion/paranoia; more social impairment; and past or current substance abuse.
Among people with two or three of these characteristics, 68 to 80 per cent developed schizophrenia during the course of the study, the researchers report.
Dr Cannon and his colleagues caution that the people in their study were seeking treatment, so the results can't be applied to the general population. Nevertheless, they say their findings suggest that the first two-and-a-half years after a diagnosis of prodromal syndrome offer "a critical window of opportunity" for identifying brain changes that may lead to psychosis, and for intervening to slow or even prevent the development of psychosis and disability.
In an editorial accompanying the study, Patrick D. McGorry of the University of Melbourne, Victoria, Australia and colleagues write that large clinical trials are now needed to investigate early treatment of schizophrenia. "While there are risks in the endeavour to reshape the early course of schizophrenia and related psychoses, it is now within our grasp," they conclude.
People with rheumatoid arthritis are at increased risk of herpes zoster, or shingles, a painful skin condition caused by a reactivation of the chickenpox virus, according to research on more than 160,000 individuals with rheumatoid arthritis.
Medications used to treat rheumatoid arthritis appear to increase vulnerability to shingles, Allison L. Smitten, from the Harvard School of Public Health, Boston, and colleagues report in the medical journal, Arthritis Care and Research.
It is "biologically plausible" that having rheumatoid arthritis may result in an increased risk of shingles due to the dysregulation of the immune system in patients with rheumatoid arthritis, they write.
By studying the US PharMetrics claims database for the period 1998-2002, which included 122,000 rheumatoid arthritis patients and one million randomly selected controls, the researchers found that the rate of shingles was significantly higher in rheumatoid arthritis patients than in controls - 9.83 versus 3.71 per 1,000 "person-years". This translates into a 91 per cent higher adjusted risk of shingles in patients with rheumatoid arthritis relative to those without rheumatoid arthritis.
A look at the UK General Practice Research Database for the period 1990-2001, which included 38,000 rheumatoid arthritis patients and 500,000 randomly selected controls, revealed rates of shingles of 10.6 per 1,000 person-years in patients with rheumatoid arthritis versus only 4.1 per 1,000 person-years, in controls - a 65 per cent increased risk in the setting of rheumatoid arthritis.
Dr Smitten and colleagues also found evidence that a variety of anti-rheumatoid arthritis drugs were associated with greater likelihood of developing shingles.
They were unable to tell if the medications themselves increased risk, or if they were simply markers for more severe disease that made patients more susceptible to reactivation of the chickenpox virus.
"Given that many of the drugs used to treat rheumatoid arthritis have been associated with substantial benefit in terms of disease improvement and quality of life, any increase in the risk of herpes zoster must be considered in the context of the benefits expected from the medications," Dr Smitten and her associates conclude.
Teen risk factors for schizophrenia identified
Five key factors can help predict whether at-risk young people will go on to develop schizophrenia, researchers have found.
The findings show that it is "feasible" to identify a person's risk of schizophrenia as accurately as gauging his or her risk of heart disease or diabetes, and raise the possibility of preventing psychotic illness, Tyrone D. Cannon of the University of California, Los Angeles and colleagues say.
The earlier schizophrenia is identified and treated, the less damaging its course, they note in the Archives of General Psychiatry. However, current methods designed to predict schizophrenia risk are imprecise, they point out.
Dr Cannon and his team followed 291 teenagers considered to be at high risk for developing schizophrenia for two-and-a-half years to look for a more accurate predictive technique. All of the study participants had been diagnosed with prodromal syndrome for schizophrenia, meaning they had non-specific symptoms such as paranoia, disorganised communication, and unusual thoughts that could signal the onset of full-blown disease.
Thirty-five per cent of the study participants developed schizophrenia during the study. Five characteristics identified at the study's outset sharply increased the likelihood that a teen would develop the disease: A genetic risk for schizophrenia combined with recent decline in function; higher levels of unusual thought content; more suspicion/paranoia; more social impairment; and past or current substance abuse.
Among people with two or three of these characteristics, 68 to 80 per cent developed schizophrenia during the course of the study, the researchers report.
Dr Cannon and his colleagues caution that the people in their study were seeking treatment, so the results can't be applied to the general population. Nevertheless, they say their findings suggest that the first two-and-a-half years after a diagnosis of prodromal syndrome offer "a critical window of opportunity" for identifying brain changes that may lead to psychosis, and for intervening to slow or even prevent the development of psychosis and disability.
In an editorial accompanying the study, Patrick D. McGorry of the University of Melbourne, Victoria, Australia and colleagues write that large clinical trials are now needed to investigate early treatment of schizophrenia. "While there are risks in the endeavour to reshape the early course of schizophrenia and related psychoses, it is now within our grasp," they conclude.