Meghan E. Glynn

Objective: Therapeutic response was evaluated among new apremilast, methotrexate (MTX), or biologic disease-modifying antirheumatic drug (bDMARD) initiators with oligoarticular psoriatic arthritis (PsA).Methods: Patients with oligoarticular PsA in the Corrona PsA/Spondyloarthritis Registry initiating treatment with apremilast, MTX, or bDMARD, and completing 6-month follow-up were included.Results: In total, 150 patients initiated monotherapy (apremilast: n = 34; MTX: n = 15; bDMARD: n = 101). Apremilast initiators had higher baseline disease activity than MTX initiators. At follow-up, apremilast initiators experienced numerically greater disease activity improvements than MTX initiators and similar improvements to bDMARD initiators.Conclusion: Findings suggest apremilast monotherapy is an effective option for patients with oligoarticular PsA.

Background: The prospective, US-based, observational Corrona PsA/SpA Registry collects real-world data on patients (pts) with PsA provided by pts and their providers. Objectives: To examine trends in characteristics of pts initiating apremilast (APR) from 2014-2019 and compare characteristics of treatment-naive pts initiating APR or methotrexate (MTX). Methods: PsA pts aged ≥18 yrs enrolled in the registry who initiated APR, MTX, and/or biologics for PsA from January 2014-August 2019 were included and stratified by year of initiation (2014-2015, 2016-2017, or 2018-2019). Demographics, clinical characteristics, treatment history, disease activity, and pt-reported outcomes (PROs) were analyzed at treatment initiation. Comparisons between treatment-naive APR vs MTX initiators during the entire 2014-2019 study period were summarized descriptively. Results: 1460 PsA pts initiated APR (n=238), MTX (n=178), and/or a biologic (n=1044), including treatment-naive APR (n=20) and MTX (n=99) initiators from 2014-2019. For APR initiators in the 3 successive time periods, respectively, mean disease duration was 10.5, 12.2, and 11.4 yrs, and 87.5%, 82.5%, and 68.6% of pts had prior use of csDMARDs (similar to biologic initiators: 77.9%, 77.2%, and 68.8%). Over time, lower joint, enthesitis, and dactylitis counts, composite disease activity, and PRO measures of disease burden were observed (Table). Compared with treatment-naive MTX initiators, treatment-naive APR initiators had longer duration of PsA (8.5 vs 5.5 yrs) and time since PsA diagnosis (3.3 vs 1.8 yrs). Rates of comorbidities such as hypertension (50.0% vs 37.8%), diabetes mellitus (38.9% vs 13.3%), and metabolic syndrome (33.3% vs 8.9%) were higher in treatment-naive APR vs MTX initiators. Greater proportions of treatment-naive APR initiators had high/very high disease activity according to CDAI, DAPSA, cDAPSA, PASDAS, and DAS-28 vs MTX initiators. Conclusion: In this Corrona Registry analysis, PsA pts initiating APR had lower disease burden in recent vs prior yrs, indicating use of APR earlier in the course of PsA is increasing in real-world practice. Treatment-naive APR initiators had greater disease activity and severity vs MTX initiators. Comorbidities were common at APR initiation. Disclosure of Interests: Alexis Ogdie Grant/research support from: Novartis, Pfizer – grant/research support, Consultant of: AbbVie, BMS, Eli Lilly, Novartis, Pfizer, Takeda – consultant, Mei Liu Shareholder of: Corrona, LLC – shareholder at the time of study conduct, Employee of: Corrona, LLC – employment at the time of study conduct, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Kelechi Emeanuru Employee of: Corrona, LLC – employment, Leslie Harrold Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Consultant of: AbbVie, BMS, Roche – consultant, Employee of: Corrona, LLC – employment, Jennifer Mohawk Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Sven Richter Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Benoit Guerette Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau

Over the past 40 years, measured ambient asbestos concentrations in the United States have been higher in urban versus rural areas. The purpose of this study was to determine whether variations in ambient asbestos concentrations have influenced pleural mesothelioma risk in females (who generally lacked historic occupational asbestos exposure relative to males). Male pleural mesothelioma incidence trends were analyzed to provide perspective for female trends. Annual age‐adjusted incidence rates from 1973 to 2012 were obtained from the SEER 9, 13, and 18 databases for urban and rural locations, and standardized rate ratios were calculated. Female rural rates exceeded urban rates in almost half of the years analyzed, although the increases were not statistically significant, which is in line with expectations if there was no observable increased risk for urban locations. In contrast, male urban rates were elevated over rural rates for nearly all years examined and were statistically significantly elevated for 22 of the 40 years. Trend analyses demonstrated that trends for females remained relatively constant over time, whereas male urban and rural incidence increased into the 1980s and 1990s, followed by a decrease/leveling off. Annual female urban and rural incidence rates remained approximately five‐ to six‐fold lower than male urban and rural incidence rates on average, consistent with the comparatively increased historical occupational asbestos exposure for males. The results suggest that differences in ambient asbestos concentrations, which have been reported to be 10‐fold or greater across regions in the United States, have not influenced the risk of pleural mesothelioma.

The objective of this study was to determine the valence state of chromium (Cr) in the blood of individuals with Cr-containing metal hip implants. Serum and red blood cell (RBC) Cr concentrations from 52 patients with Cr-containing total hip arthroplasties were measured preoperatively and at 3, 12, and 24 months postoperatively. Geometric mean and median pre-surgery serum Cr concentrations were consistently below 0.2 µg/L, while geometric mean and median pre-op RBC Cr concentrations were typically about four- to six-fold higher than the serum values. A significant 5- to 13-fold increase was found in the mean and median serum Cr concentrations three months post-surgery, with an 8- to 18-fold rise at 12 and 24 months, respectively. Steady-state serum concentrations were reached between 3 and 12 months. In contrast, there were no marked differences in mean and median RBC Cr concentrations pre- and post-surgery. Slope regression analysis for our data was similar to those reported for Cr(III) in spiked blood samples. The analysis showed that Cr released from hip implants preferentially distributed into serum and not RBC, indicating that the form of Cr present in blood of hip implant patients was in the form of non-toxic Cr(III). Our findings indicate that blood Cr concentrations Cr(III) associated with metal implants do not pose an adverse health risk to patients, which is in agreement with findings published by most investigators.

(2015). Historical ambient airborne asbestos concentrations in the United States – an analysis of published and unpublished literature (1960s–2000s) Inhalation Toxicology: Vol. 27, No. 14, pp. 754-766. doi: 10.3109/08958378.2015.1118172

In the Great Lakes region, bluff recession is a major cause of residential, commercial, municipal, and federal property loss. The average rate of recession in Allegan County, Michigan, ranged from 1 to 2 ft per year, from 1831 to 1958, or a total of 130 to 258 ft over 127 years (Powers 1958). From 1938 to 1996, a 0.1 to 1.7 ft per year recession rate was measured, for a total land loss of 5 to 100 ft over 58 years (Montgomery 1998). Reports show that recession rates are not uniform along the shoreline, nor are they similar during two different time periods at a given site (Chamberlin 1877; Powers 1958; Seibel 1972; Montgomery 1998; Chase et al. 2000). It is difficult to predict future rates of recession. Also, it is evident that recession has not slowed with the introduction of modern stabilization structures. The purpose of this research is to investigate the natural factors that influence lake-bluff instability and to demonstrate an innovative approach (i.e., dewatering the bluff) for deterring or slowing the recession rate. Three geologically distinct sites along the Lake Michigan coast in Allegan County were chosen. In 2004, measurement instrumentation was installed at each of the sites. Part of each site was dewatered using submersible pumps or gravity drains, while another part of each site was not. A total of 76 in-place inclinometers (IPIs) and 28 vibrating wire piezometers (VWPs) among 26 monitoring wells, 45 dewatering wells, and two weather stations were installed.