ADA reduces drug response, an effect that can be attenuated by concomitant immunosuppression, which reduces ADA frequency. Drug immunogenicity should be considered for the management of patients receiving biological therapies.

Objectives-Vitamin D has immune-modulating effects and may protect against the development of Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA).Methods-We identified incident cases of SLE and RA among 186,389 women followed from 1980-2002 in the Nurses' Health Study and Nurses' Health Study II cohorts. We excluded subjects with non-confirmed SLE or RA by medical record review, and those who failed to return questionnaires. Semi-quantitative food frequency questionnaires assessed vitamin D intake from food and supplements. We used cumulative-updated total energy-adjusted dietary exposures for each two year cycle.Relationships between vitamin D intake and incident SLE and RA were examined in age-adjusted and Cox proportional hazards models, adjusted for confounders. Results were pooled using metaanalysis random effects models.Results-We confirmed 190 incident cases of SLE and 722 of RA with dietary information. Increasing levels of vitamin D intake had no relationship to the relative risk of developing either SLE or RA.Conclusions-Vitamin D intake was not associated with risk of SLE or RA in these large prospective cohorts of women. Statement:The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in ARD and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://ARD.bmjjournals.com/ifora/licence.pdf). SLE and RA cases were confirmed if they met ACR criteria. Case validation rates for both SLE and RA were 7% of the total self-reports. NIH Public Access Population for AnalysisWe excluded prevalent cases of SLE and RA, and all women who reported any connective tissue disease that was not subsequently confirmed as SLE or RA as above. We included only nurses who had completed the FFQ at baseline, 1980 in the NHS and 1991 in NHSII. Women were censored at last response to questionnaires, as incident cases could not be identified. The final group included 91,739 women followed from 1980-2002 in the NHS and 94,650 women followed from 1991-2001 in the NHSII. In a sensitivity analysis, we excluded women who reported any cancer (except non-melanoma skin cancer) at any time, as cancer and its treatment may affect vitamin intake and health behaviors. Nutritional factorsThe semi-quantitative FFQ on which participants reported the frequency of consumption for specified foods over the past year was used to assess nutritional factors. NHS participants completed the FFQ in 1980, 1984, 1990 and 1994, and NHSII participants returned FFQs in 1991, 1995, alcohol and caffeine were calculated according to the nutrient content of foods, derived from the U.S. Department of Agriculture, food manufacturers, and other published sources. The accuracy and reproducibility of the FFQ for nutrients and foods have been documented in va...

Disease prevention models have shown individuals are more likely to engage in precautionary behavior if they have confidence in their ability to identify disease symptoms and understand health risks. In immigrant populations, communicating the risks poses greater challenges since linguistic and cultural barriers may impede acceptance of the new behavior. The Brazilian population on Martha's Vineyard, Massachusetts, is at high risk for Lyme disease (LD), the most common vector-borne illness in the United States largely preventable by limiting tick exposure. We surveyed 103 Brazilians on MV about their health beliefs and perceptions of LD risk and assessed their level of precautionary behaviors and the cultural factors influencing them. The population had only a moderate perception of risk and little understanding of LD. Forty-one percent did not think LD posed a risk, while 79% were not sure they could recognize symptoms. Accordingly, the population as a whole reported taking few precautions.

Immunogenicity assessment might help to optimise therapeutic decisions, leading to a better control of disease activity with significantly better clinical outcomes in patients with RA receiving TNFi.