Chun-Ying Wu

Predicting factors of malignancy in dermatomyositis and polymyositis : a case-control study

Backgroundu2003An association between dermatomyositis (DM)/polymyositis (PM) and malignancies has been widely reported in the literature. The validity of extensive evaluation for malignancies in those patients has also been questioned for decades. Only limited papers regarding the signs of malignancy and the prognostic factors in DM/PM have been reported.

Comorbidity profiles among patients with bullous pemphigoid: a nationwide population-based study.

Backgroundu2002 Bullous pemphigoid (BP) has been associated with neurological and psychiatric diseases; however, large‐scale population‐based study of different comorbid diseases in patients with BP is quite limited.

Malignancies associated with dermatomyositis and polymyositis in Taiwan: a nationwide population-based study

Backgroundu2002 Previous studies showed that idiopathic inflammatory myopathies (IIM) carried an increased risk of cancers. However, no large‐scale study of IIM has been conducted in the Chinese population.

Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan

IntroductionThe association of idiopathic inflammatory myositis (IIM) and malignancies has been reported, but rarely in Asian countries. Our aim was to investigate the risk of cancer among IIM patients without a prior history of malignancies, in Taiwan.MethodsWe conducted a nationwide cohort study of 1,012 patients with dermatomyositis (DM) and 643 patients with polymyositis (PM), but without prior history of malignancies, utilizing the National Health Insurance Database from 1997 to 2007. Standardized incidence ratios (SIRs) of cancers were analyzed.ResultsA total of 95 cancers (9.4%) in DM and 33 cancers (4.4%) in PM were identified. Overall cancer risk was significantly elevated in DM patients (SIR = 5.11, 95% confidence interval [CI] = 5.01 to 5.22) and PM patients (SIR = 2.15, 95% CI = 2.08 to 2.22). Most cancers were detected in the first year of observation. The risk of cancer decreased with observation time, yet remained elevated compared with the general population in both study groups after 5 years of follow-up. DM was associated with sustained elevated risk of cancers in every age group, whereas the risk of cancer in PM was highest in younger patients and decreased with age. DM patients were at the greatest risk of cancers of the nasopharynx, lungs and hematopoietic malignancies.ConclusionsPatients with IIM are at increased risk for cancer and should receive age-appropriate and gender-appropriate malignancy evaluations, with additional assessment for nasopharyngeal, lung and hematologic malignancy following diagnosis, and with continued vigilance for development of cancers in follow-up.

The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan.

BACKGROUNDnAn association between psoriasis and malignancy has been explored. However, no studies have been reported regarding cancer risk in Asian psoriasis populations.nnnOBJECTIVESnThe aim of this study was to investigate the risk of cancer development in association with psoriasis. The effects of age at diagnosis, treatment modalities, and observation time were also evaluated.nnnMETHODSnData for this retrospective population-based cohort study were obtained from the Taiwan National Health Insurance Research Database (NHIRD). This study included 3,686 patients with first-time diagnosis of psoriasis between 1996 and 2000. Another 200,000 patients without psoriasis served as the comparison group. All enrolled subjects were followed-up until the end of 2007. Cumulative incidences and hazard ratios (HRs) of cancer development were determined.nnnRESULTSnAmong the 3,686 psoriasis patients, 116 had incident cancers. The 7-year cumulative incidence of cancer among psoriasis patients was 4.8%. The adjusted HR for developing a cancer in association with psoriasis was 1.66 (95% confidence interval [CI], 1.38-2.00). Cancer risk was higher in male patients than in female patients (adjusted HR 1.86 vs.1.14, respectively). Certain cancers were significantly associated with psoriasis, including those of the urinary bladder and skin, followed by oropharynx/larynx, liver/gallbladder, and colon/rectum. Patients with psoriasis had an increased adjusted HR for cancer that varied by age. Younger patients with psoriasis tended to have the greatest risk of cancer. Finally, systemic phototherapy and oral medication did not significantly increase the risk of cancer. Phototherapy with UVB appeared to reduce the risk of cancer in psoriasis (adjusted HR, 0.52; 95% CI, 0.29-0.95; P = .03).nnnLIMITATIONSnNHIRD did not contain information regarding severity of psoriasis, status of smoking, alcohol use, family history of cancer, or diet. Misclassification of disease cannot be ruled out in a registry-based database.nnnCONCLUSIONSnPsoriasis carries an elevated risk of malignancies, especially in younger and in male patients. This effect is independent of systemic treatment for psoriasis. Finally, phototherapy with UVB did not increase, but rather reduced, the risk of cancer in psoriasis.

Clinicopathologic analysis of malignant melanoma in Taiwan

BACKGROUNDnMalignant melanoma is the leading cause of death among skin cancers in western countries. However, the incidence, histologic subtypes, and tumor behaviors are quite different in Asians and people of color.nnnOBJECTIVEnOur purpose was to define the tumor behaviors and possible prognostic predictors of melanomas based on a Taiwanese patient population.nnnMETHODSnFrom the 65 patients diagnosed with melanoma at Veterans General Hospital, Taichung, we analyzed mean age at onset, gender, histologic subtypes, tumor thickness, level of invasion, primary tumor locations, and metastatic sites. Univariate analysis and multivariate analyses for survival, according to clinical and histologic tumor behaviors, were performed by means of Cox proportional hazard model. Survival curves were plotted by Kaplan-Meier method.nnnRESULTSnFifty-one cutaneous melanomas were identified and analyzed by both clinical behaviors and histology. Acral lentiginous melanoma was the most common type (54.9%), followed by nodular melanoma (29.4%), superficial spreading melanoma, and lentigo maligna melanoma. Univariate analysis for overall survival of melanoma revealed that age at onset older than 55 years, male gender, ulceration of tumor, and thicker tumor have the tendency to poorer prognosis, but without significant differences. The advanced stages (III and IV) and histologic subtypes other than acral lentiginous melanoma predicted a poorer survival with significant differences. Multivariate analysis demonstrated advanced stages, and histologic subtypes were the independent risk factors for poor prognosis.nnnCONCLUSIONnWe proposed that histologic subtypes other than acral lentiginous melanoma and advanced stages have a poorer prognosis with significant differences.

Elevated plasma osteopontin level is associated with occurrence of psoriasis and is an unfavorable cardiovascular risk factor in patients with psoriasis

BACKGROUNDnThe association between psoriasis and cardiovascular diseases is well documented yet the underlying mechanisms remain elusive.nnnOBJECTIVESnWe sought to study the role of circulating osteopontin (OPN) in the pathogenesis of cardiovascular diseases in patients with psoriasis.nnnMETHODSnPlasma samples from 40 patients with psoriasis and 37 control subjects were collected for enzyme-linked immunosorbent assays. The clinical significance of OPN levels in patients with psoriasis versus control subjects was analyzed using the Mann-Whitney U test and logistic regression. DNA samples from 268 patients with psoriasis and 146 control subjects were collected for genotyping of the OPN gene.nnnRESULTSnHigher body mass index values (P = .047) and hypertension (odds ratio [OR] 2.68, P = .05) were observed in patients with psoriasis. Increased plasma OPN levels (>or=62.95 ng/mL) were significantly associated with psoriasis (OR 6.24, P = .001), hypertension (OR 3.05, P = .03), and diabetes mellitus (OR 3.13, P = .05). Occurrence of psoriasis (OR 5.12, P = .003) appeared to be the single independent risk factor for high plasma OPN values after multivariate logistic regression. Among patients with psoriasis, increased plasma OPN values were associated with the presence of hypertension (OR 4.69, P = .05). However, no significantly different allelic distributions of single nucleotide polymorphisms of the OPN gene were found between psoriasis and control groups.nnnLIMITATIONSnThe number of patients evaluated was relatively small.nnnCONCLUSIONSnHigh plasma OPN levels are an unfavorable factor for development of cardiovascular disease in patients with psoriasis.

The risk of cancer in patients with rheumatoid arthritis taking tumor necrosis factor antagonists: a nationwide cohort study.

IntroductionThe association between cancer and use of biologic therapy among rheumatoid arthritis (RA) patients remains controversial. We aimed to compare the relative risk of cancer development between RA patients taking tumor necrosis factor α (TNFα) antagonists and those taking nonbiologic disease-modifying anti-rheumatic drugs (nbDMARDs).MethodsWe conducted a nationwide cohort study between 1997 and 2011 using the Taiwan National Health Insurance Research Database. The risk of newly diagnosed cancer was compared between patients starting TNF-α antagonists (biologics cohort) and matched subjects taking nbDMARDs only (nbDMARDs cohort). Cumulative incidences and hazard ratios (HR) were calculated after adjusting for competing mortality. Standardized incidence ratio (SIR) was calculated for cancer risk. Multivariate analyses were performed using Cox proportional hazards model.ResultsWe compared 4426 new users of TNF-α antagonists and 17704 users of nbDMARDs with similar baseline covariate characteristics. The incidence rates of cancer among biologics and nbDMARDs cohorts were 5.35 (95% confidence interval (CI) 4.23 to 6.46) and 7.41 (95% CI 6.75 to 8.07) per 1000 person-years, respectively. On modified Cox proportional hazards analysis, the risk of cancer was significantly reduced in subjects in biologics cohort (adjusted HR 0.63, 95% CI 0.49 to 0.80, Pu2009<u2009.001), after adjusting for age, gender, disease duration, major co-morbidities, and prior use of DMARDs and corticosteroids. However, there was an increased risk for hematologic cancers in biologics cohort, yet without statistical significance. The effect of biologics was consistent across all multivariate stratified analyses and the association between biologics use and cancer risk was independent of dosage of concomitant nbDMARDs.ConclusionThese findings suggested that RA patients taking TNF-α antagonist are associated with a lower risk of cancer, but not for hematologic cancers, than RA patients taking nbDMARDs alone.

Association between traditional systemic antipsoriatic drugs and tuberculosis risk in patients with psoriasis with or without psoriatic arthritis: results of a nationwide cohort study from Taiwan.

BACKGROUNDnAlthough the link between tuberculosis (TB) and biologics use is well established, the risk of TB among patients with psoriasis exposed to traditional systemic therapies remains elusive.nnnOBJECTIVESnThe aim is to investigate the association between traditional systemic therapies and TB among patients with psoriasis.nnnMETHODSnWe conducted a retrospective cohort study on the risk of active TB among patients with psoriasis and psoriatic arthritis, using the National Health Insurance Research Database of Taiwan, 1996 through 2008. Standardized incidence ratios of TB were analyzed in comparison with age- and gender-matched general population. Logistic regression was used in a nested case-control analysis to estimate the odds ratios of TB related to exposure to traditional systemic agents during the year before TB development.nnnRESULTSnAmong the 81,266 patients in the psoriasis cohort, 497 new active TB cases were identified. The incidence rate of TB was 102 cases per 100,000 person-years among patients with psoriasis (standardized incidence ratio 1.22, 95% confidence interval 1.18-1.33). The risk of TB was higher in patients with severe disease (standardized incidence ratio 1.52, 95% confidence interval 1.46-1.74). To facilitate comparisons with the 497 active TB cases, a total of 1988 matched control subjects were selected for a nested case-control study. Patients taking systemic corticosteroids and nonsteroidal anti-inflammatory drugs were associated with higher incidence of TB, especially frequent users, after adjustment for multiple TB risk factors, drug exposures, hospital visits, and level of urbanization. Stratified analyses of current users and new users of these drugs revealed similar results. Finally, traditional systemic antipsoriatic treatment was not associated with TB on any of the analyses.nnnLIMITATIONnThe National Health Insurance Research Database did not contain information regarding severity of psoriasis, smoking status, alcohol use, diet, laboratory parameters, chest radiograph, or history of recent contact with an individual with TB. Misclassification of disease cannot be ruled out in a registry-based database. The accessibility of health care may be associated with the level of urbanization, which could confound the effect of drugs in multivariate analyses.nnnCONCLUSIONSnSevere psoriasis may be associated with an elevated TB risk. Traditional systemic therapies do not seem to be strongly associated with TB occurrence.