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Pan J, Wu T, Zou YW, Li QH, Ouyang ZM, Ma JD, Jia PW, Zheng HW, Lin JZ, Lu Y, Yang Y, Chen LF, Yang KM, Dai J, Dai L. Cross-sectional associations of low body mass index and being underweight with joint damage in Chinese patients with rheumatoid arthritis. Rheumatol Adv Pract 2024; 8:rkae080. [PMID: 39055542 PMCID: PMC11269820 DOI: 10.1093/rap/rkae080] [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: 10/05/2023] [Accepted: 06/08/2024] [Indexed: 07/27/2024] Open
Abstract
Objective To characterize BMI in Chinese patients with RA vs US patients and examine its association with joint damage in Chinese patients. Methods Each of the 1318 patients from a real-world Chinese RA population was first stratified by gender and then individually age-matched with one American RA patient from the US National Health and Nutritional Examination Survey 1999-2018. Data on BMI, bilateral hand radiographs and risk factors at enrolment were collected but radiographs were unavailable for the American patients. Logistic regression was used to evaluate the association of BMI with radiographic joint damage (RJD) in Chinese patients. Results Chinese patients had a significantly lower BMI [(weighted) median 21.8 vs 29.8 kg/m2; P < 0.001] and a higher prevalence of being underweight (15.2% vs 1.1%; P < 0.05) than their American counterparts. Underweight Chinese patients (BMI <18.5) had higher modified total Sharp scores (median 17 vs 10) and joint space narrowing (JSN) subscores (median 6 vs 2) (both P < 0.05) than normal-weight patients (BMI ≥18.5-<24). After controlling for confounding, continuous BMI was cross-sectionally negatively associated with RJD [adjusted prevalence odds ratio (OR) 0.90 (95% CI 0.85, 0.96)] and JSN [adjusted prevalence OR 0.92 (95% CI 0.87, 0.96)]; being underweight vs normal weight was associated with RJD [adjusted prevalence OR 2.14 (95% CI 1.37, 3.35)] and JSN [adjusted prevalence OR 1.77 (95% CI 1.10, 2.84)]. Conclusion Low BMI and being underweight were cross-sectionally associated with joint damage in Chinese RA patients, especially JSN, suggesting the clinical importance of identifying underweight patients and focusing on weight gain to prevent joint damage.
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Affiliation(s)
- Jie Pan
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Tao Wu
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Yao-Wei Zou
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Qi-Hua Li
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Zhi-Ming Ouyang
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Jian-Da Ma
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Department of Rheumatology and Immunology, Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei, P.R. China
| | - Pei-Wen Jia
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Hu-Wei Zheng
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Jian-Zi Lin
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Ye Lu
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Ying Yang
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Le-Feng Chen
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Kui-Min Yang
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Jun Dai
- Department of Public Health, College of Health Sciences, Des Moines University, West Des Moines, IA, USA
| | - Lie Dai
- Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
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Vallejo-Yagüe E, Burkard T, Finckh A, Burden AM. Comparative effectiveness of biologics in patients with rheumatoid arthritis stratified by body mass index: a cohort study in a Swiss registry. BMJ Open 2024; 14:e074864. [PMID: 38331859 PMCID: PMC10860070 DOI: 10.1136/bmjopen-2023-074864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Obesity is associated with lower treatment response in patients with rheumatoid arthritis (RA). In patients with obesity, abatacept was suggested as a preferable option to tumour necrosis factor-alpha inhibitors. We aimed to assess the comparative effectiveness of etanercept, infliximab and abatacept, compared with adalimumab, in patients with RA with obesity. Secondarily, we also investigated this in patients with overweight and normal weight for completeness. DESIGN Observational cohort study. SETTING Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry (1997-2019). PARTICIPANTS Adult patients with RA from the SCQM registry who received etanercept, infliximab, abatacept or adalimumab as their first biological or targeted synthetic disease-modifying antirheumatic drug were classified based on their body mass index (BMI) at the start of that treatment in three cohorts: obese, overweight, normal weight. They were followed for a maximum of 1 year. EXPOSURE The study exposure of interest was the patients' first biological, particularly: etanercept, infliximab and abatacept, compared with adalimumab. PRIMARY AND SECONDARY OUTCOME MEASURES The primary study outcome was remission within 12 months, defined as 28-joint Disease Activity Score (DAS28) <2.6. Missingness was addressed using confounder-adjusted response rate with attrition correction. Logistic regression was used to compare the effectiveness of etanercept, infliximab and abatacept versus adalimumab. Each BMI cohort was addressed and analysed separately. RESULTS The study included 443 obese, 829 overweight and 1243 normal weight patients with RA. There were no statistically significant differences in the odds of DAS28-remission at ≤12 months for etanercept, infliximab and abatacept, compared with adalimumab, in any of the BMI cohorts. CONCLUSIONS No differences in DAS28-remission were found between the study drugs and adalimumab as first biologic in patients with RA, independently of the BMI cohort. We did not find evidence that treatment with abatacept increased the likelihood of remission compared with adalimumab among obese patients with RA.
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Affiliation(s)
- Enriqueta Vallejo-Yagüe
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Theresa Burkard
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Andrea Michelle Burden
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
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Bergstra SA, Sepriano A, Chopra A, Winchow LL, Vega-Morales D, Salomon-Escoto K, Matthijssen XME, Landewé RB. Country-level socioeconomic status relates geographical latitude to the onset of RA: a worldwide cross-sectional analysis in the METEOR registry. Ann Rheum Dis 2023; 82:1018-1024. [PMID: 37230737 DOI: 10.1136/ard-2023-224080] [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: 05/27/2023]
Abstract
OBJECTIVE Age at rheumatoid arthritis (RA) onset varies by geographical latitude. We have investigated to what extent differences in patient-specific factors and country-level socioeconomic indicators explain this variability. METHODS Patients with RA from the worldwide METEOR registry were included. Bayesian multilevel structural equation models were used to study the relationship between the absolute value of (hospital) geographical latitude and age at diagnosis (as a proxy for age at RA onset). We examined to what extent this effect is mediated by individual patient characteristics and by country-specific socioeconomic indicators and disentangled whether the observed effects occurred at the patient, hospital, or country levels. RESULTS We included 37 981 patients from 93 hospitals in 17 geographically widespread countries. Mean age at diagnosis per country ranged from 39 (Iran) to 55 (Netherlands) years. Per degree increase in country latitude (between 9.9° and 55.8°), mean age at diagnosis increased by 0.23 years (95% credibility interval: 0.095 to 0.38) (reflecting >10 years difference in age at RA onset). For hospitals within a country, this latitude effect was negligible. Inclusion of patient-specific factors (eg, gender, anticitrullinated protein antibodies status) in the model augmented the main effect from 0.23 to 0.36 years. Inclusion of country-level socioeconomic indicators (eg, gross domestic product per capita) in the model almost effaced the main effect (from 0.23 to 0.051 (-0.37 to 0.38)). CONCLUSIONS Patients living closer to the equator get RA at a younger age. This latitude gradient was not explained by individual patient characteristics, but rather by countries' socioeconomic status, providing a direct link between countries' level of welfare and the clinical onset of RA.
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Affiliation(s)
- Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Universidade Nova de Lisboa, NOVA Medical School, Lisbon, Portugal
| | | | - Lai-Ling Winchow
- University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - David Vega-Morales
- Hospital General de Zona No. 17, Instituto Mexicano del Seguro, Monterrey, Mexico
| | - Karen Salomon-Escoto
- University of Massachusetts Chan School of Medicine, UMass Memorial Health Rheumatology Center, Worcester, Massachusetts, USA
| | | | - Robert Bm Landewé
- Amsterdam Rheumatology Center, Amsterdam Medical Center, Amsterdam, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
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[Gender-specific differences in the diagnosis and treatment of inflammatory rheumatic diseases]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01484-3. [PMID: 36877237 PMCID: PMC10366264 DOI: 10.1007/s00108-023-01484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Gender differences in the diagnosis and treatment of various diseases are increasingly being researched with the aim of optimizing treatment strategies and improving individual treatment success. METHODS This paper summarizes the existing literature for gender differences in inflammatory rheumatic diseases. RESULTS Many, but not all, inflammatory rheumatic diseases occur more frequently in women than in men. Women more often have a longer duration of symptoms until diagnosis than men, which may be due to different clinical and radiological presentations. Across diseases, women more often have lower remission and treatment response rates to antirheumatic medication compared to men. Discontinuation rates are also higher in women than in men. Whether women are more likely to develop anti-drug antibodies to biologic disease-modifying antirheumatic drugs is still unclear. For Janus kinase inhibitors, there is no evidence of differential treatment response to date. CONCLUSION Whether individual dosing regimens and gender-adapted remission criteria are also required in rheumatology cannot be deduced from the evidence available to date.
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Zou YW, Li QH, Gao JW, Pan J, Ma JD, Chen LF, Lin JZ, Mo YQ, Zhang XP, Liu PM, Dai L. Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Cardiovascular Risk in Patients With Rheumatoid Arthritis: A Cross-Sectional Study of Chinese Cohort. Front Cardiovasc Med 2022; 9:884636. [PMID: 35647047 PMCID: PMC9136028 DOI: 10.3389/fcvm.2022.884636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/15/2022] [Indexed: 12/27/2022] Open
Abstract
Background The nomenclature from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) is considered to identify more cardiovascular disease (CVD) risks in the general population. Patients with rheumatoid arthritis (RA) carry an excess risk for CVD. However, the prevalence of MAFLD and its relationship with CVD risks in RA have not been reported. Methods This cross-sectional study retrospectively analyzed clinical data from a Chinese RA cohort. MAFLD was diagnosed according to the criteria proposed by an international expert panel from 22 countries in 2020. CVD risk in patients with RA was estimated by the Prediction for Atherosclerotic Cardiovascular Disease Risk in China with a 1.5 multiplication factor. Results Among 513 included patients with RA, 78.4% were women and the mean ± SD age was 51.8 ± 12.6 years. The prevalence of MAFLD was 21.4%. There were 10.9% patients with RA concomitated with CVD events and 32.4% with a high-estimated 10-year CVD risk. Besides a higher liver fibrosis score and a higher ratio of advanced fibrosis, RA patients with MAFLD had a higher rate of CVD events (17.3 vs. 9.2%) and a higher proportion of high estimated 10-year CVD risk (55.5 vs. 26.1%) than those without. Multivariate logistic regression analysis showed that MAFLD was associated with an increase in CVD events [adjusted odds ratio (AOR) = 2.190, 95% CI 1.135–4.227] and high estimated 10-year CVD risk (AOR = 2.483, 95% CI 1.412–4.365, all p < 0.05). Conclusion Metabolic dysfunction-associated fatty liver disease was associated with increased CVD risk in patients with RA, which implies the importance of early detection and management of MAFLD in patients with RA.
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Affiliation(s)
- Yao-Wei Zou
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Pan
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-Da Ma
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Le-Feng Chen
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-Zi Lin
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying-Qian Mo
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xue-Pei Zhang
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Pin-Ming Liu,
| | - Lie Dai
- Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lie Dai,
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Triantafyllias K, Sauer C, Schwarting A. [Therapeutic effects of complex multimodal rheumatologic treatment in the Rheumatology Center, Rhineland-Palatinate]. Z Rheumatol 2022; 81:596-604. [PMID: 35532799 DOI: 10.1007/s00393-022-01209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The concept of complex multimodal rheumatologic treatment (CMRT) has been established for several years in German rheumatologic departments and aims at a multifaceted therapeutic approach to patients with rheumatic diseases. Objective of this study was to examine the therapeutic effect of CMRT in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in an acute rheumatology center. METHODS The treatment success of CMRT was evaluated by epidemiologic data, patient questionnaires on visual analog scales (VAS) regarding morning stiffness, pain and disease activity (DA), as well as clinical scores (Disease Activity Score 28 [DAS28], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI]), laboratory inflammation markers (CRP, erythrocyte sedimentation rate) and medication in three visits: visit 1 = begin of CMRT; visit 2 = end of CMRT; visit 3 = 3 months after CMRT. RESULTS In this study 162 patients from the Rheumatology Center, Rhineland-Palatinate, Germany (96 (59.3%) RA, 30 (18.8%) AS, 36 (22.2%) PsA) were recruited. Statistical examinations revealed a significant improvement of VAS(DA) (visit 2 versus visit 1: RA: p = 0.02, AS: p < 0.001, PsA: p < 0.001), morning stiffness (RA: p < 0.001, AS: p = 0.03, PsA: p < 0.001) and patient reported pain (all; p < 0.001) in the context of CMRT. In the RA and AS subgroups improvements of DAS28 and BASDAI could also be observed (visit 2 versus visit 1: both; p < 0.001). Moreover, significant improvement of patient reported outcomes could be observed 3 months after CMRT regarding VAS(DA) (RA: p = 0.02 und AS: p = 0.03, morning stiffness (PsA: p = 0.02) and patient reported pain (RA: p = 0.01)). Interestingly, subgroup analyses showed that the therapeutic benefit was independent of the concomitant pharmacotherapy. CONCLUSION The results of this study suggest a therapeutic benefit for patients being treated by CMRT and highlight the high value of this therapeutic concept in patients with systemic-inflammatory rheumatic diseases.
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Affiliation(s)
- K Triantafyllias
- Rheumazentrum Rheinland-Pfalz GmbH, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Deutschland.
| | - C Sauer
- Innere Medizin, Krankenhaus Sachsenhausen, DGD Kliniken, Frankfurt am Main, Deutschland
| | - A Schwarting
- Rheumazentrum Rheinland-Pfalz GmbH, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Deutschland.,Schwerpunkt Rheumatologie, I. Med. Klinik und Poliklinik, Johannes Gutenberg Universitätsmedizin Mainz, Mainz, Deutschland
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Strangfeld A, Albrecht K, Regierer A, Callhoff J, Zink A, Minden K. [Celebrating 33 years of the DRFZ: Epidemiology and Health Services Research]. Z Rheumatol 2022; 81:642-651. [PMID: 35380251 PMCID: PMC8980768 DOI: 10.1007/s00393-022-01187-4] [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] [Accepted: 11/25/2021] [Indexed: 11/18/2022]
Abstract
Der wissenschaftliche Fokus des Programmbereichs Epidemiologie und Versorgungsforschung des DRFZ liegt einerseits auf der Erforschung der Versorgungssituation rheumakranker Menschen in Deutschland einschließlich ihrer Defizite, Fortschritte und zeitlichen Trends. Andererseits ist ein wesentliches Ziel, durch die langfristige Beobachtung von Krankheitsverläufen in großen Kohorten Risikofaktoren für ungünstige Krankheitsverläufe, aber auch protektive Faktoren aufzudecken. Mit der Zulassung innovativer, zielgerichteter Therapien zu Beginn dieses Jahrtausends wurde die Thematik der Sicherheit und Wirksamkeit der verschiedenen antirheumatischen Therapien unter Alltagsbedingungen zu einer für Ärzte und Patienten vorrangigen Frage. Die Biologika-Register entwickelten sich zu zentralen Instrumenten des Programmbereichs, mit denen Fragen zur vergleichenden Therapiesicherheit, aber auch zur Therapiewirksamkeit und Reduktion von Risiken durch wirksame Therapie, belastbar beantwortet werden können. Im vorliegenden Artikel werden ausgewählte Ergebnisse epidemiologischer Forschung am DRFZ dargestellt. Das übergreifende Ziel der Forschung war und ist es, zur Verbesserung der Lebensqualität rheumakranker Kinder und Erwachsener beizutragen. Dem dient die klinisch-evaluative Versorgungsforschung ebenso wie die Gewinnung von Erkenntnissen, die eine wirksame, individualisierte Therapie unterstützen. Als unverzichtbare Instrumente haben sich große, langfristige Patientenkohorten und ein stabiles Netzwerk mit den klinisch tätigen Rheumatologen und Betroffenen erwiesen.
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Affiliation(s)
- Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anne Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Johanna Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Angela Zink
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Kirsten Minden
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Comparison of Psoriatic Arthritis and Rheumatoid Arthritis Patients across Body Mass Index Categories in Switzerland. J Clin Med 2021; 10:jcm10143194. [PMID: 34300360 PMCID: PMC8304983 DOI: 10.3390/jcm10143194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 01/28/2023] Open
Abstract
Abnormal body mass index (BMI) was associated with worse rheumatic markers in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Aiming to describe PsA and RA patients stratified by BMI, we performed a descriptive study in PsA and RA patients (two distinct cohorts) in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry. New users of biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were stratified by BMI at the start of their treatment (underweight, normal weight, overweight, obese). The PsA underweight and normal weight categories were merged. Age at disease onset and further characteristics at the start of the first b/tsDMARD treatment were compared across BMI categories vs. the corresponding normal weight group. The study included 819 PsA (36.5% overweight, 23.8% obese) and 3217 RA patients (4.4% underweight, 31.8% overweight, 17.0% obese). Compared to the corresponding normal weight group, PsA and RA obese patients had significantly (p < 0.05) higher C-reactive protein, worse disease activity, and lower quality of life (QoL). Obese PsA patients had significantly worse skin manifestation and pain, while obese RA patients had significantly higher erythrocyte sedimentation rate and tender joint counts, as well as lower seropositive prevalence. To conclude, obese PsA and RA patients presented worse disease activity and poorer QoL than those with normal weight.
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Jung R, Wild J, Ringen J, Karbach S, Wenzel P. Innate Immune Mechanisms of Arterial Hypertension and Autoimmune Disease. Am J Hypertens 2021; 34:143-153. [PMID: 32930786 DOI: 10.1093/ajh/hpaa145] [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] [Received: 06/15/2020] [Revised: 08/15/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
The immune system is indispensable in the development of vascular dysfunction and hypertension. The interplay between immune cells and the vasculature, kidneys, heart, and blood pressure regulating nuclei in the central nervous system results in a complex and closely interwoven relationship of the immune system with arterial hypertension. A better understanding of this interplay is necessary for optimized and individualized antihypertensive therapy. Our review article focuses on innate cells in hypertension and to what extent they impact on development and preservation of elevated blood pressure. Moreover, we address the association of hypertension with chronic autoimmune diseases. The latter are ideally suited to learn about immune-mediated mechanisms in cardiovascular disease leading to high blood pressure.
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Affiliation(s)
- Rebecca Jung
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Julia Ringen
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Susanne Karbach
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Philip Wenzel
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
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10
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Body Mass Index and Disease Activity in Chronic Inflammatory Rheumatic Diseases: Results of the Cardiovascular in Rheumatology (Carma) Project. J Clin Med 2021; 10:jcm10030382. [PMID: 33498379 PMCID: PMC7864025 DOI: 10.3390/jcm10030382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry. METHODS Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m2) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA. RESULTS Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (β = 0.029; 95%CI (0.01- 0.05); p = 0.007) and PsA (β = 0.036; 95%CI (0.015-0.058); p = 0.001) but not in those with AS (β = 0.001; 95%CI (-0.03-0.03); p = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA. CONCLUSIONS BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients.
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Haider S, Sedlak M, Kapan A, Grabovac I, Lamprecht T, Erlacher L, Quittan M, Fenzl KH, Dorner TE. Factors Associated with Objectively Measured Physical Activity in Patients with Seropositive Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239008. [PMID: 33287268 PMCID: PMC7730293 DOI: 10.3390/ijerph17239008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022]
Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, which is associated with low levels of physical activity (PA). However, the factors related to low physical activity levels have rarely been studied. Methods: In this cross-sectional study, 70 seropositive RA patients were included. Physical activity was objectively assessed with an ActiGraph GT3X+ accelerometer. In addition, body mass index, smoking status, work ability, and clinical parameters (functional disabilities, disease activity, disease duration, pain, and inflammation parameters) were measured. Results: RA patients performed a mean of 215.2 (SD: 136.6) min a week of moderate physical activity and 9.1 (SD: 26.3) min of vigorous physical activity. The total amount of moderate and vigorous physical activity (MVPA) was associated with BMI, and functional disabilities. In addition, non-smokers and patients with better work ability did more MVPA. No association could be seen with disease activity, disease duration, pain, and inflammatory markers. After mutual adjusting of all the variables, only BMI showed a significant relationship with MVPA. Conclusions: RA patients perform de facto no physical activity with vigorous intensity. Factors related to low physical activity are BMI, functional disabilities, workability and smoking status, whereas due to the study design no causal and temporal link could be made.
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Affiliation(s)
- Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
| | - Michael Sedlak
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
| | - Ali Kapan
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
- Correspondence: ; Tel.: +431-40160-34897
| | - Thomas Lamprecht
- Karl Landsteiner Institute for Autoimmune Disease and Rheumatology, 1100 Vienna, Austria; (T.L.); (L.E.); (K.H.F.)
| | - Ludwig Erlacher
- Karl Landsteiner Institute for Autoimmune Disease and Rheumatology, 1100 Vienna, Austria; (T.L.); (L.E.); (K.H.F.)
- 2nd Medical Division, Rheumatology, Klinik Favoriten, 1130 Vienna, Austria
| | - Michael Quittan
- Karl Landsteiner Institute for Remobilization and Functional Health, 1130 Vienna, Austria;
| | - Karl Heinrich Fenzl
- Karl Landsteiner Institute for Autoimmune Disease and Rheumatology, 1100 Vienna, Austria; (T.L.); (L.E.); (K.H.F.)
| | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
- Karl Landsteiner Institute for Health Promotion Research, 3454 Sitzenberg-Reidling, Austria
- Social Insurance Fund for Public Service, Railway and Mining Industries, Health Promotion Facility Sitzenberg-Reidling, 3454 Sitzenberg-Reidling, Austria
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Meißner Y, Milatz F, Callhoff J, Minden K, Regierer A, Strangfeld A. [Register and cohort studies : Overview of the most important data sources at the German Rheumatism Research Center]. Z Rheumatol 2020; 79:983-995. [PMID: 33258976 DOI: 10.1007/s00393-020-00906-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
Over the past 28 years the German Rheumatism Research Center in Berlin has initiated various epidemiological studies in which data on patients with inflammatory rheumatic diseases are collected nationwide and multicentric. The spectrum ranges from rheumatoid arthritis and spondylarthritis to connective tissue diseases and rheumatic diseases in childhood. Based on the respective scientific question, studies of different types were established. The German National Databases for adults and children annually collect cross-sectional data to map the care of patients. In two inception cohorts, adults with early arthritis and patients with juvenile idiopathic arthritis are investigated from disease onset. The long-term observational cohorts/registries RABBIT, RABBIT-SpA and JuMBO focus on the long-term efficacy and safety of biologic drugs and other targeted treatments. Rhekiss investigates women with inflammatory rheumatic diseases when trying to become pregnant, during pregnancy and postpartum. This article highlights each of these observational studies with its characteristics as well as national and international collaborations.
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Affiliation(s)
- Y Meißner
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - F Milatz
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - K Minden
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - A Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Mohammed A, Alshamarri T, Adeyeye T, Lazariu V, McNutt LA, Carpenter DO. A comparison of risk factors for osteo- and rheumatoid arthritis using NHANES data. Prev Med Rep 2020; 20:101242. [PMID: 33294313 PMCID: PMC7689317 DOI: 10.1016/j.pmedr.2020.101242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022] Open
Abstract
Both osteo- and rheumatoid arthritis increase with age. Osteoarthritis is more common in whites, but rheumatoid arthritis is in blacks. Obesity and female sex increase risk of risk of both osteo- and rheumatoid arthritis. Smoking increases risk of both forms of arthritis in women. These two forms of arthritis have many common risk factors.
Osteoarthritis and rheumatoid arthritis are both diseases of joints, but they have very different etiologies. Osteoarthritis is a disease assumed to result from wear and tear over time, whereas rheumatoid arthritis is an autoimmune disease where the body’s immune system attacks joint tissues. Using NHANES data (1999–2015), we have compared the influence of age, sex, ethnicity, body mass index and smoking on these two very different forms of arthritis. Incidence of both increases with age and are more frequent in females than males. There is little apparent difference between osteoarthritis and rheumatoid arthritis in women of normal as comparted to overweight, but both are more frequent in obese women, especially those over the age of 60. While osteoarthritis is more frequent in whites, blacks have more rheumatoid arthritis, and Hispanics show an intermediate prevalence. Smoking significantly increased the incidence of both osteoarthritis and rheumatoid arthritis in women, but increased prevalence of only RA in men. There was no effect of smoking on OA prevalence in males. It is remarkable that two diseases of joints, which have quite different causes, should have so many commonalities. The differences that exist appear to be due to a combination of inflammatory markers and access to health care.
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Affiliation(s)
- Azad Mohammed
- Institute for Health and the Environment, University at Albany, SUNY, 5 University Place, Rensselaer, NY 12144, United States
| | - Taraf Alshamarri
- Institute for Health and the Environment, University at Albany, SUNY, 5 University Place, Rensselaer, NY 12144, United States
| | - Temilayo Adeyeye
- Institute for Health and the Environment, University at Albany, SUNY, 5 University Place, Rensselaer, NY 12144, United States
| | - Victoria Lazariu
- Institute for Health and the Environment, University at Albany, SUNY, 5 University Place, Rensselaer, NY 12144, United States
| | - Louise-Anne McNutt
- Institute for Health and the Environment, University at Albany, SUNY, 5 University Place, Rensselaer, NY 12144, United States
| | - David O Carpenter
- Institute for Health and the Environment, University at Albany, SUNY, 5 University Place, Rensselaer, NY 12144, United States
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Carvalho GD, Bonfiglioli K, Caparbo VF, Takayama L, Pereira RMR, Domiciano DS. Changes to Body Composition in Women With Long-Standing Established Rheumatoid Arthritis: Differences by Level of Disease Activity. J Clin Densitom 2020; 23:639-646. [PMID: 31285112 DOI: 10.1016/j.jocd.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Few studies on rheumatoid arthritis have investigated disease activity and body composition by dual-energy X-ray absorptiometry including evaluation of visceral adipose tissue. Thus, we sought to verify the association between body composition by dual-energy X-ray absorptiometry, including visceral adipose tissue, and inflammatory activity in long-standing established rheumatoid arthritis. METHODS Seventy-eight postmenopausal women with rheumatoid arthritis (American College of Rheumatology 2010) were studied. Disease activity was assessed by composite indexes (DAS28, CDAI, SDAI) and C-reactive protein. Potential association between body composition and disease activity was analysed by Pearson correlation and Tukey´s test (p < 0.05). RESULTS There was significant negative correlation between C-reactive protein and appendicular lean mass index (r = -0.234, p = 0.039). After adjusting for confounding variables, women with C-reactive protein >10 mg/L had a lower appendicular lean mass index than those with C-reactive protein 5-10 mg/L and <5 mg/L (6.3 ± 0.8 kg/m2 vs 7.2 ± 1.2 kg/m2 vs 6.8 ± 1.0 kg/m2, respectively; p = 0.013). Women with moderate inflammation (C-reactive protein 5-10 mg/L) had more fat than those with C-reactive protein >10 mg/L and C-reactive protein <5 mg/L (12.4 ± 3.5 kg/m2 vs 9.9 ± 3.6 kg/m2 vs 10.5 ± 2.8 kg/m2, respectively; p = 0.040), as well as more visceral adipose tissue than women with higher and lower C-reactive protein (812.5 ± 266.4 cm3 vs 604.3 ± 236.3cm3 vs 658.9 ± 255.6 cm3; p = 0.009). CONCLUSIONS High inflammatory activity that persists after a long disease duration was associated with both lower muscle and fat mass (including visceral adipose tissue), which is suggestive of more exuberant rheumatoid cachexia. Conversely, moderate activity was associated with greater visceral adipose tissue, which is associated with increased cardiovascular risk. These results point to the existence of different body composition profiles according to inflammatory status and the importance of individualized approaches to muscle mass and adiposity according to disease activity level in long-standing rheumatoid arthritis.
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Affiliation(s)
- Gabriela D Carvalho
- Rheumatology Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Karina Bonfiglioli
- Rheumatology Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Valéria F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Rosa M R Pereira
- Rheumatology Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Diogo S Domiciano
- Rheumatology Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil.
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15
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Órla G, Béchet S, Walshe M. Modified Diet Use in Adults with Temporomandibular Disorders related to Rheumatoid Arthritis: A Systematic Review. Mediterr J Rheumatol 2020; 31:183-189. [PMID: 32676555 PMCID: PMC7362125 DOI: 10.31138/mjr.31.2.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 02/12/2020] [Indexed: 12/29/2022] Open
Abstract
Objective: Individuals presenting with rheumatoid arthritis (RA) frequently experience temporomandibular disorders (TMDs), which can result in limited ranges of mandibular motion, pain and fatigue on jaw function, and impaired mastication. As such, individuals with RA-related TMDs may consume a texture-modified diet in order to reduce the exacerbation of jaw pain and dysfunction, and to increase the ease of oral intake. These softer food options may not contain the recommended nutrients, vitamins, and minerals, and therefore, may not be nutritionally optimal. As unintentional body composition and weight changes are common in individuals with RA, there may be elevated risks of obesity or malnutrition in this patient subgroup. However, minimal researcth has been conducted to investigate the use of modified diets in this cohort, and therefore, the true level of risk to these patients cannot not be adequately determined. The aim of this study was to determine the prevalence of diet modifications in adults presenting with RA affecting the TMJ. Methods: All available evidence presenting data on adults with RA who consume modified diets was systematically reviewed. A range of electronic databases were searched, including: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Supplementary Google Scholar, reference list, and grey literature searches were also conducted. Independent reviewers assessed study eligibility, and methodological quality was rated using the Down’s and Black assessment. Results: One study was eligible for inclusion, and half (50.82%; CI: 37.7–63.86) of individuals with RA in this study consumed a modified diet. This study was rated to be of moderate quality. The primary limitation of this review was the lack of studies on this topic which were available for inclusion. Conclusions: Although from clinical practice, it is recognised that adults with TMD related to RA do modify their diets to cope with the functional impairment of TMD, this review confirms that minimal research has been conducted regarding the use of texture modified diets by this population. This is despite concerns regarding unintentional weight changes in this patient group. Further research investigating this area is warranted in order to improve patient outcomes and experience of care.
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Affiliation(s)
- Gilheaney Órla
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Sibylle Béchet
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
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16
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Dahmen R, Konings-Pijnappels A, Kerkhof S, Verberne S, Boers M, Roorda LD, van der Leeden M. Higher body mass index is associated with lower foot health in patients with rheumatoid arthritis: baseline results of the Amsterdam-Foot cohort. Scand J Rheumatol 2020; 49:186-194. [PMID: 32154754 DOI: 10.1080/03009742.2019.1663920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Obesity is highly prevalent in patients with rheumatoid arthritis (RA), with likely impact on weight-bearing foot joints. We explored the associations between body mass index (BMI) and measures of foot health in patients with RA and foot complaints.Method: We examined patients with RA presenting for their first custom-made therapeutic footwear or foot orthoses. Domains of foot health comprised: foot pain, foot-related activity limitations, forefoot plantar pressure, foot synovitis, and foot deformity. In regression analyses, BMI was the independent variable and foot health domains were the dependent variables.Results: The cohort at baseline comprised 230 patients [mean ± sd age 58 ± 13 years, 80% female, mean ± sd disease duration 10 ± 9 years, and median (interquartile range) BMI 26.7 (23.5-30.1) kg/m2]. Small to modest statistically significant associations were found in the majority of the measures studied between a higher BMI and more foot pain, more foot-related activity limitations, higher in-shoe measured forefoot plantar pressure, and the presence of foot synovitis. No relationships were found between BMI and barefoot measured forefoot plantar pressure or foot deformity.Conclusion: BMI is negatively associated with foot health in patients with RA. Although the clinical relevance of our findings for an individual patient is not immediately obvious, future research should consider BMI as a potential therapeutic target to improve foot health.
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Affiliation(s)
- R Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | | | - S Kerkhof
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - S Verberne
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M Boers
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,Rheumatology, Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - L D Roorda
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M van der Leeden
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Xu F, Yu C, Li DG, Yan Q, Zhang SX, Yang XD, Zhang Z. The outcomes of bariatric surgery on rheumatoid arthritis disease activity: a prospective cohort study. Sci Rep 2020; 10:3167. [PMID: 32081915 PMCID: PMC7035292 DOI: 10.1038/s41598-020-59723-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/31/2020] [Indexed: 11/09/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints. Overweight and obesity can aggravate disease activity and clinical outcome in patients with RA. However, the role of bariatric surgery in inducing weight loss in the treatment of RA has not been confirmed. In this 12-month prospective cohort study, RA patients with obesity who were referred to our hospital were included. Thirty-two patients were classified into the bariatric surgery group according to the patient's decision after a comprehensive assessment of surgery indications, and 33 patients received only pharmacotherapy for RA. At the 12-month follow-up, the response rates of ACR20, ACR50 and ACR70 were 75.0% vs. 51.5%, 53.1% vs. 39.4% and 31.3% vs. 21.2% in the bariatric surgery and non-surgery groups, respectively (all p < 0.05); the mean DAS28-ESR, DAS28-CRP and cDAI scores were 1.5 ± 0.9 vs. 2.4 ± 1.4, 1.2 ± 0.9 vs. 2.2 ± 1.7 and 9.5 ± 6.8 vs. 15.8 ± 12.5, respectively, in surgical patients compared to non-surgical patients (all p < 0.05). Compared to baseline, after 12 months, a significant reduction was observed in the use of leflunomide, biological agents, combination treatments, and NSAIDs in both groups (p < 0.05 or p < 0.01). However, there was no difference in medication use between the 2 groups either at baseline or at the 12-month follow-up (all p > 0.05). Compared to non-surgical patients, in RA patients with obesity, weight loss after bariatric surgery was associated with lower disease activity. Medication tapering for RA in patients who underwent bariatric surgery was not superior to that in non-surgical patients.
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Affiliation(s)
- Fang Xu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Chao Yu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - De-Guan Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Qiang Yan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Shang-Xin Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiao-Dong Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Zhen Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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Pappas DA, Etzel CJ, Crabtree M, Blachley T, Best J, Zlotnick S, Kremer JM. Effectiveness of Tocilizumab in Patients with Rheumatoid Arthritis Is Unaffected by Comorbidity Burden or Obesity: Data from a US Registry. J Rheumatol 2020; 47:1464-1474. [PMID: 31941801 DOI: 10.3899/jrheum.190282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Comorbidity burden and obesity may affect treatment response in patients with rheumatoid arthritis (RA). Few real-world studies have evaluated the effect of comorbidity burden or obesity on the effectiveness of tocilizumab (TCZ). This study evaluated TCZ effectiveness in treating RA patients with high versus low comorbidity burden and obesity versus nonobesity in US clinical practice. METHODS Patients in the Corrona RA registry who initiated TCZ were stratified by low or high comorbidity burden using a modified Charlson Comorbidity Index (mCCI) and by obese or nonobese status using body mass index (BMI). Improvements in disease activity and functionality after TCZ initiation were compared for the above strata of patients at 6 and 12 months after adjusting for statistically significant differences in baseline characteristics. RESULTS We identified patients with high (mCCI ≥ 2; n = 195) and low (mCCI < 2; n = 575) comorbidity burden and patients categorized as obese (BMI ≥ 30; n = 356) and nonobese (BMI < 30; n = 449) who were treated with TCZ. Most patients (> 95%) were biologic experienced and about one-third of patients received TCZ as monotherapy, with no significant differences between patients by comorbidity burden or obesity status. Improvement in disease activity and functionality at 6 and 12 months was similar between groups, regardless of comorbidity burden or obesity status. CONCLUSION In this real-world analysis, TCZ was frequently used to treat patients with high comorbidity burden or obesity. Effectiveness of TCZ did not differ by comorbidity or obesity status.
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Affiliation(s)
- Dimitrios A Pappas
- D.A. Pappas, MD, Columbia University, New York, New York; Corrona, LLC, Waltham, Massachusetts;
| | - Carol J Etzel
- C.J. Etzel, PhD, M. Crabtree, MPH, T. Blachley, MS, Corrona, LLC, Waltham, Massachusetts
| | - Margaux Crabtree
- C.J. Etzel, PhD, M. Crabtree, MPH, T. Blachley, MS, Corrona, LLC, Waltham, Massachusetts
| | - Taylor Blachley
- C.J. Etzel, PhD, M. Crabtree, MPH, T. Blachley, MS, Corrona, LLC, Waltham, Massachusetts
| | - Jennie Best
- J. Best, PhD, S. Zlotnick, PharmD, Genentech, Inc., South San Francisco, California
| | - Steve Zlotnick
- J. Best, PhD, S. Zlotnick, PharmD, Genentech, Inc., South San Francisco, California
| | - Joel M Kremer
- J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York, USA
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Long-term trends in rheumatology care : Achievements and deficits in 25 years of the German national rheumatology database. Z Rheumatol 2019; 78:65-72. [PMID: 31407089 DOI: 10.1007/s00393-019-0680-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers. OBJECTIVE In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized. METHODS Between 15 and 17 rheumatological institutions take part in the NDB and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease. RESULTS The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases. CONCLUSION The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.
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de Resende Guimarães MFB, Rodrigues CEM, Gomes KWP, Machado CJ, Brenol CV, Krampe SF, de Andrade NPB, Kakehasi AM. High prevalence of obesity in rheumatoid arthritis patients: association with disease activity, hypertension, dyslipidemia and diabetes, a multi-center study. Adv Rheumatol 2019; 59:44. [PMID: 31619287 DOI: 10.1186/s42358-019-0089-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/26/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a well-documented independent risk factor for cardiovascular disease. Obesity may provide an additional link between inflammation and accelerated atherosclerosis in RA. OBJECTIVE To evaluate the association between obesity and disease parameters and cardiovascular risk factors in RA patients. METHOD Cross-sectional study of a cohort of RA patients from three Brazilian teaching hospitals. Information on demographics, clinical parameters and the presence of cardiovascular risk factors was collected. Blood pressure, weight, height and waist circumference (WC) were measured during the first consultation. Laboratory data were retrieved from medical records. Obesity was defined according to the NCEP/ATPIII and IDF guidelines. The prevalence of obesity was determined cross-sectionally. Disease activity was evaluated using the DAS28 system (remission < 2.6; low 2.6-3.1; moderate 3.2-5.0; high > 5.1). RESULTS The sample consisted of 791 RA patients aged 54.7 ± 12.0 years, of whom 86.9% were women and 59.9% were Caucasian. The mean disease duration was 12.8 ± 8.9 years. Three quarters were rheumatoid factor-positive, the mean body mass index (BMI) was 27.1 ± 4.9, and the mean WC was 93.5 ± 12.5 cm. The observed risk factors included dyslipidemia (34.3%), type-2 diabetes (15%), hypertension (49.2%) and family history of premature cardiovascular disease (16.5%). BMI-defined obesity was highly prevalent (26.9%) and associated with age, hypertension and dyslipidemia. Increased WC was associated with diabetes, hypertension, dyslipidemia and disease activity. CONCLUSION Obesity was highly prevalent in RA patients and associated with disease activity.
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Affiliation(s)
| | | | | | - Carla Jorge Machado
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Claiton Viegas Brenol
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Alegre, Brazil
| | - Susana Ferreira Krampe
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Alegre, Brazil
| | | | - Adriana Maria Kakehasi
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Antibiotic treatment and flares of rheumatoid arthritis: a self-controlled case series study analysis using CPRD GOLD. Sci Rep 2019; 9:8941. [PMID: 31222078 PMCID: PMC6586671 DOI: 10.1038/s41598-019-45435-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/06/2019] [Indexed: 12/27/2022] Open
Abstract
There is emerging evidence of the impact of infections on rheumatoid arthritis pathogenesis and flares. We aimed to study the association between antibiotic use (and timing of use), and the occurrence of flares in patients with RA. We nested a self-controlled case series (SCCS) of patients who have RA flares within a newly diagnosed RA cohort (n = 31,992) from the UK Clinical Practice Research Datalink (CPRD) GOLD dataset. We determined associations between exposure to antibiotics (beta-lactam, imidazole, macrolide, nitrofurantoin, quinolone, sulphonamide and trimethoprim, and tetracycline) and the occurrence of RA flares. Conditional fixed-effects Poisson regression models were used to determine incidence rate ratios (IRR), offset by the natural logarithm of risk periods. A total of 1,192 (3.7%) of RA subjects had one or more flare/s during the study period, and were therefore included. Use of sulphonamide and trimethoprim was associated with an increased risk of RA flare at 29–90 days (IRR 1.71, CI 1.12–2.59, p = 0.012); 91–183 days (IRR 1.57, CI 1.06–2.33, p = 0.025); and 184–365 days (IRR 1.44, CI 1.03–2.02, p = 0.033) after commencement of antibiotic treatment. No other antibiotic group/s appear associated with RA flare/s risk. Usage of sulphonamide and trimethoprim antibiotics, is associated with a 70% increased risk of RA flare at 1–3 months, which decreases but remains significant up to 12 months after treatment. We hypothesise that the delayed onset of RA flares after specific antibiotics is mediated through the gut or urinary microbiomes. Further epidemiological and mechanistic research is needed to determine the role of infections in RA.
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Baganz L, Richter A, Albrecht K, Schneider M, Burmester GR, Zink A, Strangfeld A. Are prognostic factors adequately selected to guide treatment decisions in patients with rheumatoid arthritis? A collaborative analysis from three observational cohorts. Semin Arthritis Rheum 2019; 48:976-982. [DOI: 10.1016/j.semarthrit.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/24/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
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Merrill RM, Fowers R. To what extent does sex, age and BMI impact medical and pharmacy costs? A retrospective cohort study involving employees in a large school district in the USA. BMJ Open 2019; 9:e024078. [PMID: 31142517 PMCID: PMC6549653 DOI: 10.1136/bmjopen-2018-024078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 03/13/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To identify the extent that sex, age and body mass index (BMI) is associated with medical and pharmacy costs. DESIGN Retrospective cohort. SETTING A school district in the Western USA involving 2531 workers continuously employed during 2011-2014. MAIN OUTCOME MEASURES Medical and pharmacy costs and BMI. RESULTS Approximately 84% of employees participated in wellness screening. Participants were 1.03 (95% CI 1.01 to 1.06) times more likely to be women and younger (M=47.8 vs 49.8, p<0.001). Median medical and pharmacy costs were higher for women than men, increased with age, and were greater in morbidly obese individuals (p<0.001). Annual pharmacy claims were 18% more likely to be filed by women than men, 23% more likely filed by those aged ≥60 versus <40 years, and 6% more likely filed by morbidly obese individuals than of normal weight (p<0.001) individuals. Greater medical and pharmacy costs in older age were most pronounced in underweight and morbidly obese groups. Higher use of medication among women than men was primarily because of drugs involving birth control, osteoporosis, thyroid disease and urinary tract infection. Higher medication use in older age was primarily related to medications used to treat gastrointestinal problems. Medication use was positively associated with BMI weight classifications for most of the 33 drug types considered, with exceptions involving birth control, herpes and osteoporosis. A J-shape relationship was observed between BMI and medication use for acne, antibiotic, cold/influenza/allergy, eye infection, oedema, muscle spasms, pain and ulcers. CONCLUSIONS Medications associated with higher medical and pharmacy costs among women, older age and underweight or obese individuals are identified. Lowering medical and pharmacy costs requires weight management in older ages, particularly for underweight and obese. Higher pharmacy costs for certain drugs among underweight individuals may be associated with poorer nutrition.
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Affiliation(s)
- Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - Rylan Fowers
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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Novikova DS, Udachkina HV, Markelova EI, Kirillova IG, Misiyuk AS, Demidova NV, Popkova TV. Dynamics of body mass index and visceral adiposity index in patients with rheumatoid arthritis treated with tofacitinib. Rheumatol Int 2019; 39:1181-1189. [DOI: 10.1007/s00296-019-04303-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/09/2019] [Indexed: 12/31/2022]
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Lin JZ, Liang JJ, Ma JD, Li QH, Mo YQ, Cheng WM, He XL, Li N, Cao MH, Xu D, Dai L. Myopenia is associated with joint damage in rheumatoid arthritis: a cross-sectional study. J Cachexia Sarcopenia Muscle 2019; 10:355-367. [PMID: 30701694 PMCID: PMC6463467 DOI: 10.1002/jcsm.12381] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/15/2018] [Accepted: 11/20/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The link between body mass index (BMI) and disease characteristics in rheumatoid arthritis (RA) remains controversial. Body composition (BC) has been more frequently recommended to be used instead of BMI for more accurate assessment. Our study aimed to investigate the characteristics of BC in RA patients and their associations with disease characteristics. METHODS Body composition was assessed in consecutive Chinese RA patients and control subjects by bioelectric impedance analysis. Overfat was defined by body fat percentage (BF%) as ≥25% for men and ≥35% for women. Myopenia was defined by appendicular skeletal muscle mass index (ASMI) ≤7.0 kg/m2 in men and ≤5.7 kg/m2 in women. BMI and clinical data including disease activity, function, and radiographic assessment were collected. Active disease was defined by disease activity score in 28 joints with four variables including C-reactive protein (DAS28-CRP) ≥2.6. Functional limitation was defined as Stanford health assessment questionnaire disability index (HAQ-DI) >1. Radiographic joint damage (RJD) was defined as the Sharp/van der Heijde modified sharp score (mTSS) >10. RESULTS There were 457 RA patients (mean age 49.5 ± 13.1 years old with 82.7% women) and 1860 control subjects (mean age 34.3 ± 9.9 years old with 51.2% women) recruited. Comparisons of BMI and BC between RA patients and control subjects in age and gender stratification showed that lower BMI with 17.7% underweight and lower ASMI with 45.1% myopenia are the main characteristics in RA patients. Compared with those without myopenia, RA patients with myopenia had significantly higher DAS28-CRP (median 3.5 vs. 3.0), higher HAQ-DI (median 0.38 vs. 0.13) with higher rate of functional limitation (24.8% vs. 7.6%), and higher mTSS (median 22.3 vs. 9.0) with more RJD (71.8% vs. 45.8%) (all P < 0.001). Multivariate logistic regression analysis showed myopenia were positively associated with functional limitation (OR = 2.546, 95% CI: 1.043-6.217) and RJD (OR = 2.660, 95% CI: 1.443-4.904). All RA patients were divided into four BC subgroups according to overfat and myopenia. Those with both overfat and myopenia had the worst disease characteristics. After adjustment for confounding factors, significant additive interactions were observed between overfat and myopenia in active disease (AP = 0.528, 95% CI: 0.086-0.971), functional limitation (AP = 0.647, 95% CI: 0.356-0.937), and RJD (AP = 0.514, 95% CI: 0.139-0.890). CONCLUSIONS Myopenia is very common in RA patients that is associated with functional limitation and joint damage in RA. Further research on the underlying mechanism and the effect of skeletal muscle mass improvement in RA management are worth exploring in the future.
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Affiliation(s)
- Jian-Zi Lin
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jin-Jian Liang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jian-Da Ma
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying-Qian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wan-Mei Cheng
- Shanghai Healthcare Co. Ltd., Zhangjiang Innopark, Building 7, Shanghai, China
| | - Xiao-Ling He
- Shanghai Healthcare Co. Ltd., Zhangjiang Innopark, Building 7, Shanghai, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Ming-Hui Cao
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dan Xu
- Centre of Clinical Research and Education, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Singh S, Facciorusso A, Singh AG, Casteele NV, Zarrinpar A, Prokop LJ, Grunvald EL, Curtis JR, Sandborn WJ. Obesity and response to anti-tumor necrosis factor-α agents in patients with select immune-mediated inflammatory diseases: A systematic review and meta-analysis. PLoS One 2018; 13:e0195123. [PMID: 29771924 PMCID: PMC5957395 DOI: 10.1371/journal.pone.0195123] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/17/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We sought to evaluate the association between obesity and response to anti-tumor necrosis factor-α (TNF) agents, through a systematic review and meta-analysis. METHODS Through a systematic search through January 24, 2017, we identified randomized controlled trials (RCTs) or observational studies in adults with select immune-mediated inflammatory diseases-inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), spondyloarthropathies (SpA), psoriasis and psoriatic arthritis (PsA)-treated with anti-TNF agents, and reporting outcomes, stratified by body mass index (BMI) categories or weight. Primary outcome was failure to achieve clinical remission or response or treatment modification. We performed random effects meta-analysis and estimated odds ratios (OR) and 95% confidence interval (CI). RESULTS Based on 54 cohorts including 19,372 patients (23% obese), patients with obesity had 60% higher odds of failing therapy (OR,1.60; 95% CI,1.39-1.83;I2 = 71%). Dose-response relationship was observed (obese vs. normal BMI: OR,1.87 [1.39-2.52]; overweight vs. normal BMI: OR,1.38 [1.11-1.74],p = 0.11); a 1kg/m2 increase in BMI was associated with 6.5% higher odds of failure (OR,1.065 [1.043-1.087]). These effects were observed across patients with rheumatic diseases, but not observed in patients with IBD. Effect was consistent based on dosing regimen/route, study design, exposure definition, and outcome measures. Less than 10% eligible RCTs reported outcomes stratified by BMI. CONCLUSIONS Obesity is an under-reported predictor of inferior response to anti-TNF agents in patients with select immune-mediated inflammatory diseases. A thorough evaluation of obesity as an effect modifier in clinical trials is warranted, and intentional weight loss may serve as adjunctive treatment in patients with obesity failing anti-TNF therapy.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
- Division of Biomedical Informatics, University of California San Diego, La Jolla, California, United States of America
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Abha G. Singh
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, California, United States of America
| | - Niels Vande Casteele
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
| | - Amir Zarrinpar
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
- Institute for Diabetes and Metabolic Health, University of California, San Diego, La Jolla, California, United States of America
- VA San Diego Health Systems, La Jolla, California, United States of America
| | - Larry J. Prokop
- Department of Library Services, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Eduardo L. Grunvald
- Weight Management Program, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
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Sparks JA, Chang SC, Nguyen US, Barbhaiya M, Tedeschi SK, Lu B, Kreps DJ, Costenbader KH, Zhang Y, Choi HK, Karlson EW. Weight Change During the Early Rheumatoid Arthritis Period and Risk of Subsequent Mortality in Women With Rheumatoid Arthritis and Matched Comparators. Arthritis Rheumatol 2017; 70:18-29. [PMID: 29193837 DOI: 10.1002/art.40346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/05/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate whether weight change during the early rheumatoid arthritis (RA) period is associated with subsequent mortality and to evaluate whether there is an RA-specific effect. METHODS We identified patients with incident RA during the Nurses' Health Study (NHS; 1976-2016) and created a comparison cohort by matching each RA patient with up to 10 non-RA comparators by age and calendar year of the RA diagnosis (index date). To capture weight change around the early RA period ("peri-RA/index"), we used weight measurements collected 2-4 years before and 2-4 years after the index date. We used Cox regression analysis to estimate hazard ratios (HRs) for mortality according to peri-RA/index weight change categories, separately in each cohort and in the combined cohorts, evaluating for an RA-specific effect. RESULTS Among 121,701 women in the NHS, 902 patients with incident RA were identified and matched to 7,884 non-RA comparators. In the RA cohort, 371 deaths (41.1%) occurred during a mean follow-up of 17.0 years after the early RA period, and 2,303 deaths (29.2%) occurred in the comparison cohort during a mean follow-up of 18.4 years. Weight loss of >30 pounds during the peri-RA period had a hazard ratio (HR) for mortality of 2.78 (95% confidence interval [95% CI] 1.58-4.89) compared to stable weight; results in the comparison cohort were similar (HR 2.16, 95% CI 1.61-2.88). A weight gain of >30 pounds had no association with mortality in patients with RA (HR 1.45, 95% CI 0.69-3.07) or comparators (HR 1.19, 95% CI 0.89-1.59). For mortality, there was no statistically significant interaction between RA/comparator status and weight change category (P = 0.68). CONCLUSION Severe weight loss during the early RA period was associated with an increased subsequent mortality risk for women with and those without RA. These results extend prior observations by including non-RA comparators and finding no protective association between weight gain and mortality, providing evidence against an RA-specific obesity paradox for mortality.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shun-Chiao Chang
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Uyen-Sa Nguyen
- University of Massachusetts School of Medicine, Worcester, and Boston University School of Medicine, Boston, Massachusetts
| | - Medha Barbhaiya
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara K Tedeschi
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David J Kreps
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yuqing Zhang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hyon K Choi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Albrecht K, Luque Ramos A, Hoffmann F, Redeker I, Zink A. High prevalence of diabetes in patients with rheumatoid arthritis: results from a questionnaire survey linked to claims data. Rheumatology (Oxford) 2017; 57:329-336. [DOI: 10.1093/rheumatology/kex414] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 12/12/2022] Open
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Liu XZ, Gao Y, Fan J, Xu X, Zhang J, Gao J, Wan W, Zhao DB. Metabolic abnormalities in rheumatoid arthritis patients with comorbid diabetes mellitus. Clin Rheumatol 2017; 37:219-226. [PMID: 28944421 DOI: 10.1007/s10067-017-3847-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/18/2017] [Accepted: 09/18/2017] [Indexed: 12/17/2022]
Abstract
The metabolic characteristics of rheumatoid arthritis (RA) or diabetes mellitus (DM) have been studied, but the metabolic abnormalities of RA patients complicated with DM are not completely understood. Therefore, we recruited RA patients with DM to investigate the metabolic abnormalities in these patients. We collected data of RA patients with DM and age- and sex-matched RA and DM patients from Changhai Hospital's electronic medical record system. Data of demographically matched healthy controls were also collected from the health management system of the Hangzhou Sanatorium of People's Liberation Army. Blood pressure, uric acid, glucose, and lipid levels were compared. The clinical data of RA with DM (n = 104), DM (n = 100), and RA (n = 100) patients and healthy controls (n = 100) were collected and compared. RA patients with DM had higher blood pressure and lower high-density lipoprotein cholesterol levels than the other three groups, a higher triglycerides (TG) level than healthy controls and RA patients, and a lower TG level than DM patients. RA patients with DM exhibited a relatively high proportion of metabolic abnormalities based on existing standards. Our study examined metabolic abnormalities in RA patients with DM for the first time, and our results suggest that clinicians should pay more attention to the metabolic abnormalities of RA patients with DM.
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Affiliation(s)
- Xing Zhen Liu
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.,Army Convalescence Area, Hangzhou Sanatorium of People's Liberation Army, Hangzhou, China
| | - Ying Gao
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Jie Fan
- Army Convalescence Area, Hangzhou Sanatorium of People's Liberation Army, Hangzhou, China
| | - Xia Xu
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Ju Zhang
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Jie Gao
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Wei Wan
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Dong Bao Zhao
- Department of Rheumatology and immunology, Changhai Hospital, The Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
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Thrum S. [Obesity and autoimmunity : Adipose tissue as an immune organ?]. Z Rheumatol 2017; 76:348-350. [PMID: 28386643 DOI: 10.1007/s00393-017-0298-0] [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: 10/19/2022]
Abstract
Adipose tissue possesses crucial immunological features in the development of comorbidities of obesity. Complex interactions between the metabolic system and cells of the immune system are the cause but are not fully understood. Autoimmune diseases might therefore be influenced by obesity. Epidemiological studies provide evidence of only a modest association between obesity and the development of rheumatoid arthritis and psoriatic arthritis. In obesity the course of inflammatory rheumatic diseases is aggravated, as subjectively measured by activity parameters; however, laboratory parameters show no differences and radiographic examinations reveal less bone destruction in obesity. Furthermore, there are indications for a poorer response to treatment especially with infliximab in patients with an increased body mass index (BMI). Weight loss has a positive effect on the course of joint diseases. Due to deficits in the currently available studies there is insufficient evidence to recommend individualization of treatment decisions based on the BMI.
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Affiliation(s)
- S Thrum
- Klinik für Gastroenterologie und Rheumatologie, Sektion Rheumatologie/Gerontologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Herly M, Stengaard-Pedersen K, Hørslev-Petersen K, Hetland ML, Østergaard M, Christensen R, Løgstrup BB, Vestergaard P, Pødenphant J, Junker P, Ellingsen T. Association between baseline vitamin D metabolite levels and long-term cardiovascular events in patients with rheumatoid arthritis from the CIMESTRA trial: protocol for a cohort study with patient-record evaluated outcomes. BMJ Open 2017; 7:e014816. [PMID: 28391237 PMCID: PMC5541299 DOI: 10.1136/bmjopen-2016-014816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cardiovascular morbidity and mortality is increased in patients with rheumatoid arthritis (RA), and among these patients, the prevalence of hypovitaminosis D is high. Moreover, low vitamin D levels have been associated with increased cardiovascular risk in healthy subjects. OBJECTIVE To evaluate the long-term risk of cardiovascular events in patients having low total 25-hydroxyvitamin D levels at baseline compared with patients with normal levels, in an efficiently treated, closed cohort of patients with an early diagnosis of RA. METHODS AND ANALYSIS This study is a prospective, closed, blinded endpoint cohort study, based on secondary analyses from a previous randomised trial (CIMESTRA study; NCT00209859, approved September 1999) including 160 patients with an early diagnosis of RA from Danish University clinics. Primary outcome will be the proportion of patients with any cardiovascular event in the follow-up period, evaluated using systematic journal audits. Logistic regression models will test the hypothesis that there are more cardiovascular events in enrolled patients with a low level of vitamin D (< 50 nmol/L). Secondarily, Cox regression models, based on survival analysis, will determine the extent to which independent variables (including different levels of vitamin D at baseline) predict whether a cardiovascular event will occur, and also when this will be. ETHICS AND DISSEMINATION All patients have received verbal and written information before enrolment, and have given written consent at baseline. To disseminate comprehension of factors of prognostic importance to cardiovascular outcome in RA, we will attempt to have a first draft ready no later than 1 year after the adjudication process has finished. If low vitamin D levels can predict cardiovascular events in RA, it is relevant to take into account in a prediction model, to be considered by patients, physicians and other decision-makers. TRIAL REGISTRATION NUMBER The parental controlled trial is registered as NCT00209859.
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Affiliation(s)
- M Herly
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - K Stengaard-Pedersen
- Department of Rheumatology, Centre of Cancer and Inflammation, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - K Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, Southern University of Denmark, Graasten, Denmark
| | - M L Hetland
- Department of Rheumatology, COPECARE, Copenhagen University Hospital, Glostrup, Denmark
| | - M Østergaard
- Department of Rheumatology, COPECARE, Copenhagen University Hospital, Glostrup, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - B B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - P Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University, Denmark
| | - J Pødenphant
- Department of Rheumatology, Copenhagen University Hospital, Gentofte, Denmark
| | - P Junker
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - T Ellingsen
- Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Hugo M, Mehsen-Cetre N, Pierreisnard A, Pupier E, Cherifi B, Schaeverbeke T, Rigalleau V. High body mass index in rheumatoid arthritis: why we should promote physical activity. Arthritis Res Ther 2017; 19:2. [PMID: 28073369 PMCID: PMC5223481 DOI: 10.1186/s13075-016-1209-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- M Hugo
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France
| | - N Mehsen-Cetre
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France
| | - A Pierreisnard
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France
| | - E Pupier
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France
| | - B Cherifi
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France
| | - T Schaeverbeke
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France
| | - V Rigalleau
- Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France.
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