The algorithm achieves its aim of reliably classifying patients into a single category. The use of the algorithm in epidemiology studies should permit comparison between geographical areas.

Objective. To compare the 1-year retention rates of anti-tumor necrosis factor ␣ (anti-TNF␣) medications in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) with complementary analyses of the effect on health status. Methods. Our analyses comprised 847, 172, and 249 anti-TNF␣ treatment courses in patients with RA, PsA, and AS, respectively. Crude drug survival was compared and hazard ratios (HRs) for treatment termination were calculated with adjustments for age, sex, investigator's global assessment, and concomitant methotrexate (MTX). Adjusted changes in health-related quality of life (HRQOL) were compared among the groups. Results. Unadjusted 1-year retention rates were 65.4%, 77.3%, and 77.5% in the RA, PsA, and AS groups, respectively. The adjusted HRs for treatment termination were 0.76 (95% confidence interval [95% CI] 0.53-1.07) for PsA versus RA and 0.66 (95% CI 0.47-0.92) for AS versus RA. High baseline disease activity and female sex were significantly associated with premature treatment termination, whereas concomitant MTX was associated with better drug survival. However, the impact of MTX was apparent for RA and PsA, but not for AS in stratified analyses. The improvements in HRQOL were superior in patients with PsA and AS compared with RA. Conclusion. Our results suggest that survival of anti-TNF␣ treatment is superior in AS and PsA patients compared with RA patients. Larger improvements in HRQOL in patients with spondylarthritides may contribute to the differences in drug survival. Concomitant MTX was associated with better retention rates in RA and PsA patients, but not AS patients.

To determine whether neuropsychiatric manifestations in patients with systemic lupus erythematosus (SLE) are influenced by antibodies against the human N-methyl-D-aspartate (NMDA) receptor types NR2a or NR2b. A decapeptide was synthesized containing a sequence motif present in the extracellular ligand-binding domain of NMDA receptors NR2a and NR2b, bound by the monoclonal murine anti-DNA antibody R4A. In an ELISA with the murine monoclonal R4v as positive control, plasma samples of 57 patients with SLE were examined for the anti-peptide (anti-NR2) antibody after the patients had been subjected to comprehensive psychological and cognitive testing. Poor performance on the Visual Paired Associates test (immediate), the Grooved Pegboard test, as well as high scores on the Beck Depression Inventory, and scales D-2 (depression), Pd-4 (psychopathic deviate), Sc-8 (schizophrenia), and Ma-9 (hypomania) of the MMPI-2 were significantly associated with elevated levels of anti-NR2 antibodies. The findings in several domains indicate an association between anti-NR2 antibodies and depressed mood in addition to decreased short-time memory and learning. Antibodies to NMDA receptors thus may represent one of several mechanisms for cerebral dysfunction in patients with SLE.

Treatment with CYC and corticosteroid led to a 10-yr survival rate of 75% in WG but did not prevent severe organ damage. The presence of baseline organ damage was a marker of poor outcome. There was an association between damage and treatment given.

Objective. To determine if changes in the incidence , prevalence, and clinical presentation of Wegen-er's granulomatosis (WG) have occurred in the stable population of northern Norway during a 15-year period. Methods. We performed a retrospective cohort study using hospital discharge records from all 11 hospitals in the region and the databases of the 2 pathology departments in the area. Only patients fulfilling the American College of Rheumatology 1990 criteria for WG were included in the study, and demographic and clinical data at diagnosis were recorded. Incidence, point prevalence, and period prevalence rates were estimated for three 5-year periods. Results. Fifty-five patients (62% male) with a median age at diagnosis of 50 years (range 10-84 years) fulfilled the inclusion criteria. The annual incidence/ million population increased from 5.2 (95% confidence interval [95% CI] 2.7-9.0) during 1984-1988 to 12.0 (95% CI 8.0-17.3) during 1994-1998. The point prevalence/million increased from 30.4 (95% CI 16.6-51.0) to 95.1 (95% CI 69.1-129.0). The highest incidence rate occurred in men ages 65-74 years. There were no significant period differences in age, first organ involved , delay of diagnosis, or disease activity, but fewer patients had malaise and renal insufficiency during the earliest time period. No seasonal variation in the onset of WG was present, although we noted a pattern of annual fluctuation. Conclusion. The prevalence of WG has tripled in northern Norway over the last 15 years. While more efficacious therapy may explain part of this increase, we also found a significant trend toward increased incidence over that period. The incidence rate over the last 5 years is the highest reported so far, while the clinical presentation has remained unchanged. In Wegener's granulomatosis (WG), a systemic, necrotizing, granulomatous, small vessel vasculitis occurs , with predilection for both the upper and lower respiratory tract and the kidneys. While still considered a rare disease, some authors (1,2) have described an increasing incidence of WG. Whether this reflects a genuine increase or just increased awareness, facilitated by the availability of antineutrophil cytoplasmic antibody (ANCA) testing, is not clear. The etiology of WG is still unknown, although environmental factors, such as inhaled agents or respiratory infections, are suspected to be precipitating agents (3-7). Geographic differences have been suggested , with WG being more common in northern Europe than in southern Europe (8,9). This may be related to the finding that the onset of WG is most common in winter (2,10). In addition, a recent study from Sweden (11) reported a periodic fluctuation in the annual frequencies of ANCA-associated vasculitides, suggesting a possible relationship to periodic viral infections. The purpose of the present study was to estimate the incidence and prevalence of WG over a 15-year period in a stable population in the most northern part of Europe, where winters last as long as 6 months. Moreover, we wanted to det...