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Objective: Cognitive impairment is prevalent in systemic lupus erythematosus (SLE). There remain gaps in understanding cognition and SLE longitudinally. We studied intraindividual change in cognition in SLE over time. Methods: Data were from the University of California, San Francisco Lupus Outcome Study, which included 1281 adults with SLE. The Hopkins Verbal Learning Test‐Revised (HVLT‐R) and the Controlled Oral Word Association Test (COWAT) were administered annually over 7 years. A two‐state Markov analysis was used to model transition intensities for probabilities of change in cognition. Logistic regression examined the association between clinical variables and cognitive change. Results: Minimal transition between cognitive states was observed in the Markov analysis. Using the COWAT, higher levels of self‐reported depression were associated with decreased likelihood of cognitive improvement (Relative Risk [RR]: 0.98; 95% confidence interval [CI]: 0.96‐0.99), and higher self‐reported disease severity was associated with cognitive decline (RR: 1.05; 95% CI: 1.02‐1.09). Using the HVLT‐R, increasing age (RR: 1.02; 95% CI: 1.01‐1.03) and higher education level (RR: 1.82; 95% CI: 1.28‐2.58) were associated with cognitive improvement, and higher self‐reported disease severity (RR: 1.02; 95% CI: 1.01‐1.03) and depression (RR: 1.05; 95% CI: 1.03‐1.07) were associated with cognitive decline. Conclusion: Most individuals with SLE did not transition between states of high (Z score ≥ −1.5) or low (Z score < −1.5) cognition in a Markov analysis over a 7‐year assessment period, highlighting a degree of relative stability in cognition over time. Increasing age and higher education levels were associated with greater likelihood of cognitive improvement. Greater self‐reported SLE disease severity and depression were associated with cognitive decline. [ABSTRACT FROM AUTHOR]

Objective To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis, and to identify risk factors for its development. Methods The study was designed as a prospective cohort study involving psoriasis patients who did not have a diagnosis of arthritis at the time of study enrollment. Information was collected about lifestyle habits, comorbidities, psoriasis activity, and medications. Patients who developed inflammatory arthritis or spondylitis were classified as having PsA if they fulfilled the criteria of the Classification of Psoriatic Arthritis Study group. The annual incidence of PsA was estimated using an event per person-years analysis. Cox proportional hazards models, involving fixed and time-dependent explanatory variables, were fitted to obtain estimates of the relative risk (RR) of the onset of PsA, determined in multivariate models stratified by sex and controlled for age at onset of psoriasis. Results The data obtained from the 464 patients who were followed up for 8 years were analyzed. A total of 51 patients developed PsA during the 8 years since enrollment. The annual incidence rate of PsA was 2.7 cases (95% confidence interval 2.1-3.6) per 100 psoriasis patients. The following baseline variables were associated with the development of PsA in multivariate analysis: severe psoriasis (RR 5.4, P = 0.006), low level of education (university/college versus high school incomplete RR 0.22, P = 0.005; high school graduate versus high school incomplete RR 0.30, P = 0.049), and use of retinoid medications (RR 3.4, P = 0.02). In multivariate models with time-dependent variables, psoriatic nail pitting (RR 2.5, P = 0.002) and uveitis (RR 31.5, P = 0.0002) were associated with the development of PsA. Conclusion The incidence of PsA in patients with psoriasis is higher than previously reported. A severe psoriasis phenotype, presence of nail pitting, low level of education, and uveitis are predictive of the development of PsA in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Many chronic diseases feature recurring clinically important events. In addition, however, there often exists a random variable which is realized upon the occurrence of each event reflecting the severity of the event, a cost associated with it, or possibly a short term response indicating the effect of a therapeutic intervention. We describe a novel model for a marked point process which incorporates a dependence between continuous marks and the event process through the use of a copula function. The copula formulation ensures that event times can be modeled by any intensity function for point processes, and any multivariate model can be specified for the continuous marks. The relative efficiency of joint versus separate analyses of the event times and the marks is examined through simulation under random censoring. An application to data from a recent trial in transfusion medicine is given for illustration. [ABSTRACT FROM AUTHOR]

Background. Secondary hyperparathyroidism is frequent in prostate cancer patients with bone metastases, and this condition is worsened by the administration of potent bisphosphonates. Serum parathyroid hormone (PTH) elevation can impair the efficacy of these drugs in terms of survival. Methods. The prognostic role of elevated serum PTH levels at baseline and after 3 months of zoledronic acid administration was assessed prospectively in 643 bone metastatic prostate cancer patients enrolled in a prospective randomized, placebo-controlled study. Results. On multivariate analysis, after adjusting for major prognostic factors and bone turnover markers, elevated baseline serum PTH level was negatively associated with overall survival (hazard ratio [HR], 1.448; 95% confidence interval [CI], 1.045-2.006; p < .03) in zoledronic acid-treated patients but not in placebo-treated patients. In patients with normal baseline PTH levels, there was a trend but insignificant association between zoledronic acid administration and a better survival outcome than with placebo (HR, 0.81; 95% CI, 0.65-1.01; p =.065), whereas a trend in the opposite direction was observed in patients with elevated PTH levels (HR, 1.45; 95% CI, 0.87-2.39; p=.151); interaction test, p=.040. Elevated serum PTH level after 3 months of zoledronic acid treatment was not significantly associated with survival outcome. Conclusions. Secondary hyperparathyroidism has a negative prognostic impact in metastatic prostate cancer patients undergoing zoledronic acid administration. Counteracting elevated PTH levels by adequate doses of vitamin D may improve the efficacy of this drug. [ABSTRACT FROM AUTHOR]