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Baah E, Kohlmeier M. Obesity and the Development of Arthritis Among Adults in the United States Using NHANES Data. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2024; 17:11795441241264820. [PMID: 39091588 PMCID: PMC11292711 DOI: 10.1177/11795441241264820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 06/10/2024] [Indexed: 08/04/2024]
Abstract
Background The alarming increase in the prevalence of obesity and arthritis in America in recent times is concerning both in terms of the deleterious health effects on the individuals and economic cost. The wear and tear on the musculoskeletal and the inflammatory effects of obesity may be the reasons for the rise in arthritis among individuals with obesity. Objective To investigate the association between obesity and the development of arthritis among adults in the United States. Design A total of 17 016 participants were included from the 2012 to 2018 National Health and Nutrition Examination Survey (NHANES). Most of the participants were aged 30 years and above (79.7%). The racial distribution included 64.0% Non-Hispanic whites, 15.3% Hispanics, 11.4% Non-Hispanics blacks, and 9.4% from all other races. Methods Obesity was defined as a body mass index (BMI) > 30 kg/m², and the outcome variable of interest, arthritis status, was self-reported. Survey weighted logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval controlling for potential confounding factors. Result Nearly 40% of all participants were individuals with obesity, and 27.5% reported having some form of arthritis. The risk of developing arthritis was higher in individuals with obesity (OR: 1.55, 95% CI: 1.35-1.80), women (OR: 1.94, 95%CI: 1.66-2.28), and individuals 30 years or older (OR: 10.81, 95% CI: 6.36-18.37) with non-Hispanic whites being the most affected race. The C-reactive protein (CRP) and white blood cell count (WBC) levels were higher in all individuals with obesity even though there was no statistical difference between individuals with obesity with and without arthritis. Conclusions Obesity substantially heightens the risk of developing arthritis due to the mechanical stress on weight-bearing joints and subsequent chronic-low level inflammation contributing to disease progression.
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Affiliation(s)
- Emmanuel Baah
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Martin Kohlmeier
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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Wang H, Wu Q, Qu P, Wang S, Du S, Peng Z, Tao L, Wang W, Tang X. Diet affects inflammatory arthritis: a Mendelian randomization study of 30 dietary patterns causally associated with inflammatory arthritis. Front Nutr 2024; 11:1426125. [PMID: 39086544 PMCID: PMC11289845 DOI: 10.3389/fnut.2024.1426125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
Background The causal associations between dietary intake and the risk and severity of Inflammatory Arthritis (IA) are currently unknown. Objective In this study, we aimed to investigate the causal relationship between nine dietary categories (30 types of diet) and IA using Mendelian randomization (MR). Methods We analyzed data from 30 diets and IA in a genome-wide association study (GWAS). Single nucleotide polymorphisms (SNPs) that could influence the results of MR analyses were screened out through the Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test. SNPs were analyzed through two-sample bidirectional MR using inverse variance weighting, MR-Egger regression, and weighted median method. The multiplicity and heterogeneity of SNPs were assessed using MR-Egger intercept term tests and Cochran's Q tests. FDR correction was used to correct the p-values. Results IVW results showed that Beef intake [Odds ratio (OR) = 2.862; 95% confidence interval (CI), 1.360-6.021, p = 0.006, p_fdr < 0.05] was positively associated with rheumatoid arthritis(RA); Dried fruit intake (OR = 0.522; 95% CI, 0.349-0.781, p = 0.002, p_fdr < 0.05), and Iron intake (OR = 0.864; 95%CI, 0.777-0.960, p = 0.007, p_fdr < 0.05) were negatively associated with RA, all of which were evidence of significance. Fresh fruit intake (OR = 2.528. 95% CI, 1.063-6.011, p = 0.036, p_fdr > 0.05) was positively associated with psoriatic arthritis (PsA); Cheese intake (OR = 0.579; 95% CI, 0.367-0.914, p = 0.019, p_fdr > 0.05) was negatively associated with PsA; both were suggestive evidence. Processed meat intake (OR = 0.238; 95% CI, 0.100-0.565, p = 0.001, p_fdr < 0.05) was negatively associated with reactive arthritis (ReA), a protective factor, and significant evidence. All exposure data passed the heterogeneity check (Cochrane's Q test p > 0.05) and no directional pleiotropy was detected. Leave-one-out analyses demonstrated the robustness of the causal relationship in the positive results. Conclusion Our study presents genetic evidence supporting a causal relationship between diet and an increased risk of IA. It also identifies a causal relationship between various dietary modalities and different types of IA. These findings have significant implications for the prevention and management of IA through dietary modifications.
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Affiliation(s)
- Haiyang Wang
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Qinglin Wu
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Pengda Qu
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Shiqi Wang
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Shiyu Du
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Zhaorong Peng
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Licheng Tao
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Wuxia Wang
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
| | - Xiaohu Tang
- The First Clinical of Medicine College, Yunnan University of Chinese Medicine, Kunming, China
- Department of Rheumatology, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
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Fang TJ, Chiu MH, Huang MS, Dai CY, Yeh YT, Yen JH. Increased serum adipokines are associated with sarcopenia in non-obese women with rheumatoid arthritis. Kaohsiung J Med Sci 2024; 40:489-498. [PMID: 38602220 DOI: 10.1002/kjm2.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Large cohort studies have disclosed the association between obesity and rheumatoid arthritis (RA) risk. The sarcopenia prevalence in RA patients can be up to 31%. However, there is little information linking adipokines to sarcopenia in RA, so this study aimed to investigate whether adipokines were indeed involved in secondary sarcopenia in RA with a focus on non-obese females. Sixty-four female patients and 36 controls were included in this study. The serum adipokine levels (leptin and adiponectin) were determined by ELISA kits. The impacts of adipokines on muscle atrophy and potential autophagy were examined in mouse myoblasts, C2C12, upon treatment with recombinant leptin and adiponectin agonist (AdipoRan). Interestingly, serum adiponectin was significantly increased but the ratio of leptin/adiponectin was dramatically decreased in the RA patients with sarcopenia. After normalization by body mass, serum leptin was positively associated but adiponectin was negatively associated with muscle mass respectively, even after adjustment for fat mass. Treating C2C12 cells with leptin and AdipoRan inhibited proliferation of mature myotube respectively, as did treatment with the serum from RA patients. A combination of low leptin and high AdipoRan greatly decreased myogenin, but instead increased MAFbx and MuRF-1 as well as increased Beclin 1, Atg5, and LC3β. Taken together, our study reveals that secondary sarcopenia of RA females may be an imbalance of RA-related, but not obesity-related, increase in adipokine production; additionally, the reduced leptin/adiponectin ratio could be a better indicator in monitoring sarcopenia in non-obese RA females. Moreover, adipokine imbalance may promote muscle atrophy through inducing autophagy.
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Affiliation(s)
- Tzu-Jung Fang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Min-Hsi Chiu
- Aging and Disease Prevention Research Center, Fooyin University, Kaohsiung, Taiwan
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan
| | - Ming-Shyan Huang
- E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Yao-Tsung Yeh
- Aging and Disease Prevention Research Center, Fooyin University, Kaohsiung, Taiwan
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan
| | - Jeng-Hsien Yen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
- College of Biological Science and Technology, National Yang-Ming Chiao Tung University, Taiwan
- Institute of Biomedical Science, National Sun Yat-sen University, Kaohsiung, Taiwan
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van Dijk BT, Boeren AMP, Khidir SJH, den Hollander NK, van der Helm-van Mil AHM. Work-related physical strain and development of joint inflammation in the trajectory of emerging inflammatory and rheumatoid arthritis: a prospective cohort study. RMD Open 2024; 10:e003895. [PMID: 38599648 PMCID: PMC11015171 DOI: 10.1136/rmdopen-2023-003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES Rheumatoid arthritis (RA) mainly affects small joints. Despite the mechanical function of joints, the role of mechanical stress in the development of arthritis is insufficiently understood. We hypothesised that mechanical stress/physical strain is a risk factor for joint inflammation in RA. Therefore, we studied work-related physical strain in subjects with clinically suspected arthralgia (CSA) as a risk factor for the presence of imaging-detected subclinical joint inflammation and the development of clinical arthritis/RA. METHODS In 501 CSA patients and 155 symptom-free persons' occupation-related physical strain was quantified using the International Standard Classification of Occupations. Contrast-enhanced hand-MRIs were made and evaluated for joint inflammation (sum of synovitis/tenosynovitis/osteitis). CSA patients were followed on RA development. Age relationship was studied using an interaction term of physical strain with age. RESULTS The degree of physical strain in CSA is associated with the severity of joint inflammation, independent of educational-level/BMI/smoking (interaction physical strain-age p=0.007; indicating a stronger association with increasing age). Physical strain is associated with higher tenosynovitis scores, in particular. In symptom-free persons, physical strain was not associated with imaging-detected joint inflammation. Higher degrees of physical strain also associated with higher risks for RA development in an age-dependent manner (HR=1.20 (1.06-1.37)/10-year increase in age), independent of educational-level/BMI/smoking. This association was partly mediated by an effect via subclinical joint inflammation. CONCLUSIONS Work-related physical strain increases the risk of subclinical joint inflammation and of developing RA. The age relationship suggests an effect of long-term stress or that tenosynovium is more sensitive to stress at older age. Together, the data indicate that mechanical stress contributes to the development of arthritis in RA.
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Affiliation(s)
| | - Anna M P Boeren
- Rheumatology, LUMC, Leiden, The Netherlands
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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Takhrifa N, Taik FZ, Berrichi I, Adnine A, Abourazzak FE. Diets and Joint Symptoms: A Survey of Moroccan Patients With Chronic Inflammatory Rheumatic Disease. Cureus 2024; 16:e53868. [PMID: 38465070 PMCID: PMC10924651 DOI: 10.7759/cureus.53868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The role of diet in the onset or aggravation of chronic diseases, especially chronic inflammatory rheumatic disease (CIRD), such as rheumatoid arthritis (RA) or spondyloarthritis (SpA), is a question frequently asked by patients. Our study aims to investigate whether Moroccan patients report a relationship between certain diets and disease symptoms and to study whether patients adopt specific dietary behaviours in order to relieve their symptoms. Methods This is a cross-sectional survey that included all patients followed for CIRD. The questionnaire has three parts, patients' sociodemographic and clinical data, patients' beliefs and attitudes regarding diet in relation to their joint symptoms, and a list of 24 foods for which patients were asked to indicate whether they aggravate, improve, or leave their joint symptoms unchanged. Results Thirty-four percent of the patients reported that the food had an effect on their symptoms, with 25% of them reporting an aggravation. Honey, garlic, and olive oil were the foods most often reported to improve joint symptoms, while red meat, fish, and legumes were most often reported to worsen symptoms. Age and type of rheumatism were factors associated with reporting that food affects joint symptoms. Twenty-three percent of the patients stated that they had already had discussions about diet with their rheumatologists, while 85.7% showed interest in such discussions. Experience with a food that improves joint symptoms was the only factor associated with discussing the diet with a rheumatologist. Conclusion Nearly one-third of the patients with CIRD reported an effect of diet on their joint symptoms.
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Affiliation(s)
- Nihad Takhrifa
- Rheumatology, Mohammed VI University Hospital Center of Tangier, Tangier, MAR
| | - Fatima Zahrae Taik
- Rheumatology, Mohammed VI University Hospital Center of Tangier, Tangier, MAR
| | - Imane Berrichi
- Rheumatology, Mohammed VI University Hospital Center of Tangier, Tangier, MAR
| | - Anass Adnine
- Rheumatology, Mohammed VI University Hospital Center of Tangier, Tangier, MAR
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Dumoulin QA, Boeren AMP, Krijbolder DI, Willemze A, de Jong PHP, van Mulligen E, van Steenbergen HW, van der Helm-van Mil AHM. When does obesity exert its effect in conferring risk of developing RA: a large study in cohorts of symptomatic persons at risk. RMD Open 2024; 10:e003785. [PMID: 38216289 PMCID: PMC10806477 DOI: 10.1136/rmdopen-2023-003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Obesity is a known risk factor for developing rheumatoid arthritis (RA). However, it is unclear whether obesity exerts its risk effect during the asymptomatic or the symptomatic clinically suspect arthralgia (CSA) phase of risk. To improve understanding of the effect of obesity on RA development, we aimed to (1) compare body mass index (BMI) at CSA onset to BMI of the general population and (2) study within CSA patients if obesity increases the risk for progression to RA. METHODS 1107 symptomatic persons at risk for RA from four cohorts (CSA Leiden, CSA Rotterdam, SONAR and TREAT EARLIER placebo arm) were studied. For the first aim, baseline BMI was compared with age-matched/sex-matched BMI of the general population. Patients were stratified for anticitrullinated protein antibody (ACPA) status. Regarding the second aim, the association between BMI and inflammatory arthritis (IA) development during 2 years was studied with Cox regression analysis within each cohort and via meta-analysis in all cohorts. RESULTS CSA patients of all cohorts were more often obese than the general population (respectively 21.9% vs 14.0%, 25.7% vs 14.5%, 26.7% vs 14.5% and 33.3% vs 14.9%, in CSA Leiden, CSA Rotterdam, SONAR, TREAT EARLIER placebo arm). Both ACPA-positive and ACPA-negative CSA patients had a higher frequency of obesity. Within CSA, obesity was not associated with IA development compared to normal weight (pooled effect in meta-analysis of four cohorts HR 1.01 (95% CI 0.93 to 1.08)). CONCLUSIONS Obesity is not associated with RA development within CSA patients but BMI has already increased in CSA compared to the general population. Obesity, therefore, presumably exerts its risk effect at an early asymptomatic phase of RA development, rather than being associated with the disease processes that ultimately result in clinical arthritis.
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Affiliation(s)
- Quirine A Dumoulin
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna M P Boeren
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - Doortje I Krijbolder
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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7
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KARATAŞ A, PİŞKİN SAĞIR R, KOCA SS, DALKILIÇ E, CAN G, PEHLİVAN Y, YAZICI A, İNANÇ N, CEFLE A, ERTÜRK Z, AKAR S, ŞENEL S, BİRLİK M, AKKOÇ N, ÖNEN F. Body mass index does not affect response of rituximab in patients with rheumatoid arthritis: results from the TURKBİO registry. Turk J Med Sci 2023; 53:1321-1329. [PMID: 38813042 PMCID: PMC10763794 DOI: 10.55730/1300-0144.5698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/26/2023] [Accepted: 06/21/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Adipose tissue produces several inflammatory mediators. Thus, obesity affects the disease course and the responses to the antirheumatic agents in inflammatory diseases. The aim of the study was to determine whether the body mass index (BMI) is involved in the response to rituximab in rheumatoid arthritis (RA). Materials and methods This multicenter retrospective study included 206 RA patients who received rituximab from the Turkish Biologic (TURKBIO) registry between 2011 and the end of May 2017. Demographic and clinical data including age, sex, disease type, disease duration, and previous or current treatment with disease-modifying antirheumatic drugs (DMARDs) and biological drug durations are stored in the database. Patients with a BMI ≥30 kg/m2 were classified as obese, and patients with a BMI <30 kg/m2 were classified as nonobese. Kaplan-Meier survival analysis was performed to estimate the drug survival. The subgroups were compared using the log-rank test. Results The mean BMI of 206 patients included in the study was 27.05 (17.2-43.4) kg/m2. There were 59 (28.6%) patients in the obese group and 147 (71.4%) patients in the nonobese group. The mean age, female percentage, and baseline disease activity score 28 (DAS28) were higher in the obese group than in the nonobese group. However, the ΔDAS28 at both 6 and 12 months were not significantly different between the groups (p = 0.785 and p = 0.512, respectively). Patient pain Visual Analogue Scale (VAS), patient fatigue VAS, and patient global VAS scores were also significantly higher at baseline in the obese group (p = 0.003, p = 0.006, and p = 0.006, respectively). However, no significant difference was found in terms of changes in patient pain VAS, patient fatigue VAS, patient global VAS and physician global VAS scores at 6 and 12 months compared to those at baseline. Rituximab treatment was ongoing for 71.2% of the obese and 63.3% of the nonobese patients (p = 0.279). The median drug survival duration was 77 months in the obese group and 62 months in the nonobese group (p = 0.053). The estimated drug survival rates for rituximab were not statistically significantly different in the obese and nonobese groups. Rituximab-related side effects were also similar between the groups. Conclusion In obese and nonobese patients with RA, rituximab treatment exhibits similar side effects and similar long-term efficacy. These results suggest that obesity does not alter drug survival for rituximab and response rates, in RA and rituximab may be a favorable treatment agent in patients with RA and obesity.
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Affiliation(s)
- Ahmet KARATAŞ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazığ,
Turkiye
| | - Rabia PİŞKİN SAĞIR
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazığ,
Turkiye
| | - Süleyman Serdar KOCA
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazığ,
Turkiye
| | - Ediz DALKILIÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa,
Turkiye
| | - Gerçek CAN
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Yavuz PEHLİVAN
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa,
Turkiye
| | - Ayten YAZICI
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, İzmit,
Turkiye
| | - Nevsun İNANÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University, İstanbul,
Turkiye
| | - Ayşe CEFLE
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, İzmit,
Turkiye
| | - Zeynep ERTÜRK
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Medipol University, İstanbul,
Turkiye
| | - Servet AKAR
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Katip Çelebi University, İzmir,
Turkiye
| | - Soner ŞENEL
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - Merih BİRLİK
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Nurullah AKKOÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Celal Bayar University, Manisa,
Turkiye
| | - Fatoş ÖNEN
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
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Frazzei G, Musters A, de Vries N, Tas SW, van Vollenhoven RF. Prevention of rheumatoid arthritis: A systematic literature review of preventive strategies in at-risk individuals. Autoimmun Rev 2023; 22:103217. [PMID: 36280095 DOI: 10.1016/j.autrev.2022.103217] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disease characterized by symmetrical peripheral polyarthritis in the hands and/or feet, leading to long-term disability if not treated effectively. RA is preceded by a preclinical phase, in which genetically predisposed individuals accumulate environmental risk factors, and during which autoimmunity develops, followed by the emergence of non-specific signs and symptoms before arthritis becomes manifest. Early treatment in at-risk individuals - i.e. before the disease is fully established - has the theoretical potential to delay or prevent disease onset, with a positive impact on both patients' life and society. OBJECTIVES We aimed to understand the feasibility of preventive treatment in at-risk individuals, taking into account recently performed studies and ongoing clinical trials, as well as patient perspectives. METHODS We performed a systematic literature review (SLR) on Medline and Embase, searching articles published between 2010 and 2021 with the following key-words: "Rheumatoid arthritis", "arthralgia", "pre-treatment" or "prevent". RESULTS Our SLR identified a total of 1821 articles. Articles were independently screened by two researchers. A total of 14 articles were included after screening, and an additional 8 reports were manually included. We identified ten relevant clinical trials performed in at-risk individuals, or in individuals with undifferentiated inflammatory arthritis. Although no treatment was shown to prevent RA onset, early treatment with rituximab and abatacept delayed onset of full-blown RA, and both conventional and biological disease-modifying anti-rheumatic drugs (DMARDs) decreased disease-related physical limitations and increased DAS28-defined remission, at least temporarily. CONCLUSIONS This SLR demonstrates that early treatment of at-risk individuals may be effective in delaying RA onset, thereby decreasing disease-related limitations in individuals in the pre-clinical phase of RA. Whether this may ultimately lead to prevention of RA remains to be determined.
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Affiliation(s)
- Giulia Frazzei
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Anne Musters
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Niek de Vries
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Sander W Tas
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - Ronald F van Vollenhoven
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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9
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Frazzei G, van Vollenhoven RF, de Jong BA, Siegelaar SE, van Schaardenburg D. Preclinical Autoimmune Disease: a Comparison of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis and Type 1 Diabetes. Front Immunol 2022; 13:899372. [PMID: 35844538 PMCID: PMC9281565 DOI: 10.3389/fimmu.2022.899372] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/30/2022] [Indexed: 12/16/2022] Open
Abstract
The preclinical phase of autoimmune disorders is characterized by an initial asymptomatic phase of varying length followed by nonspecific signs and symptoms. A variety of autoimmune and inflammatory manifestations can be present and tend to increase in the last months to years before a clinical diagnosis can be made. The phenotype of an autoimmune disease depends on the involved organs, the underlying genetic susceptibility and pathophysiological processes. There are different as well as shared genetic or environmental risk factors and pathophysiological mechanisms between separate diseases. To shed more light on this, in this narrative review we compare the preclinical disease course of four important autoimmune diseases with distinct phenotypes: rheumatoid arthritis (RA), Systemic Lupus Erythematosus (SLE), multiple sclerosis (MS) and type 1 diabetes (T1D). In general, we observed some notable similarities such as a North-South gradient of decreasing prevalence, a female preponderance (except for T1D), major genetic risk factors at the HLA level, partly overlapping cytokine profiles and lifestyle risk factors such as obesity, smoking and stress. The latter risk factors are known to produce a state of chronic systemic low grade inflammation. A central characteristic of all four diseases is an on average lengthy prodromal phase with no or minor symptoms which can last many years, suggesting a gradually evolving interaction between the genetic profile and the environment. Part of the abnormalities may be present in unaffected family members, and autoimmune diseases can also cluster in families. In conclusion, a promising strategy for prevention of autoimmune diseases might be to address adverse life style factors by public health measures at the population level.
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Affiliation(s)
- Giulia Frazzei
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Giulia Frazzei,
| | - Ronald F. van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Rheumatology Center, Amsterdam, Netherlands
| | - Brigit A. de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Sarah E. Siegelaar
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
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10
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Salliot C, Nguyen Y, Mariette X, Boutron-Ruault MC, Seror R. Anthropometric Measures and Risk of Rheumatoid Arthritis in the French E3N Cohort Study. Nutrients 2022; 14:934. [PMID: 35267910 PMCID: PMC8912452 DOI: 10.3390/nu14050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to assess the relationships between anthropometric measures and risk of rheumatoid arthritis (RA). The E3N cohort included 98,995 women (aged 40−65 years at the recruitment) who completed mailed questionnaires on reproductive factors, lifestyle, and health-related information, including anthropometric measures, every 2−3 years. Cox proportional hazards regression models with age as the time scale and adjusted on known RA risk factors were used to estimate hazard ratios (HRs) and 95% confidence intervals for the risk of incident RA in the overall population (n = 78,452) and after stratification on smoking exposure. Incident RA diagnosis was validated in 698 women. Abdominal obesity (waist circumference >88 cm) was associated with RA (HR = 1.2 (1.0−1.5)), independent of BMI; whereas obesity, defined as BMI ≥ 30 kg/m2, was marginally associated with RA (HR = 1.26 (0.9−1.5), ptrend = 0.0559). Taking lean body shape (BS) as reference, medium BS at puberty (HR = 1.3 (1.0−1.7)) and medium-large BS at perimenopausal period (HR = 1.5 (1.1−1.9)) were associated with the risk of RA among never-smoker women, independent of BMI. Regarding BS trajectory, taking constantly lean BS as reference, constantly large BS from puberty to perimenopause was associated with RA among non-smokers (HR = 2.10 (1.2−3.6)), independent of BMI.
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Affiliation(s)
- Carine Salliot
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, 94800 Villejuif, France; (C.S.); (Y.N.)
- Rheumatology Department, Centre Hospitalier Régional d’Orleans, 45067 Orléans, France
- Centre of Immunology of Viral Infections and Auto-Immune Diseases (IMVA), INSERM U1184, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France; (X.M.); (R.S.)
| | - Yann Nguyen
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, 94800 Villejuif, France; (C.S.); (Y.N.)
- Department of Internal Medicine, AP-HP-Hôpital Beaujon, Paris University, 92110 Clichy, France
| | - Xavier Mariette
- Centre of Immunology of Viral Infections and Auto-Immune Diseases (IMVA), INSERM U1184, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France; (X.M.); (R.S.)
- Rheumatology Department, AP-HP-Hôpital Bicêtre, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France
| | - Marie-Christine Boutron-Ruault
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, 94800 Villejuif, France; (C.S.); (Y.N.)
| | - Raphaèle Seror
- Centre of Immunology of Viral Infections and Auto-Immune Diseases (IMVA), INSERM U1184, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France; (X.M.); (R.S.)
- Rheumatology Department, AP-HP-Hôpital Bicêtre, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France
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11
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2022; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Zemedikun DT, Gokhale K, Chandan JS, Cooper J, Lord JM, Filer A, Falahee M, Nirantharakumar K, Raza K. Type 2 diabetes mellitus, glycaemic control, associated therapies and risk of rheumatoid arthritis: a retrospective cohort study. Rheumatology (Oxford) 2021; 60:5567-5575. [PMID: 33590842 PMCID: PMC8645277 DOI: 10.1093/rheumatology/keab148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/30/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the incident risk of RA in patients with type 2 diabetes mellitus (T2DM) and to explore the role of glycaemic control and associated therapeutic use in the onset of RA. METHODS This study was a retrospective cohort study using patients derived from the IQVIA Medical Research Data (IMRD-UK) database between 1995 and 2019. A total of 224 551 newly diagnosed patients with T2DM were matched to 449 101 patients without T2DM and followed up to assess their risk of RA. Further analyses investigated the effect of glycaemic control, statin use and anti-diabetic drugs on the relationship between T2DM and RA using a time-dependent Cox regression model. RESULTS During the study period, the incidence of RA was 8.1 and 10.6 per 10 000 person-years in the exposed and unexposed groups, respectively. The adjusted hazard ratio (aHR) was 0.73 (95% CI 0.67, 0.79). In patients who had not used statins in their lifetime, the aHR was 0.89 (95% CI 0.69, 1.14). When quantifying the effects of glycaemic control, anti-diabetic drugs and statins using time-varying analyses, there was no association with glycaemic control [aHR 1.00 (95% CI 0.99, 1.00)], use of metformin [aHR 1.00 (95% CI 0.82, 1.22)], dipeptidyl peptidase-4 inhibitors [DPP4is; aHR 0.94 (95% CI 0.71, 1.24)] and the development of RA. However, statins demonstrated a protective effect for progression of RA in those with T2DM [aHR 0.76 (95% CI 0.66, 0.88)], with evidence of a duration-response relationship. CONCLUSION There is a reduced risk of RA in patients with T2DM that may be attributable to the use of statins.
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Affiliation(s)
- Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham.,Warwick Medical School, University of Warwick, Coventry
| | - Jennifer Cooper
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Janet M Lord
- Institute of Inflammation and Ageing.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham
| | | | | | | | - Karim Raza
- Institute of Inflammation and Ageing.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham.,Sandwell and West Birmingham NHS Hospitals Trust, Birmingham, UK
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13
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The Genetic, Environmental, and Immunopathological Complexity of Autoantibody-Negative Rheumatoid Arthritis. Int J Mol Sci 2021; 22:ijms222212386. [PMID: 34830268 PMCID: PMC8618508 DOI: 10.3390/ijms222212386] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
Differences in clinical presentation, response to treatment, and long-term outcomes between autoantibody-positive and -negative rheumatoid arthritis (RA) highlight the need for a better comprehension of the immunopathogenic events underlying the two disease subtypes. Whilst the drivers and perpetuators of autoimmunity in autoantibody-positive RA have started to be disclosed, autoantibody-negative RA remains puzzling, also due its wide phenotypic heterogeneity and its possible misdiagnosis. Genetic susceptibility appears to mostly rely on class I HLA genes and a number of yet unidentified non-HLA loci. On the background of such variable genetic predisposition, multiple exogeneous, endogenous, and stochastic factors, some of which are not shared with autoantibody-positive RA, contribute to the onset of the inflammatory cascade. In a proportion of the patients, the immunopathology of synovitis, at least in the initial stages, appears largely myeloid driven, with abundant production of proinflammatory cytokines and only minor involvement of cells of the adaptive immune system. Better understanding of the complexity of autoantibody-negative RA is still needed in order to open new avenues for targeted intervention and improve clinical outcomes.
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14
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Issilbayeva A, Meiramova A, Kushugulova AR, Akhmetova ZB, Biktashev D, Abdakhina BB, Aituganova AT, Zueva Y, Karlygash K, Ainabekova BA. The Clinical Course of Rheumatoid Arthritis in Kazakhstani Patients. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Rheumatoid arthritis (RA) prevalence according to the worldwide epidemiological data varies from 0.4% to 1.3%. The disability and mortality rate in RA is high. RA clinic is various, and compiles from articular and systemic manifestations.
AIM: The aim of our study was to investigate the clinical course of RA in Kazakhstani patients living in North region of our country.
METHODS: The 81 women at the age of 30–55 years with a verified diagnosis of RA who have lived in Kazakhstan for at least 10 years were recruited to the study. All participants were examined by the rheumatologist and a standard laboratory examination was carried out. Statistical analysis was conducted in IBM SPSS Statistics 26 software (IBM.USA;1).
RESULTS: The statistically significant higher frequency of erosive radiological stages, bone ankylosis (χ2 = 18.070 df = 6 p = 0.005) was found in seropositive (rheumatoid factor [RF]+) anti-citrullinated protein/peptide antibody positive (ACPA+) subgroup. The correlation analysis showed strong association between certain RA form activity and inflammatory markers, as well as disease triggers. The discriminant model which predicts the stage of radiological damage was obtained. The sensitivity of model in predicting X-ray Stage I-71.6%, Stage II-29.4%, Stage III-37.5%, and Stage IV-63.6%.
CONCLUSION: The debut of the RA on average occurred in the third decade of the patients’ life. The joint syndrome had a more unfavorable character RF+ACPA+ patients’ subgroup; however, RF+ACPA-negative (ACPA-) subgroup also showed a predisposition to poorer prognosis. The obtained discriminant model may be useful for RA patients’ management.
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15
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Koller-Smith L, Mehdi AM, March L, Tooth L, Mishra G, Thomas R. Rheumatoid arthritis is a preventable disease: 11 ways to reduce your patients' risk. Intern Med J 2021; 52:711-716. [PMID: 34553824 DOI: 10.1111/imj.15537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
New evidence shows that up to 40% of rheumatoid arthritis (RA) cases are attributable to exposure to potentially modifiable factors. We can now identify people at higher risk of RA (pre-RA) through their family history, risk factors, autoantibodies and symptoms. Counselling these patients to act to modify factors known to be associated with RA risk could prevent the development of RA, and evidence shows that informing individuals of their risk and of ways to reduce it leads to positive behavioural change and is not harmful. This consumer-focused narrative review is targeted at primary care providers and physicians to describe 11 changes that can be made, based on current evidence linking potentially modifiable factors to RA risk. These evidence-based recommendations are: Cease smoking Reduce exposure to inhaled silica, dusts and occupational risks Maintain a healthy weight Increase leisure time physical activity Maintain good dental hygiene Maximise breastfeeding if able Maximise dietary quality, and avoid high salt diets Consume high levels of Omega-3 fatty acids and fish Reduce consumption of sugar-sweetened soft drinks Consume moderate levels of alcohol Remain Vitamin D replete This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Louise Koller-Smith
- The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland.,School of Medicine, The University of Newcastle, Newcastle, New South Wales
| | - Ahmed M Mehdi
- The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales
| | - Leigh Tooth
- School of Public Health, The University of Queensland, Herston, Queensland
| | - Gita Mishra
- School of Public Health, The University of Queensland, Herston, Queensland
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland
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16
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Costello RE, Humphreys JH, Sergeant JC, Haris M, Stirling F, Raza K, van Schaardenburg D, Bruce IN. Symptoms in first-degree relatives of patients with rheumatoid arthritis: evaluation of cross-sectional data from the symptoms in persons at risk of rheumatoid arthritis (SPARRA) questionnaire in the PRe-clinical EValuation of Novel Targets in RA (PREVeNT-RA) Cohort. Arthritis Res Ther 2021; 23:210. [PMID: 34380557 PMCID: PMC8356426 DOI: 10.1186/s13075-021-02593-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) have a fourfold increased risk of developing RA. The Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire was developed to document symptoms in persons at risk of RA. The aims of this study were (1) to describe symptoms in a cohort of FDRs of patients with RA overall and stratified by seropositivity and elevated CRP and (2) to determine if patient characteristics were associated with symptoms suggestive of RA. METHODS A cross-sectional study of FDRs of patients with RA, in the PREVeNT-RA study, who completed a study questionnaire, provided a blood sample measured for rheumatoid factor, anti-CCP and CRP and completed the SPARRA questionnaire. Moderate/severe symptoms and symmetrical, small and large joint pain were identified and described. Symptoms associated with both seropositivity and elevated CRP were considered suggestive of RA. Logistic regression was used to determine if symptoms suggestive of RA were associated with patient characteristics. RESULTS Eight hundred seventy participants provided all data, 43 (5%) were seropositive and 122 (14%) had elevated CRP. The most frequently reported symptoms were sleep disturbances (20.3%) and joint pain (17.9%). Symmetrical and small joint pain were 11.3% and 12.8% higher, respectively, in those who were seropositive and 11.5% and 10.7% higher in those with elevated CRP. In the logistic regression model, seropositivity, older age and feeling depressed were associated with increased odds of small and symmetrical joint pain. CONCLUSIONS This is the first time the SPARRA questionnaire has been applied in FDRs of patients with RA and has demonstrated that the presence of symmetrical and small joint pain in this group may be useful in identifying people at higher risk of developing RA.
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Affiliation(s)
- R E Costello
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - J H Humphreys
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - J C Sergeant
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M Haris
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - F Stirling
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - K Raza
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - D van Schaardenburg
- Amsterdam Rheumatology and immunology Center, location Reade and Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK. .,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. .,Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
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17
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Wouters F, Maurits MP, van Boheemen L, Verstappen M, Mankia K, Matthijssen XME, Dorjée AL, Emery P, Knevel R, van Schaardenburg D, Toes REM, van der Helm-van Mil AHM. Determining in which pre-arthritis stage HLA-shared epitope alleles and smoking exert their effect on the development of rheumatoid arthritis. Ann Rheum Dis 2021; 81:48-55. [PMID: 34285049 DOI: 10.1136/annrheumdis-2021-220546] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The human leukocyte antigen-shared epitope (HLA-SE) alleles and smoking are the most prominent genetic and environmental risk factors for rheumatoid arthritis (RA). However, at which pre-arthritis stage (asymptomatic/symptomatic) they exert their effect is unknown. We aimed to determine whether HLA-SE and smoking are involved in the onset of autoantibody positivity, symptoms (clinically suspect arthralgia (CSA)) and/or progression to clinical arthritis. METHODS We performed meta-analyses on results from the literature on associations of HLA-SE and smoking with anti-citrullinated protein antibodies (ACPAs) in the asymptomatic population. Next, we studied associations of HLA-SE and smoking with autoantibody positivity at CSA onset and with progression to clinical inflammatory arthritis (IA) during follow-up. Associations in ACPA-positive patients with CSA were validated in meta-analyses with other arthralgia cohorts. Analyses were repeated for rheumatoid factor (RF), anti-carbamylated protein antibodies (anti-CarP) and anti-acetylated protein antibodies (AAPA). RESULTS Meta-analyses showed that HLA-SE is not associated with ACPA positivity in the asymptomatic population (OR 1.06 (95% CI:0.69 to 1.64)), whereas smoking was associated (OR 1.37 (95% CI: 1.15 to 1.63)). At CSA onset, both HLA-SE and smoking associated with ACPA positivity (OR 2.08 (95% CI: 1.24 to 3.49), OR 2.41 (95% CI: 1.31 to 4.43)). During follow-up, HLA-SE associated with IA development (HR 1.86 (95% CI: 1.23 to 2.82)), in contrast to smoking. This was confirmed in meta-analyses in ACPA-positive arthralgia (HR 1.52 (95% CI: 1.08 to 2.15)). HLA-SE and smoking were not associated with RF, anti-CarP or AAPA-positivity at CSA onset. Longitudinally, AAPA associated with IA development independent from ACPA and RF (HR 1.79 (95% CI: 1.02 to 3.16)), anti-CarP did not. CONCLUSIONS HLA-SE and smoking act at different stages: smoking confers risk for ACPA and symptom development, whereas HLA-SE mediates symptom and IA development. These data enhance the understanding of the timing of the key risk factors in the development of RA.
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Affiliation(s)
- Fenne Wouters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc P Maurits
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurette van Boheemen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Marloes Verstappen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Annemarie L Dorjée
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rachel Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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18
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Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women. Sci Rep 2020; 10:20793. [PMID: 33247198 PMCID: PMC7695821 DOI: 10.1038/s41598-020-77841-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/13/2020] [Indexed: 01/21/2023] Open
Abstract
In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09–1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74–0.87), regular physical activity (aHR 0.90; 95% CI 0.84–0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78–0.93), and cancer (aHR 0.77; 95% CI 0.64–0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.
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19
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Adiposity and the risk of rheumatoid arthritis: a systematic review and meta-analysis of cohort studies. Sci Rep 2020; 10:16006. [PMID: 32994434 PMCID: PMC7524740 DOI: 10.1038/s41598-020-71676-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Several studies have investigated associations between overweight/obesity and risk of developing rheumatoid arthritis, however, the evidence is not entirely consistent, and previous meta-analyses mainly included case–control studies, which can be affected by various biases. We therefore conducted a systematic review and meta-analysis of cohort studies on adiposity and risk of rheumatoid arthritis. Relevant studies were identified by searching PubMed and Embase databases. Random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs) for rheumatoid arthritis in relation to different measures of adiposity. Thirteen cohort studies (10 publications) were included. The summary RR per 5 kg/m2 increase in body mass index (BMI) was 1.11 (95% CI 1.05–1.18, I2 = 50%), but the association was restricted to women (1.15, 95% CI 1.08–1.21, I2 = 17%) and not observed in men (0.89, 95% CI 0.73–1.09, I2 = 58%). The summary RR per 5 kg/m2 increment in BMI at age 18 years was 1.17 (95% CI 1.01–1.36, I2 = 26%, n = 3), and per 10 cm increase in waist circumference was 1.13 (95% CI 1.02–1.25, I2 = 44%, n = 2). Higher BMI in middle age, BMI at age 18 years, and waist circumference were associated with increased rheumatoid arthritis risk, suggesting adiposity could be targeted for primary prevention.
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20
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Rondanelli M, Perdoni F, Peroni G, Caporali R, Gasparri C, Riva A, Petrangolini G, Faliva MA, Infantino V, Naso M, Perna S, Rigon C. Ideal food pyramid for patients with rheumatoid arthritis: A narrative review. Clin Nutr 2020; 40:661-689. [PMID: 32928578 DOI: 10.1016/j.clnu.2020.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/19/2022]
Abstract
Emerging literature suggests that diet plays an important modulatory role in rheumatoid arthritis (RA) because diet is an environmental factor that affects inflammation, antigen presentation, antioxidant defense mechanisms and gut microbiota. Patients with RA frequently ask their doctors about which diets to follow, and even in the absence of advice from their physicians, many patients are undertaking various dietary interventions. Given this background, the aim of this review is to evaluate the evidence to date regarding the ideal dietary approach for management of RA in order to reduce the counteracting inflammation, and to construct a food pyramid for patients with RA. The pyramid shows that carbohydrates should be consumed every day (3 portions of whole grains, preferably gluten free), together with fruits and vegetables (5 portions; among which fruit, berries and citrus fruit are to be preferred, and among the vegetables, green leafy ones.), light yogurt (125 ml), skim milk (200 ml), 1 glass (125 ml) of wine and extra virgin olive oil; weekly, fish (3 portions), white meat (3 portions), legumes (2 portions) eggs (2 portions), seasoned cheeses (2 portions), and red or processed meats (once a week). At the top of the pyramid, there are two pennants: one green means that subjects with RA need some personalized supplementation (vitamin D and omega 3) and one red means that there are some foods that are banned (salt and sugar). The food pyramid allows patients to easily figure out what to eat.
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Affiliation(s)
- Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, 27100 Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100 Italy.
| | - Federica Perdoni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia, 27100 Italy.
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia, 27100 Italy.
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy; Clinical Rheumatology Unit Gaetano Pini Hospital, Milan 20122, Italy.
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia, 27100 Italy.
| | - Antonella Riva
- Research and Development Department, Indena SpA, Milan, Italy.
| | | | - Milena Anna Faliva
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia, 27100 Italy.
| | - Vittoria Infantino
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, 27100 Italy.
| | - Maurizio Naso
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia, 27100 Italy.
| | - Simone Perna
- Department of Biology, University of Bahrain, College of Science, Sakhir Campus P. O. Box 32038 Bahrain.
| | - Chiara Rigon
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia, 27100 Italy.
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21
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Maglio C, Zhang Y, Peltonen M, Andersson-Assarsson J, Svensson PA, Herder C, Rudin A, Carlsson L. Bariatric surgery and the incidence of rheumatoid arthritis - a Swedish Obese Subjects study. Rheumatology (Oxford) 2020; 59:303-309. [PMID: 31321442 PMCID: PMC7571486 DOI: 10.1093/rheumatology/kez275] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022] Open
Abstract
Objective The aim of this study was to determine the effect of bariatric surgery on the incidence of RA in participants of the Swedish Obese Subjects (SOS) study. Methods The SOS is a longitudinal study aiming to assess the effect of bariatric surgery on mortality and obesity-related diseases. This report includes 2002 subjects with obesity who underwent bariatric surgery and 2034 matched controls; none of them had RA at baseline. Cases of incident RA were identified through the Swedish National Patient Register by searching for International Classification of Diseases codes. Both intention-to-treat analyses and per-protocol analyses are reported. In the per-protocol analysis, participants from the control group who underwent bariatric surgery later on during follow-up were censored at the time of surgery. Results During follow-up, 92 study participants developed RA. The median follow-up was 21 years (range 0–29). Bariatric surgery was neither associated with the incidence of RA in the intention-to-treat analysis [hazard ratio (HR) 0.92 (95% CI 0.59, 1.46), P = 0.74], nor in the per-protocol analysis [HR 0.86 (95% CI 0.54, 1.38), P = 0.53]. Weight change at the 2 year follow-up, expressed as the change in BMI compared with baseline, did not associate with the development of RA. Higher serum CRP levels and smoking associated with the future development of RA independent of other factors. Conclusions We did not detect any association between bariatric surgery and the incidence of RA in subjects affected by obesity followed up for up to 29 years. ClinicalTrials.gov (http://clinicaltrials.gov): NCT01479452.
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Affiliation(s)
- Cristina Maglio
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Yuan Zhang
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Andersson-Assarsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Arne Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Dusseldorf, Dusseldorf, Germany.,German Center for Diabetes Research, Muenchen-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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22
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Alpizar-Rodriguez D, Finckh A. Is the prevention of rheumatoid arthritis possible? Clin Rheumatol 2020; 39:1383-1389. [PMID: 32016656 DOI: 10.1007/s10067-020-04927-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 01/01/2023]
Abstract
Preclinical phases of rheumatoid arthritis (RA) have been described, genetic and environmental risk factors for RA development have been identified, and several biomarkers of RA have been detected long before the clinical onset of the disease; all of which have opened the possibility for preventive interventions. Several studies are currently exploring pharmacological and non-pharmacological interventions to prevent the development of RA. We will review the evidence for prevention of RA and discuss key challenges for preventive interventions, including identification of the adequate target population, the risks of applying potentially harmful and expensive therapies to asymptomatic at-risk individuals, and the importance of taking into account the preferences of individuals at risk regarding preventive treatment options.
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Affiliation(s)
- Deshiré Alpizar-Rodriguez
- Division of Rheumatology, Geneva University Hospital, Geneva, 26, Ave Beau-Séjour, 1211, Geneva, Switzerland.
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospital, Geneva, 26, Ave Beau-Séjour, 1211, Geneva, Switzerland
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23
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Finckh A, Courvoisier D, Lamacchia C. Measuring ACPA in the general population or primary care: is it useful? RMD Open 2020; 6:e001085. [PMID: 32079664 PMCID: PMC7046970 DOI: 10.1136/rmdopen-2019-001085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/13/2023] Open
Abstract
Rheumatoid arthritis (RA) is associated with a significant disease burden and high costs for society. Because the disease has identifiable preclinical stages, screening and prevention have become a possibility in RA. Anticitrullinated peptide antibodies (ACPAs) are arguably the most likely candidate biomarker to screen for RA. This paper reviews the evidence for the use of ACPAs as a screening test in the broader general population, to identify individuals at high risk of subsequent onset of RA. We will review the diagnostic properties of the test and its positive and negative predictive value in different settings. We will discuss how ACPA testing could effectively be integrated in a broader screening strategy for RA.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Celine Lamacchia
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
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24
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Rubin KH, Rasmussen NF, Petersen I, Kopp TI, Stenager E, Magyari M, Hetland ML, Bygum A, Glintborg B, Andersen V. Intake of dietary fibre, red and processed meat and risk of late-onset Chronic Inflammatory Diseases: A prospective Danish study on the "diet, cancer and health" cohort. Int J Med Sci 2020; 17:2487-2495. [PMID: 33029091 PMCID: PMC7532485 DOI: 10.7150/ijms.49314] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Human and animal studies support the involvement of diet in the development of CID -chronic inflammatory diseases such as inflammatory bowel disease, psoriasis, rheumatoid arthritis, psoriatic arthritis, and multiple sclerosis. Objective: This cohort study aimed to investigate the association between intake of fibre, red and processed meat, and occurrence of late-onset CID (50+ years of age) in the DCH: Danish Diet, Cancer and Health cohort. We hypothesised that risk of late-onset CID would be lower among those with high intake of fibre and/or low intake of meat compared to individuals with low fibre and/or high meat intake. Methods: The DCH recruited 56,468 individuals, aged 50-64 years, between 1993 and 1997. At recruitment, diet intake was registered using food frequency questionnaires as well as lifestyle factors in 56,075 persons. Exposure variables were generated as sex-adjusted tertiles of fibre and meat (g/day). Development of CIDs was identified in national registries. Hazard ratios (HR) of late-onset CIDs (adjusted for age, sex, energy intake, alcohol, smoking, education, comorbidity, and civil status) were estimated for all three exposure variables. Results: During follow-up of 1,123,754 years (median (Interquartile range) = 22.2 (20.1-23.1)), 1,758 (3.1%) participants developed at least one CID. The adjusted HRs for developing CID (low fibre 1.04 [0.89-1.22] and medium fibre 1.04 [0.91-1.18] (high fibre as reference), and medium meat 0.96 [0.86-1.09] and high meat 0.94 [0.82-1.07] (low meat as reference)) or the individual diseases were not statistically significant. Conclusion: This large study did not support that a high intake of fibre and/or a low intake of meat had a high impact on the risk of late-onset CID.
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Affiliation(s)
- Katrine Hass Rubin
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense Denmark
| | - Nathalie Fogh Rasmussen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Inge Petersen
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense Denmark
| | - Tine Iskov Kopp
- Danish Cancer Society Research Centre, Copenhagen, Denmark.,The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmarkarch, University of Southern Denmark, Odense
| | - Egon Stenager
- MS clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding) University Hospital of Southern Jutland, DK-6200 Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, DK-5000 Odense C, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmarkarch, University of Southern Denmark, Odense.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Merete Lund Hetland
- The DANBIO registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Center of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark.,Research Unit of Dermato-Venerology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Glintborg
- The DANBIO registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Center of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen
| | - Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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25
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Nguyen Y, Salliot C, Gusto G, Descamps E, Mariette X, Boutron-Ruault MC, Seror R. Improving accuracy of self-reported diagnoses of rheumatoid arthritis in the French prospective E3N-EPIC cohort: a validation study. BMJ Open 2019; 9:e033536. [PMID: 31848174 PMCID: PMC6937120 DOI: 10.1136/bmjopen-2019-033536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The French E3N-EPIC (Etude Epidémiologique auprès des femmes de la Mutuelle générale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition) cohort enrolled 98 995 women aged 40 to 65 years at inclusion since 1990 to study the main risk factors for cancer and severe chronic conditions in women. They were prospectively followed with biennially self-administered questionnaires collecting self-reported medical, environmental and lifestyle data. Our objective was to assess the accuracy of self-reported diagnoses of rheumatoid arthritis (RA) and to devise algorithms to improve the ascertainment of RA cases in our cohort. DESIGN A validation study. PARTICIPANTS Women who self-reported an inflammatory rheumatic disease (IRD) were asked to provide access to their medical record, and to answer an IRD questionnaire. Medical records were independently reviewed. PRIMARY AND SECONDARY OUTCOME MEASURES Positive predictive values (PPV) of self-reported RA alone, then coupled with the IRD questionnaire, and with a medication reimbursement database were assessed. These algorithms were then applied to the whole cohort to ascertain RA cases. RESULTS Of the 98 995 participants, 2692 self-reported RA. Medical records were available for a sample of 399 participants, including 305 who self-reported RA. Self-reported RA was accurate only for 42% participants. Combining self-reported diagnoses to answers to a specific IRD questionnaire or to the medication reimbursement database improved the PPV (75.6% and 90.1%, respectively). Using the devised algorithms, we could identify 964 RA cases in our cohort. CONCLUSION Accuracy of self-reported RA is poor but adding answers to a specific questionnaire or data from a medication reimbursement database performed satisfactorily to identify RA cases in our cohort. It will subsequently allow investigating many potential risk factors of RA in women.
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Affiliation(s)
- Yann Nguyen
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Carine Salliot
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
- Rheumatology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Gaëlle Gusto
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Elise Descamps
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin-Bicetre, France
- Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), INSERM U1184, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Christine Boutron-Ruault
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
| | - Raphaèle Seror
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin-Bicetre, France
- Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), INSERM U1184, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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26
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Alivernini S, Tolusso B, Fedele AL, Di Mario C, Ferraccioli G, Gremese E. The B side of rheumatoid arthritis pathogenesis. Pharmacol Res 2019; 149:104465. [PMID: 31574298 DOI: 10.1016/j.phrs.2019.104465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 01/01/2023]
Abstract
In the last years, a dramatic amount of research has been performedincreasing the knowledge about the biological mechanism underpinning Rheumatoid Arthritis (RA) inflammation, putting B lymphocytes in the center of RA pathogenesis. Nowadays, B cell phenotypes and autoantibodies positivity arose as important biomarkers in early and long-standing disease. Moreover, comparative analysis of peripheral blood and synovial tissue compartments enables the identification of novel physiopathological mechanisms promoting inflammation. In this narrative review we will discuss the biological relevance of B cell derived autoimmunity and in RA course, from disease onset to remission achievement.
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Affiliation(s)
- Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
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27
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Chen WMY, Subesinghe S, Muller S, Hider SL, Mallen CD, Scott IC. The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 50:252-260. [PMID: 31530401 DOI: 10.1016/j.semarthrit.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/18/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish if gravidity and parity associate with the development of rheumatoid arthritis (RA), and to establish if this effect is influenced by the time elapsed since pregnancy/childbirth, the number of pregnancies/childbirths, and serological status, through systematically reviewing the literature and undertaking a meta-analysis. METHODS We searched Medline/EMBASE (from 1946 to 2018) using the terms "rheumatoid arthritis.mp" or "arthritis, rheumatoid/" and "pregnancy.mp" or "pregnancy/" or "parity.mp" or "parity/" or "gravidity.mp" or "gravidity/" (observational study filter applied). Case-control/cohort studies that examined the relationship between parity/gravidity and the risk of RA in women were included. Studies reporting effect size data for RA in ever vs. never parous/gravid women as ORs/RRs with 95% confidence intervals were included in a meta-analysis. Other relationships (i.e. risk by pregnancy/childbirth numbers) were analysed descriptively. RESULTS Twenty studies (from 626 articles) met our inclusion criteria, comprising 14 case-control (4799 cases; 11,941 controls) and 6 cohort studies (8575 cases; 2,368,439 individuals). No significant association was observed in the meta-analysis of studies reporting the risk of RA in ever vs. never parous women (OR 0.91; 95% CI 0.80-1.04) and ever vs. never gravid women (OR 0.86; 95% CI 0.46-1.62). No consistent evidence of a relationship between the number of pregnancies/childbirths and RA risk was seen. No significant association was observed between being pregnant, or in the immediate post-partum period, and the risk of developing RA. CONCLUSION Our systematic review does not support the concept that gravidity and parity are associated with the risk of RA development.
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Affiliation(s)
- Winnie M Y Chen
- Department of Academic Rheumatology, King's College London, London, UK
| | - Sujith Subesinghe
- Department of Academic Rheumatology, King's College London, London, UK; Department of Rheumatology, Guy's and St Thomas' NHS Trust, London, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK
| | - Samantha L Hider
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK
| | - Ian C Scott
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK.
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28
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Overweight/obesity affects histological features and inflammatory gene signature of synovial membrane of Rheumatoid Arthritis. Sci Rep 2019; 9:10420. [PMID: 31320744 PMCID: PMC6639364 DOI: 10.1038/s41598-019-46927-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/05/2019] [Indexed: 12/14/2022] Open
Abstract
Overweight/obesity influence disease burden and clinical outcome of Rheumatoid Arthritis (RA). The impact of overweight/obesity on synovial tissue (ST) inflammation is largely unknown. Here, we investigated the histological and transcriptional signature of ST obtained from RA in different disease phases (disease onset, failure to first-line conventional DMARDs and in sustained clinical and ultrasound remission) finding that overweight/obese DMARDs naive RA showed higher likelihood of follicular synovitis, higher IHC scores for sublining inflammatory cells (CD68+, CD21+ and CD20+) and higher IL-1RA plasma levels than normal weight RA. Regardless to the synovitis pattern, overweight/obese DMARDs naive RA showed a worse clinical response to “Treat-to-target” (T2T) than normal weight RA at 6 and 12 months follow-up. Conversely, MTX-IR RA did not show significant differences in synovial inflammation based on BMI category. Overweight/obese RA in stable clinical and US remission showed higher degree of residual synovitis in terms of sublining CD68+, CD20+ cells and lining and sublining CD3+ compared to normal weight RA. Finally, gene expression profile analysis revealed that ST of overweight/obese DMARDs naive RA is enriched by CCL3 and MyD88 compared to normal weight RA in sustained disease remission, the latter correlating with BMI and IHC scores for synovial CD68+ cells. These findings suggest that indeed overweight/obese RA show higher degree of synovitis at disease onset and after remission achievement that influences the response rate to T2T and should be considered within the management of patients with RA.
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Body Mass Index and the Risk of Rheumatoid Arthritis: An Updated Dose-Response Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3579081. [PMID: 31355257 PMCID: PMC6634074 DOI: 10.1155/2019/3579081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
Background Extensive studies have been carried out to investigate the association between obesity and the risk of rheumatoid arthritis (RA); however, the results of the current reported original studies remain inconsistent. This study aimed to clarify the relationship between body mass index and rheumatoid arthritis by conducting an updated overall and dose-response meta-analysis. Methods The relevant literature was searched using the PubMed and Embase databases (through 20 September 2018) to identify all eligible published studies. Random-effect models and dose-response meta-analyses were used to estimate the pooled risk ratio (RR) with a 95% confidence interval (CI). Subgroup analyses were also conducted based on the characteristics of the participants. Sensitivity analyses and publication bias tests were also performed to explore potential heterogeneity and bias in the meta-analysis. Results Sixteen studies that included a total of 406,584 participants were included in the meta-analysis. Compared to participants with normal weight, the pooled RRs of rheumatoid arthritis were 1.12 (95% CI, 1.04-1.20) in overweight and 1.23 (95% CI, 1.09-1.39) in obese participants. There was evidence of a nonlinear relationship between body mass index (BMI) and RA (P for nonlinearity less than 0.001 in the overall meta-analysis, P for nonlinearity=0.025 in the case-control studies, P for nonlinearity=0.0029 in the cohort studies). No significant heterogeneity was found among studies (I2=10.9% for overweight and I2=45.5% for obesity). Conclusion The overall and dose-response meta-analysis showed that increased BMI was associated with an increased risk for rheumatoid arthritis, which might present a prevention strategy for the prevention or control of rheumatoid arthritis. The nonlinear relationship between BMI and RA might present a personal prevention strategy for RA.
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Widdifield J. Preventing Rheumatoid Arthritis: A Global Challenge. Clin Ther 2019; 41:1355-1365. [DOI: 10.1016/j.clinthera.2019.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/08/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
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Predicting Rheumatoid Arthritis in At-risk Individuals. Clin Ther 2019; 41:1286-1298. [DOI: 10.1016/j.clinthera.2019.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/26/2019] [Accepted: 04/10/2019] [Indexed: 12/18/2022]
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Zaccardelli A, Friedlander HM, Ford JA, Sparks JA. Potential of Lifestyle Changes for Reducing the Risk of Developing Rheumatoid Arthritis: Is an Ounce of Prevention Worth a Pound of Cure? Clin Ther 2019; 41:1323-1345. [PMID: 31196646 PMCID: PMC6684958 DOI: 10.1016/j.clinthera.2019.04.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Lifestyle may be important in the development of rheumatoid arthritis (RA). Therefore, changing behaviors may delay or even prevent RA onset. This article reviews the evidence basis for the associations of lifestyle factors with RA risk and considers future directions for possible interventions to reduce RA risk. METHODS The literature was reviewed for cross-sectional studies, case-control studies, cohort studies, and clinical trials investigating potentially modifiable lifestyle factors and RA risk or surrogate outcomes on the path toward development such as RA-related autoimmunity or inflammatory arthritis. The evidence related to cigarette smoking, excess weight, dietary intake, physical activity, and dental health for RA risk were summarized. FINDINGS Cigarette smoking has the strongest evidence base as a modifiable lifestyle behavior for increased seropositive RA risk. Smoking may increase seropositive RA risk through gene-environment interactions, increasing inflammation and citrullination locally in pulmonary/oral mucosa or systemically, thereby inducing RA-related autoimmunity. Prolonged smoking cessation may reduce seropositive RA risk. Evidence suggests that excess weight can increase RA risk, although this effect may differ according to sex, serologic status, and age at RA onset. TDietary intake may also affect RA risk: overall healthier patterns, high fish/omega-3 polyunsaturated fatty acid consumption, and moderate alcohol intake may reduce RA risk, whereas caffeine and sugar-sweetened soda consumption might increase RA risk. The impact of physical activity is less clear, but high levels may reduce RA risk. Periodontal disease might induce citrullination and RA-related autoimmunity, but the effect of dental hygiene behaviors on RA risk is unclear. Although the effect size estimates for these lifestyle factors on RA risk are generally modest, there may be relatively large public health benefits for targeted interventions given the high prevalence of these unhealthy behaviors. With the exception of smoking cessation, the impact of behavior change of these lifestyle factors on subsequent RA risk has not been established. Nearly all of the evidence for lifestyle factors and RA risk were derived from observational studies. IMPLICATIONS There are many potentially modifiable lifestyle factors that may affect RA risk. Improving health behaviors could have large public health benefits for RA risk given the high prevalence of many of the RA risk-related lifestyle factors. However, future research is needed to establish the effects of lifestyle changes on RA risk or surrogate outcomes such as RA-related autoimmunity or inflammatory arthritis.
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Affiliation(s)
- Alessandra Zaccardelli
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - H Maura Friedlander
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia A Ford
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Archer R, Hock E, Hamilton J, Stevens J, Essat M, Poku E, Clowes M, Pandor A, Stevenson M. Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews. Health Technol Assess 2019; 22:1-294. [PMID: 30501821 DOI: 10.3310/hta22660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. OBJECTIVE To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2). DATA SOURCES Electronic databases (e.g. MEDLINE, EMBASE, The Cochrane Library, Web of Science Conference Proceedings; searched to September 2016), registers, key websites, hand-searching of reference lists of included studies and key systematic reviews and contact with experts. STUDY SELECTION Review 1 - primary studies on the development, external validation and impact of clinical prediction models for selected outcomes in adult early RA patients. Review 2 - primary studies on the interaction between selected baseline covariates and treatment (conventional and biological disease-modifying antirheumatic drugs) on salient outcomes in adult early RA patients. RESULTS Review 1 - 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. Five external validation studies evaluating eight clinical prediction models for radiographic joint damage were also included. c-statistics from internal validation ranged from 0.63 to 0.87 for radiographic progression (different definitions, six studies) and 0.78 to 0.82 for the Health Assessment Questionnaire (HAQ). Predictive performance in external validations varied considerably. Three models [(1) Active controlled Study of Patients receiving Infliximab for the treatment of Rheumatoid arthritis of Early onset (ASPIRE) C-reactive protein (ASPIRE CRP), (2) ASPIRE erythrocyte sedimentation rate (ASPIRE ESR) and (3) Behandelings Strategie (BeSt)] were externally validated using the same outcome definition in more than one population. Results of the random-effects meta-analysis suggested substantial uncertainty in the expected predictive performance of models in a new sample of patients. Review 2 - 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. Most of the results were subject to considerable uncertainty and were not statistically significant. LIMITATIONS The meta-analysis in review 1 was limited by the availability of only a small number of external validation studies. Studies rarely investigated the interaction between predictors and treatment. SUGGESTED RESEARCH PRIORITIES Collaborative research (including the use of individual participant data) is needed to further develop and externally validate the clinical prediction models. The clinical prediction models should be validated with respect to individual treatments. Future assessments of treatment by covariate interactions should follow good statistical practice. CONCLUSIONS Review 1 - uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 - in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics. STUDY REGISTRATION This study is registered as PROSPERO CRD42016042402. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rachel Archer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Munira Essat
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Linauskas A, Overvad K, Symmons D, Johansen MB, Stengaard-Pedersen K, de Thurah A. Body Fat Percentage, Waist Circumference, and Obesity As Risk Factors for Rheumatoid Arthritis: A Danish Cohort Study. Arthritis Care Res (Hoboken) 2019; 71:777-786. [PMID: 29975015 DOI: 10.1002/acr.23694] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/03/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the relationship between bioimpedance-derived total body fat percentage, waist circumference, and body mass index (BMI) and the subsequent development of rheumatoid arthritis (RA). METHODS A population-based prospective cohort study was conducted using 55,037 patients enrolled in the Danish Diet, Cancer, and Health cohort. Baseline data included anthropometric measures and lifestyle factors. Individuals who developed RA were identified through linkage with the Danish National Patient Registry. The relationships between bioimpedance-derived body fat percentage, waist circumference, and BMI and incident RA were assessed using Cox proportional hazards regression models, stratifying by sex. All analyses were performed for overall RA and the serologic subtypes seropositive and other RA. RESULTS A total of 210 men (37.6% with seropositive RA) and 456 women (41.0% with seropositive RA) developed RA during a median follow-up of 20.1 years. In women, the overall RA risk was 10% higher for each 5% increment of total body fat (hazard ratio [HR] 1.10 [95% confidence interval (95% CI) 1.02-1.18]), 5% higher for each 5-cm increment of waist circumference (HR 1.05 [95% CI 1.01-1.10]), and nearly 50% higher in those whose BMI was in the obese range compared to normal range BMI (HR 1.46 [95% CI 1.12-1.90]). These positive associations were also found for patients with other RA. In men, there were no clear associations between body fat percentage, waist circumference, or BMI and RA. No significant associations were found for seropositive RA in women or men, possibly related to low sample size. CONCLUSION In women, higher body fat percentage, higher waist circumference, and obesity were associated with a higher risk of RA.
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Affiliation(s)
- Asta Linauskas
- Aarhus University Hospital, Aarhus, and North Denmark Regional Hospital, Hjoerring, Denmark
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Rasmussen NF, Rubin KH, Stougaard M, Tjønneland A, Stenager E, Lund Hetland M, Glintborg B, Bygum A, Andersen V. Impact of red meat, processed meat and fibre intake on risk of late-onset chronic inflammatory diseases: prospective cohort study on lifestyle factors using the Danish 'Diet, Cancer and Health' cohort (PROCID-DCH): protocol. BMJ Open 2019; 9:e024555. [PMID: 30928934 PMCID: PMC6475359 DOI: 10.1136/bmjopen-2018-024555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/08/2018] [Accepted: 02/18/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Chronic inflammatory diseases (CIDs) (Crohn's disease, ulcerative colitis, psoriasis, psoriatic arthritis, rheumatoid arthritis and multiple sclerosis) are diseases of the immune system that have some shared genetic and environmental predisposing factors, but still few studies have investigated the effects of lifestyle on disease risk of several CIDs. The primary aim of this prospective cohort study is to investigate the impact of fibre, red meat and processed meat on risk of late-onset CID, with the perspective that results of this study can contribute in supporting future diet recommendations for effective personalised prevention. METHODS AND ANALYSIS The study will use data from 57 053 persons from the prospective Danish cohort study 'Diet, Cancer and Health' together with National Health Registry data. The follow-up period is from December 1993 to December 2018. Questionnaire data on diet and lifestyle were collected at entry to the Diet, Cancer and Health study. The outcome CID is defined as having a diagnosis of one of the CIDs registered in the National Patient Registry or, for multiple sclerosis, in the Danish Multiple Sclerosis Registry during follow-up and being treated with a drug used for the specific disease. The major outcome of the analyses will be to detect variability in risk of late onset of any CID and, if power allows, disease risk of late onset of each CID diagnosis between persons with different fibre and red meat, and processed meat intake. The outcome will be adjusted for age, sex, body mass index, physical activity, energy, alcohol, fermented dairy products, education, smoking status, hormone replacement therapy and comorbidity. ETHICS AND DISSEMINATION The study is approved by the Danish Data Protection Agency (2012-58-0018). The core study is an open register-based cohort study. The study does not need approval from the Ethics committee or Institutional Review Board by Danish law. Study findings will be disseminated through peer-reviewed journals, patient associations and presentations at international conferences. TRIAL REGISTRATION NUMBER NCT03456206; Post-results.
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Affiliation(s)
- Nathalie Fogh Rasmussen
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Katrine Hass Rubin
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
| | - Maria Stougaard
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark/Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- The Multiple Sclerosis Clinic of Southern Jutland (Sonderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Jutland, Sonderborg, Denmark
| | - Merete Lund Hetland
- DANBIO Registry/Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Bente Glintborg
- DANBIO Registry/Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Rheumatology, Gentofte Hospital, Hellerup, Hovedstaden, Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, Odense Universitetshospital, Odense, Denmark
| | - Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, Hospital of Southern Jutland, Aabenraa, Denmark
- institute og molecular medicine, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
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van Beers-Tas MH, Blanken AB, Nielen MMJ, Turkstra F, van der Laken CJ, Meursinge Reynders M, van Schaardenburg D. The value of joint ultrasonography in predicting arthritis in seropositive patients with arthralgia: a prospective cohort study. Arthritis Res Ther 2018; 20:279. [PMID: 30567606 PMCID: PMC6300036 DOI: 10.1186/s13075-018-1767-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/12/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The value of joint ultrasonography (US) in the prediction of clinical arthritis in individuals at risk of developing rheumatoid arthritis (RA) is still a point of debate, due to varying scanning protocols and different populations. We investigated whether US abnormalities assessed with a standard joint protocol can predict development of arthritis in seropositive patients with arthralgia. METHODS Anti-citrullinated protein antibodies and/or rheumatoid factor positive patients with arthralgia, but without clinical arthritis were included. US was performed at baseline in 16 joints: bilateral metacarpophalangeal 2-3, proximal interphalangeal 2-3, wrist and metatarsophalangeal (MTP) joints 2-3 and 5. Images were scored semi-quantitatively for synovial thickening and for positive signs on power Doppler (PD). Association between US abnormalities and arthritis development at the joint and at the patient level was evaluated. Also, we investigated the added value of US over clinical parameters. RESULTS Out of 163 patients who underwent US examination, 51 (31%) developed clinical arthritis after a median follow-up time of 12 (interquartile range 5-24) months, of which 44 (86%) satisfied the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. US revealed synovial thickening and PD in at least one joint in 49 patients (30%) and 7 patients (4%), respectively. Synovial thickening was associated with both development and timing of clinical arthritis in any joint (patient level) when MTP joints were excluded from the US assessment (odds ratio 6.6, confidence interval (CI) 1.9-22), and hazard ratio 3.4, CI 1.6-6.8, respectively, with a mean time to arthritis of 23 versus 45 months when synovial thickening was present versus not present). There was no association between US and arthritis development at the joint level. Predictive capacity was highest in the groups with an intermediate and high risk of developing arthritis based on a prediction rule with clinical parameters. CONCLUSIONS Synovial thickening on US predicted clinical arthritis development at the patient level in seropositive patients with arthralgia when MTPs were excluded from the US assessment. Positive PD signs were infrequently seen in these at-risk individuals and was not predictive. In patients at intermediate risk of RA, US may help to identify those at higher risk of developing arthritis.
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Affiliation(s)
- Marian H van Beers-Tas
- Amsterdam Rheumatology and immunology Center
- Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands.
| | - Annelies B Blanken
- Amsterdam Rheumatology and immunology Center
- Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands
| | - Franktien Turkstra
- Amsterdam Rheumatology and immunology Center
- Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands
| | - Conny J van der Laken
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Marlies Meursinge Reynders
- Amsterdam Rheumatology and immunology Center
- Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and immunology Center
- Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center
- Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Verstappen SMM, Carmona L. Overview of changes in RMD epidemiology and outcome development in the last 10 years. Best Pract Res Clin Rheumatol 2018; 32:169-173. [PMID: 30527424 DOI: 10.1016/j.berh.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022]
Abstract
Epidemiological studies have been affected by environmental (or technological and societal) changes in the last 10 years, such as the emergence of registries, big data and machine learning algorithms, epigenetics, data protection regulations or a more solid presence of the patient perspective in outcomes research. As a consequence we, epidemiologists, are facing challenges in the design, conduct, and analysis of the studies, as well as on the interpretation of the results. Not everything that is new may be better than the old ways of doing epidemiology. In this article, we will review pros and cons of new technologies and regulations on epidemiological research, as well as ways to tackle obstacles and co-living of old and new methods.
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Affiliation(s)
- Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom.
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Zhu ZY, Xue JX, Yu LX, Bian WH, Zhang YF, Sohn KC, Shin IH, Yao C. Reducing postsurgical exudate in breast cancer patients by using San Huang decoction to ameliorate inflammatory status: a prospective clinical trial. ACTA ACUST UNITED AC 2018; 25:e507-e515. [PMID: 30607117 DOI: 10.3747/co.25.4108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Reducing inflammatory factors in wound exudate is a promising treatment approach for healing wounds in postsurgical breast cancer patients. Traditional Chinese Medicine (tcm) treatments have been shown to be beneficial and safe for optimal regulation of oxidative stress during the postoperative period. In the present clinical trial, we evaluated the effectiveness of a promising Chinese herbal formula, San Huang decoction [shd (Radix astragali, Radix et rhizoma rhei, and Rhizoma curcuma longa, 3:1:1; supplemental Table 1)], on wound inflammatory response after mastectomy. Methods The study randomized 30 patients with breast cancer who fulfilled the inclusion and exclusion criteria to either a treatment (n = 15) or a control group (n = 15). Patients in the treatment group received liquid shd, taken twice daily with or without food. Treatment was given for 1 day before surgery and for 7 days postoperatively. Participants in the control group received a placebo on the same schedule as the treatment group. Outcomes measured in every subject included clinical tcm and wound inflammation symptom scores, daily and total amounts of drainage fluid, and levels of inflammatory factors in the exudate [tumour necrosis factor α (tnf-α), interleukins 6 (il-6), 8 (il-8), and 2R (il-2R), human C-reactive protein (crp)] at 2 hours and on days 1, 3, and 7 postoperatively. Results The total amount of drainage fluid over 7 days was significantly lower in the treatment group (572.20 ± 93.95 mL) than in the control group (700.40 ± 107.38 mL). The tcm symptom score was also lower in treatment group (day 7: 1.87 ± 0.83 vs. 4.80 ± 3.61, p = 0.049), as was the inflammatory symptom score (day 7: 0.67 ± 0.72 vs. 3.67 ± 2.50, p = 0.001). Levels of tnf-α, il-6, il-8, il-2R, and crp in drainage fluid were significantly lower with shd treatment. Conclusions Perioperative treatment with shd effectively lessened postoperative exudate and ameliorated inflammatory symptoms in patients who underwent surgery for breast cancer.
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Affiliation(s)
- Z Y Zhu
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - J X Xue
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - L X Yu
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - W H Bian
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - Y F Zhang
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - K C Sohn
- Hospital of Catholic University of Daegu, Daegu, Republic of Korea
| | - I H Shin
- Hospital of Catholic University of Daegu, Daegu, Republic of Korea
| | - C Yao
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
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Linauskas A, Overvad K, Johansen MB, Stengaard-Pedersen K, de Thurah A. Positive predictive value of first-time rheumatoid arthritis diagnoses and their serological subtypes in the Danish National Patient Registry. Clin Epidemiol 2018; 10:1709-1720. [PMID: 30538575 PMCID: PMC6254991 DOI: 10.2147/clep.s175406] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purposes To assess whether the positive predictive value (PPV) of first-time rheumatoid arthritis (RA) diagnosis registration in the Danish National Patient Registry increases when data are linked to the RA treatment codes and to assess the PPV of first-time RA diagnoses according to RA serological subtypes. Methods Participants from the Danish Diet, Cancer, and Health cohort with at least one RA diagnosis, registered at one of the Central Denmark Region hospitals in the Danish National Patient Registry during the period 1977–2016, were identified. Register-based RA diagnoses were verified by scrutinizing medical records against RA classification criteria or clinical case RA. PPVs for overall RA, seropositive RA, and other RA were calculated for two models: first-time RA diagnosis registration ever in the Danish National Patient Registry and first-time RA diagnosis registration ever where subsequently a prescription had been redeemed for a synthetic disease-modifying antirheumatic drug. Results Overall, 205 of 311 first-time register-based RA diagnoses were verified (PPV: 61.9%; 95% CI: 56.9–67.0). Regarding RA serological subtypes, 93 of 150 register-based seropositive RA (PPV: 62.0; 95% CI: 53.9–69.5) and 36 of 144 other RA (PPV: 25.0; 95% CI: 18.5–32.8) were confirmed. When register-based RA diagnosis codes were linked to RA treatment codes, the PPVs increased substantially: the PPV for overall RA was 87.7% (95% CI: 82.5–91.5), the PPV for seropositive RA was 80.2% (95% CI: 71.6–86.7), and the PPV for other RA was 41.1% (95% CI: 30.2–52.9). Conclusion The first-time RA diagnoses in the Danish National Patient Registry should be used with caution in epidemiology research. However, linking registry-based RA diagnoses to the subsequent RA treatment codes increases the probability of identifying true RA diagnoses, especially overall RA and seropositive RA.
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Affiliation(s)
- Asta Linauskas
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Rheumatology, North Denmark Regional Hospital, Hjoerring, Denmark,
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Kristian Stengaard-Pedersen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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40
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Zhou Y, Sun M. A meta-analysis of the relationship between body mass index and risk of rheumatoid arthritis. EXCLI JOURNAL 2018; 17:1079-1089. [PMID: 30585275 PMCID: PMC6298202 DOI: 10.17179/excli2018-1763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023]
Abstract
The present meta-analysis aimed to evaluate the relationship between body mass index (BMI) and rheumatoid arthritis (RA). A systematic search of the Cochrane, Pubmed, and Embase databases was conducted to identify relevant studies published before September 2017 using terms related to BMI and RA. Fixed or random-effect models were used to estimate the pooled relative risk (RR) with 95 % confidence interval (CI). Subgroup analyses by sex were performed to investigate the association between BMI and RA in male and female subgroups. A total of 14 eligible studies containing 353,948 patients were included in the analysis. The pooled results suggested that the odds ratios (ORs) of RA were 1.08 (95 % CI: 1.00~1.15) for overweight, and 1.32 (95 % CI: 1.11~1.54) for obesity, respectively, suggesting that a higher BMI increases the risk of RA compared to normal weight. Further subgroup analyses showed a positive association between BMI and RA risk but only in females, with a RR of 1.11 (95 % CI: 1.00~1.22) for overweight and 1.40 (95 % CI: 1.24~1.57) for obesity. In conclusion, an increased BMI may lead to a higher risk for RA development. Furthermore, the positive association between BMI and RA risk may be stronger in female populations than in males. However, additional analyses are needed.
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Affiliation(s)
- Ying Zhou
- Division of Rheumatology, Research Institute of Surgery, Daping Hospital, the Army Medical University, Chongqing 400042, China
| | - Mingfang Sun
- Division of Rheumatology, Research Institute of Surgery, Daping Hospital, the Army Medical University, Chongqing 400042, China
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41
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Holla JFM, van Beers-Tas MH, van de Stadt LA, Landewé R, Twisk JWR, Dekker J, van Schaardenburg D. Depressive mood and low social support are not associated with arthritis development in patients with seropositive arthralgia, although they predict increased musculoskeletal symptoms. RMD Open 2018; 4:e000653. [PMID: 30018798 PMCID: PMC6045698 DOI: 10.1136/rmdopen-2018-000653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/06/2018] [Accepted: 04/21/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Studies on the role of psychosocial vulnerability in the development of arthritis must be performed early in the disease course to exclude the reverse explanation that arthritis leads to psychological symptoms. Therefore, the objective of this study was to investigate the longitudinal (5-year) association between depressive mood, daily stressors, avoidance coping and social support as predictors, and the development of arthritis and other clinical parameters as outcomes, in persons with seropositive arthralgia at risk of developing rheumatoid arthritis. Methods Five-year follow-up data of 231 patients from the Reade seropositive arthralgia cohort were used. Clinical and psychological data were collected using physical examinations and questionnaires. Mixed models and Cox regression analyses were used to assess the 5-year associations between depressive mood, daily stressors, avoidance coping or social support, and the development of arthritis or clinical parameters (tender joint count, Visual Analogue Scale (VAS) pain, VAS morning stiffness and erythrocyte sedimentation rate (ESR)). Results Higher scores for depressive mood and lower scores for social support were not associated with the development of arthritis nor with ESR. However, they were longitudinally associated with an increase in pain (p<0.001), morning stiffness (p<0.01) and tender joint count (p<0.001). No consistent associations were found between daily stressors, avoidance coping and the development of arthritis or other clinical parameters. Conclusion Although an effect on the development of arthritis could not be demonstrated, a strong longitudinal association was found between high depressive mood, low social support and clinical parameters. In persons with seropositive arthralgia, depressive symptoms and low social support may increase musculoskeletal symptoms.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | | | - Lotte A van de Stadt
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert Landewé
- Amsterdam Rheumatology and immunology Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Dekker
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Academic Medical Center, Amsterdam, The Netherlands
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42
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An unfavorable body composition is common in early arthritis patients: A case control study. PLoS One 2018; 13:e0193377. [PMID: 29565986 PMCID: PMC5863963 DOI: 10.1371/journal.pone.0193377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An unfavorable body composition is often present in chronic arthritis patients. This unfavorable composition is a loss of muscle mass, with a stable or increased (abdominal) fat mass. Since it is unknown when this unfavorable composition develops, we compared body composition in disease-modifying antirheumatic drugs (DMARD)-naive early arthritis patients with non-arthritis controls and explored the association, in early arthritis patients, with disease activity and traditional cardiovascular risk factors. METHODS 317 consecutive early arthritis patients (84% rheumatoid arthritis according to 2010 ACR/EULAR criteria) and 1268 age-/gender-/ethnicity-matched non-arthritis controls underwent a Dual-energy X-ray absorptiometry scan to assess fat percentage, fat mass index, fat mass distribution and appendicular lean (muscle) mass index. Additionally, disease activity, health assessment questionnaire (HAQ), acute phase proteins, lipid profile and blood pressure were evaluated. RESULTS Loss of muscle mass (corrected for age suspected muscle mass) was 4-5 times more common in early arthritis patients, with a significantly lower mean appendicular lean mass index (females 6% and males 7% lower, p<0.01). Patients had more fat distributed to the trunk (females p<0.01, males p = 0.07) and females had a 4% higher mean fat mass index (p<0.01). An unfavorable body composition was associated with a higher blood pressure and an atherogenic lipid profile. There was no relationship with disease activity, HAQ or acute phase proteins. CONCLUSION Loss of muscle mass is 4-5 times more common in early arthritis patients, and is in early arthritis patients associated with a higher blood pressure and an atherogenic lipid profile. Therefore, cardiovascular risk is already increased at the clinical onset of arthritis making cardiovascular risk management necessary in early arthritis patients.
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Christensen R, Heitmann BL, Andersen KW, Nielsen OH, Sørensen SB, Jawhara M, Bygum A, Hvid L, Grauslund J, Wied J, Glerup H, Fredberg U, Villadsen JA, Kjær SG, Fallingborg J, Moghadd SAGR, Knudsen T, Brodersen J, Frøjk J, Dahlerup JF, Bojesen AB, Sorensen GL, Thiel S, Færgeman NJ, Brandslund I, Bennike TB, Stensballe A, Schmidt EB, Franke A, Ellinghaus D, Rosenstiel P, Raes J, Boye M, Werner L, Nielsen CL, Munk HL, Nexøe AB, Ellingsen T, Holmskov U, Kjeldsen J, Andersen V. Impact of red and processed meat and fibre intake on treatment outcomes among patients with chronic inflammatory diseases: protocol for a prospective cohort study of prognostic factors and personalised medicine. BMJ Open 2018; 8:e018166. [PMID: 29439003 PMCID: PMC5829767 DOI: 10.1136/bmjopen-2017-018166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Chronic inflammatory diseases (CIDs) are frequently treated with biological medications, specifically tumour necrosis factor inhibitors (TNFi)). These medications inhibit the pro-inflammatory molecule TNF alpha, which has been strongly implicated in the aetiology of these diseases. Up to one-third of patients do not, however, respond to biologics, and lifestyle factors are assumed to affect treatment outcomes. Little is known about the effects of dietary lifestyle as a prognostic factor that may enable personalised medicine. The primary outcome of this multidisciplinary collaborative study will be to identify dietary lifestyle factors that support optimal treatment outcomes. METHODS AND ANALYSIS This prospective cohort study will enrol 320 patients with CID who are prescribed a TNFi between June 2017 and March 2019. Included among the patients with CID will be patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis), rheumatic disorders (rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis), inflammatory skin diseases (psoriasis, hidradenitis suppurativa) and non-infectious uveitis. At baseline (pretreatment), patient characteristics will be assessed using patient-reported outcome measures, clinical assessments of disease activity, quality of life and lifestyle, in addition to registry data on comorbidity and concomitant medication(s). In accordance with current Danish standards, follow-up will be conducted 14-16 weeks after treatment initiation. For each disease, evaluation of successful treatment response will be based on established primary and secondary endpoints, including disease-specific core outcome sets. The major outcome of the analyses will be to detect variability in treatment effectiveness between patients with different lifestyle characteristics. ETHICS AND DISSEMINATION The principle goal of this project is to improve the quality of life of patients suffering from CID by providing evidence to support dietary and other lifestyle recommendations that may improve clinical outcomes. The study is approved by the Ethics Committee (S-20160124) and the Danish Data Protecting Agency (2008-58-035). Study findings will be disseminated through peer-reviewed journals, patient associations and presentations at international conferences. TRIAL REGISTRATION NUMBER NCT03173144; Pre-results.
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Affiliation(s)
- Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
- Section for General Medicine, Department of Public Health, University of Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karina Winther Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
- Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Ole Haagen Nielsen
- Department of Gastroenterology D112, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Signe Bek Sørensen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Mohamad Jawhara
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
- Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark
- institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Lone Hvid
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Jimmi Wied
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Henning Glerup
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Søren Geill Kjær
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Jan Fallingborg
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Seyed A G R Moghadd
- Department of Internal Medicine, Herning Regional Hospital, Herning, Denmark
| | - Torben Knudsen
- Department of Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jacob Brodersen
- Department of Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jesper Frøjk
- Department of Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Bo Bojesen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Grith Lykke Sorensen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Nils J Færgeman
- Department of Biochemistry and Molecular Biology, Villum Center for Bioanalytical Sciences, University of Southern Denmark, Odense, Denmark
| | - Ivan Brandslund
- institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Tue Bjerg Bennike
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Ålborg, Denmark
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jeroen Raes
- Departmentof Microbiology and Immunology, Rega Institute, KU Leuven—University of Leuven, Leuven, Belgium
- VIB, Center for the Biology of Disease, Leuven, Belgium
| | - Mette Boye
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Lars Werner
- The Danish Psoriasis Association, The Danish Psoriasis Association, Tåstrup, Denmark
| | | | - Heidi Lausten Munk
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Torkell Ellingsen
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Uffe Holmskov
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jens Kjeldsen
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- OPEN, University of Southern Denmark, Odense, Denmark
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Falkenburg WJJ, van Schaardenburg D. Evolution of autoantibody responses in individuals at risk of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017; 31:42-52. [PMID: 29221597 DOI: 10.1016/j.berh.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 12/20/2022]
Abstract
Autoantibodies such as rheumatoid factors (RFs), anti-citrullinated protein antibodies (ACPAs), and other anti-modified protein antibodies are important risk factors for the development of rheumatoid arthritis (RA) and probably play an important role in its pathogenesis. In the phase before clinical arthritis becomes apparent, different autoantibody responses can evolve because of increases in their level, isotype switching, affinity maturation, epitope spreading, and a changing glycosylation profile. This evolution may be crucial for the pathogenic properties of the autoantibody responses, and interfering with this process in individuals at risk may become a route to prevent RA. Recent data suggest that interactions between RFs and ACPAs further amplify their inflammatory potential.
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Affiliation(s)
- Willem J J Falkenburg
- Amsterdam Rheumatology and Immunology Center, Reade, Doctor Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands; Department of Immunopathology, Sanquin Research, PO Box 9892, 1006 AN Amsterdam, The Netherlands.
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, Doctor Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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45
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Viatte S, Massey J, Bowes J, Duffus K, Eyre S, Barton A, Worthington J. Replication of Associations of Genetic Loci Outside the HLA Region With Susceptibility to Anti-Cyclic Citrullinated Peptide-Negative Rheumatoid Arthritis. Arthritis Rheumatol 2017; 68:1603-13. [PMID: 26895230 PMCID: PMC4924598 DOI: 10.1002/art.39619] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 01/28/2016] [Indexed: 12/29/2022]
Abstract
Objective Genetic polymorphisms within the HLA region explain only a modest proportion of anti–cyclic citrullinated peptide (anti‐CCP)–negative rheumatoid arthritis (RA) heritability. However, few non‐HLA markers have been identified so far. This study was undertaken to replicate the associations of anti‐CCP–negative RA with non‐HLA genetic polymorphisms demonstrated in a previous study. Methods The Rheumatoid Arthritis Consortium International densely genotyped 186 autoimmune‐related regions in3,339 anti‐CCP–negative RA patients and 15,870 controls across 6 different populations using the Illumina ImmunoChip array. We performed a case–control replication study of the anti‐CCP–negative markers with the strongest associations in that discovery study, in an independent cohort of anti‐CCP–negative UK RA patients. Individuals from the arcOGENConsortium and Wellcome Trust Case Control Consortium were used as controls. Genotyping in cases was performed using Sequenom MassArray technology. Genome‐wide data from controls were imputed using the 1000 Genomes Phase I integrated variant call set release version 3 as a reference panel. Results After genotyping and imputation quality control procedures, data were available for 15 non‐HLA single‐nucleotide polymorphisms in 1,024 cases and 6,348 controls. We confirmed the known markers ANKRD55 (meta‐analysis odds ratio [OR] 0.80; P = 2.8 × 10−13)and BLK (OR 1.13; P = 7.0 × 10−6) and identified new and specific markers of anti‐CCP–negative RA (prolactin [PRL] [OR 1.13; P = 2.1 × 10−6] and NFIA [OR 0.85; P = 2.5 × 10−6]). Neither of these loci is associated with other common, complex autoimmune diseases. Conclusion Anti‐CCP–negative RA and anti‐CCP–positive RA are genetically different disease subsets that only partially share susceptibility factors. Genetic polymorphisms located near the PRL and NFIA genes represent examples of genetic susceptibility factors specific for anti‐CCP–negative RA.
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Affiliation(s)
- Sebastien Viatte
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Jonathan Massey
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Kate Duffus
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | | | - Stephen Eyre
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Anne Barton
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Jane Worthington
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
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Kokkonen H, Stenlund H, Rantapää-Dahlqvist S. Cardiovascular risk factors predate the onset of symptoms of rheumatoid arthritis: a nested case-control study. Arthritis Res Ther 2017; 19:148. [PMID: 28666478 PMCID: PMC5493076 DOI: 10.1186/s13075-017-1351-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/26/2017] [Indexed: 11/22/2022] Open
Abstract
Background Patients with rheumatoid arthritis (RA) are at increased risk of developing cardiovascular disease (CVD). Our aim was to evaluate the impact of factors related to CVD, such as smoking, lipid levels, hypertension, body mass index (BMI) and diabetes, in individuals prior to the onset of symptoms of RA. Methods A nested case–control study was performed including data from 547 pre-symptomatic individuals (i.e. individuals who had participated in population surveys in northern Sweden prior to onset of symptoms of RA, median time to symptom onset 5.0 (interquartile range 2.0–9.0) years) and 1641 matched controls. Within the survey, health examinations prior to symptom onset were performed, blood samples were analysed for plasma glucose and lipids, and data on lifestyle factors had been collected with a questionnaire. CVD risk factors were extracted and further analysed with conditional logistic regression models for association with subsequent RA development, including hypertension, apolipoprotein (Apo)B/ApoA1 ratio, BMI, diabetes and smoking habits. Results Smoking and BMI ≥ 25 (odds ratio (OR) (95% confidence interval (CI)) =1.86 (1.48–2.35) and OR = 1.28 (1.01–1.62), respectively) were associated with increased risk for future RA development. In women, elevated ApoB/ApoA1 ratio (OR = 1.36 (1.03–1.80)) and smoking (OR = 1.82 (1.37–2.41)) were significantly associated with being pre-symptomatic for RA, whilst in men smoking (OR = 1.92 (1.26–2.92)) and diabetes (OR = 3.62 (95% CI 1.13–11.64)) were significant. In older (>50.19 years) individuals, only smoking (OR = 1.74 (1.24–2.45)) was significantly associated with increased risk of future RA, whereas in younger individuals the significant factors were elevated ApoB/ApoA1 ratio (OR = 1.39 (1.00–1.93)), BMI ≥ 25.0 (OR = 1.45 (1.04–2.02)) and smoking (OR = 2.11 (1.51–2.95)). Pre-symptomatic individuals had a higher frequency of risk factors: 41.5% had ≥3 compared with 30.4% among matched controls (OR = 2.81 (1.78–4.44)). Conclusions Several risk factors for CVD were present in pre-symptomatic individuals and significantly associated with increased risk for future RA. These factors differed in women and men. The CVD risk factors had a greater impact in younger individuals. These results urge an early analysis of cardiovascular risk factors for proposed prevention in patients with early RA.
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Affiliation(s)
- Heidi Kokkonen
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Building 6M, 901 87, Umeå, Sweden.
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Solbritt Rantapää-Dahlqvist
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Building 6M, 901 87, Umeå, Sweden
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Tedeschi SK, Barbhaiya M, Malspeis S, Lu B, Sparks JA, Karlson EW, Willett W, Costenbader KH. Obesity and the risk of systemic lupus erythematosus among women in the Nurses' Health Studies. Semin Arthritis Rheum 2017; 47:376-383. [PMID: 28688713 DOI: 10.1016/j.semarthrit.2017.05.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obesity is increasingly prevalent and related to increased risk of several autoimmune diseases, likely via generation of inflammatory adipokines. Prior studies have not evaluated obesity in relation to systemic lupus erythematosus (SLE) risk. We prospectively evaluated whether obesity was associated with increased SLE risk among women in the U.S. Nurses' Health Study cohorts. METHODS We conducted a prospective cohort study among 238,130 women in the Nurses' Health Studies (NHS, 1976-2012; NHSII, 1989-2013). Incident SLE was confirmed by American College of Rheumatology 1997 criteria and validated through medical record review. Body mass index (BMI, kg/m2) was calculated at baseline and on biennial questionnaires. Cox proportional hazards models estimated HRs (95% CIs) for SLE by cumulative average BMI category {18.5 to <25 [normal (reference)], 25 to <30 (overweight), ≥30 (obese)}, adjusting for potential time-varying confounders. Models were performed separately in each cohort; results were meta-analyzed. Sensitivity analyses used simple time-varying BMI, a 4-year lag between exposure and SLE risk window to address potential reverse causation, and evaluated BMI at age 18 and weight change since age 18. A secondary analysis started follow-up in both cohorts at similar calendar years when the prevalence of obesity in the U.S. increased most dramatically [1988 (NHS)/1989 (NHSII)]. RESULTS We identified 153 NHS incident SLE cases and 115 incident NHSII cases during 5,602,653 person-years of follow-up. At baseline, 8.4% of women in NHS and 11.8% in NHSII were obese. Mean age at enrollment was 42.5 (SD 7.2) years in NHS and 34.4 (SD 4.7) years in NHSII. Cumulative average obesity was significantly associated with SLE risk in NHSII [HR = 1.85 (1.17-2.91)], but not in NHS [HR = 1.11 (0.65-1.87)] compared to normal BMI. In the meta-analysis of both cohorts, obesity was not significantly associated with increased risk of SLE [HR = 1.46 (0.88-2.40)]. Simple time-varying BMI and lagging the exposure window by 4 years produced similar findings to the primary analysis. In NHSII, a 4.54 kg gain between age 18 and enrollment slightly increased SLE risk [HR = 1.09 (1.02-1.18)]. In the secondary analysis starting follow-up of both cohorts at similar calendar years, the point estimate for obesity in NHS was higher than the primary analysis [HR = 1.67 (0.81-3.45)]. CONCLUSION We observed an 85% significantly increased risk of SLE among obese compared to normal BMI women in the more recent NHSII cohort, but no association was observed in the earlier NHS cohort. Secular trends in obesity may account for the differences between the two birth cohorts.
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Affiliation(s)
- Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115.
| | - Medha Barbhaiya
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115
| | - Susan Malspeis
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115
| | - Bing Lu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115
| | - Elizabeth W Karlson
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115
| | - Walter Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115
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48
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Andersen V, Holmskov U, Sørensen SB, Jawhara M, Andersen KW, Bygum A, Hvid L, Grauslund J, Wied J, Glerup H, Fredberg U, Villadsen JA, Kjær SG, Fallingborg J, Moghadd SAGR, Knudsen T, Brodersen J, Frøjk J, Dahlerup JF, Nielsen OH, Christensen R, Bojesen AB, Sorensen GL, Thiel S, Færgeman NJ, Brandslund I, Stensballe A, Schmidt EB, Franke A, Ellinghaus D, Rosenstiel P, Raes J, Heitmann B, Boye M, Nielsen CL, Werner L, Kjeldsen J, Ellingsen T. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases: A Danish Multidisciplinary Collaboration on Prognostic Factors and Personalised Medicine. Nutrients 2017; 9:nu9050499. [PMID: 28505128 PMCID: PMC5452229 DOI: 10.3390/nu9050499] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/01/2017] [Accepted: 05/07/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic inflammatory diseases (CIDs), including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF) (i.e., TNF inhibitors). Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1) molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2) lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies) are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics). The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome.
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Affiliation(s)
- Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, 6200 Aabenraa, Denmark.
- Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark.
- OPEN, University of Southern Denmark, 5000 Odense, Denmark.
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark.
| | - Uffe Holmskov
- Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark.
| | - Signe Bek Sørensen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, 6200 Aabenraa, Denmark.
| | - Mohamad Jawhara
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, 6200 Aabenraa, Denmark.
| | - Karina W Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, 6200 Aabenraa, Denmark.
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark.
| | - Lone Hvid
- Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark.
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark.
| | - Jimmi Wied
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark.
| | - Henning Glerup
- Diagnostic Centre, Silkeborg Regional Hospital, University of Aarhus, 8600 Silkeborg, Denmark.
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, University of Aarhus, 8600 Silkeborg, Denmark.
| | - Jan Alexander Villadsen
- Diagnostic Centre, Silkeborg Regional Hospital, University of Aarhus, 8600 Silkeborg, Denmark.
| | - Søren Geill Kjær
- Diagnostic Centre, Silkeborg Regional Hospital, University of Aarhus, 8600 Silkeborg, Denmark.
| | - Jan Fallingborg
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9100 Aalborg, Denmark.
| | - Seyed A G R Moghadd
- Department of Internal Medicine, Regional Hospital Herning, 7400 Herning, Denmark.
| | - Torben Knudsen
- Department of Gastroenterology Hospital of South West Jutland, 6700 Esbjerg, Denmark.
| | - Jacob Brodersen
- Department of Gastroenterology Hospital of South West Jutland, 6700 Esbjerg, Denmark.
| | - Jesper Frøjk
- Department of Gastroenterology Hospital of South West Jutland, 6700 Esbjerg, Denmark.
| | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8000 Aarhus, Denmark.
| | - Ole Haagen Nielsen
- Department of Gastroenterology D112, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
| | - Anders Bo Bojesen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, 6200 Aabenraa, Denmark.
| | - Grith Lykke Sorensen
- Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark.
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark.
| | - Nils J Færgeman
- Department of Biochemistry and Molecular Biology, Villum Center for Bioanalytical Sciences, University of Southern Denmark, 5000 Odense, Denmark.
| | - Ivan Brandslund
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark.
- Department of Clinical Biochemistry, Vejle Hospital, 7100 Vejle, Denmark.
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, 9100 Aalborg, Denmark.
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, 9100 Aalborg, Denmark.
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24105 Kiel, Germany.
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24105 Kiel, Germany.
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24105 Kiel, Germany.
| | - Jeroen Raes
- Department of Microbiology and Immunology, Rega Institute, KU Leuven-University of Leuven, 3000 Leuven, Belgium.
- VIB Center for Microbiology, 3000 Leuven, Belgium.
| | - Berit Heitmann
- Department of Public Health, Section for General Medicine, University of Copenhagen, 1353 Copenhagen, Denmark.
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of the Copenhagen University Hospital, 2000 Frederiksberg, Denmark.
| | - Mette Boye
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS-Center Sonderjylland, Hospital of Southern Jutland, 6200 Aabenraa, Denmark.
| | | | - Lars Werner
- The Danish Psoriasis Association, 2630 Tåstrup, Denmark.
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, 5000 Odense, Denmark.
| | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark.
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49
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Kim SJ, Chen Z, Essani AB, Elshabrawy HA, Volin MV, Fantuzzi G, McInnes IB, Baker JF, Finn P, Kondos G, Volkov S, Swedler W, Arami S, Sweiss N, Shahrara S. Differential impact of obesity on the pathogenesis of RA or preclinical models is contingent on the disease status. Ann Rheum Dis 2017; 76:731-739. [PMID: 27797749 PMCID: PMC10026536 DOI: 10.1136/annrheumdis-2016-209206] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/15/2016] [Accepted: 09/04/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Studies were performed to uncover the significance of obesity in rheumatoid arthritis (RA) and preclinical models. METHODS Preclinical arthritis models were used to examine the impact of obesity on disease onset and remission. Conditioned media from RA adipose tissues were used to investigate the mechanism contributing to joint neutrophil influx and M1 macrophage differentiation observed in early and remission phases of arthritis. RESULTS We report that mice fed with high fat diet (HFD) have an earlier onset of collagen-induced arthritis (CIA) compared with mice on regular diet. However, the differences in CIA joint swelling between the two diet groups are lost once disease is established. We found that early arthritis triggered by obesity is due to elevated joint MIP2/interleukin-8 levels detected in CIA as well as in the RA and mouse adipose tissues and the effect of this chemokine on neutrophil recruitment. Although active disease progression is similarly affected in both diet groups, arthritis resolution is accelerated in lean mice while joint inflammation is sustained in obese mice. We document that HFD can prolong toll-like receptor (TLR)4-induced arthritis by increasing joint monocyte migration and further remodelling the recruited cells into M1 macrophages. Consistently, we show that adipose condition media can transform RA and wild-type naïve myeloid cells into M1 macrophages; however, this function is impaired by TLR4 blockade or deficiency. CONCLUSIONS We conclude that despite established disease being unaffected by obesity, the early and the resolution phases of RA are impacted by obesity through different mechanisms.
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Affiliation(s)
- Seung-Jae Kim
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zhenlong Chen
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abdul B Essani
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hatem A Elshabrawy
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael V Volin
- Department of Microbiology & Immunology, Midwestern University, Downers Grove, Illinois, USA
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Joshua F Baker
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patricia Finn
- Division of Pulmonary, Division of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - George Kondos
- Division of Cardiology, Division of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Suncica Volkov
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - William Swedler
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shiva Arami
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nadera Sweiss
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Shiva Shahrara
- Division of Rheumatology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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50
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Dessein PH, Solomon A, Hollan I. Metabolic abnormalities in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:901-915. [DOI: 10.1016/j.berh.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
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