Faculty Bibliography

Clinicians have long assumed that an association exists between crystal arthropathies and the presence of osteoarthritis (OA). However, studies establishing an independent association between calcium pyrophosphate or uric acid crystal disease and OA are sparse. Even less is known about a possible pathogenic relationship. Whereas some studies suggest that the relationships between crystals and OA may not be incidental and that crystal deposition may contribute to the onset and/or acceleration of OA joint damage, other authors have challenged this assertion. In this review, we provide an overview of past and current research elucidating the role of crystal deposition, including monosodium urate, calcium pyrophosphate, and other crystals, in OA. Given the clinical frequency of gout and that agents exist to modulate serum UA levels, special attention is given to the role of monosodium urate crystals

Background: Ocular disease has been reported in up to 75 % of patients with Behcet's Syndrome (BS) in endemic regions where permanent visual loss is common. The prevalence of eye disease in North American BS patients is unknown, but felt to be lower than in endemic regions. More prevalent and severe eye disease is expected in North American populations with an ethnic background in those regions. Methods: A BS center was established in New York City in 2004. Patients at the center completed an MDHAQ, BSAS (Behcet Syndrome Activity Score), questionnaires about past medical history, medication use, Behcet's specific history, ethnic and demographic information. These data were prospectively collected over 5 years and updated on each visit. Patients fulfilling the International Behcet's Classification Criteria were analyzed as one cohort and then in 2 groups: Group A= with ethnic background in northern/central Europe and North America and/or self declared Caucasians without Mediterranean, Middle Eastern and/or Far Eastern background; Group B= Patients with Mediterranean, Middle Eastern, North African, or Far Eastern ethnic background. These groups were compared for their prevalence, type and outcome of ocular disease. Results: 471 patients were seen for suspected BS. 296 (62.8%) fulfilled the International Behcet's Classification Criteria and were included in the present study. Of those, 121 (40.9%) patients had eye disease, which included 56 (18.9%) with uveitis, 8 (2.7%) with retinitis, 11 (3.7%) with episcleritis, and 42 (14.2%) with other eye disease. There was no statistically significant difference between Groups A (n=163) and B (n=133) regarding the prevalence of eye disease (41.1% vs. 40.6%, p<0.93), types of involvement: uveitis (19.6% vs. 18.0%, p<0.729), retinitis (1.8% vs. 3.8%, p<0.311), episcleritis (3.1% vs. 4.5%, p<0.514), baseline disease activity and use of immunosuppressive medications. None of the patients presented with or developed blindness during the study period. Conclusions: Eye involvement was less prevalent and seemed to have better outcomes in this North American cohort of BS patients than in cohorts studied in high-incidence/endemic BS regions. Contrary to our expectations, there was no significant difference in prevalence or outcome of Behcet's eye disease between North Americans of non-Mediterranean European ancestry compared to individuals of Mediterranean, Middle- or Far Eastern descent living in the US. These findings could suggest a role of environmental factors in the phenotypic expression of BS in general, and in the pathogenesis of Behcet's eye disease in particular

BACKGROUND: Myocardial infarction (MI) may be classified as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI). There is little data regarding the relationship between the infarct related artery (IRA), clinical characteristics of the patients, and the ST deviation pattern (ie, STEMI or NSTEMI). HYPOTHESIS: There is a predilection of any coronary artery to a particular ST deviation pattern of acute MI. METHODS: We reviewed our institutional database and selected patients who presented with an acute MI and underwent coronary angiography within 7 days of admission. The analysis included 830 patients of whom 563 had STEMI and 267 had NSTEMI. The culprit lesion was defined by reviewing each patient's angiographic report, electrocardiogram, and echocardiogram. TIMI flow rate was determined. RESULTS: The IRA in STEMI was most frequently the left anterior descending coronary artery (LAD) followed by the right coronary artery (RCA) and then the left circumflex coronary artery (LCX), a statistically significant difference. In patients with NSTEMI there were no significant differences in IRA. Patients with STEMI and LCX as the IRA were significantly younger and had a higher percentage of TIMI grade 3 flow then patients with STEMI and LAD or RCA as IRAs. These differences were not noted in patients with NSTEMI regardless of IRA. CONCLUSIONS: In STEMI there were significant differences in age and TIMI flow depending on the IRA. These findings were not demonstrated in patients with NSTEMI.

BACKGROUND: In ST-elevation MI (STEMI) the culprit artery is usually occluded, whereas non-STEMI (NSTEMI) it is usually patent. The location of the ruptured plaque may influence MI type. We examine whether the distance from the coronary ostium to the culprit lesion is different in STEMI as compared to NSTEMI. METHODS: We selected patients who presented with an acute MI and underwent coronary angiography during hospitalization. The analysis included 754 patients of whom 514 had STEMI and 240 had NSTEMI. The distance from the coronary ostium to the site of thrombosis was measured. RESULTS: For both STEMI and NSTEMI patients the first 60 mm of the coronary artery contained 75% of the culprit lesions. There were no significant differences in median distances from the vessel ostium to the site of thrombosis as well. CONCLUSIONS: The distance from coronary ostium to culprit lesion is similar in STEMI and NSTEMI. Culprit lesion location does not appear to influence the development of STEMI as opposed to NSTEMI.

BACKGROUND: Spontaneous reperfusion (SR) may occur in patients with ST elevation myocardial infarction (STEMI) prior to reperfusion therapy. Hyperglycemia is common on admission in patients with STEMI and is associated with a worse prognosis. Mechanisms remain unclear but may include impairment of coronary flow. The objective of this study was to examine whether acute hyperglycemia influenced the occurrence of SR in patients with STEMI. METHODS: All patients presenting to our institution with acute STEMI with measurement of glucose levels on presentation were eligible. SR was defined as a combination of significant relief of chest pain associated with an at least 70% resolution of ST segment elevation on follow-up ECG. RESULTS: 465 patients were studied of whom 77 patients met criteria for SR. Average glucose levels were not significantly different between the SR and non-SR groups (10.0+/-5.6 mmol/l versus 10.1+/-5.3; P=NS). When patients were divided into normoglycemic and hyperglycemic groups, there was no significant difference in the percentages of such patients in the SR and non-SR groups. (52% versus 54%; P=NS). CONCLUSIONS: Acute hyperglycemia on admission does not predict the occurrence of SR in a general population of patients with acute MI.

Spontaneous reperfusion (SR) of the infarct-related artery may occur in patients with ST-segment-elevation myocardial infarctions (STEMIs). Limited data are available on the angiographic characteristics of these patients. The objective of this study was to determine if there are differences in the distance of the culprit lesion from the coronary ostium in patients with STEMIs with and without SR. Patients who presented with acute STEMIs<12 hours after pain onset and who underwent coronary angiography were entered into the study. Measurement of the distance from the coronary ostium to the culprit lesion was performed. A total of 469 patients with STEMIs were included in the study, of whom 77 met criteria for SR (significant relief of chest pain associated with >or=50% resolution of ST-segment elevation on follow-up electrocardiography) and 392 did not. A highly significant difference was seen in ostial to culprit lesion distance, with the culprit lesions in the SR group being more distal than those in the non-SR group (45+/-22 vs 39+/-20 mm, p<0.009). In conclusion, the findings of this study demonstrate that the location of the culprit lesion in patients with STEMIs who undergo SR is more distal in the involved artery than in patients with STEMIs who do not undergo SR.