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Molander V, Bower H, Frisell T, Delcoigne B, Di Giuseppe D, Askling J. Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: a Swedish comparative safety study among patients with rheumatoid arthritis. Ann Rheum Dis 2023; 82:189-197. [PMID: 36150749 PMCID: PMC9887398 DOI: 10.1136/ard-2022-223050] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess and compare the incidence of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi) or other biological disease modifying antirheumatic drugs (bDMARDs). For contextualisation, to assess VTE incidences in the Swedish general population and in the RA source population. METHODS We performed a nationwide register-based, active comparator, new user design cohort study in Sweden from 2010 to 2021. The Swedish Rheumatology Quality Register was linked to national health registers to identify treatment cohorts (exposure) of initiators of a JAKi, a TNFi, or a non-TNFi bDMARD (n=32 737 treatment initiations). We also identified a general population cohort (matched 1:5, n=92 108), and an 'overall RA' comparator cohort (n=85 722). Outcome was time to first VTE during the follow-up, overall and by deep vein thrombosis (DVT) and pulmonary embolism (PE). We calculated incidence rates (IR) and multivariable-adjusted HRs using Cox regression. RESULTS Based on 559 incident VTE events, the age- and sex-standardised (to TNFi) IR (95% CI) for VTE was 5.15 per 1000 person-years (4.58 to 5.78) for patients treated with TNFi, 11.33 (8.54 to 15.04) for patients treated with JAKi, 5.86 (5.69 to 6.04) in the overall RA cohort and 3.28 (3.14 to 3.43) in the general population. The fully adjusted HR (95% CI) for VTE with JAKi versus TNFi was 1.73 (1.24 to 2.42), the corresponding HR for PE was 3.21 (2.11 to 4.88) and 0.83 (0.47 to 1.45) for DVT. CONCLUSIONS Patients with RA treated with JAKi in clinical practice are at increased risk of VTE compared with those treated with bDMARDs, an increase numerically confined to PE.
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Affiliation(s)
- Viktor Molander
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Benedicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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Omair MA, Alkhelb SA, Ezzat SE, Boudal AM, Bedaiwi MK, Almaghlouth I. Venous Thromboembolism in Rheumatoid Arthritis: The Added Effect of Disease Activity to Traditional Risk Factors. Open Access Rheumatol 2022; 14:231-242. [PMID: 36276408 PMCID: PMC9586712 DOI: 10.2147/oarrr.s284757] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Many epidemiological studies have shown an increased risk of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA). RA and VTE share some background factors, such as increasing age, smoking, and obesity. At the same time, other VTE factors, such as knee replacement and oral contraceptive pills, occur commonly in RA patients. In addition, the chronic inflammatory state of RA might hypothetically lead to endothelial injury and a hypercoagulable state. Two critical pathophysiological pathways lead to VTE. Recently, concerns increased about the increased risk of VTE in patients using Janus Kinase inhibitors. This review aims at reviewing the risk of VTE in RA and the role of traditional risk factors and disease-related inflammation and develops a conceptual framework that describes the interaction between these factors.
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Affiliation(s)
- Mohammed A Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia,Correspondence: Mohammed A Omair, Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia, Tel +966505270513, Email
| | - Sara A Alkhelb
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sadeen E Ezzat
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayah M Boudal
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed K Bedaiwi
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
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3
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Disease activity as a risk factor for venous thromboembolism in rheumatoid arthritis analysed using time-averaged DAS28CRP: a nested case-control study. Rheumatol Int 2022; 42:1939-1946. [PMID: 35384451 DOI: 10.1007/s00296-022-05121-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/18/2022] [Indexed: 01/01/2023]
Abstract
The objective of this study is to clarify the clinical features and risk factors of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA). We retrospectively reviewed the prevalence of VTE in RA patients who visited Hokkaido University Hospital from 2010 to 2019 and had more than 2 years of follow-up. To explore the risk to develop VTE, we selected 260 RA patients without VTE (non-VTE) via density sampling and identified the risk factors for VTE by multivariate logistic regression analysis. Univariate conditional logistic regression analysis showed older age (p < 0.0001, Odds Ratio [OR] 1.08, 95% Confidence Interval [CI] 1.04-1.14), increase of the body mass index (BMI) (p = 0.001, OR 1.17, 95% CI 1.06-1.31), higher prevalence of RA-associated lung disease (p = 0.002, OR 2.10, 95% CI 1.33-3.30) and more frequent glucocorticoid usage (p = 0.001, OR 2.09, 95% CI 1.34-3.51) in RA patients was associated with the development of VTE significantly. Furthermore, patients with higher time-averaged disease activity score 28 (DAS28) CRP were at elevated risk (p < 0.0001, OR 3.25, 95% CI 1.94-6.12). In conditional multivariate logistic regression analysis, time averaged DAS28CRP was significantly associated with the development of VTE (p = 0.0001, adjusted OR 3.40, 95% CI 1.77-7.85). Disease activity was identified as a major risk factor of VTE in patients with RA, suggesting that sustained clinical remission could be beneficial for decrease the risk of VTE.
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Increased risk of subsequent benign prostatic hyperplasia in non-Helicobacter pylori-infected peptic ulcer patients: a population-based cohort study. Sci Rep 2020; 10:21719. [PMID: 33303936 PMCID: PMC7728766 DOI: 10.1038/s41598-020-78913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022] Open
Abstract
The vagus nerve plays an essential role in homeostasis and inflammation. Clinically, peptic ulcer patients without helicobacter pylori (HP) infection may provide a population for studying the effect of vagal hyperactivity. There were interests in the association of gastrointestinal disease and urogenital disorders. Herein, we try to investigate subsequent risk of benign prostatic hyperplasia (BPH) in non-HP infected peptic ulcer patients. We identified 17,672 peptic ulcer admission male patients newly diagnosed in 1998-2007 from Taiwan Health Insurance Database, and 17,672 male comparison without peptic ulcer, frequency matched by age, and index-year. We assessed subsequent incidence of BPH in each cohort by the end of 2013, and then compared the risk of developing BPH between individuals with and without peptic ulcer. In addition, peptic ulcer patients underwent surgery were also examined. There were 2954 peptic ulcer patients and 2291 comparisons noted with the occurrence of BPH (25.35 and 16.70 per 1000 person-years, respectively). Compared to comparisons, peptic ulcer patients had a 1.45- and 1.26-fold BPH risk in multivariable Cox model and Fine and Gray model (95% CI 1.37-1.54 and 1.19-1.34). In age-stratified analysis, the highest risk of BPH was in 45-59 years (interaction p < 0.05). Regarding surgery types, peptic ulcer patients who underwent simple suture surgery (i.e.: with integrated vagus nerve) had a significant higher BPH risk than comparison (HR 1.50 and 95% CI 1.33-1.74; SHR 1.26 and 95% CI 1.07-1.48), while patients underwent truncal vagotomy/pyloroplasty showed a lower incidence of BPH. In this study, non-HP-infected male peptic ulcer patients were found to have an increased risk of subsequent BPH. Indicating that there might be a role of vagus nerve. Based on the limitations of retrospective nature, further studies are required.
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Mease P, Charles-Schoeman C, Cohen S, Fallon L, Woolcott J, Yun H, Kremer J, Greenberg J, Malley W, Onofrei A, Kanik KS, Graham D, Wang C, Connell C, Valdez H, Hauben M, Hung E, Madsen A, Jones TV, Curtis JR. Incidence of venous and arterial thromboembolic events reported in the tofacitinib rheumatoid arthritis, psoriasis and psoriatic arthritis development programmes and from real-world data. Ann Rheum Dis 2020; 79:1400-1413. [PMID: 32759265 PMCID: PMC7569391 DOI: 10.1136/annrheumdis-2019-216761] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
Objectives Tofacitinib is a Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ulcerative colitis, and has been investigated in psoriasis (PsO). Routine pharmacovigilance of an ongoing, open-label, blinded-endpoint, tofacitinib RA trial (Study A3921133; NCT02092467) in patients aged ≥50 years and with ≥1 cardiovascular risk factor identified a higher frequency of pulmonary embolism (PE) and all-cause mortality for patients receiving tofacitinib 10 mg twice daily versus those receiving tumour necrosis factor inhibitors and resulted in identification of a safety signal for tofacitinib. Here, we report the incidence of deep vein thrombosis (DVT), PE, venous thromboembolism (VTE; DVT or PE) and arterial thromboembolism (ATE) from the tofacitinib RA (excluding Study A3921133), PsA and PsO development programmes and observational studies. Data from an ad hoc safety analysis of Study A3921133 are reported separately within. Methods This post-hoc analysis used data from separate tofacitinib RA, PsO and PsA programmes. Incidence rates (IRs; patients with events per 100 patient-years’ exposure) were calculated for DVT, PE, VTE and ATE, including for populations stratified by defined baseline cardiovascular or VTE risk factors. Observational data from the US Corrona registries (including cardiovascular risk factor stratification), IBM MarketScan research database and the US FDA Adverse Event Reporting System (FAERS) database were analysed. Results 12 410 tofacitinib-treated patients from the development programmes (RA: n=7964; PsO: n=3663; PsA: n=783) were included. IRs (95% CI) of thromboembolic events among the all tofacitinib cohorts’ average tofacitinib 5 mg and 10 mg twice daily treated patients for RA, respectively, were: DVT (0.17 (0.09–0.27) and 0.15 (0.09–0.22)); PE (0.12 (0.06–0.22) and 0.13 (0.08–0.21)); ATE (0.32 (0.22–0.46) and 0.38 (0.28–0.49)). Among PsO patients, IRs were: DVT (0.06 (0.00–0.36) and 0.06 (0.02–0.15)); PE (0.13 (0.02–0.47) and 0.09 (0.04–0.19)); ATE (0.52 (0.22–1.02) and 0.22 (0.13–0.35)). Among PsA patients, IRs were: DVT (0.00 (0.00–0.28) and 0.13 (0.00–0.70)); PE (0.08 (0.00–0.43) and 0.00 (0.00–0.46)); ATE (0.31 (0.08–0.79) and 0.38 (0.08–1.11)). IRs were similar between tofacitinib doses and generally higher in patients with baseline cardiovascular or VTE risk factors. IRs from the overall Corrona populations and in Corrona RA patients (including tofacitinib-naïve/biologic disease-modifying antirheumatic drug-treated and tofacitinib-treated) with baseline cardiovascular risk factors were similar to IRs observed among the corresponding patients in the tofacitinib development programme. No signals of disproportionate reporting of DVT, PE or ATE with tofacitinib were identified in the FAERS database. Conclusions DVT, PE and ATE IRs in the tofacitinib RA, PsO and PsA programmes were similar across tofacitinib doses, and generally consistent with observational data and published IRs of other treatments. As expected, IRs of thromboembolic events were elevated in patients with versus without baseline cardiovascular or VTE risk factors, and were broadly consistent with those observed in the Study A3921133 ad hoc safety analysis data, although the IR (95% CI) for PE was greater in patients treated with tofacitinib 10 mg twice daily in Study A3921133 (0.54 (0.32–0.87)), versus patients with baseline cardiovascular risk factors treated with tofacitinib 10 mg twice daily in the RA programme (0.24 (0.13–0.41)).
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Affiliation(s)
- Philip Mease
- Rheumatology Clinical Research Division, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA
| | | | | | - Lara Fallon
- Inflammation and Immunology - Global Medical Affairs, Pfizer Inc, Kirkland, Quebec, Canada
| | - John Woolcott
- Inflammation and Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Huifeng Yun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joel Kremer
- Albany Medical College and The Center for Rheumatology, Albany, New York, USA
| | | | | | | | - Keith S Kanik
- Inflammation and Immunology TA, Pfizer Inc, Groton, Connecticut, USA
| | - Daniela Graham
- Inflammation and Immunology TA, Pfizer Inc, Groton, Connecticut, USA
| | - Cunshan Wang
- Statistics, Global Product Development, Pfizer Inc, Groton, Connecticut, USA
| | - Carol Connell
- Clinical Development & Operations, Pfizer Inc, Groton, Connecticut, USA
| | - Hernan Valdez
- Global Product Development, Inflammation and Immunology, Pfizer Inc, New York, New York, USA
| | - Manfred Hauben
- Worldwide Safety, Pfizer Inc, New York, New York, USA.,Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Eric Hung
- Worldwide Safety, Pfizer Inc, New York, New York, USA
| | - Ann Madsen
- Global Medical Epidemiology, Pfizer Inc, New York, New York, USA
| | - Thomas V Jones
- Worldwide Medical and Safety, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sandborn WJ, Panés J, Sands BE, Reinisch W, Su C, Lawendy N, Koram N, Fan H, Jones TV, Modesto I, Quirk D, Danese S. Venous thromboembolic events in the tofacitinib ulcerative colitis clinical development programme. Aliment Pharmacol Ther 2019; 50:1068-1076. [PMID: 31599001 PMCID: PMC6899755 DOI: 10.1111/apt.15514] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/11/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). AIM To report incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the tofacitinib UC programme. METHODS DVT and PE were evaluated from one phase 2 and two phase 3 induction studies, one phase 3 maintenance study and an ongoing, open-label, long-term extension (OLE) study (September 2018 datacut). Data were analysed in induction, maintenance and overall (patients receiving ≥ 1 dose of tofacitinib 5 or 10 mg b.d. in any phase 2, 3 or OLE study) cohorts. RESULTS 1157 patients (2404 patient-years' exposure; ≤ 6.1 years' tofacitinib treatment) were evaluated in the overall cohort. In induction, one placebo-treated patient had DVT and one had PE; no tofacitinib-treated patients had DVT/PE. In maintenance, one placebo-treated patient had DVT and one had PE; no tofacitinib-treated patients had DVT/PE. In the overall cohort, one patient had DVT (incidence rate [patients with events/100 patient-years; 95% CI]: 0.04 [0.00-0.23]); four had PE (0.16 [0.04-0.41]); all received predominant dose tofacitinib 10 mg b.d.; all had venous thromboembolism risk factors alongside UC. CONCLUSIONS In this post hoc analysis of patients with UC, during tofacitinib exposure, one patient had DVT and four had PE, all during the OLE study, on predominant dose 10 mg b.d. (83% of overall cohort patients received predominant dose 10 mg b.d.) with venous thromboembolism risk factors. This analysis is limited by small sample size and limited drug exposure; further studies are needed. ClinicalTrials.gov: NCT00787202, NCT01465763, NCT01458951, NCT01458574, NCT01470612.
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Affiliation(s)
- William J. Sandborn
- Division of GastroenterologyUniversity of California, San DiegoLa JollaCalifornia
| | - Julian Panés
- Hospital Clínic de BarcelonaIDIBAPS, CIBERehdBarcelonaSpain
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkNew York
| | | | | | | | | | | | | | | | | | - Silvio Danese
- Division of GastroenterologyIBD CenterHumanitas UniversityRozzanoMilanItaly
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Fang CW, Liao CH, Wu SC, Muo CH. Association of benign prostatic hyperplasia and subsequent risk of bladder cancer: an Asian population cohort study. World J Urol 2018; 36:931-938. [PMID: 29427001 DOI: 10.1007/s00345-018-2216-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Few studies discussed the link between benign prostatic hyperplasia (BPH) and bladder cancer. We performed this cohort study to investigate whether there is an association between BPH and subsequent risk of bladder cancer. METHODS We identified 35,092 study subjects including 17546 BPH patients and 17546 comparisons from the National Health Insurance database. The comparison cohort was frequency matched with age and index-year. We measured subsequent bladder cancer rates (per 1000 person-years) in two cohorts. Attributable risks (ARs) was calculated based on the bladder cancer rates in two cohorts. The hazard ratios (HRs) and 95% confidence intervals (CIs) for bladder cancer were estimated via Cox proportional hazard regression. RESULTS BPH patients had a higher bladder cancer rate than comparisons (AR = 0.81 per 1000 person-years) and exhibited 4.69- and 4.11-fold increases in bladder cancer risk in the crude and adjusted Cox models, respectively (95% CIs = 4.15-6.99 and 2.70-6.26). The AR was highest in patients aged 65-74 years old (AR = 1.33). BPH patients with chronic kidney disease were at an elevated bladder cancer risk. Regarding the association between bladder cancer and transurethral prostatectomy (TURP), BPH patients who underwent TURP were at a higher risk of bladder cancer (AR = 1.69; HR = 6.17, 95% CI = 3.68-10.3) than those who did not (AR = 0.69; HR = 3.73, 95% CI = 2.43-5.74). CONCLUSIONS In this study, BPH patients were found to have an increased risk of subsequent bladder cancer. Based on the limitations of retrospective nature, further studies are needed.
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Affiliation(s)
- Chu-Wen Fang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Hsi Liao
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Urology, Taichung Armed Forces General Hospital, Taichung, Taiwan
- National Defense Medical Center, Taipei, Taiwan
| | - Shih-Chi Wu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University and Hospital, No. 2, Yuh-Der Road, Taichung, 404, Taiwan
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Alanazi RM, Alanazi AA, Alenezi IQ, Alsulobi AM, Almutairy AF, Ali WMB, Alanazi MA, Alkhidhr MA, Elfetoh NMA, Ali AMB. Deep venous thrombosis in elderly patients as a surgical emergency at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Electron Physician 2018; 9:5754-5759. [PMID: 29403615 PMCID: PMC5783124 DOI: 10.19082/5754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/16/2017] [Indexed: 12/21/2022] Open
Abstract
Background Deep venous thrombosis (DVT) is a condition that occurs frequently among surgical, as well as acutely ill hospitalized medical patients, and is responsible for significant morbidity and mortality in hospitalized patients. Risk factors include older age, surgery and immobilization (as with bed rest, orthopedic casts, and sitting on long flights. Objective This study was conducted to identify the frequency and factors associated with occurrence of DVT among elderly patients referred to King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia. Methods The current study is a hospital based cross sectional study. The emergency, inpatients and outpatients' departments at KAU hospital were reviewed. We studied all the referred elderly subjects during the study period. All elderly patients (540) referred to or admitted to the hospital departments and who were clinically suspected to have DVT and subjected to Doppler examination were included in the study. Data were analyzed using descriptive statistics and Chi square test. Results Based on the results of Doppler examination, DVT was detected in 97 (18.0%) of the studied elderly population. There were no significant differences in gender between patients who developed DVT and those who were negative by Doppler examination (p=0.018). Other comorbidities as diabetes, IHD and hypertension were significantly associated with the occurrence of DVT among the participants (p=0.05, 0.05 and 0.04 respectively). Furthermore, the other investigated factors such as being bed ridden, cancer, orthopedic cast and previous DVT were not significantly associated with the development of DVT among the studied elderly patients (p=0.42, 0.16, 0.45 and 0.75 respectively). Conclusion DVT has high prevalence in Jeddah; KSA. Thrombophilia screening should be regular for elderly patients with diabetes, hypertension and bed-ridden patients with recurrent DVT or patients with other risk factors. Knowing the most common risk factors and their significance in developing DVT is essential for early detection of DVT to prevent unwanted complications for elderlies.
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Affiliation(s)
- Reham Muqbil Alanazi
- Intern, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
| | - Ashjan Aqeel Alanazi
- Medical Student, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
| | - Ibtihaj Qaseem Alenezi
- Medical Student, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
| | - Anwar Matar Alsulobi
- Intern, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
| | | | | | | | | | - Nagah Mohamed Abo Elfetoh
- Associate Professor, Community Medicine Department, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
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Lin TM, Chen WS, Sheu JJ, Chen YH, Chen JH, Chang CC. Autoimmune rheumatic diseases increase dementia risk in middle-aged patients: A nationwide cohort study. PLoS One 2018; 13:e0186475. [PMID: 29304089 PMCID: PMC5755737 DOI: 10.1371/journal.pone.0186475] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Dementia is a common neurological disease that substantially affects public health. A previous study revealed that dementia occurs when the body’s immune system attacks the cells of the brain, indicating that dementia may be similar to autoimmune rheumatic diseases (ARDs). In the current retrospective cohort study, we focused on middle-aged ARD patients (45 years or older) to investigate the association between ARDs in middle-aged people and dementia by using a nationwide population-based database in Taiwan. Method Our study analyzed the medical data of the Taiwanese population from 2001 to 2012, with a follow-up period extending until the end of 2011. We identified middle-aged patients with ARDs by using the Taiwan National Health Insurance Research Database. We selected a comparison cohort from the general population that was randomly frequency-matched by age (in 5-year increments), sex, and index year and further analyzed the dementia risk by using a Cox regression model that considers sex, age, and comorbidities. Results The study enrolled 34,660 middle-aged ARD patients (77% female, mean age = 59.8 years) and 138,640 controls. The risk of developing dementia was 1.18 times higher for middle-aged patients with ARDs compared with patients without ARDs after adjustment for age, sex, and comorbidities. Among the patients with ARDs, the subgroups with rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome (SS) were associated with a significantly higher dementia risk (adjusted hazard ratio [HR] 1.14, 95% confidence index [CI] 1.06–1.32; adjusted HR 1.07, 95% CI 0.86–1.34; adjusted HR 1.46, 95% CI 1.32–1.63, respectively). Furthermore, primary SS and secondary SS patients had the highest risks of dementia among all the ADR subgroups (adjusted HR 1.35, 95% CI 1.18–1.54; adjusted HR 1.67, 95% CI 1.43–1.95 respectively). Conclusion This nationwide retrospective cohort study demonstrated that dementia risk is significantly higher in middle-aged patients with ARDs compared with the general population.
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Affiliation(s)
- Tzu-Min Lin
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsuan Chen
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Jin-Hua Chen
- Biostatistics Center and School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- * E-mail: (CCC); (JHC)
| | - Chi-Ching Chang
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail: (CCC); (JHC)
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Alanazi OA, El-Fetoh NMA, Mohammed NA, Alanizy TMA, Alanazi YW, Alanazi MS, Alrwaili AA, Alruwaili AH, Alanazi AH, Alanazi AS. Deep Venous Thrombosis among hypertensive patients in King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia. Electron Physician 2017; 9:5472-5477. [PMID: 29238486 PMCID: PMC5718850 DOI: 10.19082/5472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/22/2017] [Indexed: 12/20/2022] Open
Abstract
Background Deep venous thrombosis (DVT) is a frequent cardiovascular disorder. It is among the main causes of morbidity and mortality among hospitalized patients and, at the same time, can be easily avoided. Studies clarified that there are a variety of factors which can be significantly associated with the development of DVT in hospitalized patients. Objective to identify frequency and factors associated with occurrence of DVT among hypertensive patients referred to KAU hospital, Jeddah, Kingdom of Saudi Arabia. Methods A cross-sectional hospital-based study was conducted from October 2016 to March, 2017. All hypertensive patients referred to or admitted to the hospital departments and who were suspected to have DVT and subjected to Doppler examination were included in the study. A questionnaire was designed to obtain data about DVT frequency among participants and factors associated with the development of DVT among them. Data was collected through face to face interviews of patients included in the study. Results DVT was detected in 13.5 % of the studied hypertensive patients. Increased age and gender had no significant association with the development of DVT among the studied patients. In addition, other studied factors and comorbidities had no significant role in DVT development among the study participants. Conclusion Knowing the most common risk factors and their significance in developing DVT is essential for early detection of DVT to prevent it, especially for hypertensive patients. Awareness campaigns should be held more often in different neighborhoods of the city.
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Affiliation(s)
- Omar Ayed Alanazi
- Intern, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Nagah Mohamed Abo El-Fetoh
- M.D., Associate Professor, Department of Public Health and Community Medicine, Faculty of Medicine and Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia.,Sohag College of Medicine, Sohag University, Egypt
| | - Nesreen Ali Mohammed
- Lecturer of Public Health and Community Medicine, Faculty of Medicine, Sohag Faculty of Medicine, Sohag University, Egypt
| | | | - Yasir Wadi Alanazi
- Intern, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | | | | | | | | | - Ahmed Saad Alanazi
- Student, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
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Hatch Q, Nelson D, Martin M, Maykel JA, Johnson EK, Champagne BJ, Hyman NH, Steele SR. Can sepsis predict deep venous thrombosis in colorectal surgery? Am J Surg 2016; 211:53-8. [DOI: 10.1016/j.amjsurg.2015.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/17/2015] [Accepted: 06/29/2015] [Indexed: 01/27/2023]
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Kim MJ, Song HJ, Kim WK, Kim SH. Superior mesenteric vein thrombosis as an early presentation of myelodysplastic syndrome: a case report. Intest Res 2014; 12:157-61. [PMID: 25349584 PMCID: PMC4204708 DOI: 10.5217/ir.2014.12.2.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/02/2013] [Accepted: 11/04/2013] [Indexed: 01/14/2023] Open
Abstract
Mesenteric venous thrombosis (MVT) is a serious condition due to its potential association with mesenteric ischemia and infarction of the small bowel. Symptoms of MVT are often vague, making accurate diagnosis and sufficient treatment difficult. However, increased awareness and new imaging modalities for this condition have improved outcomes for patients with MVT. Treatment includes anticoagulation, transcatheter therapy, and surgery. In the present report, we describe the case study of a 62-year-old woman with a presenting diagnosis of superior MVT, who was finally diagnosed with myelodysplastic syndrome. The superior MVT spontaneously dissolved after the patient underwent 6 months of systemic anticoagulation therapy. Invasive surgery or bowel resection was not required.
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Affiliation(s)
- Min Jung Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Kun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Hyung Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
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13
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Amaya-Amaya J, Montoya-Sánchez L, Rojas-Villarraga A. Cardiovascular involvement in autoimmune diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:367359. [PMID: 25177690 PMCID: PMC4142566 DOI: 10.1155/2014/367359] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/01/2014] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases (AD) represent a broad spectrum of chronic conditions that may afflict specific target organs or multiple systems with a significant burden on quality of life. These conditions have common mechanisms including genetic and epigenetics factors, gender disparity, environmental triggers, pathophysiological abnormalities, and certain subphenotypes. Atherosclerosis (AT) was once considered to be a degenerative disease that was an inevitable consequence of aging. However, research in the last three decades has shown that AT is not degenerative or inevitable. It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT. Several risk factors, known as classic risk factors, have been described. Interestingly, the excessive cardiovascular events observed in patients with ADs are not fully explained by these factors. Several novel risk factors contribute to the development of premature vascular damage. In this review, we discuss our current understanding of how traditional and nontraditional risk factors contribute to pathogenesis of CVD in AD.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Laura Montoya-Sánchez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
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Association between autoimmune rheumatic diseases and the risk of dementia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:861812. [PMID: 24877143 PMCID: PMC4022061 DOI: 10.1155/2014/861812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/31/2022]
Abstract
AIM Autoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period. METHODS Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression. RESULTS During the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79-1.76) in the ARD group after adjusting for demographics and comorbidities. CONCLUSIONS Within the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.
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Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch E, Kreder H, Hawker GA. Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2014; 66:254-63. [DOI: 10.1002/art.38231] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/10/2013] [Indexed: 01/04/2023]
Affiliation(s)
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - J. Michael Paterson
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Earl Bogoch
- University of Toronto and St. Michael's Hospital; Toronto, Ontario Canada
| | - Hans Kreder
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - Gillian A. Hawker
- University of Toronto, Institute for Clinical Evaluative Sciences, and Women's College Hospital; Toronto, Ontario Canada
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Risk of venous thromboembolism in patients with rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol 2014; 33:297-304. [DOI: 10.1007/s10067-014-2492-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/05/2014] [Indexed: 12/28/2022]
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Chung WS, Peng CL, Lin CL, Chang YJ, Chen YF, Chiang JY, Sung FC, Kao CH. Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Ann Rheum Dis 2013; 73:1774-80. [PMID: 23926057 DOI: 10.1136/annrheumdis-2013-203380] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Studies on the association between rheumatoid arthritis (RA) and deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) are scarce. This study identifies the effects of RA on the risks of developing DVT and PE in a nationwide prospective cohort study. METHODS We studied the entire Taiwan population from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with RA using the catastrophic illness registry of the Taiwan National Health Insurance Research Database (NHIRD). We also selected a comparison cohort that was randomly frequency-matched by age (each 5-year span), sex and index year from the general population. We analysed the risks of DVT and PE using Cox proportional hazards regression models, including sex, age and comorbidities. RESULTS From 23.74 million people in the cohort, 29 238 RA patients (77% women, mean age of 52.4 years) and 1 16 952 controls were followed 1 93 753 and 7 92 941 person-years, respectively. The risk of developing DVT and PE was 3.36-fold and 2.07-fold, respectively, in patients with RA compared with patients without RA, after adjusting for age, sex and comorbidities. The multiplicative increased risks of DVT and PE were also significant in patients with RA with any comorbidity. CONCLUSIONS This nationwide prospective cohort study demonstrates that DVT and PE risks significantly increased in patients with RA compared with those of the general population.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Department of Health, Executive Yuan, Taichung, Taiwan Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Chiao-Ling Peng
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yung-Fu Chen
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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