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张 警, 叶 修, 段 萌, 周 小, 姚 中, 赵 金. [Clinical and laboratory characteristics of rheumatoid arthritis with positive antinuclear antibody]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:1023-1028. [PMID: 33331308 PMCID: PMC7745268 DOI: 10.19723/j.issn.1671-167x.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyse the clinical and laboratory characteristics of antinuclear antibody (ANA) positive rheumatoid arthritis (RA) patients. METHODS The clinical and laboratory data of 428 RA cases from Department of of Rheumatology and Immunology Peking University Third Hospital from Jan 2013 to Dec 2018 were collected and used to analyse characters between ANA positive group and ANA negative group. T test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. RESULTS The number of ANA positive group was 231 (54%). The female rate was obviously higher in ANA positive group (82.7% vs. 63.5%, χ2=20.355, P < 0.01). The rate of metatarsophalangeal joints (MTPJs) involvement was lower in ANA positive group (22.1%) than in ANA negative group (33.0) (χ2=6.414, P < 0.05). The incidence of secondary Sjögren's syndrome (sSS) was much higher in ANA positive group(19.5% vs. 4.1%, χ2=23.300, P < 0.01). The positivity of rheumatoid factor (RF), as well as the positivity of anti-cyclic citrullinated peptide(CCP) antibody was much higher in ANA positive group (77.1% vs. 53.8%, χ2=25.743, P < 0.01, 74.9% vs. 59.4%, χ2=11.694, P < 0.01, respectively). The levels of immunoglobulin G (IgG) and immunoglobulin M (IgM) of ANA positive group were higher [(15.1±5.1) g/L vs. (13.8±5.3) g/L, t=2.359, P < 0.05, 1.25 (0.92) g/L vs. 1.05 (0.65) g/L, Z=-3.449, P < 0.01, respectively]. But the levels of hemoglobin (Hb) and platelet (PLT) was lower in ANA positive group[(109.64±17.98) vs. (114.47±18.48) g/L, t=-2.734, P < 0.01; (266.4×109±104.6×109) vs. (295.9×109±100.1×109) /L, t=-2.970, P < 0.01, respectively]. CONCLUSION The incidence of sSS was obviously higher in ANA positive group than in ANA negative group. Serum IgG of ANA positive group was higher, but Hb and PLT were lower.
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Affiliation(s)
- 警丰 张
- />北京大学第三医院风湿免疫科,北京 100191Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - 修玲 叶
- />北京大学第三医院风湿免疫科,北京 100191Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - 萌 段
- />北京大学第三医院风湿免疫科,北京 100191Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - 小利 周
- />北京大学第三医院风湿免疫科,北京 100191Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - 中强 姚
- />北京大学第三医院风湿免疫科,北京 100191Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - 金霞 赵
- />北京大学第三医院风湿免疫科,北京 100191Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
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Carbone L, Vasan S, Elam R, Gupta S, Tolaymat O, Crandall C, Wactawski-Wende J, Johnson KC. The Association of Methotrexate, Sulfasalazine, and Hydroxychloroquine Use With Fracture in Postmenopausal Women With Rheumatoid Arthritis: Findings From the Women's Health Initiative. JBMR Plus 2020; 4:e10393. [PMID: 33103025 PMCID: PMC7574701 DOI: 10.1002/jbm4.10393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
This study was conducted to evaluate the extent to which disease‐modifying antirheumatic medications (DMARDs) used as part of a triple therapy for the treatment of rheumatoid arthritis (RA) including methotrexate, sulfasalazine, and hydroxychloroquine are associated with fractures in postmenopausal women with RA. Incident fractures following use of methotrexate, sulfasalazine, and/or hydroxychloroquine in postmenopausal women with RA in the Women's Health Initiative were estimated by Cox proportional hazards using hazard ratios (HRs) and 95% CIs after consideration of potential confounders. There were 1201 women with RA enrolled in the Women's Health Initiative included in these analyses, of which 74% were white, 17% were black, and 9% were of other or unknown race/ethnicity. Of the women with RA, 421 (35%) had not used methotrexate, sulfasalazine, or hydroxychloroquine, whereas 519 (43%) women had used methotrexate, 83 (7%) sulfasalazine, and 363 (30%) hydroxychloroquine alone or in combination at some time during study follow‐up. Over a median length of 6.46 years of follow‐up, in multivariable adjusted models, no statistically significant association was found between methotrexate (HR, 1.1; 95% CI, 0.8–1.6), sulfasalazine (HR, 0.6; 95% CI, 0.2–1.5), or hydroxychloroquine (HR, 1.0; 95% CI, 0.7–1.5) use and incident fractures or between combination therapy with methotrexate and sulfasalazine or methotrexate and hydroxychloroquine use (HR, 0.9; 95% CI, 0.5–1.6) and incident fractures. In conclusion, postmenopausal women with RA receiving any component of triple therapy should not be expected to have any substantial reduction in fracture risk from use of these DMARDs. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Laura Carbone
- Department of Medicine, Division of Rheumatology, J. Harold Harrison MD, Distinguished University Chair in Rheumatology Medical College of Georgia at Augusta University Augusta GA USA.,Department of Rheumatology Charlie Norwood Veterans Affairs Medical Center Augusta GA USA
| | - Sowmya Vasan
- Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Rachel Elam
- Department of Rheumatology Charlie Norwood Veterans Affairs Medical Center Augusta GA USA.,Department of Medicine, Division of Rheumatology Medical College of Georgia at Augusta University Augusta GA USA
| | - Sandeepkumar Gupta
- Department of Medicine, Division of Rheumatology Medical College of Georgia at Augusta University Augusta GA USA
| | - Omar Tolaymat
- Department of Medicine, Division of Rheumatology Medical College of Georgia at Augusta University Augusta GA USA
| | - Carolyn Crandall
- Department of Medicine, Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at University of California, Los Angeles Los Angeles CA USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions University at Buffalo Buffalo NY USA
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN USA
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Should rheumatoid factor (RF) (and antinuclear antibodies (ANA)) become routinary screening test for morbidities in the general population? Autoimmun Rev 2018; 17:636-638. [DOI: 10.1016/j.autrev.2018.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/20/2018] [Indexed: 12/23/2022]
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Birru Talabi M, Mackey RH, Kuller LH, Dorman JS, Deane KD, Robinson WH, Walitt BT, Chang Y, Holers VM, Liu S, Moreland LW. Human Leukocyte Antigen Shared Epitope and Inflammation, Cardiovascular Disease, Cancer, and Mortality Among Postmenopausal Women in the Women's Health Initiative Rheumatoid Arthritis Study. Am J Epidemiol 2017; 186:245-254. [PMID: 28459968 DOI: 10.1093/aje/kwx087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/31/2016] [Indexed: 12/17/2022] Open
Abstract
Specific alleles of the human leukocyte antigen (HLA)-DRB1 gene (HLA-DRB1) encode a "shared epitope" (SE) associated with rheumatoid arthritis (RA), especially more severe cyclic-citrullinated peptide antibody-positive (anti-CCP+) RA. We evaluated associations of number of SE alleles (0, 1, or 2) with total and cardiovascular disease (CVD) mortality and incident coronary heart disease (CHD), CVD, and cancer over a mean 8.9 (standard deviation, 3.5) years of follow-up, stratifying by baseline anti-CCP status (positive (+) vs. negative (-)). A longitudinal study, the Women's Health Initiative RA Study (1993-2010), sampled postmenopausal women who reported RA at baseline (1993-1998) or follow-up in the Women's Health Initiative, classified as anti-CCP+ RA (n = 556) or anti-CCP- non-RA (n = 1,070). Among anti-CCP+ RA women, SE alleles were not related to age-adjusted risks of CHD, CVD, or cancer or to total or CVD mortality. Among anti-CCP- non-RA women, age-adjusted hazard ratios for 1 and 2 SE alleles versus 0 SE alleles were 0.41 (95% confidence interval (CI): 0.34, 0.50) and 0.44 (95% CI: 0.27, 0.72), respectively, for CVD; 0.43 (95% CI: 0.37, 0.53) and 0.30 (95% CI: 0.16, 0.64), respectively, for CHD; and 0.62 (95% CI: 0.53, 0.73) and 0.52 (95% CI: 0.33, 0.83), respectively, for cancer. Associations persisted after adjustment for CVD risk factors, joint pain, rheumatoid factor positivity, and inflammatory markers (white blood cell count or cytokine level). In future studies, investigators should evaluate SE associations among anti-CCP- adults without RA and potential mechanisms.
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Verschoor CP, McEwen LM, Kohli V, Wolfson C, Bowdish DM, Raina P, Kobor MS, Balion C. The relation between DNA methylation patterns and serum cytokine levels in community-dwelling adults: a preliminary study. BMC Genet 2017. [PMID: 28637423 PMCID: PMC5480116 DOI: 10.1186/s12863-017-0525-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The levels of circulating cytokines fluctuate with age, acute illness, and chronic disease, and are predictive of mortality; this is also true for patterns of DNA (CpG) methylation. Given that immune cells are particularly sensitive to changes in the concentration of cytokines in their microenvironment, we hypothesized that serum levels of TNF, IL-6, IL-8 and IL-10 would correlate with genome-wide alterations in the DNA methylation levels of blood leukocytes. To test this, we evaluated community-dwelling adults (n = 14; 48–78 years old) recruited to a pilot study for the Canadian Longitudinal Study on Aging (CLSA), examining DNA methylation patterns in peripheral blood mononuclear cells using the Illumina HumanMethylation 450 K BeadChip. Results We show that, apart from age, serum IL-10 levels exhibited the most substantial association to DNA methylation patterns, followed by TNF, IL-6 and IL-8. Furthermore, while the levels of these cytokines were higher in elderly adults, no associations with epigenetic accelerated aging, derived using the epigenetic clock, were observed. Conclusions As a preliminary study with a small sample size, the conclusions drawn from this work must be viewed with caution; however, our observations are encouraging and certainly warrant more suitably powered studies of this relationship. Electronic supplementary material The online version of this article (doi:10.1186/s12863-017-0525-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris P Verschoor
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St. W, MIP309A, Hamilton, ON, Canada. .,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada. .,Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada. .,Canadian Longitudinal Study on Aging, Hamilton, ON, Canada.
| | - Lisa M McEwen
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Canadian Longitudinal Study on Aging, Hamilton, ON, Canada
| | - Vikas Kohli
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St. W, MIP309A, Hamilton, ON, Canada
| | - Christina Wolfson
- Canadian Longitudinal Study on Aging, Hamilton, ON, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Dawn Me Bowdish
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St. W, MIP309A, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Canadian Longitudinal Study on Aging, Hamilton, ON, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Canadian Longitudinal Study on Aging, Hamilton, ON, Canada
| | - Michael S Kobor
- Department of Medical Genetics, Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Canadian Longitudinal Study on Aging, Hamilton, ON, Canada
| | - Cynthia Balion
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St. W, MIP309A, Hamilton, ON, Canada.,Canadian Longitudinal Study on Aging, Hamilton, ON, Canada
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Videm V, Thomas R, Brown MA, Hoff M. Self-reported Diagnosis of Rheumatoid Arthritis or Ankylosing Spondylitis Has Low Accuracy: Data from the Nord-Trøndelag Health Study. J Rheumatol 2017; 44:1134-1141. [PMID: 28412703 DOI: 10.3899/jrheum.161396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Self-reported diagnoses of inflammatory arthritis are not accurate. The primary study aim was to ascertain self-reported diagnoses of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the Norwegian population-based Nord-Trøndelag Health Study (HUNT) using hospital case files. The secondary aim was to provide updated estimates of the prevalence and incidence of RA and AS. METHODS All inhabitants ≥ 20 years old from the county of Nord-Trøndelag were invited. Data from 70,805 unique participants from HUNT2 (1995-1997) and HUNT3 (2006-2008) were included. For participants who self-reported RA or AS, case files from all 3 hospitals in the catchment area were evaluated using standardized diagnostic criteria. RESULTS Of 2703 self-reported cases of RA, 19.1% were verified in hospital files. Of 1064 self-reported cases of AS, 15.8% were verified. Of 259 cases self-reporting both RA and AS, 8.1% had RA and 5.4% had AS. Overall, a self-report of 1 or both diagnoses could not be verified in 82.1%, including 22.8% with insufficient information or no case file. The prevalence of RA was 768 (95% CI 705-835) per 100,000. The incidence of RA from HUNT2 to HUNT3 was 0.48 (0.41-0.56) per 1000 per year. The prevalence of AS was 264 (228-305) per 100,000. The incidence of AS from HUNT2 to HUNT3 was 0.19 (0.15-0.24) per 1000 per year. CONCLUSION Self-reported diagnoses of RA and AS are often false-positive. The prevalence and incidence of RA were comparable to reports from similar populations. The incidence of AS was higher than previously reported in a mixed population from Norway.
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Affiliation(s)
- Vibeke Videm
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia. .,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital.
| | - Ranjeny Thomas
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia.,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital
| | - Matthew A Brown
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia.,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital
| | - Mari Hoff
- From the Department of Laboratory Medicine, Children's and Women's Health, and the Department of Public Health and General Practice and Department of Neuroscience, NTNU - Norwegian University of Science and Technology; Department of Immunology and Transfusion Medicine, and Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway; University of Queensland, Translational Research Institute; Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital, Brisbane, Australia.,V. Videm, MD, PhD, Professor, Department of Laboratory Medicine, Children's and Women's Health, NTNU, and Senior Consultant, Department of Immunology and Transfusion Medicine, St. Olavs Hospital; R. Thomas, MBBS, FRACP, MD, Professor, Translational Research Institute, University of Queensland; M.A. Brown, MBBS, MD, Director of Genomics, Queensland University of Technology, Institute of Health and Biomedical Research, Princess Alexandra Hospital; M. Hoff, MD, PhD, Associate Professor, Department of Public Health and General Practice and Department of Neuroscience, NTNU, and Senior Consultant, Department of Rheumatology, St. Olavs Hospital
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Cruz GI, Shao X, Quach H, Ho KA, Sterba K, Noble JA, Patsopoulos NA, Busch MP, Triulzi DJ, Wong WS, Solomon BD, Niederhuber JE, Criswell LA, Barcellos LF. Increased risk of rheumatoid arthritis among mothers with children who carry DRB1 risk-associated alleles. Ann Rheum Dis 2017; 76:1405-1410. [PMID: 28391248 DOI: 10.1136/annrheumdis-2016-210662] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/02/2017] [Accepted: 03/13/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether a child's genotype affects a mother's risk of rheumatoid arthritis (RA) beyond the risk associated with her genotype and to test whether exposure to fetal alleles inherited from the father increases risk of RA among mothers without risk alleles. METHODS A case-control study was conducted among 1165 mothers (170 cases/995 controls) and their respective 1482 children. We tested the association between having any child with alleles encoding amino acids (AAs) associated with RA including the 'shared epitope' (SE) and DERAA AA sequences at positions 70-74; AA valine, lysine and alanine at positions 11, 71 and 74 of HLA-DRB1; aspartic acid at position 9 of HLA-B and phenylalanine at position 9 of DPB1. We used logistic regression models to estimate OR and 95% CI for each group of alleles, adjusting for maternal genotype and number of live births. RESULTS We found increased risk of RA among mothers who had any child with SE (OR 3.0; 95% CI 2.0 to 4.6); DERAA (OR 1.7; 95% CI 1.1 to 2.6); or valine (OR 2.3; 95% CI 1.6 to 3.5), lysine (OR 2.3; 95% CI 1.5 to 3.4) and alanine (OR 2.8; 95% CI 1.2 to 6.4) at DRB1 positions 11, 71 and 74, respectively. Among non-carrier mothers, increased risk of RA was associated with having children who carried DERAA (OR 1.7; 95% CI 1.0 to 2.7) and alleles encoding lysine at DRB1 position 71 (OR 2.3; 95% CI 1.5 to 4.8). CONCLUSION Findings support the hypothesis that a child's genotype can contribute independently to risk of RA among mothers.
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Affiliation(s)
- Giovanna Ibeth Cruz
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Xiaorong Shao
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Hong Quach
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Kimberly A Ho
- Department of Medicine, University of San Francisco, Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, San Francisco, California, USA
| | - Kirsten Sterba
- Department of Medicine, University of San Francisco, Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, San Francisco, California, USA
| | - Janelle A Noble
- Childrens Hospital Oakland Research Institute, Oakland, California, USA
| | | | - Michael P Busch
- Laboratory of Medicine, Blood Systems Research Institute, San Francisco, California, USA
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA
| | - Wendy Sw Wong
- Division of Medical Genomics, Inova Translational Medicine Institute, Falls Church, Virginia, USA
| | - Benjamin D Solomon
- Division of Medical Genomics, Inova Translational Medicine Institute, Falls Church, Virginia, USA
| | - John E Niederhuber
- Division of Medical Genomics, Inova Translational Medicine Institute, Falls Church, Virginia, USA
| | - Lindsey A Criswell
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lisa F Barcellos
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
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Curtis JR, Xie F, Mackey D, Gerber N, Bharat A, Beukelman T, Saag KG, Chen L, Nowell B, Ginsberg S. Patient's experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis. BMC Musculoskelet Disord 2016; 17:405. [PMID: 27669978 PMCID: PMC5037591 DOI: 10.1186/s12891-016-1254-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
Background Despite the prominent position of methotrexate (MTX) in Rheumatoid Arthiris (RA) therapeutics, its real-world effectiveness may be influenced by a relative lack of tolerability or other side effects that physicians may not be aware of but that are bothersome to patients. The aim of this study is to identify suboptimal patient experience with MTX and to raise awareness for clinicians to identify opportunities to mitigate bothersome symptoms and side effects and optimize response to MTX. Methods We conducted a prospective, cross-sectional, online survey among RA patients who were members of Creakyjoints, a large arthritis patient community. Eligible participants must have recently initiated a new biologic, subcutaneous (SQ) MTX, or oral MTX in the last 12 months and were uniquely assigned to one of these 3 groups. Descriptive statistics were used to compare patient-reported side effects and tolerability related to MTX use in the 3 medication groups (SQ MTX, oral MTX, and biologic). Results A total of 382 (85 %) of 448 eligible patients completed the survey and were grouped as: biologic (n = 218), SQ MTX (n = 49), and oral MTX (n = 115). Demographics were mean standard deviation (SD) age 48 (10) years, 92 % white, 91 % women. Symptoms significantly more prevalent in the SQ and oral MTX groups included diarrhea, fatigue, malaise, and hair loss. Injection related pain was lower with SQ MTX compared to SQ biologics. Out of a total of 8 potential symptoms and side effects examined, higher dose MTX (> = 20 mg/week) was associated with a 2.26 (1.25–4.09) greater likelihood of more side effects referent to < =10 mg/week. Conclusion Results from this real-world RA patient cohort suggest that MTX is accompanied by many patient-reported side effects and tolerability problems that may be under-recognized by physicians. These may impact both treatment satisfaction and medication adherence.
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Affiliation(s)
- J R Curtis
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA.
| | - F Xie
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - D Mackey
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - N Gerber
- Global Healthy Living Foundation, Upper Nyack, NY, 10960, USA
| | - A Bharat
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - T Beukelman
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - K G Saag
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - L Chen
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - B Nowell
- Global Healthy Living Foundation, Upper Nyack, NY, 10960, USA
| | - S Ginsberg
- Global Healthy Living Foundation, Upper Nyack, NY, 10960, USA
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Abstract
Twenty-five years ago, on the 75th anniversary of the Johns Hopkins Bloomberg School of Public Health, I noted that epidemiologic research was moving away from the traditional approaches used to investigate "epidemics" and their close relationship with preventive medicine. Twenty-five years later, the role of epidemiology as an important contribution to human population research, preventive medicine, and public health is under substantial pressure because of the emphasis on "big data," phenomenology, and personalized medical therapies. Epidemiology is the study of epidemics. The primary role of epidemiology is to identify the epidemics and parameters of interest of host, agent, and environment and to generate and test hypotheses in search of causal pathways. Almost all diseases have a specific distribution in relation to time, place, and person and specific "causes" with high effect sizes. Epidemiology then uses such information to develop interventions and test (through clinical trials and natural experiments) their efficacy and effectiveness. Epidemiology is dependent on new technologies to evaluate improved measurements of host (genomics), epigenetics, identification of agents (metabolomics, proteomics), new technology to evaluate both physical and social environment, and modern methods of data collection. Epidemiology does poorly in studying anything other than epidemics and collections of numerators and denominators without specific hypotheses even with improved statistical methodologies.
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Mackey RH, Kuller LH, Deane KD, Walitt BT, Chang YF, Holers VM, Robinson WH, Tracy RP, Hlatky MA, Eaton C, Liu S, Freiberg MS, Talabi MB, Schelbert EB, Moreland LW. Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative. Arthritis Rheumatol 2015; 67:2311-22. [PMID: 25988241 PMCID: PMC4551571 DOI: 10.1002/art.39198] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 05/05/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the incidence of cardiovascular disease (CVD) morbidity and mortality over the course of 10 years among the more than 160,000 postmenopausal women in the Women's Health Initiative (WHI) in relation to self-reported rheumatoid arthritis (RA), taking disease-modifying antirheumatic drugs (DMARDs), anti-cyclic citrullinated peptide (anti-CCP) positivity, rheumatoid factor (RF) positivity, CVD risk factors, joint pain, and inflammation (white blood cell count and interleukin-6 levels). METHODS Anti-CCP and RF were measured in a sample of WHI participants with self-reported RA (n = 9,988). RA was classified as self-reported RA plus anti-CCP positivity and/or taking DMARDs. Anti-CCP-negative women with self-reported RA and not taking DMARDs were classified as having "unverified RA." RESULTS Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD, and total mortality were higher in women with RA than in women with no reported RA, with multivariable-adjusted hazard ratios of 1.46 (95% confidence interval [95% CI] 1.17-1.83) for CHD and 2.55 (95% CI 1.86-3.51) for fatal CVD. Among women with RA, anti-CCP positivity and RF positivity were not significantly associated with higher risk of any outcomes, despite slightly higher risk of death for those who were anti-CCP positive than for those who were anti-CCP negative. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even in women with no reported RA. CVD incidence was increased in women with RA versus women with no reported RA at almost all risk factor levels, except for low levels of joint pain or inflammation. Among women with RA, inflammation was more strongly associated with fatal CVD and total mortality than with CHD or CVD. CONCLUSION Among postmenopausal women, RA was associated with 1.5-2.5-fold higher CVD risk. CVD risk was strongly associated with CVD risk factors, joint pain severity, and inflammation, but not with anti-CCP positivity or RF positivity.
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Affiliation(s)
| | | | | | | | | | | | - William H. Robinson
- Stanford University, Stanford, CA, and VA Palo Alto Health Care System, Palo Alto, CA
| | | | | | | | | | - Matthew S. Freiberg
- Vanderbilt University School of Medicine, and Nashville Veterans Affairs Medical Center, Nashville, TN
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