1
|
Leppien EE, Pauling EE, Smith E, Wisniewski B, Carpenter A, Schwier NC. Pain management considerations in patients living with both pain syndromes and cardiovascular diseases and disorders. Pharmacotherapy 2024; 44:184-196. [PMID: 38049207 DOI: 10.1002/phar.2897] [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: 06/30/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 12/06/2023]
Abstract
Concomitant pain syndromes and cardiovascular disease (CVD) and disorders are associated with significant morbidity, impaired quality of life, and neuropsychiatric disorders. There is an interplay between the mechanisms of pathophysiology of both CVD and pain syndromes. Patients with CVD (and/or disorders) as well as pain syndromes have an increased propensity for drug-drug/disease interactions. Therefore, an understanding of how to use pharmacotherapy to treat pain syndromes, in the context of patients who have diagnoses of CVD and/or disorders, is paramount to patients' success in achieving adequate pain control and appropriately managing CVD and/or disorders, all while decreasing the risk of adverse events (AEs) both from pharmacotherapy to treat pain and CVD (and/or disorders). Based on the appraisal of literature and authors' clinical expertise, it was determined that gabapentinoids, opioids, skeletal muscle relaxants, tricyclic antidepressants, clonidine, serotonin norepinephrine-reuptake inhibitors, dronabinol, carbamazepine, second-generation antipsychotics, non-steroidal anti-inflammatory drugs, aspirin, corticosteroids, and topical anesthetics have the most evidence for use in patients with CVD and/or disorders. However, the literature surrounding the use of pharmacotherapy for pain management is limited to retrospective studies and there is a lack of well-designed, prospective, randomized trials; this also includes head-to-head comparator studies. Unlike many CVD-related pharmacotherapy studies, data studying pain management in patients with CVD lacks standardized outcomes that are consistent among the pool of data. Overall, the decision to prescribe specific pain management therapies in patients with CVD and/or disorders should include assessment of pain severity, type of pain, drug-drug/disease interactions, adjuvant therapies required, and the risk or presence of AEs.
Collapse
Affiliation(s)
- Emily E Leppien
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Erin E Pauling
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Eric Smith
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Brady Wisniewski
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Abigayle Carpenter
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Nicholas C Schwier
- Office of Experiential Education & Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| |
Collapse
|
2
|
Impact of Artificial Infiltration on the Removal of Nonsteroidal Anti-Inflammatory Drugs during Treatment of Surface Water. ENERGIES 2021. [DOI: 10.3390/en14248406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The content of pharmaceuticals in natural waters is steadily increasing. Especially nonsteroidal anti-inflammatory drugs (NSAIDs) are often detected in natural waters due to their widespread use. This group of compounds includes commonly used representatives, such as paracetamol and ketoprofen. The quality of natural waters determines the processes applied for the treatment of drinking water. The methods used in order to remove pharmaceuticals from treated water include adsorption and biologically active filtration. Both processes also occur during artificial infiltration (forced flow of intake surface water through the ground to the collecting wells) at surface water intakes. The processes, which occur in the soil, change the water quality characteristics to a great extent. The goal of the study was to evaluate the removal efficiency of paracetamol and ketoprofen in the process of artificial infiltration used as a pre-treatment of surface water. The studies were conducted at a field experimental installation located at the technical artificial infiltration intake. The experimental installation consisted of three metering wells (piezometers) which were located on the way between the bank of the infiltration pond and the collecting well. The collected water samples allowed to evaluate the change of selected NSAIDs concentrations during the passage of water through the ground. The analysis procedure included solid phase extraction (SPE) and high-performance liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Removal of the studied NSAIDs in the infiltration process occurred with variable effectiveness throughout the year. Paracetamol was removed with annual efficiency equal to 42%, although no significant removal of ketoprofen was observed.
Collapse
|
3
|
Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis. Anatol J Cardiol 2020; 22:185-191. [PMID: 31584431 PMCID: PMC6955072 DOI: 10.14744/anatoljcardiol.2019.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The aim of the present study was to compare patients with ankylosing spondylitis (AS) with healthy controls with respect to subclinical atherosclerotic cardiovascular disease (CVD). Methods: A total of 44 patients with AS with no history of CVD, diabetes mellitus, hypertension, chronic kidney disease, and lipid-lowering drug use were compared with 40 age- and sex-matched healthy controls with respect to carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), which are surrogate markers of subclinical atherosclerosis. Correlation analysis was also performed to examine the association between surrogate markers and disease activity with inflammation [Ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP)]. Results: In addition to age and sex, both groups were comparable with respect to cigarette smoking, body mass index, and high-density lipoprotein cholesterol (p=0.425, p=0.325, and p=0.103, respectively). The level of total cholesterol was significantly lower in patients with AS (p=0.002). Nonsteroidal anti-inflammatory drug and tumor necrosis factor alpha inhibitor use ratios in patients with AS were 79.5% and 65.9%, respectively. There was no significant difference between both groups regarding PWV and CIMT (p=0.788 and p=0.253, respectively). In patients with AS, there was a significant correlation between ASDAS-CRP and CIMT (r=0.315, p=0.038), but the correlation between ASDAS-CRP and PWV was not significant (r=−0.183, p=0.234). Conclusion: The results of the present study could not provide sufficient evidence whether disease activity with inflammation caused subclinical atherosclerotic CVD in patients with AS without overt CVD. The increased atherosclerotic CVD risk is most probably multifactorial in patients with AS, but the extent of the contribution of disease activity with inflammation to increased atherosclerosis is controversial.
Collapse
|
4
|
Aktas H, Yılmaz OE, Ertugrul G, Terzi E. Intramuscular diclofenac is a cause of Nicolau syndrome in obese women: An observational study of consecutive ten patients. Dermatol Ther 2020; 33:e13392. [PMID: 32268452 DOI: 10.1111/dth.13392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022]
Abstract
Nicolau syndrome is a skin and underlying tissue necrosis resulting from vascular occlusion after various injections of certain drugs. Intramuscular injections are the most common cause but it may occur after other types of parenteral interventions. There are many medications reported as causative factors inducing Nicolau syndrome including penicillin, nonsteroidal anti-inflammatory drugs, corticosteroids, local anesthetics, and several others. We present an observational study of diclofenac induced Nicolau syndrome.
Collapse
Affiliation(s)
- Habibullah Aktas
- Faculty of Medicine, Department of Dermatology, Karabuk University, Karabuk, Turkey
| | - Onur Evren Yılmaz
- Department of Plastic and Reconstructive Surgery, Izmir Medicalpark Hospital, Izmir, Turkey
| | - Goksen Ertugrul
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Karabuk University, Turkey
| | - Erdinc Terzi
- Department of Dermatology, Private Yalova Hospital, Yalova, Turkey
| |
Collapse
|
5
|
Lahaye C, Tatar Z, Dubost JJ, Tournadre A, Soubrier M. Management of inflammatory rheumatic conditions in the elderly. Rheumatology (Oxford) 2020; 58:748-764. [PMID: 29982766 PMCID: PMC6477520 DOI: 10.1093/rheumatology/key165] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 05/08/2018] [Indexed: 12/21/2022] Open
Abstract
The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.
Collapse
Affiliation(s)
- Clément Lahaye
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Zuzana Tatar
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Jacques Dubost
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Anne Tournadre
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Martin Soubrier
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| |
Collapse
|
6
|
Dehghan M, Asgharian S, Khalesi E, Ahmadi A, Lorigooini Z. Comparative study of the effect of Thymus daenensis gel 5% and diclofenac in patients with knee osteoarthritis. Biomedicine (Taipei) 2019; 9:9. [PMID: 31124455 PMCID: PMC6533939 DOI: 10.1051/bmdcn/2019090209] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/18/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Osteoarthritis is a syndrome characterized by joint pain and reduced performance and efficien- cy in patient. Thymus daenensis has been used since old times for the treatment of bone and joint deformities and pain in traditional medicine. Purpose: This study was conducted to examine traditional usages and pharmacological features of T. daen- ensis with respect to the effect of the plant in patients with osteoarthritis. Methods: 120 patients with osteoarthritis were divided into 3 groups. Patients in each group were treated by 5% Thymus daenensis gel, 1% diclofenac gel, or placebo for 6 weeks, along with oral celecoxib capsules. Patients were assessed in different intervals, based on the VAS score for assessment of pain in the joint and different dimensions of WOMAC questionnaire. Results: Pain level (P < 0.005), stiffness during the day (P < 0.05), morning stiffness (P < 0.05) and physi- cal performance (P < 0.05) were significantly different among the groups. Conclusions: Thymus daenensis gel improves the symptoms in patients equal and without significant difference than diclofenac group. It can be argued that its use can produce a satisfactory effect on patients with osteoarthritis due to its low cost, easy access, the plant’s natively occurring in Iran.
Collapse
Affiliation(s)
- Morteza Dehghan
- Clinical Research Development Unit, kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shirin Asgharian
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elena Khalesi
- Clinical Research Development Unit, kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center, Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| |
Collapse
|
7
|
Verhoeven F, Totoson P, Marie C, Prigent-Tessier A, Wendling D, Tournier-Nappey M, Prati C, Demougeot C. Diclofenac but not celecoxib improves endothelial function in rheumatoid arthritis: A study in adjuvant-induced arthritis. Atherosclerosis 2017; 266:136-144. [PMID: 29024866 DOI: 10.1016/j.atherosclerosis.2017.09.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/03/2017] [Accepted: 09/28/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS We aimed at investigating the effect of celecoxib (COX-2 selective inhibitor) and diclofenac (non-selective COX inhibitor) on endothelial function, and at identifying the underlying mechanisms in adjuvant-induced arthritis (AIA). METHODS At the first signs of AIA, diclofenac (5 mg/kg twice a day, i.p), celecoxib (3 mg/kg/day, i.p) or saline (Vehicle) was administered for 3 weeks. Endothelial function was studied in aortic rings relaxed with acetylcholine (Ach) with or without inhibitors of NOS, arginase, EDHF and superoxide anions (O2-°) production. Aortic expression of eNOS, Ser1177-phospho-eNOS, COX-2, arginase-2, p22phox and p47phox was evaluated by Western blotting analysis. Arthritis scores, blood pressure, glycaemia and serum ADMA levels were measured. RESULTS Diclofenac and celecoxib significantly reduced arthritis score to the same extent (p<0.05). As compared to vehicle-treated AIA, celecoxib did not change whereas diclofenac improved endothelial function (p<0.05) through increased EDHF production, decreased arginase activity and expression, decreased superoxide anions production and expression of p22phox and p47phox. Diclofenac but not celecoxib significantly enhanced blood pressure and serum ADMA levels. Glycaemia was unchanged by both treatments. CONCLUSIONS Our study reveals that the effect of NSAIDs on endothelial function cannot be extrapolated from their impact on arthritis severity and suggest that changes in blood pressure and plasma ADMA levels may not be useful to predict CV risk of NSAIDs in RA.
Collapse
Affiliation(s)
- Frank Verhoeven
- PEPITE EA4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25030, Besançon, France; Service de Rhumatologie, CHRU Besançon, 25000 Besançon, France
| | - Perle Totoson
- PEPITE EA4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25030, Besançon, France
| | - Christine Marie
- INSERM U1093, Univ. Bourgogne Franche-Comté, F-21000, Dijon, France
| | | | - Daniel Wendling
- Service de Rhumatologie, CHRU Besançon, 25000 Besançon, France; EA4266, Univ. Bourgogne Franche-Comté, F-25030, Besançon, France
| | - Maude Tournier-Nappey
- PEPITE EA4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25030, Besançon, France
| | - Clément Prati
- PEPITE EA4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25030, Besançon, France; Service de Rhumatologie, CHRU Besançon, 25000 Besançon, France
| | - Céline Demougeot
- PEPITE EA4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25030, Besançon, France.
| |
Collapse
|
8
|
Tournadre A, Mathieu S, Soubrier M. Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations. Ther Adv Musculoskelet Dis 2016; 8:180-191. [PMID: 27721904 DOI: 10.1177/1759720x16664306] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, have higher rates of cardiovascular mortality. While the increased cardiovascular risk is only explained to some extent, a lot of research is currently conducted to improve our understanding of its pathogenesis, risk stratification, and optimal cardiovascular risk management. This review sought to report epidemiological data pertaining to the cardiovascular disease burden in patients with inflammatory arthritis, underlying mechanisms accounting for excessive cardiovascular risk, along with recommendations regarding risk assessment and management in this patient population.
Collapse
Affiliation(s)
- Anne Tournadre
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvain Mathieu
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Martin Soubrier
- Rheumatology Department, CHU Gabriel Montpied, 58 Rue Montalembert, F-63000 Clermont-Ferrand, France
| |
Collapse
|
9
|
Jabbari M, Hashempur MH, Razavi SZE, Shahraki HR, Kamalinejad M, Emtiazy M. Efficacy and short-term safety of topical Dwarf Elder (Sambucus ebulus L.) versus diclofenac for knee osteoarthritis: A randomized, double-blind, active-controlled trial. JOURNAL OF ETHNOPHARMACOLOGY 2016; 188:80-86. [PMID: 27125590 DOI: 10.1016/j.jep.2016.04.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/20/2016] [Accepted: 04/22/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sambucus ebulus L. (S. ebulus) has had long-standing application in Traditional Persian Medicine for joint pain and for a variety of bone and joint disorders. According to traditional use of S. ebulus and its relevant pharmacologic properties, this study was designed to evaluate the efficacy and short-term safety of topical use of S. ebulus in patients with knee osteoarthritis (OA). METHODS AND MATERIALS Seventy nine patients with knee OA were randomly enrolled in 2 parallel arms of a pilot randomized, double-blind, active-controlled clinical trial. The patients were treated by topical S. ebulus gel or 1% diclofenac gel, three times a day, as much as a fingertip unit for 4 weeks. Patients were assessed prior to enrollment and, then, 2 and 4 weeks subsequent to the intervention, in terms of scores of visual analogue scale (VAS) for self-grading of their knee joint pain, and according to 3 different domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Any observed adverse effects were also scrutinized. RESULTS The mean values of WOMAC pain score, total WOMAC score and VAS score for pain of the S. ebulus group were significantly lower compared with the diclofenac group (P=0.004, P=0.04, and P<0.001, respectively). In addition, no serious adverse effect was reported. CONCLUSION This pilot study showed that topical treatment with S. ebulus gel can be recommended for alleviating symptoms of patients with knee OA. However, longer trials involving larger samples size, are needed for achieving a comprehensive understanding about the efficacy and safety of S. ebulus in knee OA.
Collapse
Affiliation(s)
- Marzie Jabbari
- Department of Traditional Medicine, Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - Mohammad Hashem Hashempur
- Department of Traditional Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran; Essence of Parsiyan Wisdom Institute, Phytopharmaceutical and Traditional Medicine Incubator, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyede Zahra Emami Razavi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Physical Medicine and Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Kamalinejad
- Department of Pharmaceutics, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Majid Emtiazy
- Department of Traditional Medicine, Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran; The Research Center of The Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| |
Collapse
|
10
|
Le risque cardiovasculaire dans la spondyloarthrite axiale. Presse Med 2015; 44:907-11. [DOI: 10.1016/j.lpm.2015.03.023] [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: 12/08/2014] [Revised: 03/16/2015] [Accepted: 03/25/2015] [Indexed: 12/28/2022] Open
|
11
|
Polzin A, Hohlfeld T, Kelm M, Zeus T. Impairment of aspirin antiplatelet effects by non-opioid analgesic medication. World J Cardiol 2015; 7:383-391. [PMID: 26225198 PMCID: PMC4513489 DOI: 10.4330/wjc.v7.i7.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Aspirin is the mainstay in prophylaxis of cardiovascular diseases. Impaired aspirin antiplatelet effects are associated with enhanced incidence of cardiovascular events. Comedication with non-opioid analgesic drugs has been described to interfere with aspirin, resulting in impaired aspirin antiplatelet effects. Additionally, non-opioid analgesic medication has been shown to enhance the risk of cardiovascular events and death. Pain is very frequent and many patients rely on analgesic drugs to control pain. Therefore effective analgesic options without increased risk of cardiovascular events are desirable. This review focuses on commonly used non-opioid analgesics, interactions with aspirin medication and impact on cardiovascular risk.
Collapse
|
12
|
Lahaye C, Tatar Z, Dubost JJ, Soubrier M. Overview of biologic treatments in the elderly. Joint Bone Spine 2015; 82:154-60. [DOI: 10.1016/j.jbspin.2014.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/22/2014] [Indexed: 12/25/2022]
|
13
|
Mathieu S, Pereira B, Soubrier M. Cardiovascular events in ankylosing spondylitis: an updated meta-analysis. Semin Arthritis Rheum 2014; 44:551-555. [PMID: 25455683 DOI: 10.1016/j.semarthrit.2014.10.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Rheumatoid arthritis is associated with increased cardiovascular risk. In the guidelines, ankylosing spondylitis (AS) is considered to have an equally high cardiovascular risk. The literature findings remain controversial. This study aims to assess the risk of myocardial infarction (MI) and stroke in AS patients. METHODS An updated meta-analysis with a new systematic literature review using PubMed was conducted up to January 2014. Incidence of MI or stroke was calculated by metaproportion. RESULTS In addition to the 11 previously included studies, six new studies assessed the occurrence of MI or stroke in AS patients. (1) MI. A total of 2131 MI were reported in AS patients (n = 27,532) over a mean follow-up of 15 years: incidence 5.3% (1.6%-11.0%), i.e., 0.36/100 pyrs. Seven studies revealed 17,410 MI [2.5% (95% CI: 1.8%-3.4%)] in the control group (n = 1,349,964). Meta-analysis of the seven longitudinal studies showed a significant increase in MI [OR = 1.60 (95% CI: 1.32-1.93)] in AS patients. (2) Stroke. In 11 longitudinal studies (n = 51,990), 1807 strokes were reported in AS patients over 17.6 years of follow-up: incidence 3.6% (1.5%-6.5%), i.e., 0.24/100 pyrs. Three studies reported 22,899 strokes in controls (n = 1,239,041), giving an incidence of 1.78% (1.75%-1.80%). A significant increase in stroke [OR = 1.50 (95% CI: 1.39-1.62)] in AS patients was found. CONCLUSION AS patients appear to have a higher risk of MI and stroke. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS to decrease this high cardiovascular risk.
Collapse
Affiliation(s)
- Sylvain Mathieu
- Rheumatology Department, Gabriel Montpied Teaching Hospital, 58 Rue Montalembert, Clermont-Ferrand 63003, France; GenHotel-Auvergne, EA4679, Faculty of Medicine, Clermont 1 University, Clermont-Ferrand, France.
| | - Bruno Pereira
- DRCI, Gabriel Montpied Teaching Hospital, Clermont-Ferrand, France
| | - Martin Soubrier
- Rheumatology Department, Gabriel Montpied Teaching Hospital, 58 Rue Montalembert, Clermont-Ferrand 63003, France
| |
Collapse
|
14
|
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]
|
15
|
Zubcevic J, Santisteban MM, Pitts T, Baekey DM, Perez PD, Bolser DC, Febo M, Raizada MK. Functional neural-bone marrow pathways: implications in hypertension and cardiovascular disease. Hypertension 2014; 63:e129-39. [PMID: 24688127 PMCID: PMC4295780 DOI: 10.1161/hypertensionaha.114.02440] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/07/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Jasenka Zubcevic
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville FL 32610
| | - Monica M. Santisteban
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville FL 32610
| | - Teresa Pitts
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville FL 32610
| | - David M. Baekey
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville FL 32610
| | - Pablo D. Perez
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville FL 32610
| | - Donald C. Bolser
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville FL 32610
| | - Marcelo Febo
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville FL 32610
| | - Mohan K. Raizada
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville FL 32610
| |
Collapse
|
16
|
Bornstein C, Craig M, Tin D. Practice guidelines for pharmacists: The pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs. Can Pharm J (Ott) 2014; 147:97-109. [PMID: 24660010 DOI: 10.1177/1715163514521377] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Carolyn Bornstein
- The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario
| | - Marie Craig
- The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario
| | - Diane Tin
- The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario
| |
Collapse
|
17
|
Guellec D, Nocturne G, Tatar Z, Pham T, Sellam J, Cantagrel A, Saraux A. Should non-steroidal anti-inflammatory drugs be used continuously in ankylosing spondylitis? Joint Bone Spine 2014; 81:308-12. [PMID: 24589253 DOI: 10.1016/j.jbspin.2014.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The 2010 update of ASAS/EULAR recommendations for managing ankylosing spondylitis (AS) specify that continuous non-steroidal anti-inflammatory drug (NSAID) treatment should be preferred in patients with persistently active, symptomatic disease. Here, our objective was to assess whether continuous NSAID therapy improves disease control and influences radiographic progression compared to on-demand therapy. We also assessed the safety profiles of both regimens. METHODS We performed a review by searching the PubMed and Embase databases using two MeSH term combinations to compare continuous and on-demand NSAID therapy in terms of disease control, radiographic progression, and safety. RESULTS The only study evaluating the impact of continuous NSAID therapy on disease control showed no significant difference with on-demand therapy. In four studies, continuous treatment was associated with slower radiographic progression, as assessed in three studies using the modified Stoke Ankylosing Spondylitis Spinal Score (m-SASSS). Three studies compared the safety of continuous and on-demand celecoxib, two in osteoarthritis and one in AS, and found no significant differences regarding the usual side effects of Cox-2 inhibitors. CONCLUSIONS Several studies showed slower radiographic progression with continuous NSAID therapy in AS. No studies demonstrated superiority of continuous NSAID therapy regarding symptom control. Continuous NSAID therapy (at least with Cox-2 inhibitors) does not modify safety compared to on-demand therapy.
Collapse
Affiliation(s)
- Dewi Guellec
- Rheumatology department, CHU Cavale-Blanche, Brest University Hospital, boulevard Tanguy-Prigent, 29200 Brest, France
| | - Gaëtane Nocturne
- Rheumatology department, CHU Le-Kremlin-Bicêtre, Le-Kremlin-Bicêtre, France
| | - Zuzana Tatar
- Oncology department, centre Jean-Perrin, Clermont-Ferrand, France
| | - Thao Pham
- Rheumatology department, CHU Sainte-Marguerite, Marseille, France
| | - Jérémie Sellam
- Rheumatology department, Hôpital Saint-Antoine, AP-HP, Pierre-et-Marie-Curie Paris 6 University, Paris, France
| | | | - Alain Saraux
- Rheumatology department, CHU Cavale-Blanche, Brest University Hospital, boulevard Tanguy-Prigent, 29200 Brest, France.
| |
Collapse
|
18
|
Do non-steroidal anti-inflammatory drugs have disease-modifying effects in spondyloarthritis? Joint Bone Spine 2013; 80:563-4. [DOI: 10.1016/j.jbspin.2013.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/23/2022]
|
19
|
|