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Ngandu Ntumba MH, Makan K, Musenge E, Tikly M. Comorbidities in Privately Insured South Africans With Systemic Lupus Erythematosus. Cureus 2024; 16:e55470. [PMID: 38571865 PMCID: PMC10988769 DOI: 10.7759/cureus.55470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Comorbidities in systemic lupus erythematosus (SLE) impact negatively on health-related quality of life (HRQoL) and life expectancy. We investigated the frequency and spectrum of comorbidities in privately insured South Africans with SLE. Methods The data of SLE patients based on International Classification of Diseases, Tenth Revision (ICD-10) codes and insured with Discovery Health Medical Scheme (DHMS), South Africa, aged ≥16 years at diagnosis and with ≥6 months of follow-up were reviewed. Demographics, comorbidities listed in the Charlson comorbidity index (CCI), other common comorbidities, intercurrent illnesses, and drug therapy were documented. Results Of the 520 patients coded as SLE, 207 met the inclusion criteria. Most were females (90.8%), with a median (interquartile range {IQR}) age and follow-up duration of 39 (30.3-53.0) and 6.1 (3.7-8.1) years, respectively. All patients had at least one comorbidity; the most frequent CCI comorbidities were pulmonary disease (30.9%), congestive heart failure (CHF, 15%), and renal disease (14.0%). Other common comorbidities were hypertension (53.1%) and mood and anxiety disorders (46.9%). Urinary tract infections (UTIs, 37.7%) and pneumonia (33.8%) were common intercurrent illnesses. The independent predictors of CHF were renal disease (odds ratio {OR}=855), dyslipidemia (OR=15.3), and male gender (OR=43.0); the independent predictors of hypertension were age at diagnosis (OR=1.03), type 2 diabetes (OR=4.45), and renal disease (OR=4.34); and the independent predictors of mood and anxiety disorders were female gender (OR=3.98), stroke (OR=3.18), UTI (OR=2.39), and chloroquine use (OR=1.94). Conclusion In this study of privately insured South Africans with SLE, comorbidities were common, and all patients had at least one comorbidity. Hypertension, infections, and mood and anxiety disorders were the leading comorbidities overall, and pulmonary disease was the most common CCI comorbidity. There is an obvious need to formally study the burden of mental health disorders in South African SLE patients.
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Affiliation(s)
- Mbombo Henriette Ngandu Ntumba
- Department of Internal Medicine, School of Clinical Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Kavita Makan
- Division of Rheumatology, Department of Internal Medicine, School of Clinical Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Mohammed Tikly
- Division of Rheumatology, Department of Internal Medicine, School of Clinical Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
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Huang SW, Yeh WB, Lee WK, Chang R. Association between glucocorticoid discontinuation and the incidence of infection in older adults with rheumatoid arthritis: A retrospective cohort study. Int J Rheum Dis 2024; 27:e14952. [PMID: 37916528 DOI: 10.1111/1756-185x.14952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/28/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Shih-Wei Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Bin Yeh
- Department of Emergency Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Wei-Kai Lee
- Department of Emergency Medicine, Ministry of Health and Welfare Sinying Hospital, Tainan, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Su K, Li X, Jiang Z, Mei Y. Screening, prophylaxis, and challenges: Tumor necrosis factor inhibitors and latent tuberculosis infection nexus in rheumatology. Int J Rheum Dis 2024; 27:e14996. [PMID: 38061894 DOI: 10.1111/1756-185x.14996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 01/31/2024]
Affiliation(s)
- Kaisheng Su
- Department of Rheumatology, the First Hospital of Jilin University, Changchun, Jilin Province, China
- Department of Clinical Epidemiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ximeng Li
- Department of Rheumatology and Immunology, Shenzhen Third People's Hospital, National Clinical Medical Research Center for Infectious Diseases, Shenzhen, Guangdong Province, China
| | - Zhenyu Jiang
- Department of Rheumatology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yifang Mei
- Department of Rheumatology and Immunology, Shenzhen Third People's Hospital, National Clinical Medical Research Center for Infectious Diseases, Shenzhen, Guangdong Province, China
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Chen AIH, Lee YH, Perng WT, Chiou JY, Wang YH, Lin L, Wei JCC, Tsou HK. Celecoxib and Etoricoxib may reduce risk of ischemic stroke in patients with rheumatoid arthritis: A nationwide retrospective cohort study. Front Neurol 2022; 13:1018521. [PMID: 36341096 PMCID: PMC9630581 DOI: 10.3389/fneur.2022.1018521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background and purpose Previous studies reported conflicting results about the risk of ischemic stroke associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA). We aimed to investigate two specific COX-2 inhibitors, Celecoxib and Etoricoxib, and their corresponding effects on the risk of ischemic stroke in patients with RA. Patients and methods 10,857 patients newly diagnosed with RA were identified and sampled from the Taiwanese National Health Insurance Research Database during the period from 2001 to 2009. The identification of RA was based on the criteria of ICD-9-CM diagnosis code 714.0. Patients diagnosed with cerebrovascular disease and those receiving RA treatment prior to the first diagnosis of RA were excluded. Study endpoint was ischemic stroke, defined by ICD-9-CM code. Cox proportional hazard models and Kaplan Meier curves were used to reveal covariates and differences by drugs in the risk of ischemic stroke. Dosages for Celecoxib were defined as ≤ 200 and >200 mg/day; those for Etoricoxib were 0 and >0 mg/day. Results Among 7,904 RA patients, 6,669 did not take Celecoxib and 564 (8.46%) of them experienced an ischemic stroke event. Of the 597 individuals who took ≤ 200 mg/day of Celecoxib, 58 (9.72%) had strokes. Of the 638 patients who took >200 mg/day of Celecoxib, 38 (5.96%) eventually experienced a stroke. Among the 7,681 patients who did not take Etoricoxib, 654 (8.51%) experienced an ischemic stroke, while 6 (2.69%) in 223 patients who consumed Etoricoxib had a stroke event. Consuming more than 200 mg of Celecoxib per day for <3.5 years lowered the incidence rate for strokes [hazard ratio (HR) 0.67, 95% Confidence Interval (CI) 0.48–0.93 for dosage and HR 0.22, 95% CI 0.10–0.46 for duration, both p < 0.001], while consuming any dosage of Etoricoxib significantly decreases the possibility (HR 0.35, 95% CI 0.16–0.80, p < 0.001). On the other hand, consuming Etoricoxib for 8 years might have a neutral or even a potentially protective effect compared to at 3.8 years. Conclusion This population-based retrospective cohort study has shown that Celecoxib and Etoricoxib reduce the risk of ischemic stroke in patients with RA in a dose- and time-dependent manner.
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Affiliation(s)
- Acer I-Hung Chen
- Medical Intensive Care Unit, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Heng Lee
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
- Department of Center for General Education, National United University, Miaoli, Taiwan
| | - Wuu-Tsun Perng
- Department of Recreational Sport and Health Promotion, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Lichi Lin
- Department of Statistics, Oklahoma State University, Stillwater, OK, United States
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
- Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Hsi-Kai Tsou
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Su YJ, Huang JY, Chu CQ, Wei JCC. Sulfonylureas or biguanides is associated with a lower risk of rheumatoid arthritis in patients with diabetes: A nationwide cohort study. Front Med (Lausanne) 2022; 9:934184. [PMID: 35966856 PMCID: PMC9363881 DOI: 10.3389/fmed.2022.934184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveDiabetes mellitus (DM) is associated with immune dysregulation, while sulfonylureas or biguanides have been linked to anti-inflammatory mechanisms. In this study, we aimed to examine the occurrence rate of rheumatoid arthritis (RA) among DM patients and its incidence rate between different treatments.MethodsThis cohort study used the Taiwan National Health Insurance Research Database between 1997 and 2013 to evaluate the primary outcomes of the preventive role of sulfonylureas or biguanides in the development of RA. We used the Chi-square test for categorical variables and Cox proportional hazard regression and log-rank test to explore the time for development of RA in DM patients. Logistic regression was adopted to estimate the odds ratio of RA in different dosages of medication exposure.ResultsOur cohort study included 94,141 DM cases. The risk of RA development of non-sulfonylureas/biguanides users among the DM group in each analysis was set as the reference, and the adjusted hazard ratio of RA in DM patients who were using sulfonylureas or biguanides was 0.73 (95% confidence interval 0.60–0.90). Within 1 year before the index date, compared with no-biguanides users, patients with more than 180 days of prescription of biguanides had a significantly lower RA risk. Similarly, the significantly lower risk of RA was still observed in DM patients who had more than 365 days of prescription of sulfonylurea within 2 or 3 years before the index date of first RA visit (all p < 0.05).ConclusionOur data suggest that sulfonylureas or biguanides are associated with a lower rate of RA development in patients with DM; the effect of biguanides appeared more rapid than that of sulfonylureas, but the sulfonylureas might have a longer effect on lowering RA development incidence.
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Affiliation(s)
- Yu-Jih Su
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Mitochondrial Research and Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University and VA Portland Health Care System, Portland, OR, United States
- *Correspondence: Cong-Qiu Chu
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- James Cheng-Chung Wei
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