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Anisdahl K, Lirhus SS, Medhus AW, Moum B, Melberg HO, Høivik ML. Frailty risk and treatment strategy in elderly-onset inflammatory bowel disease. A Norwegian nationwide population-based registry study. Dig Liver Dis 2024:S1590-8658(24)00262-7. [PMID: 38433021 DOI: 10.1016/j.dld.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND/AIMS To determine real-world medical and surgical treatment patterns in elderly-onset inflammatory bowel disease in a nationwide cohort, and to investigate associations between frailty and treatment choices. METHODS Norwegian health registries were used to identify adult-onset (born 1950-1989) and elderly-onset (born 1910-1949) patients with Crohn's disease (CD) and ulcerative colitis (UC) diagnosed 2010-2017 (n = 13,006). Patients were classified as no, low and intermediate/high frailty risk after the Hospital Frailty Risk Score. Outcomes included use of medical and surgical treatment. RESULTS Within five years, elderly-onset patients received less biologics (13% [CD], 7% [UC]) and immunomodulators (24% [CD], 11% [UC]), and major surgery was more frequent (22% [CD], 9% [UC]) than in adult-onset. Respective log rank tests were significant (p < 0.01). Compared to no frailty risk groups, elderly-onset UC with intermediate/high frailty risk had lower probability of starting biologics (4% versus 9%), immunomodulators (7% versus 13%) and 5-aminosalisylic acids (66% versus 84%), and elderly-onset CD with intermediate/high frailty risk had higher probability of starting prednisolone (67% versus 49%). Respective log rank tests were significant (p < 0.05). CONCLUSIONS Elderly-onset patients received less biologics and immunomodulators and a larger proportion underwent major surgery. Frailty risk in elderly-onset patients was associated with increased use of prednisolone, and less use of 5-aminosalisylic acids, immunomodulators and biologics.
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Affiliation(s)
- Karoline Anisdahl
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Sandre Svatun Lirhus
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Asle W Medhus
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Moum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Østfold Hospital Trust, Viken, Norway
| | - Hans Olav Melberg
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Vosoghinia H, Saberzadeh-Ardestani B, Anushiravani A, Mansour-Ghanaei F, Fakheri H, Vahedi H, Sheikhesmaeili F, Yazdanbod A, Moosavy SH, Maleki I, Nasseri-Moghaddam S, Khosravi B, Malekzadeh M, Kasaeian A, Alatab S, Sadeghi A, Kolahdoozan S, Amani M, Saberhosseini SN, Rayatpisheh M, Ahadi M, Colombel JF, Ungaro RC, Sima AR, Malekzadeh R. Comparison of Disease Phenotype and Course among Elderly- and Early-Onset Inflammatory Bowel Diseases in the Middle East. Arch Iran Med 2023; 26:481-488. [PMID: 38310403 PMCID: PMC10862057 DOI: 10.34172/aim.2023.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/03/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients. METHODS This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes. RESULTS From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P<0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P=0.001), immunomodulators (44.9% vs 25.2%, P<0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P=0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P=0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P<0.001), immunomodulators (58.7% vs 41.8%, P=0.005) and anti-TNF (49.6% vs 35.4%, P=0.006). CONCLUSION Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.
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Affiliation(s)
- Hasan Vosoghinia
- Gastroenterology and Hepatology Department, Faculty of Medicine, Ghaem Hospital, Mashhad, Iran
| | - Bahar Saberzadeh-Ardestani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Anushiravani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hafez Fakheri
- Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homayoon Vahedi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sheikhesmaeili
- Liver and Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abbas Yazdanbod
- Gastroenterology and Hepatology Department, Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Seyed Hamid Moosavy
- Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavosh Nasseri-Moghaddam
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sudabeh Alatab
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Sadeghi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Kolahdoozan
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Rayatpisheh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Ahadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ryan C. Ungaro
- The Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ali Reza Sima
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Gu X, Jing D, Xiao Y, Zhou G, Yang S, Liu H, Chen X, Shen M. Association of air pollution and genetic risks with incidence of elderly-onset atopic dermatitis: A prospective cohort study. Ecotoxicol Environ Saf 2023; 253:114683. [PMID: 36857917 DOI: 10.1016/j.ecoenv.2023.114683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Elderly-onset atopic dermatitis (AD) is a remarkable subtype and has been put on the agenda owing to its difficulty to control. Understanding the influence of genetic and environmental exposures is crucial to preventing elderly-onset AD. OBJECTIVES To explore the association between genes and air pollution on incident elderly-onset AD. MATERIAL AND METHODS This study was based on UK Biobank that recruited over 500,000 participants. The genetic risks were categorized into low, intermediate, and high groups according to tertiles of polygenic risk scores. Mixed exposure to various air pollutants was assessed using the weighted quantile sum (WQS) and also categorized based on tertiles. Within each genetic risk group, whether air pollutant mixture was associated with incident elderly-onset AD was estimated. RESULTS 337,910 participants were included in the final analysis, and the mean age was 57.1. The median years for follow-up were 12.0, and the incident cases of AD were 2545. The medium and high air pollution mixture was significantly associated with incident AD compared with the low pollution group, with HRs of 1.182 (P = 0.003) and 1.359 (P < 0.001), respectively. In contrast, HR for medium and high genetic susceptibility was only 1.065 (P = 0.249) and 1.153 (P = 0.008). The population-attributable fraction of air pollution and genetic risk was 15.5 % (P < 0.001) and 6.4 % (P = 0.004). Additionally, compared with low genetic risk and low air pollution, high genetic risk and high air pollution was significantly associated with the incidence of elderly-onset AD with a HR of up to 1.523 (P < 0.001). There were no interactive effects between each group of genetic risks and air pollution. When grouped by sex, females could observe a stronger effect by genetic and air pollutant mixture exposure. CONCLUSION Air pollution and genetics both independently enhance the risk of newly developed AD, and the effect of air pollutants is stronger than the investigated genes.
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Affiliation(s)
- Xiaoyu Gu
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China
| | - Danrong Jing
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China
| | - Yi Xiao
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China
| | - Guowei Zhou
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China
| | - Songchun Yang
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China.
| | - Hong Liu
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China.
| | - Xiang Chen
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China.
| | - Minxue Shen
- Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China; Furong Laboratory, Changsha, Hunan 410008, China; Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410013, China.
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Lin J, Zhang M, Zhi M. Clinical characteristics of elderly-onset inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2023; 31:98-104. [DOI: 10.11569/wcjd.v31.i3.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a group of chronic non-specific intestinal inflammatory diseases whose etiology has not been elucidated. The prevalence of elderly-onset IBD is increasing; however, its disease phenotype, pathophysiology, and clinical characteristics are different from those of adult-onset IBD. In order to better manage elderly IBD patients, it is becoming increasingly important to accurately describe the unique characteristics of elderly-onset IBD. Therefore, this article, based on the domestic and foreign literature reports from 2017 to now, describes the characteristics of elderly-onset IBD with regard to pathogenesis, epidemiological characteristics, clinical features, and treatment.
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Affiliation(s)
- Jue Lin
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Min Zhang
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Min Zhi
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
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Kim YS, Na MJ, Ye BD, Cheon JH, Im JP, Kim JS. Clinical Characteristics of Korean Patients with Elderly-Onset Crohn's Disease: Results from the Prospective CONNECT Study. Gut Liver 2022; 16:995-1000. [PMID: 36379905 PMCID: PMC9668494 DOI: 10.5009/gnl220350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 08/30/2023] Open
Abstract
The clinical course and prognosis of patients with elderly-onset Crohn's disease (CD) remain unclear. This study aimed to analyze the clinical characteristics and outcomes of elderly-onset CD patients from the prospective CONNECT study cohort, a nationwide, multicenter cohort study of patients with CD in Korea. Among a total of 1,175 patients in the prospective CONNECT study cohort, 94 patients (Montreal age A3) were included and divided into two groups according to their age at diagnosis: the elderly-onset group (diagnosed with CD after 60 years of age, n=26, 67.54±6.7 years) and late adult-onset group (diagnosed as CD at age 41 to 59 years, n=68, 48.06±5.1 years). The elderly-onset group was characterized by a lower Crohn's disease activity index at diagnosis (124.89±101.9 vs 189.55±128.6, p=0.023) and higher rates of previous anti-tuberculosis treatment (34.6% vs 4.4%, p<0.001) than the late adult-onset group. Compared with the late adult-onset group, the elderly-onset group showed a significantly less use of thiopurines (p=0.003), as well as anti-tumor necrosis factor-alpha agents (p=0.047). Additionally, the elderly-onset group was less likely to require bowel resection than the late adult-onset group (p=0.067), suggesting that elderly-onset CD patients in Korea appear to have more favorable clinical outcomes than late adult-onset CD patients.
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Affiliation(s)
- You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Min Jeong Na
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Matsubara C, Yamamoto K, Maeda T, Itakura J, Uehara T, Shiote Y, Adachi K, Kamoi C, Oyama T, Shiraishi Y, Yamamoto Y, Niiya D, Yoshida C, Nanba E, Ueda Y, Imajo K. [Successful treatment with enzyme replacement therapy for pelvic fragile fracture in an elderly case of type I Gaucher's disease]. Rinsho Ketsueki 2021; 61:1654-1659. [PMID: 33441516 DOI: 10.11406/rinketsu.61.1654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 76-year-old male with lower-limb weakness was admitted to our hospital where thrombocytopenia and anemia were noticed. CT showed massive splenomegaly and multiple nodules inside the spleen. Bone marrow examination showed an increase of macrophages with large cytoplasm. Suspected of splenic lymphoma, the patient underwent splenectomy. Spleen specimens were histologically analyzed and suggested the probability of Gaucher's disease (GD). Leukocyte glucocerebrosidase (GBA) enzyme activity had decreased to 1.25 nmol/mg, and mutation analysis of GBA revealed two missense variants, p.D448H (D409H), p.L483P (L444P), which confirmed the diagnosis of type I GD. Fourteen months after splenectomy, he developed right buttock pain, and pelvic magnetic resonance imaging showed a fragile right pubic and pelvic fracture. We initiated injection of imiglucerase as enzyme replacement therapy (ERT) and administered bisphosphonate. His symptoms gradually improved without surgical treatment. In addition, thrombocytopenia and anemia also improved, and angiotensin-converting enzyme levels decreased. Type I GD should be considered a differential diagnosis of giant splenomegaly and thrombocytopenia, even in the elderly. ERT or substrate reduction therapy should be administrated to GD patients, while paying attention to the development of bone lesions.
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Affiliation(s)
| | | | - Takeshi Maeda
- Kurashiki Central Hospital, Department of Hematology
| | - Junya Itakura
- Kurashiki Central Hospital, Department of Anatomic Pathology
| | | | - Yasuhiro Shiote
- Hiroshima City Hiroshima Citizens Hospital, Department of Hematology
| | | | | | | | | | | | - Daigo Niiya
- Okayama City Hospital, Department of Hematology
| | | | - Eiji Nanba
- Tottori University, Research Strategy Division
| | - Yasunori Ueda
- Kurashiki Central Hospital, Department of Hematology
| | - Kenji Imajo
- Okayama City Hospital, Department of Hematology
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Higashiyama M, Komoto S, Suzuki Y, Watanabe M, Hibi T, Miura S, Hokari R. Relation of geriatric nutritional risk index with clinical risks in elderly-onset ulcerative colitis. J Gastroenterol Hepatol 2021; 36:163-170. [PMID: 32583472 DOI: 10.1111/jgh.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Worldwide increasing aging societies have many elderlies with intractable diseases including ulcerative colitis (UC). Reportedly, each patients' frailty as well as chronological age is a clinical risk factor of elderly-onset UC (EOUC). Because malnutrition is one of the major manifestations of frailty, we aimed to investigate the effect of malnutrition on the prognosis of EOUC with geriatric nutritional risk index (GNRI), a prognostic tool for several diseases in the elderly to estimate malnutrition, and to evaluate clinical risks among EOUC patients in Japan, the world-leading aging society. METHODS The EOUC patients (≥ 65 years at diagnosis, n = 2778) in the previous nationwide survey were classified by age and GNRI, and odds ratios (ORs) of hospitalization and UC-related surgery were determined to evaluate the effects of malnutrition on the EOUC patients as well as aging. RESULTS The risks of hospitalization and surgery were elevated as age advanced. The value of GNRI, negatively correlated with disease activity (r = -0.53), could distinguish severe activity (cutoff ≤ 86.82, sensitivity = 0.79, and specificity = 0.77) and discriminate the EOUC patients suffering from surgery and hospitalization. In a multivariate analysis, GNRI ≤ 86.82 was a higher risk of hospitalization (OR: 4.0, 95% CI, 2.5-6.5) and surgery (OR: 2.7, 95% CI, 0.98-7.4) than cutoff age ≥ 75 years old (OR of hospitalization and surgery were 1.4 [95% CI, 0.99-2.0] and 2.3 [95% CI, 0.8-6.3], respectively). CONCLUSION Malnutrition estimated by GNRI was significantly related with poor clinical courses of the EOUC patients, suggesting that evaluation of nutritional status at the onset might be useful for predicting risks of clinical courses.
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Affiliation(s)
- Masaaki Higashiyama
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Yasuo Suzuki
- Department of Internal Medicine, Sakura Medical Center, Toho University, Chiba, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Hibi
- Kitasato Institute Hospital Center for Advanced IBD Research and Treatment, Tokyo, Japan
| | - Soichiro Miura
- International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Abstract
Although management of inflammatory bowel disease follows a similar approach for all adults, there are certain characteristics making its treatment more challenging in older patients. The advent of novel medical treatments has changed the paradigm of inflammatory bowel disease, with an increasing focus on preventing disease progression in addition to controlling symptoms. The safety of these therapies in the elderly needs to be considered. Management of inflammatory bowel disease in the elderly is confounded by comorbidities that can increase the risk of medication or surgical complications; polypharmacy and altered pharmacokinetics also increase the risk of drug-drug interactions and adverse events.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Inflammatory Bowel Disease Program, VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA; Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Akbar K Waljee
- Inflammatory Bowel Disease Program, VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA; Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA. https://twitter.com/AkbarWaljee
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Sugimoto H, Matsuno S, Yamanaka N, Yumura W, Itabashi M, Takei T. Low-dose corticosteroid with mizoribine might be an effective therapy for elderly-onset ISKDC grade VI IgA vasculitis. CEN Case Rep 2020; 10:46-52. [PMID: 32754805 DOI: 10.1007/s13730-020-00513-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022] Open
Abstract
Both the diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult because of its rarity and the likely presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial: the ideal dosages of corticosteroid and/or immunosuppressants have not been determined. In the elderly, corticosteroid adverse effects can lead to severe outcomes, and a consensus regarding its benefit and risk balance has not been reached. We report a case of IgAV in an 89-year-old patient who was admitted to our hospital to investigate a 30-day history of palpable purpura and pitting edema on her leg. A renal biopsy showed membranoproliferative glomerulonephritis with IgA deposits (The International Study of Kidney Disease in Children (ISKDC) grade VI), which is a predictor of a poor prognosis; these findings led to early intervention with low-dose corticosteroid (15 mg/day) and mizoribine. As a result, a complete remission without obvious adverse effects was obtained. Early intervention with low-dose corticosteroid and mizoribine based on renal histopathology results might be an effective treatment for elderly-onset ISKDC grade VI IgAV.
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Affiliation(s)
- Hikaru Sugimoto
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Shiho Matsuno
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Noriko Yamanaka
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Wako Yumura
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Mitsuyo Itabashi
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Takashi Takei
- Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
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Romão VC, Humby F, Kelly S, Di Cicco M, Mahto A, Lazarou I, Hands R, Rocher-Ros V, van der Heijde D, Fonseca JE, Pitzalis C. Treatment-resistant synovitis and radiographic progression are increased in elderly-onset rheumatoid arthritis patients: findings from a prospective observational longitudinal early arthritis cohort study. Semin Arthritis Rheum 2020; 50:735-743. [PMID: 32531503 DOI: 10.1016/j.semarthrit.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical outcomes in elderly-onset rheumatoid arthritis (EORA), starting after the age of 60, are conflicting. Thus, we aimed to investigate in a unique biopsy-driven, treatment-naïve early arthritis cohort, the relationship between synovial pathobiology of elderly- (EORA) and younger-onset rheumatoid arthritis (YORA) patients through clinical, imaging and treatment response outcome-measures. METHODS Patients (n = 140) with early RA (<12months) starting before (YORA, n = 99) or after (EORA, n = 41) age 60 had an ultrasound-guided synovial biopsy prior to conventional immunosuppressive therapy and after 6 months. Clinical, ultrasound and radiographic data were collected prospectively and compared between groups and against immunohistological features. Using multivariate logistic regression, we determined predictors of clinical response (disease activity score-28-erythrocyte sedimentation rate [DAS28-ESR]<3.2) at 6 months and radiographic progression (≥1-unit-increase in Sharp van der Heijde [SvdH] score) at 12 months. RESULTS EORA patients were more frequently male and presented most commonly with an abrupt, polymyalgia rheumatica-like onset and extra-articular features. Both before and after treatment, DAS28-ESR was similar but ultrasound synovial-thickening (p<0.05) and power-Doppler (p<0.01) synovitis and SvdH (p<0.001) scores were higher in EORA patients. EORA was independently associated with poor treatment response at 6 months (OR=0.28, p = 0.047) and radiographic progression at 12 months (OR=4.08, p = 0.029). Synovial pathotype, synovitis scores and cellular infiltration were similar before treatment, but a pauci-immune-fibroid pathotype tended to be more common in YORA at 6 months (p = 0.093). Moreover, YORA patients had a marked improvement of all synovitis parameters (p<0.001), whereas EORA presented only mild decreases in synovitis (p<0.05), sublining macrophage (p<0.05) and T cell scores (p<0.05), with no significant changes in lining macrophages, B cells or plasma cells. CONCLUSION Early EORA presents differently and has a worse overall prognosis than YORA, with poorer clinical, histological, ultrasonographic and radiographic outcomes.
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Affiliation(s)
- Vasco C Romão
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre; Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Frances Humby
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Stephen Kelly
- Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, 275 Bancroft Road, London E1 2DG, UK
| | - Maria Di Cicco
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Arti Mahto
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Ilias Lazarou
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Rebecca Hands
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Vidalba Rocher-Ros
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - João Eurico Fonseca
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre; Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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Kobak S, Yildiz F, Semiz H, Orman M. Elderly-onset sarcoidosis: A single center comparative study. ACTA ACUST UNITED AC 2018; 16:235-238. [PMID: 30054252 DOI: 10.1016/j.reuma.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Sarcoidosis rarely affect patients older than 65 years old. The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset (EOS) and young-onset sarcoidosis (YOS) patients. METHODS One hundred and thirty one patients diagnosed with sarcoidosis according to clinical, radiologic and histopathological evaluation were included in this study. The patients with initial symptoms started after age 65 were accepted as EOS. RESULTS Twenty (15.3%) of 131 patients were diagnosed as EOS, and 111 (84.7%) patients were evaluated as YOS. Fifteen of 20 EOS patients were female and 5 of them were male. Average duration of the disease was determined as 38.4 months for YOS and 22.5 months for EOS (p=0.556). Delay of the diagnosis was 12 months for YOS while it was 3 months for EOS (p=0.001). Higher rates of fatique, comorbid diseases and more hydroxychloroquine (HQ) use were detected in EOS patients comparing to YOS (p=0.010, p=0.003 and p=0.039 respectively). CONCLUSIONS EOS patients are characterized with higher rates of fatique and comorbid diseases, less inflammatory sign and delayed diagnosis, and less DMARDs use.
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Affiliation(s)
- Senol Kobak
- Istinye University Faculty of Medicine, LIV Hospital, Department of Rheumatology, Turkey.
| | - Fidan Yildiz
- Medicalpark Hospital, Department of Chest Diseases, Turkey
| | - Huseyin Semiz
- Ege University Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Mehmet Orman
- Ege University Faculty of Medicine, Department of Statistics, Turkey
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Kawaguchi N, Suzuki N, Tateyama M, Takai Y, Misu T, Nakashima I, Itoyama Y, Aoki M. Two cases of elderly-onset hereditary neuropathy with liability to pressure palsy manifesting bilateral peroneal nerve palsies. Case Rep Neurol 2012. [PMID: 23185166 PMCID: PMC3506036 DOI: 10.1159/000342132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hereditary neuropathy with liability to pressure palsy (HNPP) is characterized by recurrent focal neuropathies, which usually become symptomatic in the second or third decade of life. However, clinical phenotypic heterogeneity among patients with HNPP has recently been reported. Certain patients show polyneuropathy-type diffuse nerve injuries, whereas others remain asymptomatic at older ages. We present two cases of elderly-onset bilateral peroneal nerve palsies with diffuse muscle weakness in the lower limbs and glove-and-stocking type sensory disturbance. Both patients were diagnosed with HNPP by genetic analyses that detected deletions of chromosome 17p11.2 in peripheral myelin protein 22 genes. Their clinical courses suggested that the Japanese sitting style termed ‘seiza’, a way of sitting on the floor with the lower legs crossed under the thighs, was a precipitating factor for the bilateral peroneal nerve palsies.
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Affiliation(s)
- Norihiko Kawaguchi
- Department of Neurology, School of Medicine, Tohoku University, Sendai, Japan
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