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Young HS, Kamaly-Asl ID, Laws PM, Pemberton P, Griffiths CEM. Genetic interaction between placental growth factor and vascular endothelial growth factor A in psoriasis. Clin Exp Dermatol 2019; 45:302-308. [PMID: 31545526 PMCID: PMC7154646 DOI: 10.1111/ced.14102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 01/13/2023]
Abstract
Background Expression of vascular endothelial growth factor A (VEGFA) is increased in chronic inflammatory skin diseases, including psoriasis, and loci for two VEGFA single nucleotide polymorphisms are associated with early‐onset psoriasis (presenting before the age of 40 years). Studies have suggested that expression of placenta growth factor (PGF) is also upregulated in cutaneous inflammation and that VEGFA‐mediated angiogenesis may be dependent on the simultaneous presence of PGF within the skin. Aim To elucidate the biological importance of PGF in psoriasis. Methods We investigated whether two commonly occurring PGF polymorphisms were associated with early‐onset psoriasis and the genetic interaction between VEGFA and PGF in psoriasis. Results We observed a significant (P = 0.04) association between rs2268614 TT and rs2268615 AA genotypes of PGF and early‐onset psoriasis. In addition, genetic complement, comprising the PGF rs2268615 AA genotype and the VEGFA −460 (rs833061) T allele, was significantly associated with the development of early‐onset psoriasis (P < 0.03). We identified that the VEGFA genotype influences PGF expression (P = 0.001) and that mean plasma levels of PGF are lower in patients with severe psoriasis compared with those with mild–moderate disease (P = 0.04). Conclusion Our observed genetic interaction between PGF and VEGFA appears relevant to psoriasis, a disease with an angiogenic basis, and may influence development of an antiangiogenic approach to treatment.
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Affiliation(s)
- H S Young
- The Dermatology Centre, Salford Royal Hospital, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Salford Royal Hospital, Manchester, UK
| | | | - P M Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Pemberton
- Department of Clinical Biochemistry, Manchester Royal Infirmary, Manchester, UK
| | - C E M Griffiths
- The Dermatology Centre, Salford Royal Hospital, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Salford Royal Hospital, Manchester, UK
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Lim XR, Xiang W, Tan JWL, Koh LW, Lian TY, Leong KP, Koh E, Chan GYL, Chan MT, Chia FL, Howe HS, Kong KO, Law WG, Loh JME, Tan S, Tan TC, Thong BY. Incidence and patterns of malignancies in a multi‐ethnic cohort of rheumatoid arthritis patients. Int J Rheum Dis 2019; 22:1679-1685. [DOI: 10.1111/1756-185x.13655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 04/22/2019] [Accepted: 05/01/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Wenwei Xiang
- Clinical Research & Innovation Office Tan Tock Seng Hospital Singapore Singapore
| | - Justina Wei Lynn Tan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Li Wearn Koh
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Tsui Yee Lian
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
- Clinical Research & Innovation Office Tan Tock Seng Hospital Singapore Singapore
| | - Ee‐Tzun Koh
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
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Smallwood MJ, Nissim A, Knight AR, Whiteman M, Haigh R, Winyard PG. Oxidative stress in autoimmune rheumatic diseases. Free Radic Biol Med 2018; 125:3-14. [PMID: 29859343 DOI: 10.1016/j.freeradbiomed.2018.05.086] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/15/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022]
Abstract
The management of patients with autoimmune rheumatic diseases such as rheumatoid arthritis (RA) remains a significant challenge. Often the rheumatologist is restricted to treating and relieving the symptoms and consequences and not the underlying cause of the disease. Oxidative stress occurs in many autoimmune diseases, along with the excess production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). The sources of such reactive species include NADPH oxidases (NOXs), the mitochondrial electron transport chain, nitric oxide synthases, nitrite reductases, and the hydrogen sulfide producing enzymes cystathionine-β synthase and cystathionine-γ lyase. Superoxide undergoes a dismutation reaction to generate hydrogen peroxide which, in the presence of transition metal ions (e.g. ferrous ions), forms the hydroxyl radical. The enzyme myeloperoxidase, present in inflammatory cells, produces hypochlorous acid, and in healthy individuals ROS and RNS production by phagocytic cells is important in microbial killing. Both low molecular weight antioxidant molecules and antioxidant enzymes, such as superoxide dismutase, catalase, glutathione peroxidase, and peroxiredoxin remove ROS. However, when ROS production exceeds the antioxidant protection, oxidative stress occurs. Oxidative post-translational modifications of proteins then occur. Sometimes protein modifications may give rise to neoepitopes that are recognized by the immune system as 'non-self' and result in the formation of autoantibodies. The detection of autoantibodies against specific antigens, might improve both early diagnosis and monitoring of disease activity. Promising diagnostic autoantibodies include anti-carbamylated proteins and anti-oxidized type II collagen antibodies. Some of the most promising future strategies for redox-based therapeutic compounds are the activation of endogenous cellular antioxidant systems (e.g. Nrf2-dependent pathways), inhibition of disease-relevant sources of ROS/RNS (e.g. isoform-specific NOX inhibitors), or perhaps specifically scavenging disease-related ROS/RNS via site-specific antioxidants.
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Affiliation(s)
- Miranda J Smallwood
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon EX1 2LU, UK
| | - Ahuva Nissim
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Annie R Knight
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon EX1 2LU, UK
| | - Matthew Whiteman
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon EX1 2LU, UK
| | - Richard Haigh
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon EX1 2LU, UK; Department of Rheumatology, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust (Wonford), Exeter EX2 5DW, UK
| | - Paul G Winyard
- University of Exeter Medical School, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
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Yarwood A, Huizinga TWJ, Worthington J. The genetics of rheumatoid arthritis: risk and protection in different stages of the evolution of RA. Rheumatology (Oxford) 2014; 55:199-209. [PMID: 25239882 DOI: 10.1093/rheumatology/keu323] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Indexed: 11/13/2022] Open
Abstract
There is now a general consensus that RA has a spectrum of disease stages that can begin many years before the onset of clinical symptoms. It is widely thought that understanding the complex interplay between genetics and environment, and their role in pathogenesis, is essential in gaining further insight into the mechanisms that drive disease development and progression. More than 100 genetic susceptibility loci have now been identified for RA through studies that have focused on patients with established RA compared with healthy controls. Studying the early preclinical phases of disease will provide valuable insights into the biological events that precede disease and could potentially identify biomarkers to predict disease onset and future therapeutic targets. In this review we will cover recent advances in the knowledge of genetic and environmental risk factors and speculate on how these factors may influence the transition from one stage of disease to another.
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Affiliation(s)
- Annie Yarwood
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, Stopford Building, University of Manchester, Manchester, UK
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands and
| | - Jane Worthington
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, Stopford Building, University of Manchester, Manchester, UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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5
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Adab P, Jiang CQ, Rankin E, Tsang YW, Lam TH, Barlow J, Thomas GN, Zhang WS, Cheng KK. Breastfeeding practice, oral contraceptive use and risk of rheumatoid arthritis among Chinese women: the Guangzhou Biobank Cohort Study. Rheumatology (Oxford) 2014; 53:860-6. [PMID: 24395920 DOI: 10.1093/rheumatology/ket456] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Hormonal and reproductive factors are implicated in the aetiology of RA, but results of previous studies have been mixed. The aim of this cross-sectional study was to assess the relationships between RA, use of oral contraceptives (OCs) and history of breastfeeding in a population of older women from South China. METHODS We used baseline data from 7349 women ≥ 50 years of age in the Guangzhou Biobank Cohort. Questionnaires were used to obtain socio-demographic, lifestyle and obstetric history data, including parity, OC use and breastfeeding practices. The main outcome was RA. Women were asked about history of RA and were examined to assess joint swelling. RF levels were measured. The presence of RA was defined in two ways: (i) as reporting physician-diagnosed RA or pain and swelling in at least three joints (including the wrist), and (ii) also having at least one of the following: positive RF, morning stiffness or objective swelling of the small joints of the hands. RESULTS Compared with those who had never breastfed, breastfeeding was associated with half the risk of RA. The risk was lower with increasing duration of breastfeeding [adjusted odds ratio (OR) 0.54 (95% CI 0.29, 1.01) for breastfeeding at least 36 months; P for trend = 0.04]. OC use had no relationship with RA. CONCLUSION Breastfeeding (especially longer duration) but not OC use is associated with a lower risk of RA. This has potentially important implications for future RA disease burden, given the declining rates of breastfeeding and the one-child policy in China. Further research is needed to explain the biological mechanism.
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Affiliation(s)
- Peymane Adab
- Department of Rheumatology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
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Mercer LK, Davies R, Galloway JB, Low A, Lunt M, Dixon WG, Watson KD, Symmons DPM, Hyrich KL. Risk of cancer in patients receiving non-biologic disease-modifying therapy for rheumatoid arthritis compared with the UK general population. Rheumatology (Oxford) 2013; 52:91-8. [PMID: 23238979 PMCID: PMC3521445 DOI: 10.1093/rheumatology/kes350] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To quantify the risk of cancer and compare it with that for the general population in a modern cohort of UK patients with RA and to identify risk factors for cancer among this cohort. METHODS The study population comprised biologic-naïve RA subjects receiving non-biologic disease-modifying therapy recruited to the British Society for Rheumatology Biologics Register from 2002 to 2009. Standardized incidence ratios (SIRs) for cancers were calculated using age- and gender-specific cancer rates in the English population. Poisson regression models adjusted for age and gender using England general population data were used to determine the association of other predictors with incident malignancy. RESULTS The cohort comprised 3771 individuals with RA contributing 13 315 person-years of follow-up. One hundred and eighty-two cancers were reported: 156 solid and 26 myelo- or lymphoproliferative cancers. The overall SIR was 1.28 (95% CI 1.10, 1.48). Risks of lung cancer (SIR 2.39, 95% CI 1.75, 3.19), Hodgkin lymphoma (SIR 12.82, 95% CI 4.16, 29.92) and non-Hodgkin lymphoma (SIR 3.12, 95% CI 1.79, 5.07) were higher compared with the general population and risks of prostate cancer (SIR 0.35, 95% CI 0.11, 0.82) and cancers of the female genital organs (SIR 0.35, 95% CI 0.10, 0.90) were reduced. Within the cohort, cancer risk was more than 2-fold higher in current or ex-smokers than in non-smokers. CONCLUSION The overall incidence of cancer was increased in this national cohort of subjects with RA. The association of RA with certain cancers needs to be considered when studying the effects of biologic therapy, such as anti-TNF, on cancer risk.
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Affiliation(s)
- Louise K Mercer
- Arthritis Research UK Epidemiology Unit, Stopford Building, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PT, UK
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Camacho EM, Verstappen SMM, Lunt M, Bunn DK, Symmons DPM. Influence of age and sex on functional outcome over time in a cohort of patients with recent-onset inflammatory polyarthritis: Results from the Norfolk arthritis register. Arthritis Care Res (Hoboken) 2011; 63:1745-52. [DOI: 10.1002/acr.20609] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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8
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Camacho EM, Lunt M, Farragher TM, Verstappen SMM, Bunn DK, Symmons DPM. The relationship between oral contraceptive use and functional outcome in women with recent-onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. ACTA ACUST UNITED AC 2011; 63:2183-91. [PMID: 21520011 DOI: 10.1002/art.30416] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Use of oral contraceptives (OCs) may prevent the development of rheumatoid arthritis, but the influence of OC use on disease outcome is unresolved. The purpose of this study was to examine functional outcome and OC use in women with inflammatory polyarthritis (IP). METHODS The Norfolk Arthritis Register (NOAR) is an inception cohort of patients with recent-onset IP. We studied patient-reported history of OC use in 663 women who were born after 1945 and who had not used OCs during followup. OC use during followup was additionally investigated in 265 women who were <50 years old and had not undergone menopause or hysterectomy during followup. All patients were recruited to the NOAR between 1990 and 2004. Functional ability was assessed using the Health Assessment Questionnaire (HAQ), with adjustment for age at symptom onset. RESULTS The median followup was 4.9 years. In the investigation analyzing OC use before symptom onset, patients who had used OCs before symptom onset had lower HAQ scores throughout followup than patients who had not taken OCs before symptom onset (difference in score at 5-year followup -0.35; 95% confidence interval [95% CI] -0.51, -0.19). Patients who were taking OCs at baseline had lower HAQ scores over time than women who were not taking OCs at baseline but had previously done so (mean difference -0.21; 95% CI -0.40, -0.02). In the investigation analyzing OC use during followup, OC use during followup was associated with lower HAQ scores over time than no OC use during followup (mean difference -0.06; 95% CI -0.16, 0.03); however, this was only significant for women with moderate or severe functional disability at the previous assessment (mean difference -0.23; 95% CI -0.40, -0.07). Further adjustment for potential confounders and exclusion of hormone replacement therapy users had little impact. CONCLUSION OC use is generally associated with a beneficial functional outcome in IP, and use before and at symptom onset appeared to have the most consistent benefit.
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Affiliation(s)
- E M Camacho
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
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9
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Symmons DP. Epidemiologic concepts and the classification of musculoskeletal conditions. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mjaavatten MD, Haugen AJ, Helgetveit K, Nygaard H, Sidenvall G, Uhlig T, Kvien TK. Pattern of joint involvement and other disease characteristics in 634 patients with arthritis of less than 16 weeks' duration. J Rheumatol 2009; 36:1401-6. [PMID: 19487273 DOI: 10.3899/jrheum.081217] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the distribution of joint involvement in a cohort of patients with very recent onset arthritis and describe the disease characteristics in these patients. METHODS A very early arthritis clinic (NOR-VEAC) was established as a multicenter study. General practitioners were asked to refer patients presenting with at least 1 swollen joint of maximum 16 weeks' duration. Clinical and laboratory markers were examined. RESULTS We included 634 patients during the first 3 years, with mean (25th-75th percentile) arthritis duration of 30 (11-63) days. Monoarthritis was present in 243 (38.3%) patients, 216 (34.1%) had oligoarthritis, and 175 (27.6%) polyarthritis. Patients with polyarthritis were older, had longer duration of arthritis, and were more frequently anti-cyclic citrullinated peptide antibody and rheumatoid factor-positive. Patients in all 3 joint pattern groups (mono-/oligo-/polyarthritis) reported substantial effect on physical function, pain, and fatigue and had elevated levels of acute-phase reactants. Knee or ankle arthritis was most frequent in patients with mono- and oligoarthritis, whereas small joint involvement was most frequent in patients with polyarthritis. CONCLUSION Patients with recent-onset arthritis report a substantial influence on health status. Mono- and oligoarthritis are at least as frequent as polyarthritis. Polyarthritic patients more frequently exhibit features associated with a worse outcome.
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Javier Narváez García F. [Treating undifferentiated arthritis. What, when, how and how long?]. REUMATOLOGIA CLINICA 2009; 5 Suppl 1:31-39. [PMID: 21794640 DOI: 10.1016/j.reuma.2008.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 12/16/2008] [Indexed: 05/31/2023]
Abstract
With the establishment of early arthritis clinics, patients can now be increasingly attended early in the course of their disease. This means that a significant proportion of these patients cannot be classified into a specific diagnosis using the traditional American College of Rheumatology (ACR) classification criteria. In these patients with undifferentiated arthritis (UA), even more important than assigning a diagnosis is the need to distinguish between patients who will develop a persistent and/or erosive disease and will be candidates for prompt treatment with disease-modifying antirheumatic drugs (DMARD), and patients in whom the disease is self limiting. Serologic markers in combination with clinical features at presentation, integrated into predictive models, are the tools currently available to the clinician for identifying these patients. Several studies have demonstrated the advantages of early treatment in UA.
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12
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Dietary antioxidants in inflammatory arthritis: do they have any role in etiology or therapy? ACTA ACUST UNITED AC 2008; 4:590-6. [DOI: 10.1038/ncprheum0920] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 08/21/2008] [Indexed: 12/31/2022]
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de Roos AJ, Cooper GS, Alavanja MC, Sandler DP. Personal and family medical history correlates of rheumatoid arthritis. Ann Epidemiol 2008; 18:433-9. [PMID: 18346911 PMCID: PMC3179430 DOI: 10.1016/j.annepidem.2007.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 12/21/2007] [Accepted: 12/30/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with rheumatoid arthritis (RA) often have comorbidities related to immune dysfunction, however, the timing of comorbidities relative to RA diagnosis and treatment is not clear. We studied personal and family medical history correlates of incident and prevalent RA in women. METHODS We used a nested case-control design including women in the Agricultural Health Study (AHS). Physician-confirmed cases of RA (n = 135) were matched to five controls each (n = 675) by birth date. We used logistic regression to examine associations between conditions listed in personal and family medical histories and both incident and prevalent RA, as estimated by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The risk of incident RA was associated with personal medical history of nonmelanoma skin cancer (OR = 4.4, 95% CI: 1.4-14.1), asthma or reactive lung disease (OR = 3.7, 95% CI: 1.3-10.5), and cataract (OR = 3.3, 95% CI: 1.0-10.8). Personal history of herpes zoster was associated with prevalent RA (OR = 2.4, 95% CI: 1.2-4.8), but not with incident RA. There were no consistent associations between family medical history and RA. CONCLUSIONS Patients with medical conditions indicating compromised immunity are at increased risk of developing RA. These results may indicate common pathogenesis of an environmental or genetic nature between such diseases.
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Affiliation(s)
- Anneclaire J de Roos
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, Seattle, WA 98109, USA.
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Sghiri R, Bouagina E, Zaglaoui H, Mestiri H, Harzallah L, Harrabi I, Ghannouchi M, Mokhtar F, Ghedira I. Diagnostic performances of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis. Rheumatol Int 2007; 27:1125-30. [PMID: 17447069 DOI: 10.1007/s00296-007-0351-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Accepted: 03/25/2007] [Indexed: 01/11/2023]
Abstract
To evaluate the rheumatoid arthritis (RA) diagnostic performances of anti-cyclic citrullinated peptide antibodies (anti-CCP). Anti-CCP was detected by an enzyme linked immunosorbent assay in 164 patients with RA and 343 controls. In addition, anti-CCP predictive value for radiological damage were investigated in 37 recent-onset RA patients followed up prospectively for 2 years. Radiological damages were assessed by Sharp method modified by van der Heijde. The sensitivity of anti-CCP was 78.7% and the specificity was 95.6%. The positive predictive value and the negative predictive value were 90.2% and 90.3%, respectively. Anti-CCP were detected in sera of 79.3% of patients with recent onset RA and 78.3% of patients with long disease duration. In univariate and multivariate analyses, anti-CCP were not predictive for radiological damage. Our study confirms the high diagnostic performances of anti-CCP in RA. They are very useful to aid the diagnostic of RA in clinical practice.
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Affiliation(s)
- Rim Sghiri
- Laboratory of Immunology, Farhat Hached Hospital, Sousse, Tunisia.
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15
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Lin L, Chen Y, Xiao Z, Huang S, Yang Z. The association of HLA-DRB1 alleles with rheumatoid arthritis in the Chinese Shantou population: a follow-up study. Biochem Cell Biol 2007; 85:227-38. [PMID: 17534404 DOI: 10.1139/o06-204] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We investigated the distribution of HLA-DRB1 alleles in a sample of the Chinese Shantou population, and explored the relationship between HLA-DRB1 alleles and the susceptibility and clinical features of rheumatoid arthritis (RA). We studied 117 consecutive patients with RA and control groups, including 38 cases of systemic lupus erythematosus and 100 healthy individuals. HLA-DRB1 genotyping was performed using PCR with sequence-specific primers. HLA-DRB1*04 subtypes were detected using spot hybridization of PCR products with sequence-specific oligonucleotide probes. We compared the frequency of HLA-DRB1 alleles in healthy control patients with that in patients with RA. Patients with RA were evaluated for sex, age at disease onset, disease duration, extra-articular involvement, presence of autoantibodies, global functional status, and radiographic damage. The frequency of HLA-DRB1*04 was found to be significantly higher in RA patients than in healthy individuals (49.6% vs 18.0%, odds ratio = 4.478, P < 0.001). HLA-DRB1*0405 was the most prominently associated subtype in RA patients (62.1% vs 27.8%, odds ratio = 4.255, P = 0.011). Compared with the HLA-DRB1*04-negative RA group, the mean duration of RA in the HLA-DRB1*04-positive RA group was longer, and the mean age at disease onset was lower. A 2-9 year follow-up study was performed, and the risk factors associated with the radiographic progression of RA were determined. Logistic regression analysis revealed that only HLA-DRB1*04 alleles were significantly associated with the radiographic progression of RA (B = 2.652, P = 0.018, Exp(B) = 14.182). Our observations indicated that the HLA-DRB1*04 alleles, especially the subtype HLA-DRB1*0405, were significantly associated with RA susceptibility in the Chinese Shantou population. The HLA-DRB1*04 alleles may be associated with the severity of RA.
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Affiliation(s)
- Ling Lin
- Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Changping Road, Shantou city, Guangdong 515041, China.
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Gromnica-Ihle E, Ostensen M. [Pregnancy in patients with rheumatoid arthritis and inflammatory spondylarthropathies]. Z Rheumatol 2007; 65:209-12, 214-6. [PMID: 16670812 DOI: 10.1007/s00393-006-0053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The activity of a rheumatic disease can be influenced by pregnancy and puerperium. Prospective studies have shown an improvement in joint involvement in rheumatoid arthritis in two thirds to three quarters of pregnancies. After birth, an exacerbation is common. In spondylarthropathies there is no relevant change in disease activity. The fetal outcome is not impaired in patients with rheumatoid arthritis and inflammatory spondylarthropathies. Every pregnancy in women with a rheumatic disease should be considered as high-risk, and such pregnancies require close collaboration between rheumatologists and obstetricians.
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Pattison DJ, Symmons DPM, Young A. Does diet have a role in the aetiology of rheumatoid arthritis? Proc Nutr Soc 2007; 63:137-43. [PMID: 15099410 DOI: 10.1079/pns2003319] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although dietary factors have been extensively studied in many chronic diseases, the role of diet in the epidemiology of rheumatoid arthritis (RA) has received little attention. Fruit and vegetables and dietary antioxidants are thought to play a protective role in the pathogenesis of CVD and some cancers, but few studies have investigated these dietary components in the aetiology of RA. Fish oil supplementation has consistently been shown to have a beneficial effect on the symptoms of established RA, but it is not known whether the PUFA present in fish oils can reduce the risk of developing the disease. There is evidence that RA is less severe in the southern Mediterranean countries, such as Italy and Greece, where oil-rich fish, fruit, vegetables and olive oil are consumed in greater amounts than in many other countries. Overall, the evidence for a role of diet in the aetiology of RA is limited to a small number of observational studies of very different designs. Recently, it was demonstrated that lower intakes of fruit and vegetables and dietary vitamin C are associated with an increased risk of developing inflammatory polyarthritis in a free-living population in Norfolk, UK. These findings provide further evidence for a role of diet in the development of inflammatory arthritis, although the mechanisms involved are uncertain.
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Affiliation(s)
- Dorothy J Pattison
- Arthritis Research Campaign Epidemiology Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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Klareskog L, Padyukov L, Lorentzen J, Alfredsson L. Mechanisms of disease: Genetic susceptibility and environmental triggers in the development of rheumatoid arthritis. ACTA ACUST UNITED AC 2006; 2:425-33. [PMID: 16932734 DOI: 10.1038/ncprheum0249] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 06/08/2006] [Indexed: 01/10/2023]
Abstract
Rheumatoid arthritis (RA) is a complex disease in which environmental agents are thought to interact with genetic factors that influence susceptibility. This interaction triggers immunologic events that eventually result in the clinical signs of arthritis. Knowledge of the chain of etiological events that lead to the development of RA is incomplete. In this review, we describe the experimental approaches that are used to address the issue of gene-environment interactions in the etiology of RA, and discuss relevant examples of such interactions. We focus on how smoking, the best-known environmental risk factor for RA, interacts with HLA-DR shared epitope genes, the main genetic risk factors for RA, and result in a high risk of RA in individuals exposed to both of these risk factors. From these and other related findings, we can begin to define the distinct environmental risk factors (such as smoking) that in certain genetic contexts (for example, the presence of HLA-DR shared epitope alleles) can trigger immune reactions (such as autoantibodies to citrullinated peptides) many years before onset of RA, and consider how these immune reactions might contribute to clinical symptoms in a subset of affected patients. Increased knowledge about these and other events involved in the development of RA should enable the design of new tools for suppressing RA pathogenesis before the onset of disease.
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Affiliation(s)
- Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Machold KP, Nell VPK, Stamm TA, Smolen JS. Aspects of early arthritis. Traditional DMARD therapy: is it sufficient? Arthritis Res Ther 2006; 8:211. [PMID: 16719936 PMCID: PMC1526637 DOI: 10.1186/ar1966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
There is increasing evidence for beneficial effects of early DMARD (disease-modifying antirheumatic drug) therapy over delayed treatment in patients who present with arthritis of recent onset. However, no universal consensus exists concerning the choice of initial drug or whether single drugs or combinations should be given as initial treatments. Recent studies have focused on the benefits of various strategies in which treatments were tailored to achieve low levels of disease activity, as assessed using validated response criteria. These studies demonstrated superiority of 'aggressive' over 'conventional' approaches. Whether the inclusion of tumour necrosis factor antagonists or other biologic targeted therapies in such strategies confers additional benefits in terms of improved long-term outcomes must be clarified by further studies. Assessment of risks in the individual patient, allowing individual 'tailoring' of the initial treatment, would be desirable.
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Affiliation(s)
- Klaus P Machold
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Abstract
Rheumatoid arthritis (RA) is a heterogeneous autoimmune disorder of unknown cause with variable clinical expression. About 70% of patients are women. Genetic factors play an important role and likely account for about 60% of disease susceptibility and expression. The association with the HLA-DRB1 gene is the best understood, although several non-HLA loci have been linked to RA, including the 18q21 region of the TNFRSR11A gene, which encodes the receptor activator of nuclear factor kappaB, important in bone resorption in RA. Genetic factors are also important in the treatment of RA because the activity of enzymes relevant in the metabolism of drugs such as methotrexate and azathioprine, including methylenetetrahydrofolate reductase and thiopurine methyltransferase, are in part genetically determined.
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Affiliation(s)
- Carl Turesson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Ho P, Bruce IN, Silman A, Symmons D, Newman B, Young H, Griffiths CEM, John S, Worthington J, Barton A. Evidence for common genetic control in pathways of inflammation for Crohn's disease and psoriatic arthritis. ACTA ACUST UNITED AC 2005; 52:3596-602. [PMID: 16255050 DOI: 10.1002/art.21393] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Clinical, pharmacologic, and epidemiologic evidence supports the hypothesis that common genetic pathways may underlie inflammatory diseases. In a previous study, a Crohn's disease gene, CARD15, was demonstrated to be associated with psoriatic arthritis (PsA). Recently, a functional haplotype of 2 single-nucleotide polymorphisms (SNPs) mapping to the organic cation transporter (OCTN) genes, SLC22A4 and SLC22A5, was identified as a second Crohn's disease susceptibility locus. The SLC22A4 gene has also been associated with rheumatoid arthritis. This study was undertaken to further elucidate associations of PsA with Crohn's disease susceptibility genes. METHODS Association with CARD15 and OCTN was investigated in UK Caucasian patients with PsA (n = 472) and population controls (n = 594), using 5' allelic discrimination assays (TaqMan). Two SNPs in OCTN, forming a haplotype previously associated with Crohn's disease, were also tested in patients with psoriasis (n = 218) and patients with early undifferentiated inflammatory arthritis (n = 386). Allele and estimated haplotype frequencies were compared between patients and controls. RESULTS No association of PsA with CARD15 was detected. In contrast, a functional SNP mapping to the promoter region of SLC22A5 (rs2631367) was associated with PsA (for CC versus GG, odds ratio 1.65, 95% confidence interval 1.13-2.41, uncorrected P = 0.005). In addition, the haplotype associated with Crohn's disease was also associated with PsA (P = 0.001). No association was detected in the cohort with psoriasis alone or in the cohort with undifferentiated inflammatory arthritis. CONCLUSION The OCTN haplotype previously associated with Crohn's disease is also associated with PsA, suggesting that these 2 diseases may share some common genetic control in pathways of inflammation.
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Affiliation(s)
- Pauline Ho
- University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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Ramjeet J, Koutantji M, Barrett EM, Scott DGI. Coping and psychological adjustment in recent-onset inflammatory polyarthritis: the role of gender and age. Rheumatology (Oxford) 2005; 44:1166-8. [PMID: 15941729 DOI: 10.1093/rheumatology/keh699] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine the role of gender, age and coping in psychological adjustment of patients with early inflammatory polyarthritis (IP). METHODS One hundred and twelve patients with IP of up to 18 months' duration from the Norfolk Arthritis Register completed questionnaires measuring coping, anxiety, disability and pain. RESULTS Thirty-six per cent of the patients were at risk of depressive symptoms. Women had significantly higher levels of depression and anxiety than men. Regression analyses showed that pain and (low) illness acceptance predicted levels of depression. Younger age, wishful thinking and covering up predicted anxiety levels. CONCLUSIONS The study found higher levels of depression and anxiety for women than men with early IP. Psychological distress was predicted by younger age, specific coping strategies and high levels of pain.
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Affiliation(s)
- J Ramjeet
- School of Nursing and Midwifery Research Unit, Yorkon Building, University of East Anglia, Norwich, Norfolk, UK.
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23
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Kaçar C, Gilgil E, Tuncer T, Bütün B, Urhan S, Arikan V, Dündar U, Oksüz MC, Sünbüloğlu G, Yildirim C, Tekeoğlu I, Yücel G. Prevalence of rheumatoid arthritis in Antalya, Turkey. Clin Rheumatol 2004; 24:212-4. [PMID: 15940553 DOI: 10.1007/s10067-004-1006-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Accepted: 07/20/2004] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the prevalence of rheumatoid arthritis (RA) in Antalya, Turkey. A cross-sectional study was performed face-to-face using a structured interview. Subjects were asked whether they had arthritis at present or previously. Subjects suspected of having RA were invited to the hospital for physical examination and laboratory investigations. Diagnosis of RA was confirmed if the patient fulfilled 1987 American College of Rheumatology (ACR) criteria for RA. A total of 3173 subjects were interviewed. The diagnosis of RA was established in 12 subjects. The prevalence of RA was determined as 0.38% [95% confidence interval (CI): 0.16-0.59]. The mean age was 49.92+/-11.56 years in subjects with RA and greater than that of other subjects (p<0.001). Of 12 subjects with RA, 9 had previously been diagnosed with the disease. Rheumatoid factor was detected in the sera of eight subjects. RA is less frequent in Turkey than in Northern Europe. Different genetic and environmental factors may have a role in this result.
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Affiliation(s)
- C Kaçar
- Department of Physical Medicine & Rehabilitation and Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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Stolt P, Källberg H, Lundberg I, Sjögren B, Klareskog L, Alfredsson L. Silica exposure is associated with increased risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis 2004; 64:582-6. [PMID: 15319232 PMCID: PMC1755463 DOI: 10.1136/ard.2004.022053] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the association between silica exposure and rheumatoid arthritis and how it is modified by cigarette smoking. METHODS Data were analysed from 276 male cases and 276 male controls aged 18 to 70 years, included in a Swedish population based study between May 1996 and June 2001. A case was defined as a person recently diagnosed with rheumatoid arthritis according to the ACR criteria. Controls were selected from the study base as a stratified random sample accounting for age, sex, and residency. Men with a self reported history of work with rock drilling, stone crushing, or exposure to stone dust in general were defined as silica exposed. Rheumatoid factor (RF) status among cases was recorded. RESULTS Silica exposed men had increased risk of rheumatoid arthritis, with an odds ratio (OR), adjusted for age, residential area, and smoking, of 2.2 (95% confidence interval, 1.2 to 3.9) among men aged 18 to 70 years, and 2.7 (1.2 to 5.8) among those aged 50 to 70 years. Men who had worked with rock drilling or stone crushing (regarded as highly exposed) had a slightly greater increase in risk of rheumatoid arthritis than silica exposed men in general, with an OR of 3.0 (1.2 to 7.6). The joint effects of silica exposure and smoking were compatible with synergy between these two exposures in the development of rheumatoid arthritis but this was not conclusive. CONCLUSIONS Silica exposure is associated with increased risk of developing rheumatoid arthritis. This association is not explained by smoking habits.
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Affiliation(s)
- P Stolt
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden.
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Wester L, Olofsson P, Ibrahim SM, Holmdahl R. Chronicity of pristane-induced arthritis in rats is controlled by genes on chromosome 14. J Autoimmun 2003; 21:305-13. [PMID: 14624754 DOI: 10.1016/s0896-8411(03)00136-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To address the possibility that genes specifically control the chronic phase of arthritis we have isolated a congenic fragment from the resistant E3 rat on the susceptible DA rat background. The isolated fragment covers the Pia6 quantitative trait locus on chromosome 14, which previously has been identified to be linked to chronic pristane induced arthritis (PIA) in gene segregation experiments of an (E3 x DA)F(2)-cross. Heterozygous Pia6 congenic rats (DA.Pia6) were protected from chronic active arthritis specifically, as determined by macroscopic scoring, histopathology and release of cartilage oligomeric matrix protein (-reflecting ongoing cartilage destruction). The difference was seen only during the chronic active phase of arthritis starting approximately 5 weeks after onset of arthritis. Interestingly, the plasma concentration of the lipocalins alpha(1)-acid glycoprotein and alpha(1)-microglobulin was found significantly altered in nai;ve congenic rats compared to the DA rat. The concentration of alpha(1)-microglobulin was found to be significantly higher throughout the disease course, while alpha(1)-acid glycoprotein had a lower concentration in nai;ve rats, which was highly significant in the chronic phase. The altered concentrations of these proteins already before development of chronic arthritis may provide a clue to the pathogenic process controlled by the Pia6 genes. We conclude that the active relapsing chronic arthritis is under a unique genetic control that is different from the control of acute arthritis and postulate that the liver plays an important role in this regulation.
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Affiliation(s)
- Lena Wester
- Institute for Immunology, University of Rostock, Rostock, Germany.
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Stolt P, Bengtsson C, Nordmark B, Lindblad S, Lundberg I, Klareskog L, Alfredsson L. Quantification of the influence of cigarette smoking on rheumatoid arthritis: results from a population based case-control study, using incident cases. Ann Rheum Dis 2003; 62:835-41. [PMID: 12922955 PMCID: PMC1754669 DOI: 10.1136/ard.62.9.835] [Citation(s) in RCA: 407] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To quantify the influence of cigarette smoking on the risk of developing rheumatoid arthritis (RA). METHODS 679 cases and 847 controls included during May 1996-June 2000 in a case-control study, using incident cases, comprising the population aged 18-70 years of a defined area of Sweden, were investigated. A case was defined as a person from the study base who received for the first time a diagnosis of RA using the 1987 American College of Rheumatology criteria, and controls were randomly selected from the study base. Self reported smoking habits among cases and controls, and rheumatoid factor status among cases were registered. The incidence of RA in current smokers, ex-smokers, and ever-smokers, respectively, was compared with that of never-smokers. RESULTS Current smokers, ex-smokers, and ever-smokers of both sexes had an increased risk for seropositive RA (for ever-smokers the odds ratio was 1.7 (95% confidence interval (95% CI) 1.2 to 2.3) for women, and 1.9 (95% CI 1.0 to 3.5) for men), but not for seronegative RA. The increased risk was only apparent among subjects who had smoked > or =20 years, was evident at an intensity of smoking of 6-9 cigarettes/day, and remained for up to 10-19 years after smoking cessation. The risk increased with increasing cumulative dose of smoking. CONCLUSION Smokers of both sexes have an increased risk of developing seropositive, but not seronegative, RA. The increased risk occurs after a long duration, but merely a moderate intensity, of smoking and may remain for several years after smoking cessation.
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Affiliation(s)
- P Stolt
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden.
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Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 2003; 62:722-7. [PMID: 12860726 PMCID: PMC1754626 DOI: 10.1136/ard.62.8.722] [Citation(s) in RCA: 381] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the trends in incidence of extra-articular rheumatoid arthritis (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine possible predictors of ExRA occurrence. METHODS Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 609 cases of RA in Olmsted County, MN, diagnosed during 1955-94. These cases had been previously classified using the ACR 1987 criteria for RA. Patients were followed up from 1955 to 2000 (median follow up 11.8 years; range 0.1-42.8), and incident ExRA manifestations were recorded according to predefined criteria. Time to first presentation of ExRA was compared in patients with RA by decade of diagnosis. Possible ExRA risk factors were identified in case record reviews. RESULTS ExRA occurred in 247 patients (40.6%). A subgroup of 78 patients (12.8%) had ExRA manifestations considered to be severe in a previous study from Malmö, Sweden. The incidence of severe ExRA did not change significantly over the decades (p=0.165). In a multivariate analysis the main predictors of severe ExRA were smoking at RA diagnosis (risk ratio (RR)=2.94; 95% confidence interval (95% CI) 1.68 to 5.13) and early disability (Steinbrocker class III-IV at diagnosis) (RR=2.45; 95% CI 1.51 to 4.00). The effect of smoking overwhelmed the weaker effect of rheumatoid factor seropositivity. CONCLUSION There was no decrease in the incidence of extra-articular manifestations in patients with RA diagnosed up to 1995. Smoking and early disability are independent risk factors for extra-articular RA.
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Affiliation(s)
- C Turesson
- Department of Rheumatology, Malmö University Hospital, Lund University, Sweden.
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Brahee DD, Pierre-Jerome C, Kettner NW. Clinical and radiological manifestations of the rheumatoid wrist. A comprehensive review. J Manipulative Physiol Ther 2003; 26:323-9. [PMID: 12819627 DOI: 10.1016/s0161-4754(03)00046-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The intent of this review article is to present the common clinical and radiological features of the rheumatoid wrist as seen in everyday practice. Imaging of the rheumatoid wrist is discussed with emphasis on magnetic resonance imaging (MRI) and its current and future role in the diagnosis and treatment follow-up of the disease. DATA SOURCE A search of the current medical literature from 1990 to present through PubMed was performed without constraints. Search terms used included: MRI, rheumatoid arthritis, wrist, treatment, diagnosis, radiology, clinical manifestations, and incidence. STUDY SELECTION The articles included in this review were selected by historical significance, date of publication, pertinent review information, and, most specifically, those articles studying the current uses for imaging the rheumatoid wrist. DATA SYNTHESIS This review demonstrated an overall agreement between numerous studies that the usefulness of MRI evaluation of the rheumatoid wrist is in its early stages of development. Many of the features of this examination of the wrist are discussed and contrasted with plain film radiographic examination. RESULTS The role of the clinician in the diagnosis and treatment, including complementary care, as well as the follow-up of rheumatoid arthritis in the wrist is unquestionable. The role of plain film examination as a diagnostic tool is excellent. The current and future role of MRI of rheumatoid arthritis is becoming obvious and will likely become the diagnostic imaging tool of choice in the near future. CONCLUSION MRI provides more specific information on rheumatoid lesions in the wrist than plain film imaging. This is especially true when intravenous contrast is utilized. The clinician's use of physical examination, laboratory examination, radiography, and MRI will provide for early diagnosis, treatment, and follow-up of RA in the wrist.
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Affiliation(s)
- Deborah D Brahee
- Private practice of chiropractic radiology, N. Miami, FL 33161, USA.
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Symmons DPM. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol 2002; 16:707-22. [PMID: 12473269 DOI: 10.1053/berh.2002.0257] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease. There is some evidence that it may have been brought from North America to Europe during the 18th century. Its arrival in rural parts of the developing world is still more recent. The incidence and prevalence of RA appear to have fallen in Europe, North America and Japan in the last 50 years. During this time the peak age of onset has risen. Risk factors for the development of RA include genetic factors, an adverse pregnancy outcome, smoking, obesity and recent infections. The oral contraceptive pill and some dietary constituents may be protective. Older age and female gender are risk factors both for the development of RA and for a worse outcome. This risk factor profile offers some opportunities for primary and secondary prevention. However, treatment is the greatest determinant of RA outcome.
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Affiliation(s)
- Deborah P M Symmons
- University of Manchester Medical School, Oxford Road, Manchester, M13 9PT, UK
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Dessein PH, Joffe BI, Stanwix AE, Moomal Z. Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate and its relation to clinical variables in inflammatory arthritis. ARTHRITIS RESEARCH 2001; 3:183-8. [PMID: 11299059 PMCID: PMC30711 DOI: 10.1186/ar296] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2001] [Accepted: 02/06/2001] [Indexed: 11/24/2022]
Abstract
Hypothalamic-pituitary-adrenal underactivity has been reported in rheumatoid arthritis (RA). This phenomenon has implications with regard to the pathogenesis and treatment of the disease. The present study was designed to evaluate the secretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEAS) and its relation to clinical variables in RA, spondyloarthropathy (Spa), and undifferentiated inflammatory arthritis (UIA). Eighty-seven patients (38 with RA, 29 with Spa, and 20 with UIA) were studied, of whom 54 were women. Only 12 patients (14%) had taken glucocorticoids previously. Age-matched, healthy women (134) and men (149) served as controls. Fasting blood samples were taken for determination of the erythrocyte sedimentation rate (ESR), serum DHEAS and insulin, and plasma glucose. Insulin resistance was estimated by the homeostasis-model assessment (HOMAIR). DHEAS concentrations were significantly decreased in both women and men with inflammatory arthritis (IA) (P < 0.001). In 24 patients (28%), DHEAS levels were below the lower extreme ranges found for controls. Multiple intergroup comparisons revealed similarly decreased concentrations in each disease subset in both women and men. After the ESR, previous glucocorticoid usage, current treatment with nonsteroidal anti-inflammatory drugs, duration of disease and HOMAIR were controlled for, the differences in DHEAS levels between patients and controls were markedly attenuated in women (P = 0.050) and were no longer present in men (P = 0.133). We concluded that low DHEAS concentrations are commonly encountered in IA and, in women, this may not be fully explainable by disease-related parameters. The role of hypoadrenalism in the pathophysiology of IA deserves further elucidation. DHEA replacement may be indicated in many patients with IA, even in those not taking glucocorticoids.
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Affiliation(s)
- P H Dessein
- Department of Rheumatology, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Harrison B, Symmons D. Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature. II. Outcome at three years. Rheumatology (Oxford) 2000; 39:939-49. [PMID: 10986297 DOI: 10.1093/rheumatology/39.9.939] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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