ObjectivesTo determine the prevalence of anticitrullinated protein antibodies (ACPAs) and their association with known rheumatoid arthritis (RA) risk factors in the general population.MethodsLifelines is a multidisciplinary prospective population-based cohort study in the Netherlands. Cross-sectional data from 40 136 participants were used. The detection of ACPA was performed by measuring anti-CCP2 on the Phadia-250 analyser with levels ≥6.2 U/mL considered positive. An extensive questionnaire was taken on demographic and clinical information, including smoking, periodontal health and early symptoms of musculoskeletal disorders. RA was defined by a combination of self-reported RA, medication use for the indication of rheumatism and visiting a medical specialist within the last year.ResultsOf the total 40 136 unselected individuals, 401 (1.0%) had ACPA level ≥6.2 U/mL. ACPA positivity was significantly associated with older age, female gender, smoking, joint complaints, RA and first degree relatives with rheumatism. Of the ACPA-positive participants, 22.4% had RA (15.2% had defined RA according to our criteria and 7.2% self-reported RA only). In participants without RA, 311 (0.8%) were ACPA-positive. In the non-RA group, older age, smoking and joint complaints remained significantly more frequently present in ACPA-positive compared with ACPA-negative participants.ConclusionsIn this large population-based study, the prevalence of ACPA levels ≥6.2 U/mL was 1.0% for the total group and 0.8% when excluding patients with RA. Older age, smoking and joint complaints were more frequently present in ACPA-positive Lifelines participants. To our knowledge, this study is the largest study to date on ACPA positivity in the general, mostly Caucasian population.

INTRODUCTION: As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures.

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An open, multi-centre study was carried out in 117 pregnant women presenting with vaginal candidosis to assess the effectiveness of econazole in providing mycological control and symptom relief, and in preventing, as far as possible, the risk of contamination of the newborn: nearly 50% of the patients were in the last month of pregnancy. Patients received a single course of econazole given as 1 vaginal pessary (150 mg) on 3 consecutive days. Clinical and mycological assessments were made 1 week after the end of treatment and again at delivery, unless it happened before the first control visit. The infants were investigated at birth and 1 week afterwards. An 80% mycological cure rate was obtained and there was complete or marked relief of symptoms in the majority of patients after treatment. Twenty patients received further antimycotic treatment before delivery either because of failure (13) or relapse (7) after the single course of econazole. The relapse rate was 13.3%. No congenital abnormality was observed in the neonates and only 1 infant, born to a mother who was positive for Candida at the time of delivery, developed oral candidosis. Local tolerance of the vaginal pessaries was good and there were no reports of side-effects.

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