Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: evaluation of 165 patients

Disease profile of rheumatoid arthritis and its complications in hispanic population

BACKGROUND

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that is associated with functional disability and reduced quality of life. The central pathology of RA is the inflammation of diarthrodial joints, but approximately 40% of patients experience extra-articular manifestations of RA. Extra-articular manifestations are complications of RA that constitute multisystem disorders, associated with genetic and environmental conditions, and increase mortality in RA patients. Observational studies of RA patients have suggested ethnic disparities exist for minority populations; however, less is known about the distribution and prevalence of RA complications and drug-related problems (DRPs). Our objective was to construct a disease profile of RA-related complications in the Hispanic Mexican-American population compared to the non-Hispanic population of El Paso, Texas.

METHODS

A retrospective study was conducted in a Texas Tech University Health Science Center El Paso from 2009 to 2019 to assess the prevalence of RA-related complications in the Hispanic vs non-Hispanic population. The primary parameters were RA diagnosis, serological status, RA-treatment modalities, and history of associated complications. Data were extracted by chart review and correlated to disease-related and treatment-related complications. STATA was used to perform statistical analyses. A p-value of < 0.05 determined statistical significance.

RESULTS

One thousand five hundred five (N=1505) patients, diagnosed with RA, were included in this study. Of the cohort, 82.52% of patients were females, 76.81% were Hispanic, and 64.12% had no smoking history. From the total cohort, seven hundred fifty-six (N=756) patients had documentation of serological markers (Rheumatoid factor (RF) and/or Anti-cyclic citrullinated peptide (Anti-CCP)); 78.44% of patients whose serological status was documented, were positive for RF and/or Anti-CCP. Multivariate regression analysis revealed Hispanics have 15% and 17% less risk of overall RA complications and drug-related side-effects, respectively, compared to non-Hispanics (p-value <0.0001). However, within the entire cohort, those with a family history of RA had a 44% more risk of complications compared to those without family history (p-value <0.0001). Additionally, modifiable risk factors, i.e., active smoking and alcohol use had a higher complication risk, 19% and 21%, respectively (p-value <0.0001). Significantly, all patients seropositive for RF, and/or anti-CCP had a lower prevalence of RA-related and drug-related complications. However, non-Hispanic patients seropositive for RF or anti-CCP had a higher prevalence of specific complications of RA and DRPs compared to Hispanic patients.

CONCLUSION

In our retrospective review, analysis of sociodemographic characteristics reveals that Hispanic patients paradoxically have less risk of disease-related and treatment-related complications compared to non-Hispanic populations in El Paso, Texas. Genetic predisposition, modifiable environment/lifestyle factors had a higher prevalence of RA complications, congruent with established studies. Further analysis reveals that seropositive RA-patients have decreased complication prevalence compared to seronegative cohorts.

Incidence and Reappraisal of Known Risk Factors Associated with Carpal Tunnel Syndrome: A Nationwide, 11-Year, Population-Based Study in South Korea

Background and Purpose

Previous studies have revealed various risk factors for carpal tunnel syndrome (CTS), but few large-scale studies have been conducted. We used data from the 11-year, longitudinal, nationwide population-based National Health Insurance Service–National Health Screening cohort to identify the actual risk factors for CTS.

Methods

We collected patients with CTS newly diagnosed using electrodiagnostic studies while excluding radiculopathy, plexopathy, or polyneuropathy, which can be confused with CTS. The crude and standardized incidence rates of CTS were calculated. Univariate and multivariate Cox analyses and the incidence of CTS were used to identify the risk factors for newly diagnosed CTS.

Results

The standardized incidence was 130.8/100,000 person-years based on the World Health Organization World Standard Population as a reference. Multivariate Cox analysis identified that the risk factors for CTS were being middle-aged, female, and obese, and having rheumatoid arthritis and Raynaud's syndrome, whereas gout and hypothyroidism were not risk factors. Diabetes and end-stage renal disease did not show a significant hazard ratio, although it is implicit that the durations of these diseases affect the development of CTS.

Conclusions

This study calculated the incidence of CTS and reappraised the associated risk factors found in previous studies. This information will be helpful for determining the pathophysiology of CTS, and hence aid the establishment of effective new public health policies.

Handheld dermatoscopy as an easy-to-use capillaroscopic instrument in rheumatoid arthritis: a cross-sectional study

Background/aim

Nailfold video capillaroscopy is considered as a reliable method for evaluating peripheral microangiopathy in rheumatologic diseases. In this study, we aimed to demonstrate the utility of handheld dermatoscopy as an easy-to-use nailfold capillaroscopic instrument in patients with rheumatoid arthritis.

Materials and methods

This cross-sectional study included patients with rheumatoid arthritis and healthy subjects. A handheld dermatoscopic examination of proximal nail fold was performed in each subject. The possible correlation of capillaroscopic findings with disease activity was evaluated using the disease activity score 28 (DAS28).

Results

A total of 59 patients with rheumatoid arthritis and 60 healthy subjects were enrolled in the study. The presence of capillaryenlargement, avascular areas, capillary deformities, and capillary vascular anomalies in the group of patients showed a statistically significant difference when compared with the healthy subjects. No correlation was found between the nail fold capillaroscopic findings and DAS28 score.

Conclusion

Hand-held dermatoscopy seems to be a useful technique in the evaluation of nail fold capillary changes. We suggest that in patients with rheumatoid arthritis, when capillaroscopic examination is needed, it can be evaluated using handheld dermatoscopy. Selected patients who showed findings using this method can be further examined with classical capillaroscopy to obtain more quantitative data.

Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis

Objective.

Rheumatoid arthritis (RA) and other rheumatic diseases may present with ocular manifestations.

The purpose of our work was to determine the prevalence and type of eye involvement in RA and other connective tissue diseases through a metaanalysis and literature review.

Methods.

A systematic review of the literature was performed using Medline, Web of Science, and the Cochrane Library from their inceptions until January 7, 2019. Conjunctivitis, keratoconjunctivitis sicca, xeropthalmia, uveitis, eye hemorrhage, optic neuritis, papilledema, orbital disease, retinal artery/vein occlusion, macular edema, retinitis, chorioretinitis, scleritis, iridocyclitits, choroid hemorrhage, blindness, and amaurosis fugax were searched for prevalence in patients with RA, systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), dermatomyositis, polymyositis, systemic sclerosis, Sjögren syndrome (SS), undifferentiated connective tissue disease, giant cell arteritis, granulomatosis polyangiitis (GPA; formerly Wegener granulomatosis), systemic vasculitis, and sarcoidosis.

Results.

There were 3394 studies identified and 65 included. The prevalence of eye involvement was 18% in RA, 26% in GPA, 27% in giant cell arteritis, 27% in sarcoidosis, 31% in SLE, and 35% in APS. The most common manifestation was dry eye syndrome (“dry eye”; keratoconjunctivitis sicca) in most diseases analyzed, with an especially high frequency of 89% in SS. Anterior and posterior uveitis were the most common ocular complications in sarcoidosis, occurring in 16% (95% CI 3–28) and 6% (95% CI 3–9) of patients, respectively.

Conclusion.

Eye involvement is present in approximately one-fifth of patients with RA, and a one-quarter to one-third of patients with connective tissue diseases (other than SS at 89%) and vasculitis.

Neutropenia in the Elderly: A Rheumatology Perspective

The majority of rheumatic diseases are chronic and require long-term use of disease-modifying agents to confer the best chance of controlling the disease. A significant proportion of these drugs have a risk, albeit small, of potentially serious side effects, such as neutropenia; therefore, there has been an understandable concern over the use of potentially toxic rheumatic drugs in the elderly. Factors that may contribute to this concern include age, pre-existing co-morbidities, polypharmacy, difficulty in monitoring side effects, and patient perception. The risk of using such medication needs to be balanced with their benefits in controlling chronic disease. This review discusses how rheumatic disease and anti-rheumatic medication are associated with neutropenia in an older age group. Of the rheumatic diseases, we give special focus to rheumatoid arthritis and the use of methotrexate, as well as touching on management considerations in neutropenia.

Factors Associated with Erosive Arthritis in Rheumatoid Arthritis and Other Connective Tissue Diseases: A Retrospective Study From a Southern Chinese Population

OBJECTIVE

To investigate the clinical predictors of erosive arthritis (EA) in patients with rheumatoid arthritis (RA) and other connective tissue diseases.

METHODS

Four hundred and one consecutive patients with newly diagnosed RA between January 2010 and January 2013 were enrolled in the study. During the study period, 729 consecutive patients with non-RA connective tissue diseases were also included, and a cross-sectional study was performed. Medical records were reviewed. Only those patients with data for 2 years were considered in the analysis (338).

RESULTS

Erosive arthritis was noted in 60.4% (204 /338) of patients with RA and occurred early in RA. The multivariate logistic regression analysis indicated that rheumatoid nodules, anemia, and positive anticyclic citrullinated peptide antibody (ACPA) were strongly associated factors for the occurrence of EA in RA patients. Erosive arthritis was also noted in 1.5% of patients with SLE, 5.8% of patients with primary Sjögren syndrome, and 9.1% (3/33) of patients with systemic sclerosis. When compared with patients without EA, high level and prominently higher positive rate of ACPA was found in these patients with EA. On receiver operating characteristic curve analysis, ACPA exhibited a maximum sensitivity with a cutoff value of 1.6 U/mL and 0.6 U/mL for RA and SLE patients, respectively.

CONCLUSION

Erosive arthritis had a high prevalence in Chinese RA patients and occurred early. Anemia, rheumatoid nodules, and ACPA were associated with EA in RA. Erosive arthritis also could be detected in SLE, primary Sjögren syndrome, and systemic sclerosis. Anticyclic citrullinated peptide antibodies were also associated with EA in these diseases. Intensive monitoring for erosions was recommended for RA patients with a cutoff of ACPA greater than 1.6 U/mL and greater than 0.6 U/mL for SLE patients.

Felty's Syndrome, Insights and Updates

Felty’s syndrome (FS) is characterized by the triad of seropositive rheumatoid arthritis (RA) with destructive joint involvement, splenomegaly and neutropenia. Current data shows that 1-3 % of RA patients are complicated with FS with an estimated prevalence of 10 per 100,000 populations. The complete triad is not an absolute requirement, but persistent neutropenia with an absolute neutrophil count (ANC) generally less than 1500/mm3 is necessary for establishing the diagnosis. Felty’s syndrome may be asymptomatic but serious local or systemic infections may be the first clue to the diagnosis. FS is easily overlooked by parallel diagnoses of Sjӧgren syndrome or systemic lupus erythematosus or lymphohematopoietic malignancies. The role of genetic (HLA DR4) is more prominent in FS in comparison to classic rheumatoid arthritis. There is large body of evidence that in FS patients, both cellular and humoral immune systems participate in neutrophil activation, and apoptosis and its adherence to endothelial cells in the spleen. It has been demonstrated that proinflammatory cytokines may have inhibitory effects on bone marrow granulopoiesis. Binding of IgGs to neutrophil extracellular chromatin traps (NET) leading to neutrophil death plays a crucial role in its pathophysiology. In turn, "Netting" neutrophils may activate auto-reactive B cells leading to further antibody and immune complex formation. In this review we discuss on basic pathophysiology, epidemiology, genetics, clinical, laboratory and treatment updates of Felty’s syndrome.

[Demographic and clinical features of patients with rheumatoid arthritis in Piauí, Brazil--evaluation of 98 patients]

INTRODUCTION

Brazilian epidemiological studies on rheumatoid arthritis are scarce, mainly in the northeast; thus many data currently available originate from the international literature.

OBJECTIVES

To describe demographic, clinical and serological characteristics of patients with rheumatoid arthritis (RA) followed-up by the same physician, in state of Piauí, Brazil.

PATIENTS AND METHODS

Data were collected between August 2010 and March 2013, in three health services of Piauí that provided health care in Rheumatology: a university-affiliated hospital, a public outpatient clinic and a private clinic.

RESULTS

The numbers represent mean ± SD or percentage: 47.5±11.03 years-old non-Caucasian woman, non-smoker (59.2%), low educational level, mean disease duration of 7.7 years ± 7.6, and major extra-articular manifestations were rheumatoid nodules (19.4%) and sicca syndrome (46.9%).

CONCLUSION

Features of rheumatoid arthritis obtained in this study are similar to those found in some national and international studies, but we observed higher female preponderance and illiteracy rate, in addition to a moderately severe erosive disease on average, with frequent sicca and other extra-articular manifestations.

Prevalence of chronic diseases at the onset of inflammatory arthritis: a population-based study

OBJECTIVE

Little is known about the presence of chronic morbidity in inflammatory arthritis (IA) patients at disease onset. Previous studies have been mainly performed in established IA patients or they focus on isolated co-morbid diseases. Our aim was to determine the prevalence of chronic diseases at the onset of IA and to determine whether this is different from the number that one might expect based on age and sex. Patients and methods. A nested case-control study from 2001 to 2010 using data from patient electronic medical records in general practice. Totally, 3354 patients with newly diagnosed IA were included. Each patient was matched on age, sex and general practice with two control patients. In total, 121 different chronic diseases were studied.

RESULTS

In total, 70% of the IA patients had at least one chronic disease at the onset of IA, compared with 59% of the control patients (P < 0.001). The highest prevalence in IA patients was found for cardiovascular diseases (35%), musculoskeletal diseases (27%) and neurological diseases (22%). Compared with the control patients, patients with IA had the highest increased risk for musculoskeletal diseases [odds ratio, OR = 1.7 (95% confidence interval: 1.6-19)] and for neurological diseases [OR = 1.6 (1.4-1.7)] at the onset of IA.

CONCLUSION

At the onset of IA, nearly three-quarters of patients with IA had at least one other chronic disease. Since multi-morbidity affects treatment and outcome of the IA patient, these diseases should be taken into account when treating IA patients.

The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study

INTRODUCTION

With the development of country-specific FRAX® tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended.

OBJECTIVES

The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact.

PATIENTS AND METHODS

Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50 years or more.

RESULTS

Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0 % at the age of 50 years to 31 % at the age of 90 years. Approximately 8.6 % of the female Turkish population aged 50 years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6 % without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50 years or more eligible for treatment was 3.1 %.

CONCLUSIONS

FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment.