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Crowson CS, Gunderson TM, Davis JM, Myasoedova E, Kronzer VL, Coffey CM, Atkinson EJ. Using Unsupervised Machine Learning Methods to Cluster Comorbidities in a Population-Based Cohort of Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:210-219. [PMID: 35724274 PMCID: PMC9763549 DOI: 10.1002/acr.24973] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To identify clusters of comorbidities in patients with rheumatoid arthritis (RA) using 4 methods and to compare to patients without RA. METHODS In this retrospective, population-based study, residents of 8 Minnesota counties with prevalent RA as of January 1, 2015 were identified. Age-, sex-, and county-matched non-RA comparators were selected from the same underlying population. Diagnostic codes were retrieved for 5 years before January 1, 2015. Using 2 codes ≥30 days apart, 44 previously defined morbidities and 11 nonoverlapping chronic disease categories based on Clinical Classifications Software were defined. Unsupervised machine learning methods of interest included hierarchical clustering, factor analysis, K-means clustering, and network analysis. RESULTS Two groups of 1,643 patients with and without RA (72% female; mean age 63.1 years in both groups) were studied. Clustering of comorbidities revealed strong associations among mental/behavioral comorbidities and among cardiovascular risk factors and diseases. The clusters were associated with age and sex. Differences between the 4 clustering methods were driven by comorbidities that are rare and those that were weakly associated with other comorbidities. Common comorbidities tended to group together consistently across approaches. The instability of clusters when using different random seeds or bootstrap sampling impugns the usefulness and reliability of these methods. Clusters of common comorbidities between RA and non-RA cohorts were similar. CONCLUSION Despite the higher comorbidity burden in patients with RA compared to the general population, clustering comorbidities did not identify substantial differences in comorbidity patterns between the RA and non-RA cohorts. The instability of clustering methods suggests caution when interpreting clustering using 1 method.
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Ishigami T, Nanki T, Sugawara T, Uchida K, Takeda H, Sawasaki T, Chen L, Doi H, Arakawa K, Saigo S, Yoshimi R, Taguri M, Kimura K, Hibi K, Wakui H, Azushima K, Tamura K. Rationale and Design of the Orencia Atherosclerosis and Rheumatoid Arthritis Study (ORACLE Arthritis Study): Implications of Biologics against Rheumatoid Arthritis and the Vascular Complications, Subclinical Atherosclerosis. Methods Protoc 2021; 4:mps4040083. [PMID: 34842780 PMCID: PMC8628894 DOI: 10.3390/mps4040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
To explore the biological and immunological basis of human rheumatoid arthritis and human atherosclerosis, we planned and reported a detailed design and rationale for Orencia Atherosclerosis and Rheumatoid Arthritis Study (ORACLE Arthritis Study) using highly sensitive, high-throughput, human autoantibody measurement methods with cell-free protein synthesis technologies. Our previous study revealed that subjects with atherosclerosis had various autoantibodies in their sera, and the titers of anti-Th2 cytokine antibodies were correlated with the severity of atherosclerosis. Because rheumatoid arthritis is a representative autoimmune disease, we hypothesized that both rheumatoid arthritis and atherosclerosis are commonly developed by autoantibody-mediated autoimmune processes, leading to incessant inflammatory changes in both articular joint tissues and vessel walls. We planned a detailed examination involving carotid artery ultrasonography, measurements of adhesion molecules, such as ICAM-1 (intercellular adhesion molecule 1) and VCAM-1 (vascular cell adhesion molecule 1) for the evaluation of atherosclerosis progression, and high-throughput, high-sensitivity, autoantibody analyses using cell-free technologies, with detailed examinations of the disease activity of rheumatoid arthritis. Analyses of correlations and associations between biological markers and degrees of carotid atherosclerosis over time under consistent conditions may enable us to understand the biological and humoral immunity background of human atherosclerosis and autoimmune diseases.
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Affiliation(s)
- Tomoaki Ishigami
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
- Correspondence: or ; Tel.: +81-45-787-2635 (ext. 6312)
| | - Toshihiro Nanki
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan;
| | - Takuya Sugawara
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Kotaro Uchida
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Hiroyuki Takeda
- Proteo-Science Center, Ehime University, Matsuyama 790-8577, Japan; (H.T.); (T.S.)
| | - Tatsuya Sawasaki
- Proteo-Science Center, Ehime University, Matsuyama 790-8577, Japan; (H.T.); (T.S.)
| | - Lin Chen
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Long Mian Avenue 109 Jiangning, Nanjing 210011, China;
| | - Hiroshi Doi
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Kentaro Arakawa
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Sae Saigo
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Ryusuke Yoshimi
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Masataka Taguri
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Kazuo Kimura
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Kiyoshi Hibi
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Hiromichi Wakui
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Kengo Azushima
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
| | - Kouichi Tamura
- Department of Medical Science and Cardio-Renal Medicine, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan; (T.S.); (K.U.); (H.D.); (K.A.); (S.S.); (R.Y.); (M.T.); (K.K.); (K.H.); (H.W.); (K.A.); (K.T.)
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Alisik T, Alisik M, Nacir B, Ayhan FF, Genc H, Erel O. Evaluation of dysfunctional high-density lipoprotein levels with myeloperoxidase/paraoxonase-1 ratio in rheumatoid arthritis. Int J Clin Pract 2021; 75:e14172. [PMID: 33756027 DOI: 10.1111/ijcp.14172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate dysfunctional high-density lipoprotein cholesterol (HDL) by measuring myeloperoxidase (MPO)/paraoxonase 1 (PON1) ratio in patients with rheumatoid arthritis (RA) and to investigate the relationship between dysfunctional HDL and cardiovascular disease (CVD) in RA patients. METHODS Sixty-seven healthy individuals and 130 RA patients were included in the study. Routine lipid panels (triglyceride (TG), low-density lipoprotein cholesterol (LDL), HDL, total cholesterol (TC), PON1 and MPO levels were measured. Disease activity scores-28 (DAS28) of RA patients were calculated. Cardiological examination records of the patients were assessed to detect patients who also have CVD. RESULTS There were no significant differences between RA and control groups in routine lipid profiles (P > .05 for all). MPO/PON1 ratios were significantly elevated in the RA group compared with the control group (P < .001). MPO/PON1 ratios were higher in RA patients with CVD history compared with those without CVD (P < .05). MPO/PON1 ratios were correlated with DAS28 scores (rho: 0.357, P < .001). CONCLUSION HDL dysfunction determined by the MPO/PON1 ratio may be associated with the pathophysiology of increased CVD in RA. Thus, evaluating dysfunctional HDL levels by measuring the MPO/PON1 ratio in RA patients may allow more detailed patient follow-up, as well as the reduction of CVD events in RA patients with therapeutic agents aiming to increase the functional properties of HDL by decreasing this ratio.
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Affiliation(s)
- Tugba Alisik
- Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Murat Alisik
- Medical Biochemistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Baris Nacir
- Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | | | - Hakan Genc
- Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ozcan Erel
- Medical Biochemistry, Yildirim Beyazit University, Ankara, Turkey
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Abstract
The term inflammatory joint disease (IJD) encompasses a group of chronic conditions with predominant joint involvement. They share an increased risk of cardiovascular (CV) complications. However, the implication of the sex in the risk of CV disease in IJD has not been specifically addressed. The aim of this work is to assess the influence of sex on the clinical expression of CV manifestations associated to IJD. With this objective, an update of the current knowledge of the sex influence on CV disease in patients with IJD was conducted. A PubMed database search of the most relevant literature on this topic was performed mainly based on studies published in English over the last 10 years. Although most studies on IJD were not specifically designed to address sex differences regarding CV complications, it seems that men with rheumatoid arthritis (RA) are at higher risk of pericarditis, ischemic heart disease, heart failure (HF) with reduced ejection fraction (EF), and CV mortality than women with RA. In contrast, HF with preserved EF and diastolic dysfunction is more frequent in women with RA. Men with ankylosing spondylitis present more frequently disorders of the conduction system and aortic valvulopathy than women. A limited number of studies addressed CV differences according to sex in psoriatic arthritis. Although there are some differences according to sex in the clinical expression of CV complications in patients with IJD, much research is still needed to better identify the implication of sex in the risk of CV disease in these patients.
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Prescribing Trend of Antirheumatic Drugs in Taiwan and Risk of Cardiovascular Disease in Patients with Rheumatoid Arthritis: A Nationwide Cohort Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7987529. [PMID: 30915358 PMCID: PMC6402220 DOI: 10.1155/2019/7987529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 01/31/2023]
Abstract
We aimed to investigate the prescribing trend of antirheumatic drugs and assess the risk of cardiovascular disease in patients with rheumatoid arthritis in Taiwan. This study was a retrospective cohort study, conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 15,366 new rheumatoid arthritis patients from 2003 to 2010. To avoid selection bias, we applied propensity score matching to obtain general patients, as the control group. Cox proportional hazard model was used to evaluate the risk of cardiovascular disease in rheumatoid arthritis patients. The most common prescriptions of rheumatoid arthritis were nonsteroidal anti-inflammatory drugs. After controlling for related variables, rheumatoid arthritis patients had a higher risk of cardiovascular disease than general patients (adjusted hazard ratio [aHR] = 1.31; 95% confidence interval [CI]: 1.23-1.39). Age was the most significantly associated risk factor with the cardiovascular disease. Other observed risk factors for cardiovascular disease included hypertension (aHR = 1.57, 95% CI: 1.48-1.65), diabetes mellitus (aHR = 1.47, 95% CI: 1.38-1.57), and chronic kidney disease (aHR = 1.48, 95% CI: 1.31-1.66). Patients with rheumatoid arthritis indeed had a higher risk of incident cardiovascular diseases. Besides, age, hypertension, diabetes mellitus, and chronic kidney disease were also associated with a higher risk of cardiovascular disease.
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Tiosano S, Yavne Y, Gendelman O, Watad A, Comaneshter D, Shoenfeld Y, Cohen AD, Amital D. Stroke among Rheumatoid Arthritis Patients: Does Age Matter? A Real-Life Study. Neuroepidemiology 2017; 49:99-105. [PMID: 29136635 DOI: 10.1159/000481992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/03/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS Rheumatoid arthritis (RA) is a chronic, debilitating autoimmune disease that affects the joints and it is known to be associated with cardiovascular morbidity. However, the association between RA and stroke among different age groups has not been explored. The objective of our study was to evaluate the association between RA and stroke in different age strata. METHODS Cross-sectional study, utilizing the database of Israel's largest healthcare provider. The proportion of stroke was compared between patients diagnosed with RA and age- and gender-matched controls. The study sample was divided into 2 age groups: young (≤65 years) and elderly (>65 years). Multivariable analysis was performed using logistic regression. RESULTS The study included 11,782 RA patients and 57,973 age- and gender-matched controls. RA patients, primarily young, had more cardiovascular risk factors than controls. Stroke rates were significantly elevated among young RA patients in comparison with controls (3.74 vs. 2.20%, respectively, p < 0.001). In multivariate analysis, RA was found to be independently associated with stroke (OR 1.18, 95% CI 1.09-1.28). CONCLUSION RA is independently associated with stroke, especially among RA patients under 65 years, for whom cardiovascular risk factors were more prominent. Physicians should advise RA patients to manage their risk factors strictly.
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Affiliation(s)
- Shmuel Tiosano
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yarden Yavne
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Gendelman
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Yehuda Shoenfeld
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniela Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ness-Ziona/Beer-Yaakov Mental Health Center, Beer-Yaakov, Israel
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Davis JM, Lin G, Oh JK, Crowson CS, Achenbach SJ, Therneau TM, Matteson EL, Rodeheffer RJ, Gabriel SE. Five-year changes in cardiac structure and function in patients with rheumatoid arthritis compared with the general population. Int J Cardiol 2017; 240:379-385. [PMID: 28427850 DOI: 10.1016/j.ijcard.2017.03.108] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have increased risk of heart failure with preserved ejection fraction. The development and progression of left ventricular dysfunction before onset of clinical heart failure are unknown. The objective of this study was to evaluate longitudinal changes in cardiac structure and function of patients with RA compared with persons in the general population. METHODS A prospective longitudinal study of a population-based cohort of 160 patients with RA and a population-based cohort of 1391 persons without RA (non-RA cohort) was performed. Each participant underwent 2-dimensional, pulsed-wave tissue Doppler echocardiography at baseline and after 4 to 5years of follow-up. Age- and sex-adjusted linear regression models were used to test for differences between the RA and non-RA cohorts in annualized rates of change for echocardiographic parameters. RESULTS Mitral A velocity increased more rapidly among the patients with RA than the non-RA cohort (age- and sex-adjusted parameter estimate, 0.030; P<0.001). Correspondingly, the mean mitral inflow E/A ratio decreased faster in the RA cohort than the non-RA cohort (adjusted parameter estimate, -0.096; P<0.001). The left atrial volume index increased at a higher rate in the RA cohort than the non-RA cohort (adjusted parameter estimate, 0.150; P<0.001). CONCLUSIONS This pattern of echocardiographic findings confirms previous cross-sectional studies and indicates that subclinical changes in diastolic function occur more rapidly over 5years in RA patients than in the general population. Further research into the mechanisms of myocardial disease in these patients and the relationship with disease activity and treatment is warranted.
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Affiliation(s)
- John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States.
| | - Grace Lin
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Terry M Therneau
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
| | | | - Sherine E Gabriel
- Division of Epidemiology, Mayo Clinic, Rochester, MN, United States; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Leite JSM, Cruzat VF, Krause M, Homem de Bittencourt PI. Physiological regulation of the heat shock response by glutamine: implications for chronic low-grade inflammatory diseases in age-related conditions. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s41110-016-0021-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ursini F, Russo E, D'Angelo S, Arturi F, Hribal ML, D'Antona L, Bruno C, Tripepi G, Naty S, De Sarro G, Olivieri I, Grembiale RD. Prevalence of Undiagnosed Diabetes in Rheumatoid Arthritis: an OGTT Study. Medicine (Baltimore) 2016; 95:e2552. [PMID: 26886599 PMCID: PMC4998599 DOI: 10.1097/md.0000000000002552] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by an excess of cardiovascular disease (CVD) risk, estimated to be at least 50% greater when compared to the general population. Although the widespread diffusion of type 2 diabetes mellitus (T2DM) awareness, there is still a significant proportion of patients with T2DM that remain undiagnosed. Aim of this cross-sectional study was to evaluate the prevalence of undiagnosed diabetes and prediabetes in RA patients. For the present study, 100 consecutive nondiabetic RA patients were recruited. Age- and sex-matched subjects with noninflammatory diseases (osteoarthritis or fibromyalgia) were used as controls. After overnight fasting, blood samples were obtained for laboratory evaluation including serum glucose, total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, uric acid, erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hs-CRP), rheumatoid factor (RF), and anti-Cyclic Citrullinated Peptide Antibodies (ACPA). A standard Oral Glucose Tolerance Test (OGTT) with 75 g of glucose was performed and blood samples were collected at time 0, 30, 60, 90, and 120 minutes, for measurement of plasma glucose concentrations. The prevalence of impaired fasting glucose (IFG) (9/100 vs 12/100, P = 0.49), impaired glucose tolerance (IGT) (19/100 vs 12/100, P = 0.17), and concomitant IFG/IGT (5/100 vs 9/100, P = 0.27) was similar between groups, whereas the prevalence of diabetes was significantly higher in RA patients (10/100 vs 2/100, P = 0.02). In a logistic regression analysis, increasing age (OR = 1.13, 95% CI 1.028-1.245, P = 0.01) and disease duration (OR = 1.90, 95% CI 1.210-2.995, P = 0.005) were both associated with an increased likelihood of being classified as prediabetes (i.e. IFG and/or IGT) or T2DM. A ROC curve was built to evaluate the predictivity of disease duration on the likelihood of being diagnosed with T2DM. The area under the ROC curve was 0.67 (95% CI: 0.56-0.78, P = 0.004). We identified the best cut-off of 33 months that yielded a sensitivity of 61% and a specificity of 70% for classification of T2DM patients. According to our data, RA seems to be characterized by an elevated prevalence of undiagnosed diabetes, especially in patients with longer disease duration.
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Affiliation(s)
- Francesco Ursini
- From the Department of Health Sciences (FU, ER, FA, MLH, LD, CB, SN, RDG, GDS); University of Catanzaro "Magna Graecia", Catanzaro; Rheumatology Department of Lucania (SD, IO); San Carlo Hospital of Potenza, Potenza; and CNR-IFC (GT), Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio Calabria, Italy
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Mankad R. Atherosclerotic vascular disease in the autoimmune rheumatologic patient. Curr Atheroscler Rep 2015; 17:497. [PMID: 25721102 DOI: 10.1007/s11883-015-0497-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, have a strong association with an increased risk of atherosclerotic cardiovascular diseases (ASCVD), particularly ischemic heart disease (IHD). A majority of the autoimmune conditions occur predominantly in women, and as women continue to experience a higher cardiovascular mortality compared to men, this potential added risk factor must be recognized. Inflammation and immune mechanisms have been shown to be an underlying mechanism for the development of atherosclerosis, thus sharing a common mechanism with rheumatologic conditions. There is an under recognition, in both patient and physician, of the increased cardiovascular (CV) risk within the autoimmune population, with present CV risk profile algorithms performing poorly in these patients. Traditional risk factors play a role in the development of IHD in the autoimmune patient, but their overall significance is unclear and does not fully explain the elevated CV risk. The role of inflammation and risk factors in autoimmune conditions, and their link to the elevated CV risk will be explored within this article.
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Affiliation(s)
- Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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Purcarea A, Sovaila S, Gheorghe A, Udrea G, Stoica V. Cardiovascular disease risk scores in the current practice: which to use in rheumatoid arthritis? J Med Life 2014; 7:461-7. [PMID: 25713603 PMCID: PMC4316119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/29/2014] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is the highest prevalence disease in the general population (GP) and it accounts for 20 million deaths worldwide each year. Its prevalence is even higher in rheumatoid arthritis. Early detection of subclinical disease is critical and the use of cardiovascular risk prediction models and calculators is widely spread. The impact of such techniques in the GP was previously studied. Despite their common background and similarities, some disagreement exists between most scores and their importance in special high-risk populations like rheumatoid arthritis (RA), having a low level of evidence. The current article aims to single out those predictive models (models) that could be most useful in the care of rheumatoid arthritis patients.
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Affiliation(s)
- A Purcarea
- Strasbourg Medical University; Internal Medicine Department, Civil Hospital, Strasbourg, France
| | - S Sovaila
- Internal Medicine Department, Civil Hospital, Strasbourg, France
| | - A Gheorghe
- Internal Medicine Department, Hospital Geomed-Klinik, Gerolzhofen, Germany
| | - G Udrea
- "Carol Davila" University of Medicine and Pharmacy; Internal Medicine and Rheumatology Department,"Cantacuzino" Hospital, Bucharest, Romania
| | - V Stoica
- "Carol Davila" University of Medicine and Pharmacy; Internal Medicine and Rheumatology Department,"Cantacuzino" Hospital, Bucharest, Romania
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Soubrier M, Chamoux NB, Tatar Z, Couderc M, Dubost JJ, Mathieu S. Cardiovascular risk in rheumatoid arthritis. Joint Bone Spine 2014; 81:298-302. [DOI: 10.1016/j.jbspin.2014.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
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Abstract
Rheumatic diseases are associated with an increased risk of cardiovascular (CV) mortality attributed to a higher incidence of heart failure (HF) and ischemic heart disease. Although traditional CV risk factors contribute to the increased incidence seen in this population, by themselves they do not account for the increased risk; in fact, obesity and hyperlipidemia may play a paradoxic role. Immune-mediated mechanisms and chronic inflammation likely play a role in the pathogenesis of CV disease in patients with rheumatic diseases. The usual clinical features of ischemic heart disease and HF are less likely to be seen in this patient population.
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Affiliation(s)
- Kerry Wright
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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