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Schäfer C, Keyßer G, Reuß-Borst M. [Influence of smoking, nutrition and other modifiable environmental factors on rheumatoid arthritis]. Z Rheumatol 2024:10.1007/s00393-024-01559-y. [PMID: 39158701 DOI: 10.1007/s00393-024-01559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/20/2024]
Abstract
Numerous reports in recent years have focused on the influence of environmental factors on rheumatoid arthritis. This article provides an overview of the current study situation on the influence of modifiable environmental factors on the development and course of rheumatoid arthritis. Lifestyle factors, such as cigarette smoking, diet, exercise and body weight can be individually influenced. Factors such as air pollution and socioeconomic status can be influenced by environmental and sociopolitical measures at a public level. Epidemiological studies have identified nicotine abuse, an unhealthy diet and obesity as well as a low level of education and social status as risk factors for the development of rheumatoid arthritis. Numerous factors are also associated with a poorer response to treatment and a worse prognosis. As randomized interventional studies on most environmental factors are hardly feasible, the causal relationship of the individual factors to the incidence and progression of rheumatoid arthritis is difficult to quantify. Nevertheless, the current evidence already enables the provision of appropriate counselling to patients with rheumatoid arthritis with respect to a healthy lifestyle including abstaining from cigarette smoking, maintaining a healthy diet, physical activity and avoiding obesity.
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Affiliation(s)
- Christoph Schäfer
- Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Gernot Keyßer
- Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - Monika Reuß-Borst
- Schwerpunktpraxis für Rheumatologie, Frankenstraße 36, 97708, Bad Bocklet, Deutschland
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2
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Bermas BL, Gerber DE. The Joint Problem of Rheumatoid Arthritis and Lung Cancer. J Thorac Oncol 2024; 19:196-198. [PMID: 38325979 DOI: 10.1016/j.jtho.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Bonnie L Bermas
- Division of Rheumatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David E Gerber
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
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Zaręba W, Krawiec P, Banaszkiewicz M, Batko K, Gołąb A, Plicner D, Żuber Z, Batko B. Newly developed cardiovascular risk factors in rheumatoid arthritis patients initiating biologic treatment. Reumatologia 2024; 61:424-431. [PMID: 38322099 PMCID: PMC10839918 DOI: 10.5114/reum/176554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a risk factor (RF) for cardiovascular (CV) disease, a leading cause of mortality in RA patients. Material and methods Consecutive records of RA patients with high disease activity screened upon biologic therapy initiation were reviewed between January 2001 and 2018. Patients with at least 6-month follow-up and baseline disease activity scores were enrolled (n = 353) and stratified into manifest CV disorder ("overt CVD"), any traditional CV risk factor ("atCVrisk") and no CV risk factor ("vlCVrisk") groups. Results Overall, mean (SD) patient age was 51.4 (±12.2) years, and 291 (82.4%) subjects were female. Median follow-up was 41.9 (IQR 18.6, 80) months. Overall, 89 (25.2%) individuals developed at least one new CV RF, of which 65 (18.4%) acquired one and 24 (6.8%) two or more. Incident lipid disorders (42, 11.9%), followed by hypertension (14, 4%), atrial fibrillation (17, 4.8%) and venous thromboembolism (VTE) (16, 4.5%), were common. Incident major adverse cardiac events (MACE) were not reported in the vlCVrisk group, in contrast to atCVrisk (n = 8, 4.2%) or overt CVD (n = 4, 18.2%). Age was a significant predictor of incident CV risk factor (HR 1.04, 95% CI: 1.02-1.07; p < 0.01). In age-adjusted analyses, only baseline body mass index (BMI) (HR 1.11, 95% CI: 1.04-1.18; p < 0.01), but not ever smoking (p = 0.93), male sex (p = 0.26), positive RF (p = 0.24), positive ACPA (p = 0.90), or baseline disease activity (p = 0.19), were independent predictor of incident CV risk factors. Conclusions Patients with RA initiating biologics should be screened for cardiometabolic risk factors, especially at an older age. The presence of at least one risk factor may be linked to a worse long-term prognosis.
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Affiliation(s)
- Wojciech Zaręba
- Department of Cardiology, Jozef Dietl Specialist Hospital, Krakow, Poland
| | - Piotr Krawiec
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
| | - Małgorzata Banaszkiewicz
- Department of Nephrology and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Batko
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
- Department of Nephrology and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksandra Gołąb
- Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, Poland
| | - Dariusz Plicner
- Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Zbigniew Żuber
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
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Lopez-Olivo MA, Michaud K, Schumacher R, Minnix J, Cinciripini P, Suarez-Almazor ME. Smoking cessation patterns, usefulness of quitting methods, and tobacco cessation motivators and barriers to quit in patients with rheumatoid arthritis. Clin Rheumatol 2023:10.1007/s10067-023-06593-w. [PMID: 37093403 DOI: 10.1007/s10067-023-06593-w] [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: 01/28/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Tobacco use is highly discouraged in patients with rheumatoid arthritis (RA) due to related short and long-term health implications. We aimed to evaluate smoking cessation patterns in patients with RA. In addition, we ascertained perceptions on the usefulness of quitting methods, and perceived motivators and barriers to quit. METHODS We surveyed adults with RA enrolled in the FORWARD Databank who self-identified as former or current tobacco users. RESULTS Three hundred forty-eight participants completed the survey and responded to the question "do you currently smoke" (former use = 319; current use = 29). Nicotine replacement therapy (NRT) was perceived as extremely/somewhat useful by 31%, followed by individual 27% and group counseling 21%. Experiencing a major health event was the most common motivator to quit. Current users on average smoked 17 cigarettes per day. Six of the 29 current users had used electronic cigarettes in the past 30 days. The most frequent methods used to quit were "cold turkey quitting," NRT, and prescription medicines. Only 8 of the 23 current users had plans to quit or expressed being ready to make changes to quit. Reasons most frequently listed to not quit were using smoking to manage negative emotions, as a pleasurable habit, to manage other addictions, and to provide a sense of control (e.g., to cope with RA). CONCLUSIONS Current users expressed several negative emotions including coping with the disease and "being a pleasurable habit" when trying to quit. Future cessation programs should address these barriers to support patients with RA. Key Points • First study characterizing the smoking behavior of patients with RA in the USA. Current users were younger, had a shorter disease duration, and worse disease outcomes compared to former smokers. • Former and current users reported similar motivators to quit, with experiencing a major health event being most common. Only about a third of participants who quit or who were still smoking received advice from a health professional. • The most common reasons for not quitting were that smoking help to manage negative emotions and was a pleasurable habit. Future studies should focus on cessation programs that support participants with RA by addressing the unique perceptions about smoking in this population.
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Affiliation(s)
- Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jennifer Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA.
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Lopez-Olivo MA, Sharma G, Singh G, James J, Krause KJ, Cinciripini P, Volk RJ, Suarez-Almazor ME. A systematic review with meta-analysis of the effects of smoking cessation strategies in patients with rheumatoid arthritis. PLoS One 2022; 17:e0279065. [PMID: 36520847 PMCID: PMC9754184 DOI: 10.1371/journal.pone.0279065] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Smoking rates among patients with rheumatoid arthritis (RA) exceed those in the general population. This study identified smoking cessation strategies used in patients with RA and synthesized data on their effects. METHODS We conducted a systematic review of studies that reported effects of interventions for smoking cessation in patients with RA. We searched 5 electronic databases until March 2022. Screening, quality appraisal, and data collection were done independently by 2 reviewers. RESULTS We included 18 studies reporting interventions for patients or providers: 14 evaluated strategies for patients (5 education on cardiovascular risk factors including smoking, 3 educational interventions on smoking cessation alone, 3 education with nicotine replacement and counseling, and 1 study each: education with nicotine replacement, counseling sessions alone, and a social marketing campaign). Smoking cessation rates ranged from 4% (95% CI: 2%-6%, 24 to 48 weeks) for cardiovascular risk education to 43% (95% CI: 21%-67%, 104 weeks) for counseling sessions alone. The pooled cessation rate for all interventions was 22% (95% CI: 8%-41%, 4 weeks to 104 weeks; 9 studies). Four interventions trained providers to ascertain smoking status and provide referrals for smoking cessation. The pooled rates of referrals to quit services increased from 5% in pre-implementation populations to 70% in post-implementation populations. CONCLUSION Studies varied in patient characteristics, the interventions used, and their implementation structure. Only 3 studies were controlled clinical trials. Additional controlled studies are needed to determine best practices for smoking cessation for patients with RA.
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Affiliation(s)
- Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Gaurav Sharma
- Department of Internal Medicine, University of South Alabama, Mobile, Alabama, United States of America
| | | | - Justin James
- City University of New York School of Medicine, New York, New York, United States of America
| | - Kate J. Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Paul Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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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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Alfredsson L, Klareskog L, Hedström AK. Influence of Smoking on Disease Activity and Quality of Life in Patients With Rheumatoid Arthritis: Results From a Swedish Case-Control Study With Longitudinal Follow-Up. Arthritis Care Res (Hoboken) 2022; 75:1269-1277. [PMID: 36149365 DOI: 10.1002/acr.25026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Inconclusive findings have been reported regarding the influence of smoking on disease outcomes in established rheumatoid arthritis (RA). This study was undertaken to investigate the influence of smoking habits on disease activity and health-related quality of life (HRQoL) in RA patients. METHODS Patients with newly diagnosed RA (n = 1,531) from the population-based case-control Epidemiological Investigation of Rheumatoid Arthritis study were followed up for up to 3 years after recruitment. Using logistic regression models, the risks of unfavorable outcomes in patients with different smoking habits were compared using self-reported swollen and tender joint counts, the Short Form 36 health survey, the Health Assessment Questionnaire, and the Hospital Anxiety and Depression Scale by calculating odds ratios with 95% confidence intervals. RESULTS At 1-year and 3-year follow-up, current smokers reported higher disease activity and lower HRQoL life compared to non-smokers, regarding both physical and mental aspects. Patients who stopped smoking within 1-year post-baseline had less disease activity measured as swollen joint counts at 1-year follow-up compared to those who continued smoking. Patients who stopped smoking after the 1-year follow-up had higher disease activity and lower HRQoL at baseline than smokers who did not quit, and late smoking cessation was not associated with more favorable outcomes compared to continued smoking. CONCLUSION Current smoking is associated with increased disease activity and lower HRQoL among RA patients. Smoking cessation within the first year after baseline appears to have a favorable effect on disease activity.
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Affiliation(s)
| | - Lars Klareskog
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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8
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Wieczorek M, Gwinnutt JM, Ransay-Colle M, Balanescu A, Bischoff-Ferrari H, Boonen A, Cavalli G, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm TA, Walker-Bone K, Welling J, Zlatkovic-Svenda M, Verstappen SM, Guillemin F. Smoking, alcohol consumption and disease-specific outcomes in rheumatic and musculoskeletal diseases (RMDs): systematic reviews informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:e002170. [PMID: 35351808 PMCID: PMC8966569 DOI: 10.1136/rmdopen-2021-002170] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/07/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A EULAR taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). The aim of this paper was to review the literature on the relationship between smoking and alcohol consumption with regard to RMD-specific outcomes. METHODS Two systematic reviews were conducted to identify systematic reviews and meta-analyses, published between 2013 and 2018, related to smoking and alcohol consumption in seven RMDs: osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), systemic sclerosis (SSc) and gout. Two additional systematic reviews were performed to identify original longitudinal studies on smoking and alcohol consumption and disease-specific outcomes. RESULTS Nine reviews and 65 original studies on smoking as well as two reviews and 14 original studies on alcohol consumption met the inclusion criteria. While most studies were moderate/poor quality, smoking was significantly associated with poorer outcomes: cardiovascular comorbidity; poorer response to RA treatment; higher disease activity and severity in early RA; axSpA radiographic progression. Results were heterogeneous for OA while there was limited evidence for PsA, SSc and gout. Available studies on alcohol mainly focused on RA, reporting a positive association between alcohol intake and radiographic progression. Five studies assessed alcohol consumption in gout, reporting a significant association between the number and type of alcoholic beverages and the occurrence of flares. CONCLUSION Current literature supports that smoking has a negative impact on several RMD-specific outcomes and that moderate or high alcohol consumption is associated with increased risk of flares in RA and gout.
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Affiliation(s)
- Maud Wieczorek
- Centre on Aging and Mobility, University Hospital Zurich, Zurich City Hospital - Waid and University of Zurich, Zurich, Switzerland
- EA4360 Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - James Martin Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, Zurich City Hospital - Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht Univeristy, Maastricht, The Netherlands
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Ernst Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
- Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria
- Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht Univeristy, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain
- Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana Zlatkovic-Svenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
- Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Suzanne Mm Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Francis Guillemin
- EA4360 Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France
- CIC-1433 Epidemiologie Clinique, Inserm, CHRU Nancy, University of Lorraine, Nancy, France
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9
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Roelsgaard IK, Ikdahl E, Rollefstad S, Wibetoe G, Esbensen BA, Kitas GD, van Riel P, Gabriel S, Kvien TK, Douglas K, Wållberg-Jonsson S, Rantapää Dahlqvist S, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon CA, Pascual-Ramos V, Contreras-Yáñez I, Sfikakis PP, González-Gay MA, Crowson CS, Semb AG. Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients. Rheumatology (Oxford) 2021; 59:1997-2004. [PMID: 31782789 PMCID: PMC7382591 DOI: 10.1093/rheumatology/kez557] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status. Results Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5–6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P < 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P < 0.001, respectively]. The CVD event rates for former and never smokers were comparable. Conclusion Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.
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Affiliation(s)
- Ida K Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bente A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark.,Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK.,Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Sherine Gabriel
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karen Douglas
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | | | | | - George Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick H Dessein
- Vrije Universiteit Brussel, Brussels, Belgium.,Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Linda Tsang
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Irazú Contreras-Yáñez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Petros P Sfikakis
- First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miguel A González-Gay
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Universidad de Cantabria, Spain
| | - Cynthia S Crowson
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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10
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Gwinnutt JM, Verstappen SM, Humphreys JH. The impact of lifestyle behaviours, physical activity and smoking on morbidity and mortality in patients with rheumatoid arthritis. Best Pract Res Clin Rheumatol 2020; 34:101562. [PMID: 32646673 DOI: 10.1016/j.berh.2020.101562] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Rheumatoid arthritis (RA) is associated with pain, disability and increased risk of developing comorbidities and premature mortality. While these poor outcomes have improved in line with advances in the treatment of RA, they still persist to some degree today. Physical activity and smoking are two areas of patients' lives where changes may have a substantial impact on the poor outcomes associated with RA. Physical activity in RA has been well studied, with many randomised trials indicating the benefits of physical activity on pain and disability. A number of observational studies have assessed the impact of smoking on RA, also indicating the benefits of quitting smoking on RA-related outcomes, but with less consistent findings, potentially due to epidemiological challenges (e.g. collider bias, recall bias). There are also a number of barriers preventing patients making these positive lifestyle changes, such as lack of time and motivation, lack of knowledge and advice, as well as disease-specific barriers, such as pain and fatigue.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Suzanne Mm Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Jenny H Humphreys
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Gudelj Gračanin A, Marković I, Golob M, Lucijanić M, Valetić AM, Morović-Vergles J. The effect of smoking on disease activity in rheumatoid arthritis - our experience. Acta Clin Croat 2020; 59:312-317. [PMID: 33456119 PMCID: PMC7808239 DOI: 10.20471/acc.2020.59.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate the association of smoking with disease activity, seropositivity, age and gender in patients with rheumatoid arthritis. We included 89 rheumatoid arthritis patients. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism rheumatoid arthritis classification criteria. Activity of the disease was measured by Disease Activity Score 28-joint count C-reactive protein (DAS28CRP). The subjects were stratified into smoking and non-smoking groups and cross-sectionally analyzed. There were 24 (27%) smokers and 65 (73%) nonsmokers. The mean age of patients was 57.1±8.8 years. The mean DAS28CRP was 5.81 in the smoking group and 5.57 in the non-smoking group, without statistically significant difference between the two groups (p=0.148). Similarly, smokers did not differ significantly from non-smokers according to age (p=0.443), gender (p=0.274), rheumatoid factor positivity (p=0.231), anti-citrullinated protein antibody positivity (p=0.754) or seropositivity (p=0.163). In this study, we found no association between smoking status and disease activity, seropositivity, age or gender in rheumatoid arthritis patients. Furthermore, disease activity was not related to age, gender or seropositivity. Additional studies on the effects of smoking on rheumatoid arthritis activity are needed.
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Affiliation(s)
- Ana Gudelj Gračanin
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Marković
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Majda Golob
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marko Lucijanić
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Marija Valetić
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Jadranka Morović-Vergles
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Roelsgaard IK, Esbensen BA, Østergaard M, Rollefstad S, Semb AG, Christensen R, Thomsen T. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database Syst Rev 2019; 9:CD012958. [PMID: 31476270 PMCID: PMC6718206 DOI: 10.1002/14651858.cd012958.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic inflammatory joint diseases (IJDs) affect 1% to 2% of the population in developed countries. IJDs include rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and other forms of spondyloarthritis (SpA). Tobacco smoking is considered a significant environmental risk factor for developing IJDs. There are indications that smoking exacerbates the symptoms and worsens disease outcomes. OBJECTIVES The objective of this review was to investigate the evidence for effects of smoking cessation interventions on smoking cessation and disease activity in smokers with IJD. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library; PubMed/MEDLINE; Embase; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and three trials registers to October 2018. SELECTION CRITERIA We included randomised controlled trials testing any form of smoking cessation intervention for adult daily smokers with a diagnosis of IJD, and measuring smoking cessation at least six months after baseline. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included two studies with 57 smokers with a diagnosis of rheumatoid arthritis (RA). We identified no studies including other IJDs. One pilot study compared a smoking cessation intervention specifically for people with RA with a less intensive, generic smoking cessation intervention. People included in the study had a mean age of 56.5 years and a disease duration of 7.7 years (mean). The second study tested effects of an eight-week cognitive-behavioural patient education intervention on cardiovascular disease (CVD) risk for people with RA and compared this with information on CVD risk only. The intervention encouraged participants to address multiple behaviours impacting CVD risk, including smoking cessation, but did not target smoking cessation alone. People included in the study had a mean age of 62.2 years (intervention group) and 60.8 years (control group), and disease duration of 11.6 years (intervention group) and 14.1 years (control group). It was not appropriate to perform a meta-analysis of abstinence data from the two studies due to clinical heterogeneity between interventions. Neither of the studies individually provided evidence to show benefit of the interventions tested. Only one study reported on adverse effects. These effects were non-serious, and numbers were comparable between trial arms. Neither of the studies assessed or reported disease activity or any of the predefined secondary outcomes. We assessed the overall certainty of evidence as very low due to indirectness, imprecision, and high risk of detection bias based on GRADE. AUTHORS' CONCLUSIONS We found very little research investigating the efficacy of smoking cessation intervention specifically in people with IJD. Included studies are limited by imprecision, risk of bias, and indirectness. Neither of the included studies investigated whether smoking cessation intervention reduced disease activity among people with IJD. High-quality, adequately powered studies are warranted. In particular, researchers should ensure that they measure disease markers and quality of life, in addition to long-term smoking cessation.
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Affiliation(s)
- Ida K Roelsgaard
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
| | - Bente A Esbensen
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
- University of CopenhagenDepartment of Clinical MedicineCopenhagenDenmark
| | - Mikkel Østergaard
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
| | | | - Anne G Semb
- Diakonhjemmet HospitalPreventive Cardio‐Rheuma ClinicOsloNorway
| | - Robin Christensen
- Bispebjerg and Frederiksberg HospitalMusculoskeletal Statistics Unit, The Parker InstituteCopenhagenDenmark
- Odense University HospitalDepartment of RheumatologyOdenseDenmark
| | - Thordis Thomsen
- Copenhagen University Hospital Herlev‐GentofteHerlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of AnesthesiologyCopenhagenDenmark
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Abstract
BACKGROUND Medication-based strategies to treat rheumatoid arthritis are crucial in terms of outcome. They aim at preventing joint destruction, loss of function and disability by early and consistent inhibition of inflammatory processes. OBJECTIVE Achieving consensus about evidence-based recommendations for the treatment of rheumatoid arthritis with disease-modifying anti-rheumatic drugs in Germany. METHODS Following a systematic literature research, a structured process among expert rheumatologists was used to reach consensus. RESULTS The results of the consensus process can be summed up in 6 overarching principles and 10 recommendations. There are several new issues compared to the version of 2012, such as differentiated adjustments to the therapeutic regime according to time point and extent of treatment response, the therapeutic goal of achieving remission as assessed by means of the simplified disease activity index (SDAI) as well as the potential use of targeted synthetic DMARDs (JAK inhibitors) and suggestions for a deescalating in case of achieving a sustained remission. Methotrexate still plays the central role at the beginning of the treatment and as a combination partner in the further treatment course. When treatment response to methotrexate is inadequate, either switching to or combining with another conventional synthetic DMARD is an option in the absence of unfavourable prognostic factors. Otherwise biologic or targeted synthetic DMARDs are recommended according to the algorithm. Rules for deescalating treatment with glucocorticoids and-where applicable-DMARDs give support for the management of patients who have reached a sustained remission. DISCUSSION The new guidelines set up recommendations for RA treatment in accordance with the treat-to-target principle. Modern disease-modifying drugs, now including also JAK inhibitors, are available in an algorithm.
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Roh S. Smoking as a Preventable Risk Factor for Rheumatoid Arthritis: Rationale for Smoking Cessation Treatment in Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sungwon Roh
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea
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Hafström I, Ajeganova S, Andersson MLE, Bala SV, Bergman S, Bremander A, Forslind K, Malm K, Svensson B. A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis - results of clinical relevance. Open Access Rheumatol 2019; 11:207-217. [PMID: 31565006 PMCID: PMC6744369 DOI: 10.2147/oarrr.s218448] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE At the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care. PATIENTS AND METHODS BARFOT is a multicentre observational study of patients with early RA, consecutively included 1992-2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality. RESULTS In all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and co-morbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed. CONCLUSION A register-based study like BARFOT has provided a basis for optimal long-term management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.
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Affiliation(s)
- Ingiäld Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Correspondence: Ingiäld HafströmRheumatology Unit, R92, Karolinska University Hospital, 141 86Stockholm, SwedenTel +46 73 699 6235Email
| | - Sofia Ajeganova
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maria LE Andersson
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
| | - Sidona-Valentina Bala
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Medicine, Section of Rheumatology, Helsingborg’s Hospital, Helsingborg, Sweden
| | - Stefan Bergman
- Spenshult Research and Development Center, Halmstad, Sweden
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Bremander
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kristina Forslind
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Research and Education, Skånevård Sund, Region Skåne, Helsingborg´s Hospital, Helsingborg, Sweden
| | - Karina Malm
- Spenshult Research and Development Center, Halmstad, Sweden
- Rheumatology, Capio Movement, Halmstad, Sweden
| | - Björn Svensson
- Faculty of Medicine, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
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Kadłubowska M, Bąk E, Marcisz C, Kózka M, Michalik A, Kolonko J, Krawczyk B, Dobrzyń-Matusiak D, Kapusta-Nowak Z. Perception vs pain and beliefs about pain control and Type A behavior pattern in patients with chronic ischemia of lower extremities or with rheumatoid arthritis. J Pain Res 2018; 11:3051-3059. [PMID: 30568486 PMCID: PMC6276602 DOI: 10.2147/jpr.s182703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective The study aimed at determining the experience of pain taking into consideration beliefs about pain control, Type A behavior pattern and sociodemographic factors in patients with chronic ischemia of the lower extremities or with rheumatoid arthritis (RA). Methods The study enrolled 100 patients with peripheral arterial disease (PAD) and 100 patients with RA. The subjective sensation of pain was assessed using the Visual Analog Scale (VAS); beliefs about pain control were analyzed using the Beliefs about Pain Control Questionnaire (BPCQ), taking into consideration internal factors, the influence of physicians and accidental events (chance); and Type A behavior features (haste and competition) were analyzed using the Framingham Type A Scale. The multiple regression model was used to assess associations between the experienced pain and the BPCQ value, the Framingham Type A Scale and sociodemographic factors. Results The pain intensity degree was found to be comparable in patients with PAD and with RA. The median determined using the VAS was 5.75 in both of the studied groups. In patients with PAD, lower VAS values were associated with the BPCQ – internal factors (P<0.05) whereas a higher VAS value was related to the BPCQ – physicians’ influence (P<0.001). In patients with RA, a higher VAS value was associated with BPCQ – physicians’ influence (P<0.05), disease duration (P<0.05) and smoking cigarettes (P<0.05). Conclusion Experiencing pain by patients with chronic ischemia of the lower extremities occurs at a moderate level and is beneficially connected with the internal factors and adversely connected with the external factors of beliefs about pain control. Patients with RA reported pain ailments of a moderate level in connection with the adverse influence of the external factors of beliefs about pain control, the duration of the disease and smoking cigarettes. Experiencing pain by patients with chronic ischemia of the lower extremities and RA does not seem to be related to Type A behavior.
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Affiliation(s)
- Monika Kadłubowska
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Ewelina Bąk
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Czesław Marcisz
- Medical University of Silesia, Department of Gerontology and Geriatric Nursing, School of Health Sciences, Katowice, Poland
| | - Maria Kózka
- Jagiellonian University Medical College, Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Cracow, Poland
| | - Anna Michalik
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Jolanta Kolonko
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Bożena Krawczyk
- University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland,
| | - Dorota Dobrzyń-Matusiak
- Medical University of Silesia, Department of Nursing Propaedeutics, School of Health Sciences, Katowice, Poland
| | - Zofia Kapusta-Nowak
- Medical University of Silesia, Department of Health Promotion and Community Nursing, School of Health Sciences, Katowice, Poland
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Chatzidionysiou K, Lukina G, Gabay C, Hetland ML, Hauge EM, Pavelka K, Nordström D, Canhão H, Tomsic M, Rotar Z, Lie E, Kvien TK, van Vollenhoven RF, Saevarsdottir S. Smoking and response to rituximab in rheumatoid arthritis: results from an international European collaboration. Scand J Rheumatol 2018; 48:17-23. [PMID: 30260261 DOI: 10.1080/03009742.2018.1466363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate whether smoking habits predict response to rituximab (RTX) in rheumatoid arthritis (RA). METHOD We included patients from the CERERRA international cohort receiving the first treatment cycle with available smoking status (n = 2481, smokers n = 528, non-current smokers n = 1953) and at least one follow-up visit. Outcome measures were change in Disease Activity Score based on 28-joint count (ΔDAS28) and European League Against Rheumatism (EULAR) good response at 6 months, with non-current smokers as the referent group. RESULTS Compared with non-smokers at baseline, smokers were more often rheumatoid factor (RF)/anti-citrullinated protein antibody (ACPA) positive and males, had shorter disease duration, lower DAS28 and Health Assessment Questionnaire (HAQ) score, a higher number of prior biological disease-modifying anti-rheumatic drugs, and were more likely to receive concomitant conventional synthetic disease-modifying anti-rheumatic drug (csDMARDs). Disease activity had decreased less in smokers at 6 months (ΔDAS28 = 1.5 vs 1.7, p = 0.006), although the difference was no longer significant after correction for baseline DAS28 (p = 0.41). EULAR good response rates did not differ between smokers and non-smokers overall or stratified by RF/ACPA status, although smokers had lower good response rates among seronegative patients (ACPA-negative: 6% vs 14%, RF-negative: 11% vs 18%). Smoking did not predict good response [odds ratio (OR) = 1.04, 95% confidence interval (CI) = 0.76-1.41], while ACPA, DAS28, HAQ, and concomitant csDMARDs were significant predictors for good response. However, when stratified by country, smokers were less likely to achieve good response in Sweden (unadjusted OR = 0.24, 95% CI = 0.07-0.89), and a trend was seen in the Czech Republic (OR = 0.45, 95% CI = 0.16-1.02). CONCLUSION In this large, observational, multinational RA cohort, smokers starting RTX differed from non-smokers by having shorter disease duration and lower disease activity, but more previous treatments. The overall results do not support smoking as an important predictor for response to RTX in patients with RA.
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Affiliation(s)
- K Chatzidionysiou
- a Rheumatology Unit, Department of Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - G Lukina
- b ARBITER, Institute of Rheumatology , Moscow , Russia
| | - C Gabay
- c SCQM Registry , University Hospital of Geneva , Geneva , Switzerland
| | - M L Hetland
- d DANBIO and Copenhagen Center for Arthritis Research , Center for Rheumatology and Spine Diseases, Rigshospitalet , Glostrup , Denmark.,e Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - E M Hauge
- f Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - K Pavelka
- g ATTRA Registry , Institute of Rheumatology , Prague , Czech Republic
| | - D Nordström
- h ROB-FIN Helsinki University Central Hospital , Helsinki , Finland
| | - H Canhão
- i CEDOC, EpiDoC Unit, NOVA Medical School and National School of Public Health , Universidade Nova de Lisboa , Lisbon , Portugal , on behalf of the Rheumatic Diseases Portuguese Register
| | - M Tomsic
- j BioRx.si University Medical Centre , Ljubljana , Slovenia
| | - Z Rotar
- j BioRx.si University Medical Centre , Ljubljana , Slovenia
| | - E Lie
- k Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - T K Kvien
- k Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - R F van Vollenhoven
- a Rheumatology Unit, Department of Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - S Saevarsdottir
- a Rheumatology Unit, Department of Medicine , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
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Daien CI, Hua C, Combe B, Landewe R. Non-pharmacological and pharmacological interventions in patients with early arthritis: a systematic literature review informing the 2016 update of EULAR recommendations for the management of early arthritis. RMD Open 2017; 3:e000404. [PMID: 28151539 PMCID: PMC5237765 DOI: 10.1136/rmdopen-2016-000404] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/09/2016] [Indexed: 12/20/2022] Open
Abstract
Objective To perform a systematic literature review (SLR) on pharmacological and non-pharmacological treatments, in order to inform the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis (EA). Methods The expert committee defined research questions concerning non-pharmacological interventions, patient information and education, non-steroidal anti-inflammatory drug, glucocorticoid (GC) and disease-modifying antirheumatic drugs (DMARDs) use, as well as on disease monitoring. The SLR included articles published after the last EULAR SLR until November 2015 found in the MEDLINE, EMBASE and Cochrane databases and abstracts from the 2014 and 2015 American College of Rheumatology and EULAR conferences. Results Exercise programmes may improve pain and physical function in patients with EA. Patients with EA treated within the first 3 months of symptoms have better clinical and radiological outcomes than those treated beyond 3 months. The clinical and radiological efficacy of GCs is confirmed, with similar efficacy of oral and parenteral administrations. Long-term data raise concerns regarding cardiovascular safety when using GCs. Step-up DMARD therapy is as effective as intensive DMARD therapy ‘ab initio’ for the long-term outcome of EA. Short-term superiority of intensive therapy with bDMARDs is not maintained on withdrawal of bDMARD. Patients with early psoriatic arthritis have better skin and joint outcomes when tight control is used compared to standard care. Conclusions The findings confirm the beneficial effect of exercise programmes and the importance of early drug therapy and tight control. They support the use of methotrexate and GCs as first-line drugs, although the long-term use of GCs raises safety concerns.
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Affiliation(s)
- Claire Immediato Daien
- Rheumatology department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Charlotte Hua
- Rheumatology department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Bernard Combe
- Rheumatology department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology , Amsterdam Rheumatology Center, Amsterdam & Zuyderland Medical Centre , Heerlen , The Netherlands
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Sokolove J, Wagner CA, Lahey LJ, Sayles H, Duryee MJ, Reimold AM, Kerr G, Robinson WH, Cannon GW, Thiele GM, Mikuls TR. Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: a cross-sectional analysis of US veterans. Rheumatology (Oxford) 2016; 55:1969-1977. [PMID: 27477806 DOI: 10.1093/rheumatology/kew285] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 06/24/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cigarette smoking is a major risk factor for RA and has been associated with increased disease severity and lower rates of disease remission. We hypothesized that inflammation and disease activity would be associated with smoking status and this would be related to levels of ACPA. METHODS RA patients from the Veterans Affairs RA registry were studied (n = 1466): 76.9% anti-CCP2 positive, 89% male, median age 63 years (interquartile range 57-72), median disease duration 8.45 years (interquartile range 2.8-18). Baseline serum samples were evaluated for levels of anti-CCP2, RF, 19 distinct ACPAs and 17 cytokines. Smoking status at baseline was recorded as current, former or never. The association of smoking status with cytokines, autoantibodies and disease activity (DAS28) was evaluated. RESULTS Among anti-CCP-positive RA patients, RA-associated cytokines (false-discovery rates q < 0.1%) and DAS28 (P < 0.01) were higher in current smokers compared with former or never smokers. DAS28 and cytokine levels were similar between former and never smokers. In contrast, ACPA concentrations were higher among both current and former smokers compared with never smokers, and levels of ACPA were not associated with DAS28 or cytokine levels. CONCLUSION Among anti-CCP2-positive RA patients, current smoking status is associated with elevations in pro-inflammatory cytokines and increased RA disease activity. Similar levels of inflammation and disease activity among former and never smokers suggests that the detrimental effects of smoking could be ameliorated through tobacco cessation. The effect of tobacco cessation on RA disease activity should be evaluated prospectively.
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Affiliation(s)
- Jeremy Sokolove
- VA Palo Alto Health Care System .,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Catriona A Wagner
- VA Palo Alto Health Care System.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Lauren J Lahey
- VA Palo Alto Health Care System.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Harlan Sayles
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
| | - Michael J Duryee
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
| | - Andreas M Reimold
- Dallas VA Medical Center.,Division of Rheumatic Diseases, University of Texas Southwestern University Medical Center, Dallas, TX
| | - Gail Kerr
- DC VA Medical Center.,Division of Rheumatology, Georgetown University.,Division of Rheumatology, Howard University, Washington, DC
| | - William H Robinson
- VA Palo Alto Health Care System.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Grant W Cannon
- George E. Wahlen VA Medical Center.,Division of Rheumatology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Geoffrey M Thiele
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
| | - Ted R Mikuls
- VA Nebraska Western-Iowa Health Care System.,Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE
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Anderson R, Meyer PWA, Ally MMTM, Tikly M. Smoking and Air Pollution as Pro-Inflammatory Triggers for the Development of Rheumatoid Arthritis. Nicotine Tob Res 2016; 18:1556-65. [PMID: 26957528 DOI: 10.1093/ntr/ntw030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/27/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Smoking is now well recognized not only as a risk factor for rheumatoid arthritis (RA), but also as a determinant of disease activity, severity, response to therapy, and possibly mortality. METHODS Studies, mostly recent, which have provided significant insights into the molecular and cellular mechanisms which underpin the pathogenesis of smoking-related RA, as well as the possible involvement of other types of outdoor and indoor pollution form the basis of this review. RESULTS Smoking initiates chronic inflammatory events in the lungs. These, in turn, promote the release of the enzymes, peptidylarginine deiminases 2 and 4 from smoke-activated, resident and infiltrating pulmonary phagocytes. Peptidylarginine deiminases mediate conversion of various endogenous proteins to putative citrullinated autoantigens. In genetically susceptible individuals, these autoantigens trigger the production of anti-citrullinated peptide, pathogenic autoantibodies, an event which precedes the development of RA. CONCLUSIONS An increasing body of evidence has linked chronic inflammatory events in the lungs of smokers, to the production of anti-citrullinated peptide autoantibodies and development of RA. Creation of awareness of the associated risks, assessment of smoking status and implementation of compelling antismoking strategies must be included in the routine clinical management of patients presenting with suspected RA. IMPLICATIONS Chronic inflammatory mechanisms operative in the lungs of smokers lead to the production of anti-citrullinated protein antibodies which, in turn, drive the development of RA. These mechanistic insights not only reinforce the association between smoking and risk for RA, but also the necessity to increase the level of awareness in those at highest risk.
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Affiliation(s)
- Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa;
| | - Pieter W A Meyer
- Department of Immunology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
| | - Mahmood M T M Ally
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Gerlag DM, Norris JM, Tak PP. Towards prevention of autoantibody-positive rheumatoid arthritis: from lifestyle modification to preventive treatment. Rheumatology (Oxford) 2015; 55:607-14. [PMID: 26374913 PMCID: PMC4795536 DOI: 10.1093/rheumatology/kev347] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 01/02/2023] Open
Abstract
Recent advances in research into the earliest phases of RA have provided additional insights into the processes leading from the healthy to the diseased state. These insights have opened the way for the development of preventive strategies for RA, which represents a significant paradigm shift from treatment to prevention and will have major implications for patients as well as society. It would be a huge step forward if clinical signs and symptoms, disability, impaired quality of life and the need for chronic immunosuppressive treatment could be prevented. RA can be seen as a prototypic autoimmune disease, and discoveries about the preclinical diseased state for RA could potentially facilitate research into prevention of other immune-mediated inflammatory diseases such as type 1 diabetes, SLE and multiple sclerosis. This review focuses on the current knowledge of factors contributing to the development of RA and discusses the opportunities for intervention.
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Affiliation(s)
| | - Jill M Norris
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Paul P Tak
- Department of Rheumatology, University of Ghent, Ghent, Belgium, Department of Medicine, University of Cambridge, Cambridge and Research and Development, GlaxoSmithKline, Stevenage, UK
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22
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Aimer P, Stamp LK, Stebbings S, Cameron V, Kirby S, Croft S, Treharne GJ. Developing a Tailored Smoking Cessation Intervention for Rheumatoid Arthritis Patients. Musculoskeletal Care 2015; 14:2-14. [PMID: 25982887 DOI: 10.1002/msc.1106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Smoking is associated with an increased risk of comorbidities in rheumatoid arthritis (RA) and may reduce the efficacy of anti-rheumatic therapies. Smoking cessation is therefore an important goal in RA. Our previous qualitative research identified five RA-related barriers to smoking cessation: lack of support; limited knowledge of the relationship between smoking and RA; uncontrolled pain; inability to exercise; and using smoking as a coping strategy. The aim of this article is to describe the process of developing a smoking cessation intervention for RA patients based on these themes. METHODS A comprehensive review of the literature on smoking cessation was undertaken. A tailored smoking cessation programme was designed to address each RA-specific barrier. A meeting was convened with key staff of Arthritis New Zealand to develop a consensus on feasible design to deliver a smoking cessation programme based on existing best practice and smoking cessation resources, and tailored within existing Arthritis New Zealand service delivery frameworks. RESULTS A three-month intervention was designed to be delivered by trained arthritis educators, with the following key components: nicotine replacement therapy for eight weeks; a telephone or face-to-face interview with each patient to determine their individual specific RA-related barriers to smoking cessation; and individualized education and support activities which addressed these barriers. The intervention also included three follow-up telephone calls; a support website; and 12 weekly smoking cessation advice emails. CONCLUSIONS A RA-specific smoking cessation invention was developed, matching support to specific issues within each patient's experience. A pilot study is in progress to evaluate the programme's efficacy. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pip Aimer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Vicky Cameron
- Department of Medicine, University of Otago, Christchurch, New Zealand
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23
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Effects of cigarette smoking on early arthritis: a cross-sectional study—data from the Argentine Consortium for Early Arthritis (CONAART). Rheumatol Int 2014; 35:855-9. [DOI: 10.1007/s00296-014-3188-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
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24
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Naranjo A, Khan NA, Cutolo M, Lee SS, Lazovskis J, Laas K, Pandya S, Sokka T. Smoking cessation advice by rheumatologists: results of an international survey. Rheumatology (Oxford) 2014; 53:1825-9. [PMID: 24840678 DOI: 10.1093/rheumatology/keu213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to understand practices regarding smoking cessation among rheumatologists for patients with inflammatory rheumatic diseases. METHODS A survey was sent to the rheumatologists participating in the multinational Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) group. The survey inquired about the clinical practice characteristics and practices regarding smoking cessation (proportion of smokers with inflammatory rheumatic diseases given smoking cessation advice, specific protocols and written advice material, availability of dedicated smoking cessation clinic). RESULTS Rheumatologists from 44 departments in 25 countries (16 European) completed the survey. The survey involved 395 rheumatologists, of whom 25 (6.3%) were smokers, and 199 nurses for patient education, of whom 44 (22.1%) were smokers. Eight departments (18.1 %) had a specific protocol for smoking cessation; 255 (64.5%) rheumatologists reported giving smoking cessation advice to all or almost all smokers with inflammatory diseases. In a regression model, early arthritis clinics (P = 0.01) and high gross domestic product countries (P = 0.001) were both independently associated with advice by the rheumatologist. Nurse gives advice to most patients in 11 of the 36 (30.5%) departments with nurses for patient education. CONCLUSION Advice for smoking cessation within rheumatology departments is not homogeneous. In half of the departments, most doctors give advice to quit smoking to all or almost all patients with inflammatory diseases. However, only one in five departments have a specific protocol for smoking cessation. Our data highlight the need to improve awareness of the importance of and better practice implementation of smoking cessation advice for inflammatory rheumatic disease patients.
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Affiliation(s)
- Antonio Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland.
| | - Nasim A Khan
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Maurizio Cutolo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Shin-Seok Lee
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Juris Lazovskis
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Karin Laas
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Sapan Pandya
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
| | - Tuulikki Sokka
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland
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25
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Socioeconomic status. The relationship with health and autoimmune diseases. Autoimmun Rev 2014; 13:641-54. [PMID: 24418307 DOI: 10.1016/j.autrev.2013.12.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/24/2013] [Indexed: 12/15/2022]
Abstract
Socioeconomic status (SES) is a hierarchical social classification associated with different outcomes in health and disease. The most important factors influencing SES are income, educational level, occupational class, social class, and ancestry. These factors are closely related to each other as they present certain dependent interactions. Since there is a need to improve the understanding of the concept of SES and the ways it affects health and disease, we review herein the tools currently available to evaluate SES and its relationship with health and autoimmune diseases.
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26
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Andersson MLE, Bergman S, Söderlin MK. The Effect of Socioeconomic Class and Immigrant Status on Disease Activity in Rheumatoid Arthritis: Data from BARFOT, a Multi-Centre Study of Early RA. Open Rheumatol J 2013; 7:105-11. [PMID: 24358069 PMCID: PMC3866699 DOI: 10.2174/1874312901307010105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/19/2013] [Accepted: 10/10/2013] [Indexed: 12/23/2022] Open
Abstract
Background: There have been no reports on the effect of immigrant status and socioeconomic status on outcome in rheumatoid arthritis (RA) in Sweden.
Methods: Between 1992 and 2006, 2,800 patients were included in the BARFOT study on early RA in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire (HAQ), treatment and European League Against Rheumatism (EULAR) response criteria were registered. In 2010, 1,430 patients completed a questionnaire enquiring about demographics and lifestyle factors.
Results: One hundred and thirty-nine of the 1,430 patients (9.7%) were immigrants. At baseline immigrants had higher mean HAQ (1.2 vs 0.97 for non-immigrants, p=0.001), DAS28 (5.6 vs 5.2, p=0.000), visual analog scale (VAS) pain (56 mm vs 45 mm, p=0.000), VAS global health (53 mm vs 44 mm, p=0.000) and tender joint count (TJC) (10 vs 8, p=0.000). These differences persisted for up to 2 years of follow-up (for HAQ, for up to 8 years of follow-up). Immigrant status did not have any effect on swollen joint count (SJC), ESR, CRP or EULAR response. Socioeconomic class did not have any effect on treatment or outcome.
Conclusions: Immigrants scored worse in pain, function and TJC for up to 2 years of follow-up, but they did not differ from non-immigrants in objective measures of inflammation or EULAR outcome. This could be due to different perceptions of health and pain and/or the stress of immigration. Socioeconomic class had no effect on treatment or outcome, and this could be due to the relatively egalitarian society in Sweden.
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Affiliation(s)
- Maria L E Andersson
- Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden
| | - Stefan Bergman
- Department of Rheumatology, IKVL, Lund University, Lund, and Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden
| | - Maria K Söderlin
- Karlskrona Central Hospital, Karlskrona, Sweden ; Department of Rheumatology, IKVL, Lund University, Lund, and Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden
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Naranjo A, Bilbao A, Erausquin C, Ojeda S, Francisco FM, Rúa-Figueroa I, Rodríguez-Lozano C. Results of a specific smoking cessation program for patients with arthritis in a rheumatology clinic. Rheumatol Int 2013; 34:93-9. [PMID: 24005567 DOI: 10.1007/s00296-013-2851-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study is to evaluate an intervention program in smoker patients. We selected consecutive active smoker patients with rheumatoid arthritis, spondyloarthritis, or connective tissue diseases. The intervention consisted of the following: (1) a baseline visit, which included verbal and written advice by the rheumatologist, emphasizing the practical benefits of smoking cessation. Patients completed a questionnaire that included smoking dependence tests and previous attempts to quit. (2) A follow-up visit to the nurse in the 3rd month for reinforcement and the receiving of pharmacological treatment to help patients quit smoking. The primary outcome was total abstinence in the last 7 days of a phone interview at 3, 6, and 12 months. The secondary outcome was a reduction in cigarette consumption by at least 50%. A total of 945 patients were screened. About 185 (19.5%) were current smokers, and 152 were included for intervention. In the previous 5 years, the mean annual withdrawal rate was 4.6%. The smoking cessation rate was 11.8, 14.4, and 15.7% at 3, 6, and 12 months (OR compared with previous cessation rate 3.8 (CI 95% 1.8-8.1)). Twenty-nine patients (19%) reduced ≥50% of the cigarette consumption at 12 months. The linear regression analysis showed that a score of less dependence (p = 0.03) and previous attempts to quit smoking (p = 0.04) were significantly associated with definitive smoking cessation at 12 months. One out of six patients quit smoking with the aid of an educational program which included verbal and written advice by the rheumatologist and the nurse. As far as we know, this is the first interventional study in smoker patients with arthritis.
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Affiliation(s)
- Antonio Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, C/Barranco de La Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain,
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