1
|
Marsh K, Mac Gearailt C, O'Shea F, Fitzgerald G. In axial spondyloarthritis current smoking is associated with lower prevalence of uveitis and peripheral arthritis in males, but not females. Joint Bone Spine 2024; 91:105746. [PMID: 38821214 DOI: 10.1016/j.jbspin.2024.105746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Affiliation(s)
| | | | - Finbar O'Shea
- Trinity College Dublin, Dublin, Ireland; St James's Hospital, Dublin, Ireland
| | - Gillian Fitzgerald
- Galway University Hospital Galway, Galway, Ireland; University of Galway, Galway, Ireland
| |
Collapse
|
2
|
Dong C, Braun J, Ma KSK. Safety and efficacy of pharmacological treatments for axial spondyloarthritis. Int J Rheum Dis 2023; 26:2130-2133. [PMID: 37910029 DOI: 10.1111/1756-185x.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Chen Dong
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr Universität Bochum, Bochum, Germany
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Zhong Y, Chen Y, Zhang X, Cai W, Zhao C, Zhao W. No evidence of a causal relationship between ankylosing spondylitis and cardiovascular disease: a two-sample Mendelian randomization study. Front Cardiovasc Med 2023; 10:1243867. [PMID: 37900560 PMCID: PMC10600491 DOI: 10.3389/fcvm.2023.1243867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Observational studies have suggested an increased risk of cardiovascular disease in individuals with ankylosing spondylitis. However, these studies are prone to confounding factors and reverse causality. To address these limitations, we conducted a Mendelian randomization study to assess the causal relationship between AS and CVD. Methods The study population comprises 9,069 individuals with ankylosing spondylitis and 509,093 individuals with either of six common cardiovascular diseases and a related indicator. Causal analysis using summary effect estimates and inverse variance weighting were employed as the main methods. Results The CAUSE analysis showed no evidence of a causal relationship between AS and CVD. The odds ratios for total CVD, heart failure, myocardial infarction, valvular heart disease, ischemic heart disease, and venous thromboembolism, Arterial stiffness index, were as follows: OR, 1.01; 95% confidence interval, 0.96-1.05; P = 0.91; OR, 1.03; 95% CI, 0.99-1.08; P = 0.50; OR, 0.94; 95% CI, 0.86-1.03; P = 0.53; OR, 0.99; 95% CI, 0.94-1.04; P = 0.99; OR, 0.98; 95% CI, 0.91-1.04; P = 0.94; OR, 0.98; 95% CI, 0.91-1.04; P = 0.99; β, -0.0019; 95% CI, 0.97-1.01; P = 0.99. The IVW and weighted median methods also yielded consistent results, and no heterogeneity or pleiotropy was found. Likewise, a reverse Mendelian randomization analysis did not uncover a heritable causal relationship between AS and CVD. Conclusion This Mendelian randomization study does not support a causal relationship between AS and CVD. Further research is needed to confirm this association.
Collapse
Affiliation(s)
- Yan Zhong
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - YingWen Chen
- College of Traditional Chinese Medicine, Tianjin University of Chinese Medicine, Tianjin, China
| | - XinYue Zhang
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - WenJun Cai
- Department of Orthopedics, The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - ChangWei Zhao
- Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - WenHai Zhao
- Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| |
Collapse
|
4
|
Kaya MN, Yurumez S, Tekgöz E, Kılıç Ö, Çınar M, Yılmaz S. The Role of Rheumatologist in Smoking Cessation of Ankylosing Spondylitis Patients: A Single-Center Cross-Sectional Study. Cureus 2023; 15:e45461. [PMID: 37727839 PMCID: PMC10506527 DOI: 10.7759/cureus.45461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES Smoking has a well-established detrimental effect on the prognosis and treatment success in patients with ankylosing spondylitis. It is important to encourage and convince patients to quit smoking. We aimed to evaluate the contribution of rheumatologists to smoking cessation in patients with ankylosing spondylitis. METHODS This single-center cross-sectional study was conducted in a tertiary research hospital between March 2022 and June 2022. The data related to demographics, smoking status, duration of smoking, average number of cigarettes smoked per day, reasons for quitting smoking, and methods of quitting smoking were obtained through face-to-face interviews. RESULTS This study was carried out on 308 patients. A total of 102 ankylosing spondylitis patients quit smoking. Of the patients who quit smoking, 39 (38.3%) patients quit smoking with a recommendation of a rheumatologist and 29 (28.4%) patients quit because of their concerns related to ankylosing spondylitis disease. The most commonly used methods for quitting smoking were herbal supplements in 40 (39.2%) patients and medication for smoking cessation in 40 (39.2%) patients. CONCLUSIONS It has been shown that about one-fifth of ankylosing spondylitis patients are not questioned by a rheumatologist about smoking. On the other hand, it was seen that the factor with the greatest effect on those who quit smoking was the rheumatologist. Therefore, rheumatologists should question all ankylosing spondylitis patients about smoking and encourage smokers to quit in order to achieve better outcomes in the long term.
Collapse
Affiliation(s)
- Mehmet Nur Kaya
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Seda Yurumez
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Emre Tekgöz
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Özlem Kılıç
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Muhammet Çınar
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Sedat Yılmaz
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| |
Collapse
|
5
|
YARKAN TUĞSAL H, KENAR G, CAN G, ÇAPAR S, ZENGİN B, AKAR S, DALKILIÇ E, ŞENEL S, KOCA SS, GÖKER B, YAZICI A, İNANÇ N, ELLİDOKUZ H, AKKOÇ N, ÖNEN F. The impact of smoking on response to tumor necrosis factor-α inhibitor treatment in patients with ankylosing spondylitis. Turk J Med Sci 2023; 53:970-978. [PMID: 38031953 PMCID: PMC10760557 DOI: 10.55730/1300-0144.5661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 08/18/2023] [Accepted: 02/01/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND To investigate the impact of smoking on disease activity, treatment retention, and response in patients with ankylosing spondylitis (AS) treated with their first tumor necrosis factor-α inhibitor (TNFi). METHODS AS patients who started their first TNFi treatment for the active axial disease (BASDAI ≥ 4) from TURKBIO Registry were included. Treatment response of smoker (current and ex-smokers) and nonsmoker (never smoker) patients were primarily evaluated as achievement of BASDAI50 or improvement in BASDAI at least 20 mm at 3 months and 6 months compared to baseline. RESULTS There were 322 patients with AS (60% male, 59% smoker, mean age: 38.3 years). The median follow-up time was 2.8 years (Q1- Q3: 1.3-3.8), and disease duration was 3.5 years (Q1-Q3: 0.7-8.2). Smokers had male predominance (p < 0.001), lower ESR (p = 0.03), higher BASDAI (p = 0.02), BASFI (p = 0.05), HAQ-AS (p = 0.007), and ASDAS-CRP (p = 0.04) compared with nonsmokers at baseline. In the multivariate analysis, male gender [OR 2.7 (95%CI 1.4-5), p = 0.002], and concomitant conventional synthetic disease-modifying antirheumatic drug use [OR 2.4 (95%CI 1.1-5.2), p = 0.03] were associated with better treatment response. There was an association of male gender [HR 2.4 (95%CI 1.6-3.7), p < 0.001], older age (≥30years) [HR 1.8 (95%CI 1.1-2.8), p = 0.01], and response to treatment [HR 1.8 (95%CI 1.2-2.9), p = 0.008] with better treatment retention. No impact of smoking status was found on treatment retention and response in univariate and multivariate analyses. DISCUSSION This study suggested that smoking was associated with poorer patient-reported outcomes in biologic naïve AS patients initiating their first TNFi treatment, but it had no impact on the TNFi treatment response and retention rate.
Collapse
Affiliation(s)
- Handan YARKAN TUĞSAL
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Gökçe KENAR
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Gerçek CAN
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Sedat ÇAPAR
- Department of Statistics, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Berrin ZENGİN
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Servet AKAR
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Katip Çelebi University, İzmir,
Turkiye
| | - Ediz DALKILIÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa,
Turkiye
| | - Soner ŞENEL
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - Süleyman Serdar KOCA
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazığ,
Turkiye
| | - Berna GÖKER
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Ayten YAZICI
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkiye
| | - Nevsun İNANÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University, İstanbul,
Turkiye
| | - Hülya ELLİDOKUZ
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Nurullah AKKOÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Celal Bayar University, Manisa,
Turkiye
| | - Fatoş ÖNEN
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| |
Collapse
|
6
|
Ku CH, Lee YH, Wei JCC, Braun J. Current aspects for the treatment of axial spondyloarthritis. Int J Rheum Dis 2023; 26:5-7. [PMID: 36591903 DOI: 10.1111/1756-185x.14473] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Chiao-Hsin Ku
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Heng Lee
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.,Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan.,Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany and Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
7
|
Insights from studying a large cohort of patients: Commentary on Tardif and co-workers. Pain 2022; 164:919-920. [PMID: 36515469 DOI: 10.1097/j.pain.0000000000002812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
|
8
|
Exarchou S, Turesson C, Lindström U, Ramonda R, Landewé RBM, Dagfinrud H, van Gaalen F, van der Heijde D, Jacobsson LTH. Lifestyle Factors and Disease Activity over Time in Early Axial Spondyloarthritis - The SPondyloArthritis Caught Early (SPACE) Cohort. J Rheumatol 2021; 49:365-372. [PMID: 34470793 DOI: 10.3899/jrheum.210046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to study the importance of baseline Body Mass Index (BMI), smoking and alcohol consumption (AC) for disease activity (DA) over one year in early axial spondyloarthritis (axSpA), stratified by sex. METHODS In the SPondyloArthritis Caught Early cohort (patients with chronic back pain for ≥3 months, ≤2 years and onset <45 years), ASDAS was recorded at inclusion, 3 and 12 months. All patients included in the analysis had axSpA based on a high physician's level of confidence at baseline. Differences in ASDAS over 1 year by BMI (normal <25, overweight 25-29.9, obese ≥30 kg/m2), smoking history (never/previous/current) and AC (none, 0.1-2, 3-5, ≥6 units/week) at baseline were estimated using mixed linear regression models. RESULTS There were 344 subjects (mean age 30 years; 49% men). In women, obesity was associated with 0.60 (95% CL 0.28, 0.91) higher ASDAS compared to normal BMI. In both sexes, AC tended to be associated with lower DA over one year, with a significant association only in women with the highest AC (mean difference -0.55 (96% CL-1.05, -0.04). Smoking was associated with higher ASDAS over one year compared to never smoking in both sexes, albeit the difference reached statistical significance only in female former smokers. Results were similar in multivariable analysis, adjusted for all lifestyle factors and other confounders. CONCLUSION In early axSpA, BMI and smoking are associated with higher DA over one year, and AC with lower DA. The magnitude of the modest associations may differ between men and women.
Collapse
Affiliation(s)
- Sofia Exarchou
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Ulf Lindström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Roberta Ramonda
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Robert B M Landewé
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Hanne Dagfinrud
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Floris van Gaalen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Désirée van der Heijde
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| | - Lennart T H Jacobsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Funding: Sofia Exarchou's work with the study was funded by the Swedish Rheumatism Association. Apart from this, the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Conflict of Interest: Dr. Exarchou reports grants from Swedish Rheumatism Association, during the conduct of the study; personal fees from Novartis, personal fees from Abbvie outside the submitted work. Dr. Turesson reports personal fees from Abbvie, personal fees from Pfizer, grants and personal fees from Bristol-Myers Squibb, personal fees from Roche, outside the submitted work. Dr. Lindström has nothing to disclose. Dr. Ramonda has nothing to disclose. Dr. Landewé has nothing to disclose. Dr. Dagfinrud has nothing to disclose. Dr. van Gaalen reports grants from MSD, grants from AbbVie, grants from Stichting Vrienden van Sole Mio, grants from UCB, grants and personal fees from Novartis, grants from Pfizer, outside the submitted work. Dr. van der Heijde reports personal fees from Abbvie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daiichi, personal fees from Eisai, personal fees from Eli-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, other from Imaging Rheumatology bv, outside the submitted work. Dr. Jacobsson reports personal fees from Pfizer, personal fees from Abbvie, personal fees from Novartis, personal fees from Eli-Lily, personal fees from Janssen, outside the submitted work. Corresponding author: Sofia Exarchou, M.D., PhD, Rheumatology, Department of Clinical Sciences Malmö, Lund University; Jan Waldenströms gata 1B, 205 02, Malmö, Sweden. E-mail:
| |
Collapse
|
9
|
Farouk HM, Abdel-Rahman MA, Hassan RM. Relationship between smoking, clinical, inflammatory, and radiographic parameters in patients with ankylosing spondylitis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00076-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ankylosing spondylitis (AS) is an autoimmune multisystemic disease that attacks the spine, sacroiliacs, and often causes asymmetrical peripheral oligoarthritis. It results from the interaction between the genetic factors mainly Human Leukocyte Antigen B27 (HLA B27) and environmental factors. Current smoking has been reported to be a major risk factor for the incidence and progression of ankylosing spondylitis. So, we aim to explore the relationship between smoking and each of the clinical, inflammatory markers, functional limitation, and radiographic progression in ankylosing spondylitis patients.
Results
Fifty ankylosing spondylitis patients were included in this study. Comparisons of clinical data, radiographic, and inflammatory markers among smokers and nonsmokers revealed that AS current smokers showed a statistically significant decrease in chest expansion, increase in the occiput to wall distance (p < 0.001**), higher inflammatory marker, higher disease activity indices (Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index), higher Bath Ankylosing Spondylitis functional index, and modified Stoke Ankylosing Spondylitis Spine Score than nonsmokers (P < 0.001**). The smoking index was positively correlated with BASFI, ASDAS, (mSASSS) (r = 0.584, p = 0.005*) and negatively correlated with chest expansion.
Conclusions
Current smoking in ankylosing spondylitis patients is associated with higher disease activity, inflammatory markers, functional disability, and radiological progression. This may add to the disease burden and thus interferes with the personal daily activities, physical mobility, life quality, and the response to TNFi therapy. So, stopping smoking is a mandatory step in controlling the disease activity and having favorable outcome.
Collapse
|
10
|
Derakhshan MH, Dean L, Jones GT, Siebert S, Gaffney K. Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. RMD Open 2021; 6:rmdopen-2020-001206. [PMID: 32641447 PMCID: PMC7425116 DOI: 10.1136/rmdopen-2020-001206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Extra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a 'real-world' cohort of patients with axSpA. METHODS Clinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed. RESULTS AAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less preference for etanercept over other TNFi. CONCLUSION The higher occurrence of AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with axSpA are consistent with current pathophysiology. Patients with previous AAU and IBD are more likely to be prescribed adalimumab and less likely to receive etanercept, consistent with the superior efficacy of monoclonal TNFi for these indications. Future work will determine whether EAMs influence TNFi survival, or effectiveness, and whether this varies between agents.
Collapse
Affiliation(s)
- Mohammad H Derakhshan
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK ,
| | - Linda Dean
- Epidemiology Group, Univesity of Aberdeen, Aberdeen, UK
| | | | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospital, Norwich, UK ,
| |
Collapse
|
11
|
Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology (Oxford) 2020; 59:1472-1481. [PMID: 32236486 DOI: 10.1093/rheumatology/keaa093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/05/2019] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
Tobacco smoking is a major threat to health. There is no doubt about the need to promote and support cessation at every opportunity. Smoking has a clear role in RA, but what evidence is there that the same relationship exists in SpA? In this review, we examine (the less cited) paradoxes and contradictions in the existing axial SpA (axSpA) and PsA literature; for example, smoking appears to be 'protective' for some axSpA manifestations. We also highlight findings from higher quality evidence: smoking is associated with increased risk of PsA and the risk of psoriasis in axSpA. The relationship between smoking and SpA is far from simple. Our aim is to highlight the harms of smoking in SpA and bring attention to inconsistencies in the literature to inform further research.
Collapse
Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool.,Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool
| | - Nicola J Goodson
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool.,Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool
| | - Selina Robertson
- Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| |
Collapse
|
12
|
Macfarlane GJ, Pathan E, Jones GT, Dean LE. Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS. Rheumatology (Oxford) 2020; 59:2481-2490. [PMID: 31990352 PMCID: PMC7449799 DOI: 10.1093/rheumatology/kez657] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit. METHODS The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the 'biologic' sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state. RESULTS 335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12-17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%). CONCLUSION Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.
Collapse
Affiliation(s)
- Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ejaz Pathan
- Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, Toronto, Canada
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
13
|
Jones GT, Dean LE, Pathan E, Hollick RJ, Macfarlane GJ. Real-world evidence of TNF inhibition in axial spondyloarthritis: can we generalise the results from clinical trials? Ann Rheum Dis 2020; 79:914-919. [PMID: 32327428 DOI: 10.1136/annrheumdis-2019-216841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/14/2020] [Accepted: 04/05/2020] [Indexed: 11/04/2022]
Abstract
Management guidelines assume that results from clinical trials can be generalised, although seldom is data available to test this assumption. We aimed to determine the proportion of patients commencing tumour necrosis factor inhibition (TNFi) who would have been eligible for relevant clinical trials, and whether treatment response differs between these groups and the trials themselves. The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) recruited a real-world cohort of TNFi-naïve spondyloarthritis patients with data collection from clinical records and patient questionnaires. Participant characteristics were extracted from trials identified from a recent Health Technology Assessment of TNFi for ankylosing spondylitis/non-radiographic axial spondyloarthritis. Descriptive statistics were used to determine the differences, including treatment response, between BSRBR-AS participants who would/would not have been eligible for the clinical trials and with trial participants. Among 2420 BSRBR-AS participants, those commencing TNFi (34%) had shorter symptom duration (15 vs 22 years) but more active disease (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 6.4 vs 4.0; Bath Ankylosing Spondylitis Disease Functional Index (BASFI) 6.2 vs 3.8). Of those commencing TNFi, 41% met eligibility criteria for ≥1 of fourteen relevant trials; they reported higher disease activity (BASDAI 6.9 vs 6.1) and poorer function (BASFI 6.6 vs 6.0). 61.7% of trial participants reported a positive treatment response, vs 51.3% of BSRBR-AS patients (difference: 10.4%; 95% CI 4.4% to 16.5%). Potential eligibility for trials did not influence treatment response (difference 2.0%; -9.4% to 13.4%). Fewer patients in the real world respond to TNFi than is reported in the trial literature. This has important implications for the generalisability of trial results, and the cost-effectiveness of TNFi agents.
Collapse
Affiliation(s)
- Gareth T Jones
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Ejaz Pathan
- Department of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Rosemary J Hollick
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
14
|
Zhang F, Ma C, Zhang B, Bi L. Dynamic changes in gut microbiota under the influence of smoking and TNF-α-blocker in patients with ankylosing spondylitis. Clin Rheumatol 2020; 39:2653-2661. [PMID: 32219620 DOI: 10.1007/s10067-020-05032-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/21/2020] [Accepted: 03/05/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study aimed to investigate the relationship among smoking, TNF-α-blocker therapy, and the dynamic changes in gut microbiota in patients with ankylosing spondylitis (AS). METHODS Using a 16S rRNA sequence, 98 fecal samples of 20 AS patients collected after 0, 1, 3 and 6 months of anti-TNF-α treatment and from 20 matched health controls were examined. The variation in composition, abundance, and diversity of gut microbiota was analyzed. The dynamic effects of smoking and treatment on gut microbiota and therapeutic efficacy in AS patients were studied. RESULTS The increased relative abundance of microbiota in AS nonsmokers was g_Comamonas and g_Desulfovibrio, while that in AS smokers was g_Actinomyces, g_Collinsella, g_Lachnospiraceae_UCG-008, and g_Paraprevotella. The relative abundance of gut microbiota showed dynamic variation. The improvement rate of ASDAS in AS nonsmokers was higher than that in AS smokers (2.297 vs 1.736) after anti-TNF-α treatment. The β-diversity of gut microbiota in AS smokers was lower than that in AS nonsmokers and improved with treatment. CONCLUSIONS Both smoking and TNF-α-blocker had significant effects on the composition, relative abundance, and diversity of gut microbiota in AS patients. The AS smokers characteristically shared g_Collinsella and g_Dorea. The relative abundance of gut microbiota revealed high variability and was in dynamic fluctuation during treatment. The response of gut microbiota to anti-TNF-α treatment was found to be heterogeneous and selective. AS nonsmokers showed a greater improvement rate of ASDAS-CRP with treatment than AS smokers did. The AS smokers showed a lower β-diversity of gut microbiota, and improved after treatment. Key Points • Characterized the dynamic variation in gut microbiota in AS patients classified as smokers and nonsmokers during treatment with anti-TNF-α. • Confirmed the interaction between smoking, anti-TNF-α therapy, and gut microbiota.
Collapse
Affiliation(s)
- Fangze Zhang
- Department of Endoscopy Center, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Cuili Ma
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China
| | - Bin Zhang
- Department of Endoscopy Center, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China.
| | - Liqi Bi
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033, Jilin, People's Republic of China.
| |
Collapse
|
15
|
Zhao S, Jones GT, Macfarlane GJ, Hughes DM, Dean LE, Moots RJ, Goodson NJ. Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis: results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS). Rheumatology (Oxford) 2020; 58:811-819. [PMID: 30561738 DOI: 10.1093/rheumatology/key371] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/13/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The effects of smoking on disease manifestations in axial SpA are inadequately described. Utilizing a large and well-characterized cohort, we investigated the association between smoking and extra-axial manifestations, and smoking and disease severity measures. METHODS Baseline data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were explored. Our analyses focused on extra-axial manifestations and other disease severity measures, including scales for fatigue, sleep, anxiety and depression. Logistic and linear models were used to quantify associations between disease characteristics according to smoking status (current/ex/never) and quantity (heavy/light), adjusting for age, gender, BMI, education, deprivation, comorbidities, symptom duration and alcohol status. RESULTS A total of 2031 participants were eligible for the current analysis (68% male, mean age 49 years). Of these, 24% were current and 32% ex-smokers. When compared with non-smokers, current smokers had lower odds of uveitis [OR 0.7, 95% CI 0.5-0.9] and higher odds of psoriasis (ORadj 1.6, 95% CI 1.1-2.3). Ex- and current smokers had incrementally more severe disease than never smokers, with higher BASDAI (β = 0.3, 95% CI 0.1-0.6; β = 0.9, 95% CI 0.6-1.2) and BASFI (β = 0.5, 95% CI 0.2-0.8; β = 1.3, 95% CI 1.0-1.6); similar associations were observed for fatigue, sleep, anxiety and depression. CONCLUSION In this large cross-sectional study, we observed that smoking is independently associated with an adverse disease profile in axial SpA, including worse fatigue, sleep, anxiety and depression, and higher odds of psoriasis. The paradoxical association between current smoking and reduced odds of uveitis is interesting and warrants further investigation.
Collapse
Affiliation(s)
- Sizheng Zhao
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Linda E Dean
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Robert J Moots
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Nicola J Goodson
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| |
Collapse
|
16
|
Atzeni F, Nucera V, Galloway J, Zoltán S, Nurmohamed M. Cardiovascular risk in ankylosing spondylitis and the effect of anti-TNF drugs: a narrative review. Expert Opin Biol Ther 2019; 20:517-524. [PMID: 31847607 DOI: 10.1080/14712598.2020.1704727] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Cardiovascular (CV) mortality is increased in patients with ankylosing spondylitis (AS), but little is known about CV morbidity beyond the fact that they have a two-fold higher prevalence of ischemic heart disease than controls due to the inflammatory pattern of the disease itself, and a higher prevalence of traditional CV risk factors than the general population. Anti-TNF drugs reduce inflammation and a number of studies have reported a reduction in sub-clinical atherosclerosis in AS patients treated with anti-TNF drugs, thus suggesting that inflammation contributes to their higher CV risk. Anti-TNF drugs also alter the lipid profiles of AS patients, although these changes may reflect their normalization secondary to inflammation control, and improve their other myocardial alterations.Areas covered: This review concentrates on the risk of cardiovascular morbidity and mortality among AS patients and the effect of anti-TNF drugs on this risk, with particular emphasis on the putative causes involved and the aspects that are relevant in clinical practice.Expert opinion: The growing evidence of CV disease in AS means that all clinicians need to know how to prevent it and treat patients appropriately. It is important to bear in mind the EULAR guidelines, which state that a rheumatologist is responsible for monitoring all AS patients for signs of CV involvement because this is essential in order to ensure that they are treated properly. As there is little clinical evidence concerning the effects of biological drugs other than anti-TNF agents, treatment should be decided on the basis of the clinical aspects of the type of AS and the CV co-morbidity: for example, patients who are hypertensive or dyslipidemic should immediately start treatment with an anti-hypertensive agent and/or a statin. All of the patients should be educated to prevent CV events by keeping to a balanced healthy diet, avoiding tobacco smoking, and maintaining normal blood pressure, LDL-cholesterol and glucose levels. Finally, all clinicians (but particularly rheumatologists) should always bear in mind CV complications in order to guarantee that the quality of life of AS patients is as good as possible.
Collapse
Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, Messina, Italy
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London, UK
| | - Szekanecz Zoltán
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Mike Nurmohamed
- Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Zhao SS, Macfarlane GJ, Jones GT, Gaffney K, Hughes DM, Moots RJ, Goodson NJ. Smoking does not protect patients with axial spondyloarthritis from attacks of uveitis. Ann Rheum Dis 2019; 78:1287-1288. [PMID: 31005901 DOI: 10.1136/annrheumdis-2019-215348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - David M Hughes
- Departmentof Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Robert J Moots
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Nicola J Goodson
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK .,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| |
Collapse
|
18
|
Real-world evidence in rheumatic diseases: relevance and lessons learnt. Rheumatol Int 2019; 39:403-416. [PMID: 30725156 DOI: 10.1007/s00296-019-04248-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022]
Abstract
An emerging trend in the medical literature, including the Rheumatology literature, is that of accumulating large, multicentric, multi-national data based on registries of patients seen in real life situations. Such real-world evidence (RWE) may help provide valuable insights into the long-term outcomes of disease in unselected patients seen in daily practice, including patients belonging to vulnerable populations such as extremes of age, during pregnancy and lactation. Evidences gathered from real life practice settings can help understand drug prescription patterns, including adherence to treatment guidelines, cost-effectiveness of therapy, and real-life long-term outcomes, and adverse effects of treatment with particular medications. Registry-based data also helps analyze comorbidities in patients with rheumatic diseases, and their impact on quality of life, morbidity and mortality. Traditionally, a randomized controlled trial (RCT), or systematic reviews of multiple, homogenous RCTs, have been considered the cornerstone of evidence-based medicine, and RWE does, at times, provide differing viewpoints from the results of particular drugs in clinical trial settings. Therefore, in the present day, it is prudent to consider the complementary nature of information derived from RWE to that obtained from rigorous, clinical trial settings. Future guidelines for disease management may consider it relevant to include information from RWE in addition to that available from clinical trials, to help devise management guidelines that are harmonious with routine practice settings.
Collapse
|
19
|
Shimabuco AY, Gonçalves CR, Moraes JCB, Waisberg MG, Ribeiro ACDM, Sampaio-Barros PD, Goldenstein-Schainberg C, Bonfa E, Saad CGS. Factors associated with ASDAS remission in a long-term study of ankylosing spondylitis patients under tumor necrosis factor inhibitors. Adv Rheumatol 2018; 58:40. [PMID: 30657103 DOI: 10.1186/s42358-018-0040-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/23/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To determine the clinical and demographic factors associated with disease remission and drug survival in patients with ankylosing spondylitis (AS) on TNF inhibitors. METHODS Data from a longitudinal electronic database of AS patients under anti-TNF therapy between June/2004 and August/2013. Demographic, clinical parameters, disease activity by ASDAS remission (< 1.3) and inactive/low (< 2.1) were analyzed to characterize reasons for drug survival and switching of anti-TNF. RESULTS Among 117 AS patients, 69 (59%) were prescribed only one anti-TNF, 48 (41%) switched to a second anti-TNF and 13 (11%) to a third anti-TNF. Considering ASDAS-CRP < 1.3, 31 (39%) patients were inactive at the end of the study. Non-switchers (P = 0.04), younger age (P = 0.004), non-smoking (P = 0.016), shorter disease duration (P = 0.047), more frequent use of SSZ (P = 0.037) and lower BASDAI (P = 0.027), BASMI (P = 0.034) and BASFI (P = 0.003) at baseline were associated with remission. In the multivariate analysis younger age (P = 0.016) and lower BASDAI (P = 0.032) remained as remission predictors. CONCLUSION This study supports that ASDAS-CRP remission is an achievable goal not only for non-switchers but also for second anti-TNF, particularly in patients with younger age and lower BASDAI at baseline. Co-medication and non-smoker status seems to have a beneficial effect in anti-TNF response in this population.
Collapse
Affiliation(s)
- Andrea Y Shimabuco
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Celio R Gonçalves
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Julio C B Moraes
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Mariana G Waisberg
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Ana Cristina de M Ribeiro
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Percival D Sampaio-Barros
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Claudia Goldenstein-Schainberg
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Eloisa Bonfa
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil
| | - Carla G S Saad
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil.
| |
Collapse
|
20
|
Sari I, Haroon N. Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification. Curr Rheumatol Rep 2018; 20:82. [DOI: 10.1007/s11926-018-0795-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
21
|
|
22
|
Actualisation 2018 des recommandations de la Société française de rhumatologie (SFR) pour la prise en charge en pratique courante des malades atteints de spondyloarthrite. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rhum.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
23
|
Smoking quantity determines disease activity and function in Chinese patients with ankylosing spondylitis. Clin Rheumatol 2018; 37:1605-1616. [PMID: 29589132 DOI: 10.1007/s10067-018-4016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/21/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022]
Abstract
The objective of this study was to systemically and comprehensively evaluate the associations between smoking and disease outcomes in patients with ankylosing spondylitis (AS). Information on smoking, clinical features, and sociodemographic characteristics was collected by a questionnaire administered directly to the patient. Group differences were analyzed by t test or chi-square test. Logistic regression analysis was conducted with the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), C-reactive protein, and erythrocyte sedimentation rate as the dependent variables and different stratification of smoking duration, smoking intensity, and cumulative smoking as independent variables. In order to compare our results with previous studies, meta-analysis was performed to calculate standardized mean difference (SMD) for relationship between outcomes and smoking status. A total of 1178 AS patients were analyzed. Compared with non-smokers, the risk of having active disease (BASDAI ≥ 4) was higher in patients who smoked at least 15 years, or 15 cigarettes per day, or 15 pack-years (OR = 1.70 [1.06, 2.73], 1.75 [1.08, 2.82], and 1.97 [1.06, 3.67], respectively); and smokers had increasing risk of BASDAI ≥ 4 with increasing years of smoking, or cigarettes per day, or pack-years (p-trend = 0.010, 0.008 and 0.006, respectively). The risk of having active disease was higher in patients who smoked at least 15 cigarettes per day or 15 pack-years (OR = 1.74 [1.06, 2.84] and 2.89 [1.56, 5.35], respectively), with increasing number of cigarettes per day and pack-years. Smokers had an increased risk of BASFI ≥ 4 (p-trend = 0.040 and 0.007, respectively). By meta-analysis, current, former and ever smokers had significantly higher BASDAI (SMD = 0.34 [0.18, 0.48], 0.10 [0.01, 0.19], and 0.27 [0.20, 0.34], respectively) and BASFI (SMD = 0.35 [0.16, 0.55], 0.30 [0.22, 0.39], and 0.35 [0.21, 0.50], respectively) compared to non-smokers. Smoking is a risk factor for greater disease activity and worse functioning in AS patients.
Collapse
|
24
|
Wendling D, Lukas C, Prati C, Claudepierre P, Gossec L, Goupille P, Hudry C, Miceli-Richard C, Molto A, Pham T, Saraux A, Dougados M. 2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis. Joint Bone Spine 2018; 85:275-284. [PMID: 29407043 DOI: 10.1016/j.jbspin.2018.01.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update French Society for Rheumatology recommendations about the management in clinical practice of patients with spondyloarthritis (SpA). SpA is considered across the range of clinical phenotypes (axial, peripheral, and entheseal) and concomitant manifestations. Psoriatic arthritis is included among the SpA phenotypes. METHODS According to the standard procedure advocated by the EULAR for developing recommendations, we first reviewed the literature published since the previous version of the recommendations issued in June 2013. A task force used the results to develop practice guidelines, which were then revised and graded using AGREE II. RESULTS Four general principles and 15 recommendations were developed. The first four recommendations deal with treatment goals and general considerations (assessment tools and comorbidities). Recommendations 5 and 6 are on non-pharmacological treatments. Recommendation 7 is about nonsteroidal anti-inflammatory drugs, which are the cornerstone of the treatment, and recommendations 8 to 10 are on analgesics, glucocorticoid therapy, and conventional disease-modifying antirheumatic drugs. Biologics are the focus of recommendations 11 through 14, which deal with newly introduced drug classes, including their indications (active disease despite conventional therapy and, for nonradiographic axial SpA, objective evidence of inflammation) and monitoring, and with patient management in the event of treatment failure or disease remission. Finally, recommendation 15 is about surgical treatments. CONCLUSION This update incorporates recent data into a smaller number of more simply formulated recommendations, with the goal of facilitating their use for guiding the management of patients with SpA.
Collapse
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4266, université Bourgogne Franche-Comté, place Goudimel, 25030 Besançon, France.
| | - Cédric Lukas
- EA2415, département de rhumatologie, institut universitaire de recherche clinique, université de Montpellier, CHU de Lapeyronie, 34000 Montpellier, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4267, FHU Increase, université Bourgogne Franche-Comté, 25030 Besançon, France
| | - Pascal Claudepierre
- Service de rhumatologie, groupe hospitalier Henri-Mondor, AP-HP, Créteil, 94000, France; EA 7379-épiderme, université Paris Est Créteil, Créteil, 94000, France
| | - Laure Gossec
- UPMC universié Paris 06, Sorbonne universités, institut Pierre-Louis d'épidémiologie et de santé publique (UMRS 1136), 75252 Paris, France; Rheumatology department, hôpital Pitié Salpêtrière, AP-HP, 75013 Paris, France
| | - Philippe Goupille
- Service de rhumatologie, CHRU de Tours, 37000 Tours, France; UMR CNRS 7292, université François-Rabelais, 37000 Tours, France
| | - Christophe Hudry
- Cabinet de rhumatologie, 75008 Paris, France; Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France
| | - Corinne Miceli-Richard
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France
| | - Anna Molto
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France; INSERM (UU1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris 14, France
| | - Thao Pham
- Service de rhumatologie, hôpital Sainte-Marguerite, Aix-Marseille université, AP-HM, 13000 Marseille, France
| | - Alain Saraux
- Service de rhumatologie, CHU de Brest, 29609 Brest cedex, France; UMR1227, université de Bretagne Occidentale, labex IGO, Brest, 29000 France
| | - Maxime Dougados
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France; INSERM (UU1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris 14, France
| |
Collapse
|