Systemic lupus erythematosus (SLE) is a chronic systemic inflammatory disease associated with a high prevalence of cardiovascular disease (CVD). Hydroxychloroquine (HCQ) is commonly used to control disease activity in patients with SLE. We evaluated its potential additional therapeutic effect for reducing CVD in SLE patients. We conducted a retrospective cohort study, in which one million participants were sampled from 23 million beneficiaries and data were collected from 2000 to 2013. In total, 826 SLE patients receiving HCQ medication were included after exclusion for previous CVD. The total number of SLE patients was 795 after follow-up for more than one year. After adjusting for chronic comorbidity, a significantly decreased hazard ratio (HR) for coronary artery disease (CAD) was found among SLE patients with a high usage of HCQ for at least 318 days (HR = 0.31, 95% confidence interval, CI: 0.12–0.76). A low HR for CAD was observed in SLE patients with a high cumulative dose of at least 100,267 mg HCQ (HR = 0.25, 95% CI: 0.09–0.66). However, there was no significant lowering of the HR for stroke. Long-term HCQ therapy decreases the HR of CVD in SLE patients. The cardiovascular protective effect of HCQ therapy was associated with decrease in CAD, but not stroke.

Sjögren's syndrome is an autoimmune disorder involving exocrine glands that occurs alone or in association with various autoimmune and connective tissue diseases. The severity of Sjögren's syndrome ranges from isolated sicca syndrome to severe complications such as vasculitis, lung and renal involvement. Overt or latent renal tubular acidosis caused by autoimmune tubulointerstitial nephritis, is a common extraglandular manifestation in Sjögren's syndrome. Osteomalacia is a rare complication of renal tubular acidosis, and it was reported to be associated with distal renal tubular acidosis in Sjögren's syndrome. We report a 60-year-old woman who presented with multiple bone deformity and general muscle weakness. Osteomalacia was secondary to Fanconi's syndrome, and the Fanconi's syndrome was a result of renal involvement in Sjögren's syndrome. Fanconi's syndrome is a rare kidney manifestation in Sjögren's syndrome. It may be latent and may precede the subjective sicca symptoms. These findings suggest that evidence for Sjögren's syndrome should be sought in adult patients with unexplained osteomalacia and renal tubular acidosis, even in the absence of subjective sicca syndrome. Conversely, in patients with Sjögren's syndrome, early investigation and treatment of renal tubular dysfunction may prevent future complications, such as osteomalacia.

cute myocardial infarction (AMI) involving 2 or 3 coronary arteries simultaneously is extremely rare and usually has poor outcomes, including death. 1-4 We report on a 46-year-old Taiwanese man with simultaneous total occlusion in the left anterior descending and right coronary arteries (LAD and RCA), presenting with chest pain, cardiogenic shock, ventricular fibrillation (VF) and then asystole. This patient survived eventually although multiple organs failure occurred during hospitalization. Case ReportA 46-year-old Taiwanese man was admitted with simultaneous acute anterior and inferior myocardial infarction. His risk factors for coronary artery disease were smoking and being a male older than 40 years of age. A 12-lead surface electrocardiogram (ECG) at a clinic showed acute inferolateral myocardial infarction (Fig 1A). About 30 min later, he was referred to our hospital. His blood pressure, pulse rate and respiratory rate were 95/64 mmHg, 110 beats/min and 16 breaths/min, respectively, when he was referred to our emergency department. A chest X-ray revealed bilateral interstitial pulmonary edema. A 12-lead surface ECG showed simultaneous acute inferior and antero-lateral myocardial infarcation ( Fig 1B) and a monitor ECG showed 2 nd degree Mobitz type 1 atrio-ventricular block ( Fig 1C). Right-side ECG revealed no right ventricular infarction. Laboratory data showed troponin-I 0.843 ng/ml (AMI cutoff value: 0.5 ng/ml), creatine kinase (CK) 2,014 IU/L, CK-MB isoenzyme 104 IU/L and serum creatinine 1.2 mg/dl. While waiting for emergent percutaneous coronary intervention (PCI), aspirin, heparin and glycoprotein IIb/IIIa receptor antagonist tirofiban were given as the primary PCI protocol.VF and then asystole were found in our catheterization room before diagnostic catheterization. After endotracheal intubation and cardiopulmonary resuscitation (CPR), coronary angiograms revealed total occlusion of the middle LAD artery below the septal branch, total occlusion of the distal RCA (Figs 2A,B) and insignificant stenosis of the nondominant left circumflex artery. Frequent VF attack was still noted after diagnostic catheterization. The LAD lesion was soon and easily passed through using a 0.014"LS floppy guidewire (Boston). After balloon angioplasty, thrombus was found and Thrombolysis In Myocardial Infarction (TIMI) grade II flow was noted. After stenting for LAD, TIMI grade III flow was observed and no more VF attacks were discovered, but shock and sinus bradycardia with a heart beat 50 beats/min were still noted. A temporary transvenous pacemaker was then inserted. No collateral circulation from the LAD to RCA was noted after PCI for LAD. Thereafter, the RCA lesion was also soon and easily passed through using a 0.014"LS floppy guidewire (Boston) and a 2.5×20 mm Sprinter balloon catheter (Metronic) was inflated up to 12 atm, and then a 2.75×24 mm Micro-Driver stent (Metronic) was deployed smoothly. TIMI grade III flow of the LAD and RCA were observed after PCI (Figs 2C,D). The blood pressure was 90/60 mmHg after PC...

Aim: Periodontitis and valvular heart disease (VHD) are common diseases. Both diseases are related to chronic inflammation and share many common risk factors.Previous periodontal studies had focused mainly on atherosclerotic cardiovascular disease. This study aimed to determine whether periodontitis is associated with the development of VHD. Materials and methods:This was a retrospective nationwide cohort study using Taiwan's Longitudinal Health Insurance Database. Using ICD-9-CM coding, both the periodontitis and non-periodontitis groups were matched.Results: There were 8483 cases and 4919 cases of VHD diagnosed in the periodontitis group and non-periodontitis group, respectively. The cumulative incidence of VHD was significantly higher in the periodontitis group (log-rank test, p < .001), with the incidence density of 6.44 (95% CI, 6.31-6.58) per 1000 person-years in the periodontitis group compared to 4.65 (95% CI, 4.52-4.78) in the non-periodontitis group. The relative risk for VHD was 1.39 (95% CI, 1.34-1.44). After multivariate analysis, periodontitis was independently associated with a risk for VHD (HR, 1.38; 95% CI, 1.33-1.42, p < .001). Intensive treatment of periodontitis significantly lowered the risk for VHD (HR, 0.68; 95% CI, 0.60-0.77, p < .001). Conclusions:Periodontitis was significantly associated with the development of VHD.Treatment of periodontitis reduced the risk for VHD. K E Y W O R D Speriodontitis, taiwan national health insurance research database (NHIRD), valvular heart disease Clinical Relevance• Scientific rationale for study: Is there an association between periodontitis and valvular heart disease ? No large-scale epidemiology study had ever answered this topic.• Principal finding: In this large-scale retrospective cohort study, periodontitis was statistically associated with a significant risk for valvular heart disease (HR, 1.38). Treatment of periodontal disease reduced the risk (HR, 0.43).