101
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Yates W, McCluskey P, Wakefield D. Long-term immunosuppressive therapy for inflammatory eye disease – the link between systemic treatment, cardiovascular risk and disease? EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1349610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- William Yates
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Denis Wakefield
- School of Medical Sciences, University of New South Wales, Kensington, Australia
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102
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Stigliano C, Ramirez MR, Singh JV, Aryal S, Key J, Blanco E, Decuzzi P. Methotraxate-Loaded Hybrid Nanoconstructs Target Vascular Lesions and Inhibit Atherosclerosis Progression in ApoE -/- Mice. Adv Healthc Mater 2017; 6. [PMID: 28402587 DOI: 10.1002/adhm.201601286] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/23/2017] [Indexed: 01/01/2023]
Abstract
Atherosclerosis is an inflammatory disorder characterized by the progressive thickening of blood vessel walls eventually resulting in acute vascular syndromes. Here, intravenously injectable hybrid nanoconstructs are synthesized for tempering immune cell inflammation locally and systemically. Lipid and polymer chains are nanoprecipitated to form 100 nm spherical polymeric nanoconstructs (SPNs), loaded with methotrexate (MTX) and subsequently labeled with Cu64 and fluorescent probes for combined nuclear/optical imaging. Upon engulfment into macrophages, MTX SPNs intracellularly release their anti-inflammatory cargo significantly lowering the production of proinflammatory cytokine (interleukin 6 and tumor necrosis factor α) already at 0.06 mg mL-1 of MTX. In ApoE-/- mice, fed with high-fat diet up to 17 weeks, nuclear and optical imaging demonstrates specific accumulation of SPNs within lipid-rich plaques along the arterial tree. Histological analyses confirm SPN uptake into macrophages residing within atherosclerotic plaques. A 4-week treatment with biweekly administration of MTX SPNs is sufficient to reduce the plaque burden in ApoE-/- mice by 50%, kept on high-fat diet for 10 weeks. Systemic delivery of MTX to macrophages via multifunctional, hybrid nanoconstructs constitutes an effective strategy to inhibit atherosclerosis progression and induce, potentially, the resorption of vascular lesions.
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Affiliation(s)
- Cinzia Stigliano
- Department of Translational Imaging & Nanomedicine; Houston Methodist Research Institute; Houston TX 77030 USA
| | - Maricela R. Ramirez
- Department of Translational Imaging & Nanomedicine; Houston Methodist Research Institute; Houston TX 77030 USA
| | - Jaykrishna V. Singh
- Department of Translational Imaging & Nanomedicine; Houston Methodist Research Institute; Houston TX 77030 USA
| | - Santosh Aryal
- Department of Chemistry; Nanotechnology Innovation Center of Kansas State (NICKS); Kansas State University; Manhattan KS 66506 USA
| | - Jaehong Key
- Department of Biomedical Engineering; Yonsei University; Wonju Gangwon-do 220-710 Republic of Korea
| | - Elvin Blanco
- Department of Translational Imaging & Nanomedicine; Houston Methodist Research Institute; Houston TX 77030 USA
| | - Paolo Decuzzi
- Laboratory of Nanotechnology for Precision Medicine; Fondazione Istituto Italiano di Tecnologia; Via Morego 30 Genoa 16163 Italy
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103
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The Therapeutic Potential of Anti-Inflammatory Exerkines in the Treatment of Atherosclerosis. Int J Mol Sci 2017; 18:ijms18061260. [PMID: 28608819 PMCID: PMC5486082 DOI: 10.3390/ijms18061260] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 12/15/2022] Open
Abstract
Although many cardiovascular (CVD) medications, such as antithrombotics, statins, and antihypertensives, have been identified to treat atherosclerosis, at most, many of these therapeutic agents only delay its progression. A growing body of evidence suggests physical exercise could be implemented as a non-pharmacologic treatment due to its pro-metabolic, multisystemic, and anti-inflammatory benefits. Specifically, it has been discovered that certain anti-inflammatory peptides, metabolites, and RNA species (collectively termed “exerkines”) are released in response to exercise that could facilitate these benefits and could serve as potential therapeutic targets for atherosclerosis. However, much of the relationship between exercise and these exerkines remains unanswered, and there are several challenges in the discovery and validation of these exerkines. This review primarily highlights major anti-inflammatory exerkines that could serve as potential therapeutic targets for atherosclerosis. To provide some context and comparison for the therapeutic potential of exerkines, the anti-inflammatory, multisystemic benefits of exercise, the basic mechanisms of atherosclerosis, and the limited efficacies of current anti-inflammatory therapeutics for atherosclerosis are briefly summarized. Finally, key challenges and future directions for exploiting these exerkines in the treatment of atherosclerosis are discussed.
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104
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Moreira DM, Lueneberg ME, da Silva RL, Fattah T, Gottschall CAM. MethotrexaTE THerapy in ST-Segment Elevation MYocardial InfarctionS. J Cardiovasc Pharmacol Ther 2017; 22:538-545. [DOI: 10.1177/1074248417699884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Methotrexate is an anti-inflammatory drug that has been shown to have anti-ischemic effects. Our aim was to evaluate if methotrexate could reduce infarct size in patients with ST-segment elevation myocardial infarction (STEMI). Methods: We randomly assigned patients with STEMI to receive either methotrexate or placebo. Primary outcome was infarct size determined by calculating the area under the curve (AUC) for creatine kinase (CK) release. Secondary outcomes were AUC of CK MB (CK-MB) and AUC of troponin I; peak CK, peak CK-MB, and troponin I; B-type natriuretic peptide (BNP) level, high-sensitivity C-reactive protein (hsCRP) result, and erythrocyte sedimentation rate (ESR); left ventricular ejection fraction (LVEF); thrombolysis in myocardial infarction (TIMI) frame count; Killip score; mortality and reinfarction incidence; and incidence of adverse reactions. Results: We included 84 patients. Median AUC of CK was 78 861.0 in the methotrexate group and 68 088.0 in the placebo group ( P = .10). Patients given methotrexate and placebo exhibited, respectively, median AUC for CK-MB of 9803.4 and 8037.0 ( P = .42); median AUC for troponin of 3691.1 and 2132.6 ( P = .09); peak CK of 2806.0 and 2147.0 ( P = .05); peak CK-MB of 516.0 and 462.3 ( P = .25); and peak troponin of 121.0 and 85.1 ( P = .06). At 3 months, LVEF was lower in patients who received methotrexate (49.0% ± 14.1%) than in patients given placebo (56.4% ± 10.0%; P = .01). There were no differences in hsCRP, ESR, BNP, Killip scores, TIMI frame count, reinfarction, and mortality rates. There was a higher median serum glutamic–pyruvic transaminase levels in the methotrexate group. Conclusion: Methotrexate did not reduce infarction size and worsened LVEF at 3 months ( Clinicaltrials.gov identifier NCT01741558).
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Affiliation(s)
- Daniel Medeiros Moreira
- Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil
- Instituto de Cardiologia do Rio Grande do Sul—FUC, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Tammuz Fattah
- Instituto de Cardiologia de Santa Catarina, São José, Santa Catarina, Brazil
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105
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Cardiovascular inflammation is reduced with methotrexate in diabetes. Mol Cell Biochem 2017; 432:159-167. [PMID: 28303409 DOI: 10.1007/s11010-017-3006-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/04/2017] [Indexed: 02/06/2023]
Abstract
Diabetes increases the risk of vascular events and mortality. While earlier type 2 diabetes trials demonstrated that intensive glucose lowering reduces microvascular complications, it is only recently that treatment with some of the newer antihyperglycemic agents has been associated with macrovascular benefits. We report herein that db/db mice concomitantly fed the Western diet and treated with the anti-inflammatory agent methotrexate display a less aggressive inflammatory (lower serum IL-1β, IL-6, SDF-1, and TNFα levels; higher circulating adiponectin, IL-12p70 and IL-10 concentrations; lower aortic VCAM-1 levels) profile than their saline-treated counterpart. Furthermore, acetylcholine-elicited endothelium-dependent vasodilatation was significantly greater in thoracic aortic segments from the former group. Collectively, the data lend support to the notion that alterations in the inflammatory system may be involved in the macrovascular benefits observed in type 2 diabetes trials and provide credence for the development of anti-inflammatory tools to lower CV risk and CV events in diabetes.
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106
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Mahmoudi M, Aslani S, Fadaei R, Jamshidi AR. New insights to the mechanisms underlying atherosclerosis in rheumatoid arthritis. Int J Rheum Dis 2017; 20:287-297. [PMID: 28205331 DOI: 10.1111/1756-185x.12999] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is an inflammatory circumstance, which has been associated with increased risk of cardiovascular disease (CVD). Although RA management has been promoted, mortality rate due to CVD remains remarkable. Approximately, 50% of premature death cases in RA are attributable to CVD. RA patients develop atherosclerosis in a greater amount than the general population. Moreover, atherosclerotic lesions develop rapidly in RA patients and might be more susceptible to rupture. The inflammatory condition of RA, such as cytokines, abnormally activated immune cells, play a role in the initiation, perpetuation and exacerbation of atherosclerosis. RA and CVD have genetic and environmental contributing risk factors in common, implying to potential coincidence of both disorders. Accelerated atherosclerosis in RA is attributed to inflammation, which carries its role out both through modulation of traditional risk factors and direct effect on the vessel wall. Hence, anti-inflammatory medications in RA like tumor necrosis factor blockers might have a beneficial effect on preventing cardiovascular development. Increasing age, smoking, hypertension, male gender, hypercholesterolemia and diabetes are enumerated as traditional CVD risk factors. Hopefully, further understanding of the cardiovascular risk factors by perceiving the disease conditions behind CVD, will improve management of cardiovascular risks in patients with RA.
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Affiliation(s)
- Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Aslani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Fadaei
- Biochemistry Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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107
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Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study. Rheumatol Int 2016; 37:487-493. [PMID: 28032180 PMCID: PMC5357293 DOI: 10.1007/s00296-016-3638-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/19/2016] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate (a) the mortality in a clinical cohort of patients with established rheumatoid arthritis in comparison with the general Dutch population over 15 years, (b) the trend in the mortality ratio during the study period, and (c) causes of death and compare these with the general population. In 1997, a sample of 1222 patients was randomly selected from the register of a large rheumatology outpatient clinic. Their mortality and primary causes of death between 1997 and 2012 were obtained from Statistics Netherlands. The standardized mortality ratio (SMR) for all-cause mortality and the number of life-years lost in the study period, adjusted for age, sex, and calendar year, were calculated. A linear poisson regression analysis was performed to evaluate change in all-cause SMR over time. Finally, the SMRs for cause-specific mortality were calculated. The mean age of the population at baseline was 60.4 (SD 15.4) years, and 72.6% of the patients were women. The estimated SMR (95% CI) for all-cause mortality was 1.54 (1.41, 1.67) with about one life-year lost over the study period. There was a trend to decreasing SMR (2% annually, p = .07). Mortality was higher compared with the general population for circulatory system diseases, respiratory system diseases, musculoskeletal system diseases, and digestive system diseases (p < .05). The observed mortality among patients with RA was 54% higher than in the general population after adjustment for age, sex and calendar year. More than one life-year was lost over 15 years, and the mortality tended to decrease over time. The mortality was higher for cardiovascular, respiratory, musculoskeletal and digestive diseases.
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108
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Huet F, Akodad M, Fauconnier J, Lacampagne A, Roubille F. Anti-inflammatory drugs as promising cardiovascular treatments. Expert Rev Cardiovasc Ther 2016; 15:109-125. [DOI: 10.1080/14779072.2017.1273771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Fabien Huet
- Cardiology Department, Hôpital Arnaud de Villeneuve, CHU de Montpellier, UFR de Médecine, Université Montpellier 1, Montpellier cedex, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier cedex, France
| | - Mariama Akodad
- Cardiology Department, Hôpital Arnaud de Villeneuve, CHU de Montpellier, UFR de Médecine, Université Montpellier 1, Montpellier cedex, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier cedex, France
| | - Jérémy Fauconnier
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier cedex, France
| | - Alain Lacampagne
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier cedex, France
| | - François Roubille
- Cardiology Department, Hôpital Arnaud de Villeneuve, CHU de Montpellier, UFR de Médecine, Université Montpellier 1, Montpellier cedex, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier cedex, France
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109
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Bertrand MJ, Tardif JC. Inflammation and beyond: new directions and emerging drugs for treating atherosclerosis. Expert Opin Emerg Drugs 2016; 22:1-26. [PMID: 27927063 DOI: 10.1080/14728214.2017.1269743] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cardiovascular (CV) atherosclerotic disease remains the leading cause of morbidity and mortality worldwide, despite the advances in contemporary therapies. Inflammation is an important process in atherosclerosis, leading to plaque rupture and acute coronary syndrome. Although statin therapy has substantially reduced CV events in primary and secondary prevention, many treated patients will have recurrent adverse CV events despite the standard of care. Thus, drug development aiming to target inflammatory pathways seems a promising avenue for novel therapies in atherosclerosis. Areas covered: Statins have been extensively studied and are the most effective lipid-lowering drugs available for CV prevention. Novel anti-inflammatory drugs are being tested in Phase II and III trials, targeting pathways like interleukin-1, leukotrienes, TNF-α, P-selectin, CCL2-CCR2 and MAP Kinase. Expert opinion: Novel anti-inflammatory therapies seem promising additions to address the residual CV risk present despite the current standard of care, but large clinical trials have not yet shown beneficial effects on clinical events. PCSK9 inhibitors have been shown to substantially reduce LDL-C, however their long-term safety and effects on CV risk are currently being investigated. Pharmacogenomics holds great potential in future lipid trials, enabling the identification of patients who will respond with greater benefits and smaller risk to therapies and to decrease failure rates in drug development, as genotype-dependent effects of the CETP inhibitor dalcetrapib were shown in the dal-OUTCOMES and dal-PLAQUE-2 trials.
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Affiliation(s)
- Marie-Jeanne Bertrand
- a Montreal Heart Institute, Department of medicine , Université de Montréal , Montreal , Canada
| | - Jean-Claude Tardif
- a Montreal Heart Institute, Department of medicine , Université de Montréal , Montreal , Canada
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110
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Prognostic factors of methotrexate-associated lymphoproliferative disorders associated with rheumatoid arthritis and plausible application of biological agents. Mod Rheumatol 2016; 27:773-777. [DOI: 10.1080/14397595.2016.1259714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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111
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Tam HW, Yeo KJ, Leong PY, Chen CH, Li YC, Ma CM, Wang YH, Chiou JY, Wei JCC. Sulfasalazine might reduce risk of cardiovascular diseases in patients with ankylosing spondylitis: A nationwide population-based retrospective cohort study. Int J Rheum Dis 2016; 20:363-370. [PMID: 27943609 DOI: 10.1111/1756-185x.12986] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM To assess the effects of celecoxib and sulfasalazine on cardiovascular risk in patients with ankylosing spondylitis (AS). METHODS We performed a 10-year population-based retrospective cohort study. A total of 1208 AS patients and 19 328 non-AS patients were sampled from the Taiwan National Health Insurance (NHI) database. We compared these two groups of patients to identify the differences in the exposure of non-steroidal anti-inflammatory drugs and sulfasalazine and their effects on cardiovascular risk. Univariate analyses were performed using Chi-squared tests for dichotomous variables and t-tests for continuous variables. Cox proportional hazard models were conducted to investigate the risk of developing cardiovascular diseases (CVD). RESULTS AS patients had an adjusted hazard ratio (HR) of 1.72 (CI = 1.46-2.02, P < 0.01) for CVD compared with non-AS controls. The risk increased significantly with the progression of the disease. The use of celecoxib and sulfasalazine provided protective effects against CVD in both groups of patients. Both drugs at high cumulative defined daily doses (DDD) and celecoxib alone at high cumulative DDD showed significant protective effects against CVD in AS patients and the control group, respectively. Sulfasalazine at ≥ 0.5 DDD (1000 mg/day) reduced CVD risk in patients with AS (HR = 0.65, CI = 0.43-0.998, P < 0.05). CONCLUSIONS In this population-based retrospective cohort study, sulfasalazine at its optimal dose reduced CVD risk in patients with AS. Celecoxib was neutral regarding CVD risk in AS patients.
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Affiliation(s)
- Hong-Wei Tam
- School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
| | - Kai-Jieh Yeo
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Tai Chung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Tai Chung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
| | - Chao-Hsi Chen
- School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
| | - Yuan-Chao Li
- School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
| | - Chien-Ming Ma
- School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Tai Chung, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Tai Chung, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Tai Chung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Tai Chung, Taiwan
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112
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Charles-Schoeman C, Wicker P, Gonzalez-Gay MA, Boy M, Zuckerman A, Soma K, Geier J, Kwok K, Riese R. Cardiovascular safety findings in patients with rheumatoid arthritis treated with tofacitinib, an oral Janus kinase inhibitor. Semin Arthritis Rheum 2016; 46:261-271. [DOI: 10.1016/j.semarthrit.2016.05.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/29/2016] [Accepted: 05/27/2016] [Indexed: 12/18/2022]
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113
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Progression of noncalcified and calcified coronary plaque by CT angiography in SLE. Rheumatol Int 2016; 37:59-65. [PMID: 27882428 DOI: 10.1007/s00296-016-3615-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/17/2016] [Indexed: 01/07/2023]
Abstract
Premature coronary artery disease remains the major cause of late death in systemic lupus erythematosus (SLE). Coronary artery calcium (CAC) represents an advanced stage of atherosclerosis, whereas noncalcified coronary atherosclerotic plaque (NCP) typically is more prone to trigger acute coronary events. The aim of this study was to assess the stability of NCP over time and identify factors associated with changes in NCP in patients with SLE. CT coronary angiography and calcium scanning were performed at baseline and follow-up in thirty-six SLE patients. Duration between baseline and follow-up NCP assessment ranged from 2 to 8 years. CAC was quantified by the Agatston score and classified as none, low (1-99), moderate (100-299) or high calcium score (300 and above). NCP was quantified based on a previously validated score and classified as none, low (<0.5) or high (0.5+). SLE disease activity was quantified using the SELENA-SLEDAI and physician global assessment indices. To assess the association between quantitative clinical variables and changes in NCP, adjusting for time, we used linear regression models. The group of 36 SLE patients were 75% females, 75% Caucasians, 17% African-Americans, 8% other ethnicities. The mean age of patients was 46.6 years. For NCP, 17/36 (47%) of the patients switched qualitative NCP class (none, low, high) between baseline and follow-up, whereas for CAC only 3/35 (9%) switched qualitative class. Increasing years between assessments were associated with an increase in NCP (P = 0.038). The proportion of time on immunosuppressants was associated with a decrease in NCP (P = 0.06). Calcified coronary plaque levels remained relatively stable over a period of 2-8 years. Noncalcified coronary plaque levels were more variable. Use of immunosuppressive drugs appeared to be protective against noncalcified coronary plaque progression.
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114
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Understanding cardiovascular risk in rheumatoid arthritis: Still a long way to go. Atherosclerosis 2016; 256:123-124. [PMID: 27993384 DOI: 10.1016/j.atherosclerosis.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/09/2016] [Indexed: 01/22/2023]
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115
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O'Neill F, Charakida M, Topham E, McLoughlin E, Patel N, Sutill E, Kay CWM, D'Aiuto F, Landmesser U, Taylor PC, Deanfield J. Anti-inflammatory treatment improves high-density lipoprotein function in rheumatoid arthritis. Heart 2016; 103:766-773. [PMID: 27852695 PMCID: PMC5529963 DOI: 10.1136/heartjnl-2015-308953] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 09/20/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022] Open
Abstract
Objective Patients with rheumatoid arthritis (RA) are at increased cardiovascular risk. Recent studies suggest that high-density lipoprotein (HDL) may lose its protective vascular phenotype in inflammatory conditions. However, the effects of common anti-inflammatory treatments on HDL function are not yet known. Methods We compared the function of HDL in 18 patients with RA and 18 matched healthy controls. Subsequently, patients were randomised to (methotrexate+infliximab (M+I) (5 mg/kg)) or methotrexate+placebo (M+P) infusions for 54 weeks. At week 54 and thereafter, all patients received infliximab therapy until completion of the trial (110 weeks), enabling assessment of the impact of 1 year of infliximab therapy in all patients. HDL functional properties were assessed at baseline, 54 weeks and 110 weeks by measuring the impact on endothelial nitric oxide (NO) bioavailability and superoxide production (SO), paraoxonase activity (PON-1) and cholesterol efflux. Results All HDL vascular assays were impaired in patients compared with controls. After 54 weeks, NO in response to HDL was significantly greater in patients who received M+I compared with those who received M+P. Endothelial SO in response to HDL was reduced in both groups, but PON-1 and cholesterol efflux remained unchanged. All vascular measures improved compared with baseline after ≥1 infliximab therapy in the analysis at 110 weeks. No significant trend was noted for cholesterol efflux. Conclusions HDL function can be improved with anti-inflammatory treatment in patients with RA. The M+I combination was superior to the M+P alone, suggesting that the tumour necrosis factor-α pathway may have a role in HDL vascular properties.
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Affiliation(s)
- Francis O'Neill
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Marietta Charakida
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Eric Topham
- Institute of Structural & Molecular Biology and London Centre for Nanotechnology, University College London, London, UK
| | - Eve McLoughlin
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Neha Patel
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Emma Sutill
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Christopher W M Kay
- Institute of Structural & Molecular Biology and London Centre for Nanotechnology, University College London, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, University College London Eastman Dental Institute, London, UK
| | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Peter C Taylor
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - John Deanfield
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK.,National Institute for Cardiovascular Outcomes Research, University College London, London, UK
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116
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Andersen JK, Oma I, Prayson RA, Kvelstad IL, Almdahl SM, Fagerland MW, Hollan I. Inflammatory cell infiltrates in the heart of patients with coronary artery disease with and without inflammatory rheumatic disease: a biopsy study. Arthritis Res Ther 2016; 18:232. [PMID: 27729056 PMCID: PMC5059899 DOI: 10.1186/s13075-016-1136-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The cause of premature cardiovascular disease (CVD) in inflammatory rheumatic diseases (IRDs) has not been fully elucidated. As inflammation may play a role, we wanted to compare the occurrence and extent of inflammatory cell infiltrates (ICIs), small vessel vasculitis, and the amount of adipose tissue and collagen in cardiac biopsies taken from patients with coronary artery disease with and without IRDs. Methods From among the Feiring Heart Biopsy Study subjects, we selected patients undergoing coronary artery bypass grafting from whom paraffin-embedded, formalin-fixed specimens from the right atrium were available. The sample comprised 48 patients with IRD and 40 non-IRD patients. Hematoxylin and eosin staining was used to examine the presence and location of ICIs and vasculitis, and Lendrum (Martius yellow, scarlet, and blue) staining was carried out for collagen and adipose tissue. Results Epicardial ICIs were found in 27 (56 %) patients with IRD and 24 (60 %) non-IRD patients. There were no significant differences between patients with IRD and non-IRD patients in the amount of cardiac ICIs and adipose tissue, but patients with IRD had more collagen in the myocardium than non-IRD patients. Small vessel vasculitis was not observed in any cardiac specimen. Patients with epicardial ICIs were, on average, 7 years younger than those without. Conclusions Our results do not support the notion that inflammation in cardiac peri-, epi-, and myocardium plays a more important role in CVD of patients with IRD than non-IRD patients. The increased amount of collagen in the myocardium of patients with IRD suggests differences in extracellular matrix composition and/or mass, which might play a role in cardiac remodeling, and represent targets for novel therapies against heart failure.
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Affiliation(s)
- Jacqueline K Andersen
- Department of Health, Technology and Society, Norwegian University of Science and Technology (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.
| | - Ingvild Oma
- Department of Pathology, Innlandet Hospital Trust, Lillehammer, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sven Martin Almdahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ivana Hollan
- Hospital for Rheumatic Diseases, Lillehammer, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Bonek K, Głuszko P. Cardiovascular risk assessment in rheumatoid arthritis - controversies and the new approach. Reumatologia 2016; 54:128-35. [PMID: 27504023 PMCID: PMC4967980 DOI: 10.5114/reum.2016.61214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/21/2016] [Indexed: 12/13/2022] Open
Abstract
The current methods of cardiovascular (CV) risk assessment in the course of inflammatory connective tissue diseases are a subject of considerable controversy. Comparing different methods of CV risk assessment in current rheumatoid arthritis (RA) guidelines, only a few of them recommend the use of formal risk calculators. These are the EULAR guidelines suggesting the use of SCORE and the British Society for Rheumatology guidelines performed in collaboration with NICE preferring the use of QRISK-2. Analyzing the latest American and British reports, two main concepts could be identified. The first one is to focus on risk calculators developed for the general population taking into account RA, and the calculator that might fulfill this role is the new QRISK-2 presented by NICE in 2014. The second concept is to create RA-specific risk calculators, such as the Expanded Cardiovascular Risk Prediction Score for RA. In this review we also discuss the efficiency of a new Pooled Cohort Equation and other calculators in the general and RA population.
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Affiliation(s)
- Krzysztof Bonek
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Głuszko
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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118
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A critical view on cardiovascular risk in systemic sclerosis. Rheumatol Int 2016; 37:85-95. [PMID: 27405985 DOI: 10.1007/s00296-016-3530-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/05/2016] [Indexed: 12/22/2022]
Abstract
Systemic Sclerosis (SSc) is an autoimmune disorder characterized by microvascular injury and diffuse fibrosis of the skin and internal organs. While macrovascular disease and higher risk for cardiovascular events are well documented in other systemic rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus, the presence and extent of atherosclerosis among patients with SSc is yet to be established. Primary cardiac involvement, due to impairment of coronary microvascular circulation and myocardial fibrosis, considerably affects prognosis and life expectancy of individuals with SSc, representing one of the leading causes of death in this population. On the other hand the existence and prevalence of atherosclerotic coronary disease remains an issue of debate as studies comparing structural and morphological markers of atherosclerosis and cardiovascular events between SSc patients and the general population have yielded controversial results. The aim of this review is to summarize recent literature about the prevalence of cardiovascular disease in SSc, review the surrogate markers of CVD that have been evaluated and examine whether common pathogenic mechanisms exist between SSc and macrovascular disease.
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Lorenzatti AJ, Retzlaff BM. Unmet needs in the management of atherosclerotic cardiovascular disease: Is there a role for emerging anti-inflammatory interventions? Int J Cardiol 2016; 221:581-6. [PMID: 27420583 DOI: 10.1016/j.ijcard.2016.07.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/04/2016] [Indexed: 01/18/2023]
Abstract
Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Despite extraordinary advances in the understanding of the pathophysiology and the utilization of very effective medications such as statins, there still remains a significant residual risk. In fact, even after optimal interventional and medical therapy, the possibility of recurrent myocardial infarction remains at approximately one third for five years after acute coronary syndromes, thus emphasizing the urgent need for novel therapies to prevent the progress of atherosclerosis. In addition, over the past two decades, although atherosclerosis has been clearly identified as an inflammatory disease of the arterial wall from compelling data of animal and human studies, clinical applications related to this accumulated knowledge are scarce. This review presents a brief description of the role of inflammation in atherogenesis, and examines selected potential anti-inflammatory interventions that are being tested in on-going clinical trials which have been designed to prevent adverse cardiovascular events as well as provide a proof of concept regarding the inflammatory hypothesis of atherosclerosis.
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Affiliation(s)
- Alberto J Lorenzatti
- Cardiology Department, Cordoba Hospital, Cordoba, Argentina; DAMIC Medical Institute for Research, Teaching, Patient Care, Cordoba, Argentina.
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120
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Nus M, Mallat Z. Immune-mediated mechanisms of atherosclerosis and implications for the clinic. Expert Rev Clin Immunol 2016; 12:1217-1237. [PMID: 27253721 DOI: 10.1080/1744666x.2016.1195686] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A large body of evidence supports the inflammatory hypothesis of atherosclerosis, and both innate and adaptive immune responses play important roles in all disease stages. Areas covered: Here, we review our understanding of the role of the immune response in atherosclerosis, focusing on the pathways currently amenable to therapeutic modulation. We also discuss the advantages or undesirable effects that may be foreseen from targeting the immune response in patients at high cardiovascular risk, suggesting new avenues for research. Expert commentary: There is an extraordinary opportunity to directly test the inflammatory hypothesis of atherosclerosis in the clinic using currently available therapeutics. However, a more balanced interpretation of the experimental and translational data is needed, which may help address and identify in more detail the appropriate settings where an immune pathway can be targeted with minimal risk.
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Affiliation(s)
- Meritxell Nus
- a Division of Cardiovascular Medicine, Department of Medicine , University of Cambridge , Cambridge , UK
| | - Ziad Mallat
- a Division of Cardiovascular Medicine, Department of Medicine , University of Cambridge , Cambridge , UK
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121
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Treat-to-target therapy does not prevent excessive progression of carotid intima media thickness during the first year of therapy in early rheumatoid arthritis. ACTA ACUST UNITED AC 2016; 1:e36-e43. [PMID: 28905017 PMCID: PMC5421530 DOI: 10.5114/amsad.2016.60225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 12/15/2022]
Abstract
Introduction The aim of the study was to investigate the presence of subclinical atherosclerosis and predictors of change in carotid intima-media measures in early rheumatoid arthritis patients (eRA) as compared to chronic RA patients and patients without arthritis. Material and methods Fifty-five consecutive eRA patients were assessed at the time of diagnosis and after 1 year of therapy. Fifty-five sex- and age-matched chronic RA patients and 29 patients without inflammatory disease were used as controls. Carotid artery intima-media thickness (CIMT) and carotid plaques were measured at baseline and after follow-up. In eRA patients ultrasound assessment of hand joints was performed before and after treatment. Carotid artery intima-media thickness was assessed again after 2 years in 44 eRA patients. Results Carotid artery intima-media thickness progression after 1 year of therapy was higher in eRA patients compared to both control groups (p = 0.017) and correlated with symptoms duration (p = 0.017) and DMARD monotherapy (p = 0.015). Ultrasound progression of hand joint erosions was associated with longer symptoms duration (p = 0.006). After 2 years of observation CIMT progression was similar in all examined groups. Conclusions We observed rapid CIMT progression during the first year of RA therapy. Longer symptoms duration and less aggressive therapy were associated with CIMT increase.
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Immune-inflammatory responses in atherosclerosis: Role of an adaptive immunity mainly driven by T and B cells. Immunobiology 2016; 221:1014-33. [PMID: 27262513 DOI: 10.1016/j.imbio.2016.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/06/2016] [Accepted: 05/23/2016] [Indexed: 01/22/2023]
Abstract
Adaptive immune response plays an important role in atherogenesis. In atherosclerosis, the proinflammatory immune response driven by Th1 is predominant but the anti-inflammatory response mediated mainly by regulatory T cells is also present. The role of Th2 and Th17 cells in atherogenesis is still debated. In the plaque, other T helper cells can be observed such as Th9 and Th22 but is little is known about their impact in atherosclerosis. Heterogeneity of CD4(+) T cell subsets presented in the plaque may suggest for plasticity of T cell that can switch the phenotype dependening on the local microenvironment and activating/blocking stimuli. Effector T cells are able to recognize self-antigens released by necrotic and apoptotic vascular cells and induce a humoral immune reaction. Tth cells resided in the germinal centers help B cells to switch the antibody class to the production of high-affinity antibodies. Humoral immunity is mediated by B cells that release antigen-specific antibodies. A variety of B cell subsets were found in human and murine atherosclerotic plaques. In mice, B1 cells could spontaneously produce atheroprotective natural IgM antibodies. Conventional B2 lymphocytes secrete either proatherogenic IgG, IgA, and IgE or atheroprotective IgG and IgM antibodies reactive with oxidation-specific epitopes on atherosclerosis-associated antigens. A small population of innate response activator (IRA) B cells, which is phenotypically intermediate between B1 and B2 cells, produces IgM but possesses proatherosclerotic properties. Finally, there is a minor subset of splenic regulatory B cells (Bregs) that protect against atherosclerotic inflammation through support of generation of Tregs and production of anti-inflammatory cytokines IL-10 and TGF-β and proapoptotic molecules.
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123
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Bernelot Moens SJ, van der Valk FM, Strang AC, Kroon J, Smits LP, Kneepkens EL, Verberne HJ, van Buul JD, Nurmohamed MT, Stroes ESG. Unexpected arterial wall and cellular inflammation in patients with rheumatoid arthritis in remission using biological therapy: a cross-sectional study. Arthritis Res Ther 2016; 18:115. [PMID: 27209093 PMCID: PMC4875657 DOI: 10.1186/s13075-016-1008-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/28/2016] [Indexed: 12/11/2022] Open
Abstract
Background Increasing numbers of patients (up to 40 %) with rheumatoid arthritis (RA) achieve remission, yet it remains to be elucidated whether this also normalizes their cardiovascular risk. Short-term treatment with TNF inhibitors lowers arterial wall inflammation, but not to levels of healthy controls. We investigated whether RA patients in long-term remission are characterized by normalized inflammatory activity of the arterial wall and if this is dependent on type of medication used (TNF-inhibitor versus nonbiological disease-modifying antirheumatic drugs (DMARDs)). Methods Arterial wall inflammation, bone marrow and splenic activity (index of progenitor cell activity) was assessed with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in RA patients in remission (disease activity score (DAS28) <2.6 for >6 months) and healthy controls. We performed ex vivo characterization of monocytes using flow cytometry and a transendothelial migration assay. Results Overall, arterial wall inflammation was comparable in RA patients (n = 23) in long-term remission and controls (n = 17). However, RA subjects using current anti-TNF therapy (n = 13, disease activity score 1.98[1.8–2.2]) have an almost 1.2-fold higher 18F-FDG uptake in the arterial wall compared to those using DMARDs (but with previous anti-TNF therapy) (n = 10, disease activity score 2.24[1.3–2.5]), which seemed to be predominantly explained by longer duration of their rheumatic disease in a multivariate linear regression analysis. This coincided with increased expression of pro-adhesive (CCR2) and migratory (CD11c, CD18) surface markers on monocytes and a concomitant increased migratory capacity. Finally, we found increased activity in bone marrow and spleen in RA patients using anti-TNF therapy compared to those with DMARDs and controls. Conclusions A subset of patients with RA in clinical remission have activated monocytes and increased inflammation in the arterial wall, despite the use of potent TNF blocking therapies. In these subjects, RA disease duration was the most important contributor to the level of arterial wall inflammation. This increased inflammatory state implies higher cardiovascular risk in these patients, who thus may require more stringent CV risk management. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1008-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophie J Bernelot Moens
- Department of Vascular Medicine, Academic Medical Center, Room F4-211, PO Box 22660, Amsterdam, 1100 DD, The Netherlands.
| | - Fleur M van der Valk
- Department of Vascular Medicine, Academic Medical Center, Room F4-211, PO Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Aart C Strang
- Department of Vascular Medicine, Academic Medical Center, Room F4-211, PO Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Jeffrey Kroon
- Department of Molecular Cell Biology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, The Netherlands
| | - Loek P Smits
- Department of Vascular Medicine, Academic Medical Center, Room F4-211, PO Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Eva L Kneepkens
- Departments of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap D van Buul
- Department of Molecular Cell Biology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Departments of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Center, Room F4-211, PO Box 22660, Amsterdam, 1100 DD, The Netherlands
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Kraakman MJ, Dragoljevic D, Kammoun HL, Murphy AJ. Is the risk of cardiovascular disease altered with anti-inflammatory therapies? Insights from rheumatoid arthritis. Clin Transl Immunology 2016; 5:e84. [PMID: 27350883 PMCID: PMC4910124 DOI: 10.1038/cti.2016.31] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Atherosclerosis is the most common form of CVD, which is complex and multifactorial with an elevated risk observed in people with either metabolic or inflammatory diseases. Accumulating evidence now links obesity with a state of chronic low-grade inflammation and has renewed our understanding of this condition and its associated comorbidities. An emerging theme linking disease states with atherosclerosis is the increased production of myeloid cells, which can initiate and exacerbate atherogenesis. Although anti-inflammatory drug treatments exist and have been successfully used to treat inflammatory conditions such as rheumatoid arthritis (RA), a commonly observed side effect is dyslipidemia, inadvertently, a major risk factor for the development of atherosclerosis. The mechanisms leading to dyslipidemia associated with anti-inflammatory drug use and whether CVD risk is actually increased by this dyslipidemia are of great therapeutic importance and currently remain poorly understood. Here we review recent data providing links between inflammation, hematopoiesis, dyslipidemia and CVD risk in the context of anti-inflammatory drug use.
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Affiliation(s)
- Michael J Kraakman
- Department of Haematopoiesis and Leukocyte Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Dragana Dragoljevic
- Department of Haematopoiesis and Leukocyte Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Immunology, Monash University, Melbourne, Victoria, Australia
| | - Helene L Kammoun
- Department of Haematopoiesis and Leukocyte Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Immunology, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Murphy
- Department of Haematopoiesis and Leukocyte Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Immunology, Monash University, Melbourne, Victoria, Australia
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125
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Jandali B, Tang WHW, Husni E. Heart Failure and Inflammatory Arthritis: the Relationship of Systemic Inflammation. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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126
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Bester FCJ, Bosch FJ, van Rensburg BJJ. The specialist physician's approach to rheumatoid arthritis in South Africa. Korean J Intern Med 2016; 31:219-36. [PMID: 26932399 PMCID: PMC4773728 DOI: 10.3904/kjim.2015.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 12/03/2022] Open
Abstract
Rheumatoid arthritis (RA) is expected to increase in Africa and South Africa. Due to the low numbers of rheumatologists in South Africa, specialist physicians also have to care for patients with RA. Furthermore several new developments have taken place in recent years which improved the management and outcome of RA. Classification criteria were updated, assessment follow-up tools were refined and above all, several new biological disease-modifying anti-rheumatic drugs were developed. Therefore it is imperative for specialist physicians to update themselves with the newest developments in the management of RA. This article provides an overview of the newest developments in the management of RA in the South African context. This approach may well apply to countries with similar specialist to patient ratios and disease profiles.
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Affiliation(s)
- Frederik C. J. Bester
- Department of Internal Medicine, Rosepark Life Health Care Hospital, Bloemfontein, South Africa
| | - Fredricka J. Bosch
- Department of Internal Medicine, Rosepark Life Health Care Hospital, Bloemfontein, South Africa
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127
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Misra DP, Shenoy SN. Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk. Rheumatol Int 2016; 37:151-167. [DOI: 10.1007/s00296-016-3435-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022]
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128
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Evensen K, Aulie HA, Rønning OM, Flatø B, Russell D. Carotid Atherosclerosis in Adult Patients with Persistently Active Juvenile Idiopathic Arthritis Compared with Healthy Controls. J Rheumatol 2016; 43:810-5. [DOI: 10.3899/jrheum.150499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/22/2022]
Abstract
Objective.Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease in childhood. It is regarded as a systemic inflammatory disease with possible increased risk of cardiovascular disease (CVD). The aim of this study was to assess carotid intima-media thickness (IMT) and carotid stenosis as surrogate measures for CVD in adults with longterm active JIA and healthy age- and sex-matched controls.Methods.Seventy-five patients with JIA (age 28–45 yrs) with persistently active disease at least 15 years after disease onset were reexamined after a median of 29 years and compared with 75 matched controls. Patients and controls were examined by color duplex ultrasound of the carotid arteries to compare carotid IMT and carotid stenosis in the 2 groups.Results.Patients with JIA did not have increased carotid IMT values compared with the controls (mean ± SD: 0.56 mm ± 0.09 vs 0.58 mm ± 0.07, p = 0.289). Patients with a higher disease activity indicated by the Juvenile Arthritis Disease Activity Score value above the median value had increased carotid IMT compared with the patients with a lower value, but not statistically different compared with controls. No carotid stenoses were detected in patients or controls.Conclusion.We found similar carotid IMT values in adult patients with JIA and controls.
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Garcia M, Miller VM, Gulati M, Hayes SN, Manson JE, Wenger NK, Bairey Merz CN, Mankad R, Pollak AW, Mieres J, Kling J, Mulvagh SL. Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice. Mayo Clin Proc 2016; 91:226-40. [PMID: 26848004 DOI: 10.1016/j.mayocp.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/17/2022]
Abstract
Over the past decade, an emerging clinical research focus on cardiovascular (CV) disease (CVD) risk in women has highlighted sex-specific factors that are uniquely important in the prevention and early detection of coronary atherosclerosis in women. Concurrently, a 30% decrease in the number of female deaths from CVD has been observed. Despite this, CVD continues to be the leading cause of death in women, outnumbering deaths from all other causes combined. Clinical practice approaches that focus on the unique aspects of CV care for women are needed to provide necessary resources for the prevention, diagnosis, and treatment of CVD in women. In addition to increasing opportunities for women to participate in CV research, Women's Heart Clinics offer unique settings in which to deliver comprehensive CV care and education, ensuring appropriate diagnostic testing, while monitoring effectiveness of treatment. This article reviews the emerging need and role of focused CV care to address sex-specific aspects of diagnosis and treatment of CVD in women.
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Affiliation(s)
- Mariana Garcia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN; Department of Physiology, Mayo Clinic, Rochester, MN; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Martha Gulati
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA
| | - Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amy W Pollak
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Jennifer Mieres
- Department of Cardiology, Hofstra North Short-LIJ School of Medicine, Hempstead, NY
| | - Juliana Kling
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Sharon L Mulvagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compán MV, Oliver S, Schoels M, Scholte-Voshaar M, Stamm T, Stoffer M, Takeuchi T, Aletaha D, Andreu JL, Aringer M, Bergman M, Betteridge N, Bijlsma H, Burkhardt H, Cardiel M, Combe B, Durez P, Fonseca JE, Gibofsky A, Gomez-Reino JJ, Graninger W, Hannonen P, Haraoui B, Kouloumas M, Landewe R, Martin-Mola E, Nash P, Ostergaard M, Östör A, Richards P, Sokka-Isler T, Thorne C, Tzioufas AG, van Vollenhoven R, de Wit M, van der Heijde D. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016; 75:3-15. [PMID: 25969430 PMCID: PMC4717393 DOI: 10.1136/annrheumdis-2015-207524] [Citation(s) in RCA: 963] [Impact Index Per Article: 120.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. OBJECTIVE To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. METHODS A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. RESULTS The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). CONCLUSIONS The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd R Burmester
- Department of Rheumatology, Clinical Immunology Free University and Humboldt University, Charité-University Medicine, Berlin, Germany
| | - Vivian Bykerk
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, USA
| | - Maxime Dougados
- Department of Rheumatology B, Cochin Hospital, René Descartes University, Paris, France
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital,Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Monika Schoels
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Marieke Scholte-Voshaar
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Tanja Stamm
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Michaela Stoffer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose Louis Andreu
- Rheumatology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Martin Aringer
- Department of Medicine III, University Medical Center TU Dresden, Dresden, Germany
| | - Martin Bergman
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Neil Betteridge
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Hans Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, and VU University Medical Center, Amsterdam, The Netherlands
| | - Harald Burkhardt
- Division of Rheumatology, Department of Medicine, Johann-Wolfgang-Goethe University Frankfurt, German
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - Bernard Combe
- Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France
| | - Patrick Durez
- Pôle de Recherche en Rhumatologie, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joao Eurico Fonseca
- Rheumatology Research Unit, Instituto de de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Alan Gibofsky
- Weill Medical College, Cornell University Hospital for Special Surgery, New York, USA
| | - Juan J Gomez-Reino
- Rheumatology Unit, Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Pekka Hannonen
- Department of Medicine, Central Hospital, Jyväskylä, Finland
| | | | - Marios Kouloumas
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Robert Landewe
- Academic Medical Center, University of Amsterdam, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | | | - Peter Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - Mikkel Ostergaard
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Östör
- Rheumatology Clinical Research Unit, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Pam Richards
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | | | - Carter Thorne
- Division of Rheumatology, Southlake Regional Health Centre, Newarket, Ontario, Canada
| | | | | | - Martinus de Wit
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Desirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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131
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Sintek MA, Sparrow CT, Mikuls TR, Lindley KJ, Bach RG, Kurz HI, Novak E, Singh J. Repeat revascularisation outcomes after percutaneous coronary intervention in patients with rheumatoid arthritis. Heart 2015; 102:363-9. [DOI: 10.1136/heartjnl-2015-308634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/18/2015] [Indexed: 11/03/2022] Open
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Mankad R. Atherosclerotic vascular disease in the autoimmune rheumatologic patient. Curr Atheroscler Rep 2015; 17:497. [PMID: 25721102 DOI: 10.1007/s11883-015-0497-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, have a strong association with an increased risk of atherosclerotic cardiovascular diseases (ASCVD), particularly ischemic heart disease (IHD). A majority of the autoimmune conditions occur predominantly in women, and as women continue to experience a higher cardiovascular mortality compared to men, this potential added risk factor must be recognized. Inflammation and immune mechanisms have been shown to be an underlying mechanism for the development of atherosclerosis, thus sharing a common mechanism with rheumatologic conditions. There is an under recognition, in both patient and physician, of the increased cardiovascular (CV) risk within the autoimmune population, with present CV risk profile algorithms performing poorly in these patients. Traditional risk factors play a role in the development of IHD in the autoimmune patient, but their overall significance is unclear and does not fully explain the elevated CV risk. The role of inflammation and risk factors in autoimmune conditions, and their link to the elevated CV risk will be explored within this article.
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Affiliation(s)
- Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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133
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Kim HJ, Kim MJ, Lee CK, Hong YH. Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis. J Korean Med Sci 2015; 30:1589-96. [PMID: 26539002 PMCID: PMC4630474 DOI: 10.3346/jkms.2015.30.11.1589] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/14/2015] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate the effects of rheumatoid arthritis (RA) and antirheumatic drugs on atherosclerosis by comparing carotid intima-media thickness (CIMT) as an indicator for cardiovascular diseases (CVD). This study included 44 female RA patients who met the 2010 ACR/EULAR criteria and age-matched 22 healthy females. CIMT was measured on both carotid arteries using a B-mode ultrasound scan. The mean value of both sides was taken as the CIMT of the subject. The CIMT was evaluated according to the use of drugs, disease activity and CVD risk factors in RA patients as a case-control study. Higher CIMT was observed in RA patients as compared with healthy subjects (0.705 ± 0.198 mm, 0.611 ± 0.093 mm, respectively, P < 0.05). With adjustment for the CVD risk factors, disease activity and the use of anti-rheumatic drugs, methotrexate (MTX) only showed a favorable effect on CIMT in RA. A significantly lower CIMT was observed in RA with MTX as compared with RA without MTX (0.644 ± 0.136 mm, 0.767 ± 0.233 mm, respectively, P < 0.05). The effects were correlated with MTX dosage (β = -0.029, P < 0.01). The use of MTX should be considered in high priority not only to control arthritis but also to reduce the RA-related CVD risk to mortality.
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Affiliation(s)
- Hyun-Je Kim
- Department of Internal Medicine, School of Medicine, Yeungnam University, Daegu, Korea
| | - Min-Jung Kim
- Department of Internal Medicine, School of Medicine, Yeungnam University, Daegu, Korea
| | - Choong-Ki Lee
- Department of Internal Medicine, School of Medicine, Yeungnam University, Daegu, Korea
| | - Young-Hoon Hong
- Department of Internal Medicine, School of Medicine, Yeungnam University, Daegu, Korea
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134
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Mantel Ä, Holmqvist M, Nyberg F, Tornling G, Frisell T, Alfredsson L, Askling J. Risk Factors for the Rapid Increase in Risk of Acute Coronary Events in Patients With New-Onset Rheumatoid Arthritis: A Nested Case-Control Study. Arthritis Rheumatol 2015; 67:2845-54. [DOI: 10.1002/art.39267] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 06/25/2015] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Fredrik Nyberg
- University of Gothenburg, Gothenburg, Sweden, and AstraZeneca Research and Development; Mölndal Sweden
| | | | | | | | - Johan Askling
- Karolinska Institute and Karolinska University Hospital; Stockholm Sweden
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135
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Jiang L, He A, He X, Tao C. MicroRNA-126 enhances the sensitivity of osteosarcoma cells to cisplatin and methotrexate. Oncol Lett 2015; 10:3769-3778. [PMID: 26788206 DOI: 10.3892/ol.2015.3790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/16/2015] [Indexed: 12/21/2022] Open
Abstract
The establishment of novel chemotherapy drugs for osteosarcoma is urgently required, and the mechanisms and effects of cisplatin (DDP) and methotrexate (MTX) in the current treatment of osteosarcoma have not been fully elucidated. The present study aimed to observe the effect of DDP, MTX and rapamycin on osteosarcoma cell proliferation and apoptosis, and to investigate the association between miR-126 and the effects of DDP and MTX in osteosarcoma cells. miR-126-overexpressing and -silencing lentiviral vectors were constructed, and MG63 and U-2 OS osteosarcoma cells were infected. An MTT assay was conducted to detect transfected cell proliferation, and the effects of the chemotherapy drugs on transfected cell apoptosis were detected by flow cytometry. The cell cycle of the transfected cells was analyzed via flow cytometry. As the miR-126-overexpressing and -silencing osteosarcoma cell lines were successfully constructed, it was observed that DDP and MTX inhibited osteosarcoma cell proliferation. With the decreased expression of miR-126, the sensitivity of osteosarcoma cells to DDP and MTX was reduced at the same concentration. The flow cytometry suggested that DDP and MTX could promote the apoptosis of osteosarcoma cells with overexpressed miR-126, whereas they could not significantly impact the apoptosis of the miR-126-silenced osteosarcoma cells. Meanwhile, DDP inhibited the cell cycle of the miR-126-overexpressing osteosarcoma cells. In conclusion, DDP and MTX inhibited the proliferation and promoted the apoptosis of the osteosarcoma cells, and these processes were dependent upon the expression of miR-126.
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Affiliation(s)
- Liangdong Jiang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Aiyong He
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Xiaojie He
- Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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136
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Eder L, Gladman DD. Atherosclerosis in psoriatic disease: latest evidence and clinical implications. Ther Adv Musculoskelet Dis 2015; 7:187-95. [PMID: 26425147 DOI: 10.1177/1759720x15591801] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
It is widely accepted that atherosclerosis is caused by chronic low-grade inflammation that results from an interaction between immune mechanisms and metabolic abnormalities within the vessel wall. Population-based studies have found an increased cardiovascular risk in patients with psoriasis and psoriatic arthritis (PsA). This risk is higher in patients with severe disease phenotypes, such as those with severe psoriasis and with musculoskeletal inflammation. Higher levels of inflammatory biomarkers also predict the development of clinical cardiovascular events in these patients. The effect of medications used for PsA on cardiovascular risk is limited to observational studies. Antitumor necrosis factor agents and methotrexate have been associated with reduced cardiovascular risk. These data highlight the importance of screening for cardiovascular risk factors in these patients.
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Affiliation(s)
- Lihi Eder
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst St. 1E-410B, Toronto, Ontario, Canada M5T 2S8
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Rollefstad S, Ikdahl E, Hisdal J, Olsen IC, Holme I, Hammer HB, Smerud KT, Kitas GD, Pedersen TR, Kvien TK, Semb AG. Rosuvastatin-Induced Carotid Plaque Regression in Patients With Inflammatory Joint Diseases: The Rosuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and Other Inflammatory Joint Diseases Study. Arthritis Rheumatol 2015; 67:1718-28. [PMID: 25778850 DOI: 10.1002/art.39114] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/10/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) and carotid artery plaques have an increased risk of acute coronary syndromes. Statin treatment with the goal of achieving a low-density lipoprotein (LDL) cholesterol level of ≤1.8 mmoles/liter (≤70 mg/dl) is recommended for individuals in the general population who have carotid plaques. The aim of the ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study was to evaluate the effect of 18 months of intensive lipid-lowering treatment with rosuvastatin with regard to change in carotid plaque height. METHODS Eighty-six patients (60.5% of whom were female) with carotid plaques and inflammatory joint disease (55 with RA, 21 with AS, and 10 with psoriatic arthritis) were treated with rosuvastatin to obtain the LDL cholesterol goal. Carotid plaque height was evaluated by B-mode ultrasonography. RESULTS The mean ± SD age of the patients was 60.8 ± 8.5 years, and the median compliance with rosuvastatin treatment was 97.9% (interquartile range [IQR] 96.0-99.4). At baseline, the median number and height of the carotid plaques were 1.0 (range 1-8) and 1.80 mm (IQR 1.60-2.10), respectively. The mean ± SD change in carotid plaque height after 18 months of treatment with rosuvastatin was -0.19 ± 0.35 mm (P < 0.0001). The mean ± SD baseline LDL cholesterol level was 4.0 ± 0.9 mmoles/liter (154.7 ± 34.8 mg/dl), and the mean reduction in the LDL cholesterol level was -2.3 mmoles/liter (95% confidence interval [95% CI] -2.48, -2.15) (-88.9 mg/dl [95% CI -95.9, -83.1]). The mean ± SD LDL cholesterol level during the 18 months of rosuvastatin treatment was 1.7 ± 0.4 mmoles/liter (area under the curve). After adjustment for age/sex/blood pressure, no linear relationship between a reduction in carotid plaque height and the level of LDL cholesterol exposure during the study period was observed. Attainment of the LDL cholesterol goal of ≤1.8 mmoles/liter (≤70 mg/dl) or the amount of change in the LDL cholesterol level during the study period did not influence the degree of carotid plaque height reduction. CONCLUSION Intensive lipid-lowering treatment with rosuvastatin induced atherosclerotic regression and reduced the LDL cholesterol level significantly in patients with inflammatory joint disease.
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Affiliation(s)
| | - E Ikdahl
- Diakonhjemmet Hospital, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital, Aker, Oslo, Norway
| | - I C Olsen
- Diakonhjemmet Hospital, Oslo, Norway
| | - I Holme
- Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - K T Smerud
- Smerud Medical Research International AS, Oslo, Norway
| | - G D Kitas
- The Dudley Group NHS Foundation Trust, West Midlands, UK
| | - T R Pedersen
- Centre of Preventive Medicine, Oslo University Hospital, Ullevål, and University of Oslo, Oslo, Norway
| | - T K Kvien
- Diakonhjemmet Hospital, Oslo, Norway
| | - A G Semb
- Diakonhjemmet Hospital, Oslo, Norway
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Psoriasis and the Risk of Major Cardiovascular Events: Cohort Study Using the Clinical Practice Research Datalink. J Invest Dermatol 2015; 135:2189-2197. [DOI: 10.1038/jid.2015.87] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/30/2015] [Accepted: 02/14/2015] [Indexed: 02/01/2023]
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Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis and Low Cardiovascular Risk: The Role of von Willebrand Factor Activity. PLoS One 2015; 10:e0130462. [PMID: 26247590 PMCID: PMC4527675 DOI: 10.1371/journal.pone.0130462] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/20/2015] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate association between von Willebrand factor (vWF) activity, inflammation markers, disease activity, and subclinical atherosclerosis in patients with rheumatoid arthritis (RA) and low cardiovascular risk. Methods Above mentioned parameters were determined in blood samples of 74 non-diabetic, normotensive, female subjects, with no dyslipidemia(42 patients, 32 matched healthy controls, age 45.3±10.0 vs. 45.2±9.8 years). Intima-media thickness (IMT) was measured bilaterally, at common carotid, bifurcation, and internal carotid arteries. Subclinical atherosclerosis was defined as IMT>IMTmean+2SD in controlsat each carotid level and atherosclerotic plaque as IMT>1.5 mm. Majority of RA patients were on methotrexate (83.3%), none on steroids >10 mg/day or biologic drugs. All findings were analysed in the entire study population and in RA group separately. Results RA patients with subclinical atherosclerosis had higher vWF activity than those without (133.5±69.3% vs. 95.3±36.8%, p<0.05). Predictive value of vWF activity for subclinical atherosclerosis was confirmed by logistic regression. vWF activity correlated significantly with erythrocyte sedimentation rate, fibrinogen, modified disease activity scores (mDAS28–ESR, mDAS28–CRP), modified Health Assessment Questionnaire (p<0.01 for all), duration of smoking, number of cigarettes/day, rheumatoid factor concentration (p<0.05 for all), and anti-CCP antibodies (p<0.01). In the entire study population, vWF activity was higher in participants with subclinical atherosclerosis (130±68% vs. 97±38%, p<0.05) or atherosclerotic plaques (123±57% vs. 99±45%, p<0.05) than in those without. Duration of smoking was significantly associated with vWF activity (β 0.026, p = 0.039). Conclusions We demonstrated association of vWF activity and subclinical atherosclerosis in low-risk RA patients as well as its correlation with inflammation markers, all parameters of disease activity, and seropositivity. Therefore, vWF might be a valuable marker of early atherosclerosis in RA patients.
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Kastbom A, Ärlestig L, Rantapää-Dahlqvist S. Genetic Variants of the NLRP3 Inflammasome Are Associated with Stroke in Patients with Rheumatoid Arthritis. J Rheumatol 2015; 42:1740-5. [PMID: 26178285 DOI: 10.3899/jrheum.141529] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Inflammasomes are intracellular protein complexes important for the production of pro-inflammatory cytokines. Studies have suggested that the NLRP3 inflammasome influences both the severity of rheumatoid arthritis (RA) and development of atherosclerosis. Therefore, we investigated whether functional genetic variants related to the NLRP3 inflammasome influence the risk of cardiovascular (CV) disease (CVD) in patients with RA. METHODS The incidence of CVD was assessed in 522 patients with established RA by a retrospective survey of medical records in combination with a 6-year prospective followup. NLRP3-Q705K and CARD8-C10X genotypes were analyzed in relation to CVD by logistic regression, adjusting for traditional risk factors, antirheumatic treatment, and age at the onset of RA. RESULTS Carriage of the NLRP3-Q705K minor allele was associated with an increased risk of stroke/transient ischemic attack (TIA; OR 2.01, 95% CI 1.0-4.1, p = 0.05), while CARD8-C10X was not associated with any type of CV event. Patients with ≥ 1 variant allele in both polymorphisms had an increased risk of CVD when compared with patients without variant alleles present in both polymorphisms (adjusted OR 3.05, 95% CI 1.42-6.54, p = 0.004). Stratification showed that this risk was confined to stroke/TIA (adjusted OR 5.09, 95% CI 2.27-11.44, p < 0.0001) and not to myocardial infarction (MI)/angina pectoris (adjusted OR 1.58, 95% CI 0.67-3.73). Risk estimates were consistently higher among female patients. CONCLUSION Genetic variants of the NLRP3 inflammasome influence the risk of stroke/TIA, but not of MI/angina pectoris in Swedish patients with established RA.
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Affiliation(s)
- Alf Kastbom
- From the Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping; the Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.A. Kastbom, MD, PhD, Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University; L. Ärlestig, PhD; S. Rantapää-Dahlqvist, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University.
| | - Lisbeth Ärlestig
- From the Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping; the Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.A. Kastbom, MD, PhD, Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University; L. Ärlestig, PhD; S. Rantapää-Dahlqvist, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Solbritt Rantapää-Dahlqvist
- From the Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping; the Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.A. Kastbom, MD, PhD, Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University; L. Ärlestig, PhD; S. Rantapää-Dahlqvist, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
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Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, Siu S, Kraft J, Lynde C, Pope J, Gulliver W, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B. Evidence-based Recommendations for the Management of Comorbidities in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis: Expert Opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol 2015; 42:1767-80. [DOI: 10.3899/jrheum.141112] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
Objective.Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.Methods.Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960–12/2012), together with abstracts from major rheumatology and dermatology congresses (2010–2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.Results.A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.Conclusion.These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.
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Yamamoto K, Goto H, Hirao K, Nakajima A, Origasa H, Tanaka K, Tomobe M, Totsuka K. Longterm Safety of Tocilizumab: Results from 3 Years of Followup Postmarketing Surveillance of 5573 Patients with Rheumatoid Arthritis in Japan. J Rheumatol 2015; 42:1368-75. [DOI: 10.3899/jrheum.141210] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 01/07/2023]
Abstract
Objective.To evaluate the longterm safety of tocilizumab (TCZ) for the treatment of rheumatoid arthritis (RA) in a real-world clinical setting in Japan.Methods.In this longterm extension of a single-arm, observational postmarketing surveillance study, a total of 5573 patients who initiated intravenous TCZ between April 2008 and July 2009 were observed for 3 years, regardless of its continuation, for incidence of fatal events, serious infections, malignancy, gastrointestinal perforations, and serious cardiac dysfunction.Results.Of the 5573 patients who were enrolled, 4527 patients (81.23%) completed 3 years of followup. There were no increases in the proportions of patients with fatal events, serious infection, malignancy, GI perforation, or serious cardiac dysfunction over 3 years. The all-cause mortality rate during followup was 2.58% (0.95/100 patient-yrs), and the standardized mortality ratio was 1.27 (95% CI, 1.08 to 1.50). Patients who were older with longer disease duration and respiratory comorbidities were more likely to discontinue TCZ treatment following serious infection during the first year. Among patients who completed 3 years of TCZ treatment, serious infection developed at a constant rate during the 3-year treatment period. The proportion of malignancy during followup was 2.24% (0.83/100 patient-yrs), and the standardized incidence ratio was 0.79 (95% CI, 0.66 to 0.95).Conclusion.The safety profile of TCZ was consistent over time regarding mortality, serious infections, malignancy, gastrointestinal perforation, and serious cardiac dysfunction. These data confirm the longterm safety of TCZ use in patients with RA in a real-world clinical setting.
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Khan R, Spagnoli V, Tardif JC, L'Allier PL. Novel anti-inflammatory therapies for the treatment of atherosclerosis. Atherosclerosis 2015; 240:497-509. [DOI: 10.1016/j.atherosclerosis.2015.04.783] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/18/2022]
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Nurmohamed M, Bao Y, Signorovitch J, Trahey A, Mulani P, Furst DE. Longer durations of antitumour necrosis factor treatment are associated with reduced risk of cardiovascular events in patients with rheumatoid arthritis. RMD Open 2015; 1:e000080. [PMID: 26535138 PMCID: PMC4612693 DOI: 10.1136/rmdopen-2015-000080] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 12/20/2022] Open
Abstract
Objective To assess the effects of treatment with antitumour necrosis factor (TNF) agents, methotrexate, or other non-biological disease-modifying antirheumatic drugs (DMARDs) on cardiovascular event risks among patients with rheumatoid arthritis (RA). Methods We conducted a retrospective study using data from the MarketScan claims database. Patients with RA with ≥1 prescription for an index drug were included. Each patient's use of an index drug was calculated cumulatively as a time-varying exposure. The incidence of cardiovascular events among patients with RA was determined. Associations between drug exposures and occurrence of cardiovascular events were assessed with Cox proportional hazards models. Results Of 113 677 patients identified, 35.8%, 41.1% and 23.1% received anti-TNF agents, methotrexate and other DMARDs, respectively. Patients were treated for an average of 7.6 months; 2138 patients (1.9%) had a cardiovascular event following their index prescription. Each additional 6 months of anti-TNF therapy use versus non-use reduced the risk (HR; 95% CI) for any cardiovascular event by 12% (0.88; 0.81 to 0.95, p=0.002). Anti-TNF therapy was associated with a 13% and 12% reduction in cardiovascular events in patients aged ≥50 years (0.87; 0.80 to 0.95, p=0.002) and in those without prior methotrexate use (0.88; 0.78 to 0.99, p=0.04), respectively. Cumulative use of 1, 2 or 3 years of anti-TNF therapy versus non-use is expected to reduce cardiovascular event risks by 21%, 38% and 51%, respectively. Conclusions Anti-TNF therapy was associated with a significantly lower risk of cardiovascular events among patients with RA, older patients with RA and patients without prior exposure to methotrexate.
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Affiliation(s)
- Michael Nurmohamed
- Departments of Internal Medicine and Rheumatology , VU University Medical Centre , Amsterdam , The Netherlands
| | - Yanjun Bao
- Health Economics and Outcomes Research, AbbVie , North Chicago, Illinois , USA
| | | | - Alex Trahey
- The Analysis Group , Boston, Massachusetts , USA
| | - Parvez Mulani
- Health Economics and Outcomes Research, AbbVie , North Chicago, Illinois , USA
| | - Daniel E Furst
- University of California-Los Angeles (UCLA) , Los Angeles, California , USA
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Methotrexate, Cyclosporine A, and Biologics Protect against Atherosclerosis in Rheumatoid Arthritis. J Immunol Res 2015; 2015:759610. [PMID: 26090499 PMCID: PMC4452098 DOI: 10.1155/2015/759610] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction. The risk of cardiovascular disease is increased in rheumatoid arthritis (RA). A meta-analysis showed increased intima media thickness (IMT) in RA. It has been shown that disease modifying antirheumatic drugs (DMARDs) may influence the progression of atherosclerosis. However, it was suggested that biologics may be more efficient than other DMARDs (including methotrexate—MTX) in protecting against atherosclerosis. Objectives. The aim of this study was to assess the influence of different RA characteristics and treatment regimens on IMT and atherosclerotic plaques. Patients and Methods. 317 RA patients and 111 controls were included in the study. IMT was measured in carotid (CIMT) and femoral (FIMT) arteries. Arteries were screened for the presence of plaques. Results. CIMT, FIMT, and prevalence of plaques were lower in patients treated with methotrexate (MTX) ≥ 20 mg/wk, cyclosporine (CsA), or biologics than in patients treated with lower doses of MTX and other disease modifying antirheumatic drugs. No differences in IMT between patients treated with MTX ≥ 20 mg/wk, biologics, or CsA were found. Conclusions. We found a beneficial effect of MTX ≥ 20 mg/wk, biologics, and CsA on atherosclerosis. We do not confirm a stronger influence of biologics on IMT compared with therapeutic doses of MTX.
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Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol 2015; 11:390-400. [PMID: 25825281 DOI: 10.1038/nrrheum.2015.40] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) has long been associated with increased cardiovascular risk, but despite substantial improvements in disease management, mortality remains high. Atherosclerosis is more prevalent in RA than in the general population, and atherosclerotic lesions progress at a faster rate and might be more prone to rupture, causing clinical events. Cells and cytokines implicated in RA pathogenesis are also involved in the development and progression of atherosclerosis, which is generally recognized as an inflammatory condition. The two diseases also share genetic and environmental risk factors, which suggests that patients who develop RA might also be predisposed to developing cardiovascular disease. In RA, inflammation and atherosclerosis are closely linked. Inflammation mediates its effects on atherosclerosis both through modulation of traditional risk factors and by directly affecting the vessel wall. Treatments such as TNF inhibitors might have a beneficial effect on cardiovascular risk. However, whether this benefit is attributable to effective control of inflammation or whether targeting specific cytokines, implicated in atherosclerosis, provides additional risk reduction is unclear. Further knowledge of the predictors of cardiovascular risk, the effects of early control of inflammation and of drug-specific effects are likely to improve the recognition and management of cardiovascular risk in patients with RA.
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Affiliation(s)
- Sarah Skeoch
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Brunswick Street, Manchester M13 9PL, UK
| | - Ian N Bruce
- NIHR Manchester Musculoskeletal Biomedical Research Unit, and Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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147
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Abstract
In the era of biologic therapies, methotrexate (MTX), a classic immunomodulator, is still the cornerstone of systemic treatment of psoriasis. MTX has been used for many years, achieving good responses with a good safety profile. However, only a few randomized clinical trials have been performed involving MTX, and most of the current evidence comes from pivotal studies of biologic drugs. The aim of this article is to make an extensive review of the MTX mechanism of action, pharmacokinetics, efficacy, safety and tolerability, especially focusing on the future perspective of this old drug and recent advances in the field of pharmacogenetics.
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Affiliation(s)
- Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
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Pain reduction with oral methotrexate in knee osteoarthritis, a pragmatic phase iii trial of treatment effectiveness (PROMOTE): study protocol for a randomized controlled trial. Trials 2015; 16:77. [PMID: 25872649 PMCID: PMC4351849 DOI: 10.1186/s13063-015-0602-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/11/2015] [Indexed: 02/01/2023] Open
Abstract
Background Osteoarthritis (OA) is the fastest growing cause of disability worldwide. Current treatments for OA are severely limited and a large proportion of people with OA live in constant, debilitating pain. There is therefore an urgent need for novel treatments to reduce pain. Synovitis is highly prevalent in OA and is associated with pain. In inflammatory arthritides such as rheumatoid arthritis, methotrexate (MTX) is the gold standard treatment for synovitis and has a well-known, acceptable toxicity profile. We propose that using MTX to treat patients with symptomatic knee OA will be a practical and safe treatment to reduce synovitis and, consequently, pain. Methods/Design Pain Reduction with Oral Methotrexate in knee Osteoarthritis, a pragmatic phase III trial of Treatment Effectiveness (PROMOTE) is an investigator-initiated, multi-centre, randomized, double-blind, pragmatic placebo-controlled trial. A total of 160 participants with symptomatic knee OA will be recruited across primary and secondary care sites in the United Kingdom and randomized on a 1:1 basis to active treatment or placebo, in addition to usual care, for 12 months. As is usual practice for MTX, dosing will be escalated over six weeks to 25 mg (or maximum tolerated dose) weekly for the remainder of the study. The primary endpoint is change in average knee pain during the past week (measured on an 11-point numerical rating scale) between baseline and six months. Secondary endpoints include other self-reported pain, function and quality-of-life measures. A health economics analysis will also be performed. A magnetic resonance imaging substudy will be conducted to provide an explanatory mechanism for associated symptom change by examining whether MTX reduces synovitis and whether this is related to symptom change. Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modelling analyses. All analyses will be conducted on an intention-to-treat basis. Discussion The PROMOTE trial is designed to examine whether MTX is an effective analgesic treatment for OA. The MRI substudy will address the relationship between synovitis and symptom change. This will potentially provide a much needed new treatment for knee OA. Trial registration Current Controlled Trials identifier: ISRCTN77854383 (registered: 25 October 2013).
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149
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Effectiveness of methotrexate therapy with occasional corticosteroid in rheumatoid arthritis. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J 2015; 36:482-9c. [PMID: 25433021 PMCID: PMC4340364 DOI: 10.1093/eurheartj/ehu403] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A variety of systemic inflammatory rheumatic diseases associate with an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Although this recognition has stimulated intense basic science and clinical research, the precise nature of the relationship between local and systemic inflammation, their interactions with traditional CV risk factors, and their role in accelerating atherogenesis remains unresolved. The individual rheumatic diseases have both shared and unique attributes that might impact CV events. Understanding of the positive and negative influences of individual anti-inflammatory therapies remains rudimentary. Clinicians need to adopt an evidence-based approach to develop diagnostic techniques to identify those rheumatologic patients most at risk of CV disease and to develop effective treatment protocols. Development of optimal preventative and disease-modifying approaches for atherosclerosis in these patients will require close collaboration between basic scientists, CV specialists, and rheumatologists. This interface presents a complex, important, and exciting challenge.
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Affiliation(s)
- Justin C Mason
- Vascular Sciences Unit and Rheumatology Section, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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