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Tidblad L, Westerlind H, Delcoigne B, Askling J, Saevarsdottir S. Comorbidities and chance of remission in patients with early rheumatoid arthritis receiving methotrexate as first-line therapy: a Swedish observational nationwide study. RMD Open 2023; 9:e003714. [PMID: 38123483 DOI: 10.1136/rmdopen-2023-003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES This study aims to examine whether comorbidities affect the likelihood of reaching primary remission on methotrexate monotherapy as the first disease-modifying antirheumatic drug (DMARD) in early rheumatoid arthritis (RA). METHODS We used nationwide Swedish clinical and quality registers to collect RA disease activity measures and comorbidity data for patients diagnosed with RA 2007-2020 (n=11 001). The primary outcome was failure to reach 28-joint Disease Activity Score (DAS28) remission at 3 months. Secondary outcomes included Boolean, Simplified Disease Activity Index/Clinical Disease Activity Index remission, European Alliance of Associations for Rheumatology response and no swollen joint count at 3 and 6 months. For each comorbidity, and for combinations thereof, we calculated adjusted relative risks (RRs) of failure to reach remission, using modified Poisson regression. RESULTS In total, 53% (n=4019/7643) failed to reach DAS28 remission after 3 months of methotrexate monotherapy, ranging from 66% (n=25/38) among patients with chronic kidney disease to 48% (n=154/319) in patients with previous cancer. The risk of not reaching DAS28 remission at 3 months (RR adjusted for sex and age) was increased among patients with endocrine (RR 1.08, 95% CI 1.01 to 1.15), gastrointestinal (RR 1.16, 95% CI 1.03 to 1.30), infectious (RR 1.21, 95% CI 1.06 to 1.38), psychiatric (RR 1.24, 95% CI 1.15 to 1.35) and respiratory comorbidities (RR 1.16, 95% CI 1.01 to 1.32). Having three or more comorbidity categories was associated with a 27% higher risk of DAS28 remission failure at 3 months. A similar pattern was observed for the secondary outcomes. CONCLUSIONS Comorbidities decrease the chance of reaching remission on methotrexate as DMARD monotherapy in patients with early RA and are important to consider when assessing treatment outcomes.
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Affiliation(s)
- Liselotte Tidblad
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Bedeković D, Kirner D, Bošnjak I, Kibel A, Šarić S, Novak S, Prus V. The Influence of Rheumatoid Arthritis and Osteoarthritis on the Occurrence of Arterial Hypertension: An 8-Year Prospective Clinical Observational Cohort Study. J Clin Med 2023; 12:7158. [PMID: 38002770 PMCID: PMC10672072 DOI: 10.3390/jcm12227158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Rheumatoid arthritis (RA) increases the risk of cardiovascular mortality and morbidity, including a 50-60% increased risk of cardiovascular disease (CVD). Arterial hypertension (HT) is considered the major contributing risk factor for CVD development in RA patients. In this investigation, we compared the incidence and prevalence of HT between RA and osteoarthritis (OA) and the influence of HT on CVD development in CVD-naive patients in both groups. This was a prospective clinical cohort investigation with an 8-year follow-up period. A total of 201 participants, 124 with RA (investigation group) and 77 with OA (control group), without diagnosed CVD or symptomatic heart failure were included. After selection according to inclusion and exclusion criteria, both groups underwent initial and final visits, and the investigation group underwent annual visits to assess disease activity. Case report forms were completed for each visit. The obtained data were analyzed by a statistician. No difference in the incidence or prevalence of HT was found between the investigation and control groups. No difference in the prevalence of HT was reported between the study groups and age-standardized data from the general population. The investigation group had a higher incidence of CVD than the control group. RA participants with long-term remission had a marginally lower HT prevalence. Although previous studies reported a higher HT prevalence in RA than in OA and the general population, our findings did not support this. The RA group had a higher incidence of CVD, but it is possible that optimal disease control with long-term remission could reduce HT incidence and prevalence while also having beneficial effects on other cardiovascular risk factors (CV) and, consequently, CVD occurrence.
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Affiliation(s)
- Dražen Bedeković
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (D.B.); (D.K.); (A.K.); (S.Š.)
- Faculty of Medicine Osijek, Department of Internal Medicine, J. J. Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Damir Kirner
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (D.B.); (D.K.); (A.K.); (S.Š.)
- Faculty of Medicine Osijek, Department of Internal Medicine, J. J. Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Ivica Bošnjak
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (D.B.); (D.K.); (A.K.); (S.Š.)
| | - Aleksandar Kibel
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (D.B.); (D.K.); (A.K.); (S.Š.)
- Faculty of Medicine Osijek, Department of Physiology and Immunology, J. J. Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
| | - Sandra Šarić
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (D.B.); (D.K.); (A.K.); (S.Š.)
- Faculty of Medicine Osijek, Department of Internal Medicine, J. J. Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Rijeka, 51000 Rijeka, Croatia;
- Faculty of Medicine Rijeka, Department of Internal Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Višnja Prus
- Department of Rheumatology and Clinical Immunology, Internal Medicine Clinic, University Hospital Osijek J. Huttlera 4, 31000 Osijek, Croatia;
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Dutt S, Roul P, Yang Y, Johnson TM, Michaud K, Sauer B, Cannon GW, Baker JF, Curtis JR, Mikuls TR, England BR. Multimorbidity Patterns and Rheumatoid Arthritis Disease Outcomes: Findings From a Multicenter, Prospective Cohort. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25184. [PMID: 37394710 PMCID: PMC10758525 DOI: 10.1002/acr.25184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To determine whether unique multimorbidity patterns are associated with long-term rheumatoid arthritis (RA) disease severity. METHODS We conducted a cohort study within the Veterans Affairs Rheumatoid Arthritis registry. We applied previously derived multimorbidity patterns based on the presence of diagnostic codes for relevant conditions prior to enrollment using linked administrative data. Disease activity and functional status were assessed longitudinally up to 5 years after enrollment. The association of multimorbidity patterns with disease activity and functional status were assessed using generalized estimating equations models adjusting for relevant confounders. RESULTS We studied 2,956 participants, of which 88.2% were male, 76.9% reported white race, and 79.3% had a smoking history. Mental health and substance abuse (β 0.12 [95% confidence interval {CI} 0.00, 0.23]), cardiovascular (β 0.25 [95% CI 0.12, 0.38]), and chronic pain (β 0.21 [95% CI 0.11, 0.31]) multimorbidity were associated with higher Disease Activity Score in 28 joints (DAS28) scores. Mental health and substance abuse (β 0.09 [0.03, 0.15]), cardiovascular (β 0.11 [95% CI 0.04, 0.17]), and chronic pain multimorbidity (β 0.15 [95% CI 0.10, 0.20]) were also associated with higher Multidimensional Health Assessment Questionnaire (MDHAQ) scores. The metabolic pattern of multimorbidity was not associated with DAS28 or MDHAQ. The number of multimorbidity patterns present was highly associated with DAS28 and MDHAQ (P trend < 0.001), and patients with all four multimorbidity patterns had the highest DAS28 (β 0.59 [95% CI 0.36, 0.83]) and MDHAQ (β 0.27 [95% CI 0.16, 0.39]) scores. CONCLUSION Mental health and substance abuse, chronic pain, and cardiovascular multimorbidity patterns are associated with increased RA disease activity and poorer functional status. Identifying and addressing these multimorbidity patterns may facilitate achieving RA treatment targets.
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Affiliation(s)
- Sarah Dutt
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Tate M. Johnson
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE
- FORWARD, the National Data Bank for Rheumatic Disease, Wichita, KS
| | - Brian Sauer
- VA Salt Lake City & University of Utah, Salt Lake City, UT
| | | | - Joshua F. Baker
- Corporal Michael J. Crescenz VA Medical Center & University of Pennsylvania, Philadelphia, PA
| | | | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Bryant R. England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
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Hsieh SC, Tsai PH, Kuo CF, Cheng TT, Lai NS, Lin JC, Lin LH, Tsai CY. Health-related quality of life improvement by adalimumab therapy in patients with rheumatoid arthritis in Taiwan: A nationwide prospective study. J Chin Med Assoc 2023; 86:366-374. [PMID: 36692418 DOI: 10.1097/jcma.0000000000000889] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To determine the effects of adalimumab on health-related quality of life (HRQoL) in Taiwanese patients with moderate-to-severe rheumatoid arthritis (RA) (NCT02616380). METHODS During a 24-week observational period, 100 biologic-naive patients with RA received 40 mg adalimumab subcutaneously, every 2 weeks. The primary endpoint was a change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score at 24 weeks. The secondary endpoints included change in HAQ-DI at week 12, number and percentage of patients achieving a meaningful improvement in HAQ-DI at weeks 12 and 24, and changes in the 36-Item Short Form Health Survey (SF-36), EuroQol 5-dimension 3-level version (EQ-5D-3L) index, and Work Productivity and Activity Impairment (WPAI) questionnaire scores at weeks 12 and 24. RESULTS At weeks 12 and 24, mean changes in HAQ-DI from baseline were -0.34 ± 0.46 and -0.44 ± 0.59 (both p < 0.001), and clinically meaningful improvement in HAQ-DI was achieved by 60.4% and 59.6% of patients, respectively. SF-36, EQ-5D-3L index, and WPAI scores significantly improved ( p < 0.001) from baseline to weeks 12 and 24. Exploratory analyses showed diabetes was significantly associated with changes in HAQ-DI, EQ-5D-3L, and WPAI scores whereas peptic ulcer correlated with changes in the SF-36 physical component summary T-score. CONCLUSION HRQoL improved after initiation of adalimumab therapy in Taiwanese patients with moderate-to-severe RA.
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Affiliation(s)
- Song-Chou Hsieh
- Division of Rheumatology, Immunology & Allergy, Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Ping-Han Tsai
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, ROC
| | - Jing-Chi Lin
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Liang-Hung Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan, ROC
| | - Chang-Youh Tsai
- Division of Immunology and Rheumatology, Department of Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan, ROC
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Tidblad L, Westerlind H, Delcoigne B, Askling J, Saevarsdottir S. Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study. RMD Open 2022; 8:rmdopen-2022-002700. [PMID: 36564100 PMCID: PMC9791425 DOI: 10.1136/rmdopen-2022-002700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine how comorbidities in patients with early rheumatoid arthritis (RA) associate with use of different disease-modifying antirheumatic drugs (DMARDs). METHODS We used Swedish nationwide clinical and quality registers to collect comorbidity data for patients diagnosed with RA during 2006-2019 (n=13 505). We compared the use of DMARDs at diagnosis and after 1 year, in relation to comorbidity categories 5 years prior to RA diagnosis and overall comorbidity burden. For each comorbidity category, we also calculated adjusted ORs of being on treatment with other (or no) DMARDs compared with methotrexate (MTX) monotherapy 1 year after RA diagnosis. RESULTS At RA diagnosis, 68% (n=9178) of all patients were treated with MTX monotherapy, with the lowest proportion in patients with chronic kidney (CKD, 48%, n=50) and respiratory diseases (57%, n=413). At 1 year, most patients still received MTX monotherapy (<11% decrease, across all comorbidity categories). At 1 year, 13% received biological/targeted synthetic DMARDs, with the lowest proportion among patients with malignant diseases (OR=0.69, 95% CI=0.51 to 0.95). Being without DMARD at 1 year was more common among patients with CKD (OR=3.25, 95% CI=2.20 to 4.81), respiratory diseases (OR=1.83, 95% CI=1.32 to 2.53) or a history of hospitalisation due to infection (OR=1.47, 95% CI=1.23 to 1.75), and among patients with higher comorbidity burden and older age. CONCLUSION In a nationwide setting with universal healthcare, most comorbid conditions do not limit the initiation or continuation of MTX or other DMARDs in early RA, although patients with certain comorbid conditions, higher comorbidity burden and higher age were somewhat less intensively treated.
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Affiliation(s)
- Liselotte Tidblad
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Benedicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Miura T, Miyakoshi N, Kashiwagura T, Tsuchie H, Sugimura Y, Shimada Y. The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-021-00109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to assess the association of disease activity with the presence of comorbidities in patients with rheumatoid arthritis, using the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry, a multicenter, cross-sectional registry in Japan with the highest proportion of elderly people. We included 1838 patients (mean age: 66.4 years old) who visited our affiliated institutions between April 2018 and March 2019. The patients were divided into two groups based on the disease activity in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) into the remission or low disease activity group (L group) and the moderate or high disease activity group (H group). Patient demographics and comorbidities in the two groups were compared.
Results
The most common comorbidity was hypertension (33.7%), followed by renal disease (25.2%), respiratory disease (12.2%), diabetes mellitus (8.1%), cardiovascular disease (8.0%), malignancies (5.7%), and cerebrovascular disease (4.7%). The H group was older (p<0.0001); had a higher prevalence of hypertension (p<0.0001), diabetes (p=0.0011), respiratory disease (p<0.0001), cerebrovascular disease (p<0.0001), and cardiovascular disease (p=0.0030); and was less likely to use anti-rheumatic drugs. The prevalence of comorbidities other than renal disease and malignant tumor was higher in the H group. Multivariate logistic regression analysis showed that female sex (p=0.0054), advanced Steinbrocker class (p<0.0001), high anti-citrullinated protein antibody levels (p=0.0211), high prednisolone dose (p<0.0001), and absence of biologics’ or JAK inhibitors’ use (p<0.0001) were risk factors for high disease activity, and shorter treatment period was a low-risk factor for high disease activity (p=0.0041). Among comorbidities, the presence of cerebrovascular disease (p=0.0334) was the only independent risk factor for high disease activity.
Conclusions
In our registry study with a high proportion of elderly RA patients, cerebrovascular disease was associated with high disease activity in patients with RA. Therefore, when treating elderly patients with RA, we need to pay careful attention to cerebrovascular disease, and treatment should be aimed at achieving adequate control of RA.
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Gómez-Puerta JA, Sanmartí R. Rheumatoid arthritis patients "al nostro cuore". Eur J Intern Med 2022; 96:46-48. [PMID: 34916129 DOI: 10.1016/j.ejim.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- José A Gómez-Puerta
- Arthritis Unit, Rheumatology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and University of Barcelona, Barcelona, Spain.
| | - Raimon Sanmartí
- Arthritis Unit, Rheumatology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and University of Barcelona, Barcelona, Spain
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Serum Adropin Levels in Patients with Rheumatoid Arthritis. Life (Basel) 2022; 12:life12020169. [PMID: 35207457 PMCID: PMC8875108 DOI: 10.3390/life12020169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 12/13/2022] Open
Abstract
Adropin is a secretory protein that mainly modulates metabolic homeostasis and endothelial function. There is growing evidence supporting association of adropin with various inflammatory diseases, including rheumatoid arthritis (RA). This study aimed to compare serum adropin levels between 70 patients with RA and 70 matched healthy controls. Furthermore, we explored adropin correlations with RA disease activity, glucose metabolism parameters and inflammatory biomarkers. Serum adropin levels were determined by a competitive enzyme-linked immunosorbent assay. Serum adropin levels were significantly lower in RA patients than in the control group (2.85 ± 0.91 vs. 4.02 ± 0.99 ng/mL, p < 0.001). In the RA group, serum adropin levels had a significant negative correlation with total cholesterol (r = −0.172, p = 0.043), HbA1c (r = −0.406, p < 0.001), fasting glucose (r = −0.377, p < 0.001) and HOMA-IR (the homeostasis model assessment-estimated insulin resistance; (r = −0.315, p = 0.008)). Multiple linear regression analysis showed that serum adropin levels retained a significant association with levels of fasting glucose (β ± SE, −0.450 ± 0.140, p = 0.002) and HbA1c (−0.528 ± 0.223, p = 0.021) after model adjustments. These findings imply that adropin could have an impact on metabolic homeostasis in RA, although further well-designed studies are warranted in order to establish this.
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Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management. J Clin Med 2021; 10:jcm10163566. [PMID: 34441861 PMCID: PMC8396818 DOI: 10.3390/jcm10163566] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE—more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.
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Chen J, Norling LV, Cooper D. Cardiac Dysfunction in Rheumatoid Arthritis: The Role of Inflammation. Cells 2021; 10:cells10040881. [PMID: 33924323 PMCID: PMC8070480 DOI: 10.3390/cells10040881] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/25/2022] Open
Abstract
Rheumatoid arthritis is a chronic, systemic inflammatory disease that carries an increased risk of mortality due to cardiovascular disease. The link between inflammation and atherosclerotic disease is clear; however, recent evidence suggests that inflammation may also play a role in the development of nonischemic heart disease in rheumatoid arthritis (RA) patients. We consider here the link between inflammation and cardiovascular disease in the RA community with a focus on heart failure with preserved ejection fraction. The effect of current anti-inflammatory therapeutics, used to treat RA patients, on cardiovascular disease are discussed as well as whether targeting resolution of inflammation might offer an alternative strategy for tempering inflammation and subsequent inflammation-driven comorbidities in RA.
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Affiliation(s)
- Jianmin Chen
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (J.C.); (L.V.N.)
| | - Lucy V. Norling
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (J.C.); (L.V.N.)
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London EC1M 6BQ, UK
| | - Dianne Cooper
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; (J.C.); (L.V.N.)
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London EC1M 6BQ, UK
- Correspondence:
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Verma AK, Bhatt D, Goyal Y, Dev K, Beg MMA, Alsahli MA, Rahmani AH. Association of Rheumatoid Arthritis with Diabetic Comorbidity: Correlating Accelerated Insulin Resistance to Inflammatory Responses in Patients. J Multidiscip Healthc 2021; 14:809-820. [PMID: 33880030 PMCID: PMC8052128 DOI: 10.2147/jmdh.s285469] [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: 10/06/2020] [Accepted: 12/10/2020] [Indexed: 12/23/2022] Open
Abstract
Over the past two decades, with advancement of medical research and technology, treatments of many diseases including chronic disorders like rheumatoid arthritis (RA) have been revolutionized. Treatment and management of RA has been refined by advances in understanding its pathologic mechanisms, the development of drugs which target them and its association with various other chronic comorbidities like diabetes. Diabetes prevalence is closely associated with RA since elevated insulin resistance have been observed with RA. It is also associated with inflammation caused due to pro-inflammatory cytokines like tumour necrosis factor α and interleukin 6. Inflammation encourages insulin resistance and also stimulates other factors like a high level of rheumatoid factor in the blood leading to positivity of rheumatoid factor in RA patients. The degree of RA inflammation also tends to influence the criticality of insulin resistance, which increases with high activity of RA and vice versa. Markers of glucose metabolism appear to be improved by DMARDs like methotrexate, hydroxychloroquine, interleukin 1 antagonists and TNF antagonist while glucocorticoids adversely affect glycemic control especially when administered chronically. The intent of the present review paper is to understand the association between RA, insulin resistance and diabetes; the degree to which both can influence the other along with the plausible impact of RA medications on diabetes and insulin resistance.
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Affiliation(s)
- Amit K Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Deepti Bhatt
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Yamini Goyal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | | | - Mohammed A Alsahli
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
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Cui K, Movahedi M, Bombardier C, Kuriya B. Cardiovascular risk factors are negatively associated with rheumatoid arthritis disease outcomes. Ther Adv Musculoskelet Dis 2021; 13:1759720X20981217. [PMID: 33643444 PMCID: PMC7890714 DOI: 10.1177/1759720x20981217] [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: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Aims: Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but the influence of CVD risk factors on RA outcomes is limited. We examined if CVD risk factors alone are associated with RA disease activity and disability. Methods: We performed a cross-sectional analysis of participants in the Ontario Best Practices Research Initiative, RA registry. Patients were categorized into mutually exclusive CVD categories: (1) No established CVD and no CVD risk factors; (2) CVD risk factors only including ⩾1 of hypertension, dyslipidemia, diabetes, or smoking; or (3) history of established CVD event. Multivariable regression analyses examined the effect of CVD status on Disease Activity Score 28 (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire Disability Index (HAQ-DI) scores at baseline. Results: Of 2033 patients, 50% had at least 1 CVD risk factor, even in the absence of established CVD. The presence of ⩾1 CVD risk factor was independently associated with higher CDAI [β coefficient 1.59, 95% confidence interval (CI) 0.29–2.90, p = 0.02], DAS28-ESR (β coefficient 0.20, 95% CI 0.06–0.34, p = 0.01) and HAQ-DI scores (β coefficient 0.15, 95% CI 0.08–0.22, p < 0.0001). The total number of CVD risk factors displayed a dose response, as >1 CVD risk factor was associated with higher disease activity and disability, compared with having one or no CVD risk factors. Conclusion: CVD risk factors alone, or in combination, are associated with higher disease activity and disability in RA. This emphasizes the importance of risk factor recognition and management, not only to prevent CVD, but also to improve potential RA outcomes.
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Affiliation(s)
- Kangping Cui
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Bindee Kuriya
- Division of Rheumatology, Sinai Health System, University of Toronto, 60 Murray Street, Room 2-008, Toronto, Ontario M5T 3L9, Canada
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13
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Manrique-Arija S, Mena-Vazquez N, Ureña I, Rioja J, Valdivielso P, Ginel-Mendoza L, Abad-Sánchez S, Jiménez-Núñez FG, Oliver-Martos B, Fernandez-Nebro A. Cumulative inflammatory burden and obesity as determinants of insulin resistance in patients with established rheumatoid arthritis: cross-sectional study. BMJ Open 2021; 11:e044749. [PMID: 33563625 PMCID: PMC7875272 DOI: 10.1136/bmjopen-2020-044749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To describe the prevalence of insulin resistance (IR) in patients with established rheumatoid arthritis (RA) and to analyse the contribution of cumulative inflammatory burden and other factors to its development. DESIGN Observational cross-sectional study. PARTICIPANTS Patients with RA and controls matched for age, sex and Body Mass Index. We excluded patients with diabetes. SETTINGS Patients from an RA inception cohort at Hospital Regional Universitario de Málaga, Spain, were recruited between September 2016 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES IR was evaluated using the homeostasis model assessment for IR and beta-cell function and the quantitative insulin sensitivity check index. Other variables included the cumulative 28-Joint Disease Activity Score (DAS28) with C reactive protein (CRP) body composition and cytokines. Two logistic regression models were constructed to identify factors associated with IR in patients with RA. RESULTS Eighty-nine patients with RA and 80 controls were included. The prevalence of IR was similar in both cases and controls. Inflammatory activity was controlled appropriately in patients during follow-up (mean DAS28 3.1 (0.8)). The presence of IR in patients with RA was associated with obesity (OR 6.01, 95% CI 1.9 to 8.7), higher cumulative DAS28-CRP values during follow-up (OR 2.8, 95% CI 1.3 to 6.0), and higher interleukin-1β levels (OR 1.6, 95% CI 1.1 to 2.4). The second model showed that the risk of IR increased by 10% for each kilogram of excess body fat. CONCLUSION In patients with well-controlled, established RA, IR is associated mainly with poorer control of inflammation from diagnosis and with obesity, specifically total fat mass.
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Affiliation(s)
- Sara Manrique-Arija
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Mena-Vazquez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Inmaculada Ureña
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - José Rioja
- Departamento de Medicina y Dermatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- UGC de Medicina Interna, Instituto de InvestigaciónBiomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Salomé Abad-Sánchez
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain
| | - Francisco G Jiménez-Núñez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Begoña Oliver-Martos
- UGC Neurociencias, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernandez-Nebro
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
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14
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Lila AM, Gordeev AV, Olyunin YA, Galushko EA. Multimorbidity in rheumatology. From comprehensive assessment of disease to evaluation of a set of diseases. MODERN RHEUMATOLOGY JOURNAL 2019. [DOI: 10.14412/1996-7012-2019-3-4-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Li G, Chi W, Bai B, Li Y, Wei T, Fu L. Dose-response associations between metabolic indexes and the risk of comorbid type 2 diabetes mellitus among rheumatoid arthritis patients from Northern China: a case-control study. BMJ Open 2019; 9:e028011. [PMID: 31278101 PMCID: PMC6615834 DOI: 10.1136/bmjopen-2018-028011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate whether there were any differences in the patterns of metabolic abnormalities between patients with rheumatoid arthritis (RA) with comorbid type 2 diabetes mellitus (T2DM) and other populations, and to plot the dose-response relationships between metabolic indexes and the risk of comorbid T2DM among patients with RA. DESIGN AND SETTING This is a retrospective case-control study using electronic medical records (EMRs). Patients with RA and/or T2DM or controls who were admitted to the First Affiliated Hospital of China Medical University between April 2008 and December 2016 were retrospectively recruited through the EMR system. After age-matching and sex-matching, 261 controls, 274 patients with T2DM, 276 patients with RA and 151 patients with RA+T2DM were eventually recruited. RESULTS Patients with RA+T2DM exhibited higher levels of systolic blood pressure (SBP), fasting plasma glucose (FPG) and triglyceride (TG) than the RA only patients. Moreover, the proportions of impaired fasting glucose (IFG), and total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) dyslipidaemia in the RA+T2DM group were higher than those in the RA alone group (for IFG: 28.48% vs 18.84%, p=0.02; for TC: 25.17% vs 15.22%, p=0.01; for LDL-C: 25.83% vs 17.03%; p=0.03). Rheumatoid factor (RF) positivity and IFG were independent risk indicators for comorbid T2DM among patients with RA (for RF positivity: OR=0.45; 95% CI: 0.29 to 0.69; p<0.001; for IFG: OR=1.70; 95% CI: 1.04 to 2.76; p=0.03). CONCLUSION Linear dose-response associations between SBP, TC, TG and the risk of comorbid T2DM among patients with RA were observed, whereas a non-linear dose-response association between FPG and the risk of comorbid T2DM was found. Patients with RA+T2DM were more likely to exhibit metabolic abnormalities than RA only patients. Patients with RA+T2DM with metabolic abnormalities deserve more attention from rheumatologists and endocrinologists.
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Affiliation(s)
- Guangxiao Li
- Department of Medical Record Management Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Weijun Chi
- Department of Medical Record Management Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bingqing Bai
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Li
- Department of Experiment Teaching Center, School of Public Health, China Medical University, Shenyang, China
| | - Tingting Wei
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lingyu Fu
- Department of Medical Record Management Center, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Batko B, Urbański K, Świerkot J, Wiland P, Raciborski F, Jędrzejewski M, Koziej M, Cześnikiewicz-Guzik M, Guzik TJ, Stajszczyk M. Comorbidity burden and clinical characteristics of patients with difficult-to-control rheumatoid arthritis. Clin Rheumatol 2019; 38:2473-2481. [PMID: 31076943 DOI: 10.1007/s10067-019-04579-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Difficult-to-treat rheumatoid arthritis (RA) is a significant clinical problem despite no clear definition. We aimed to provide clinical characteristics and associated comorbidities of RA patients in relation to disease control. METHODS RA characteristics and physician-recorded comorbidities were analyzed in a sample of 1937 RA patients. Patients treated for RA for 5.2 y (IQR, 2.1-11.3) were classified as difficult-to-control when presenting with DAS28-ESR > 3.2 despite previous use of at least 2 csDMARDs. A comparison of demographic and RA-related characteristics between difficult-to-treat and low disease activity patients (DAS28-ESR ≤ 3.2) was performed. Comorbidity burden was assessed by calculating Rheumatic Diseases Comorbidity Index (RDCI). Logistic regression model was constructed for difficult-to-control disease. RESULTS Hypertension (46.9% (95%CI, 44.7-49.2)), coronary artery disease (CAD) (18.5% (95%CI, 16.8-20.3)), and diabetes (14.4% (95%CI, 12.9-16.0)) were the most prevalent conditions in RA patients. When compared with the adequate control group, difficult-to-control patients were increasingly burdened with hypertension (52.7% (95%CI, 47.5-57.8) vs. 42.0% (95%CI, 36.6-47.6); p = 0.006), cardiovascular diseases (24.2% (95%CI, 20.1-28.9) vs. 11.1% (95%CI, 8.0-15.1); p < 0.001), respiratory system diseases (7.0% (95%CI, 4.8-10.2) vs. 3.3% (95%CI, 1.8-5.9); p = 0.03) and gastroduodenal ulcers (2.3% (95%CI, 1.2-4.4) vs. 0.3% (95%CI, 0.1-1.8); p = 0.04). Patients with higher RDCI had lower chance to obtain low disease activity (OR 0.69 (95%CI, 0.61-0.79); p < 0.001). In multivariate analysis, RDCI was independently associated with difficult-to-control disease (OR 1.46 (95%CI, 1.21-1.76); p < 0.001). CONCLUSIONS RA patients suffer from a variety of comorbidities. Cardiovascular and respiratory system diseases occur twice as often in difficult-to-control patients. RDCI may provide a valuable tool in evaluating a risk for difficult-to-control RA. Key Points • Hypertension, coronary artery disease and diabetes are the most prevalent comorbidities in rheumatoid arthritis. • Cardiovascular and respiratory tract diseases as well as gastroduodenal ulcers are more common among difficult-to-control patients, when compared with subjects with adequately controlled RA. • Rheumatic Diseases Comorbidity Index is an independent predictor for difficult-to-control RA.
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Affiliation(s)
- Bogdan Batko
- Department of Rheumatology, J. Dietl Specialist Hospital, 1 Skarbowa St, 31-121, Krakow, Poland.
| | - Karol Urbański
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University School of Medicine, Krakow, Poland
| | - Marta Cześnikiewicz-Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland.,Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Tomasz J Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland.,BHF Centre of Research Excellence, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marcin Stajszczyk
- Rheumatology and Autoimmune Diseases Department, Silesian Rheumatology Center, Ustron, Poland
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Xu Y, Zhu W, Wang T, Jin L, Liu T, Li X, Guan Z, Jiang Z, Meng X, Wang J, Guo Y. Low molecule weight fucoidan mitigates atherosclerosis in ApoE (-/-) mouse model through activating multiple signal pathway. Carbohydr Polym 2019; 206:110-120. [PMID: 30553304 DOI: 10.1016/j.carbpol.2018.10.097] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/11/2018] [Accepted: 10/27/2018] [Indexed: 12/31/2022]
Abstract
Atherosclerosis (AS) is a chronic inflammatory disease, and many factors are implicated in its progression. This work aims to study the preventive effects and the regulatory mechanism of low-molecular-weight fucoidan (LMWF), which is obtained from Saccharina japonica, on the development of AS. Serum biochemical indices and pathological analyses were determined via ELISA, hematoxylin and eosin (HE) and Oil Red O staining. These results indicated that LMWF ameliorated areas with atherosclerotic lesions and had a significant antioxidant effect. Anticoagulant assays showed that LMWF might serve as a potential anticoagulation drug for inhibiting the formation of atherothrombosis. Double immunofluorescence staining illustrated that LMWF inhibited both SMC proliferation and migration and macrophage formation and differentiation. A molecular biology experiment showed that LMWF exhibited an apparent regulatory effect on various signaling pathways. In conclusion, our results revealed that LMWF mitigated AS in the ApoE (-/-) mouse model by activating multiple signal pathways.
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Affiliation(s)
- Yingjie Xu
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Wenlong Zhu
- Business School, Qingdao University of Technology, Qingdao, 266520, China
| | - Tingting Wang
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Liying Jin
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Tianwei Liu
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Xu Li
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Zijiao Guan
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Zhifeng Jiang
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Xianze Meng
- Department of Integrated Traditional Chinese and Western Medicine, No. 401 Hospital of People's Liberation Army, Qingdao, 266000, China
| | - Jigang Wang
- Department of pathology, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yunliang Guo
- Institute of Cerebrovascular Diseases, Affiliated Hospital of Qingdao University, Qingdao 266003, China.
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Luque Ramos A, Redeker I, Hoffmann F, Callhoff J, Zink A, Albrecht K. Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey. J Rheumatol 2019; 46:564-571. [PMID: 30647170 DOI: 10.3899/jrheum.180668] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the prevalence of comorbidities in a population-based cohort of persons with rheumatoid arthritis (RA) compared to matched controls and to examine their association with patient-reported outcomes in a survey sample. METHODS Data of 96,921 persons with RA [International Classification of Diseases, 10th ed (ICD-10) M05/M06] and 484,605 age- and sex-matched controls without RA of a German statutory health fund were studied regarding 26 selected comorbidities (ICD-10). A self-reported questionnaire, comprising joint counts [(tender joint count (TJC), swollen joint count (SJC)], functional status (Hannover Functional Ability Questionnaire), effect of the disease (Rheumatoid Arthritis Impact of Disease), and well-being (World Health Organization 5-item Well-Being Index; WHO-5) was sent to a random sample of 6193 persons with RA, of whom 3184 responded. For respondents who confirmed their RA (n = 2535), associations between comorbidities and patient-reported outcomes were analyzed by multivariable linear regression. RESULTS Compared to controls, all investigated comorbidities were more frequent in persons with RA (mean age 63 yrs, 80% female). In addition to cardiovascular risk factors, the most common were osteoarthritis (44% vs 21%), depression (32% vs 20%), and osteoporosis (26% vs 9%). Among the survey respondents, 87% of those with 0-1 comorbidity but only 77% of those with ≥ 8 comorbidities were treated by rheumatologists. Increasing numbers of comorbidities were associated with poorer values for TJC, SJC, function, and WHO-5. CONCLUSION Compared to a matched population, persons with RA present with increased prevalence of numerous comorbidities. Patients with RA and multimorbidity are at risk of insufficient rheumatological care and poorer patient-reported outcomes.
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Affiliation(s)
- Andres Luque Ramos
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany. .,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre.
| | - Imke Redeker
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Falk Hoffmann
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Johanna Callhoff
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Angela Zink
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Katinka Albrecht
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
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Bartoloni E, Alunno A, Valentini V, Luccioli F, Valentini E, La Paglia GMC, Leone MC, Cafaro G, Marcucci E, Gerli R. Targeting Inflammation to Prevent Cardiovascular Disease in Chronic Rheumatic Diseases: Myth or Reality? Front Cardiovasc Med 2018; 5:177. [PMID: 30619884 PMCID: PMC6297850 DOI: 10.3389/fcvm.2018.00177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/29/2018] [Indexed: 01/10/2023] Open
Abstract
Evidence for increased risk of cardiovascular morbidity and mortality in chronic inflammatory rheumatic diseases has accumulated during the last years. Traditional cardiovascular risk factors contribute in part to the excess of cardiovascular risk in these patients and several mechanisms, including precocious acceleration of subclinical atherosclerotic damage, inflammation, and immune system deregulation factors, have been demonstrated to strictly interplay in the induction and progression of atherosclerosis. In this setting, chronic inflammation is a cornerstone of rheumatic disease pathogenesis and exerts also a pivotal role in all stages of atherosclerotic damage. The strict link between inflammation and atherosclerosis suggests that cardiovascular risk may be reduced by rheumatic disease activity control. There are data to suggest that biologic therapies, in particular TNFα antagonists, may improve surrogate markers of cardiovascular disease and reduce CV adverse outcome. Thus, abrogation of inflammation is considered an important outcome for achieving not only control of rheumatic disease, but also reduction of cardiovascular risk. However, the actual effect of anti-rheumatic therapies on atherosclerosis progression and CV outcome in these patients is rather uncertain due to great literature inconsistency. In this paper, we will summarize some of the main mechanisms linking the inflammatory pathogenic background underlying rheumatic diseases and the vascular damage observed in these patients, with a particular emphasis on the pathways targeted by currently available therapies. Moreover, we will analyze current evidence on the potential atheroprotective effects of these treatments on cardiovascular outcome pointing out still unresolved questions.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Valentina Valentini
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Filippo Luccioli
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Eleonora Valentini
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | | | - Maria Comasia Leone
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
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20
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Kasai S, Sakai R, Koike R, Kohsaka H, Miyasaka N, Harigai M. Higher risk of hospitalized infection, cardiovascular disease, and fracture in patients with rheumatoid arthritis determined using the Japanese health insurance database. Mod Rheumatol 2018; 29:788-794. [DOI: 10.1080/14397595.2018.1519889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Shoko Kasai
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoko Sakai
- Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Department of Rheumatology, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ryuji Koike
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Masayoshi Harigai
- Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Department of Rheumatology, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
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21
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Romano S, Salustri E, Ruscitti P, Carubbi F, Penco M, Giacomelli R. Cardiovascular and Metabolic Comorbidities in Rheumatoid Arthritis. Curr Rheumatol Rep 2018; 20:81. [DOI: 10.1007/s11926-018-0790-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Caporali R, Crepaldi G, Codullo V, Benaglio F, Monti S, Todoerti M, Montecucco C. 20 years of experience with tumour necrosis factor inhibitors: what have we learned? Rheumatology (Oxford) 2018; 57:vii5-vii10. [DOI: 10.1093/rheumatology/key059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Roberto Caporali
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Veronica Codullo
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Francesca Benaglio
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Sara Monti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Monica Todoerti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia
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Conti F, Atzeni F, Massaro L, Chiara Gerardi M, Gremese E, Passiu G, Carletto A, Malavolta N, Foti R, Ramonda R, Sarzi-Puttini P. The influence of comorbidities on the efficacy of tumour necrosis factor inhibitors, and the effect of tumour necrosis factor inhibitors on comorbidities in rheumatoid arthritis: report from a National Consensus Conference. Rheumatology (Oxford) 2018; 57:vii11-vii22. [DOI: 10.1093/rheumatology/key209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Fabrizio Conti
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome
| | | | - Laura Massaro
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome
| | | | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Gemelli, Catholic University of the Sacred Heart, Rome
| | - Giuseppe Passiu
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, University Hospital, Verona
| | - Nazzarena Malavolta
- Gestione delle Malattie Reumatiche, Connettivo e Malattie Metaboliche dell’Osso AOU di Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Rosario Foti
- Rheumatology Unit A.O.U. Policlinico V.E. Catania
| | - Roberta Ramonda
- Department of Rheumatology, University of Padova, Padova, Italy
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Muñoz-Fernández S, Otón-Sánchez T, Carmona L, Calvo-Alén J, Escudero A, Narváez J, Rodríguez Heredia JM, Romero Yuste S, Vela P, Luján Valdés S, Royo García A, Baquero JL. Use of prognostic factors of rheumatoid arthritis in clinical practice and perception of their predictive capacity before and after exposure to evidence. Rheumatol Int 2018; 38:2289-2296. [DOI: 10.1007/s00296-018-4152-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/01/2018] [Indexed: 01/01/2023]
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25
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Cardoso PRG, Matias KA, Dantas AT, Marques CDL, Pereira MC, Duarte ALBP, Rego MJBDM, Pitta IDR, Pitta MGDR. Losartan, but not Enalapril and Valsartan, Inhibits the Expression of IFN-γ, IL-6, IL-17F and IL-22 in PBMCs from Rheumatoid Arthritis Patients. Open Rheumatol J 2018; 12:160-170. [PMID: 30288187 PMCID: PMC6151964 DOI: 10.2174/1874312901812010160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/27/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Rheumatoid Arthritis (RA) is a chronic and inflammatory disease that affects about 1% of the world's population. Almost 70% of RA patients have a cardiovascular disease such as Systemic Arterial Hypertension (SAH). Inflammatory cytokines are clearly involved in the pathogenesis of RA and correlated with SAH. Objective: It is necessary to understand whether the antihypertensive drugs have a dual effect as immunomodulators and which one is the best choice for RA SAH patients. Methods: Peripheral Blood Mononuclear Cells (PBMCs) from 16 RA patients were purified and stimulated or not stimulated with anti-CD3 and anti-CD28 mAB and were treated with Enalapril, Losartan and Valsartan at 100μM. Patients were evaluated for clinical and laboratory variables including measures of disease activity by Clinical Disease Activity Index (CDAI) and Disease Activity Score (DAS28). Cytokines were quantified by ELISA sandwich. Results: Losartan was able to reduce levels of IFN-γ (p = 0.0181), IL-6 (p = 0.0056), IL-17F (0.0046) and IL-22 (p = 0.0234) in RA patients. In addition, patients in remission and mild score (DAS28<3.2 and CDAI<10) had a better response to treatment. On the other hand, patients in moderate and severe activity had poor response to Losartan in cytokine inhibition. Conclusion: PBMCs from RA patients are responsive in inhibiting proinflammatory cytokines using Losartan better than Enalapril and Valsartan and it could be a better antihypertensive choice for patients with RA and systemic arterial hypertension treatment.
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Affiliation(s)
- Pablo R G Cardoso
- Laboratory of Immunomodulation and New Therapeutic Approaches (LINAT), Nucleus of Research in Immunomodulation and New Therapeutic Approaches Suely Galdino (Nupit SG), Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Katherine A Matias
- Laboratory of Immunomodulation and New Therapeutic Approaches (LINAT), Nucleus of Research in Immunomodulation and New Therapeutic Approaches Suely Galdino (Nupit SG), Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Andrea T Dantas
- Rheumatology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - Claudia D L Marques
- Rheumatology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - Michelly C Pereira
- Laboratory of Immunomodulation and New Therapeutic Approaches (LINAT), Nucleus of Research in Immunomodulation and New Therapeutic Approaches Suely Galdino (Nupit SG), Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Angela L B P Duarte
- Rheumatology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - Moacyr Jesus Barreto de Melo Rego
- Laboratory of Immunomodulation and New Therapeutic Approaches (LINAT), Nucleus of Research in Immunomodulation and New Therapeutic Approaches Suely Galdino (Nupit SG), Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Ivan da Rocha Pitta
- Laboratory of Immunomodulation and New Therapeutic Approaches (LINAT), Nucleus of Research in Immunomodulation and New Therapeutic Approaches Suely Galdino (Nupit SG), Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Maira Galdino da Rocha Pitta
- Laboratory of Immunomodulation and New Therapeutic Approaches (LINAT), Nucleus of Research in Immunomodulation and New Therapeutic Approaches Suely Galdino (Nupit SG), Federal University of Pernambuco (UFPE), Recife, Brazil
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Risk of adverse outcomes in patients with rheumatoid arthritis hospitalized for stroke-a cross-sectional study. Clin Rheumatol 2018; 37:2917-2926. [PMID: 30209695 DOI: 10.1007/s10067-018-4287-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
Specific data regarding the full range of stroke outcomes among patients with rheumatoid arthritis (RA) are lacking. This study aimed to investigate outcomes in RA patients hospitalized for a stroke. The study retrieved data from the Taiwan Longitudinal Health Insurance Database 2005. We identified 26,336 patients who were hospitalized for stroke treatment. Of these patients, 736 patients with a prior diagnosis of RA before the index hospitalization were selected as the study group. We selected 2208 age-sex-matched patients without RA as the comparison group. We performed conditional logistic regressions to calculate odds ratios (ORs) for in-hospital mortality and secondary diagnoses of pneumonia, urinary tract infections (UTIs), peptic ulcers, acute respiratory failure, and the use of mechanical ventilation to compare RA patients and comparison patients. We also compared the length of stay (LOS) and hospitalization costs between patients with RA and comparison patients. We found that RA patients had a significantly increased risk of peptic ulcer during the stroke hospitalization (OR = 1.52, 95% CI = 1.05-2.20). However, there were no significant differences between patients with RA and comparison patients in terms of in-hospital mortality, pneumonia, UTIs, acute respiratory failure, or the use of mechanical ventilation. Furthermore, the LOS of stroke hospitalization did not differ between the two groups. We concluded that RA patients hospitalized for a stroke do not have a significantly different risk of in-hospital mortality, pneumonia, UTIs, and mechanical ventilator use, but they have a higher risk of peptic ulcers. Additionally, among patients with a subarachnoid/intracerebral hemorrhagic stroke, RA patients were more likely to have received mechanical ventilation than comparison patients (adjusted OR = 1.89, 95% CI = 1.14-3.15).
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Oxidized low density lipoproteins: The bridge between atherosclerosis and autoimmunity. Possible implications in accelerated atherosclerosis and for immune intervention in autoimmune rheumatic disorders. Autoimmun Rev 2018; 17:366-375. [DOI: 10.1016/j.autrev.2017.11.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023]
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Armagan B, Sari A, Erden A, Kilic L, Erdat EC, Kilickap S, Kiraz S, Bilgen SA, Karadag O, Akdogan A, Ertenli I, Kalyoncu U. Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity: Single center real life results. Medicine (Baltimore) 2018; 97:e9930. [PMID: 29595700 PMCID: PMC5895384 DOI: 10.1097/md.0000000000009930] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to assess the frequency of comorbidities and multimorbidities in rheumatoid arthritis (RA) patients under biologic therapy and their effects on biological disease modifying antirheumatic drugs (DMARDs) choice, timing, and response.Hacettepe University Biologic Registry (HUR-BIO) is single center biological DMARD registry. Cardiovascular, infectious, cancer, and other comorbidities were recorded with face to face interviews. Multimorbidity is defined as >1 comorbidity. Disease duration, initial date of biological DMARDs, initial and overall biological DMARD choice were recorded. Disease activity score-28 (DAS-28) responses were compared to comorbidity presence and multimorbidity.Total of 998 RA patients were enrolled into the study. The mean age was 53.1 (12.5) and mean disease duration (standard deviation [SD]) was 11.7 (7.5) years. At least 1 comorbidity was detected in 689 (69.1%) patients, 375 (37.9%) patients had multimorbidity. Patients had mean 1.36 ± 1.32 comorbidity. The median durations of first biological DMARDs prescription were 60 (3-552) months after RA diagnosis. For multimorbidity patients, the median first biological prescription duration was longer than the duration for patients without multimorbidity (72 [3-552] vs 60 [3-396] months, P < .001). The physicians prescribe tumor necrosis factor inhibitor (TNFi) biological drugs less frequently than other biological DMARDs in patients with at least 1 comorbidity (66.2% vs 74.5%, P = .007) or multimorbidity (34.6% vs 43.5%, P = .006). Patients with comorbidities and multimorbidity achieved DAS-28 remission less frequently than patients without comorbidity (31.6% vs 42.6%, P = .012 and 27.2% vs 39.7%, P = .001, respectively).In real life, physicians may postpone to prescribe biological DMARDs and less frequently choose TNFi biological drugs in patients with multimorbidity. Furthermore, comorbidity may have a negative effect on the treatment response.
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Affiliation(s)
| | | | | | | | | | - Saadettin Kilickap
- Division of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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29
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Aslam F, Khan NA. Tools for the Assessment of Comorbidity Burden in Rheumatoid Arthritis. Front Med (Lausanne) 2018; 5:39. [PMID: 29503820 PMCID: PMC5820312 DOI: 10.3389/fmed.2018.00039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/02/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Comorbidities influence the prognosis, clinical outcomes, disease activity, and treatment response in rheumatoid arthritis (RA). RA patients have a high-comorbidity burden necessitating their study. Comorbidity indices are used to measure comorbidities and to study their impacts on different outcomes. A large number of such indices are used in clinical research. Some indices have been specifically developed in RA patients. Aim This review aims to provide an overview of generic and specific comorbidity indices commonly used in RA research. Methods We performed a critical literature review of comorbidity indices in RA using the PubMed database. Results/discussion This non-systematic literature review provides an overview of generic and specific comorbidity indices commonly used in RA studies. Some of the older but commonly used comorbidity indices like the Charlson comorbidity index and the Elixhauser comorbidity measure were primarily developed to estimate mortality risk from comorbid diseases. They were not specifically developed for RA patients but have been widely used in rheumatology comorbidity measurement. Of the many comorbidity indices available, only the rheumatic disease comorbidity index (RDCI) and the multimorbidity index have been specifically developed in RA patients. The functional comorbidity index was developed to look at functional disability and has been used in RA patients considering that morbidity is more important than mortality in such patients. While there is limited data comparing these indices, available evidence seems to favor the use of RDCI as it predicts mortality, hospitalization, disability, and healthcare utilization. The choice of the index, however, depends on several factors such as the population under study, outcome of interest, and sources of data. More research is needed to study the RA-specific comorbidity measures to make evidence-based recommendations for the choice of a comorbidity measure.
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Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ, United States
| | - Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences & Central Arkansas Veterans Health Care System, Little Rock, AR, United States
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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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Ruscitti P, Margiotta DPE, Macaluso F, Iacono D, D’Onofrio F, Emmi G, Atzeni F, Prete M, Perosa F, Sarzi-Puttini P, Emmi L, Cantatore FP, Triolo G, Afeltra A, Giacomelli R, Valentini G. Subclinical atherosclerosis and history of cardiovascular events in Italian patients with rheumatoid arthritis: Results from a cross-sectional, multicenter GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Medicine (Baltimore) 2017; 96:e8180. [PMID: 29049200 PMCID: PMC5662366 DOI: 10.1097/md.0000000000008180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Several studies have pointed out a significant association between rheumatoid arthritis (RA) and accelerated atherosclerosis. At the best of our knowledge, no such study has been carried out in a large Italian series and, in this study, we aimed to investigate the prevalence of both subclinical atherosclerosis and history of cardiovascular events (CVEs), in patients consecutively admitted from January 1, 2015 to December 31, 2015 to Rheumatology Units throughout the whole Italy.Centers members of GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) were invited to enrol patients consecutively admitted from January 1, 2015 to December 31, 2015 and satisfying American College of Rheumatology/ European League Against Rheumatism criteria for RA and to investigate each of them for: traditional cardiovascular risk factors: sex, age, smoking habit, total cholesterol, triglycerides, glycaemia, high blood pressure, metabolic syndrome (MS), type 2 diabetes (T2D); RA features: disease duration as assessed from the first symptom, disease activity as evaluated by DAS28, radiographic damage as assessed by hands and feet x-ray, and previous joint surgery; prevalence of both subclinical atherosclerosis and history of CVEs.Eight centers participated to the study. From January 1, 2015 to December 31, 2015, the 1176 patients, who had been investigated for all the items, were enrolled in the study. They were mostly women (80.52%), with a median age of 60 years (range, 18-91 years), a median disease duration of 12 years (range, 0.8-25 years), seropositive in 69.21%. Nineteen percent were in remission; 17.51% presented low disease activity; 39.45% moderate disease activity; 22.61% high disease activity.Eighty-two patients (6.9%) had a history for CVEs (58 myocardial infarction, 38 heart failure, 10 ischemic transitory attack, and 7 stroke). This figure appears to be lower than that reported worldwide (8.5%). After excluding the 82 patients with a history of CV events, subclinical atherosclerosis was detected in 16% of our patients, (176 patients), a figure lower than that reported worldwide (32.7%) and in previous Italian studies.This is the first Italian multicenter study on subclinical and clinical atherosclerosis in patients with RA. We pointed out a low prevalence of both subclinical atherosclerosis and history of CV events.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila
| | | | - Federica Macaluso
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo
| | - Daniela Iacono
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples
| | - Francesca D’Onofrio
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Fabiola Atzeni
- Rheumatology Section, L. Sacco University Hospital, Milan
| | - Marcella Prete
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Federico Perosa
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | | | - Lorenzo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Francesco Paolo Cantatore
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia
| | - Giovanni Triolo
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo
| | - Antonella Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome
| | - Roberto Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila
| | - Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples
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Ruscitti P, Ursini F, Cipriani P, Ciccia F, Liakouli V, Carubbi F, Guggino G, Berardicurti O, Grembiale R, Triolo G, De Sarro G, Giacomelli R. Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis: Results from a cross-sectional study. Medicine (Baltimore) 2017; 96:e7896. [PMID: 28834907 PMCID: PMC5572029 DOI: 10.1097/md.0000000000007896] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 02/04/2023] Open
Abstract
Although the better management of rheumatoid arthritis (RA) has significantly improved the long-term outcome of affected patients, a significant proportion of these may develop associated comorbidities including cardiometabolic complications. However, it must be pointed out that a comprehensive cardiometabolic evaluation is still poorly integrated into the management of RA patients, due to a limited awareness of the problem, a lack of appropriate clinical studies, and optimal strategies for cardiovascular (CV) risk reduction in RA. In addition, although several studies investigated the possible association between traditional CV risk factors and RA, conflicting results are still available.On this basis, we planned this cross-sectional study, aimed at investigating the prevalence of type 2 diabetes (T2D) and impaired fasting glucose (IFG) in RA patients compared with age- and gender- matched control individuals. Furthermore, we analyzed the role of both traditional and RA-related CV risk factors in predicting T2D and IFG.We observed an increased prevalence of T2D in RA patients when compared with age- and gender-matched controls. Regression analyses demonstrated that the presence of high blood pressure (HBP), a longer disease duration, and exposure to corticosteroids (CCS) were significantly associated with an increased likelihood of being classified as T2D. In addition, we observed an increased prevalence of IFG in RA patients when compared with age- and gender-matched controls. Regression analyses demonstrated that a higher body mass index (BMI), the presence of metabolic syndrome (MetS), higher levels of total cholesterol, the presence of radiographic damage, and higher serum levels of C-reactive protein (CRP) were significantly associated with an increased likelihood of presenting IFG.In this cross-sectional study, we observed an increased prevalence of T2D and IFG in an Italian cohort of RA patients when compared with age- and gender-matched control individuals. Interestingly, both RA-specific features, such as disease duration, CCS exposure, and radiographic damage, and traditional CV risk factors, such as HBP and MetS, were significantly associated with glucose metabolism abnormalities.
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Affiliation(s)
- Piero Ruscitti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro
| | - Paola Cipriani
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila
| | - Francesco Ciccia
- Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Vasiliki Liakouli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila
| | - Francesco Carubbi
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila
| | - Giuliana Guggino
- Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Onorina Berardicurti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila
| | | | - Giovanni Triolo
- Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | | | - Roberto Giacomelli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila
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Ruscitti P, Ursini F, Cipriani P, Liakouli V, Carubbi F, Berardicurti O, De Sarro G, Giacomelli R. Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study. PLoS One 2017; 12:e0181203. [PMID: 28704564 PMCID: PMC5507528 DOI: 10.1371/journal.pone.0181203] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Despite of the European League Against Rheumatism (EULAR) provided different sets of recommendations for the management of cardiovascular risk in inflammatory arthritis patients, it must be pointed out that cardiometabolic comorbidity, such as type 2 diabetes (T2D), remains still underdiagnosed and undertreated in patients affected by rheumatoid arthritis (RA). METHODS In this work, we designed a single centre, prospective study in order to better investigate the occurrence of T2D during the course of 1 year of follow-up. Furthermore, we evaluated the role of both traditional cardiovascular and RA-specific related risk factors to predict the occurrence of new T2D. RESULTS In this study, we evaluated 439 consecutive RA patients and we observed that 7.1% of our patients (31/439) developed T2D, after 12 month of prospective follow-up. The regression analysis showed that the presence of high blood pressure, the impaired fasting glucose (IFG) at the first observation and the poor EULAR-DAS28 response, after 12 months of follow-up, were significantly associated with an increased likelihood of being classified as T2D. Similarly, we observed that 7.7% of our patients (34/439) showed IFG after 12 months of prospective follow-up. The regression analysis showed that the presence of high blood pressure and the poor EULAR-DAS28 response after 12 months of follow-up, were significantly associated with an increased likelihood of showing IFG. CONCLUSIONS Our study supports the hypothesis of a significant short-term risk of T2D in RA patients and of a close associations between uncontrolled disease activity and glucose metabolism derangement. Further multicentre, randomised-controlled studies are surely needed in order to elucidate these findings and to better ascertain the possible contribution of different therapeutic regimens to reduce this risk.
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Affiliation(s)
- Piero Ruscitti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Paola Cipriani
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vasiliki Liakouli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Carubbi
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Onorina Berardicurti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Roberto Giacomelli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Johnson KW, Shameer K, Glicksberg BS, Readhead B, Sengupta PP, Björkegren JLM, Kovacic JC, Dudley JT. Enabling Precision Cardiology Through Multiscale Biology and Systems Medicine. ACTA ACUST UNITED AC 2017; 2:311-327. [PMID: 30062151 PMCID: PMC6034501 DOI: 10.1016/j.jacbts.2016.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/20/2022]
Abstract
The traditional paradigm of cardiovascular disease research derives insight from large-scale, broadly inclusive clinical studies of well-characterized pathologies. These insights are then put into practice according to standardized clinical guidelines. However, stagnation in the development of new cardiovascular therapies and variability in therapeutic response implies that this paradigm is insufficient for reducing the cardiovascular disease burden. In this state-of-the-art review, we examine 3 interconnected ideas we put forth as key concepts for enabling a transition to precision cardiology: 1) precision characterization of cardiovascular disease with machine learning methods; 2) the application of network models of disease to embrace disease complexity; and 3) using insights from the previous 2 ideas to enable pharmacology and polypharmacology systems for more precise drug-to-patient matching and patient-disease stratification. We conclude by exploring the challenges of applying a precision approach to cardiology, which arise from a deficit of the required resources and infrastructure, and emerging evidence for the clinical effectiveness of this nascent approach.
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Affiliation(s)
- Kipp W Johnson
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khader Shameer
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin S Glicksberg
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ben Readhead
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Partho P Sengupta
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johan L M Björkegren
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Biochemistry and Biophysics Vascular Biology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joel T Dudley
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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35
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Chen HM, Chen CM. Factors Associated with Quality of Life Among Older Adults with Chronic Disease in Taiwan. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study. PLoS One 2017; 12:e0170108. [PMID: 28103312 PMCID: PMC5245879 DOI: 10.1371/journal.pone.0170108] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022] Open
Abstract
Objectives Several studies showed the close relationship between Rheumatoid Arthritis (RA) and cerebro-cardiovascular events (CVEs) and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV) and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis. Methods We designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis. Results We enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH), type 2 diabetes mellitus and metabolic syndrome (MS), at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis. Conclusions Our study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.
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Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry. Clin Rheumatol 2017; 36:753-761. [DOI: 10.1007/s10067-016-3528-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022]
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Pretorius E, Akeredolu OO, Soma P, Kell DB. Major involvement of bacterial components in rheumatoid arthritis and its accompanying oxidative stress, systemic inflammation and hypercoagulability. Exp Biol Med (Maywood) 2016; 242:355-373. [PMID: 27889698 PMCID: PMC5298544 DOI: 10.1177/1535370216681549] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We review the evidence that infectious agents, including those that become dormant within the host, have a major role to play in much of the etiology of rheumatoid arthritis and the inflammation that is its hallmark. This occurs in particular because they can produce cross-reactive (auto-)antigens, as well as potent inflammagens such as lipopolysaccharide that can themselves catalyze further inflammagenesis, including via β-amyloid formation. A series of observables coexist in many chronic, inflammatory diseases as well as rheumatoid arthritis. They include iron dysregulation, hypercoagulability, anomalous morphologies of host erythrocytes, and microparticle formation. Iron dysregulation may be responsible for the periodic regrowth and resuscitation of the dormant bacteria, with concomitant inflammagen production. The present systems biology analysis benefits from the philosophical idea of "coherence," that reflects the principle that if a series of ostensibly unrelated findings are brought together into a self-consistent narrative, that narrative is thereby strengthened. As such, we provide a coherent and testable narrative for the major involvement of (often dormant) bacteria in rheumatoid arthritis.
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Affiliation(s)
- Etheresia Pretorius
- 1 Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, Pretoria 0007, South Africa
| | - Oore-Ofe Akeredolu
- 1 Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, Pretoria 0007, South Africa
| | - Prashilla Soma
- 1 Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, Pretoria 0007, South Africa
| | - Douglas B Kell
- 2 School of Chemistry, The University of Manchester, Manchester, M13 9PL, UK.,3 The Manchester Institute of Biotechnology, The University of Manchester, Manchester, M1 7DN, UK.,4 Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, Manchester, M1 7DN, UK
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Wu H, Wang K, Wang H, Chen F, Huang W, Chen Y, Chen J, Tao J, Wen X, Xiong S. Novel self-assembled tacrolimus nanoparticles cross-linking thermosensitive hydrogels for local rheumatoid arthritis therapy. Colloids Surf B Biointerfaces 2016; 149:97-104. [PMID: 27736727 DOI: 10.1016/j.colsurfb.2016.10.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/26/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
Abstract
The aim was to explore the potential application of novel self-assembled nanoparticles cross-linking thermosensitive hydrogels composed of polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol (Soluplus) and tacrolimus (FK-506) for local therapy of rheumatoid arthritis (RA). The sol-gel transition temperature (Tsol-gel), gelation time, rheological behaviors, in vitro release, in vivo gelation and retention, and therapeutic efficacy against adjuvant-induced arthritis (AIA) rats were compared between the Soluplus hydrogels and widely studied poloxamer 407 (P407) delivery systems. In sol, the spherical and uniform FK506 loaded Soluplus nanoparticles (Soluplus-SNPs) were self-assembled with encapsulation efficiency of 99.5±1.5% and particle size of 73.9±2.9nm. The decreased Tsol-gel of Soluplus-SNPs hydrogels was associated with the addition of salts, elevation of pH and ionic strength. The optimal Tsol-gel of Soluplus-SNPs with concentrations of 10%-30% in phosphate buffer (50mM, pH 7.4) was from 37.4±0.1°C to 32.8±0.3°C and the gelation time was not greater than 2min. Soluplus-SNPs gelling systems showed lower viscosity and wider range concentrations in sol state at 25°C and stronger gel strength at 37°C than P407, which resulting in longer sustained release of FK506 but without burst-release in vitro, and longer retention time in the local injection site in vivo. The therapeutic efficacy to treat AIA rats was significantly enhanced from d10 to d17 after a single dose of FK506 loaded in 10% and 20% Soluplus-SNPs hydrogels. In conclusion, Soluplus-SNPs hydrogel is a potential sustainable delivery system for FK506 to treat RA locally.
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Affiliation(s)
- Huimin Wu
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Kaiyuan Wang
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Hanning Wang
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Fang Chen
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Wencong Huang
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Yuqi Chen
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Jiali Chen
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Jin Tao
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China
| | - Xiaoguang Wen
- Overseas Pharmaceuticals, Ltd, China Medical City, Taizhou, 225300, PR China
| | - Subin Xiong
- College of Pharmaceutical Sciences, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, 310032, PR China.
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Autoimmune atherosclerosis in 3D: How it develops, how to diagnose and what to do. Autoimmun Rev 2016; 15:756-69. [DOI: 10.1016/j.autrev.2016.03.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
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41
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Lazúrová I, Tomáš Ľ. Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment. Clin Rev Allergy Immunol 2016; 52:323-332. [DOI: 10.1007/s12016-016-8566-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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