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Pignatti E, Maccaferri M, Pisciotta A, Carnevale G, Salvarani C. A comprehensive review on the role of mesenchymal stromal/stem cells in the management of rheumatoid arthritis. Expert Rev Clin Immunol 2024; 20:463-484. [PMID: 38163928 DOI: 10.1080/1744666x.2023.2299729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease with systemic manifestations. Although the success of immune modulatory drug therapy is considerable, about 40% of patients do not respond to treatment. Mesenchymal stromal/stem cells (MSCs) have been demonstrated to have therapeutic potential for inflammatory diseases. AREAS COVERED This review provides an update on RA disease and on pre-clinical and clinical studies using MSCs from bone marrow, umbilical cord, adipose tissue, and dental pulp, to regulate the immune response. Moreover, the clinical use, safety, limitations, and future perspective of MSCs in RA are discussed. Using the PubMed database and ClincalTrials.gov, peer-reviewed full-text papers, abstracts and clinical trials were identified from 1985 through to April 2023. EXPERT OPINION MSCs demonstrated a satisfactory safety profile and potential for clinical efficacy. However, it is mandatory to deepen the investigations on how MSCs affect the proinflammatory deregulated RA patients' cells. MSCs are potentially good candidates for severe RA patients not responding to conventional therapies but a long-term follow-up after stem cells treatment and standardized protocols are needed. Future research should focus on well-designed multicenter randomized clinical trials with adequate sample sizes and properly selected patients satisfying RA criteria for a valid efficacy evaluation.
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Affiliation(s)
- Elisa Pignatti
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Monia Maccaferri
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Pisciotta
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Carnevale
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Deane KD. Rheumatoid arthritis: prediction of future clinically-apparent disease, and prevention. Curr Opin Rheumatol 2024; 36:225-234. [PMID: 38441488 PMCID: PMC10959682 DOI: 10.1097/bor.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW This review discusses updates in the prediction and prevention of future rheumatoid arthritis (RA). RECENT FINDINGS In individuals with musculoskeletal symptoms and elevated antibodies to citrullinated proteins (ACPA) without clinical inflammatory arthritis (IA), a 'simple' score has a positive predictive value (PPV) of ∼28% for clinical IA/RA within 1 year, and a comprehensive score (including ultrasound) has a PPV of ∼71% for clinical RA within 5 years. Controlled clinical trials in individuals at-risk for future RA have been performed using corticosteroids, rituximab, atorvastatin, methotrexate, hydroxychloroquine and abatacept. Abatacept modestly reduced rates of incident clinical RA and imaging inflammation within the trials, rituximab delayed clinical IA, and methotrexate improved function, symptoms and imaging inflammation. Vitamin D with or without omega 3 fatty acids reduced incidence of autoimmune diseases, including RA. While not proven in controlled clinical trials, observational studies suggest exercise, weight loss and smoking cessation may reduce progression to clinical RA. SUMMARY Prediction and prevention of RA is advancing although there are no currently approved interventions for prevention. Future studies should include deeper evaluation of the pathophysiology of RA development to improve prediction and identify key pathways to target in future clinical trials, as well as develop infrastructure to support prevention-related research.
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Affiliation(s)
- Kevin D Deane
- University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, Colorado USA
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3
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O'Neil LJ, Alpízar-Rodríguez D, Deane KD. Rheumatoid Arthritis: The Continuum of Disease and Strategies for Prediction, Early Intervention, and Prevention. J Rheumatol 2024; 51:337-349. [PMID: 38224993 PMCID: PMC10984790 DOI: 10.3899/jrheum.2023-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/17/2024]
Abstract
Rheumatoid arthritis (RA) is known to include a pre-RA stage that can be defined as the presence of familial or genetic risk factors, biomarker abnormalities (eg, anticitrullinated protein antibodies [ACPA]), symptoms, and even abnormal imaging findings prior to the development of the onset of clinical RA with inflammatory arthritis that is apparent on physical examination. Indeed, there are multiple completed or ongoing retrospective case-control as well as prospective observational studies to identify the key biologic drivers of disease. Further, building on the predictive ability of combinations of biomarkers, symptoms, and imaging for future RA, there are multiple clinical trials completed, underway, or in development to identify approaches that may prevent, delay, or ameliorate future clinical RA in at-risk individuals. Importantly, however, although an effective preventive intervention has not yet been identified, at-risk individuals are being increasingly identified in clinical care; this presents a challenge of how to manage these individuals in clinical practice. This review will discuss the current understanding of the biology and natural history of RA development, nomenclature, and current models for prediction of future RA, as well as evaluate the current and ongoing clinical prevention trials with the overall goal to provide insights into the challenges and opportunities in the field of RA prevention. Moreover, this review will provide up-to-date options for clinical management of individuals at risk for RA.
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Affiliation(s)
- Liam J O'Neil
- L.J. O'Neil, MD, MHSc, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kevin D Deane
- K.D. Deane, MD, PhD, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA.
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Courel-Ibáñez J, Vetrovsky T, Růžičková N, Marañón C, Durkalec-Michalski K, Tomcik M, Filková M. Integrative non-pharmacological care for individuals at risk of rheumatoid arthritis. Rheumatol Int 2024; 44:413-423. [PMID: 38180500 DOI: 10.1007/s00296-023-05507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
There is increasing knowledge in the recognition of individuals at risk for progression to rheumatoid arthritis (RA) before the clinical manifestation of the disease. This prodromal phase preceding the manifestation of RA may represent a "window of opportunity" for preventive interventions that may transform the clinical approach to this disease. However, limited evidence exists in support of effective interventions to delay the onset or even halt the manifestation of RA. Given the multifactorial nature of RA development and disease progression, the latest guidelines for established RA stress the use of integrative interventions and multidisciplinary care strategies, combining pharmacologic treatment with non-pharmacological approaches. Accordingly, individuals at risk of RA could be offered an integrative, multifactorial intervention approach. Current data point toward pharmacological intervention reverting the subclinical inflammation and delay in the disease onset. In addition, targeting life style modifiable factors (smoking cessation, dental health, physical activity, and diet) may presumably improve RA prognosis in individuals at risk, mainly by changes in epigenetics, autoantibodies, cytokines profiles, and microbiome. Nonetheless, the benefits of multidisciplinary interventions to halt the manifestation of RA in at-risk individuals remain unknown. As there is a growing knowledge of possible pharmacological intervention in the preclinical phase, this narrative review aims to provide a comprehensive overview of non-pharmacological treatments in individuals at risk of RA. Considering the mechanisms preceding the clinical manifestation of RA we explored all aspects that would be worth modifying and that would represent an integrative non-pharmacological care for individuals at risk of RA.
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Affiliation(s)
- Javier Courel-Ibáñez
- Department of Physical Education and Sport, University of Granada, C/Camino de Alfacar, 21, 18071, Granada, Spain.
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Nora Růžičková
- Department of Rheumatology, 1st Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Concepción Marañón
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENYO), Granada, Spain
| | - Krzysztof Durkalec-Michalski
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- Department of Sports Dietetics, Poznan University of Physical Education, Poznan, Poland
| | - Michal Tomcik
- Department of Rheumatology, 1st Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Mária Filková
- Department of Rheumatology, 1st Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic
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Dumoulin QA, Boeren AMP, Krijbolder DI, Willemze A, de Jong PHP, van Mulligen E, van Steenbergen HW, van der Helm-van Mil AHM. When does obesity exert its effect in conferring risk of developing RA: a large study in cohorts of symptomatic persons at risk. RMD Open 2024; 10:e003785. [PMID: 38216289 PMCID: PMC10806477 DOI: 10.1136/rmdopen-2023-003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Obesity is a known risk factor for developing rheumatoid arthritis (RA). However, it is unclear whether obesity exerts its risk effect during the asymptomatic or the symptomatic clinically suspect arthralgia (CSA) phase of risk. To improve understanding of the effect of obesity on RA development, we aimed to (1) compare body mass index (BMI) at CSA onset to BMI of the general population and (2) study within CSA patients if obesity increases the risk for progression to RA. METHODS 1107 symptomatic persons at risk for RA from four cohorts (CSA Leiden, CSA Rotterdam, SONAR and TREAT EARLIER placebo arm) were studied. For the first aim, baseline BMI was compared with age-matched/sex-matched BMI of the general population. Patients were stratified for anticitrullinated protein antibody (ACPA) status. Regarding the second aim, the association between BMI and inflammatory arthritis (IA) development during 2 years was studied with Cox regression analysis within each cohort and via meta-analysis in all cohorts. RESULTS CSA patients of all cohorts were more often obese than the general population (respectively 21.9% vs 14.0%, 25.7% vs 14.5%, 26.7% vs 14.5% and 33.3% vs 14.9%, in CSA Leiden, CSA Rotterdam, SONAR, TREAT EARLIER placebo arm). Both ACPA-positive and ACPA-negative CSA patients had a higher frequency of obesity. Within CSA, obesity was not associated with IA development compared to normal weight (pooled effect in meta-analysis of four cohorts HR 1.01 (95% CI 0.93 to 1.08)). CONCLUSIONS Obesity is not associated with RA development within CSA patients but BMI has already increased in CSA compared to the general population. Obesity, therefore, presumably exerts its risk effect at an early asymptomatic phase of RA development, rather than being associated with the disease processes that ultimately result in clinical arthritis.
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Affiliation(s)
- Quirine A Dumoulin
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna M P Boeren
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - Doortje I Krijbolder
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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Scherlinger M, Schaeverbeke T. Correspondence on 'Factors associated with progression to inflammatory arthritis in first-degree relatives of individuals with RA following autoantibody positive screening in a non-clinical setting'. Ann Rheum Dis 2023; 82:e221. [PMID: 33757969 DOI: 10.1136/annrheumdis-2021-220345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Marc Scherlinger
- Rheumatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, Strasbourg, France
| | - Thierry Schaeverbeke
- Rheumatology, CHU Bordeaux, Bordeaux, France
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, Bordeaux, France
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He D, Fan Y, Qiao Y, Liu S, Zheng X, Zhu J. Depressive symptom trajectories and new-onset arthritis in a middle-aged and elderly Chinese population. J Psychosom Res 2023; 172:111422. [PMID: 37379786 DOI: 10.1016/j.jpsychores.2023.111422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Previous studies reported that depression was associated with a high risk of arthritis. However, the effect of different long-term depressive symptom trajectory patterns on the risk of arthritis has not been evaluated. Our study aimed to explore the association between depressive symptom trajectories and the risk of arthritis. METHODS A total of 5583 participants from the China Health and Retirement Longitudinal Study from 2011 to 2018 were included in this analysis. Group-based trajectory modeling was used to identify depressive symptom trajectories, and a multivariable competitive Cox regression model was used to examine the association of depressive symptom trajectories with arthritis during follow-up. RESULTS Five depressive symptom trajectories were identified in our research: stable-high, decreasing, increasing, stable-moderate and stable-low. Compared with participants in the stable-low trajectory group, those in the stable-moderate, increasing, decreasing and stable-high trajectory groups had a higher cumulative risk of arthritis, with HRs (95% CIs) for arthritis of 1.64 (1.30, 2.07), 1.86 (1.30, 2.66), 1.99 (1.41, 2.80) and 2.19 (1.38, 3.48), respectively. Participants with the stable-high symptoms trajectory had the highest cumulative risk of arthritis. There was still a high risk of arthritis, although the depression state was reduced and remained at a level that is generally considered reasonable. CONCLUSIONS The higher depressive symptoms trajectories were significantly associated with the increased risk of arthritis, and the long-term depressive symptoms trajectories may be a strong predictor of having arthritis.
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Affiliation(s)
- Dingliu He
- Department of Clinical Nutrition, Yancheng No.1 People's Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, 224001, PR China
| | - Yayun Fan
- Department of Clinical Nutrition, Yancheng No.1 People's Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, 224001, PR China
| | - Yanan Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Siyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Xiaowei Zheng
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine Jiangnan University, 1800 Lihu Road, Binhu District, Wuxi, Jiangsu Province 214122, PR China.
| | - Juanjuan Zhu
- Department of Clinical Nutrition, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, 224001, PR China.
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8
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Chinthala R, Baghel AS, Shubhangi K, Bhagavathi NNL. A case-control study for exploring the association of Prakriti with Rheumatoid Arthritis. J Ayurveda Integr Med 2023; 14:100789. [PMID: 37703672 PMCID: PMC10505973 DOI: 10.1016/j.jaim.2023.100789] [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: 11/22/2021] [Revised: 07/11/2023] [Accepted: 07/22/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Deha-Prakriti (DP) is a unique contribution of Ayurveda, which distinguishes the population into three main groups viz., Vata, Pitta, and Kapha predominant individuals. Its assessment helps physicians to prescribe a suitable diet, daily regimen, and lifestyle that prevents non-communicable diseases. Amavata (Rheumatoid Arthritis) is a disease that needs personalized management approach. AIM To evaluate the association of DP with Amavata (∼Rheumatoid Arthritis). OBJECTIVE To evaluate DP-based susceptibility in the manifestation of Amavata vis-à-vis Rheumatoid Arthritis. METHODOLOGY A case-control study was conducted from 18.04.2018 to 09.01.2020, involving 150 cases (patients of Amavata), and 150 controls (healthy volunteers), matching in age (between 18 to 50 years), and sex, selected from Jamnagar. CCRAS-PAS for both the groups, Health Assessment proforma of TRISUTRA project CSIR-AYURGENOMICS, were used. Logistic regression analyses were conducted to determine the relationship between DP and Amavata. RESULTS The proportion of people with Vata dosha in the case group (53.79%) was substantially higher (P < 0.0001) than in the control group (24.91%). Pitta (39.35%) and Kapha (36.27%) doshas were found to be more prevalent in the control group (P < 0.0001). There was a six-percent rise in the likelihood of developing Amavata with every unit increase in Vata percentage, according to logistic regression analysis. CONCLUSION Vata predominant DP has a significant association with Amavata. Vata predominant DP individuals are more susceptible to Amavata than Pitta and Kapha predominant DP individuals.
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Affiliation(s)
- Rajkumar Chinthala
- Department of Samhita & Siddhanta, TTD's SV Ayurvedic College, A Constituent Educational Institute of Tirumala Tirupathi Devasthanams, Tirupathi, Andhra Pradesh, 517507, India.
| | - Arjun Singh Baghel
- Department of Basic Principles, Institute of Teaching and Research in Ayurveda, Jamnagar, 361008, India.
| | - Kamble Shubhangi
- Department of Basic Principles, Institute of Teaching and Research in Ayurveda, Jamnagar, 361008, India.
| | - N N L Bhagavathi
- TSWRDCW (Telangana Social Welfare Residential Degree Colleges for Women), Warangal (East), Rangashaipet, Telangana, 506005, India.
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Klareskog L, Alfredsson L. Prevention vs treatment of rheumatoid arthritis. IMMUNOTHERAPY ADVANCES 2023; 3:ltad016. [PMID: 37662832 PMCID: PMC10473452 DOI: 10.1093/immadv/ltad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023] Open
Abstract
Whether a yet chronic and not curable disease like rheumatoid arthritis (RA) can be subject to prevention or whether available resources should be focused on treatment is a classical dilemma. Similar to the case in most other chronic diseases, the focus in research as well as in clinical practice has been on the treatment of established diseases, resulting in drugs that are efficient in eliminating most joint damage but not able to cure the disease or stop needs for continuous treatment of the disease. Less effort has been spent on identifying and implementing ways to prevent the disease. We argue in this review that knowledge concerning the longitudinal evolvement of the major, 'seropositive' subset of RA has now come to a stage where prevention should be a large part of the research agenda and that we should prepare for prevention as part of clinical practice in RA. We describe briefly the knowledge basis for broad public health-based prevention as well as for a 'precision prevention' strategy. In the latter, individuals at high risk for RA will be identified, monitored, and ultimately provided with advice on how to change lifestyle/environment or be given treatment with drugs able to delay and ultimately stop the development of RA. Whether this potential of precision prevention for RA will change the broader clinical practice will depend on whether specific and long-lasting interference with disease-inducing immunity, ultimately 'tolerance therapy', will become a reality.
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Affiliation(s)
- Lars Klareskog
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Sardana Y, Bhatti GK, Singh C, Sharma PK, Reddy PH, Bhatti JS. Progression of pre-rheumatoid arthritis to clinical disease of joints: Potential role of mesenchymal stem cells. Life Sci 2023; 321:121641. [PMID: 36997059 DOI: 10.1016/j.lfs.2023.121641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
Rheumatoid arthritis (RA) related autoimmunity is developed at mucosal sites due to the interplay between genetic risk factors and environmental triggers. The pre-RA phase that leads to anti-citrullinated protein antibodies, rheumatoid factor, and other autoantibodies spread in the systemic circulation may not affect articular tissue for years until a mysterious second hit triggers the localization of RA-related autoimmunity in joints. Several players in the joint microenvironment mediate the synovial innate and adaptive immunological processes, eventually leading to clinical synovitis. There still exists a gap in the early phase of RA pathogenesis, i.e., the progression of diseases from the systemic circulation to joints. The lack of better understanding of these events results in the inability to answer questions about why only after a certain point of time the disease appears in joints and why in some cases, it simply remains latent and doesn't affect joints at all. In the current review, we focused on the immunomodulatory and regenerative role of mesenchymal stem cells and associated exosomes in RA pathology. We also highlighted the age-related dysregulations in activities of mesenchymal stem cells and how that might trigger homing of systemic autoimmunity to joints.
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Affiliation(s)
- Yogesh Sardana
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India
| | - Gurjit Kaur Bhatti
- Department of Medical Lab Technology, University Institute of Applied Health Sciences, Chandigarh University, Mohali, India
| | - Charan Singh
- Department of Pharmaceutical Sciences, Hemvati Nandan Bahuguna Garhwal University, Uttarakhand, India
| | | | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA.
| | - Jasvinder Singh Bhatti
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India.
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Simons G, Veldwijk J, DiSantostefano RL, Englbrecht M, Radawski C, Bywall KS, Valor Méndez L, Hauber B, Raza K, Falahee M. Preferences for preventive treatments for rheumatoid arthritis: discrete choice survey in the UK, Germany and Romania. Rheumatology (Oxford) 2023; 62:596-605. [PMID: 36068022 PMCID: PMC9891433 DOI: 10.1093/rheumatology/keac397] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To quantify preferences for preventive therapies for rheumatoid arthritis (RA) across three countries. METHODS A web-based survey including a discrete choice experiment was administered to adults recruited via survey panels in the UK, Germany and Romania. Participants were asked to assume they were experiencing arthralgia and had a 60% chance of developing RA in the next 2 years and completed 15 choices between no treatment and two hypothetical preventive treatments. Treatments were defined by six attributes (effectiveness, risks and frequency/route of administration) with varying levels. Participants also completed a choice task with fixed profiles reflecting subjective estimates of candidate preventive treatments. Latent class models (LCMs) were conducted and the relative importance of attributes, benefit-risk trade-offs and predicted treatment uptake was subsequently calculated. RESULTS Completed surveys from 2959 participants were included in the analysis. Most participants preferred treatment over no treatment and valued treatment effectiveness to reduce risk more than other attributes. A five-class LCM best fitted the data. Country, perceived risk of RA, health literacy and numeracy predicted class membership probability. Overall, the maximum acceptable risk for a 40% reduction in the chance of getting RA (60% to 20%) was 21.7%, 19.1% and 2.2% for mild side effects, serious infection and serious side effects, respectively. Predicted uptake of profiles reflecting candidate prevention therapies differed across classes. CONCLUSION Effective preventive pharmacological treatments for RA were acceptable to most participants. The relative importance of treatment attributes and likely uptake of fixed treatment profiles were predicted by participant characteristics.
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Affiliation(s)
- Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Larissa Valor Méndez
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Brett Hauber
- Pfizer, Inc., New York, NY.,Comparative Health Outcomes, Policy, and Economics Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Hahn J, Malspeis S, Choi MY, Stevens E, Karlson EW, Lu B, Cui J, Yoshida K, Kubzansky L, Sparks JA, Costenbader KH. Association of Healthy Lifestyle Behaviors and the Risk of Developing Rheumatoid Arthritis Among Women. Arthritis Care Res (Hoboken) 2023; 75:272-276. [PMID: 35040282 PMCID: PMC9289074 DOI: 10.1002/acr.24862] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether a healthy lifestyle, defined by a healthy lifestyle index score (HLIS), was associated with rheumatoid arthritis (RA) risk, overall and with seropositive/seronegative subtypes. METHODS We analyzed female nurses in the Nurses' Health Study (NHS, 1986-2016) and NHSII (1991-2017). Lifestyle and medical information were collected on biennial questionnaires. Medical records confirmed incident RA and serostatus. The HLIS index includes 5 modifiable components: smoking, alcohol consumption, body mass index, physical activity, and diet. Cox regression, adjusted for confounders, modeled associations between HLIS and incident RA. The population attributable risk estimated the proportion of incident RA preventable if participants adopted ≥4 healthy lifestyle factors. RESULTS A total of 1,219 incident RA cases (776 seropositive, 443 seronegative) developed in 4,467,751 person-years. Higher (healthier) HLIS was associated with lower overall RA risk (hazard ratio [HR] 0.86 [95% confidence interval (95% CI) 0.82-0.90]), seropositive RA risk (HR 0.85 [95% CI 0.80-0.91]), and seronegative RA risk (HR 0.87 [95% 0.80-0.94]). Women with 5 healthy lifestyle factors had the lowest risk (HR 0.42 [95% CI 0.22-0.80]). The population attributable risk for adhering to ≥4 lifestyle factors was 34% for RA. CONCLUSION In this prospective cohort, healthier lifestyle was associated with a lower RA risk. A substantial proportion of RA may be preventable by a healthy lifestyle.
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Affiliation(s)
- Jill Hahn
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - May Y Choi
- Brigham and Women's Hospital, Boston, Massachusetts, and University of Calgary, Calgary, Alberta, Canada
| | - Emma Stevens
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Bing Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jing Cui
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Laura Kubzansky
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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13
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Lopes EW, Chan SSM, Song M, Ludvigsson JF, Håkansson N, Lochhead P, Clark A, Burke KE, Ananthakrishnan AN, Cross AJ, Palli D, Bergmann MM, Richter JM, Chan AT, Olén O, Wolk A, Khalili H. Lifestyle factors for the prevention of inflammatory bowel disease. Gut 2022; 72:gutjnl-2022-328174. [PMID: 36591609 PMCID: PMC10241983 DOI: 10.1136/gutjnl-2022-328174] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/05/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To estimate the proportion of cases of Crohn's disease (CD) and ulcerative colitis (UC) that could be prevented by modifiable lifestyle factors. DESIGN In a prospective cohort study of US adults from the Nurses' Health Study (NHS; n=72 290), NHSII (n=93 909) and Health Professionals Follow-up Study (HPFS; n=41 871), we created modifiable risk scores (MRS; 0-6) for CD and UC based on established lifestyle risk factors, and healthy lifestyle scores (HLS; 0-9) derived from American healthy lifestyle recommendations. We calculated the population attributable risk by comparing the incidence of CD and UC between low-risk (CD-MRS≤1, UC-MRS≤2, HLS≥7) and high-risk groups. We externally validated our findings in three European cohorts: the Swedish Mammography Cohort (n=37 275), Cohort of Swedish Men (n=40 810) and European Prospective Investigation into Cancer and Nutrition (n=404 144). RESULTS Over 5 117 021 person-years of follow-up (NHS, HPFS: 1986-2016; NHSII: 1991-2017), we documented 346 CD and 456 UC cases. Adherence to a low MRS could have prevented 42.9% (95% CI 12.2% to 66.1%) of CD and 44.4% (95% CI 9.0% to 69.8%) of UC cases. Similarly, adherence to a healthy lifestyle could have prevented 61.1% (95% CI 16.8% to 84.9%) of CD and 42.2% (95% CI 1.7% to 70.9%) of UC cases. In our validation cohorts, adherence to a low MRS and healthy lifestyle could have, respectively, prevented 43.9%-51.2% and 48.8%-60.4% of CD cases and 20.6%-27.8% and 46.8%-56.3% of UC cases. CONCLUSIONS Across six US and European cohorts, a substantial burden of inflammatory bowel diseases risk may be preventable through lifestyle modification.
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Affiliation(s)
- Emily W Lopes
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simon S M Chan
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mingyang Song
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Orebro universitet, Orebro, Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lochhead
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy
| | - Manuela M Bergmann
- Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrucke, Nuthetal, Germany
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ola Olén
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska institutet, Stockholm, Sweden
- Pediatric Gastroenterology Unit, Sachs' Children's Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute, of MIT and Harvard, Cambridge, MA, USA
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14
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Desai N, Federico L, Baker JF. Lifestyle, Hormonal, and Metabolic Environmental Risks for Rheumatoid Arthritis. Rheum Dis Clin North Am 2022; 48:799-811. [PMID: 36332996 DOI: 10.1016/j.rdc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although there is a substantial body of literature focused on understanding noninhalational risk-factors for rheumatoid arthritis, the data are mixed and often conflicting. Given the other health benefits for certain lifestyle modifications, it seems reasonable for clinicians to promote healthy lifestyle habits related to diet, exercise, maintenance of health weight, and maintenance of good dental hygiene. Overall, however, these lifestyle modifications may be expected to have modest benefit, and other strategies to prevent rheumatoid arthritis in high-risk patients are needed.
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Affiliation(s)
- Nancy Desai
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA
| | - Lydia Federico
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA
| | - Joshua F Baker
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA; Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA; Department of Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA.
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15
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Venetsanopoulou AI, Alamanos Y, Voulgari PV, Drosos AA. Epidemiology of rheumatoid arthritis: genetic and environmental influences. Expert Rev Clin Immunol 2022; 18:923-931. [PMID: 35904251 DOI: 10.1080/1744666x.2022.2106970] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic systemic disease characterized by articular involvement and extra-articular manifestations. The incidence and prevalence of the disease vary across populations, and there is an ongoing debate on whether a change of RA occurrence over time exists or is due to methodological issues and other biases. Moreover, the disease's onset is related to an interaction of genetic and environmental factors that influence its expression. AREAS COVERED This review explores the latest knowledge on RA epidemiology and the possible risk factors associated with its presentation to identify potential warning signs that may in the future help disease management. EXPERT OPINION Current epidemiological evidence suggests a significant impact of smoking, sex hormones, and lifestyle status in RA occurrence. However, the association between these variables has not yet been thoroughly studied. Still, their effect must be interpreted as they may present subsequently integral indicators for a more rational approach of the disease.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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16
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Izadi Z, Schmajuk G. Towards the patient-centred care of rheumatoid arthritis. Nat Rev Rheumatol 2022; 18:367-368. [PMID: 35596082 DOI: 10.1038/s41584-022-00794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zara Izadi
- School of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA.
| | - Gabriela Schmajuk
- School of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
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17
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Mazzucca CB, Scotti L, Cappellano G, Barone-Adesi F, Chiocchetti A. Nutrition and Rheumatoid Arthritis Onset: A Prospective Analysis Using the UK Biobank. Nutrients 2022; 14:nu14081554. [PMID: 35458116 PMCID: PMC9025922 DOI: 10.3390/nu14081554] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects the joints. The multifactorial etiopathogenesis of RA has been heavily investigated, but is still only partially understood. Diet can represent both a risk factor and a protective factor, based on some evidence that suggests specific properties of certain foods and their ability to increase/reduce inflammation. To date, the studies done on this topic provide discordant results and are heterogeneous in terms of design and cohort size. In this work, we investigated for the first time the relationship between nutrition and the risk of RA onset using a sample size of about half a million subjects from one of the largest publicly available biobanks that is the UK biobank. Results showed that oily fish, alcohol, coffee and breakfast cereals have protective roles in RA; whereas, tea can increase the risk of RA. In conclusion, the obtained results confirm that diet plays key roles in RA, either by promoting or by preventing RA onset and development. Future research should focus on unravelling the effects of dietary habits on immune-mediated diseases to establish better preventive strategies.
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Affiliation(s)
- Camilla Barbero Mazzucca
- Dipartimento di Scienze Della Salute, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Diseases—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Lorenza Scotti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, 28100 Novara, Italy; (L.S.); (F.B.-A.)
| | - Giuseppe Cappellano
- Dipartimento di Scienze Della Salute, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Diseases—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Francesco Barone-Adesi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, 28100 Novara, Italy; (L.S.); (F.B.-A.)
| | - Annalisa Chiocchetti
- Dipartimento di Scienze Della Salute, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Diseases—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
- Correspondence:
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18
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Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated once an individual displays the clinical findings of inflammatory arthritis (IA). However, growing evidence supports that there is a 'pre-RA' stage that can be identified through factors such as autoantibodies in absence of clinically apparent IA. In particular, biomarkers, including antibodies to citrullinated protein antigens (ACPA), demonstrate a high risk for future IA/RA, and multiple clinical trials have been developed to intervene in individuals in pre-RA to prevent or delay clinically apparent disease. Herein, we will discuss in more depth what is currently known about the natural history of RA, and the emerging possibility that early 'diagnosis' of RA-related autoimmunity followed by an intervention can lead to the delay or prevention of the first onset of clinically apparent RA.
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19
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Gupta UC, Gupta SC, Gupta SS. Clinical Overview of Arthritis with a Focus on Management Options and Preventive Lifestyle Measures for Its Control. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401318666220204095629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT:
Arthritis is the spectrum of conditions that cause swelling and tenderness of one or more body joints with key symptoms of joint pain and stiffness. Its progression is closely tied to age. Although there are a number of arthritis types, such as, ankylosing, gout, joint infections, juvenile idiopathic, reactive and septic; the two most common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis causes the articulating smooth cartilage that covers the ends of bones, where they form a joint, to breakdown. Rheumatoid arthritis is a disease in which the immune system attacks joints, beginning with the cartilaginous lining of the joints. The latter is considered a systemic disease, i.e. affecting many parts of the body, but the respiratory system is involved in 10 to 20 % of all mortality. Osteoarthritis is one of the leading causes of disability globally. Several preventive measures to control arthritis have been suggested, such as the use of analgesics, non-steroid anti-inflammatory drugs, moderate to vigorous physical activity and exercise, reducing sedentary hours, getting adequate sleep and maintaining a healthy body weight. Foods including, a Mediterranean diet rich in fruits and vegetables, fish oil, medicinal plants and microbiota are vital protective methods. The intake of vitamins such as A and C, minerals e.g., selenium and zinc; poly unsaturated and n-3 fatty acids is also a significant preventive measures.
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Affiliation(s)
- Umesh Chandra Gupta
- Emeritus Research Scientist, Agriculture and Agri-food Canada, Charlottetown Research and Development Centre, 440 University Avenue, Charlottetown, PE, C1A 4N6, Canada
| | - Subhas Chandra Gupta
- Chairman and Professor, The Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, California, 92354, USA
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20
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Yu XH, Bo L, Cao RR, Yang YQ, He P, Lei SF, Deng FY. Systematic Evaluation of Rheumatoid Arthritis Risk by Integrating Lifestyle Factors and Genetic Risk Scores. Front Immunol 2022; 13:901223. [PMID: 35874719 PMCID: PMC9299428 DOI: 10.3389/fimmu.2022.901223] [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: 03/21/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Effective identification of high-risk rheumatoid arthritis (RA) individuals is still a challenge. Whether the combined effects of multiple previously reported genetic loci together with lifestyle factors can improve the prediction of RA risk remains unclear. Methods Based on previously reported results and a large-scale Biobank dataset, we constructed a polygenic risk score (PRS) for RA to evaluate the combined effects of the previously identified genetic loci in both case-control and prospective cohorts. We then evaluated the relationships between several lifestyles and RA risk and determined healthy lifestyles. Then, the joint effects of healthy lifestyles and genetic risk on RA risk were evaluated. Results We found a positive association between PRS and RA risk (OR = 1.407, 95% confidence interval (CI) = 1.354~1.463; HR = 1.316, 95% CI = 1.257~1.377). Compared with the low genetic risk group, the group with intermediate or high genetic risk had a higher risk (OR = 1.347, 95% CI = 1.213~1.496; HR = 1.246, 95% CI = 1.108~1.400) (OR = 2.169, 95% CI = 1.946~2.417; HR = 1.762, 95% CI = 1.557~1.995). After adjusting for covariates, we found protective effects of three lifestyles (no current smoking, regular physical activity, and moderate body mass index) on RA risk and defined them as healthy lifestyles. Compared with the individuals with low genetic risks and favorable lifestyles, those with high genetic risks and unfavorable lifestyles had as high as OR of 4.637 (95%CI = 3.767~5.708) and HR of 3.532 (95%CI = 2.799~4.458). Conclusions In conclusion, the integration of PRS and lifestyles can improve the prediction of RA risk. High RA risk can be alleviated by adopting healthy lifestyles but aggravated by adopting unfavorable lifestyles.
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Affiliation(s)
- Xing-Hao Yu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Lin Bo
- Department of Rheumatology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rong-Rong Cao
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Yi-Qun Yang
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Pei He
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Fei-Yan Deng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
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21
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Zemedikun DT, Gokhale K, Chandan JS, Cooper J, Lord JM, Filer A, Falahee M, Nirantharakumar K, Raza K. Type 2 diabetes mellitus, glycaemic control, associated therapies and risk of rheumatoid arthritis: a retrospective cohort study. Rheumatology (Oxford) 2021; 60:5567-5575. [PMID: 33590842 PMCID: PMC8645277 DOI: 10.1093/rheumatology/keab148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/30/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the incident risk of RA in patients with type 2 diabetes mellitus (T2DM) and to explore the role of glycaemic control and associated therapeutic use in the onset of RA. METHODS This study was a retrospective cohort study using patients derived from the IQVIA Medical Research Data (IMRD-UK) database between 1995 and 2019. A total of 224 551 newly diagnosed patients with T2DM were matched to 449 101 patients without T2DM and followed up to assess their risk of RA. Further analyses investigated the effect of glycaemic control, statin use and anti-diabetic drugs on the relationship between T2DM and RA using a time-dependent Cox regression model. RESULTS During the study period, the incidence of RA was 8.1 and 10.6 per 10 000 person-years in the exposed and unexposed groups, respectively. The adjusted hazard ratio (aHR) was 0.73 (95% CI 0.67, 0.79). In patients who had not used statins in their lifetime, the aHR was 0.89 (95% CI 0.69, 1.14). When quantifying the effects of glycaemic control, anti-diabetic drugs and statins using time-varying analyses, there was no association with glycaemic control [aHR 1.00 (95% CI 0.99, 1.00)], use of metformin [aHR 1.00 (95% CI 0.82, 1.22)], dipeptidyl peptidase-4 inhibitors [DPP4is; aHR 0.94 (95% CI 0.71, 1.24)] and the development of RA. However, statins demonstrated a protective effect for progression of RA in those with T2DM [aHR 0.76 (95% CI 0.66, 0.88)], with evidence of a duration-response relationship. CONCLUSION There is a reduced risk of RA in patients with T2DM that may be attributable to the use of statins.
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Affiliation(s)
- Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham.,Warwick Medical School, University of Warwick, Coventry
| | - Jennifer Cooper
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Janet M Lord
- Institute of Inflammation and Ageing.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham
| | | | | | | | - Karim Raza
- Institute of Inflammation and Ageing.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham.,Sandwell and West Birmingham NHS Hospitals Trust, Birmingham, UK
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22
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Mazzucca CB, Raineri D, Cappellano G, Chiocchetti A. How to Tackle the Relationship between Autoimmune Diseases and Diet: Well Begun Is Half-Done. Nutrients 2021; 13:nu13113956. [PMID: 34836210 PMCID: PMC8620243 DOI: 10.3390/nu13113956] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023] Open
Abstract
Nutrition and immunity are closely related, and the immune system is composed of the most highly energy-consuming cells in the body. Much of the immune system is located within the GI tract, since it must deal with the huge antigenic load introduced with food. Moreover, the incidence of immune-mediated diseases is elevated in Westernized countries, where “transition nutrition” prevails, owing to the shift from traditional dietary patterns towards Westernized patterns. This ecological correlation has fostered increasing attempts to find evidence to support nutritional interventions aimed at managing and reducing the risk of immune-mediated diseases. Recent studies have described the impacts of single nutrients on markers of immune function, but the knowledge currently available is not sufficient to demonstrate the impact of specific dietary patterns on immune-mediated clinical disease endpoints. If nutritional scientists are to conduct quality research, one of many challenges facing them, in studying the complex interactions between the immune system and diet, is to develop improved tools for investigating eating habits in the context of immunomediated diseases.
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Affiliation(s)
- Camilla Barbero Mazzucca
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (D.R.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Disease—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Davide Raineri
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (D.R.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Disease—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Giuseppe Cappellano
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (D.R.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Disease—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Annalisa Chiocchetti
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases—IRCAD, Università del Piemonte Orientale, 28100 Novara, Italy; (C.B.M.); (D.R.); (G.C.)
- Center for Translational Research on Autoimmune and Allergic Disease—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
- Correspondence:
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23
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Fowler-Woods A, Smolik I, Anaparti V, O’Neil L, El-Gabalawy H. Can Studying Genetically Predisposed Individuals Inform Prevention Strategies for RA? Healthcare (Basel) 2021; 9:1301. [PMID: 34682981 PMCID: PMC8544392 DOI: 10.3390/healthcare9101301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is a prevalent autoimmune disorder in which complex genetic predisposition interacts with multiple environmental factors to precipitate chronic and progressive immune-mediated joint inflammation. Currently, in most affected individuals, ongoing suppression of the inflammation is required to prevent irreversible damage and functional loss. The delineation of a protracted preclinical period in which autoimmunity is initially established and then evolves to become pathogenic provides unprecedented opportunities for interventions that have the potential to prevent the onset of this lifelong disease. Clinical trials aimed at assessing the impact of specific prevention strategies require the identification of individuals who are at high risk of future RA development. Currently, these risk factors include a strong family history of RA, and the detection of circulating RA-associated autoantibodies, particularly anti-citrullinated protein antibodies (ACPA). Yet, even in such individuals, there remains considerable uncertainty about the likelihood and the timeframe for future disease development. Thus, individuals who are approached to participate in such clinical trials are left weighing the risks and benefits of the prevention measures, while having large gaps in our current understanding. To address this challenge, we have undertaken longitudinal studies of the family members of Indigenous North American RA patients, this population being known to have a high prevalence of RA, early age of onset, and familial clustering of cases. Our studies have indicated that the concepts of "risk" and "prevention" need to be communicated in a culturally relevant manner, and proposed prevention interventions need to have an appropriate balance of effectiveness, safety, convenience, and cultural acceptability. We have focused our proposed prevention studies on immunomodulatory/anti-inflammatory nutritional supplements that appear to strike such a complex balance.
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Affiliation(s)
- Amanda Fowler-Woods
- Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3W 0W3, Canada;
| | - Irene Smolik
- Rheumatic Diseases Unit, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1M4, Canada;
| | - Vidyanand Anaparti
- Manitoba Center for Proteomics and Systems Biology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; (V.A.); (L.O.)
| | - Liam O’Neil
- Manitoba Center for Proteomics and Systems Biology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; (V.A.); (L.O.)
| | - Hani El-Gabalawy
- Manitoba Center for Proteomics and Systems Biology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; (V.A.); (L.O.)
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Hedenstierna L, Bellocco R, Ye W, Adami HO, Åkerstedt T, Trolle Lagerros Y, Hedström AK. Effects of alcohol consumption and smoking on risk for RA: results from a Swedish prospective cohort study. RMD Open 2021; 7:rmdopen-2020-001379. [PMID: 33414179 PMCID: PMC7797247 DOI: 10.1136/rmdopen-2020-001379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/22/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Several, but not all studies, have shown a dose-dependent inverse association with alcohol consumption and rheumatoid arthritis (RA), whereas smoking is an established risk factor for RA. We aimed to study the association between alcohol consumption and RA incidence and investigate a potential interaction between alcohol and smoking habits, regarding RA incidence. Methods We used a prospective cohort study, based on 41 068 participants with detailed assessment of alcohol intake, smoking and potential confounders at baseline in 1997. We ascertained a total of 577 incident cases of RA during a mean of 17.7 years of follow-up through linkage to nationwide and essentially complete databases. Multivariate Cox proportional hazards models were used to estimate HR with 95% CI. Interaction on the additive scale between alcohol and smoking was estimated by calculating the attributable proportion due to interaction (AP). Results Overall, alcohol consumption was associated with a 30% reduced incidence of RA (HR 0.69, 95% CI 0.55 to 0.86) with a dose–response relationship (p value for trend <0.001) which remained significant after stratification by age and smoking habits. The positive association between smoking and RA incidence was reduced with increasing alcohol consumption (p value for trend <0.001). A synergistic effect was observed between alcohol and smoking (AP 0.40, 95% CI 0.15 to 0.64), indicating that 40% of the cases among the double exposed are due to the interaction per se. Conclusions Our findings suggest an inverse association between alcohol consumption and RA incidence, and a synergistic effect between alcohol and smoking.
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Affiliation(s)
- Louise Hedenstierna
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden .,Center of Rheumatology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Torbjörn Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research, Stockholm University, Stockholm University, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialst Center, Stockholm Health Services, Stockholm, Sweden
| | - Anna Karin Hedström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Effect of exercise training on fatigue and pain in patients with systemic autoimmune myopathies: A systematic review. Autoimmun Rev 2021; 20:102897. [PMID: 34274546 DOI: 10.1016/j.autrev.2021.102897] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023]
Abstract
Systemic autoimmune myopathies (or idiopathic inflammatory myopathies) are a wide group of rare rheumatic diseases characterized by muscle weakness due to muscle inflammation. Recent evidence has continually reinforced the relevance of the perception of pain and fatigue as parameters of notable contribution to reducing the quality of life of these patients. However, due to the multidimensional characteristic of these variables, few studies address the effects of pharmacological and non-pharmacological therapies, such as exercise training on these variables. With regard to patients with systemic autoimmune myopathies, the outcomes related to the effects of exercise training are focused on muscle strength and endurance, few explore the effects on the perception of pain and fatigue. Given this, studies that review systematically the available evidence of the effects of exercise training on these perceptions can contribute to management of this parameter in clinical practice. Given this context, the present study aims to review systematically the effectiveness of exercise training specifically on the perception of pain and fatigue.
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Hensvold A, Klareskog L. Towards prevention of autoimmune diseases: The example of rheumatoid arthritis. Eur J Immunol 2021; 51:1921-1933. [PMID: 34110013 DOI: 10.1002/eji.202048952] [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: 12/04/2020] [Revised: 04/18/2021] [Indexed: 12/16/2022]
Abstract
Prevention is the ultimate aim for clinicians and scientists concerned with severe diseases, like many immune-mediated conditions. Here, we describe recent progress in the understanding of etiology and molecular pathogenesis of rheumatoid arthritis (RA), which make this disease a potential prototype for prevention that may include both public health measures and targeted and personalized approaches that we call "personalized prevention." Critical components of this knowledge are (i) better understanding of the dynamics of the RA-associated autoimmunity that may begin many years before onset of joint inflammation; (ii) insights into how this immunity may be triggered at mucosal surfaces after distinct environmental challenges; (iii) better understanding of which features of the pre-existing immunity may cause symptoms that precede joint inflammation and predict a high risk for imminent arthritis development; and (iv) how molecular events occurring before onset of inflammation might be targeted by existing or future therapies, ultimately by specific targeting of Major histocompatibility complex (MHC) class II restricted and RA-specific immunity. Our main conclusion is that studies and interventions in the phase of autoimmunity preceding RA offer new opportunities to prevent the disease and thereby also understand the molecular pathogenesis of its different variants.
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Affiliation(s)
- Aase Hensvold
- Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden.,Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden
| | - Lars Klareskog
- Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden.,Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden.,Rheumatology Section, Theme inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
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Asoudeh F, Jayedi A, Kavian Z, Ebrahimi-Mousavi S, Nielsen SM, Mohammadi H. A systematic review and meta-analysis of observational studies on the association between animal protein sources and risk of rheumatoid arthritis. Clin Nutr 2021; 40:4644-4652. [PMID: 34237693 DOI: 10.1016/j.clnu.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the linear and nonlinear dose-response associations of animal-based dietary protein intake and risk of developing rheumatoid arthritis (RA). METHODS A systematic search of MEDLINE, Scopus and Embase was conducted up to October 2020. Observational studies that report risk estimates of RA for animal-based protein consumption were included. We calculated pooled relative risks (RRs) by using a random-effects model. Linear and non-linear dose-response analyses were performed to examine the dose-response relations between animal-based protein consumption and RA. RESULTS Seven cohort studies (n = 457,554) with 3545 incident cases and six case-control studies with 3994 cases and 5252 controls were identified. Highest compared with the lowest category of fish consumption was inversely associated with risk of RA (RR: 0.89; 95% CI, 0.80 to 0.99; I2 = 0%, n = 10). Also, a 100 g/day increment in fish intake was associated with a 15% decreased risk of RA. Dose-response analysis showed a modest U-shaped association between fish consumption and incidence of RA, with the lowest risk at a fish intake of 20-30 g/day (Pnon-linearity = 0.04). We found no significant association between consumption of red meat, poultry or dairy and the risk of RA. CONCLUSION The present study revealed a significant reverse association between fish consumption and risk of RA. While we observed no association between red meat, dairy or poultry consumption and risk of RA. Further well-designed prospective studies are needed to support our findings.
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Affiliation(s)
- Farzaneh Asoudeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Zahra Kavian
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sara Ebrahimi-Mousavi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Zaccardelli A, Sparks JA. Challenges and Opportunities of Targeted Behavioral Interventions for Groups at Risk for Developing Rheumatoid Arthritis. Healthcare (Basel) 2021; 9:641. [PMID: 34071429 PMCID: PMC8226912 DOI: 10.3390/healthcare9060641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is a serious autoimmune disease which causes painful, swollen joints and can impact quality of life and increase morbidity and mortality. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk from behaviors, elevation of RA-related autoantibodies, and early clinical disease manifestations such as undifferentiated arthritis. Early interventions are crucial to slowing progression to and potentially preventing RA onset. Modification of behaviors among at-risk individuals may decrease RA risk. There are several challenges and opportunities in implementing preventative behavioral interventions, which may vary within different at-risk groups. Methods: We performed a narrative review of the literature, including meta-analyses focused on RA risk-related behaviors as well as publications investigating the potential efficacy of behavioral modifications on RA risk. Results: There are multiple behavioral risk factors associated with RA, including smoking, obesity, low physical activity, low quality diet, and poor dental hygiene, which may contribute to progression to clinical RA. Meta-analyses have been performed for smoking, excess body weight, and physical activity. Likelihood of adopting behavioral modifications may increase as RA risk increases. Conclusions: Clinicians may be able to tailor preventative approaches to various RA at-risk groups to help reduce RA risk, but further research is needed. A better understanding of the relationship of behaviors with RA risk and optimized approaches to implementing behavioral changes may allow for clinicians to tailor their preventative approaches for at-risk individuals.
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Affiliation(s)
- Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA;
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA;
- Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 20115, USA
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29
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Deane KD, Holers VM. Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift. Arthritis Rheumatol 2021; 73:181-193. [PMID: 32602263 PMCID: PMC7772259 DOI: 10.1002/art.41417] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents with signs and symptoms of inflammatory arthritis (IA) as well as other features, such as autoantibodies and/or imaging findings, that provide sufficient confidence that the individual has RA-like IA (e.g., meeting established classification criteria) that warrants therapeutic intervention. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g., joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically apparent IA and classifiable RA. Indeed, the discovery of the "pre-RA" stage of seropositive disease has led to the development of several clinical trials in which individuals are studied to identify ways to delay or prevent the onset of clinically apparent IA/RA. This review focuses on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of pre-RA development, prediction of the likelihood and timing of future classifiable RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review discusses challenges and opportunities to be addressed to effect a paradigm shift in RA, where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.
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Affiliation(s)
- Kevin D. Deane
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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30
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Sparks JA, Malspeis S, Hahn J, Wang J, Roberts AL, Kubzansky LD, Costenbader KH. Depression and Subsequent Risk for Incident Rheumatoid Arthritis Among Women. Arthritis Care Res (Hoboken) 2021; 73:78-89. [PMID: 32937012 DOI: 10.1002/acr.24441] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association of depression with subsequent risk of rheumatoid arthritis (RA) by serologic phenotype. METHODS We performed a cohort study using pooled data from the Nurses' Health Study (NHS; 1992-2014) and the NHSII (1993-2015). Depression was defined according to the following composite definition: diagnosis by clinician, regular antidepressant use, or a 5-question Mental Health Inventory score of <60 using time-updated questionnaires during follow-up. Incident RA cases met research criteria by medical record review. Information on covariates, including smoking, diet, and body mass index, was obtained using questionnaires. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for RA risk (overall and by serologic phenotype) according to depression status and adjusted for potential confounders. All analyses included a time separation between assessments of depression and the window for RA risk of at least 4 years to lower the possibility that depressive symptoms due to early RA prior to diagnosis explained any associations. RESULTS Among 195,358 women, we identified 858 cases of incident RA (65% seropositive) over 3,087,556 person-years (median 17.9 years per participant). Compared to women without depression, those with depression had multivariable HRs as follows: 1.28 (95% CI 1.10-1.48) for all RA; 1.12 (95% CI 0.93-1.35) for seropositive RA; and 1.63 (95% CI 1.27-2.09) for seronegative RA. When analyzing components of the composite depression exposure variable, regular antidepressant use was not associated with subsequent seropositive RA (HR 1.21 [95% CI 0.97-1.49]) and was associated with seronegative RA (HR 1.75 [95% CI 1.32-2.32]). CONCLUSION Indicators of depression, specifically antidepressant use, were associated with subsequent increased risk for seronegative RA, and this finding was not explained by measured lifestyle factors prior to clinical presentation.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jill Hahn
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jiaqi Wang
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea L Roberts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Laura D Kubzansky
- Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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31
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Ye D, Mao Y, Xu Y, Xu X, Xie Z, Wen C. Lifestyle factors associated with incidence of rheumatoid arthritis in US adults: analysis of National Health and Nutrition Examination Survey database and meta-analysis. BMJ Open 2021; 11:e038137. [PMID: 33500279 PMCID: PMC7843328 DOI: 10.1136/bmjopen-2020-038137] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To quantify rheumatoid arthritis (RA) cases attributable to selected non-genetic risk factors. DESIGN National Health and Nutrition Examination Survey (NHANES) and meta-analysis. PARTICIPANTS US adults. DATA SOURCES The prevalence of exposure was obtained from NHANES. Weighted analysis was performed to account for the complex sampling design in NHANES. PubMed and Web of Science up to 31 March 2019 were searched to identify epidemiological studies reported the association between non-genetic risk factors and RA in US adults. Relative risk (RR) value and the corresponding CI were pooled by meta-analysis to evaluate the associations between modifiable risk factors and RA. Population attributable fraction (PAF) was calculated based on the prevalence and RR data. RESULTS The weighted percentages of former smokers, current smokers and overweight or obese people were 24.84%, 23.93% and 63.97%, and the average alcohol consumption was 51.34 g/week. In the meta-analysis, we found that former smokers (RR 1.22, 95% CI 1.10 to 1.36) and current smokers (RR 1.47, 95% CI 1.29 to 1.68) had higher risks of RA. Overweight and obese individuals had 1.27-fold (95% CI 1.09 to 1.48) increased risk of RA. Each per 50 g/week increment of alcohol consumption was associated with 8% (95% CI 0% to 16%) reduction in the risk of RA. Therefore, PAF value of smoking was 14.00% (95% CI 8.13% to 23.33%). Excess body mass index (BMI) was found to account for 14.73% (95% CI 5.45% to 23.50%) of RA incidence. The fraction of RA risk attributed by low alcohol intake was 8.21% (95% CI 0.31% to 16.39%). Collectively, we found that 32.69% (95% CI 13.41% to 50.96%) of RA cases were attributable to smoking, overweight or obesity and low alcohol drinking. CONCLUSION Nearly 33% of RA incidence was attributed to smoking, excess BMI and low alcohol drinking in USA. Our findings could provide a basis for developing guidelines of RA prevention and control in USA.
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Affiliation(s)
- Ding Ye
- Department of Epidemiology and Biostatistics, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yingying Mao
- Department of Epidemiology and Biostatistics, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yang Xu
- Department of Epidemiology and Biostatistics, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xueli Xu
- Department of Epidemiology and Biostatistics, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhijun Xie
- Institute of Basic Research in Clinical Medicine, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chengping Wen
- Institute of Basic Research in Clinical Medicine, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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32
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Sparks JA. Clinical application of personalized rheumatoid arthritis risk information: Translational epidemiology leading to precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020; 6:147-149. [PMID: 34124370 DOI: 10.1080/23808993.2021.1857237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
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van Boheemen L, Bolt JW, Ter Wee MM, de Jong HM, van de Sande MG, van Schaardenburg D. Patients' and rheumatologists' perceptions on preventive intervention in rheumatoid arthritis and axial spondyloarthritis. Arthritis Res Ther 2020; 22:217. [PMID: 32933547 PMCID: PMC7493385 DOI: 10.1186/s13075-020-02314-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/07/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Individuals at risk of developing rheumatoid arthritis (RA) may benefit from lifestyle or pharmacological interventions aimed at primary prevention. The same may apply to individuals at risk of axial spondyloarthritis (axSpA). Our aim was to investigate and compare the willingness of individuals at risk of RA or axSpA and rheumatologists to initiate preventive intervention. METHODS Individuals at risk of RA (arthralgia and anti-citrullinated protein antibodies and/or rheumatoid factor positivity without arthritis (RA-risk cohort; n = 100)), axSpA (first-degree relatives of HLA-B27-positive axSpA patients (SpA-risk cohort; n = 38)), and Dutch rheumatologists (n = 49) completed a survey on preventive intervention which included questions about disease perception, lifestyle intervention, and preventive medication. RESULTS At-risk individuals reported willingness to change median 7 of 13 lifestyle components in the areas of smoking, diet, and exercise. In contrast, 35% of rheumatologists gave lifestyle advice to ≥ 50% of at-risk patients. The willingness to use 100% effective preventive medication without side effects was 53% (RA-risk), 55% (SpA-risk), and 74% (rheumatologists) at 30% disease risk which increased to 69% (RA-risk) and 92% (SpA-risk and rheumatologists) at 70% risk. With minor side effects, willingness was 26%, 29%, and 31% (at 30% risk) versus 40%, 66%, and 76% (at 70% risk), respectively. CONCLUSIONS Risk perception and willingness to start preventive intervention were largely similar between individuals at risk of RA and axSpA. Although the willingness to change lifestyle is high among at-risk individuals, most rheumatologists do not advise them to change their lifestyle. In contrast, rheumatologists are more willing than at-risk patients to start preventive medication.
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Affiliation(s)
- Laurette van Boheemen
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center (ARC)-Reade, PO box 58271, 1040 HG, Amsterdam, the Netherlands.
| | - Janne W Bolt
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marieke M Ter Wee
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, VUmc, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VUmc, Amsterdam, the Netherlands
| | - Henriëtte M de Jong
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marleen G van de Sande
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center (ARC)-Reade, PO box 58271, 1040 HG, Amsterdam, the Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Rodd ZA, Hauser SR, Swartzwelder HS, Waeiss RA, Lahiri DK, Bell RL. Regulation of the deleterious effects of binge-like exposure to alcohol during adolescence by α7 nicotinic acetylcholine receptor agents: prevention by pretreatment with a α7 negative allosteric modulator and emulation by a α7 agonist in alcohol-preferring (P) male and female rats. Psychopharmacology (Berl) 2020; 237:2601-2611. [PMID: 32607619 PMCID: PMC7502519 DOI: 10.1007/s00213-020-05557-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/18/2020] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES Binge-like alcohol consumption during adolescence associates with several deleterious consequences during adulthood including an increased risk for developing alcohol use disorder (AUD) and other addictions. Replicated preclinical data has indicated that adolescent exposure to binge-like levels of alcohol results in a reduction of choline acetyltransferase (ChAT) and an upregulation in the α7 nicotinic receptor (α7). From this information, we hypothesized that the α7 plays a critical role in mediating the effects of adolescent alcohol exposure. METHODS Male and female P rats were injected with the α7 agonist AR-R17779 (AR) once during 6 time points between post-natal days (PND) 29-37. Separate groups were injected with the α7 negative allosteric modulator (NAM) dehydronorketamine (DHNK) 2 h before administration of 4 g/kg EtOH (14 total exposures) during PND 28-48. On PND 75, all rats were given access to water and ethanol (15 and 30%) for 6 consecutive weeks (acquisition). All rats were then deprived of EtOH for 2 weeks and then, alcohol was returned (relapse). RESULTS Administration of AR during adolescence significantly increased acquisition of alcohol consumption during adulthood and prolonged relapse drinking in P rats. In contrast, administration of DHNK prior to binge-like EtOH exposure during adolescence prevented the increase in alcohol consumption observed during acquisition of alcohol consumption and the enhancement of relapse drinking observed during adulthood. DISCUSSION The data indicate that α7 mediates the effects of alcohol during adolescence. The data also indicate that α7 NAMs are potential prophylactic agents to reduce the deleterious effects of adolescent alcohol abuse.
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Affiliation(s)
- Zachary A Rodd
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA.
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Sheketha R Hauser
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - H Scott Swartzwelder
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - R Aaron Waeiss
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Debomoy K Lahiri
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Richard L Bell
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Building, 320 W. 15th Street, Suite 300B, Indianapolis, IN, 46202-2266, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Greenblatt HK, Kim HA, Bettner LF, Deane KD. Preclinical rheumatoid arthritis and rheumatoid arthritis prevention. Curr Opin Rheumatol 2020; 32:289-296. [PMID: 32205569 PMCID: PMC7340337 DOI: 10.1097/bor.0000000000000708] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW This review is to provide an update on the current understanding of rheumatoid arthritis (RA) development related to disease development prior to the onset clinically apparent synovitis (i.e. Pre-RA), and opportunities for disease prevention. RECENT FINDINGS A growing number of studies have demonstrated that serum elevations of autoantibodies rheumatoid factor, antibodies to citrullinated protein/peptide antigens (ACPAs) and antibodies to other posttranslationally modified proteins (e.g. carbamylated proteins) are highly predictive of future development of inflammatory arthritis/RA during a period that can be termed Pre-RA. Other factors including genetic, environmental, symptoms and imaging findings can also enhance prediction. Moreover, several novel biomarkers and changes in autoantibodies (e.g. glycosylation of variable domains) have been identified in Pre-RA. There has also been growing evidence that initiation and propagation of RA-related autoimmunity during the Pre-RA phase may be related to mucosal processes. The discovery of Pre-RA has also underpinned the development of several clinical prevention trials in RA; specifically, the PRAIRI study demonstrated that a single dose of rituximab can delay the onset of clinically apparent IA in at-risk individuals. Additional studies are evaluating the ability of drugs including abatacept, hydroxychloroquine and methotrexate to prevent or delay future RA. SUMMARY The results from ongoing natural history and prevention trials in RA should further inform several critical issues in RA prevention including identification and enrolment of individuals at high-risk of imminent RA, the efficacy, safety and cost-effectiveness of prevention, and potentially the identification of new targets for prevention.
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Affiliation(s)
| | - Hyoun-Ah Kim
- University of Colorado Anschutz Medical Campus
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
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The Influence of Socio-Demographic Factors, Lifestyle and Psychiatric Indicators on Adherence to Treatment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study. ACTA ACUST UNITED AC 2020; 56:medicina56040178. [PMID: 32295226 PMCID: PMC7230943 DOI: 10.3390/medicina56040178] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022]
Abstract
Background and Objectives: Rheumatoid arthritis (RA) is a severe autoimmune disease characterized by chronic inflammation of the joints accompanied by the progressive deformation and destruction of cartilage and joint bones. This study aims to gain insight into the outcomes related to adherence in patients with rheumatoid arthritis. Predicting the medication adherence in RA patients is a key point to improve the treatment outcome. Materials and Methods: A number of 119 Romanian patients with RA were included and divided into two groups: first group included 79 patients treated with conventional therapy and second group included 40 patients treated with biologic therapy. A CQR-9 (compliance questionnaire rheumatology with nine items) and PDSQ (psychiatric diagnostic screening questionnaire) were performed to assess correlations between medication adherence, patient sociodemographic variables, 11 psychiatric scales (major depressive disorder, posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, psychosis, agoraphobia, social phobia, drug abuse/dependence, generalized anxiety disorder, somatization disorder, hypochondriasis) and lifestyle (bulimia, alcohol intake). Results: Whilst modelling factors associated with adherence, it was found that women and patients with higher education are more adherent. From the psychiatric indicators, only major depressive disorder and post-traumatic stress disorder were found to be positively correlated with therapeutic adherence. None of the assessed lifestyle factors influenced the adherence of RA patients. Conclusion: The knowledge of factors that impact on treatment adherence can be useful for clinicians to guide patient-centred care.
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Mahler M, Martinez-Prat L, Sparks JA, Deane KD. Precision medicine in the care of rheumatoid arthritis: Focus on prediction and prevention of future clinically-apparent disease. Autoimmun Rev 2020; 19:102506. [PMID: 32173516 DOI: 10.1016/j.autrev.2020.102506] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
There is an emerging understanding that an individual's risk for future rheumatoid arthritis (RA) can be determined using a combination of factors while they are still in a state where clinically-apparent inflammatory arthritis (IA) is not yet present. Indeed, this concept has underpinned several completed and ongoing prevention trials in RA. Importantly, risk factors can be divided into modifiable (e.g. smoking, exercise, dental care and diet) and non-modifiable factors (e.g. genetics, sex, age). In addition, there are now several biomarkers including autoantibodies, inflammatory markers and imaging techniques that are highly predictive of future clinically-apparent IA/RA. Although none of the prevention studies have yet provided major breakthroughs, several of them have provided valuable insights that can help to improve the design of future clinical trials and enable RA prevention. In aggregate, these findings suggest that the most accurate disease prediction models will require the combination of demographic and clinical information, biomarkers and potentially medical imaging data to identify individuals for intervention. This review summarizes some of the key aspects around precision medicine in RA with special focus on disease prediction and prevention.
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Affiliation(s)
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin D Deane
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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38
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Alpizar-Rodriguez D, Finckh A. Is the prevention of rheumatoid arthritis possible? Clin Rheumatol 2020; 39:1383-1389. [PMID: 32016656 DOI: 10.1007/s10067-020-04927-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 01/01/2023]
Abstract
Preclinical phases of rheumatoid arthritis (RA) have been described, genetic and environmental risk factors for RA development have been identified, and several biomarkers of RA have been detected long before the clinical onset of the disease; all of which have opened the possibility for preventive interventions. Several studies are currently exploring pharmacological and non-pharmacological interventions to prevent the development of RA. We will review the evidence for prevention of RA and discuss key challenges for preventive interventions, including identification of the adequate target population, the risks of applying potentially harmful and expensive therapies to asymptomatic at-risk individuals, and the importance of taking into account the preferences of individuals at risk regarding preventive treatment options.
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Affiliation(s)
- Deshiré Alpizar-Rodriguez
- Division of Rheumatology, Geneva University Hospital, Geneva, 26, Ave Beau-Séjour, 1211, Geneva, Switzerland.
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospital, Geneva, 26, Ave Beau-Séjour, 1211, Geneva, Switzerland
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Friedlander HM, Ford JA, Zaccardelli A, Terrio AV, Cho MH, Sparks JA. Obstructive lung diseases and risk of rheumatoid arthritis. Expert Rev Clin Immunol 2020; 16:37-50. [PMID: 31774329 DOI: 10.1080/1744666x.2019.1698293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Smoking is an established risk factor for both lung diseases and rheumatoid arthritis (RA). Chronic mucosal airway inflammation may result in immune tolerance loss, neoantigen formation, and production of RA-related autoantibodies that increase the subsequent risk of RA. In this review, we aimed to summarize the current evidence supporting the role of obstructive lung diseases and subsequent risk of RA.Areas covered: We identified scientific articles discussing the biologic mechanisms linking mucosal airway inflammation and RA risk. We also identified studies investigating asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, chronic tuberculous and nontuberculous mycobacterial infections, and interstitial lung disease with subsequent risk for RA.Expert opinion: The current evidence supports the hypothesis that mucosal airway inflammation may increase the risk of developing RA. However, most studies investigating this relationship have been retrospective and may not have adequately addressed the role of smoking. Larger prospective studies may provide stronger evidence for obstructive lung disease and RA risk. Determining the role of obstructive lung disease in RA pathogenesis may provide opportunity for RA prevention and screening strategies, while identifying novel biologic mechanisms that could offer targets to improve treatment and outcomes.
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Affiliation(s)
- H Maura Friedlander
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Julia A Ford
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alessandra Zaccardelli
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Alexsandra V Terrio
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Michael H Cho
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA, USA.,Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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40
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Associations About Arthritis. Clin Ther 2019; 41:1227-1229. [DOI: 10.1016/j.clinthera.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
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41
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Davis JM. Rheumatoid Arthritis: A Severe Disease That Preventive Approaches Would Greatly Benefit. Clin Ther 2019; 41:1240-1245. [DOI: 10.1016/j.clinthera.2019.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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42
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Isaacs JD, Iqbal K. Potential Pharmacologic Targets for the Prevention of Rheumatoid Arthritis. Clin Ther 2019; 41:1312-1322. [DOI: 10.1016/j.clinthera.2019.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 11/16/2022]
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43
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Deane KD, Cheung TT. Rheumatoid Arthritis Prevention: Challenges and Opportunities to Change the Paradigm of Disease Management. Clin Ther 2019; 41:1235-1239. [PMID: 31196651 DOI: 10.1016/j.clinthera.2019.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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44
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Deane KD, Holers VM. The Natural History of Rheumatoid Arthritis. Clin Ther 2019; 41:1256-1269. [PMID: 31196652 DOI: 10.1016/j.clinthera.2019.04.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This article reviews the phases of rheumatoid arthritis (RA) development in terms of the evolution of disease, with a focus on events that occur before the first appearance of clinically apparent inflammatory arthritis. This presynovitis period is defined in individuals who eventually develop classified RA as the pre-RA phase. We include additional discussion of the relevance of this model of RA development to the concept of disease prevention. METHODS The information provided in this review was identified through searches of the medical literature through MEDLINE and a review of references from published manuscripts as well as information obtained by the authors through attendance at various conferences and working groups related to pre-RA. FINDINGS It is now well established that RA develops in a series of phases. The first of these phases is believed to be the presence of genetic and/or environmental risk factors for RA in the absence of detectable systemic autoimmunity in the blood. After this phase, autoimmunity may be detectable through a variety of means (eg, autoantibodies, autoreactive cells) in peripheral blood; in addition, there is emerging evidence that perhaps initiation and early propagation of RA-related autoimmunity may occur at mucosal sites. The presence of autoimmunity detectable in the blood through serologic or other testing is followed in most individuals by a propagation phase that is characterized by an expansion of autoimmunity, inflammation, and symptoms. This transition may be associated with similar or different genetic and environmental factors that initially triggered autoimmunity, as well as continued mucosal inflammation and local RA-related autoantibody production. Eventually, clinically detectable inflammatory arthritis develops that can be classified as RA. IMPLICATIONS Understanding the phases of RA development are critical to the development of preventive strategies for this disease.
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Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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Cope AP. Considerations for Optimal Trial Design for Rheumatoid Arthritis Prevention Studies. Clin Ther 2019; 41:1299-1311. [PMID: 31196650 DOI: 10.1016/j.clinthera.2019.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/07/2019] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
The field of rheumatology has made major contributions to medicine through the identification of cellular and molecular targets and with the development of therapies for the treatment of an impressive range of immune-mediated rheumatic diseases. In recent years new milestones have been achieved. These include the recognition of an "at risk" state, defined by distinct clusters of characteristics, including disease-specific autoantibodies in serum and symptom complexes that include inflammatory joint pain. Studies seeking to prevent high-risk individuals from progressing to a state of clinically apparent arthritis have been initiated. Here, exploiting the current evidence base, an experimental framework to inform trial design is described, taking into consideration study patient phenotypes and highlighting the impact of risk stratification and the options available for therapeutic intervention according to the different phases of the preclinical syndrome. Pragmatic primary end points and suggestions for a set of risk-focused trial outcome measures are proposed, including both clinical assessments and patient-reported outcome measures. Rheumatoid arthritis prevention studies provide an important experimental framework for generating deeper insights into risk stratification and for refining trial design in the future. To this end, a research agenda is suggested, together with some considerations for imaging and for biological sampling. This commentary concludes with some of the operational issues that arise from such studies and addresses some of the challenges associated with recruitment and retention of the at-risk trial participant.
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Affiliation(s)
- Andrew P Cope
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Guys Campus, London, United Kingdom.
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