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Wilton KM, Crowson CS, Matteson EL. Malignancy incidence in patients with psoriatic arthritis: a comparison cohort-based incidence study. Clin Rheumatol 2016; 35:2603-7. [PMID: 27572325 DOI: 10.1007/s10067-016-3396-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 12/19/2022]
Abstract
Malignancy is a major cause of death in patients with inflammatory disease. The risk of individual malignancies is altered in some inflammatory diseases, such as rheumatoid arthritis and psoriasis. This study aimed to examine malignancy incidence in patients with psoriatic arthritis (PsA), a related inflammatory disease. Institutional cancer registry and medical record linkage systems were retrospectively reviewed in a population-based incidence cohort of 217 patients with PsA and 434 age- and sex-matched comparators. Malignancy rates were compared using adjusted Cox models. Incidence of overall malignancy (excluding NMSC; hazard ratio (HR) 1.64; 95 % confidence interval (CI) 1.03-2.61) and breast cancer (HR 3.59; 95 % CI 1.22-10.61), but not NMSC (HR 1.23; 95 % CI 0.72-2.09), were significantly elevated in the PsA cohort. Age and female sex were similar predisposing risk factors in both cohorts. The overall incidence of malignancy, as well as the risk of breast cancer, was higher in patients with PsA than in the general population.
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Affiliation(s)
| | - Cynthia S Crowson
- Department of Health Sciences Research, Rochester, MN, USA.,Division of Rheumatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA
| | - Eric L Matteson
- Department of Health Sciences Research, Rochester, MN, USA. .,Division of Rheumatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
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52
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Polachek A, Touma Z, Anderson M, Eder L. Reply. Arthritis Care Res (Hoboken) 2016; 69:457. [PMID: 27482649 DOI: 10.1002/acr.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/19/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Ari Polachek
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Zahi Touma
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Lihi Eder
- University of Toronto, Women's College Research Institute, and Women's College Hospital, Toronto, Ontario, Canada
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53
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Ahmed N, Prior JA, Chen Y, Hayward R, Mallen CD, Hider SL. Prevalence of cardiovascular-related comorbidity in ankylosing spondylitis, psoriatic arthritis and psoriasis in primary care: a matched retrospective cohort study. Clin Rheumatol 2016; 35:3069-3073. [PMID: 27485152 DOI: 10.1007/s10067-016-3362-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/27/2016] [Accepted: 07/15/2016] [Indexed: 12/21/2022]
Abstract
The aim of this study is to compare the prevalence of cardiovascular (CVD)-related comorbidities in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) or psoriasis (Ps) in UK primary care against matched cohorts. Matched retrospective cohort study used a primary care consultation database. Three cohorts were constructed using all patients with a Read code diagnosis of AS, PsA or Ps between 1999 and 2009; each cohort was then compared in a 1:4 ratio to a matched cohort. The prevalence of CVD-related comorbidities (hypertension, ischaemic heart disease, hyperlipidaemia and diabetes mellitus) were identified by the first consultation of a comorbid Read code, in those with an inflammatory condition of interest. The prevalence of CVD-related comorbidities was compared between each inflammatory cohort and their matched cohort using Fisher's exact test. Ninety-four AS, 106 PsA and 290 Ps patients were identified. Compared with matched cohorts, the most prevalent CVD-related comorbidity in patients with AS was hypertension (35 (37.2 %) vs. 96 matched (25.5 %), p = 0.03); this was also the case for PsA (41 (38.7 %) vs. 114 matched (26.9 %), p = 0.02). No differences were seen in the prevalence of other CVD-related comorbidities in those with AS, PsA or Ps compared to their matched cohorts. Our findings provide UK comparisons of CVD-related comorbidities in patients with AS, PsA and Ps alone; specifically, demonstrating increased prevalence of hypertension in AS and PsA cohorts compared to their matched cohorts. This further supports the argument for more evidence in the need for screening and intervention around CVD comorbidities in inflammatory conditions.
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Affiliation(s)
- Nadeem Ahmed
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - James A Prior
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK.
| | - Ying Chen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - Richard Hayward
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - Samantha L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK.,Haywood Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, Staffordshire, ST6 7AG, UK
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54
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Cantini F, Niccoli L, Nannini C, Cassarà E, Kaloudi O, Giulio Favalli E, Becciolini A, Biggioggero M, Benucci M, Li Gobbi F, Grossi V, Infantino M, Meacci F, Manfredi M, Guiducci S, Bellando-Randone S, Matucci-Cerinic M, Foti R, Di Gangi M, Mosca M, Tani C, Palmieri F, Goletti D. Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. Semin Arthritis Rheum 2016; 45:519-32. [DOI: 10.1016/j.semarthrit.2015.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 02/08/2023]
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Ganzetti G, Campanati A, Molinelli E, Offidani A. Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: Three different diseases on a unique background. World J Cardiol 2016; 8:120-131. [PMID: 26981209 PMCID: PMC4766264 DOI: 10.4330/wjc.v8.i2.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/04/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic inflammatory immune-mediated skin disease, frequently associated with systemic comorbidities. According to recent data, patients with psoriasis show a greater prevalence of metabolic syndrome, which confers a higher cardiovascular risk. The link between these pathological conditions appears to be a chronic low-grade inflammatory status. The aim of this review is to focus on the multiple epidemiological and physio-pathogenetic aspects linking non-alcoholic fatty liver disease, psoriasis, and cardiovascular disease.
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Chiu HY, Hsieh CF, Chiang YT, Tsai YW, Huang WF, Li CY, Wang TS, Tsai TF. Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis. PLoS One 2016; 11:e0146462. [PMID: 26745869 PMCID: PMC4712908 DOI: 10.1371/journal.pone.0146462] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/17/2015] [Indexed: 01/08/2023] Open
Abstract
Background The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown. Methods Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs. Results Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22–1.28) and stroke (aHR, 1.24; 95% CI, 1.16–1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults. Conclusions The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.
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Affiliation(s)
- Hsien-Yi Chiu
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Feng Hsieh
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ting Chiang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Weng-Foung Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-Shun Wang
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Dermatology, National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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Primdahl J, Ferreira RJO, Garcia-Diaz S, Ndosi M, Palmer D, van Eijk-Hustings Y. Nurses' Role in Cardiovascular Risk Assessment and Management in People with Inflammatory Arthritis: A European Perspective. Musculoskeletal Care 2015; 14:133-51. [PMID: 26549188 DOI: 10.1002/msc.1121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cardiovascular risk (CVR) assessment and management in patients with inflammatory arthritis (IA) is recommended but European nurses' involvement in this role has not been well studied. AIM The aim of the present study was to explore European nurses' role in assessing and managing CVR, in order to suggest topics for practice development and research in this area regarding persons with IA. METHODS We searched Embase, Cinahl, Cochrane, PsycInfo and PubMed databases and included European articles from the past ten years if they described how nurses assess and/or manage CVR. In addition to the systematic review, we provided case studies from five different countries to illustrate national guidelines and nurses' role regarding CVR assessment and management in patients with IA. RESULTS Thirty-three articles were included. We found that trained nurses were undertaking CVR assessment and management in different settings and groups of patients. The assessments include blood pressure, body mass index, waist circumference, glucose and lipid-profile, adherence to medication and behavioural risk factors (unhealthy diet, physical inactivity, alcohol and smoking). Different tools were used to calculate patients' risk. Risk management differed from brief advice to long-term follow-up. Nurses tended to take a holistic and individually tailored approach. Clinical examples of inclusion of rheumatology nurses in these tasks were scarce. CONCLUSION Nurses undertake CVR assessment, communication and management in different types of patients. This is considered to be a highly relevant task for rheumatology nursing, especially in patients with IA. Further studies are needed to assess patients' perspective, effectiveness and cost-effectiveness of nurse-led CVR. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jette Primdahl
- King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark. .,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark and Hospital of Southern Jutland, Aabenraa, Denmark.
| | - Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Coimbra, Portugal
| | - Silvia Garcia-Diaz
- Moises Broggi Hospital, Consorci Sanitari Integral CSI, Barcelona, Spain
| | - Mwidimi Ndosi
- School of Healthcare, University of Leeds, Leeds, UK
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58
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Eder L, Wu Y, Chandran V, Cook R, Gladman DD. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis 2015; 75:1680-6. [DOI: 10.1136/annrheumdis-2015-207980] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/26/2015] [Indexed: 12/15/2022]
Abstract
ObjectiveTo assess the incidence and risk factors of cardiovascular events in patients with psoriatic arthritis (PsA).MethodsA cohort analysis was conducted involving patients recruited and followed over the period from 1978 to 2013 in a large PsA clinic. The participants were assessed at 6 to 12-month intervals according to a standard protocol. The collected information included demographics, lifestyle habits, medical history, medications use and PsA-related outcomes. The primary outcome was a composite major cardiovascular end point comprising myocardial infarction, ischaemic stroke, revascularisation or cardiovascular death. The association between the features of disease activity and the occurrence of cardiovascular events was assessed using Cox proportional hazard models.ResultsA total of 1091 patients with PsA were analysed. During the follow-up period, 104 cardiovascular events occurred. A considerable proportion of patients developed a cardiovascular event (19.8% of the patients by the age of 70 years and 30.1% of patient by the age of 80 years). No trend in the risk of developing cardiovascular events was observed over the decades from 1978 to 2013 (p=0.73). In multivariate analysis, the following variables were independent predictors of major cardiovascular events: hypertension (relative risk (RR) 1.81, p=0.015), diabetes (RR 2.72, p<0.001) and the number of dactylitic digits (RR 1.20, p<0.001). Sedimentation rate was a significant predictor only among women (RR 1.83, p=0.02).ConclusionA significant proportion of patients with PsA develop cardiovascular events during the course of their disease. Increased cardiovascular risk is associated with a combination of traditional cardiovascular risk factors and disease activity.
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59
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Hong J, Maron DJ, Shirai T, Weyand CM. Accelerated atherosclerosis in patients with chronic inflammatory rheumatologic conditions. ACTA ACUST UNITED AC 2015; 10:365-381. [PMID: 27042216 DOI: 10.2217/ijr.15.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atherosclerosis is a complex inflammatory disease involving aberrant immune and tissue healing responses, which begins with endothelial dysfunction and ends with plaque development, instability and rupture. The increased risk for coronary artery disease in patients with rheumatologic diseases highlights how aberrancy in the innate and adaptive immune system may be central to development of both disease states and that atherosclerosis may be on a spectrum of immune-mediated conditions. Recognition of the tight association between chronic inflammatory disease and complications of atherosclerosis will impact the understanding of underlying pathogenic mechanisms and change diagnostic and therapeutic approaches in patients with rheumatologic syndromes as well as patients with coronary artery disease. In this review, we provide a summary of the role of the immune system in atherosclerosis, discuss the proposed mechanisms of accelerated atherosclerosis seen in association with rheumatologic diseases, evaluate the effect of immunosuppression on atherosclerosis and provide updates on available risk assessment tools, biomarkers and imaging modalities.
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Affiliation(s)
- Jison Hong
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - David J Maron
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Tsuyoshi Shirai
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Cornelia M Weyand
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
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60
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Kaushik P, Solomon DH, Greenberg JD, Anderson JT, Reed G, Pala O, Sumbul-Yuksel B, Kadam P, Kremer JM. Subcutaneous nodules are associated with cardiovascular events in patients with rheumatoid arthritis: results from a large US registry. Clin Rheumatol 2015; 34:1697-704. [PMID: 26242470 DOI: 10.1007/s10067-015-3032-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/24/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Subcutaneous nodules are the most common conspicuous extra-articular manifestation of rheumatoid arthritis (RA). Cardiovascular disease (CVD) is the leading cause of death in patients with RA. The objective of this study is to examine the possibility of a relationship between subcutaneous nodules and "first ever" cardiovascular disease event, i.e., myocardial infarction (MI), stroke, or cardiovascular death in a large registry-cohort of patients with RA. Patient information was collected from the CORRONA registry from October 2001 to September 2011. A total of 26,042 patients with RA were studied for the presence or absence of subcutaneous nodules. Cox proportional hazards regression models were constructed to estimate the hazard ratios (HR) for CVD events in relation to subcutaneous nodules at baseline. Three statistical models were used to examine the association between subcutaneous nodules and CVD: Model A adjusted for age and sex associated risk, model B adjusted for traditional CV risk factors, and model C adjusted for factors in models A and B plus underlying RA-specific measures. The definition of primary exposure was "subcutaneous nodules at baseline." A total of 3908 patients had subcutaneous nodules at baseline. Of the 566 total composite CVD events, 138 occurred in the group that had SCN at baseline. Incidence rate-ratio values (patients with subcutaneous nodules at baseline vs. no subcutaneous nodules at baseline) for composite CVD events, MI, stroke, and cardiovascular death were 1.55, 1.65, 1.37, and 1.68, respectively. Adjusted HR values (95 % CI) for composite CVD events based on "subcutaneous nodules-status at baseline" (primary exposure) were as follows: 1.35 (1.11-1.63) for model A, 1.25 (1.03-1.52) for model B, and 1.03 (0.831-1.277) for model C. Subcutaneous nodules were associated with increased CVD events in RA. This association persisted after adjusting for age, sex, and traditional CV risk factors.
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Affiliation(s)
- Prashant Kaushik
- Division of Rheumatology Stratton VAMC, Albany, NY, USA. .,Department of Internal Medicine Albany Medical College, Albany, NY, USA.
| | - Daniel H Solomon
- Divisions of Rheumatology & Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | - George Reed
- University of Massachusetts Medical School, Worcester, MA, USA.
| | - Ozlem Pala
- University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Bahar Sumbul-Yuksel
- Division of Rheumatology, University of Nevada School of Medicine, Reno, NV, USA.
| | | | - Joel M Kremer
- Albany Medical College and Director of Research, The Center for Rheumatology, Albany, NY, USA.
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