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Jiang Z, Chen L, Liu A, Qi J, Wang J, Li Y, Jiang H, Zhang J, Huang S, Mao C, Ying Z. Rheumatoid arthritis and the risk of chronic kidney diseases: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1360026. [PMID: 38818388 PMCID: PMC11137270 DOI: 10.3389/fmed.2024.1360026] [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: 12/22/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
Background The extra-articular lesions of rheumatoid arthritis (RA) are reported to involve multiple organs and systems throughout the body, including the heart, kidneys, liver, and lungs. This study assessed the potential causal relationship between RA and the risk of chronic kidney diseases (CKDs) using the Mendelian randomization (MR) analysis. Method Independent genetic instruments related to RA and CKD or CKD subtypes at the genome-wide significant level were chosen from the publicly shared summary-level data of genome-wide association studies (GWAS). Then, we obtained some single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs), which are associated with RA in individuals of European origin, and had genome-wide statistical significance (p5 × 10-8). The inverse-variance weighted (IVW) method was the main analysis method in MR analysis. The other methods, such as weighted median, MR-Egger, simple mode, and weighted mode were used as supplementary sensitivity analyses. Furthermore, the levels of pleiotropy and heterogeneity were assessed using Cochran's Q test and leave-one-out analysis. Furthermore, the relevant datasets were obtained from the Open GWAS database. Results Using the IVW method, the main method in MR analysis, the results showed that genetically determined RA was associated with higher risks of CKD [odds ratio (OR): 1.22, 95% confidence interval (CI) 1.13-1.31; p < 0.001], glomerulonephritis (OR: 1.23, 95% CI 1.15-1.31; p < 0.000), amyloidosis (OR = 1.43, 95% CI 1.10-1.88, p < 0.001), and renal failure (OR = 1.18, 95% CI 1.00-1.38, p < 0.001). Then, using multiple MR methods, it was confirmed that the associations persisted in sensitivity analyses, and no pleiotropy was detected. Conclusion The findings revealed a causal relationship between RA and CKD, including glomerulonephritis, amyloidosis, and renal failure. Therefore, RA patients should pay more attention to monitoring their kidney function, thus providing the opportunity for earlier intervention and lower the risk of progression to CKDs.
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Affiliation(s)
- Zhaoyu Jiang
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Lin Chen
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Aihui Liu
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Jiaping Qi
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Jing Wang
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Yixuan Li
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Huan Jiang
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Ju Zhang
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Shan Huang
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Chengliang Mao
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Zhenhua Ying
- Zhejiang Province People’s Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Department of Rheumatology and Immunology of Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, China
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Tang Y, Varavko Y, Aringazina R, Menshikova I. Changes in renal function and morphological variations of kidney diseases in rheumatoid arthritis patients. Asian J Urol 2024; 11:304-310. [PMID: 38680581 PMCID: PMC11053339 DOI: 10.1016/j.ajur.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Rheumatoid nephropathy is one of the most severe extra-articular manifestations of rheumatoid arthritis (RA) associated with a very unfavorable prognosis. This study aimed to identify changes in renal function and morphological variations of kidney diseases in RA patients. Methods The study enrolled patients (126 patients) between 18 and 55 years of age with a confirmed active RA of more than 12 months. Each patient underwent the following range of laboratory and instrumental research methods: general clinical analysis of blood and urine, performing urinalysis according to Nechiporenko method; determining daily proteinuria; determining the blood content of glucose, urea, creatinine, uric acid, total bilirubin, liver transaminase level, ionogram, lipidogram, and coagulogram; determining the blood content of rheumatoid factor, anti-streptolysin O, and C-reactive protein; and X-ray of the joints of hands and feet. Renal function was examined by estimating glomerular filtration rate, tubular reabsorption index, and renal functional reserve. For studying the morphological changes in the kidneys under ultrasound examination, renal biopsy was performed in 31 patients with RA with urinary syndrome (proteinuria more than 0.3 g per day and hematuria). Results Nephropathy in RA is characterized by impaired renal function and manifested by an increased blood creatinine and a decrease in glomerular filtration rate and renal functional reserve. Among morphological variations of nephropathy at RA, mesangial proliferative glomerulonephritis prevails, accounting for 48.4% of patients. Other disorders include the secondary amyloidosis (29.0% of patients), tubulointerstitial nephritis (16.1%), membranous glomerulonephritis (3.2%), and focal-segmental glomerulosclerosis (3.2%). Conclusion Kidney damage is a common systemic manifestation of RA with a long and active course, a major nephropathy trigger.
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Affiliation(s)
- Yan Tang
- College of Medical Technology, Yongzhou Vocational Technical College, Yongzhou, China
| | - Yuliya Varavko
- Department of Internal Diseases Propaedeutics, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Raisa Aringazina
- Department of Internal Diseases No. 1, Non-Commercial Joint-Stock Society “West Kazakhstan Marat Ospanov Medical University”, Aktobe, Kazakhstan
| | - Irina Menshikova
- Department of Hospital Therapy No. 1, I. M. Sechenov First Moscow State Medical University of Ministry of Health of Russian Federation (Sechenov University), Moscow, Russian Federation
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Suh SH, Jung JH, Oh TR, Yang EM, Choi HS, Kim CS, Bae EH, Ma SK, Han KD, Kim SW. Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study. Front Med (Lausanne) 2023; 10:1116489. [PMID: 36817794 PMCID: PMC9932810 DOI: 10.3389/fmed.2023.1116489] [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: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Despite the risk of incident chronic kidney disease among the patients with rheumatoid arthritis (RA), the association of RA and the risk of end-stage renal disease (ESRD) has not been clearly elucidated. We aimed to investigate the association of RA and the risk of ESRD. Materials and methods A total of 929,982 subjects with (n = 154,997) or without (n = 774,985) RA from the National Health Insurance Service (NHIS) database in Koreas (corresponding to the period between 2009 and 2017) were retrospectively analyzed. RA was defined by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), codes plus any dispensing of disease-modifying anti-rheumatic drugs. The primary outcome was incident ESRD, identified by a combination of the ICD-10-CM codes and a special code assigned to patients receiving maintenance dialysis for ≥ 3 months or those with a transplant kidney. Results Compared to the subjects without RA, the subjects with RA resulted in an increased incidence of ESRD (incidence rates of 0.374 versus 0.810 cases per 1,000 person-years). Accordingly, compared to the subjects without RA, the risk of ESRD was significantly increased among the subjects with RA (adjusted hazard ratio 2.095, 95% confidence interval 1.902-2.308). Subgroup analyses revealed that the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals. Conclusion Rheumatoid arthritis (RA) increase the risk of ESRD. As the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals, kidney-protective treatment, such as biologic agents, should be preferentially considered among these patients with RA.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin Hyung Jung
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea,*Correspondence: Kyung-Do Han,
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea,Soo Wan Kim,
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McLoone P, Jani BD, Siebert S, Morton FR, Canning J, Macdonald S, Mair FS, Nicholl BI. Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565221148616. [PMID: 36798088 PMCID: PMC9926377 DOI: 10.1177/26335565221148616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE We aimed to classify individuals with RA and ≥2 additional long-term conditions (LTCs) and describe the association between different LTC classes, number of LTCs and adverse health outcomes. METHODS We used UK Biobank participants who reported RA (n=5,625) and employed latent class analysis (LCA) to create classes of LTC combinations for those with ≥2 additional LTCs. Cox-proportional hazard and negative binomial regression were used to compare the risk of all-cause mortality, major adverse cardiac events (MACE), and number of emergency hospitalisations over an 11-year follow-up across the different LTC classes and in those with RA plus one additional LTC. Persons with RA without LTCs were the reference group. Analyses were adjusted for demographic characteristics, smoking, BMI, alcohol consumption and physical activity. RESULTS A total of 2,566 (46%) participants reported ≥2 LTCs in addition to RA. This involved 1,138 distinct LTC combinations of which 86% were reported by ≤2 individuals. LCA identified 5 morbidity-classes. The distinctive condition in the class with the highest mortality was cancer (class 5; HR 2.66 95%CI (1.91-3.70)). The highest MACE (HR 2.95 95%CI (2.11-4.14)) and emergency hospitalisations (rate ratio 3.01 (2.56-3.54)) were observed in class 3 which comprised asthma, COPD & CHD. There was an increase in mortality, MACE and emergency hospital admissions within each class as the number of LTCs increased. CONCLUSIONS The risk of adverse health outcomes in RA varied with different patterns of multimorbidity. The pattern of multimorbidity should be considered in risk assessment and formulating management plans in patients with RA.
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Affiliation(s)
- Philip McLoone
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Fraser R Morton
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Jordan Canning
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
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Amjadi A, Pasdar Y, Rezaeian S, Nachvak M, Ghavamzadeh S, Alizadeh M, Abdollahzad H, Navabi J. The Association Between Dietary Acidity and Clinical Symptoms in Patients With Rheumatoid Arthritis. Clin Nutr Res 2022; 11:277-288. [DOI: 10.7762/cnr.2022.11.4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Arezoo Amjadi
- Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
| | - Shahab Rezaeian
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
| | - Mostafa Nachvak
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
| | - Saeid Ghavamzadeh
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia 5756115111, Iran
- Department of Nutrition, School of Medicine, Urmia University of Medical Sciences, Urmia 5756115111, Iran
| | - Mohammad Alizadeh
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia 5756115111, Iran
- Department of Nutrition, School of Medicine, Urmia University of Medical Sciences, Urmia 5756115111, Iran
| | - Hadi Abdollahzad
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia 5756115111, Iran
- Department of Nutrition, School of Medicine, Urmia University of Medical Sciences, Urmia 5756115111, Iran
| | - Jafar Navabi
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
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Higuchi T, Tanaka E, Inoue E, Abe M, Saka K, Sugano E, Sugitani N, Higuchi Y, Ochiai M, Yamaguchi R, Sugimoto N, Ikari K, Yamanaka H, Harigai M. Impact of Concomitant Chronic Kidney Disease on Hospitalized Infections and Remission in Patients with Rheumatoid Arthritis: Results from the IORRA Cohort. Mod Rheumatol 2021; 32:875-884. [PMID: 34751783 DOI: 10.1093/mr/roab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the impact of concomitant chronic kidney disease (CKD) on unfavourable clinical events and remission in Japanese patients with rheumatoid arthritis (RA). METHODS We included 5,103 patients with RA with CKD from the Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort in 2012. CKD stages were classified into four groups: CKD with normal eGFR ≥60 ml/min/1.73 m2 and proteinuria; mild CKD, eGFR ≥45-<60; moderate CKD, eGFR ≥30-<45; and severe CKD, eGFR <30. We assessed the association between concomitant CKD and the occurrence of unfavourable clinical events or achieving remission during a 5-year observational period. RESULTS Of the 5,103 patients with RA, 686 (86.6%) had CKD. Concomitant CKD was associated with hospitalized infections (adjusted hazard ratio [aHR] 1.52, 95% confidence interval [CI] 1.07-2.13, p=0.02), especially in the moderate to severe CKD group (aHR 1.93, 95% CI 1.12-3.13, p=0.02). Of all subjects, 2,407 (47.2%) had active RA at baseline and 401 (16.7%) had CKD. Concomitant CKD was also associated with failure of achieving remission (aHR 0.82, 95% CI 0.68-0.99, p=0.04). CONCLUSION Concomitant CKD was a risk factor for hospitalized infections in Japanese patients with RA and failure of achieving remission in patients with active RA.
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Affiliation(s)
- Tomoaki Higuchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Mai Abe
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kumiko Saka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eri Sugano
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naohiro Sugitani
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yoko Higuchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Moeko Ochiai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Rei Yamaguchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naoki Sugimoto
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsunori Ikari
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Department of Orthopedic Surgery, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Sanno Medical Center, Tokyo, Japan.,Department of Rheumatology, International University of Health and Welfare, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Yang P, Zhu K, Lin S, Chen Z, Liu M, Liu Q, Lin C, Chu C, Xu Q. Association between neutrophils and renal impairment of rheumatoid arthritis: A retrospective cross-sectional study. Immun Inflamm Dis 2021; 9:1000-1008. [PMID: 34033704 PMCID: PMC8342230 DOI: 10.1002/iid3.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Previous studies have shown that increased neutrophils, as a manifestation of oxidative stress, may be involved in the progression of kidney disease. To our knowledge, little is known about the relationship between neutrophils and renal impairment in rheumatoid arthritis (RA). Therefore, we aim to investigate whether neutrophil is associated with renal impairment in RA patients. METHODS We retrospectively investigated the renal function of 602 RA patients in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine by estimated glomerular filtration rate (eGFR) from September 2018 and September 2019. The exposure variable was neutrophils, and the main outcome was eGFR. General data (gender, age, duration, hypertension, diabetes, hobbies, and medication history), whole blood markers, lipid indexes, and inflammatory indexes were collected as much as possible. We used multivariable logistic regression analysis to evaluate the association between neutrophils and renal impairment in RA participants. RESULTS A total of 89 cases (14.8%) had renal impairment with eGFR < 60 ml/min/1.73 m2 , and 75 cases (84.3%) were female. Subgroup analysis showed that female (odds ratio [OR] = 0.523, 95% confidence interval [CI]: 0.318-0.867, p = .011), neutrophils greater thsn 7.5 × 109 /L (OR = 2.314, 95% CI: 1.310-4.087, p = .004), NLR > 3.53 (OR = 1.757, 95% CI: 1.104-2.799, p = .018), hemoglobin less than 120 g/L (OR = 2.413, 95% CI: 1.418-4.118, p = .001), and UA > 360 μmol/L (OR = 6.052, 95% CI: 3.708-9.878, p < .001) was related to renal damage in RA. Adjusted for several confounders, the multivariable analysis indicated that neutrophils greater than 7.5 × 109 /L (OR = 1.784, 95% CI: 1.164-3.288, p = .031) was independently associated with an increased risk of renal impairment in RA. CONCLUSION Our study demonstrated that neutrophils greater than 7.5 × 109 /L was associated with a high risk of renal impairment in RA, suggesting that neutrophil may be a biomarker for renal impairment in RA.
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Affiliation(s)
- Pei‐Dan Yang
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Medical SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Kai‐Jun Zhu
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Department of RheumatologyZhengzhou Second HospitalZhengzhouChina
| | - Si‐Min Lin
- The First Medical SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Zhi‐Xin Chen
- Chinese Medicine DepartmentSouth China Agricultural University HospitalGuangzhouChina
| | - Min‐Ying Liu
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Medical SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Qing‐Ping Liu
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Medical SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Chang‐Song Lin
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Medical SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Cong‐Qiu Chu
- Division of RheumatologyOregon Health & Science UniversityPortlandOregonUSA
| | - Qiang Xu
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Medical SchoolGuangzhou University of Chinese MedicineGuangzhouChina
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8
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Deng Y, Wang C, Shen Y, Shen B, Ding F, Tang G, Liu W. Prevalence and risk of chronic kidney disease in oral lichen planus: a large cross-sectional study from eastern China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1078. [PMID: 34422990 PMCID: PMC8339811 DOI: 10.21037/atm-21-699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022]
Abstract
Background Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease which is frequently associated with comorbidities such as diabetes and cardiovascular diseases. However, little is known about the association of OLP with impaired kidney function. To elucidate the possible association of chronic kidney disease (CKD) with OLP and its severity, this study investigated the prevalence of CKD as well as its risk factors in patients with OLP. Methods A large prospective cross-sectional study of 1,021 patients with OLP was carried out using questionnaires and laboratory tests available from an oral medicine clinic at a university in eastern China. According to the Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic guideline, CKD was classified based on the estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m2) or urinary albumin to creatinine ratio (UACR, >30 mg/g). Results The prevalence of CKD in the patients with OLP in this study was 14.3% (95% CI, 12.3–16.6%), which was higher than that in the general Chinese population (10.8%; 95% CI, 10.2–11.3%). The mean values of serum creatinine, eGFR, UACR, and urine N-acetyl-β-D-glucosidase in patients with CKD were significantly higher than those in patients without CKD (all P<0.01). Pearson’s correlation analysis revealed that CKD stage and UACR were positively correlated with the severity of OLP (both P<0.001). Importantly, multivariate regression analysis revealed that age ≥58 years old, female sex, and hypertension were independent risk factors for incident CKD and abnormal UACR (>30 mg/g) in patients with OLP (all P<0.01). Conclusions This study has reported for the first time that CKD is a comorbidity in patients with OLP. The occurrence and staging of incident CKD are associated with OLP and its severity.
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Affiliation(s)
- Yiwen Deng
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chengyi Wang
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yeqing Shen
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyao Tang
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ahmed S, Gasparyan AY, Zimba O. Comorbidities in rheumatic diseases need special consideration during the COVID-19 pandemic. Rheumatol Int 2021; 41:243-256. [PMID: 33388969 PMCID: PMC7778868 DOI: 10.1007/s00296-020-04764-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 02/08/2023]
Abstract
Comorbidities in rheumatic and musculoskeletal diseases (RMDs) not only increase morbidity and mortality but also confound disease activity, limit drug usage and increase chances of severe infections or drug-associated adverse effects. Most RMDs lead to accelerated atherosclerosis and variable manifestations of the metabolic syndrome. Literature on COVID-19 in patients with RMDs, and the effects of various comorbidities on COVID-19 was reviewed. The initial data of COVID-19 infections in RMDs have not shown an increased risk for severe disease or the use of different immunosuppression. However, there are some emerging data that patients with RMDs and comorbidities may fare worse. Various meta-analyses have reiterated that pre-existing hypertension, cardiovascular disease, stroke, diabetes, chronic kidney disease, heart failure, lung disease or obesity predispose to increased COVID-19 mortality. All these comorbidities are commonly encountered in the various RMDs. Presence of comorbidities in RMDs pose a greater risk than the RMDs themselves. A risk score based on comorbidities in RMDs should be developed to predict severe COVID-19 and death. Additionally, there should be active management of such comorbidities to mitigate these risks. The pandemic must draw our attention towards, and not away from, comorbidities.
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Affiliation(s)
- Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India.
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK
| | - Olena Zimba
- Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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