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Mertz P, Wollenschlaeger C, Chasset F, Dima A, Arnaud L. Rheumatoid vasculitis in 2023: Changes and challenges since the biologics era. Autoimmun Rev 2023; 22:103391. [PMID: 37468085 DOI: 10.1016/j.autrev.2023.103391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Significant changes in the epidemiology and natural history of rheumatoid vasculitis (RV) have occurred with the introduction of biological therapies such as TNF inhibitors (TNFi) and rituximab. PURPOSE This scoping review aims to address the key current challenges and propose updated criteria for RV. This will aid future descriptive observational studies and prospective therapeutic trials. METHODOLOGY The MEDLINE database was searched for eligible articles from inception through December 2022. Articles were selected based on language and publication date after 1998, corresponding to the approval of the first TNFi in rheumatic diseases. RESULTS Sixty articles were included in the review. The mean incidence of RV has decreased since the approval of biologic therapies in RA, from 9.1 (95% CI: 6.8-12.0) per million between 1988 and 2000 to 3.9 (95% CI: 2.3-6.2) between 2001 and 2010, probably due to significant improvement in RA severity and a decrease in smoking habits. Factors associated with an increased risk of RV include smoking at RA diagnosis, longer disease duration, severe RA, immunopositivity, and male gender (regardless of age). Homozygosity for the HLA-DRB104 shared epitope is linked to RV, while the presence of HLA-C3 is a significant predictor of vasculitis in patients without HLA-DRB104. Cutaneous (65-88%), neurologic (35-63%), and cardiac (33%) manifestations are common in RV, often associated with constitutional symptoms (70%). Histologic findings range from small vessel vasculitis to medium-sized necrotizing arteritis, but definite evidence of vasculitis is not required in the 1984 Scott and Bacon diagnostic criteria. Existing data on RV treatment are retrospective, and no formal published guidelines are currently available. CONCLUSION The understanding of RV pathogenesis has improved since its initial diagnostic criteria, with a wider range of clinical manifestations identified. However, a validated and updated criteria that incorporates these advances is currently lacking, impeding the development of descriptive observational studies and prospective therapeutic trials. PRIMARY FUNDING SOURCE This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Philippe Mertz
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France; Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, France.
| | - Clara Wollenschlaeger
- Dermatology Clinic, Hôpitaux Universitaires et Université de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine, Service de dermatologie et Allergologie, AP-HP, hôpital Tenon, et INSERM U1135, CIMI, Paris
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Laurent Arnaud
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France; Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, France
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Takamatsu K, Kusanagi Y, Horikoshi H, Nakanishi T, Wada A, Koumoto S, Katsurada Y, Tsuda H, Hokari R, Kimura F, Itoh K. Acute Pancreatitis Coincided with Multiple Arteriolar Aneurysms in a Patient with Polyarteritis Nodosa. Mod Rheumatol Case Rep 2021; 6:234-238. [PMID: 34878139 DOI: 10.1093/mrcr/rxab052] [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: 08/20/2021] [Revised: 10/20/2021] [Accepted: 11/20/2021] [Indexed: 11/12/2022]
Abstract
A 78-year-old man presented to our hospital with a history of 10kg weight loss within 6 months previously, and general fatigue and fever for 2 and 1 months, respectively. On hospitalization, the patient was diagnosed with polyarteritis nodosa after multiple microaneurysms were observed in the liver, kidney, pancreas, and mesenteries. He achieved remission with the administration of 1,000mg methylprednisolone for 3 days, followed by prednisolone (55mg/day). Steroids were successfully tapered with no re-elevation in inflammation. Two months after the administration of steroids, the patient complained of acute abdominal pain, and developed severe acute pancreatitis. During treatment for pancreatitis, the patient died due to septic shock and disseminated intravascular coagulation. An autopsy revealed necrotizing vasculitis in the intrapancreatic arteries and ischemia of the downstream arterioles resulting in acute pancreatitis.
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Affiliation(s)
- Ko Takamatsu
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasuyoshi Kusanagi
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideyuki Horikoshi
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takashi Nakanishi
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akinori Wada
- Division of Gastroenterology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Shunsuke Koumoto
- Division of Gastroenterology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yuka Katsurada
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryota Hokari
- Division of Gastroenterology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Fumihiko Kimura
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenji Itoh
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
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Alkhayyat M, Abou Saleh M, Grewal MK, Abureesh M, Mansoor E, Simons-Linares CR, Abelson A, Chahal P. Pancreatic manifestations in rheumatoid arthritis: a national population-based study. Rheumatology (Oxford) 2021; 60:2366-2374. [PMID: 33244600 DOI: 10.1093/rheumatology/keaa616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES RA is a systemic autoimmune disease characterized by persistent joint inflammation. Extra-articular manifestations of RA can involve different organs including the gastrointestinal (GI) system. Using a large database, we sought to describe the epidemiology of pancreas involvement in RA. METHODS We queried a multicentre database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems in the US from 1999 to 2019. After excluding patients younger than 18, a cohort of individuals with Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) diagnosis of RA was identified. Within this cohort, patients who developed a SNOMED-CT diagnosis of acute pancreatitis (AP), chronic pancreatitis (CP) and primary pancreatic cancer (PaCa) after at least 30 days of RA diagnosis were identified. Statistical analysis for multivariate model was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp) to adjust for several factors. RESULTS Of the 56 183 720 individuals in the database, 518 280 patients had a diagnosis of RA (0.92%). Using a multivariate regression model, patients with RA were more likely to develop AP [odds ratio (OR): 2.51; 95% CI: 2.41, 2.60], CP (OR: 2.97; 95% CI: 2.70, 3.26) and PaC (OR: 1.79; 95% CI: 1.52, 2.10). CONCLUSION In this large database, we found a modest increased risk of AP and CP among patients with RA after adjusting for the common causes of pancreatitis. Further studies are required to better understand this association and the effect of medications used for RA.
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Affiliation(s)
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY
| | - Emad Mansoor
- Department of Gastroenterology, University Hospitals Cleveland Medical Center
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Abby Abelson
- Department of Rheumatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
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Bély M, Apáthy Á. Pancreatitis in rheumatoid arthritis and the role of systemic vasculitis of autoimmune origin in the pathogenesis of pancreatitis – A postmortem clinicopathologic study of 161 patients. ACTA ACUST UNITED AC 2019. [DOI: 10.15406/ghoa.2019.10.00351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Application of Transcranial Color Doppler Ultrasonography for Assessing Middle Cerebral Arteries in Rheumatoid Arthritis. Ultrasound Q 2017; 33:281-283. [PMID: 28877097 DOI: 10.1097/ruq.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To assess the role of ultrasonography for assessing middle cerebral arteries (MCAs) in rheumatoid arthritis (RA). Middle cerebral arteries of 32 RA patients and 32 healthy volunteers were examined by ultrasonography. Peak systolic blood flow velocity (PSV), end-diastolic velocity, and resistance index (RI) of MCA were measured using Doppler ultrasound. Results were expressed as mean ± SD. No significant difference in peak systolic velocity was obtained between RA patients (52.44 ± 19.56 cm/s) and healthy volunteers (51.59 ± 16.83 cm/s, P > 0.05). End-diastolic velocity in RA patients was significantly lower (15.41 ± 5.44 cm/s vs 24.54 ± 8.45 cm/s, P < 0.01) and RI markedly higher (0.66 ± 0.10 vs 0.60 ± 0.06, P < 0.05) compared with control values. Resistance index in 32 RA patients increased with disease duration (2 months to 31 years), from a median value of 0.350 to 0.830; there was a strong correlation between RI and disease duration (r = 0.965, P < 0.05). A point of 0.64 in receiver operating characteristic curve was chosen as the cutoff point, and the area under the curve was 0.918. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90.6%, 87.5%,87.9%, 90.3%, and 89.1%, respectively. Color Doppler ultrasound in RA patients with hemodynamic changes of MCAs could be a relatively sensitive tool for the detection of cerebral atherosclerotic lesions. This could enable timely intervention for early clinical reference.
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Chang CC, Chiou CS, Lin HL, Wang LH, Chang YS, Lin HC. Increased Risk of Acute Pancreatitis in Patients with Rheumatoid Arthritis: A Population-Based Cohort Study. PLoS One 2015; 10:e0135187. [PMID: 26262880 PMCID: PMC4532490 DOI: 10.1371/journal.pone.0135187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/18/2015] [Indexed: 12/24/2022] Open
Abstract
The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis.
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Affiliation(s)
- Chi Ching Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi Sheng Chiou
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiu Li Lin
- Department of Neurology, General Cathay Hospital, Sijhih Branch, New Taipei City, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Li Hsuan Wang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiu-Chen Lin
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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