This study confirms that PsA is a chronic, progressive disease in the majority of patients. Despite clinical improvement with current DMARD treatment, PsA results in radiological damage in up to 47% of patients at a median interval of 2 yr.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • A number of factors have been hypothesized to increase the risk of amiodarone‐induced pulmonary toxicity (AIPT), although there remains some controversy in the literature as to their relative significance. • This study aimed to clarify this situation to permit better characterization of patients at risk of AIPT and thus guide the development of guidelines for the monitoring for AIPT in patients receiving the drug. WHAT THIS STUDY ADDS • Via compilation and analysis of a database of 237 AIPT cases, it was demonstrated that only patient age and duration of therapy significantly affected the risk of AIPT. • A small cohort of hospital AIPT patients demonstrated these ‘at‐risk’ characteristics, suggesting that targeted monitoring of patients aged >60 years and those on amiodarone for 6–12 months may enhance the safety of these patients and minimize their risk of morbidity and mortality secondary to AIPT. AIMS A number of factors have been hypothesized to increase the risk of amiodarone‐induced pulmonary toxicity (AIPT). This study aimed to confirm these risk factors and determine whether a cohort of tertiary hospital patients diagnosed with AIPT demonstrated comparable characteristics. METHODS Phase I of this study involved compilation of a database of adverse reactions to amiodarone reported to the Australian and US drug agencies, and identification of risk factors for AIPT using logistic regression analysis. In Phase II, AIPT cases were identified via a retrospective review of medical records of patients discharged from Fremantle Hospital and Health Service, Western Australia (FHHS) between 2000 and 2005 with diagnosed interstitial lung disease. Data were collected regarding these patients’ risk factors for AIPT and compared with those previously identified in Phase I. RESULTS A total of 237 cases of AIPT were identified from agency data. Patients aged > 60 years and those on amiodarone for 6–12 months (odds ratio 18.28, 95% confidence interval 6.42, 52.04) were determined to be at the highest risk of AIPT. Australian data also suggested increased risk in patients who had received cumulative doses of 101–150 g. The seven AIPT cases identified among the FHHS patients were all at high risk of AIPT based on their age and duration of amiodarone therapy. CONCLUSION Contrary to previous findings, only patient age and the duration of amiodarone therapy were confirmed as significant risk factors for AIPT. Targeted monitoring of these patients may facilitate early identification and management of AIPT.

This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence in patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care.

Objective-Macrovascular disease in scleroderma has recently been described in two comparative studies. The aim of this study was to map its anatomical distribution. Methods-In a retrospective cohort study of 20 scleroderma patients, the results of Doppler studies of arteries in the limbs, neck, and abdomen were compared with those from 20 cohort negative patients. The latter were matched for age, sex, and the presence/absence of hypertension, hyperlipidaemia, smoking, and diabetes status. Arteries were compared quantitatively using a body surface area adjusted measurement of intraluminal diameter, and qualitatively using descriptive characteristics of the arterial walls. The latter were binomially categorised under three non-exclusive headings-thickening, stenosis, and calcification. Results-The ulnar arteries in scleroderma patients were significantly narrower than those of the negative cohort. The arterial walls were also characterised by smooth thickening along their entire length. The characteristics of the other arteries, including those of the lower limbs, were not significantly diVerent from those of the negative cohort. Conclusion-The ulnar artery seems to be specifically targeted in patients with scleroderma. Assessment of the ulnar artery should be considered in these patients by means of a modified Allen's test or Doppler sonography especially in the presence of digital gangrene.

This study confirms that the application of classification criteria of PsA based on the pattern and number of involved joints may be confounded in established PsA by the effects of DMARDs. The application of classification criteria based on disease pattern prior to treatment may be more useful in studies of pathogenesis and long-term outcome in PsA.