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Stevens MA, Dykhoff HJ, Kronzer VL, Myasoedova E, Davis JM, Duarte-García A, Crowson CS. Disparities in multimorbidity and comorbidities in rheumatoid arthritis by sex across the lifespan. Rheumatology (Oxford) 2024; 63:1639-1648. [PMID: 37651451 PMCID: PMC11147539 DOI: 10.1093/rheumatology/kead454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Multimorbidity is burdensome for people with RA. We investigated differences in multimorbidity and comorbidities by sex and age in the RA population. METHODS This cross-sectional analysis used national administrative claims (OptumLabs® Data Warehouse) from people with RA and non-RA comparators (matched on age, sex, race, census region, index year and length of baseline insurance coverage) from 2010-2019. RA was determined using a validated algorithm. Multimorbidity was defined as ≥2 (MM2+) or ≥5 (MM5+) comorbidities from a validated set of 44 chronic conditions. We used logistic regression to assess associations between characteristics and multimorbidity. RESULTS The sample included 154 391 RA patients and 154 391 non-RA comparators. For people aged 18-50 years, RA women (vs RA men) had 7.5 and 4.4 (vs 3.2 and 0.9 in non-RA women vs non-RA men) percentage point increases for MM2+ and MM5+, respectively. For people aged 51+ years, RA women (vs RA men) had 2.1 and 2.5 (vs 1.2 and 0.3 in non-RA women vs non-RA men) percentage point increases for MM2+ and MM5+, respectively. Interactions revealed that differences in multimorbidity between women and men were exacerbated by RA (vs non-RA) (P < 0.05), with more pronounced effects in people aged 18-50. Men had more cardiovascular-related conditions, whereas RA women had more psychological, neurological and general musculoskeletal conditions. Other comorbidities varied by sex and age. CONCLUSION Multimorbidity disproportionately impacts women with RA. Research, clinical and policy agendas for rheumatic diseases should acknowledge and support the variation in care needs by sex and gender across the lifespan.
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Affiliation(s)
- Maria A Stevens
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- OptumLabs, Eden Prairie, MN, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hayley J Dykhoff
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Vanessa L Kronzer
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - John M Davis
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alí Duarte-García
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Ben Shimol J. Perimenopause in women with rheumatologic diseases: a spotlight on an under-addressed transition. Climacteric 2024; 27:115-121. [PMID: 37990992 DOI: 10.1080/13697137.2023.2276201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
Abundant research has been published describing the effects invoked during menopause across different organ systems. Changing levels of estrogen and progesterone result in bidirectional alterations of immune cell pathways. Overall, the net trend dampens immunoregulation and promotes inflammation. In paradigmatic rheumatologic diseases, the combined effect is far from predictable. While some features may abate during menopause, studies have shown a general increased frequency toward disease exacerbation. Similarly, while impossible to isolate the ramifications of menopause in women with fibromyalgia, a tendency toward enhanced symptoms is unquestionably apparent. Furthermore, the comorbidities accrued by increasing age and the consequences of long-term medication use may also confound this picture. Periodic rheumatologic visits are warranted, with clinical assessments directed toward a multi-disciplinary approach. Ultimately, while an arsenal of effective tools is available for caring for these women and their underlying conditions, more studies are needed to better clarify how the different stages surrounding perimenopause affect subpopulations with rheumatic diseases and fibromyalgia-related disorders so that clinical course can be predicted and addressed prior to the emergence of symptomatology.
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Affiliation(s)
- J Ben Shimol
- Department of Rheumatology, Barzilai University Medical Center, Ashqelon, Israel
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3
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Jakubaszek MP. The significance of prolactin in systemic connective tissue diseases. Reumatologia 2023; 61:264-270. [PMID: 37745140 PMCID: PMC10515120 DOI: 10.5114/reum/170319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Does prolactin (PRL) level testing in the diagnosis of systemic connective tissue diseases make sense and should we test it in everyday practice? Material and methods Connective tissue diseases (CTDs) are a group of heterogeneous disorders, involving multiple body systems. Rheumatoid arthritis (RA) is one of the most common connective tissue diseases with a global prevalence of 0.3-1% and can be inherited. Less common are systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis (SSc), primary Sjögren's syndrome (pSS) and inflammatory myositis. Prolactin is responsible for lactation, breast growth and many other bodily processes, and is elevated in blood of woman who are pregnant or breastfeeding. Hyperprolactinemia is relatively common in women, so some rheumatic diseases may be caused by high prolactin levels, and it should be detected during diagnosis. Results Prolactin signals are found in arthritic joint tissues (chondrocytes and synovial fibroblasts) to inhibit cartilage degradation, synovitis and osteoclastogenesis. On the other hand, hyperprolactinemia also promotes the conversion of PRL to vasoinhibin, a fragment of PRL that directly stimulates and indirectly inhibits arthritis in a cell type-dependent manner. The role of the PRL/vasoinhibin axis in inflammatory arthritis should still be monitored and further research is needed to help elucidate the role of PRL in rheumatic diseases in order to ultimately develop new therapeutic interventions that can be tested in patients. Conclusions Nowadays, there are no clear indications for prolactin testing in the diagnosis of systemic connective tissue diseases. In the case of suspicion or confirmation of some systemic connective tissue diseases, such as rheumatoid arthritis or systemic lupus erythematosus, testing the prolactin level makes sense when severity of disease symptoms is observed.
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Affiliation(s)
- Michał Piotr Jakubaszek
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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4
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Corciulo C, Scheffler JM, Humeniuk P, Del Carpio Pons A, Stubelius A, Von Mentzer U, Drevinge C, Barrett A, Wüstenhagen S, Poutanen M, Ohlsson C, Lagerquist MK, Islander U. Physiological levels of estradiol limit murine osteoarthritis progression. J Endocrinol 2022; 255:39-51. [PMID: 35993439 PMCID: PMC9513658 DOI: 10.1530/joe-22-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
Abstract
Among patients with knee osteoarthritis (OA), postmenopausal women are over-represented. The purpose of this study was to determine whether deficiency of female sex steroids affects OA progression and to evaluate the protective effect of treatment with a physiological dose of 17β-estradiol (E2) on OA progression using a murine model. Ovariectomy (OVX) of female mice was used to mimic a postmenopausal state. OVX or sham-operated mice underwent surgery for destabilization of the medial meniscus (DMM) to induce OA. E2 was administered in a pulsed manner for 2 and 8 weeks. OVX of OA mice did not influence the cartilage phenotype or synovial thickness, while both cortical and trabecular subchondral bone mineral density (BMD) decreased after OVX compared with sham-operated mice at 8 weeks post-DMM surgery. Additionally, OVX mice displayed decreased motor activity, reduced threshold of pain sensitivity, and increased number of T cells in the inguinal lymph nodes compared to sham-operated mice 2 weeks after OA induction. Eight weeks of treatment with E2 prevented cartilage damage and thickening of the synovium in OVX OA mice. The motor activity was improved after E2 replacement at the 2 weeks time point, which was also associated with lower pain sensitivity in the OA paw. E2 treatment protected against OVX-induced loss of subchondral trabecular bone. The number of T cells in the inguinal lymph nodes was reduced by E2 treatment after 8 weeks. This study demonstrates that treatment with a physiological dose of E2 exerts a protective role by reducing OA symptoms.
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Affiliation(s)
- Carmen Corciulo
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Julia M Scheffler
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Piotr Humeniuk
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alicia Del Carpio Pons
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Stubelius
- Division of Chemical Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ula Von Mentzer
- Division of Chemical Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Christina Drevinge
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Aidan Barrett
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sofia Wüstenhagen
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Matti Poutanen
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie K Lagerquist
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Islander
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Shin DW, Shin JI, Koyanagi A, Jacob L, Smith L, Lee H, Chang Y, Song TJ. Global, regional, and national neck pain burden in the general population, 1990–2019: An analysis of the global burden of disease study 2019. Front Neurol 2022; 13:955367. [PMID: 36119688 PMCID: PMC9477009 DOI: 10.3389/fneur.2022.955367] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study describes the global epidemiology and trends associated with neck pain. Global Burden of Disease data collected between 1990 and 2019 were used to determine the global burden of neck pain in the general populations of 204 countries. Methods Global, regional, and national burdens of neck pain determined by prevalence, incidence, and years lived with a disability (YLD) from 1990 to 2019 were comprehensively analyzed according to age, gender, and socio-demographic index using the Global Burden of Disease Study 1990 and 2019 data provided by the Institute for Health Metrics and Evaluation. Results Globally, in 2019, the age-standardized rates for prevalence, incidence, and YLD of neck pain per 100,000 population was 2,696.5 (95% uncertainty interval [UI], 2,177.0 to 3,375.2), 579.1 (95% UI, 457.9 to 729.6), and 267.4 (95% UI, 175.5 to 383.5) per 100,000 population, respectively. Overall, there was no significant difference in prevalence, incidence, or YLD of neck pain between 1990 and 2019. The highest age-standardized YLD of neck pain per 100,000 population in 2019 was observed in high-income North America (479.1, 95% UI 323.0 to 677.6), Southeast Asia (416.1, 95% UI 273.7 to 596.5), and East Asia (356.4, 95% UI 233.2 to 513.2). High-income North America (17.0, 95% UI 9.0 to 25.4%) had the largest increases in YLD of neck pain per 100,000 population from 1990 to 2019. At the national level, the highest age-standardized YLD of neck pain was found in the Philippines (530.1, 95% UI 350.6 to 764.8) and the highest change age-standardized YLD between 1990 and 2019 was found in the United States (18.4, 95% UI 9.9 to 27.6%). Overall, the global burden of neck pain increased with age until the age of 70–74 years, and was higher in women than men. In general, positive associations between socio-demographic index and burden of neck pain were found. Conclusions Because neck pain is a major public health burden with a high prevalence, incidence, and YLD worldwide, it is important to update its epidemiological data and trends to cope with the future burden of neck pain.
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Affiliation(s)
- Dong Woo Shin
- Department of Neurology, Mokdong Hospital Ewha Woman's University College of Medicine, Seoul, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Barcelona, Spain
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- Centre for Health, Performance, and Well-Being, Anglia Ruskin University, Cambridge, United Kingdom
| | - Heajung Lee
- Department of Neurology, Seoul Hospital Ewha Woman's University College of Medicine, Seoul, South Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital Ewha Woman's University College of Medicine, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital Ewha Woman's University College of Medicine, Seoul, South Korea
- *Correspondence: Tae-Jin Song
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6
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Sabatier P, Wack M, Pouchot J, Danchin N, Jannot AS. A data-driven pipeline to extract potential adverse drug reactions through prescription, procedures and medical diagnoses analysis: application to a cohort study of 2,010 patients taking hydroxychloroquine with an 11-year follow-up. BMC Med Res Methodol 2022; 22:166. [PMID: 35676635 PMCID: PMC9175346 DOI: 10.1186/s12874-022-01628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Context Real-life data consist of exhaustive data which are not subject to selection bias. These data enable to study drug-safety profiles but are underused because of their temporality, necessitating complex models (i.e., safety depends on the dose, timing, and duration of treatment). We aimed to create a data-driven pipeline strategy that manages the complex temporality of real-life data to highlight the safety profile of a given drug. Methods We proposed to apply the weighted cumulative exposure (WCE) statistical model to all health events occurring after a drug introduction (in this paper HCQ) and performed bootstrap to select relevant diagnoses, drugs and interventions which could reflect an adverse drug reactions (ADRs). We applied this data-driven pipeline on a French national medico-administrative database to extract the safety profile of hydroxychloroquine (HCQ) from a cohort of 2,010 patients. Results The proposed method selected eight drugs (metopimazine, anethole trithione, tropicamide, alendronic acid & colecalciferol, hydrocortisone, chlormadinone, valsartan and tixocortol), twelve procedures (six ophthalmic procedures, two dental procedures, two skin lesions procedures and osteodensitometry procedure) and two medical diagnoses (systemic lupus erythematous, unspecified and discoid lupus erythematous) to be significantly associated with HCQ exposure. Conclusion We provide a method extracting the broad spectrum of diagnoses, drugs and interventions associated to any given drug, potentially highlighting ADRs. Applied to hydroxychloroquine, this method extracted among others already known ADRs. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01628-3. • The challenge of drug-safety signal detection methods is to handle four types of difficulties: ○ The data source, the study of long-term adverse drug reactions or effects not suspected by healthcare professionals, requires the use of a real-life data source. ○ The consideration of a broad spectrum of potential adverse drug reactions (ADRs), and not only candidate ADRs. ○ The temporal impact (meaning that safety depends on the dose, date and duration of treatment). ○ The difference between true ADRs and disease natural course. • We aimed to create a data-driven pipeline strategy, without any assumption of any ADRs, which take into account the complex temporality of real-life data to provide the safety profile of a given drug. • Our pipeline used three sources of real-life data to establish a safety profile of a given drug: drug prescriptions, procedures and medical diagnoses. • We successfully applied our data-driven pipeline strategy to hydroxychloroquine (HCQ). Our pipeline enabled us to find diagnoses, drugs and interventions related to HCQ and which could reflect an ADR due to HCQ or the disease itself. • This data-driven pipeline strategy may be of interest to other experts involved in the pharmacovigilance discipline.
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Affiliation(s)
- P Sabatier
- Inria, HeKA, PariSantéCampus, 10 Rue d'Oradour-sur-Glane, 75015, Paris, France. .,Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, 75006, Paris, France. .,AP-HP: Medical Informatics Department, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France.
| | - M Wack
- Inria, HeKA, PariSantéCampus, 10 Rue d'Oradour-sur-Glane, 75015, Paris, France.,Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, 75006, Paris, France.,AP-HP: Medical Informatics Department, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France
| | - J Pouchot
- AP-HP: Department of Cardiology, Georges Pompidou European Hospital, 75015, Paris, France
| | - N Danchin
- AP-HP: Department of Internal Medicine, Georges Pompidou European Hospital, 75015, Paris, France
| | - A S Jannot
- Inria, HeKA, PariSantéCampus, 10 Rue d'Oradour-sur-Glane, 75015, Paris, France.,Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, 75006, Paris, France.,AP-HP: Medical Informatics Department, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France
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7
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Mishra A, Wang Y, Yin F, Vitali F, Rodgers KE, Soto M, Mosconi L, Wang T, Brinton RD. A tale of two systems: Lessons learned from female mid-life aging with implications for Alzheimer's prevention & treatment. Ageing Res Rev 2022; 74:101542. [PMID: 34929348 PMCID: PMC8884386 DOI: 10.1016/j.arr.2021.101542] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023]
Abstract
Neurological aging is frequently viewed as a linear process of decline, whereas in reality, it is a dynamic non-linear process. The dynamic nature of neurological aging is exemplified during midlife in the female brain. To investigate fundamental mechanisms of midlife aging that underlie risk for development of Alzheimer's disease (AD) in late life, we investigated the brain at greatest risk for the disease, the aging female brain. Outcomes of our research indicate that mid-life aging in the female is characterized by the emergence of three phases: early chronological (pre-menopause), endocrinological (peri-menopause) and late chronological (post-menopause) aging. The endocrinological aging program is sandwiched between early and late chronological aging. Throughout the three stages of midlife aging, two systems of biology, metabolic and immune, are tightly integrated through a network of signaling cascades. The network of signaling between these two systems of biology underlie an orchestrated sequence of adaptative starvation responses that shift the brain from near exclusive dependence on a single fuel, glucose, to utilization of an auxiliary fuel derived from lipids, ketone bodies. The dismantling of the estrogen control of glucose metabolism during mid-life aging is a critical contributor to the shift in fuel systems and emergence of dynamic neuroimmune phenotype. The shift in fuel reliance, puts the largest reservoir of local fatty acids, white matter, at risk for catabolism as a source of lipids to generate ketone bodies through astrocytic beta oxidation. APOE4 genotype accelerates the tipping point for emergence of the bioenergetic crisis. While outcomes derived from research conducted in the female brain are not directly translatable to the male brain, the questions addressed in a female centric program of research are directly applicable to investigation of the male brain. Like females, males with AD exhibit deficits in the bioenergetic system of the brain, activation of the immune system and hallmark Alzheimer's pathologies. The drivers and trajectory of mechanisms underlying neurodegeneration in the male brain will undoubtedly share common aspects with the female in addition to factors unique to the male. Preclinical and clinical evidence indicate that midlife endocrine aging can also be a transitional bridge to autoimmune disorders. Collectively, the data indicate that endocrinological aging is a critical period "tipping point" in midlife which can initiate emergence of the prodromal stage of late-onset-Alzheimer's disease. Interventions that target both immune and metabolic shifts that occur during midlife aging have the potential to alter the trajectory of Alzheimer's risk in late life. Further, to achieve precision medicine for AD, chromosomal sex is a critical variable to consider along with APOE genotype, other genetic risk factors and stage of disease.
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Affiliation(s)
- Aarti Mishra
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Yiwei Wang
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Fei Yin
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Francesca Vitali
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Kathleen E Rodgers
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Maira Soto
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Tian Wang
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA
| | - Roberta D Brinton
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ 85719, USA.
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8
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Chen S, Chen M, Wu X, Lin S, Tao C, Cao H, Shao Z, Xiao G. Global, regional and national burden of low back pain 1990-2019: A systematic analysis of the Global Burden of Disease study 2019. J Orthop Translat 2022; 32:49-58. [PMID: 34934626 PMCID: PMC8639804 DOI: 10.1016/j.jot.2021.07.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To comprehensively analyze the global level and trends of prevalence, incidence and years lived with disability (YLDs) for low back pain (LBP) from 1990 to 2019 by age, sex and sociodemographic index (SDI). METHODS Publicly available modelled data and methods were obtained from the Global Burden of Diseases (GBD) study 2019, and used to evaluate the global burden of LBP through a systematic analysis. RESULTS Globally, the age-standardized prevalence, incidence and YLDs rate of LBP were slightly decreased from 1990 to 2019, but the number of the prevalent cases, incident cases and YLDs had substantially increased, and LBP remains the leading cause of YLDs in 2019 worldwide. The number of prevalent cases was increased with age and peaked at the age of 45-54 years for both sexes, and the global prevalence rate was higher in females than in males and increased with age, peaking at the 80-84 age group in both sexes in 2019. Overall, a positive association between the age-standardized YLD rate and SDI was observed over the past thirty years. At the national revel, the United States, Denmark and Switzerland had the three highest levels of age-standardized prevalence, while Zambia, Zimbabwe and Canada showed the highest increase in the age-standardized prevalence during 1990-2019. CONCLUSIONS LBP is a major public health issue globally, and its burden remains high. Increasing population awareness about its risk factors and preventive measures for LBP are needed to reduce the future burden of this condition. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Due to the high prevalence and heavy burden of LBP globally, it is important to update its epidemiological data. This systematic analysis provides researchers and healthcare policy makers with up-to-date, comprehensive and comparable information on global LBP burden, which is of clinical translational significance.
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Affiliation(s)
- Sheng Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Mingjue Chen
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Xiaohao Wu
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Sixiong Lin
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Chu Tao
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Huiling Cao
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guozhi Xiao
- Department of Biochemistry, School of Medicine, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Shenzhen Key Laboratory of Cell Microenvironment, Southern University of Science and Technology, Shenzhen, 518055, China
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9
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Bowman S, Lu H. Aromatase inhibitor-induced inflammatory myopathies: A case series. Joint Bone Spine 2021; 89:105308. [PMID: 34774793 DOI: 10.1016/j.jbspin.2021.105308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Aromatase inhibitors (AIs) are widely used in the adjuvant therapy setting in patients with estrogen receptor-positive breast cancer. Rheumatic side effects of AIs have been reported, including bone loss, arthralgias, myalgias, and tenosynovitis. There is emerging evidence that AIs are linked to new-onset autoimmune diseases. Here, we describe three novel cases of inflammatory myopathies that occurred during AI therapy. METHODS In total, three patients with inflammatory myopathy in the setting of AI therapy were treated in the Section of Rheumatology, MD Anderson Cancer Center. All the patients were retrospectively chart reviewed. We obtained verbal consent from the patients for use of their cases for teaching and publication purposes and only de-identified data have been used. RESULTS None of our patients from these three cases had a history of autoimmune disease and all had undergone recent cancer screenings, indicating no re-occurrence of breast cancer and no evidence of new cancer. The completion or discontinuation of AI therapy was associated with the resolution of the myopathies in all three cases. CONCLUSIONS This case series suggests a link between AIs and the new onset of inflammatory myopathy. If a patient develops an inflammatory myopathy while on an AI, the AI therapy should be considered the possible trigger. If the myopathy cannot be controlled with immunosuppression, then discontinuation of the AI should be considered.
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Affiliation(s)
- Savannah Bowman
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1465 Houston, TX 77030, United States; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
| | - Huifang Lu
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1465 Houston, TX 77030, United States.
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10
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Saes MO, Machado KP, Facchini LA, Thumé E. Rheumatic diseases and associated factors in older adults: a Brazilian population-based study. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2020049.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: Rheumatic diseases have high occurrence in older adults, which may lead to a reduction in independence and quality of life. Objective: To calculate prevalence and to identify factors associated with rheumatic diseases in older adults of the urban area of a municipality in Southern Brazil. Methods: Cross-sectional population-based study, conducted in 2008 in the city of Bagé-RS, Brazil with older adults aged 60 years or over. The outcome was defined from the question "Has any doctor told you that you have rheumatism, arthritis or arthrosis?" Poisson regression was used for the crude and adjusted analysis. Results: A total of 1,593 participants were interviewed. 27.3% (95% CI 25.0-29.5) reported having medical diagnosis of at least one of the rheumatic diseases studied. In the adjusted analysis, it was found that female sex (RP=2.86; 95% CI 2.28-3.59; p≤0.001), without schooling (RP=1.24; 95% CI 1.0-1.58; p=0.047), not living alone (RP=1.29; 95% CI 1.03-1.61; p=0.024), poor self-perception of health (PR=1.54; 95% CI 1.63-2.02; p=0.001), spinal problems (PR=1,96; 95% CI 1.67-2.31; p≤0.001), fall in the last year (PR=1.22; 95% CI 1.04-1.43; p=0.013), incapacity for instrumental activities of daily living (PR=1.20; 95% CI 1.02-1.41; p=0.028) and healthcare appointment in the last 3 months (PR=1.20; 95% CI 1.01-1.42; p=0.035) were associated with the presence of rheumatic diseases (rheumatism, arthritis and arthrosis). Conclusion: It is suggested that care of musculoskeletal problems of the spine should be increased, in order to reduce falls and functional disability in older adults, based on actions focused on the prevention of these problems.
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11
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Stojanovic A, Veselinovic M, Zong Y, Jakovljevic V, Pruner I, Antovic A. Increased Expression of Extracellular Vesicles Is Associated With the Procoagulant State in Patients With Established Rheumatoid Arthritis. Front Immunol 2021; 12:718845. [PMID: 34394126 PMCID: PMC8358654 DOI: 10.3389/fimmu.2021.718845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022] Open
Abstract
This study sought to identify different subpopulations of extracellular vesicles (EVs) in plasma from female patients with established rheumatoid arthritis (RA) in relation to the activation of coagulation and fibrin formation in these patients. Forty women were included in the study, 20 patients and 20 age-matched healthy controls. The mean disease duration in patients was 13.0 (5.0-25.0) years, with medium to high disease activity despite ongoing treatment with low-dose prednisolone and methotrexate. There were no differences between the investigated groups regarding the presence of traditional cardiovascular risk factors. The concentration of phosphatidylserine-positive (PS+) EVs; platelet (CD42a+), leucocyte (CD45+), monocyte (CD14+), and endothelial (CD144+)-derived EVs; and EVs-expressing tissue factor (CD142+), P-selectin (CD62P+), and E-selectin (CD62E+) were determined by flow cytometry analysis. Overall hemostasis potential (OHP) was assessed to follow the hemostatic disturbances, including the parameters for overall coagulation potential (OCP) and overall fibrinolytic potential (OFP). Fibrin clot turbidity was measured together with clot lysis time, and scanning electron microscopy was performed. Increased concentrations of PS+, CD42a+, CD142+, CD45+, CD14+, and CD62P+ EVs were found in plasma from patients with RA compared to healthy controls, and the concentrations of PS+, CD42a+, CD14+, and CD62P+ EVs were positively correlated with the inflammatory parameters in RA patients. Positive correlations were also found between the levels of PS+ and CD42a+ EVs and OCP as well as between the levels of PS+, CD42a+, and CD62P+EVs and OHP. The levels of PS+, CD42a+, CD14+, CD62P+, and CD62E+ EVs were negatively correlated with OFP. Elevated levels of circulating EVs of different cell origins were found in patients with established RA, in relation to the inflammatory burden and coagulation activation in the disease.
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Affiliation(s)
- Aleksandra Stojanovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mirjana Veselinovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Yanan Zong
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Human Pathology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Iva Pruner
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Aleksandra Antovic
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
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12
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Debi R, Yakobov S, Bhatt P, Lakin R. Too sympathetic to exercise: abnormal autonomic and metaboreflex activation in exercising rheumatoid arthritis patients. J Physiol 2021; 599:2135-2136. [PMID: 33569784 DOI: 10.1113/jp281407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ryan Debi
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Simona Yakobov
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Parashar Bhatt
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Robert Lakin
- Department of Biology, York University, Toronto, Ontario, Canada
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13
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Stojanovic A, Veselinovic M, Draginic N, Rankovic M, Andjic M, Bradic J, Bolevich S, Antovic A, Jakovljevic V. The Influence of Menopause and Inflammation on Redox Status and Bone Mineral Density in Patients with Rheumatoid Arthritis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9458587. [PMID: 33505593 PMCID: PMC7810566 DOI: 10.1155/2021/9458587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/28/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
Although oxidative stress is considered to be one of the key pathogenic factors in rheumatoid arthritis (RA), there is insufficient knowledge regarding the impact of menopause on redox status in this population. Thus, this study is aimed at assessing the influence of menopause within healthy women and within RA patients as well as the impact of RA in premenopausal and postmenopausal women on redox status, with special reference to bone mineral density (BMD). A total of 90 women were included in the study, 42 with RA and 48 age-matched healthy controls. They were divided into subgroups according to the presence of menopause. Following oxidative stress parameters were measured spectrophotometrically: index of lipid peroxidation (measured as TBARS), nitrites (NO2 -), superoxide anion radical (O2 -), hydrogen peroxide (H2O2), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH). BMD was assessed by using a dual-energy X-ray absorptiometry scanner. Comorbidities and drug history were recorded. The levels of H2O2 and TBARS were elevated in patients with RA, while NO2 - and O2 - increased in healthy women, both in premenopausal and postmenopausal groups. SOD activity decreased in postmenopausal RA patients. BMD was reduced in postmenopausal RA women. There was a correlation between NO2 - and O2 - with Health Assessment Questionnaire (HAQ) index in RA patients. Given that postmenopausal state was associated with elevated oxidative stress within healthy women and that menopausal state did not affect redox homeostasis within RA patients, but the redox homeostasis was altered in both RA groups compared to healthy women, it can be presumed that impaired redox status in RA occurred due to presence of the disease, irrespective of age. Moreover, menopause attenuates BMD reduction in women with RA. These results may indicate the need for therapeutic use of antioxidants in the form of supplements in women with RA, regardless of age.
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Affiliation(s)
- Aleksandra Stojanovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Mirjana Veselinovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Nevena Draginic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Marina Rankovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Marijana Andjic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Jovana Bradic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Sergey Bolevich
- I.M. Sechenov First Moscow State Medical University, Department of Human Pathology, Trubetskaya str. 8, 119991 Moscow, Russia
| | - Aleksandra Antovic
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
| | - Vladimir Jakovljevic
- I.M. Sechenov First Moscow State Medical University, Department of Human Pathology, Trubetskaya str. 8, 119991 Moscow, Russia
- University of Kragujevac, Faculty of Medical Sciences, Department of Physiology, Svetozara Markovica 69, 34000 Kragujevac, Serbia
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14
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Park S, Moon BR, Kim JE, Kim HJ, Zhang T. Aqueous Extracts of Morus alba Root Bark and Cornus officinalis Fruit Protect against Osteoarthritis Symptoms in Testosterone-Deficient and Osteoarthritis-Induced Rats. Pharmaceutics 2020; 12:pharmaceutics12121245. [PMID: 33371279 PMCID: PMC7767081 DOI: 10.3390/pharmaceutics12121245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
Water extracts of both Morus alba L. root bark (MBW) and Cornus officinalis Siebold and Zucc fruit (CFW) have traditionally been used to promote men's health in the elderly in Asia. We determined that the 12-week consumption of MBW and CFW could alleviate testosterone-deficiency syndrome and osteoarthritis (OA) symptoms in testosterone-deficient rats, and the action mechanisms were explored. Rats with bilateral orchiectomy (ORX) were fed a 45% fat diet containing either 0.5% MBW (ORX-MBW), 0.5% CFW(ORX-CFW), or 0.5% dextrin (ORX-CON). Sham-operated rats also received 0.5% dextrin (Non-ORX-CON). After 8 weeks of treatment, all rats had an injection of monoiodoacetate (MIA) into the left knee, and they continued the same diet for the additional 4 weeks. ORX-CFW and ORX-MBW partially prevented the reduction of serum testosterone concentrations and decreased insulin resistance, compared to the ORX-CON. ORX-CFW and ORX-MBW protected against the reduction of bone mineral density (BMD) and lean body mass (LBM) compared to the ORX-CON. The limping and edema scores were lower in the order of the ORX-CON, ORX-CRF = ORX-MBW, and Non-ORX-CON (p < 0.05). The scores for pain behaviors, measured by weight-distribution on the OA leg and maximum running velocity on a treadmill, significantly decreased in the same order as limping scores. ORX-MBW protected against the increased expression of matrix metalloproteinase (MMP)-3 and MMP-13 and reduced the production of inflammatory markers such as TNF-α and IL-1β, by MIA in the articular cartilage, compared to the ORX-CON (p < 0.05). The cartilage damage near the tidemark of the knee and proteoglycan loss was significantly less in ORX-MBW than ORX-CON. In conclusion, MBW, possibly CFW, could be effective alternative therapeutic agents for preventing osteoarthritis in testosterone-deficient elderly men.
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Affiliation(s)
- Sunmin Park
- Department Food & Nutrition, Obesity/Diabetes Center, Hoseo University, Asan 31499, Korea; (B.R.M.); (J.E.K.); (H.J.K.); (T.Z.)
- Department of Bio-Convergence System, Hoseo University, Asan 31499, Korea
- Correspondence: ; Tel.: +82-41-540-5345; Fax: +82-41-548-0670
| | - Bo Reum Moon
- Department Food & Nutrition, Obesity/Diabetes Center, Hoseo University, Asan 31499, Korea; (B.R.M.); (J.E.K.); (H.J.K.); (T.Z.)
| | - Ji Eun Kim
- Department Food & Nutrition, Obesity/Diabetes Center, Hoseo University, Asan 31499, Korea; (B.R.M.); (J.E.K.); (H.J.K.); (T.Z.)
| | - Hyun Joo Kim
- Department Food & Nutrition, Obesity/Diabetes Center, Hoseo University, Asan 31499, Korea; (B.R.M.); (J.E.K.); (H.J.K.); (T.Z.)
| | - Ting Zhang
- Department Food & Nutrition, Obesity/Diabetes Center, Hoseo University, Asan 31499, Korea; (B.R.M.); (J.E.K.); (H.J.K.); (T.Z.)
- Department of Bio-Convergence System, Hoseo University, Asan 31499, Korea
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15
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Tsaliki M, Koelsch KA, Chambers A, Talsania M, Scofield RH, Chakravarty EF. Ovarian antibodies among SLE women with premature menopause after cyclophosphamide. Int J Rheum Dis 2020; 24:120-124. [PMID: 33300669 DOI: 10.1111/1756-185x.14022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Women with systemic lupus erythematosus (SLE) are at risk of premature ovarian failure when treated with cyclophosphamide. This risk is increased when autoimmune thyroid disease is present. We undertook this study to determine whether the presence of ovarian autoimmunity also increased the risk of early ovarian failure among women receiving cyclophosphamide. METHODS We examined the records of women enrolled in the Lupus Family Registry and Repository, a cross-sectional study of ~3300 SLE subjects, for treatment with cyclophosphamide as well as menopausal status. We defined premature menopause as permanent, spontaneous cessation of menstruation before age 45. We measured anti-ovarian antibodies by enzyme-linked immunosorbent assay using stored sera. RESULTS There were 258 women treated with cyclophosphamide in whom presence of absence or premature menopause could by defined. A total of 169 (65.6%) had premature ovarian failure, while 89 (34.6%) did not. While anti-ovarian antibodies were present in a small percentage of patients, there was no association of premature menopause to either level of these antibodies (16.2 ± 20.3 units vs 17.4 ± 21.7 units, P = NS by Fisher's exact test), or positivity on this testing (11 of 169 [6.5%] positive vs 8 of 89 [8.9%], χ2 = 0.53, P = .46, 95% CI 0.95-1.1). Neither renal disease nor hypothyroidism increased the risk of premature ovarian failure in these women receiving cyclophosphamide. CONCLUSION Anti-ovarian antibodies among women with SLE are not associated with premature ovarian failure after treatment with cyclophosphamide.
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Affiliation(s)
- Martha Tsaliki
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine and Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Kristi A Koelsch
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine and Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Ambre Chambers
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine and Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Mitali Talsania
- Section of Endocrinology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - R Hal Scofield
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine and Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Eliza F Chakravarty
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine and Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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16
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Angum F, Khan T, Kaler J, Siddiqui L, Hussain A. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus 2020; 12:e8094. [PMID: 32542149 PMCID: PMC7292717 DOI: 10.7759/cureus.8094] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
Autoimmune disorders are characterized as a condition in which the host's immune system mistakenly attacks itself. These disorders cause the immune system to cause a systemic reaction by attacking multiple organs or may be localized to attacking one specific organ, such as the skin. The exact mechanism of such autoimmune conditions is not well understood; however, the presumed mechanism tends to vary amongst the disorders. Autoimmune diseases present with a clear gender bias with a greater prevalence amongst women, occurring at a rate of 2 to 1. Many autoimmune disorders tend to affect women during periods of extensive stress, such as pregnancy, or during a great hormonal change. A far greater number of women are affected every year with autoimmune diseases, leading to researchers attempting to identify the underlying factors, which could be responsible for this disparity. Autoimmune disorders occur as a result of multiple factors as some disorders may be genetic, while others are sporadic. Throughout this review, various hypotheses are explored that provide insight into the increased susceptibility of autoimmune disorders within women.
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Affiliation(s)
- Fariha Angum
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Tahir Khan
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Jasndeep Kaler
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | | | - Azhar Hussain
- Healthcare Administration, Franklin University, Columbus, USA
- Medicine, Xavier University School of Medicine, Oranjestad, ABW
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17
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Medolago NB, Ferrasi AC, Rocha OMD, Pardini MIDMC, Grotto RMT, Galvani AF, Silva GF. Human platelet antigen-3 polymorphism as a risk factor for rheumatological manifestations in hepatitis C. Rev Soc Bras Med Trop 2020; 53:e20190210. [PMID: 31994660 PMCID: PMC7083341 DOI: 10.1590/0037-8682-0210-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is involved in the pathogenesis of autoimmune and rheumatic disorders. Although the human platelet antigens (HPA) polymorphism are associated with HCV persistence, they have not been investigated in rheumatological manifestations (RM). This study focused on verifying associations between allele and genotype HPA and RM in patients with chronic hepatitis C. METHODS Patients (159) with chronic hepatitis C of both genders were analyzed. RESULTS Women showed association between HPA-3 polymorphisms and RM. CONCLUSIONS An unprecedented strong association between rheumatological manifestations and HPA-3 polymorphism, possibly predisposing women to complications during the disease course, was observed.
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Affiliation(s)
- Natália Bronzatto Medolago
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | - Adriana Camargo Ferrasi
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | - Oswaldo Melo da Rocha
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | - Rejane Maria Tommasini Grotto
- Universidade Estadual Paulista, Departamento de Bioprocessos e Biotecnologia, Faculdade de Ciências Agronômicas, Botucatu, SP, Brasil
| | - Aline Faria Galvani
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | - Giovanni Faria Silva
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
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18
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Ceribelli A, De Santis M, Selmi C. Sex and autoimmune disease: Four mechanisms pointing at women. Mediterr J Rheumatol 2019; 30:162-166. [PMID: 32185359 PMCID: PMC7045856 DOI: 10.31138/mjr.30.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 11/15/2022] Open
Abstract
The ultimate goal of modern medicine is a personalized approach being tailored on the single patient, ie, tailored, based on a finely tuned definition of the immunogenetics, epigenetics, microbiome, and biomarkers, to maximize results and minimize risks particularly of new targeted treatments. Among individual factors around which to tailor the patient management are sex and age, with gender-medicine finally becoming central to the research agenda. Of note, we are not convinced that a whole personalized medicine approach in its current form will necessarily include gender medicine and thus this should remain central to the research agenda. To tackle this crucial issue, however, we should first be able to answer a question of paramount importance, that is, why does autoimmunity affect women more than men? The growing number of experimental works in this area militate against an easy answer to this question, but we will herein briefly discuss four major candidates (sex hormones, sex chromosomes, environmental factors, and the microbiome) to which some unsuspected others may be ancillary.
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Affiliation(s)
- Angela Ceribelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,BIOMETRA Department, University of Milan, Italy
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19
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Selmi C, Gershwin ME. Sex and autoimmunity: proposed mechanisms of disease onset and severity. Expert Rev Clin Immunol 2019; 15:607-615. [PMID: 31033369 DOI: 10.1080/1744666x.2019.1606714] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Chronic autoimmune diseases affect 5-10% of the population worldwide and are largely predominant in women. Sex hormone changes have been widely investigated based on changes in the clinical phenotypes observed during pregnancy and menopause. It is known that females with autoimmune diseases manifest a higher rate of circulating leukocytes with a single X chromosome, and there have been several reports on the role of X chromosome gene dosage through inactivation or duplication in autoimmunity. However, it is also important not to overlook men with autoimmune diseases, who might manifest a more frequent loss of the Y chromosome in circulating leukocytes. Areas covered: In the present review, we will discuss the current evidence supporting the mechanisms of female predominance in rheumatic diseases, by discussing the role of reproductive history, sex hormones and abnormalities related to them, clinical differences between male and female patients, and epigenetic changes that have been evaluated through twin studies on genetic and environmental changes in rheumatic patients. Expert opinion: The influence of sex hormones and chromosomes on the function of the innate and adaptive immune systems needs to be clarified, to better understand the risk of autoimmune diseases, early diagnostic tools, and therapeutic response.
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Affiliation(s)
- Carlo Selmi
- a Division of Rheumatology and Clinical Immunology , Humanitas Research Hospital , Milan , Italy.,b BIOMETRA Department , University of Milan , Milan , Italy
| | - M Eric Gershwin
- c Division of Rheumatology, Allergy, and Clinical Immunology , University of California , Davis , CA , USA
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Gottschalk MS, Eskild A, Tanbo TG, Bjelland EK. Childbirth close to natural menopause: does age at menopause matter? Reprod Biomed Online 2019; 39:169-175. [PMID: 31122832 DOI: 10.1016/j.rbmo.2019.03.209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
RESEARCH QUESTION Does a successful spontaneous pregnancy in the years close to natural menopause depend on age at menopause? DESIGN This was a retrospective population-based study of 4157 parous postmenopausal women in Norway, born during the years 1925-1940. Data were obtained by two self-administered questionnaires in the HUNT2 Survey (1995-1997). We calculated the proportions of women who gave birth within 5 years and within 10 years prior to menopause both among all women, and according to categories of age at menopause. RESULTS Overall, 2.7% (114/4157) of all women gave birth within 5 years, and 11.7% (487/4157) gave birth within 10 years, prior to menopause. Among women with menopause before the age of 45 years, 23.5% (81/344) gave birth within 5 years, and 55.5% (191/344) gave birth within 10 years, before menopause. Among the women with menopause at the age of 55 years or older, no women (0/474) gave birth within 5 years, and 0.2% (1/474) gave birth within 10 years, prior to menopause. CONCLUSIONS More than half of the women with menopause before the age of 45 years gave birth within the 10 years before natural menopause, whereas virtually no women with menopause at the age of 55 years or older did. Thus, the length of the sterile interval before natural menopause may vary by age at menopause.
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Affiliation(s)
- Marthe Sørli Gottschalk
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Gunnar Tanbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Reproductive Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Shen PC, Chang PC, Jou IM, Chen CH, Lee FH, Hsieh JL. Hand tendinopathy risk factors in Taiwan: A population-based cohort study. Medicine (Baltimore) 2019; 98:e13795. [PMID: 30608391 PMCID: PMC6344158 DOI: 10.1097/md.0000000000013795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
De Quervain's disease, carpal tunnel syndrome (CTS), and trigger finger (digit) are three common pathological conditions of the hand. They are considered overuse syndromes and occur predominantly in females. The prevalence rate and cause-specific risks of these three tendinopathies have not yet been clarified. Data from 41,871 cases listed in the Taiwan National Health Insurance Research Database (NHIRD) from 2010 to 2014 were analyzed. The prevalence rate of these 3 conditions by age, sex, and the risk factors of female-dominant diseases (e.g., osteoporosis, rheumatoid arthritis [RA], and tendinopathy), diabetes mellitus, and hormone antagonist treatment was evaluated. We found that 1.59% of the population developed CTS, 0.49% developed de Quervain's, and 1.07% developed trigger finger. Cases were more likely to develop the three hand tendinopathies if they were female, between 50 and 59 years old, and, according to a multivariate analysis, comorbid with RA, diabetes, using hormone antagonists. Our findings should provide an understanding of the risk factors associated with hand tendinopathy.
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Affiliation(s)
- Po-Chuan Shen
- Department of Orthopedics, Tainan Hospital, Ministry of Health and Welfare, Tainan
| | - Po-Chun Chang
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical Unirversity
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital
| | - Chung-Hwan Chen
- Departments of Orthopedics, College of Medicine, Kaohsiung Medical University
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Fang-Hsin Lee
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jeng-Long Hsieh
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
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Jeong HS, Hong SJ, Choi SJ, Kim JH, Song GG, Jung JH. Effects of oral contraceptives on rheumatoid arthritis in Korean menopausal women: A nationwide cross-sectional study. Maturitas 2018; 112:24-28. [DOI: 10.1016/j.maturitas.2018.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/20/2018] [Accepted: 03/30/2018] [Indexed: 01/21/2023]
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Marrie RA, Graff L, Walker JR, Fisk JD, Patten SB, Hitchon CA, Lix LM, Bolton J, Sareen J, Katz A, Berrigan LI, Marriott JJ, Singer A, El-Gabalawy R, Peschken CA, Zarychanski R, Bernstein CN. Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study. JMIR Res Protoc 2018; 7:e15. [PMID: 29343461 PMCID: PMC5792704 DOI: 10.2196/resprot.8794] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood. OBJECTIVE The objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants. METHODS Between November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations. RESULTS The final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001). CONCLUSIONS This paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.
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Affiliation(s)
| | | | | | | | | | | | - Lisa M Lix
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
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Kerkhof PLM, Khamaganova I. Sex-Specific Cardiovascular Comorbidities with Associations in Dermatologic and Rheumatic Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:489-509. [DOI: 10.1007/978-3-319-77932-4_30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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