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Petzinna SM, Winter L, Skowasch D, Pizarro C, Weber M, Kütting D, Behning C, Bauer CJ, Schäfer VS. Assessing sleep-related breathing disorders among newly diagnosed rheumatoid and psoriatic arthritis patients: a cross-sectional study. Rheumatol Int 2024; 44:1025-1034. [PMID: 38713410 PMCID: PMC11108881 DOI: 10.1007/s00296-024-05610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to develop a screening algorithm for early detection. METHODS We evaluated newly diagnosed RA or PsA patients using the Epworth Sleepiness Scale (ESS) questionnaire, cardiorespiratory polygraphy (RPG), and clinical and laboratory assessments. Sleep apnea syndrome (SAS) was diagnosed based on pathological RPG findings excessive daytime sleepiness, defined as ESS score above 10. RESULTS The study included 39 patients (22 RA, 17 PsA) and 23 controls. In RPG, SRBD was identified in 38.5% of arthritis patients compared to 39.1% of controls (p = 1.00), with male gender (p = .004) and age (p < .001) identified as risk factors. Excessive daytime sleepiness was noted in 36.4% of RA patients, 17.6% of PsA patients, and 21.7% of controls. Of the 24 patients diagnosed with SRBD, 41.6% met the criteria for SAS. SAS prevalence was 31.8% among RA patients, 0% in PsA patients, and 13% in controls. A significant association was observed between excessive daytime sleepiness and SRBD (p = .036). CONCLUSION Our findings reveal a high prevalence of SRBD in newly diagnosed, untreated RA and PsA patients in ESS and RPG, with excessive daytime sleepiness being a reliable predictor of SRBD. Patients with RA exhibited a higher predisposition to SAS. We therefore suggest incorporating ESS and RPG as screening tools in RA or PsA for early detection and management of SRBD.
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Affiliation(s)
- Simon M Petzinna
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany.
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Lone Winter
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Dirk Skowasch
- Clinic of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Carmen Pizarro
- Clinic of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Clinic of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Daniel Kütting
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Claus-Jürgen Bauer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Valentin S Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
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Inchingolo F, Inchingolo AM, Fatone MC, Avantario P, Del Vecchio G, Pezzolla C, Mancini A, Galante F, Palermo A, Inchingolo AD, Dipalma G. Management of Rheumatoid Arthritis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:662. [PMID: 38928909 PMCID: PMC11203333 DOI: 10.3390/ijerph21060662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms "rheumatoid arthritis" and "primary care" from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs' approach to the disease and patients is mandatory.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Pasquale Avantario
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
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3
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Al-Maini M, Maindarkar M, Kitas GD, Khanna NN, Misra DP, Johri AM, Mantella L, Agarwal V, Sharma A, Singh IM, Tsoulfas G, Laird JR, Faa G, Teji J, Turk M, Viskovic K, Ruzsa Z, Mavrogeni S, Rathore V, Miner M, Kalra MK, Isenovic ER, Saba L, Fouda MM, Suri JS. Artificial intelligence-based preventive, personalized and precision medicine for cardiovascular disease/stroke risk assessment in rheumatoid arthritis patients: a narrative review. Rheumatol Int 2023; 43:1965-1982. [PMID: 37648884 DOI: 10.1007/s00296-023-05415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
The challenges associated with diagnosing and treating cardiovascular disease (CVD)/Stroke in Rheumatoid arthritis (RA) arise from the delayed onset of symptoms. Existing clinical risk scores are inadequate in predicting cardiac events, and conventional risk factors alone do not accurately classify many individuals at risk. Several CVD biomarkers consider the multiple pathways involved in the development of atherosclerosis, which is the primary cause of CVD/Stroke in RA. To enhance the accuracy of CVD/Stroke risk assessment in the RA framework, a proposed approach involves combining genomic-based biomarkers (GBBM) derived from plasma and/or serum samples with innovative non-invasive radiomic-based biomarkers (RBBM), such as measurements of synovial fluid, plaque area, and plaque burden. This review presents two hypotheses: (i) RBBM and GBBM biomarkers exhibit a significant correlation and can precisely detect the severity of CVD/Stroke in RA patients. (ii) Artificial Intelligence (AI)-based preventive, precision, and personalized (aiP3) CVD/Stroke risk AtheroEdge™ model (AtheroPoint™, CA, USA) that utilizes deep learning (DL) to accurately classify the risk of CVD/stroke in RA framework. The authors conducted a comprehensive search using the PRISMA technique, identifying 153 studies that assessed the features/biomarkers of RBBM and GBBM for CVD/Stroke. The study demonstrates how DL models can be integrated into the AtheroEdge™-aiP3 framework to determine the risk of CVD/Stroke in RA patients. The findings of this review suggest that the combination of RBBM with GBBM introduces a new dimension to the assessment of CVD/Stroke risk in the RA framework. Synovial fluid levels that are higher than normal lead to an increase in the plaque burden. Additionally, the review provides recommendations for novel, unbiased, and pruned DL algorithms that can predict CVD/Stroke risk within a RA framework that is preventive, precise, and personalized.
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Affiliation(s)
- Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON, L4Z 4C4, Canada
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA
- Asia Pacific Vascular Society, New Delhi, 110001, India
| | - George D Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, DY1 2HQ, UK
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, M13 9PL, UK
| | - Narendra N Khanna
- Asia Pacific Vascular Society, New Delhi, 110001, India
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, 110001, India
| | | | - Amer M Johri
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Canada
| | - Laura Mantella
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Vikas Agarwal
- Department of Immunology, SGPIMS, Lucknow, 226014, India
| | - Aman Sharma
- Department of Immunology, SGPIMS, Lucknow, 226014, India
| | - Inder M Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124, Thessaloniki, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, 94574, USA
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124, Cagliari, Italy
| | - Jagjit Teji
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753, Delmenhorst, Germany
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, UHID, 10 000, Zagreb, Croatia
| | - Zoltan Ruzsa
- Invasive Cardiology Division, University of Szeged, Szeged, Hungary
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, 95823, USA
| | - Martin Miner
- Men's Health Centre, Miriam Hospital Providence, Providence, RI, 02906, USA
| | - Manudeep K Kalra
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of the Republic of Serbia, University of Belgrade, 11000, Belgrade, Serbia
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138, Cagliari, Italy
| | - Mostafa M Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID, 83209, USA
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA.
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4
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Nattagh‐Eshtivani E, Pahlavani N, Ranjbar G, Gholizadeh Navashenaq J, Salehi‐Sahlabadi A, Mahmudiono T, Nader Shalaby M, Jokar M, Nematy M, Barghchi H, Havakhah S, Maddahi M, Rashidmayvan M, Khosravi M. Does propolis have any effect on rheumatoid arthritis? A review study. Food Sci Nutr 2022; 10:1003-1020. [PMID: 35432965 PMCID: PMC9007309 DOI: 10.1002/fsn3.2684] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/05/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease in which inflammation and oxidative stress play a key role in its pathophysiology. Complementary therapies along with medications may be effective in the control of RA. Propolis is a natural substance extracted from beehives, which have confirmed anti-inflammatory and antioxidant effects. The present study aimed to review the possible effects of propolis on inflammation, oxidative stress, and lipid profile in patients with RA. English articles in online databases such as PubMed‑Medline, AMED, Google Scholar, EMBASE, Scopus, and Web of Science databases were searched. Pieces of evidence show that supplementation with propolis may have therapeutic effects on RA patients. Due to increased inflammation and oxidative stress in the affected joints of RA patients, propolis could inhibit the inflammatory cascades by inhibiting the nuclear factor kappa B pathway and reducing reactive oxygen species, malondialdehyde, and interleukin-17 by increasing some antioxidants. Therefore, inflammation and pain reduce, helping improve and control RA in patients. Further investigations are required with larger sample sizes and different doses of propolis to demonstrate the definite effects of propolis on various aspects of RA.
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Affiliation(s)
- Elyas Nattagh‐Eshtivani
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | - Naseh Pahlavani
- Health Sciences Research CenterTorbat Heydariyeh University of Medical SciencesTorbat HeydariyehIran
- Children Growth and Development Research CenterResearch Institute for Prevention of Non‐Communicable DiseaseQazvin University of Medical SciencesQazvinIran
| | - Golnaz Ranjbar
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Ammar Salehi‐Sahlabadi
- Student Research CommitteeDepartment of Clinical Nutrition and DieteticsSchool of Nutrition and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Trias Mahmudiono
- Departmentof NutritionFaculty of Public HealthUniversitas AirlanggaAirlanggaIndonesia
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health DepartmentFaculty of Physical EducationSuez Canal UniversityIsmailiaEgypt
| | - Mohammadhassan Jokar
- Rheumatic Diseases Research CenterSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohsen Nematy
- Metabolic Syndrome Research CenterMashhad University of Medical SciencesMashhadIran
| | - Hanieh Barghchi
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
| | - Shahrzad Havakhah
- Addiction and Behavioral Sciences Research CenterNorth Khorasan University of Medical SciencesBojnurdIran
| | - Mona Maddahi
- Student Research CommitteeMashhad University of Medical SciencesMashhadIran
| | | | - Maryam Khosravi
- Department of NutritionSchool of MedicineMashhad University of Medical SciencesMashhadIran
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5
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Nattagh‐Eshtivani E, Pahlavani N, Ranjbar G, Gholizadeh Navashenaq J, Salehi‐Sahlabadi A, Mahmudiono T, Nader Shalaby M, Jokar M, Nematy M, Barghchi H, Havakhah S, Maddahi M, Rashidmayvan M, Khosravi M. Does propolis have any effect on rheumatoid arthritis? A review study. Food Sci Nutr 2022. [DOI: https:/doi.org/10.1002/fsn3.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Elyas Nattagh‐Eshtivani
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Naseh Pahlavani
- Health Sciences Research Center Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
- Children Growth and Development Research Center Research Institute for Prevention of Non‐Communicable Disease Qazvin University of Medical Sciences Qazvin Iran
| | - Golnaz Ranjbar
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | | | - Ammar Salehi‐Sahlabadi
- Student Research Committee Department of Clinical Nutrition and Dietetics School of Nutrition and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Trias Mahmudiono
- Departmentof Nutrition Faculty of Public Health Universitas Airlangga Airlangga Indonesia
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health Department Faculty of Physical Education Suez Canal University Ismailia Egypt
| | - Mohammadhassan Jokar
- Rheumatic Diseases Research Center School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Hanieh Barghchi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Shahrzad Havakhah
- Addiction and Behavioral Sciences Research Center North Khorasan University of Medical Sciences Bojnurd Iran
| | - Mona Maddahi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
| | | | - Maryam Khosravi
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
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6
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Nattagh‐Eshtivani E, Pahlavani N, Ranjbar G, Gholizadeh Navashenaq J, Salehi‐Sahlabadi A, Mahmudiono T, Nader Shalaby M, Jokar M, Nematy M, Barghchi H, Havakhah S, Maddahi M, Rashidmayvan M, Khosravi M. Does propolis have any effect on rheumatoid arthritis? A review study. Food Sci Nutr 2022. [DOI: https://doi.org/10.1002/fsn3.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Elyas Nattagh‐Eshtivani
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Naseh Pahlavani
- Health Sciences Research Center Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
- Children Growth and Development Research Center Research Institute for Prevention of Non‐Communicable Disease Qazvin University of Medical Sciences Qazvin Iran
| | - Golnaz Ranjbar
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | | | - Ammar Salehi‐Sahlabadi
- Student Research Committee Department of Clinical Nutrition and Dietetics School of Nutrition and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Trias Mahmudiono
- Departmentof Nutrition Faculty of Public Health Universitas Airlangga Airlangga Indonesia
| | - Mohammed Nader Shalaby
- Biological Sciences and Sports Health Department Faculty of Physical Education Suez Canal University Ismailia Egypt
| | - Mohammadhassan Jokar
- Rheumatic Diseases Research Center School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Hanieh Barghchi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Shahrzad Havakhah
- Addiction and Behavioral Sciences Research Center North Khorasan University of Medical Sciences Bojnurd Iran
| | - Mona Maddahi
- Student Research Committee Mashhad University of Medical Sciences Mashhad Iran
| | | | - Maryam Khosravi
- Department of Nutrition School of Medicine Mashhad University of Medical Sciences Mashhad Iran
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7
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Braz NFT, Pinto MRC, Vieira ÉLM, Souza AJ, Teixeira AL, Simões-E-Silva AC, Kakehasi AM. Renin-angiotensin system molecules are associated with subclinical atherosclerosis and disease activity in rheumatoid arthritis. Mod Rheumatol 2020; 31:119-126. [PMID: 32149558 DOI: 10.1080/14397595.2020.1740418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare serum levels of RAS components in women with RA versus healthy females and to investigate the association between these molecules and subclinical atherosclerosis. METHODS A cross-sectional study involving female RA patients without ischemic CVD. Disease activity was assessed using the DAS28 and the CDAI. IMT of the common carotid artery was evaluated by ultrasonography. Serum levels of Ang II, Ang-(1-7), ACE and ACE2 were determined by enzyme immunoassay. RESULTS Fifty women with RA, mean 48.2 (7.3) years, were compared to 30 healthy women, paired by age. RA patients had higher plasma levels of Ang II (p < .01), Ang-(1-7) (p < .01), and ACE (p < .01) than controls. The ratios of ACE to ACE2 were higher in RA patients, whereas Ang II/Ang-(1-7) ratios were lower in RA patients. The presence of hypertension and the treatment with ACE inhibitors did not significantly modify serum levels of Ang II, Ang-(1-7), ACE and ACE2 in patients with RA. Seven RA patients had altered IMT, and eight patients exhibited atherosclerotic plaque. There was a negative correlation between ACE2 levels and IMT (p = .041). IMT positively correlated with age (p = .022), disease duration (p = .012) and overall Framingham risk score (p = .008). Ang II concentrations positively correlated with DAS28 (p = .034) and CDAI (p = .040). CONCLUSION Patients with RA had an activation of the RAS, suggesting an association with disease activity and cardiovascular risk. Rheumatological key messages Imbalance of both RAS axes may be associated with cardiovascular risk and disease activity in rheumatoid arthritis. Ultrasonography of the carotid arteries can identify early, subclinical atherosclerotic disease in rheumatoid arthritis patients. Angiotensin-converting enzyme inhibition or angiotensin 1 receptor blockade may be beneficial for rheumatoid arthritis patients.
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Affiliation(s)
- Nayara Felicidade Tomaz Braz
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Raquel C Pinto
- Rheumatology Unit, Clinic Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Antonio Lucio Teixeira
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana C Simões-E-Silva
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Maria Kakehasi
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Locomotor Apparatus Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
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8
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Guimarães MFBDR, de Andrade MVM, Machado CJ, Vieira ÉLM, Pinto MRDC, Júnior ALT, Kakehasi AM. Leptin as an obesity marker in rheumatoid arthritis. Rheumatol Int 2018; 38:1671-1677. [PMID: 29947997 DOI: 10.1007/s00296-018-4082-5] [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: 05/11/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022]
Abstract
The determination of excess of body fat mass provides a more suitable determinant of obesity in rheumatoid arthritis patients; however, body mass index (BMI) may not be accurate for the quantification of adiposity. To identify a marker of excess adiposity in women with rheumatoid arthritis (RA) using different methods for fat mass evaluation. A cross-sectional study was conducted in adult female patients with RA. Disease activity was assessed by DAS28-ESR, and obesity was determined by waist circumference (WC), BMI and dual-energy X-ray absorptiometry (DXA). The Human Bone Metabolism kit (Merck Millipore, Darmstadt, Alemanha) was used to determine the plasma levels of leptin, TNF-α, IL-6, and IL-1β by quantification of serum proteins by technical microspheres (LUMINEX, TX, USA). Adiponectin was measured by enzyme-linked immunosorbent assay sandwich kit (R&D Systems, Minneapolis, MN, USA). Eighty-nine female patients, median age of 55.4 (± 11.6) years, and median disease duration of 16.4 (± 14.9) years were included. The frequency of obesity was 33.7% according to BMI, 89.9% with WC, and 56.1% with DXA. The median serum leptin concentration was the only marker that correlated with body fat percentage according to the three methods. This correlation was positive and not influenced by DAS28, C-reactive protein, erythrocyte sedimentation rate, or inflammatory cytokines levels (IL-6, TNF-α, IL-1β). Analysis of ROC curves determined the cut-off point of 10.3 ng/mL of leptin as an obesity marker, with a sensitivity of 96.43% and a specificity of 23.81%. Serum leptin correlates positively with fat mass and is potentially useful in excess fat mass determination in clinical practice.
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Affiliation(s)
| | | | | | | | - Maria Raquel da Costa Pinto
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Adriana Maria Kakehasi
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,Faculdade de Medicina, UFMG, Belo Horizonte, Brazil
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9
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Demmelmaier I, Björk A, Dufour AB, Nordgren B, Opava CH. Trajectories of Fear-Avoidance Beliefs on Physical Activity Over Two Years in People With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:695-702. [PMID: 28941003 PMCID: PMC5947112 DOI: 10.1002/acr.23419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022]
Abstract
Objective To identify and describe 2‐year trajectories of fear‐avoidance beliefs on physical activity and to identify predictors of these trajectories in people with rheumatoid arthritis (RA). Methods We included 2,569 persons with RA (77% women, mean age 58 years). Data on fear‐avoidance beliefs (Fear‐Avoidance Beliefs Questionnaire physical activity subscale [FABQ‐PA]; range 0–24), sociodemographics, disease‐related variables, self‐efficacy, and health‐enhancing physical activity (HEPA) were collected from registers and by questionnaires at baseline, 14, and 26 months. K‐means cluster analysis was used to identify fear‐avoidance trajectories, and multinomial logistic regression was used to identify predictors of trajectory membership. Results Three trajectories of fear‐avoidance beliefs were identified: low (n = 1,060, mean FABQ‐PA = 3), moderate (n = 1,043, mean FABQ‐PA = 9), and high (n = 466, mean FABQ‐PA = 15). Consistent predictors of being in the high fear‐avoidance trajectory versus the other 2 trajectories were high activity limitation, male sex, income below average, not performing current HEPA, and elevated anxiety/depression. In addition, less consistent predictors such as shorter education, more pain, and low exercise self‐efficacy were also identified. Conclusion Stable trajectories of fear‐avoidance beliefs on physical activity exist among people with RA. Fear‐avoidance may be targeted more effectively by tailoring physical activity promotion to vulnerable socioeconomic groups, men, and those with high activity limitation and anxiety/depression.
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Affiliation(s)
| | | | - Alyssa B Dufour
- Karolinska Institutet, Stockholm, Sweden, and Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Birgitta Nordgren
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christina H Opava
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Scanlon EM, Mankad R, Crowson CS, Kullo IJ, Mulvagh SL, Matteson EL, Kvrgic Z, Davis JM. Cardiovascular risk assessment in patients with rheumatoid arthritis: a correlative study of noninvasive arterial health testing. Clin Rheumatol 2016; 36:763-771. [PMID: 27988813 DOI: 10.1007/s10067-016-3515-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
This study aimed to determine the relationship between noninvasive measures of arterial health and both estimated 10-year cardiovascular risk and measures of disease activity over time in established rheumatoid arthritis. Fifty rheumatoid arthritis patients underwent noninvasive arterial health testing (brachial artery reactivity, aortic augmentation index [AIx], pulse wave velocity, carotid artery intima-media thickness, and carotid artery plaque presence) and assessment of clinical disease activity (tender or swollen joint counts, Clinical Disease Activity Index [CDAI], and Health Assessment Questionnaire II [HAQ-II]). Clinical measures during 3 years before the study visit were averaged. Arterial health testing was compared with the American Heart Association/American College of Cardiology (AHA/ACC) Pooled Cohort Equation. Spearman methods identified correlations between disease activity measures, cardiac biomarkers, and arterial health parameters. Among the patients (mean age, 57.5 years), disease activity was moderate (mean [SD] CDAI, 16.9 [15.3]). At the study visit, corrected aortic augmentation index correlated with CDAI (r = 0.37, P = .009) and HAQ-II (r = 0.33, P = .02). AIx correlated with time-averaged tender joint count (r = 0.37, P = .008), CDAI (r = 0.36, P = .01), HAQ-II (r = 0.36, P = .01), swollen joint count (r = 0.36, P = .10), patient global assessment (r = 0.33, P = .02), physician global assessment (r = 0.35, P = .01), and pain score (r = 0.38, P = .007). The AHA/ACC low-risk group (<5% 10-year risk) had highest prevalence of carotid plaques. Arterial health testing may identify increased risk of cardiovascular disease compared with risk obtained through AHA/ACC Pooled Cohort Equation. Measures of arterial stiffness correlate with the burden of disease activity over time.
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Affiliation(s)
- Erin M Scanlon
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sharon L Mulvagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Zoran Kvrgic
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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van Breukelen—van der Stoep DF, van Zeben D, Klop B, van de Geijn GJM, Janssen HJW, Hazes MJMW, Birnie E, van der Meulen N, De Vries MA, Castro Cabezas M. Association of Cardiovascular Risk Factors with Carotid Intima Media Thickness in Patients with Rheumatoid Arthritis with Low Disease Activity Compared to Controls: A Cross-Sectional Study. PLoS One 2015; 10:e0140844. [PMID: 26485681 PMCID: PMC4617300 DOI: 10.1371/journal.pone.0140844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/01/2015] [Indexed: 02/07/2023] Open
Abstract
Objectives Rheumatoid arthritis (RA) has been identified as an independent cardiovascular risk factor. The importance of risk factors such as hypertension and hyperlipidemia in the generation of atherosclerosis in RA patients is unclear. This study analyzed clinical parameters associated with carotid intima media thickness (cIMT) in patients with RA. Methods Subjects with RA and healthy controls without RA, both without known cardiovascular disease, were included. Participants underwent a standard physical examination and laboratory measurements including a lipid profile. cIMT was measured semi-automatically by ultrasound. Results In total 243 RA patients and 117 controls were included. The median RA disease duration was 7 years (IQR 2–14 years). The median DAS28 was 2.4 (IQR 1.6–3.2) and 114 (50.4%) of the RA patients were in remission. The presence of RA and cIMT were not associated (univariate analysis). Multivariable regression analysis showed that cIMT in RA patients was associated with age (B = 0.006, P<0.001) and systolic blood pressure (B = 0.003, P = 0.003). In controls, cIMT was associated with age (B = 0.006, P<0.001) and smoking (B = 0.097, P = 0.001). Conclusion cIMT values were similar between RA patients and controls. Hypertension was strongly associated with cIMT in RA patients. After adjustment, no association between cIMT and specific RA disease characteristics was found in this well treated RA cohort.
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Affiliation(s)
| | - Derkjen van Zeben
- Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Boudewijn Klop
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Hans J. W. Janssen
- Department of Clinical Chemistry, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Erwin Birnie
- Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- Statistics and Education, St. Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Noelle van der Meulen
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Marijke A. De Vries
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
- * E-mail:
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12
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Zhang J, Chen L, Delzell E, Muntner P, Hillegass WB, Safford MM, Millan IYN, Crowson CS, Curtis JR. Republished: The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Postgrad Med J 2015; 90:722-9. [PMID: 25431465 DOI: 10.1136/postgradmedj-2013-204715rep] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. METHODS We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. RESULTS We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. CONCLUSIONS This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.
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Affiliation(s)
- Jie Zhang
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lang Chen
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William B Hillegass
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Iris Yolanda Navarro Millan
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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13
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Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.
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14
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van Breukelen-van der Stoep DF, Zijlmans J, van Zeben D, Klop B, van de Geijn GJM, van der Meulen N, Hazes M, Birnie E, Castro Cabezas M. Adherence to cardiovascular prevention strategies in patients with rheumatoid arthritis. Scand J Rheumatol 2015; 44:443-8. [PMID: 26169960 DOI: 10.3109/03009742.2015.1028997] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular disease (CVD). Recent national and international guidelines suggest strict treatment of CVD risk factors in RA. The aim of this study was to evaluate the self-reported adherence to CV prevention strategies in patients with RA. METHOD RA patients visiting an outpatient clinic for strict CVD risk management received a validated questionnaire to evaluate adherence to CV prevention strategies. Strict treatment targets were defined and lifestyle recommendations were given following a prespecified protocol. CVD risk was assessed using the SCORE algorithm. RESULTS In total, 111 questionnaires were returned (response rate of 82%). A high 10-year CVD risk (≥ 20%) was present in 53%, but only 3% thought they had an increased CVD risk. A total of 53% of patients reported that they 'follow the doctors' suggestions exactly' and 75% reported finding it 'easy to follow the suggestions'. Of the 69% of patients who were prescribed lipid- and/or blood pressure-lowering drugs, 90% reported taking all prescribed tablets. The advice to follow a diet was given to 42%, of whom 68% said they followed the advised diet. Physical exercise was advised to 67%, of whom 62% said they performed specific physical exercise on at least 3 days a week. The adherence to lifestyle recommendations was not significantly different across the CVD risk groups. CONCLUSIONS RA patients tend to underestimate their CVD risk. The self-reported adherence of RA patients to CVD risk management was high concerning pharmaceutical interventions and moderate in the case of lifestyle interventions.
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Affiliation(s)
| | - J Zijlmans
- a Department of Rheumatology , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
| | - D van Zeben
- a Department of Rheumatology , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
| | - B Klop
- b Department of Internal Medicine , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
| | - G J M van de Geijn
- c Department of Clinical Chemistry , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
| | - N van der Meulen
- b Department of Internal Medicine , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
| | - M Hazes
- d Department of Rheumatology , Erasmus Medical Centre , Rotterdam , The Netherlands
| | - E Birnie
- e Institute of Health Policy and Management , Erasmus University , Rotterdam , The Netherlands.,f Statistics and Education , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
| | - M Castro Cabezas
- b Department of Internal Medicine , Sint Franciscus Gasthuis , Rotterdam , The Netherlands
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15
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Helli B, Mowla K, Mohammadshahi M, Jalali MT. Effect of Sesamin Supplementation on Cardiovascular Risk Factors in Women with Rheumatoid Arthritis. J Am Coll Nutr 2015; 35:300-7. [DOI: 10.1080/07315724.2015.1005198] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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16
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Hollan I, Dessein PH, Ronda N, Wasko MC, Svenungsson E, Agewall S, Cohen-Tervaert JW, Maki-Petaja K, Grundtvig M, Karpouzas GA, Meroni PL. Prevention of cardiovascular disease in rheumatoid arthritis. Autoimmun Rev 2015; 14:952-69. [PMID: 26117596 DOI: 10.1016/j.autrev.2015.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022]
Abstract
The increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) has been recognized for many years. However, although the characteristics of CVD and its burden resemble those in diabetes, the focus on cardiovascular (CV) prevention in RA has lagged behind, both in the clinical and research settings. Similar to diabetes, the clinical picture of CVD in RA may be atypical, even asymptomatic. Therefore, a proactive screening for subclinical CVD in RA is warranted. Because of the lack of clinical trials, the ideal CVD prevention (CVP) in RA has not yet been defined. In this article, we focus on challenges and controversies in the CVP in RA (such as thresholds for statin therapy), and propose recommendations based on the current evidence. Due to the significant contribution of non-traditional, RA-related CV risk factors, the CV risk calculators developed for the general population underestimate the true risk in RA. Thus, there is an enormous need to develop adequate CV risk stratification tools and to identify the optimal CVP strategies in RA. While awaiting results from randomized controlled trials in RA, clinicians are largely dependent on the use of common sense, and extrapolation of data from studies on other patient populations. The CVP in RA should be based on an individualized evaluation of a broad spectrum of risk factors, and include: 1) reduction of inflammation, preferably with drugs decreasing CV risk, 2) management of factors associated with increased CV risk (e.g., smoking, hypertension, hyperglycemia, dyslipidemia, kidney disease, depression, periodontitis, hypothyroidism, vitamin D deficiency and sleep apnea), and promotion of healthy life style (smoking cessation, healthy diet, adjusted physical activity, stress management, weight control), 3) aspirin and influenza and pneumococcus vaccines according to current guidelines, and 4) limiting use of drugs that increase CV risk. Rheumatologists should take responsibility for the education of health care providers and RA patients regarding CVP in RA. It is immensely important to incorporate CV outcomes in testing of anti-rheumatic drugs.
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Affiliation(s)
- I Hollan
- Lillehammer Hospital for Rheumatic Diseases, Norway
| | - P H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Ronda
- Department of Pharmacy, University of Parma, Italy
| | - M C Wasko
- Department of Rheumatology, West Penn Hospital Allegheny Health Network, USA
| | - E Svenungsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - S Agewall
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - J W Cohen-Tervaert
- Clinical and Experimental Immunology, Maastricht University, Maastricht, The Netherlands
| | - K Maki-Petaja
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - M Grundtvig
- Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway
| | - G A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, USA; Los Angeles Biomedical Research Institute, Torrance, USA
| | - P L Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Italy; IRCCS Istituto Auxologico Italiano, Italy
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17
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Smakotina SA, Zelendinova AR, Bondareva IN, Berns SA. Pleiotropic effects of atorvastatin in rheumatoid arthritis patients with no history of cardiovascular diseases. TERAPEVT ARKH 2015; 87:72-76. [DOI: 10.17116/terarkh201587972-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Zhang J, Chen L, Delzell E, Muntner P, Hillegass WB, Safford MM, Millan IYN, Crowson CS, Curtis JR. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis 2014; 73:1301-8. [PMID: 24796336 DOI: 10.1136/annrheumdis-2013-204715] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. METHODS We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. RESULTS We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. CONCLUSIONS This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.
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Affiliation(s)
- Jie Zhang
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lang Chen
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William B Hillegass
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Iris Yolanda Navarro Millan
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Chung WS, Lin CL, Peng CL, Chen YF, Lu CC, Sung FC, Kao CH. Rheumatoid arthritis and risk of acute myocardial infarction--a nationwide retrospective cohort study. Int J Cardiol 2013; 168:4750-4. [PMID: 23938220 DOI: 10.1016/j.ijcard.2013.07.233] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) imposes substantial social costs, including an increased risk of work-related disability and accelerated cardiovascular diseases. The aim of the study is to determine the risk of acute myocardial infarction (AMI) associated with RA in a nationwide retrospective cohort study. METHODS Using the catastrophic illness registry of the Taiwan National Health Insurance Research Database (NHIRD), we identified patients with RA from 1998 to 2010. We also randomly selected non-RA controls frequency-matched by age, sex, and index year from the general population free of RA. The risk of AMI was analyzed using Cox proportional hazards regression models including sex, age, and comorbidities. RESULTS From a total of 23.74 million people in the cohort, 29,260 RA patients and 117,040 controls were followed for 193,987 and 792,254 person-years, respectively. The incidence density rate increased in all groups of RA patients than those of the controls. RA patients had a 1.33-fold higher overall incidence of AMI than controls, with an adjusted hazard ration of 1.38. Although the overall adjusted hazard ratio of AMI increased with age, the age-specific RA patients to controls incidence rate ratio was higher for younger RA patients. Subjects with comorbidities of hypertension, diabetes hyperlipidemia, CVA, COPD, or ESRD had increased risk of AMI. Subjects with ESRD had the highest hazard of AMI. CONCLUSION This nationwide retrospective cohort study indicates that AMI risk increased by 38% in RA patients compared to the general population. Comorbidities increase the AMI risk independently.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Department of Health, Executive Yuan, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Rivera VM, Jeffery DR, Weinstock-Guttman B, Bock D, Dangond F. Results from the 5-year, phase IV RENEW (Registry to Evaluate Novantrone Effects in Worsening Multiple Sclerosis) study. BMC Neurol 2013; 13:80. [PMID: 23841877 PMCID: PMC3710498 DOI: 10.1186/1471-2377-13-80] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 07/01/2013] [Indexed: 12/22/2022] Open
Abstract
Background Registry to Evaluate Novantrone Effects in Worsening Multiple Sclerosis (RENEW) was a 5-year, phase IV study in which the safety of Mitoxantrone was monitored in a patient cohort from the United States (US). The objective of the study was to evaluate the long-term safety profile of Mitoxantrone in patients with secondary progressive multiple sclerosis (SPMS), progressive relapsing multiple sclerosis (PRMS), and worsening relapsing-remitting multiple sclerosis (RRMS). Methods Overall, 509 patients (395 SPMS, 81 worsening RRMS, 33 PRMS) were enrolled and treated at 46 multiple sclerosis (MS) treatment centers located in the US. Patients received Mitoxantrone in accordance with the package insert every 3 months. During the treatment phase, patients received laboratory workups and cardiac monitoring every 3 months and then annually for a total of 5 years. Results Five hundred and nine subjects were enrolled in this trial and received at least one infusion of Mitoxantrone. Overall, 172 (33.8%) completed the 5-year trial (i.e., participated for 5 years ± 3 months [treatment + follow-up]); 337 (66.2%) did not complete the 5-year trial. Annual follow-up data were available for 250 of 509 enrolled patients. Left ventricular ejection fraction reduction under 50% was reported in 27 (5.3%) patients during the treatment phase (n = 509) and 14 (5.6%) patients during the annual follow-up phase (n = 250). Signs and symptoms of congestive heart failure were observed in 10 (2.0%) patients (six during treatment phase and four during the annual follow-up phase). Post-hoc analyses of the risk for cardiotoxicity outcomes revealed that cumulative dose exposure is the primary risk factor associated with the risk of cardiac toxicity with Mitoxantrone. Therapy-related leukemia was reported in three (0.6%) patients who received total cumulative Mitoxantrone doses of 73.5 mg/m2, 107.3 mg/m2, and 97.1 mg/m2 respectively. During the treatment phase, persistent amenorrhea developed in 22% (28/128) of women with regular menses and 51% (25/49) of women with irregular menses at baseline. During the annual follow-up phase, persistent amenorrhea developed in 5% (4/73) of women with regular menses at baseline. Conclusion RENEW results are consistent with the known safety profile of Mitoxantrone, and provide additional long-term safety data for Mitoxantrone in MS patients.
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Cardiovascular disease in autoimmune rheumatic diseases. Autoimmun Rev 2013; 12:1004-15. [PMID: 23541482 DOI: 10.1016/j.autrev.2013.03.013] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 03/07/2013] [Indexed: 12/18/2022]
Abstract
Various autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis, spondyloarthritis, vasculitis and systemic lupus erythematosus, are associated with premature atherosclerosis. However, premature atherosclerosis has not been uniformly observed in systemic sclerosis. Furthermore, although experimental models of atherosclerosis support the role of antiphospholipid antibodies in atherosclerosis, there is no clear evidence of premature atherosclerosis in antiphospholipid syndrome (APA). Ischemic events in APA are more likely to be caused by pro-thrombotic state than by enhanced atherosclerosis. Cardiovascular disease (CVD) in ARDs is caused by traditional and non-traditional risk factors. Besides other factors, inflammation and immunologic abnormalities, the quantity and quality of lipoproteins, hypertension, insulin resistance/hyperglycemia, obesity and underweight, presence of platelets bearing complement protein C4d, reduced number and function of endothelial progenitor cells, apoptosis of endothelial cells, epigenetic mechanisms, renal disease, periodontal disease, depression, hyperuricemia, hypothyroidism, sleep apnea and vitamin D deficiency may contribute to the premature CVD. Although most research has focused on systemic inflammation, vascular inflammation may play a crucial role in the premature CVD in ARDs. It may be involved in the development and destabilization of both atherosclerotic lesions and of aortic aneurysms (a known complication of ARDs). Inflammation in subintimal vascular and perivascular layers appears to frequently occur in CVD, with a higher frequency in ARD than in non-ARD patients. It is possible that this inflammation is caused by infections and/or autoimmunity, which might have consequences for treatment. Importantly, drugs targeting immunologic factors participating in the subintimal inflammation (e.g., T- and B-cells) might have a protective effect on CVD. Interestingly, vasa vasorum and cardiovascular adipose tissue may play an important role in atherogenesis. Inflammation and complement depositions in the vessel wall are likely to contribute to vascular stiffness. Based on biopsy findings, also inflammation in the myocardium and small vessels may contribute to premature CVD in ARDs (cardiac ischemia and heart failure). There is an enormous need for an improved CVD prevention in ARDs. Studies examining the effect of DMARDs/biologics on vascular inflammation and CV risk are warranted.
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Cardiovascular disease in rheumatoid arthritis: a systematic literature review in latin america. ARTHRITIS 2012. [PMID: 23193471 PMCID: PMC3501796 DOI: 10.1155/2012/371909] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background. Cardiovascular disease (CVD) is the major predictor of poor prognosis in rheumatoid arthritis (RA) patients. There is an increasing interest to identify "nontraditional" risk factors for this condition. Latin Americans (LA) are considered as a minority subpopulation and ethnically different due to admixture characteristics. To date, there are no systematic reviews of the literature published in LA and the Caribbean about CVD in RA patients. Methods. The systematic literature review was done by two blinded reviewers who independently assessed studies for eligibility. The search was completed through PubMed, LILACS, SciELO, and Virtual Health Library scientific databases. Results. The search retrieved 10,083 potential studies. A total of 16 articles concerning cardiovascular risk factors and measurement of any cardiovascular outcome in LA were included. The prevalence of CVD in LA patients with RA was 35.3%. Non-traditional risk factors associated to CVD in this population were HLA-DRB1 shared epitope alleles, rheumatoid factor, markers of chronic inflammation, long duration of RA, steroids, familial autoimmunity, and thrombogenic factors. Conclusions. There is limited data about CVD and RA in LA. We propose to evaluate cardiovascular risk factors comprehensively in the Latin RA patient and to generate specific public health policies in order to diminish morbi-mortality rates.
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García-Bermúdez M, López-Mejías R, González-Juanatey C, Castañeda S, Miranda-Filloy JA, Blanco R, Fernández-Gutiérrez B, Balsa A, González-Álvaro I, Gómez-Vaquero C, Llorca J, Martín J, González-Gay MA. Association of the methionine sulfoxide reductase A rs10903323 gene polymorphism with cardiovascular disease in patients with rheumatoid arthritis. Scand J Rheumatol 2012; 41:350-3. [DOI: 10.3109/03009742.2012.677063] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Till S. Physical activity, a lasting legacy from the 2012 Olympics and Paralympics. Rheumatology (Oxford) 2012; 51:1141-2. [DOI: 10.1093/rheumatology/kes136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Kastrup J. Can YKL-40 be a new inflammatory biomarker in cardiovascular disease? Immunobiology 2012; 217:483-91. [DOI: 10.1016/j.imbio.2011.04.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 02/08/2011] [Accepted: 04/21/2011] [Indexed: 12/28/2022]
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26
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BOEHNCKE WOLFHENNING. Epidemiology and Potential Pathomechanisms of Cardiovascular Comorbidities in Psoriasis: A Report from the GRAPPA 2010 Annual Meeting. J Rheumatol 2012; 39:441-4. [DOI: 10.3899/jrheum.111245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is increasing awareness that psoriasis is more than “skin deep.” Several recent reviews focused on biomarkers have indicated the systemic dimension of psoriasis and the comorbidity that psoriasis shares with other chronic inflammatory diseases. Of emerging significance is the relationship to cardiovascular disease, which contributes substantially to patients’ increased mortality. This article examines currently available evidence favoring the concept of a causal link between psoriasis and cardiovascular disease, and summarizes a report represented at the 2010 Annual Meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis).
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Niemi K, Teirilä L, Lappalainen J, Rajamäki K, Baumann MH, Öörni K, Wolff H, Kovanen PT, Matikainen S, Eklund KK. Serum amyloid A activates the NLRP3 inflammasome via P2X7 receptor and a cathepsin B-sensitive pathway. THE JOURNAL OF IMMUNOLOGY 2011; 186:6119-28. [PMID: 21508263 DOI: 10.4049/jimmunol.1002843] [Citation(s) in RCA: 214] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serum amyloid A (SAA) is an acute-phase protein, the serum levels of which can increase up to 1000-fold during inflammation. SAA has a pathogenic role in amyloid A-type amyloidosis, and increased serum levels of SAA correlate with the risk for cardiovascular diseases. IL-1β is a key proinflammatory cytokine, and its secretion is strictly controlled by the inflammasomes. We studied the role of SAA in the regulation of IL-1β production and activation of the inflammasome cascade in human and mouse macrophages, as well as in THP-1 cells. SAA could provide a signal for the induction of pro-IL-1β expression and for inflammasome activation, resulting in secretion of mature IL-1β. Blocking TLR2 and TLR4 attenuated SAA-induced expression of IL1B, whereas inhibition of caspase-1 and the ATP receptor P2X(7) abrogated the release of mature IL-1β. NLRP3 inflammasome consists of the NLRP3 receptor and the adaptor protein apoptosis-associated speck-like protein containing CARD (a caspase-recruitment domain) (ASC). SAA-mediated IL-1β secretion was markedly reduced in ASC(-/-) macrophages, and silencing NLRP3 decreased IL-1β secretion, confirming NLRP3 as the SAA-responsive inflammasome. Inflammasome activation was dependent on cathepsin B activity, but it was not associated with lysosomal destabilization. SAA also induced secretion of cathepsin B and ASC. In conclusion, SAA can induce the expression of pro-IL-1β and activation of the NLRP3 inflammasome via P2X(7) receptor and a cathepsin B-sensitive pathway. Thus, during systemic inflammation, SAA may promote the production of IL-1β in tissues. Furthermore, the SAA-induced secretion of active cathepsin B may lead to extracellular processing of SAA and, thus, potentially to the development of amyloid A amyloidosis.
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Affiliation(s)
- Katri Niemi
- Wihuri Research Institute, 00140 Helsinki, Finland.
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Semerano L, Assier E, Delavallée L, Boissier MC. Kinoid of human tumor necrosis factor-alpha for rheumatoid arthritis. Expert Opin Biol Ther 2011; 11:545-50. [DOI: 10.1517/14712598.2011.566856] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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29
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Mathiasen AB, Henningsen KMA, Harutyunyan MJ, Mygind ND, Kastrup J. YKL-40: a new biomarker in cardiovascular disease? Biomark Med 2010; 4:591-600. [DOI: 10.2217/bmm.10.58] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular disease in the form of coronary artery disease is the most common cause of death in western countries. Early treatment with stabilizing drugs and mechanical revascularization by percutaneous coronary intervention or coronary bypass surgery has reduced the mortality significantly. But in spite of improved treatments, many patients are still plagued by a high frequency of angina symptoms, hospitalizations and a poor prognosis. There is a need for new independent or supplementary biomarkers that can help to predict cardiovascular disease and cardiovascular events earlier and more precisely, and thus accompany existing biomarkers in both primary and secondary cardiovascular prevention. One such potential new biomarker is the protein YKL-40. As an independent biomarker in both cardiovascular diseases and noncardiovascular diseases, current evidence suggests YKL-40 to be most useful as a marker of disease severity, prognosis and short survival. However, future studies will evaluate whether YKL-40 can be used for monitoring of the treatment effect in different patient populations with a distinct disease diagnosis. In this article we explore present knowledge on YKL-40 as a biomarker in cardiovascular disease.
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Affiliation(s)
- Anders Bruun Mathiasen
- Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Kristoffer Mads Aaris Henningsen
- Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Marina Jurjevna Harutyunyan
- Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Naja Dam Mygind
- Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Jens Kastrup
- Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Bartoloni E, Alunno A, Bistoni O, Gerli R. How early is the atherosclerotic risk in rheumatoid arthritis? Autoimmun Rev 2010; 9:701-7. [DOI: 10.1016/j.autrev.2010.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 06/02/2010] [Indexed: 12/25/2022]
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