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Stamatis P, Mohammad MA, Gisslander K, Merkel PA, Englund M, Turesson C, Erlinge D, Mohammad AJ. Myocardial infarction in a population-based cohort of patients with biopsy-confirmed giant cell arteritis in southern Sweden. RMD Open 2024; 10:e003960. [PMID: 38599652 PMCID: PMC11015192 DOI: 10.1136/rmdopen-2023-003960] [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: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To determine the incidence rate (IR) of myocardial infarction (MI), relative risk of MI, and impact of incident MI on mortality in individuals with biopsy-confirmed giant cell arteritis (GCA). METHODS MIs in individuals diagnosed with GCA 1998-2016 in Skåne, Sweden were identified by searching the SWEDEHEART register, a record of all patients receiving care for MI in a coronary care unit (CCU). The regional diagnosis database, with subsequent case review, identified GCA patients receiving care for MI outside of a CCU. A cohort of 10 reference subjects for each GCA case, matched for age, sex and area of residence, was used to calculate the incidence rate ratio (IRR) of MI in GCA to that in the general population. RESULTS The GCA cohort comprised 1134 individuals. During 7958 person-years of follow-up, 102 were diagnosed with incident MI, yielding an IR of 12.8 per 1000 person-years (95% CI 10.3 to 15.3). The IR was highest in the 30 days following GCA diagnosis and declined thereafter. The IRR of MI in GCA to that of the background population was 1.29 (95% CI 1.05 to 1.59). Mortality was higher in GCA patients who experienced incident MI than in those without MI (HR 2.8; 95% CI 2.2 to 3.6). CONCLUSIONS The highest incidence of MI occurs within the 30 days following diagnosis of GCA. Individuals with GCA have a moderately increased risk of MI compared with a reference population. Incident MI has a major impact on mortality in GCA.
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Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Sunderby Hospital, Luleå, Sweden
| | | | - Karl Gisslander
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund Universtiy, Malmö, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Ben-Shabat N, Shabat A, Watad A, Kridin K, Bragazzi NL, McGonagle D, Comaneshter D, Cohen AD, Amital H. Mortality in Ankylosing Spondylitis According to Treatment: A Nationwide Retrospective Cohort Study of 5,900 Patients From Israel. Arthritis Care Res (Hoboken) 2022; 74:1614-1622. [PMID: 33973404 DOI: 10.1002/acr.24616] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/08/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In this large population-based study we aimed: 1) to assess mortality in patients with ankylosing spondylitis (AS) compared to the general population, considering demographics, comorbidities, and treatment, and 2) to assess factors associated with mortality within patients with AS. METHODS This study was designed as a retrospective cohort study using the electronic database of the largest health maintenance organization in Israel. All patients with AS diagnosed between 2002 and 2018 were included. Controls were matched by age, sex, clinic, and enrollment time. Follow-up continued until death or the end of the study. RESULTS The study comprised 5,930 AS patients and 29,018 matched controls who were followed up for a median period of 7.5 years. There were 667 deaths within the AS cohort and 2,919 deaths within controls; the mean age at death was 76.9 years and 77.1 years, respectively (P = 0.74). A total of 3,249 AS patients (54.8%) were treated only with nonsteroidal antiinflammatory drugs, 1,760 (29.7%) were treated with tumor necrosis factor inhibitors (TNFi), and 1,687 (28.4%) with disease-modifying antirheumatic drugs (DMARDs). Mortality rates were increased among AS patients compared to controls, with an age- and sex-adjusted hazard ratio (HR) of 1.19 (95% confidence interval [95% CI] 1.10-1.30). The association was significant for men (HR 1.15 [95% CI 1.04-1.27]) and women (HR 1.32 [95% CI 1.13-1.54]), and after adjusting for background comorbidities (HR 1.14 [95% CI 1.05-1.24]). AS patients treated with TNFi or with a combination of TNFi and DMARDs did not have significant difference in mortality rates compared to controls (HR 0.67 [95% CI 0.38-1.18] and HR 0.93 [95% CI 0.69-1.25], respectively). Age, male sex, mean C-reactive protein (CRP) levels and general comorbidities were predictors of mortality within the AS cohort. CONCLUSION AS patients had an increased mortality risk compared to the general population after adjusting for age, sex, and baseline comorbidities. AS patients treated with TNFi did not demonstrate excess mortality compared to matched controls. Within the AS cohort, age, male sex, background comorbidities, and higher CRP levels were identified as risk factors for mortality.
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Affiliation(s)
- Niv Ben-Shabat
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, and Sheba Medical Center, Ramat Gan, Israel
| | - Aviv Shabat
- Hadassah Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, and Sheba Medical Center, Ramat Gan, Israel, and University of Leeds and Chapel Allerton Hospital, Leeds, UK
| | - Khalaf Kridin
- University of Lübeck, Lübeck, Germany, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, University of Genoa, Genoa, Italy, and York University, Toronto, Ontario, Canada
| | | | | | - Arnon D Cohen
- Clalit Health Services Tel Aviv, Tel-Aviv, and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Sheba Medical Center, Ramat Gan, and Ben Gurion University of the Negev, Beer Sheva, Israel
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Abstract
Large-vessel vasculitis (LVV) manifests as inflammation of the aorta and its major branches and is the most common primary vasculitis in adults. LVV comprises two distinct conditions, giant cell arteritis and Takayasu arteritis, although the phenotypic spectrum of primary LVV is complex. Non-specific symptoms often predominate and so patients with LVV present to a range of health-care providers and settings. Rapid diagnosis, specialist referral and early treatment are key to good patient outcomes. Unfortunately, disease relapse remains common and chronic vascular complications are a source of considerable morbidity. Although accurate monitoring of disease activity is challenging, progress in vascular imaging techniques and the measurement of laboratory biomarkers may facilitate better matching of treatment intensity with disease activity. Further, advances in our understanding of disease pathophysiology have paved the way for novel biologic treatments that target important mediators of disease in both giant cell arteritis and Takayasu arteritis. This work has highlighted the substantial heterogeneity present within LVV and the importance of an individualized therapeutic approach. Future work will focus on understanding the mechanisms of persisting vascular inflammation, which will inform the development of increasingly sophisticated imaging technologies. Together, these will enable better disease prognostication, limit treatment-associated adverse effects, and facilitate targeted development and use of novel therapies.
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Antonini L, Dumont A, Lavergne A, Castan P, Barakat C, Gallou S, Sultan A, Deshayes S, Aouba A, de Boysson H. Real-life analysis of the causes of death in patients consecutively followed for giant cell arteritis in a French centre of expertise. Rheumatology (Oxford) 2021; 60:5080-5088. [PMID: 33693495 DOI: 10.1093/rheumatology/keab222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe, in a real-life setting, the direct causes of death in a cohort of consecutive patients with GCA. METHODS We retrospectively analysed the deaths that occurred in a cohort of 470 consecutive GCA patients from a centre of expertise between January 2000 and December 2019. Among the 120 patients who died, we retrieved data from the medical files of 101 patients. RESULTS Cardiovascular events were the dominant cause of death (n = 41, 41%) followed by infections (n = 22, 22%), geriatric situations (i.e. falls or senile deterioration; n = 17, 17%) and cancers (n = 15, 15%). Patients in each of these four groups were compared with the other deceased patients pooled together. Patients who died from cardiovascular events were more frequently male (46 vs 27%; P = 0.04) with a past history of coronary artery disease (29 vs 8%; P = 0.006). Patients who died from infections mostly had ongoing glucocorticoid treatment (82 vs 53%; P = 0.02) with higher cumulative doses (13 994 vs 9150 mg; P = 0.03). Patients who died from geriatric causes more frequently had osteoporosis (56 vs 17%; P = 0.0009) and had mostly discontinued glucocorticoid treatment (76 vs 33%; P = 0.001). The predictive factors of death in multivariate analysis were a history of coronary disease [hazard ratio (HR) 2.39; 95% CI 1.27, 4.21; P = 0.008], strokes at GCA diagnosis (HR 2.54; 95% CI 1.05, 5.24; P = 0.04), any infection during follow-up (HR 1.93; 95% CI 1.24, 2.98; P = 0.004) and fever at GCA diagnosis (HR 1.99; 95% CI 1.16, 3.28; P = 0.01). CONCLUSION Our study provides real-life insight on the cause-specific mortality in GCA patients.
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Affiliation(s)
- Luca Antonini
- Department of Internal Medicine, Caen University Hospital
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| | | | - Paul Castan
- Department of Internal Medicine, Caen University Hospital
| | - Clivia Barakat
- Department of Internal Medicine, Caen University Hospital
| | - Sophie Gallou
- Department of Internal Medicine, Caen University Hospital
| | - Audrey Sultan
- Department of Internal Medicine, Caen University Hospital
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
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Garvey TD, Koster MJ, Crowson CS, Warrington KJ. Incidence, survival, and diagnostic trends in GCA across seven decades in a North American population-based cohort. Semin Arthritis Rheum 2021; 51:1193-1199. [PMID: 34644662 DOI: 10.1016/j.semarthrit.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To analyze trends in the incidence and use of diagnostic modalities for GCA in a population-based cohort over the past seven decades. To explore survival trends in patients with GCA compared with the general population. METHODS A population-based cohort of patients diagnosed with GCA was extended with new incident cases from 2010 to 2019. Three time periods were compared: Period One (1950-1979), Period Two (1980-1999), and Period Three (2000-2019). Cases were classified as: Diagnostic Group One, temporal artery biopsy (TAB) positive; Diagnostic Group Two, TAB-negative or not done with positive large-vessel imaging; or Diagnostic Group Three, clinical diagnosis of GCA. Survival was evaluated by comparing Kaplan-Meier estimated mortality rates for cases of GCA against expected mortality rates from Minnesota life tables RESULTS: Age- and sex-adjusted incident rates per 100,000 ≥ 50 years of age (95% CI) were 13.5 (10.1, 16.9) in Period One, 21.0 (17.1, 25.0) in Period Two, and 15.0 (12.4, 17.5) in Period Three. The percent of patients in Diagnostic Group One decreased over the three time periods (89%, 86%, and 72%) while the patients in Diagnostic Group Three increased (11%, 14%, and 17%). Standardized mortality ratios (95% CI) were 1.03 (0.79, 1.32), 1.11 (0.91, 1.34), and 0.82 (0.64, 1.04) across Periods 1-3, respectively. CONCLUSIONS Incidence of GCA in females in the population declined, resulting in a decreasing overall incidence. More patients have been identified by large-vessel imaging and fewer by positive TABs. No significant difference in survival between patients with GCA and the general population was observed.
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Affiliation(s)
- Thomas D Garvey
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America.
| | - Matthew J Koster
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America
| | - Cynthia S Crowson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kenneth J Warrington
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America
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Mahroum N, Zoubi M, Lavine N, Ohayon A, Amital H, Shoenfeld Y. The mosaic of autoimmunity - A taste for more. The 12th international congress of autoimmunity 2021 (AUTO12) virtual. Autoimmun Rev 2021; 20:102945. [PMID: 34509655 DOI: 10.1016/j.autrev.2021.102945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022]
Abstract
Notwithstanding the fact that the 12th international congress of autoimmunity (AUTO12) was held virtual this year, the number of the abstracts submitted and those presented crossed the thousand marks. Leading investigators and researchers from all over the world presented the latest developments of their research in the domain of autoimmunity and its correlation with various diseases. In terms of mechanisms of autoimmunity, an update on the mechanisms behind the association of autoimmunity with systemic diseases focusing on hyperstimulation was presented during AUTO12. In addition, a new mechanism of ASIA syndrome caused by an intrauterine contraceptive device was revealed demonstrating a complete resolution of symptoms following device removal. In regard to the correlation between autoimmunity and neurogenerative diseases, the loss of structural protein integrity as the trigger of immunological response was shown. Schizophrenia as well, and its correlation to pro-inflammatory cytokines was also addressed. Furthermore, and as it was said AUTO12 virtual due to COVID-19 pandemic, various works were dedicated to SARS-CoV-2 infection and COVID-19 in terms of autoimmune mechanisms involved in the pathogenesis, treatment and complications of COVID-19. For instance, the correlation between autoimmunity and the severity of COVID-19 was viewed. Moreover, the presence and association of autoantibodies in COVID-19 was also demonstrated, as well as the clinical outcomes of COVID-19 in patients with rheumatic diseases. Finally, immune-mediated reactions and processes secondary to SARS-CoV-2 vaccination was displayed. Due to the immense importance of all of the topics addressed and while several hundreds of works were presented which cannot be summed up in one paper, we aimed hereby to highlight some of the outstanding abstracts and presentations during AUTO12.
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Affiliation(s)
- Naim Mahroum
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Magdi Zoubi
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Noy Lavine
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; St. George School of Medicine, University of London, London, UK
| | - Aviran Ohayon
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; St. George School of Medicine, University of London, London, UK
| | - Howard Amital
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Ariel University, Ariel, Israel; Saint Petersburg State University, Saint-Petersburg, Russia
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The risk of depression and anxiety in patients with familial mediterranean fever - a cross-sectional study. J Affect Disord 2021; 292:695-699. [PMID: 34157665 DOI: 10.1016/j.jad.2021.05.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Familial Mediterranean Fever (FMF) is an autosomal recessive autoinflammatory disease associated with various systemic comorbidities. Recent research regarding the association with depression and anxiety has yielded conflicting results. The current study aims were to examine whether such an association exists using big data analysis methodology. METHODS This study was conducted as a cross-sectional analysis based on the Clalit Health Services database. We compared the proportions of depression and anxiety in patients diagnosed with FMF and age- and sex- matched controls. We used the Chi-square test and T-test for univariate analysis. Multivariate logistic regression was then applied to control for possible confounding variables. RESULTS The study included 7,670 patients with FMF and 7,670 matched controls. The prevalence of both depression and anxiety was found to be higher in the FMF group as compared to controls (6.22% and 4.58%, respectively, p<0.001, and 4.93% and 3.14%, respectively, p<0.001). These proportions remained significant after adjusting for important confounders, such as smoking and socioeconomic status. LIMITATIONS Temporal association does not indicate a causal relationship, the validity of the diagnoses relies on clinical records and is not based on formal classifications or diagnostic criteria, information regarding disease duration and other parameters were not accessible. CONCLUSIONS Our data imply that FMF is independently associated with both depression and anxiety. These findings highlight the importance of raising awareness for these comorbidities.
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Abstract
PURPOSE OF REVIEW Aortitis is the inflammation of the aorta due to various causes. Clinical presentations vary as well as the imaging findings. Exact pathogenetic mechanisms or triggering factors, as well as the best diagnostic and monitoring modalities and treatment strategies, are yet to be elucidated. We reviewed recent studies in aortitis and associated diseases. RECENT FINDINGS Multiple cohort studies reporting long-term outcomes in patients with noninfectious aortitis were recently published. Comparative features of isolated aortitis were described. Six angiographic clusters for giant cell arteritis and Takayasu have been identified. New classification criteria have been proposed for IgG4-related disease by a data-driven method. The ultrasonographic slope sign and a halo score were described as specific imaging parameters in giant cell arteritis. The promising role of PET-computed tomography, not only in the diagnosis of aortitis but also in monitoring disease activity, has been noted. Results of in-vitro studies on Janus kinase (JAK)/signal transducers and activators of transcription and mammalian target of rapamycin (mTOR) pathways, comparative studies with leflunomide as an induction therapy, and a long-term follow-up study with tocilizumab may contribute to the management of Takayasu arteritis. SUMMARY An impressive number of studies have addressed aortitis in recent years. However, there still is a lack of robust data on causes, monitoring disease activity by imaging and biomarkers, and drugs providing steroid-free remission in noninfectious aortitis.
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Dar L, Ben-Shabat N, Tiosano S, Watad A, McGonagle D, Komaneshter D, Cohen A, Bragazzi NL, Amital H. The Incidence and Predictors of Solid- and Hematological Malignancies in Patients with Giant Cell Arteritis: A Large Real-World Database Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7595. [PMID: 34300046 PMCID: PMC8306706 DOI: 10.3390/ijerph18147595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The association between giant cell arteritis (GCA) and malignancies had been widely investigated with studies reporting conflicting results. Therefore, in this study, we aimed to investigate this association using a large nationwide electronic database. METHODS This study was designed as a retrospective cohort study including GCA patients first diagnosed between 2002-2017 and age, sex and enrollment time-matched controls. Follow-up began at the date of first GCA-diagnosis and continued until first diagnosis of malignancy, death or end of study follow-up. RESULTS The study enrolled 7213 GCA patients and 32,987 age- and sex-matched controls. The mean age of GCA diagnosis was 72.3 (SD 9.9) years and 69.1% were women. During the follow-up period, 659 (9.1%) of GCA patients were diagnosed with solid malignancies and 144 (2.0%) were diagnosed with hematologic malignancies. In cox-multivariate-analysis the risk of solid- malignancies (HR = 1.12 [95%CI: 1.02-1.22]), specifically renal neoplasms (HR = 1.60 [95%CI: 1.15-2.23]) and sarcomas (HR = 2.14 [95%CI: 1.41-3.24]), and the risk of hematologic malignancies (HR = 2.02 [95%CI: 1.66-2.47]), specifically acute leukemias (HR = 1.81 [95%CI: 1.06-3.07]), chronic leukemias (HR = 1.82 [95%CI: 1.19-2.77]), Hodgkin's lymphomas (HR = 2.42 [95%CI: 1.12-5.20]), non-Hodgkin's-lymphomas (HR = 1.66: [95%CI 1.21-2.29]) and multiple myeloma(HR = 2.40 [95%CI: 1.63-3.53]) were significantly increased in GCA patients compared to controls. Older age at GCA-diagnosis (HR = 1.36 [95%CI: 1.25-1.47]), male-gender (HR = 1.46 [95%CI: 1.24-1.72]), smoking (HR = 1.25 [95%CI: 1.04-1.51]) and medium-high socioeconomic status (HR = 1.27 [95%CI: 1.07-1.50]) were independently associated with solid malignancy while age (HR = 1.47 [95%CI: 1.22-1.77]) and male-gender (HR = 1.61 [95%CI: 1.14-2.29]) alone were independently associated with hematologic- malignancies. CONCLUSION our study demonstrated higher incidence of hematologic and solid malignancies in GCA patients. Specifically, leukemia, lymphoma, multiple myeloma, kidney malignancies, and sarcomas. Age and male gender were independent risk factors for hematological malignancies among GCA patients, while for solid malignancies, smoking and SES were risk factors as well.
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Affiliation(s)
- Lior Dar
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel; (N.B.-S.); (S.T.); (A.W.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Niv Ben-Shabat
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel; (N.B.-S.); (S.T.); (A.W.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Shmuel Tiosano
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel; (N.B.-S.); (S.T.); (A.W.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Abdulla Watad
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel; (N.B.-S.); (S.T.); (A.W.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Section of Musculoskeletal Diseases, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK;
| | - Dennis McGonagle
- Section of Musculoskeletal Diseases, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK;
| | - Doron Komaneshter
- Chief Physician’s Office, Clalit Health Services, Tel-Aviv 6209813, Israel; (D.K.); (A.C.)
| | - Arnon Cohen
- Chief Physician’s Office, Clalit Health Services, Tel-Aviv 6209813, Israel; (D.K.); (A.C.)
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON M3J 1P3, Canada;
| | - Howard Amital
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel; (N.B.-S.); (S.T.); (A.W.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
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Garvey TD, Koster MJ, Warrington KJ. My Treatment Approach to Giant Cell Arteritis. Mayo Clin Proc 2021; 96:1530-1545. [PMID: 34088416 DOI: 10.1016/j.mayocp.2021.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults 50 years or older. Expanded use of advanced arterial imaging has assisted both in the diagnosis of GCA and recognition of disease subsets. Although glucocorticoids have been the mainstay of treatment for almost 7 decades, new therapeutic options have emerged. This review aims to provide the clinician with a pragmatic approach to evaluating and managing patients with GCA while also addressing recent diagnostic and therapeutic developments.
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Affiliation(s)
- Thomas D Garvey
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Matthew J Koster
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Rodriguez-Pla A, Rossello-Urgell J. Trend and Geographic Disparities in the Mortality Rates of Primary Systemic Vasculitis in the United States from 1999 to 2019: A Population-Based Study. J Clin Med 2021; 10:1759. [PMID: 33919526 PMCID: PMC8074184 DOI: 10.3390/jcm10081759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
The current data on rates and geographic distribution of vasculitis mortality are limited. We aimed to estimate the mortality rates of primary systemic vasculitis and its geographic distribution using recent population data in the United States. The mortality rates of vasculitis from 1999 to 2019 were obtained from the Center for Disease Control (CDC) Wonder Multiple Cause of Death (MCD). The age-adjusted rates per million for vasculitis as MCD and as an underlying cause of death (UCD) were calculated by state using demographics. A joinpoint regression analysis was applied to evaluate trends over time. The age-adjusted mortality rate of vasculitis as MCD was 4.077 (95% CI: 4.029-4.125) and as a UCD was 1.888 per million (95% CI: 1.855-1.921). Since 1999, mortality rates have progressively decreased. The age-adjusted mortality rate was higher in females than in males. The highest mortality rate for vasculitis as MCD was in White patients (4.371; 95% CI: 4.317-4.424). The northern states and areas with lower populations had higher mortality rates. We found a trend of progressive decreases in the mortality rates of vasculitis, as well as gender, racial, and geographic disparities. Further analyses are warranted to better understand the factors associated with these disparities in order to implement targeted public health interventions to decrease them.
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Affiliation(s)
| | - Jose Rossello-Urgell
- Statistics and Epidemiology Consultant, ARJR Media LLC, Scottsdale, AZ 85259, USA;
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Li KJ, Semenov D, Turk M, Pope J. A meta-analysis of the epidemiology of giant cell arteritis across time and space. Arthritis Res Ther 2021; 23:82. [PMID: 33706808 PMCID: PMC7948334 DOI: 10.1186/s13075-021-02450-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Giant cell arteritis (GCA) is a common large vessel vasculitis in those over age 50 years. This meta-analysis examined the geographical and temporal distribution of the incidence, prevalence, and mortality of GCA. METHODS A systematic review was conducted using EMBASE, Scopus, and PubMed from their inceptions until 2019. Studies were included if they reported at least 50 or more GCA patients and defined the location and time frame. Articles on mortality were included and standardized mortality ratio (SMR) was extracted where possible. Mean pooled prevalence, incidence, and SMR were calculated using a random effects model. Linear regression was used to explore correlations between latitude and incidence, prevalence, and mortality. RESULTS Of the 3569 citations identified, 107 were included. The pooled incidence of GCA was 10.00 [9.22, 10.78] cases per 100,000 people over 50 years old. This incidence was highest in Scandinavia 21.57 [18.90, 24.23], followed by North and South America 10.89 [8.78, 13.00], Europe 7.26 [6.05, 8.47], and Oceania 7.85 [- 1.48, 17.19]. Pooled prevalence was 51.74 [42.04, 61.43] cases per 100,000 people over age 50. Annual mortality was 20.44 [17.84, 23.03] deaths/1000. Mortality generally decreased over the years of publication (p = 0.0008). Latitude correlated significantly with incidence (p = 0.0011), but not with prevalence, or mortality. CONCLUSIONS GCA incidence varies nearly 3-fold between regions and is highest in Scandinavia but not significantly. Mortality may be improving over time.
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Affiliation(s)
- Katherine J Li
- Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, 268 Grosvenor St, D2 Rheumatology, London, ON, N6A 4V2, Canada
| | - Daniel Semenov
- Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, 268 Grosvenor St, D2 Rheumatology, London, ON, N6A 4V2, Canada
| | - Matthew Turk
- University College Dublin, School of Medicine and Medical Sciences, Dublin 4, Ireland
| | - Janet Pope
- Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, 268 Grosvenor St, D2 Rheumatology, London, ON, N6A 4V2, Canada.
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Barra L, Pope JE, Pequeno P, Gatley JM, Widdifield J. Increased mortality for individuals with Giant Cell Arteritis: a population-based study. Arthritis Care Res (Hoboken) 2021; 74:1294-1299. [PMID: 33544963 DOI: 10.1002/acr.24573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reports of mortality risks among individuals with GCA have been mixed. Our aim was to evaluate all-cause mortality among individuals with GCA relative to the general population over time. METHODS We performed a population-based study in Ontario, Canada, using health administrative data. We studied a cohort of 22,677 GCA patients aged ≥50 years identified using a validated case definition (with 81% positive predictive value, 100% specificity). General population comparators were residents aged ≥50 years without GCA. Deaths were ascertained from vital statistics. Annual crude, age/sex-standardized and age- and sex-specific all-cause mortality rates were determined for individuals with and without GCA between 2000 and 2018. Standardized mortality ratios (SMRs) were estimated. RESULTS Age- and sex-standardized mortality rates were significantly higher for GCA patients than comparators, and trending to increase over time with 50.0 (95% confidence interval (CI) 34.0, 71.1) deaths per 1000 GCA patients in 2000 and 57.6 (95% CI 50.8, 65.2) deaths per 1000 in 2018, whereas mortality rates in the general population significantly declined over time. The annual SMRs for GCA patients generally increased over time with the lowest SMR occurring in 2002 (1.22; 95% CI 1.03, 1.40) and the highest in 2018 (1.92; 95% CI 1.81, 2.03). GCA mortality rates were more elevated for males than females. CONCLUSION Over a 19-year period, mortality rates were increased among GCA patients relative to the general population and more premature deaths were occurring in younger age groups. The relative excess mortality for GCA patients did not improve over time.
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Affiliation(s)
- Lillian Barra
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | | | | | - Jessica Widdifield
- ICES, Toronto, Ontario, Canada.,Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ben-Shabat N, Watad A, Shabat A, Bragazzi NL, Comaneshter D, Cohen AD, Amital H. Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study. Nutrients 2020; 12:nu12051400. [PMID: 32414130 PMCID: PMC7285142 DOI: 10.3390/nu12051400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023] Open
Abstract
In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002–2007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03–1.58]). In AS patients, insufficient levels of vitamin D (<30 ng/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02–2.50]). This association was more prominent with the decrease in vitamin D levels (< 20 ng/mL, HR 1.63 [95% CI 1.03–2.60]; <10 ng/mL, HR 1.79 [95% CI 1.01–3.20]) and among male patients (<30 ng/mL, HR 2.11 [95% CI 1.20–3.72]; <20 ng/mL, HR 2.12 [95% CI 1.19–3.80]; <10 ng/mL, HR 2.23 [95% CI 1.12–4.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.
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Affiliation(s)
- Niv Ben-Shabat
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel; (N.B.-S.); (H.A.)
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel; (N.B.-S.); (H.A.)
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Chapel Allerton Hospital, University of Leeds, Leeds LS7 4SA, UK
- Correspondence: ; Tel.: +972-3-530-2652
| | - Aviv Shabat
- Hadassah Faculty of Medicine, The Hebrew University, Jerusalem 9112001, Israel;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Doron Comaneshter
- Chief Physician’s Office, Clalit Health Services Tel Aviv, Tel-Aviv 6209813, Israel; (D.C.); (A.D.C.)
| | - Arnon D. Cohen
- Chief Physician’s Office, Clalit Health Services Tel Aviv, Tel-Aviv 6209813, Israel; (D.C.); (A.D.C.)
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel; (N.B.-S.); (H.A.)
- Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
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