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González-Gay MÁ, Castañeda S, Ferraz-Amaro I. Metabolic Syndrome: A Predisposing Factor for Rheumatoid Arthritis. J Rheumatol 2024; 51:329-331. [PMID: 38302172 DOI: 10.3899/jrheum.2023-1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Miguel Á González-Gay
- M.A. González-Gay, MD, PhD, Medicine and Psychiatry Department, University of Cantabria, Santander, and Division of Rheumatology, IIS-Fundación Jiménez Díaz, Madrid;
| | - Santos Castañeda
- S. Castañeda, MD, PhD, Division of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid
| | - Iván Ferraz-Amaro
- I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias, and Department of Internal Medicine, Universidad de La Laguna, Tenerife, Spain
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Qiu F, Li J, Gan L, Legerlotz K. Arthritis prevalence is associated with metabolic syndrome risk factors but not with physical activity in middle-aged and older patients - a cross-sectional study. BMC Geriatr 2024; 24:242. [PMID: 38459429 PMCID: PMC10924363 DOI: 10.1186/s12877-024-04859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND In light of the aging population, increasingly suffering from the metabolic syndrome (MS), strategies need to be developed to address global public health challenges known to be associated with MS such as arthritis. As physical activity (PA) may play a crucial role in tackling those challenges, this study aimed to determine the association between the number of MS risk factors, PA and arthritis in people ≥ 50 years old. METHODS Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used to estimate the prevalence of arthritis and MS risk factors in the European population ≥ 50 years and to evaluate the associations between MS risk factors, PA and arthritis. Binary logistic regression was performed to calculate the odds ratio of different factors. RESULTS 73,125 participants were included in the analysis. 55.75% of patients stated at least one of the three MS risk factors. The prevalence of rheumatoid arthritis (RA) and osteoarthritis (OA)/other rheumatism among ≥ 50 years population was 10.19% and 19.32% respectively. Females showed a higher prevalence of arthritis than males. Prevalence did not differ between groups with different levels of PA. Arthritis prevalence was positively correlated with the number of MS risk factors (P < 0.01) but not with PA (P > 0.05). CONCLUSION Middle-aged and older Europeans with multiple comorbidities suffered from RA, OA or other rheumatism more frequently than participants with fewer comorbidities, while the level of physical activity was not associated with the number of metabolic risk factors in patients with RA and OA/other rheumatism.
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Affiliation(s)
- Fanji Qiu
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Jinfeng Li
- Department of Kinesiology, Iowa State University, 50011, Ames, USA, IA
| | - Liaoyan Gan
- Alberta International School of Recreation, Sport and Tourism of Beijing Sport University, Beijing Sport University, 572423, Lingshui, China
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, T6G2R3, Edmonton, Canada
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
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Slouma M, Lahmar W, Mohamed G, Dhrif O, Dhahri R, Bellali H, Gharsallah I, Ebdelli N. Associated factors with liver fibrosis in rheumatoid arthritis patients treated with methotrexate. Clin Rheumatol 2024; 43:929-938. [PMID: 38159207 DOI: 10.1007/s10067-023-06847-7] [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: 08/18/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION There are conflicting findings on the link between liver fibrosis and cumulative methotrexate dosages. We aimed to determine the frequency of liver fibrosis in rheumatoid arthritis patients treated with methotrexate and to identify its associated factors. METHODS We conducted a cross-sectional study over 9 months (April-December 2021), including rheumatoid arthritis patients treated with methotrexate. Demographic and clinical data were collected. Liver stiffness was assessed by FibroScan. Fibrosis and significant liver fibrosis were defined as liver stiffness higher than 6 and 7.2 kPa, respectively. Liver tests, albuminemia, lipid profile, and blood glycemia were measured. Metabolic syndrome was also evaluated. Statistical analyses were performed using SPSS. RESULTS We included 21 men and 47 women. The mean age was 51.60 ± 1.82 years. The mean disease duration was 8.29 ± 6.48 years. The mean weekly intake of methotrexate was 13.76 ± 3.91 mg. The mean methotrexate duration was 4.67 ± 4.24 years. The mean cumulative dose was 3508.87 ± 3390.48 mg. Hypoalbuminemia and metabolic syndrome were found in 34% and 25% of cases. We noted increased alkaline phosphatase levels in four cases. The mean liver stiffness was 4.50 ± 1.53 kPa. Nine patients had liver fibrosis, and four had significant fibrosis. Associated factors with liver fibrosis were as follows: age ≥ 60 years (OR:22.703; 95%CI [1.238-416.487]; p = 0.035), cumulated dose of methotrexate ≥ 3 g (OR: 76.501; 95%CI [2.383-2456.070]; p = 0.014), metabolic syndrome (OR: 42.743; 95%CI [1.728-1057.273]; p = 0.022), elevated alkaline phosphatase levels (OR: 28.252; 95%CI [1.306-611.007]; p = 0.033), and hypoalbuminemia (OR: 59.302; 95%CI [2.361-1489.718]; p = 0.013). CONCLUSION Cumulating more than 3 g of methotrexate was associated with liver fibrosis in rheumatoid arthritis patients. Having a metabolic syndrome, higher age, hypoalbuminemia, and elevated alkaline phosphatase levels were also likely to be independently associated with liver fibrosis. Key points • Rheumatoid arthritis patients require monitoring hepatic fibrosis when the cumulated dose of methotrexate is above 3 g. • Metabolic syndrome is a risk factor for liver fibrosis, suggesting that its management is necessary to prevent this complication. • Hypoalbuminemia and elevated alkaline phosphatase levels (twice the upper limit) in rheumatoid arthritis patients treated with methotrexate were associated with liver fibrosis.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia.
- University of Tunis El Manar, 1068, Tunis, Tunisia.
| | - Wided Lahmar
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Ghanem Mohamed
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Gastrology, Military Hospital, 1008, Tunis, Tunisia
| | - Omar Dhrif
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Internal Medicine, Military Hospital of Bizerta, 7000, Bizerta, Tunisia
| | - Rim Dhahri
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Hedia Bellali
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Epidemiology, Hbib Thameur Hospital, 1008, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, 1008, Tunis, Tunisia
- University of Tunis El Manar, 1068, Tunis, Tunisia
| | - Nabil Ebdelli
- University of Tunis El Manar, 1068, Tunis, Tunisia
- Department of Gastrology, Military Hospital, 1008, Tunis, Tunisia
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Elazab SA, Elsayed WE, Alrahim NM, Elsaid MA, Akab SM, Mohammed Enayet AAE, Mohamed MSE, Elazab SA, Sonbol MM, Fath Allah RM. Relationship between Triglyceride-Glucose Index and Disease Activity and Subclinical Atherosclerosis in Rheumatoid Arthritis. Curr Rheumatol Rev 2024; 20:191-199. [PMID: 37873948 DOI: 10.2174/0115733971259984230922054439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND In rheumatoid arthritis (RA), insulin resistance (IR) is related to inflammatory markers, disease activity, and progression of atherosclerotic changes. Triglyceride-glucose (TyG) index is a relatively new indicator of IR. AIMS The present study aimed to investigate the relationship between TyG index, disease activity and subclinical atherosclerosis (SCA) in RA patients. METHODS The present case-control study included 100 RA patients and 50 age- and sex-matched healthy controls. All participants were subjected to careful history taking through clinical examination and standard laboratory assessment. The TyG index was calculated as TyG index = ln (Fasting triglyceride (mg/dL) × fasting glucose (mg/dL))/2. Carotid intima-media thickness (CIMT) measurement was done using B-mode ultrasound. RESULTS Patients had significantly higher TyG index as compared to controls. Patients with high disease activity had significantly higher frequency of extraarticular manifestations (39.6% versus 51.6%, p = 0.028), higher Larsen score (3.8 ± 1.3 versus 2.8 ± 1.2, p < 0.001), higher anti-cyclic citrullinated peptide (anti-CCP) levels (median (IQR): 243.1 (205.0-408.0) U/ml versus 99.0 (78.0-332.5), p < 0.001), higher TyG index (4.8 ± 0.22 versus 4.67 ± 0.24, p = 0.006), and higher CIMT (0.87 ± 0.22 versus 0.77 ± 0.17 mm, p = 0.018). Patients with SCA had higher BMI (34.6 ± 6.2 versus 30.5 ± 5.3 Kg/m2, p < 0.001), higher Larsen score (3.7 ± 1.4 versus 3.1 ± 1.3, p = 0.028) and higher TyG index (4.89 ± 0.23 versus 4.64 ± 0.19, p < 0.001). Binary logistic regression analysis identified patients' age (OR (95% CI): 0.94 (0.89-0.99), p = 0.018), Larsen score (OR (95% CI): 1.93 (1.32-2.82), p = <0.001), anti-CCP (OR (95%): 1.04 (1.02-1.07), p = 0.032), and TyG index (OR (95% CI): 22.67 (2.14-240.4), p = 0.01) as significant predictors of high disease activity in multivariate analysis. CONCLUSION IR estimated by the TyG index is related to disease activity and SCA in RA patients.
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Mantilla MJ, Chaves JJ, Santacruz JC, Rodríguez-Salas G, Rueda I, Santos AM, Londoño J, Mantilla JC. Causes of death in patients with autoimmune and rheumatic diseases-a 16-year autopsy-based study. Autops Case Rep 2023; 13:e2023430. [PMID: 37287565 PMCID: PMC10243749 DOI: 10.4322/acr.2023.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 06/09/2023]
Abstract
Introduction the autopsy is an essential medical procedure; however, its use has declined over the decades. In autoimmune and rheumatological diseases, anatomical and microscopic diagnosis is critical to diagnose of the cause of death. For this reason, our objective is to describe the cause of death in patients diagnosed with autoimmune and rheumatic diseases who underwent an autopsy in a Pathology reference center in Colombia. Materials and methods a retrospective and descriptive study of autopsy reports. Results between January 2004 and December 2019, 47 autopsies of patients with autoimmune and rheumatological diseases were performed. Systemic lupus erythematosus and rheumatoid arthritis were the most common diseases. The leading cause of death was related to infections, being opportunistic infections in the majority of the cases. Conclusions our autopsy-based study was focused on patients with autoimmune and rheumatological conditions. Infections are the leading cause of death, particularly opportunistic infections, diagnosed mainly by microscopy. Thus, the autopsy should continue to be considered the "gold standard" to determine the cause of death in this population.
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Affiliation(s)
| | - Juan José Chaves
- Fundación Universitaria de Ciencias de la Salud, Departamento de Patología, Bogotá, Colombia
| | | | | | - Igor Rueda
- Universidad de La Sabana, Departamento de Reumatología, Chía, Colombia
| | - Ana Maria Santos
- Universidad de La Sabana, Departamento de Reumatología, Chía, Colombia
| | - John Londoño
- Universidad de La Sabana, Departamento de Reumatología, Chía, Colombia
| | - Julio Cesar Mantilla
- Universidad Industrial de Santander, Departamento de Patología, Bucaramanga, Colombia
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Fornari Laurindo L, Minniti G, José Tofano R, Quesada K, Federighi Baisi Chagas E, Maria Barbalho S. Detection of Metabolic Syndrome Using Insulin Resistance Indexes: A Cross-Sectional Observational Cohort Study. ENDOCRINES 2023. [DOI: 10.3390/endocrines4020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Insulin resistance (IR) is considered cardinal to the pathophysiology of metabolic syndrome (MetS). Previously, several simple indexes of IR calculated from biochemical and anthropometric variables have been proposed. However, these indexes are population-dependent; therefore, further studies on a global scale are necessary. The present study assessed the diagnostic accuracy of eight IR indicators, namely, METS-IR, TG-HDL-c, TyG, TyG-BMI, TyG-NC, TyG-NHtR, TyG-WC, and TyG-WHtR, in indicating MetS among a Brazilian population. For this, 268 patients (152 men and 116 women, 53–59 years of age) were included in the study, out of which 111 were diagnosed with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All indexes achieved significant accuracy, with TyG-WC (0.849 (0.800–0.889)), TyG (0.837 (0.787–0.879)), and TG-HDL-c (0.817 (0.765–0.861)) having the highest area under the curve (AUC). Further, the most heightened diagnostic sensitivities were observed for TG-HDL-c (90.99%), TyG-WC (89.19%), and TyG-NC (84.68%), whereas the highest diagnostic specificities were noted for TyG (73.89%), TyG-WHtR (72.61%), and TyG-WC (66.88%). Thus, TyG-WC, TyG, and TG-HDL-c reached the greatest AUC values in our analyses, making them useful diagnostic indicators of MetS, and crucial for patients’ clinical management.
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Affiliation(s)
- Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Avenida Monte Carmelo, 800, Marília 17519-030, SP, Brazil
| | - Giulia Minniti
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Ricardo José Tofano
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Karina Quesada
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Eduardo Federighi Baisi Chagas
- Postgraduate Program in Health and Aging, Faculdade de Medicina de Marília (FAMEMA), Avenida Monte Carmelo, 800, Marília 17519-030, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília 17525-902, SP, Brazil
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Avenida Castro Alves, 62, Marília 17500-000, SP, Brazil
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Mangoni AA, Sotgia S, Zinellu A, Carru C, Pintus G, Damiani G, Erre GL, Tommasi S. Methotrexate and cardiovascular prevention: an appraisal of the current evidence. Ther Adv Cardiovasc Dis 2023; 17:17539447231215213. [PMID: 38115784 PMCID: PMC10732001 DOI: 10.1177/17539447231215213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023] Open
Abstract
New evidence continues to accumulate regarding a significant association between excessive inflammation and dysregulated immunity (local and systemic) and the risk of cardiovascular events in different patient cohorts. Whilst research has sought to identify novel atheroprotective therapies targeting inflammation and immunity, several marketed drugs for rheumatological conditions may serve a similar purpose. One such drug, methotrexate, has been used since 1948 for treating cancer and, more recently, for a wide range of dysimmune conditions. Over the last 30 years, epidemiological and experimental studies have shown that methotrexate is independently associated with a reduced risk of cardiovascular disease, particularly in rheumatological patients, and exerts several beneficial effects on vascular homeostasis and blood pressure control. This review article discusses the current challenges with managing cardiovascular risk and the new frontiers offered by drug discovery and drug repurposing targeting inflammation and immunity with a focus on methotrexate. Specifically, the article critically appraises the results of observational, cross-sectional and intervention studies investigating the effects of methotrexate on overall cardiovascular risk and individual risk factors. It also discusses the putative molecular mechanisms underpinning the atheroprotective effects of methotrexate and the practical advantages of using methotrexate in cardiovascular prevention, and highlights future research directions in this area.
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Affiliation(s)
- Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA 5042, Australia
| | - Salvatore Sotgia
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Quality Control Unit, University Hospital (AOUSS), Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Quality Control Unit, University Hospital (AOUSS), Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Quality Control Unit, University Hospital (AOUSS), Sassari, Italy
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Quality Control Unit, University Hospital (AOUSS), Sassari, Italy
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Italian Centre of Precision Medicine and Chronic Inflammation, Milan, Italy
| | - Gian Luca Erre
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University Hospital (AOUSS) and University of Sassari, Sassari, Italy
| | - Sara Tommasi
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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Schäfer C, Keyßer G. Lifestyle Factors and Their Influence on Rheumatoid Arthritis: A Narrative Review. J Clin Med 2022; 11:jcm11237179. [PMID: 36498754 PMCID: PMC9736780 DOI: 10.3390/jcm11237179] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
In recent years, a possible association of lifestyle factors with rheumatoid arthritis (RA) has attracted increasing public interest. The aim of this review is to provide an overview of the extent and the limitations of current evidence regarding lifestyle factors and RA. The PubMed medical database was screened for epidemiological and prospective studies investigating the contribution of lifestyle factors to the development and the course of the disease. Large epidemiological studies have identified smoking, unhealthy diet and adiposity, as well as a low educational level and low socioeconomic status, as factors that increase the incidence of RA. In addition, several lifestyle habits influence the response of RA to antirheumatic drugs. Among others, smoking, obesity and poor physical activity are associated with a worse treatment outcome. Methodological problems often impair firm conclusions with respect to the causal role of these factors in the risk and the course of RA. However, current evidence is sufficient to recommend a healthy diet, the prevention of obesity, the cessation of smoking and the maintenance of a high level of physical activity to support the effectivity of modern antirheumatic medication.
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