The accuracy of idiopathic pulmonary fibrosis (IPF) diagnoses is improving with the use of multidisciplinary team meetings and updated guidelines, based on the findings of a study that compared diagnostic agreement of individual clinicians and teams evaluating patients with interstitial lung disease.

Pulmonologists who participate in multidisciplinary team meetings said the findings validate the team approach.

“The [study’s] data confirm what we see in clinical practice ... it takes a multidisciplinary – and perhaps often multiple pulmonologists – to review these cases,” Marilyn K. Glassberg, MD,professor of medicine and surgery and director of the interstitial lung disease program at the University of Miami Health System, said in an interview.“This study demonstrates the importance of multiple perspectives when evaluating a patient and coming to a diagnosis at a time when reliable biomarkers are not available.”

The study, published in The Lancet Respiratory Medicine (2016;4[7]:557-65), is the first evaluation of multidisciplinary team agreement on diagnosis of interstitial lung disease since updated guidelines were published, according to Simon L. F. Walsh, MD, of Kings College Hospital NHS Foundation Trust, London, and his colleagues.

In 2015, the American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Latin American Thoracic Association (ALTA) adopted joint guidelines for the treatment of IPF. In 2013, the ATS and ERS updated guidelines for the classification and terminology for idiopathic interstitial pneumonias.

“Our study shows ... in [IPF], MDTMs (multidisciplinary team meetings) have a higher level of agreement on diagnoses, assign diagnoses with higher confidence more frequently, and provide diagnoses that have non-significant greater prognostic separation than do clinicians or radiologists in most cases,” the researchers wrote.

Before MDTMs were initiated, the clinicians, radiologists, and pathologists who would be participating in them independently reviewed each patient’s case without consulting other specialists and provided up to five diagnoses with diagnostic likelihoods for each patient.

For the study, 70 patients were evaluated and the level of diagnostic agreement was assessed at seven international centers for the diagnosis of interstitial lung disease (diffuse parenchymal lung disease). Following independent reviews of the 70 cases, the clinician, radiologist, and pathologist from each center met as a multidisciplinary team to review the same cases together and give up to five diagnoses with diagnostic likelihoods.

All clinical information supplied in the first stage of the study, including pulmonary function test results, high-resolution CT at presentation, and digitalized surgical lung biopsy slides, were available to the multidisciplinary team. The patients’ outcomes were used to validate the diagnoses. The survival period for each patient was calculated based on the date of referral to the host institution to the minimum date of death, date patient was last known to be alive, or June 1, 2015 – the end of the study period.

The inter-MDTM agreement was better than interobserver agreement for all diagnoses (unweighted kappa value (K) = 0.50), and inter-MDTM agreement was highest for IPF (K = 0.60) and connective tissue disease-related interstitial lung disease (K = 0.64).

“We have shown an acceptable level [based on a K of greater than 0.40 being deemed clinically acceptable] of diagnostic agreement exists between multidisciplinary teams in the setting of diffuse parenchymal lung disease. Additionally, we showed that this agreement was validated by the nonsignificant increases toward greater prognostic separation of an IPF diagnosis made by multidisciplinary teams than by individual clinicians or radiologists,” the researchers wrote.

The weighted kappa (KW) values for estimation of diagnostic likelihood for diagnoses of IPF were 0.72 (0.67-0.76) for clinicians, 0.60 (0.46-0.66) for radiologists, 0.58 (0.45-0.66) for pathologists and 0.71 (0.64-0.77) for MDTMs.

For connective tissue disease–related interstitial lung diseases, the KW for estimation of diagnostic likelihood for diagnoses for MDTMs were 0.73 (0.68-0.78), compared with 0.76 (0.70-0.78) for clinicians, 0.17 (0.08-0.31) for radiologists, and 0.21 (0.06-0.36) for pathologists.

Krishna Thavarajah, MD,, who sees patients with interstitial lung disease within the Henry Ford Health System in Detroit, has been participating in MDTMs for nearly 6 years.

“The accuracies of diagnoses for patients with IPF are much better than even 10 years ago,” she said in an interview. “I think this is because of the improvement in consistency in diagnostic criteria based on the updated guidelines in IPF. Among the MDTMs that participated in the study, the agreement about diagnoses was highest for IPF. The interobserver agreement for clinicians was also pretty high for IPF.”

In her work within an academic center, Dr. Glassberg sees patients in an IPF clinic and in a separate autoimmune disorders clinic. For each clinic, there is a multidisciplinary team. In the IPF clinic, there are three pulmonologists and a radiologist, and when there is a biopsy, there are two pathologists. Dr. Glassberg’s IPF team also includes four pulmonary radiologists.

During her MDTMs, Dr. Thavarajah, a radiologist, and a pathologist will examine a patient’s chest imaging and pathology slides. They sit together until they become confident of their diagnosis in the absence of a biopsy.

There are times when the team tells a patient the probable diagnosis and acknowledges the small chance of an alternative diagnosis. “It was comforting to me that, in the Lancet study, there was a good level of agreement in diagnosis of IPF among multidisciplinary teams, whether the patients had undergone a biopsy or not,” said Dr. Thavarajah. “The mortality of patients given a diagnosis of IPF was worse than those given a diagnosis of non-IPF to validate the IPF diagnosis.”

Establishing and implementing MDTMs is challenging, though, said Dr. Glassberg.

“[We] need to address how multidisciplinary teams could work for doctors who are in smaller cities or who are not in academic centers. We need to utilize existing channels to create new avenues for these colleagues to present their cases – particularly challenging ones or patients who need to be referred – to be evaluated by an interdisciplinary team. The Internet may offer these opportunities for networking and decision making, said Dr. Glassberg.

The study was funded by the National Institute of Health Research, Imperial College London. Several of the study’s authors declared receiving personal fees, grants, or research support from a variety of sources, but had no financial disclosures relevant to this study.

[email protected]

The accuracy of idiopathic pulmonary fibrosis (IPF) diagnoses is improving with the use of multidisciplinary team meetings and updated guidelines, based on the findings of a study that compared diagnostic agreement of individual clinicians and teams evaluating patients with interstitial lung disease.

Pulmonologists who participate in multidisciplinary team meetings said the findings validate the team approach.

“The [study’s] data confirm what we see in clinical practice ... it takes a multidisciplinary – and perhaps often multiple pulmonologists – to review these cases,” Marilyn K. Glassberg, MD,professor of medicine and surgery and director of the interstitial lung disease program at the University of Miami Health System, said in an interview.“This study demonstrates the importance of multiple perspectives when evaluating a patient and coming to a diagnosis at a time when reliable biomarkers are not available.”

The study, published in The Lancet Respiratory Medicine (2016;4[7]:557-65), is the first evaluation of multidisciplinary team agreement on diagnosis of interstitial lung disease since updated guidelines were published, according to Simon L. F. Walsh, MD, of Kings College Hospital NHS Foundation Trust, London, and his colleagues.

In 2015, the American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Latin American Thoracic Association (ALTA) adopted joint guidelines for the treatment of IPF. In 2013, the ATS and ERS updated guidelines for the classification and terminology for idiopathic interstitial pneumonias.

“Our study shows ... in [IPF], MDTMs (multidisciplinary team meetings) have a higher level of agreement on diagnoses, assign diagnoses with higher confidence more frequently, and provide diagnoses that have non-significant greater prognostic separation than do clinicians or radiologists in most cases,” the researchers wrote.

Before MDTMs were initiated, the clinicians, radiologists, and pathologists who would be participating in them independently reviewed each patient’s case without consulting other specialists and provided up to five diagnoses with diagnostic likelihoods for each patient.

For the study, 70 patients were evaluated and the level of diagnostic agreement was assessed at seven international centers for the diagnosis of interstitial lung disease (diffuse parenchymal lung disease). Following independent reviews of the 70 cases, the clinician, radiologist, and pathologist from each center met as a multidisciplinary team to review the same cases together and give up to five diagnoses with diagnostic likelihoods.

All clinical information supplied in the first stage of the study, including pulmonary function test results, high-resolution CT at presentation, and digitalized surgical lung biopsy slides, were available to the multidisciplinary team. The patients’ outcomes were used to validate the diagnoses. The survival period for each patient was calculated based on the date of referral to the host institution to the minimum date of death, date patient was last known to be alive, or June 1, 2015 – the end of the study period.

The inter-MDTM agreement was better than interobserver agreement for all diagnoses (unweighted kappa value (K) = 0.50), and inter-MDTM agreement was highest for IPF (K = 0.60) and connective tissue disease-related interstitial lung disease (K = 0.64).

“We have shown an acceptable level [based on a K of greater than 0.40 being deemed clinically acceptable] of diagnostic agreement exists between multidisciplinary teams in the setting of diffuse parenchymal lung disease. Additionally, we showed that this agreement was validated by the nonsignificant increases toward greater prognostic separation of an IPF diagnosis made by multidisciplinary teams than by individual clinicians or radiologists,” the researchers wrote.

The weighted kappa (KW) values for estimation of diagnostic likelihood for diagnoses of IPF were 0.72 (0.67-0.76) for clinicians, 0.60 (0.46-0.66) for radiologists, 0.58 (0.45-0.66) for pathologists and 0.71 (0.64-0.77) for MDTMs.

For connective tissue disease–related interstitial lung diseases, the KW for estimation of diagnostic likelihood for diagnoses for MDTMs were 0.73 (0.68-0.78), compared with 0.76 (0.70-0.78) for clinicians, 0.17 (0.08-0.31) for radiologists, and 0.21 (0.06-0.36) for pathologists.

Krishna Thavarajah, MD,, who sees patients with interstitial lung disease within the Henry Ford Health System in Detroit, has been participating in MDTMs for nearly 6 years.

“The accuracies of diagnoses for patients with IPF are much better than even 10 years ago,” she said in an interview. “I think this is because of the improvement in consistency in diagnostic criteria based on the updated guidelines in IPF. Among the MDTMs that participated in the study, the agreement about diagnoses was highest for IPF. The interobserver agreement for clinicians was also pretty high for IPF.”

In her work within an academic center, Dr. Glassberg sees patients in an IPF clinic and in a separate autoimmune disorders clinic. For each clinic, there is a multidisciplinary team. In the IPF clinic, there are three pulmonologists and a radiologist, and when there is a biopsy, there are two pathologists. Dr. Glassberg’s IPF team also includes four pulmonary radiologists.

During her MDTMs, Dr. Thavarajah, a radiologist, and a pathologist will examine a patient’s chest imaging and pathology slides. They sit together until they become confident of their diagnosis in the absence of a biopsy.

There are times when the team tells a patient the probable diagnosis and acknowledges the small chance of an alternative diagnosis. “It was comforting to me that, in the Lancet study, there was a good level of agreement in diagnosis of IPF among multidisciplinary teams, whether the patients had undergone a biopsy or not,” said Dr. Thavarajah. “The mortality of patients given a diagnosis of IPF was worse than those given a diagnosis of non-IPF to validate the IPF diagnosis.”

Establishing and implementing MDTMs is challenging, though, said Dr. Glassberg.

“[We] need to address how multidisciplinary teams could work for doctors who are in smaller cities or who are not in academic centers. We need to utilize existing channels to create new avenues for these colleagues to present their cases – particularly challenging ones or patients who need to be referred – to be evaluated by an interdisciplinary team. The Internet may offer these opportunities for networking and decision making, said Dr. Glassberg.

The study was funded by the National Institute of Health Research, Imperial College London. Several of the study’s authors declared receiving personal fees, grants, or research support from a variety of sources, but had no financial disclosures relevant to this study.

[email protected]

The accuracy of idiopathic pulmonary fibrosis (IPF) diagnoses is improving with the use of multidisciplinary team meetings and updated guidelines, based on the findings of a study that compared diagnostic agreement of individual clinicians and teams evaluating patients with interstitial lung disease.

Pulmonologists who participate in multidisciplinary team meetings said the findings validate the team approach.

“The [study’s] data confirm what we see in clinical practice ... it takes a multidisciplinary – and perhaps often multiple pulmonologists – to review these cases,” Marilyn K. Glassberg, MD,professor of medicine and surgery and director of the interstitial lung disease program at the University of Miami Health System, said in an interview.“This study demonstrates the importance of multiple perspectives when evaluating a patient and coming to a diagnosis at a time when reliable biomarkers are not available.”

The study, published in The Lancet Respiratory Medicine (2016;4[7]:557-65), is the first evaluation of multidisciplinary team agreement on diagnosis of interstitial lung disease since updated guidelines were published, according to Simon L. F. Walsh, MD, of Kings College Hospital NHS Foundation Trust, London, and his colleagues.

In 2015, the American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Latin American Thoracic Association (ALTA) adopted joint guidelines for the treatment of IPF. In 2013, the ATS and ERS updated guidelines for the classification and terminology for idiopathic interstitial pneumonias.

“Our study shows ... in [IPF], MDTMs (multidisciplinary team meetings) have a higher level of agreement on diagnoses, assign diagnoses with higher confidence more frequently, and provide diagnoses that have non-significant greater prognostic separation than do clinicians or radiologists in most cases,” the researchers wrote.

Before MDTMs were initiated, the clinicians, radiologists, and pathologists who would be participating in them independently reviewed each patient’s case without consulting other specialists and provided up to five diagnoses with diagnostic likelihoods for each patient.

For the study, 70 patients were evaluated and the level of diagnostic agreement was assessed at seven international centers for the diagnosis of interstitial lung disease (diffuse parenchymal lung disease). Following independent reviews of the 70 cases, the clinician, radiologist, and pathologist from each center met as a multidisciplinary team to review the same cases together and give up to five diagnoses with diagnostic likelihoods.

All clinical information supplied in the first stage of the study, including pulmonary function test results, high-resolution CT at presentation, and digitalized surgical lung biopsy slides, were available to the multidisciplinary team. The patients’ outcomes were used to validate the diagnoses. The survival period for each patient was calculated based on the date of referral to the host institution to the minimum date of death, date patient was last known to be alive, or June 1, 2015 – the end of the study period.

The inter-MDTM agreement was better than interobserver agreement for all diagnoses (unweighted kappa value (K) = 0.50), and inter-MDTM agreement was highest for IPF (K = 0.60) and connective tissue disease-related interstitial lung disease (K = 0.64).

“We have shown an acceptable level [based on a K of greater than 0.40 being deemed clinically acceptable] of diagnostic agreement exists between multidisciplinary teams in the setting of diffuse parenchymal lung disease. Additionally, we showed that this agreement was validated by the nonsignificant increases toward greater prognostic separation of an IPF diagnosis made by multidisciplinary teams than by individual clinicians or radiologists,” the researchers wrote.

The weighted kappa (KW) values for estimation of diagnostic likelihood for diagnoses of IPF were 0.72 (0.67-0.76) for clinicians, 0.60 (0.46-0.66) for radiologists, 0.58 (0.45-0.66) for pathologists and 0.71 (0.64-0.77) for MDTMs.

For connective tissue disease–related interstitial lung diseases, the KW for estimation of diagnostic likelihood for diagnoses for MDTMs were 0.73 (0.68-0.78), compared with 0.76 (0.70-0.78) for clinicians, 0.17 (0.08-0.31) for radiologists, and 0.21 (0.06-0.36) for pathologists.

Krishna Thavarajah, MD,, who sees patients with interstitial lung disease within the Henry Ford Health System in Detroit, has been participating in MDTMs for nearly 6 years.

“The accuracies of diagnoses for patients with IPF are much better than even 10 years ago,” she said in an interview. “I think this is because of the improvement in consistency in diagnostic criteria based on the updated guidelines in IPF. Among the MDTMs that participated in the study, the agreement about diagnoses was highest for IPF. The interobserver agreement for clinicians was also pretty high for IPF.”

In her work within an academic center, Dr. Glassberg sees patients in an IPF clinic and in a separate autoimmune disorders clinic. For each clinic, there is a multidisciplinary team. In the IPF clinic, there are three pulmonologists and a radiologist, and when there is a biopsy, there are two pathologists. Dr. Glassberg’s IPF team also includes four pulmonary radiologists.

During her MDTMs, Dr. Thavarajah, a radiologist, and a pathologist will examine a patient’s chest imaging and pathology slides. They sit together until they become confident of their diagnosis in the absence of a biopsy.

There are times when the team tells a patient the probable diagnosis and acknowledges the small chance of an alternative diagnosis. “It was comforting to me that, in the Lancet study, there was a good level of agreement in diagnosis of IPF among multidisciplinary teams, whether the patients had undergone a biopsy or not,” said Dr. Thavarajah. “The mortality of patients given a diagnosis of IPF was worse than those given a diagnosis of non-IPF to validate the IPF diagnosis.”

Establishing and implementing MDTMs is challenging, though, said Dr. Glassberg.

“[We] need to address how multidisciplinary teams could work for doctors who are in smaller cities or who are not in academic centers. We need to utilize existing channels to create new avenues for these colleagues to present their cases – particularly challenging ones or patients who need to be referred – to be evaluated by an interdisciplinary team. The Internet may offer these opportunities for networking and decision making, said Dr. Glassberg.

The study was funded by the National Institute of Health Research, Imperial College London. Several of the study’s authors declared receiving personal fees, grants, or research support from a variety of sources, but had no financial disclosures relevant to this study.

[email protected]

SYDNEY - Australia declared on Monday the AIDS epidemic is no longer a public health issue there, a month after the United Nations adopted an ambitious target to eliminate the threat globally by 2030.

The government-backed Australian Federation of AIDS Organisations (AFAO) and top scientists said the number of people being diagnosed with AIDS in Australia was now so small it was no longer reported.

AIDS cases in Australia peaked in 1994, at 953 cases, according to the Kirby Institute for infection and immunity in society.

Since then, following the introduction of antiretroviral treatment, that prevent AIDS developing in people who are infected with the HIV virus, and awareness campaigns, AIDS diagnoses have declined sharply.

"Australia is incredibly fortunate to be in the position and its because of farsighted government policy," said Darryl O'Donnell, chief executive AFAO.

"We had community organizations of gay men, sex workers and drug users doing outreach campaigns that were extraordinarily effective," O'Donnell said.

A spokeswoman for the Federal Department of Health said while it was tremendous that AIDS was "not the automatic death sentence that it once was," approximately 1,100 cases of HIV are detected each year.

"We must not let down our guard."

Worldwide there are 36.7 million people living with HIV, according to the World Health Organisation, with 180,000 people dying from AIDS-related illness in the Asia-Pacific region last year.

The United Nations agreed a new declaration on ending the AIDS epidemic at a meeting in New York last month.

The UNAIDS Fast-Track approach to ending the AIDS epidemic has a set of time-bound targets, including reducing the number of people newly infected with HIV from 2.1 million in 2015 to fewer than 500,000 in 2020, reducing the number of people dying from AIDS-related illnesses from 1.1 million in 2015 to fewer than 500,000 in 2020 and eliminating HIV-related discrimination.

Andrew Grulich, head of the HIV Epidemiology and Prevention Program at the Kirby Institute, said other countries could learn from Australia.

"The thing that has characterized Australia is a partnership between all sectors involved," he said. "Community, research and the government - and having bipartisan political support."

SYDNEY - Australia declared on Monday the AIDS epidemic is no longer a public health issue there, a month after the United Nations adopted an ambitious target to eliminate the threat globally by 2030.

The government-backed Australian Federation of AIDS Organisations (AFAO) and top scientists said the number of people being diagnosed with AIDS in Australia was now so small it was no longer reported.

AIDS cases in Australia peaked in 1994, at 953 cases, according to the Kirby Institute for infection and immunity in society.

Since then, following the introduction of antiretroviral treatment, that prevent AIDS developing in people who are infected with the HIV virus, and awareness campaigns, AIDS diagnoses have declined sharply.

"Australia is incredibly fortunate to be in the position and its because of farsighted government policy," said Darryl O'Donnell, chief executive AFAO.

"We had community organizations of gay men, sex workers and drug users doing outreach campaigns that were extraordinarily effective," O'Donnell said.

A spokeswoman for the Federal Department of Health said while it was tremendous that AIDS was "not the automatic death sentence that it once was," approximately 1,100 cases of HIV are detected each year.

"We must not let down our guard."

Worldwide there are 36.7 million people living with HIV, according to the World Health Organisation, with 180,000 people dying from AIDS-related illness in the Asia-Pacific region last year.

The United Nations agreed a new declaration on ending the AIDS epidemic at a meeting in New York last month.

The UNAIDS Fast-Track approach to ending the AIDS epidemic has a set of time-bound targets, including reducing the number of people newly infected with HIV from 2.1 million in 2015 to fewer than 500,000 in 2020, reducing the number of people dying from AIDS-related illnesses from 1.1 million in 2015 to fewer than 500,000 in 2020 and eliminating HIV-related discrimination.

Andrew Grulich, head of the HIV Epidemiology and Prevention Program at the Kirby Institute, said other countries could learn from Australia.

"The thing that has characterized Australia is a partnership between all sectors involved," he said. "Community, research and the government - and having bipartisan political support."

SYDNEY - Australia declared on Monday the AIDS epidemic is no longer a public health issue there, a month after the United Nations adopted an ambitious target to eliminate the threat globally by 2030.

The government-backed Australian Federation of AIDS Organisations (AFAO) and top scientists said the number of people being diagnosed with AIDS in Australia was now so small it was no longer reported.

AIDS cases in Australia peaked in 1994, at 953 cases, according to the Kirby Institute for infection and immunity in society.

Since then, following the introduction of antiretroviral treatment, that prevent AIDS developing in people who are infected with the HIV virus, and awareness campaigns, AIDS diagnoses have declined sharply.

"Australia is incredibly fortunate to be in the position and its because of farsighted government policy," said Darryl O'Donnell, chief executive AFAO.

"We had community organizations of gay men, sex workers and drug users doing outreach campaigns that were extraordinarily effective," O'Donnell said.

A spokeswoman for the Federal Department of Health said while it was tremendous that AIDS was "not the automatic death sentence that it once was," approximately 1,100 cases of HIV are detected each year.

"We must not let down our guard."

Worldwide there are 36.7 million people living with HIV, according to the World Health Organisation, with 180,000 people dying from AIDS-related illness in the Asia-Pacific region last year.

The United Nations agreed a new declaration on ending the AIDS epidemic at a meeting in New York last month.

The UNAIDS Fast-Track approach to ending the AIDS epidemic has a set of time-bound targets, including reducing the number of people newly infected with HIV from 2.1 million in 2015 to fewer than 500,000 in 2020, reducing the number of people dying from AIDS-related illnesses from 1.1 million in 2015 to fewer than 500,000 in 2020 and eliminating HIV-related discrimination.

Andrew Grulich, head of the HIV Epidemiology and Prevention Program at the Kirby Institute, said other countries could learn from Australia.

"The thing that has characterized Australia is a partnership between all sectors involved," he said. "Community, research and the government - and having bipartisan political support."

A comparison of psoriasis-like eruptions in Kawasaki disease (KD) with classic psoriasis shows a distinct phenotype with greater remission, report Ellen S. Haddock, AB, MBA and coauthors from the School of Medicine at the University of California, San Diego.

Investigators performed a retrospective study of 11 KD cases with a psoriasiform eruption matched by gender, age, and ethnicity with psoriasis-only and KD-only controls. Genotyping was performed in 10 cases for a deletion of two late cornified envelope genes associated with pediatric-onset psoriasis.

KD-associated eruptions were similar to classic psoriasis in presentation, but with less frequent diaper area involvement, more crust, more serious exudate, and significantly higher remission (91% vs. 23%; P less than .001), the authors noted.

The findings indicate that despite similarities to classic psoriasis, “this appears to be a distinct phenotype with significantly greater propensity for remission,” the authors concluded.

Read the full article in the Journal of the American Academy of Dermatology.

A comparison of psoriasis-like eruptions in Kawasaki disease (KD) with classic psoriasis shows a distinct phenotype with greater remission, report Ellen S. Haddock, AB, MBA and coauthors from the School of Medicine at the University of California, San Diego.

Investigators performed a retrospective study of 11 KD cases with a psoriasiform eruption matched by gender, age, and ethnicity with psoriasis-only and KD-only controls. Genotyping was performed in 10 cases for a deletion of two late cornified envelope genes associated with pediatric-onset psoriasis.

KD-associated eruptions were similar to classic psoriasis in presentation, but with less frequent diaper area involvement, more crust, more serious exudate, and significantly higher remission (91% vs. 23%; P less than .001), the authors noted.

The findings indicate that despite similarities to classic psoriasis, “this appears to be a distinct phenotype with significantly greater propensity for remission,” the authors concluded.

Read the full article in the Journal of the American Academy of Dermatology.

A comparison of psoriasis-like eruptions in Kawasaki disease (KD) with classic psoriasis shows a distinct phenotype with greater remission, report Ellen S. Haddock, AB, MBA and coauthors from the School of Medicine at the University of California, San Diego.

Investigators performed a retrospective study of 11 KD cases with a psoriasiform eruption matched by gender, age, and ethnicity with psoriasis-only and KD-only controls. Genotyping was performed in 10 cases for a deletion of two late cornified envelope genes associated with pediatric-onset psoriasis.

KD-associated eruptions were similar to classic psoriasis in presentation, but with less frequent diaper area involvement, more crust, more serious exudate, and significantly higher remission (91% vs. 23%; P less than .001), the authors noted.

The findings indicate that despite similarities to classic psoriasis, “this appears to be a distinct phenotype with significantly greater propensity for remission,” the authors concluded.

Read the full article in the Journal of the American Academy of Dermatology.

Click here to download the PDF.

Click here to download the PDF.

Click here to download the PDF.

We appreciate Dr. Nasrallah referencing our work to assert that “most SGAs are similar to FGAs.” (Current Psychiatry, Comments & Controversies, October 2013, p. 39-40; http://bit.ly/177QOy6). What we actually found in our 2003¹ and 2011² meta-analyses was that “some antipsychotics are more efficacious than others,” and the first-generation antipsychotic vs second-generation antipsychotic distinction is not very useful clinically.³ These findings have repeatedly been replicated.³

John M. Davis, MD
Professor
Department of Psychiatry
University of Illinois at Chicago
Chicago, Illinois

Ira D. Glick, MD
Professor Emeritus of Psychiatry and Behavioral Sciences
Department of Psychiatry
Stanford University School of Medicine
Stanford, California

We appreciate Dr. Nasrallah referencing our work to assert that “most SGAs are similar to FGAs.” (Current Psychiatry, Comments & Controversies, October 2013, p. 39-40; http://bit.ly/177QOy6). What we actually found in our 2003¹ and 2011² meta-analyses was that “some antipsychotics are more efficacious than others,” and the first-generation antipsychotic vs second-generation antipsychotic distinction is not very useful clinically.³ These findings have repeatedly been replicated.³

John M. Davis, MD
Professor
Department of Psychiatry
University of Illinois at Chicago
Chicago, Illinois

Ira D. Glick, MD
Professor Emeritus of Psychiatry and Behavioral Sciences
Department of Psychiatry
Stanford University School of Medicine
Stanford, California

We appreciate Dr. Nasrallah referencing our work to assert that “most SGAs are similar to FGAs.” (Current Psychiatry, Comments & Controversies, October 2013, p. 39-40; http://bit.ly/177QOy6). What we actually found in our 2003¹ and 2011² meta-analyses was that “some antipsychotics are more efficacious than others,” and the first-generation antipsychotic vs second-generation antipsychotic distinction is not very useful clinically.³ These findings have repeatedly been replicated.³

John M. Davis, MD
Professor
Department of Psychiatry
University of Illinois at Chicago
Chicago, Illinois

Ira D. Glick, MD
Professor Emeritus of Psychiatry and Behavioral Sciences
Department of Psychiatry
Stanford University School of Medicine
Stanford, California

Thinking of joining an online physician collaboration network but don't know where to start?

Here is a list of large physician online communities and listservs to help you connect, communicate, and network with your colleagues.

Sermo: This online community of physicians has over 200,000 members in 68 specialties. It is a place where physicians can securely post questions, insights, and observations for discussion.

Medscape Physician Connect: This is another online private community of physicians that has over 170,000 members.

Doximity: This online networking site is similar to LinkedIn, except that is is only for physicians. Users create a profile to connect with colleagues and to access the "nation’s most complete physician directory," according to their website.

DermRounds: This online networking site is the Facebook of dermatology. Users can pose questions, share videos and images, learn about upcoming CME conferences, and more.

RxDerm-L: This listserv group is open to dermatologists and dermatology residents only. To subscribe, send an email to [email protected], and in the body of the message write "subscribe rxderm-L" followed by your name.

ACADERM-L: This listserv group is open to teaching dermatolgists, or dermatologists serving in an administraction for a dermatology program. To subscribe, send an email to [email protected], and in the body of the message write "subscribe acaderm-L" followed by your name.

AMA Listservs: The AMA offers multiple listservs, including ones for residents and fellows and young physicians.

Thinking of joining an online physician collaboration network but don't know where to start?

Here is a list of large physician online communities and listservs to help you connect, communicate, and network with your colleagues.

Sermo: This online community of physicians has over 200,000 members in 68 specialties. It is a place where physicians can securely post questions, insights, and observations for discussion.

Medscape Physician Connect: This is another online private community of physicians that has over 170,000 members.

Doximity: This online networking site is similar to LinkedIn, except that is is only for physicians. Users create a profile to connect with colleagues and to access the "nation’s most complete physician directory," according to their website.

DermRounds: This online networking site is the Facebook of dermatology. Users can pose questions, share videos and images, learn about upcoming CME conferences, and more.

RxDerm-L: This listserv group is open to dermatologists and dermatology residents only. To subscribe, send an email to [email protected], and in the body of the message write "subscribe rxderm-L" followed by your name.

ACADERM-L: This listserv group is open to teaching dermatolgists, or dermatologists serving in an administraction for a dermatology program. To subscribe, send an email to [email protected], and in the body of the message write "subscribe acaderm-L" followed by your name.

AMA Listservs: The AMA offers multiple listservs, including ones for residents and fellows and young physicians.

Thinking of joining an online physician collaboration network but don't know where to start?

Here is a list of large physician online communities and listservs to help you connect, communicate, and network with your colleagues.

Sermo: This online community of physicians has over 200,000 members in 68 specialties. It is a place where physicians can securely post questions, insights, and observations for discussion.

Medscape Physician Connect: This is another online private community of physicians that has over 170,000 members.

Doximity: This online networking site is similar to LinkedIn, except that is is only for physicians. Users create a profile to connect with colleagues and to access the "nation’s most complete physician directory," according to their website.

DermRounds: This online networking site is the Facebook of dermatology. Users can pose questions, share videos and images, learn about upcoming CME conferences, and more.

RxDerm-L: This listserv group is open to dermatologists and dermatology residents only. To subscribe, send an email to [email protected], and in the body of the message write "subscribe rxderm-L" followed by your name.

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AMA Listservs: The AMA offers multiple listservs, including ones for residents and fellows and young physicians.

According to a CDC study, 59% of physicians use social media networks. 

Do you use social media networking? If so, share your favorite places to network in the poll below, or leave a note for your colleagues in the comments field.

According to a CDC study, 59% of physicians use social media networks. 

Do you use social media networking? If so, share your favorite places to network in the poll below, or leave a note for your colleagues in the comments field.

According to a CDC study, 59% of physicians use social media networks. 

Do you use social media networking? If so, share your favorite places to network in the poll below, or leave a note for your colleagues in the comments field.

MIAMI – Patients with psoriatic arthritis had a higher prevalence and greater extent of coronary artery plaque in a pilot study comparison with healthy control patients that may point to increased risk independent of traditional cardiovascular risk factors.

In the study, coronary artery plaque as assessed by cardiac computed tomography angiography (CCTA) occurred in 39 (78%) of 50 patients with psoriatic arthritis, a significantly higher rate than that observed for healthy controls (11 of 25, 44%).

©vizualis/thinkstockphotos.com

Investigators not only measured plaque volume, but also assessed the type of plaque: calcified, noncalcified, or mixed. Mixed plaque predominated. This could be important because “noncalcified and mixed carry higher risk for rupture and later cardiovascular events,” Agnes Szentpetery, MD, a research fellow at St. Vincent’s University Hospital in Dublin, said at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

She and her colleagues also found more clinically significant stenosis among the 50 participants with psoriatic arthritis, compared with 25 healthy controls matched for age, sex, smoking status, and presence of metabolic syndrome. “This pilot study is the first to assess coronary plaques in asymptomatic patients with psoriatic arthritis with CCTA,” Dr. Szentpetery said.

Total plaque volume was higher in the psoriatic arthritis group versus controls, and higher in the left main artery for psoriatic arthritis patients, both with and without metabolic syndrome.

The study points to increased risk independent of traditional cardiovascular risk factors. For example, CCTA revealed no difference in plaque volume between patients with and without metabolic disease. In addition, a previous study suggests “the burden of carotid artery plaques is higher in patients with psoriatic arthritis compared to those with psoriasis alone,” Dr. Szentpetery said, citing a cross-sectional study comparing 125 people with psoriasis to 114 others with psoriatic arthritis (Ann Rheum Dis. 2013 May;72[5]:715-20).

Perhaps not surprisingly, inflammation could be driving the association between psoriatic and cardiovascular disease risk. Other investigators suggest chronic, low-grade inflammation leads to atherosclerosis through a maladaptive immune response and altered lipid metabolism, for example (Nat Med. 2011 Nov;17[11]:1410-22).

In the current study, the patients with psoriatic arthritis had well-established disease, occurring for a mean duration of 19 years. Mean age was 58 years, and 54% were men. Approximately 60% were taking disease-modifying antirheumatic drugs, two-thirds were taking biologics, and about one-third were on combination treatment. Controls were similar demographically with a mean age of 57 years, and 52% were men.

Interestingly, Psoriasis Area and Severity Index (PASI) scores did not correlate with increased risk. During discussion after the presentation of the study, a researcher unaffiliated with the study offered an answer. “It could be their skin disease was controlled by the biologics. You had 67% on biologics,” said Nehal Mehta, MD, Clinical Research Scholar in the section of inflammation and cardiometabolic disease at the National Heart, Lung, and Blood Institute. “We at the NIH see a strong correlation between PASI and coronary artery disease risk.”

“We know methotrexate and anti-TNF agents can have a protective effect on atherosclerosis, but we did not look at this specifically,” Dr. Szentpetery said. Overall, PASI scores were relatively low in the study population, she added, which “may explain why we did not see the correlation with PASI scores.”

Dr. Szentpetery and Dr. Mehta had no relevant financial disclosures.

MIAMI – Patients with psoriatic arthritis had a higher prevalence and greater extent of coronary artery plaque in a pilot study comparison with healthy control patients that may point to increased risk independent of traditional cardiovascular risk factors.

In the study, coronary artery plaque as assessed by cardiac computed tomography angiography (CCTA) occurred in 39 (78%) of 50 patients with psoriatic arthritis, a significantly higher rate than that observed for healthy controls (11 of 25, 44%).

©vizualis/thinkstockphotos.com

Investigators not only measured plaque volume, but also assessed the type of plaque: calcified, noncalcified, or mixed. Mixed plaque predominated. This could be important because “noncalcified and mixed carry higher risk for rupture and later cardiovascular events,” Agnes Szentpetery, MD, a research fellow at St. Vincent’s University Hospital in Dublin, said at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

She and her colleagues also found more clinically significant stenosis among the 50 participants with psoriatic arthritis, compared with 25 healthy controls matched for age, sex, smoking status, and presence of metabolic syndrome. “This pilot study is the first to assess coronary plaques in asymptomatic patients with psoriatic arthritis with CCTA,” Dr. Szentpetery said.

Total plaque volume was higher in the psoriatic arthritis group versus controls, and higher in the left main artery for psoriatic arthritis patients, both with and without metabolic syndrome.

The study points to increased risk independent of traditional cardiovascular risk factors. For example, CCTA revealed no difference in plaque volume between patients with and without metabolic disease. In addition, a previous study suggests “the burden of carotid artery plaques is higher in patients with psoriatic arthritis compared to those with psoriasis alone,” Dr. Szentpetery said, citing a cross-sectional study comparing 125 people with psoriasis to 114 others with psoriatic arthritis (Ann Rheum Dis. 2013 May;72[5]:715-20).

Perhaps not surprisingly, inflammation could be driving the association between psoriatic and cardiovascular disease risk. Other investigators suggest chronic, low-grade inflammation leads to atherosclerosis through a maladaptive immune response and altered lipid metabolism, for example (Nat Med. 2011 Nov;17[11]:1410-22).

In the current study, the patients with psoriatic arthritis had well-established disease, occurring for a mean duration of 19 years. Mean age was 58 years, and 54% were men. Approximately 60% were taking disease-modifying antirheumatic drugs, two-thirds were taking biologics, and about one-third were on combination treatment. Controls were similar demographically with a mean age of 57 years, and 52% were men.

Interestingly, Psoriasis Area and Severity Index (PASI) scores did not correlate with increased risk. During discussion after the presentation of the study, a researcher unaffiliated with the study offered an answer. “It could be their skin disease was controlled by the biologics. You had 67% on biologics,” said Nehal Mehta, MD, Clinical Research Scholar in the section of inflammation and cardiometabolic disease at the National Heart, Lung, and Blood Institute. “We at the NIH see a strong correlation between PASI and coronary artery disease risk.”

“We know methotrexate and anti-TNF agents can have a protective effect on atherosclerosis, but we did not look at this specifically,” Dr. Szentpetery said. Overall, PASI scores were relatively low in the study population, she added, which “may explain why we did not see the correlation with PASI scores.”

Dr. Szentpetery and Dr. Mehta had no relevant financial disclosures.

MIAMI – Patients with psoriatic arthritis had a higher prevalence and greater extent of coronary artery plaque in a pilot study comparison with healthy control patients that may point to increased risk independent of traditional cardiovascular risk factors.

In the study, coronary artery plaque as assessed by cardiac computed tomography angiography (CCTA) occurred in 39 (78%) of 50 patients with psoriatic arthritis, a significantly higher rate than that observed for healthy controls (11 of 25, 44%).

©vizualis/thinkstockphotos.com

Investigators not only measured plaque volume, but also assessed the type of plaque: calcified, noncalcified, or mixed. Mixed plaque predominated. This could be important because “noncalcified and mixed carry higher risk for rupture and later cardiovascular events,” Agnes Szentpetery, MD, a research fellow at St. Vincent’s University Hospital in Dublin, said at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

She and her colleagues also found more clinically significant stenosis among the 50 participants with psoriatic arthritis, compared with 25 healthy controls matched for age, sex, smoking status, and presence of metabolic syndrome. “This pilot study is the first to assess coronary plaques in asymptomatic patients with psoriatic arthritis with CCTA,” Dr. Szentpetery said.

Total plaque volume was higher in the psoriatic arthritis group versus controls, and higher in the left main artery for psoriatic arthritis patients, both with and without metabolic syndrome.

The study points to increased risk independent of traditional cardiovascular risk factors. For example, CCTA revealed no difference in plaque volume between patients with and without metabolic disease. In addition, a previous study suggests “the burden of carotid artery plaques is higher in patients with psoriatic arthritis compared to those with psoriasis alone,” Dr. Szentpetery said, citing a cross-sectional study comparing 125 people with psoriasis to 114 others with psoriatic arthritis (Ann Rheum Dis. 2013 May;72[5]:715-20).

Perhaps not surprisingly, inflammation could be driving the association between psoriatic and cardiovascular disease risk. Other investigators suggest chronic, low-grade inflammation leads to atherosclerosis through a maladaptive immune response and altered lipid metabolism, for example (Nat Med. 2011 Nov;17[11]:1410-22).

In the current study, the patients with psoriatic arthritis had well-established disease, occurring for a mean duration of 19 years. Mean age was 58 years, and 54% were men. Approximately 60% were taking disease-modifying antirheumatic drugs, two-thirds were taking biologics, and about one-third were on combination treatment. Controls were similar demographically with a mean age of 57 years, and 52% were men.

Interestingly, Psoriasis Area and Severity Index (PASI) scores did not correlate with increased risk. During discussion after the presentation of the study, a researcher unaffiliated with the study offered an answer. “It could be their skin disease was controlled by the biologics. You had 67% on biologics,” said Nehal Mehta, MD, Clinical Research Scholar in the section of inflammation and cardiometabolic disease at the National Heart, Lung, and Blood Institute. “We at the NIH see a strong correlation between PASI and coronary artery disease risk.”

“We know methotrexate and anti-TNF agents can have a protective effect on atherosclerosis, but we did not look at this specifically,” Dr. Szentpetery said. Overall, PASI scores were relatively low in the study population, she added, which “may explain why we did not see the correlation with PASI scores.”

Dr. Szentpetery and Dr. Mehta had no relevant financial disclosures.

Micrograph showing LSCs

Image by Robert Paulson

New research suggests leukemia stem cells (LSCs) can “hide” in gonadal adipose tissue (GAT) and transform the tissue so they can survive treatment.

Experiments in a mouse model of chronic myeloid leukemia (CML) showed that LSCs are enriched in GAT.

While there, the LSCs create a microenvironment that supports leukemic growth and resistance to treatment, and expression of the fatty acid transporter CD36 makes LSCs particularly resistant.

Craig Jordan, PhD, of University of Colorado in Aurora, and his colleagues conducted this research and detailed their findings in Cell Stem Cell.

The researchers began by examining cancer cells found in GAT from mice with blast crisis CML. Rather than containing the expected mix of regular leukemia cells and LSCs, the tissue was enriched for LSCs.

And these GAT-resident LSCs used a different energy source than LSCs in the bone marrow microenvironment. The GAT-resident LSCs powered their survival and growth with fatty acids, manufacturing energy by the process of fatty acid oxidization.

In fact, the GAT-resident LSCs actively signaled fat to undergo lipolysis, which released fatty acids into the microenvironment.

“The basic biology was fascinating,” Dr Jordan said. “The tumor adapted the local environment to suit itself.”

Dr Jordan and his colleagues also found that CD36 played a role. CD36+ LSCs were enriched in GAT, were more likely to migrate to GAT than to bone marrow, and were protected from treatment by GAT.

The researchers tested the effects of several drugs (cytarabine, doxorubicin, etoposide, SN-38, irinotecan, and dasatinib) on CD36+ LSCs, CD36- LSCs, and bulk leukemia cells ex vivo.

Both CD36+ and CD36- LSCs were more resistant to treatment than bulk leukemia cells, but CD36+ LSCs were preferentially drug-resistant.

The researchers observed similar results in leukemic mice and found evidence to suggest that CD36 plays a similar role in patients with blast crisis CML and those with acute myeloid leukemia.

Micrograph showing LSCs

Image by Robert Paulson

New research suggests leukemia stem cells (LSCs) can “hide” in gonadal adipose tissue (GAT) and transform the tissue so they can survive treatment.

Experiments in a mouse model of chronic myeloid leukemia (CML) showed that LSCs are enriched in GAT.

While there, the LSCs create a microenvironment that supports leukemic growth and resistance to treatment, and expression of the fatty acid transporter CD36 makes LSCs particularly resistant.

Craig Jordan, PhD, of University of Colorado in Aurora, and his colleagues conducted this research and detailed their findings in Cell Stem Cell.

The researchers began by examining cancer cells found in GAT from mice with blast crisis CML. Rather than containing the expected mix of regular leukemia cells and LSCs, the tissue was enriched for LSCs.

And these GAT-resident LSCs used a different energy source than LSCs in the bone marrow microenvironment. The GAT-resident LSCs powered their survival and growth with fatty acids, manufacturing energy by the process of fatty acid oxidization.

In fact, the GAT-resident LSCs actively signaled fat to undergo lipolysis, which released fatty acids into the microenvironment.

“The basic biology was fascinating,” Dr Jordan said. “The tumor adapted the local environment to suit itself.”

Dr Jordan and his colleagues also found that CD36 played a role. CD36+ LSCs were enriched in GAT, were more likely to migrate to GAT than to bone marrow, and were protected from treatment by GAT.

The researchers tested the effects of several drugs (cytarabine, doxorubicin, etoposide, SN-38, irinotecan, and dasatinib) on CD36+ LSCs, CD36- LSCs, and bulk leukemia cells ex vivo.

Both CD36+ and CD36- LSCs were more resistant to treatment than bulk leukemia cells, but CD36+ LSCs were preferentially drug-resistant.

The researchers observed similar results in leukemic mice and found evidence to suggest that CD36 plays a similar role in patients with blast crisis CML and those with acute myeloid leukemia.

Micrograph showing LSCs

Image by Robert Paulson

New research suggests leukemia stem cells (LSCs) can “hide” in gonadal adipose tissue (GAT) and transform the tissue so they can survive treatment.

Experiments in a mouse model of chronic myeloid leukemia (CML) showed that LSCs are enriched in GAT.

While there, the LSCs create a microenvironment that supports leukemic growth and resistance to treatment, and expression of the fatty acid transporter CD36 makes LSCs particularly resistant.

Craig Jordan, PhD, of University of Colorado in Aurora, and his colleagues conducted this research and detailed their findings in Cell Stem Cell.

The researchers began by examining cancer cells found in GAT from mice with blast crisis CML. Rather than containing the expected mix of regular leukemia cells and LSCs, the tissue was enriched for LSCs.

And these GAT-resident LSCs used a different energy source than LSCs in the bone marrow microenvironment. The GAT-resident LSCs powered their survival and growth with fatty acids, manufacturing energy by the process of fatty acid oxidization.

In fact, the GAT-resident LSCs actively signaled fat to undergo lipolysis, which released fatty acids into the microenvironment.

“The basic biology was fascinating,” Dr Jordan said. “The tumor adapted the local environment to suit itself.”

Dr Jordan and his colleagues also found that CD36 played a role. CD36+ LSCs were enriched in GAT, were more likely to migrate to GAT than to bone marrow, and were protected from treatment by GAT.

The researchers tested the effects of several drugs (cytarabine, doxorubicin, etoposide, SN-38, irinotecan, and dasatinib) on CD36+ LSCs, CD36- LSCs, and bulk leukemia cells ex vivo.

Both CD36+ and CD36- LSCs were more resistant to treatment than bulk leukemia cells, but CD36+ LSCs were preferentially drug-resistant.

The researchers observed similar results in leukemic mice and found evidence to suggest that CD36 plays a similar role in patients with blast crisis CML and those with acute myeloid leukemia.