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Lin S, Chen W, Alqahtani MS, Elkamchouchi DH, Ge Y, Lu Y, Zhang G, Wang M. Exploring the therapeutic potential of layered double hydroxides and transition metal dichalcogenides through the convergence of rheumatology and nanotechnology using generative adversarial network. ENVIRONMENTAL RESEARCH 2024; 241:117262. [PMID: 37839531 DOI: 10.1016/j.envres.2023.117262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/10/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
Two-dimensional Layered double hydroxides (LDHs) are highly used in the biomedical domain due to their biocompatibility, biodegradability, controlled drug loading and release capabilities, and improved cellular permeability. The interaction of LDHs with biological systems could facilitate targeted drug delivery and make them an attractive option for various biomedical applications. Rheumatoid Arthritis (RA) requires targeted drug delivery for optimum therapeutic outcomes. In this study, stacked double hydroxide nanocomposites with dextran sulphate modification (LDH-DS) were developed while exhibiting both targeting and pH-sensitivity for rheumatological conditions. This research examines the loading, release kinetics, and efficiency of the therapeutics of interest in the LDH-based drug delivery system. The mean size of LDH-DS particles (300.1 ± 8.12 nm) is -12.11 ± 0.4 mV. The encapsulation efficiency was 48.52%, and the loading efficacy was 16.81%. In vitro release tests indicate that the drug's discharge is modified more rapidly in PBS at pH 5.4 compared to pH 5.6, which later reached 7.3, showing the case sensitivity to pH. A generative adversarial network (GAN) is used to analyze the drug delivery system in rheumatology. The GAN model achieved high accuracy and classification rates of 99.3% and 99.0%, respectively, and a validity of 99.5%. The second and third administrations resulted in a significant change with p-values of 0.001 and 0.05, respectively. This investigation unequivocally demonstrated that LDH functions as a biocompatible drug delivery matrix, significantly improving delivery effectiveness.
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Affiliation(s)
- Suxian Lin
- Department of Rheumatology, Wenzhou People's Hospital, Wenzhou, 325000, China
| | - Weiwei Chen
- Department of Rheumatology, Wenzhou People's Hospital, Wenzhou, 325000, China
| | - Mohammed S Alqahtani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia; BioImaging Unit, Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH, U.K
| | - Dalia H Elkamchouchi
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Yisu Ge
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou 325100, China
| | - Yanjie Lu
- Department of Digital Media Technology, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Guodao Zhang
- Department of Digital Media Technology, Hangzhou Dianzi University, Hangzhou 310018, China.
| | - Mudan Wang
- Department of Nephrology, Wenzhou People's Hospital, Wenzhou, 325000, China.
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2
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Schreiber S, Rubin DT, Ng SC, Peyrin-Biroulet L, Danese S, Modesto I, Guo X, Su C, Kwok KK, Jo H, Chen Y, Yndestad A, Reinisch W, Dubinsky MC. Major Adverse Cardiovascular Events by Baseline Cardiovascular Risk in Patients with Ulcerative Colitis Treated with Tofacitinib: Data from the OCTAVE Clinical Programme. J Crohns Colitis 2023; 17:1761-1770. [PMID: 37402275 PMCID: PMC10673809 DOI: 10.1093/ecco-jcc/jjad104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/24/2023] [Accepted: 07/03/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease have increased risk of atherosclerotic cardiovascular [CV] disease [ASCVD]. Tofacitinib is an oral Janus kinase inhibitor for the treatment of ulcerative colitis [UC]. We report major adverse CV events [MACE] in the UC OCTAVE programme, stratified by baseline CV risk. METHODS Rates of MACE were analysed by baseline [first tofacitinib exposure] CV risk profile: prior ASCVD, or 10-year ASCVD risk categories [low, borderline, intermediate, high]. RESULTS Of 1157 patients [2814.4 patient-years of exposure; ≤7.8 years' tofacitinib treatment], 4% had prior ASCVD and 83% had no prior ASCVD and low-borderline baseline 10-year ASCVD risk. Eight [0.7%] patients developed MACE; one had prior ASCVD. Incidence rates [unique patients with events/100 patient-years of exposure; 95% confidence intervals] for MACE were: 0.95 [0.02-5.27] in patients with prior ASCVD; and 1.81 [0.05-10.07], 1.54 [0.42-3.95], 0.00 [0.00-2.85], and 0.09 [0.01-0.32] in patients without prior ASCVD and with high, intermediate, -borderline, and low baseline 10-year ASCVD risk, respectively. For the 5/7 patients with MACE and without prior ASCVD, 10-year ASCVD risk scores were numerically higher [>1%] prior to MACE versus at baseline, primarily due to increasing age. CONCLUSIONS Most patients receiving tofacitinib in the UC OCTAVE programme had low baseline 10-year ASCVD risk. MACE were more frequent in patients with prior ASCVD and higher baseline CV risk. This analysis demonstrates potential associations between baseline CV risk and MACE in patients with UC, suggesting CV risk should be assessed individually in clinical practice. CLINICALTRIALS.GOV NCT00787202; NCT01465763; NCT01458951; NCT01458574; NCT01470612.
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Affiliation(s)
- Stefan Schreiber
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Siew C Ng
- Institute of Digestive Disease, Department of Medicine and Therapeutics, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, CHRU-Nancy, University of Lorraine, Nancy, France
- Inserm, NGERE, University of Lorraine, Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | - Yan Chen
- Pfizer Inc, Collegeville, PA, USA
| | | | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marla C Dubinsky
- Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pawar VA, Tyagi A, Verma C, Sharma KP, Ansari S, Mani I, Srivastva SK, Shukla PK, Kumar A, Kumar V. Unlocking therapeutic potential: integration of drug repurposing and immunotherapy for various disease targeting. Am J Transl Res 2023; 15:4984-5006. [PMID: 37692967 PMCID: PMC10492070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
Drug repurposing, also known as drug repositioning, entails the application of pre-approved or formerly assessed drugs having potentially functional therapeutic amalgams for curing various disorders or disease conditions distinctive from their original remedial indication. It has surfaced as a substitute for the development of drugs for treating cancer, cardiovascular diseases, neurodegenerative disorders, and various infectious diseases like Covid-19. Although the earlier lines of findings in this area were serendipitous, recent advancements are based on patient centered approaches following systematic, translational, drug targeting practices that explore pathophysiological ailment mechanisms. The presence of definite information and numerous records with respect to beneficial properties, harmfulness, and pharmacologic characteristics of repurposed drugs increase the chances of approval in the clinical trial stages. The last few years have showcased the successful emergence of repurposed drug immunotherapy in treating various diseases. In this light, the present review emphasises on incorporation of drug repositioning with Immunotherapy targeted for several disorders.
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Affiliation(s)
| | - Anuradha Tyagi
- Department of cBRN, Institute of Nuclear Medicine and Allied ScienceDelhi 110054, India
| | - Chaitenya Verma
- Department of Pathology, Wexner Medical Center, Ohio State UniversityColumbus, Ohio 43201, USA
| | - Kanti Prakash Sharma
- Department of Nutrition Biology, Central University of HaryanaMahendragarh 123029, India
| | - Sekhu Ansari
- Division of Pathology, Cincinnati Children’s Hospital Medical CenterCincinnati, Ohio 45229, USA
| | - Indra Mani
- Department of Microbiology, Gargi College, University of DelhiNew Delhi 110049, India
| | | | - Pradeep Kumar Shukla
- Department of Biological Sciences, Faculty of Science, Sam Higginbottom University of Agriculture, Technology of SciencePrayagraj 211007, UP, India
| | - Antresh Kumar
- Department of Biochemistry, Central University of HaryanaMahendergarh 123031, Haryana, India
| | - Vinay Kumar
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical CenterColumbus, Ohio 43210, USA
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4
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Olivera PA, Lasa JS, Peretto G, Zuily S, Danese S, Peyrin-Biroulet L. Review article: Risk of cardiovascular events in patients with inflammatory bowel disease receiving small molecule drugs. Aliment Pharmacol Ther 2023; 57:1231-1248. [PMID: 37038269 DOI: 10.1111/apt.17509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/18/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate-to-severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine-1-phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune-mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities. AIM To review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies. METHODS Published literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD. RESULTS Evidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose-dependent, first-dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs. CONCLUSIONS Available evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
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Affiliation(s)
- Pablo A Olivera
- IBD Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Juan S Lasa
- IBD Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
- Gastroenterology Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Giovanni Peretto
- Myocarditis Disease Unit, Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stephane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, INSERM, DCAC and CHRU-Nancy, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- INSERM NGERE and Department of Hepatogastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-lés-Nancy, France
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5
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Bello N, Meyers KJ, Workman J, Hartley L, McMahon M. Cardiovascular events and risk in patients with systemic lupus erythematosus: Systematic literature review and meta-analysis. Lupus 2023; 32:325-341. [PMID: 36547368 PMCID: PMC10012401 DOI: 10.1177/09612033221147471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease that typically affects women aged 16-55 years. Cardiovascular disease (CVD) is a well-recognized complication of SLE. This systematic literature review and meta-analysis evaluated the relative risk (RR; compared with non-SLE controls), absolute risk (AR; as incidence proportion, n/N), and incidence rate (IR) of CVD events (including stroke, myocardial infarction [MI], and CVD [composite or undefined]) in adult patients with SLE. The RR of CV risk factors (including hypertension, diabetes, and metabolic syndrome [MetS]) was also examined. METHODS PubMed and Embase were searched on September 10, 2020. Observational studies published between January 2010 and September 2020 that reported RR, AR, and/or IR of CVD events, or RR of CV risk factors, were eligible. Pooled risk estimates were calculated using a random-effects model. RESULTS Forty-six studies (16 cross-sectional, 15 retrospective cohort, 14 prospective cohort, and 1 case-control) were included in meta-analyses. Most studies were considered high quality (Critical Appraisal Skills Programme checklists). Compared with adults without SLE, patients with SLE had statistically significantly higher RRs (95% CIs) of stroke (2.51 [2.03-3.10]; 12 studies), MI (2.92 [2.45-3.48]; 11 studies), CVD (2.24 [1.94-2.59]; 8 studies), and hypertension (2.70 [1.48-4.92]; 7 studies). RRs of diabetes (1.24 [0.78-1.96]; 3 studies) and MetS (1.49 [0.95-2.33]; 7 studies) were elevated but not significant. RRs of stroke and MI were generally higher in younger versus older patients with SLE. In patients with SLE, the pooled estimate of AR (95% CI) was 0.03 (0.02-0.05), 0.01 (0.00-0.02), and 0.06 (0.03-0.10) for stroke (7 studies), MI (6 studies), and CVD (8 studies), respectively. The pooled estimate of IR per 1000 person-years (95% CI) was 4.72 (3.35-6.32), 2.81 (1.61-4.32), and 11.21 (8.48-14.32) for stroke (10 studies), MI (6 studies), and CVD (8 studies), respectively. Although heterogeneity (based on I2 value) was high in most analyses, sensitivity analyses confirmed the robustness of the pooled estimates. CONCLUSIONS This meta-analysis found an increased risk of stroke, MI, CVD, and hypertension in patients with SLE compared with the general population, despite substantial heterogeneity across the included studies.
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Affiliation(s)
| | | | | | | | - Maureen McMahon
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
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Mena-Vázquez N, Lisbona-Montañez JM, Redondo-Rodriguez R, Mucientes A, Manrique-Arija S, Rioja J, Garcia-Studer A, Ortiz-Márquez F, Cano-García L, Fernández-Nebro A. Inflammatory profile of incident cases of late-onset compared with young-onset rheumatoid arthritis: A nested cohort study. Front Med (Lausanne) 2022; 9:1016159. [PMID: 36425102 PMCID: PMC9679221 DOI: 10.3389/fmed.2022.1016159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/25/2022] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES To describe the characteristics of patients between late-onset rheumatoid arthritis (LORA) with young-onset (YORA), and analyze their association with cumulative inflammatory burden. METHODS We performed a nested cohort study in a prospective cohort comprising 110 patients with rheumatoid arthritis (RA) and 110 age- and sex-matched controls. The main variable was cumulative inflammatory activity according to the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR). High activity was defined as DAS28 ≥ 3.2 and low activity as DAS28 < 3.2. The other variables recorded were inflammatory cytokines, physical function, and comorbid conditions. Two multivariate models were run to identify factors associated with cumulative inflammatory activity. RESULTS A total of 22/110 patients (20%) met the criteria for LORA (≥ 60 years). Patients with LORA more frequently had comorbid conditions than patients with YORA and controls. Compared with YORA patients, more LORA patients had cumulative high inflammatory activity from onset [13 (59%) vs. 28 (31%); p = 0.018] and high values for CRP (p = 0.039) and IL-6 (p = 0.045). Cumulative high inflammatory activity in patients with RA was associated with LORA [OR (95% CI) 4.69 (1.49-10.71); p = 0.008], smoking [OR (95% CI) 2.07 (1.13-3.78); p = 0.017], anti-citrullinated peptide antibody [OR (95% CI) 3.24 (1.15-9.13); p = 0.025], average Health Assessment Questionnaire (HAQ) score [OR (95% CI) 2.09 (1.03-14.23); p = 0.034], and physical activity [OR (95% CI) 0.99 (0.99-0.99); p = 0.010]. The second model revealed similar associations with inflammatory activity in patients with LORA. CONCLUSION Control of inflammation after diagnosis is poorer and comorbidity more frequent in patients with LORA than in YORA patients and healthy controls.
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Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose Manuel Lisbona-Montañez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Rocío Redondo-Rodriguez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Arkaitz Mucientes
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - José Rioja
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Aimara Garcia-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Ortiz-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
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Prevention and risk assessment of cardiovascular events in a population of patients with psoriasis and psoriatic arthritis. Reumatologia 2022; 60:266-274. [PMID: 36186830 PMCID: PMC9494789 DOI: 10.5114/reum.2022.119043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Psoriasis is a chronic, inflammatory, often relapsing disease that is frequently associated with other diseases of similar pathogenesis. The multi-morbidity in the psoriasis population significantly impedes both diagnosis and implementation of appropriate preventive measures. However, the common denominator for this group of diseases is the inflammatory process that initiates the appearance of subsequent symptoms and health consequences, most of which can be avoided or alleviated by modifying the patient’s lifestyle and incorporating appropriate treatment. Health consequences associated with systemic inflammation include cardiovascular incidents and other cardiometabolic diseases. This article was based on available publications on the onset, incidence, and prevention of cardiovascular disease in the psoriasis patient population.
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8
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Alsing CL, Nystad TW, Igland J, Gjesdal CG, Midtbø H, Tell GS, Fevang BT. Trends in the occurrence of ischaemic heart disease over time in rheumatoid arthritis: 1821 patients from 1972 to 2017. Scand J Rheumatol 2022; 52:233-242. [PMID: 35272584 DOI: 10.1080/03009742.2022.2040116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate trends of acute myocardial infarction (AMI) and ischaemic heart disease (IHD) in rheumatoid arthritis (RA) patients compared with the general population over time. METHOD We performed a retrospective cohort study of 1821 RA patients diagnosed from 1972 to 2013. Aggregated counts of the total population of the same county (Hordaland, Norway) and period were used for comparison. Information on AMI and IHD events was obtained from hospital patient administrative systems or cardiovascular registries. We estimated incidence rates and excess of events [standardized event ratio (SER) with 95% confidence interval (CI)] compared with the general population by Poisson regression. RESULTS There was an average annual decline of 1.6% in age- and gender-adjusted AMI incidence rates from 1972 to 2017 (p < 0.035). The difference in events (excess events) in RA patients compared with the general population declined on average by 1.3% per year for AMI and by 2.3% for IHD from 1972 to 2014. There were no significant excess AMI (SER 1.05, 95% CI 0.82-1.35) or IHD events (SER 1.02, 95% CI 0.89-1.16) for RA patients diagnosed after 1998 compared with the general population. CONCLUSION Incidence rates and excess events of AMI and IHD in RA patients declined from 1972 to 2017. There were no excess AMI or IHD events in RA patients diagnosed after 1998 compared with the general population.
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Affiliation(s)
- C L Alsing
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - T W Nystad
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Science, Bergen, Norway
| | - C G Gjesdal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - H Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - G S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - B T Fevang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
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9
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Ramírez J, Azuaga-Piñango AB, Celis R, Cañete JD. Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:742713. [PMID: 34692732 PMCID: PMC8531250 DOI: 10.3389/fmed.2021.742713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
PsA is characterized by a high prevalence of cardiovascular (CV) comorbidities. Recognizing these comorbidities is critical due to their influence on the quality of life and the choice of therapy. Imaging techniques also play an important role in the evaluation of the CV risk in psoriatic disease, improving the prediction of CV events when combined with clinical scores as a predictive tool. Meta-analyses point to a significant reduction in the incidence of CV events associated with the suppression of inflammatory activity when using systemic therapies. Consequently, the mortality rate in PsA patients has fallen in the last 40 years and is now similar to that of the general population, including cardiovascular causes. Obesity is an especially relevant CV comorbidity in patients with psoriatic disease, most of whom are overweight/obese. Body mass index (BMI) is a risk factor for PsA and a causal relationship with psoriasis has been demonstrated by Mendelian randomized studies. The study of fat distribution shows that patients with psoriasis are characterized by visceral fat accumulation, which correlates with CV risk measurements. These findings suggest that approaches to the prevention and treatment of psoriatic disease might come from targeting adiposity levels, in addition to the immune pathways. Weight loss treatment with low energy diets in patients with PsA has been associated with significant improvements in disease activity. Novel strategies using a multimorbidity approach, focused more on patients outcomes, are necessary to better address comorbidities, improve clinical outcomes and the quality of life of patients with psoriatic disease.
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Affiliation(s)
- Julio Ramírez
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | | | - Raquel Celis
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
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10
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Jaaouani A, Ismaiel A, Popa SL, Dumitrascu DL. Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut-Heart Connection. J Clin Med 2021; 10:4710. [PMID: 34682835 PMCID: PMC8538087 DOI: 10.3390/jcm10204710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.
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Affiliation(s)
- Ayman Jaaouani
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (S.-L.P.); (D.L.D.)
| | - Stefan-Lucian Popa
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (S.-L.P.); (D.L.D.)
| | - Dan L. Dumitrascu
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (S.-L.P.); (D.L.D.)
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Antirheumatic therapy is not associated with changes in circulating N-terminal pro-brain natriuretic peptide levels in patients with autoimmune arthritis. PLoS One 2021; 16:e0253793. [PMID: 34170978 PMCID: PMC8232407 DOI: 10.1371/journal.pone.0253793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/14/2021] [Indexed: 01/09/2023] Open
Abstract
Background Patients with autoimmune arthritis (AA) are at increased risk for impaired cardiac function and heart failure. This may be partly due to the effect of inflammation in heart function. The impact of antirheumatic drugs on cardiac dysfunction in AA remains controversial. Therefore, we aimed to examine effects of antirheumatic treatment on serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in AA patients and its relationship to inflammatory markers. Methods We examined 115 patients with AA (64 rheumatoid arthritis (RA), 31 psoriatic arthritis and 20 ankylosis spondylitis) starting with methotrexate (MTX) monotherapy or tumor necrosis factor inhibitors (TNFi) with or without MTX co-medication. NT-proBNP (measured in serum by ECLIA from Roche Diagnostics), and other clinical and laboratory parameters were evaluated at baseline, after 6 weeks and 6 months of treatment. Results NT-proBNP levels did not change significantly after 6 weeks and 6 months of antirheumatic therapy (pbaseline-6weeks = 0.939; pbaseline-6months = 0.485), although there was a modest improvement from 6 weeks to 6 months in the MTX only treatment group (median difference = -18.2 [95% CI = -32.3 to -4.06], p = 0.013). There was no difference in the effects of MTX monotherapy and TNFi regimen on NT-proBNP levels. The changes in NT-proBNP after antirheumatic treatment positively correlated with changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Baseline NT-proBNP levels were related to baseline CRP and ESR levels, and some other established markers of disease activities in crude analyses. Conclusion Circulating levels of NT-proBNP were related to established inflammatory markers at baseline, and the changes in NT-proBNP after antirheumatic treatment were positively related to these markers. Nevertheless, antirheumatic therapy did not seem to affect NT-proBNP levels compared to baseline, even though inflammatory markers significantly improved.
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12
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Forte F, Buonaiuto A, Calcaterra I, Iannuzzo G, Ambrosino P, Di Minno MND. Association of systemic lupus erythematosus with peripheral arterial disease: a meta-analysis of literature studies. Rheumatology (Oxford) 2021; 59:3181-3192. [PMID: 32793980 DOI: 10.1093/rheumatology/keaa414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE SLE patients have an increased cardiovascular morbidity and mortality. Contrasting data are available about the association between peripheral arterial disease (PAD) and SLE. We aimed to perform a meta-analysis of studies evaluating the association between SLE and PAD. METHODS Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases according to preferred reporting items for systematic reviews and meta-analyses guidelines. RESULTS Eight studies reporting on 263 258 SLE patients and 768 487 controls showed that the prevalence of PAD was 15.8% (95% CI: 10.5%, 23.2%) in SLE patients and 3.9% (95% CI: 1.8%, 7.9%) in controls with a corresponding odds ratio of 4.1 (95% CI: 1.5, 11.6; P <0.001). In addition, five studies reporting on ankle-brachial index showed significantly lower values in 280 SLE patients as compared with 201 controls (mean difference: -0.018; 95% CI: -0.034, -0.001; P =0.033). Meta-regression models showed that age, hypertension and diabetes were inversely associated with the difference in the prevalence of PAD between SLE patients and non-SLE controls, whereas no effect for all the other clinical and demographic variables on the evaluated outcome was found. CONCLUSION SLE patients exhibit an increased prevalence of PAD and lower ankle-brachial index values as compared with non-SLE controls. This should be considered when planning prevention, interventional and rehabilitation strategies for these chronic patients with functional disability and poor long-term outcomes.
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Affiliation(s)
- Francesco Forte
- Department of Clinical Medicine and Surgery, Federico II University, Naples
| | - Alessio Buonaiuto
- Department of Clinical Medicine and Surgery, Federico II University, Naples
| | - Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Federico II University, Naples
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples
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13
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Papagoras C, Voulgari PV, Drosos AA. Cardiovascular Disease in Spondyloarthritides. Curr Vasc Pharmacol 2020; 18:473-487. [PMID: 31330576 DOI: 10.2174/1570161117666190426164306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 12/15/2022]
Abstract
The spondyloarthritides are a group of chronic systemic inflammatory joint diseases, the main types being ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Evidence accumulating during the last decades suggests that patients with AS or PsA carry an increased risk for cardiovascular disease and cardiovascular death. This risk appears to be mediated by systemic inflammation over and above classical cardiovascular risk factors. The excess cardiovascular risk in those patients has been formally acknowledged by scientific organizations, which have called physicians' attention to the matter. The application by Rheumatologists of new effective anti-rheumatic treatments and treat-to-target strategies seems to benefit patients from a cardiovascular point of view, as well. However, more data are needed in order to verify whether anti-rheumatic treatments do have an effect on cardiovascular risk and whether there are differences among them in this regard. Most importantly, a higher level of awareness of the cardiovascular risk is needed among patients and healthcare providers, better tools to recognize at-risk patients and, ultimately, commitment to address in parallel both the musculoskeletal and the cardiovascular aspect of the disease.
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Affiliation(s)
- Charalampos Papagoras
- 1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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14
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Dextran sulfate-modified pH-sensitive layered double hydroxide nanocomposites for treatment of rheumatoid arthritis. Drug Deliv Transl Res 2020; 11:1096-1106. [PMID: 32779111 DOI: 10.1007/s13346-020-00832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To reduce the side effects of methotrexate and increase its anti-inflammatory effect, we developed a drug delivery system, dextran sulfate-modified methotrexate-loaded layered double hydroxide nanocomposites (LDH-MTX-DS), with both targeting and pH-sensitivity for the treatment of rheumatoid arthritis. The nanocomposites had a mean particle size of 303.1 ± 8.07 nm, zeta potential of - 12.4 ± 0.7 mV, encapsulation efficiency of 49.64%, and loading efficiency of 16.81%. In vitro release experiments demonstrated that the drug was released faster in PBS at pH 5.5 than at pH 7.4, which reflected the pH-sensitivity of this system. Cellular uptake assays displayed higher cellular uptake rate of the dextran sulfate-modified targeting carrier compared with that of a non-targeting carrier (P < 0.01), which indicated that the LDH-MTX-DS could actively target scavenger receptors on the surface of activated RAW 264.7 cells. In vivo pharmacodynamic experiments showed that, after the second (P < 0.001) and third (P < 0.05) administrations, the preparation group exhibited significantly improved therapeutic efficacy in adjuvant-induced arthritis (AIA) rats when compared with free MTX alone. These results indicated that this drug delivery system was promising in the treatment of rheumatoid arthritis. Graphical abstract.
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15
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Targeting perivascular and epicardial adipose tissue inflammation: therapeutic opportunities for cardiovascular disease. Clin Sci (Lond) 2020; 134:827-851. [PMID: 32271386 DOI: 10.1042/cs20190227] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Major shifts in human lifestyle and dietary habits toward sedentary behavior and refined food intake triggered steep increase in the incidence of metabolic disorders including obesity and Type 2 diabetes. Patients with metabolic disease are at a high risk of cardiovascular complications ranging from microvascular dysfunction to cardiometabolic syndromes including heart failure. Despite significant advances in the standards of care for obese and diabetic patients, current therapeutic approaches are not always successful in averting the accompanying cardiovascular deterioration. There is a strong relationship between adipose inflammation seen in metabolic disorders and detrimental changes in cardiovascular structure and function. The particular importance of epicardial and perivascular adipose pools emerged as main modulators of the physiology or pathology of heart and blood vessels. Here, we review the peculiarities of these two fat depots in terms of their origin, function, and pathological changes during metabolic deterioration. We highlight the rationale for pharmacological targeting of the perivascular and epicardial adipose tissue or associated signaling pathways as potential disease modifying approaches in cardiometabolic syndromes.
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16
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Gelosa P, Castiglioni L, Camera M, Sironi L. Drug repurposing in cardiovascular diseases: Opportunity or hopeless dream? Biochem Pharmacol 2020; 177:113894. [DOI: 10.1016/j.bcp.2020.113894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022]
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17
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Lee MP, Desai RJ, Jin Y, Brill G, Ogdie A, Kim SC. Association of Ustekinumab vs TNF Inhibitor Therapy With Risk of Atrial Fibrillation and Cardiovascular Events in Patients With Psoriasis or Psoriatic Arthritis. JAMA Dermatol 2020; 155:700-707. [PMID: 30916734 DOI: 10.1001/jamadermatol.2019.0001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Accumulating evidence indicates that there is an increased risk of cardiovascular disease among patients with psoriatic disease. Although an emerging concern that the risk of atrial fibrillation (AF) may also be higher in this patient population adds to the growing support of initiating early interventions to control systemic inflammation, evidence on the comparative cardiovascular safety of current biologic treatments remains limited. Objective To evaluate the risk of AF and major adverse cardiovascular events (MACE) associated with use of ustekinumab vs tumor necrosis factor inhibitors (TNFi) in patients with psoriasis or psoriatic arthritis. Design, Setting, and Participants This cohort study included data from a nationwide sample of 78 162 commercially insured patients in 2 US commercial insurance databases (Optum and MarketScan) from September 25, 2009, through September 30, 2015. Patients were included if they were 18 years or older, had psoriasis or psoriatic arthritis, and initiated ustekinumab or a TNFi therapy. Exclusion criteria included history of AF or receipt of antiarrhythmic or anticoagulant therapy during the baseline period. Exposures Initiation of ustekinumab vs TNFi therapy. Main Outcomes and Measures Incident AF and MACE, including myocardial infarction, stroke, or coronary revascularization. Results A total of 60 028 patients with psoriasis or psoriatic arthritis (9071 ustekinumab initiators and 50 957 TNFi initiators) were included in the analyses. The mean (SD) age was 46 (13) years in Optum and 47 (13) in MarketScan, and 29 495 (49.1%) were male. Overall crude incidence rates (reported per 1000 person-years) for AF were 5.0 (95% CI, 3.8-6.5) for ustekinumab initiators and 4.7 (95% CI, 4.2-5.2) for TNFi initiators, and for MACE were 6.2 (95% CI, 4.9-7.8) for ustekinumab initiators and 6.1 (95% CI, 5.5-6.7) for TNFi initiators. The combined adjusted hazard ratio for incident AF among ustekinumab initiators was 1.08 (95% CI, 0.76-1.54) and for MACE among ustekinumab initiators was 1.10 (95% CI, 0.80-1.52) compared with TNFi initiators. Conclusions and Relevance No substantially different risk of incident AF or MACE after initiation of ustekinumab vs TNFi was observed in this study. This information may be helpful when weighing the risks and benefits of various systemic treatment strategies for psoriatic disease.
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Affiliation(s)
- Moa P Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexis Ogdie
- Center for Clinical Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Packer M. Potential Role of Atrial Myopathy in the Pathogenesis of Stroke in Rheumatoid Arthritis and Psoriasis: A Conceptual Framework and Implications for Prophylaxis. J Am Heart Assoc 2020; 9:e014764. [PMID: 31973602 PMCID: PMC7033881 DOI: 10.1161/jaha.119.014764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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19
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Sparks JA, Lesperance T, Accortt NA, Solomon DH. Subsequent Cardiovascular Events Among Patients With Rheumatoid Arthritis, Psoriatic Arthritis, or Psoriasis: Patterns of Disease-Modifying Antirheumatic Drug Treatment. Arthritis Care Res (Hoboken) 2020; 71:512-520. [PMID: 29799667 PMCID: PMC6252288 DOI: 10.1002/acr.23609] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/22/2018] [Indexed: 12/25/2022]
Abstract
Objective To examine disease‐modifying antirheumatic drug (DMARD) treatments and estimate the risk of a subsequent cardiovascular (CV) event following an initial CV event in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis. Methods We analyzed data from MarketScan claims databases (January 1, 2006 to June 30, 2015) for adults with RA, PsA, or psoriasis and an initial/index CV event (acute myocardial infarction, stroke, or coronary revascularization) while receiving DMARDs (tumor necrosis factor inhibitor [TNFi] biologic DMARDs [bDMARDs], conventional synthetic DMARDs [csDMARDs], or non‐TNFi bDMARDs). We studied DMARD treatment patterns following the index event and rates of subsequent CV events. We used Cox regression to investigate predictors of DMARD discontinuation and risk factors for subsequent CV events. Results Among 10,254 patients, 15.3% discontinued and 15.5% switched DMARD therapy after the index CV event. Independent predictors of DMARD discontinuation included a psoriasis diagnosis, renal disease, hypertension, heart failure, diabetes mellitus, older age, and baseline csDMARD or non‐TNFi bDMARD use (versus TNFi bDMARDs). Rates per 1,000 patient‐years of subsequent events were 75.2 (95% confidence interval [95% CI] 54.4–96.0) for patients taking TNFi bDMARDs, 83.6 (95% CI 53.3–113.9) for csDMARDs, and 122.4 (95% CI 60.6–184.3) for non‐TNFi bDMARDs. A diagnosis of RA (versus psoriasis) and heart failure at baseline, but not a DMARD pattern after the index event, were independently associated with an increased risk of subsequent CV event. Conclusion In this large nationwide study, nearly one‐third of patients with RA, PsA, or psoriasis switched or discontinued DMARD therapy following a CV event. There was no association between DMARD class and the risk of a subsequent CV event.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Daniel H Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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20
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Ramirez GA, Canti V, Del Rosso S, Erra R, Moiola L, Magnoni M, Bozzolo EP, Manfredi AA, Rovere-Querini P. Diagnostic performance of aPS/PT antibodies in neuropsychiatric lupus and cardiovascular complications of systemic lupus erythematosus. Autoimmunity 2019; 53:21-27. [PMID: 31782311 DOI: 10.1080/08916934.2019.1696778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Systemic lupus erythematosus (SLE) is associated with a constellation of complications affecting multiple organs, including neuropsychiatric manifestations (NPSLE) and ischaemic events, leading to increased long-term morbidity. Antiphospholipid antibodies (aPL) are a major determinant of vascular inflammation and thromboembolic risk. The diagnostic role of anti-phosphatidylserine/prothrombin (aPS/PT) antibodies in this setting is incompletely defined.Aim: To verify whether aPS/PT add to diagnostics and disease stratification in patients with SLE with or without other aPL.Methods: 131 consecutive patients were studied, including 20 patients with SLE and secondary antiphospholipid syndrome (APS). aPS/PT IgG and IgM were assessed through ELISA and patients were stratified based on the presence of other aPL, on their clinical and laboratory features at time of blood sampling and on their clinical history. Synthetic indices of disease activity, chronic damage and cardiovascular risk were calculated at time of venipuncture.Results: Fifty-one (38.9%) patients with SLE had aPS/PT and 15 (11.5%) patients had aPS/PT as the only aPL (aPS/PT-only). aPS/PT-only patients had a significantly higher prevalence of NPSLE than quadruple aPL-negative patients (p = .007). Patients with aPS/PT were more likely to have a history of ischaemia, thrombocytopenia and Libman-Sacks' endocarditis. The presence of aPS/PT also associated with previous accrual of at least one damage item (p = .043), but had limited predictive values for damage progression in the short term.Conclusion: aPS/PT antibodies provide non-redundant information that could contribute to risk assessment and stratification of patients with SLE.
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Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Immunology, Transplantation and Infectious Immunity, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Canti
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Immunology, Transplantation and Infectious Immunity, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefania Del Rosso
- Laboratory Medicine, Autoimmunity Section, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberta Erra
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Immunology, Transplantation and Infectious Immunity, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lucia Moiola
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Magnoni
- Cardiothoracic and Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrica P Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Immunology, Transplantation and Infectious Immunity, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo A Manfredi
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Immunology, Transplantation and Infectious Immunity, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere-Querini
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Immunology, Transplantation and Infectious Immunity, IRCCS Ospedale San Raffaele, Milan, Italy
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Should all patients with psoriasis receive statins? Analysis according to different strategies. An Bras Dermatol 2019; 94:691-697. [PMID: 31789271 PMCID: PMC6939080 DOI: 10.1016/j.abd.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background Different strategies have been proposed for the cardiovascular risk management of patients with psoriasis. Objective To estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy. Methods A retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed. Results A total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1–27.0%) and 1.9% (IQR 0.4–5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively. Study limitations This was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis. Conclusion This population with psoriasis was mostly classified at moderate–high risk and the statin therapy indication was similar when applying the two strategies evaluated.
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Ramirez GA, Manfredi AA, Maugeri N. Misunderstandings Between Platelets and Neutrophils Build in Chronic Inflammation. Front Immunol 2019; 10:2491. [PMID: 31695699 PMCID: PMC6817594 DOI: 10.3389/fimmu.2019.02491] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022] Open
Abstract
Regulated hemostasis, inflammation and innate immunity entail extensive interactions between platelets and neutrophils. Under physiological conditions, vascular inflammation offers a template for the establishment of effective intravascular immunity, with platelets providing neutrophils with an array of signals that increase their activation threshold, thus limiting collateral damage to tissues and promoting termination of the inflammatory response. By contrast, persistent systemic inflammation as observed in immune-mediated diseases, such as systemic vasculitides, systemic sclerosis, systemic lupus erythematosus or rheumatoid arthritis is characterized by platelet and neutrophil reciprocal activation, which ultimately culminates in the generation of thrombo-inflammatory lesions, fostering vascular injury and organ damage. Here, we discuss recent evidence regarding the multifaceted aspects of platelet-neutrophil interactions from bone marrow precursors to shed microparticles. Moreover, we analyse shared and disease-specific events due to an aberrant deployment of these interactions in human diseases. To restore communications between the pillars of the immune-hemostatic continuum constitutes a fascinating challenge for the near future.
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Affiliation(s)
- Giuseppe A Ramirez
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo A Manfredi
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Norma Maugeri
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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Lauper K, Courvoisier DS, Chevallier P, Finckh A, Gabay C. Incidence and Prevalence of Major Adverse Cardiovascular Events in Rheumatoid Arthritis, Psoriatic Arthritis, and Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2019; 70:1756-1763. [PMID: 29609199 DOI: 10.1002/acr.23567] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/27/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the risk of major adverse cardiovascular events (MACE) in a large observational cohort of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (SpA) patients. METHODS We conducted a mixed retrospective and prospective cohort study using data from patients with RA, PsA, or axial SpA included in the Swiss Clinical Quality Management registry. The primary outcome of interest was a composite of myocardial infarction, transient or permanent cerebrovascular event, or cardiovascular-associated death. RESULTS A total of 5,315 patients were eligible for the analysis of incidence, with a total follow-up time of 37,495 patient-years for RA, 19,837 patient-years for axial SpA, and 9,171 patient-years for PsA. The unadjusted incidence rate of MACE per 1,000 patient-years was 2.67 for RA, 1.41 for axial SpA, and 1.42 for PsA. Compared to the unadjusted incidence rate ratios (IRRs) in patients with RA, those in patients with axial SpA were 0.53 (95% confidence interval [95% CI] 0.34-0.80; P = 0.003) and in patients with PsA were 0.53 (95% CI 0.30-0.95; P = 0.03). After adjustment for traditional cardiovascular risk factors, age at disease onset, sex, and disease duration, the difference was not significant between RA and axial SpA (adjusted IRR 0.93 [95% CI 0.51-1.69]; P = 0.80) or between RA and PsA (adjusted IRR 0.56 [95% CI 0.27-1.14]; P = 0.11). We found a similar result with the analysis of prevalence. CONCLUSION There was no significant difference in the incidence and prevalence of MACE between RA and axial SpA or PsA, suggesting that inflammation, rather than a particular disease, drives the increased risk of cardiovascular disease.
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Affiliation(s)
- Kim Lauper
- Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Axel Finckh
- Geneva University Hospitals, Geneva, Switzerland
| | - Cem Gabay
- Geneva University Hospitals, Geneva, Switzerland
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Dumont A, Parienti JJ, Delmas C, Boutemy J, Maigné G, Martin Silva N, Sultan A, Planchard G, Aouba A, de Boysson H. Factors Associated with Relapse and Dependence on Glucocorticoids in Giant Cell Arteritis. J Rheumatol 2019; 47:108-116. [PMID: 30877210 DOI: 10.3899/jrheum.181127] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant cell arteritis (GCA). METHODS We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. RESULTS The 326 patients (73% women) were followed up for 62 (12-262) months. During followup, 171 (52%) patients relapsed, including 113 (35%) who developed GC dependence. Relapsing patients had less history of stroke (p = 0.01) and presented large-vessel vasculitis (LVV) more frequently on imaging (p = 0.01) than patients without relapse. During the first months, therapeutic strategy did not differ among relapsing and nonrelapsing patients. GC-dependent patients were less likely to have a history of stroke (p = 0.004) and presented LVV on imaging more frequently (p = 0.005) than patients without GC-dependent disease. In multivariable analyses, LVV was an independent predictive factor of relapse (HR 1.49, 95% CI 1.002-2.12; p = 0.04) and GC dependence (OR 2.19, 95% CI 1.19-4.05; p = 0.01). Conversely, stroke was a protective factor against relapse (HR 0.21, 95% CI 0.03-0.68; p = 0.005) and GC-dependent disease (OR 0.10, 95% CI 0.001-0.31; p = 0.0005). Patients with a GC-dependent disease who received a GC-sparing agent had a shorter GC treatment duration than those without (p = 0.008). CONCLUSION In this study, LVV was an independent predictor of relapse and GC dependence. Further prospective studies are needed to confirm these findings and to determine whether patients with LVV require a different treatment approach.
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Affiliation(s)
- Anael Dumont
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Jean-Jacques Parienti
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Claire Delmas
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Jonathan Boutemy
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Gwénola Maigné
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Nicolas Martin Silva
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Audrey Sultan
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Gaétane Planchard
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Achille Aouba
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Hubert de Boysson
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France. .,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital.
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Derakhshan MH, Goodson NJ, Packham JC, Sengupta R, Molto A, Marzo-Ortega H, Siebert S. Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study. J Rheumatol 2019; 46:701-709. [PMID: 30647169 DOI: 10.3899/jrheum.180538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is associated with a number of cardiovascular (CV) comorbidities. We examined the association of SpA disease duration and delay in diagnosis with CV-related conditions. METHODS Using data from the COMOSPA study, the associations between SpA disease duration and CV-related conditions were evaluated in univariable and multivariable logistic regression models. Each model examined 1 CV-related factor as dependent and "SpA disease duration" as a predictor, adjusted for relevant confounders. RESULTS Data from 3923 subjects (median SpA disease duration 5.1 yrs, interquartile range 1.3-11.8 yrs) were available for analysis. The main CV-related conditions were hypertension (HTN; 22.4%), ischemic heart disease (2.6%), stroke (1.3%), and diabetes mellitus (5.5%). HTN was associated with SpA disease duration in both univariable and multivariable analysis, with an OR of 1.129 (95% CI 1.072-1.189; p < 0.001) for each 5-year increase in SpA disease duration. Other factors associated with HTN were age, male sex, current body mass index, ever steroid therapy, and ever synthetic disease-modifying antirheumatic drug therapy, but not nonsteroidal antiinflammatory drugs (NSAID). In subgroup analysis, the strongest association of HTN and disease duration was seen in subjects with the axial-only SpA phenotype (OR 1.202, 95% CI 1.053-1.372) but not in those with peripheral-only SpA (OR 0.902, 95% CI 0.760-1.070). The other CV conditions were not associated with SpA disease duration. CONCLUSION Duration of SpA disease in the ASAS-COMOSPA cohort is associated with higher odds of HTN, particularly in those with axial disease, but not with other CV-related conditions. The association with HTN does not appear to be related to NSAID exposure.
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Affiliation(s)
- Mohammad H Derakhshan
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Nicola J Goodson
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Jonathan C Packham
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Raj Sengupta
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Anna Molto
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Helena Marzo-Ortega
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Stefan Siebert
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. .,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow.
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Ramirez GA. Genetics in systemic lupus erythematosus: entering the borough of cardiovascular risk. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S14. [PMID: 30613589 DOI: 10.21037/atm.2018.09.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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Ramirez GA, Efthymiou M, Isenberg DA, Cohen H. Under crossfire: thromboembolic risk in systemic lupus erythematosus. Rheumatology (Oxford) 2018; 58:940-952. [DOI: 10.1093/rheumatology/key307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/31/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giuseppe A Ramirez
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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Packer M. Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. J Am Coll Cardiol 2018; 71:2360-2372. [PMID: 29773163 DOI: 10.1016/j.jacc.2018.03.509] [Citation(s) in RCA: 324] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/20/2018] [Accepted: 03/18/2018] [Indexed: 02/07/2023]
Abstract
Epicardial adipose tissue has unique properties that distinguish it from other depots of visceral fat. Rather than having distinct boundaries, the epicardium shares an unobstructed microcirculation with the underlying myocardium, and in healthy conditions, produces cytokines that nourish the heart. However, in chronic inflammatory disorders (especially those leading to heart failure with preserved ejection fraction), the epicardium becomes a site of deranged adipogenesis, leading to the secretion of proinflammatory adipokines that can cause atrial and ventricular fibrosis. Accordingly, in patients at risk of heart failure with preserved ejection fraction, drugs that promote the accumulation or inflammation of epicardial adipocytes may lead to heart failure, whereas treatments that ameliorate the proinflammatory characteristics of epicardial fat may reduce the risk of heart failure. These observations suggest that epicardial adipose tissue is a transducer of the adverse effects of systemic inflammation and metabolic disorders on the heart, and thus, represents an important target for therapeutic interventions.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
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Held J, Mosheimer-Feistritzer B, Gruber J, Mur E, Weiss G. Methotrexate therapy impacts on red cell distribution width and its predictive value for cardiovascular events in patients with rheumatoid arthritis. BMC Rheumatol 2018; 2:6. [PMID: 30886957 PMCID: PMC6390531 DOI: 10.1186/s41927-018-0012-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methotrexate (MTX) is well known to affect folic acid metabolism, so MTX treatment can result in alterations of mean corpuscular volume (MCV), which may impact on red cell distribution width (RDW), as MCV levels feed into RDW calculation. We thus questioned whether RDW levels and subsequently its diagnostic utility in RA subjects, as reported before, are influenced by ongoing MTX therapy.We assessed the impact of disease modifying drug (DMARD) treatment, especially MTX, on RDW and evaluated their influence on the predictive value of RDW for cardiovascular (CV) events in patients with rheumatoid arthritis (RA). As far as we know, this is the first study evaluating the influence of MTX on RDW. METHODS Medical treatment, disease activity, laboratory parameters and history of CV events were retrospectively analysed in 385 RA patients at disease onset and at last follow up at our clinic. Additionally, in patients with CV event, data were recorded at last follow up prior the CV event. RESULTS Disease parameters and laboratory findings associated with a serious vascular event were older age (p < 0,001), longer disease duration (p = 0,002) and a higher RDW at diagnosis (p = 0,025). No differences in RDW levels became evident with any other treatment regimen beside MTX. MTX treated patients had significantly higher RDW compared to subjects without this drug (p < 0,001). In RA patients without MTX treatment, we found RDW level significantly different between those with versus without a CV event, whereas this difference disappeared in subjects receiving MTX. CONCLUSION MTX impacts on RDW and might therefor reduce its prognostic value for CV events in patients taking MTX, whereas an increased RDW at diagnosis remains an early risk predictor for myocardial infarction and stroke in RA patients.
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Affiliation(s)
- Julia Held
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Birgit Mosheimer-Feistritzer
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Johann Gruber
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Erich Mur
- Department for Physical Medicine and Rehabilitation, University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
- Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Innsbruck, Austria
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Naldi L, Pezzolo E. Back to the Future: Looking at the Skin to Predict Death—A Lesson from Psoriasis. J Invest Dermatol 2018; 138:20-22. [DOI: 10.1016/j.jid.2017.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
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Ruscitti P, Margiotta DPE, Macaluso F, Iacono D, D’Onofrio F, Emmi G, Atzeni F, Prete M, Perosa F, Sarzi-Puttini P, Emmi L, Cantatore FP, Triolo G, Afeltra A, Giacomelli R, Valentini G. Subclinical atherosclerosis and history of cardiovascular events in Italian patients with rheumatoid arthritis: Results from a cross-sectional, multicenter GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Medicine (Baltimore) 2017; 96:e8180. [PMID: 29049200 PMCID: PMC5662366 DOI: 10.1097/md.0000000000008180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Several studies have pointed out a significant association between rheumatoid arthritis (RA) and accelerated atherosclerosis. At the best of our knowledge, no such study has been carried out in a large Italian series and, in this study, we aimed to investigate the prevalence of both subclinical atherosclerosis and history of cardiovascular events (CVEs), in patients consecutively admitted from January 1, 2015 to December 31, 2015 to Rheumatology Units throughout the whole Italy.Centers members of GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) were invited to enrol patients consecutively admitted from January 1, 2015 to December 31, 2015 and satisfying American College of Rheumatology/ European League Against Rheumatism criteria for RA and to investigate each of them for: traditional cardiovascular risk factors: sex, age, smoking habit, total cholesterol, triglycerides, glycaemia, high blood pressure, metabolic syndrome (MS), type 2 diabetes (T2D); RA features: disease duration as assessed from the first symptom, disease activity as evaluated by DAS28, radiographic damage as assessed by hands and feet x-ray, and previous joint surgery; prevalence of both subclinical atherosclerosis and history of CVEs.Eight centers participated to the study. From January 1, 2015 to December 31, 2015, the 1176 patients, who had been investigated for all the items, were enrolled in the study. They were mostly women (80.52%), with a median age of 60 years (range, 18-91 years), a median disease duration of 12 years (range, 0.8-25 years), seropositive in 69.21%. Nineteen percent were in remission; 17.51% presented low disease activity; 39.45% moderate disease activity; 22.61% high disease activity.Eighty-two patients (6.9%) had a history for CVEs (58 myocardial infarction, 38 heart failure, 10 ischemic transitory attack, and 7 stroke). This figure appears to be lower than that reported worldwide (8.5%). After excluding the 82 patients with a history of CV events, subclinical atherosclerosis was detected in 16% of our patients, (176 patients), a figure lower than that reported worldwide (32.7%) and in previous Italian studies.This is the first Italian multicenter study on subclinical and clinical atherosclerosis in patients with RA. We pointed out a low prevalence of both subclinical atherosclerosis and history of CV events.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila
| | | | - Federica Macaluso
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo
| | - Daniela Iacono
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples
| | - Francesca D’Onofrio
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Fabiola Atzeni
- Rheumatology Section, L. Sacco University Hospital, Milan
| | - Marcella Prete
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Federico Perosa
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | | | - Lorenzo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Francesco Paolo Cantatore
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia
| | - Giovanni Triolo
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo
| | - Antonella Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome
| | - Roberto Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila
| | - Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples
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