Kerri Wachter

The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years who are current or former smokers undergo a one-time ultrasound screening for abdominal aortic aneurysm.

The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.

“This is an important recommendation, because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently smokers or who have been regular smokers are at the highest risk for AAA, according to the task force.

The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concluded that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).

In 1996, the task force last reviewed the topic and concluded that there was insufficient evidence to screen for such aneurysms.

The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which is the cause of approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.

The condition is less likely to occur in people who have never smoked, and the U.S. Preventive Services Task Force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).

The U.S. Preventive Services Task Force is also recommending that women should not be screened for AAA (grade D).

Published research indicates that women are at low risk for such aneurysms, though few studies have been conducted in women. Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years.

The U.S. Preventive Services Task Force found no evidence of benefit from routine screening for AAA in all women and also concluded that potential harms—mortality and complications of surgery—outweighed the potential benefits of screening and subsequent surgery.

The Agency for Healthcare Research and Quality is sponsoring an evidence review comparing endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and complications of endovascular repair of AAA are not known.

The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years who are current or former smokers undergo a one-time ultrasound screening for abdominal aortic aneurysm.

The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.

“This is an important recommendation, because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently smokers or who have been regular smokers are at the highest risk for AAA, according to the task force.

The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concluded that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).

In 1996, the task force last reviewed the topic and concluded that there was insufficient evidence to screen for such aneurysms.

The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which is the cause of approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.

The condition is less likely to occur in people who have never smoked, and the U.S. Preventive Services Task Force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).

The U.S. Preventive Services Task Force is also recommending that women should not be screened for AAA (grade D).

Published research indicates that women are at low risk for such aneurysms, though few studies have been conducted in women. Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years.

The U.S. Preventive Services Task Force found no evidence of benefit from routine screening for AAA in all women and also concluded that potential harms—mortality and complications of surgery—outweighed the potential benefits of screening and subsequent surgery.

The Agency for Healthcare Research and Quality is sponsoring an evidence review comparing endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and complications of endovascular repair of AAA are not known.

The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years who are current or former smokers undergo a one-time ultrasound screening for abdominal aortic aneurysm.

The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.

“This is an important recommendation, because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently smokers or who have been regular smokers are at the highest risk for AAA, according to the task force.

The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concluded that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).

In 1996, the task force last reviewed the topic and concluded that there was insufficient evidence to screen for such aneurysms.

The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which is the cause of approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.

The condition is less likely to occur in people who have never smoked, and the U.S. Preventive Services Task Force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).

The U.S. Preventive Services Task Force is also recommending that women should not be screened for AAA (grade D).

Published research indicates that women are at low risk for such aneurysms, though few studies have been conducted in women. Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years.

The U.S. Preventive Services Task Force found no evidence of benefit from routine screening for AAA in all women and also concluded that potential harms—mortality and complications of surgery—outweighed the potential benefits of screening and subsequent surgery.

The Agency for Healthcare Research and Quality is sponsoring an evidence review comparing endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and complications of endovascular repair of AAA are not known.

The Food and Drug Administration is warning consumers about possible false results from several unapproved home-use diagnostic test kits marketed in the United States via the Internet by Globus Media of Montreal.

The test kits are not approved for sale in the United States. There is concern that the use of these products could lead to false results that could contribute to significant adverse health consequences, but there are no confirmed instances of false results, according to the FDA.

The kits are labeled as Rapid HIV Test Kit, Rapid Syphilis Test Kit, One Step Cassette Style Cocaine Test, One Step Cassette Style Marijuana (THC) Test, One Step Cassette Style Amphetamine Test, Rapid Dengue Fever Test, and One Step Midstream Style HCG Urine (Home) Pregnancy Test.

The tests, sold through Web sites such as www.htkit.com

No home-use test kits intended for diagnosing HIV, syphilis, and dengue fever have been approved for sale in the United States.

The Food and Drug Administration is warning consumers about possible false results from several unapproved home-use diagnostic test kits marketed in the United States via the Internet by Globus Media of Montreal.

The test kits are not approved for sale in the United States. There is concern that the use of these products could lead to false results that could contribute to significant adverse health consequences, but there are no confirmed instances of false results, according to the FDA.

The kits are labeled as Rapid HIV Test Kit, Rapid Syphilis Test Kit, One Step Cassette Style Cocaine Test, One Step Cassette Style Marijuana (THC) Test, One Step Cassette Style Amphetamine Test, Rapid Dengue Fever Test, and One Step Midstream Style HCG Urine (Home) Pregnancy Test.

The tests, sold through Web sites such as www.htkit.com

No home-use test kits intended for diagnosing HIV, syphilis, and dengue fever have been approved for sale in the United States.

The Food and Drug Administration is warning consumers about possible false results from several unapproved home-use diagnostic test kits marketed in the United States via the Internet by Globus Media of Montreal.

The test kits are not approved for sale in the United States. There is concern that the use of these products could lead to false results that could contribute to significant adverse health consequences, but there are no confirmed instances of false results, according to the FDA.

The kits are labeled as Rapid HIV Test Kit, Rapid Syphilis Test Kit, One Step Cassette Style Cocaine Test, One Step Cassette Style Marijuana (THC) Test, One Step Cassette Style Amphetamine Test, Rapid Dengue Fever Test, and One Step Midstream Style HCG Urine (Home) Pregnancy Test.

The tests, sold through Web sites such as www.htkit.com

No home-use test kits intended for diagnosing HIV, syphilis, and dengue fever have been approved for sale in the United States.

The availability of a newly released set of standard magnetic resonance reference images may usher in even greater use of the technology in the evaluation of patients with rheumatoid arthritis.

The European League Against Rheumatism-Outcome Measures in Rheumatoid Arthritis Clinical Trials (EULAR-OMERACT) MRI reference image atlas published last month is intended to improve the performance and generalizability of the MRI scoring system previously developed by the group (Ann. Rheum. Dis. 2005;64 [suppl. 1]:i1-155). In 2002, OMERACT released the Rheumatoid Arthritis MRI Score (RAMRIS) for the evaluation of inflammatory and destructive changes in RA hands and wrists.

Intended for clinical researchers, but also translatable as an educational tool for practicing physicians, the atlas is composed of 1,002 representative images of synovitis, bone erosion, and edema in the metacarpophalangeal and wrist joints.

Selection of the images was decided by consensus among six readers from MRI centers in Auckland, New Zealand; Copenhagen; Leeds, England; and Sydney, Australia. After the initial selection phase, all images were then reviewed to confirm the feature and grade allocated on scoring.

The document displays all severity grades of synovitis in the metacarpophalangeal joints and in each of the wrist joint areas. In addition, it maps out various severity grades of bone erosion and edema in the metacarpal head and phalangeal base and in five selected wrist joint bones (distal radius, scaphoid, lunate, capitate, and metacarpal base). For each individual grade, the atlas includes examples of both the “low” and “high” ends of the spectrum.

The collection of reference images provides a much-needed visual touchstone for MR assessment of RA, said Orrin M. Troum, M.D., of the University of Southern California, Los Angeles. “This is a positive step forward for rheumatologists. … I think ultimately we may be able to do away with x-ray.”

A number of studies have demonstrated the superior sensitivity of MRI compared with conventional radiography, particularly in identifying early disease, which is crucial to improving outcomes for patients with aggressive disease. MRI has been shown to be two to nine times more sensitive than x-rays for the detection of bone erosion.

“It's been well documented that people with RA, if identified and treated earlier, do better,” said Dr. Troum. MRI can make all the difference in the patient with aggressive RA because erosions can be visualized earlier, allowing treatment to be initiated and disease progression to be halted, which all leads to less disability later.

The advent of structure-modifying therapies gave rise to the necessity of MRI assessment in RA patients, said Charles Peterfy, M.D., a musculoskeletal radiologist and a coauthor of the atlas.

Before biologics, there was no real need to have such detailed information about joint structure because having it didn't alter the course of clinical management. The availability of agents that halt disease progression changed everything, he said.

The challenge now is to identify those patients who will go on to develop aggressive disease before severe impairment sets in.

It's estimated that “20%-40% of patients with early disease aren't going to progress,” said Dr. Peterfy, who also is chief medical officer of Synarc, a San Francisco-based company that does MR imaging for clinical trials. Treating these patients empirically with biologics would be much too expensive and would entail an unacceptable level of unnecessary toxicity.

MRI can help identify those with aggressive disease because the technique allows direct visualization and assessment of synovitis and bone edema, which is a probable precursor of bone erosion.

“In early disease, MR identifies the aggressive phenotype much more sensitively than x-ray or any other test does so far,” Dr. Peterfy said.

The MRI atlas may help rheumatologists monitor treatment, adjust dosages, or change treatment regimens altogether. “That's the way I could see MR being used in the clinic,” Dr. Peterfy said.

Core Set of Basic MRI Sequences

It is suggested that future MRI studies that intend to assess inflammatory as well as destructive changes in rheumatoid arthritis joints should include the following:

▸ Imaging in two planes* with T1 weighted images before and after intravenous gadolinium contrast.**

▸ A T2 weighted fat saturated sequence or, if the latter is not available, a STIR (short tau inversion recovery) sequence.

*Can be acquired by obtaining a two-dimensional sequence in two planes, or a three-dimensional sequence with isometric voxels in one plane allowing reconstruction in other planes.

**Intravenous gadolinium injection is probably not essential if only destructive changes (bone erosions) are considered important.

Source: Ann. Rheum. Dis. 2005;64 (suppl. 1):i8-10

The availability of a newly released set of standard magnetic resonance reference images may usher in even greater use of the technology in the evaluation of patients with rheumatoid arthritis.

The European League Against Rheumatism-Outcome Measures in Rheumatoid Arthritis Clinical Trials (EULAR-OMERACT) MRI reference image atlas published last month is intended to improve the performance and generalizability of the MRI scoring system previously developed by the group (Ann. Rheum. Dis. 2005;64 [suppl. 1]:i1-155). In 2002, OMERACT released the Rheumatoid Arthritis MRI Score (RAMRIS) for the evaluation of inflammatory and destructive changes in RA hands and wrists.

Intended for clinical researchers, but also translatable as an educational tool for practicing physicians, the atlas is composed of 1,002 representative images of synovitis, bone erosion, and edema in the metacarpophalangeal and wrist joints.

Selection of the images was decided by consensus among six readers from MRI centers in Auckland, New Zealand; Copenhagen; Leeds, England; and Sydney, Australia. After the initial selection phase, all images were then reviewed to confirm the feature and grade allocated on scoring.

The document displays all severity grades of synovitis in the metacarpophalangeal joints and in each of the wrist joint areas. In addition, it maps out various severity grades of bone erosion and edema in the metacarpal head and phalangeal base and in five selected wrist joint bones (distal radius, scaphoid, lunate, capitate, and metacarpal base). For each individual grade, the atlas includes examples of both the “low” and “high” ends of the spectrum.

The collection of reference images provides a much-needed visual touchstone for MR assessment of RA, said Orrin M. Troum, M.D., of the University of Southern California, Los Angeles. “This is a positive step forward for rheumatologists. … I think ultimately we may be able to do away with x-ray.”

A number of studies have demonstrated the superior sensitivity of MRI compared with conventional radiography, particularly in identifying early disease, which is crucial to improving outcomes for patients with aggressive disease. MRI has been shown to be two to nine times more sensitive than x-rays for the detection of bone erosion.

“It's been well documented that people with RA, if identified and treated earlier, do better,” said Dr. Troum. MRI can make all the difference in the patient with aggressive RA because erosions can be visualized earlier, allowing treatment to be initiated and disease progression to be halted, which all leads to less disability later.

The advent of structure-modifying therapies gave rise to the necessity of MRI assessment in RA patients, said Charles Peterfy, M.D., a musculoskeletal radiologist and a coauthor of the atlas.

Before biologics, there was no real need to have such detailed information about joint structure because having it didn't alter the course of clinical management. The availability of agents that halt disease progression changed everything, he said.

The challenge now is to identify those patients who will go on to develop aggressive disease before severe impairment sets in.

It's estimated that “20%-40% of patients with early disease aren't going to progress,” said Dr. Peterfy, who also is chief medical officer of Synarc, a San Francisco-based company that does MR imaging for clinical trials. Treating these patients empirically with biologics would be much too expensive and would entail an unacceptable level of unnecessary toxicity.

MRI can help identify those with aggressive disease because the technique allows direct visualization and assessment of synovitis and bone edema, which is a probable precursor of bone erosion.

“In early disease, MR identifies the aggressive phenotype much more sensitively than x-ray or any other test does so far,” Dr. Peterfy said.

The MRI atlas may help rheumatologists monitor treatment, adjust dosages, or change treatment regimens altogether. “That's the way I could see MR being used in the clinic,” Dr. Peterfy said.

Core Set of Basic MRI Sequences

It is suggested that future MRI studies that intend to assess inflammatory as well as destructive changes in rheumatoid arthritis joints should include the following:

▸ Imaging in two planes* with T1 weighted images before and after intravenous gadolinium contrast.**

▸ A T2 weighted fat saturated sequence or, if the latter is not available, a STIR (short tau inversion recovery) sequence.

*Can be acquired by obtaining a two-dimensional sequence in two planes, or a three-dimensional sequence with isometric voxels in one plane allowing reconstruction in other planes.

**Intravenous gadolinium injection is probably not essential if only destructive changes (bone erosions) are considered important.

Source: Ann. Rheum. Dis. 2005;64 (suppl. 1):i8-10

The availability of a newly released set of standard magnetic resonance reference images may usher in even greater use of the technology in the evaluation of patients with rheumatoid arthritis.

The European League Against Rheumatism-Outcome Measures in Rheumatoid Arthritis Clinical Trials (EULAR-OMERACT) MRI reference image atlas published last month is intended to improve the performance and generalizability of the MRI scoring system previously developed by the group (Ann. Rheum. Dis. 2005;64 [suppl. 1]:i1-155). In 2002, OMERACT released the Rheumatoid Arthritis MRI Score (RAMRIS) for the evaluation of inflammatory and destructive changes in RA hands and wrists.

Intended for clinical researchers, but also translatable as an educational tool for practicing physicians, the atlas is composed of 1,002 representative images of synovitis, bone erosion, and edema in the metacarpophalangeal and wrist joints.

Selection of the images was decided by consensus among six readers from MRI centers in Auckland, New Zealand; Copenhagen; Leeds, England; and Sydney, Australia. After the initial selection phase, all images were then reviewed to confirm the feature and grade allocated on scoring.

The document displays all severity grades of synovitis in the metacarpophalangeal joints and in each of the wrist joint areas. In addition, it maps out various severity grades of bone erosion and edema in the metacarpal head and phalangeal base and in five selected wrist joint bones (distal radius, scaphoid, lunate, capitate, and metacarpal base). For each individual grade, the atlas includes examples of both the “low” and “high” ends of the spectrum.

The collection of reference images provides a much-needed visual touchstone for MR assessment of RA, said Orrin M. Troum, M.D., of the University of Southern California, Los Angeles. “This is a positive step forward for rheumatologists. … I think ultimately we may be able to do away with x-ray.”

A number of studies have demonstrated the superior sensitivity of MRI compared with conventional radiography, particularly in identifying early disease, which is crucial to improving outcomes for patients with aggressive disease. MRI has been shown to be two to nine times more sensitive than x-rays for the detection of bone erosion.

“It's been well documented that people with RA, if identified and treated earlier, do better,” said Dr. Troum. MRI can make all the difference in the patient with aggressive RA because erosions can be visualized earlier, allowing treatment to be initiated and disease progression to be halted, which all leads to less disability later.

The advent of structure-modifying therapies gave rise to the necessity of MRI assessment in RA patients, said Charles Peterfy, M.D., a musculoskeletal radiologist and a coauthor of the atlas.

Before biologics, there was no real need to have such detailed information about joint structure because having it didn't alter the course of clinical management. The availability of agents that halt disease progression changed everything, he said.

The challenge now is to identify those patients who will go on to develop aggressive disease before severe impairment sets in.

It's estimated that “20%-40% of patients with early disease aren't going to progress,” said Dr. Peterfy, who also is chief medical officer of Synarc, a San Francisco-based company that does MR imaging for clinical trials. Treating these patients empirically with biologics would be much too expensive and would entail an unacceptable level of unnecessary toxicity.

MRI can help identify those with aggressive disease because the technique allows direct visualization and assessment of synovitis and bone edema, which is a probable precursor of bone erosion.

“In early disease, MR identifies the aggressive phenotype much more sensitively than x-ray or any other test does so far,” Dr. Peterfy said.

The MRI atlas may help rheumatologists monitor treatment, adjust dosages, or change treatment regimens altogether. “That's the way I could see MR being used in the clinic,” Dr. Peterfy said.

Core Set of Basic MRI Sequences

It is suggested that future MRI studies that intend to assess inflammatory as well as destructive changes in rheumatoid arthritis joints should include the following:

▸ Imaging in two planes* with T1 weighted images before and after intravenous gadolinium contrast.**

▸ A T2 weighted fat saturated sequence or, if the latter is not available, a STIR (short tau inversion recovery) sequence.

*Can be acquired by obtaining a two-dimensional sequence in two planes, or a three-dimensional sequence with isometric voxels in one plane allowing reconstruction in other planes.

**Intravenous gadolinium injection is probably not essential if only destructive changes (bone erosions) are considered important.

Source: Ann. Rheum. Dis. 2005;64 (suppl. 1):i8-10

BUDAPEST, HUNGARY — While infliximab therapy for the treatment of rheumatoid arthritis lowers rheumatoid factor titers, the biologic appears to have little effect on another increasingly relevant marker of disease activity: anticyclic citrullinated peptide antibodies, Nathalie Bardin, M.D., said at the 4th International Congress on Autoimmunity.

“The long-term effect of infliximab therapy leads to a reduction in rheumatoid factor titers and the induction of IgG anti-double-stranded DNA [anti-dsDNA].” Yet there was no change in anticyclic citrullinated peptide (anti-CCP) levels,” said Dr. Bardin of Hôpital de la Conception, Marseille, France.

In a study of 33 rheumatoid arthritis (RA) patients, 20 treated with infliximab (Remicade), 13 untreated, and 20 controls with undetermined arthritis, the researchers measured levels of anti-CCP, anti-dsDNA antibodies, and IgM rheumatoid factor (RF).

Anti-CCP antibodies were identified in 70% of RA patients, regardless of treatment, but only 10% of those with undetermined arthritis. RF was found in 60% of RA patients but only 10% of the controls. The frequency of RF was 55% in treated patients compared with 69% in untreated patients.

Dr. Bardin also followed 16 RA patients over 2 years of infliximab therapy. No change in anti-CCP level was found, but there was a drop in RF titers, she said. “IgG anti-dsDNA was only detected in patients treated with infliximab.” Because of its high specificity and sensitivity, anti-CCP antibody testing is increasingly seen as an important marker of disease activity in RA patients.

In a study of 54 patients with early RA, 35 patients with established RA, 33 healthy donors, and 76 patients with non-RA autoimmune diseases, researchers at the University of Florence (Italy) confirmed that the presence of anti-CCP antibodies is specific to the diagnosis of RA and is also an indicator of bone lesions (Autoimmunity 2004;37:495-501).

BUDAPEST, HUNGARY — While infliximab therapy for the treatment of rheumatoid arthritis lowers rheumatoid factor titers, the biologic appears to have little effect on another increasingly relevant marker of disease activity: anticyclic citrullinated peptide antibodies, Nathalie Bardin, M.D., said at the 4th International Congress on Autoimmunity.

“The long-term effect of infliximab therapy leads to a reduction in rheumatoid factor titers and the induction of IgG anti-double-stranded DNA [anti-dsDNA].” Yet there was no change in anticyclic citrullinated peptide (anti-CCP) levels,” said Dr. Bardin of Hôpital de la Conception, Marseille, France.

In a study of 33 rheumatoid arthritis (RA) patients, 20 treated with infliximab (Remicade), 13 untreated, and 20 controls with undetermined arthritis, the researchers measured levels of anti-CCP, anti-dsDNA antibodies, and IgM rheumatoid factor (RF).

Anti-CCP antibodies were identified in 70% of RA patients, regardless of treatment, but only 10% of those with undetermined arthritis. RF was found in 60% of RA patients but only 10% of the controls. The frequency of RF was 55% in treated patients compared with 69% in untreated patients.

Dr. Bardin also followed 16 RA patients over 2 years of infliximab therapy. No change in anti-CCP level was found, but there was a drop in RF titers, she said. “IgG anti-dsDNA was only detected in patients treated with infliximab.” Because of its high specificity and sensitivity, anti-CCP antibody testing is increasingly seen as an important marker of disease activity in RA patients.

In a study of 54 patients with early RA, 35 patients with established RA, 33 healthy donors, and 76 patients with non-RA autoimmune diseases, researchers at the University of Florence (Italy) confirmed that the presence of anti-CCP antibodies is specific to the diagnosis of RA and is also an indicator of bone lesions (Autoimmunity 2004;37:495-501).

BUDAPEST, HUNGARY — While infliximab therapy for the treatment of rheumatoid arthritis lowers rheumatoid factor titers, the biologic appears to have little effect on another increasingly relevant marker of disease activity: anticyclic citrullinated peptide antibodies, Nathalie Bardin, M.D., said at the 4th International Congress on Autoimmunity.

“The long-term effect of infliximab therapy leads to a reduction in rheumatoid factor titers and the induction of IgG anti-double-stranded DNA [anti-dsDNA].” Yet there was no change in anticyclic citrullinated peptide (anti-CCP) levels,” said Dr. Bardin of Hôpital de la Conception, Marseille, France.

In a study of 33 rheumatoid arthritis (RA) patients, 20 treated with infliximab (Remicade), 13 untreated, and 20 controls with undetermined arthritis, the researchers measured levels of anti-CCP, anti-dsDNA antibodies, and IgM rheumatoid factor (RF).

Anti-CCP antibodies were identified in 70% of RA patients, regardless of treatment, but only 10% of those with undetermined arthritis. RF was found in 60% of RA patients but only 10% of the controls. The frequency of RF was 55% in treated patients compared with 69% in untreated patients.

Dr. Bardin also followed 16 RA patients over 2 years of infliximab therapy. No change in anti-CCP level was found, but there was a drop in RF titers, she said. “IgG anti-dsDNA was only detected in patients treated with infliximab.” Because of its high specificity and sensitivity, anti-CCP antibody testing is increasingly seen as an important marker of disease activity in RA patients.

In a study of 54 patients with early RA, 35 patients with established RA, 33 healthy donors, and 76 patients with non-RA autoimmune diseases, researchers at the University of Florence (Italy) confirmed that the presence of anti-CCP antibodies is specific to the diagnosis of RA and is also an indicator of bone lesions (Autoimmunity 2004;37:495-501).

CHICAGO — Uterine artery embolization appears to have a slight edge over myomectomy in terms of recovery after treatment of uterine fibroids, according to data presented at the annual meeting of the Radiological Society of North America.

Uterine artery embolization (UAE) was “superior in terms of adverse events, time off from work, time until the resumption of normal activities, and hospital stay,” said Scott C. Goodwin, M.D., chief of imaging services at Greater Los Angeles Veterans Affairs Medical Center. UAE was superior for hospital stay, time off, and time to resume activities by a roughly three to one margin.

In the prospective study, 149 patients underwent UAE and 60 underwent myomectomy. Embolization was performed with Contour PVA particles.

Patients were included in the study if they were older than 30 years and had symptomatic fibroids. Women in the UAE group did not desire to become pregnant. The researchers collected overall and fibroid-specific quality of life scores (QOLs) before the procedures were undertaken.

Women in the UAE group were older, more likely to have been previously pregnant, and to have had longer periods than those in the myomectomy group. Myomectomy patients were more likely to have a miscellaneous pelvic abnormality or a tubal ligation and to have had more fibroids than UAE patients.

“In terms of the QOLs, we did not find an overall difference [between the two groups], though if you look specifically at the 36-40 age group, there were some differences in terms of sleep, mental health, and restricted activity in favor of the UAE group,” Dr. Goodwin said. There was also no significant difference in terms of reduction of uterine volume or in bleeding score reduction.

Though the major efficacy outcomes were similar between the two groups, the study was not powered sufficiently to determine whether there were actually any statistically significant differences between groups in terms of efficacy, Dr. Goodwin said.

The adverse event rate (UTI and vaginal discharge, among others) in the UAE group was 22%, compared with 40% in the myomectomy group (UTI, hemorrhage, and others).

The major adverse event rate was 4% in the UAE group, compared with 1.7% in the myomectomy group. Major adverse events included significant postembolization syndrome—described as flu-like symptoms—enlargement of a multicystic adnexal mass, excessive vaginal discharge, and a ruptured appendix (not related to the procedure).

Due to study design, among the women in the UAE group, 19% were considered failures (including 4 patients who withdrew consent, 10 who were lost to follow-up, and 8 who failed to meet QOL criteria, among others). In comparison, the failure rate was 25% in the myomectomy group (including five patients who failed to meet QOL criteria, one patient requiring a hysterectomy, and three patients who were lost to follow-up, among others).

Despite the findings, not all women are good candidates for UAE. Dr. Goodwin does not recommend that women undergo the procedure if they are not symptomatic. Instead, he advises them to watch and wait, he said.

Fertility is also a consideration. There is some risk of premature ovarian failure following embolization, though this varies with age. He estimated that a woman under 35 years has very little chance of this occurring, while a woman under 40 has a roughly 1% chance. Over the age of 50 the risk goes up to 30%-40%.

UAE is also contraindicated in women with a severe allergy to the contrast dye used in imaging and those with poor renal function.

The uterine artery is shown before embolization.

Fibroids can't be seen in the angiogram after embolization. Photos courtesy Dr. Scott C. Goodwin

CHICAGO — Uterine artery embolization appears to have a slight edge over myomectomy in terms of recovery after treatment of uterine fibroids, according to data presented at the annual meeting of the Radiological Society of North America.

Uterine artery embolization (UAE) was “superior in terms of adverse events, time off from work, time until the resumption of normal activities, and hospital stay,” said Scott C. Goodwin, M.D., chief of imaging services at Greater Los Angeles Veterans Affairs Medical Center. UAE was superior for hospital stay, time off, and time to resume activities by a roughly three to one margin.

In the prospective study, 149 patients underwent UAE and 60 underwent myomectomy. Embolization was performed with Contour PVA particles.

Patients were included in the study if they were older than 30 years and had symptomatic fibroids. Women in the UAE group did not desire to become pregnant. The researchers collected overall and fibroid-specific quality of life scores (QOLs) before the procedures were undertaken.

Women in the UAE group were older, more likely to have been previously pregnant, and to have had longer periods than those in the myomectomy group. Myomectomy patients were more likely to have a miscellaneous pelvic abnormality or a tubal ligation and to have had more fibroids than UAE patients.

“In terms of the QOLs, we did not find an overall difference [between the two groups], though if you look specifically at the 36-40 age group, there were some differences in terms of sleep, mental health, and restricted activity in favor of the UAE group,” Dr. Goodwin said. There was also no significant difference in terms of reduction of uterine volume or in bleeding score reduction.

Though the major efficacy outcomes were similar between the two groups, the study was not powered sufficiently to determine whether there were actually any statistically significant differences between groups in terms of efficacy, Dr. Goodwin said.

The adverse event rate (UTI and vaginal discharge, among others) in the UAE group was 22%, compared with 40% in the myomectomy group (UTI, hemorrhage, and others).

The major adverse event rate was 4% in the UAE group, compared with 1.7% in the myomectomy group. Major adverse events included significant postembolization syndrome—described as flu-like symptoms—enlargement of a multicystic adnexal mass, excessive vaginal discharge, and a ruptured appendix (not related to the procedure).

Due to study design, among the women in the UAE group, 19% were considered failures (including 4 patients who withdrew consent, 10 who were lost to follow-up, and 8 who failed to meet QOL criteria, among others). In comparison, the failure rate was 25% in the myomectomy group (including five patients who failed to meet QOL criteria, one patient requiring a hysterectomy, and three patients who were lost to follow-up, among others).

Despite the findings, not all women are good candidates for UAE. Dr. Goodwin does not recommend that women undergo the procedure if they are not symptomatic. Instead, he advises them to watch and wait, he said.

Fertility is also a consideration. There is some risk of premature ovarian failure following embolization, though this varies with age. He estimated that a woman under 35 years has very little chance of this occurring, while a woman under 40 has a roughly 1% chance. Over the age of 50 the risk goes up to 30%-40%.

UAE is also contraindicated in women with a severe allergy to the contrast dye used in imaging and those with poor renal function.

The uterine artery is shown before embolization.

Fibroids can't be seen in the angiogram after embolization. Photos courtesy Dr. Scott C. Goodwin

CHICAGO — Uterine artery embolization appears to have a slight edge over myomectomy in terms of recovery after treatment of uterine fibroids, according to data presented at the annual meeting of the Radiological Society of North America.

Uterine artery embolization (UAE) was “superior in terms of adverse events, time off from work, time until the resumption of normal activities, and hospital stay,” said Scott C. Goodwin, M.D., chief of imaging services at Greater Los Angeles Veterans Affairs Medical Center. UAE was superior for hospital stay, time off, and time to resume activities by a roughly three to one margin.

In the prospective study, 149 patients underwent UAE and 60 underwent myomectomy. Embolization was performed with Contour PVA particles.

Patients were included in the study if they were older than 30 years and had symptomatic fibroids. Women in the UAE group did not desire to become pregnant. The researchers collected overall and fibroid-specific quality of life scores (QOLs) before the procedures were undertaken.

Women in the UAE group were older, more likely to have been previously pregnant, and to have had longer periods than those in the myomectomy group. Myomectomy patients were more likely to have a miscellaneous pelvic abnormality or a tubal ligation and to have had more fibroids than UAE patients.

“In terms of the QOLs, we did not find an overall difference [between the two groups], though if you look specifically at the 36-40 age group, there were some differences in terms of sleep, mental health, and restricted activity in favor of the UAE group,” Dr. Goodwin said. There was also no significant difference in terms of reduction of uterine volume or in bleeding score reduction.

Though the major efficacy outcomes were similar between the two groups, the study was not powered sufficiently to determine whether there were actually any statistically significant differences between groups in terms of efficacy, Dr. Goodwin said.

The adverse event rate (UTI and vaginal discharge, among others) in the UAE group was 22%, compared with 40% in the myomectomy group (UTI, hemorrhage, and others).

The major adverse event rate was 4% in the UAE group, compared with 1.7% in the myomectomy group. Major adverse events included significant postembolization syndrome—described as flu-like symptoms—enlargement of a multicystic adnexal mass, excessive vaginal discharge, and a ruptured appendix (not related to the procedure).

Due to study design, among the women in the UAE group, 19% were considered failures (including 4 patients who withdrew consent, 10 who were lost to follow-up, and 8 who failed to meet QOL criteria, among others). In comparison, the failure rate was 25% in the myomectomy group (including five patients who failed to meet QOL criteria, one patient requiring a hysterectomy, and three patients who were lost to follow-up, among others).

Despite the findings, not all women are good candidates for UAE. Dr. Goodwin does not recommend that women undergo the procedure if they are not symptomatic. Instead, he advises them to watch and wait, he said.

Fertility is also a consideration. There is some risk of premature ovarian failure following embolization, though this varies with age. He estimated that a woman under 35 years has very little chance of this occurring, while a woman under 40 has a roughly 1% chance. Over the age of 50 the risk goes up to 30%-40%.

UAE is also contraindicated in women with a severe allergy to the contrast dye used in imaging and those with poor renal function.

The uterine artery is shown before embolization.

Fibroids can't be seen in the angiogram after embolization. Photos courtesy Dr. Scott C. Goodwin

WASHINGTON — It is important to balance risks with benefits when considering a selective serotonin reuptake inhibitor to treat a child or adolescent, several experts said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Among other things, session participants discussed the Food and Drug Administration's requirement of a black box warning alerting prescribers and patients to the risk of suicidal behavior with antidepressants in children and adolescents.

“I think this is very important. This is not a contraindication. This [warning] box is not telling clinicians that they can't use these drugs. What it's saying is that if a clinician is considering using an antidepressant in a child or adolescent, they need to consider the risk and balance that against the clinical need,” said Thomas Laughren, M.D., of the FDA's division of neuropharmacological drug products, Rockville, Md.

Selective serotonin reuptake inhibitors (SSRIs) do appear to work better than placebo in the short-term therapy of depression in children and adolescents, said Neal Ryan, M.D., of the Western Psychiatric Institute and Clinic in Pittsburgh. This is probably true in general, though fluoxetine is the only one with an indication for children.

Combining an SSRI with cognitive-behavioral therapy (CBT) might even be more effective, according to recent findings. In the Treatment for Adolescents with Depression Study (TADS), SSRIs combined with CBT showed the best results for treating depression. The results also suggested that pharmacotherapy is more effective than psychotherapy alone, but this finding needs to be duplicated in other studies, Dr. Ryan said.

For clinicians, the real problem is how to balance the increased short-term risk—an extra 2 per 100 patients who will either attempt suicide or exhibit suicidality because of the use of an SSRI—and the potentially decreased long-term risk of suicidal thoughts and behavior attributable to depression, Dr. Ryan said.

Clinicians are left with the dilemma of what to do about the next depressed child to come into the office: Pick an SSRI alone, choose psychotherapy alone, or combine an SSRI with psychotherapy. “I think we're going to have a rich debate on that,” he said.

When considering an SSRI in a pediatric patient, it's important to inform the family of potential risks and benefits and follow the FDA's monitoring suggestions. “I think also that we need to advocate for more studies. I think we're all scared that we won't get any more data on this question,” he said.

Mark Olfson, M.D., of Columbia University, New York, is not optimistic about the prospects for this type of research: “For the foreseeable future, I believe the pharmaceutical industry is going to view this whole area as radioactive and stay away from it.”

Future research should focus on which subgroups of patients are at higher risk and when in the course of treatment. One strategy would be to monitor depressed children closely for short periods of SSRI therapy, looking for somatic subjective dysphoria, changes in attention, changes in impulsivity, or other indicators of suicidality, Dr. Olfson said.

Dr. Ryan said that he sees a need for longer-term studies.

The long-term effects of the treatment of depression have not been studied. It may be that effective drug therapy for depression may decrease the long-term risk of suicide, but there is no clear evidence yet, he said.

It's also important to look at the bigger public health picture, Dr. Olfson said. “We need to be clear about the distinct-ions between suicidal ideation and the suicide attempts that were the subject of the randomized controlled trials analyses and actual suicide or serial suicide attempts that we encounter in practice.”

The rates of suicidal ideation and suicide attempts in a normal adolescent population also need to be considered. According to the Centers for Disease Control and Prevention's 2003 National Youth Risk Behavior Survey, 16.9% of normal adolescents in grades 9-12 had seriously considered attempting suicide in the previous 12 months and 8.5% had attempted suicide at least once in that time period, he noted.

“Those numbers stand in very sharp contrast to the comparatively small number of kids who show up in our emergency rooms and hospitals following actual suicide attempts,” Dr. Olfson said. “It's my own belief—that, in fact, the recent increase in the use of these medications in kids has actually saved lives.”

WASHINGTON — It is important to balance risks with benefits when considering a selective serotonin reuptake inhibitor to treat a child or adolescent, several experts said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Among other things, session participants discussed the Food and Drug Administration's requirement of a black box warning alerting prescribers and patients to the risk of suicidal behavior with antidepressants in children and adolescents.

“I think this is very important. This is not a contraindication. This [warning] box is not telling clinicians that they can't use these drugs. What it's saying is that if a clinician is considering using an antidepressant in a child or adolescent, they need to consider the risk and balance that against the clinical need,” said Thomas Laughren, M.D., of the FDA's division of neuropharmacological drug products, Rockville, Md.

Selective serotonin reuptake inhibitors (SSRIs) do appear to work better than placebo in the short-term therapy of depression in children and adolescents, said Neal Ryan, M.D., of the Western Psychiatric Institute and Clinic in Pittsburgh. This is probably true in general, though fluoxetine is the only one with an indication for children.

Combining an SSRI with cognitive-behavioral therapy (CBT) might even be more effective, according to recent findings. In the Treatment for Adolescents with Depression Study (TADS), SSRIs combined with CBT showed the best results for treating depression. The results also suggested that pharmacotherapy is more effective than psychotherapy alone, but this finding needs to be duplicated in other studies, Dr. Ryan said.

For clinicians, the real problem is how to balance the increased short-term risk—an extra 2 per 100 patients who will either attempt suicide or exhibit suicidality because of the use of an SSRI—and the potentially decreased long-term risk of suicidal thoughts and behavior attributable to depression, Dr. Ryan said.

Clinicians are left with the dilemma of what to do about the next depressed child to come into the office: Pick an SSRI alone, choose psychotherapy alone, or combine an SSRI with psychotherapy. “I think we're going to have a rich debate on that,” he said.

When considering an SSRI in a pediatric patient, it's important to inform the family of potential risks and benefits and follow the FDA's monitoring suggestions. “I think also that we need to advocate for more studies. I think we're all scared that we won't get any more data on this question,” he said.

Mark Olfson, M.D., of Columbia University, New York, is not optimistic about the prospects for this type of research: “For the foreseeable future, I believe the pharmaceutical industry is going to view this whole area as radioactive and stay away from it.”

Future research should focus on which subgroups of patients are at higher risk and when in the course of treatment. One strategy would be to monitor depressed children closely for short periods of SSRI therapy, looking for somatic subjective dysphoria, changes in attention, changes in impulsivity, or other indicators of suicidality, Dr. Olfson said.

Dr. Ryan said that he sees a need for longer-term studies.

The long-term effects of the treatment of depression have not been studied. It may be that effective drug therapy for depression may decrease the long-term risk of suicide, but there is no clear evidence yet, he said.

It's also important to look at the bigger public health picture, Dr. Olfson said. “We need to be clear about the distinct-ions between suicidal ideation and the suicide attempts that were the subject of the randomized controlled trials analyses and actual suicide or serial suicide attempts that we encounter in practice.”

The rates of suicidal ideation and suicide attempts in a normal adolescent population also need to be considered. According to the Centers for Disease Control and Prevention's 2003 National Youth Risk Behavior Survey, 16.9% of normal adolescents in grades 9-12 had seriously considered attempting suicide in the previous 12 months and 8.5% had attempted suicide at least once in that time period, he noted.

“Those numbers stand in very sharp contrast to the comparatively small number of kids who show up in our emergency rooms and hospitals following actual suicide attempts,” Dr. Olfson said. “It's my own belief—that, in fact, the recent increase in the use of these medications in kids has actually saved lives.”

WASHINGTON — It is important to balance risks with benefits when considering a selective serotonin reuptake inhibitor to treat a child or adolescent, several experts said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Among other things, session participants discussed the Food and Drug Administration's requirement of a black box warning alerting prescribers and patients to the risk of suicidal behavior with antidepressants in children and adolescents.

“I think this is very important. This is not a contraindication. This [warning] box is not telling clinicians that they can't use these drugs. What it's saying is that if a clinician is considering using an antidepressant in a child or adolescent, they need to consider the risk and balance that against the clinical need,” said Thomas Laughren, M.D., of the FDA's division of neuropharmacological drug products, Rockville, Md.

Selective serotonin reuptake inhibitors (SSRIs) do appear to work better than placebo in the short-term therapy of depression in children and adolescents, said Neal Ryan, M.D., of the Western Psychiatric Institute and Clinic in Pittsburgh. This is probably true in general, though fluoxetine is the only one with an indication for children.

Combining an SSRI with cognitive-behavioral therapy (CBT) might even be more effective, according to recent findings. In the Treatment for Adolescents with Depression Study (TADS), SSRIs combined with CBT showed the best results for treating depression. The results also suggested that pharmacotherapy is more effective than psychotherapy alone, but this finding needs to be duplicated in other studies, Dr. Ryan said.

For clinicians, the real problem is how to balance the increased short-term risk—an extra 2 per 100 patients who will either attempt suicide or exhibit suicidality because of the use of an SSRI—and the potentially decreased long-term risk of suicidal thoughts and behavior attributable to depression, Dr. Ryan said.

Clinicians are left with the dilemma of what to do about the next depressed child to come into the office: Pick an SSRI alone, choose psychotherapy alone, or combine an SSRI with psychotherapy. “I think we're going to have a rich debate on that,” he said.

When considering an SSRI in a pediatric patient, it's important to inform the family of potential risks and benefits and follow the FDA's monitoring suggestions. “I think also that we need to advocate for more studies. I think we're all scared that we won't get any more data on this question,” he said.

Mark Olfson, M.D., of Columbia University, New York, is not optimistic about the prospects for this type of research: “For the foreseeable future, I believe the pharmaceutical industry is going to view this whole area as radioactive and stay away from it.”

Future research should focus on which subgroups of patients are at higher risk and when in the course of treatment. One strategy would be to monitor depressed children closely for short periods of SSRI therapy, looking for somatic subjective dysphoria, changes in attention, changes in impulsivity, or other indicators of suicidality, Dr. Olfson said.

Dr. Ryan said that he sees a need for longer-term studies.

The long-term effects of the treatment of depression have not been studied. It may be that effective drug therapy for depression may decrease the long-term risk of suicide, but there is no clear evidence yet, he said.

It's also important to look at the bigger public health picture, Dr. Olfson said. “We need to be clear about the distinct-ions between suicidal ideation and the suicide attempts that were the subject of the randomized controlled trials analyses and actual suicide or serial suicide attempts that we encounter in practice.”

The rates of suicidal ideation and suicide attempts in a normal adolescent population also need to be considered. According to the Centers for Disease Control and Prevention's 2003 National Youth Risk Behavior Survey, 16.9% of normal adolescents in grades 9-12 had seriously considered attempting suicide in the previous 12 months and 8.5% had attempted suicide at least once in that time period, he noted.

“Those numbers stand in very sharp contrast to the comparatively small number of kids who show up in our emergency rooms and hospitals following actual suicide attempts,” Dr. Olfson said. “It's my own belief—that, in fact, the recent increase in the use of these medications in kids has actually saved lives.”

The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years, who are or have been smokers, undergo a one-time ultrasound screening for abdominal aortic aneurysm.

The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.

“This is an important recommendation because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently or have been regular smokers are at the highest risk for AAA, according to the task force.

The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concludes that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).

The task force last reviewed the topic in 1996 and concluded at that time that there was insufficient evidence to screen for such aneurysms.

The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which causes approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.

The condition is less likely to occur in people who have never smoked, and the preventive services task force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).

The USPSTF is also recommending that women not be screened for AAA (grade D). Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years. The USPSTF found no evidence of benefit from routine screening for AAA in all women and concluded that potential harms from screening—mortality and complications of surgery—outweighed potential benefits.

The Agency for Healthcare Research and Quality is sponsoring an evidence review of endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and harms of endovascular repair of AAA are not known.

The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years, who are or have been smokers, undergo a one-time ultrasound screening for abdominal aortic aneurysm.

The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.

“This is an important recommendation because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently or have been regular smokers are at the highest risk for AAA, according to the task force.

The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concludes that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).

The task force last reviewed the topic in 1996 and concluded at that time that there was insufficient evidence to screen for such aneurysms.

The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which causes approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.

The condition is less likely to occur in people who have never smoked, and the preventive services task force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).

The USPSTF is also recommending that women not be screened for AAA (grade D). Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years. The USPSTF found no evidence of benefit from routine screening for AAA in all women and concluded that potential harms from screening—mortality and complications of surgery—outweighed potential benefits.

The Agency for Healthcare Research and Quality is sponsoring an evidence review of endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and harms of endovascular repair of AAA are not known.

The U.S. Preventive Services Task Force is recommending that men between the ages of 65 and 75 years, who are or have been smokers, undergo a one-time ultrasound screening for abdominal aortic aneurysm.

The recommendation is based on new evidence that has shown that screening and surgery to repair large abdominal aortic aneurysms (AAAs) are effective at reducing the number of deaths in men as a result of this condition. Between 59% and 83% of patients with a ruptured AAA die before reaching the hospital and undergoing surgery, according to estimates.

“This is an important recommendation because evidence now exists that screening high-risk men for abdominal aortic aneurysms can reduce deaths from aneurysm,” task force chair Ned Calonge, M.D., said in a statement. Men 65 years and older who are currently or have been regular smokers are at the highest risk for AAA, according to the task force.

The recommendation is grade B, meaning that the task force found at least fair evidence that screening improves important health outcomes and concludes that benefits outweigh harms (Ann. Intern. Med. 2005;142:198-202).

The task force last reviewed the topic in 1996 and concluded at that time that there was insufficient evidence to screen for such aneurysms.

The task force noted that there is evidence that surgery to repair the aorta in people with an aortic diameter of at least 5.5 cm reduces the number of deaths caused by AAA, which causes approximately 9,000 deaths each year in this country. However, the number may be underestimated because most people with AAA die before reaching a hospital and their deaths may be attributed to other causes.

The condition is less likely to occur in people who have never smoked, and the preventive services task force found that screening these patients for AAA would have little net benefit. Therefore the task force made no recommendation either for or against routine screening for this condition in men between 65 and 75 years who have never smoked (grade C).

The USPSTF is also recommending that women not be screened for AAA (grade D). Death from an aneurysm is rare in women, and most of these deaths occur in women older than 80 years. The USPSTF found no evidence of benefit from routine screening for AAA in all women and concluded that potential harms from screening—mortality and complications of surgery—outweighed potential benefits.

The Agency for Healthcare Research and Quality is sponsoring an evidence review of endovascular repair of AAA that is expected to be published next year. The technique has been shown to have short-term benefits, compared with open surgical repair. The long-term effectiveness and harms of endovascular repair of AAA are not known.

BUDAPEST, HUNGARY – Autoimmune striatal dysfunction may be the underlying cause of dementia-like presentations, in rare cases.

This was the case for a 48-year-old woman, who presented with a 1-year history of progressive difficulties with attention and memory, said Gabriel C. Léger, M.D., speaking at the 4th International Congress on Autoimmunity.

Her husband complained that there had been a profound change in her personality. In particular, he found her to have become uninhibited and exhaustingly hypersexual. She had progressive difficulties functioning at home and at work–finally losing her job.

Her medical history included an episode of self-limiting, ballistic-like movements of the right side of her body during her early 20s. Exhaustive testing turned up no cause. The condition resolved spontaneously after a few months. She had no history of rheumatic fever or childhood chorea. However, at the age of 17 years her mother had Sydenham's chorea, which lasted about 1 year.

Cognitive testing also revealed attention and memory (acquisition) deficits. In addition, the patient displayed frontal network dysfunction, which psychologic testing confirmed.

Her physical exam was unremarkable, except for some mild psychomotor activity of the right hand and right side of the face. The usual battery of tests was unrevealing, as were infectious and autoimmune serologies, said Dr. Léger, a neurologist at the University of Montreal.

The clinicians initially diagnosed frontotemporal dementia, but “the presence of a very mild focal examination bothered us just a little bit,” said Dr. Léger. An FDG-PET scan revealed a dramatic increase in metabolism in the left striatum–70% more metabolic activity than in the right striatum.

Hypermetabolic lesions have traditionally been associated with diseases of autoimmunity, Dr. Léger noted. They treated her with a 3-day course of pulsed methylprednisolone sodium succinate, followed by a 2-week prednisone taper period.

Within weeks, she noted a resolution of her attention deficits. FDG-PET imaging demonstrated a fairly substantial resolution of the asymmetry of the striatum.

Based on the suspicion that autoimmunity against the basal ganglia was involved, the researchers sent pre- and post-therapy plasma to the laboratory for analysis. High titers of antibodies to the striatum–the antibodies found in Sydenham's chorea–were found in the pretreatment sample and reduced titers were found in the post-treatment sample.

Unlike this case, previous studies involving hypermetabolic lesions have also involved previously diagnosed disorders, such as Sydenham's chorea, Dr. Léger said.

BUDAPEST, HUNGARY – Autoimmune striatal dysfunction may be the underlying cause of dementia-like presentations, in rare cases.

This was the case for a 48-year-old woman, who presented with a 1-year history of progressive difficulties with attention and memory, said Gabriel C. Léger, M.D., speaking at the 4th International Congress on Autoimmunity.

Her husband complained that there had been a profound change in her personality. In particular, he found her to have become uninhibited and exhaustingly hypersexual. She had progressive difficulties functioning at home and at work–finally losing her job.

Her medical history included an episode of self-limiting, ballistic-like movements of the right side of her body during her early 20s. Exhaustive testing turned up no cause. The condition resolved spontaneously after a few months. She had no history of rheumatic fever or childhood chorea. However, at the age of 17 years her mother had Sydenham's chorea, which lasted about 1 year.

Cognitive testing also revealed attention and memory (acquisition) deficits. In addition, the patient displayed frontal network dysfunction, which psychologic testing confirmed.

Her physical exam was unremarkable, except for some mild psychomotor activity of the right hand and right side of the face. The usual battery of tests was unrevealing, as were infectious and autoimmune serologies, said Dr. Léger, a neurologist at the University of Montreal.

The clinicians initially diagnosed frontotemporal dementia, but “the presence of a very mild focal examination bothered us just a little bit,” said Dr. Léger. An FDG-PET scan revealed a dramatic increase in metabolism in the left striatum–70% more metabolic activity than in the right striatum.

Hypermetabolic lesions have traditionally been associated with diseases of autoimmunity, Dr. Léger noted. They treated her with a 3-day course of pulsed methylprednisolone sodium succinate, followed by a 2-week prednisone taper period.

Within weeks, she noted a resolution of her attention deficits. FDG-PET imaging demonstrated a fairly substantial resolution of the asymmetry of the striatum.

Based on the suspicion that autoimmunity against the basal ganglia was involved, the researchers sent pre- and post-therapy plasma to the laboratory for analysis. High titers of antibodies to the striatum–the antibodies found in Sydenham's chorea–were found in the pretreatment sample and reduced titers were found in the post-treatment sample.

Unlike this case, previous studies involving hypermetabolic lesions have also involved previously diagnosed disorders, such as Sydenham's chorea, Dr. Léger said.

BUDAPEST, HUNGARY – Autoimmune striatal dysfunction may be the underlying cause of dementia-like presentations, in rare cases.

This was the case for a 48-year-old woman, who presented with a 1-year history of progressive difficulties with attention and memory, said Gabriel C. Léger, M.D., speaking at the 4th International Congress on Autoimmunity.

Her husband complained that there had been a profound change in her personality. In particular, he found her to have become uninhibited and exhaustingly hypersexual. She had progressive difficulties functioning at home and at work–finally losing her job.

Her medical history included an episode of self-limiting, ballistic-like movements of the right side of her body during her early 20s. Exhaustive testing turned up no cause. The condition resolved spontaneously after a few months. She had no history of rheumatic fever or childhood chorea. However, at the age of 17 years her mother had Sydenham's chorea, which lasted about 1 year.

Cognitive testing also revealed attention and memory (acquisition) deficits. In addition, the patient displayed frontal network dysfunction, which psychologic testing confirmed.

Her physical exam was unremarkable, except for some mild psychomotor activity of the right hand and right side of the face. The usual battery of tests was unrevealing, as were infectious and autoimmune serologies, said Dr. Léger, a neurologist at the University of Montreal.

The clinicians initially diagnosed frontotemporal dementia, but “the presence of a very mild focal examination bothered us just a little bit,” said Dr. Léger. An FDG-PET scan revealed a dramatic increase in metabolism in the left striatum–70% more metabolic activity than in the right striatum.

Hypermetabolic lesions have traditionally been associated with diseases of autoimmunity, Dr. Léger noted. They treated her with a 3-day course of pulsed methylprednisolone sodium succinate, followed by a 2-week prednisone taper period.

Within weeks, she noted a resolution of her attention deficits. FDG-PET imaging demonstrated a fairly substantial resolution of the asymmetry of the striatum.

Based on the suspicion that autoimmunity against the basal ganglia was involved, the researchers sent pre- and post-therapy plasma to the laboratory for analysis. High titers of antibodies to the striatum–the antibodies found in Sydenham's chorea–were found in the pretreatment sample and reduced titers were found in the post-treatment sample.

Unlike this case, previous studies involving hypermetabolic lesions have also involved previously diagnosed disorders, such as Sydenham's chorea, Dr. Léger said.

WASHINGTON – Higher intake of n-3 fatty acids may have a protective effect against cognitive impairment, according to data presented at the annual meeting of the Gerontological Society of America.

In a study of almost 1,000 people aged 65 and older, those with dementia had significantly lower plasma levels of n-3 fatty acids, said Antonio Cherubini, M.D., of the Institute of Gerontology and Geriatrics in Perugia, Italy.

The n-3 fatty acids are an important component of the neuronal membrane, influencing membrane fluidity and all the related functions, such as signal transduction and enzyme function. Fish–particularly fatty fish, such as mackerel and albacore tuna–are the primary source of n-3 fatty acids.

Dr. Cherubini presented data from the Aging in Chianti (InCHIANTI) study, a population-based trial conducted between 1998 and 2000 in the Chianti region of Italy.

The 935 volunteers were categorized as having normal cognition (725 subjects), cognitive impairment without meeting criteria for dementia (153 subjects), or dementia (57 subjects). Cognitive function was screened using the Mini-Mental State Examination. The subjects with age- and education-unadjusted scores lower than 26 on the examination underwent more detailed tests.

The diagnosis of dementia was made according to DSM-IV criteria. Plasma fatty acid levels were determined using gas chromatography.

Subjects with dementia had the lowest n-3 fatty acid plasma concentrations–as a percentage of total fatty acid plasma concentrations in mg/L–with a mean of 2.7%, compared with 3.0% for the cognitively impaired group and 3.2% for the normal cognition group.

Subjects with dementia had the highest plasma concentrations of saturated fatty acids–as a percentage of total fatty acid plasma concentrations in mg/L–with a mean of 31.4%, compared with 30.1% for the cognitive impairment group and 30.3% for the normal cognition group.

“Subjects in the second group–those who have cognitive impairment but not dementia–tended to have intermediate values in many of the fatty acids,” Dr. Cherubini said.

The finding of lower n-3 fatty acid plasma concentrations in subjects with dementia persisted even after adjusting for age, gender, education, smoking status, cholesterol and triacylglycerol levels, alcohol, fatty acid and total energy daily intakes, and total plasma levels of fatty acids.

The difference between normal subjects and those with mild cognitive impairment was no longer significant after adjustment, he said.

Previous studies have examined the relationship between n-3 fatty acid consumption and the development of dementia, but the results have been conflicting. This may be because the studies involved small sample sizes and relied on only one indicator of n-3 fatty acid status–intake or blood concentration–Dr. Cherubini said.

WASHINGTON – Higher intake of n-3 fatty acids may have a protective effect against cognitive impairment, according to data presented at the annual meeting of the Gerontological Society of America.

In a study of almost 1,000 people aged 65 and older, those with dementia had significantly lower plasma levels of n-3 fatty acids, said Antonio Cherubini, M.D., of the Institute of Gerontology and Geriatrics in Perugia, Italy.

The n-3 fatty acids are an important component of the neuronal membrane, influencing membrane fluidity and all the related functions, such as signal transduction and enzyme function. Fish–particularly fatty fish, such as mackerel and albacore tuna–are the primary source of n-3 fatty acids.

Dr. Cherubini presented data from the Aging in Chianti (InCHIANTI) study, a population-based trial conducted between 1998 and 2000 in the Chianti region of Italy.

The 935 volunteers were categorized as having normal cognition (725 subjects), cognitive impairment without meeting criteria for dementia (153 subjects), or dementia (57 subjects). Cognitive function was screened using the Mini-Mental State Examination. The subjects with age- and education-unadjusted scores lower than 26 on the examination underwent more detailed tests.

The diagnosis of dementia was made according to DSM-IV criteria. Plasma fatty acid levels were determined using gas chromatography.

Subjects with dementia had the lowest n-3 fatty acid plasma concentrations–as a percentage of total fatty acid plasma concentrations in mg/L–with a mean of 2.7%, compared with 3.0% for the cognitively impaired group and 3.2% for the normal cognition group.

Subjects with dementia had the highest plasma concentrations of saturated fatty acids–as a percentage of total fatty acid plasma concentrations in mg/L–with a mean of 31.4%, compared with 30.1% for the cognitive impairment group and 30.3% for the normal cognition group.

“Subjects in the second group–those who have cognitive impairment but not dementia–tended to have intermediate values in many of the fatty acids,” Dr. Cherubini said.

The finding of lower n-3 fatty acid plasma concentrations in subjects with dementia persisted even after adjusting for age, gender, education, smoking status, cholesterol and triacylglycerol levels, alcohol, fatty acid and total energy daily intakes, and total plasma levels of fatty acids.

The difference between normal subjects and those with mild cognitive impairment was no longer significant after adjustment, he said.

Previous studies have examined the relationship between n-3 fatty acid consumption and the development of dementia, but the results have been conflicting. This may be because the studies involved small sample sizes and relied on only one indicator of n-3 fatty acid status–intake or blood concentration–Dr. Cherubini said.

WASHINGTON – Higher intake of n-3 fatty acids may have a protective effect against cognitive impairment, according to data presented at the annual meeting of the Gerontological Society of America.

In a study of almost 1,000 people aged 65 and older, those with dementia had significantly lower plasma levels of n-3 fatty acids, said Antonio Cherubini, M.D., of the Institute of Gerontology and Geriatrics in Perugia, Italy.

The n-3 fatty acids are an important component of the neuronal membrane, influencing membrane fluidity and all the related functions, such as signal transduction and enzyme function. Fish–particularly fatty fish, such as mackerel and albacore tuna–are the primary source of n-3 fatty acids.

Dr. Cherubini presented data from the Aging in Chianti (InCHIANTI) study, a population-based trial conducted between 1998 and 2000 in the Chianti region of Italy.

The 935 volunteers were categorized as having normal cognition (725 subjects), cognitive impairment without meeting criteria for dementia (153 subjects), or dementia (57 subjects). Cognitive function was screened using the Mini-Mental State Examination. The subjects with age- and education-unadjusted scores lower than 26 on the examination underwent more detailed tests.

The diagnosis of dementia was made according to DSM-IV criteria. Plasma fatty acid levels were determined using gas chromatography.

Subjects with dementia had the lowest n-3 fatty acid plasma concentrations–as a percentage of total fatty acid plasma concentrations in mg/L–with a mean of 2.7%, compared with 3.0% for the cognitively impaired group and 3.2% for the normal cognition group.

Subjects with dementia had the highest plasma concentrations of saturated fatty acids–as a percentage of total fatty acid plasma concentrations in mg/L–with a mean of 31.4%, compared with 30.1% for the cognitive impairment group and 30.3% for the normal cognition group.

“Subjects in the second group–those who have cognitive impairment but not dementia–tended to have intermediate values in many of the fatty acids,” Dr. Cherubini said.

The finding of lower n-3 fatty acid plasma concentrations in subjects with dementia persisted even after adjusting for age, gender, education, smoking status, cholesterol and triacylglycerol levels, alcohol, fatty acid and total energy daily intakes, and total plasma levels of fatty acids.

The difference between normal subjects and those with mild cognitive impairment was no longer significant after adjustment, he said.

Previous studies have examined the relationship between n-3 fatty acid consumption and the development of dementia, but the results have been conflicting. This may be because the studies involved small sample sizes and relied on only one indicator of n-3 fatty acid status–intake or blood concentration–Dr. Cherubini said.

WASHINGTON – Comorbid psychiatric conditions appear to be very common among children with medically refractory epilepsy, Jay A. Salpekar, M.D., said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

In a study of 24 children (16 boys and 8 girls) recommended for epilepsy surgery, 22 were diagnosed with at least one psychiatric disorder, said Dr. Salpekar of Children's National Medical Center in Washington. Seven children were diagnosed with two or more psychiatric disorders

The patients ranged in age from 6 to 17 years and had an average IQ greater than 70. After undergoing clinical psychiatric evaluations, 12 children were diagnosed with anxiety disorders, 11 with attention deficit hyperactivity disorder, and 7 with mood disorders.

Parents completed the Child Behavior Checklist (CBCL) for their children, and 19 children had at least one CBCL subcategory T score above 65–1.5 standard deviations above normal. The most common problems were in the somatic, social, and attention subcategories. Thirteen children had at least one T score above 70–2 standard deviations above normal. The most common problems for these children were also in the somatic, social, and attention subcategories.

The 14 children with temporal lobe foci appeared to have more psychiatric problems than the 10 children with extratemporal foci. Among the children with temporal lobe foci, six were diagnosed with anxiety, eight with ADHD, and five with mood disorders. Each of these children averaged about two CBCL subcategory T scores greater than 65, and those with extratemporal lobe foci averaged one CBCL subcategory T score greater than 65, Dr. Salpekar reported.

Children with extratemporal lobe epilepsy also had fewer clinical psychiatric diagnoses. “There is something, not only about chronic epilepsy, but about temporal lobe chronic epilepsy” in particular, that leads to greater psychiatric comorbidity, he said.

WASHINGTON – Comorbid psychiatric conditions appear to be very common among children with medically refractory epilepsy, Jay A. Salpekar, M.D., said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

In a study of 24 children (16 boys and 8 girls) recommended for epilepsy surgery, 22 were diagnosed with at least one psychiatric disorder, said Dr. Salpekar of Children's National Medical Center in Washington. Seven children were diagnosed with two or more psychiatric disorders

The patients ranged in age from 6 to 17 years and had an average IQ greater than 70. After undergoing clinical psychiatric evaluations, 12 children were diagnosed with anxiety disorders, 11 with attention deficit hyperactivity disorder, and 7 with mood disorders.

Parents completed the Child Behavior Checklist (CBCL) for their children, and 19 children had at least one CBCL subcategory T score above 65–1.5 standard deviations above normal. The most common problems were in the somatic, social, and attention subcategories. Thirteen children had at least one T score above 70–2 standard deviations above normal. The most common problems for these children were also in the somatic, social, and attention subcategories.

The 14 children with temporal lobe foci appeared to have more psychiatric problems than the 10 children with extratemporal foci. Among the children with temporal lobe foci, six were diagnosed with anxiety, eight with ADHD, and five with mood disorders. Each of these children averaged about two CBCL subcategory T scores greater than 65, and those with extratemporal lobe foci averaged one CBCL subcategory T score greater than 65, Dr. Salpekar reported.

Children with extratemporal lobe epilepsy also had fewer clinical psychiatric diagnoses. “There is something, not only about chronic epilepsy, but about temporal lobe chronic epilepsy” in particular, that leads to greater psychiatric comorbidity, he said.

WASHINGTON – Comorbid psychiatric conditions appear to be very common among children with medically refractory epilepsy, Jay A. Salpekar, M.D., said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

In a study of 24 children (16 boys and 8 girls) recommended for epilepsy surgery, 22 were diagnosed with at least one psychiatric disorder, said Dr. Salpekar of Children's National Medical Center in Washington. Seven children were diagnosed with two or more psychiatric disorders

The patients ranged in age from 6 to 17 years and had an average IQ greater than 70. After undergoing clinical psychiatric evaluations, 12 children were diagnosed with anxiety disorders, 11 with attention deficit hyperactivity disorder, and 7 with mood disorders.

Parents completed the Child Behavior Checklist (CBCL) for their children, and 19 children had at least one CBCL subcategory T score above 65–1.5 standard deviations above normal. The most common problems were in the somatic, social, and attention subcategories. Thirteen children had at least one T score above 70–2 standard deviations above normal. The most common problems for these children were also in the somatic, social, and attention subcategories.

The 14 children with temporal lobe foci appeared to have more psychiatric problems than the 10 children with extratemporal foci. Among the children with temporal lobe foci, six were diagnosed with anxiety, eight with ADHD, and five with mood disorders. Each of these children averaged about two CBCL subcategory T scores greater than 65, and those with extratemporal lobe foci averaged one CBCL subcategory T score greater than 65, Dr. Salpekar reported.

Children with extratemporal lobe epilepsy also had fewer clinical psychiatric diagnoses. “There is something, not only about chronic epilepsy, but about temporal lobe chronic epilepsy” in particular, that leads to greater psychiatric comorbidity, he said.