Update in Rheumatology: Evidence Published in 2016

46-Year Trends in Systemic Lupus Erythematosus Mortality in the United States, 1968 to 2013: A Nationwide Population-Based Study: Annals of Internal Medicine: Vol 167, No 11

Background: No large population-based studies have been done on systemic lupus erythematosus (SLE) mortality trends in the United States. Objective: To identify secular trends and population characteristics associated with SLE mortality. Design: Population-based study using a national mortality database and census data. Setting: United States. Participants: All U.S. residents, 1968 through 2013. Measurements: Joinpoint trend analysis of annual age-standardized mortality rates (ASMRs) for SLE and non-SLE causes by sex, race/ethnicity, and geographic region; multiple logistic regression analysis to determine independent associations of demographic variables and period with SLE mortality. Results: There were 50 249 SLE deaths and 100 851 288 non-SLE deaths from 1968 through 2013. Over this period, the SLE ASMR decreased less than the non-SLE ASMR, with a 34.6% cumulative increase in the ratio of the former to the latter. The non-SLE ASMR decreased every year starting in 1968, whereas the SLE ASMR decreased between 1968 and 1975, increased between 1975 and 1999, and decreased thereafter. Similar patterns were seen in both sexes, among black persons, and in the South. However, statistically significant increases in the SLE ASMR did not occur among white persons over the 46-year period. Females, black persons, and residents of the South had higher SLE ASMRs and larger cumulative increases in the ratio of the SLE to the non-SLE ASMR (31.4%, 62.5%, and 58.6%, respectively) than males, other racial/ethnic groups, and residents of other regions, respectively. Multiple logistic regression showed independent associations of sex, race, and region with SLE mortality risk and revealed significant racial/ethnic differences in associations of SLE mortality with sex and region. Limitations: Underreporting of SLE on death certificates may have resulted in underestimates of SLE ASMRs. Accuracy of coding on death certificates is difficult to ascertain. Conclusion: Rates of SLE mortality have decreased since 1968 but remain high relative to non-SLE mortality, and significant sex, racial, and regional disparities persist. Primary Funding Source: None.

Blood Pressure Treatment Targets in Adults Aged 60 Years or Older

With the Merit-Based Incentive Payment System, Pay for Performance Is Now National Policy

Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017*

The Affordable Care Act: Do No Harm

At Last, a Good Estimate of the Magnitude of the Private-Sale Loophole for Firearms

A Tale of Two Trials: Reconciling Differences in Results by Exploring Heterogeneous Treatment Effects

Methods and Reporting Studies Assessing Fecal Microbiota Transplantation: A Systematic Review: Annals of Internal Medicine: Vol 167, No 1

Background: Fecal microbiota transplantation (FMT) could be a novel treatment option for several chronic diseases associated with altered gut microbiota. Purpose: To examine the conduct and reporting of studies assessing FMT. Data Sources: Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science from inception to 31 January 2017. Study Selection: Two reviewers independently examined titles and abstracts to identify all English-language reports of human clinical studies assessing the safety or efficacy of FMT. Data Extraction: Three reviewers independently assessed study types and characteristics and the reporting of important methodological components of the FMT intervention. Data Synthesis: Most (84%) of the 85 published reports found addressed the use of FMTs for Clostridium difficile infection or inflammatory bowel disease, and most (87%) were non–randomized controlled trials. Important methodological components that were not reported in published studies included the following: eligibility criteria for donors (47%), materials used for collecting stools and the period of collection (96%), methods used for conservation of stools (76%), the amount and type of stools used (for example, fresh or frozen), and duration of stool conservation (67%). Many (58%) did not report an analysis of microbiota composition. Limitations: Lack of universal consensus regarding the most important methodological components of FMT and inability to assess the actual conduct of studies and whether the publication process affected the completeness of reporting. Conclusion: Key components of FMT interventions, which are necessary to replicate and understand study findings about efficacy and safety, are poorly reported. Primary Funding Source: No specific funding.

Guidelines to Limit Added Sugar Intake: Junk Science or Junk Food?