Objective. To determine the incidence and disease-specific predictors of clinically recognized psoriatic arthritis (PsA) in patients with psoriasis. Methods. We identified an incidence cohort of psoriasis subjects age >18 years diagnosed between January 1, 1970 and December 31, 1999 in a population-based setting. Psoriasis diagnoses were validated by confirmatory diagnosis in the medical record. Incident and clinically recognized PsA subjects were classified according to the Classification of Psoriatic Arthritis (CASPAR) criteria. Cox proportional hazards models were used to identify predictors of PsA within the psoriasis cohort. Results. The psoriasis incidence cohort comprised 1,633 subjects. Of these, 40 were diagnosed with PsA concurrently with psoriasis and were excluded from analysis. The remaining 1,593 psoriasis subjects had a mean age of 43 years and 50% were men. Over 20,936 person-years of followup, 57 subjects were clinically recognized with new-onset PsA, with a cumulative incidence of 1.7% (95% confidence interval [95% CI] 1.0 -2.3%), 3.1% (95% CI 2.2-4.1%), and 5.1% (95% CI 3.7-6.6%) at 5, 10, and 20 years following psoriasis incidence, respectively. Psoriasis features associated with higher risk of PsA were scalp lesions (hazard ratio [HR] 3.89, 95% CI 2.18 -6.94), nail dystrophy (HR 2.93, 95% CI 1.68 -5.12), and intergluteal/perianal lesions (HR 2.35, 95% CI 1.32-4.19). Calendar year was not associated with risk of PsA (P ‫؍‬ 0.15), indicating that the likelihood of PsA in psoriasis subjects did not change over time. Conclusion. In this population-based study, <10% of patients with psoriasis developed clinically recognized PsA during a 30-year period. Psoriasis features associated with a higher likelihood of PsA were nail dystrophy, scalp lesions, and intergluteal/perianal psoriasis.

Objective. Behçet's disease (BD) is a rare, multisystem inflammatory disorder of unknown cause. Although welldocumented in Eastern populations, epidemiologic data is scarce in North American countries. Here we describe the incidence and prevalence of BD in Olmsted County, Minnesota over 45 years. Methods. We identified an incidence cohort of subjects age >18 years who had a clinical diagnosis of and/or fulfilled the International Study Group (ISG) criteria for BD from January 1, 1960 to January 1, 2005. Age-and sex-specific incidence and prevalence were estimated and age-and sex-adjusted to the 2000 US total population. Results. The study population was comprised of 13 subjects with BD; 11 fulfilled ISG criteria between 1960 and 2005. Mean ؎ SD age was 31 ؎ 9 years, and 69% were white. Point prevalence in 2000 was 5.2 per 100,000 population (95% confidence interval [95% CI] 0.64 -9.84). The overall annual age-and sex-adjusted incidence of BD was 0.38 per 100,000 population (95% CI 0.17-0.59), with a higher incidence in women (0.51 per 100,000; 95% CI 0.17-0.84) than in men (0.26 per 100,000; 95% CI 0.004 -0.52). Dermatologic lesions included oral ulcers (100%), genital ulcers (62%), erythema nodosum (46%), and papulopustular lesions (54%). Ocular lesions, vascular complications, and central nervous system involvement were present in 8, 3, and 3 subjects, respectively. Conclusion. Our study shows an overall incidence of 0.38 per 100,000 population, which is comparable with other Western populations. The prevalence of 5.2 per 100,000 population is similar to estimates reported in Western countries, but lower than that in countries along the Silk Road.

Objective To determine time trends in incidence, prevalence, and clinical characteristics of psoriatic arthritis (PsA) over a 30-year period. Methods We identified a population-based incidence cohort of subjects aged 18 or over who fulfilled ClASsification of Psoriatic ARthritis (CASPAR) criteria for PsA between 1/1/1970 and 12/31/1999 in Olmsted County, Minnesota. PsA incidence date was defined as the diagnosis date of those who fulfilled CASPAR criteria. Age- and sex-specific incidence rates were estimated and age- and sex-adjusted to 2000 U.S. white population. Results The PsA incidence cohort comprised 147 adult subjects with a mean age of 42.7 years and 61% were males. The overall age- and sex-adjusted annual incidence of PsA per 100,000 was 7.2 (95% CI 6.0, 8.4) with a higher incidence in males (9.1, 95% CI 7.1, 11.0) than females (5.4, 95% CI 4.0, 6.9). The age and sex-adjusted incidence of PsA per 100,000 increased from 3.6 (95% CI 2.0, 5.2) between 1970-79 to 9.8 (95% CI 7.7, 11.9) between 1990-2000 (p for trend < 0.001). The point prevalence per 100,000 was 158 (95% CI 132, 185) in 2000 with a higher prevalence in males (193, 95% CI 150, 237) than females (127, 95% CI 94, 160). At incidence, most PsA subjects had oligoarticular involvement (49%) with enthesopathy (29%). Conclusions The incidence of PsA has been rising over thirty years in males and females. Reasons for the increase are unknown, but may be related to a true change in incidence or greater physician awareness of the diagnosis.

A prospective randomised trial was performed in patients given HLA-identical sibling bone marrow transplants for haematological malignancy comparing the combination of cyclosporin and methotrexate (CM) (n = 20) with the combination of cyclosporin, methotrexate and prednisolone (CMP) (n = 21) as prophylaxis for graft-versus-host disease (GVHD). There was no significant differences between the two arms for the incidence of acute GVHD grades I-IV, acute GVHD grades II-IV, chronic GVHD, interstitial pneumonitis, relapse, survival and disease-free survival. The actuarial incidence of acute GVHD grades II-IV in the CMP group was 10% and in the CM group 15% (ns). The incidence of leukaemic relapse in good risk patients was 42% in the CMP group and 40% in the CM group (ns), although the majority of these relapses were cytogenetic relapses only in patients with chronic myeloid leukaemia. The incidence of acute GVHD grades II-IV in both arms of the current trial was significantly lower than in our previous trial comparing cyclosporin and methotrexate as single agents. Leukaemic relapse is now the principal cause of treatment failure in this patient population. We conclude that prednisolone should not be included as part of the prophylactic GVHD regime and that further improvement in therapeutic outcome is dependent upon better control of the underlying malignancy.

In contradistinction to the literature reports, the most prevalent organism for IP was P. acnes. Patients managed aggressively with both antibiotics and surgery, demonstrated lower mortality rates. Therefore, clinicians should maintain a high index of suspicion for IP so that timely and appropriate mortality-reducing strategies can be offered.