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Objective: Men with systemic lupus erythematosus (SLE) are an understudied population. The present study characterized differences between men and women with SLE. Methods: We examined cross‐sectionally participants with SLE in the All of Us Research Program, a US cohort with a participant survey at enrollment (May 2018 to June 2022) and linked electronic health record (EHR) data. We described and compared characteristics of men and women with SLE encompassing disease manifestations and prescribed medications from EHR data and socioeconomic factors, including health literacy and health care access and utilization, from surveys. We reported racial variations stratified by sex. Results: Of 1,462 participants with SLE, 126 (9%) were male. Men reported lower educational attainment and less fatigue than women. Myocardial infarction was significantly more common in men. Men had significantly less confidence in completing medical forms than women and exhibited a trend toward requiring more help in reading health‐related materials. Barriers to health care access and utilization were common in both men and women (40% versus 47%, respectively, reporting some reason for delay in care; P = 0.35). Women of race other than Black or African American or White more often reported delaying care due to cultural differences between patient and provider. Conclusion: Our study demonstrated major clinical and health literacy differences in men and women with SLE. Socioeconomic factors were significant barriers to health care in both sexes. Our study suggests men have disproportionately poorer health literacy, which may exacerbate preexisting disparities. Further large prospective studies, focusing on recruiting men, are needed to better characterize racial differences in men with SLE. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested an association between bone mineral density (BMD) and heart failure (HF) risk that may be racedependent. Methods: We evaluated the relationship between BMD and incident HF in a cohort of older adults, the Health, Aging, and Body Composition (Health ABC) study (n = 2835), and next performed a pooled analysis involving a second older cohort, the Cardiovascular Health Study (n = 1268). Hip BMD was measured by dual-energy X-ray absorptiometry in both cohorts and spine BMD by computed tomography in a subset from Health ABC. Results: In Health ABC, lower BMD at the total hip was associated with higher incident HF in Black women after multivariable adjustment. Similar associations were found for BMD at the femoral neck and spine. In both cohorts, pooled analysis again revealed an association between lower total hip BMD and increased risk of HF in Black women (HR = 1.41 per 0.1-g/cm² decrement [95% CI = 1.23–1.62]), and showed the same to be true for White men (HR = 1.12 [1.03–1.21]). There was a decreased risk of HF in Black men (HR 0.80 [0.70–0.91]), but no relationship in White women. The associations were numerically stronger with HFpEF for Black women and White men, and with HFrEF for Black men. Findings were similar for femoral neck BMD. Sensitivity analyses delaying HF follow-up by 2 years eliminated the association in Black men. Conclusions: Lower BMD was associated with higher risk of HF and especially HFpEF in older Black women and White men, highlighting the need for additional investigation into underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic spinal cord injury (SCI). Type: Systematic review. Literature Survey: Medline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966, to March 1, 2019. Methodology: Search was restricted to English language and adults (age ≥ 18 yr). Titles and abstracts were reviewed for relevance to study topics for inclusion. Case reports, reviews, non‐SCI population studies, and studies examining fractures at the time of acute SCI were excluded. References of included articles from the original search and task force and external submissions yielded two additional articles that were included in the review after voting by task force members. Data extraction was performed by four task force members using a data extraction form, glossary, and instructions created in Microsoft Excel. Quality assessment was performed by three methodologists using prespecified criteria. Synthesis: Twenty‐three articles were included. Use of surgery to treat LE fractures in chronic SCI has increased, though nonoperative management was still more frequently reported. Regardless of type of management, amputations, nonunion/malunion, and pressure injuries were among the most commonly reported complications. Functional and quality of life outcomes were less frequently reported. Conclusions: There is insufficient evidence to support operative versus nonoperative management as best practice for management of LE fracture of SCI. Existing literature was limited by small sample sizes, lack of randomization or matched study designs, significant heterogeneity in populations and treatment strategies studied, and variability in defining and reporting outcomes of interest. The field would benefit from future research to address study design issues and standardization of outcome reporting to facilitate comparison of outcomes of operative versus nonoperative management. [ABSTRACT FROM AUTHOR]

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease in Western societies. Despite its significance, there are no well-proven pharmacological treatments. Two novel classes of potential pharmacotherapies are the glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase-4 inhibitors (DPP-4I), collectively known as incretin-based therapies. These have several metabolic and anti-inflammatory actions that may be of benefit in NAFLD. The aim of this meta-analysis was to evaluate their efficacy via a structured retrieval and pooled analysis of relevant studies. Methods: Studies were sourced from electronic databases and meeting abstracts. Main inclusion criteria were original studies investigating treatment of adults with NAFLD using GLP-1 RA/DPP-4I. Key outcomes were a change in serum alanine transaminase (ALT), as a marker of liver inflammation, and improvement in disease status measured by imaging or histology. Results: Initial searching retrieved 1357 peer-reviewed articles and abstracts. Four studies met all inclusion and exclusion criteria. There were a total of 136 participants with NAFLD and concomitant type 2 diabetes mellitus (T2DM). Meta-analysis (random-effects model) revealed a significant decrease in serum ALT following treatment (mean reduction 14.1 IU/L, 95% confidence intervals [CI] 8.3-19.8, P < 0.0001). In two studies with imaging and tissue data, treatment was found to significantly reduce steatosis, inflammation, and fibrosis. Conclusion: The significant decrease in a key biochemical marker of hepatic inflammation following treatment with incretin-based therapies, as well as improvements in imaging and histology, suggests these agents may be effective options for managing NAFLD with comorbid T2DM. [ABSTRACT FROM AUTHOR]

Objective To examine the relationship between knee osteoarthritis (OA) and muscle parameters in a biracial cohort of older adults. Methods Participants in the Health, Aging and Body Composition Study (n = 858) were included in this cross-sectional analysis. Computed tomography was used to measure muscle area, and quadriceps strength was measured isokinetically. Muscle quality (specific torque) was defined as strength per unit of muscle area for both the entire thigh and quadriceps. Knee OA was assessed based on radiographic features and knee pain. We compared muscle parameters between those with and without radiographic knee OA (+RKOA group and −RKOA group, respectively) and among 4 groups defined by +RKOA and −RKOA with and without pain. Results The mean ± SD age was 73.5 ± 2.9 years and the mean ± SD body mass index (BMI) was 27.9 ± 4.8 kg/m2. Fifty-eight percent of participants were women and 44% were African American. Compared to the −RKOA participants, +RKOA participants had a higher BMI (30.2 versus 26.8 kg/m2), larger thigh muscles (117.9 versus 108.9 cm2), and a greater amount of intermuscular fat (12.5 versus 9.9 cm2; all P < 0.0001). In adjusted models, the +RKOA participants had significantly lower specific torque ( P < 0.001), indicating poorer muscle quality, than −RKOA participants, but there was no difference between groups in quadriceps specific torque. The +RKOA without pain ( P < 0.05) and the +RKOA with pain ( P < 0.001) participants had lower specific torque compared to the −RKOA without pain group. There were no significant differences in quadriceps specific torque among groups. Conclusion Muscle quality was significantly poorer in participants with RKOA regardless of pain status. Future studies should address how lifestyle interventions might affect muscle quality and progression of knee OA. [ABSTRACT FROM AUTHOR]

A 64-year-old white man was admitted to the hospital with a nonhealing abdominal eruption. He denied insect bites, recent travel, fever, or chills. One year prior to admission, he had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in the retroperitoneum, which initially responded to chemotherapy, including eight cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Six months later, he presented with renal failure and was found to have ureteral compression from a recurrent retroperitoneal mass. Biopsy of this mass again revealed DLBCL positive for CD20, CD10, and CD79a and negative for CD3, CD5, and Cam5.2 by immunohistochemistry. Chemotherapy with R-CHOP was resumed, and his renal function normalized. Two months later, he presented with an erythematous plaque on his abdomen. Admission hospital laboratory tests are shown in Table 1 . On physical examination, he was afebrile, with a blood pressure of 100/68 mmHg and pulse of 105/min. Bilateral axillary lymphadenopathy was present, without splenomegaly or hepatomegaly. On skin examination, there was a dusky, erythematous, indurated plaque with sharp demarcations. Significant nonpitting edema was present ( Fig. 1 ). Computed tomography (CT) scan and ultrasound of the abdomen and pelvis were negative for abscess. An infectious disease consultation was obtained, and treatment for cellulitis with vancomycin 1 g every 12 h, cefepime 2 g every 12 h, and metronidazole 500 mg every 6 h was initiated. Blood cultures remained negative throughout the hospital course; however, there was no improvement in the skin lesion. Subsequently, a dermatology consultation was obtained. Dermatology's initial diagnosis was that of lymphoma mimicking carcinoma erysipeloides. A punch biopsy was consistent with DLBCL with tumor cells similar in morphology to those seen in the biopsy of the retroperitoneal mass ( Fig. 2 ). The immunohistochemistry results were also similar to those seen in the biopsy of the retroperitoneal mass, with the exception that CD20 staining was absent, consistent with continued rituximab treatment ( Fig. 3 ). The diagnosis of lymphoma mimicking carcinoma erysipeloides was confirmed, antibiotics were discontinued, and, following the patient's wishes, he was discharged home with comfort care only. He died the next day. [ABSTRACT FROM AUTHOR]

The article describes the case of a 67-year-old African American man who went to the clinic due to bilateral shoulder pain for four months.

Objective: To examine the cross-sectional association between use of medications that have a bone antiresorptive effect (estrogen, raloxifene, and alendronate) and both the structural features of knee osteoarthritis (OA), assessed by magnetic resonance imaging (MRI) and radiography, and the symptoms of knee OA in elderly women., Methods: Women in the Health, Aging and Body Composition Study underwent MRI and radiography of the knee if they reported symptoms of knee OA, and women without significant knee symptoms were selected as controls. MR images of the knee were assessed for multiple features of OA using the Whole-Organ MRI scoring method, and radiographs were read for Kellgren and Lawrence grade and individual features of OA. Concurrent medication use and knee symptoms were assessed by interview, and knee pain severity was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)., Results: There were 818 postmenopausal women from whom we obtained MR images of the knee and data on medication use. Among these women, 214 (26.2%) were receiving antiresorptive drugs. We found no significant association between overall use of antiresorptive drugs and the presence of knee pain and radiographic changes of OA of the knee. Use of alendronate, but not estrogen, was associated with less severity of knee pain as assessed by WOMAC scores. Both alendronate use and estrogen use were associated with significantly less subchondral bone attrition and bone marrow edema-like abnormalities in the knee as assessed by MRI, as compared with women who had not received these medications., Conclusion: Elderly women being treated with alendronate and estrogen had a significantly decreased prevalence of knee OA-related subchondral bone lesions compared with those reporting no use of these medications. Alendronate use was also associated with a reduction in knee pain according to the WOMAC scores.