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Chen Y, Tang H, Luo N, Liang X, Yang P, Zhang X, Huang J, Yang Q, Huang S, Lin L. Association between flavonoid intake and rheumatoid arthritis among US adults. J Nutr Biochem 2024; 131:109673. [PMID: 38866190 DOI: 10.1016/j.jnutbio.2024.109673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
Basic research shows that flavonoids have anti-inflammatory effects that influence rheumatoid arthritis (RA) in rats. Investigating potential dietary interventions for RA helps prevent the onset and progression of the disease. Clinical evidence on the association of flavonoid and subclass intake with RA is lacking. Using three survey cycles of 2007-2008, 2009-2010, and 2017-2018 from the National Health and Nutrition Survey and the United States Department of Agriculture's Food and Nutrient Database for Dietary Studies (FNDDS), we analyzed 7,419 American adults (≥20 years old). The values of flavonoid and subclass intake were calculated using FNDDS. The status questions for self-reported RA were from the NHANES codebook. Weighted analyses, revealed that among the 7,419 participants included in this study (mean age of 44.69 years [standard error, 0.40] and 3,584 [48.31%] were female), 408 met the classification criteria for RA. According to the multivariable logistic regression model, compared with the risk of RA in the first quartile (Q1), the risks of RA in the second quartile (Q2), the third quartile (Q3) and the fourth quartile (Q4) were lower (Q2: OR=0.55, 95% CI: 0.38-0.80; Q3: OR=0.66, 95% CI: 0.44-0.97; Q4: OR=0.64, 95% CI: 0.46-0.89; trend: P=.03). The association between total flavonoids and RA remained significant after full consideration of confounding factors. With regard to the subclasses of flavonoids, high flavanones intake was associated with low RA prevalence in Model 3 (Q3: OR= 0.60, 95% CI:0.39-0.92; Q4: OR = 0.56, 95% CI: 0.32-0.99, trend: P=.02), but no such association was found in the other subclasses. Total flavonoids intake protected against RA, and the risk of developing RA decreased significantly with increasing intake of total flavonoids. Total flavonoids and flavanones were significantly associated with reduced RA risk for the American adult population. We highlighted the importance of employing diverse methodologies to assess the health effects of flavonoids.
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Affiliation(s)
- Yan Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China; Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Haoxian Tang
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China; Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Nan Luo
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China; Department of Psychiatry, Shantou University Mental Health Center, Shantou, Guangdong, China
| | - Xiaoqing Liang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China; Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Penchao Yang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China; Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Xuan Zhang
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China; Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jingtao Huang
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China; Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qinglong Yang
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China; Department of Urology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shuxin Huang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
| | - Ling Lin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China; Department of Rheumatology, Shantou University Medical College, Shantou, China.
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Schäfer C, Keyßer G, Reuß-Borst M. [Influence of smoking, nutrition and other modifiable environmental factors on rheumatoid arthritis]. Z Rheumatol 2024:10.1007/s00393-024-01559-y. [PMID: 39158701 DOI: 10.1007/s00393-024-01559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/20/2024]
Abstract
Numerous reports in recent years have focused on the influence of environmental factors on rheumatoid arthritis. This article provides an overview of the current study situation on the influence of modifiable environmental factors on the development and course of rheumatoid arthritis. Lifestyle factors, such as cigarette smoking, diet, exercise and body weight can be individually influenced. Factors such as air pollution and socioeconomic status can be influenced by environmental and sociopolitical measures at a public level. Epidemiological studies have identified nicotine abuse, an unhealthy diet and obesity as well as a low level of education and social status as risk factors for the development of rheumatoid arthritis. Numerous factors are also associated with a poorer response to treatment and a worse prognosis. As randomized interventional studies on most environmental factors are hardly feasible, the causal relationship of the individual factors to the incidence and progression of rheumatoid arthritis is difficult to quantify. Nevertheless, the current evidence already enables the provision of appropriate counselling to patients with rheumatoid arthritis with respect to a healthy lifestyle including abstaining from cigarette smoking, maintaining a healthy diet, physical activity and avoiding obesity.
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Affiliation(s)
- Christoph Schäfer
- Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Gernot Keyßer
- Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - Monika Reuß-Borst
- Schwerpunktpraxis für Rheumatologie, Frankenstraße 36, 97708, Bad Bocklet, Deutschland
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Ni Y, Cao Y, Qiu Y, Li Y. Association between dietary retinol intake and rheumatoid arthritis based on NHANES database. BMC Public Health 2024; 24:2167. [PMID: 39127632 DOI: 10.1186/s12889-024-19620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE This study focused on the investigation of the correlation between dietary retinol intake and rheumatoid arthritis (RA) using the National Health and Nutrition Examination Survey (NHANES) database. METHODS Data from five NHANES cycles from 2003 to 2012 were utilized for this study. Dietary retinol intake was considered as the independent variable, and RA was the dependent variable. A weighted logistic regression method was applied to construct the relational model of the two variables. Stratified analysis without adjusting for confounding factors and subgroup analysis with confounding factors adjusted were conducted to explore the association between dietary retinol intake and RA. The optimal intake of dietary retinol was determined by the restricted cubic splines (RCS) analysis. RESULTS 22,971 samples were included in this study. The weighted logistic regression model was employed to construct the relational model of dietary retinol intake and RA (OR: 0.95, 95% CI: 0.91-0.99, p = 0.019). Stratified analysis displayed a great influence on the relational model exerted by the interaction between gender and retinol intake (p for interaction = 0.014). A significant association between retinol intake and RA was also indicated in the model adjusted for demographic characteristics (OR: 0.95, 95% CI: 0.90-1.00, p = 0.029). Subgroup analysis by gender showed that in the female population, unadjusted model (OR: 0.90, 95% CI: 0.84-0.96, p = 0.002), model adjusted for demographic characteristics only (OR: 0.89, 95% CI: 0.83-0.96, p = 0.002), and model adjusted for all confounding factors (OR: 0.91, 95% CI: 0.85-0.99, p = 0.019) indicated dietary retinol intake as a protective factor against RA. RCS analysis demonstrated that in the female population, regardless of the model used (Crude, Model I, and Model II), an intake of dietary retinol > 354.86 mcg was associated with RA disease reduction (OR < 1.0, p-non-linear < 0.05, p-overall < 0.05). CONCLUSION Increased dietary retinol intake was associated with RA disease reduction, particularly in the female population. Women are recommended to increase their dietary retinol intake (> 354.86 mcg) to reduce the risk of RA.
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Affiliation(s)
- Yuexin Ni
- Grade 11, Upper School, Hamden Hall Country Day School, Hamden, CT, USA
| | - Yating Cao
- Business School, The Chinese University of Hong Kong, Sanxiang Haishang D2- 25CD at the intersection of Keyuan South Road and Dongbin Road, Nanshan District, Shenzhen City, 518000, China
| | - Yun Qiu
- Chinese University of Hong Kong (Shenzhen) Business School, Shenzhen City, China
| | - Yingyuan Li
- Business School, The Chinese University of Hong Kong, Sanxiang Haishang D2- 25CD at the intersection of Keyuan South Road and Dongbin Road, Nanshan District, Shenzhen City, 518000, China.
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Braga GDC, Simões JLB, Teixeira Dos Santos YJ, Filho JCM, Bagatini MD. The impacts of obesity in rheumatoid arthritis and insights into therapeutic purinergic modulation. Int Immunopharmacol 2024; 136:112357. [PMID: 38810303 DOI: 10.1016/j.intimp.2024.112357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
Rheumatoid Arthritis (RA) is an autoimmune condition responsible for the impairment of synovia and joints, endangering the functionality of individuals and contributing to mortality. Currently, obesity is increasing worldwide, and recent studies have suggested an association between such condition and RA. In this sense, obese individuals present a lower capacity for achieving remission and present more intense symptoms of the disease, demonstrating a link between both disorders. Different studies aim to understand the possible connection between the conditions; however, few is known in this sense. Therefore, knowing that obesity can alter the activity of multiple body systems, this work's objective is to evaluate the main modifications caused by obesity, which can be linked to the pathophysiology of RA, highlighting as relevant topics obesity's negative impact triggering systemic inflammation, intestinal dysbiosis, endocrine disbalances. Furthermore, the relationship between oxidative stress and obesity also deserves to be highlighted, considering the influence of reactive oxygen species (ROS) accumulation in RA exacerbation. Additionally, many of those characteristics influenced by obesity, along with the classic peculiarities of RA pathophysiology, can also be associated with purinergic signaling. Hence, this work suggests possible connections between the purinergic system and RA, proposing potential therapeutic targets against RA to be studied.
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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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Scott IC, Bajpai R, Hider SL, Helliwell T, Mallen CD, Muller S. The relationship between obesity and patient-reported outcome measures in people with polymyalgia rheumatica. Rheumatol Adv Pract 2024; 8:rkae081. [PMID: 39006539 PMCID: PMC11239789 DOI: 10.1093/rap/rkae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/29/2024] [Indexed: 07/16/2024] Open
Abstract
Objective To examine the association between obesity and patient-reported outcome measures (PROMs) in a primary care-based cohort of people with PMR. Methods The PMR Cohort Study recruited people with incident PMR from 382 general practices. Self-completed questionnaires (0, 12, 24 months) captured a range of PROMs for pain, stiffness, anxiety, depression, fatigue, function and quality of life, alongside data on BMI. People were categorized as underweight/normal weight (BMI < 25kg/m2), overweight (25-29.99 kg/m2) or obese (≥30 kg/m2). Piecewise, multilevel, linear mixed-effects regression models examined relationships between BMI categories and PROMs over time, adjusting for confounding variables. Chi-squared tests examined the relationship between obesity and glucocorticoid persistence. Results 644 people with PMR were included. At baseline, 33.9% were normal/underweight, 40.6% overweight and 25.5% obese. Compared with normal/underweight people, those with obesity had significantly worse scores for the following: pain and stiffness at 12 months; fatigue at 12 and 24 months; depression at baseline; physical function at all time points; and quality of life at baseline and 12 months. They also had significantly smaller improvements in stiffness (1.13 units on an 11-point numeric rating scale; P = 0.001) and physical function (0.14 units measured using the modified Health Assessment Questionnaire; P = 0.025) between 0 and 12 months. BMI categories did not relate to persistent glucocorticoid use at 12 months (P = 0.110) or 24 months (P = 0.166). Conclusion Obesity associates with poorer outcomes for a range of PROMs in people with PMR. Consideration should be given to providing weight management support to people with PMR and obesity.
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Affiliation(s)
- Ian C Scott
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Ram Bajpai
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Samantha L Hider
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Toby Helliwell
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Centre for Academic Social Care, Public Health, Community and Primary Care (COSMIC), Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Campo M, Hjelle H, Granlund AVB, Sandvik AK, Ness-Jensen E. The relationship between weight change and inflammatory bowel disease. A population-based cohort study, the HUNT study. Scand J Gastroenterol 2024; 59:830-834. [PMID: 38738865 DOI: 10.1080/00365521.2024.2353099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The incidence of inflammatory bowel disease (IBD) is increasing. The prevalence of overweight and obesity is increasing in parallel with IBD and could contribute to IBD development. The aim of this study was to assess the relationship between weight change and the risk for IBD. METHODS Data gathered from 55,896 adult participants in the three first population-based Trøndelag Health Studies (HUNT1-3), Norway, performed in 1984-2008 was used. The exposure was change in body mass index between two HUNT studies. The outcome was a new IBD diagnosis recorded during a ten-year follow-up period after the exposure assessment. The risk of IBD by weight change was assessed by Cox regression analyses reporting hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for sex, age, and smoking status. RESULTS There were 334 new cases of ulcerative colitis (UC) and 54 of Crohn's disease (CD). Weight loss decreased the risk of a new UC diagnosis by 38% (adjusted HR 0.62, 95% CI 0.39-0.97) and seemed to double the risk of getting a new CD diagnosis (adjusted HR 2.01, 95% CI 0.91-4.46). Weight gain was not associated with a new diagnosis of neither UC (adjusted HR 1.00, 95% CI 0.78-1.26) nor CD (adjusted HR 1.08, 95% CI 0.56-2.08). CONCLUSION In this study, weight loss was associated with decreased risk of UC. However, no associations were seen between weight gain and the risk of UC or CD, suggesting that the increasing weight in the general population cannot explain the increasing incidence of IBD.
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Affiliation(s)
- Martin Campo
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Heidi Hjelle
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway
| | - Atle van Beelen Granlund
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gastroenterology and Hepatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Center of Molecular Inflammation Research, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Kristian Sandvik
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gastroenterology and Hepatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Center of Molecular Inflammation Research, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eivind Ness-Jensen
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Gheisary Z, Hoja I, Liu J, Papagerakis P, Weber LP, Fenton M, Katselis GS, Lieffers JRL, Papagerakis S. Association of Sleep Quality and General, Mental, and Oral Health with Lifestyle Traits (Dietary Intake, Smoking Status) in Arthritis: A Cross-Sectional Study from the Canadian Community Health Survey (CCHS). Nutrients 2024; 16:2091. [PMID: 38999838 PMCID: PMC11243648 DOI: 10.3390/nu16132091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.
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Affiliation(s)
- Zohre Gheisary
- Department of Biochemistry, Microbiology, and Immunology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Ibrahim Hoja
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
- Health Sciences, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Juxin Liu
- Department of Mathematics and Statistics, College of Arts and Science, University of Saskatchewan, 106 Wiggins Road, Saskatoon, SK S7N 5E6, Canada;
| | - Petros Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
| | - Lynn P. Weber
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada;
| | - Mark Fenton
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
| | - George S. Katselis
- Department of Medicine, Canadian Centre for Rural and Agricultural Health, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada;
| | - Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Silvana Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
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Khokhar M, Dey S, Tomo S, Jaremko M, Emwas AH, Pandey RK. Unveiling Novel Drug Targets and Emerging Therapies for Rheumatoid Arthritis: A Comprehensive Review. ACS Pharmacol Transl Sci 2024; 7:1664-1693. [PMID: 38898941 PMCID: PMC11184612 DOI: 10.1021/acsptsci.4c00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic debilitating autoimmune disease, that causes joint damage, deformities, and decreased functionality. In addition, RA can also impact organs like the skin, lungs, eyes, and blood vessels. This autoimmune condition arises when the immune system erroneously targets the joint synovial membrane, resulting in synovitis, pannus formation, and cartilage damage. RA treatment is often holistic, integrating medication, physical therapy, and lifestyle modifications. Its main objective is to achieve remission or low disease activity by utilizing a "treat-to-target" approach that optimizes drug usage and dose adjustments based on clinical response and disease activity markers. The primary RA treatment uses disease-modifying antirheumatic drugs (DMARDs) that help to interrupt the inflammatory process. When there is an inadequate response, a combination of biologicals and DMARDs is recommended. Biological therapies target inflammatory pathways and have shown promising results in managing RA symptoms. Close monitoring for adverse effects and disease progression is critical to ensure optimal treatment outcomes. A deeper understanding of the pathways and mechanisms will allow new treatment strategies that minimize adverse effects and maintain quality of life. This review discusses the potential targets that can be used for designing and implementing precision medicine in RA treatment, spotlighting the latest breakthroughs in biologics, JAK inhibitors, IL-6 receptor antagonists, TNF blockers, and disease-modifying noncoding RNAs.
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Affiliation(s)
- Manoj Khokhar
- Department
of Biochemistry, All India Institute of
Medical Sciences, Jodhpur, 342005 Rajasthan, India
| | - Sangita Dey
- CSO
Department, Cellworks Research India Pvt
Ltd, Bengaluru, 560066 Karnataka, India
| | - Sojit Tomo
- Department
of Biochemistry, All India Institute of
Medical Sciences, Jodhpur, 342005 Rajasthan, India
| | - Mariusz Jaremko
- Smart-Health
Initiative (SHI) and Red Sea Research Center (RSRC), Division of Biological
and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal, 23955 Jeddah, Saudi Arabia
| | - Abdul-Hamid Emwas
- Core
Laboratories, King Abdullah University of
Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia
| | - Rajan Kumar Pandey
- Department
of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm 17177, Sweden
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Zhang Y, Zhang J, Liu Y, Ren S, Tao N, Meng F, Cao Q, Liu R. High fat diet increases the severity of collagen-induced arthritis in mice by altering the gut microbial community. Adv Rheumatol 2024; 64:44. [PMID: 38816873 DOI: 10.1186/s42358-024-00382-y] [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: 08/11/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES Research has demonstrated that obesity may be associated with rheumatoid arthritis (RA). In addition, gut microbiota and its metabolites contribute to the occurrence and development of RA and obesity. However, the mechanism by which obesity affects RA remains unclear. In this study, we aimed to investigate whether gut microbiota and their metabolites alter the effects of high fat diet (HFD) on the severity of collagen-induced arthritis (CIA) in mice. METHODS Briefly, mice were divided into normal group (N), CIA model group (C), HFD group (T), and HFD CIA group (CT). Hematoxylin and Eosin staining(HE) and Safranin O-fast green staining were conducted, and levels of blood lipid and inflammatory cytokines were measured. 16S rDNA sequencing technique and liquid chromatography-mass spectrometry (LC-MS)-based metabolomics were performed to explore changes in the microbiota structure to further reveal the pathomechanism of HFD on CIA. RESULTS HFD aggravated the severity of CIA in mice. The CT group had the highest proportion of microbial abundance of Blautia, Oscillibacter, Ruminiclostridium-9, and Lachnospiraceae UCG 006 at the genus level, but had a lower proportion of Alistipes. Additionally, the fecal metabolic phenotype of the combined CT group shows significant changes, with differential metabolites enriched in 9 metabolic pathways, including primary bile acid biosynthesis, arginine biosynthesis, sphingolipid metabolism, purine metabolism, linoleic acid metabolism, oxytocin signaling pathway, aminoacyl-tRNA biosynthesis, the pentose phosphate pathway, and sphingolipid signaling pathway. Correlation analysis revealed that some of the altered gut microbiota genera were strongly correlated with changes in fecal metabolites, total cholesterol (TC), triglyceride (TG), and inflammatory cytokine levels. CONCLUSIONS This study shows that HFD may aggravate inflammatory reaction in CIA mice by altering the gut microbiota and metabolic pathways.
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Affiliation(s)
- Yang Zhang
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China
| | - Jie Zhang
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China
| | - Yantong Liu
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China
| | - Shuang Ren
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China
| | - Ning Tao
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China
| | - Fanyan Meng
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China
| | - Qi Cao
- Liaoning University of Traditional Chinese Medicine, Shenyang, 110001, Liaoning, China
| | - Ruoshi Liu
- The First Hospital of China Medical University, Shenyang, 110002, Liaoning, China.
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11
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Ma Z, Wu S, Guo Y, Ouyang S, Wang N. Association of advanced lung cancer inflammation index with all-cause and cardiovascular mortality in US patients with rheumatoid arthritis. Front Nutr 2024; 11:1397326. [PMID: 38873560 PMCID: PMC11169605 DOI: 10.3389/fnut.2024.1397326] [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: 03/19/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction As a systemic autoimmune disorder, the prognosis of rheumatoid arthritis (RA) is intricately linked to inflammation. This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a comprehensive indicator of inflammation combined with nutritional status, and all-cause and cardiovascular mortality among patients diagnosed with RA. Methods The 2,305 RA patients from NHANES (2001-2018) included in the analysis were categorized into three groups according to ALI tertiles. Weighted Kaplan-Meier and multivariate COX regression analyses evaluated the relationship between ALI and mortality. The time-dependent characteristic curve (ROC) was used to assess the prediction accuracy of ALI. Results During a median follow-up of 7.92 years, 591 participants died from all causes, including 197 from cardiovascular diseases. Increased ALI was associated with a decreased probability of death. The full COX model revealed lower all-cause mortality hazard risks in the T2 (HR: 0.67, 95%CI: 0.54-0.83) and T3 (HR: 0.47 95%CI: 0.33-0.67, p for tend <0.001) groups compared to T1, and the risk of cardiovascular mortality was also lower in the groups of T2 (HR: 0.47, 95%CI: 0.31-0.70) and T3 (HR: 0.34, 95%CI: 0.19-0.62, p for trend <0.001). Furthermore, the ROC analysis underscored the strong predictive capability of ALI (AUC for 1-year all-cause and cardiovascular mortality were 0.73 and 0.79, respectively). Conclusion This cohort study demonstrated the higher accuracy of ALI in predicting mortality in RA patients, highlighting the important clinical value of ALI in risk assessment and prognosis evaluation.
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Affiliation(s)
- Zhuang Ma
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Shixin Wu
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yitong Guo
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Shiyi Ouyang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Ningning Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Health Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, China
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12
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Lu Z, Xie Z, Shen K, Wu X, Feng E. Association of dietary inflammatory index with immune-inflammatory biomarkers in rheumatoid arthritis patients: results from NHANES 1999-2018. Front Nutr 2024; 11:1353964. [PMID: 38860155 PMCID: PMC11163113 DOI: 10.3389/fnut.2024.1353964] [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: 12/11/2023] [Accepted: 04/29/2024] [Indexed: 06/12/2024] Open
Abstract
Background Synovial inflammation is the main reason for joint damage in patients with rheumatoid arthritis (RA). Diet is recognized as one of the therapeutic strategies to control the inflammatory activity in RA. However, few studies have investigated the association between diet and immune-inflammatory biomarkers in RA patients. Our study aims to examine the correlation between dietary inflammatory potential and systemic immune-inflammation Index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) in the RA population. Materials and methods The National Health and Nutrition Examination Survey (NHANES) was the data source utilized in this study, spanning from 1999 to 2018. The study encompassed 2,500 RA participants in total. The dietary inflammatory potential was calculated by the dietary inflammation index (DII) score based on dietary recall interviews. The generalized multiple linear regression analyses were used to evaluate the relationship between DII and immune-inflammatory markers. Furthermore, subgroup analyses and restricted cubic spline models were performed. Results After full adjustments, there were significant positive correlations between DII levels and SII/NLR in RA patients (SII, β: 14.82, 95% CI: 5.14-24.50, p = 0.003; NLR, β: 0.04, 95% CI: 0.01-0.08, p = 0.005). It was noteworthy that inconsistent results were observed in the association between DII and SII as well as NLR in subgroups of red blood cell levels (Interaction p-value <0.001). Conclusion Pro-inflammatory dietary status in the RA population is significantly positively correlated with SII and NLR, influenced by variations in red blood cell levels.
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Affiliation(s)
- Zhiming Lu
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhiheng Xie
- Department of Orthopaedic, Anxi County Hospital, Quanzhou, China
| | - Kaiwei Shen
- Faculty of Medicine, Institute of Biochemistry and Molecular Biology, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Xunyuan Wu
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Eryou Feng
- Fujian Medical University Union Hospital, Fuzhou, China
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13
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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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14
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Sharma A, Sharma C, Sharma L, Wal P, Mishra P, Sachdeva N, Yadav S, Vargas De-La Cruz C, Arora S, Subramaniyan V, Rawat R, Behl T, Nandave M. Targeting the vivid facets of apolipoproteins as a cardiovascular risk factor in rheumatoid arthritis. Can J Physiol Pharmacol 2024; 102:305-317. [PMID: 38334084 DOI: 10.1139/cjpp-2023-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mostly, cardiovascular diseases are blamed for casualties in rheumatoid arthritis (RA) patients. Customarily, dyslipidemia is probably the most prevalent underlying cause of untimely demise in people suffering from RA as it hastens the expansion of atherosclerosis. The engagement of inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), etc., is crucial in the progression and proliferation of both RA and abnormal lipid parameters. Thus, lipid abnormalities should be monitored frequently in patients with both primary and advanced RA stages. An advanced lipid profile examination, i.e., direct role of apolipoproteins associated with various lipid molecules is a more dependable approach for better understanding of the disease and selecting suitable therapeutic targets. Therefore, studying their apolipoproteins is more relevant than assessing RA patients' altered lipid profile levels. Among the various apolipoprotein classes, Apo A1 and Apo B are primarily being focused. In addition, it also addresses how calculating Apo B:Apo A1 ratio can aid in analyzing the disease's risk. The marketed therapies available to control lipid abnormalities are associated with many other risk factors. Hence, directly targeting Apo A1 and Apo B would provide a better and safer option.
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Affiliation(s)
- Aditi Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Chakshu Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Lalit Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Pranay Wal
- Pranveer Singh Institute of Technology, Pharmacy, Kanpur, Uttar Pradesh, India
| | - Preeti Mishra
- Raja Balwant Singh Engineering Technical Campus, Bichpuri, Agra, India
| | - Nitin Sachdeva
- Department of Anesthesia, Mediclinic Aljowhara Hospital, Al Ain, United Arab Emirates
| | - Shivam Yadav
- School of Pharmacy, Babu Banarasi Das University, Lucknow, Uttar Pradesh, India
| | - Celia Vargas De-La Cruz
- Department of Pharmacology, Bromatology and Toxicology, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Lima 15001, Peru
- E-Health Research Center, Universidad de Ciencias y Humanidades, Lima 15001, Peru
| | - Sandeep Arora
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
| | - Vetriselvan Subramaniyan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor Darul Ehsan, Malaysia
- Centre for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu 600077, India
| | - Ravi Rawat
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Bidholi, Dehradun, Uttarakhand, India
| | - Tapan Behl
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India
| | - Mukesh Nandave
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Delhi, India
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15
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Tournadre A, Beauger M. Weight loss affects disease activity and treatment response in inflammatory rheumatic diseases. Joint Bone Spine 2024; 91:105647. [PMID: 37783311 DOI: 10.1016/j.jbspin.2023.105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 10/04/2023]
Abstract
The quantity and quality of the adipose tissue is altered in obesity: hypertrophy of adipocytes, decrease in expandability, fibrosis, production of pro-inflammatory cytokines and adipokines, inflammatory infiltration by pro-inflammatory M1 macrophages and T lymphocytes. Excess adipose tissue and obesity are associated with low-grade inflammation that can aggravate chronic inflammatory diseases, decrease treatment efficacy, contribute to the development of comorbidities, and of the disease in its preclinical phase. Obesity increases the incidence of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis with a weight-dose effect. It is also a predictor of worse response to treatment, in particular TNF inhibitors. Weight loss induced by bariatric surgery decreases the risk of psoriasis and psoriatic arthritis and improves disease activity and remission in RA. A 5% weight loss through a low-calorie diet improves the response to TNF inhibitors in psoriatic arthritis, losing even more weight improves the response even more. In RA, the beneficial effect of weight loss from a low-calorie diet on disease activity has been reported in a few observational studies but has not been demonstrated in a randomized controlled trial. Screening and management of obesity are part of the dietary recommendations of the French Society for Rheumatology in patients with chronic inflammatory rheumatic diseases. Of course, this should be combined with other lifestyle modifications such as smoking cessation, higher food quality, increased physical activity and reduced sedentary behavior.
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Affiliation(s)
- Anne Tournadre
- Service de rhumatologie, hôpital G-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Unité de nutrition humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
| | - Marine Beauger
- Service de rhumatologie, hôpital G-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
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16
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den Hollander NK, van der Helm-van Mil AHM, van Steenbergen HW. Improving our understanding of the paradoxical protective effect of obesity on radiographic damage: a large magnetic resonance imaging-study in early arthritis. Rheumatology (Oxford) 2024; 63:1007-1014. [PMID: 37389420 PMCID: PMC10986809 DOI: 10.1093/rheumatology/kead320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Obesity conveys a risk for RA development, while paradoxically, associating with less radiographic progression after RA diagnosis. Using MRI we can study this surprising association in detail from MRI-detected synovitis and osteitis to MRI-detected erosive progression, which precedes radiographic progression. Previous research suggested obesity associates with less osteitis and synovitis. We therefore aimed to (i) validate the previously suggested association between BMI and MRI-detected osteitis/synovitis; (ii) study whether this is specific for ACPA-positive or ACPA-negative RA or also present in other arthritides; (iii) study whether MRI-detected osteitis associates with MRI-detected erosive progression; and (iv) study whether obesity associates with MRI-detected erosive progression. METHODS We studied 1029 early arthritis patients (454 RA, 575 other arthritides), consecutively included in Leiden Early Arthritis Clinic. At baseline patients underwent hand-and-foot MRI that were RAMRIS-scored, and 149 RA patients underwent follow-up MRIs. We studied associations between baseline BMI and MRI-detected osteitis/synovitis (using linear regression), and erosive progression (using Poisson mixed models). RESULTS In RA, higher BMI associated with less osteitis at disease onset (β = 0.94; 95% CI: 0.93, 0.96) but not with synovitis. Higher BMI associated with less osteitis in ACPA-positive RA (β = 0.95; 95% CI: 0.93, 0.97), ACPA-negative RA (β = 0.97; 95% CI: 0.95, 0.99) and other arthritides (β = 0.98; 95% CI: 0.96, 0.99). Over 2 years, overweight and obesity associated with less MRI-detected erosive progression (P = 0.02 and 0.03, respectively). Osteitis also associated with erosive progression over 2 years (P < 0.001). CONCLUSIONS High BMI relates to less osteitis at disease onset, which is not confined to RA. Within RA, high BMI and less osteitis associated with less MRI-detected erosive progression. This suggests that the protective effect of obesity on radiographic progression is exerted via a path of less osteitis and subsequently fewer MRI-detected erosions.
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Affiliation(s)
| | - 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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17
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Luo P, Xu W, Ye D, Chen W, Ying J, Liu B, Li J, Sun X, He Z, Wen C, Mao Y. Metabolic Syndrome Is Associated With an Increased Risk of Rheumatoid Arthritis: A Prospective Cohort Study Including 369,065 Participants. J Rheumatol 2024; 51:360-367. [PMID: 38224984 DOI: 10.3899/jrheum.2023-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To explore the associations between metabolic syndrome (MetS) and its individual components and the risk of rheumatoid arthritis (RA). METHODS A total of 369,065 individuals were included in the present study based on the UK Biobank. Multivariable Cox proportional hazards regression models were applied to estimate the associations between MetS and its individual components and the risk of RA. Mediation analysis was performed to further assess the potential mediating role of C-reactive protein (CRP) in the relationship between MetS and RA. RESULTS During a median follow-up period of 12.04 years, a total of 4901 incident RA cases were documented. MetS (hazard ratio [HR] 1.22, 95% CI 1.14-1.30) and 4 of its 5 components (elevated waist circumference [WC; HR 1.21, 95% CI 1.12-1.32], elevated triglyceride [TG] level [HR 1.12, 95% CI 1.05-1.19], reduced high-density lipoprotein cholesterol [HDL-C] level [HR 1.31, 95% CI 1.23-1.39], and hyperglycemia [HR 1.15, 95% CI 1.05-1.25]) were associated with an increased risk of RA. In addition, the risk of RA increased as the number of diagnosed MetS components increased, with the highest risk in participants with all 5 components. Mediation analysis showed that CRP might mediate the association between MetS and RA, accounting for 9.27% of the total effect. CONCLUSION These findings indicated positive associations between MetS and 4 of its components (WC, TG, HDL-C, and hyperglycemia) and the risk of RA, highlighting the importance of MetS management in the prevention of RA.
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Affiliation(s)
- Peiyang Luo
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - WanLi Xu
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ding Ye
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weiwei Chen
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiacheng Ying
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Liu
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiayu Li
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohui Sun
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhixing He
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengping Wen
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China.
| | - Yingying Mao
- P. Luo, W.L. Xu, MPH, D. Ye, PhD, W. Chen, J. Ying, B. Liu, MPH, J. Li, PhD, X. Sun, PhD, Z. He, PhD, C. Wen, PhD, MD, Y. Mao, PhD, Zhejiang Chinese Medical University, Hangzhou, China.
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18
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Qiu F, Li J, Gan L, Legerlotz K. Arthritis prevalence is associated with metabolic syndrome risk factors but not with physical activity in middle-aged and older patients - a cross-sectional study. BMC Geriatr 2024; 24:242. [PMID: 38459429 PMCID: PMC10924363 DOI: 10.1186/s12877-024-04859-9] [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: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND In light of the aging population, increasingly suffering from the metabolic syndrome (MS), strategies need to be developed to address global public health challenges known to be associated with MS such as arthritis. As physical activity (PA) may play a crucial role in tackling those challenges, this study aimed to determine the association between the number of MS risk factors, PA and arthritis in people ≥ 50 years old. METHODS Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used to estimate the prevalence of arthritis and MS risk factors in the European population ≥ 50 years and to evaluate the associations between MS risk factors, PA and arthritis. Binary logistic regression was performed to calculate the odds ratio of different factors. RESULTS 73,125 participants were included in the analysis. 55.75% of patients stated at least one of the three MS risk factors. The prevalence of rheumatoid arthritis (RA) and osteoarthritis (OA)/other rheumatism among ≥ 50 years population was 10.19% and 19.32% respectively. Females showed a higher prevalence of arthritis than males. Prevalence did not differ between groups with different levels of PA. Arthritis prevalence was positively correlated with the number of MS risk factors (P < 0.01) but not with PA (P > 0.05). CONCLUSION Middle-aged and older Europeans with multiple comorbidities suffered from RA, OA or other rheumatism more frequently than participants with fewer comorbidities, while the level of physical activity was not associated with the number of metabolic risk factors in patients with RA and OA/other rheumatism.
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Affiliation(s)
- Fanji Qiu
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Jinfeng Li
- Department of Kinesiology, Iowa State University, 50011, Ames, USA, IA
| | - Liaoyan Gan
- Alberta International School of Recreation, Sport and Tourism of Beijing Sport University, Beijing Sport University, 572423, Lingshui, China
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, T6G2R3, Edmonton, Canada
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
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Jung H, Jung HU, Baek EJ, Kwon SY, Kang JO, Lim JE, Oh B. Integration of risk factor polygenic risk score with disease polygenic risk score for disease prediction. Commun Biol 2024; 7:180. [PMID: 38351177 PMCID: PMC10864389 DOI: 10.1038/s42003-024-05874-7] [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: 09/19/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Polygenic risk score (PRS) is useful for capturing an individual's genetic susceptibility. However, previous studies have not fully exploited the potential of the risk factor PRS (RFPRS) for disease prediction. We explored the potential of integrating disease-related RFPRSs with disease PRS to enhance disease prediction performance. We constructed 112 RFPRSs and analyzed the association of RFPRSs with diseases to identify disease-related RFPRSs in 700 diseases, using the UK Biobank dataset. We uncovered 6157 statistically significant associations between 247 diseases and 109 RFPRSs. We estimated the disease PRSs of 70 diseases that exhibited statistically significant heritability, to generate RFDiseasemetaPRS-a combined PRS integrating RFPRSs and disease PRS-and compare the prediction performance metrics between RFDiseasemetaPRS and disease PRS. RFDiseasemetaPRS showed better performance for Nagelkerke's pseudo-R2, odds ratio (OR) per 1 SD, net reclassification improvement (NRI) values and difference of R2 considered by variance of R2 in 31 out of 70 diseases. Additionally, we assessed risk classification between two models by examining OR between the top 10% and remaining 90% individuals for the 31 diseases; RFDiseasemetaPRS exhibited better R2, NRI and OR than disease PRS. These findings highlight the importance of utilizing RFDiseasemetaPRS, which can provide personalized healthcare and tailored prevention strategies.
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Affiliation(s)
- Hyein Jung
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Hae-Un Jung
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | | | - Shin Young Kwon
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Ji-One Kang
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ji Eun Lim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Bermseok Oh
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
- Mendel Inc, Seoul, Republic of Korea.
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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20
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Nan K, Zhang M, Hu S, Shao X, Liu L, Zhi Y, Xu P. Relationship of weight change patterns from young to middle adulthood with incident rheumatoid arthritis and osteoarthritis: a retrospective cohort study. Front Endocrinol (Lausanne) 2024; 14:1308254. [PMID: 38234426 PMCID: PMC10791826 DOI: 10.3389/fendo.2023.1308254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Background The relationship between weight change patterns and arthritis onset, specifically rheumatoid arthritis (RA) and osteoarthritis (OA), is unclear. We examined the association between weight changes from young adulthood to midlife and arthritis onset. Methods Using data from NHANES 1999-2018, participants with self-reported arthritis were selected. Age at diagnosis determined arthritis onset. Weight change patterns were based on BMI at age 25 and 10 years before the survey. Patterns were categorized as stable non-obese, non-obese to obese, obese to non-obese, and stable obese. Cox regression models and restricted cubic spline (RCS) analysis were employed, calculating hazard ratios (HRs) and 95% confidence intervals (CIs) considering covariates. Results Out of 20,859 participants (male 11,017, 52.82%), 4922 developed arthritis over a mean 8.66-year follow-up. Compared to stable non-obese individuals, the HRs for arthritis were 1.55 (95% CI=1.45 to 1.66, P < 0.0001) for non-obese to obese and 1.74 (95% CI=1.56 to 1.95, P < 0.0001) for stable obese. Those gaining 10-20 kg had a HR of 1.33 (95% CI=1.22 to 1.46, P < 0.0001), and gains >20 kg had a HR of 1.56 (95% CI=1.42 to 1.71, P < 0.0001), compared to stable weight (change within 2.5 kg). Identical results observed for OA and RA. RCS showed a nonlinear relationship between weight change and arthritis (all P < 0.01). Conclusions Stable obesity and weight gain during adulthood increase arthritis risk. Maintaining a non-obese weight throughout adult years might reduce arthritis risk in later life.
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Affiliation(s)
- Kai Nan
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ming Zhang
- Department of General Practice, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shouye Hu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaolong Shao
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Lin Liu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yang Zhi
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Peng Xu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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21
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Flores-Alvarado DE, Esquivel-Valerio JA, Vega-Morales D, Garza-Cisneros AN, Balderas-Palacios MA, Galarza-Delgado DA, Garcia-Leal M. Impact of obesity and overweight on C-reactive protein concentrations and disease activity in rheumatoid arthritis: A systematic review and meta-analysis. Int J Rheum Dis 2023; 26:2498-2508. [PMID: 37888904 DOI: 10.1111/1756-185x.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
AIM This study aims to assess the association of obesity and CRP concentrations in adult patients with rheumatoid arthritis (RA), and its influence on measures of disease activity. METHODS A comprehensive search was performed using Scopus, Web of Science, MEDLINE, and EMBASE, from the time of their inception to November 2021. Observational studies that evaluated the association between CRP concentrations and obesity or overweight in patients with RA were considered eligible. Correlation coefficients were pooled using the inverse variance method, while effect sizes were pre-calculated for adjusted standardized regression coefficients (β). RESULTS A total of 10 studies, which comprised 4024 patients, were included in this systematic review. Individually, most studies report a significant association between CRP concentrations and a higher body mass index or other adiposity measures, but the statistical significance was not sustained when pooling their data together. Through the estimates provided in the present review, it is noted that CRP tends to be more elevated in female patients with RA that have a higher BMI. However, this association is not present in men. CONCLUSION CRP tends to be elevated in female patients with RA that have a higher BMI. Further research is required to assess this possible sex-related difference and to aid shared decision-making in order to avoid over-treatment and increased burden in patients with obesity and RA. PROSPERO registration number: CRD42022314580.
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Affiliation(s)
- Diana E Flores-Alvarado
- Rheumatology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jorge A Esquivel-Valerio
- Rheumatology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Vega-Morales
- Rheumatology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Andrea N Garza-Cisneros
- Rheumatology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mario A Balderas-Palacios
- Rheumatology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Dionicio A Galarza-Delgado
- Rheumatology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mariana Garcia-Leal
- Plataforma INVEST UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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22
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Miladi S, Makhlouf Y, Boussaa H, Zakraoui L, Ben Abdelghani K, Fazaa A, Laatar A. Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review. PLoS One 2023; 18:e0294277. [PMID: 37976258 PMCID: PMC10655969 DOI: 10.1371/journal.pone.0294277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Obesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis. METHODS This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included. RESULTS Three studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p<0.05). Similarly, prior BMS in RA patients was significantly associated with reduced odds ratios for all the morbidities and in-hospital mortality compared with no prior BMS (36.5% vs 54.6%, OR = 0.45, 95% CI (0.42, 0.48), p< 0.001) and (0.4% vs 0.9%, OR = 0.41, 95% CI (0.27-0.61), p < 0.001) respectively. CONCLUSION To conclude, published data indicate that BMS seems a promising alternative in reducing RA disease activity as well as morbidity and mortality in patients with obesity.
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Affiliation(s)
- Saoussen Miladi
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Yasmine Makhlouf
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Hiba Boussaa
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Leith Zakraoui
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Kawther Ben Abdelghani
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Alia Fazaa
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Ahmed Laatar
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
- University Tunis El Manar, Tunis, Tunisia
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Bilski J, Schramm-Luc A, Szczepanik M, Mazur-Biały AI, Bonior J, Luc K, Zawojska K, Szklarczyk J. Adipokines in Rheumatoid Arthritis: Emerging Biomarkers and Therapeutic Targets. Biomedicines 2023; 11:2998. [PMID: 38001998 PMCID: PMC10669400 DOI: 10.3390/biomedicines11112998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease manifested by joint involvement, extra-articular manifestations, and general symptoms. Adipose tissue, previously perceived as an inert energy storage organ, has been recognised as a significant contributor to RA pathophysiology. Adipokines modulate immune responses, inflammation, and metabolic pathways in RA. Although most adipokines have a pro-inflammatory and aggravating effect on RA, some could counteract this pathological process. The coexistence of RA and sarcopenic obesity (SO) has gained attention due to its impact on disease severity and outcomes. Sarcopenic obesity further contributes to the inflammatory milieu and metabolic disturbances. Recent research has highlighted the intricate crosstalk between adipose tissue and skeletal muscle, suggesting potential interactions between these tissues in RA. This review summarizes the roles of adipokines in RA, particularly in inflammation, immune modulation, and joint destruction. In addition, it explores the emerging role of adipomyokines, specifically irisin and myostatin, in the pathogenesis of RA and their potential as therapeutic targets. We discuss the therapeutic implications of targeting adipokines and adipomyokines in RA management and highlight the challenges and future directions for research in this field.
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Affiliation(s)
- Jan Bilski
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.I.M.-B.); (K.Z.)
| | - Agata Schramm-Luc
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.S.-L.); (K.L.)
| | - Marian Szczepanik
- Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Agnieszka Irena Mazur-Biały
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.I.M.-B.); (K.Z.)
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland; (J.B.); (J.S.)
| | - Kevin Luc
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.S.-L.); (K.L.)
| | - Klaudia Zawojska
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.I.M.-B.); (K.Z.)
| | - Joanna Szklarczyk
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland; (J.B.); (J.S.)
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24
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Li X, Zhu J, Zhao W, Zhu Y, Zhu L, Shi R, Wang Z, Pan H, Wang D. The Causal Effect of Obesity on the Risk of 15 Autoimmune Diseases: A Mendelian Randomization Study. Obes Facts 2023; 16:598-605. [PMID: 37827145 PMCID: PMC10697740 DOI: 10.1159/000534468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Observational studies have shown that obesity is a risk factor for various autoimmune diseases. However, the causal relationship between obesity and autoimmune diseases is unclear. Mendelian randomization (MR) was used to investigate the causal effects of obesity on 15 autoimmune diseases. METHODS MR analysis employed instrumental variables, specifically single-nucleotide polymorphisms associated with obesity measures such as body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio. The study utilized UK Biobank and FinnGen data to estimate the causal relationship between obesity and autoimmune diseases. RESULTS Genetically predicted BMI was associated with risk for five autoimmune diseases. The odds ratio per 1-SD increase in genetically predicted BMI, the OR was 1.28 (95% CI, 1.18-1.09; p < 0.001) for asthma, 1.37 (95% CI, 1.24-1.51; p < 0.001) for hypothyroidism, 1.52 (95% CI, 1.27-1.83; p < 0.001) for psoriasis, 1.22 (95% CI, 1.06-1.40; p = 0.005) for rheumatoid arthritis, and 1.55 (95% CI, 1.32-1.83; p < 0.001) for type 1 diabetes. However, after adjusting for genetic susceptibility to drinking and smoking, the correlation between BMI and rheumatoid arthritis was not statistically significant. Genetically predicted waist circumference, hip circumference, and waist and hip circumference were associated with 6, 6, and 1 autoimmune disease, respectively. CONCLUSION This study suggests that obesity may be associated with an increased risk of several autoimmune diseases, such as asthma, hypothyroidism, psoriasis, rheumatoid arthritis, and type 1 diabetes.
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Affiliation(s)
- Xunliang Li
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China,
| | - Jie Zhu
- Department of Infectious Disease, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenman Zhao
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyu Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rui Shi
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhijuan Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haifeng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Deguang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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25
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Arkema EV, Rossides M, Cozier YC. Sarcoidosis and its relation to other immune-mediated diseases: Epidemiological insights. J Autoimmun 2023:103127. [PMID: 37816661 DOI: 10.1016/j.jaut.2023.103127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023]
Abstract
Several epidemiological studies show a co-occurrence of sarcoidosis with other immune-mediated diseases (IMD). There are many similarities between sarcoidosis and IMDs in their geographical distribution and risk factors. Understanding these similarities and identifying the differences can help us to better understand sarcoidosis and put it into context with other IMDs. In this review, we present the current knowledge about the overlap between sarcoidosis and other IMDs derived from epidemiological studies. Epidemiologic methods utilize study design and statistical analysis to describe the patterns in data and, ideally, identify causal relationships between an exposure and a health outcome. We discuss how study design and analysis may affect the interpretation of epidemiological studies on this topic and highlight some theories that attempt to explain the relation between sarcoidosis and other IMDs.
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Affiliation(s)
- Elizabeth V Arkema
- Karolinska Institutet, Department of Medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden.
| | - Marios Rossides
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden; Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yvette C Cozier
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA; Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, USA
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26
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Maisha JA, El-Gabalawy HS, O’Neil LJ. Modifiable risk factors linked to the development of rheumatoid arthritis: evidence, immunological mechanisms and prevention. Front Immunol 2023; 14:1221125. [PMID: 37767100 PMCID: PMC10520718 DOI: 10.3389/fimmu.2023.1221125] [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: 05/11/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Rheumatoid Arthritis (RA) is a common autoimmune disease that targets the synovial joints leading to arthritis. Although the etiology of RA remains largely unknown, it is clear that numerous modifiable risk factors confer increased risk to developing RA. Of these risk factors, cigarette smoking, nutrition, obesity, occupational exposures and periodontal disease all incrementally increase RA risk. However, the precise immunological mechanisms by which these risk factors lead to RA are not well understood. Basic and translational studies have provided key insights into the relationship between inflammation, antibody production and the influence in other key cellular events such as T cell polarization in RA risk. Improving our general understanding of the mechanisms which lead to RA will help identify targets for prevention trials, which are underway in at-risk populations. Herein, we review the modifiable risk factors that are linked to RA development and describe immune mechanisms that may be involved. We highlight the few studies that have sought to understand if modification of these risk factors reduces RA risk. Finally, we speculate that modification of risk factors may be an appealing avenue for prevention for some at-risk individuals, specifically those who prefer lifestyle interventions due to safety and economic reasons.
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Affiliation(s)
| | | | - Liam J. O’Neil
- Manitoba Centre for Proteomics and Systems Biology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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27
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Паневин ТС, Зоткин ЕГ, Лила АМ. [Impact of surgical treatment of morbid obesity on joint diseases]. PROBLEMY ENDOKRINOLOGII 2023; 69:70-76. [PMID: 37694869 PMCID: PMC10520909 DOI: 10.14341/probl13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/02/2023] [Indexed: 09/12/2023]
Abstract
The prevalence of obesity in the modern world is increasing. Obesity is an independent risk factor for some rheumatic diseases and also worsens their course. The presence of chronic joint disease can make it difficult for obesity to reduce activity, creating a vicious circle where joint pain makes exercise difficult and being overweight exacerbates joint pain. At the same time, there is a conditionally radical method of treating obesity - bariatric surgery (BS), which is currently used when conservative methods are ineffective. The purpose of this review is to analyze the data presented in the world literature on the impact of BS on the course of the most common rheumatic diseases. The available data show the possibility of a positive effect of BS not only on weight loss, but also on the course of a number of rheumatic diseases.
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Affiliation(s)
- Т. С. Паневин
- Научно-исследовательский институт ревматологии им. В.А. Насоновой
| | - Е. Г. Зоткин
- Научно-исследовательский институт ревматологии им. В.А. Насоновой
| | - А. М. Лила
- Научно-исследовательский институт ревматологии им. В.А. Насоновой;
Российская медицинская академия непрерывного профессионального образования
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28
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Rose J. Autoimmune Connective Tissue Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis. Immunol Allergy Clin North Am 2023; 43:613-625. [PMID: 37394263 DOI: 10.1016/j.iac.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Systemic lupus erythematosus and rheumatoid arthritis are just 2 of several autoimmune connective tissue diseases that are primarily chronic in nature but can present to the emergency department by virtue of an acute exacerbation of disease. Beyond an acute exacerbation of disease, their predilection for invading multiple organ systems lends itself to the potential for patients presenting to the emergency department with either a single or isolated symptom or a myriad of signs and/or symptoms indicative of a degree of disease complexity and severity that warrant timely recognition and resuscitation.
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Affiliation(s)
- Jonathan Rose
- Department of Emergency Medicine, Memorial Healthcare System, Memorial Hospital West, 703 N Flamingo Road, Pembroke Pines, FL 33028, USA.
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29
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Yıldırım Keskin A, Şentürk S, Kimyon G. Eating attitude in patients with rheumatoid arthritis: The relationship between pain, body mass index, disease activity, functional status, depression, anxiety and quality of life. Arch Psychiatr Nurs 2023; 44:52-58. [PMID: 37197863 DOI: 10.1016/j.apnu.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/29/2023] [Accepted: 04/08/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE The aim of this study is to evaluate the relationship between eating attitude and pain, body mass index, disease activity, functional status, depression, anxiety and quality of life in patients with rheumatoid arthritis (RA). DESIGN AND METHODS This descriptive and cross-sectional study was conducted with 111 RA patients between January 2021 and May 2021. FINDINGS The Eating Attitudes Test scores of the participants had a positive significant relationship with their Visual Analog Scale scores (r = 0.257), Health Assessment Questionnaire scores (r = 0.221), Beck Anxiety Inventory scores (r = 0.287), Beck Depression Inventory scores (p = 0.224), and Rheumatoid Arthritis Quality of Life Scale scores (r = 0.298) (p < 0.05). This study showed that when the eating attitudes of the RA patients were negative, their anxiety and depression levels increased, and their quality of life was negatively affected. PRACTICE IMPLICATIONS In the positive management of depression and anxiety, by creating treatment guidelines, the moderation of the eating attitudes of patients and increasing their quality of life levels should be ensured.
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Affiliation(s)
- Alev Yıldırım Keskin
- Assistant Professor, Department of Nursing, Aksehir Kadir Yallagoz Health School, Selcuk University, Aksehir, Konya, Turkey.
| | - Sibel Şentürk
- Associate Professor, Department of Nursing, Bucak Health School, Burdur Mehmet Akif Ersoy University, Bucak, Burdur, Turkey.
| | - Gezmiş Kimyon
- Associate Professor, Department of Rheumatology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Turkey.
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30
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Zhu M, Ding Q, Lin Z, Fu R, Zhang F, Li Z, Zhang M, Zhu Y. New Targets and Strategies for Rheumatoid Arthritis: From Signal Transduction to Epigenetic Aspect. Biomolecules 2023; 13:biom13050766. [PMID: 37238636 DOI: 10.3390/biom13050766] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that can lead to joint damage and even permanent disability, seriously affecting patients' quality of life. At present, the complete cure for RA is not achievable, only to relieve the symptoms to reduce the pain of patients. Factors such as environment, genes, and sex can induce RA. Presently, non-steroidal anti-inflammatory drugs, DRMADs, and glucocorticoids are commonly used in treating RA. In recent years, some biological agents have also been applied in clinical practice, but most have side effects. Therefore, finding new mechanisms and targets for treating RA is necessary. This review summarizes some potential targets discovered from the perspective of epigenetics and RA mechanisms.
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Affiliation(s)
- Menglin Zhu
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Qian Ding
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Zhongxiao Lin
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Rong Fu
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Fuyuan Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Zhaoyi Li
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Mei Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Yizhun Zhu
- State Key Laboratory of Quality Research in Chinese Medicine, School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
- Shanghai Key Laboratory of Bioactive Small Molecules, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai 201203, China
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31
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Castillo DM, Lafaurie GI, Romero-Sánchez C, Delgadillo NA, Castillo Y, Bautista-Molano W, Pacheco-Tena C, Bello-Gualtero JM, Chalem-Choueka P, Castellanos JE. The Interaction Effect of Anti-RgpA and Anti-PPAD Antibody Titers: An Indicator for Rheumatoid Arthritis Diagnosis. J Clin Med 2023; 12:jcm12083027. [PMID: 37109363 PMCID: PMC10144073 DOI: 10.3390/jcm12083027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Porphyromonas gingivalis secretes virulence factors like Arg-gingipains and peptidyl arginine deiminase (PPAD), that are associated with rheumatoid arthritis (RA) pathogenesis. However, there is no information regarding the antibody titers for these bacterial enzymes as systemic indicators or biomarkers in RA. In this cross-sectional study, 255 individuals were evaluated: 143 were diagnosed with RA, and 112 were without RA. Logistic regression models adjusted for age, sex, basal metabolic index, smoking, and periodontitis severity were used to evaluate the association of RA with rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPAs), erythrocyte sedimentation rate, high sensitivity C-reactive protein, anti-RgpA, anti-PPAD, and double positive anti-RgpA/anti-PPAD. It was found that RF (odds ratio [OR] 10.6; 95% confidence interval [CI] 4.4-25), ACPAs (OR 13.7; 95% CI 5.1-35), and anti-RgpA/anti-PPAD double positivity (OR 6.63; 95% CI 1.61-27) were associated with RA diagnoses. Anti-RgpA was also associated with RA (OR 4.09; 95% CI 1.2-13.9). The combination of anti-RgpA/anti-PPAD showed a high specificity of 93.7% and 82.5% PPV in identifying individuals with RA. RgpA antibodies were associated with the periodontal inflammatory index in RA individuals (p < 0.05). The double positivity of the anti-RgpA/anti-PPAD antibodies enhanced the diagnosis of RA. Therefore, RgpA antibodies and anti-RgpA/anti-PPAD may be biomarkers for RA.
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Affiliation(s)
- Diana Marcela Castillo
- Unidad de Investigación Básica Oral-UIBO, Vicerrectoría de Investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá 110121, Colombia
| | - Gloria Inés Lafaurie
- Unidad de Investigación Básica Oral-UIBO, Vicerrectoría de Investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá 110121, Colombia
| | - Consuelo Romero-Sánchez
- Cellular and Molecular Immunilogy Group (INMUBO), School of Dentistry, Universidad El Bosque, Bogotá 110121, Colombia
- Clinical Immunology Group, Rheumatology and Immunology Department, Hospital Militar Central, Bogotá 110231, Colombia
- Clinical Immunology Group, School of Medicine, Universidad Militar Nueva Granada, Bogotá 110231, Colombia
| | - Nathaly Andrea Delgadillo
- Unidad de Investigación Básica Oral-UIBO, Vicerrectoría de Investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá 110121, Colombia
| | - Yormaris Castillo
- Unidad de Investigación Básica Oral-UIBO, Vicerrectoría de Investigaciones, Facultad de Odontología, Universidad El Bosque, Bogotá 110121, Colombia
| | - Wilson Bautista-Molano
- Cellular and Molecular Immunilogy Group (INMUBO), School of Dentistry, Universidad El Bosque, Bogotá 110121, Colombia
| | | | - Juan Manuel Bello-Gualtero
- Clinical Immunology Group, Rheumatology and Immunology Department, Hospital Militar Central, Bogotá 110231, Colombia
- Clinical Immunology Group, School of Medicine, Universidad Militar Nueva Granada, Bogotá 110231, Colombia
| | | | - Jaime E Castellanos
- Facultad de Odontología, Universidad Nacional de Colombia, Bogotá 111321, Colombia
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Romero-Gómez M, Aller R, Ampuero J, Fernández Rodríguez C, Augustín S, Latorre R, Rivera-Esteban J, Martínez Urroz B, Gutiérrez García ML, López SA, Albillos A, Hernández M, Graupera I, Benlloch S, Olveira A, Crespo J, Calleja JL. AEEH «Consensus about detection and referral of hidden prevalent liver diseases». GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:236-247. [PMID: 35569541 DOI: 10.1016/j.gastrohep.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Manuel Romero-Gómez
- Servicio de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (HUVR/CSIC/US), Universidad de Sevilla, Sevilla, España.
| | - Rocío Aller
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, España
| | - Javier Ampuero
- Servicio de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (HUVR/CSIC/US), Universidad de Sevilla, Sevilla, España
| | | | - Salvador Augustín
- Servei de Hepatología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Raquel Latorre
- Servicio de Aparato Digestivo, Hospital Universitario Son Llàtzer, Palma de Mallorca, Islas Baleares, España
| | | | | | | | - Sonia Alonso López
- Servicio de Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Agustín Albillos
- Servicio de Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Marta Hernández
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Universidad Autónoma de Madrid, Majadahonda, Madrid, España
| | - Isabel Graupera
- Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, España
| | - Salvador Benlloch
- Servicio de Aparato Digestivo, Hospital Arnau de Vilanova, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Antonio Olveira
- Servicio de Aparato Digestivo, Hospital La Paz, Madrid, España
| | - Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla. IDIVAL, Santander, Cantabria, España
| | - José Luis Calleja
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Universidad Autónoma de Madrid, Majadahonda, Madrid, España
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Tian P, Xiong J, Wu W, Shi S, Chen A, Chen K, Chen W, Wu A, Liao Y. Impact of the malnutrition on mortality in Rheumatoid arthritis patients: A cohort study from NHANES 1999-2014. Front Nutr 2023; 9:993061. [PMID: 36687731 PMCID: PMC9845564 DOI: 10.3389/fnut.2022.993061] [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: 07/13/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background Patients with Rheumatoid arthritis (RA) are prone to malnutrition. However, it is rare studies assessing the relationship between malnutrition and all-cause mortality in patients with RA. Objective To investigate the relationship between malnutrition and all-cause mortality in patients with RA in a large national sample cohort. Methods We analyzed data on 1,976 adults ≥ 18 years of age during National Health and Nutrition Examination Survey (NHANES) 1999-2014. We chose the Controlled Nutritional Status Score (CONUT) and the Nutritional Risk Index (NRI) to assess the nutritional status of patients with RA. The Kaplan-Meier (KM) survival curves Cox proportional hazards regression models were used to analyze the associations between malnutrition and all-cause mortality. Results Of the 1,976 patients with RA (57.38 ± 0.40 years, female 59.9%, non-Hispanic white 69.9%), the prevalence of malnutrition was 18.8% by used the CONUT and 26.6% by used the NRI. The KM survival curves showed that malnutrition was associated with a higher incidence of all-cause mortality during the 10-year follow-up period (log-rank test, P < 0.001). In the fully corrected model, the adjusting hazard ratio (aHR) for all-cause mortality in patients with moderate to severe malnutrition with CONUT and NRI were 5.63 (95% CI, 2.55-12.45; P < 0.001) and 2.56 (95% CI, 1.81-3.62; P < 0.001), respectively, compared with patients without malnutrition. Conclusion Malnutrition is very prevalent in patients with RA, approximately 18.8% (CONUT) to 26.6% (NRI). Malnutrition is strongly associated with an increased risk of all-cause mortality. These findings underscore the importance of attention and intervention in the nutritional status of patients with RA. Further clinical trials are needed to prospectively assess the effect of nutritional interventions on the prognosis of patients with RA.
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Affiliation(s)
- Pan Tian
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jialing Xiong
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China,Department of Internal Medicine, The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wanxia Wu
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China,Department of Internal Medicine, The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Shanshan Shi
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China,Department of Internal Medicine, The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Aizhen Chen
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Weihua Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China,Department of Internal Medicine, The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Aiyu Wu
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China,*Correspondence: Aiyu Wu,
| | - Ying Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China,Ying Liao,
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Schäfer C, Keyßer G. Lifestyle Factors and Their Influence on Rheumatoid Arthritis: A Narrative Review. J Clin Med 2022; 11:jcm11237179. [PMID: 36498754 PMCID: PMC9736780 DOI: 10.3390/jcm11237179] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
In recent years, a possible association of lifestyle factors with rheumatoid arthritis (RA) has attracted increasing public interest. The aim of this review is to provide an overview of the extent and the limitations of current evidence regarding lifestyle factors and RA. The PubMed medical database was screened for epidemiological and prospective studies investigating the contribution of lifestyle factors to the development and the course of the disease. Large epidemiological studies have identified smoking, unhealthy diet and adiposity, as well as a low educational level and low socioeconomic status, as factors that increase the incidence of RA. In addition, several lifestyle habits influence the response of RA to antirheumatic drugs. Among others, smoking, obesity and poor physical activity are associated with a worse treatment outcome. Methodological problems often impair firm conclusions with respect to the causal role of these factors in the risk and the course of RA. However, current evidence is sufficient to recommend a healthy diet, the prevention of obesity, the cessation of smoking and the maintenance of a high level of physical activity to support the effectivity of modern antirheumatic medication.
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Chen C, Wang P, Zhang RD, Fang Y, Jiang LQ, Fang X, Zhao Y, Wang DG, Ni J, Pan HF. Mendelian randomization as a tool to gain insights into the mosaic causes of autoimmune diseases. Clin Exp Rheumatol 2022; 21:103210. [PMID: 36273526 DOI: 10.1016/j.autrev.2022.103210] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
Autoimmune diseases (ADs) are a broad range of disorders which are characterized by long-term inflammation and tissue damage arising from an immune response against one's own tissues. It is now widely accepted that the causes of ADs include environmental factors, genetic susceptibility and immune dysregulation. However, the exact etiology of ADs has not been fully elucidated to date. Because observational studies are plagued by confounding factors and reverse causality, no firm conclusions can be drawn about the etiology of ADs. Over the years, Mendelian randomization (MR) analysis has come into focus, offering unique perspectives and insights into the etiology of ADs and promising the discovery of potential therapeutic interventions. In MR analysis, genetic variation (alleles are randomly dispensed during meiosis, usually irrespective of environmental or lifestyle factors) is used instead of modifiable exposure to explore the link between exposure factors and disease or other outcomes. Therefore, MR analysis can provide a valuable method for exploring the causal relationship between different risk factors and ADs when its inherent assumptions and limitations are fully considered. This review summarized the recent findings of MR in major ADs, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), and type 1 diabetes mellitus (T1DM), focused on the effects of different risk factors on ADs risks. In addition, we also discussed the opportunities and challenges of MR methods in ADs research.
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Affiliation(s)
- Cong Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China
| | - Peng Wang
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China; Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China
| | - Ruo-Di Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China
| | - Yang Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China
| | - Ling-Qiong Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China
| | - Xi Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China
| | - Yan Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China
| | - De-Guang Wang
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China; Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China.
| | - Jing Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China.
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China; Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University, China.
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The burden of rheumatoid arthritis in the Middle East and North Africa region, 1990-2019. Sci Rep 2022; 12:19297. [PMID: 36369238 PMCID: PMC9652423 DOI: 10.1038/s41598-022-22310-0] [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: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0-135.7) and an annual incidence rate of 5.9 (5.2-6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2-136.7), with an age-standardised rate of 19.0 (13.9-24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7-28.2). The highest point prevalence was found in females aged 50-54, and in males aged 45-49. The highest number of DALYs was observed in the 50-54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.
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Body mass index, genetic susceptibility, and Alzheimer's disease: a longitudinal study based on 475,813 participants from the UK Biobank. J Transl Med 2022; 20:417. [PMID: 36085169 PMCID: PMC9463868 DOI: 10.1186/s12967-022-03621-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between body mass index (BMI) and Alzheimer's disease (AD) remains controversial. Genetic and environmental factors are now considered contributors to AD risk. However, little is known about the potential interaction between genetic risk and BMI on AD risk. OBJECTIVE To study the causal relationship between BMI and AD, and the potential interaction between AD genetic risk and BMI on AD risk. METHODS AND RESULTS Using the UK Biobank database, 475,813 participants were selected for an average follow-up time of more than 10 years. MAIN FINDINGS 1) there was a nonlinear relationship between BMI and AD risk in participants aged 60 years or older (p for non-linear < 0.001), but not in participants aged 37-59 years (p for non-linear = 0.717) using restricted cubic splines; 2) for participants aged 60 years and older, compared with the BMI (23-30 kg/m2) group, the BMI (< 23 kg/m2) group was associated with a higher AD risk (HR = 1.585; 95% CI 1.304-1.928, p < 0.001) and the BMI (> 30 kg/m2) group was associated with a lower AD risk (HR = 0.741; 95% CI 0.618-0.888, p < 0.01) analyzed using the Cox proportional risk model; 3) participants with a combination of high AD genetic risk score (AD-GRS) and BMI (< 23 kg/m2) were associated with the highest AD risk (HR = 3.034; 95% CI 2.057-4.477, p < 0.001). In addition, compared with the BMI (< 23 kg/m2), the higher BMI was associated with a lower risk of AD in participants with the same intermediate or high AD-GRS; 4) there was a reverse causality between BMI and AD when analyzed using bidirectional Mendelian randomization (MR). CONCLUSION There was a reverse causality between BMI and AD analyzed using MR. For participants aged 60 years and older, the higher BMI was associated with a lower risk of AD in participants with the same intermediate or high AD genetic risk. BMI (23-30 kg/m2) may be a potential intervention for AD.
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Chen W, Liu K, Huang L, Mao Y, Wen C, Ye D, He Z. Beef intake and risk of rheumatoid arthritis: Insights from a cross-sectional study and two-sample Mendelian randomization. Front Nutr 2022; 9:923472. [PMID: 36147307 PMCID: PMC9486088 DOI: 10.3389/fnut.2022.923472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBeef is common in daily diet, but its association with the risk of rheumatoid arthritis (RA) remains uncertain. The objective of this study is to explore the relationship between beef intake and the risk of RA.Materials and methodsWe investigated the association between beef intake and risk of RA by multivariate logistic regression, based on the National Health and Nutrition Examination Survey (NHANES) 1999–2016 involving 9,618 participants. The dose–response relationship between beef intake and RA was explored as well. Furthermore, we performed Mendelian randomization (MR) analysis to examine the causal effect of beef intake on RA. Genetic instruments for beef intake were selected from a genome-wide association study (GWAS) including 335,576 individuals from the UK Biobank study, and summary statistics relating to RA were obtained from a GWAS meta-analysis of 14,361 RA patients and 43,923 controls. The inverse-variance weighted (IVW) approach was used to estimate the causal association, and MR-Egger regression and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test were applied to evaluate the pleiotropy and outliers.ResultsCompared with the lowest quintile (0 to ≤33.50 g/d), beef intake was found to be significantly associated with the risk of RA [odds ratio (OR): 1.94; 95% confidence interval (CI): 1.20–3.12] in the third quintile (50.26 to ≤76.50 g/d). Moreover, a reversed “U” dose–response relationship between beef and RA (Pnon–linearity = 0.023) was found. In the MR analysis, beef intake was associated with an increased risk of RA (OR: 3.05; 95% CI: 1.11–8.35; P = 0.030) by the IVW method. The results from MR-Egger regression and MR-PRESSO test showed that there were no pleiotropic variations and outliers.ConclusionThis study indicated that there is suggestive evidence to support the causal effect of beef intake on the risk of RA, while further studies are warranted to elucidate the exact association.
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Affiliation(s)
- Weiwei Chen
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ke Liu
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lin Huang
- Institute of Basic Research in Clinical Medicine, School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yingying Mao
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chengping Wen
- Institute of Basic Research in Clinical Medicine, School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ding Ye
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Ding Ye,
| | - Zhixing He
- Institute of Basic Research in Clinical Medicine, School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- *Correspondence: Zhixing He,
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Romão VC, Fonseca JE. Disease mechanisms in preclinical rheumatoid arthritis: A narrative review. Front Med (Lausanne) 2022; 9:689711. [PMID: 36059838 PMCID: PMC9437632 DOI: 10.3389/fmed.2022.689711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
In the last decades, the concept of preclinical rheumatoid arthritis (RA) has become established. In fact, the discovery that disease mechanisms start years before the onset of clinical RA has been one of the major recent insights in the understanding of RA pathogenesis. In accordance with the complex nature of the disease, preclinical events extend over several sequential phases. In a genetically predisposed host, environmental factors will further increase susceptibility for incident RA. In the initial steps of preclinical disease, immune disturbance mechanisms take place outside the joint compartment, namely in mucosal surfaces, such as the lung, gums or gut. Herein, the persistent immunologic response to altered antigens will lead to breach of tolerance and trigger autoimmunity. In a second phase, the immune response matures and is amplified at a systemic level, with epitope spreading and widening of the autoantibody repertoire. Finally, the synovial and bone compartment are targeted by specific autoantibodies against modified antigens, initiating a local inflammatory response that will eventually culminate in clinically evident synovitis. In this review, we discuss the elaborate disease mechanisms in place during preclinical RA, providing a broad perspective in the light of current evidence.
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Affiliation(s)
- Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
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Zhao SS, Bowes J, Barton A, Davey Smith G, Richardson T. Separating the effects of childhood and adult body size on inflammatory arthritis: a Mendelian randomisation study. RMD Open 2022; 8:e002321. [PMID: 35995490 PMCID: PMC9403135 DOI: 10.1136/rmdopen-2022-002321] [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: 03/07/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Using Mendelian randomisation (MR), we examined whether childhood body size affects risk of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), gout and systemic lupus erythematosus (SLE) after accounting for the effect of adult body size. METHODS Genetic instruments for childhood (age 10 years) and adult body size were derived using data from 453 169 individuals from the UK Biobank study (313 and 580 variants respectively), which have been previously validated using body mass index data from three independent populations. Genome-wide association data comprised 22 350 RA, 9069 AS, 3609 PsA, 13 179 gout and 5201 SLE cases. For each outcome, we conducted univariable MR to estimate the total effects of childhood and adult body size, and multivariable MR to examine the independent effect of childhood body size after accounting for adult body size. RESULTS Genetically predicted childhood body size had a total effect on risk of PsA (OR 2.18 per change in body size category; 95% CI 1.43 to 3.31), gout (OR 2.18; 95% CI 1.43 to 3.31) and SLE (OR 2.44; 95% CI 1.14 to 5.22), but not RA (OR 0.95; 95% CI 0.70 to 1.29) or AS (OR 0.96; 95% CI 0.61 to 1.52). After accounting for adult body size, the direct effect of childhood body size was little changed for PsA (OR 1.92; 1.14 to 3.25) and SLE (OR 2.69; 1.24 to 5.87) but was attenuated for gout (OR 1.40; 95% CI 0.94 to 2.09). CONCLUSIONS Our findings suggest that, for PsA and SLE, the risk conferred from having a larger body size during childhood may not be fully reversable even when a healthy size is achieved in adulthood.
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Affiliation(s)
- Sizheng Steven Zhao
- 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 Academic Health Science Centre, Manchester, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom Richardson
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Novo Nordisk Research Centre, Headington, Oxford, UK
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41
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Lin IC, Liu H. Impact of Bariatric Surgery on Outcomes of Patients with Rheumatoid Arthritis: a Propensity Score-Matched Analysis of US Nationwide Inpatient Sample, 2005-2018. Obes Surg 2022; 32:2966-2974. [PMID: 35768690 DOI: 10.1007/s11695-022-06177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Obesity has been considered one of the risk factors with more critical disease progression and poor treatment response in rheumatoid arthritis (RA). We herein utilized an extensive, nationally representative database to examine the impact of bariatric surgery on clinical outcomes in RA patients. MATERIALS AND METHODS This retrospective analysis utilized nationally representative data of the Healthcare Cost and Utilization Project-National Inpatient Sample database (HCUP-NIS) from 2005 to 2018. Associations between bariatric surgery and in-hospital outcomes of RA patients were determined by the univariate and multivariate logistic regression analyses. RESULTS After 1:4 propensity score (PS) matching, totally 33,075 hospitalized adults with RA were included as primary cohort for subsequent analyses. Among them, 6615 patients had prior bariatric surgery and 26,460 patients had not. After adjusting for relevant confounders in the multivariate analysis, prior bariatric surgery was significantly and independently associated with reduced odds for any morbidity and in-hospital mortality (aOR: 0.41, 95% CI: 0.27-0.61, p < 0.01) as compared with no prior bariatric surgery. Adults with RA who had prior bariatric surgery also had a significantly lower odds for having unfavorable discharge and prolonged length of stay (LOS) as compared with those without bariatric surgery (aOR: 0.43, 95% CI: 0.39-0.46, p < 0.01). CONCLUSIONS Prior bariatric surgery is associated with better in-patient outcomes among RA, including in-hospital mortality, major morbidities, discharge destination, and LOS.
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Affiliation(s)
- I-Chen Lin
- Division of Colorectal Surgery, Department of Surgery, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan
| | - Hsien Liu
- Division of General Surgery, Department of Surgery, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan.
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42
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Mao Y, Hu W, Xia B, Liu L, Liu Q. Association Between History of Gestational Diabetes Mellitus and the Risk of Arthritis in Women. Front Public Health 2022; 10:878845. [PMID: 35692328 PMCID: PMC9184514 DOI: 10.3389/fpubh.2022.878845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The association between gestational diabetes mellitus (GDM) and the risk of arthritis has not been reported. GDM increases the risk of long-term complications including diabetes and metabolic syndrome that are positively associated with the risk of arthritis. This study aimed to explore the association between GDM and the risk of arthritis. Methods Women (age ≥ 20 years) who had delivered at least one live birth were included from the 2007 to 2018 National Health and Nutrition Examination Survey cohort (N = 11,997). Patients who had a history of GDM and arthritis were identified by in-home interview. Subgroup analyses were conducted by arthritis types and status of obesity, current diabetes, metabolic syndrome, smoking, alcohol drinking, and physical activity. Results GDM was associated with increased odds of arthritis [multivariable-adjusted odds ratio (95% confidence interval): 1.31 (1.06–1.62)], and the result was similar in sensitivity analysis with further adjustment for metabolic syndrome [1.30 (1.05–1.60)]. In subgroup analyses, GDM was associated with increased odds of osteoarthritis [1.47 (1.05–2.06)], while no association was observed with rheumatoid arthritis [1.04 (0.69–1.57)] and other types [1.26 (0.94–1.68)]. GDM was associated with increased odds of arthritis in women without metabolic syndrome [1.34 (1.00–1.78)] and diabetes [1.35 (1.03–1.76)], in obese individuals [1.64 (1.24–2.16)], current/former smokers [1.43 (1.05–1.95)], and current drinkers [1.76 (1.00–3.14)], and in individuals engaging in higher levels of physical activity [1.53 (1.06–2.20)]. Conclusions GDM was associated with increased odds of arthritis, and the association was independent of type 2 diabetes and metabolic syndrome.
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Affiliation(s)
- Yuanyuan Mao
- Suzhou Medical College of Soochow University, Suzhou, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Wenbin Hu
- Department of Chronic and Noncommunicable Disease Control and Preventions, The Kunshan Center for Disease Control and Prevention, Suzhou, China
| | - Bin Xia
- Suzhou Medical College of Soochow University, Suzhou, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Li Liu
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Qin Liu
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
- *Correspondence: Qin Liu
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43
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Biswas I, Lewis S, Chattopadhyay K. Content, Structure and Delivery Characteristics of Yoga Interventions for Managing Rheumatoid Arthritis: A Systematic Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6102. [PMID: 35627636 PMCID: PMC9140818 DOI: 10.3390/ijerph19106102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023]
Abstract
The global burden of rheumatoid arthritis among adults is rising. Yoga might be a potential solution for managing rheumatoid arthritis. This systematic review aims to synthesise the content, structure and delivery characteristics of effective yoga interventions for managing rheumatoid arthritis. The JBI methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines will be followed. PRISMA for systematic review protocols (PRISMA-P) was used to write the protocol. Randomised controlled trials assessing the effectiveness of yoga interventions for managing rheumatoid arthritis in adults will be included in this review. We aim to search the following databases to find published and unpublished studies: ABIM, AMED, AYUSH Research Portal, CAM-QUEST, CINAHL, CENTRAL, EMBASE, MEDLINE, PeDro, PsycInfo, SPORTDiscus, TRIP, Web of Science, DART-Europe-e-theses portal, EthOS, OpenGrey and ProQuest Dissertations and Theses. No date or language restrictions will be applied. A narrative synthesis will be conducted. Meta-regression will be conducted to explore the statistical evidence for which components (content, structure and delivery characteristics) of yoga interventions are effective.
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Affiliation(s)
- Isha Biswas
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK; (S.L.); (K.C.)
| | - Sarah Lewis
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK; (S.L.); (K.C.)
| | - Kaushik Chattopadhyay
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK; (S.L.); (K.C.)
- The Nottingham Centre for Evidence-Based Healthcare—A JBI Centre of Excellence, Nottingham NG5 1PB, UK
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44
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Challener GJ, Myasoedova E, Crowson CS, Giblon RE, Atkinson EJ, Davis JM. Body mass index trend and variability in rheumatoid arthritis. Clin Rheumatol 2022; 41:349-355. [PMID: 34510294 PMCID: PMC10440724 DOI: 10.1007/s10067-021-05919-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize and compare trends in body mass index (BMI) and variability in BMI between subjects with rheumatoid arthritis (RA) and matched non-RA subjects and to determine predictors of BMI trends and variability within RA subjects. METHODS This retrospective population-based cohort study included 1114 Olmsted County, Minnesota residents, 558 with incident RA (age ≥ 18 years, 1987 ACR criteria met in 1995-2009) and 556 non-RA subjects from the same underlying population with similar age, sex, and index calendar year. All subjects were followed until death, migration, or 12/31/2018. Generalized linear models with smoothing splines and random effects to account for multiple measurements per subject were used to examine trends in BMI measurements over time. RESULTS Mean BMI of patients with incident RA (28.8 kg/m2) was not significantly different from that of non-RA subjects (28.9 kg/m2). There was no significant difference in BMI trends over time between RA and non-RA cohorts, or between seropositive for rheumatoid factor (RF) and/or citrullinated antibody (CCP-antibody) and seronegative RA patients, or between male and female subjects. RA subjects were noted to have significantly higher BMI variability following diagnosis compared to non-RA subjects [difference in standard deviation between RA and non-RA subjects prior to index (p = 0.12), 0-5 years after index (p = 0.044), and 5-15 years after index (p = 0.013)]. CONCLUSION The BMI trajectory of the RA population is not significantly different compared to that of the non-RA population, but patients with RA demonstrate higher variability in BMI following diagnosis compared to the non-RA population. Key Points • This study uniquely characterizes longitudinal trajectory in BMI measures and their variability in the RA population versus the non-RA population • This study suggests that RA patients have greater BMI variability compared to the non-RA population, which is highly relevant as BMI variability is increasingly understood as a cardiovascular risk factor.
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Affiliation(s)
- Gregory J Challener
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Elena Myasoedova
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rachel E Giblon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - John M Davis
- Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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45
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Romão VC, Fonseca JE. Etiology and Risk Factors for Rheumatoid Arthritis: A State-of-the-Art Review. Front Med (Lausanne) 2021; 8:689698. [PMID: 34901047 PMCID: PMC8661097 DOI: 10.3389/fmed.2021.689698] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common systemic inflammatory rheumatic disease. It is associated with significant burden at the patient and societal level. Extensive efforts have been devoted to identifying a potential cause for the development of RA. Epidemiological studies have thoroughly investigated the association of several factors with the risk and course of RA. Although a precise etiology remains elusive, the current understanding is that RA is a multifactorial disease, wherein complex interactions between host and environmental factors determine the overall risk of disease susceptibility, persistence and severity. Risk factors related to the host that have been associated with RA development may be divided into genetic; epigenetic; hormonal, reproductive and neuroendocrine; and comorbid host factors. In turn, environmental risk factors include smoking and other airborne exposures; microbiota and infectious agents; diet; and socioeconomic factors. In the present narrative review, aimed at clinicians and researchers in the field of RA, we provide a state-of-the-art overview of the current knowledge on this topic, focusing on recent progresses that have improved our comprehension of disease risk and development.
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Affiliation(s)
- Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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46
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Rose J. Autoimmune Connective Tissue Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis. Emerg Med Clin North Am 2021; 40:179-191. [PMID: 34782087 DOI: 10.1016/j.emc.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic lupus erythematosus and rheumatoid arthritis are just 2 of several autoimmune connective tissue diseases that are primarily chronic in nature but can present to the emergency department by virtue of an acute exacerbation of disease. Beyond an acute exacerbation of disease, their predilection for invading multiple organ systems lends itself to the potential for patients presenting to the emergency department with either a single or isolated symptom or a myriad of signs and/or symptoms indicative of a degree of disease complexity and severity that warrant timely recognition and resuscitation.
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Affiliation(s)
- Jonathan Rose
- Department of Emergency Medicine, Memorial Healthcare System, Memorial Hospital West, 703 N Flamingo Road, Pembroke Pines, FL 33028, USA.
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47
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Greuter T, Porchet F, Braga-Neto MB, Rossel JB, Biedermann L, Schreiner P, Scharl M, Schoepfer AM, Safroneeva E, Straumann A, Rogler G, Vavricka SR. Impact of obesity on disease activity and disease outcome in inflammatory bowel disease: Results from the Swiss inflammatory bowel disease cohort. United European Gastroenterol J 2021; 8:1196-1207. [PMID: 33276710 DOI: 10.1177/2050640620954556] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the impact of obesity on disease activity and disease outcome in patients with inflammatory bowel disease. PATIENTS AND METHODS The impact of obesity on inflammatory bowel disease disease activity and outcome was retrospectively assessed in 3075 patients enrolled in the prospective nation-wide Swiss inflammatory bowel disease cohort between July 2006 and September 2018. Baseline characteristics, disease activity and disease course in 325 obese inflammatory bowel disease patients (body mass index ≥30 kg/m2) were compared to 1725 normal weight inflammatory bowel disease individuals (body mass index 18.5-24.9). RESULTS Among 3075 patients in the prospective Swiss inflammatory bowel disease cohort, 325 patients (10.6%) were obese, namely, 194 Crohn's disease patients, 131 ulcerative colitis, and inflammatory bowel disease-unclassified patients. Disease activity scores were elevated in obese Crohn's disease (Crohn's Disease Activity Index 33 vs 20, p = 0.001), but not ulcerative colitis patients. Obese Crohn's disease, but not ulcerative colitis patients were less likely to be in remission based on a Crohn's Disease Activity Index less than 100 and a calprotectin less than 100 ug/g. In a multivariate regression model, obesity was negatively associated with disease remission in Crohn's disease (odds ratio 0.610, 95% confidence interval 0.402-0.926, p = 0.020), but not ulcerative colitis. Increased soft stool frequency was observed in both obese Crohn's disease and ulcerative colitis patients. Adjusted Cox regression models revealed increased risk of complicated disease course in obese Crohn's disease patients (hazard ratio 1.197, 95% confidence interval 1.046-1.370, p = 0.009). No association between obesity and disease progression, index treatment failure was seen neither in Crohn's disease nor ulcerative colitis. CONCLUSION Obesity is associated with decreased rates of disease remission and increased risk of complicated disease course in Crohn's disease over a six-year follow-up period. No effects were seen on disease progression and index treatment failure neither in Crohn's disease nor ulcerative colitis.
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Affiliation(s)
- Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Department of Medicine, GZO Regional Health Center, Zurich, Switzerland.,Division of Gastroenterology and Hepatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Frédéric Porchet
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jean-Benoit Rossel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Center for Gastroenterology and Hepatology, Zurich, Switzerland
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48
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Bettner LF, Peterson RA, Bergstedt DT, Kelmenson LB, Demoruelle MK, Mikuls TR, Edison JD, Parish MC, Feser ML, Frazer-Abel AA, Moss LK, Mahler M, Holers VM, Deane KD. Combinations of Anticyclic Citrullinated Protein Antibody, Rheumatoid Factor, and Serum Calprotectin Positivity Are Associated With the Diagnosis of Rheumatoid Arthritis Within 3 Years. ACR Open Rheumatol 2021; 3:684-689. [PMID: 34288565 PMCID: PMC8516104 DOI: 10.1002/acr2.11309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/15/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate the prevalence of elevations of anti‐cyclic citrullinated peptide‐3 (anti‐CCP3) antibody, rheumatoid factor IgM (RF‐IgM) and serum calprotectin (sCP) in pre–rheumatoid arthritis (RA) as well as the diagnostic accuracies of these biomarkers for the timing of diagnosis of future RA. Methods A total of 215 RA cases, each with approximately three pre‐RA diagnoses and one post–RA diagnosis serum sample, and controls were identified from the Department of Defense Serum Repository. All case samples and a single sample from each control subject were tested for anti‐CCP3 (IgG), RF‐IgM, and sCP. The diagnostic accuracies of biomarkers for future RA were evaluated. Results Anti‐CCP3, RF‐IgM, and sCP were elevated in pre‐RA, with anti‐CCP3 and sCP significantly elevated compared with RF‐IgM at the earliest time points. Within the cases, the combination of anti‐CCP3 and RF‐IgM positivity had a positive predictive value (PPV) of 35.6% for a diagnosis of RA in 3 years or less, which is significantly higher than the PPV of 18.7% for anti‐CCP3 positivity alone (P < 0.001). A combination of anti‐CCP3, RF‐IgM, and sCP had the highest PPV (53.0%) for a diagnosis of RA in 3 years or less; however, this was not significantly higher than the PPV for anti‐CCP3 and RF‐IgM positivity (P = 0.248). Conclusion Anti‐CCP3, RF‐IgM, and sCP are elevated in pre‐RA; furthermore, combinations of elevations of these biomarkers are more commonly seen in the period of less than or equal to 3 years to diagnosis. This may be considered in creating inclusion criteria in prevention trials in RA. In addition, the biologic relationships of these biomarkers in pre‐RA need exploration.
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Affiliation(s)
- Leah F Bettner
- University of Colorado, Aurora, Colorado, and University of North Carolina at Chapel Hill
| | - Ryan A Peterson
- University of Colorado and Colorado School of Public Health, Aurora
| | | | | | | | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Jess D Edison
- Walter Reed National Military Medical Center, Bethesda, Maryland
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49
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Hensvold A, Klareskog L. Towards prevention of autoimmune diseases: The example of rheumatoid arthritis. Eur J Immunol 2021; 51:1921-1933. [PMID: 34110013 DOI: 10.1002/eji.202048952] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/18/2021] [Indexed: 12/16/2022]
Abstract
Prevention is the ultimate aim for clinicians and scientists concerned with severe diseases, like many immune-mediated conditions. Here, we describe recent progress in the understanding of etiology and molecular pathogenesis of rheumatoid arthritis (RA), which make this disease a potential prototype for prevention that may include both public health measures and targeted and personalized approaches that we call "personalized prevention." Critical components of this knowledge are (i) better understanding of the dynamics of the RA-associated autoimmunity that may begin many years before onset of joint inflammation; (ii) insights into how this immunity may be triggered at mucosal surfaces after distinct environmental challenges; (iii) better understanding of which features of the pre-existing immunity may cause symptoms that precede joint inflammation and predict a high risk for imminent arthritis development; and (iv) how molecular events occurring before onset of inflammation might be targeted by existing or future therapies, ultimately by specific targeting of Major histocompatibility complex (MHC) class II restricted and RA-specific immunity. Our main conclusion is that studies and interventions in the phase of autoimmunity preceding RA offer new opportunities to prevent the disease and thereby also understand the molecular pathogenesis of its different variants.
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Affiliation(s)
- Aase Hensvold
- Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden.,Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden
| | - Lars Klareskog
- Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden.,Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden.,Rheumatology Section, Theme inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
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50
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Novella-Navarro M, Plasencia-Rodríguez C, Nuño L, Balsa A. Risk Factors for Developing Rheumatoid Arthritis in Patients With Undifferentiated Arthritis and Inflammatory Arthralgia. Front Med (Lausanne) 2021; 8:668898. [PMID: 34211986 PMCID: PMC8239127 DOI: 10.3389/fmed.2021.668898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/24/2021] [Indexed: 12/18/2022] Open
Abstract
Currently, there is an increasing interest in treating patients at risk of rheumatoid arthritis (RA) to prevent the development of this chronic disease. In this sense, research has focused attention on the early identification of predictive factors of this disease. Autoantibodies and markers of systemic inflammation can be present before clinical arthritis and RA development. So, the phase of inflammatory arthralgia preceding clinical arthritis is an important part of the window of opportunity and, starting treatment might prevent progression to chronic arthritis. Additionally, the early diagnosis and treatment initiation, in patients with inflammatory arthritis at risk of persistence and/or erosive progression, are fundamental because may allow optimal clinical responses, better chances of achieving sustained remission, preventing irreversible organ damage and optimizing long-term outcomes. This review aims to give an overview of clinical risk factors for developing RA, both in suspected arthralgia and in undifferentiated arthritis. Besides taking into consideration the role of serological markers (immunological and acute phase reactants) and clinical features assessed at consultation such as: articular affection and patient's clinical perception. Other features as sociodemographic and environmental factors (lifestyle habits, microbiota, periodontal disease among others), have been included in this revision to give an insight on strategies to prevent development of RA and/or to treat it in early stages.
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Affiliation(s)
| | | | - Laura Nuño
- Rheumatology Department Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Balsa
- Rheumatology Department Hospital Universitario La Paz, Madrid, Spain
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