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Hale ED, Morris M, Hewlett S, Treharne GJ, Kitas GD. Meeting the needs of children who have parents with chronic inflammatory musculoskeletal diseases. Rheumatology (Oxford) 2011; 50:431-3. [DOI: 10.1093/rheumatology/keq193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kitas GD, Gabriel SE. Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. Ann Rheum Dis 2010; 70:8-14. [DOI: 10.1136/ard.2010.142133] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shukla S, Lawrence A, Aggarwal A, Naik S, Gullick NJ, Evans HG, Jayaraj D, Kirkham BW, Taams LS, Judah SM, Nixon N, Dawes P, Mattey DL, Yeo L, Schmutz C, Toellner KM, Salmon M, Filer AD, Buckley C, Raza K, Scheel-Toellner D, Hashizume M, Yoshida H, Koike N, Suzuki M, Mihara M, Stavropoulos-Kalinoglou A, Metsios GS, Douglas KM, Panoulas VF, Koutedakis Y, Kitas GD, Church LD, Filer AD, Hildago E, Howlett K, Thomas A, Rapecki S, Scheel-Toellner D, Buckley CD, Raza K, Juarez M, Kolasinski J, Govindan J, Quilter A, Williamson L, Collins DA, Price EJ, Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas K, Kitas GD, Lachmann HJ, Kuemmerle-Deschner JB, Hachulla E, Hoyer J, Smith J, Leslie K, Kone-Paut I, Braun J, Widmer A, Patel N, Preiss R, Hawkins PN. Cytokines and Inflammatory Mediators [30-39]: 30. The LPS Stimulated Production of Interleukin-10 is not Associated with -819C/T and -592C/A Promoter Polymorphisms in Healthy Indian Subjects. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Backhouse MR, Keenan AM, Young A, James D, Cox N, Williams P, Musa R, Helliwell PS, Kingsley GH, Packham JC, McHugh NJ, Mulherin DM, Kitas GD, Chakravarty K, Ibrahim F, Taylor H, Kowalczyk A, Maddison PJ, Scott DL, D'Cruz D, Tanasescu C, Navarra S, Guzman R, Gallacher A, Levy RA, Li EK, Thomas M, Jimenez RE, Leon MG, Hall S, Lan JL, Kim HY, Pineda L, Zhong J, Freimuth WW. BSR and BHPR Plenary Oral [OP1-OP3]: OP1. Use of Conservative and Surgical Foot Care in Rheumatoid Arthritis: The Eras Cohort. Rheumatology (Oxford) 2010; 49 Suppl 1:i1-167. [DOI: 10.1093/rheumatology/keq700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Castelino M, Gibbons L, McHugh N, Korendowych E, Bruce IN, Ho P, Barton A, Orozco G, Barton A, Eyre S, Worthington J, Ke X, Thomson W, Toms TE, Smith JP, Panoulas VF, Douglas KM, Kitas GD, Plant D, Farragher T, Flynn E, Martin P, Eyre S, Bunn D, Worthington J, Symmons D, Barton A, Thomson W. Genetics [315-318]: 315. Investigation of Association of the Erap1 Gene with Psoriatic Arthritis. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Westlake SL, Colebatch AN, Baird J, Kiely P, Quinn M, Choy E, Ostor AJ, Edwards CJ, Jankowska B, Uchmanowicz I, Polanski J, Dudek K, Suresh R, Horwood N, Sandoo A, van Zanten JV, Smith JP, Carroll D, Toms TE, Kitas GD, Chitale S, Estrach C, Thompson R, Sathyamurthy S, Goodson N, Toms TE, Panoulas VF, Douglas KM, Kitas GD, Abozaid HS, Fathi NA, Scott DL, Steer S, Galloway J, Dixon W, Mercer L, Watson K, Mark L, Hyrich K, Symmons D, Hirsch G, Klocke R, Toberty E, Coulson E, Saravanan V, Heycock C, Rynne M, Hamilton J, Kelly C, Tsang R, Coulson E, Saravanan V, Heycock C, Hamilton J, Kelly C, El Miedany Y, Palmer D, Collins D, Arnold T, Juarez M, Waller R, Williamson L, Price E, Suppiah R, Doyle A, Rai R, Dalbeth N, Lobo M, Braun J, McQueen F, Cader Z, Filer A, Buckley CD, Raza K, Mirjafari H, Farragher T, Verstappen SM, Bunn D, Charlton-Menys V, Marshall T, Symmons DP, Bruce IN, Steven R, Crilly A, Lockhart JC, Ferrell WR, McInnes IB, Ahmed U, Rabbani N, Filer A, Watts R, Raza K, Thornalley P, Nikiphorou E, Young A, Kiely P, Walsh D, Williams R, Iskandar M, Farragher T, Bunn D, Symmons D, El Miedany Y, El Gaafary M, Palmer D, Filer A, de Pablo P, Allen G, Nightingale P, Jordan A, Jobanputra P, Buckley C, Raza K, Gordon R, Snowden N, Gwynne C, Amos N, Camilleri J, El Miedany Y, El Gaafary M, Youssef S, Palmer D, Silburn S, Pullar T, Vinod K, Fardon T, Scott IC, Kingsley G, Scott DL, Koduri G, Norton S, Young A, Cox N, Prouse P, Dixey J, Williams P, Jones N, Suppiah R, Newton J, Litwic AE, Ledingham JM, Stavropoulos-Kalinoglou A, Metsios GS, Panoulas VF, Koutedakis Y, Kitas GD, Ramachandran Nair J, Mewar D, Long KS, Coulson E, Saravanan V, Heycock C, Hamilton J, Kelly C, El Miedany Y, Youssef S, Palmer D. Rheumatoid Arthritis: Clinical Aspects [322-355]: 322. The Effect of Biologics on Cardiovascular Disease in Patients with Rheumatoid Arthritis: A Systematic Literature Review. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Norton S, Done J, Sacker A, Young A, Cox N, Treharne GJ, McGavock ZC, Tonks A, Kafka SA, Hale ED, Kitas GD, Fletcher D, Sanderson T, Baker G, Street P, Hewlett S, Stynes S, Peat G, Myers H, Croft P, Bosworth AM, Crake D, Hurley M, Patel A, Walsh N, Mitchell H, Kumar K, Gordhan C, Situnayake D, Raza K, Bacon P, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Stevenson K, Roddy E, Jordan K, Waldron N, Brown S, McCabe C, McHugh N, Hewlett S, Shelmerdine J, Ferenkeh-Koroma A, Breslin A, Sawyer S, Haas M, Elliott B, Law RJ, Breslin A, Oliver E, Mawn L, Markland D, Peter M, Thom J, Hewlett S, Sanderson T, May J, Bingham CO, March L, Alten R, Pohl C, Woodworth T, Bartlett S, Cliss A, Morris M, Ambler N, Knops B, Hammond A, Almeida C, Hewlett S. BHPR: Research [278-290]: 278. What does the Hospital Anxiety and Depression Scale Measure? Evidence of a Bifactor Structure and Item Bias. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lloyd M, Makadsi R, Ala A, Connor P, Gwynne C, Rhys Dillon B, Lawson T, Emery P, Mease PJ, Rubbert-Roth A, Curtis JR, Muller-Ladner U, Gaylis N, Armstrong GK, Reynard M, Tyrrell H, Joshi N, Loke Y, MacGregor A, Malaiya R, Rachapalli SM, Parton T, King L, Parker G, Nesbitt A, Schiff M, Sheikzadeh A, Formosa D, Domanska B, Morgan D, van Vollenhoven R, Cifaldi M, Roy S, Chen N, Gotlieb L, Malaise M, Langtree M, Lam M, Malipeddi A, Hassan W, El Miedany Y, El Gaafary M, Palmer D, Dutta S, Breslin A, Ahmad Y, Morcos PN, Zhang X, Grange S, Schmitt C, Malipeddi AS, Neame R, Isaacs JD, Olech E, Tak PP, Deodhar A, Keystone E, Emery P, Yocum D, Hessey E, Read S, Blunn KJ, Williams RB, McDowell JA, Rees DH, Young A, Marks JL, Westlake SL, Baird J, Kiely PD, Ostor AJ, Quinn MA, Taylor PC, Edwards CJ, Vagadia V, Bracewell C, McKay N, Collini A, Kidd E, Wright D, Watson K, Williams E, Mossadegh S, Ledingham J, Combe B, Schwartzman S, Massarotti E, Keystone EC, Luijtens K, van der Heijde D, Mariette X, Kivitz A, Isaacs JD, Stohl W, Tak PP, Jones R, Jahreis A, Armstrong G, Shaw T, Westhovens R, Strand V, Keystone EC, Purcaru O, Khanna D, Smolen J, Kavanaugh A, Keystone EC, Fleischmann RM, Emery P, Dougados M, Baldassare AR, Armstrong GK, Linnik M, Reynard M, Tyrrell H, McInnes IB, Combe B, Burmester G, Schiff M, Keiserman M, Codding C, Songcharoen S, Berman A, Nayiager S, Saldate C, Aranda R, Becker JC, Zhao C, Le Bars M, Dougados M, Burmester GR, Kary S, Unnebrink K, Guerette B, Oezer U, Kupper H, Dougados M, Keystone EC, Guerette B, Patra K, Lavie F, Gasparyan AY, Sandoo A, Stavropoulos-Kalinoglou A, Kitas GD, Dubash SR, Linton S, Emery P, Genovese MC, Fleischmann RM, Matteson EL, Hsia EC, Xu S, Doyle MK, Rahman MU, Keystone E, Curtis J, Fleischmann R, Mease P, Khanna D, Smolen J, Coteur G, Combe B, van Vollenhoven R, Smolen J, Schiff M, Fleischmann R, Combe B, Goel N, Desai C, Curtis J, Keystone E, Emery P, Choy E, Van Vollenhoven R, Keystone E, Furie R, Blesch A, Wang CD, Curtis JR, Hughes LD, Young A, Done DJ, Treharne G, van Vollenhoven RF, Emery P, Bingham CO, Keystone EC, Fleischmann RM, Furst DE, Macey K, Sweetster MT, Lehane PB, Farmer P, Long SG, Kremer JM, Russell AS, Emery P, Abud-Mendoza C, Szechinski J, Becker JC, Wu G, Westhovens R, Keystone EC, Kavanaugh A, van der Heijde D, Sinisi S, Guerette B, Keystone EC, Fleischmann R, Smolen J, Strand V, Landewe R, Combe B, Mease P, Ansari Z, Goel N, van der Heijde D, Emery P, Alavi A, Fitzgerald O, Collins ES, Fraser O, Tarelli E, Ng VC, Breshnihan B, Veale DJ, Axford JS, Aletaha D, Alasti F, Smolen JS, Keystone EC, Schiff MH, Rovensky J, Taylor M, John AK, Balbir-Gurman A, Hughes LD, Young A, John Done D, Treharne GJ, Ezard C, Willott R, Butt S, Gadsby K, Deighton C, Tsuru T, Terao K, Suzaki M, Nakashima H, Akiyama A, Nishimoto N, Smolen J, Wordsworth P, Doyle MK, Kay J, Matteson EL, Landewe R, Hsia E, Zhou Y, Rahman MU, Van Vollenhoven R, Siri D, Furie R, Krasnow J, Alecock E, Alten R, Nishimoto N, Kawata Y, Aoki C, Mima T, van Vollenhoven RF, Nishimoto N, Yamanaka H, Woodworth T, Schiff MH, Taylor A, Pope JE, Genovese MC, Rubbert A, Keystone EC, Hsia EC, Buchanan J, Klareskog L, Murphy FT, Wu Z, Parasuraman S, Rahman MU, Kay J, Wordsworth P, Doyle MK, Smolen J, Buchanan J, Matteson EL, Hsia EC, Landewe R, Zhou Y, Shreekant P, Rahman MU, Smolen JS, Gomez-Reino JJ, Davies C, Alecock E, Rubbert-Roth A, Emery P. Rheumatoid Arthritis: Treatment [151-201]: 151. Should we be Looking More Carefully for Methotrexate Induced Liver Disease? Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, Sandoo A, Toms TE, Nevill AM, Koutedakis Y, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Clin Exp Rheumatol 2009; 27:985-988. [PMID: 20149317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE It has been frequently stated that rheumatoid cachexia (RC) associates with increased cardiovascular risk; however, no studies to date have investigated this. The aim of this study was to investigate the association of RC with multiple novel and classical cardiovascular disease (CVD) risk factors and the presence of established CVD in rheumatoid arthritis (RA). METHODS A total of 34 RA patients with RC (RA+RC) were identified from a database of 400 RA patients using published RC criteria and compared to the remaining patients (RA-RC) who did not fulfil RC criteria. All patients were assessed for fat and fat-free mass, albumin (indicator of catabolism), disease activity/severity, novel and classical risk CVD factors and established CVD. RESULTS Fat-free mass (kg) and albumin (g/L) were significantly decreased in RA+RC vs. RA-RC patients: 37.3(33.9-41.6) vs. 45.9(41.2-55.5), p<0.001 and 39.6 + or - 6.7 vs. 42.4 + or - 4.9, p=0.001). Percent body fat was not significantly different. No significant differences were detected in either the classical or novel CVD risk factors, 10-year CVD risk or the prevalence of established CVD. CONCLUSIONS RC does not appear to be associated with worse CVD profile in RA patients, but this needs to be confirmed in prospective studies.
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Stavropoulos-Kalinoglou A, Metsios GS, Smith JP, Panoulas VF, Douglas KMJ, Jamurtas AZ, Koutedakis Y, Kitas GD. What predicts obesity in patients with rheumatoid arthritis? An investigation of the interactions between lifestyle and inflammation. Int J Obes (Lond) 2009; 34:295-301. [PMID: 19859075 DOI: 10.1038/ijo.2009.220] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether physical activity, diet or inflammation is a more important determinant of body mass index (BMI) and body fat (BF) in patients with rheumatoid arthritis (RA). METHODS A total of 150 RA patients (102 female) were assessed for BMI and BF. Their habitual physical activity was assessed with the international physical activity questionnaire (IPAQ) and their energy intake with a 3-day food diary. Pro-inflammatory cytokines (interleukins, IL-1 and IL-6, and tumor necrosis factor-alpha), erythrocyte sedimentation rate, C-reactive protein, disease activity score-28 and physical function (Health Assessment Questionnaire-HAQ) were also measured. RESULTS BMI correlated inversely with IPAQ (r=-0.511, P=0.000) and positively with energy intake (r=0.331, P=0.016) and HAQ (r=0.133, P=0.042). BF correlated inversely with IPAQ (r=-0.575, P=0.000) and positively with HAQ (r=0.201, P=0.037). Normal weight patients were more physically active compared with those who were either overweight (P=0.006) or obese (P=0.000). Underweight patients consumed significantly fewer calories compared with other patients (P<0.05 in all cases). Cytokines or HAQ did not differ between weight groups. IPAQ was the sole predictor of obesity, whereas energy intake was the sole predictor of underweight. CONCLUSIONS Inflammation does not seem to influence BMI and BF in RA. As in the general population, high levels of habitual physical activity associate with low BMI and BF in RA. Energy intake is a major determinant of being underweight in those who consume fewer calories. Further research is needed to investigate the suitability of exercise and diet modalities, and their effects on the body composition of RA patients.
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Treharne GJ, Lyons AC, Booth DA, Mason SR, Kitas GD. Reactions to disability in patients with early versus established rheumatoid arthritis. Scand J Rheumatol 2009; 33:30-8. [PMID: 15124940 DOI: 10.1080/03009740310004685] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study examined differences in reactions to disability between early and established rheumatoid arthritis (RA) patients, and whether these reactions were related to age, physical functioning, acceptance of illness, or self-efficacy. METHODS Thirty-four patients with early RA (< 2 years since diagnosis) and 84 patients with established RA (> 4 years since diagnosis) completed the Reactions to Impairment and Disability Inventory (RIDI), and measures of anxiety, depression, acceptance of illness, self-efficacy, and physical functioning. RESULTS Early RA patients reported greater future denial than established RA patients. Younger patients reported more hostility than older patients. Accepting the illness was uniquely related to less anger and hostility. Higher self-efficacy for pain specifically related to greater shock, while patients with poorer self-efficacy for other symptoms reported worse anxiety, depression, shock, and anger. CONCLUSIONS Denial may be a coping strategy in the early stages of RA: anxiety, depression, shock, and anger appear to persist. Longitudinal studies of RA patients from diagnosis are required to plan interventions timed to maximize patient benefit and optimize healthcare resource utilization.
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Kitas GD, Farr M, Waterhouse L, Bacon PA. Influence of Acetylator Status on Sulphasalazine Efficacy and Toxicity in Patients with Rheumatoid Arthrftis. Scand J Rheumatol 2009; 21:220-5. [PMID: 1359635 DOI: 10.3109/03009749209099228] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The influence of acetylator status on the therapeutic efficacy and the toxicity of sulphasalazine (SASP) was assessed in 106 patients with rheumatoid arthritis (RA). Changes of indices of disease activity after 6 months, and progression of erosions after 2 years of SASP treatment were similar in fast and slow acetylators. Incidence and nature of withdrawals and side-effects, and requirement for intra-articular steroid injections or combination therapy due to poor response to SASP were almost identical in the two groups. A significant increase of the hepatic enzyme aspartate transaminase was noted mainly in slow acetylators, but was not associated with clinical disease. These results suggest that acetylator status does not relate significantly to either the efficacy or the toxicity of SASP in RA. It is possible that hepatic metabolism is affected by SASP, particularly in slow acetylators, but this does not lead to clinically identifiable problems.
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Daoussis D, Panoulas VF, Antonopoulos I, John H, Toms TE, Wong P, Nightingale P, Douglas KMJ, Kitas GD. Cardiovascular risk factors and not disease activity, severity or therapy associate with renal dysfunction in patients with rheumatoid arthritis. Ann Rheum Dis 2009; 69:517-21. [PMID: 19279016 DOI: 10.1136/ard.2008.105049] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA). It specifically addressed the hypotheses that renal dysfunction in these patients may associate with the presence of insulin resistance, dyslipidaemia, uric acid levels and/or current levels of systemic inflammation. METHODS Renal function was assessed by estimated glomerular filtration rate (GFR) using the modification of diet in renal disease equation in 400 consecutive RA patients for this cross-sectional, single-centre study. Risk factors for renal dysfunction were recorded/measured in all participants. Correlations between GFR and other variables were analysed by Pearson or Spearman test as appropriate. Linear regression was used to test the independence of the associations between GFR and other variables. RESULTS In this RA patient cohort, 67.75% of patients had a reduced GFR of less than 90 ml/minute per 1.73 m(2) and 12.75% had a GFR of less than 60 ml/minute per 1.73 m(2). Multivariable analysis revealed significant associations between GFR and age (beta = -0.370, p<0.001), female sex (beta = -0.181, p=0.002), total cholesterol (beta = -0.112, p=0.022), serum uric acid (SUA) (beta = -0.425, p<0.001) and the presence of extra-articular disease, apart from sicca and/or nodules (beta = -0.084, p=0.040). CONCLUSIONS Renal dysfunction in RA is quite common and associates with classic cardiovascular risk factors such as advanced age and dyslipidaemia, levels of SUA and the presence of extra-articular disease. Renal dysfunction was not related to other RA-related factors including disease activity and duration, disability and past or present use of nephrotoxic medications.
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Panoulas VF, Douglas KMJ, Smith JP, Stavropoulos-Kalinoglou A, Metsios GS, Nightingale P, Kitas GD. Transforming growth factor-beta1 869T/C, but not interleukin-6 -174G/C, polymorphism associates with hypertension in rheumatoid arthritis. Rheumatology (Oxford) 2008; 48:113-8. [PMID: 19106168 DOI: 10.1093/rheumatology/ken443] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Part of the deleterious effects of systemic inflammation on the cardiovascular system of patients with RA may be exerted via increased propensity to hypertension. IL-6 and TGF-beta1 are important regulators of the inflammatory response. In some, but not all, studies, IL6 -174G/C (rs1800795) and TGFB1 869T/C (rs1982073) gene polymorphisms have been associated with hypertension in the general population. The present study addressed their potential association with hypertension in RA patients. METHODS TGFB1 869T/C and IL6 -174G/C were identified in 400 RA patients and 422 local, non-RA controls using real-time PCR and melting curve analysis. Binary logistic and linear regression models were used to identify the independence of the effects of the polymorphisms on hypertension. RESULTS Genotypic and allelic frequencies of the two polymorphisms were similar in RA and controls. Within the RA group, there was no significant association between IL6 -174G/C and hypertension, but TGF 869T-allele carriers had significantly increased prevalence of hypertension compared with CC homozygotes (70.2 vs 55.2%; P = 0.023). This association remained significant after adjustment for other hypertension risk factors and medication (odds ratio = 1.96; 95% CI 1.02, 3.77; P = 0.044), and was more pronounced in patients with increased systemic inflammation. CONCLUSIONS This study suggests an association of TGFB1 869T/C, but not of IL6 -174G/C, with hypertension in RA patients. If this finding is confirmed in prospective studies, this polymorphism could be used as a screening tool for RA patients with higher risk of developing hypertension and lead to increased surveillance and earlier treatment.
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Stavropoulos-Kalinoglou A, Metsios GS, Panoulas VF, Douglas KMJ, Nevill AM, Jamurtas AZ, Kita M, Koutedakis Y, Kitas GD. Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 68:242-5. [PMID: 18677010 DOI: 10.1136/ard.2008.095596] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the association of body mass index (BMI) with modifiable cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA). METHODS BMI, disease activity, selected CVD risk factors and CVD medication were assessed in 378 (276 women) patients with RA. Patients exceeding accepted thresholds in >or=3 CVD risk factors were classified as having the metabolic syndrome (MetS). RESULTS BMI independently associated with hypertension (OR = 1.28 (95% CI = 1.22 to 1.34); p = 0.001), high-density lipoprotein (OR = 1.10 (95% CI = 1.06 to 1.15); p = 0.025), insulin resistance (OR = 1.13 (95% CI = 1.08 to 1.18); p = 0.000) and MetS (OR = 1.15 (95% CI = 1.08 to 1.21); p = 0.000). In multivariable analyses, BMI had the strongest associations with CVD risk factors (F(1-354) = 8.663, p = 0.000), and this was followed by lipid-lowering treatment (F(1-354) = 7.651, p = 0.000), age (F(1-354) = 7.541, p = 0.000), antihypertensive treatment (F(1-354) = 4.997, p = 0.000) and gender (F(1-354) = 4.707, p = 0.000). Prevalence of hypertension (p = 0.004), insulin resistance (p = 0.005) and MetS (p = 0.000) was significantly different between patients with RA who were normal, overweight and obese, and BMI differed significantly according to the number of risk factors present (p = 0.000). CONCLUSIONS Increasing BMI associates with increased CVD risk independently of many confounders. RA-specific BMI cut-off points better identify patients with RA at increased CVD risk. Weight-loss regimens should be developed and applied in order to reduce CVD in patients with RA.
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Treharne GJ, Lyons AC, Hale ED, Goodchild CE, Booth DA, Kitas GD. Predictors of fatigue over 1 year among people with rheumatoid arthritis. PSYCHOL HEALTH MED 2008; 13:494-504. [DOI: 10.1080/13548500701796931] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Panoulas VF, Ahmad N, Fazal AA, Kassamali RH, Nightingale P, Kitas GD, Labib M. The inter-operator variability in measuring waist circumference and its potential impact on the diagnosis of the metabolic syndrome. Postgrad Med J 2008; 84:344-7. [DOI: 10.1136/pgmj.2008.068825] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Panoulas VF, Metsios GS, Pace AV, John H, Treharne GJ, Banks MJ, Kitas GD. Hypertension in rheumatoid arthritis. Rheumatology (Oxford) 2008; 47:1286-98. [PMID: 18467370 DOI: 10.1093/rheumatology/ken159] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RA associates with an increased burden of cardiovascular disease, which is at least partially attributed to classical risk factors such as hypertension (HT) and dyslipidaemia. HT is highly prevalent, and seems to be under-diagnosed and under-treated among patients with RA. In this review, we discuss the mechanisms that may lead to increased blood pressure in such patients, paying particular attention to commonly used drugs for the treatment of RA. We also suggest screening strategies and management algorithms for HT, specific to the RA population, although it is clear that these need to be formally assessed in prospective randomized controlled trials designed specifically for the purpose, which, unfortunately, are currently lacking.
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Treharne GJ, Douglas KMJ, Iwaszko J, Panoulas VF, Hale ED, Mitton DL, Piper H, Erb N, Kitas GD. Polypharmacy among people with rheumatoid arthritis: the role of age, disease duration and comorbidity. Musculoskeletal Care 2008; 5:175-90. [PMID: 17623274 DOI: 10.1002/msc.112] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with rheumatoid arthritis (RA) often have comorbidities with associated disability and complex medication regimens. Little published evidence exists about why people with RA require so many medications, although it is logical to hypothesize that this may relate to older age, longer duration of RA, more active RA, worse functional disability and a greater number of comorbidities. OBJECTIVES We set out to quantify polypharmacy in RA and identify its predictors in an observational cohort. METHODS The case notes of 348 people receiving secondary care for RA were reviewed to record polypharmacy. The 28-joint Disease Activity Score (DAS28) was calculated and the Health Assessment Questionnaire (HAQ) and the Self-administered Comorbidity Questionnaire (SCQ) were completed. RESULTS The mean total number of medications was 5.39, with a maximum of 16; of these, a mean of 2.41 medications were directly for RA. A mediational relationship was identified: older age and longer RA duration were significant predictors of a greater total number of medications, but these relationships were explained by the greater number of comorbidities in older participants and those with longer RA duration. Polypharmacy was not related to RA activity or functional disability. CONCLUSIONS Polypharmacy is common among people with RA and associates with older age and longer RA duration through a greater number of comorbidities. Regular review of the full treatment plan of individuals with RA by pharmacists and other health professionals specializing in rheumatology, to weigh the benefits and risks of each medication and their interactions in light of RA activity and comorbidities, is advocated.
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Goodchild CE, Treharne GJ, Booth DA, Kitas GD, Bowman SJ. Measuring fatigue among women with Sjögren's syndrome or rheumatoid arthritis: a comparison of the Profile of Fatigue (ProF) and the Multidimensional Fatigue Inventory (MFI). Musculoskeletal Care 2008; 6:31-48. [PMID: 18085596 DOI: 10.1002/msc.124] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Fatigue is common in both Sjögren's syndrome (SS) and rheumatoid arthritis (RA) and can restrict functioning. AIMS We tested the convergent validity of the Profile of Fatigue (ProF) using the Multidimensional Fatigue Inventory (MFI) in SS and RA. METHODS The 16-item ProF and the 20-item MFI were completed by 82 White-British women aged 35-79 years (mean 60.4 years). Thirty-four had been diagnosed with SS for a mean of 7.0 years and 48 had been diagnosed with RA for a mean of 14.5 years. The ProF measures four somatic facets of fatigue and two mental facets; the MFI contains one mental and four somatic facets. The structures of the items from both measures were tested by principal component factor analysis using varimax rotation. RESULTS No significant differences in fatigue were found between the women with SS or RA. Five factors explained a total of 76% of the variance of the MFI; six factors explained 94% of the variance of the ProF. Mental fatigue items from both questionnaires loaded onto separate factors from somatic fatigue items; the two original facets of mental fatigue in the ProF were replicated. The four somatic fatigue facets of the ProF were generally replicated but the somatic facets of the MFI did not replicate as clearly. Equivalent facets correlated well between the two questionnaires (r >or= 0.65). CONCLUSIONS Both the ProF and the MFI distinguish between somatic and mental fatigue in SS and RA but the ProF appears better at resolving somatic facets of fatigue.
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Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, Koutedakis Y, Nevill AM, Douglas KMJ, Kita M, Kitas GD. New resting energy expenditure prediction equations for patients with rheumatoid arthritis. Rheumatology (Oxford) 2008; 47:500-6. [PMID: 18304942 DOI: 10.1093/rheumatology/ken022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Resting energy expenditure (REE), one of the main components of total energy expenditure, can be measured via indirect calorimetry and/or predicted from equations. The latter may be misleading in RA, as they do not take into account the metabolic alterations occurring in RA. The objectives of this study are to evaluate the accuracy of widely used REE-predictive equations in RA patients against measured REE and to develop RA-specific equations. METHODS We assessed REE (via indirect calorimetry and several predictive equations), fat-free mass (FFM; via bioelectrical impedance) and disease activity (CRP) in RA patients and healthy controls. Data from 60 RA patients (experimental group) were used to assess the accuracy of existing REE equations and to develop new equations. The new equations were validated in an independent cross-validation group of 22 RA patients. These two groups were merged and two final equations were developed. RESULTS All equations significantly under-predicted measured REE (from 15% to 18.2%, all at P < 0.001) in the RA experimental group, but not in the control group. After both equations demonstrated a high validity in the cross-validation group, the new final REE prediction equations developed from the total RA sample (n = 82) were: Model 1: REE (kcal/day) = 126.1 x FFM(0.638) x CRP(0.045) (R(2) = 0.70) and Model 2: REE (kcal/day) = 598.8 x weight(0.47) x age(-0.29) x CRP(0.066) (R(2) = 0.62). CONCLUSION The new equations provide an accurate prediction of REE in RA patients and could be used for clinical monitoring of resting metabolism of these patients without the requirement for specialized personnel.
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Panoulas VF, Nikas SN, Smith JP, Douglas KMJ, Nightingale P, Milionis HJ, Treharne GJ, Toms TE, Kita MD, Kitas GD. Lymphotoxin 252A>G polymorphism is common and associates with myocardial infarction in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 67:1550-6. [PMID: 18230628 DOI: 10.1136/ard.2007.082594] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is more prevalent and more likely to lead to death in patients with rheumatoid arthritis (RA). Single nucleotide polymorphisms of the genes for lymphotoxin-A (LT-A) and its regulatory protein galectin-2 (LGALS2) have been implicated as genetic risk factors for acute cardiovascular events in the general population: we hypothesised that their risk alleles/genotypes (a) may be more frequent among patients with RA compared with non-RA controls (thus explaining some of the increased CVD in RA), and (b) may be more frequent among patients with RA with prevalent CVD compared with patients with RA without CVD. METHODS Genomic DNA samples were collected from 388 patients with RA and 399 local population controls without RA. LT-A gene intron 1 252A>G and LGALS2 intron 1 3279C>T single nucleotide polymorphisms were identified using real-time polymerase chain reaction and melting curve analysis. RESULTS LT-A 252GG homozygotes were significantly more prevalent among patients with RA compared with controls (19.8% vs 11.8%, p = 0.002; OR(GG/GA,AA) = 1.85, 95% CI 1.25 to 2.75, p = 0.002). Patients with RA possessing LT-A 252 GG were significantly more likely to have had a myocardial infarction compared with those with LT-A 252 AA or GA (13% vs 5.5%, p = 0.02; adjusted OR(GG/GA,AA) = 3.03, 95% CI 1.2 to 7.68, p = 0.002). The frequency of LGALS2 polymorphisms was similar between RA and controls and was not associated with CVD among patients with RA. CONCLUSIONS The LT-A 252GG genotype occurs more frequently among patients with RA than the general population. In RA, this genotype appears to associate with increased likelihood of suffering an myocardial infarction.
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Metsios GS, Stavropoulos-Kalinoglou A, Douglas KMJ, Koutedakis Y, Nevill AM, Panoulas VF, Kita M, Kitas GD. Blockade of tumour necrosis factor-alpha in rheumatoid arthritis: effects on components of rheumatoid cachexia. Rheumatology (Oxford) 2008; 46:1824-7. [PMID: 18032540 DOI: 10.1093/rheumatology/kem291] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is accompanied by increased resting energy expenditure (REE) and decreased fat-free mass (FFM). This is referred to as rheumatoid cachexia and is attributed to high levels of tumour necrosis factor-alpha (TNF-alpha). This study aimed to investigate the effects of anti-TNF-alpha therapy on REE, body composition, physical activity and protein intake in RA patients. METHODS Twenty RA patients [50% female; age: (mean +/- s.d.) 61.1 +/- 6.8 yrs; body mass index (BMI): 28.3 +/- 3.7 kg/m2] and 12 age-sex-BMI-matched healthy controls were assessed. REE (indirect calorimetry), body composition (bioelectrical impedance), the International Physical Activity Questionnaire (IPAQ), diet, Health Assessment Questionnaire (HAQ), disease activity [disease activity score 28 (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein] and serum TNF-alpha were measured before (Baseline) as well as 2 weeks (Time-1) and 12 weeks (Time-2) after initiation of anti-TNF-alpha treatment. Controls were only assessed at Baseline. RESULTS RA patients had significantly higher REE than controls at Baseline (1799.4 +/- 292.0 vs 1502.9 +/- 114.5 kcal/day, P = 0.002). Within the RA group, REE increased significantly between Time-1 and Time-2 (P = 0.001) but not between Baseline and Time-2. Sustained significant increases were observed in IPAQ (P = 0.001) and protein intake (P = 0.001). There were no significant changes in FFM or body fat. ESR (P = 0.002), DAS28 (P < 0.001), HAQ (P < 0.001) and TNF-alpha (P = 0.024) improved significantly. Physical activity (P = 0.001) and protein intake (P = 0.024) were significant between-subject factors for the elevation of REE. CONCLUSIONS After 12 weeks of anti-TNF-alpha therapy, there were significant improvements in disease activity and physical function, as well as physical activity and protein intake, but no significant changes in REE or FFM. There is a need for longer-term studies in this field.
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Metsios GS, Stavropoulos-Kalinoglou A, Nevill AM, Douglas KMJ, Koutedakis Y, Kitas GD. Cigarette smoking significantly increases basal metabolic rate in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 67:70-3. [PMID: 17502358 DOI: 10.1136/ard.2006.068403] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Basal metabolic rate (BMR) is the most important indicator of human metabolism and its abnormalities have been linked to undesirable health outcomes. Cigarette smoking associates with increased BMR in healthy individuals; it is also related with worse disease outcomes in patients with rheumatoid arthritis(RA), in whom BMR is high due to hypercatabolism caused by systemic inflammation. We aimed to investigate whether smokers with RA demonstrated higher BMR levels than their non-smoking counterparts. METHODS A total of 53 patients with RA (36 female, 17 male, 20 current smokers) were assessed for: BMR(indirect calorimetry), anthropometrical data, fat-free mass (bioelectrical impedance), physical function (health assessment questionnaire; HAQ) and disease activity(disease activity score DAS28 and C reactive protein). RESULTS RA smokers and non-smokers were not significantly different for age, height, weight, body mass index and fat-free mass. Compared to non-smokers,smokers with RA demonstrated significantly higher BMR (mean (SD) 1513.9 (263.3) vs 1718.1 (209.2) kcal/day; p,0.001) and worse HAQ (1.0 (0.8) vs 1.7 (0.8); p=0.01). The BMR difference was significantly predicted by the interaction smoking/gender (p=0.04). BMR was incrementally higher in light, moderate and heavy smokers (p=0.018), and correlated with the daily number of cigarettes smoked (r=0.68, p=0.04). CONCLUSION Current cigarette smoking further increases BMR in patients with RA and has a negative impact on patients self-reported functional status. Education regarding smoking cessation is needed for the RA population.
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Panoulas VF, Douglas KMJ, Stavropoulos-Kalinoglou A, Metsios GS, Nightingale P, Kita MD, Elisaf MS, Kitas GD. Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis. Rheumatology (Oxford) 2008; 47:72-5. [PMID: 18077493 DOI: 10.1093/rheumatology/kem311] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) associates with increased cardiovascular morbidity and mortality that is due to both traditional and novel cardiovascular risk factors. Hypertension (HT), one of the most common risk factors for cardiovascular disease, is highly prevalent in RA. The effects of long-term glucocorticoid (GC) therapy on blood pressure have not been established yet. This study examined whether GC exposure associates with HT in patients with RA. METHODS Four hundred consecutive RA patients with detailed clinical and laboratory assessments were categorized into three groups according to GC exposure: no or limited exposure (N/L-E); a low-dose (< 7.5 mg) long-term exposure (LD/LT-E); and medium-dose (> or = 7.5 mg) long-term exposure (MD/LT-E). The association of GC exposure with HT was evaluated using logistic regression analysis. RESULTS HT was more prevalent in the MD/LT-E group (84.7%) than the LD/LT-E or N/L-E groups (70.7 and 67.3%, respectively, P = 0.028). Logistic regression revealed increased odds for HT when comparing MD/LT-E with N/L-E, after adjustment for HT risk factors [odds ratio (OR) = 2.57, 95% CI 1.01-6.56, P = 0.049] and RA disease characteristics (OR = 3.64, 95% CI: 1.36-9.77, P = 0.01). CONCLUSIONS MD/LT GC exposure associates with a very high prevalence of HT. This appears to be independent of other risk factors for HT or of channelling bias due to disease severity, even though the latter cannot be excluded given the cross-sectional nature of our study. RA patients in this GC exposure group should be particularly targeted for early identification and aggressive management of HT.
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