Uveitis increases the risk of stroke among patients with ankylosing spondylitis: A nationwide population-based longitudinal study

Role of Huangqin Qingre Chubi Capsule in the Reduction of the Risk of Re-Admission in Patients With Ankylosing Spondylitis: A Cohort Study

Objective

This study evaluates whether Huangqin Qingre Chubi Capsule (HQC), a traditional Chinese medicine (TCM) compound, is associated with the risk of re-admission in patients with ankylosing spondylitis (AS).

Methods

In this study, we retrospectively collected the clinical data of 1,296 AS patients. Patients were allocated into HQC and non-HQC groups. Baseline data between the two groups were matched with propensity score matching (PSM). Influencing factors for the risk of re-admission in AS patients were analyzed with the Cox proportional hazards model. The effect of HQC intervention duration on the risk of re-admission was assessed with Kaplan-Meier survival curves. The random walk model and association rule analysis were utilized to determine the correlation between HQC and improvements in immunoinflammatory markers.

Results

The re-admission rate was significantly lower in the HQC group than in the non-HQC group (P < 0.01). The risk of re-admission was significantly lower in patients aged > 40 years (P < 0.01) than in patients aged < 40 years and also markedly lower in HQC users than in non-HQC users (P < 0.01), suggesting that age and the use of HQC were key factors influencing the risk of re-admission. Longer HQC intervention duration was associated with better improvements in ESR, CRP, and C4, and HQC was closely correlated with improvements in ESR, CRP, IgA, and C4.

Conclusion

HQC treatment can reduce the risk of re-admission in AS patients, which may be associated with improvements in ESR, CRP, IgA, and C4. The risk decreases with prolonged HQC treatment.

Risk of Uveitis in Dengue Fever Patients: A Population-Based Cohort Study in Taiwan

Dengue-related ocular complications were considered rare, but recent evidence points to a broader spectrum of manifestations, including uveitis. This study utilized the Taiwan National Health Insurance Research Database (NHIRD) to investigate the incidence of uveitis in dengue patients, aiming to fill this research gap. This population-based, retrospective cohort study utilized the Taiwan National Health Insurance Research Database (NHIRD) and included patients with and without Dengue fever. The non-Dengue fever cohort comprised randomly selected control patients who were matched. Hazard ratios and Kaplan-Meier analysis were conducted to compare the incidence of uveitis in the Dengue and non-Dengue cohorts. Subgroup analyses were carried out based on age groups, genders, and comorbidities. A total of 26 950 patients diagnosed with Dengue fever were included in the study (49.6% female, mean age at index 41.63 years). Based on a 1:4 matching ratio, 107 800 control subjects without uveitis (50.03% female, mean age at index 41.41 years) were also included. The adjusted hazard ratio (aHR) of uveitis was higher in the Dengue fever group than in the non-Dengue fever group (aHR = 1.38, p < 0.001). A history of stroke or transient ischemic attack (TIA) was not associated with uveitis. Stratified analyses revealed that patients with Dengue fever had an increased risk regardless of their sex and age. The Kaplan-Meier method with the log-rank test showed a significantly higher cumulative incidence of uveitis in the Dengue fever cohort than in the non-Dengue fever cohort (p < 0.001). In the subgroup analysis for most major comorbidities, the significantly higher risk for uveitis in those patients with Dengue fever, was only demonstrated in the subgroups of those without these major comorbidities. Our findings showed Dengue infection to be associated with increased risk for uveitis. Clinicians should be attentive to a history of stroke or TIA in patients with Dengue fever.

Unraveling the connection: Uveitis prevalence and risk factors in psoriasis patients - a population-based study

The association between uveitis and spondyloarthropathy (SpA)-related conditions is well-established. However, evidence describing the link between uveitis and psoriasis, and psoriasis without concomitant SpA-related conditions is scarce and conflicting. This large-scale population-based study sought to describe the prevalence and features of uveitis among psoriasis patients in Israel as well as investigating the risk for uveitis in different subgroups of psoriasis patients compared to the general population. We conducted a retrospective study utilizing the electronic database of the Meuhedet Health Maintenance Organization. The study included all patients diagnosed with psoriasis between 2000 and 2020, each patient was matched with four controls based on age, sex, place of residence, and index date. Logistic regression models were employed to assess the association between psoriasis and uveitis while adjusting for the presence of SpA-related conditions. A total of 61 003 psoriasis patients and 244 012 matched controls were included. The prevalence of uveitis was 1.3% versus 1.1% respectively (OR  1.12; 95% CI 1.10-1.30; p < 0.001). When adjusting to psoriasis severity, concurrent SpA, and psoriasis treatment no significant association was found. The rates of uveitis among psoriasis patients with concurrent SpA-related conditions was 3.2% compared to 1.4% in controls without psoriasis or SpA (OR 2.38; 95% CI 2.00-2.83; p < 0.001), while in psoriasis patients without SpA, the rate of uveitis was 1.0% and was similar to controls. Although crude rates of uveitis were higher in patients with severe psoriasis compared to mild psoriasis (2.1% vs. 1.1%), after adjustment, no significant association compared to controls was found in either group. Our findings suggest that the positive association between psoriasis and uveitis is primarily mediated by the coexistence of other SpA-related conditions. These findings imply the presence of a shared pathogenetic mechanism and set the direction for a phenotypic-targeted screening strategy.

Validation of diagnosis algorithms for ankylosing spondylitis in claim-based database

BACKGROUND

Claims-based algorithms using International Classification of Diseases (ICD) codes have become a common approach for researchers to define ankylosing spondylitis (AS) in studies. To address potential misclassification bias caused by the claim-based algorithms, we conducted the current study to validate whether these algorithms of medical claims could accurately represent AS diagnoses.

METHODS

Patients diagnosed with AS based on ICD codes were retrieved from the electronic medical records database at a Taiwanese medical center (Chung Shan University Hospital, Taiwan). After random sampling and stratification based on age and sex, the medical information of participants was appraised based on the 2009 ASAS guideline to evaluate the actual status of ICD codes claim-based AS patients. Positive predict values (PPV) of different algorithms of ICD codes were also calculated.

RESULTS

Within the 4160 patients with claim-based AS diagnosis, 387 eligible patients were finally included in the study design after random sampling. The PPV of the diagnostic algorithm of having at least 4 outpatient or 1 inpatient ICD record was 72.77 (95% CI, 66.79-78.75), whereas the PPV increased to 85.64 when the diagnoses were restricted to be made by rheumatologists (95% CI, 80.53-90.74).

CONCLUSIONS

While performing database studies, researchers should be aware of the low PPV of specific algorithms when defining AS. Algorithms with higher PPV were recommended to be adopted to avoid misclassification biases.