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Why and How Should We Assess the Cardiovascular Risk in Patients with Juvenile Idiopathic Arthritis? A Single-Centre Experience with Carotid Intima-Media Measurements. CHILDREN 2023; 10:children10030422. [PMID: 36979980 PMCID: PMC10047782 DOI: 10.3390/children10030422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023]
Abstract
Background: Children diagnosed with juvenile idiopathic arthritis (JIA) are thought to be more likely to develop cardiovascular disease in adulthood. The factors modulating the cardiovascular risk, involving exposure to secondhand smoking, sedentary lifestyle and abnormal body mass index, might have had a stronger impact during the COVID-19 pandemic. The lack of reliable prognostic markers for a higher probability of cardiovascular events might be solved by carotid intima-media thickness (cIMT) measurement. The paramount goal of the study was to assess its usefulness in JIA patients. Materials and Methods: The results of cIMT measured by a single physician in 45 children diagnosed with JIA were compared to 37 age- and sex-matched healthy counterparts. The analysis also involved anthropometric parameters, laboratory tests, and a survey regarding lifestyle-related factors. Results: Four JIA patients appeared to have cIMT above the 94th percentile. A positive correlation between erythrocytes sedimentation rate (ESR) and right carotid artery percentiles was found. Passive smoking increased the cardiovascular risk regardless of JIA. Doubling the daily screen time during the pandemic led to a significant reduction in children’s physical activity. However, the number of enrolled subjects was not enough to make significant recommendations. Conclusions: cIMT measurements remain an interesting perspective for future cardiovascular screening of children with JIA. It has yet to be determined whether it should be considered in all JIA patients on a reliable basis.
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Nic an Riogh E, Dunne E, Cowley S, Leamy K, McCarthy G, Kenny D, Stack J. Dynamic platelet function: A novel biomarker in inflammatory arthritis? PLoS One 2022; 17:e0261825. [PMID: 35077469 PMCID: PMC8789097 DOI: 10.1371/journal.pone.0261825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients with inflammatory arthritis die prematurely of cardiovascular disease. Inflammation activates platelets. Since treatment of inflammatory arthritis is associated with reduced mortality, and decreased platelet reactivity reduces cardiovascular events, we hypothesised that platelet reactivity as measured by dynamic platelet function (DPF) would be increased in patients with inflammatory arthritis and that reactivity could be reduced with therapeutic intervention. Objectives To characterise platelet function using a validated physiological assay in patients with inflammatory arthritis before and after disease improvement. Methods 22 patients were recruited and treated as per local protocol. DPF was measured at baseline and after clinical improvement. Video microscopy was utilised to measure dynamic platelet behaviour in microliters of blood perfused over von Willebrand factor (VWF) at arterial shear rates (1500 s-1). Motion-analysis software measured the number of platelets interacting with VWF, translocating across VWF, the speed and distance platelets travelled across VWF, and stably adhering to the surface. Platelet parameters at baseline and following improvement were compared using Wilcoxon signed rank test and paired student t-test. Changes in platelet function were correlated to inflammatory disease markers by Pearson Correlation. Results 18 patients completed the study. Platelet adhesion decreased and platelet motion increased following treatment. Tender joint count correlated with platelet adhesion (Pearson r = 0.616, p≤0.01) while CRP correlated with velocity of platelet movement (Pearson r = 0.563, p≤0.01). Conclusions Improvement in clinical markers of inflammation is associated with a corresponding change in platelet function. Given the association between reduced mortality and decreased platelet reactivity our results suggest that an appropriate assay of platelet function could guide future therapy of patients with inflammatory arthritis.
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Affiliation(s)
- Eithne Nic an Riogh
- Rheumatology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eimear Dunne
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Sharon Cowley
- Rheumatology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kelly Leamy
- Rheumatology Department, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Geraldine McCarthy
- Rheumatology Department, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Dermot Kenny
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - John Stack
- Rheumatology Department, Mater Misericordiae University Hospital, Dublin, Ireland
- * E-mail:
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Early-onset subclinical cardiovascular damage assessed by non-invasive methods in children with Juvenile Idiopathic Arthritis: analytical cross-sectional study. Rheumatol Int 2020; 41:423-429. [PMID: 32857280 DOI: 10.1007/s00296-020-04689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Chronic inflammation starting early in life and continuing into adulthood may predispose children with Juvenile Idiopathic Arthritis (JIA) to cardiovascular (CV) complications. To compare non-invasive CV risk markers- left ventricular mass index (LVMi), brachial artery flow mediated dilatation (FMD) and carotid artery intima-media thickness (CIMT) between patients with JIA and healthy controls. Measurements of LVMi, CIMT and FMD and lipid profile were compared between 4 and 18 year old 81 patients with JIA and 78 age and sex matched healthy controls. Among 81, 20 had systemic onset, 19 enthesitis related arthritis, 9 polyarticular rheumatoid factor (RF) + ve, 19 polyarticular RF -ve, 11 oligo-articular, and 3 un-differentiated JIA. FMD was significantly lower (p < 0.001), CIMT and LVMi significantly higher in patients (p ≤ 0.001). CIMT showed positive correlation with blood pressure (p = 0.001), disease duration (p ≤ 0.001) and negative correlation with high density lipoprotein (HDL) (p ≤ 0.001). FMD correlated positively with HDL (p = 0.006) and negatively with disease duration (p ≤ 0.001). CIMT (p = 0.017) and FMD (p = 0.04) were significantly worse in active than inactive disease. Children with JIA have worse lipid profile, increased LVMi, CIMT, and reduced brachial artery FMD, suggestive of early cardiovascular dysfunction.
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Persell SD, Lee JY, Lipiszko D, Peprah YA, Ruderman EM, Schachter M, Majka DS. Outreach to Promote Management of Cardiovascular Risk in Primary Care Among Patients With Rheumatoid Arthritis Seen in Rheumatology Practice. ACR Open Rheumatol 2020; 2:131-137. [PMID: 31989787 PMCID: PMC7077787 DOI: 10.1002/acr2.11116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 12/28/2022] Open
Abstract
Objective Rheumatoid arthritis (RA) confers a 1.5‐ to 2.0‐fold increased risk of cardiovascular disease (CVD). A prior multifaceted quality improvement approach to improving CVD preventive care increased CVD risk factor assessments, but there was no significant effect on the management of risk factors. We tested the impact of adding a proactive outreach strategy promoting primary care treatment of CVD risk factors among patients with RA through their rheumatology practice. Methods Through electronic health record searches, we identified patients with RA who were potential candidates for hypertension treatment initiation or intensification, statin therapy, or a smoking‐cessation intervention. A nonclinician care manager contacted patients by phone and mail on behalf of the rheumatologists, provided information about the identified risk factor(s), recommend follow‐up with primary care physicians (PCPs), sent correspondence to PCPs, and followed up with patients to see what actions had been taken. We measured preventive cardiology quality indicators and compared preintervention and intervention time periods using interrupted time series methods. Results During the 6‐month intervention period, the proportion of patients prescribed at least moderate‐intensity statin treatment for primary prevention rose from 18.4% to 23.8%. The rate of increase was 1.06% greater per month than during the preceding period (P < 0.001). Rates of increase in hypertension diagnosis and control improved more rapidly during this phase (P < 0.001 for each) and reversed preceding negative trends. Conclusion Implementing proactive nonclinician outreach to encourage primary care–based treatment of CVD risk factors was associated with increases in statin prescribing and in hypertension diagnosis and control. Smoking was not affected.
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Affiliation(s)
- Stephen D Persell
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ji Young Lee
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dawid Lipiszko
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yaw A Peprah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eric M Ruderman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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5
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Perez-Vazquez F, Bäck M, Chavarria-Avila E, Gomez-Bañuelos E, Ramos-Becerra CG, Pizano-Martínez Ó, Salazar-Páramo M, Grover-Páez F, Nava-Zavala AH, Cardona-Muñoz EG, Cardona-Müller D, Duran-Barragán S, Mera-Riofrio VN, Prado-Bachega N, Vazquez-Del Mercado M. Enalapril Influence on Arterial Stiffness in Rheumatoid Arthritis Women: A Randomized Clinical Trial. Front Med (Lausanne) 2020; 6:341. [PMID: 32118001 PMCID: PMC7025600 DOI: 10.3389/fmed.2019.00341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction: Cardiovascular parameters disruption can be found in patients at early stages of rheumatoid arthritis (RA). The primary endpoint of this study was the reduction of arterial stiffness in RA patients without traditional cardiovascular risk factors or previous comorbidities, measured by cardio-ankle vascular index (CAVI) through the enalapril intervention. The secondary endpoints were the enalapril influence on carotid femoral pulse wave velocity (cfPWV), carotid intima media thickness (cIMT), carotid artery distensibility (cDistensibility), Young's incremental elastic modulus (Einc)]. Materials and Methods: Fifty-three patients were enrolled in a clinical, randomized, closed-label trial. The subjects were randomly assigned into two groups: One receiving 5 mg of enalapril (27) or placebo (26), both twice a day. The drug was acquired at Victory Enterprises®. The placebo was kindly provided by the Universidad de Guadalajara (UdeG), as well as the blinding into two groups: A and B. Enalapril and placebo were packed into bottles without labeling. Clinical assessment included a structured questionnaire to gather demographic and clinical variables as well as determination of CAVI, cfPWV, cIMT, carotid artery distensibility and Einc. The whole set of evaluations were analyzed at the baseline and at the end of 12 weeks of intervention. Results: The CAVI measurement at baseline was 7.1 ± 1.4 and increased up to 7.5 ± 1.2 at the end of 12 weeks. Meanwhile, the enalapril group was as follows: 7.4 ± 1.2 and at the of intervention, reduced to 7.1 ± 0.9. A reduction in delta CAVI of 0.21 in the enalapril intervention group was found. In contrast, an increase of 0.39 was observed in the placebo group. The delta CAVI reduction was not influenced by age or peripheral systolic blood pressure (pSBP). Discussion: Enalapril seems to be effective in CAVI reduction in RA patients. The effect of enalapril intervention on arterial stiffness translated to the clinical context might be interpreted as a reduction of 6.4 years of arterial aging. Trial Registration: The protocol was approved by the Institutional Review Board with the register CI-0117 from UdeG, and 0211/18 from Hospital Civil “Dr. Juan I. Menchaca”, Secretaría de Salud Jalisco: DGSP/DDI/D.INV.28/18 and retrospectively registered at ClinicalTrials.gov Protocol Registration and Results System: NCT03667131.
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Affiliation(s)
- Felipe Perez-Vazquez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Magnus Bäck
- Department of Cardiology and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Efrain Chavarria-Avila
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Departamento de Disciplinas Filosofico, Metodologicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Servicio de Reumatología PNPC 004086 CONACyT, Hospital Civil Dr. Juan I. Menchaca, Guadalajara, Mexico
| | - Eduardo Gomez-Bañuelos
- Servicio de Reumatología PNPC 004086 CONACyT, Hospital Civil Dr. Juan I. Menchaca, Guadalajara, Mexico
| | - Carlos G Ramos-Becerra
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Óscar Pizano-Martínez
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| | - Mario Salazar-Páramo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| | - Fernando Grover-Páez
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arnulfo H Nava-Zavala
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico.,Hospital General de Occidente, Secretaría de Salud, Zapopan, Mexico
| | - Ernesto G Cardona-Muñoz
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - David Cardona-Müller
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Sergio Duran-Barragán
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Servicio de Reumatología PNPC 004086 CONACyT, Hospital Civil Dr. Juan I. Menchaca, Guadalajara, Mexico.,UDG-CA-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Valeria N Mera-Riofrio
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Natalia Prado-Bachega
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Monica Vazquez-Del Mercado
- Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.,Servicio de Reumatología PNPC 004086 CONACyT, Hospital Civil Dr. Juan I. Menchaca, Guadalajara, Mexico.,UDG-CA-703, Inmunología y Reumatología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
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Pak S. Primary care providers' awareness, knowledge, and practice with regard to cardiovascular risk in patients with rheumatoid arthritis : PCPs' awareness, knowledge, and practice with regard to CV risks in patients with RA. Clin Rheumatol 2019; 39:755-760. [PMID: 31873809 DOI: 10.1007/s10067-019-04901-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic auto-inflammatory disease associated with increased cardiovascular risk. Early identification and aggressive cardiovascular risk factor modification are critical for improvement in morbidity and mortality in patients with RA. This study is a cross-sectional survey with the purpose of evaluating primary care providers' awareness, practice patterns, and satisfaction with continuing medical education on cardiovascular risk in patients with RA. Our study showed that 71% of clinicians felt that the CME on RA patient management regarding CV risk factors is inadequate. Only 37% of providers reported feeling well prepared to manage CV risk for RA patients. Only 15% of participants were actively initiating a discussion regarding CV risk with RA patients. A better understanding of the educational needs and practice patterns of primary care providers may warrant the development of strategies for cardiovascular risk management in patients with RA.
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Affiliation(s)
- Stella Pak
- Department of Medicine, Orange Regional Medical Center, 707 East Main Street, Middletown, NY, 10940, USA.
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Janghorbani M, Barzegar M, Mirmosayyeb O, Shaygannejad V. Case Reports: Ischemic Strokes in a Young Woman With Manifestations of Multiple Sclerosis. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2018. [DOI: 10.29252/cjns.4.15.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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8
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Majka DS, Lee JY, Peprah YA, Lipiszko D, Friesema E, Ruderman EM, Persell SD. Changes in Care After Implementing a Multifaceted Intervention to Improve Preventive Cardiology Practice in Rheumatoid Arthritis. Am J Med Qual 2018; 34:276-283. [PMID: 30196708 DOI: 10.1177/1062860618798719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Rheumatoid arthritis (RA) increases cardiovascular disease (CVD) risk. However, CVD risk factor identification and treatment is often inadequate. The authors implemented a multifaceted rheumatology practice intervention to improve CVD risk factor measurement, assessment, and management. The intervention included clinician education, point-of-care decision support, feedback, and care management. The authors measured quality indicators from electronic health records and assessed impact with interrupted time series. Following the intervention, more RA patients had all major CVD risk factors assessed (53% vs 72.2%), and the rate of increase was greater during the intervention period than baseline (difference of 0.74% per month, P = .0016). Moderate- or high-intensity statin prescribing increased (21.6% to 28.2%), but the rate of change was not different from baseline. Several other quality measures did not increase. Although CVD risk factor assessment improved, the intervention did not affect risk factor management and control. Other strategies are needed to optimize CVD prevention in RA.
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9
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Asymmetric Dimethyl Arginine as a Biomarker of Atherosclerosis in Rheumatoid Arthritis. Mediators Inflamm 2018; 2018:3897295. [PMID: 29576746 PMCID: PMC5822828 DOI: 10.1155/2018/3897295] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/27/2017] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular disease is the main cause of morbidity and mortality in rheumatoid arthritis (RA). Despite the advent on new drugs targeting the articular manifestations, the burden of cardiovascular disease is still an unmet need in the management of RA. The pathophysiology of accelerated atherosclerosis associated to RA is not yet fully understood, and reliable and specific markers of early cardiovascular involvement are still lacking. Asymmetric dimethylarginine is gaining attention for its implication in the pathogenesis of endothelial dysfunction and as biomarkers of subclinical atherosclerosis. Moreover, the metabolic pathway of methylarginines offers possible targets for therapeutic interventions to decrease the cardiovascular risk. The purpose of this review is to describe the main causes of increased methylarginine levels in RA, their implication in accelerated atherosclerosis, the possible role as biomarkers of cardiovascular risk, and finally the available data on current pharmacological treatment.
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Radner H, Lesperance T, Accortt NA, Solomon DH. Incidence and Prevalence of Cardiovascular Risk Factors Among Patients With Rheumatoid Arthritis, Psoriasis, or Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2017; 69:1510-1518. [PMID: 27998029 DOI: 10.1002/acr.23171] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/07/2016] [Accepted: 12/13/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To estimate prevalence and incidence of cardiovascular (CV) risk factors of hypertension, diabetes mellitus, hyperlipidemia, and obesity in patients with rheumatoid arthritis (RA), psoriasis, or psoriatic arthritis (PsA). METHODS Patients with RA, psoriasis, or PsA were identified based on medical and pharmacy claims from the MarketScan claims databases from January 1, 2002 through December 31, 2014. Primary outcomes included age- and sex-standardized prevalence of CV risk factors during the 12 months preceding diagnosis date and incidence rates per 1,000 patient-years, with 95% confidence intervals (95% CIs) during followup. RESULTS Prevalence for RA, psoriasis, and PsA cohorts for hypertension was 18.6% (95% CI 18.3-18.8), 16.6% (95% CI 16.3-17.0), and 19.9% (95% CI 19.4-20.4), respectively; for diabetes mellitus 6.2% (95% CI 6.1-6.4), 6.3% (95% CI 6.0-6.5), and 7.8% (95% CI 7.4-8.2); for hyperlipidemia 9.9% (95% CI 9.7-10.1), 10.4% (95% CI 10.2-10.7), and 11.6% (95% CI 11.2-12.0); and for obesity 4.4% (95% CI 4.2-4.6), 3.8% (95% CI 3.5-4.0), and 6.0% (95% CI 5.6-6.5). Incidence rates per 1,000 patient-years during followup for RA, psoriasis, and PsA cohorts, respectively, for hypertension were 74.0 (95% CI 72.5-75.5), 68.2 (95% CI 65.9-70.4), and 79.8 (95% CI 76.3-83.3); for diabetes mellitus 10.6 (95% CI 10.1-11.1), 13.0 (95% CI 12.1-13.8), and 14.7 (95% CI 13.5-16.0); for hyperlipidemia 40.3 (95% CI 39.4-41.3), 47.1 (95% CI 45.4-48.7), and 52.0 (95% CI 49.6-54.3); and for obesity 24.4 (95% CI 23.4-25.4), 26.4 (95% CI 25.0-27.8), and 32.9 (95% CI 30.6-35.2). CONCLUSION Patients with RA, psoriasis, and PsA have high prevalence and incidence of CV risk factors, suggesting the need for risk factor monitoring of these patients.
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Affiliation(s)
| | | | | | - Daniel H Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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11
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Breunig M, Kleinert S, Lehmann S, Kneitz C, Feuchtenberger M, Tony HP, Angermann CE, Ertl G, Störk S. Simple screening tools predict death and cardiovascular events in patients with rheumatic disease. Scand J Rheumatol 2017; 47:102-109. [PMID: 28812405 DOI: 10.1080/03009742.2017.1337924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Patients with rheumatic disease (RD) have an increased mortality risk compared with the general population, mainly due to cardiovascular disease (CVD). We aimed to identify patients at high risk of CVD and mortality by comparing three screening tools suitable for clinical practice. METHOD In this prospective, single-centre study, consecutive patients with rheumatoid arthritis (RA), systemic autoimmune disease (SAI), or spondyloarthritides (SpA) including psoriatic arthritis underwent a comprehensive cardiovascular risk assessment. Patients were predefined as being at high risk for cardiovascular events or death if any of the following were present: European Systematic COronary Risk Evaluation (SCORE) ≥ 3%, N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥ 200 pg/mL, or any pathological electrocardiogram pattern. RESULTS The patient population (n = 764) comprised 352 patients with RA, 260 with SAI, and 152 with SpA. After a median follow-up of 5.2 years, 6.0% of RD patients had died (7.0%, 7.2%, and 1.4% of patients in the RA, SAI, and SpA subgroups), and 5.0% had experienced a cardiovascular event (5.0%, 6.4%, and 2.8%, respectively). For all RD patients and the RA and SAI subgroups, NT-proBNP ≥ 200 pg/mL and SCORE ≥ 3% identified patients with a 3.5-5-fold increased risk of all-cause death and cardiovascular events. Electrocardiogram pathology was associated with increased mortality risk, but not with cardiovascular events. CONCLUSION NT-proBNP ≥ 200 pg/mL or SCORE ≥ 3% identifies RA and SAI patients with increased risk of cardiovascular events and death. Both tools are suitable as easy screening tools in daily practice to identify patients at risk for further diagnostics and closer long-term follow-up.
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Affiliation(s)
- M Breunig
- a Comprehensive Heart Failure Center Würzburg , University Hospital and University of Würzburg , Würzburg , Germany.,b Department of Internal Medicine I, Cardiology , University Hospital Würzburg , Würzburg , Germany
| | - S Kleinert
- c Medical Practice for Rheumatology and Nephrology , Erlangen , Germany.,d Department of Internal Medicine II, Rheumatology/Clinical Immunology , University Hospital of Würzburg , Würzburg , Germany
| | - S Lehmann
- a Comprehensive Heart Failure Center Würzburg , University Hospital and University of Würzburg , Würzburg , Germany
| | - C Kneitz
- e Clinic for Internal Medicine II, Rostock Clinic South , Rostock , Germany
| | - M Feuchtenberger
- d Department of Internal Medicine II, Rheumatology/Clinical Immunology , University Hospital of Würzburg , Würzburg , Germany.,f Department of Internal Medicine II , Hospital Burghausen , Burghausen , Germany
| | - H-P Tony
- d Department of Internal Medicine II, Rheumatology/Clinical Immunology , University Hospital of Würzburg , Würzburg , Germany
| | - C E Angermann
- a Comprehensive Heart Failure Center Würzburg , University Hospital and University of Würzburg , Würzburg , Germany.,b Department of Internal Medicine I, Cardiology , University Hospital Würzburg , Würzburg , Germany
| | - G Ertl
- a Comprehensive Heart Failure Center Würzburg , University Hospital and University of Würzburg , Würzburg , Germany.,b Department of Internal Medicine I, Cardiology , University Hospital Würzburg , Würzburg , Germany
| | - S Störk
- a Comprehensive Heart Failure Center Würzburg , University Hospital and University of Würzburg , Würzburg , Germany.,b Department of Internal Medicine I, Cardiology , University Hospital Würzburg , Würzburg , Germany
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Vázquez-Del Mercado M, Gomez-Bañuelos E, Chavarria-Avila E, Cardona-Muñoz E, Ramos-Becerra C, Alanis-Sanchez A, Cardona-Muller D, Grover-Paez F, Perez-Vazquez FDJ, Navarro-Hernandez RE, Valadez-Soto JM, Saldaña-Millan AA, Gonzalez-Rosas L, Ramos-Lopez G, Petri MH, Bäck M. Disease duration of rheumatoid arthritis is a predictor of vascular stiffness: a cross-sectional study in patients without known cardiovascular comorbidities: A STROBE-compliant article. Medicine (Baltimore) 2017; 96:e7862. [PMID: 28816989 PMCID: PMC5571726 DOI: 10.1097/md.0000000000007862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to analyze the impact of disease duration on carotid to femoral pulse wave velocity (cfPWV) in rheumatoid arthritis (RA) patients without either known traditional cardiovascular risk factors or previous comorbidities.Patients with RA diagnosis attending the rheumatology outpatient clinic of Hospital Civil Juan I. Menchaca, Guadalajara, Mexico, were analyzed. A total of 106 RA patients without known traditional cardiovascular risk factors were selected. All subjects were evaluated for RA disease duration, RA disease activity score on 28 joints (DAS28), serum lipids, rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Arterial stiffness was measured as cfPWV by noninvasive tonometry. A multivariate regression model was used to analyze the contribution of RA disease duration and age on cfPWV. cfPWV was positively correlated with age (r = 0.450, P < .001), RA disease duration (r = 0.340, P < .001), total cholesterol (r = 0.312, P = .002), and low density lipoprotein (LDL-c) cholesterol (r = 0.268, P = .012). Patients with a RA disease duration ≥10 years exhibited significantly increased cfPWV compared with patients with disease duration <2 years (8.4 ± 1.8 vs 7.0 ± 0.8) and ≥2 to <10 years (8.4 ± 1.8 vs 7.8 ± 1.3), respectively. Age, RA disease duration, and triglycerides were predictors of cfPWV in multivariate analyses. According to the β-coefficients, each year of disease duration (β = 0.072) had a greater impact on cfPWV than age (β = 0.054).Each year of life with RA contributes to a higher rate of vascular aging or stiffening than a year of life without RA. The cumulative damage provided by RA was most pronounced in patients with disease duration ≥10 years.
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Affiliation(s)
- Mónica Vázquez-Del Mercado
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
- Servicio de Reumatología, Especialidad en Reumatología, División de Medicina Interna, Hospital Civil Dr. Juan I. Menchaca
| | - Eduardo Gomez-Bañuelos
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud
| | - Efrain Chavarria-Avila
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
- Departamento de Disciplinas Metodológicas, Filosóficas e Instrumentales, Centro Universitario de Ciencias de la Salud
| | - Ernesto Cardona-Muñoz
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
| | - Carlos Ramos-Becerra
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
| | - Adrián Alanis-Sanchez
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
| | - David Cardona-Muller
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
| | - Fernando Grover-Paez
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
| | - Felipe de J. Perez-Vazquez
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
| | - Rosa-Elena Navarro-Hernandez
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
| | - Jorge M. Valadez-Soto
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
| | - Adan A. Saldaña-Millan
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
| | - Lorena Gonzalez-Rosas
- Instituto de Investigación en Reumatología y del Sistema Musculo Esquelético, Centro Universitario de Ciencias de la Salud
- Servicio de Reumatología, Especialidad en Reumatología, División de Medicina Interna, Hospital Civil Dr. Juan I. Menchaca
| | - Gabriel Ramos-Lopez
- Servicio de Cardiología, División de Medicina Interna, OPD Hospital Civil de Guadalajara, Juan I. Menchaca, Guadalajara, Jalisco, Mexico
| | - Marcelo H. Petri
- Department of Medicine, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Medicine, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Association of Vagotomy and Decreased Risk of Subsequent Ischemic Stroke in Complicated Peptic Ulcer Patients: an Asian Population Study. World J Surg 2017; 41:3171-3179. [DOI: 10.1007/s00268-017-4127-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Aslan AN, Şirin Özcan AN, Erten Ş, Alsancak Y, Durmaz T. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCAND CARDIOVASC J 2017. [DOI: 10.1080/14017431.2017.1343493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Abdullah Nabi Aslan
- Department of Cardiology, Atatürk Education and Research Hospital, Ankara, Turkey
| | - Ayşe Nur Şirin Özcan
- Department of Radiology, Atatürk Education and Research Hospital, Ankara, Turkey
| | - Şükran Erten
- Department of Cardiology, Atatürk Education and Research Hospital, Ankara, Turkey
- Department of Rheumatology, Atatürk Education and Research Hospital, Ankara, Turkey
| | - Yakup Alsancak
- Department of Cardiology, Atatürk Education and Research Hospital, Ankara, Turkey
| | - Tahir Durmaz
- Faculty of Medicine, Department of Cardiology, Yıldırım Beyazıt University, Ankara, Turkey
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Myocardial Perfusion in Rheumatoid Arthritis Patients: Associations with Traditional Risk Factors and Novel Biomarkers. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6509754. [PMID: 28553649 PMCID: PMC5434312 DOI: 10.1155/2017/6509754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/02/2017] [Indexed: 12/16/2022]
Abstract
Introduction. Cardiovascular (CV) diseases are a major cause of death in rheumatoid arthritis (RA) patients. Novel biomarkers [B-type natriuretic peptide (BNP); osteoprotegerin (OPG)/receptor activator of nuclear factor-kappa B ligand (RANKL) ratio; and dickkopf-1 (DKK-1)] have been used in CV risk assessment. We analysed, in established RA patients, the presence of silent myocardial ischemia and its association with clinical variables, BNP, and bone and atheroma biomarkers. Methods. From a single-center tertiary referral hospital, RA patients asymptomatic for CV disease were submitted to myocardial perfusion scintigraphy (MPS) under adenosine stress and biomarkers measurements. Logistic regression was used to estimate crude odds ratios (OR) and 95% confidence intervals (CI). Results. In 189 patients, perfusion defects were frequent (25%) and associated with BNP ≥ 100 pg/mL (OR = 5.68; 95% CI: 2.038–15.830), fourth log OPG/RANKL ratio quartile (OR = 2.88; 95% CI: 1.091–7.622), and DKK-1 ≥ 133 pmol/L (OR = 2.69; 95% CI: 1.058–6.840). Similar associations were confirmed in those with C-reactive protein > or ≤ 3 mg/L. No relationship was found with the majority of traditional CV factors nor with disease variables. Conclusions. Our results corroborated the hypothesis that MPS could reveal subclinical CV dysfunction, supported the utility of BNP measurements as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients.
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Majka DS, Vu THT, Pope RM, Teodorescu M, Karlson EW, Liu K, Chang RW. Association of Rheumatoid Factors With Subclinical and Clinical Atherosclerosis in African American Women: The Multiethnic Study of Atherosclerosis. Arthritis Care Res (Hoboken) 2017; 69:166-174. [DOI: 10.1002/acr.22930] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 04/06/2016] [Accepted: 04/26/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Darcy S. Majka
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Thanh-Huyen T. Vu
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Richard M. Pope
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Marius Teodorescu
- TheraTest Laboratories; University of Illinois College of Medicine; Chicago
| | | | - Kiang Liu
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Rowland W. Chang
- Northwestern University Feinberg School of Medicine; Chicago Illinois
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Ahmad HS, Othman G, Farrag SE, El-Hafez AA, Monir AA. Subclinical heart failure in juvenile idiopathic arthritis: a consequence of chronic inflammation and subclinical atherosclerosis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.181881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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18
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Endothelial Dysfunction and Inflammation: Immunity in Rheumatoid Arthritis. Mediators Inflamm 2016; 2016:6813016. [PMID: 27122657 PMCID: PMC4829719 DOI: 10.1155/2016/6813016] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/09/2016] [Accepted: 03/17/2016] [Indexed: 12/14/2022] Open
Abstract
Inflammation, as a feature of rheumatoid arthritis (RA), leads to the activation of endothelial cells (ECs). Activated ECs induce atherosclerosis through an increased expression of leukocyte adhesion molecules. Endothelial dysfunction (ED) is recognized as a failure of endothelial repair mechanisms. It is also an early preclinical marker of atherosclerosis and is commonly found in RA patients. RA is now established as an independent cardiovascular risk factor, while mechanistic determinants of ED in RA are still poorly understood. An expanding body of study has shown that EC at a site of RA is both active participant and regulator of inflammatory process. Over the last decade, a role for endothelial dysfunction in RA associated with cardiovascular disease (CVD) has been hypothesized. At the same time, several maintenance drugs targeting this phenomenon have been tested, which has promising results. Assessment of endothelial function may be a useful tool to identify and monitor RA patients.
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Picco L, Subramaniam M, Abdin E, Vaingankar JA, Chong SA. Prevalence and correlates of heart disease among adults in Singapore. Asian J Psychiatr 2016; 19:37-43. [PMID: 26957336 DOI: 10.1016/j.ajp.2015.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
Abstract
Heart disease is one of the leading causes of morbidity and mortality worldwide and it has been well established that it is associated with both mental and physical conditions. This paper describes the prevalence of heart disease with mental disorders and other chronic physical conditions among the Singapore resident population. Data were from the Singapore Mental Health Study which was a representative, cross-sectional epidemiological survey undertaken with 6616 Singapore residents, between December 2009 and December 2010. The Composite International Diagnostic Interview Version 3.0 was used to establish the diagnosis of mental disorders, while a chronic medical conditions checklist was used to gather information on 15 physical conditions, including various forms of heart disease. Health-related quality of life was measured using the Euro-Quality of Life Scale (EQ-5D). The lifetime prevalence of heart disease was 2.8%. Socio-demographic correlates of heart disease included older age, Indian ethnicity, secondary education (vs. tertiary) and being economically inactive. After adjusting for socio-demographic variables and other comorbid physical and mental disorders, the prevalence of major depressive disorder and bipolar disorder were significantly higher among those with heart disease, as were diabetes, arthritis, kidney failure and lung disease. These findings highlight important associations between heart disease and various socio-demographic correlates, mental disorders and physical conditions. Given the high prevalence of mood disorders among heart disease patients, timely and appropriate screening and treatment of mental disorders among this group is essential.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore.
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
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20
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Tseng CH, Huang WS, Lin CL, Chang YJ. Increased risk of ischaemic stroke among patients with multiple sclerosis. Eur J Neurol 2014; 22:500-6. [PMID: 25443663 DOI: 10.1111/ene.12598] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Inflammatory processes including autoimmune diseases which ignite endothelial dysfunction and atherosclerosis may promote development of cardiovascular diseases including ischaemic stroke. This study aimed to evaluate whether multiple sclerosis (MS) increases stroke risk. METHODS A national insurance claim data set of 22 million enrollees in Taiwan was used to identify 1174 patients with MS and 4696 randomly selected age- and gender-matched controls from 1 January 1997 to 31 December 2010. Both cohorts were followed up until the occurrence of stroke or censor. Relevant covariates, such as age, gender, hypertension, diabetes, hyperlipidaemia, coronary artery disease, congestive heart failure and pregnancy, were included for further survey. The hazard ratio (HR) of stroke was assessed using a Cox proportional hazards regression model. RESULTS After adjusting for the relevant covariates, the MS cohort had an increased risk of stroke (adjusted HR = 12.1 for 1 year; adjusted HR = 4.69 for 2-5 years) compared with the control cohort within 5 years of follow-up. Amongst participants without comorbidities, the MS cohort was still at a greater stroke risk than the control cohort [HR 4.93, 95% confidence interval (CI) 2.85-8.55]. Moreover, in the population aged ≤40, MS was associated with a significantly increased risk of stroke (HR 12.7, 95% CI 3.44-46.7). CONCLUSIONS Multiple sclerosis is declared to be associated with an increased risk in developing stroke, which requires closer attention to this group of patients for stroke prevention, especially in the younger population.
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Affiliation(s)
- C-H Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University College of Medicine, Taichung, Taiwan
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21
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Majka DS, Chang RW. Is preclinical autoimmunity benign?: The case of cardiovascular disease. Rheum Dis Clin North Am 2014; 40:659-68. [PMID: 25437283 DOI: 10.1016/j.rdc.2014.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although there are many examples of autoantibodies in disease-free individuals, they can be a preclinical phenomenon heralding future autoimmune rheumatic disease. They may be a marker for autoreactive B-cell activation and other inflammatory autoimmune processes. The increased prevalence of cardiovascular disease (CVD) in autoimmune rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus, and the increased risk of CVD in patients with rheumatic disease with autoantibodies, suggest that CVD may have autoimmune features. Autoantibodies might be risk markers for subclinical and clinical CVD development not only in patients with rheumatic diseases but in the general population as well.
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Affiliation(s)
- Darcy S Majka
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 East Huron, M300, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Rowland W Chang
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 240 East Huron, M300, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
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Adalimumab decreases aortic stiffness independently of its effect in disease activity in patients with rheumatoid arthritis. Clin Rheumatol 2014; 34:359-64. [DOI: 10.1007/s10067-014-2718-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/20/2014] [Accepted: 06/05/2014] [Indexed: 01/01/2023]
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Tseng CH, Chen JH, Muo CH, Chang YJ, Sung FC, Hsu CY. Increased risk of ischaemic stroke amongst patients with chronic osteomyelitis: a population-based cohort study in Taiwan. Eur J Neurol 2014; 22:633-9. [PMID: 24602152 DOI: 10.1111/ene.12387] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/27/2013] [Indexed: 12/31/2022]
Affiliation(s)
- C.-H. Tseng
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; College of Medicine; China Medical University; Taichung Taiwan
| | - J.-H. Chen
- Graduate Institute of Clinical Medical Science; College of Medicine; China Medical University; Taichung Taiwan
- Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
| | - C.-H. Muo
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Institute of Environmental Health; College of Public Health; China Medical University; Taichung Taiwan
| | - Y.-J. Chang
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Institute of Environmental Health; College of Public Health; China Medical University; Taichung Taiwan
| | - F.-C. Sung
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Institute of Environmental Health; College of Public Health; China Medical University; Taichung Taiwan
| | - C. Y. Hsu
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; College of Medicine; China Medical University; Taichung Taiwan
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Bili A, Tang X, Pranesh S, Bozaite R, Morris SJ, Antohe JL, Kirchner HL, Wasko MCM. Tumor Necrosis Factor α Inhibitor Use and Decreased Risk for Incident Coronary Events in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2014; 66:355-63. [DOI: 10.1002/acr.22166] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 09/03/2013] [Indexed: 01/08/2023]
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Totoson P, Maguin-Gaté K, Prati C, Wendling D, Demougeot C. Mechanisms of endothelial dysfunction in rheumatoid arthritis: lessons from animal studies. Arthritis Res Ther 2014; 16:202. [PMID: 24457026 PMCID: PMC3978571 DOI: 10.1186/ar4450] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by articular and extra-articular manifestations involving cardiovascular diseases (CVDs), which account for 30% to 50% of all deaths. In patients with RA, atherosclerosis lesions occur earlier and have a more rapid evolution than in the general population. Beyond mortality, the impact of CVD on quality of life, combined with the associated increase in health-care costs, renders CVD in RA a major public health problem. Recent studies showed that patients with RA are characterized by the presence of endothelial dysfunction (ED), which is recognized as a key event in the development of atherosclerosis. By definition, ED is a functional and reversible alteration of endothelial cells, leading to a shift of the actions of the endothelium toward reduced vasodilation, proinflammatory state and proliferative and prothrombotic properties. Although the improvement of endothelial function is becoming an important element of the global management of patients with RA, the mechanistic determinants of ED in RA are still poorly understood. Animal models of RA provide the unique opportunity to unravel the pathophysiological features of ED in RA. The present review summarizes the available data on mechanisms underlying ED in animal models of RA and proposes attractive prospects in order to discover novel therapeutic strategies of RA-associated ED.
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Aspirin use in rheumatoid arthritis patients with increased risk of cardiovascular disease. ISRN RHEUMATOLOGY 2013; 2013:589807. [PMID: 24307951 PMCID: PMC3836298 DOI: 10.1155/2013/589807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/08/2013] [Indexed: 01/07/2023]
Abstract
Objectives. To examine the patterns of low-dose aspirin use in rheumatoid arthritis (RA) patients with high risk for coronary artery disease (CAD).
Methods. Cross-sectional study of 36 consecutive RA patients with a Framingham score ≥10% for CAD. Eligible RA patients were provided with a questionnaire on CAD risk factors and use of low-dose aspirin. For aspirin nonusers, the reason for nonuse was requested by both the patient and rheumatologist. Questions for patients included physician's advice, self-preference, history of gastrointestinal bleeding, allergy to aspirin, or concomitant use of other anti-inflammatory medications. Questions for rheumatologists included awareness of the increased CAD risk, attribution, patient preference, history of gastrointestinal bleeding, allergy to aspirin, and medication interactions.
Results. Patients participated in the study; 8 patients reported using daily aspirin, while 23 patients did not. The main reason cited by patients for not taking aspirin was that they were not instructed by their primary care physician (PCP) to do so (n = 16), which was also the main reason cited by rheumatologists (n = 9).
Conclusion. This study confirmed underutilization of aspirin in RA patients at high risk for CAD, largely due to the perception that this is an issue which should be handled by the PCP.
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Bouillet L, Baudet AE, Deroux A, Sidibé A, Dumestre-Perard C, Mannic T, Treillard B, Arboleas MA, Chiquet CA, Gulino-Debrac DG, Vilgrain IY. Auto-antibodies to vascular endothelial cadherin in humans: association with autoimmune diseases. J Transl Med 2013; 93:1194-202. [PMID: 24061286 DOI: 10.1038/labinvest.2013.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/12/2013] [Accepted: 08/17/2013] [Indexed: 11/09/2022] Open
Abstract
To identify patients with autoimmune diseases who are at high risk of developing vascular cell dysfunction, early biomarkers must be identified. This study was designed to detect and characterize circulating autoantibodies to VE-cadherin (AAVEs) in patients with early-stage autoimmune diseases. An enzyme-linked immunosorbent assay (ELISA) was developed to capture autoantibodies, using a recombinant human VE-cadherin fragment covering the extracellular domains as a target antigen. AAVEs specificity for the target antigen was confirmed by western blotting. Basal AAVEs levels were determined for healthy donors (n=75). Sera from patients (n=100) with various autoimmune diseases, including rheumatoid arthritis (n=23), systemic lupus erythematosus (SLE, n=31), systemic sclerosis (n=30), and Behçet's disease (BD, n=16) were also tested. Levels of AAVEs were significantly higher in rheumatoid arthritis (P<0.0001), SLE (P<0.05), and BD (P<0.05) populations than in healthy subjects. Purified immunoglobulin G (IgG) from a BD patient with exceptionally high AAVEs levels recognized the EC1-4 fragment in western blots. Further characterization of the epitopes recognized by AAVEs showed that BD patients had antibodies specific for the EC3 and EC4 domains, whereas SLE patients preferentially recognized the EC1 fragment. This suggests that distinct epitopes of human VE-cadherin might be recognized in different immune diseases. Purified IgG from BD patients was found to induce endothelial cell retraction, redistribution of VE-cadherin, and cause the formation of numerous intercellular gaps. Altogether, these data demonstrate a potential pathogenic effect of AAVEs isolated from patients with dysimmune disease. This is the first description of AAVEs in humans. Because regions EC1 and EC3-4 have been shown to be involved in homophilic VE-cadherin interactions, AAVEs produced in the course of dysimmune diseases might be specific biomarkers for endothelial injury, which is part of the early pathogenicity of these diseases.
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Affiliation(s)
- L Bouillet
- 1] Grenoble University Hospital, Internal Medicine Department, Grenoble, France [2] INSERM, Unit 1036, Biology of Cancer and Infection, Grenoble, France [3] Joseph Fourier University UJF-Grenoble 1, Biology of Cancer and Infection, Grenoble, France [4] CEA, DSV/iRTSV, Biology of Cancer and Infection, Grenoble, France
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Solomon DH, Peters MJL, Nurmohamed MT, Dixon W. Unresolved questions in rheumatology: motion for debate: the data support evidence-based management recommendations for cardiovascular disease in rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 65:1675-83. [PMID: 23606026 PMCID: PMC3798129 DOI: 10.1002/art.37975] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 04/09/2013] [Indexed: 02/06/2023]
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Ajeganova S, Andersson MLE, Frostegård J, Hafström I. Disease factors in early rheumatoid arthritis are associated with differential risks for cardiovascular events and mortality depending on age at onset: a 10-year observational cohort study. J Rheumatol 2013; 40:1958-66. [PMID: 23950188 DOI: 10.3899/jrheum.130365] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate, within the first 2 years of diagnosis with rheumatoid arthritis (RA), associations between disease-related measures and cardiovascular disease (CVD) and mortality in patients with RA onset before and after 65 years of age. METHODS The study population (n = 741; 67.5% women) was derived from the Better Anti-Rheumatic Pharmaco Therapy (BARFOT) early RA cohort, recruited 1993-1999. The mean age was 55 years (SD 14.7). The outcomes were incident CVD events and all-cause mortality until 2010. Area under the curve (AUC) for disease measures at inclusion, 1 and 2 years, and decrease in measures after 1 year were calculated. RESULTS In all, 177 CVD events and 151 deaths occurred over 10 years of observation. In adjusted Cox regression analyses, seropositivity for rheumatoid factor (RF) or anticitrullinated protein antibodies (ACPA); white blood (cell) count at diagnosis; and AUC of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and visual analog scale (VAS)-pain were associated with higher CVD risk among patients with disease onset before 65 years of age. Among patients with disease onset after 65 years, larger decreases in CRP, ESR, health assessment questionnaire (HAQ), and use of methotrexate decreased CVD risk, whereas use of glucocorticoids heightened CVD risk. AUC of CRP, ESR, HAQ, and HAQ after 2 years was related to risk of death in both age groups. Seropositivity and AUC for VAS-pain in the younger group and use of glucocorticoids in the elderly were associated with poorer survival. CONCLUSION Early treatment of RA may improve longterm outcomes. Presence of RF or ACPA associates with CVD and mortality among RA patients with disease onset before 65 years. Age stratification may improve evaluation of risk for CVD and mortality in early RA.
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Affiliation(s)
- Sofia Ajeganova
- From the Unit of Rheumatology, Department of Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm; R and D Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström and Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund; Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institute, Stockholm; Unit of Rheumatology, Department of Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
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Głowińska-Olszewska B, Bossowski A, Dobreńko E, Hryniewicz A, Konstantynowicz J, Milewski R, Łuczyński W, Piotrowska-Jastrzębska J, Kowal-Bielecka O. Subclinical cardiovascular system changes in obese patients with juvenile idiopathic arthritis. Mediators Inflamm 2013; 2013:436702. [PMID: 23554546 PMCID: PMC3608356 DOI: 10.1155/2013/436702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/03/2013] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We aimed to determine the prevalence of excess body mass in juvenile idiopathic arthritis (JIA) children and to investigate the influence of obesity into the early, subclinical changes in cardiovascular system in these patients. METHODS Fifty-eight JIA patients, aged median 13 years, were compared to 36 healthy controls. Traditional cardiovascular risk factors and inflammatory markers (hsCRP, IL-6, TNF α, adiponectin) were studied together with IMT (intima-media thickness), FMD (flow mediated dilation), and LVMi (left ventricle mass index) as surrogate markers of subclinical atherosclerosis. RESULTS Thirteen JIA children (22%) were obese and had increased systolic blood pressure, cholesterol, triglycerides, insulin, HOMA, hsCRP, and IL-6 compared to nonobese JIA and controls. FMD was decreased compared to nonobese JIA and controls, whereas IMT and LVMi were increased. In multivariate regression analysis, TNF α, SDS-BMI, and systolic blood pressure were independent predictors of early CV changes in JIA. CONCLUSIONS Coincident obesity is common in JIA children and is associated with insulin resistance, dyslipidemia, and increased levels of inflammatory markers leading to early changes in cardiovascular system. Thus, medical care of children with JIA should include strategies preventing cardiovascular disease by maintenance of adequate body weight.
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Affiliation(s)
- Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Białystok, Poland.
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Undiagnosed medical comorbidities in the uninsured: a significant predictor of mortality following trauma. J Trauma Acute Care Surg 2013; 73:1093-8; discussion 1098-9. [PMID: 23117376 DOI: 10.1097/ta.0b013e31826fc844] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Lack of health care insurance has been correlated with increased mortality after trauma. Medical comorbidities significantly affect trauma outcomes. Access to health care and thereby being diagnosed with a pretrauma comorbidity is highly dependent on insurance status. The objective of this study was to determine whether rates of diagnosed or undiagnosed preexisting comorbidities significantly contribute to disparities in mortality rates observed between insured and uninsured trauma patients. METHODS Review of trauma patients admitted to a Level I trauma center during a 5-year period. Data extracted from the registry included age, sex, Injury Severity Score (ISS), comorbidities, mortality, and insurance status. Multivariate logistic regression analysis was performed using age, sex, and insurance status to predict comorbidities and age, sex, ISS, and insurance status to predict mortality. RESULTS Insured patients were older (54 years vs. 38, p < 0.001) and more likely female (41.3% vs. 22.5%, p < 0.001). When adjusting for age and sex, insured patients were more likely to have a pretrauma diagnosis of coronary artery disease (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.54-2.83), diabetes mellitus (OR, 2.09; 95% CI, 1.61-2.72), hypertension (OR, 1.97; 95% CI, 1.65-2.35), asthma/emphysema (OR, 1.64; 95% CI, 1.32-2.04), neurologic problems (OR, 1.79; 95% CI, 1.31-2.44), and gastroesophageal reflux disease (OR, 2.03; 95% CI, 1.33-3.11), compared with patients without insurance. In the analysis to predict mortality, having insurance was protective (OR, 0.57; 95% CI, 0.45-0.71). Among patients with no diagnosed comorbidities, insured patients had the lowest mortality risk (OR, 0.5; 95% CI, 0.38-0.67). When analyzing only patients with diagnosed comorbidities, insurance status had no impact on mortality risk (OR, 0.81; 95% CI, 0.53-1.22). CONCLUSION Undiagnosed preexisting comorbidities play a crucial role in determining outcomes following trauma. Diagnosis of medical comorbidities may be a marker of access to health care and may be associated with treatment, which may explain the gap in mortality rates between insured and uninsured trauma patients. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.
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Armstrong AW, Callis Duffin K, Garg A, Gelfand JM, Gottlieb AB, Krueger GG, Qureshi AA, Rosen CF. Exploring priority research areas in psoriasis and psoriatic arthritis from dermatologists' perspective: a report from the GRAPPA 2011 annual meeting. J Rheumatol 2012; 39:2204-10. [PMID: 23118289 DOI: 10.3899/jrheum.120825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
At the 2011 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Naples, Italy, the GRAPPA dermatology members led discussions on priority research areas in psoriasis and psoriatic arthritis (PsA). These discussions centered on 3 primary areas: evaluation of PsA screening tools, updates on psoriasis comorbidities, and new developments in genetics and comparative effectiveness research. Introductory presentations were followed by engaging panel discussions and audience interaction. The members agreed that screening tools are highly valuable in early detection of PsA among dermatology patients and that efforts are necessary to develop tools suitable for adoption in clinical practice. Members also agreed that a collaborative investigation to evaluate the effect of psoriasis treatments on cardiovascular comorbidities would be highly informative. Finally, the members supported continued efforts to explore the genetic basis of psoriasis and more studies focused on comparative effectiveness of existing treatments.
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, University of California Davis, Sacramento, California 95816, USA.
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Cardiovascular disease in rheumatoid arthritis: a systematic literature review in latin america. ARTHRITIS 2012. [PMID: 23193471 PMCID: PMC3501796 DOI: 10.1155/2012/371909] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background. Cardiovascular disease (CVD) is the major predictor of poor prognosis in rheumatoid arthritis (RA) patients. There is an increasing interest to identify "nontraditional" risk factors for this condition. Latin Americans (LA) are considered as a minority subpopulation and ethnically different due to admixture characteristics. To date, there are no systematic reviews of the literature published in LA and the Caribbean about CVD in RA patients. Methods. The systematic literature review was done by two blinded reviewers who independently assessed studies for eligibility. The search was completed through PubMed, LILACS, SciELO, and Virtual Health Library scientific databases. Results. The search retrieved 10,083 potential studies. A total of 16 articles concerning cardiovascular risk factors and measurement of any cardiovascular outcome in LA were included. The prevalence of CVD in LA patients with RA was 35.3%. Non-traditional risk factors associated to CVD in this population were HLA-DRB1 shared epitope alleles, rheumatoid factor, markers of chronic inflammation, long duration of RA, steroids, familial autoimmunity, and thrombogenic factors. Conclusions. There is limited data about CVD and RA in LA. We propose to evaluate cardiovascular risk factors comprehensively in the Latin RA patient and to generate specific public health policies in order to diminish morbi-mortality rates.
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Fairweather D, Petri MA, Coronado MJ, Cooper LT. Autoimmune heart disease: role of sex hormones and autoantibodies in disease pathogenesis. Expert Rev Clin Immunol 2012; 8:269-84. [PMID: 22390491 DOI: 10.1586/eci.12.10] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) and autoimmune diseases (ADs) are the first and third highest causes of death in the USA, respectively. Men have an increased incidence of the majority of CVDs, including atherosclerosis, myocarditis, dilated cardiomyopathy and heart failure. By contrast, nearly 80% of all ADs occur in women. However, in one category of ADs, rheumatic diseases, CVD is the main cause of death. Factors that link rheumatic ADs to CVD are inflammation and the presence of autoantibodies. In this review we will examine recent findings regarding sex differences in the immunopathogenesis of CVD and ADs, explore possible reasons for the increased occurrence of CVD within rheumatic ADs and discuss whether autoantibodies, including rheumatoid factor, could be involved in disease pathogenesis.
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Affiliation(s)
- DeLisa Fairweather
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health Sciences, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Ajeganova S, de Faire U, Jogestrand T, Frostegård J, Hafström I. Carotid atherosclerosis, disease measures, oxidized low-density lipoproteins, and atheroprotective natural antibodies for cardiovascular disease in early rheumatoid arthritis -- an inception cohort study. J Rheumatol 2012; 39:1146-54. [PMID: 22589258 DOI: 10.3899/jrheum.111334] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although an enhanced risk of cardiovascular disease (CVD) in persons with rheumatoid arthritis (RA) is well established, the mechanisms behind it remain unclear. We studied whether carotid atherosclerosis, RA disease measures, or potential cardiovascular biomarkers influenced the incidence of CVD in an RA inception cohort. METHODS RA disease measures and CVD biomarkers were assessed at 0, 3, 12, 24, and 60 months after disease onset, and carotid ultrasonography after 5 years. The study outcome was incident CVD events - acute myocardial infarction, angina pectoris, congestive heart failure, or ischemic cerebrovascular event. Survival analysis and Cox and longitudinal regressions were used for statistical analyses. RESULTS A total of 105 patients, without CVD events prior to RA onset, experienced 17 CVD events, an incidence rate of 1.35 events per 100 person-years (95% CI 0.71-2.0). The rate of CVD events did not differ with regard to measures of carotid intima-media thickness, but it was higher for patients with bilateral carotid plaques than for those without (p = 0.012). Improvement in Disease Activity Score for 28 joints, visual analog scale for pain, and Stanford Health Assessment Questionnaire score over the first year, as well as usage of methotrexate (MTX), was associated, independent of age, with reduction of risk of CVD event [hazard ratios 0.68 (95% CI 0.5-0.97), 0.97 (95% CI 0.95-0.99), 0.35 (95% CI 0.15-0.82), and 0.34 (95% CI 0.12-0.91), respectively]. In longitudinal analyses, increasing oxidized low-density lipoprotein (oxLDL) and probability for low antiphosphorylcholine antibodies (anti-PC) were observed in those who experienced a subsequent CVD event. CONCLUSION Bilateral carotid plaques were associated with poor CVD-free survival. Early reductions of inflammation, pain, and disability as well as MTX usage were associated with better CVD outcome. Elevated oxLDL and low IgM anti-PC levels may link chronic inflammation in RA to enhanced risk of CVD events.
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Abstract
Rheumatoid arthritis, as well as other types of arthritides and connective tissue diseases, is associated with accelerated atherosclerosis, and increased cardiovascular morbidity and mortality. The early signs of cardiovascular disease therefore need to be recognized in patients with these conditions so that effective cardiovascular protection can be introduced. This Review provides an overview of validated techniques that are currently available to determine subclinical atherosclerosis in patients with rheumatic conditions. Techniques for early assessment of endothelial dysfunction include brachial artery flow-mediated vasodilation and laser Doppler flowmetry. Coronary circulation can be assessed by measuring coronary flow reserve using CT, MRI or PET based techniques. The standard indicators of arterial stiffness are pulse-wave velocity and the augmentation index. Carotid atherosclerosis is determined by the common carotid intima-media thickness (ccIMT) measurement or by the assessment of plaques and plaque areas. The combination of ccIMT with plaque assessment is likely to increase the predictive value of this approach. The potential use of a multimarker approach to increase the diagnostic and prognostic value of these clinical assessments is also discussed.
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Sidibé A, Mannic T, Arboleas M, Subileau M, Gulino-Debrac D, Bouillet L, Jan M, Vandhuick T, Le Loët X, Vittecoq O, Vilgrain I. Soluble VE-cadherin in rheumatoid arthritis patients correlates with disease activity: evidence for tumor necrosis factor α-induced VE-cadherin cleavage. ACTA ACUST UNITED AC 2012; 64:77-87. [PMID: 21905018 DOI: 10.1002/art.33336] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that principally attacks synovial joints. However, accelerated atherosclerosis and increased cardiovascular morbidity and mortality are major clinical consequences of endothelial dysfunction in RA patients. Tumor necrosis factor α (TNFα) is the major mediator of inflammation in RA, related to vascular injury by targeting VE-cadherin, an endothelium-specific adhesion molecule of vital importance for endothelium integrity and angiogenesis. We undertook this study to examine the mechanisms regulating VE-cadherin processing by TNFα and their occurrence in RA. METHODS Human umbilical vein endothelial cells were used in primary culture and treated with recombinant TNFα to study VE-cadherin cleavage. Cell lysates and conditioned media were analyzed by Western blotting for VE-cadherin cytoplasmic domain and extracellular domain (VE-90) generation, respectively. VE-90 was analyzed at baseline and at the 1-year followup in sera from 63 RA patients (from the Very Early Rheumatoid Arthritis cohort) with disease duration of <6 months. RESULTS TNFα induced a time-dependent shedding of VE-90 in cell media. This effect was prevented by tyrosine kinase inhibitors (genistein and PP2) or by knocking down Src kinase. In contrast, tyrosine phosphatase blockade enhanced VE-cadherin cleavage, confirming the requirement of tyrosine phosphorylation processes. In addition, using the matrix metalloproteinase (MMP) activator APMA and the MMP inhibitor GM6001, we demonstrated that MMPs are involved in TNFα-induced VE-cadherin cleavage. Of major importance, VE-90 was detected in sera from the 63 RA patients and was positively correlated with the Disease Activity Score at baseline and after 1-year followup. CONCLUSION These findings provide the first evidence of VE-cadherin proteolysis upon TNFα stimulation and suggest potential clinical relevance of soluble VE-cadherin in management of RA.
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Affiliation(s)
- Adama Sidibé
- INSERM Unité 1036, Joseph Fourier University-Grenoble 1, and CEA Grenoble, Grenoble, France
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Chang CA, Gottlieb AB, Lizzul PF. Management of psoriatic arthritis from the view of the dermatologist. Nat Rev Rheumatol 2011; 7:588-98. [PMID: 21912431 DOI: 10.1038/nrrheum.2011.125] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.
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Affiliation(s)
- Caroline A Chang
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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Kleinert S, Krueger K. Kardiovaskuläre Komorbidität und ihre Risikofaktoren bei rheumatoider Arthritis. Z Rheumatol 2011; 70:464-72. [DOI: 10.1007/s00393-011-0755-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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