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David M, Dieude P, Debray MP, Le Guen P, Crestani B, Borie R. [Low-dose methotrexate: Indications and side effects, particularly in cases of diffuse interstitial pneumonia]. Rev Mal Respir 2024:S0761-8425(24)00234-1. [PMID: 39025770 DOI: 10.1016/j.rmr.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 06/09/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Methotrexate (MTX) is a folate antagonist used as an immunosuppressant in a number of conditions, including rheumatoid arthritis (RA). Low-dose MTX (MTX-LD) is associated with a risk of haematological, hepatic, gastrointestinal and pulmonary toxicity, which may up until now have limited its use. STATE OF THE ART In RA, data from retrospective cohorts have reported a possible excess risk of methotrexate toxicity in cases of underlying interstitial lung disease (ILD). However, recent prospective and retrospective multicentre studies have found no such increased risk, and have reassuringly concluded that MTX-LD can be prescribed in cases of RA-associated ILD (RA-ILD). PERSPECTIVES AND CONCLUSIONS Current recommendations are not to delay the introduction of MTX in patients with RA at risk of developing ILD or in the presence of RA-ILD with mild to moderate respiratory impairment.
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Affiliation(s)
- M David
- Service de pneumologie A, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Cité, Inserm, PHERE, 75018 Paris, France.
| | - P Dieude
- Université Paris Cité, Inserm, PHERE, 75018 Paris, France; Service de rhumatologie A, hôpital Bichat, AP-HP, Paris, France
| | - M P Debray
- Service de radiologie, hôpital Bichat, AP-HP, Paris, France
| | - P Le Guen
- Service de pneumologie A, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Cité, Inserm, PHERE, 75018 Paris, France
| | - B Crestani
- Service de pneumologie A, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Cité, Inserm, PHERE, 75018 Paris, France
| | - R Borie
- Service de pneumologie A, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Cité, Inserm, PHERE, 75018 Paris, France
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2
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El Hasbani G, E Nassar J, Elsayed Ali AM, Uthman I, Jawad A. The impact of nicotine smoking on spondyloarthritis and rheumatoid arthritis. Reumatismo 2024; 76. [PMID: 38916171 DOI: 10.4081/reumatismo.2024.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/18/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE Nicotine has major side effects on human health through numerous mechanisms, one of which is the alteration of the immune system and its genetic components. Such alteration can be a predisposing factor for autoimmune diseases such as spondyloarthritis (SpA) and rheumatoid arthritis (RA). This review aims to shed light on the effects of nicotine smoking on the pathophysiology, clinical presentation, and management of SpA and RA. METHODS This review looked into the studies, excluding case reports and series, which were cited by PubMed/MEDLINE. RESULTS Patients with established autoimmune conditions may have a different underlying pathophysiology and disease course when exposed to nicotine through cigarette smoking. Through the involvement of several cytokines, endothelial dysfunction, and epigenetic mechanisms, the severity of SpA is more prominent in smokers. The global health status, pain, and fatigue are worse in SpA patients. The evidence on the effect of nicotine smoking on the treatment of SpA is still limited. Nicotine can contribute to RA via the disruption of cellular regulatory activity, inflammatory responses, morphological, physiological, biochemical, and enzymatic responses. As such, smokers with RA have higher disease activity and are more likely to be seropositive through the citrullination of peptides. In addition, these patients are at risk of achieving a suboptimal response to tumor necrosis factor inhibitors. CONCLUSIONS Cigarette smoking can substantially affect the pathophysiology and clinical presentation of patients with SpA and RA. The impact of nicotine on the management of these diseases still needs to be further studied.
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Affiliation(s)
- G El Hasbani
- Department of Medicine, Hartford HealthCare St. Vincent's Medical Center, Bridgeport, CT.
| | - J E Nassar
- Faculty of Medicine, American University of Beirut.
| | | | - I Uthman
- Department of Internal Medicine, American University of Beirut Medical Center.
| | - A Jawad
- Department of Rheumatology, Royal London Hospital.
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3
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Ljung L, Jönsson E, Franklin J, Berglin E, Lundquist A, Rantapää-Dahlqvist S. Incidence and predisposing factors of extra-articular manifestations in contemporary rheumatoid arthritis. Eur J Intern Med 2024:S0953-6205(24)00185-7. [PMID: 38705755 DOI: 10.1016/j.ejim.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Rheumatoid arthritis [RA) is a chronic inflammatory disease, with potential for extra-articular manifestations (ExRA). The incidence and predisposing factors for ExRA and the mortality were evaluated in an early RA inception cohort. METHODS Patients (n = 1468; 69 % females, mean age (SD) 57.3(16.3) years) were consecutively included at the date of diagnosis, between 1 January 1996 and 31 December 2016, and assessed prospectively. In December 2016 development of ExRA was evaluated by a patient questionnaire and a review of medical records. Cumulative incidence and incidence rates were compared between 5-year periods and between patients included before and after 1 January 2001. Cox proportional hazard regression models were used to identify predictors for ExRA, and models with ExRA as time-dependent variables to estimate the mortality. RESULTS After a mean (SD) follow-up of 9.3(4.9) years, 238 cases (23.3 %) had ExRA and 151 (14.7 %) had ExRA without rheumatoid nodules. Most ExRA developed within 5 years from diagnosis. Rheumatoid nodules (10.5 %) and keratoconjunctivitis sicca (7.1 %) were the most frequent manifestations, followed by pulmonary fibrosis (6.1 %). The ExRA incidence among more recently diagnosed patients was similar as to the incidence among patients diagnosed before 2001. Seropositivity, smoking and early biological treatment were associated with development of ExRA. After 15 years 20 % had experienced ExRA. ExRA was associated with increased mortality, HR 3.029 (95 % CI 2.177-4.213). CONCLUSIONS Early development of ExRA is frequent, particularly rheumatoid nodules. Predisposing factors were age, RF positivity, smoking and early biological treatment. The patients with ExRA had a 3-fold increase in mortality.
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Affiliation(s)
- Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden; Academic Specialist Center, Center for Rheumatology, Health Care Services Stockholm County (SLSO), Stockholm, Sweden
| | - Elias Jönsson
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden
| | - Johan Franklin
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden
| | - Ewa Berglin
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden
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4
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Kimbrough BA, Crowson CS, Davis JM, Matteson EL, Myasoedova E. Decline in Incidence of Extra-Articular Manifestations of Rheumatoid Arthritis: A Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2024; 76:454-462. [PMID: 37691141 PMCID: PMC10924769 DOI: 10.1002/acr.25231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The focus of this study was to assess changes in the cumulative incidence of extra-articular manifestations of rheumatoid arthritis (ExRAs) and associated mortality risk. METHODS This study evaluated trends in occurrence of ExRAs using a population-based inception cohort that included all adult patients with incident rheumatoid arthritis (RA) from 1985 through 2014 meeting the 1987 American College of Rheumatology criteria. Patients were divided into two cohorts based on the incidence date of RA, 1985 to 1999 and 2000 to 2014. The occurrence of ExRAs was determined by manual chart review, and the 10-year cumulative incidence was estimated for each ExRA in both cohorts. Cox proportional hazard models were used to determine associations between specific demographic and RA disease characteristics and ExRAs and between ExRAs and mortality. RESULTS There were 907 patients included, 296 in the 1985 to 1999 cohort and 611 in the 2000 to 2014 cohort. The 10-year cumulative incidence of any ExRA decreased significantly between the earlier and later cohorts (45.1% vs 31.6%, P < 0.001). This was largely driven by significant declines in subcutaneous rheumatoid nodules (30.9% vs 15.8%, P < 0.001) and nonsevere ExRAs (41.4% vs 28.8%, P = 0.001). Identified risk factors for the development of any ExRAs include rheumatoid factor positivity (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.43-2.86) and current smoking (HR 1.61, 95% CI 1.10-2.34). Mortality was increased in patients with either nonsevere (HR 1.83, 95% CI 1.18-2.85) or severe ExRAs (HR 3.05, 95% CI 1.44-6.49). CONCLUSIONS The incidence of ExRAs has decreased over time. Mortality remains increased in patients with ExRAs.
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Affiliation(s)
- Bradly A. Kimbrough
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Cynthia S. Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Eric L. Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Elena Myasoedova
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Alfredsson L, Klareskog L, Hedström AK. Influence of Smoking on Disease Activity and Quality of Life in Patients With Rheumatoid Arthritis: Results From a Swedish Case-Control Study With Longitudinal Follow-Up. Arthritis Care Res (Hoboken) 2022; 75:1269-1277. [PMID: 36149365 DOI: 10.1002/acr.25026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Inconclusive findings have been reported regarding the influence of smoking on disease outcomes in established rheumatoid arthritis (RA). This study was undertaken to investigate the influence of smoking habits on disease activity and health-related quality of life (HRQoL) in RA patients. METHODS Patients with newly diagnosed RA (n = 1,531) from the population-based case-control Epidemiological Investigation of Rheumatoid Arthritis study were followed up for up to 3 years after recruitment. Using logistic regression models, the risks of unfavorable outcomes in patients with different smoking habits were compared using self-reported swollen and tender joint counts, the Short Form 36 health survey, the Health Assessment Questionnaire, and the Hospital Anxiety and Depression Scale by calculating odds ratios with 95% confidence intervals. RESULTS At 1-year and 3-year follow-up, current smokers reported higher disease activity and lower HRQoL life compared to non-smokers, regarding both physical and mental aspects. Patients who stopped smoking within 1-year post-baseline had less disease activity measured as swollen joint counts at 1-year follow-up compared to those who continued smoking. Patients who stopped smoking after the 1-year follow-up had higher disease activity and lower HRQoL at baseline than smokers who did not quit, and late smoking cessation was not associated with more favorable outcomes compared to continued smoking. CONCLUSION Current smoking is associated with increased disease activity and lower HRQoL among RA patients. Smoking cessation within the first year after baseline appears to have a favorable effect on disease activity.
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Affiliation(s)
| | - Lars Klareskog
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Wieczorek M, Gwinnutt JM, Ransay-Colle M, Balanescu A, Bischoff-Ferrari H, Boonen A, Cavalli G, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm TA, Walker-Bone K, Welling J, Zlatkovic-Svenda M, Verstappen SMM, Guillemin F. Smoking, alcohol consumption and disease-specific outcomes in rheumatic and musculoskeletal diseases (RMDs): systematic reviews informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002170. [PMID: 35351808 PMCID: PMC8966569 DOI: 10.1136/rmdopen-2021-002170] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/07/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A EULAR taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). The aim of this paper was to review the literature on the relationship between smoking and alcohol consumption with regard to RMD-specific outcomes. METHODS Two systematic reviews were conducted to identify systematic reviews and meta-analyses, published between 2013 and 2018, related to smoking and alcohol consumption in seven RMDs: osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), systemic sclerosis (SSc) and gout. Two additional systematic reviews were performed to identify original longitudinal studies on smoking and alcohol consumption and disease-specific outcomes. RESULTS Nine reviews and 65 original studies on smoking as well as two reviews and 14 original studies on alcohol consumption met the inclusion criteria. While most studies were moderate/poor quality, smoking was significantly associated with poorer outcomes: cardiovascular comorbidity; poorer response to RA treatment; higher disease activity and severity in early RA; axSpA radiographic progression. Results were heterogeneous for OA while there was limited evidence for PsA, SSc and gout. Available studies on alcohol mainly focused on RA, reporting a positive association between alcohol intake and radiographic progression. Five studies assessed alcohol consumption in gout, reporting a significant association between the number and type of alcoholic beverages and the occurrence of flares. CONCLUSION Current literature supports that smoking has a negative impact on several RMD-specific outcomes and that moderate or high alcohol consumption is associated with increased risk of flares in RA and gout.
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Affiliation(s)
- Maud Wieczorek
- Centre on Aging and Mobility, University Hospital Zurich, Zurich City Hospital - Waid and University of Zurich, Zurich, Switzerland,EA4360 Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - James Martin Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, Zurich City Hospital - Waid and University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht Univeristy, Maastricht, The Netherlands
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Ernst Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht Univeristy, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana Zlatkovic-Svenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Suzanne MM Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Francis Guillemin
- EA4360 Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France,CIC-1433 Epidemiologie Clinique, Inserm, CHRU Nancy, University of Lorraine, Nancy, France
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7
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Kumar P, Kalpana F, Khamuani MK, Lohana S, Dembra S, Jahangir M, Anees F, Kumar B. Frequency of Cardiovascular Manifestation in Patients With Rheumatoid Arthritis. Cureus 2021; 13:e14631. [PMID: 34046269 PMCID: PMC8140648 DOI: 10.7759/cureus.14631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease. The increased inflammatory burden in RA may result in atherosclerosis, myocardial infarction (MI), and subsequent mortality. In this study, we will determine the frequency of cardiovascular manifestation in RA patients through history, laboratory workup, and echocardiography. Methods This cross-sectional study was conducted in the rheumatology unit of a tertiary care hospital in Pakistan. Three hundred and twenty-two (n=322) participants with a previously confirmed diagnosis of RA were enrolled in this study via consecutive convenient non-probability sampling. Results Cardiovascular manifestations were present in 188 (58.3%) participants. More participants had positive rheumatoid factor (82.9% vs. 32.8%; p-value: < 0.0001) in RA patients with cardiovascular manifestation compared to RA patients without cardiovascular manifestation. Patients with cardiovascular manifestations have a significantly higher C-reactive protein (CRP; 10.21 ± 2.81 mg/L vs. 8.17± 2.01 mg/L; p value: < 0.0001) and erythrocyte sedimentation rate (ESR; 16.2 ± 3.14 mg/L vs. 15.1 ± 2.99 mg/L; p value: 0.0017). Conclusion In this study, patients with a cardiovascular manifestation had a higher frequency of patients with rheumatoid factor, higher mean values of CRP and ESR. The early diagnosis and management of cardiac manifestations would aid in controlling the severity of the disease and the overall mortality.
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Affiliation(s)
- Pardeep Kumar
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fnu Kalpana
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | | | - Sameer Lohana
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Suman Dembra
- Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Maha Jahangir
- Anesthesiology, Dow University of Health Sciences, Karachi, PAK
| | - Faryal Anees
- Obstetrics and Gynecology, Agha Khan University Hospital, Karachi, PAK.,Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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8
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Juge PA, Lee JS, Lau J, Kawano-Dourado L, Rojas Serrano J, Sebastiani M, Koduri G, Matteson E, Bonfiglioli K, Sawamura M, Kairalla R, Cavagna L, Bozzalla Cassione E, Manfredi A, Mejia M, Rodríguez-Henriquez P, González-Pérez MI, Falfán-Valencia R, Buendia-Roldán I, Pérez-Rubio G, Ebstein E, Gazal S, Borie R, Ottaviani S, Kannengiesser C, Wallaert B, Uzunhan Y, Nunes H, Valeyre D, Saidenberg-Kermanac'h N, Boissier MC, Wemeau-Stervinou L, Flipo RM, Marchand-Adam S, Richette P, Allanore Y, Dromer C, Truchetet ME, Richez C, Schaeverbeke T, Lioté H, Thabut G, Deane KD, Solomon JJ, Doyle T, Ryu JH, Rosas I, Holers VM, Boileau C, Debray MP, Porcher R, Schwartz DA, Vassallo R, Crestani B, Dieudé P. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J 2021; 57:13993003.00337-2020. [PMID: 32646919 PMCID: PMC8212188 DOI: 10.1183/13993003.00337-2020] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/13/2020] [Indexed: 01/25/2023]
Abstract
QUESTION ADDRESSED BY THE STUDY Methotrexate (MTX) is a key anchor drug for rheumatoid arthritis (RA) management. Fibrotic interstitial lung disease (ILD) is a common complication of RA. Whether MTX exposure increases the risk of ILD in patients with RA is disputed. We aimed to evaluate the association of prior MTX use with development of RA-ILD. METHODS Through a case-control study design with discovery and international replication samples, we examined the association of MTX exposure with ILD in 410 patients with chronic fibrotic ILD associated with RA (RA-ILD) and 673 patients with RA without ILD. Estimates were pooled over the different samples using meta-analysis techniques. RESULTS Analysis of the discovery sample revealed an inverse relationship between MTX exposure and RA-ILD (adjusted OR 0.46, 95% CI 0.24-0.90; p=0.022), which was confirmed in the replication samples (pooled adjusted OR 0.39, 95% CI 0.19-0.79; p=0.009). The combined estimate using both the derivation and validation samples revealed an adjusted OR of 0.43 (95% CI 0.26-0.69; p=0.0006). MTX ever-users were less frequent among patients with RA-ILD compared to those without ILD, irrespective of chest high-resolution computed tomography pattern. In patients with RA-ILD, ILD detection was significantly delayed in MTX ever-users compared to never-users (11.4±10.4 years and 4.0±7.4 years, respectively; p<0.001). ANSWER TO THE QUESTION Our results suggest that MTX use is not associated with an increased risk of RA-ILD in patients with RA, and that ILD was detected later in MTX-treated patients.
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Affiliation(s)
- Pierre-Antoine Juge
- Dept of Rheumatology, DMU Locomotion, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France.,These authors contributed equally
| | - Joyce S Lee
- Dept of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,These authors contributed equally
| | - Jessica Lau
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,These authors contributed equally
| | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor) Medical School of the University of São Paulo, São Paulo, Brazil
| | - Jorge Rojas Serrano
- Unidad de Enfermedades del Intersticio Pulmonar y Reumatología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosió Villegas, Ciudad de México, México
| | - Marco Sebastiani
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gouri Koduri
- Rheumatology Dept, Southend University Hospital NHSFT, Southend-on-Sea, UK
| | - Eric Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Dept of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Karina Bonfiglioli
- Division of Rheumatology, Medical School of the University of São Paulo, São Paulo, Brazil
| | - Marcio Sawamura
- Division of Radiology, Medical School of the University of São Paulo, São Paulo, Brazil
| | - Ronaldo Kairalla
- Pulmonary Division, Heart Institute (InCor) Medical School of the University of São Paulo, São Paulo, Brazil
| | - Lorenzo Cavagna
- University and IRCCS Policlinico S. Matteo Foundation of Pavia, Pavia, Italy
| | | | - Andreina Manfredi
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mayra Mejia
- Unidad de Enfermedades del Intersticio Pulmonar y Reumatología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosió Villegas, Ciudad de México, México
| | | | - Montserrat I González-Pérez
- Unidad de Enfermedades del Intersticio Pulmonar y Reumatología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosió Villegas, Ciudad de México, México
| | - Ramcés Falfán-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Ciudad de México, México
| | - Ivette Buendia-Roldán
- Research Direction, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad de México, México
| | - Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Ciudad de México, México
| | - Esther Ebstein
- Dept of Rheumatology, DMU Locomotion, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Steven Gazal
- Dept of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Raphaël Borie
- Dept of Pulmonology, Centre de Référence des Maladies Pulmonaires Rares, INSERM UMR1152, DHU APOLLO, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Sébastien Ottaviani
- Dept of Rheumatology, DMU Locomotion, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Caroline Kannengiesser
- Dept of Genetics, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Benoît Wallaert
- CHRU de Lille, Service de Pneumologie et Immuno-Allergologie, Centre de compétence des maladies pulmonaires rares, FHU IMMINENT, Lille, France
| | - Yurdagul Uzunhan
- Dept of Pulmonology, Centre de Référence des Maladies Pulmonaires Rares, Inserm 1272, Hôpital Avicenne, APHP, Université Paris 13, Bobigny, France
| | - Hilario Nunes
- Dept of Pulmonology, Centre de Référence des Maladies Pulmonaires Rares, Inserm 1272, Hôpital Avicenne, APHP, Université Paris 13, Bobigny, France
| | - Dominique Valeyre
- Dept of Pulmonology, Centre de Référence des Maladies Pulmonaires Rares, Inserm 1272, Hôpital Avicenne, APHP, Université Paris 13, Bobigny, France
| | | | | | - Lidwine Wemeau-Stervinou
- CHRU de Lille, Service de Pneumologie et Immuno-Allergologie, Centre de compétence des maladies pulmonaires rares, FHU IMMINENT, Lille, France
| | | | | | - Pascal Richette
- AP-HP, Hôpital Lariboisière, Service de Rhumatologie, DMU Locomotion, Université de Paris, Paris, France.,INSERM, UMR_1132, Paris, France
| | - Yannick Allanore
- APHP, Hôpital Cochin, Service de Rhumatologie A, Université de Paris, Paris, France.,INSERM, U1016, UMR_8104, Paris, France
| | - Claire Dromer
- Service de Pneumologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | - Huguette Lioté
- APHP, Hôpital Tenon, Service de Pneumologie, Paris, France
| | - Gabriel Thabut
- APHP, Hôpital Bichat, INSERM 1152, Service de Pneumologie B, DHU FIRE, Université de Paris, Paris, France
| | - Kevin D Deane
- Dept of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Tracy Doyle
- Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ivan Rosas
- Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - V Michael Holers
- Dept of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine Boileau
- Dept of Genetics, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Marie-Pierre Debray
- Dept of Radiology, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Raphaël Porcher
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - David A Schwartz
- Dept of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Bruno Crestani
- Dept of Genetics, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France.,These authors contributed equally
| | - Philippe Dieudé
- Dept of Rheumatology, DMU Locomotion, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France.,These authors contributed equally
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9
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Roelsgaard IK, Thomsen T, Østergaard M, Semb AG, Andersen L, Esbensen BA. How do people with rheumatoid arthritis experience participation in a smoking cessation trial: a qualitative study. Int J Qual Stud Health Well-being 2020; 15:1725997. [PMID: 32046611 PMCID: PMC7034478 DOI: 10.1080/17482631.2020.1725997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: The aim of this study was to gain more knowledge on how people with rheumatoid arthritis (RA) experienced participation in a randomized controlled trial (RCT) testing the effect of a smoking cessation intervention since this intervention have not been tested on an RA population before Methods: We conducted a qualitative study with semi-structured individual interviews with 12 participants from the intervention group in the RCT. Results: Through thematic analysis we identified four themes: Instilling hope for smoking cessation, referring to the initial invitation to participate in the RCT; Various components of importance in the intervention, referring to cooperation with the smoking cessation counsellor, improved carbon monoxide levels, fear of becoming addicted to nicotine replacement therapy, and suggestions for additional components in the intervention which could promote motivation; Breaking habits, referring to ongoing reflection on quitting smoking; and Increased awareness of health, arthritis and smoking, referring to the lack of information on smoking and RA from health professionals, and the impact of smoking on RA symptoms and overall health. Conclusion: The results reflect the participants’ perspective on what is meaningful to them when trying to quit smoking and adds important knowledge to future smoking cessation studies in this patient group.
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Affiliation(s)
- Ida Kristiane Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Thordis Thomsen
- Herlev Anaesthesia Critical and Emergency Care Science Unit, ACES, Department of Anesthesiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lena Andersen
- The Danish Rheumatism Association, Gentofte, Denmark
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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10
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Gudelj Gračanin A, Marković I, Golob M, Lucijanić M, Valetić AM, Morović-Vergles J. The effect of smoking on disease activity in rheumatoid arthritis - our experience. Acta Clin Croat 2020; 59:312-317. [PMID: 33456119 PMCID: PMC7808239 DOI: 10.20471/acc.2020.59.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate the association of smoking with disease activity, seropositivity, age and gender in patients with rheumatoid arthritis. We included 89 rheumatoid arthritis patients. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism rheumatoid arthritis classification criteria. Activity of the disease was measured by Disease Activity Score 28-joint count C-reactive protein (DAS28CRP). The subjects were stratified into smoking and non-smoking groups and cross-sectionally analyzed. There were 24 (27%) smokers and 65 (73%) nonsmokers. The mean age of patients was 57.1±8.8 years. The mean DAS28CRP was 5.81 in the smoking group and 5.57 in the non-smoking group, without statistically significant difference between the two groups (p=0.148). Similarly, smokers did not differ significantly from non-smokers according to age (p=0.443), gender (p=0.274), rheumatoid factor positivity (p=0.231), anti-citrullinated protein antibody positivity (p=0.754) or seropositivity (p=0.163). In this study, we found no association between smoking status and disease activity, seropositivity, age or gender in rheumatoid arthritis patients. Furthermore, disease activity was not related to age, gender or seropositivity. Additional studies on the effects of smoking on rheumatoid arthritis activity are needed.
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Affiliation(s)
- Ana Gudelj Gračanin
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Marković
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Majda Golob
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marko Lucijanić
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Marija Valetić
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Jadranka Morović-Vergles
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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11
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Guellec D, Cozien S, Ruyssen-Witrand A, Dieudé P, Saraux A. Prevalence and clinical significance of extra-articular manifestations at diagnosis in the ESPOIR cohort with recent-onset arthritis. Semin Arthritis Rheum 2020; 50:409-413. [DOI: 10.1016/j.semarthrit.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
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12
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Vitturi BK, Nascimento BAC, Alves BR, de Campos FSC, Torigoe DY. Cognitive impairment in patients with rheumatoid arthritis. J Clin Neurosci 2019; 69:81-87. [PMID: 31447371 DOI: 10.1016/j.jocn.2019.08.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Neurological manifestations of Rheumatoid Arthritis (RA) are usually uncommon. However, a number of recent studies have reported that the burden of cognitive impairment in RA could be significant. We sought to explore the prevalence and clinical predictors of cognitive impairment in persons with RA. METHODS This is a cross-sectional case-control study with patients with RA. Different trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire (HAQ). Cognitive impairment was evaluated with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS). Using a proper statistical analysis, we compared the neurological outcomes between case and controls and we determined the clinical predictors of cognitive decline. RESULTS A total of 210 patients with RA and 70 healthy controls were included in our study. More than two thirds of our patients were classified as cognitively impaired. The mean MMSE and MoCA scores were significantly lower in RA subjects compared to the control group (p < 0.001). Neuropshychiatric impairment was more prevalent in RA patients (59.5%) than in controls (17.1%) as well (p < 0.001). Greater functional limitations were correlated with worse MMSE, MoCA and HADS scores (p < 0.001). CONCLUSION The findings of this study suggest that there is evidence of cognitive impairment in adults with RA.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Departament of Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
| | | | - Beatriz Rizkallah Alves
- Departament of Rheumatology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Dawton Yukito Torigoe
- Departament of Rheumatology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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13
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Hafström I, Ajeganova S, Andersson MLE, Bala SV, Bergman S, Bremander A, Forslind K, Malm K, Svensson B. A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis - results of clinical relevance. Open Access Rheumatol 2019; 11:207-217. [PMID: 31565006 PMCID: PMC6744369 DOI: 10.2147/oarrr.s218448] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE At the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care. PATIENTS AND METHODS BARFOT is a multicentre observational study of patients with early RA, consecutively included 1992-2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality. RESULTS In all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and co-morbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed. CONCLUSION A register-based study like BARFOT has provided a basis for optimal long-term management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.
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Affiliation(s)
- Ingiäld Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Correspondence: Ingiäld HafströmRheumatology Unit, R92, Karolinska University Hospital, 141 86Stockholm, SwedenTel +46 73 699 6235Email
| | - Sofia Ajeganova
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maria LE Andersson
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
| | - Sidona-Valentina Bala
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Medicine, Section of Rheumatology, Helsingborg’s Hospital, Helsingborg, Sweden
| | - Stefan Bergman
- Spenshult Research and Development Center, Halmstad, Sweden
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Bremander
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kristina Forslind
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Research and Education, Skånevård Sund, Region Skåne, Helsingborg´s Hospital, Helsingborg, Sweden
| | - Karina Malm
- Spenshult Research and Development Center, Halmstad, Sweden
- Rheumatology, Capio Movement, Halmstad, Sweden
| | - Björn Svensson
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
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14
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Chatzidionysiou K, Lukina G, Gabay C, Hetland ML, Hauge EM, Pavelka K, Nordström D, Canhão H, Tomsic M, Rotar Z, Lie E, Kvien TK, van Vollenhoven RF, Saevarsdottir S. Smoking and response to rituximab in rheumatoid arthritis: results from an international European collaboration. Scand J Rheumatol 2018; 48:17-23. [PMID: 30260261 DOI: 10.1080/03009742.2018.1466363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate whether smoking habits predict response to rituximab (RTX) in rheumatoid arthritis (RA). METHOD We included patients from the CERERRA international cohort receiving the first treatment cycle with available smoking status (n = 2481, smokers n = 528, non-current smokers n = 1953) and at least one follow-up visit. Outcome measures were change in Disease Activity Score based on 28-joint count (ΔDAS28) and European League Against Rheumatism (EULAR) good response at 6 months, with non-current smokers as the referent group. RESULTS Compared with non-smokers at baseline, smokers were more often rheumatoid factor (RF)/anti-citrullinated protein antibody (ACPA) positive and males, had shorter disease duration, lower DAS28 and Health Assessment Questionnaire (HAQ) score, a higher number of prior biological disease-modifying anti-rheumatic drugs, and were more likely to receive concomitant conventional synthetic disease-modifying anti-rheumatic drug (csDMARDs). Disease activity had decreased less in smokers at 6 months (ΔDAS28 = 1.5 vs 1.7, p = 0.006), although the difference was no longer significant after correction for baseline DAS28 (p = 0.41). EULAR good response rates did not differ between smokers and non-smokers overall or stratified by RF/ACPA status, although smokers had lower good response rates among seronegative patients (ACPA-negative: 6% vs 14%, RF-negative: 11% vs 18%). Smoking did not predict good response [odds ratio (OR) = 1.04, 95% confidence interval (CI) = 0.76-1.41], while ACPA, DAS28, HAQ, and concomitant csDMARDs were significant predictors for good response. However, when stratified by country, smokers were less likely to achieve good response in Sweden (unadjusted OR = 0.24, 95% CI = 0.07-0.89), and a trend was seen in the Czech Republic (OR = 0.45, 95% CI = 0.16-1.02). CONCLUSION In this large, observational, multinational RA cohort, smokers starting RTX differed from non-smokers by having shorter disease duration and lower disease activity, but more previous treatments. The overall results do not support smoking as an important predictor for response to RTX in patients with RA.
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Affiliation(s)
- K Chatzidionysiou
- a Rheumatology Unit, Department of Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - G Lukina
- b ARBITER, Institute of Rheumatology , Moscow , Russia
| | - C Gabay
- c SCQM Registry , University Hospital of Geneva , Geneva , Switzerland
| | - M L Hetland
- d DANBIO and Copenhagen Center for Arthritis Research , Center for Rheumatology and Spine Diseases, Rigshospitalet , Glostrup , Denmark.,e Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - E M Hauge
- f Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - K Pavelka
- g ATTRA Registry , Institute of Rheumatology , Prague , Czech Republic
| | - D Nordström
- h ROB-FIN Helsinki University Central Hospital , Helsinki , Finland
| | - H Canhão
- i CEDOC, EpiDoC Unit, NOVA Medical School and National School of Public Health , Universidade Nova de Lisboa , Lisbon , Portugal , on behalf of the Rheumatic Diseases Portuguese Register
| | - M Tomsic
- j BioRx.si University Medical Centre , Ljubljana , Slovenia
| | - Z Rotar
- j BioRx.si University Medical Centre , Ljubljana , Slovenia
| | - E Lie
- k Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - T K Kvien
- k Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - R F van Vollenhoven
- a Rheumatology Unit, Department of Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - S Saevarsdottir
- a Rheumatology Unit, Department of Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
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15
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AL-Bashaireh AM, Haddad LG, Weaver M, Kelly DL, Chengguo X, Yoon S. The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:4184190. [PMID: 30112011 PMCID: PMC6077562 DOI: 10.1155/2018/4184190] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.
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Affiliation(s)
| | - Linda G. Haddad
- College of Health and Human Services, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Michael Weaver
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Xing Chengguo
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Saunjoo Yoon
- College of Nursing, University of Florida, Gainesville, FL, USA
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16
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Leon L, Redondo M, Fernández-Nebro A, Gómez S, Loza E, Montoro M, Garcia-Vicuña R, Galindo M. Expert recommendations on the psychological needs of patients with rheumatoid arthritis. Rheumatol Int 2018; 38:2167-2182. [PMID: 29808295 DOI: 10.1007/s00296-018-4057-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish feasible and practical recommendations for the management of the psychological needs of patients with rheumatoid arthritis (RA) from the moment of diagnosis through the course of the disease. METHODS A nominal group meeting was held with an RA expert team including rheumatologists and psychologists, at which a guided discussion addressed the most important psychological and emotional needs in RA. Based on the comments collected, and a literature review, a matrix document of recommendations for telematics discussion was prepared, as well as a Delphi survey to test agreement with these recommendations. Agreement was defined if at least 80% of participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grading of recommendations was established following the Oxford criteria, and the degree of agreement through the Delphi. RESULTS Thirteen recommendations were established, addressing several key processes: (1) identification of psychological problems and needs in patients with RA, and a guideline for their management in daily practice; (2) communication with patients; (3) referral criteria to mental health professionals. CONCLUSIONS These recommendations are intended to help health care professionals openly address the psychological aspects of patients in daily practice to follow and treat them properly.
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Affiliation(s)
- Leticia Leon
- Rheumatology Unit, IDISSC, San Carlos Clinical Hospital, Madrid, Spain.,Faculty of Heath Sciences, Camilo José Cela University, Madrid, Spain
| | - Marta Redondo
- Faculty of Heath Sciences, Camilo José Cela University, Madrid, Spain
| | - Antonio Fernández-Nebro
- Rheumatology Clinical Management Unit, Biomedical Research Institute in Malaga (IBIMA), Regional University Hospital in Malaga, University of Malaga, Malaga, Spain
| | - Susana Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | | | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | | | - María Galindo
- Rheumatology Service, 12 de Octubre University Hospital, Av. Cordoba, s/n, 28041, Madrid, Spain.
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17
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Rydell E, Forslind K, Nilsson JÅ, Jacobsson LTH, Turesson C. Smoking, body mass index, disease activity, and the risk of rapid radiographic progression in patients with early rheumatoid arthritis. Arthritis Res Ther 2018; 20:82. [PMID: 29720260 PMCID: PMC5932864 DOI: 10.1186/s13075-018-1575-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/22/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Identification of risk factors for rapid joint destruction in early rheumatoid arthritis (RA) can be helpful for optimizing treatment, and improving our understanding of destructive arthritis and its mechanisms. The objective of this study was to investigate the relationship between early RA patient characteristics and subsequent rapid radiographic progression (RRP). METHODS An inception cohort of patients with early RA (symptom duration < 12 months), recruited during 1995-2005 from a defined area (Malmö, Sweden), was investigated. Radiographs of the hands and feet were scored in chronological order according to the modified Sharp-van der Heijde score (SHS), by a trained reader. RRP was defined as an increase of ≥ 5 points in SHS per year. RESULTS Two hundred and thirty-three patients were included. Radiographs were available from 216 patients at baseline, 206 patients at 1 year, and 171 patients at 5 years. Thirty-six patients (22%) had RRP up to 5 years. In logistic regression models, rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP), and increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) at baseline, predicted RRP over 5 years. Patients identified as overweight or obese had a significantly reduced risk of RRP up to 5 years (odds ratio (OR) 0.26; 95% confidence interval (CI) 0.11-0.63; adjusted for RF, baseline erosions, and ESR). Similar point estimates were obtained when stratifying for antibody status, and in models adjusted for smoking. A history of ever smoking was associated with a significantly increased risk of RRP up to 5 years, independent of body mass index (BMI) (OR 3.17; 95% CI 1.22-8.28; adjusted for BMI). At the 1-year follow-up, erosive changes, Disease Activity Score of 28 joints, Health Assessment Questionnaire, swollen joint count, and patient's global assessment of disease activity and pain were also significantly associated with RRP up to 5 years. CONCLUSIONS A history of smoking, presence of RF and/or anti-CCP and early erosions, high initial disease activity and active disease at 1 year, all increase the risk of RRP. Patients with a high BMI may have a reduced risk of severe joint damage. This pattern was not explained by differences in disease activity or antibody status. The results of this study suggest independent effects of smoking and BMI on the risk of RRP.
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Affiliation(s)
- Emil Rydell
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, SE-202 13, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga Marie Nilssons gata 32, SE-214 28, Malmö, Sweden.
| | - Kristina Forslind
- Department of Research and Education, Helsingborg Hospital, Charlotte Yhlens gata 10, SE-251 87, Helsingborg, Sweden.,Rheumatology, Department of Clinical Sciences, Helsingborg, Lund University, Svartbrödragränden 3-5, SE-251 87, Helsingborg, Sweden
| | - Jan-Åke Nilsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, SE-202 13, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Inga Marie Nilssons gata 32, SE-214 28, Malmö, Sweden
| | - Lennart T H Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, SE-202 13, Malmö, Sweden.,Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Guldhedsgatan 10 A, SE-405 30, Göteborg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, SE-202 13, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Inga Marie Nilssons gata 32, SE-214 28, Malmö, Sweden
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18
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Vittecoq O, Richard L, Banse C, Lequerré T. The impact of smoking on rheumatoid arthritis outcomes. Joint Bone Spine 2017; 85:135-138. [PMID: 29246527 DOI: 10.1016/j.jbspin.2017.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Olivier Vittecoq
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France.
| | - Laetitia Richard
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France
| | - Christopher Banse
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France
| | - Thierry Lequerré
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France
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19
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Bluett J, Jani M, Symmons DPM. Practical Management of Respiratory Comorbidities in Patients with Rheumatoid Arthritis. Rheumatol Ther 2017; 4:309-332. [PMID: 28808949 PMCID: PMC5696283 DOI: 10.1007/s40744-017-0071-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 12/18/2022] Open
Abstract
Lung disease is one of the most common causes of extra-articular morbidity and mortality in patients with rheumatoid arthritis (RA). Development of pulmonary manifestations may be due to the systemic disease itself; to serious respiratory adverse events such as pneumonitis and infections secondary to therapy; or to lifestyle habits such as smoking. Rheumatologists often need to make important treatment decisions and plan future care in RA patients with respiratory comorbidities, despite the absence of clear evidence or consensus. In this review we evaluate the clinical assessment and management of RA-associated interstitial lung disease, bronchiectasis, serious (including opportunistic) infection, and smoking-related diseases. We summarize the international recommendations for the management of such conditions where available, refer to published best practice on the basis of scientific literature, and propose practical management suggestions to aid informed decision-making.
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Affiliation(s)
- James Bluett
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Dermatological and Musculoskeletal Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Meghna Jani
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Dermatological and Musculoskeletal Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Dermatological and Musculoskeletal Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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20
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Theander L, Nyhäll-Wåhlin BM, Nilsson JÅ, Willim M, Jacobsson LT, Petersson IF, Turesson C. Severe Extraarticular Manifestations in a Community-based Cohort of Patients with Rheumatoid Arthritis: Risk Factors and Incidence in Relation to Treatment with Tumor Necrosis Factor Inhibitors. J Rheumatol 2017; 44:981-987. [DOI: 10.3899/jrheum.161103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 01/17/2023]
Abstract
Objective.The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA.Methods.A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression models were used to assess potential predictors of severe ExRA.Results.During treatment with TNF inhibitors, there were 17 patients with new onset of severe ExRA in 2400 person-years at risk (PY; 0.71/100 PY, 95% CI 0.41–1.13) compared with 104 in 15,599 PY (0.67/100 PY, 95% CI 0.54–0.81) in patients without TNF inhibitors. This corresponded to an incidence rate ratio of 1.06 (95% CI 0.60–1.78). The age- and sex-adjusted HR for ExRA in anti-TNF–treated patients was 1.21 (95% CI 1.02–1.43), with similar findings in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Male sex, positive rheumatoid factor (RF), long disease duration, and greater disability were predictors for ExRA.Conclusion.This study suggests that patients treated with TNF inhibitors are at a slightly increased risk of developing severe ExRA. RF-positive patients with disabling disease of long duration were more likely to develop severe ExRA.
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21
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Sakthiswary R, Singh R. Has the median nerve involvement in rheumatoid arthritis been overemphasized? REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:122-128. [PMID: 28343616 DOI: 10.1016/j.rbre.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 07/05/2016] [Indexed: 12/31/2022] Open
Abstract
Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.
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Affiliation(s)
- Rajalingham Sakthiswary
- Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Department of Medicine, Cheras, Malaysia.
| | - Rajesh Singh
- Monash University Malaysia, Jeffrey Cheah School of Medicine and Health Sciences, Department of Orthopaedics, Bandar Sunway, Malaysia
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22
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Sakthiswary R, Singh R. O envolvimento do nervo mediano na artrite reumatoide tem sido excessivamente valorizado? REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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23
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Aimer P, Treharne GJ, Stebbings S, Frampton C, Cameron V, Kirby S, Stamp LK. Efficacy of a Rheumatoid Arthritis-Specific Smoking Cessation Program: A Randomized Controlled Pilot Trial. Arthritis Care Res (Hoboken) 2016; 69:28-37. [PMID: 27333261 DOI: 10.1002/acr.22960] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/29/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Smoking adversely influences comorbidities in rheumatoid arthritis (RA). The aim of this pilot study was to investigate whether smoking cessation is increased following a 3-month smoking cessation intervention tailored for people with RA. METHODS Thirty-nine current smokers with RA were recruited. Participants were randomized into the control group to receive the current local standard of care for smoking cessation (i.e., ABC = brief advice and subsidized nicotine replacement therapy [NRT], or into the intervention group to receive ABC plus additional smoking cessation advice for 3 months (ABC+), including face-to-face, telephone, and e-mail contact. Advice was tailored to the participants' specific needs from a range of intervention tools focused on education about smoking and RA, pain control, exercise, coping, and support. The primary outcome was smoking cessation at 6 months. The secondary outcome was sustained reduction in smoking at 6 months. Disease and psychosocial characteristics of quitters and nonquitters were examined. RESULTS The overall smoking cessation rate was 24%. There was no significant difference in smoking cessation rates between the ABC and ABC+ groups (21% versus 26%; P = 0.70). The mean number of cigarettes smoked daily was reduced by 44% (P < 0.001) but did not differ between ABC and ABC+ groups (mean reduction 47% versus 41%; P = 0.72). Successful quitters had more years in education and had smoked less across their lifetime, but these differences were not statistically significant. CONCLUSION Smoking cessation in RA may lead to a reduced comorbid burden. The lack of added benefit of the tailored intervention suggests that brief advice and NRT are currently the best practice for supporting people with RA who wish to quit smoking.
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Affiliation(s)
- Pip Aimer
- University of Otago, Christchurch, New Zealand
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24
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Sokolove J, Wagner CA, Lahey LJ, Sayles H, Duryee MJ, Reimold AM, Kerr G, Robinson WH, Cannon GW, Thiele GM, Mikuls TR. Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: a cross-sectional analysis of US veterans. Rheumatology (Oxford) 2016; 55:1969-1977. [PMID: 27477806 DOI: 10.1093/rheumatology/kew285] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 06/24/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cigarette smoking is a major risk factor for RA and has been associated with increased disease severity and lower rates of disease remission. We hypothesized that inflammation and disease activity would be associated with smoking status and this would be related to levels of ACPA. METHODS RA patients from the Veterans Affairs RA registry were studied (n = 1466): 76.9% anti-CCP2 positive, 89% male, median age 63 years (interquartile range 57-72), median disease duration 8.45 years (interquartile range 2.8-18). Baseline serum samples were evaluated for levels of anti-CCP2, RF, 19 distinct ACPAs and 17 cytokines. Smoking status at baseline was recorded as current, former or never. The association of smoking status with cytokines, autoantibodies and disease activity (DAS28) was evaluated. RESULTS Among anti-CCP-positive RA patients, RA-associated cytokines (false-discovery rates q < 0.1%) and DAS28 (P < 0.01) were higher in current smokers compared with former or never smokers. DAS28 and cytokine levels were similar between former and never smokers. In contrast, ACPA concentrations were higher among both current and former smokers compared with never smokers, and levels of ACPA were not associated with DAS28 or cytokine levels. CONCLUSION Among anti-CCP2-positive RA patients, current smoking status is associated with elevations in pro-inflammatory cytokines and increased RA disease activity. Similar levels of inflammation and disease activity among former and never smokers suggests that the detrimental effects of smoking could be ameliorated through tobacco cessation. The effect of tobacco cessation on RA disease activity should be evaluated prospectively.
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Affiliation(s)
- Jeremy Sokolove
- VA Palo Alto Health Care System .,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Catriona A Wagner
- VA Palo Alto Health Care System.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Lauren J Lahey
- VA Palo Alto Health Care System.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Harlan Sayles
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
| | - Michael J Duryee
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
| | - Andreas M Reimold
- Dallas VA Medical Center.,Division of Rheumatic Diseases, University of Texas Southwestern University Medical Center, Dallas, TX
| | - Gail Kerr
- DC VA Medical Center.,Division of Rheumatology, Georgetown University.,Division of Rheumatology, Howard University, Washington, DC
| | - William H Robinson
- VA Palo Alto Health Care System.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Grant W Cannon
- George E. Wahlen VA Medical Center.,Division of Rheumatology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Geoffrey M Thiele
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
| | - Ted R Mikuls
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
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25
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Lagrutta M, Alle G, Parodi RL, Greca AA. Manifestaciones extraarticulares graves de artritis reumatoide en ausencia de artritis activa, tras remisión espontánea sostenida. Presentación de un caso. ACTA ACUST UNITED AC 2016; 12:223-5. [DOI: 10.1016/j.reuma.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/10/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
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26
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Severs M, van Erp SJH, van der Valk ME, Mangen MJJ, Fidder HH, van der Have M, van Bodegraven AA, de Jong DJ, van der Woude CJ, Romberg-Camps MJL, Clemens CHM, Jansen JM, van de Meeberg PC, Mahmmod N, Ponsioen CY, Bolwerk C, Vermeijden JR, Pierik MJ, Siersema PD, Leenders M, van der Meulen-de Jong AE, Dijkstra G, Oldenburg B. Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:455-61. [PMID: 26721937 PMCID: PMC4946753 DOI: 10.1093/ecco-jcc/jjv238] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Smoking affects the course of disease in patients with ulcerative colitis (UC) and Crohn's disease (CD). We aimed to study the association between smoking and extra-intestinal manifestations (EIMs) in inflammatory bowel disease (IBD). METHODS We cross-sectionally explored the association between smoking and EIMs in IBD in three cohort studies: (1) the COIN study, designed to estimate healthcare expenditures in IBD; (2) the Groningen study, focused on cigarette smoke exposure and disease behaviour in IBD; and (3) the JOINT study, evaluating joint and back manifestations in IBD. RESULTS In the COIN, Groningen and JOINT cohorts, 3030, 797 and 225 patients were enrolled, of whom 16, 24 and 23.5% were current smokers, respectively. Chronic skin disorders and joint manifestations were more prevalent in smoking IBD patients than in non-smokers (COIN, 39.1 vs 29.8%, p <0.01; Groningen, 41.7 vs 30.0%, p <0.01) in both CD and UC. In the JOINT cohort, smoking was more prevalent in IBD patients with joint manifestations than in those without (30.3 vs 13.0%, p <0.01). EIMs appeared to be more prevalent in high- than in low-exposure smokers (56.0 vs 37.1%, p = 0.10). After smoking cessation, the prevalence of EIMs in IBD patients rapidly decreased towards levels found in never smokers (lag time: COIN cohort, 1-2 years; Groningen cohort, within 1 year). CONCLUSIONS There is a robust dose-dependent association between active smoking and EIMs in both CD and UC patients. Smoking cessation was found to result in a rapid reduction of EIM prevalence to levels encountered in never smokers.
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Affiliation(s)
- M. Severs
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S. J. H. van Erp
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M. E. van der Valk
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. J. J. Mangen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. H. Fidder
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. van der Have
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A. A. van Bodegraven
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands,Department of Gastroenterology and Hepatology, Atrium-Orbis Medical Centre, Sittard, The Netherlands
| | - D. J. de Jong
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C. J. van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M. J. L. Romberg-Camps
- Department of Gastroenterology and Hepatology, Atrium-Orbis Medical Centre, Sittard, The Netherlands
| | - C. H. M. Clemens
- Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, The Netherlands
| | - J. M. Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - P. C. van de Meeberg
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - N. Mahmmod
- Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands
| | - C. Y. Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam,The Netherlands
| | - C. Bolwerk
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, The Netherlands
| | - J. R. Vermeijden
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands
| | - M. J. Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P. D. Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. Leenders
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - G. Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B. Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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27
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Kiely PDW. Biologic efficacy optimization—a step towards personalized medicine. Rheumatology (Oxford) 2015; 55:780-8. [DOI: 10.1093/rheumatology/kev356] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Indexed: 01/19/2023] Open
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28
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Effects of cigarette smoking on early arthritis: a cross-sectional study—data from the Argentine Consortium for Early Arthritis (CONAART). Rheumatol Int 2014; 35:855-9. [DOI: 10.1007/s00296-014-3188-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
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29
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Smoking and rheumatoid arthritis. Int J Mol Sci 2014; 15:22279-95. [PMID: 25479074 PMCID: PMC4284707 DOI: 10.3390/ijms151222279] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/11/2014] [Accepted: 10/17/2014] [Indexed: 12/26/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by both genetic and environmental factors. Smoking has been implicated as one of the most important extrinsic risk factors for its development and severity. Recent developments have shed light on the pathophysiology of RA in smokers, including oxidative stress, inflammation, autoantibody formation and epigenetic changes. The association of smoking and the development of RA have been demonstrated through epidemiologic studies, as well as through in vivo and animal models of RA. With increased use of biological agents in addition to standard disease-modifying antirheumatic drugs (DMARDs), there has been interest in how smoking affects drug response in RA treatment. Recent evidence suggests the response and drug survival in people treated with anti-tumour necrosis factor (anti-TNF) therapy is poorer in heavy smokers, and possible immunological mechanisms for this effect are presented in the current paper.
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30
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Naranjo A, Khan NA, Cutolo M, Lee SS, Lazovskis J, Laas K, Pandya S, Sokka T. Smoking cessation advice by rheumatologists: results of an international survey. Rheumatology (Oxford) 2014; 53:1825-9. [PMID: 24840678 DOI: 10.1093/rheumatology/keu213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to understand practices regarding smoking cessation among rheumatologists for patients with inflammatory rheumatic diseases. METHODS A survey was sent to the rheumatologists participating in the multinational Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) group. The survey inquired about the clinical practice characteristics and practices regarding smoking cessation (proportion of smokers with inflammatory rheumatic diseases given smoking cessation advice, specific protocols and written advice material, availability of dedicated smoking cessation clinic). RESULTS Rheumatologists from 44 departments in 25 countries (16 European) completed the survey. The survey involved 395 rheumatologists, of whom 25 (6.3%) were smokers, and 199 nurses for patient education, of whom 44 (22.1%) were smokers. Eight departments (18.1 %) had a specific protocol for smoking cessation; 255 (64.5%) rheumatologists reported giving smoking cessation advice to all or almost all smokers with inflammatory diseases. In a regression model, early arthritis clinics (P = 0.01) and high gross domestic product countries (P = 0.001) were both independently associated with advice by the rheumatologist. Nurse gives advice to most patients in 11 of the 36 (30.5%) departments with nurses for patient education. CONCLUSION Advice for smoking cessation within rheumatology departments is not homogeneous. In half of the departments, most doctors give advice to quit smoking to all or almost all patients with inflammatory diseases. However, only one in five departments have a specific protocol for smoking cessation. Our data highlight the need to improve awareness of the importance of and better practice implementation of smoking cessation advice for inflammatory rheumatic disease patients.
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Affiliation(s)
- Antonio Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland.
| | - Nasim A Khan
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Maurizio Cutolo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Shin-Seok Lee
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Juris Lazovskis
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Karin Laas
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Sapan Pandya
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Tuulikki Sokka
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
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Saevarsdottir S, Rezaei H, Geborek P, Petersson I, Ernestam S, Albertsson K, Forslind K, van Vollenhoven RF. Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial. Ann Rheum Dis 2014; 74:1509-14. [PMID: 24706006 PMCID: PMC4515990 DOI: 10.1136/annrheumdis-2013-204601] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 03/15/2014] [Indexed: 11/17/2022]
Abstract
Objectives To study clinical predictors for radiographic progression after 1 year in an early rheumatoid arthritis (RA) trial. Methods In the SWEFOT trial population, disease modifying antirheumatic drug (DMARD) naïve RA patients started methotrexate; 3-month responders (DAS28 <3.2) continued (n=147), while non-responders were randomised to addition of sulfasalazine+hydroxychloroquine (n=130) or infliximab (n=128). X-rays were scored by the Sharp-van der Hejde score (SHS) method and radiographic progression was defined as a ≥5 increase after 1 year. Potential baseline predictors of radiographic progression were tested using multivariable logistic regression, adjusted for potential confounders. Results 79 of 311 patients with available radiographs at baseline and follow-up had radiographic progression. The following baseline parameters were independent predictors of radiographic progression at 1 year: baseline erosions (adjusted OR=2.29, 95% CI 1.24 to 4.24), erythrocyte sedimentation rate (adjusted OR per tertile increase=1.72, 95% CI 1.12 to 2.65) and C-reactive protein (adjusted OR per tertile increase=1.52, 95% CI 1.03 to 2.26). Current smoking was an independent predictor of radiographic progression (adjusted OR=2.17, 95% CI 1.06 to 4.45). These results remained after further adjustment for treatment strategy. Three-dimensional matrix including current smoking status, erosions and C-reactive protein tertiles showed a 12–63% risk gradient from patients carrying none compared with all predictors. Rheumatoid factor (RF)/anti-cyclic citrullinated peptide (anti-CCP) positivity did not significantly predict radiographic progression using SHS increase ≥5 as cut-off. In a secondary exploratory analysis using cut-off >1, both RF and anti-CCP positivity were significant predictors in the unadjusted, but not the adjusted analyses. The other parameters also remained significant using this lower cut-off. Conclusions In addition to previously described predictors, we identified smoking as a strong independent risk factor for radiographic progression in early RA. Trial registration number NCT00764725.
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Affiliation(s)
- Saedis Saevarsdottir
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Unit for Clinical Therapy Research, Karolinska Institute, Stockholm, Sweden
| | - Hamed Rezaei
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden Unit for Clinical Therapy Research, Karolinska Institute, Stockholm, Sweden
| | - Pierre Geborek
- Section of Rheumatology, Institution of Clinical Science, University Hospital, Lund, Sweden
| | | | - Sofia Ernestam
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | - Kristina Forslind
- Section of Rheumatology, Institution of Clinical Science, University Hospital, Lund, Sweden Department of Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg, Sweden
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Atzeni F, Boiardi L, Sallì S, Benucci M, Sarzi-Puttini P. Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis. Expert Rev Clin Immunol 2014; 9:649-57. [PMID: 23899235 DOI: 10.1586/1744666x.2013.811173] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. Usual interstitial pneumonia and nonspecific interstitial pneumonia seem to be the most frequent patterns in RA patients with ILD, although the proportion of patients with usual interstitial pneumonia is higher than among patients with other systemic rheumatic autoimmune diseases. RA patients with ILD most frequently present with chronic symptoms of cough and dyspnea when climbing stairs or walking uphill. A physical examination may reveal inhalatory crackles and a pulmonary function test demonstrates restrictive physiology, often with reduced diffusing capacity. High-resolution computed tomography is generally sufficient to confirm a diagnosis of ILD, although a minority of cases may require a surgical lung biopsy. Conventional disease-modifying antirheumatic drugs such as methotrexate (MTX) or leflunomide (LEF) and biological agents such as TNF-blocking agents or rituximab may trigger or aggravate ILD in RA patients, and infections may contribute to increased mortality in such patients. LEF should not be used in patients with a history of MTX pneumonitis. The prevalence of interstitial pneumonia among RA patients treated with anti-TNF agents ranges from 0.5 to 3%; however, as the evidence that anti-TNF increases or decreases the risk of ILD is controversial, it is not clear whether this indicates more severe RA requiring biological therapy or the effect of exposure to potentially toxic drugs such as MTX or LEF. The development of treatment-related ILD is a paradoxical adverse event, and patients should be warned about this rare but serious complication of biological or disease-modifying antirheumatic drug therapy.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, L Sacco University Hospital, Milan, Italy.
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Vesperini V, Lukas C, Fautrel B, Le Loet X, Rincheval N, Combe B. Association of Tobacco Exposure and Reduction of Radiographic Progression in Early Rheumatoid Arthritis: Results From a French Multicenter Cohort. Arthritis Care Res (Hoboken) 2013; 65:1899-906. [DOI: 10.1002/acr.22057] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 06/03/2013] [Indexed: 01/23/2023]
Affiliation(s)
| | - Cedric Lukas
- Lapeyronie Hospital, Montpellier I University; UMR5535, Montpellier France
| | | | | | | | - Bernard Combe
- Lapeyronie Hospital, Montpellier I University; UMR5535, Montpellier France
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Abate M, Vanni D, Pantalone A, Salini V. Cigarette smoking and musculoskeletal disorders. Muscles Ligaments Tendons J 2013; 3:63-9. [PMID: 23888288 DOI: 10.11138/mltj/2013.3.2.063] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cigarette smoking has deleterious effects on the musculo-skeletal system. The loss of bone mineral content and increased incidence of fractures are the best known negative consequences. The pathogenesis is complex, due to direct toxic effects on osteoblasts/osteoclasts activity of nicotine, and indirect actions on sex and adrenocortical hormones, vitamin D, intestinal calcium absorption, vessels and oxygen supply. Smoking may favour the onset or aggravate the progression of rheumatoid arthritis and back pain. Negative influences have been observed on muscle and on tendons. Moreover, smoking habit is associated to a number of short term post-operative complications and higher resource consumption. Smoking cessation is highly advisable with positive effects on the bone metabolism on the long term. More positive and immediate results can be obtained in patients submitted to orthopedic surgery: the healing process is improved, the frequency of complications is reduced, and the length of hospital stay is shortened.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University of Study "G. D'Annunzio" Chieti - Pescara, Italy
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Maska LB, Sayles HR, O'Dell JR, Curtis JR, Bridges SL, Moreland LW, Cofield SS, Mikuls TR. Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64:1804-10. [PMID: 22730343 PMCID: PMC3467327 DOI: 10.1002/acr.21758] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/07/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cigarette smoking has emerged as a risk factor for the development of rheumatoid arthritis (RA). Recent studies have suggested that cigarette smoking may lead to lower treatment response rates with methotrexate (MTX) and some biologic agents in RA. Knowledge of whether tobacco exposure reduces treatment efficacy is important, since smoking could represent a modifiable factor in optimizing RA treatment. METHODS The study participants included patients with early RA (<3 years in duration) enrolled in the Treatment of Early Aggressive Rheumatoid Arthritis study, a randomized, blinded, placebo-controlled clinical trial comparing early intensive therapy (MTX + etanercept or MTX + hydroxychloroquine + sulfasalazine triple therapy) versus initial treatment with MTX with step-up to MTX + etanercept or to triple therapy if the disease was still active at 24 weeks. Serum cotinine was measured using a commercially available enzyme-linked immunosorbent assay at baseline and at 48 weeks, with detectable concentrations at both visits serving as an indicator of smoking status. The mean Disease Activity Score in 28 joints (DAS28) was compared by smoking status, adjusting for baseline disease activity. RESULTS Of the 412 subjects included in the analysis, 293 (71%) were categorized as nonsmokers and 119 (29%) as current smokers. There were no differences in the mean DAS28 score between 48 and 102 weeks based on smoking status for the overall group (P = 0.881) or by specific treatment assignment. CONCLUSION Among patients enrolled in a large randomized controlled trial of early RA with poor prognostic factors, smoking status did not impact treatment responses for those receiving early combination or initial MTX with step-up therapy at 24 weeks if the disease was still active.
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Affiliation(s)
- Leann B Maska
- University of Nebraska Medical Center, Omaha, NE 68198-3025, USA
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Different risk factors between interstitial lung disease and airway disease in rheumatoid arthritis. Respir Med 2012; 106:1591-9. [DOI: 10.1016/j.rmed.2012.07.006] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 12/19/2022]
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Pikwer M, Nilsson JÅ, Bergström U, Jacobsson LTH, Turesson C. Early menopause and severity of rheumatoid arthritis in women older than 45 years. Arthritis Res Ther 2012; 14:R190. [PMID: 22901865 PMCID: PMC3580586 DOI: 10.1186/ar4021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022] Open
Abstract
Introduction We aimed to investigate whether recognized hormonal predictors of rheumatoid arthritis (RA) also influence the severity of RA. Methods One hundred thirty-four incident RA cases identified by four different local and national registers, who had participated in a community-based health survey between 1991 and 1996, were included. By a retrospective structured review of the medical records, information on the use of disease-modifying antirheumatic drugs (DMARDs), erosions on radiographs, rheumatoid factor (RF) status, and disability measured by using the health assessment questionnaire (HAQ) were collected. The variables were added to the SPSS TwoStep Cluster Analysis to reveal natural groupings of RA severity. Known hormonal predictors analyzed were breastfeeding history, history of oral contraceptive (OC) use, and menopausal age. Results The mean age at RA diagnosis was 63.4 years; 72% were RF positive, and 28% had received biological treatment. Three clusters were identified, one with severe RA, one with mild/moderate RF-positive RA, and one with mild/moderate RF-negative RA. A significant difference (P = 0.005) was found in the distribution of clusters between patients with a history of early menopause compared with those with menopause after 45 years, with a higher proportion with mild/moderate RF-negative RA in the early-menopause subset. No major difference in severity of the disease was noted depending on OC use or history of breastfeeding. Conclusions Early menopause was associated with a milder form of RA. Hormonal changes may influence pathways that are distinct from those leading to severe, progressive disease.
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Nyhäll-Wåhlin BM, Petersson IF, Jacobsson C, Geborek P, Nilsson JÅ, Nilsson K, Jacobsson LTH, Turesson C. Extra-articular manifestations in a community-based sample of patients with rheumatoid arthritis: incidence and relationship to treatment with TNF inhibitors. Scand J Rheumatol 2012; 41:434-7. [PMID: 22813208 DOI: 10.3109/03009742.2012.695803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the incidence of severe extra-articular rheumatoid arthritis (ExRA) in a community-based cohort of RA patients, and to evaluate whether treatment with tumour necrosis factor (TNF) inhibitors has any effect on the risk of ExRA. METHODS In a review of clinical records from 1 July 1997 to 31 December 2004, severe ExRA manifestations were classified according to predefined criteria. Patients were censored at the development of ExRA, death, emigration, or 31 December 2004. Exposure to anti-TNF treatment has continuously and independently been recorded as part of a regional follow-up system. RESULTS During treatment with TNF inhibitors, there were two patients with new onset of ExRA in 408 person-years at risk (pyr) [0.49/100 pyr, 95% confidence interval (CI) 0.06-1.77]. Among those without anti-TNF treatment there were 63 patients with ExRA in 5425 pyr (1.16/100 pyr, 95% CI 0.89-1.49). The relative risk comparing those treated to those not treated with TNF inhibitors was 0.42 (95% CI 0.10-1.73). CONCLUSION Our data show a lower incidence of ExRA in patients treated with TNF inhibitors but further studies with a larger sample size are needed for a more accurate estimate of the size of the effect.
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Abstract
Although treat-to-target goals for rheumatoid arthritis (RA) have been well-established through several guidelines in recent years, concerns regarding treat-to-prevent goals for RA remain unclear. RA patients are typically subjected to over- or under-treatment because it is difficult for clinicians to determine the prognosis of RA patients. This typically results in failure to select and identify patient subsets that should receive monotherapy or combination therapy to treat early RA. Understanding treat-to-prevent goals, as well as unfavorable prognoses, risk factors, and prediction methods for RA, is therefore critical for making treatment decisions. Rapid radiographic progression plays a central role in contributing to other composite RA indices, so this may be the best method for defining treat-to-prevent goals for RA. Accordingly, risk factors of rapid radiographic progression have been defined and two prediction models were retrospectively derived based on clinical trial data. Additional studies are required to develop risk models that can be used for accurate predictions.
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Affiliation(s)
- Min Yang
- Rheumatology Center, PLA General Hospital of Chengdu Military Area Command, Chengdu, Sichuan Province, PR China
| | - Mingyang Guo
- Rheumatology Center, PLA General Hospital of Chengdu Military Area Command, Chengdu, Sichuan Province, PR China
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Thompson MK, Axford JS, Sofat N. Rheumatoid arthritis in 2011: an editorial. Best Pract Res Clin Rheumatol 2011; 25:435-46. [PMID: 22137916 DOI: 10.1016/j.berh.2011.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 10/14/2022]
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Prete M, Racanelli V, Digiglio L, Vacca A, Dammacco F, Perosa F. Extra-articular manifestations of rheumatoid arthritis: An update. Autoimmun Rev 2011; 11:123-31. [PMID: 21939785 DOI: 10.1016/j.autrev.2011.09.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/03/2011] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) is an immune-mediated disease involving chronic low-grade inflammation that may progressively lead to joint destruction, deformity, disability and even death. Despite its predominant osteoarticular and periarticular manifestations, RA is a systemic disease often associated with cutaneous and organ-specific extra-articular manifestations (EAM). Despite the fact that EAM have been studied in numerous RA cohorts, there is no uniformity in their definition or classification. This paper reviews current knowledge about EAM in terms of frequency, clinical aspects and current therapeutic approaches. In an initial attempt at a classification, we separated EAM from RA co-morbidities and from general, constitutional manifestations of systemic inflammation. Moreover, we distinguished EAM into cutaneous and visceral forms, both severe and not severe. In aggregated data from 12 large RA cohorts, patients with EAM, especially the severe forms, were found to have greater co-morbidity and mortality than patients without EAM. Understanding the complexity of EAM and their management remains a challenge for clinicians, especially since the effectiveness of drug therapy on EAM has not been systematically evaluated in randomized clinical trials.
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Affiliation(s)
- Marcella Prete
- Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Piazza G. Cesare 11, Bari, Italy
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Bergstrom U, Jacobsson LTH, Nilsson JA, Berglund G, Turesson C. Pulmonary dysfunction, smoking, socioeconomic status and the risk of developing rheumatoid arthritis. Rheumatology (Oxford) 2011; 50:2005-13. [DOI: 10.1093/rheumatology/ker258] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Myasoedova E, Crowson CS, Turesson C, Gabriel SE, Matteson EL. Incidence of extraarticular rheumatoid arthritis in Olmsted County, Minnesota, in 1995-2007 versus 1985-1994: a population-based study. J Rheumatol 2011; 38:983-9. [PMID: 21459933 DOI: 10.3899/jrheum.101133] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess incidence and mortality effects of extraarticular rheumatoid arthritis (ExRA) in patients with incident RA in 1995-2007 compared to 1985-1994, in Olmsted County, Minnesota, USA. METHODS Data on incident ExRA were abstracted from medical records of patients with RA - Olmsted County residents who first met the 1987 American College of Rheumatology criteria for RA between January 1, 1995, and December 31, 2007. Patients were followed until death, migration from Olmsted County, or December 31, 2008. ExRA were classified using the predefined criteria and compared to the corresponding 1985-1994 inception RA cohort (n = 147). RESULTS The 1995-2007 cohort included 463 patients with RA followed for a mean of 6.3 years; mean age was 55.6 years, 69% were women, 67% were positive for rheumatoid factor (RF). The 10-year cumulative incidence of any ExRA (50.1%) and severe ExRA (6.7%) in the 1995-2007 cohort was similar to the 1985-1994 cohort (46.2% and 9.7%, respectively). The 10-year cumulative incidence of vasculitis, but not other features of ExRA, was significantly lower in the 1995-2007 cohort (0.6%) compared to the 1985-1994 cohort (3.6%). RF positivity, erosions/destructive changes, and use of methotrexate, other disease-modifying antirheumatic drugs and systemic corticosteroids were significantly associated with ExRA in the 1995-2007 cohort. ExRA was associated with mortality risk (HR 2.1, 95% CI 1.2, 3.7) in the 1995-2007 cohort. The decrease in mortality following ExRA in the 1995-2007 cohort versus the 1985-1994 cohort did not reach statistical significance (HR 0.6, 95% CI 0.3, 1.2, p = 0.16). CONCLUSION ExRA remains a common complication associated with increased mortality in RA. The occurrence of vasculitis appears to be decreasing in recent years.
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Svärd A, Kastbom A, Söderlin MK, Reckner-Olsson Å, Skogh T. A comparison between IgG- and IgA-class antibodies to cyclic citrullinated peptides and to modified citrullinated vimentin in early rheumatoid arthritis and very early arthritis. J Rheumatol 2011; 38:1265-72. [PMID: 21459947 DOI: 10.3899/jrheum.101086] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Because of their slightly higher sensitivity, it has been argued that antibodies to modified citrullinated vimentin (anti-MCV) are superior to antibodies to cyclic citrullinated peptides (anti-CCP), while others claim that anti-CCP is preferable because of higher diagnostic specificity for rheumatoid arthritis (RA). We evaluated IgG- and IgA-class anti-MCV and anti-CCP as diagnostic and prognostic markers in early arthritis. METHODS Two Swedish arthritis populations were examined: 215 patients with early RA (≤ 12 months' duration) from the Swedish TIRA-1 cohort, and 69 patients with very early arthritis (≤ 3 months' duration) from the Kronoberg Arthritis Incidence cohort, in which 22% were diagnosed with RA. IgG anti-CCP and anti-MCV antibodies were analyzed with commercial kits. These tests were modified for IgA-class antibody detection. Results were related to disease course, smoking habits, and shared epitope status. RESULTS In the TIRA-1 cohort, occurrence of IgG anti-MCV and IgG anti-CCP showed a 93% overlap, although IgG anti-MCV had higher diagnostic sensitivity. Twenty-four percent tested positive for IgA anti-MCV compared to 29% for IgA anti-CCP. In the Kronoberg Arthritis Incidence cohort, 15% tested positive for IgG anti-MCV and 6% for IgA anti-MCV, compared to 10% positive for IgG anti-CCP and 3% positive for IgA anti-CCP, revealing that anti-CCP had higher diagnostic specificity for RA. As previously reported for IgA anti-CCP, IgA anti-MCV antibodies occurred in a small proportion of high-level IgG antibody-positive sera and were associated with a more aggressive disease course. Smokers were more often positive for antibodies to citrullinated proteins, most strikingly among the patients who were IgA anti-MCV-positive. CONCLUSION The occurrences of IgG-class anti-MCV and anti-CCP in early RA largely overlap. The sensitivity of anti-MCV is slightly higher, while the diagnostic specificity is higher for anti-CCP. In both instances a positive test predicts an unfavorable disease course, possibly slightly more so for anti-MCV. Although associated with a more active disease over time, IgA-class anti-CCP or anti-MCV do not add any diagnostic advantage.
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Affiliation(s)
- Anna Svärd
- Rheumatology Clinic, Falun Hospital, Falun, Sweden.
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Karabulut G, Kitapcioglu G, Inal V, Kalfa M, Yargucu F, Keser G, Emmungil H, Gokmen NM, Kocanaogullari H, Aksu K. Cigarette smoking in primary Sjögren's syndrome: positive association only with ANA positivity. Mod Rheumatol 2011; 21:602-7. [PMID: 21445716 DOI: 10.1007/s10165-011-0446-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
Smoking is well known to contribute to the pathogenesis and severity of some systemic autoimmune rheumatic diseases and especially to the production of certain autoantibodies. Primary Sjögren's syndrome (pSS) is an autoimmune disease, affecting primarily the exocrine glands. It may also cause extraglandular involvement in some cases. In this study, we aimed to determine the frequency of smoking habits in our cohort of pSS patients and to investigate whether the frequencies of autoantibody positivity and extraglandular involvement were significantly different between patients with and without smoking. In this cross-sectional study, 207 patients with pSS (F/M 203/4), fulfilling the United States-European Consensus Criteria, and 602 healthy controls (F/M 534/68) were included. Patients and controls were classified into five groups: never smokers, current smokers, former smokers; ever smokers, and passive smokers. The χ(2) and Kruskal-Wallis tests were used for statistical analysis; a p value of less than 0.05 was accepted as statistically significant. While the frequency of current smokers was significantly lower in the pSS group compared with the healthy controls (11.6 vs 22.3%), the frequencies of former smokers (30.4 vs 11.8%), ever smokers (42.0 vs 34.1%), and passive smokers (47.3 vs 37.5%) were significantly higher in the pSS group compared with the healthy controls. In pSS patients, only antinuclear antibody (ANA) positivity was significantly associated with smoking habits, while there was no significant association with other autoantibodies or with the presence of extraglandular involvement. We found that in pSS patients smoking was significantly associated only with ANA positivity. Unlike the deleterious effects of smoking upon disease severity and anti-cyclic citrullinated protein (CCP) antibody production in rheumatoid arthritis, we could not find any association of smoking with extraglandular involvement and/or anti-Ro/anti-La antibody positivity in pSS. These results are indeed in line with the limited number of previous studies reported in the literature. Further studies with higher numbers of pSS patients are required to confirm the seemingly negative association of smoking with pSS.
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Affiliation(s)
- Gonca Karabulut
- Division of Rheumatology, Department of Internal Medicine, Ege University School of Medicine, Bornova, Izmir, Turkey
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Saevarsdottir S, Wedrén S, Seddighzadeh M, Bengtsson C, Wesley A, Lindblad S, Askling J, Alfredsson L, Klareskog L. Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts. ACTA ACUST UNITED AC 2011; 63:26-36. [PMID: 20862678 DOI: 10.1002/art.27758] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether cigarette smoking influences the response to treatment in patients with early rheumatoid arthritis (RA). METHODS We retrieved clinical information about patients entering the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) early RA cohort from 1996 to 2006 (n=1,998) who were also in the Swedish Rheumatology Register (until 2007). Overall, 1,430 of the 1,621 registered patients were followed up from the time of inclusion in the EIRA cohort. Of these, 873 started methotrexate (MTX) monotherapy at inclusion, and 535 later started treatment with a tumor necrosis factor (TNF) inhibitor as the first biologic agent. The primary outcome was a good response according to the European League Against Rheumatism criteria at the 3-month visit. The influence of cigarette smoking (current or past) on the response to therapy was evaluated by logistic regression, with never smokers as the referent group. RESULTS Compared with never smokers, current smokers were less likely to achieve a good response at 3 months following the start of MTX (27% versus 36%; P=0.05) and at 3 months following the start of TNF inhibitors (29% versus 43%; P=0.03). In multivariate analyses in which clinical, serologic, and genetic factors were considered, the inverse associations between current smoking and good response remained (adjusted odds ratio [OR] for MTX response 0.60 [95% CI 0.39-0.94]; adjusted OR for TNF inhibitor response 0.52 [95% CI 0.29-0.96]). The lower likelihood of a good response remained at later followup visits. Evaluating remission or joint counts yielded similar findings. Past smoking did not affect the chance of response to MTX or TNF inhibitors. Evaluating the overall cohort, which reflects all treatments used, current smoking was similarly associated with a lower chance of a good response (adjusted ORs for the 3-month, 6-month, 1-year, and 5-year visits 0.61, 0.65, 0.78, 0.66, and 0.61, respectively). CONCLUSION Among patients with early RA, current cigarette smokers are less likely to respond to MTX and TNF inhibitors.
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Affiliation(s)
- Saedis Saevarsdottir
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Nyhäll-Wåhlin BM, Turesson C, Jacobsson LTH, Nilsson JÅ, Forslind K, Albertsson K, Rönnelid J, Petersson IF. The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years. Scand J Rheumatol 2010; 40:81-7. [DOI: 10.3109/03009742.2010.509103] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Rheumatoid arthritis is characterised by persistent synovitis, systemic inflammation, and autoantibodies (particularly to rheumatoid factor and citrullinated peptide). 50% of the risk for development of rheumatoid arthritis is attributable to genetic factors. Smoking is the main environmental risk. In industrialised countries, rheumatoid arthritis affects 0·5-1·0% of adults, with 5-50 per 100 000 new cases annually. The disorder is most typical in women and elderly people. Uncontrolled active rheumatoid arthritis causes joint damage, disability, decreased quality of life, and cardiovascular and other comorbidities. Disease-modifying antirheumatic drugs (DMARDs), the key therapeutic agents, reduce synovitis and systemic inflammation and improve function. The leading DMARD is methotrexate, which can be combined with other drugs of this type. Biological agents are used when arthritis is uncontrolled or toxic effects arise with DMARDs. Tumour necrosis factor inhibitors were the first biological agents, followed by abatacept, rituximab, and tocilizumab. Infections and high costs restrict prescription of biological agents. Long-term remission induced by intensive, short-term treatment selected by biomarker profiles is the ultimate goal.
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MESH Headings
- Antirheumatic Agents/therapeutic use
- Arthritis, Juvenile
- Arthritis, Rheumatoid/classification
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/pathology
- Arthritis, Rheumatoid/physiopathology
- Arthritis, Rheumatoid/therapy
- Autoantibodies/blood
- Biomarkers/blood
- Cartilage/pathology
- Cost-Benefit Analysis
- Critical Pathways
- Fibroblasts/pathology
- Glucocorticoids/therapeutic use
- Humans
- Incidence
- Inflammation/physiopathology
- Rheumatoid Factor/blood
- Risk Factors
- Still's Disease, Adult-Onset
- Synovial Membrane/pathology
- Treatment Outcome
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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Affiliation(s)
- David L Scott
- Department of Rheumatology, King's College London School of Medicine, London, UK.
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