Objective. To evaluate the risk of serious bacterial infections associated with tumor necrosis factor ␣ (TNF␣) antagonists among rheumatoid arthritis (RA) patients.Methods. A retrospective cohort study of US RA patients enrolled in a large health care organization identified patients who received either TNF␣ antagonists or methotrexate (MTX). Administrative data were used to identify hospitalizations with possible bacterial infections; corresponding medical records were abstracted and reviewed by infectious disease specialists for evidence of definite infections. Proportional hazards models evaluated time-dependent infection risks associated with TNF␣ antagonists.Results. Hospital medical records with claimsidentified suspected bacterial infections were abstracted (n ‫؍‬ 187) among RA patients who received TNF␣ antagonists (n ‫؍‬ 2,393; observation time 3,894 personyears) or MTX (n ‫؍‬ 2,933; 4,846 person-years). Over a median followup time of 17 months, the rate of hospitalization with a confirmed bacterial infection was 2.7% among the patients treated with TNF␣ antagonists compared with 2.0% among the patients treated with MTX only. The multivariable-adjusted hazard ratio (HR) of infection among the patients who received TNF␣ antagonists was 1.9 (95% confidence interval [95% CI] 1.3-2.8) compared with patients who received MTX only. The incidence of infections was highest within 6 months after initiating TNF␣ antagonist therapy (2.9 versus 1.4 infections per 100 person-years; multivariable-adjusted HR 4.2, 95% CI 2.0-8.8).Conclusion. The multivariable-adjusted risk of hospitalization with a physician-confirmed definite bacterial infection was ϳ2-fold higher overall and 4-fold higher in the first 6 months among patients receiving TNF␣ antagonists versus those receiving MTX alone. RA patients were at increased risk of serious infections, irrespective of the method used to define an infectious outcome. Patients and physicians should vigilantly monitor for signs of infection when using TNF␣ antagonists, particularly shortly after treatment initiation.

Similar diagnostic ability was found for all imaging techniques, but none demonstrated superiority to subjective assessment of the ONH. Agreement between disease classification with subjective assessment of ONH and imaging techniques was greater for techniques that evaluate ONH topography than with techniques that evaluate RNFL parameters. A combination of subjective ONH evaluation with RNFL parameters provides additive information, may have clinical impact, and deserves to be considered in the design of future studies comparing objective techniques with subjective evaluation by general eye care providers.

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Patients with glaucoma who have moderate or severe visual field impairment in the central 24 degrees radius field in the worse-functioning eye are at increased risk of involvement in a vehicle crash.

Introduction and Hypothesis: We determined the prevalence and predictors of osteoporosis evaluation and treatment in high risk nursing home residents.