Diana Mahoney

The cardiovascular risk in rheumatoid arthritis is comparable to that of diabetes, a large Danish study has shown.

Further, the risk of myocardial infarction (MI) in rheumatoid arthritis patients corresponds to that observed in the general population of individuals without the musculoskeletal condition who are, on average, 10 years older and does not appear to be affected by the duration of drug treatment for the disease, Dr. Jesper Lindhardsen of Gentofte University Hospital in Copenhagen, Denmark, and colleagues reported.

Using nationwide registers encompassing the entire Danish population older than 16 years, the investigators identified individuals with new-onset rheumatoid arthritis (RA), new onset diabetes, and new MI during a 10-year period, excluding individuals with prior disease and incomplete data entries from the full cohort of 4,311,022 subjects, they wrote.

During the 10-year study period, 9,921 individuals developed RA and 129,659 developed diabetes, the authors reported. Compared with the diabetes patients, "RA patients were more often women, used less cardioprotective medications, and had less comorbidity, whereas age was similar in the two groups," they reported.

Regarding cardiovascular outcomes, 265 of the RA patients and 3,948 of the diabetes patients had new MI, representing in both cohorts a 1.7 increased incidence rate ratio (IRR) of MI in a fully adjusted model compared with the general population in which 75,870 individuals had new myocardial infarctions, they wrote. The IRR among patients with both RA and diabetes was 2.6, "which roughly equaled the predicted additive risk for the two separate diseases, they wrote (Ann. Rheum. Dis. 2011;70:929-34).

The investigators conducted a nested case-control study that corroborated the comparable risk of MI in the RA and diabetes patients. The findings demonstrated that the increased risk in these groups was independent of treatment duration within the timeframe of the current study, they wrote.

Stratified by gender, the MI risk estimates did not differ between women and men in the RA group. In the diabetes patients, however, women were at significantly higher risk than men for the adverse cardiovascular outcome, the authors wrote. An age-dependent pattern of MI risk was also observed. Specifically, among women with RA and diabetes, respectively, the risk of MI in those younger than 50 years old was 5.5 and 5.9 times that observed in the age-matched reference group, they reported. Additionally, for women between 50 and 65 years of age, the IRRs were 1.7 and 2.6 for RA and diabetes patients, respectively.

The age-stratified patterns observed in men were different, the authors stated, noting that "the IRRs in the two oldest age groups were comparable, and even tended to be slightly higher in the 50-65 years age group of RA patients compared to the same-aged [diabetes] patients." And while the youngest men with RA had a markedly raised IRR, diabetes patients in the same age stratum had a significantly higher risk, with an IRR of 4.9 compared with 2.1, they said.

In a fully adjusted regression model in which the IRRs for MI in RA patients were calculated according to 10-year subject age intervals, "RA patients had the same, or higher, risk of MI as control subjects who were, on average, 10 years older," the authors reported.

Although the study has several limitations, including the identification of RA patients based on dispensed prescriptions and diagnosis versus the 1987 American College of Rheumatology criteria, the reliance on the use of glucose-lowering drugs as a proxy for diabetes, and the lack of information about classic cardiovascular risk factors, "the results corroborate and expand previous findings in this area of research and indicate that patients with RA should be considered for more aggressive primary [cardiovascular disease] prevention," the authors stressed.

In an accompanying editorial, Dr. Michael T. Nurmohamed and Dr. George Kitas of VU University Medical Centre in Amsterdam wrote that the findings of the current study should put to bed any doubt or debate about an enhanced cardiovascular risk in RA. "Importantly, they also provide further evidence that the cardiovascular risk in RA is broadly similar to that of contemporarily managed diabetes," they stated. The results of the study, as well as the success of cardiovascular risk management in diabetes provides a clear incentive to identify and actively manage, if necessary, cardiovascular risk in all RA patients as part of quality routine rheumatological practice" (Ann. Rheum. Dis. 2011;70:881-3).

The study was sponsored by an unrestricted grant from the Danish Rheumatism Association. The authors of the study and the accompanying editorial reported having no conflicts of interest to disclose.

The cardiovascular risk in rheumatoid arthritis is comparable to that of diabetes, a large Danish study has shown.

Further, the risk of myocardial infarction (MI) in rheumatoid arthritis patients corresponds to that observed in the general population of individuals without the musculoskeletal condition who are, on average, 10 years older and does not appear to be affected by the duration of drug treatment for the disease, Dr. Jesper Lindhardsen of Gentofte University Hospital in Copenhagen, Denmark, and colleagues reported.

Using nationwide registers encompassing the entire Danish population older than 16 years, the investigators identified individuals with new-onset rheumatoid arthritis (RA), new onset diabetes, and new MI during a 10-year period, excluding individuals with prior disease and incomplete data entries from the full cohort of 4,311,022 subjects, they wrote.

During the 10-year study period, 9,921 individuals developed RA and 129,659 developed diabetes, the authors reported. Compared with the diabetes patients, "RA patients were more often women, used less cardioprotective medications, and had less comorbidity, whereas age was similar in the two groups," they reported.

Regarding cardiovascular outcomes, 265 of the RA patients and 3,948 of the diabetes patients had new MI, representing in both cohorts a 1.7 increased incidence rate ratio (IRR) of MI in a fully adjusted model compared with the general population in which 75,870 individuals had new myocardial infarctions, they wrote. The IRR among patients with both RA and diabetes was 2.6, "which roughly equaled the predicted additive risk for the two separate diseases, they wrote (Ann. Rheum. Dis. 2011;70:929-34).

The investigators conducted a nested case-control study that corroborated the comparable risk of MI in the RA and diabetes patients. The findings demonstrated that the increased risk in these groups was independent of treatment duration within the timeframe of the current study, they wrote.

Stratified by gender, the MI risk estimates did not differ between women and men in the RA group. In the diabetes patients, however, women were at significantly higher risk than men for the adverse cardiovascular outcome, the authors wrote. An age-dependent pattern of MI risk was also observed. Specifically, among women with RA and diabetes, respectively, the risk of MI in those younger than 50 years old was 5.5 and 5.9 times that observed in the age-matched reference group, they reported. Additionally, for women between 50 and 65 years of age, the IRRs were 1.7 and 2.6 for RA and diabetes patients, respectively.

The age-stratified patterns observed in men were different, the authors stated, noting that "the IRRs in the two oldest age groups were comparable, and even tended to be slightly higher in the 50-65 years age group of RA patients compared to the same-aged [diabetes] patients." And while the youngest men with RA had a markedly raised IRR, diabetes patients in the same age stratum had a significantly higher risk, with an IRR of 4.9 compared with 2.1, they said.

In a fully adjusted regression model in which the IRRs for MI in RA patients were calculated according to 10-year subject age intervals, "RA patients had the same, or higher, risk of MI as control subjects who were, on average, 10 years older," the authors reported.

Although the study has several limitations, including the identification of RA patients based on dispensed prescriptions and diagnosis versus the 1987 American College of Rheumatology criteria, the reliance on the use of glucose-lowering drugs as a proxy for diabetes, and the lack of information about classic cardiovascular risk factors, "the results corroborate and expand previous findings in this area of research and indicate that patients with RA should be considered for more aggressive primary [cardiovascular disease] prevention," the authors stressed.

In an accompanying editorial, Dr. Michael T. Nurmohamed and Dr. George Kitas of VU University Medical Centre in Amsterdam wrote that the findings of the current study should put to bed any doubt or debate about an enhanced cardiovascular risk in RA. "Importantly, they also provide further evidence that the cardiovascular risk in RA is broadly similar to that of contemporarily managed diabetes," they stated. The results of the study, as well as the success of cardiovascular risk management in diabetes provides a clear incentive to identify and actively manage, if necessary, cardiovascular risk in all RA patients as part of quality routine rheumatological practice" (Ann. Rheum. Dis. 2011;70:881-3).

The study was sponsored by an unrestricted grant from the Danish Rheumatism Association. The authors of the study and the accompanying editorial reported having no conflicts of interest to disclose.

The cardiovascular risk in rheumatoid arthritis is comparable to that of diabetes, a large Danish study has shown.

Further, the risk of myocardial infarction (MI) in rheumatoid arthritis patients corresponds to that observed in the general population of individuals without the musculoskeletal condition who are, on average, 10 years older and does not appear to be affected by the duration of drug treatment for the disease, Dr. Jesper Lindhardsen of Gentofte University Hospital in Copenhagen, Denmark, and colleagues reported.

Using nationwide registers encompassing the entire Danish population older than 16 years, the investigators identified individuals with new-onset rheumatoid arthritis (RA), new onset diabetes, and new MI during a 10-year period, excluding individuals with prior disease and incomplete data entries from the full cohort of 4,311,022 subjects, they wrote.

During the 10-year study period, 9,921 individuals developed RA and 129,659 developed diabetes, the authors reported. Compared with the diabetes patients, "RA patients were more often women, used less cardioprotective medications, and had less comorbidity, whereas age was similar in the two groups," they reported.

Regarding cardiovascular outcomes, 265 of the RA patients and 3,948 of the diabetes patients had new MI, representing in both cohorts a 1.7 increased incidence rate ratio (IRR) of MI in a fully adjusted model compared with the general population in which 75,870 individuals had new myocardial infarctions, they wrote. The IRR among patients with both RA and diabetes was 2.6, "which roughly equaled the predicted additive risk for the two separate diseases, they wrote (Ann. Rheum. Dis. 2011;70:929-34).

The investigators conducted a nested case-control study that corroborated the comparable risk of MI in the RA and diabetes patients. The findings demonstrated that the increased risk in these groups was independent of treatment duration within the timeframe of the current study, they wrote.

Stratified by gender, the MI risk estimates did not differ between women and men in the RA group. In the diabetes patients, however, women were at significantly higher risk than men for the adverse cardiovascular outcome, the authors wrote. An age-dependent pattern of MI risk was also observed. Specifically, among women with RA and diabetes, respectively, the risk of MI in those younger than 50 years old was 5.5 and 5.9 times that observed in the age-matched reference group, they reported. Additionally, for women between 50 and 65 years of age, the IRRs were 1.7 and 2.6 for RA and diabetes patients, respectively.

The age-stratified patterns observed in men were different, the authors stated, noting that "the IRRs in the two oldest age groups were comparable, and even tended to be slightly higher in the 50-65 years age group of RA patients compared to the same-aged [diabetes] patients." And while the youngest men with RA had a markedly raised IRR, diabetes patients in the same age stratum had a significantly higher risk, with an IRR of 4.9 compared with 2.1, they said.

In a fully adjusted regression model in which the IRRs for MI in RA patients were calculated according to 10-year subject age intervals, "RA patients had the same, or higher, risk of MI as control subjects who were, on average, 10 years older," the authors reported.

Although the study has several limitations, including the identification of RA patients based on dispensed prescriptions and diagnosis versus the 1987 American College of Rheumatology criteria, the reliance on the use of glucose-lowering drugs as a proxy for diabetes, and the lack of information about classic cardiovascular risk factors, "the results corroborate and expand previous findings in this area of research and indicate that patients with RA should be considered for more aggressive primary [cardiovascular disease] prevention," the authors stressed.

In an accompanying editorial, Dr. Michael T. Nurmohamed and Dr. George Kitas of VU University Medical Centre in Amsterdam wrote that the findings of the current study should put to bed any doubt or debate about an enhanced cardiovascular risk in RA. "Importantly, they also provide further evidence that the cardiovascular risk in RA is broadly similar to that of contemporarily managed diabetes," they stated. The results of the study, as well as the success of cardiovascular risk management in diabetes provides a clear incentive to identify and actively manage, if necessary, cardiovascular risk in all RA patients as part of quality routine rheumatological practice" (Ann. Rheum. Dis. 2011;70:881-3).

The study was sponsored by an unrestricted grant from the Danish Rheumatism Association. The authors of the study and the accompanying editorial reported having no conflicts of interest to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

Strong signals for a correlation between diabetes and osteoarthritis in several epidemiological and experimental studies have led to the concept of a diabetes-induced OA phenotype. If confirmed, knowledge of the phenotype could have a dramatic impact on the prevention and progression of the musculoskeletal disease, according to Dr. Francis Berenbaum, head of the department of rheumatology at Pierre and Marie Curie University in Paris.

An association between diabetes and OA was first noted in the literature in 1961 in a paper that assessed the occurrence of definite radiological OA in 6 anatomical areas of 30 patients with diabetes and 30 matched controls, which showed a statistically significant correlation between diabetes and OA of the feet and knees (Tufts Folia Med. 1961;7:13-9 Dr. Berenbaum reported online ahead of print in the Annals of Rheumatic Diseases.

Since that time, multiple cross-sectional studies have been published, including one that looked at OA patterns in 809 patients with knee or hip-joint replacement and found that bilateral OA occurred more frequently in patients with non-insulin-dependent diabetes (Scand. J. Rheumatol. 2001;30:169-71).

Most recently, a study designed to test the hypothesis that vascular cell adhesion molecule 1 predicts severe knee or hip OA showed an increased prevalence of non-insulin-dependent diabetes among the 60 patients who underwent joint replacement surgery relative to the 852 patients who did not (Arthritis Rheum. 2009;60:2381-9).

Although it cannot be definitively concluded from the collective case-control studies that diabetes is an independent risk factor for OA given the potential for interference with the results by such confounders as age, weight, and level of activity, "taken together, there may be a positive signal for an independent correlation between OA and diabetes," Dr. Berenbaum wrote (Ann Rheum Dis. 2011 [Epub. Doi:10.1136/ard.2010.146399]).

In vitro, in vivo, and human experimental data also point toward an independent association. For example, advanced glycation end products (AGEs) accumulate in diabetic tissues as a result of hyperglycemia and research data have suggested that AGE modification may contribute to the pathogenesis of OA, Dr. Berenbaum noted. "To the best of my knowledge, to date no experimental studies have assessed the level of AGE formation in diabetic cartilage compared to normal cartilage, either in human or animal cartilage," he stated. "However, it seems realistic to consider that an increased concentration of glucose in the diabetic cartilage–matrix environment would lead to the same deleterious result."

With respect to in vivo data, in the streptozotocin-induced diabetes rat model that mimics type I diabetes, "cartilage becomes resistant to the anabolic action of insulin-like growth factor 1 [IGF-1], a condition that is correctable by hypophysectomy, suggesting a metabolic impairment at the tissue level," Dr. Berenbaum wrote.

Diabetes-induced peripheral nerve impairment, which has been described in human experimental data, "could be an added risk factor for OA in patients with diabetes," Dr. Berenbaum hypothesized, given the presence of local and systemic neurological dysfunction in some patients with OA. Similarly, low-grade systemic inflammation has been associated with both cartilage loss and hyperglycemia. As such, he stated, "I propose that an independent hyperglycemia-induced systemic inflammation may also have an impact on the progression of OA."

Given the multiple signs pointing to a correlation between diabetes and OA, "it is time to encourage the scientific community to perform prospective studies devoted to confirm or invalidate this hypothesis," Dr. Berenbaum wrote. Such studies should be designed to provide insight into the mechanisms underlying the interactions between both diseases, he said, noting that "a better knowledge of the specificities of a diabetes-induced OA phenotype compared to the others should lead to a personalized approach of preventive and curative treatments for OA."

Dr. Berenbaum reported having no competing interests to disclose.

The stem cell facelift sounds like science: transplanting adult stem cells from the body's own fat tissue into the face so the stem cell growth factors can generate new tissue and restore the smoothness and skin tightness of youth.

However, the problem, according to Dr. J. Peter Rubin, codirector of the Adipose Stem Cell Center at the University of Pittsburgh, is that the science "just isn't there yet," so marketing stem cell procedures for aesthetic medicine is "premature and possibly unethical."

Of approximately 9,000 reports in the medical literature about stem cells, only 20 are peer-reviewed studies about their use in aesthetic procedures, Dr. Rubin said at the annual meeting of the American Society for Aesthetic Plastic Surgery, and none "demonstrate superiority of stem cell facelift over [conventional] facelift with standard fat grafting."

Despite the dearth of evidence demonstrating the safety or efficacy of stem cell therapies in aesthetic medicine, the procedures are being widely marketed, he said, noting that in some cases, the treatments don't even include any stem cell work, but simply involve regular fat grafting.

In an effort to discourage the proliferation of unsubstantiated claims about stem cell therapies, a joint task force of the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released a position statement at the meeting recommending against the marketing and promotion of stem cell procedures in aesthetic surgery until there is adequate clinical evidence to support doing so.

Specifically, the ASAPS/ASPS position statement stressed that "the marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time," and as such recommends that:

• The use of phrases such as stem cell therapy or stem cell procedure be reserved for treatments or techniques in which the collection, processing, and therapeutic action of stem cells are the primary goal of treatment rather than the passive result. "Standard fat grafting procedures that do transfer some stem cells naturally present within the tissue should be described as fat grafting procedures, not stem cell procedures," according to the document.

• Data on outcomes and safety should be collected and reported by physicians performing stem cell therapies to advance the knowledge and the science of the process.
• Stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval.
• Stem cell procedures should be performed in compliance with Food and Drug Administration regulatory guidelines.

"There are encouraging data from laboratory and clinical studies suggesting the use of adult stem cells is promising, but there is not enough science to justify the widespread marketing of it," said Dr. Rubin.

The goal of the position statement is not to diminish enthusiasm about the potential for stem cell treatments," he said, "but to support evidence-based practices in order to protect patients' best interests."

Dr. Rubin receives educational support from Covidien.

The stem cell facelift sounds like science: transplanting adult stem cells from the body's own fat tissue into the face so the stem cell growth factors can generate new tissue and restore the smoothness and skin tightness of youth.

However, the problem, according to Dr. J. Peter Rubin, codirector of the Adipose Stem Cell Center at the University of Pittsburgh, is that the science "just isn't there yet," so marketing stem cell procedures for aesthetic medicine is "premature and possibly unethical."

Of approximately 9,000 reports in the medical literature about stem cells, only 20 are peer-reviewed studies about their use in aesthetic procedures, Dr. Rubin said at the annual meeting of the American Society for Aesthetic Plastic Surgery, and none "demonstrate superiority of stem cell facelift over [conventional] facelift with standard fat grafting."

Despite the dearth of evidence demonstrating the safety or efficacy of stem cell therapies in aesthetic medicine, the procedures are being widely marketed, he said, noting that in some cases, the treatments don't even include any stem cell work, but simply involve regular fat grafting.

In an effort to discourage the proliferation of unsubstantiated claims about stem cell therapies, a joint task force of the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released a position statement at the meeting recommending against the marketing and promotion of stem cell procedures in aesthetic surgery until there is adequate clinical evidence to support doing so.

Specifically, the ASAPS/ASPS position statement stressed that "the marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time," and as such recommends that:

• The use of phrases such as stem cell therapy or stem cell procedure be reserved for treatments or techniques in which the collection, processing, and therapeutic action of stem cells are the primary goal of treatment rather than the passive result. "Standard fat grafting procedures that do transfer some stem cells naturally present within the tissue should be described as fat grafting procedures, not stem cell procedures," according to the document.

• Data on outcomes and safety should be collected and reported by physicians performing stem cell therapies to advance the knowledge and the science of the process.
• Stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval.
• Stem cell procedures should be performed in compliance with Food and Drug Administration regulatory guidelines.

"There are encouraging data from laboratory and clinical studies suggesting the use of adult stem cells is promising, but there is not enough science to justify the widespread marketing of it," said Dr. Rubin.

The goal of the position statement is not to diminish enthusiasm about the potential for stem cell treatments," he said, "but to support evidence-based practices in order to protect patients' best interests."

Dr. Rubin receives educational support from Covidien.

The stem cell facelift sounds like science: transplanting adult stem cells from the body's own fat tissue into the face so the stem cell growth factors can generate new tissue and restore the smoothness and skin tightness of youth.

However, the problem, according to Dr. J. Peter Rubin, codirector of the Adipose Stem Cell Center at the University of Pittsburgh, is that the science "just isn't there yet," so marketing stem cell procedures for aesthetic medicine is "premature and possibly unethical."

Of approximately 9,000 reports in the medical literature about stem cells, only 20 are peer-reviewed studies about their use in aesthetic procedures, Dr. Rubin said at the annual meeting of the American Society for Aesthetic Plastic Surgery, and none "demonstrate superiority of stem cell facelift over [conventional] facelift with standard fat grafting."

Despite the dearth of evidence demonstrating the safety or efficacy of stem cell therapies in aesthetic medicine, the procedures are being widely marketed, he said, noting that in some cases, the treatments don't even include any stem cell work, but simply involve regular fat grafting.

In an effort to discourage the proliferation of unsubstantiated claims about stem cell therapies, a joint task force of the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released a position statement at the meeting recommending against the marketing and promotion of stem cell procedures in aesthetic surgery until there is adequate clinical evidence to support doing so.

Specifically, the ASAPS/ASPS position statement stressed that "the marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time," and as such recommends that:

• The use of phrases such as stem cell therapy or stem cell procedure be reserved for treatments or techniques in which the collection, processing, and therapeutic action of stem cells are the primary goal of treatment rather than the passive result. "Standard fat grafting procedures that do transfer some stem cells naturally present within the tissue should be described as fat grafting procedures, not stem cell procedures," according to the document.

• Data on outcomes and safety should be collected and reported by physicians performing stem cell therapies to advance the knowledge and the science of the process.
• Stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval.
• Stem cell procedures should be performed in compliance with Food and Drug Administration regulatory guidelines.

"There are encouraging data from laboratory and clinical studies suggesting the use of adult stem cells is promising, but there is not enough science to justify the widespread marketing of it," said Dr. Rubin.

The goal of the position statement is not to diminish enthusiasm about the potential for stem cell treatments," he said, "but to support evidence-based practices in order to protect patients' best interests."

Dr. Rubin receives educational support from Covidien.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

Photo credit: © Monkey Business/Fotolia.com

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

Photo credit: © Monkey Business/Fotolia.com

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

Photo credit: © Monkey Business/Fotolia.com

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

Photo credit: © Monkey Business/Fotolia.com

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

Photo credit: © Monkey Business/Fotolia.com

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

Despite national efforts to improve the quality of care and health outcomes of individuals with asthma, the overall prevalence of the chronic respiratory disease in the United States increased by more than 12% between 2001 and 2009, according to a report released May 3 by the Centers for Disease Control and Prevention.

Based on data from the 2001-2009 National Health Interview Survey and the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System, the prevalence of asthma among people of all ages increased from 20.3 million (7.3%) in 2001 to 24.6 million (8.2%) in 2009, the agency reported in the May 3 issue of the Morbidity and Mortality Weekly Report. The prevalence among children younger than 18 years increased from 8.7% to 9.6% during this period, with the highest prevalence rates observed among poor children, at 13.5%; non-Hispanic black children, at 17.0%; and boys, at 11.3%. Among adults, asthma prevalence increased from 6.9% in 2001 to 7.7% in 2009, with the highest rates seen in poor adults (10.6%) and in women (9.7%), according to the report (MMWR 2011;60:1-7).

Photo credit: © Monkey Business/Fotolia.com

"Approximately 1 out of every 12 individuals in the United States has asthma, and the number is rising," said Ileana Arias, Ph.D., principal deputy director of the CDC. "The estimated total cost of asthma in terms of medical expenses, lost school or work days, and premature death was $56 billion in 2007," she said in a press briefing. Although the reasons for the increased prevalence of the condition are unclear, particularly in light of improvements that have been made in outdoor air quality and the reduction of two common asthma triggers (smoking and second-hand smoke), "we do know that there are measures that can be taken to control asthma symptoms to avoid exacerbations and many attacks, and health care providers, insurers, people with asthma, and others should work together to implement these measures," she said.

A review of the disease characteristics and self-management education status data for 2008 showed that "more than half [52.6%] of the people with asthma reported having an attack within the prior year. Nearly 42% missed 1 or more days of work or school because of their asthma, 26% visited the emergency department or urgent care center for treatment, and 7% were hospitalized," Paul Garbe, DVM, chief of the CDC’s Air Pollution and Respiratory Health Branch, said during the press briefing. "The estimated per person/per year medical expenses associated with asthma between 2002 and 2007 was $3,259."

Assessing gaps in health care coverage and access could alter the asthma landscape, Dr. Garbe said. "Of the nearly 90% of asthma patients with health insurance, approximately 12% reported not being able to afford their prescription medicine, 37% had ever seen or talked to a specialist physician about their asthma, and 86% had ever talked to a primary care provider about it," he said. Among the uninsured asthma population, 40% reportedly couldn’t afford medication, nearly 20% had seen or talked to an asthma specialist, and 60% had seen or talked to a primary care physician about their asthma.

Further, although it is well understood that optimal asthma control includes self-management training, appropriate use of inhaled corticosteroids, and avoidance of environmental allergens and irritants, only one-third of the population had ever been given an action plan as recommended by the National Institute of Health’s National Asthma Education and Prevention Program (NAEPP), Dr. Garbe said. An action plan, as defined by the NAEPP, is a written form developed by health care providers that addresses the asthma-related needs and circumstances of individual patients, including how to monitor symptoms, when to make medication changes, how to identify and avoid irritants and allergens, how to recognize worsening symptoms, and when to take action.

The CDC has worked with health departments in some states to develop and implement interventions based on the guidelines. In Connecticut, for example, "a program for in-home education and environmental assessment has been implemented in an effort to reduce the number of children and adults who rely on the emergency department as their primary source of health care," Dr. Garbe said. "Since the program began, there has been a dramatic reduction in the average number of emergency/urgent care visits for asthma, from approximately three in a 6-month period to fewer than one." Rhode Island and New York also have developed asthma education programs designed to reduce the human and economic costs of asthma, he said.

Although potentially limited by the fact that the databases from which the results were obtained are based on adult self-report or adult proxy responses for children and thus are vulnerable to recall bias, the findings do suggest that people with asthma are doing a suboptimal job of managing their symptoms and that coordinated efforts at the local, state, and national levels should target patient education. Evidence-based interventions to reduce environmental risk factors for asthma also are needed, Dr. Garbe said.

Dr. Arias and Dr. Garbe disclosed no financial conflicts of interest.

SAN ANTONIO – Partial fundoplication improves dysphagia and regurgitation symptom scores in patients undergoing laparoscopic Heller myotomy for esophageal achalasia, regardless of whether the fundus is laid over the anterior esophagus or wrapped around the back of it, a multicenter study has shown.

Previous studies have demonstrated that partial fundoplication minimizes the likelihood of developing gastroesophageal reflux disease (GERD), but none has systematically compared the risks and benefits associated with wrapping the gastric fundus anterior to the esophagus (Dor fundoplication) or posterior to the esophagus (Toupet fundoplication), Dr. Arthur Rawlings said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

"The type of fundoplication that should be performed is controversial, and currently determined by surgeon’s choice rather than scientific evidence," he said. "Some surgeons advocate the Dor because they say it’s less complicated to perform, [avoids] the need for complete posterior dissection, completely disrupt the posterior esophageal ligament, and does cover the exposed esophageal mucosa." On the other hand, he noted, "other surgeons advocate for a Toupet fundoplication because it keeps the edges of the myotomy separated and possibly provides better reflux control."

To compare symptom frequency and severity as well as physiological differences associated with the two procedures, Dr. Rawlings of Washington University, St. Louis, and his colleagues conducted a multicenter, prospective trial. In all, 85 patients undergoing laparoscopic Heller myotomy at five sites in 2003-2008 were randomized to the Dor or Toupet partial fundoplication. The investigators assessed symptomatic GERD scores based on a 5-point (0-4) Likert scale preoperatively and at 2-6 weeks, 6 months, and 12 months postoperatively. They also evaluated 24-hour pH testing at 6-12 months, calculating the percentage of total pH time less than 4 and a composite DeMeester pH score, he said.

Both groups had similar age, sex distribution, and illness characteristics. The researchers obtained 6- to 12-month pH studies for 24 of the 49 patients who were randomized to the Dor procedure and 19 of the 36 patients who were randomized to the Toupet procedure, Dr. Rawlings said. The results reported at the meeting represent those obtained for the patients for whom pH-testing results were available, he explained.

In both groups, dysphagia and regurgitation symptom frequency and severity scores improved substantially, compared with preoperative measures, Dr. Rawlings said. "Statistically significant improvements were observed in both groups for all but heartburn and chest pain measures," he noted. Specifically, in the Dor group, the preoperative solid dysphagia, heartburn, and regurgitation scores of 3.0, 1.5, and 2.8, respectively, improved to 1.3, 0.7, and 0.7 at 6 months, and the preoperative scores in the Toupet group of 3.1, 1.0, and 3.3 improved to 1.0, 0.3, and 0.1, respectively, he said.

There was no significant difference between the two groups with respect to DeMeester pH scores or the percentage of pH time less than 4, although abnormal acid reflux was experienced by 42% of the Dor patients and just 21% of the Toupet patients, said Dr. Rawlings. The difference between the median DeMeester pH scores at 6 months for the Dor (7.2) and Toupet (2.2) groups did not reach statistical significance, he said.

In a subgroup analysis of individuals with abnormal reflux scores regardless of fundoplication procedure, "the only thing that fell out as significant was heartburn frequency and severity," Dr. Rawlings stated.

The findings indicate that both the Dor and Toupet procedures following Heller myotomy produce comparable decreases in reflux symptoms and improvements in quality of life, according to Dr. Rawlings. The differences in pathological acid reflux between the two groups, though not statistically significant, "do support the use of pH testing following Heller myotomy for detecting abnormal esophageal acid exposure," he said.

This study was supported a SAGES research grant. Dr. Rawlings disclosed financial relationships with Lifecell Corp. and Cook Medical.

SAN ANTONIO – Partial fundoplication improves dysphagia and regurgitation symptom scores in patients undergoing laparoscopic Heller myotomy for esophageal achalasia, regardless of whether the fundus is laid over the anterior esophagus or wrapped around the back of it, a multicenter study has shown.

Previous studies have demonstrated that partial fundoplication minimizes the likelihood of developing gastroesophageal reflux disease (GERD), but none has systematically compared the risks and benefits associated with wrapping the gastric fundus anterior to the esophagus (Dor fundoplication) or posterior to the esophagus (Toupet fundoplication), Dr. Arthur Rawlings said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

"The type of fundoplication that should be performed is controversial, and currently determined by surgeon’s choice rather than scientific evidence," he said. "Some surgeons advocate the Dor because they say it’s less complicated to perform, [avoids] the need for complete posterior dissection, completely disrupt the posterior esophageal ligament, and does cover the exposed esophageal mucosa." On the other hand, he noted, "other surgeons advocate for a Toupet fundoplication because it keeps the edges of the myotomy separated and possibly provides better reflux control."

To compare symptom frequency and severity as well as physiological differences associated with the two procedures, Dr. Rawlings of Washington University, St. Louis, and his colleagues conducted a multicenter, prospective trial. In all, 85 patients undergoing laparoscopic Heller myotomy at five sites in 2003-2008 were randomized to the Dor or Toupet partial fundoplication. The investigators assessed symptomatic GERD scores based on a 5-point (0-4) Likert scale preoperatively and at 2-6 weeks, 6 months, and 12 months postoperatively. They also evaluated 24-hour pH testing at 6-12 months, calculating the percentage of total pH time less than 4 and a composite DeMeester pH score, he said.

Both groups had similar age, sex distribution, and illness characteristics. The researchers obtained 6- to 12-month pH studies for 24 of the 49 patients who were randomized to the Dor procedure and 19 of the 36 patients who were randomized to the Toupet procedure, Dr. Rawlings said. The results reported at the meeting represent those obtained for the patients for whom pH-testing results were available, he explained.

In both groups, dysphagia and regurgitation symptom frequency and severity scores improved substantially, compared with preoperative measures, Dr. Rawlings said. "Statistically significant improvements were observed in both groups for all but heartburn and chest pain measures," he noted. Specifically, in the Dor group, the preoperative solid dysphagia, heartburn, and regurgitation scores of 3.0, 1.5, and 2.8, respectively, improved to 1.3, 0.7, and 0.7 at 6 months, and the preoperative scores in the Toupet group of 3.1, 1.0, and 3.3 improved to 1.0, 0.3, and 0.1, respectively, he said.

There was no significant difference between the two groups with respect to DeMeester pH scores or the percentage of pH time less than 4, although abnormal acid reflux was experienced by 42% of the Dor patients and just 21% of the Toupet patients, said Dr. Rawlings. The difference between the median DeMeester pH scores at 6 months for the Dor (7.2) and Toupet (2.2) groups did not reach statistical significance, he said.

In a subgroup analysis of individuals with abnormal reflux scores regardless of fundoplication procedure, "the only thing that fell out as significant was heartburn frequency and severity," Dr. Rawlings stated.

The findings indicate that both the Dor and Toupet procedures following Heller myotomy produce comparable decreases in reflux symptoms and improvements in quality of life, according to Dr. Rawlings. The differences in pathological acid reflux between the two groups, though not statistically significant, "do support the use of pH testing following Heller myotomy for detecting abnormal esophageal acid exposure," he said.

This study was supported a SAGES research grant. Dr. Rawlings disclosed financial relationships with Lifecell Corp. and Cook Medical.

SAN ANTONIO – Partial fundoplication improves dysphagia and regurgitation symptom scores in patients undergoing laparoscopic Heller myotomy for esophageal achalasia, regardless of whether the fundus is laid over the anterior esophagus or wrapped around the back of it, a multicenter study has shown.

Previous studies have demonstrated that partial fundoplication minimizes the likelihood of developing gastroesophageal reflux disease (GERD), but none has systematically compared the risks and benefits associated with wrapping the gastric fundus anterior to the esophagus (Dor fundoplication) or posterior to the esophagus (Toupet fundoplication), Dr. Arthur Rawlings said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

"The type of fundoplication that should be performed is controversial, and currently determined by surgeon’s choice rather than scientific evidence," he said. "Some surgeons advocate the Dor because they say it’s less complicated to perform, [avoids] the need for complete posterior dissection, completely disrupt the posterior esophageal ligament, and does cover the exposed esophageal mucosa." On the other hand, he noted, "other surgeons advocate for a Toupet fundoplication because it keeps the edges of the myotomy separated and possibly provides better reflux control."

To compare symptom frequency and severity as well as physiological differences associated with the two procedures, Dr. Rawlings of Washington University, St. Louis, and his colleagues conducted a multicenter, prospective trial. In all, 85 patients undergoing laparoscopic Heller myotomy at five sites in 2003-2008 were randomized to the Dor or Toupet partial fundoplication. The investigators assessed symptomatic GERD scores based on a 5-point (0-4) Likert scale preoperatively and at 2-6 weeks, 6 months, and 12 months postoperatively. They also evaluated 24-hour pH testing at 6-12 months, calculating the percentage of total pH time less than 4 and a composite DeMeester pH score, he said.

Both groups had similar age, sex distribution, and illness characteristics. The researchers obtained 6- to 12-month pH studies for 24 of the 49 patients who were randomized to the Dor procedure and 19 of the 36 patients who were randomized to the Toupet procedure, Dr. Rawlings said. The results reported at the meeting represent those obtained for the patients for whom pH-testing results were available, he explained.

In both groups, dysphagia and regurgitation symptom frequency and severity scores improved substantially, compared with preoperative measures, Dr. Rawlings said. "Statistically significant improvements were observed in both groups for all but heartburn and chest pain measures," he noted. Specifically, in the Dor group, the preoperative solid dysphagia, heartburn, and regurgitation scores of 3.0, 1.5, and 2.8, respectively, improved to 1.3, 0.7, and 0.7 at 6 months, and the preoperative scores in the Toupet group of 3.1, 1.0, and 3.3 improved to 1.0, 0.3, and 0.1, respectively, he said.

There was no significant difference between the two groups with respect to DeMeester pH scores or the percentage of pH time less than 4, although abnormal acid reflux was experienced by 42% of the Dor patients and just 21% of the Toupet patients, said Dr. Rawlings. The difference between the median DeMeester pH scores at 6 months for the Dor (7.2) and Toupet (2.2) groups did not reach statistical significance, he said.

In a subgroup analysis of individuals with abnormal reflux scores regardless of fundoplication procedure, "the only thing that fell out as significant was heartburn frequency and severity," Dr. Rawlings stated.

The findings indicate that both the Dor and Toupet procedures following Heller myotomy produce comparable decreases in reflux symptoms and improvements in quality of life, according to Dr. Rawlings. The differences in pathological acid reflux between the two groups, though not statistically significant, "do support the use of pH testing following Heller myotomy for detecting abnormal esophageal acid exposure," he said.

This study was supported a SAGES research grant. Dr. Rawlings disclosed financial relationships with Lifecell Corp. and Cook Medical.

SAN ANTONIO – Partial fundoplication improves dysphagia and regurgitation symptom scores in patients undergoing laparoscopic Heller myotomy for esophageal achalasia, regardless of whether the fundus is laid over the anterior esophagus or wrapped around the back of it, a multicenter study has shown.

Previous studies have demonstrated that partial fundoplication minimizes the likelihood of developing gastroesophageal reflux disease (GERD), but none has systematically compared the risks and benefits associated with wrapping the gastric fundus anterior to the esophagus (Dor fundoplication) or posterior to the esophagus (Toupet fundoplication), Dr. Arthur Rawlings said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

"The type of fundoplication that should be performed is controversial, and currently determined by surgeon’s choice rather than scientific evidence," he said. "Some surgeons advocate the Dor because they say it’s less complicated to perform, [avoids] the need for complete posterior dissection, completely disrupt the posterior esophageal ligament, and does cover the exposed esophageal mucosa." On the other hand, he noted, "other surgeons advocate for a Toupet fundoplication because it keeps the edges of the myotomy separated and possibly provides better reflux control."

To compare symptom frequency and severity as well as physiological differences associated with the two procedures, Dr. Rawlings of Washington University, St. Louis, and his colleagues conducted a multicenter, prospective trial. In all, 85 patients undergoing laparoscopic Heller myotomy at five sites in 2003-2008 were randomized to the Dor or Toupet partial fundoplication. The investigators assessed symptomatic GERD scores based on a 5-point (0-4) Likert scale preoperatively and at 2-6 weeks, 6 months, and 12 months postoperatively. They also evaluated 24-hour pH testing at 6-12 months, calculating the percentage of total pH time less than 4 and a composite DeMeester pH score, he said.

Both groups had similar age, sex distribution, and illness characteristics. The researchers obtained 6- to 12-month pH studies for 24 of the 49 patients who were randomized to the Dor procedure and 19 of the 36 patients who were randomized to the Toupet procedure, Dr. Rawlings said. The results reported at the meeting represent those obtained for the patients for whom pH-testing results were available, he explained.

In both groups, dysphagia and regurgitation symptom frequency and severity scores improved substantially, compared with preoperative measures, Dr. Rawlings said. "Statistically significant improvements were observed in both groups for all but heartburn and chest pain measures," he noted. Specifically, in the Dor group, the preoperative solid dysphagia, heartburn, and regurgitation scores of 3.0, 1.5, and 2.8, respectively, improved to 1.3, 0.7, and 0.7 at 6 months, and the preoperative scores in the Toupet group of 3.1, 1.0, and 3.3 improved to 1.0, 0.3, and 0.1, respectively, he said.

There was no significant difference between the two groups with respect to DeMeester pH scores or the percentage of pH time less than 4, although abnormal acid reflux was experienced by 42% of the Dor patients and just 21% of the Toupet patients, said Dr. Rawlings. The difference between the median DeMeester pH scores at 6 months for the Dor (7.2) and Toupet (2.2) groups did not reach statistical significance, he said.

In a subgroup analysis of individuals with abnormal reflux scores regardless of fundoplication procedure, "the only thing that fell out as significant was heartburn frequency and severity," Dr. Rawlings stated.

The findings indicate that both the Dor and Toupet procedures following Heller myotomy produce comparable decreases in reflux symptoms and improvements in quality of life, according to Dr. Rawlings. The differences in pathological acid reflux between the two groups, though not statistically significant, "do support the use of pH testing following Heller myotomy for detecting abnormal esophageal acid exposure," he said.

This study was supported a SAGES research grant. Dr. Rawlings disclosed financial relationships with Lifecell Corp. and Cook Medical.

SAN ANTONIO – Partial fundoplication improves dysphagia and regurgitation symptom scores in patients undergoing laparoscopic Heller myotomy for esophageal achalasia, regardless of whether the fundus is laid over the anterior esophagus or wrapped around the back of it, a multicenter study has shown.

Previous studies have demonstrated that partial fundoplication minimizes the likelihood of developing gastroesophageal reflux disease (GERD), but none has systematically compared the risks and benefits associated with wrapping the gastric fundus anterior to the esophagus (Dor fundoplication) or posterior to the esophagus (Toupet fundoplication), Dr. Arthur Rawlings said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

"The type of fundoplication that should be performed is controversial, and currently determined by surgeon’s choice rather than scientific evidence," he said. "Some surgeons advocate the Dor because they say it’s less complicated to perform, [avoids] the need for complete posterior dissection, completely disrupt the posterior esophageal ligament, and does cover the exposed esophageal mucosa." On the other hand, he noted, "other surgeons advocate for a Toupet fundoplication because it keeps the edges of the myotomy separated and possibly provides better reflux control."

To compare symptom frequency and severity as well as physiological differences associated with the two procedures, Dr. Rawlings of Washington University, St. Louis, and his colleagues conducted a multicenter, prospective trial. In all, 85 patients undergoing laparoscopic Heller myotomy at five sites in 2003-2008 were randomized to the Dor or Toupet partial fundoplication. The investigators assessed symptomatic GERD scores based on a 5-point (0-4) Likert scale preoperatively and at 2-6 weeks, 6 months, and 12 months postoperatively. They also evaluated 24-hour pH testing at 6-12 months, calculating the percentage of total pH time less than 4 and a composite DeMeester pH score, he said.

Both groups had similar age, sex distribution, and illness characteristics. The researchers obtained 6- to 12-month pH studies for 24 of the 49 patients who were randomized to the Dor procedure and 19 of the 36 patients who were randomized to the Toupet procedure, Dr. Rawlings said. The results reported at the meeting represent those obtained for the patients for whom pH-testing results were available, he explained.

In both groups, dysphagia and regurgitation symptom frequency and severity scores improved substantially, compared with preoperative measures, Dr. Rawlings said. "Statistically significant improvements were observed in both groups for all but heartburn and chest pain measures," he noted. Specifically, in the Dor group, the preoperative solid dysphagia, heartburn, and regurgitation scores of 3.0, 1.5, and 2.8, respectively, improved to 1.3, 0.7, and 0.7 at 6 months, and the preoperative scores in the Toupet group of 3.1, 1.0, and 3.3 improved to 1.0, 0.3, and 0.1, respectively, he said.

There was no significant difference between the two groups with respect to DeMeester pH scores or the percentage of pH time less than 4, although abnormal acid reflux was experienced by 42% of the Dor patients and just 21% of the Toupet patients, said Dr. Rawlings. The difference between the median DeMeester pH scores at 6 months for the Dor (7.2) and Toupet (2.2) groups did not reach statistical significance, he said.

In a subgroup analysis of individuals with abnormal reflux scores regardless of fundoplication procedure, "the only thing that fell out as significant was heartburn frequency and severity," Dr. Rawlings stated.

The findings indicate that both the Dor and Toupet procedures following Heller myotomy produce comparable decreases in reflux symptoms and improvements in quality of life, according to Dr. Rawlings. The differences in pathological acid reflux between the two groups, though not statistically significant, "do support the use of pH testing following Heller myotomy for detecting abnormal esophageal acid exposure," he said.

This study was supported a SAGES research grant. Dr. Rawlings disclosed financial relationships with Lifecell Corp. and Cook Medical.

SAN ANTONIO – Partial fundoplication improves dysphagia and regurgitation symptom scores in patients undergoing laparoscopic Heller myotomy for esophageal achalasia, regardless of whether the fundus is laid over the anterior esophagus or wrapped around the back of it, a multicenter study has shown.

Previous studies have demonstrated that partial fundoplication minimizes the likelihood of developing gastroesophageal reflux disease (GERD), but none has systematically compared the risks and benefits associated with wrapping the gastric fundus anterior to the esophagus (Dor fundoplication) or posterior to the esophagus (Toupet fundoplication), Dr. Arthur Rawlings said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

"The type of fundoplication that should be performed is controversial, and currently determined by surgeon’s choice rather than scientific evidence," he said. "Some surgeons advocate the Dor because they say it’s less complicated to perform, [avoids] the need for complete posterior dissection, completely disrupt the posterior esophageal ligament, and does cover the exposed esophageal mucosa." On the other hand, he noted, "other surgeons advocate for a Toupet fundoplication because it keeps the edges of the myotomy separated and possibly provides better reflux control."

To compare symptom frequency and severity as well as physiological differences associated with the two procedures, Dr. Rawlings of Washington University, St. Louis, and his colleagues conducted a multicenter, prospective trial. In all, 85 patients undergoing laparoscopic Heller myotomy at five sites in 2003-2008 were randomized to the Dor or Toupet partial fundoplication. The investigators assessed symptomatic GERD scores based on a 5-point (0-4) Likert scale preoperatively and at 2-6 weeks, 6 months, and 12 months postoperatively. They also evaluated 24-hour pH testing at 6-12 months, calculating the percentage of total pH time less than 4 and a composite DeMeester pH score, he said.

Both groups had similar age, sex distribution, and illness characteristics. The researchers obtained 6- to 12-month pH studies for 24 of the 49 patients who were randomized to the Dor procedure and 19 of the 36 patients who were randomized to the Toupet procedure, Dr. Rawlings said. The results reported at the meeting represent those obtained for the patients for whom pH-testing results were available, he explained.

In both groups, dysphagia and regurgitation symptom frequency and severity scores improved substantially, compared with preoperative measures, Dr. Rawlings said. "Statistically significant improvements were observed in both groups for all but heartburn and chest pain measures," he noted. Specifically, in the Dor group, the preoperative solid dysphagia, heartburn, and regurgitation scores of 3.0, 1.5, and 2.8, respectively, improved to 1.3, 0.7, and 0.7 at 6 months, and the preoperative scores in the Toupet group of 3.1, 1.0, and 3.3 improved to 1.0, 0.3, and 0.1, respectively, he said.

There was no significant difference between the two groups with respect to DeMeester pH scores or the percentage of pH time less than 4, although abnormal acid reflux was experienced by 42% of the Dor patients and just 21% of the Toupet patients, said Dr. Rawlings. The difference between the median DeMeester pH scores at 6 months for the Dor (7.2) and Toupet (2.2) groups did not reach statistical significance, he said.

In a subgroup analysis of individuals with abnormal reflux scores regardless of fundoplication procedure, "the only thing that fell out as significant was heartburn frequency and severity," Dr. Rawlings stated.

The findings indicate that both the Dor and Toupet procedures following Heller myotomy produce comparable decreases in reflux symptoms and improvements in quality of life, according to Dr. Rawlings. The differences in pathological acid reflux between the two groups, though not statistically significant, "do support the use of pH testing following Heller myotomy for detecting abnormal esophageal acid exposure," he said.

This study was supported a SAGES research grant. Dr. Rawlings disclosed financial relationships with Lifecell Corp. and Cook Medical.