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Ferraz-Amaro I, Genre F, Blanco R, Calvo-Rio V, Corrales-Selaya C, Portilla V, Aurrecoechea E, Batanero R, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, López-Medina C, Ladehesa-Pineda L, Castañeda S, Vicente-Rabaneda EF, Fernández-Carballido C, Martínez Vidal MP, Castro Corredor D, Anino Fernández J, Peiteado D, Plasencia-Rodriguez C, Expósito R, Garcia Vivar ML, Galíndez-Agirregoikoa E, Vegas N, Urionagüena I, Montes-Perez E, Gonzalez-Gay MA, Rueda-Gotor J. Sex-specific impact of inflammation on traditional cardiovascular risk factors and atherosclerosis in axial spondyloarthritis. A multicentre study of 913 patients. RMD Open 2024; 10:e004187. [PMID: 38942590 DOI: 10.1136/rmdopen-2024-004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/18/2024] [Indexed: 06/30/2024] Open
Abstract
INTRODUCTION The nature of the relationship between inflammation, cardiovascular (CV) risk factors and atherosclerosis in axial spondyloarthritis (axSpA) remains largely unknown and sex differences in this regard are yet to be assessed. METHODS Study including 611 men and 302 women from the Spanish multicentre AtheSpAin cohort to assess CV disease in axSpA. Data on CV disease risk factors were collected both at disease diagnosis and at enrolment, and data on disease activity, functional indices and carotid ultrasonography only at enrolment. RESULTS After a median disease duration of 9 years, patients of both sexes who at disease diagnosis had elevated acute phase reactants (APRs), more frequently had hypertension and obesity. The same occurred with dyslipidaemia in men and with diabetes mellitus in women. At enrolment, CV risk factors were independently associated with APR and with activity and functional indices, with various sex differences. C reactive protein (CRP) values were inversely associated with HDL-cholesterol in men (β coefficient: -1.2 (95% CI: -0.3 to -0.07) mg/dL, p=0.001), while erythrocyte sedimentation rate values were positively associated with triglycerides in women (β coefficient: 0.6 (95% CI: 0.04 to 1) mg/dL, p=0.035). Furthermore, only women showed an independent relationship between insulin resistance parameters and APR or disease activity. Both men and women with high-very high CV risk according to the Systematic Assessment of Coronary Risk Evaluation 2 and CRP levels higher than 3 mg/L at diagnosis of the disease presented carotid plaques significantly more frequently than those with normal CRP levels at disease diagnosis. CONCLUSION Inflammation is associated with atherosclerosis and CV disease in axSpA. A gender-driven effect is observed in this relationship.
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Affiliation(s)
- Ivan Ferraz-Amaro
- Servicio de Reumatologia, Hospital Universitario de Canarias, La Laguna, Spain
| | - Fernanda Genre
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Vanesa Calvo-Rio
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Reumatologia, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Cristina Corrales-Selaya
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Hospital Universitario Marqués de Valdecilla, Servicio de Reumatología, Santander, Spain
| | | | | | - Ricardo Batanero
- Endocrino, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Carlos Rodríguez-Lozano
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | | | - Santos Castañeda
- Rheumatology Department, Hospital Universitario La Princesa, Madrid, Spain
- Rheumatology, FJD, Madrid, Spain
| | | | | | | | - David Castro Corredor
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | - Maria Luz Garcia Vivar
- Department of Rheumatology, Osakidetza Basque Health Service, Basurto University Hospital, Barcelona, Spain
| | | | - Nuria Vegas
- Reumatologia, Hospital de Galdakao-Usansolo, Galdakao, Spain
| | - Irati Urionagüena
- Rheumatology Division, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Miguel A Gonzalez-Gay
- Rheumatology, ISS Fundacion Jimenez Diaz, Madrid, Spain
- Department of Medicine and Psychiatry, Medicine, University of Cantabria, Santander, Spain
| | - Javier Rueda-Gotor
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Reumatologia, Hospital Sierrallana y Tres Mares, Torrelavega, Spain
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Bedeković D, Bošnjak I, Bilić-Ćurčić I, Kirner D, Šarić S, Novak S. Risk for cardiovascular disease development in rheumatoid arthritis. BMC Cardiovasc Disord 2024; 24:291. [PMID: 38834973 DOI: 10.1186/s12872-024-03963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis have significant cardiovascular mortality and morbidity. OBJECTIVE To investigate the effects of chronic inflammation in rheumatoid arthritis on cardiovascular morbidity association with cardiovascular risk factors risk factors. Mortality report is secondary just to show trends without sufficient statistical power as it is accidental endpoint. METHODS A total of 201 individuals without previous cardiovascular disease, 124 with rheumatoid arthritis (investigation group) and 77 with osteoarthritis (control group), were included in the study and followed up for an average of 8 years to assess the development of fatal or non-fatal cardiovascular diseases. The incidence and prevalence of cardiovascular risk factors were also investigated. RESULTS The total incidence of one or more fatal or nonfatal cardiovascular events was 43.9% in the investigation group and 37.5% in the control group. Of these patients, 31.7% and 30.9% survived cardiovascular events in the investigation and control groups, respectively. The most common cardiovascular disease among participants who completed the study and those who died during the study was chronic heart failure. The results of the subgroup analysis showed that strict inflammation control plays a central role in lowering cardiovascular risk. CONCLUSION A multidisciplinary approach to these patients is of paramount importance, especially with the cooperation of immunologists and cardiologists for early detection, prevention, and management of cardiovascular risks and diseases.
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Affiliation(s)
- Dražen Bedeković
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Ivica Bošnjak
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia.
| | - Ines Bilić-Ćurčić
- Department for Pharmacology, Faculty of Medicine, J. J. Strossmayer University of Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, J. Huttlera 4, Osijek, 31000, Croatia
| | - Damir Kirner
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Sandra Šarić
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Rijeka, Rijeka, Croatia
- Faculty of Medicine Rijeka, Department of Internal Medicine, University of Rijeka, Braće Branchetta 20/1, Rijeka, 51000, Croatia
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Xu F, Xie L, He J, Huang Q, Shen Y, Chen L, Zeng X. Detection of common pathogenesis of rheumatoid arthritis and atherosclerosis via microarray data analysis. Heliyon 2024; 10:e28029. [PMID: 38628735 PMCID: PMC11019104 DOI: 10.1016/j.heliyon.2024.e28029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Despite extensive research reveal rheumatoid arthritis (RA) is related to atherosclerosis (AS), common pathogenesis between these two diseases still needs to be explored. In current study, we explored the common pathogenesis between rheumatoid arthritis (RA) and atherosclerosis (AS) by identifying 297 Differentially Expressed Genes (DEGs) associated with both diseases. Through KEGG and GO functional analysis, we highlighted the correlation of these DEGs with crucial biological processes such as the vesicle transport, immune system process, signaling receptor binding, chemokine signaling and many others. Employing Protein-Protein Interaction (PPI) network analysis, we elucidated the associations between DEGs, revealing three gene modules enriched in immune system process, vesicle, signaling receptor binding, Pertussis, and among others. Additionally, through CytoHubba analysis, we pinpointed 11 hub genes integral to intergrin-mediated signaling pathway, plasma membrane, phosphotyrosine binding, chemokine signaling pathway and so on. Further investigation via the TRRUST database identified two key Transcription Factors (TFs), SPI1 and RELA, closely linked with these hub genes, shedding light on their regulatory roles. Finally, leveraging the collective insights from hub genes and TFs, we proposed 10 potential drug candidates targeting the molecular mechanisms underlying RA and AS pathogenesis. Further investigation on xCell revealed that 14 types of cells were all different in both AS and RA. This study underscores the shared pathogenic mechanisms, pivotal genes, and potential therapeutic interventions bridging RA and AS, offering valuable insights for future research and clinical management strategies.
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Affiliation(s)
- Fan Xu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian Province, China
| | - Linfeng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qiuyu Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian Province, China
| | - Yanming Shen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Fujian Medical University, Fuzhou, Fujian Province, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian Province, China
| | - Xiaohong Zeng
- Department of Rheumatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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Al-Ewaidat OA, Naffaa MM. Stroke risk in rheumatoid arthritis patients: exploring connections and implications for patient care. Clin Exp Med 2024; 24:30. [PMID: 38294723 PMCID: PMC10830780 DOI: 10.1007/s10238-023-01288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024]
Abstract
Rheumatoid arthritis (RA) can independently increase the risk of stroke, affecting both young and adult RA patients. Recent attention has been drawn to the association between stroke and RA, supported by mounting evidence. Given that stroke is a significant and an urgent public health concern, this review aims to highlight the relationship between stroke and RA, covering mechanisms, underlying risk factors, early detection tools, and treatment implications. By uncovering the connection that links RA to stroke, we can pave the way for targeted healthcare practices and the development of preventive strategies for individuals with RA. Therefore, further research is imperative to deepen our understanding of this association and, ideally, guide treatment decisions for individuals at risk of both RA and stroke.
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Affiliation(s)
- Ola A Al-Ewaidat
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, 60202, USA
| | - Moawiah M Naffaa
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA.
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Santos CS, Salgueiro RR, Morales CM, Castro CÁ, Álvarez ED. Risk factors for cardiovascular disease in primary Sjögren's syndrome (pSS): a 20-year follow-up study. Clin Rheumatol 2023; 42:3021-3031. [PMID: 37402929 DOI: 10.1007/s10067-023-06686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease characterized by a chronic grade of inflammation. Cardiovascular events represent the major causes of morbidity and mortality in patients with inflammatory rheumatic diseases; however, the significance and prevalence of cardiovascular disease in patients with pSS remain unclear. OBJECTIVE To determine the clinical significance of cardiovascular disease in pSS and analyze the risk of cardiovascular disease according to glandular/extraglandular involvement and positivity to anti-Ro/SSA and/or anti-La/SSB autoantibodies. METHODS A retrospective study including patients diagnosed with pSS fulfilling the 2016 ACR/EULAR classification criteria was followed and evaluated in our outpatient clinic between 2000 and 2022. The prevalence of cardiovascular risk factors with pSS was evaluated, and a possible association with clinical and immunological characteristics, the treatments received, and the impact on cardiovascular disease were determined. Univariate and multivariate regression analyses were performed in an attempt to determine potential risk factors associated with cardiovascular involvement. RESULTS A total of 102 pSS patients were included. Eighty-two percent were female, with a mean age of 65±24 years and a disease duration of 12.5 ±6 years. Thirty-six patients (36%) had at least one cardiovascular risk factor. Arterial hypertension was diagnosed in 60 (59%) patients, dyslipidemia in 28 (27%), diabetes in 15 (15%), obesity in 22 (22%), and hyperuricemia in 19 (18%). History of arrhythmia was found in 25 (25%), conduction defects in 10 (10%), arterial peripheral vascular disease in 7 (7%), venous thrombosis in 10 (10%), coronary artery disease in 24 (24%), and cerebrovascular disease in 22 (22%) of patients. Patients with extraglandular involvement had a higher prevalence of arterial hypertension (p=0.04), dyslipidemia (p=0.003), LDL mean values (p=0.038), hyperuricemia (p=0.03), and coronary artery disease (p=0.01) after adjusting for age, sex, disease duration, and the significant variables in the univariate analysis. Patients with Ro/SSA and La/SSB autoantibodies had a substantially higher risk of hyperuricemia (p=0.01), arrhythmia (p=0.01), coronary artery disease (p=0.02), cerebrovascular disease (p=0.02), and venous thrombosis (p =0.03). In the multivariate logistic regression analysis, higher odds of cardiovascular risk factors were associated with extraglandular involvement (p=0.02), treatment with corticosteroids (p=0.02), ESSDAI>13 (p=0.02), inflammatory markers including ESR levels (p 0.007), and serologic markers such as low C3 levels (p=0.03) and hypergammaglobulinemia (p=0.02). CONCLUSIONS Extraglandular involvement was associated with a higher prevalence of arterial hypertension, dyslipidemia, hyperuricemia, and coronary artery disease. Anti-Ro/SSA and anti-La/SSB seropositivity was associated with a higher prevalence of cardiac rhythm abnormalities, hyperuricemia, venous thrombosis, coronary artery disease, and cerebrovascular disease. Raised inflammatory markers, disease activity measured by ESSDAI, extraglandular involvement, serologic markers including hypergammaglobulinemia and low C3, and treatment with corticosteroids were associated with a higher risk for cardiovascular comorbidities. Key Points • Patients with pSS are vulnerable to cardiovascular risk factors. There is an interconnection between extraglandular involvement, disease activity, inflammatory markers, and cardiovascular risk comorbidities. • Anti-Ro/SSA and anti-La/SSB seropositivity was associated with a higher frequency of cardiac conduction abnormalities, coronary artery disease, venous thrombosis, and stroke. • Hypergammaglobulinemia, elevated ESR, and low C3 are associated with a higher prevalence of cardiovascular comorbidities. • Valid risk stratification tools to help with prevention and consensus on the management of CVDs in pSS patients are warranted.
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Affiliation(s)
- Cristiana Sieiro Santos
- Rheumatology Department, Complejo Asistencial Universitario de León, Altos de Nava S/N, 24008, León, Spain.
| | | | - Clara Moriano Morales
- Rheumatology Department, Complejo Asistencial Universitario de León, Altos de Nava S/N, 24008, León, Spain
| | - Carolina Álvarez Castro
- Rheumatology Department, Complejo Asistencial Universitario de León, Altos de Nava S/N, 24008, León, Spain
| | - Elvira Díez Álvarez
- Rheumatology Department, Complejo Asistencial Universitario de León, Altos de Nava S/N, 24008, León, Spain
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Bedeković D, Bošnjak I, Šarić S, Kirner D, Novak S. Role of Inflammatory Cytokines in Rheumatoid Arthritis and Development of Atherosclerosis: A Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1550. [PMID: 37763669 PMCID: PMC10534747 DOI: 10.3390/medicina59091550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Uncontrolled chronic inflammation results in cardiovascular disease and early death. In this review, we studied the impact of rheumatoid arthritis on the cardiovascular system, including the early and accelerated development of atherosclerosis and its clinical manifestations, focusing on the inflammatory mechanisms leading to arterial wall damage, rapid atherosclerotic plaque formation, and thrombosis. Furthermore, the effect of medications used to treat rheumatoid arthritis on the cardiovascular system was studied. The effect of chronic inflammation and medication on traditional cardiovascular risk factors is not the main subject of this review. We observed that uncontrolled chronic inflammation and some medications directly impact all the stages of atherosclerosis. In conclusion, reducing inflammation and maintaining long-term remission in rheumatoid arthritis may prevent early atherosclerosis. We believe that this review will encourage a better interdisciplinary approach to the management of these patients and further research in this field.
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Affiliation(s)
- Dražen Bedeković
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
- Faculty of Medicine Osijek, Department of Internal Medicine, Josip Juraj Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Ivica Bošnjak
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
| | - Sandra Šarić
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
- Faculty of Medicine Osijek, Department of Internal Medicine, Josip Juraj Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Damir Kirner
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
- Faculty of Medicine Osijek, Department of Internal Medicine, Josip Juraj Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia;
- Faculty of Medicine Rijeka, Department of Internal Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
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Giachi A, Cugno M, Gualtierotti R. Disease-modifying anti-rheumatic drugs improve the cardiovascular profile in patients with rheumatoid arthritis. Front Cardiovasc Med 2022; 9:1012661. [PMID: 36352850 PMCID: PMC9637771 DOI: 10.3389/fcvm.2022.1012661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting about 0. 5–1% of the adult population and manifesting as persistent synovitis, systemic inflammation and production of autoantibodies. Patients affected by RA not only experience chronic disease progression, but are also burdened by a 1.5-fold increased cardiovascular (CV) risk, which is comparable to the risk experienced by patients with type 2 diabetes mellitus. RA patients also have a higher incidence and prevalence of coronary artery disease (CAD). Although RA patients frequently present traditional CV risk factors such as insulin resistance and active smoking, previous studies have clarified the pivotal role of chronic inflammation–driven by proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha)–in accelerating the process of atherosclerosis and impairing the coagulation system. Over the last years, a number of studies have shown that disease-modifying anti-rheumatic drugs (DMARDs) reducing the inflammatory state in general improve the CV risk, however some drugs may carry some apparent negative effects. Thus, RA is a model of disease in which targeting inflammation may counteract the progression of atherosclerosis and reduce CV risk. Clinical and experimental evidence indicates that the management of RA patients should be tailored based on the positive and negative effects of DMARDs on CV risk together with the individual traditional CV risk profile. The identification of genetic, biochemical and clinical biomarkers, predictive of evolution and response to treatment, will be the next challenge for a precision approach to reduce the burden of the disease.
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Affiliation(s)
- Andrea Giachi
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Cugno
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
- *Correspondence: Massimo Cugno
| | - Roberta Gualtierotti
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
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Calvo Alén J, Lavin-Gomez BA, Aurrecoechea E, Guerra Ruiz AR, Martínez Taboada V, Gómez Gerique J. TNF Inhibitors Exert a "Hidden" Beneficial Effect in the Cardiovascular Lipoprotein Profile of RA Patients. Biologics 2022; 16:187-197. [PMID: 36281333 PMCID: PMC9587304 DOI: 10.2147/btt.s364191] [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: 02/26/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
Abstract
Purpose A high cardiovascular risk has been described in patients with rheumatoid arthritis (RA); the effects of different biological agents have also been described in these patients. The aim of the present study is to examine the effects of tumor necrosis factor inhibitors (TNFi) in the lipoprotein profile of RA patients using a broad laboratory assessment including a large number of non-routine tests. Patients and Methods RA patients treated with and without TNFi (70 patients in each group) were cross-sectionally compared regarding a broad spectrum of lipoprotein parameters including serum levels of total and HDL, LDL and VLDL cholesterol triglycerides, lipoprotein A (LpA), apolipoprotein A1 (Apo A), B100 (Apo B) and paroxonase. For each lipoprotein subfraction (HDL, LDL and VLDL), we assess specific concentrations of cholesterol, triglycerides, phospholipids and proteins and total mass of each one. Additionally, HDL Apo A, LDL and VLDL Apo B concentrations and number of particles of LDL and VLDL were also determined. Exploratory univariate and multivariate analyses of the different variables were performed. Results Seventy patients in each subset were enrolled. Patients on treatment with TNFi showed a trend to be younger and to have a longer disease duration. Regarding the lipoprotein analyses, borderline significant higher levels of serum Apo A were detected and an independent association with lower HDL mass, LDL triglyceride, VLDL cholesterol, VLDL Apo B, VLDL mass, number of VLDL cholesterol molecules and number of particles of VLDL was clearly observed. Conclusion TNFi treatment was associated with beneficial atherogenic effects at the lipoprotein level especially centered in the VLDL-related parameters consistent with a reduction of the atherogenic risk.
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Affiliation(s)
- Jaime Calvo Alén
- Rheumatology Department, Hospital Universitario Araba, Universidad del País Vasco, and Instituto de Investigación Biomédica BIOARABA, Vitoria, Spain,Correspondence: Jaime Calvo Alén, Rheumatology Department, Hospital Universitario Araba, Universidad del País Vasco, C/ Francisco Leandro de Viana s/n, Vitoria, Alava, 01009, Spain, Tel +34 945007576, Email
| | | | - Elena Aurrecoechea
- Rheumatology Division, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Armando Raul Guerra Ruiz
- Clinical Biochemistry Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Víctor Martínez Taboada
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla Universidad de Cantabria, Santander, Spain
| | - Juan Gómez Gerique
- Clinical Biochemistry Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Rueda-Gotor J, Ferraz-Amaro I, Genre F, González Mazón I, Corrales A, Portilla V, Llorca J, Agudo-Bilbao M, Aurrecoechea E, Expósito R, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez-Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, Vivar MLG, Galíndez-Agirregoikoa E, Perez EM, Fernández Díaz C, Blanco R, González-Gay MÁ. Cardiovascular and disease-related features associated with extra-articular manifestations in axial spondyloarthritis. A multicenter study of 888 patients. Semin Arthritis Rheum 2022; 57:152096. [PMID: 36150319 DOI: 10.1016/j.semarthrit.2022.152096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To determine the potential impact of extra-articular manifestations (EAMs) on disease characteristics and cardiovascular (CV) risk in patients with axial spondylarthritis (axSpA). METHODS This is a cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort to study atherosclerosis in axSpA. Data on the history of CV events, subclinical carotid atherosclerosis, and disease-related features, including EAMs, were collected. RESULTS 888 axSpA patients were recruited. Concomitant acute anterior uveitis (AAU), psoriasis (PSO), and inflammatory bowel disease (IBD) were present in 177 (19.9%), 96 (10.8%), and 57 (6.4%) patients, respectively. When compared with axSpA patients without EAMs, a significant increase in past CV events was observed in patients with PSO (9% versus 4%, p = 0.048) and in those with at least one EAM (7% versus 4%, p = 0.032) or with more than one EAM (11% versus 4%, p = 0.022). The frequency of carotid plaques and the values of cIMT were higher in patients with EAMs than in those without EAMs, although only the univariable analysis for carotid plaques in patients with PSO (39% versus 30%, p = 0.038) and for cIMT in patients with AAU (665 ± 156 µm versus 637 ± 139 µm, p = 0.042) and those with at least one EAM (661 ± 155 µm versus 637 ± 139 µm, p = 0.024) showed significant results. In addition, patients with PSO or IBD were found to have specific disease-related features, such as higher ESR at diagnosis, and more frequent use of glucocorticoids and TNF inhibitors than those without EAMs. Also, PSO patients had more commonly peripheral involvement and those with AAU more severe radiographic damage than those without EAMs. The frequency of HLA B27 was higher in patients with AAU and lower in those with PSO or IBD compared to those without EAMs. CONCLUSION Patients with axSpA and EAMs, in addition to displaying their own disease-related features, are likely to have an increased CV risk that appears proportional to the number of EAMs and could be related to proatherogenic factors other than traditional CV risk factors, such as the inflammatory load and the use of glucocorticoids.
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Affiliation(s)
- Javier Rueda-Gotor
- Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain.
| | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain
| | - Iñigo González Mazón
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Virginia Portilla
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | | | | | - Rosa Expósito
- Division of Rheumatology, Hospital Comarcal, Laredo, Cantabria, Spain
| | | | | | - Carlos Rodríguez-Lozano
- Rheumatology Division, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Esther F Vicente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | | | - M Paz Martínez-Vidal
- Rheumatology Division, Hospital General Universitario de Alicante, Alicante, Spain
| | - David Castro-Corredor
- Rheumatology Division, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | | | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel Ángel González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain; Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain; University of the Witwatersrand, Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, South Africa
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10
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Nattagh‐Eshtivani E, Pahlavani N, Ranjbar G, Gholizadeh Navashenaq J, Salehi‐Sahlabadi A, Mahmudiono T, Nader Shalaby M, Jokar M, Nematy M, Barghchi H, Havakhah S, Maddahi M, Rashidmayvan M, Khosravi M. Does propolis have any effect on rheumatoid arthritis? A review study. Food Sci Nutr 2022; 10:1003-1020. [PMID: 35432965 PMCID: PMC9007309 DOI: 10.1002/fsn3.2684] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/05/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease in which inflammation and oxidative stress play a key role in its pathophysiology. Complementary therapies along with medications may be effective in the control of RA. Propolis is a natural substance extracted from beehives, which have confirmed anti-inflammatory and antioxidant effects. The present study aimed to review the possible effects of propolis on inflammation, oxidative stress, and lipid profile in patients with RA. English articles in online databases such as PubMed‑Medline, AMED, Google Scholar, EMBASE, Scopus, and Web of Science databases were searched. Pieces of evidence show that supplementation with propolis may have therapeutic effects on RA patients. Due to increased inflammation and oxidative stress in the affected joints of RA patients, propolis could inhibit the inflammatory cascades by inhibiting the nuclear factor kappa B pathway and reducing reactive oxygen species, malondialdehyde, and interleukin-17 by increasing some antioxidants. Therefore, inflammation and pain reduce, helping improve and control RA in patients. Further investigations are required with larger sample sizes and different doses of propolis to demonstrate the definite effects of propolis on various aspects of RA.
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Affiliation(s)
- Elyas Nattagh‐Eshtivani
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | - Naseh Pahlavani
- Health Sciences Research CenterTorbat Heydariyeh University of Medical SciencesTorbat HeydariyehIran
- Children Growth and Development Research CenterResearch Institute for Prevention of Non‐Communicable DiseaseQazvin University of Medical SciencesQazvinIran
| | - Golnaz Ranjbar
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Ammar Salehi‐Sahlabadi
- Student Research CommitteeDepartment of Clinical Nutrition and DieteticsSchool of Nutrition and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Trias Mahmudiono
- Departmentof NutritionFaculty of Public HealthUniversitas AirlanggaAirlanggaIndonesia
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health DepartmentFaculty of Physical EducationSuez Canal UniversityIsmailiaEgypt
| | - Mohammadhassan Jokar
- Rheumatic Diseases Research CenterSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohsen Nematy
- Metabolic Syndrome Research CenterMashhad University of Medical SciencesMashhadIran
| | - Hanieh Barghchi
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | - Shahrzad Havakhah
- Addiction and Behavioral Sciences Research CenterNorth Khorasan University of Medical SciencesBojnurdIran
| | - Mona Maddahi
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
| | | | - Maryam Khosravi
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
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11
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Nattagh‐Eshtivani E, Pahlavani N, Ranjbar G, Gholizadeh Navashenaq J, Salehi‐Sahlabadi A, Mahmudiono T, Nader Shalaby M, Jokar M, Nematy M, Barghchi H, Havakhah S, Maddahi M, Rashidmayvan M, Khosravi M. Does propolis have any effect on rheumatoid arthritis? A review study. Food Sci Nutr 2022. [DOI: https:/doi.org/10.1002/fsn3.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Elyas Nattagh‐Eshtivani
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Naseh Pahlavani
- Health Sciences Research Center Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
- Children Growth and Development Research Center Research Institute for Prevention of Non‐Communicable Disease Qazvin University of Medical Sciences Qazvin Iran
| | - Golnaz Ranjbar
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | | | - Ammar Salehi‐Sahlabadi
- Student Research Committee Department of Clinical Nutrition and Dietetics School of Nutrition and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Trias Mahmudiono
- Departmentof Nutrition Faculty of Public Health Universitas Airlangga Airlangga Indonesia
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health Department Faculty of Physical Education Suez Canal University Ismailia Egypt
| | - Mohammadhassan Jokar
- Rheumatic Diseases Research Center School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Hanieh Barghchi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Shahrzad Havakhah
- Addiction and Behavioral Sciences Research Center North Khorasan University of Medical Sciences Bojnurd Iran
| | - Mona Maddahi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
| | | | - Maryam Khosravi
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
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12
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Xiao L, Yang Z, Lin S. Identification of hub genes and transcription factors in patients with rheumatoid arthritis complicated with atherosclerosis. Sci Rep 2022; 12:4677. [PMID: 35304503 PMCID: PMC8933589 DOI: 10.1038/s41598-022-08274-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to explore the overlapping key genes, pathway networks and transcription factors (TFs) related to the pathogenesis of rheumatoid arthritis (RA) and atherosclerosis. The gene expression profiles of RA and atherosclerosis were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) between RA and atherosclerosis were identified. The biological roles of common DEGs were explored through enrichment analysis. Hub genes were identified using protein–protein interaction networks. TFs were predicted using Transcriptional Regulatory Relationships Unraveled by Sentence Based Text Mining (TRRUST) database. The hub genes and TFs were validated with other datasets. The networks between TFs and hub genes were constructed by CytoScape software. A total of 131 DEGs (all upregulated) were identified. Functional enrichment analyses indicated that DEGs were mostly enriched in leukocyte migration, neutrophil activation, and phagocytosis. CytoScape demonstrated 12 hub genes and one gene cluster module. Four of the 12 hub genes (CSF1R, CD86, PTPRC, and CD53) were validated by other datasets. TRRUST predicted two TFs, including Spi-1 proto-oncogene (SPI1) and RUNX family transcription factor 1(RUNX1). The expression of RUNX1 was validated with another dataset. Our study explored the common pathogenesis of RA and atherosclerosis. These results may guide future experimental research and clinical transformation.
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Affiliation(s)
- Lu Xiao
- Department of Rheumatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan, 570311, China
| | - Zhou Yang
- Department of Rheumatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan, 570311, China
| | - Shudian Lin
- Department of Rheumatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan, 570311, China.
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13
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Nattagh‐Eshtivani E, Pahlavani N, Ranjbar G, Gholizadeh Navashenaq J, Salehi‐Sahlabadi A, Mahmudiono T, Nader Shalaby M, Jokar M, Nematy M, Barghchi H, Havakhah S, Maddahi M, Rashidmayvan M, Khosravi M. Does propolis have any effect on rheumatoid arthritis? A review study. Food Sci Nutr 2022. [DOI: https://doi.org/10.1002/fsn3.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Elyas Nattagh‐Eshtivani
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Naseh Pahlavani
- Health Sciences Research Center Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
- Children Growth and Development Research Center Research Institute for Prevention of Non‐Communicable Disease Qazvin University of Medical Sciences Qazvin Iran
| | - Golnaz Ranjbar
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | | | - Ammar Salehi‐Sahlabadi
- Student Research Committee Department of Clinical Nutrition and Dietetics School of Nutrition and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Trias Mahmudiono
- Departmentof Nutrition Faculty of Public Health Universitas Airlangga Airlangga Indonesia
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health Department Faculty of Physical Education Suez Canal University Ismailia Egypt
| | - Mohammadhassan Jokar
- Rheumatic Diseases Research Center School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Hanieh Barghchi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Shahrzad Havakhah
- Addiction and Behavioral Sciences Research Center North Khorasan University of Medical Sciences Bojnurd Iran
| | - Mona Maddahi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
| | | | - Maryam Khosravi
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
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14
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Subclinical Atherosclerosis Measure by Carotid Ultrasound and Inflammatory Activity in Patients with Rheumatoid Arthritis and Spondylarthritis. J Clin Med 2022; 11:jcm11030662. [PMID: 35160112 PMCID: PMC8836873 DOI: 10.3390/jcm11030662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: To compare the effect of inflammation on subclinical atherosclerosis using carotid ultrasound in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Methods: Cross-sectional study including 347 participants (148 RA, 159 SpA, and 40 controls). We measured the carotid intima media thickness (cIMT) and detection of atheromatous plaques using carotid ultrasound. We recorded disease activity (DAS28-CRP/ASDAS-CRP) and traditional cardiovascular risk factors. We performed descriptive, bivariate, and linear multivariate analyses (dependent variable: cIMT) to evaluate the influence of diagnosis on cIMT in all patients. Two additional multivariate analyses were performed by stratifying patients according to their inflammatory activity. Results: cIMT correlated with the mean CRP during the previous 5 years in RA, but not with CRP at the cut-off date. We did not find such differences in patients with SpA. The first multivariate model revealed that increased cIMT was more common in patients with RA than in those with SpA (β coefficient, 0.045; 95% confidence interval (95% CI), 0.0002–0.09; p = 0.048) after adjusting for age, sex, disease course, and differential cardiovascular risk factors (arterial hypertension, smoking, statins, and corticosteroids). The second model revealed no differences in cIMT between the 2 groups of patients classified as remission–low activity (β coefficient, 0.020; 95% CI, −0.03 to 0.080; p = 0.500). However, when only patients with moderate–high disease activity were analysed, the cIMT was 0.112 mm greater in those with RA (95% CI, 0.013–0.212; p = 0.026) than in those with SpA after adjusting for the same variables. Conclusions: Subclinical atherosclerosis measured by carotid ultrasound in patients with RA and SpA is comparable when the disease is well controlled. However, when patients have moderate–high disease activity, cIMT is greater in patients with RA than in those with SpA after adjusting for age, sex, disease course, and cardiovascular risk factors. Our results point to greater involvement of disease activity in subclinical atherosclerosis in patients with RA than in those with SpA.
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15
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Lai ECC, Huang YC, Liao TC, Weng MY. Premature coronary artery disease in patients with immune-mediated inflammatory disease: a population-based study. RMD Open 2022; 8:rmdopen-2021-001993. [PMID: 35064093 PMCID: PMC8785203 DOI: 10.1136/rmdopen-2021-001993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background The associations between premature atherosclerosis and immune-mediated inflammatory diseases (IMIDs) are not fully investigated. To determine whether IMIDs are associated with premature atherosclerosis, we examined the risk of incident coronary artery disease (CAD) in men less than 45 years old and women less than 50 years old with various forms of IMIDs compared with general population. Methods A population-based cohort was established and included patients with IMID, who were followed until the development of CAD, withdrawal from the insurance system, death, or 31 December 2016, whichever point came first. Patients with IMID included rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjogren’s syndrome (SjS), idiopathic inflammatory myositis, systemic sclerosis (SSc), Behcet’s disease (BD), and systemic vasculitis (SV). The comparison group was 1 000 000 beneficiaries sampled at random from the whole population as matched control participants. The Kaplan-Meier method was used to compare the cumulative incidences of CAD in patients with and without IMID. Results Among 58 862 patients with IMID, 2139 (3.6%) developed CAD and 346 (1.3%) developed premature CAD. Relative to the comparison cohorts, the adjusted HRs for premature CAD were 1.43 (95% CI 1.09 to 1.86) for primary SjS, 2.85 (95% CI 2.63 to 3.43) for SLE, 3.18 (95% CI 1.99 to 5.09) for SSc and 2.27 (95% CI 1.01 to 5.07) for SV. Conclusions Primary Sjogren’s syndrome, SLE, SSc and SV are associated with an increased risk of premature CAD. Our findings will support essential efforts to improve awareness of IMID impacting young adults.
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Affiliation(s)
- Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Chun Huang
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Yu Weng
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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16
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Rojas-Giménez M, López-Medina C, Calvo-Gutiérrez J, Puche-Larrubia MÁ, Gómez-García I, Seguí-Azpilcueta P, Ábalos-Aguilera MDC, Ruíz D, Collantes-Estévez E, Escudero-Contreras A. Association between Carotid Intima-Media Thickness and the Use of Biological or Small Molecule Therapies in Patients with Rheumatoid Arthritis. Diagnostics (Basel) 2021; 12:diagnostics12010064. [PMID: 35054229 PMCID: PMC8775122 DOI: 10.3390/diagnostics12010064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of this study was to assess the association of carotid intima-media thickness (CIMT), and also the presence of atheromatous plaque, with biological and targeted synthetic disease-modifying antirheumatic drugs, in an established cohort of patients with rheumatoid arthritis (RA). Patients and Methods: We conducted a cross-sectional observational study based on a cohort of patients with RA and a registry of healthy controls, in whom the CIMT and presence of atheromatous plaque were assessed by ultrasound. Data were collected on disease activity, lab results and treatments. Descriptive and bivariate analyses were performed and two multivariate linear regression models (with CIMT as the dependent variable) were constructed to identify variables independently associated with CIMT in our sample of patients with RA. Results: A total of 176 individuals (146 patients with RA and 30 controls) were included. A higher percentage of patients than controls had atheromatous plaque (33.8% vs. 12.5%, p = 0.036), but no differences were found in terms of CIMT (0.64 vs. 0.61, p = 0.444). Compared to values in patients on other therapies, the CIMT was smaller among patients on tumour necrosis factor alpha (TNFα) inhibitors (mean [SD]: 0.58 [0.10] vs. 0.65 [0.19]; p = 0.013) and among those on Janus kinase inhibitors (mean [SD]: 0.52 [0.02] vs. 0.64 [0.18]; p < 0.001), while no differences were found as a function of the use of the other therapies considered. The multivariate linear regression analysis to identify factors associated with CIMT in our patients, adjusting for traditional cardiovascular risk factors such as hypertension, high levels of low-density lipoproteins, diabetes mellitus and smoking, showed that male sex, older age and having a greater cumulative erythrocyte sedimentation rate were independently associated with a larger CIMT, while patients on TNFα inhibitors had a CIMT 0.075 mm smaller than those on other treatments. Conclusions: The use of TNFα inhibitors may protect against subclinical atherosclerosis in patients with RA, patients on this biologic having smaller CIMTs than patients on other disease-modifying antirheumatic drugs. Nonetheless, these results should be confirmed in prospective studies with larger sample sizes.
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Affiliation(s)
- Marta Rojas-Giménez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Clementina López-Medina
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
- Correspondence:
| | - Jerusalem Calvo-Gutiérrez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - María Ángeles Puche-Larrubia
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Ignacio Gómez-García
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Pedro Seguí-Azpilcueta
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - María del Carmen Ábalos-Aguilera
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - Desirée Ruíz
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - Alejandro Escudero-Contreras
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
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17
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Plasma expression of microRNA-425-5p and microRNA-451a as biomarkers of cardiovascular disease in rheumatoid arthritis patients. Sci Rep 2021; 11:15670. [PMID: 34341435 PMCID: PMC8329234 DOI: 10.1038/s41598-021-95234-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022] Open
Abstract
To validate in a cohort of 214 rheumatoid arthritis patients a panel of 10 plasmatic microRNAs, which we previously identified and that can facilitate earlier diagnosis of cardiovascular disease in rheumatoid arthritis patients. We identified 10 plasma miRs that were downregulated in male rheumatoid arthritis patients and in patients with acute myocardial infarction compared to controls suggesting that these microRNAs could be epigenetic biomarkers for cardiovascular disease in rheumatoid arthritis patients. Six of those microRNAs were validated in independent plasma samples from 214 rheumatoid arthritis patients and levels of expression were associated with surrogate markers of cardiovascular disease (carotid intima-media thickness, plaque formation, pulse wave velocity and distensibility) and with prior cardiovascular disease. Multivariate analyses adjusted for traditional confounders and treatments showed that decreased expression of microRNA-425-5p in men and decreased expression of microRNA-451 in women were significantly associated with increased (β = 0.072; p = 0.017) and decreased carotid intima-media thickness (β = −0.05; p = 0.013), respectively. MicroRNA-425-5p and microRNA-451 also increased the accuracy to discriminate patients with pathological carotid intima-media thickness by 1.8% (p = 0.036) in men and 3.5% (p = 0.027) in women, respectively. In addition, microRNA-425-5p increased the accuracy to discriminate male patients with prior cardiovascular disease by 3% (p = 0.008). Additionally, decreased expression of microRNA-451 was significantly associated with decreased pulse wave velocity (β = −0.72; p = 0.035) in overall rheumatoid arthritis population. Distensibility showed no significant association with expression levels of the microRNAs studied. We provide evidence of a possible role of microRNA-425-5p and microRNA-451 as useful epigenetic biomarkers to assess cardiovascular disease risk in patients with rheumatoid arthritis.
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Ruiz-Limon P, Ladehesa-Pineda ML, Lopez-Medina C, Lopez-Pedrera C, Abalos-Aguilera MC, Barbarroja N, Arias-Quiros I, Perez-Sanchez C, Arias-de la Rosa I, Ortega-Castro R, Escudero-Contreras A, Collantes-Estevez E, Jimenez-Gomez Y. Potential Role and Impact of Peripheral Blood Mononuclear Cells in Radiographic Axial Spondyloarthritis-Associated Endothelial Dysfunction. Diagnostics (Basel) 2021; 11:diagnostics11061037. [PMID: 34199950 PMCID: PMC8226914 DOI: 10.3390/diagnostics11061037] [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: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
Endothelial dysfunction (ED) is well known as a process that can lead to atherosclerosis and is frequently presented in radiographic axial spondyloarthritis (r-axSpA) patients. Here, we investigated cellular and molecular mechanisms underlying r-axSpA-related ED, and analyzed the potential effect of peripheral blood mononuclear cells (PBMCs) in promoting endothelial injury in r-axSpA. A total of 30 r-axSpA patients and 32 healthy donors (HDs) were evaluated. The endothelial function, inflammatory and atherogenic profile, and oxidative stress were quantified. In vitro studies were designed to evaluate the effect of PBMCs from r-axSpA patients on aberrant endothelial activation. Compared to HDs, our study found that, associated with ED and the plasma proatherogenic profile present in r-axSpA, PBMCs from these patients displayed a pro-oxidative, proinflammatory, and proatherogenic phenotype, with most molecular changes noticed in lymphocytes. Correlation studies revealed the relationship between this phenotype and the microvascular function. Additional in vitro studies confirmed that PBMCs from r-axSpA patients promoted endothelial injury. Altogether, this study suggests the relevance of r-axSpA itself as a strong and independent cardiovascular risk factor, contributing to a dysfunctional endothelium and atherogenic status by aberrant activation of PBMCs. Lymphocytes could be the main contributors in the development of ED and subsequent atherosclerosis in this pathology.
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Affiliation(s)
- Patricia Ruiz-Limon
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
- UGC of Endocrinology and Nutrition, The Biomedical Research Institute of Málaga (IBIMA), Virgen de la Victoria Hospital, 29010 Málaga, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Correspondence: (P.R.-L.); (Y.J.-G.)
| | - Maria L. Ladehesa-Pineda
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Clementina Lopez-Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Chary Lopez-Pedrera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Maria C. Abalos-Aguilera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Nuria Barbarroja
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Isabel Arias-Quiros
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Carlos Perez-Sanchez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Ivan Arias-de la Rosa
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Rafaela Ortega-Castro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Alejandro Escudero-Contreras
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Eduardo Collantes-Estevez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
| | - Yolanda Jimenez-Gomez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (M.L.L.-P.); (C.L.-M.); (C.L.-P.); (M.C.A.-A.); (N.B.); (I.A.-Q.); (C.P.-S.); (I.A.-d.l.R.); (R.O.-C.); (A.E.-C.); (E.C.-E.)
- UGC Rheumatology, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Córdoba, Spain
- Correspondence: (P.R.-L.); (Y.J.-G.)
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Liu W, Ma W, Liu H, Li C, Zhang Y, Liu J, Liang Y, Zhang S, Wu Z, Zang C, Guo J, Li L. Stroke risk in arthritis: A systematic review and meta-analysis of cohort studies. PLoS One 2021; 16:e0248564. [PMID: 33725018 PMCID: PMC7963101 DOI: 10.1371/journal.pone.0248564] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/01/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Stroke is a major contributor to the global burden of disease. Although numerous modifiable risk factors (RF) for stroke have been identified, some remain unexplained. Increasing studies have investigated stroke risk in arthritis, but their results are inconsistent. We aimed to synthesize, quantify, and compare the risk of stroke for the major types of arthritis in cohort studies by using a systematic review and meta-analysis approach. METHODS We searched Chinese and English databases to identify relevant studies from inception to April 30, 2020. Only studies adjusting at least for age and sex were included. We calculated pooled effect estimates for relative risk (RR) and 95% confidence interval (CI) and identified potential sources of heterogeneity and publication bias. RESULTS A total of 1,348 articles were retrieved, and after an preliminary screening of titles and abstracts, 69 were reviewed for full text, and finally, 32 met the criteria for meta-analysis. Stroke risk in arthritis was significantly increased in studies adjusting for age and sex (RR = 1.36, 95% CI: 1.27-1.46) and for at least one traditional risk factor (RR = 1.40, 95% CI: 1.28-1.54). The results of studies stratified by stroke subtype were consistent with the main finding (ischemic stroke: RR = 1.53, 95% CI: 1.32-1.78; hemorrhagic stroke: RR = 1.45, 95% CI: 1.15-1.84). In subgroup analysis by arthritis type, stroke risk was significantly increased in rheumatoid arthritis (RR = 1.38, 95% CI: 1.29-1.48), ankylosing spondylitis (RR = 1.49, 95% CI: 1.25-1.77), psoriatic arthritis (RR = 1.33, 95% CI: 1.22-1.45), and gout (RR = 1.40, 95% CI: 1.13-1.73) but not osteoarthritis (RR = 1.03, 95% CI: 0.91-1.16). Age and sex subgroup analyses indicated that stroke risk was similar by sex (women: RR = 1.47, 95% CI: 1.31-1.66; men: RR = 1.44, 95% CI: 1.28-1.61); risk was higher with younger age (<45 years) (RR = 1.46, 95% CI: 1.17-1.82) than older age (≥65 years) (RR = 1.17, 95% CI: 1.08-1.26). CONCLUSIONS Stroke risk was increased in multiple arthritis and similar between ischemic and hemorrhagic stroke. Young patients with arthritis had the highest risk.
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Affiliation(s)
- Wei Liu
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Wei Ma
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Hua Liu
- Department of Neurology, The Third People’s Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Chunyan Li
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Yangwei Zhang
- Department of Neurology, Nanchong Central Hospital & The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jie Liu
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Yu Liang
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Sijia Zhang
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Zhen Wu
- Second Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Chenghao Zang
- Second Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jianhui Guo
- Second Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Liyan Li
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
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20
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von Scheidt M, Zhao Y, de Aguiar Vallim TQ, Che N, Wierer M, Seldin MM, Franzén O, Kurt Z, Pang S, Bongiovanni D, Yamamoto M, Edwards PA, Ruusalepp A, Kovacic JC, Mann M, Björkegren JLM, Lusis AJ, Yang X, Schunkert H. Transcription Factor MAFF (MAF Basic Leucine Zipper Transcription Factor F) Regulates an Atherosclerosis Relevant Network Connecting Inflammation and Cholesterol Metabolism. Circulation 2021; 143:1809-1823. [PMID: 33626882 DOI: 10.1161/circulationaha.120.050186] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is a multifactorial condition with both genetic and exogenous causes. The contribution of tissue-specific functional networks to the development of atherosclerosis remains largely unclear. The aim of this study was to identify and characterize central regulators and networks leading to atherosclerosis. METHODS Based on several hundred genes known to affect atherosclerosis risk in mouse (as demonstrated in knockout models) and human (as shown by genome-wide association studies), liver gene regulatory networks were modeled. The hierarchical order and regulatory directions of genes within the network were based on Bayesian prediction models, as well as experimental studies including chromatin immunoprecipitation DNA-sequencing, chromatin immunoprecipitation mass spectrometry, overexpression, small interfering RNA knockdown in mouse and human liver cells, and knockout mouse experiments. Bioinformatics and correlation analyses were used to clarify associations between central genes and CAD phenotypes in both human and mouse. RESULTS The transcription factor MAFF (MAF basic leucine zipper transcription factor F) interacted as a key driver of a liver network with 3 human genes at CAD genome-wide association studies loci and 11 atherosclerotic murine genes. Most importantly, expression levels of the low-density lipoprotein receptor (LDLR) gene correlated with MAFF in 600 CAD patients undergoing bypass surgery (STARNET [Stockholm-Tartu Atherosclerosis Reverse Network Engineering Task]) and a hybrid mouse diversity panel involving 105 different inbred mouse strains. Molecular mechanisms of MAFF were tested in noninflammatory conditions and showed positive correlation between MAFF and LDLR in vitro and in vivo. Interestingly, after lipopolysaccharide stimulation (inflammatory conditions), an inverse correlation between MAFF and LDLR in vitro and in vivo was observed. Chromatin immunoprecipitation mass spectrometry revealed that the human CAD genome-wide association studies candidate BACH1 (BTB domain and CNC homolog 1) assists MAFF in the presence of lipopolysaccharide stimulation with respective heterodimers binding at the MAF recognition element of the LDLR promoter to transcriptionally downregulate LDLR expression. CONCLUSIONS The transcription factor MAFF was identified as a novel central regulator of an atherosclerosis/CAD-relevant liver network. MAFF triggered context-specific expression of LDLR and other genes known to affect CAD risk. Our results suggest that MAFF is a missing link between inflammation, lipid and lipoprotein metabolism, and a possible treatment target.
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Affiliation(s)
- Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (M.v.S., S.P., H.S.).,Deutsches Zentrum für Herz- und Kreislauferkrankungen, Partner Site Munich Heart Alliance, Germany (M.v.S., D.B., H.S.)
| | | | - Thomas Q de Aguiar Vallim
- Departments of Medicine (T.Q.d.A.V., N.C., P.A.E., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles.,Biological Chemistry (T.Q.d.A.V., P.A.E.), David Geffen School of Medicine, University of California, Los Angeles
| | - Nam Che
- Departments of Medicine (T.Q.d.A.V., N.C., P.A.E., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles.,Microbiology, Immunology and Molecular Genetics (N.C., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles.,Human Genetics (N.C., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Michael Wierer
- Department of Proteomics and Signal Transduction, Max-Planck Institute of Biochemistry, Martinsried, Germany (M.W., M.M.)
| | - Marcus M Seldin
- Department of Biological Chemistry and Center for Epigenetics and Metabolism, University of California, Irvine (M.M.S.)
| | - Oscar Franzén
- Integrated Cardio Metabolic Centre, Karolinska Institutet, Novum, Huddinge, Sweden (O.F., J.L.M.B.)
| | - Zeyneb Kurt
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (Z.K.)
| | - Shichao Pang
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (M.v.S., S.P., H.S.)
| | - Dario Bongiovanni
- Deutsches Zentrum für Herz- und Kreislauferkrankungen, Partner Site Munich Heart Alliance, Germany (M.v.S., D.B., H.S.).,Department of Internal Medicine, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Germany (D.B.)
| | - Masayuki Yamamoto
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (M.Y.)
| | - Peter A Edwards
- Departments of Medicine (T.Q.d.A.V., N.C., P.A.E., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles.,Biological Chemistry (T.Q.d.A.V., P.A.E.), David Geffen School of Medicine, University of California, Los Angeles
| | - Arno Ruusalepp
- Department of Cardiac Surgery, Tartu University Hospital, Estonia (A.R.).,Clinical Gene Networks AB, Stockholm, Sweden (A.R., J.L.M.B.)
| | - Jason C Kovacic
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York (J.C.K., J.L.M.B.)
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max-Planck Institute of Biochemistry, Martinsried, Germany (M.W., M.M.)
| | - Johan L M Björkegren
- Integrated Cardio Metabolic Centre, Karolinska Institutet, Novum, Huddinge, Sweden (O.F., J.L.M.B.).,Clinical Gene Networks AB, Stockholm, Sweden (A.R., J.L.M.B.).,Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York (J.C.K., J.L.M.B.)
| | - Aldons J Lusis
- Departments of Medicine (T.Q.d.A.V., N.C., P.A.E., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles.,Microbiology, Immunology and Molecular Genetics (N.C., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles.,Human Genetics (N.C., A.J.L.), David Geffen School of Medicine, University of California, Los Angeles
| | - Xia Yang
- Department of Integrative Biology and Physiology, Institute for Quantitative and Computational Biosciences (Y.Z., X.Y.), David Geffen School of Medicine, University of California, Los Angeles
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (M.v.S., S.P., H.S.).,Deutsches Zentrum für Herz- und Kreislauferkrankungen, Partner Site Munich Heart Alliance, Germany (M.v.S., D.B., H.S.)
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21
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Wilton KM, Achenbach SJ, Karmacharya P, Ernste FC, Matteson EL, Crowson CS. Erectile Dysfunction in Men With Psoriatic Arthritis: A Population-based Cohort Study. J Rheumatol 2020; 48:527-532. [PMID: 33060322 DOI: 10.3899/jrheum.200903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To define the incidence of erectile dysfunction (ED) in a population-based cohort of men with psoriatic arthritis (PsA). METHODS Data pertaining to demographics, ED, and potential confounding diagnosis were extracted from a comprehensive medical record system for a population-based cohort of men with PsA and an age-matched male comparator cohort. Cumulative incidence of ED adjusted for competing risk of death was compared between the 2 cohorts. RESULTS There were 128 age-matched pairs of men with PsA and without PsA in the described cohorts. At baseline, there was a 7% prevalence of ED in men with PsA prior to diagnosis compared to a 3% prevalence of ED in the comparator cohort (P = 0.16). After PsA diagnosis/index date, diagnosis with PsA was associated with an increased risk of ED (age-adjusted HR 1.45, 95% CI 0.79-2.68), but this association did not reach statistical significance. This was based on 24 cases of ED in the men with PsA and 18 cases within the comparator cohort. No confounding factors or ED treatment strategies differed significantly between men with PsA and ED and comparators with ED. CONCLUSION Men with PsA may have an increased risk of ED, which was detected but likely underpowered in this study. Whether this difference is secondary to higher prevalence of traditional risk factors of ED in men with PsA compared to the general population will require further study.
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Affiliation(s)
- Katelynn M Wilton
- K.M. Wilton, BS, Medical Scientist Training Program, Mayo Clinic College of Medicine and Science
| | - Sara J Achenbach
- S.J. Achenbach, MS, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science
| | - Paras Karmacharya
- P. Karmacharya, MBBS, F.C. Ernste, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Floranne C Ernste
- P. Karmacharya, MBBS, F.C. Ernste, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Eric L Matteson
- E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Biomedical Statistics and Informatics, and Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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22
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Fernández-Ortiz AM, Ortiz AM, Pérez S, Toledano E, Abásolo L, González-Gay MA, Castañeda S, González-Álvaro I. Effects of disease activity on lipoprotein levels in patients with early arthritis: can oxidized LDL cholesterol explain the lipid paradox theory? Arthritis Res Ther 2020; 22:213. [PMID: 32917272 PMCID: PMC7488761 DOI: 10.1186/s13075-020-02307-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background An increased risk of cardiovascular (CV) complications has been described in patients with rheumatoid arthritis (RA). It is the result of the combined effect of classic CV risk factors and others that are specific to the disease. Methods We assessed data from 448 early arthritis (EA) patients: 79% women, age (median [p25-p75]) at onset: 55 [44–67] years and disease duration at study entry 5 [3–8] months; and 72% fulfilled the 1987 RA criteria at 2 years of follow-up. Rheumatoid factor was positive in 54% of patients and anti-citrullinated peptide antibodies in 50%. The follow-up of patients ranged from 2 to 5 years with more than 1400 visits with lipoprotein measurements available (mean 2.5 visits/patient). Demographic- and disease-related variables were systematically recorded. Total cholesterol (TC), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) levels were obtained from routine laboratory tests. Oxidized-LDL (oxLDL-C) levels were assessed using a commercial ELISA kit. We fitted population-averaged models nested by patient and visit to determine the effect of independent variables on serum levels of TC, its fractions, and oxLDL-C. Results After adjustment for several confounders, high-disease activity was significantly associated with decreased TC, HDL-C, and LDL-C levels and increased oxLDL-C levels. Standardized coefficients showed that the effect of disease activity was greater on oxLDL-C and HDL-C. Interestingly, we observed that those patients with lower levels of LDL-C showed higher oxLDL-C/LDL-C ratios. Conclusions High-disease activity in EA patients results in changes in the HDL-C and oxLDL-C levels, which in turn may contribute to the increased risk of CV disease observed in these patients.
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Affiliation(s)
| | - Ana M Ortiz
- Rheumatology Division, Hospital Universitario La Princesa, IIS-IP, Diego de León 62, 28006, Madrid, Spain
| | - Silvia Pérez
- Rheumatology Division, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Esther Toledano
- Rheumatology Division, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Lydia Abásolo
- Rheumatology Division, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Miguel A González-Gay
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Santos Castañeda
- Rheumatology Division, Hospital Universitario La Princesa, IIS-IP, Diego de León 62, 28006, Madrid, Spain.,Cátedra UAM-Roche, EPID-Future, Universidad Autónoma Madrid, Madrid, Spain
| | - Isidoro González-Álvaro
- Rheumatology Division, Hospital Universitario La Princesa, IIS-IP, Diego de León 62, 28006, Madrid, Spain.
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Alonso-Molero J, Prieto-Peña D, Mendoza G, Atienza-Mateo B, Corrales A, González-Gay MÁ, Llorca J. Misperception of the Cardiovascular Risk in Patients with Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165954. [PMID: 32824469 PMCID: PMC7459763 DOI: 10.3390/ijerph17165954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
The risk of cardiovascular (CV) disease and mortality is increased by rheumatoid arthritis (RA). However, data on how RA patients perceive their own CV risk and their adherence to CV prevention factors are scarce. We conducted an observational study on 266 patients with RA to determine whether the perceived CV risk correlates to the objective CV risk, and if it influences their compliance with a Mediterranean diet and physical exercise. The objective CV risk was calculated according to the modified European League Against Rheumatism (EULAR) Systematic Coronary Risk Evaluation (SCORE). The perceived CV risk did not correlate to the objective CV risk. The correlation was even lower when carotid ultrasound was used. Notably, 64.62% of patients miscalculated their CV risk, with 43.08% underestimating it. Classic CV risk factors, carotid ultrasound markers and ESR and CRP showed significant correlation with the objective CV risk. However, only hypertension and RA disease features showed association with the perceived CV risk. Neither the objective CV risk nor the perceived CV risk were associated with the accomplishment of a Mediterranean diet or physical activity. In conclusion, RA patients tend to underestimate their actual CV risk, giving more importance to RA features than to classic CV risk factors. They are not concerned enough about the beneficial effects of physical activity or diet.
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Affiliation(s)
- Jéssica Alonso-Molero
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria—IDIVAL, ES-39008 Santander, Spain;
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Diana Prieto-Peña
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, ES-39011 Santander, Spain; (D.P.-P.); (B.A.-M.); (A.C.)
| | - Guadalupe Mendoza
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica 02, Universidad de Colima, 28040 Guadalajara, Mexico;
| | - Belén Atienza-Mateo
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, ES-39011 Santander, Spain; (D.P.-P.); (B.A.-M.); (A.C.)
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, ES-39011 Santander, Spain; (D.P.-P.); (B.A.-M.); (A.C.)
| | - Miguel Á. González-Gay
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria—IDIVAL, ES-39008 Santander, Spain;
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, ES-39011 Santander, Spain; (D.P.-P.); (B.A.-M.); (A.C.)
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Facultad de Medicina, Avda., Cardenal Herrera Oria s/n., ES-39008 Santander, Spain
- Correspondence: (M.Á.G.-G.); (J.L.)
| | - Javier Llorca
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria—IDIVAL, ES-39008 Santander, Spain;
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Facultad de Medicina, Avda., Cardenal Herrera Oria s/n., ES-39008 Santander, Spain
- Correspondence: (M.Á.G.-G.); (J.L.)
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Beltai A, Barnetche T, Daien C, Lukas C, Gaujoux-Viala C, Combe B, Morel J. Cardiovascular Morbidity and Mortality in Primary Sjögren's Syndrome: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2020; 72:131-139. [PMID: 30570824 DOI: 10.1002/acr.23821] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with immune-mediated inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus are at increased risk of cardiovascular disease. However, the cardiovascular risk of patients with primary Sjögren's syndrome (SS) remains poorly studied. We aimed to investigate the association between primary SS and cardiovascular morbidity and mortality. METHODS We performed a systematic review of articles in Medline and the Cochrane Library and recent abstracts from US and European meetings, searching for reports of randomized controlled studies of cardiovascular morbidity and cardiovascular mortality in primary SS. The relative risk (RR) values for cardiovascular morbidity and mortality associated with primary SS were collected and pooled in a meta-analysis with a random-effects model by using Review Manager (Cochrane collaboration). RESULTS The literature search revealed 484 articles and abstracts of interest; 14 studies (67,124 patients with primary SS) were included in the meta-analysis. With primary SS versus control populations, the risk was significantly increased for coronary morbidity (RR 1.34 [95% confidence interval (95% CI) 1.06-1.38]; P = 0.01), cerebrovascular morbidity (RR 1.46 [95% CI 1.43-1.49]; P < 0.00001), heart failure rate (odds ratio 2.54 [95% CI 1.30-4.97]; P < 0.007), and thromboembolic morbidity (RR 1.78 [95% CI 1.41-2.25]; P < 0.00001), with no statistically significant increased risk of cardiovascular mortality (RR 1.48 [95% CI 0.77-2.85]; P = 0.24). CONCLUSION This meta-analysis demonstrates that primary SS is associated with increased cardiovascular morbidity, which suggests that these patients should be screened for cardiovascular comorbidities and considered for preventive interventions, in a multidisciplinary approach with cardiologists.
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Affiliation(s)
- Aurélie Beltai
- CHU Montpellier, University of Montpellier, Montpellier, France
| | | | - Claire Daien
- CHU Montpellier, University of Montpellier, Montpellier, France
| | - Cedric Lukas
- CHU Montpellier, University of Montpellier, Montpellier, France
| | - Cécile Gaujoux-Viala
- Teaching Hospital of Nîmes, Nîmes, and University of Montpellier, Montpellier, France
| | - Bernard Combe
- CHU Montpellier, University of Montpellier, Montpellier, France
| | - Jacques Morel
- CHU Montpellier, University of Montpellier, Montpellier, France
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25
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Serum homocysteine levels and their association with clinical characteristics of inflammatory arthritis. Clin Rheumatol 2020; 39:3295-3302. [PMID: 32377996 DOI: 10.1007/s10067-020-05093-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/18/2020] [Accepted: 04/08/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of our study was to explore the serum levels of homocysteine (Hcy) and its association with clinical characteristics in patients with different types of inflammatory arthritis. METHODS A total of 242 patients diagnosed with inflammatory arthritis (which included rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout), 49 with osteoarthritis (OA), and 36 with hyperuricaemia (HUA) and 81 healthy controls (HCs) were enrolled for comparisons. RESULTS The serum Hcy levels of patients with RA, AS, and OA were comparable with those of the HC group (P > 0.05). However, the serum level of Hcy was significantly higher in patients with gout than in HCs (18.75 ± 9.98 vs. 14.20 ± 6.22 μmol/L, P = 0.007). In addition, we found that the serum Hcy level was much higher in RA patients who received methotrexate (MTX) therapy without folic acid supplementation than in those who received MTX with folic acid supplementation (13.39 ± 4.80 vs. 9.41 ± 2.04 μmol/L, P = 0.001). Furthermore, there was a positive correlation between uric acid and Hcy in patients without uric acid-lowering treatment (r = 0.537, P = 0.002), but the correlation was eliminated after adjusting uric acid-lowering treatment (r = 0.139, P = 0.393). Finally, consistent with the above findings, hyperhomocysteinaemia (HHcy) was more common in gout patients (P < 0.05). CONCLUSION Screening for HHcy in patients with gout and RA, especially RA patients treated with MTX, might be necessary, and patients with HHcy might benefit from earlier supplementation with folic acid. Key Points • Serum homocysteine (Hcy) was elevated and the rate of hyperhomocysteinaemia (HHcy) was significantly higher in gout. • Rheumatoid arthritis (RA) patients who received methotrexate (MTX) treatment without folic acid supplementation showed higher serum Hcy than those who received MTX treatment with folic acid supplementation. • The serum Hcy level was positively correlated with age in only RA patients. • Serum Hcy was correlated with uric acid in gout patients, but the correlation was eliminated after adjusting uric acid-lowering treatment.
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Braz NFT, Pinto MRC, Vieira ÉLM, Souza AJ, Teixeira AL, Simões-E-Silva AC, Kakehasi AM. Renin-angiotensin system molecules are associated with subclinical atherosclerosis and disease activity in rheumatoid arthritis. Mod Rheumatol 2020; 31:119-126. [PMID: 32149558 DOI: 10.1080/14397595.2020.1740418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare serum levels of RAS components in women with RA versus healthy females and to investigate the association between these molecules and subclinical atherosclerosis. METHODS A cross-sectional study involving female RA patients without ischemic CVD. Disease activity was assessed using the DAS28 and the CDAI. IMT of the common carotid artery was evaluated by ultrasonography. Serum levels of Ang II, Ang-(1-7), ACE and ACE2 were determined by enzyme immunoassay. RESULTS Fifty women with RA, mean 48.2 (7.3) years, were compared to 30 healthy women, paired by age. RA patients had higher plasma levels of Ang II (p < .01), Ang-(1-7) (p < .01), and ACE (p < .01) than controls. The ratios of ACE to ACE2 were higher in RA patients, whereas Ang II/Ang-(1-7) ratios were lower in RA patients. The presence of hypertension and the treatment with ACE inhibitors did not significantly modify serum levels of Ang II, Ang-(1-7), ACE and ACE2 in patients with RA. Seven RA patients had altered IMT, and eight patients exhibited atherosclerotic plaque. There was a negative correlation between ACE2 levels and IMT (p = .041). IMT positively correlated with age (p = .022), disease duration (p = .012) and overall Framingham risk score (p = .008). Ang II concentrations positively correlated with DAS28 (p = .034) and CDAI (p = .040). CONCLUSION Patients with RA had an activation of the RAS, suggesting an association with disease activity and cardiovascular risk. Rheumatological key messages Imbalance of both RAS axes may be associated with cardiovascular risk and disease activity in rheumatoid arthritis. Ultrasonography of the carotid arteries can identify early, subclinical atherosclerotic disease in rheumatoid arthritis patients. Angiotensin-converting enzyme inhibition or angiotensin 1 receptor blockade may be beneficial for rheumatoid arthritis patients.
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Affiliation(s)
- Nayara Felicidade Tomaz Braz
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Raquel C Pinto
- Rheumatology Unit, Clinic Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Antonio Lucio Teixeira
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana C Simões-E-Silva
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Maria Kakehasi
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Locomotor Apparatus Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Abstract
The term inflammatory joint disease (IJD) encompasses a group of chronic conditions with predominant joint involvement. They share an increased risk of cardiovascular (CV) complications. However, the implication of the sex in the risk of CV disease in IJD has not been specifically addressed. The aim of this work is to assess the influence of sex on the clinical expression of CV manifestations associated to IJD. With this objective, an update of the current knowledge of the sex influence on CV disease in patients with IJD was conducted. A PubMed database search of the most relevant literature on this topic was performed mainly based on studies published in English over the last 10 years. Although most studies on IJD were not specifically designed to address sex differences regarding CV complications, it seems that men with rheumatoid arthritis (RA) are at higher risk of pericarditis, ischemic heart disease, heart failure (HF) with reduced ejection fraction (EF), and CV mortality than women with RA. In contrast, HF with preserved EF and diastolic dysfunction is more frequent in women with RA. Men with ankylosing spondylitis present more frequently disorders of the conduction system and aortic valvulopathy than women. A limited number of studies addressed CV differences according to sex in psoriatic arthritis. Although there are some differences according to sex in the clinical expression of CV complications in patients with IJD, much research is still needed to better identify the implication of sex in the risk of CV disease in these patients.
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Asanuma YF, Aizaki Y, Noma H, Yokota K, Matsuda M, Kozu N, Takebayashi Y, Nakatani H, Hasunuma T, Kawai S, Mimura T. Plasma pentraxin 3 is associated with progression of radiographic joint damage, but not carotid atherosclerosis, in female rheumatoid arthritis patients: 3-year prospective study. Mod Rheumatol 2019; 30:959-966. [PMID: 31615315 DOI: 10.1080/14397595.2019.1681583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Pentraxin 3 (PTX3) has an important role in inflammation, immunity, and atherosclerosis. Rheumatoid arthritis (RA) is a chronic inflammatory disease featuring both joint damage and atherosclerosis. We investigated whether the plasma PTX3 level was associated with progression of joint destruction and subclinical atherosclerosis in RA patients.Methods: Plasma PTX3 levels were measured in 72 women with RA and 80 female control subjects. In RA patients, we also evaluated clinical characteristics, medications, and at one and three years, joint damage and atherosclerosis. Then we investigated whether PTX3 was associated with progression of joint destruction or an increase of carotid intima-media thickness (IMT).Results: Plasma PTX3 levels were significantly higher in the RA patients than in healthy controls (4.05 ± 2.91 ng/mL vs. 1.61 ± 1.05 ng/mL, p < .001). By multivariate linear regression analysis, the plasma pentraxin 3 level was independently associated with radiographic progression of joint damage for 3 years in the RA patients after adjustment for age, disease duration, body mass index, rheumatoid factor, MMP-3, Disease Activity Score 28-ESR, postmenopausal status, current use of corticosteroids and biologic use. On the other hands, pentraxin 3 was not associated with an increase of carotid intima-media thickness in RA patients.Conclusion: Female RA patients had elevated plasma PTX3 levels compared with control female subjects. PTX3 was independently associated with radiographic progression of joint damage in the RA patients, but not with carotid atherosclerosis.
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Affiliation(s)
- Yu Funakubo Asanuma
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Yoshimi Aizaki
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Kazuhiro Yokota
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Mayumi Matsuda
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Noritsune Kozu
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan.,Kozu Orthopaedic Clinic, Chiba, Japan
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Nakatani
- Department of Research, Clinical Trial Center, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Tomoko Hasunuma
- Department of Research, Clinical Trial Center, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Shinichi Kawai
- Department of Inflammation and Pain Control Research, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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An HJ, Zhang J. Diagnostic accuracy of digital X-ray radiogrammetry on hand bone loss for patients with rheumatoid arthritis. Medicine (Baltimore) 2019; 98:e17280. [PMID: 31574843 PMCID: PMC6775331 DOI: 10.1097/md.0000000000017280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will aim to evaluate the diagnostic accuracy of digital X-ray radiogrammetry (DXR) on hand bone loss (HBL) for rheumatoid arthritis (RA). METHODS In this study, we will search the literature from PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG from the inception to June 1, 2019 without language restrictions. All case-controlled studies on assessing diagnostic accuracy of DXR on HBL for diagnosis of RA will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be used for eligible studies. We will apply RevMan V.5.3 software and Stata V.12.0 software for statistical analysis. RESULTS We will evaluate diagnostic accuracy of DXR on HBL in patients with RA by assessing the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION This study will detect the diagnostic accuracy of DXR evaluation on HBL in patients with RA. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139489.
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Affiliation(s)
- Hong-Jian An
- Department of Computed Tomography, Qishan County Hospital, Qishan, Shaanxi
| | - Jun Zhang
- Department of Imaging, The Fourth People's Hospital of Shaanxi, Xi’an, China
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Reiss AB, Silverman A, Khalfan M, Vernice NA, Kasselman LJ, Carsons SE, De Leon J. Accelerated Atherosclerosis in Rheumatoid Arthritis: Mechanisms and Treatment. Curr Pharm Des 2019; 25:969-986. [DOI: 10.2174/1381612825666190430113212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/14/2019] [Indexed: 12/11/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder that increases the risk of developing cardiovascular disease. There is accumulating evidence that the RA disease state accelerates the formation of atherosclerotic plaques. Treatments for RA improve joint symptomatology and may reduce inflammation, but consideration of their effects on the cardiovascular system is generally low priority.Objective:Since cardiovascular disease is the leading cause of mortality in RA patients, the impact of RA therapies on atherosclerosis is an area in need of attention and the focus of this review.Results:The drugs used to treat RA may be analgesics, conventional disease-modifying anti-rheumatic drugs, and/or biologics, including antibodies against the cytokine tumor necrosis factor-α. Pain relievers such as nonselective non-steroidal anti-inflammatory drugs and cyclooxygenase inhibitors may adversely affect lipid metabolism and cyclooxygenase inhibitors have been associated with increased adverse cardiovascular events, such as myocardial infarction and stroke. Methotrexate, the anchor disease-modifying anti-rheumatic drug in RA treatment has multiple atheroprotective advantages and is often combined with other therapies. Biologic inhibitors of tumor necrosis factor-α may be beneficial in preventing cardiovascular disease because tumor necrosis factor-α promotes the initiation and progression of atherosclerosis. However, some studies show a worsening of the lipid profile in RA with blockade of this cytokine, leading to higher total cholesterol and triglycerides.Conclusion:Greater understanding of the pharmacologic activity of RA treatments on the atherosclerotic process may lead to improved care, addressing both damages to the joints and heart.
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Affiliation(s)
- Allison B. Reiss
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Andrew Silverman
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Muhammed Khalfan
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Nicholas A. Vernice
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Lora J. Kasselman
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Steven E. Carsons
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Joshua De Leon
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
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Shi N, Zhang S, Silverman G, Li M, Cai J, Niu H. Protective effect of hydroxychloroquine on rheumatoid arthritis-associated atherosclerosis. Animal Model Exp Med 2019; 2:98-106. [PMID: 31392302 PMCID: PMC6600633 DOI: 10.1002/ame2.12065] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease. We examined the effect of gut microbiota in a mouse model of RA that develops atherosclerosis. METHODS We created three groups of K/BxN female mice that were positive for the anti-glucose-6-phosphate isomerase (GPI) antibody: control diet (CD), high fat diet (HFD), and HFD with hydroxychloroquine (HFD + HCQ). Serological tests were used to detect the serum levels of total cholesterol (TCHO), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), anti-GPI antibody titers, and serum cytokines. Atherosclerotic plaque was determined by histological analysis, and gut microbiota were determined by 16sV4 sequencing. RESULTS Relative to mice given the CD, those receiving the HFD had increased serum levels of LDL-C, TCHO, and TG, decreased serum levels of HDL-C, increased atherosclerotic lesions in the aortic root, and altered gut microbiota. Addition of HCQ to HFD decreased the serum levels of LDL-C, TCHO, and TG, increased serum levels of HDL-C, and decreased the atherosclerotic lesions in the aortic root. Mice receiving HFD + HCQ also had the greatest bacterial diversity among the three experimental groups. Moreover, HCQ treatment significantly increased the abundance of Akkermansia and Parabacteroides, and decreased the abundance of Clostridium sensu stricto cluster 1, and therefore may be responsible for the reduced RA-associated atherosclerosis and dyslipidemia. CONCLUSION Our mouse model of RA indicated that HFD increased ankle width and aggravated atherosclerosis and dyslipidemia, and that HCQ alleviated the dyslipidemia and atherosclerosis, but had no effect on ankle width.
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Affiliation(s)
- Na Shi
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Shuangyue Zhang
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Gregg Silverman
- Department of Rheumatology, Langone Medical CenterNew York UniversityNew York CityNew York
| | - Mengtao Li
- Peking Union Medical College HospitalBeijingChina
| | - Jun Cai
- Fuwai HospitalChinese Academy of Medical SciencesBeijingChina
| | - Haitao Niu
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
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32
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El-Menoufy MA, El-Kak AEAA, Ahmed MA. Unusual CD4+CD28− T lymphocyte subset is implicated in the pathogenesis of early atherosclerosis in patients with rheumatoid arthritis. THE EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Assessment of arterial stiffness variables in patients with rheumatoid arthritis: A mediation analysis. Sci Rep 2019; 9:4543. [PMID: 30872715 PMCID: PMC6418197 DOI: 10.1038/s41598-019-41069-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/26/2019] [Indexed: 01/11/2023] Open
Abstract
We aimed to study arterial stiffness variables in patients with rheumatoid arthritis (RA), specifically considering their associations with path model mediation analysis. We examined arterial stiffness expressed by the pulse wave velocity (PVW), augmentation index (AIx), distensibility, and clinical and biochemical characteristics in a cohort of 214 RA patients. Variable associations were analysed using multivariate linear regression analysis. We also used path model mediation analysis for PWV variable. Our results indicate that age, systolic blood pressure (SBP), and body mass index (BMI) were significantly associated with PWV, and collectively accounted for 32% of PWV variability. The parallel mediation analysis showed that SBP and BMI accounted for 21% and 7% (a total of 28%) of the total effect of age on PWV, respectively, indicating a partial mediation effect. The associated variables with AIx were age and tender joint count, while those with distensibility were BMI and sex, overall accounting for 16.5% and 4.7% of the variation in AIx and distensibility, respectively. We observed no associations of arterial stiffness with inflammatory variables, disease activity and duration, or cholesterol levels. In conclusion, in our population of RA patients, age is the most important variable that determines the increase in PWV. We have also shown that a significant proportion of the negative effects of age on PWV occurs through increases in SBP and BMI. In our study, lipid and inflammation variables were not associated with an increase in arterial stiffness.
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López-Mejías R, Carmona FD, Genre F, Remuzgo-Martínez S, González-Juanatey C, Corrales A, Vicente EF, Pulito-Cueto V, Miranda-Filloy JA, Ramírez Huaranga MA, Blanco R, Robustillo-Villarino M, Rodríguez-Carrio J, Alperi-López M, Alegre-Sancho JJ, Mijares V, Lera-Gómez L, Pérez-Pampín E, González A, Ortega-Castro R, López-Pedrera C, García Vivar ML, Gómez-Arango C, Raya E, Narvaez J, Balsa A, López-Longo FJ, Carreira P, González-Álvaro I, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Ferraz-Amaro I, Gualillo O, Castañeda S, Martín J, Llorca J, González-Gay MA. Identification of a 3'-Untranslated Genetic Variant of RARB Associated With Carotid Intima-Media Thickness in Rheumatoid Arthritis: A Genome-Wide Association Study. Arthritis Rheumatol 2019; 71:351-360. [PMID: 30251476 PMCID: PMC6590191 DOI: 10.1002/art.40734] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
Objective To investigate the genetic background influencing the development of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA). Methods We performed a genome‐wide association study (GWAS) in which, after quality control and imputation, a total of 6,308,944 polymorphisms across the whole genome were analyzed in 2,989 RA patients of European origin. Data on subclinical atherosclerosis, obtained through assessment of carotid intima‐media thickness (CIMT) and presence/absence of carotid plaques by carotid ultrasonography, were available for 1,355 individuals. Results A genetic variant of the RARB gene (rs116199914) was associated with CIMT values at the genome‐wide level of significance (minor allele [G] β coefficient 0.142, P = 1.86 × 10−8). Interestingly, rs116199914 overlapped with regulatory elements in tissues related to CV pathophysiology and immune cells. In addition, biologic pathway enrichment and predictive protein–protein relationship analyses, including suggestive GWAS signals of potential relevance, revealed a functional enrichment of the collagen biosynthesis network related to the presence/absence of carotid plaques (Gene Ontology no. 0032964; false discovery rate–adjusted P = 4.01 × 10−3). Furthermore, our data suggest potential influences of the previously described candidate CV risk loci NFKB1,MSRA, and ZC3HC1 (P = 8.12 × 10−4, P = 5.94 × 10−4, and P = 2.46 × 10−4, respectively). Conclusion The present findings strongly suggest that genetic variation within RARB contributes to the development of subclinical atherosclerosis in patients with RA.
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Affiliation(s)
| | | | - Fernanda Genre
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | | | - Alfonso Corrales
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | | | | | | | - Ricardo Blanco
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Javier Rodríguez-Carrio
- University of Oviedo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Mercedes Alperi-López
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Verónica Mijares
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio González
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | | | | | | | | - Oreste Gualillo
- Servizo Galego de Saude and Instituto de Investigación Sanitaria de Santiago, Santiago, University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, Granada, Spain
| | - Javier Llorca
- University of Cantabria and CIBER Epidemiología y Salud Pública, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | - Miguel A González-Gay
- Instituto de Investigación Sanitaria Valdecilla and University of Cantabria, Santander, Spain, and University of the Witwatersrand, Johannesburg, South Africa
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Muñoz ÓM, Reyna Carrasco ÓA, Castelblanco SM, García ÁA, Fernández-Avila DG. Impacto terapéutico de las estatinas en el perfil lipídico y riesgo cardiovascular en pacientes con artritis reumatoide: Revisión sistemática de la literatura y metaanálisis. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rcreu.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Widdifield J, Abrahamowicz M, Paterson JM, Huang A, Thorne JC, Pope JE, Kuriya B, Beauchamp ME, Bernatsky S. Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis. J Rheumatol 2018; 46:467-474. [PMID: 30504508 DOI: 10.3899/jrheum.180427] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We evaluated the associations between time-varying methotrexate (MTX) use and risk of cardiovascular events (CVE) in patients with rheumatoid arthritis (RA). METHODS We studied an inception cohort of 23,994 patients with RA diagnosed after their 65th birthday. Multivariable Cox regression models were fit to evaluate the associations between time-varying MTX use, controlling for other risk factors, and time to CVE. Alternative models assessed the cumulative duration of MTX use over the (1) first year, (2) previous year (recent use), and (3) entire duration of followup. We also assessed whether the strength of the association varied over time. RESULTS Over 115,453 patient-years (PY), 3294 (13.7%) patients experienced a CVE (28.5 events per 1000 PY; 95% CI 27.6-29.5). In the multivariable analyses, the model assessing time-varying continuous use in the most recent year yielded the best fit. Increasing recent MTX use was associated with lower CVE risks (HR 0.79 for continuous use vs no use in past 12 months, 95% CI 0.70-0.88; p < 0.0001). Greater MTX use in the first year after cohort entry was also protective (HR 0.84, 95% CI 0.72-0.96; p = 0.0048), but this effect decreased with increasing followup. In contrast, longer MTX use during the entire followup was not clearly associated with CVE risk (HR 0.98, 95% CI 0.95-1.01; p = 0.1441). CONCLUSION We observed about a 20% decrease in CVE associated with recent continuous MTX use. Greater MTX use in the first year of cohort entry also appeared to be important in the association between MTX and CVE risk.
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Affiliation(s)
- Jessica Widdifield
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada. .,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation.
| | - Michal Abrahamowicz
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - J Michael Paterson
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Anjie Huang
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - J Carter Thorne
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Janet E Pope
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Bindee Kuriya
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Marie-Eve Beauchamp
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Sasha Bernatsky
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
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Lipids and Atherogenic Indices Fluctuation in Rheumatoid Arthritis Patients on Long-Term Tocilizumab Treatment. Mediators Inflamm 2018; 2018:2453265. [PMID: 30405318 PMCID: PMC6204176 DOI: 10.1155/2018/2453265] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 12/05/2022] Open
Abstract
Rheumatoid arthritis (RA) patients are at high risk of cardiovascular (CV) events, and the chronic inflammatory state may generate quantitative and qualitative changes in lipoprotein fractions. The anti-IL-6 receptor tocilizumab (TCZ), even if effective in inflammation and joint damage prevention, determined significant alterations to RA patients' lipid levels in randomized controlled trials, but real-world data are lacking. We evaluated the changes in lipid fraction levels and disease activity in a longitudinal cohort of RA patients on long-term treatment with tocilizumab (TCZ) in a community setting. We retrospectively selected 40 naïve-biologic RA patients on treatment with intravenous TCZ compared to 20 RA patients on methotrexate treatment as the control group. Total cholesterol (Tot-Chol), low-density lipoproteins (LDL), high-density lipoprotein (HDL), and triglyceride (TG) levels were measured at the baseline and at 12, 24, and 52 weeks thereafter. At the same points, 28-joint disease activity score (DAS28), clinical disease activity index (CDAI), and EULAR clinical responses were also assessed. During the first 24 weeks, we observed in TCZ-treated patients a progressive statistically significant (p < 0.001) increase in Tot-Chol, LDL, HDL, and TG, which returned close to the baseline at 52 weeks. But no changes in the lipid-related CV risk indices Tot-Chol/HDL and LDL/HDL ratios and the atherogenic index (log10 TG/HDL) were detectable. Notably, we observed a statistically significant negative correlation between changes in lipid fractions and DAS28 or CDAI. The prolonged treatment with TCZ was associated to a transient increase in cholesterol's fractions during the first 6 months of treatment, with inverse correlation to disease activity, but with no impact on surrogate lipid indices of atherogenic risk. These findings may aid clinicians in interpreting the RA patient's lipid profile in daily clinical practice.
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Mendonça JA, de Andrade BB, de Aquino JLB, Leandro-Merhi VA, Damian GB. Spectral Doppler and automated software-guided ultrasound assessment of bilateral common carotid intima-media thickness in spondyloarthritis: is there a correlation with clinical findings? Drugs Context 2018; 7:212538. [PMID: 30214463 PMCID: PMC6132676 DOI: 10.7573/dic.212538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 01/25/2023] Open
Abstract
Background and aim Limited information is currently available about whether carotid intima-media thickness (IMT) correlates with the degree of disease activity in spondyloarthritis. The objective of this study was to evaluate the correlation between articular and carotid ultrasound data and laboratory and clinical variables in patients with spondyloarthritis. Methods Twenty-two patients with spondyloarthritis, recruited consecutively via the spondyloarthritis service of the Universidade Pontifícia Católica de Campinas, São Paulo, Brazil, were assessed using carotid artery ultrasound (radiofrequency quality intima-media thickness, RF-QIMT), joint ultrasound, clinical evaluation, and laboratory tests. Results Mean (standard deviation, SD) carotid RF-QIMT was 0.643 (0.16) mm. Mean (SD) resistive index (RI) values for the right and left carotid arteries were 0.67 (0.12) and 0.82 (0.38), respectively. Mean (SD) RI values for the right and left sacroiliac joints were 1.10 (0.97) and 0.94 (0.13), respectively. Several significant correlations were detected between ultrasound, clinical, and laboratory variables. Notably, there were correlations between sacroiliac RI and erythrocyte sedimentation rate (p=0.027) and RF-QIMT (p=0.037); between RF-QIMT and Framingham score (p=0.012) and metabolic parameters, including abdominal waist measurement, body mass index (BMI) (p=0.032 to p=0.044). Conclusions In patients with spondyloarthritis, RF-QIMT detected atherosclerotic changes in the carotid artery wall, and spectral Doppler detected inflammatory activity in sacroiliac joints. Positive correlations were observed between these ultrasound findings and parameters reflecting patients’ metabolic profile and alterations in inflammatory markers.
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Affiliation(s)
- José Alexandre Mendonça
- Serviço de Reumatologia e Pós Graduação da Universidade Pontifícia Católica de Campinas, São Paulo, Brazil.,Graduate Program in Health Sciences, PUC-Campinas - SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - Beatriz Bisetto de Andrade
- Serviço de Reumatologia e Pós Graduação da Universidade Pontifícia Católica de Campinas, São Paulo, Brazil.,Graduate Program in Health Sciences, PUC-Campinas - SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - José Luis Braga de Aquino
- Graduate Program in Health Sciences, PUC-Campinas - SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil.,Serviço de Clínica Cirúrgica e Pós Graduação da Universidade Pontifícia Católica de Campinas, São Paulo, Brazil
| | - Vania Aparecida Leandro-Merhi
- Graduate Program in Health Sciences, PUC-Campinas - SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil.,Serviço de Nutrição e Pós Graduação da Universidade Pontifícia Católica de Campinas, São Paulo, Brazil
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Lee JY, Kang MJ, Choi JY, Park JS, Park JK, Lee EY, Lee EB, Pap T, Yi EC, Song YW. Apolipoprotein B binds to enolase-1 and aggravates inflammation in rheumatoid arthritis. Ann Rheum Dis 2018; 77:1480-1489. [PMID: 29997113 DOI: 10.1136/annrheumdis-2018-213444] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/13/2018] [Accepted: 06/17/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Immune cells from patients with rheumatoid arthritis (RA) express more enolase-1 (ENO1) on their surface than those from healthy subjects, and they elicit an enhanced inflammatory response. This study is aimed to identify the ligands of ENO1 that could promote inflammatory loops in vitro and enhance the arthritis severity in vivo. METHODS ENO1-binding proteins in RA synovial fluid were identified by mass spectromety, and affinity to ENO1 was evaluated by means of a ligand blotting and binding assay, surface plasmon resonance and confocal microscopy. Proinflammatory response by the interaction between ENO1 and apolipoprotein B (apoB) was tested in vitro and in vivo using peripheral blood mononuclear cells and a K/BxN serum transfer arthritis model and low-density lipoproteins receptor (LDLR) knockout mice. RESULTS ApoB in the synovid fluid of patients with RA was identified as a specific ligand to ENO1 with a higher affinity than plasminogen, a known ENO1 ligand. ApoB binding to ENO1 on monocytes elicited the production of tumour necrosis factor-α, interleukins (IL)-1β and IL-6 through both p38 mitogen-activated protein kinase and NF-κB pathways. In the K/BxN serum transfer arthritis model, administration of apoB increased the production of proinflammatory cytokines and exaggerated arthritis severity. The severity of K/BxN serum transfer arthritis in LDLR knockout mice was comparable with wild-type mice. CONCLUSIONS A key component of atherogenic lipids, apoB, aggravated arthritis by potentiating the inflammatory response via its interaction with ENO1 expressed on the surface of immune cells. This suggests a novel mechanism by which lipid metabolism regulates chronic inflammation in RA.
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Affiliation(s)
- Joo Youn Lee
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Min Jueng Kang
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Ji Yong Choi
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Ji Soo Park
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Jin Kyun Park
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Thomas Pap
- Institute of Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
| | - Eugene C Yi
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
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40
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Possible Modulation of Vascular Function Measures in Rheumatoid Arthritis by Homocysteine. Int J Rheumatol 2018; 2018:8498651. [PMID: 30057616 PMCID: PMC6051258 DOI: 10.1155/2018/8498651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022] Open
Abstract
The effect of homocysteine on cardiovascular diseases is still equivocal, especially in rheumatoid arthritis patients. In this investigation, the association between homocysteine with blood flow and vascular resistance in rheumatoid arthritis was examined. Serum levels of homocysteine were determined in thirty-one rheumatoid arthritis patients and nineteen apparently healthy subjects using ELISA. Additionally, strain-gauge plethysmography was used to determine both forearm blood flow and vascular function at rest and after occlusion. Forearm occlusion blood flow (patients: 21.9 ± 6.55 versus control: 25.5 ± 6.10ml/100mL/min) was lower (p < 0.05) while occlusion vascular resistance (patients: 4.77 ± 2.08 versus controls 3.05 ± 0.96U) was greater (p < 0.01) in rheumatoid arthritis than in the controls. Level of serum homocysteine was similar (p = 0.803) in rheumatoid arthritis group and healthy group. In addition, level of serum homocysteine was correlated with resting blood flow (r = −0.41; p < 0.02) and resting vascular resistance (r = 0.31, p < 0.05) in the patients group. The study confirms altered vascular function in rheumatoid arthritis. Uniquely, the results show that homocysteine was related to resting, but not postischemia, vascular measures. These relationships indicate that homocysteine might impact the vasculature in rheumatoid arthritis.
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41
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Dynamic of changes in coronary artery calcification in early rheumatoid arthritis patients over 18 months. Rheumatol Int 2018; 38:1217-1224. [DOI: 10.1007/s00296-018-4045-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
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Arya R, Escalante A, Farook VS, Restrepo JF, Battafarano DF, Almeida M, Kos MZ, Fourcaudot MJ, Mummidi S, Kumar S, Curran JE, Jenkinson CP, Blangero J, Duggirala R, Del Rincon I. A genetic association study of carotid intima-media thickness (CIMT) and plaque in Mexican Americans and European Americans with rheumatoid arthritis. Atherosclerosis 2018; 271:92-101. [PMID: 29482039 PMCID: PMC5886018 DOI: 10.1016/j.atherosclerosis.2017.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/25/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Little is known about specific genetic determinants of carotid-intima-media thickness (CIMT) and carotid plaque in subjects with rheumatoid arthritis (RA). We have used the Metabochip array to fine map and replicate loci that influence variation in these phenotypes in Mexican Americans (MAs) and European Americans (EAs). METHODS CIMT and plaque were measured using ultrasound from 700 MA and 415 EA patients with RA and we conducted association analyses with the Metabochip single nucleotide polymorphism (SNP) data using PLINK. RESULTS In MAs, 12 SNPs from 11 chromosomes and 6 SNPs from 6 chromosomes showed suggestive associations (p < 1 × 10-4) with CIMT and plaque, respectively. The strongest association was observed between CIMT and rs17526722 (SLC17A2 gene) (β ± SE = -0.84 ± 0.18, p = 3.80 × 10-6). In EAs, 9 SNPs from 7 chromosomes and 7 SNPs from 7 chromosomes showed suggestive associations with CIMT and plaque, respectively. The top association for CIMT was observed with rs1867148 (PPCDC gene, β ± SE = -0.28 ± 0.06, p = 5.11 × 10-6). We also observed strong association between plaque and two novel loci: rs496916 from COL4A1 gene (OR = 0.51, p = 3.15 × 10-6) in MAs and rs515291 from SLCA13 gene (OR = 0.50, p = 3.09 × 10-5) in EAs. CONCLUSIONS We identified novel associations between CIMT and variants in SLC17A2 and PPCDC genes, and between plaque and variants from COL4A1 and SLCA13 that may pinpoint new candidate risk loci for subclinical atherosclerosis associated with RA.
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Affiliation(s)
- Rector Arya
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA.
| | - Agustin Escalante
- Department of Medicine, Division of Rheumatology and Clinical Immunology, The University of Texas Health, San Antonio, TX, USA
| | - Vidya S Farook
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Jose F Restrepo
- Department of Medicine, Division of Rheumatology and Clinical Immunology, The University of Texas Health, San Antonio, TX, USA
| | | | - Marcio Almeida
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Mark Z Kos
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Marcel J Fourcaudot
- Division of Diabetes, Department of Medicine, The University of Texas Health, San Antonio, TX, USA
| | - Srinivas Mummidi
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Satish Kumar
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Joanne E Curran
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Christopher P Jenkinson
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - John Blangero
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Ravindranath Duggirala
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA; South Texas Diabetes and Obesity Institute, School of Medicine, The University of Texas Rio Grande Valley, Edinburg/Brownsville, TX, USA
| | - Inmaculada Del Rincon
- Department of Medicine, Division of Rheumatology and Clinical Immunology, The University of Texas Health, San Antonio, TX, USA
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Lee UK, Chang TI, Garrett N, Friedlander AH. Males With Rheumatoid Arthritis Often Evidence Carotid Atheromas on Panoramic Imaging: A Risk Indicator of Future Cardiovascular Events. J Oral Maxillofac Surg 2018; 76:1447-1453. [PMID: 29406256 DOI: 10.1016/j.joms.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Males with rheumatoid arthritis (RA) are at an exceedingly high risk of adverse intraoperative ischemic events, given the role of systemic inflammation in the atherogenic process. We hypothesized that their panoramic images would demonstrate calcified carotid artery atheromas (CCAPs) significantly more often than those from a general population of similarly aged men. PATIENTS AND METHODS We implemented a retrospective observational study. The sample was composed of male patients older than 55 years of age who had undergone panoramic imaging studies. The predictor variable was the diagnosis of RA confirmed by a positive rheumatoid factor (RF) titer, and the outcome variable was the prevalence rate of CCAPs. The other major study variable was the level of RF among the patients evidencing CCAPs. The prevalence of CCAPs among the patients with RA was then compared with that of a historical general population of similarly aged men. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS Of the 100 men (mean age 69.89 ± 8.927 years) with RA, 29 (29%; mean age 72.10 ± 7.68 years) had atheromas (CCAP+). Of these 29 men, 25 (86%; mean age 71.88 ± 7.43 years) had a RF titer of ≥41 IU/mL, twice that of normal. A statistically significant (P < .05) association was found between a diagnosis of RA and the presence of an atheroma on the panoramic image compared with the 3% rate found in the historical cohort. CONCLUSIONS The results of the present study suggest that CCAP, a risk indicator of future adverse cardiovascular events, is frequently seen on panoramic images of male patients with RA and that these individuals routinely manifest high titer levels of RF, a biologic marker of inflammation. Oral and maxillofacial surgeons planning surgery for male patients with RA must be uniquely vigilant for the presence of these lesions.
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Affiliation(s)
- Urie K Lee
- Oral and Maxillofacial Surgery Veterans Affairs Special Fellow, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tina I Chang
- Director, Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Great Los Angeles Healthcare System, Los Angeles, CA; and Instructor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA
| | - Neal Garrett
- Professor Emeritus, School of Dentistry, University of California, Los Angeles, CA
| | - Arthur H Friedlander
- Associate Chief of Staff, Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director, Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center; and Professor-in-Residence, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA.
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Nadali M, Pullerits R, Andersson KME, Silfverswärd ST, Erlandsson MC, Bokarewa MI. High Expression of STAT3 in Subcutaneous Adipose Tissue Associates with Cardiovascular Risk in Women with Rheumatoid Arthritis. Int J Mol Sci 2017; 18:ijms18112410. [PMID: 29137196 PMCID: PMC5713378 DOI: 10.3390/ijms18112410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022] Open
Abstract
Despite the predominance of female patients and uncommon obesity, rheumatoid arthritis (RA) is tightly connected to increased cardiovascular morbidity. The aim of this study was to investigate transcriptional activity in the subcutaneous white adipose tissue (WAT) with respect to this disproportionate cardiovascular risk (CVR) in RA. CVR was estimated in 182 female patients, using the modified Systematic Coronary Risk Evaluation scale, and identified 93 patients with increased CVR. The overall transcriptional activity in WAT was significantly higher in patients with CVR and was presented by higher serum levels of WAT products leptin, resistin and IL-6 (all, p < 0.001). CVR was associated with high WAT-specific transcription of the signal transducer and activator of transcription 3 (STAT3) and the nuclear factor NF-kappa-B p65 subunit (RELA), and with high transcription of serine-threonine kinase B (AKT1) in leukocytes. These findings suggest Interleukin 6 (IL-6) and leptin take part in WAT-specific activation of STAT3. The binary logistic regression analysis confirmed an independent association of CVR with IL-6 in serum, and with STAT3 in WAT. The study shows an association of CVR with transcriptional activity in WAT in female RA patients. It also emphasizes the importance of STAT3 regulatory circuits for WAT-related CVR in RA.
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Affiliation(s)
- Mitra Nadali
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 46 Gothenburg, Sweden.
- Rheumatology Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
| | - Rille Pullerits
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 46 Gothenburg, Sweden.
- Rheumatology Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden.
| | - Karin M E Andersson
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 46 Gothenburg, Sweden.
| | - Sofia Töyrä Silfverswärd
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 46 Gothenburg, Sweden.
| | - Malin C Erlandsson
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 46 Gothenburg, Sweden.
- Rheumatology Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
| | - Maria I Bokarewa
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 46 Gothenburg, Sweden.
- Rheumatology Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
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El Zohri MH, ELGendi SS, Ahmed GH, Mohammed MZ. Brachial artery flow-mediated dilation and carotid intima-media thickness for assessment of subclinical atherosclerosis in rheumatoid arthritis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_37_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pan L, Wang T. Features of cardiac remodeling in Patients with Acute Coronary Syndrome Complicated with Rheumatoid Arthritis. Sci Rep 2017; 7:10268. [PMID: 28860666 PMCID: PMC5579266 DOI: 10.1038/s41598-017-11123-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular diseases are important factors to increased morbidity and mortality in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the effects of RA on cardiac remodeling in patients with acute coronary syndrome (ACS). Sixty-one patients with ACS complicated with RA (RA group) and 55 age- and sex-matched patients with ACS without RA (control group) were enrolled. We compared the parameters of laboratory and echocardiogram across the 2 groups. Levels of serum brain natriuretic peptide in patients with RA were significantly higher than control group. Prevalence of left ventricular hypertrophy (LVH), and LV diastolic dysfunction (E/A < 1) were significantly higher in the RA patients, while the LV ejection fraction (EF%) was significantly lower in RA patients. Incidence of tricuspid regurgitation and pulmonary regurgitation were significantly higher in ACS patients with RA than in the ACS patients without RA. In RA group, levels of serum high density lipoprotein cholesterol were negatively correlated with C reactive protein (CRP), EF% was also negatively correlated with CRP. The prevalence of LVH and mitral regurgitation showed positive correlations with ESR. Early intervention for controlling the inflammation associated with RA can play a significant role in preventing cardiac remodeling in ACS patients.
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Affiliation(s)
- Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Tian Wang
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. .,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China.
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Robustillo-Villarino M, Alegre-Sancho JJ, Rodilla-Sala E, Corrales A, Llorca J, Gonzalez-Gay MA, Dessein PH. Pulse wave velocity and augmentation index are not independently associated with carotid atherosclerosis in patients with rheumatoid arthritis. Clin Rheumatol 2017; 36:2601-2606. [DOI: 10.1007/s10067-017-3680-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/30/2017] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
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Spinelli FR, Pecani A, Ciciarello F, Colasanti T, Di Franco M, Miranda F, Conti F, Valesini G, Alessandri C. Association between antibodies to carbamylated proteins and subclinical atherosclerosis in rheumatoid arthritis patients. BMC Musculoskelet Disord 2017; 18:214. [PMID: 28545441 PMCID: PMC5445290 DOI: 10.1186/s12891-017-1563-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/09/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients carry a high risk of cardiovascular morbidity and mortality. The excess of cardiovascular disease cannot be entirely explained by traditional risk factors and the immune system contributes to the development of atherosclerosis. Moreover, post-translational modifications such as citrullination and carbamylation have been linked to inflammation and atherosclerosis. Anti-carbamylated proteins antibodies (anti-CarP) are a new subset of autoantibodies identified in RA patients. This study aimed to investigate a possible association between anti-CarP and subclinical atherosclerosis in RA patients. METHODS We enrolled RA patients and normal healthy controls (NHS) without known cardiovascular risk factors or heart disease. Cardiovascular risk was assessed using the Modified Systemic Coronary Risk Evaluation (mSCORE). Anti-CarP were investigated by a solid phase "home-made" ELISA. Anti-citrullinated protein antibodies (ACPA) and Rheumatoid Factor (RF) were investigated by ELISA assays. Subclinical atherosclerosis was evaluated by brachial artery Flow-Mediated Dilatation (FMD) and Carotid Intima-Media Thickness (c-IMT) while arterial stiffness by Ankle-Brachial Index (ABI) and Cardio-Ankle Vascular Index (CAVI). RESULTS We enrolled 50 RA patients (34 F and 16 M, mean age 58.4 ± 13.1 years, mean disease duration 127 ± 96.7 months) and 30 age and sex matched NHS. According to the mSCORE, 58% of patients had a low risk, 32% a moderate and 8% a high risk for cardiovascular disease. FMD was significantly lower in RA patients than in NHS (5.6 ± 3.2 vs 10.7 ± 8.1%; p < 0.004) and CAVIs significantly higher in a RA patients compared to NHS (left CAVI 8.9 ± 1.7 vs 8.1 ± 1.5; p < 0.04 for and right CAVI 8.8 ± 1.6 vs 8.0 ± 1.4; p < 0.04 for the). ABI and c-IMT did not differ between the two populations. The multivariate regression analysis showed a significant association of anti-CarP antibodies with FMD, left and right CAVI and both c-IMT (r = 1.6 and p = 0.05; r = 1.7 and p = 0.04; r = 2.9 and p = 0.05; r = 1.5 and p = 0.03; r = 1.1 and p = 0.03 respectively). CONCLUSIONS This study confirms that RA patients, without evidence of cardiovascular disease or traditional risk factors, have an impaired endothelial function. Moreover, we found an association with anti-CarP antibodies suggesting a possible contribution of these autoantibodies to endothelial dysfunction, the earliest stage of atherosclerosis. Besides ultrasound assessment, anti-CarP should be assessed in RA patients and considered an additional cardiovascular risk factor.
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Affiliation(s)
- Francesca Romana Spinelli
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Arbi Pecani
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesco Ciciarello
- Department of Cardiovascular, Respiratory, Nephrology and Geriatrics Sciences, Sapienza University of Rome, Rome, Italy
| | - Tania Colasanti
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Manuela Di Franco
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesca Miranda
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cristiano Alessandri
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Distinct Patterns of Dietary Intake in Different Functional Classes of Patients With Rheumatoid Arthritis. TOP CLIN NUTR 2017. [DOI: 10.1097/tin.0000000000000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pascual J, González I, Corona D, Hispán P, Ramos J, Sánchez-Paya J, Jemec G. Assessment of subclinical atherosclerosis in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2017; 31:1229-1238. [DOI: 10.1111/jdv.14076] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/23/2016] [Indexed: 01/02/2023]
Affiliation(s)
- J.C. Pascual
- Department of Dermatology; Alicante University General Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation); Alicante Spain
| | - I. González
- Department of Dermatology; Alicante University General Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation); Alicante Spain
| | - D. Corona
- Department of Neurology; Alicante University General Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation); Alicante Spain
| | - P. Hispán
- Department of Dermatology; Alicante University General Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation); Alicante Spain
| | - J.M. Ramos
- Department of Internal Medicine; Alicante University General Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation); Alicante Spain
| | - J. Sánchez-Paya
- Epidemiology Unit; Alicante University General Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation); Alicante Spain
| | - G.B. Jemec
- Department of Dermatology; Zealand University Hospital Roskilde; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
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