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Purpose Studies of the relation of fibromyalgia (FM) and widespread pain (WSP) to mortality have differed as to the presence or absence of an association and the extent of cause-specific mortality. However, no studies have investigated which definitions of FM and WSP associate with mortality, nor of FM mortality in other diseases. We investigated these issues and the meaning of mortality in patients with FM. Methods We used Cox regression to study 35,248 rheumatic disease patients with up to 16 years of mortality follow-up in all patients and separately in those with diagnoses of rheumatoid arthritis (RA) (N = 26,458), non-inflammatory rheumatic disorders (NIRMD) (N = 5,167) and clinically diagnosed FM (N = 3,659). We applied 2016 FM criteria and other FM and WSP criteria to models adjusted for age and sex as well as to models that included a full range of covariates, including comorbid disease and functional status. We estimated the degree of explained of variance (R2) as a measure of predictive ability. Results We found positive associations between al`l definitions of FM and WSP and all-cause mortality, with relative risks (RR)s ranging from 1.19 (95%CI 1.15–1.24) for American College of Rheumatology (ACR) 1990 WSP to 1.38 (1.31–1.46) in age and sex adjusted revised 2016 criteria (FM 2016). However, in full covariate models the FM 2016 RR reduced further to 1.15 (1.09–1.22). The association with mortality was noted with RA (1.52 (1.43–1.61)), NIRMD (1.43 (1.24–1.66)) and clinical FM (1.41 (1.14–1.75) - where 37% of FM diagnosed patients did not satisfy FM 2016 criteria. In the all-patient analyses, the age and sex explained variation (R2) was 0.255, increasing to 0.264 (4.4%) when FM 2016 criteria were added, and to 0.378 in a full covariate model. Death causes related to FM 2016 status included accidents, 1.45 (1.11–1.91); diabetes 1.78 (1.16–2,71); suicide, 3.01 (1.55–5.84) and hypertensive related disorders, 3.01 (1.55–5.84). Cancer deaths were less common 0.77 (0.68–0.88). Conclusions FM is weakly associated with mortality within all criteria definitions of FM and WSP examined (3.4% of explained variance), and across all diseases (RA, NIRMD, clinical FM) equally. Clinical and criteria-defined FM had different mortality outcomes. We found no evidence for a positive association of cancer and FM or WSP.

Introduction Prior studies have identified associations between obesity and numerous conditions that increase risks for chronic pain. However, the impact of obesity on prescription opioid use is not well known. This study investigates the association between obesity and incidence of long-term prescription opioid use. Methods Fifteen panels of the Medical Expenditure Panel Survey from 2000 to 2015 were pooled to generate a sample of civilian non-institutionalized adults aged 30–84 years who were prescription opioid–naive for approximately 9 months. Incident long-term prescription opioid use was defined as reporting use at 2 of 3 interviews during a 15-month follow-up. BMI was reported at baseline. Analyses were completed in 2019. Results Among opioid–naive adults (n=89,629), obesity was strongly associated with incident long-term prescription opioid use. The association increased at progressively higher BMI values, with 24% elevated odds (95% CI=7%, 44%) in adults with overweight (25–29.9 kg/m2) and 158% increased odds (95% CI=106%, 224%) among adults with Class III obesity (40–49.9 kg/m2). These associations grew with higher-dosage opioids. Of the reasons for opioid use, joint pain, back pain, injury, and muscle/nerve pain contributed the most to the excess use observed among adults with obesity. At the population level, 27.0% of incident long-term prescription opioid use (95% CI=19.0%, 34.8%) was attributable to adults having a BMI above normal weight (25–49.9 kg/m2). Conclusions These findings suggest that obesity has contributed to prescription opioid use in the U.S. Future investments in chronic pain reduction may benefit from increased integration with obesity prevention and treatment.

OBJECTIVE: Obesity, defined by body mass index (BMI, kg/m(2)), is associated with lower mortality risk in numerous chronic disease states, a phenomenon termed the obesity paradox. Indices of obesity, including BMI and % body fat are confounded by muscle mass, while DXA-derived fat mass index (kg/m(2)) is not. We compared the associations between obesity and mortality in persons with chronic kidney disease (CKD) using several estimates of obesity, including fat mass index, and determined whether muscle mass, inflammation and weight loss modify these associations. DESIGN: Retrospective cohort study SETTING AND SUBJECTS: 2,852 NHANES participants from 1999–2006, aged 20 years or more with body composition measures and CKD defined as estimated glomerular filtration rate 10% weight loss was 20% in participants that were obese by fat mass index, compared with 40% in the remainder. Prior weight loss was associated with mortality, and the protective association of obesity was no longer significant after adjustment for prior weight loss. Inflammation did not modify these associations. CONCLUSIONS: An apparent protective association of high fat mass was seen in chronic kidney disease, particularly among persons with lower muscle mass. The prevalence of prior weight loss was two-fold lower among obese compared to non-obese persons, confounding these associations.

Shortened telomeres are associated with several different subtypes of interstitial lung disease (ILD), although studies of telomere length and ILD in rheumatoid arthritis (RA) are lacking.Within the Veterans Affairs Rheumatoid Arthritis (VARA) registry, we performed cross-sectional and case-control studies of prevalent and incident ILD, respectively. We randomly selected a subset of RA patients with ILD and individually matched them to RA patients without ILD according to age, sex, and VARA enrollment date. Telomere length was measured on peripheral blood leukocytes collected at registry enrollment using quantitative PCR (T/S ratio). Short telomeres were defined as a T/S ratio in the lowest 10th percentile of the cohort.Our cross-sectional study cohort was comprised of 54 RA-ILD patients and 92 RA-non-ILD patients. T/S ratios significantly differed between patients with and without prevalent ILD (1.56 [IQR 1.30, 1.78] vs. 1.96 [IQR 1.65, 2.27], p 0.001). Similarly, prevalence of ILD was significantly higher in patients with short vs. normal-length telomeres (73.3% vs. 32.8%, p = 0.002). Short telomeres were independently associated with an increased odds of prevalent ILD compared to normal-length telomeres (adjusted OR 6.60, 95% CI 1.78-24.51, p = 0.005). In our case-control analysis, comprised of 22 incident RA-ILD cases and 36 RA-non-ILD controls, short telomeres were not associated with incident RA-ILD (adjusted OR 0.90, 95% CI 0.06-13.4, p = 0.94).Short telomeres were strongly associated with prevalent but not incident ILD among patients with RA. Additional studies are needed to better understand telomere length dynamics among RA patients with and without ILD.

Objective Although post-traumatic stress disorder (PTSD) is identified as a risk factor in the development of rheumatoid arthritis (RA), associations of PTSD with disease progression are less clear. To explore whether PTSD might influence disease-related measures of systemic inflammation in RA, we compared serum cytokine/chemokine (cytokine) concentrations in RA patients with and without PTSD. Methods Participants were U.S. Veterans with RA and were categorized as having PTSD, other forms of depression/anxiety, or neither based on administrative diagnostic codes. Multiplex cytokines were measured using banked serum. Associations of PTSD with cytokine parameters (including a weighted cytokine score) were assessed using multivariable regression, stratified by anti-CCP status and adjusted for age, sex, race, and smoking status. Results Among 1,460 RA subjects with mean (SD) age of 64 (11) years and disease duration of 11 (11) years, 91% were male, 77% anti-CCP positive, and 80% ever smokers. Of these, 11.6% had PTSD, 23.7% other depression/anxiety, and 64.7% had neither. PTSD, but not depression/anxiety, was associated with a higher cytokine score and number of high-concentration analytes in adjusted models, though this was limited to anti-CCP positive subjects. PTSD was associated with heightened expression of several individual cytokines including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12, IL-17, IFN-γ, GM-CSF, MCP-1, and TNF-α. Conclusion Anti-CCP positive RA patients with PTSD have higher serum cytokine concentrations than those without PTSD, demonstrating that systemic inflammation characteristic of RA is heightened in the context of this relatively common psychiatric comorbidity.

Resume Introduction La mucoviscidose s’accompagne d’un risque accru d’osteoporose et d’une augmentation consequente du risque fracturaire. Le but de ce travail etait d’analyser les facteurs independants predictifs, au depart et a deux ans de suivi, d’une modification de la densite minerale osseuse (DMO) chez les adultes mucoviscidosiques. Methodes Soixante-quatre patients adultes atteints de mucoviscidose, âges de 18 a 57 ans, ont ete recrutes dans la clinique de mucoviscidose du Massachussets General Hospital. Une absorptiometrie biphotonique a rayons X (DXA) a ete realisee au rachis et au radius a l’inclusion puis a deux ans (chez 39 sujets). L’indice de masse maigre (IMM) et l’indice de masse grasse (IMG) ont ete estimes a partir du poids, de la taille et de l’impedancemetrie bioelectrique tetrapolaire. Tous les sujets ont ete soumis a une spirometrie pulmonaire dans un delai d’un mois a compter de la visite de suivi. Des modeles de regression lineaire ont permis d’evaluer les variables predictives du Z score de DMO au depart et les modifications du Z score au rachis AP a 2 ans. Deux definitions d’une DMO basse ont ete etudiees a partir du Z score (≤ −1,0 et ≤ −2,0). Resultats Un defaut de mineralisation osseuse a ete retrouve chez 52 % des sujets. Ces derniers etaient majoritairement des hommes (67 % vs. 32 %, p = 0,009), sous traitement par glucocorticoides (21 % vs. 0 %, p Conclusions Le sexe masculin, la petite taille et une insuffisance de masse maigre sont correles a une DMO basse dans la mucoviscidose. L’adiposite elevee et les troubles respiratoires sont predictifs d’une modification negative du Z score de DMO a deux ans de suivi.

Introduction Cystic fibrosis (CF) is associated with osteoporosis and incident fracture. This study assessed independent predictors of baseline and 2-year changes in bone mineral density (BMD) in adults with CF. Methods Sixty-four adult patients with CF, ages 18–57, were recruited from the Massachusetts General Hospital Cystic Fibrosis Care Center. Dual-energy X-ray absorptiometry (DXA) was performed at the spine and radius at baseline and 2 years (in 39 subjects). Estimates of fat-free mass index (FFMI) and fat mass index (FMI) were determined using height, weight, and tetrapolar bioelectric impedance analysis. All subjects completed lung spirometry within 1 month of the study visit. Linear regression models evaluated predictors of baseline BMD Z-scores and change in PA spine BMD Z-score over 2 years. Two definitions of low BMD were studied based on Z-score (≤–1.0 and ≤–2.0). Results Low BMD was present in 52% of subjects. Subjects with low BMD were more likely to be male (67% vs. 32%, P = 0.009), were more likely to be currently using glucocorticoids (21% vs. 0%, P P = 0.04), and were more likely to have had a previous fracture (60% vs. 46%, P = 0.007). In multivariable models, greater FFMI and height, but not greater FMI, were associated with greater BMD. In multivariable models, low forced vital capacity (FVC) and greater FMI were associated with greater loss of BMD at the PA spine over two years. Conclusions Male sex, short stature, and low lean mass are associated with low BMD in CF. Greater adiposity and lower lung function are predictors of negative change in BMD Z-score over 2 years.

Improvements in clinical care have led to increased life expectancy in patients with cystic fibrosis (CF) over the past several decades. Whether these improvements have had significant effects on bone health in patients with CF is unclear.This is a cross-sectional study comparing clinical characteristics and bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DXA) in adults with CF evaluated in 1995-1999 to age-, race-, and gender-matched patients with CF evaluated in 2011-2013 at the same center on calibrated DXA machines.The cohorts were similar in terms of age, BMI, pancreatic insufficiency, presence of F508del mutation, and reproductive history. In the most recent cohort, pulmonary function was superior, and fewer patients had vitamin D deficiency or secondary hyperparathyroidism. Areal BMD measures of the PA spine, lateral spine, and distal radius were similarly low in the two cohorts.Although pulmonary function and vitamin D status were better in patients in the present-day cohort, areal BMD of the spine was reduced in a significant number of patients and was no different in patients with CF today than in the late 1990s. Further attention to optimizing bone health may be necessary to prevent CF-related bone disease.

Background/purpose The objective of this study was to identify independent associations between body composition and bone outcomes, including cortical structure and cortical and trabecular volumetric bone mineral density (vBMD) across the adult age spectrum. Methods This cross-sectional study evaluated over 400 healthy adults (48% male, 44% black race), ages 21–78 years. Multivariable linear regression models evaluated associations between whole-body DXA measures of lean body mass index (LBMI) and fat mass index (FMI) and tibia peripheral quantitative CT (pQCT) measures of cortical section modulus, cortical and trabecular vBMD and muscle density (as a measure of intramuscular fat), adjusted for age, sex, and race. All associations reported below were statistically significant (p Results Older age and female sex were associated with lower LBMI and muscle strength. Black race was associated with greater LBMI but lower muscle density. Greater FMI was associated with lower muscle density. Cortical section modulus was positively associated with LBMI and muscle strength and negatively associated with FMI. Adjustment for body composition eliminated the greater section modulus observed in black participants and attenuated the lower section modulus in females. Greater LBMI was associated with lower cortical BMD and greater trabecular BMD. FMI was not associated with either BMD outcome. Greater muscle density was associated with greater trabecular and cortical BMD. Associations between body composition and bone outcomes did not vary by sex (no significant tests for interaction). Conclusions These data highlight age-, sex- and race-specific differences in body composition, muscle strength and muscle density, and demonstrate discrete associations with bone density and structure. These data also show that age-, sex- and race-related patterns of bone density and strength are independent of differences in body composition. Longitudinal studies are needed to examine the temporal relations between changes in bone and body composition.

Background A combined open surgical and endovascular approach to managing aneurysms of the distal aortic arch (hybrid arch repair) is evolving as a viable treatment option. Our aim is to describe a treatment strategy in high-risk patients and report the technical and clinical success of the hybrid approach to aneurysms involving the distal aortic arch. Methods From July 2005 until December 2009, 27 consecutive patients with aneurysms of the distal aortic arch were treated via a hybrid arch repair. Of this group, 23 patients underwent aortic arch debranching and revascularization before endovascular stent deployment in the ascending aorta (type I). Four patients required ascending aortic and transverse arch replacement before stent graft deployment (type II). Results A stent graft was successfully deployed in 100% of patients after aortic arch vessel debranching via median sternotomy. The mean age of the patients was 71 ± 7.5 years. The average cardiopulmonary bypass time was 199 ± 84 minutes with an average crossclamp time of 57 ± 53 minutes. Deep hypothermic circulatory arrest was required in 4 patients (all type II). The average length of stay was 17.2 ± 14 days. The complications included stroke in 3 (11%) patients, permanent paralysis in 2 (7%), and perioperative death in 3 (11%) patients. Conclusions Early results of type I and II hybrid arch repair, in this cohort of patients with mutiple comorbid risk factors, are acceptable and even encouraging. This evolving approach to aneurysms involving the aortic arch may extend the indications for use of endovascular prostheses in the treatment of patients with complex aortic arch disease.