1
|
Yu KH, Chen HH, Cheng TT, Jan YJ, Weng MY, Lin YJ, Chen HA, Cheng JT, Huang KY, Li KJ, Su YJ, Leong PY, Tsai WC, Lan JL, Chen DY. Consensus recommendations on managing the selected comorbidities including cardiovascular disease, osteoporosis, and interstitial lung disease in rheumatoid arthritis. Medicine (Baltimore) 2022; 101:e28501. [PMID: 35029907 PMCID: PMC8735742 DOI: 10.1097/md.0000000000028501] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA)-related comorbidities, including cardiovascular disease (CVD), osteoporosis (OP), and interstitial lung disease (ILD), are sub-optimally managed. RA-related comorbidities affect disease control and lead to impairment in quality of life. We aimed to develop consensus recommendations for managing RA-related comorbidities. METHODS The consensus statements were formulated based on emerging evidence during a face-to-face meeting of Taiwan rheumatology experts and modified through three-round Delphi exercises. The quality of evidence and strength of recommendation of each statement were graded after a literature review, followed by voting for agreement. Through a review of English-language literature, we focused on the existing evidence of management of RA-related comorbidities. RESULTS Based on experts' consensus, eleven recommendations were developed. CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and at changes in DMARDs therapy. Considering the detrimental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on CVD risks, we recommend using the lowest possible dose of corticosteroids and prescribing NSAIDs cautiously. The OP/fragility fracture risk assessment includes dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA. The FRAX-based approach with intervention threshold is a useful strategy for managing OP. RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging and a multidisciplinary decision approach to determine RA-ILD severity. A treat-to-target strategy would limit RA-related comorbidities. CONCLUSIONS These consensus statements emphasize that adequate control of disease activity and the risk factors are needed for managing RA-related comorbidities, and may provide useful recommendations for rheumatologists on managing RA-related comorbidities.
Collapse
Affiliation(s)
- Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Biomedicine Science, National Chung Hsing University, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yeong-Jian Jan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Meng-Yu Weng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital
| | - Yeong-Jang Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-An Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jui-Tseng Cheng
- Division of Allergy, Immunology and Rheumatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Kuang-Yung Huang
- Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital
- College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Jih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology and Immunology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Yuan Chen
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
2
|
Arnaud L, Mertz P, Gavand PE, Martin T, Chasset F, Tebacher-Alt M, Lambert A, Muller C, Sibilia J, Lebrun-Vignes B, Salem JE. Drug-induced systemic lupus: revisiting the ever-changing spectrum of the disease using the WHO pharmacovigilance database. Ann Rheum Dis 2019; 78:504-508. [DOI: 10.1136/annrheumdis-2018-214598] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveDrug-induced lupus (DIL) is an idiosyncratic side effect of treatments in which symptoms overlap with those of systemic lupus erythematosus (SLE). The spectrum of DIL constantly evolves with that of the pharmacopoeia. Here, we used VigiBase, the WHO global individual case safety reports (ICSRs) database, to identify the main drugs associated with DIL.MethodsWe analysed all ICSRs classified as ‘systemic lupus erythematosus’ according to the Medical Dictionary for Drug Regulatory Activities term (preferred term level) in VigiBase. The drugs considered in the analysis were those not used to treat SLE, with a positive lower end of the 95% credibility interval for the information component (IC025) ≥0, an indicator value for disproportionate Bayesian reporting.ResultsA total of 12 166 DIL ICSRs were identified using VigiBase. From those, 8163 ICSRs reporting on 118 suspected drugs with IC025 ≥0 were extracted. The median age at DIL onset was 49 years and the female to male sex ratio was 4.3. The median delay between start of suspected treatment and DIL occurrence was 172 days. DIL was reported as serious adverse event in 55.4%. Among the 118 suspected drugs, 42 had not been previously reported in association with DIL. The drugs associated with the highest number of DIL cases were infliximab, adalimumab, etanercept, procainamide and hydralazine.ConclusionThis study enables the identification of 118 drugs associated with DIL. The list of suspected drugs may prove useful to physicians when confronted with potential DIL cases.Trial registration numberNCT03480529.
Collapse
|
3
|
Henry S, Bond R, Rosen S, Grines C, Mieres J. Challenges in Cardiovascular Risk Prediction and Stratification in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
4
|
Cardiovascular disease in rheumatoid arthritis: medications and risk factors in China. Clin Rheumatol 2017; 36:1023-1029. [PMID: 28342151 DOI: 10.1007/s10067-017-3596-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
This study aims to assess the risk factors of cardiovascular disease (CVD) and to determine the association of traditional and biologic disease-modifying anti-rheumatic drugs (DMARDs) with risk for CVD in Chinese rheumatoid arthritis (RA) patients. A cross-sectional cohort of 2013 RA patients from 21 hospitals around China was established. Medical history of CVD was documented. The patients' social background, clinical manifestations, comorbidities, and medications were also collected. Of the 2013 patients, 256 had CVD with an incidence of 12.7%. Compared with non-CVD controls, RA patients with CVD had a significantly advanced age, long-standing median disease duration, more often male and more deformity joints. Patients with CVD also had higher rates of smoking, rheumatoid nodules, interstitial lung disease, and anemia. The prevalence of comorbidities, including hypothyroidism, diabetes mellitus (DM), hypertension, and hyperlipidemia, was also significant higher in the CVD group. In contrast, patients treated with methotrexate, hydroxychloroquine (HCQ), and TNF blockers had lower incidence of CVD. The multivariate analysis showed that the use of HCQ was a protective factor of CVD, while hypertension, hyperlipidemia, and interstitial lung disease were independent risk factors of CVD. Our study shows that the independent risk factors of CVD include hypertension, hyperlipidemia, and interstitial lung disease. HCQ reduces the risk of CVD in patients with RA.
Collapse
|
5
|
Zheng WY, Zheng WX, Hua L. Detecting shared pathways linked to rheumatoid arthritis with other autoimmune diseases in a in silico analysis. Mol Biol 2016. [DOI: 10.1134/s0026893316030146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
6
|
Garcia M, Miller VM, Gulati M, Hayes SN, Manson JE, Wenger NK, Bairey Merz CN, Mankad R, Pollak AW, Mieres J, Kling J, Mulvagh SL. Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice. Mayo Clin Proc 2016; 91:226-40. [PMID: 26848004 DOI: 10.1016/j.mayocp.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/17/2022]
Abstract
Over the past decade, an emerging clinical research focus on cardiovascular (CV) disease (CVD) risk in women has highlighted sex-specific factors that are uniquely important in the prevention and early detection of coronary atherosclerosis in women. Concurrently, a 30% decrease in the number of female deaths from CVD has been observed. Despite this, CVD continues to be the leading cause of death in women, outnumbering deaths from all other causes combined. Clinical practice approaches that focus on the unique aspects of CV care for women are needed to provide necessary resources for the prevention, diagnosis, and treatment of CVD in women. In addition to increasing opportunities for women to participate in CV research, Women's Heart Clinics offer unique settings in which to deliver comprehensive CV care and education, ensuring appropriate diagnostic testing, while monitoring effectiveness of treatment. This article reviews the emerging need and role of focused CV care to address sex-specific aspects of diagnosis and treatment of CVD in women.
Collapse
Affiliation(s)
- Mariana Garcia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN; Department of Physiology, Mayo Clinic, Rochester, MN; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Martha Gulati
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA
| | - Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amy W Pollak
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Jennifer Mieres
- Department of Cardiology, Hofstra North Short-LIJ School of Medicine, Hempstead, NY
| | - Juliana Kling
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Sharon L Mulvagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
7
|
Arnaud L, Mathian A, Adoue D, Bader-Meunier B, Baudouin V, Belizna C, Bonnotte B, Boumedine F, Chaib A, Chauchard M, Chiche L, Daugas E, Ghali A, Gobert P, Gondran G, Guettrot-Imbert G, Hachulla E, Hamidou M, Haroche J, Hervier B, Hummel A, Jourde-Chiche N, Korganow AS, Kwon T, Le Guern V, Le Quellec A, Limal N, Magy-Bertrand N, Marianetti-Guingel P, Martin T, Martin Silva N, Meyer O, Miyara M, Morell-Dubois S, Ninet J, Papo T, Pennaforte JL, Polomat K, Pourrat J, Queyrel V, Raymond I, Remy P, Sacre K, Schmidt J, Sibilia J, Viallard JF, Viau Brabant A, Wahl D, Bruckert E, Amoura Z. [Screening and management of cardiovascular risk factors in systemic lupus erythematosus: Recommendations for clinical practice based on the literature and expert opinion]. Rev Med Interne 2014; 36:372-80. [PMID: 25455954 DOI: 10.1016/j.revmed.2014.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/17/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To develop French recommendations about screening and management of cardiovascular risk factors in systemic lupus erythematosus (SLE). METHODS Thirty-nine experts qualified in internal medicine, rheumatology and nephrology have selected recommendations from a list developed based on evidence from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS Experts recommended an annual screening of cardiovascular risk factors in SLE. Statins should be prescribed for primary prevention in SLE patients based on the level of LDL-cholesterol and the number of cardiovascular risk factors, considering SLE as an additional risk factor. For secondary prevention, experts have agreed on an LDL-cholesterol target of <0.7 g/L. Hypertension should be managed according to the 2013 European guidelines, using renin-angiotensin system blockers as first line agents in case of renal involvement. Aspirin can be prescribed in patients with high cardiovascular risk or with antiphospholipid antibodies. CONCLUSION These recommendations about the screening and management of cardiovascular risk factors in SLE can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients.
Collapse
Affiliation(s)
- L Arnaud
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France.
| | - A Mathian
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | - D Adoue
- Service de médecine interne et immunopathologie clinique, hôpital Purpan, Toulouse, France
| | - B Bader-Meunier
- Service d'immunologie et rhumatologie pédiatrique, centre de référence des maladies rares rhumatologiques et inflammatoires pédiatriques (CERHUMIP), hôpital Necker, Paris, France
| | - V Baudouin
- Service de néphrologie pédiatrique, hôpital Robert-Debré, Paris, France
| | - C Belizna
- Service de médecine interne, CHU d'Angers, Angers, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Bocage, Dijon, France
| | - F Boumedine
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Chaib
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Chauchard
- Service de médecine interne, hôpital Bichat, Claude-Bernard, Paris, France
| | - L Chiche
- Service de médecine interne, hôpital de la Conception, Marseille, France
| | - E Daugas
- Service de néphrologie, hôpital Bichat, Paris, France
| | - A Ghali
- Service de médecine interne, CHU d'Angers, Angers, France
| | - P Gobert
- Service de médecine interne et néphrologie, centre hospitalier d'Avignon, Avignon, France
| | - G Gondran
- Service de médecine interne A, hôpital Dupuytren, CHU de Limoges, Limoges, France
| | - G Guettrot-Imbert
- Service de médecine interne, hôpital Gabriel-Montpied, CHU, Clermont-Ferrand, France
| | - E Hachulla
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, Lille, France
| | - M Hamidou
- Service de médecine interne, Nantes, France
| | - J Haroche
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | - B Hervier
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Hummel
- Service de néphrologie adulte, hôpital Necker, Paris, France
| | - N Jourde-Chiche
- Service de néphrologie, hôpital de la Conception, Marseille, France
| | - A-S Korganow
- Service d'immunologie clinique, hôpital civil, CHU de Strasbourg, Strasbourg, France
| | - T Kwon
- Service de néphrologie pédiatrique, hôpital Robert-Debré, Paris, France
| | - V Le Guern
- Service de médecine interne, centre de référence maladies systémiques et auto-immunes rares, sclérodermies, vascularites, groupe hospitalier Cochin, Paris, France
| | - A Le Quellec
- Service de médecine interne A, hôpital Saint-Éloi, Montpellier, France
| | - N Limal
- Service de médecine interne, CHU Henri-Mondor, Créteil, France
| | - N Magy-Bertrand
- Service de médecine interne, CHU Jean-Minjoz, Besançon, France
| | | | - T Martin
- Service d'immunologie clinique, hôpital civil, CHU de Strasbourg, Strasbourg, France
| | | | - O Meyer
- Service de rhumatologie, hôpital Bichat-Claude-Bernard, Paris, France
| | - M Miyara
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Morell-Dubois
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, Lille, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Herriot, CHRU de Lyon, Lyon, France
| | - T Papo
- Service de médecine interne, hôpital Bichat, Claude-Bernard, Paris, France
| | - J-L Pennaforte
- Service de médecine interne, CHU de Reims, Reims, France
| | - K Polomat
- Service de médecine interne 5D, CHU de Martinique, Fort-de-France, Martinique
| | - J Pourrat
- Service de néphrologie, hôpital Rangueil, CHU, Toulouse, France
| | - V Queyrel
- Service de médecine interne, hôpital de l'Archet, Nice, France
| | - I Raymond
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, centre François-Magendie, Pessac, France
| | - P Remy
- Service de néphrologie, groupe hospitalier Henri-Mondor, Créteil, France
| | - K Sacre
- Service de médecine interne, hôpital Bichat, Claude-Bernard, Paris, France
| | - J Schmidt
- Service de médecine interne, CHU Nord, Amiens, France
| | - J Sibilia
- Service de rhumatologie, CHU Hautepierre, Strasbourg, France
| | - J-F Viallard
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, centre François-Magendie, Pessac, France
| | - A Viau Brabant
- Service de médecine interne, CHU de Reims, Reims, France
| | - D Wahl
- Inserm U 1116, service de médecine vasculaire, département de médecine interne, institut lorrain du cœur et des vaisseaux Louis-Mathieu, centre de compétence régional des maladies systémiques et auto-immunes rares, CHU de Nancy, université de Lorraine, Vandœuvre-lès-Nancy, France
| | - E Bruckert
- Service d'endocrinologie, métabolisme et prévention cardiovasculaire, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Z Amoura
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | | |
Collapse
|
8
|
Arnaud L, Mathian A, Bruckert E, Amoura Z. Le risque cardiovasculaire au cours du lupus systémique. Rev Med Interne 2014; 35:723-9. [DOI: 10.1016/j.revmed.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/02/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
|
9
|
Medical and Productivity Costs of Rheumatoid Arthritis in The Czech Republic: Cost-of-Illness Study Based on Disease Severity. Value Health Reg Issues 2014; 4:75-81. [PMID: 29702811 DOI: 10.1016/j.vhri.2014.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE International pharmacoeconomic studies suggest that functional impairment can be a significant predictor for the evaluation of direct and productivity costs for rheumatoid arthritis (RA). We calculated the direct and productivity costs for five Health Assessment Questionnaire (HAQ) groups of patients (HAQ scores <0.6, 0.6 ≥ 1.1, 1.1 ≥ 1.6, 1.6 ≥ 2.1, and ≥2.1) in the Czech Republic. METHODS This was a retrospective cross-sectional study. We included 261 patients with RA, aged 18 to 84 years. We applied a bottom-up method by retrospectively reviewing individual patient medical records. Patients' demographic characteristics, patient-reported outcome, and clinical parameters were gathered at the time of data collection. For the calculation of productivity costs, we used the friction cost approach, based on patient absenteeism with a friction period of 130 workdays, with average monthly income used as the denominator. Costs were expressed as a mean value per patient with RA in each HAQ group. RESULTS Mean patient age was 56.4 years. average time from diagnosis was 14.5 years, the mean HAQ score was 1.15, and the Disease Activity Score in 28 joints was 3.45. A total of 47.5% patients were treated with biologics. Mean annual direct medical costs for each HAQ group were €5315, €7357, €7697, €7716, and €8968, respectively. The mean annual indirect costs associated with productivity loss were €1414, €1459, €1610, €1876, and €2307, respectively. CONCLUSIONS Direct costs and productivity costs for patients with RA are closely related to the value of the HAQ score. The annual mean total (direct plus productivity) costs per patient 1) treated with biologics, 2) without biologic treatment, and 3) from the overall cohort were €14,763, €3,559, and €8,882, respectively.
Collapse
|
10
|
Soubrier M, Chamoux NB, Tatar Z, Couderc M, Dubost JJ, Mathieu S. Cardiovascular risk in rheumatoid arthritis. Joint Bone Spine 2014; 81:298-302. [DOI: 10.1016/j.jbspin.2014.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
|
11
|
Soubrier M, Mathieu S, Hermet M, Makarawiez C, Bruckert E. Do all lupus patients need statins? Joint Bone Spine 2012; 80:244-9. [PMID: 23098926 DOI: 10.1016/j.jbspin.2012.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 01/12/2023]
Abstract
Statin therapy decreases cardiovascular morbidity and mortality rates when used as either primary or secondary prevention. An immunomodulating effect of statins has been suggested. Incontrovertible evidence of accelerated atheroma has been obtained in patients with systemic lupus erythematosus (SLE). Routine statin therapy in SLE patients might therefore produce both cardiovascular and immunological benefits. However, routine statin therapy is inappropriate in SLE patients, the main reason being the absence of a vast interventional study done specifically in this population. An immunomodulating role for statins in SLE has not been convincingly established. The effect of statin therapy on markers for subclinical atheroma (intima-media thickness changes over time) is unclear, and there are no studies proving that statins are effective when used for primary or secondary cardiovascular prevention. Nevertheless, we believe that a serum lipid profile should be obtained once a year in all SLE patients. There is a sound rationale for classifying all SLE patients as being at high cardiovascular risk and those receiving secondary prevention as at very high risk. Consequently, the serum LDL-cholesterol level must be kept below 100 mg/dL and 70 mg/dL in these two populations, respectively. Statins are the only widely recommended drugs for achieving these treatment targets. Statin therapy requires specific monitoring precautions (transaminase levels) given the high prevalence of comorbidities and use of concomitant medications in SLE patients.
Collapse
Affiliation(s)
- Martin Soubrier
- Service de rhumatologie, hôpital G.-Montpied, place H.-Dunant, BP 69, 63003 Clermont-Ferrand, France.
| | | | | | | | | |
Collapse
|
12
|
De Vera MA, Choi H, Abrahamowicz M, Kopec J, Lacaille D. Impact of statin discontinuation on mortality in patients with rheumatoid arthritis: A population-based study. Arthritis Care Res (Hoboken) 2012; 64:809-16. [DOI: 10.1002/acr.21643] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
13
|
Pham T, Bachelez H, Berthelot JM, Blacher J, Bouhnik Y, Claudepierre P, Constantin A, Fautrel B, Gaudin P, Goëb V, Gossec L, Goupille P, Guillaume-Czitrom S, Hachulla E, Huet I, Jullien D, Launay O, Lemann M, Maillefert JF, Marolleau JP, Martinez V, Masson C, Morel J, Mouthon L, Pol S, Puéchal X, Richette P, Saraux A, Schaeverbeke T, Soubrier M, Sudre A, Tran TA, Viguier M, Vittecoq O, Wendling D, Mariette X, Sibilia J. TNF alpha antagonist therapy and safety monitoring. Joint Bone Spine 2011; 78 Suppl 1:15-185. [PMID: 21703545 DOI: 10.1016/s1297-319x(11)70001-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop and/or update fact sheets about TNFα antagonists treatments, in order to assist physicians in the management of patients with inflammatory joint disease. METHODS 1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable; 2. identification and review of publications relevant to each topic; 3. development and/or update of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The experts were rheumatologists and invited specialists in other fields, and they had extensive experience with the management of chronic inflammatory diseases, such as rheumatoid. They were members of the CRI (Club Rhumatismes et Inflammation), a section of the Société Francaise de Rhumatologie. Each fact sheet was revised by several experts and the overall process was coordinated by three experts. RESULTS Several topics of major interest were selected: contraindications of TNFα antagonists treatments, the management of adverse effects and concomitant diseases that may develop during these therapies, and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA and SpA, initiation and monitoring of TNFα antagonists treatments, management of patients with specific past histories, and specific clinical situations such as pregnancy; 2. diseases other than RA, such as juvenile idiopathic arthritis; 3. models of letters for informing the rheumatologist and general practitioner; 4. and patient information. CONCLUSION These TNFα antagonists treatments fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on these therapies. They will be available continuously at www.cri-net.com and updated at appropriate intervals.
Collapse
Affiliation(s)
- Thao Pham
- Rheumatology Department, CHU Sainte-Marguerite, Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Amin AM, Nawito ZO, Atfy RA, El-Hadidi KT. Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients? Rheumatol Int 2011; 32:2075-81. [DOI: 10.1007/s00296-011-1926-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 03/27/2011] [Indexed: 11/28/2022]
|
15
|
Cardiovascular events and survival in rheumatoid arthritis: effects of anti-tumor necrosis factor-alpha treatment. Transl Res 2011; 157:6-9. [PMID: 21146145 DOI: 10.1016/j.trsl.2010.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 10/28/2010] [Indexed: 11/22/2022]
|
16
|
Ruyssen-Witrand A, Fautrel B, Saraux A, Le Loët X, Pham T. Risque cardiovasculaire associé à la corticothérapie à faible dose dans la polyarthrite rhumatoïde : revue de la littérature. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.rhum.2010.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
17
|
Mathieu S, Motreff P, Soubrier M. Spondyloarthropathies: an independent cardiovascular risk factor? Joint Bone Spine 2010; 77:542-5. [PMID: 20646947 DOI: 10.1016/j.jbspin.2010.05.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2010] [Indexed: 12/16/2022]
Abstract
An increase in cardiovascular mortality and morbidity has been convincingly documented in rheumatoid arthritis. Data on spondyloarthropathies are more limited. Here, we discuss published studies indicating that patients with spondyloarthropathies are at increased risk for cardiovascular disease. The excess risk is probably multifactorial, being related both to chronic systemic inflammation and to high prevalences of conventional cardiovascular risk factors. Cardiovascular risk management in patients with spondyloarthropathies requires optimal control of disease activity combined with interventions targeting conventional cardiovascular risk factors.
Collapse
Affiliation(s)
- Sylvain Mathieu
- Service de rhumatologie, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
| | | | | |
Collapse
|
18
|
Pham T, Claudepierre P, Constantin A, de Bandt M, Fautrel B, Gossec L, Gottenberg JE, Goupille P, Guillaume S, Hachulla E, Masson C, Morel J, Puéchal X, Saraux A, Schaeverbeke T, Wendling D, Bruckert E, Pol S, Mariette X, Sibilia J. Tocilizumab: therapy and safety management. Joint Bone Spine 2010; 77 Suppl 1:S3-100. [PMID: 20610315 DOI: 10.1016/s1297-319x(10)70001-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To develop fact sheets about tocilizumab, in order to assist physicians in the management of patients with inflammatory joint disease. METHODS 1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable; 2. identification and review of publications relevant to each topic; 3. development of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The 20 experts were rheumatologists and invited specialists in other fields, and they had extensive experience with the management of RA. They were members of the CRI (Club Rhumatismes et Inflammation), a section of the Société Francaise de Rhumatologie. Each fact sheet was revised by several. experts and the overall process was coordinated by three experts. RESULTS Several topics of major interest were selected: contraindications of tocilizumab; the management of adverse effects and concomitant diseases that may develop during tocilizumab therapy; and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: Several topics of major interest were selected: contraindications of tocilizumab; the management of adverse effects and concomitant diseases that may develop during tocilizumab therapy; and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA, initiation and monitoring of tocilizumab therapy, management of patients with specific past histories, and specific clinical situations such as pregnancy; 2. diseases other than RA, such as juvenile idiopathic arthritis; 3. models of letters for informing the rheumatologist and general practitioner; 4. and patient information. CONCLUSION These tocilizumab fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on tocilizumab therapy. They will be available continuously at www.cri-net.com and updated at appropriate intervals.
Collapse
Affiliation(s)
- Thao Pham
- Service de Rhumatologie, CHU Conception, Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Soubrier M, Mathieu S, Payet S, Dubost JJ, Ristori JM. Elderly-onset rheumatoid arthritis. Joint Bone Spine 2010; 77:290-6. [PMID: 20554241 DOI: 10.1016/j.jbspin.2010.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2009] [Indexed: 12/14/2022]
Abstract
The treatment of elderly-onset rheumatoid arthritis pursues the same objectives as in younger patients: to control the clinical manifestations, to prevent structural damage, to preserve function, and to decrease excess mortality. In the elderly, the presence of co-morbidities and increased rate of drug-related adverse effects raise specific therapeutic challenges. Nonsteroidal anti-inflammatory drugs are associated with cardiovascular, gastrointestinal, and renal adverse events. The role for corticosteroid therapy remains controversial. Although glucocorticoids provide a short-term decrease in clinical activity and probably a medium-term decrease in structural damage, these benefits are offset by numerous adverse effects. Methotrexate was effective in clinical trials and observational studies and did not produce a higher adverse event rate compared to younger patients, provided renal function was normal. Data on the efficacy of TNFalpha antagonists in therapeutic trials are available only for etanercept. Disease activity decreased and function improved. The adverse event rate was higher in older patients, but this was also true of the conventional drugs used as comparators. Registry data confirm that TNFalpha antagonist therapy is effective in RA. An increased rate of infections was found only in some registries. To combat the 2-fold cardiovascular risk increase associated with RA, disease activity should be stringently controlled and all cardiovascular risk factors managed aggressively.
Collapse
Affiliation(s)
- Martin Soubrier
- Service de Rhumatologie, hôpital G.-Montpied, BP 69, 63003 Clermont-Ferrand, France.
| | | | | | | | | |
Collapse
|
20
|
Ruyssen-Witrand A, Fautrel B, Saraux A, Le Loët X, Pham T. Cardiovascular risk induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review. Joint Bone Spine 2010; 78:23-30. [PMID: 20471897 DOI: 10.1016/j.jbspin.2010.02.040] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 02/03/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the association between cardiovascular (CV) risk and low-dose corticosteroids (LD-CT, defined as a daily dose <10mg/day of prednisone) in rheumatoid arthritis (RA) patients. METHODS DATA SOURCE A systematic review of the literature up to June 2009 was performed. DATA EXTRACTION (1) cardiovascular risk factors: high blood pressure, glycemia and lipid profile, carotid intima-media thickness, pulse-wave velocity, ventricular function; (2) "hard" outcomes: heart failure (HF), stroke, myocardial infarction (MI) or mortality. DATA ANALYSIS descriptive, comparing CV risk between LD-CT-treated RA patients and LD-CT-non-treated RA patients. RESULTS Of the 1138 screened reports, the literature search identified 37 assessing CV risk in LD-CT treated RA. The analysis showed a protective effect on serum lipid profile, an increase of insulin resistance or glycemia, probably no effect on blood pressure, no effect on atherosclerosis, discrepancies regarding arterial stiffness and no effect on ventricular function or heart rate variability. An association of LD-CT with major CV events was found in 4/6 studies. This included MI (HR=1.7 [1.2-2.3]), stroke (OR=4.36 [1.60-11.90] for LDC between 6 and 10mg/day), mortality (HR=2.03 [1.25-3.32]) and a composite index of CV events (in the group of rheumatoid factor positive RA, HR=2.21 [1.22-4.00]). Two studies did not find any significant association between LD-CT exposure and mortality (OR=2.25 [0.29-102.5]) or a composite index of CV events (OR=1.3 [0.8-2.0]). CONCLUSION Although the literature review showed poor association between LDC exposure and CV risk factors, a trend of increasing major CV events was identified.
Collapse
Affiliation(s)
- Adeline Ruyssen-Witrand
- Service de rhumatologie B, hôpital Cochin, AP-HP, université Paris-V René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | | | | | | | | |
Collapse
|
21
|
Soubrier M, Mathieu S, Bruckert E. Risque cardiovasculaire en rhumatologie : critères et scores. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.monrhu.2010.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Goulenok TM, Meune C, Gossec L, Dougados M, Kahan A, Allanore Y. Usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy or rheumatoid arthritis. Joint Bone Spine 2010; 77:146-50. [PMID: 20189433 DOI: 10.1016/j.jbspin.2010.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy (SpA) or rheumatoid arthritis (RA). METHODS We included consecutive patients with SpA or RA or with degenerative joint disease (control group) admitted over a 6-month period and free of cardiovascular events. A 12-lead electrocardiogram (ECG) was obtained and was interpreted by a cardiologist who was unaware of the diagnosis. RESULTS We included 108 patients with SpA (mean duration, 11+/-10 years), 106 with RA (mean duration, 12+/-9 years), and 74 with degenerative joint disease (controls). No patient had cardiovascular symptoms or a prior history of cardiovascular disease. The only difference in cardiovascular risk factors across the three populations was a higher prevalence of diabetes in the RA and control groups. We found no differences between the SpA or RA groups and the control group regarding the rates of the following ECG findings: premature beats, atrioventricular block (2.8% in the SpA group, 1.9% in the RA group, and 2.7% in the control group), complete or incomplete left bundle branch block (0.9%, 0.9%, and 2.7%, respectively), complete right bundle branch bloc or left bundle branch block (0.9%, 4.7%, and 4.1%, respectively); and abnormalities suggesting myocardial ischemia (10.2%, 19.8%, and 17.6%, respectively). CONCLUSION In patients with SpA or RA who have no cardiovascular symptoms or history of cardiovascular disease, a routine ECG shows no increase in the cardiac abnormalities specifically associated with these joint diseases, compared to controls with degenerative joint disease.
Collapse
Affiliation(s)
- Tiphaine Miquel Goulenok
- Services de rhumatologie A, hôpital Cochin, AP-HP, université Paris-Descartes, 27, rue du faubourg 75679 Paris cedex 14, France
| | | | | | | | | | | |
Collapse
|
23
|
John H, Hale ED, Treharne GJ, Carroll D, Kitas GD. 'All singing from the same hymn sheet': healthcare professionals' perceptions of developing patient education material about the cardiovascular aspects of rheumatoid arthritis. Musculoskeletal Care 2009; 7:256-271. [PMID: 19517492 DOI: 10.1002/msc.157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in Britain, and its prevention is a priority. Rheumatoid arthritis (RA) patients have an increased risk of CVD, and management of modifiable classical risk factors requires a programme with patient education at its heart. Before a programme for RA patients is implemented, it is important to explore the perceptions of patients and relevant healthcare professionals and consider how these could influence the subsequent content, timing and delivery of such education. Here, we assess healthcare professionals' perceptions. METHODS Qualitative focus group methodology was adopted. Four group meetings of healthcare professionals were held using a semi-structured interview schedule. The focus group transcripts were analysed using interpretative phenomenological analysis. RESULTS Three superordinate themes emerged: professional determinations about people with RA, including their perceptions about patients' priorities and motivations; communication about CVD risk, including what should be communicated, how, to whom and when; and responsibility for CVD management, referring to patients and the healthcare community. CONCLUSIONS Although healthcare professionals agree that it is important to convey the increased CVD risk to patients with RA, there is concern they may be less proactive in promoting risk management strategies. There was uncertainty about the best time to discuss CVD with RA patients. Maintaining a close relationship between primary and secondary care was thought to be important, with all healthcare professionals 'singing from the same hymn sheet'. These findings can inform the development of novel education material to fulfil a currently unmet clinical need.
Collapse
Affiliation(s)
- Holly John
- Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Russells Hall Hospital, Dudley, UK.
| | | | | | | | | |
Collapse
|
24
|
Crilly MA, Kumar V, Clark HJ, Scott NW, Macdonald AG, Williams DJ. Arterial stiffness and cumulative inflammatory burden in rheumatoid arthritis: a dose–response relationship independent of established cardiovascular risk factors. Rheumatology (Oxford) 2009; 48:1606-12. [PMID: 19858120 DOI: 10.1093/rheumatology/kep305] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael A Crilly
- Section of Population Health, Institute of Applied Health Sciences, Aberdeen University Medical School, Aberdeen AB25 2ZD, UK.
| | | | | | | | | | | |
Collapse
|
25
|
Tanasescu C, Jurcut C, Jurcut R, Ginghina C. Vascular disease in rheumatoid arthritis: from subclinical lesions to cardiovascular risk. Eur J Intern Med 2009; 20:348-54. [PMID: 19524171 DOI: 10.1016/j.ejim.2008.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 07/31/2008] [Accepted: 09/04/2008] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) is one of the most prevalent and complex inflammatory diseases affecting primarily the joints, but also associating several extra-articular features. The vascular disease in RA encompasses a large spectrum of lesions, from rheumatoid vasculitis to atherosclerotic lesions. During the last years the importance of the vascular disease related to atherosclerosis in terms of cardiovascular morbidity and global mortality became evident in RA. The inflammatory hypothesis of atherosclerosis in RA implies that mediators originating from the inflamed synovial tissue or from the liver may have systemic vascular consequences, leading to endothelial dysfunction and structural abnormalities of the vessels. Hence, the global management of patients with RA must include the improvement of cardiovascular risk in parallel with the management of joint disease.
Collapse
Affiliation(s)
- Coman Tanasescu
- Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania.
| | | | | | | |
Collapse
|
26
|
Vliet Vlieland TPM, Pattison D. Non-drug therapies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2009; 23:103-16. [PMID: 19233050 DOI: 10.1016/j.berh.2008.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Non-pharmacological treatment modalities are often used as an adjunct to drug therapy in patients with rheumatoid arthritis (RA). The aim of this overview is to summarize the available evidence on the effectiveness of these modalities in early RA. The few available randomized controlled trials that have specifically investigated patients with early RA support the effectiveness of dynamic exercise and cognitive behavioural interventions, and to a lesser extent of joint protection programmes and foot orthoses. The effectiveness of multidisciplinary team-care programmes, specialist nurse care, electro-physical modalities (including passive hydrotherapy), wrist orthoses, and dietary interventions have not been studied in patients with early RA. Current recommendations on the usage of non-pharmacological treatment modalities in sets of guidelines on the management of early RA vary with respect to their scope, strength and level of detail. The results of this review indicate a need for further investigation into the most clinically effective and cost-effective strategies to deliver non-pharmacological treatment modalities as well as comprehensive arthritis care models in early RA.
Collapse
Affiliation(s)
- Theodora P M Vliet Vlieland
- Leiden University Medical Center, Department of Orthopaedics and Department of Rheumatology, Leiden, The Netherlands.
| | | |
Collapse
|
27
|
|
28
|
Ruyssen-Witrand A, Mouterde G, Dernis E, Gaudin P, Wendling D, Cantagrel A, Claudepierre P, Fautrel B, Maillefert JF, Saraux A, Schaeverbeke T, Tebib J, Pham T, Le Loët X. Tolérance des glucocorticoïdes dans la polyarthrite rhumatoïde : élaboration de recommandations pour la pratique clinique, à partir d’une analyse systématique de la littérature et de l’opinion d’experts. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1169-8330(08)70010-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
29
|
Abstract
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are associated with increased mortality, largely as a consequence of cardiovascular disease. Increased cardiovascular morbidity and mortality in patients with RA and SLE cannot be entirely explained by traditional risk factors, suggesting that the systemic inflammation that characterizes these diseases may accelerate atherosclerosis. We used carotid ultrasonography to investigate the prevalence and correlates to preclinical atherosclerosis in patients with RA and SLE. Because atherosclerosis is a systemic disease, assessment of carotid plaque by ultrasonography provides a robust, direct measure of systemic atherosclerosis. We observed a substantially increased prevalence of carotid plaque in RA and SLE patients compared with age- and sex-matched controls, which remained after adjustment for traditional risk factors. The presence of carotid atherosclerosis was associated with disease duration in both RA and SLE and damage in SLE. These data support the hypothesis that inflammation associated with RA and SLE contributes to accelerated atherosclerosis and argue that RA and SLE disease activity should be more aggressively managed.
Collapse
|
30
|
Späh F. Inflammation in atherosclerosis and psoriasis: common pathogenic mechanisms and the potential for an integrated treatment approach. Br J Dermatol 2008; 159 Suppl 2:10-7. [PMID: 18700910 DOI: 10.1111/j.1365-2133.2008.08780.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Inflammation plays a key role in the pathogenesis of a number of chronic inflammatory systemic diseases (CISDs), including psoriasis, rheumatoid arthritis, systemic lupus erythematosus and Crohn's disease, and also in the pathogenesis of atherosclerosis. CISDs and cardiovascular diseases, such as atherosclerosis, share common pathogenic features, and cardiovascular disease is an important cause of morbidity and mortality in patients with CISDs. Activated inflammatory cells and pro-inflammatory cytokines contribute to the development of psoriatic lesions and play an important role in the breakdown of atherosclerotic plaques. Psoriasis and atherosclerosis also have similar histological characteristics involving T cells, macrophages and monocytes. In particular, the extravasation of T cells through the epithelium is characteristic of both psoriatic and atherosclerotic plaques. Cardiovascular disease is an important cause of morbidity and mortality in patients with psoriasis, which is associated with an increased cardiovascular risk profile compared with the general population. Patients with psoriasis are at increased risk of arterial hypertension, coronary heart disease, hyperlipidaemia, obesity and type II diabetes, which are more prevalent than in control patients. This increased risk could be due to the effects of chronic inflammatory changes, particularly the infiltration of T cells and subsequent secretion of pro-inflammatory cytokines. Some drugs used in the treatment of cardiovascular disease, such as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors have anti-inflammatory activity. In addition, systemic treatments for psoriasis may, by decreasing inflammation, reduce the risk of cardiovascular disease. It is suggested, therefore, that an integrated approach to the treatment of the inflammatory processes underlying both psoriasis and atherosclerosis may be beneficial in reducing cardiovascular risk in patients with psoriasis. The newer targeted biological therapies, such as efalizumab and infliximab, which offer the potential for long-term disease control in psoriasis, may be of particular use in this setting.
Collapse
Affiliation(s)
- F Späh
- HELIOS Klinikum Krefeld, Medizinische Klinik I, Lutherplatz 40, D-47805 Krefeld, Germany.
| |
Collapse
|
31
|
Abstract
Psoriasis is a chronic, inflammatory, immune-mediated skin disease associated with substantial comorbidity. Traditional comorbid conditions include psychological/psychiatric disorders, psoriatic arthritis and inflammatory bowel disease. Increasingly, an association with metabolic dysfunction, including obesity and the metabolic syndrome, and cardiovascular disease, with consequent effects on morbidity and mortality, has been recognized in psoriasis. The underlying inflammatory mechanisms of both psoriasis and psoriasis-associated comorbidities involve mediation by proinflammatory T-helper type 1 cytokines. For effective management of psoriasis and related comorbidities, an integrated approach targeting both cutaneous and systemic inflammation may be beneficial, and strategies to improve overall management of the patient should be encouraged to reduce the disease burden. This paper discusses the emerging role of biological agents in this approach, and offers an appreciation of the role of existing anti-psoriasis and adjunctive therapies.
Collapse
Affiliation(s)
- W Gulliver
- Newlab Clinical Research Inc., 1 Paton Street, Suite 007, St. John's NL, Canada.
| |
Collapse
|
32
|
Pereira I, Laurindo I, Burlingame R, Anjos L, Viana V, Leon E, Vendramini M, Borba E. Auto-antibodies do not influence development of atherosclerotic plaques in rheumatoid arthritis. Joint Bone Spine 2008; 75:416-21. [DOI: 10.1016/j.jbspin.2008.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
|
33
|
Severe atherosclerosis in rheumatoid arthritis and hyperhomocysteinemia: Is there a link? Joint Bone Spine 2008; 75:499-501. [DOI: 10.1016/j.jbspin.2007.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/24/2007] [Indexed: 11/20/2022]
|
34
|
Bhatia GS, Sosin MD, Patel JV, Grindulis KA, Khattak FH, Davis RC, Lip GYH. Plasma indices of endothelial and platelet activation in Rheumatoid Disease: relationship to cardiovascular co-morbidity. Int J Cardiol 2008; 134:97-103. [PMID: 18501982 DOI: 10.1016/j.ijcard.2008.01.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 01/15/2008] [Accepted: 01/20/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rheumatoid Disease (RD) is associated with ischaemic heart disease (IHD). We sought to investigate whether abnormalities of endothelial function and platelet activation in patients with established RD were related to co-morbid cardiovascular risk factors. METHODS In a cross-sectional study, RD patients with no cardiac risk factors and normal cardiac function (RD, n=73), those with cardiovascular disease or risk factors and normal cardiac function (RD-risk, n=59), and those with left ventricular systolic dysfunction (RD-LVSD, n=21) were recruited, and compared to healthy controls (HC, n=76). Plasma levels of von Willebrand factor (vWF, an index of endothelial damage/dysfunction), soluble E-selectin (sE-sel, a marker of endothelial activation), and soluble P-selectin (sP-sel, an index of platelet activation) were studied. RESULTS Plasma levels of vWF and sP-sel (but not sE-sel) were significantly higher among 153 RD patients compared to controls (p=0.002 and p<0.001, respectively). Levels of vWF progressively rose with increasing cardiovascular risk across the four subgroups (p for trend<0.001). Previous IHD was independently associated with vWF levels, and diabetes mellitus (DM) was similarly associated with all three markers. RD itself and beta-blocker use were associated with sP-sel. CONCLUSION Plasma levels of vWF and sP-sel are higher among RD patients. Levels of vWF were particularly influenced by cardiac risk factor status, and associated with known IHD and DM.
Collapse
Affiliation(s)
- Gurbir S Bhatia
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B187QH, England UK
| | | | | | | | | | | | | |
Collapse
|
35
|
Shelling ML, Federman DG, Prodanovich S, Kirsner RS. Psoriasis and vascular disease: an unsolved mystery. Am J Med 2008; 121:360-5. [PMID: 18456026 DOI: 10.1016/j.amjmed.2008.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 01/15/2008] [Accepted: 01/16/2008] [Indexed: 12/20/2022]
Abstract
Psoriasis is an immune disease most commonly recognized for its skin and joint manifestations. These produce significant physical, social, and psychological distress in affected patients and resultant reductions in their quality of life. As expected, these concerns are vital in providing symptomatic improvement and in selecting an individualized therapy. Yet, the approach in management of these patients is likely to change given the growing body of evidence linking psoriasis and vascular disease. Stemming from an anecdotally described relationship, the association between psoriasis and vascular disease has become a focus of current research to further elucidate the pathophysiology underlying and connecting these two diseases. This article includes a review of the classical cardiovascular risk factors, the atherothrombotic markers, and the environmental stressors associated with psoriasis, as well as a critical review of the observed vascular diseases, the proposed mechanism of atherosclerosis, and the benefits of treatment of psoriasis.
Collapse
Affiliation(s)
- Michael L Shelling
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | | | | | | |
Collapse
|
36
|
Vinsonneau U, Brondex A, Mansourati J, Saraux A, Cornily JC, Arlès F, Godon P, Quiniou G. Cardiovascular disease in patients with spondyloarthropathies. Joint Bone Spine 2008; 75:18-21. [PMID: 17913549 DOI: 10.1016/j.jbspin.2007.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 04/03/2007] [Indexed: 11/19/2022]
Abstract
Spondyloarthropathies are associated with a greater cardiovascular risk than expected based on the cardiac lesions known to occur in these diseases. The prevalence of several conventional risk factors is high in spondyloarthropathy patients, and chronic inflammation also contributes to premature plaque formation. In addition, susceptibility genes for spondyloarthropathies may be associated with an increased risk of cardiovascular disease. Finally, several drugs used to treat spondyloarthropathies may contribute to the occurrence of cardiovascular events. A careful evaluation of the cardiovascular risk profile is a key component of the management of patients with spondyloarthropathies.
Collapse
Affiliation(s)
- Ulric Vinsonneau
- Cardiology Department, Clermont Tonnerre Armed Forces Teaching Hospital, BP 41, 29240 Brest Armées, France.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Paraskevas KI. Statin treatment for rheumatoid arthritis: a promising novel indication. Clin Rheumatol 2007; 27:281-7. [DOI: 10.1007/s10067-007-0806-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 11/16/2007] [Accepted: 11/16/2007] [Indexed: 01/30/2023]
|
38
|
Saseen JJ. Putting New Disease-Modifying Antirheumatic Drugs into Perspective. Pharmacotherapy 2007; 27:1609-10. [DOI: 10.1592/phco.27.12.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
39
|
Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford) 2007; 45 Suppl 4:iv4-7. [PMID: 16980723 DOI: 10.1093/rheumatology/kel313] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular features in rheumatoid arthritis (RA) are common. Among those are the classical extra-articular features that not only include pericarditis, cardiomyopathy/myocarditis, cardiac amyloidosis, coronary vasculitis, arrhythmia and valve diseases, but also congestive heart failure and ischaemic heart disease which are found more frequently and are associated with an increased mortality compared with the general population. This overview discusses the epidemiological aspects of these cardiovascular diseases and their relevance for diagnosis and treatment of RA.
Collapse
Affiliation(s)
- A E Voskuyl
- Department of Rheumatology, 4-A-42, VU University Medical Center, POB 9057, 1007 MB Amsterdam, The Netherlands.
| |
Collapse
|
40
|
Matucci-Cerinic M, Seferović PM. Heart involvement in autoimmune rheumatic diseases: the "phantom of the opera". Rheumatology (Oxford) 2007; 45 Suppl 4:iv1-3. [PMID: 16980716 DOI: 10.1093/rheumatology/kel316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Matucci-Cerinic
- Department of Medicine and Surgery, Division of Medicine I and Rheumatology University of Florence, AOUC, Florence, Italy.
| | | |
Collapse
|
41
|
Allanore Y. Cardiovascular mortality in patients with inflammatory rheumatic disorders. Joint Bone Spine 2007; 74:120-2. [PMID: 17324603 DOI: 10.1016/j.jbspin.2006.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 06/28/2006] [Indexed: 11/29/2022]
|
42
|
Sokka T, Häkkinen A, Kautiainen H, Maillefert JF, Toloza S, MØrk hansen T, Calvo-Alen J, Oding R, Liveborn M, Huisman M, Alten R, Pohl C, Cutolo M, Immonen K, Woolf A, Murphy E, Sheehy C, Quirke E, Celik S, Yazici Y, Tlustochowicz W, Kapolka D, Skakic V, Rojkovich B, Müller R, Stropuviene S, Andersone D, Drosos AA, Lazovskis J, Pincus T. Physical inactivity in patients with rheumatoid arthritis: Data from twenty-one countries in a cross-sectional, international study. ACTA ACUST UNITED AC 2007; 59:42-50. [DOI: 10.1002/art.23255] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
43
|
|