151
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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152
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Impairment of myocardial functions and arterial stiffness in patients with lichen planus. An Bras Dermatol 2020; 95:180-186. [PMID: 32146010 PMCID: PMC7175034 DOI: 10.1016/j.abd.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/30/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Lichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities. OBJECTIVE The purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group. METHODS Fifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry. RESULTS No statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p=0.006, and p=0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p<0.001, and p=0.005, respectively). STUDY LIMITATIONS Relatively low number of patients. CONCLUSION The positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.
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153
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Al-Lawati H, Vakili MR, Lavasanifar A, Ahmed S, Jamali F. Reduced Heart Exposure of Diclofenac by Its Polymeric Micellar Formulation Normalizes CYP-Mediated Metabolism of Arachidonic Acid Imbalance in An Adjuvant Arthritis Rat Model: Implications in Reduced Cardiovascular Side Effects of Diclofenac by Nanodrug Delivery. Mol Pharm 2020; 17:1377-1386. [DOI: 10.1021/acs.molpharmaceut.0c00069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hanan Al-Lawati
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mohammad Reza Vakili
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Afsaneh Lavasanifar
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Surur Ahmed
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Fakhreddin Jamali
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
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154
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Persell SD, Lee JY, Lipiszko D, Peprah YA, Ruderman EM, Schachter M, Majka DS. Outreach to Promote Management of Cardiovascular Risk in Primary Care Among Patients With Rheumatoid Arthritis Seen in Rheumatology Practice. ACR Open Rheumatol 2020; 2:131-137. [PMID: 31989787 PMCID: PMC7077787 DOI: 10.1002/acr2.11116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 12/28/2022] Open
Abstract
Objective Rheumatoid arthritis (RA) confers a 1.5‐ to 2.0‐fold increased risk of cardiovascular disease (CVD). A prior multifaceted quality improvement approach to improving CVD preventive care increased CVD risk factor assessments, but there was no significant effect on the management of risk factors. We tested the impact of adding a proactive outreach strategy promoting primary care treatment of CVD risk factors among patients with RA through their rheumatology practice. Methods Through electronic health record searches, we identified patients with RA who were potential candidates for hypertension treatment initiation or intensification, statin therapy, or a smoking‐cessation intervention. A nonclinician care manager contacted patients by phone and mail on behalf of the rheumatologists, provided information about the identified risk factor(s), recommend follow‐up with primary care physicians (PCPs), sent correspondence to PCPs, and followed up with patients to see what actions had been taken. We measured preventive cardiology quality indicators and compared preintervention and intervention time periods using interrupted time series methods. Results During the 6‐month intervention period, the proportion of patients prescribed at least moderate‐intensity statin treatment for primary prevention rose from 18.4% to 23.8%. The rate of increase was 1.06% greater per month than during the preceding period (P < 0.001). Rates of increase in hypertension diagnosis and control improved more rapidly during this phase (P < 0.001 for each) and reversed preceding negative trends. Conclusion Implementing proactive nonclinician outreach to encourage primary care–based treatment of CVD risk factors was associated with increases in statin prescribing and in hypertension diagnosis and control. Smoking was not affected.
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Affiliation(s)
- Stephen D Persell
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ji Young Lee
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dawid Lipiszko
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yaw A Peprah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eric M Ruderman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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155
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Taylor PC, Law ST. When the first visit to the rheumatologist is established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2020; 33:101479. [PMID: 32001168 DOI: 10.1016/j.berh.2019.101479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The outlook for people living with rheumatoid arthritis (RA) has improved tremendously in a generation. Major contributions to this include recognition of the importance of early treatment initiation, improved understanding of the pathobiology, the identification of therapeutic targets and their subsequent validation in clinic trials and the realisation of the importance of 'tight control' of inflammatory responses. Despite these advances, many patients meeting classification criteria present for the first time to a rheumatologist with longstanding symptoms. There is no definition as to when RA becomes 'established'. But there is evidence that a 'window of opportunity' exists over about 12-16 weeks symptom duration, during which treatment intervention gives rise to the most optimal outcomes. This review addresses issues regarding the management of patients presenting outside the window of opportunity in terms of heterogeneity of presentation, assessment, therapeutic goals and treatment options as well as the importance of a multidisciplinary approach to holistic care.
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156
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Karpouzas GA, Ormseth SR, Hernandez E, Budoff MJ. Impact of Cumulative Inflammation, Cardiac Risk Factors, and Medication Exposure on Coronary Atherosclerosis Progression in Rheumatoid Arthritis. Arthritis Rheumatol 2020; 72:400-408. [PMID: 31532064 DOI: 10.1002/art.41122] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/12/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To explore incidence and progression of coronary atherosclerosis and identify determinants in patients with rheumatoid arthritis (RA). We specifically evaluated the impact of inflammation, cardiac risk factors, duration of medication exposure, and their interactions on coronary plaque progression. METHODS One hundred one participants with baseline coronary computed tomography angiography findings underwent follow-up assessment a mean ± SD of 83 ± 3.6 months after baseline. Plaque burden was reported as the segment involvement score (describing the number of coronary segments with plaque) and the segment stenosis score (characterizing the cumulative plaque stenosis over all evaluable segments). Plaque composition was classified as noncalcified, mixed, or calcified. Coronary artery calcium (CAC) was quantified using the Agatston method. RESULTS Total plaque increased in 48% of patients, and progression was predicted by older age, higher cumulative inflammation, and total prednisone dose (P < 0.05). CAC progressors were older, more obese, hypertensive, and had higher cumulative inflammation compared to nonprogressors (P < 0.05). Longer exposure to biologics was associated with lower likelihood of noncalcified plaque progression, lesion remodeling, and constrained CAC change in patients without baseline calcification, independent of inflammation, prednisone dose, or statin exposure (all P < 0.05). Longer statin treatment further restricted noncalcified plaque progression and attenuated the effect of inflammation on increased plaque and CAC (P < 0.05). Stringent systolic blood pressure (BP) control further weakened the effect of inflammation on total plaque progression. CONCLUSION Inflammation was a consistent and independent predictor of coronary atherosclerosis progression in RA. It should therefore be specifically targeted toward mitigating cardiovascular risk. Biologic disease-modifying antirheumatic drugs, statins, and BP control may further constrain plaque progression directly or indirectly.
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157
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Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, Sepriano A, van Vollenhoven RF, de Wit M, Aletaha D, Aringer M, Askling J, Balsa A, Boers M, den Broeder AA, Buch MH, Buttgereit F, Caporali R, Cardiel MH, De Cock D, Codreanu C, Cutolo M, Edwards CJ, van Eijk-Hustings Y, Emery P, Finckh A, Gossec L, Gottenberg JE, Hetland ML, Huizinga TWJ, Koloumas M, Li Z, Mariette X, Müller-Ladner U, Mysler EF, da Silva JAP, Poór G, Pope JE, Rubbert-Roth A, Ruyssen-Witrand A, Saag KG, Strangfeld A, Takeuchi T, Voshaar M, Westhovens R, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020; 79:685-699. [PMID: 31969328 DOI: 10.1136/annrheumdis-2019-216655] [Citation(s) in RCA: 1565] [Impact Index Per Article: 391.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field. METHODS An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items. RESULTS The task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high. CONCLUSIONS These updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Robert B M Landewé
- Amsterdam University Medical Center, Amsterdam, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Maxime Dougados
- Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques, Paris, France
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maarten de Wit
- EULAR Patient Research Partner; Department Medical Humanities, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - John Askling
- Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alejandro Balsa
- Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ, Madrid, Spain
| | - Maarten Boers
- Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Maya H Buch
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, and IRCCS S Matteo Foundation, Pavia, Italy
| | | | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Maurizio Cutolo
- Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa, Genoa, Italy
| | - Christopher John Edwards
- Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Yvonne van Eijk-Hustings
- Department of Patient & Care and Department of Rheumatology, University of Maastricht, Maastricht, The Netherlands
| | - Paul Emery
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Axel Finckh
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France
| | - Jacques-Eric Gottenberg
- Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique, Strasbourg, France
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marios Koloumas
- European League Against Rheumatism, Zurich, Switzerland.,Cyprus League against Rheumatism, Nikosia, Cyprus
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Beijing University People's Hospital, Beijing, China
| | - Xavier Mariette
- Université Paris-Sud, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Jose A P da Silva
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra, Coimbra, Portugal
| | - Gyula Poór
- National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary
| | - Janet E Pope
- University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, Ontario, Canada
| | | | | | - Kenneth G Saag
- Department of Medicine, Division of Rheumatology, University of Alabama at Birmingham, Brmingham, Alabama, USA
| | - Anja Strangfeld
- Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Tsutomu Takeuchi
- Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven; Rheumatology, University Hospitals Leuven, Leuven, Belgium
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158
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3630] [Impact Index Per Article: 907.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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159
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Pak S. Primary care providers' awareness, knowledge, and practice with regard to cardiovascular risk in patients with rheumatoid arthritis : PCPs' awareness, knowledge, and practice with regard to CV risks in patients with RA. Clin Rheumatol 2019; 39:755-760. [PMID: 31873809 DOI: 10.1007/s10067-019-04901-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic auto-inflammatory disease associated with increased cardiovascular risk. Early identification and aggressive cardiovascular risk factor modification are critical for improvement in morbidity and mortality in patients with RA. This study is a cross-sectional survey with the purpose of evaluating primary care providers' awareness, practice patterns, and satisfaction with continuing medical education on cardiovascular risk in patients with RA. Our study showed that 71% of clinicians felt that the CME on RA patient management regarding CV risk factors is inadequate. Only 37% of providers reported feeling well prepared to manage CV risk for RA patients. Only 15% of participants were actively initiating a discussion regarding CV risk with RA patients. A better understanding of the educational needs and practice patterns of primary care providers may warrant the development of strategies for cardiovascular risk management in patients with RA.
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Affiliation(s)
- Stella Pak
- Department of Medicine, Orange Regional Medical Center, 707 East Main Street, Middletown, NY, 10940, USA.
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160
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Abstract
The term inflammatory joint disease (IJD) encompasses a group of chronic conditions with predominant joint involvement. They share an increased risk of cardiovascular (CV) complications. However, the implication of the sex in the risk of CV disease in IJD has not been specifically addressed. The aim of this work is to assess the influence of sex on the clinical expression of CV manifestations associated to IJD. With this objective, an update of the current knowledge of the sex influence on CV disease in patients with IJD was conducted. A PubMed database search of the most relevant literature on this topic was performed mainly based on studies published in English over the last 10 years. Although most studies on IJD were not specifically designed to address sex differences regarding CV complications, it seems that men with rheumatoid arthritis (RA) are at higher risk of pericarditis, ischemic heart disease, heart failure (HF) with reduced ejection fraction (EF), and CV mortality than women with RA. In contrast, HF with preserved EF and diastolic dysfunction is more frequent in women with RA. Men with ankylosing spondylitis present more frequently disorders of the conduction system and aortic valvulopathy than women. A limited number of studies addressed CV differences according to sex in psoriatic arthritis. Although there are some differences according to sex in the clinical expression of CV complications in patients with IJD, much research is still needed to better identify the implication of sex in the risk of CV disease in these patients.
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161
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Kosheleva NA, Nikitina NM, Andreeva EU. [Case of a Сombination of Lupus Erythematosus, Antiphospholipid Syndrome and Myocardial Infarction]. KARDIOLOGIIA 2019; 59:92-96. [PMID: 31849316 DOI: 10.18087/cardio.2019.12.n610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease of unknown etiology characterized by a wide range of clinical manifestations with damage to various organs and systems of the body. There are bad prognostic factors for SLE: damage to the heart, kidney, central nervous system, the development of hematological crises and secondary antiphospholipid syndrome. A number of authors consider systemic lupus erythematosus a "new" risk factor for atherosclerosis. The overall risk of myocardial infarction (MI) in patients with SLE is 10 times higher than in the general population. The article presents clinical case report of the development of myocardial infarction in a woman with SLE, receiving therapy for secondary antiphospholipid syndrome.
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Affiliation(s)
- N A Kosheleva
- Saratov State Medical University named after V. I. Razumovsky
| | - N M Nikitina
- Saratov State Medical University named after V. I. Razumovsky
| | - E U Andreeva
- Saratov State Medical University named after V. I. Razumovsky
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162
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Castañeda S, Vicente-Rabaneda EF, García-Castañeda N, Prieto-Peña D, Dessein PH, González-Gay MA. Unmet needs in the management of cardiovascular risk in inflammatory joint diseases. Expert Rev Clin Immunol 2019; 16:23-36. [DOI: 10.1080/1744666x.2019.1699058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
- Department of Medicine, Cátedra UAM-ROCHE, EPID Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | - Diana Prieto-Peña
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Patrick H. Dessein
- Honorary Research Professor, School of Physiology and School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Miguel A. González-Gay
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- School of Medicine, University of Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Murray K, Low C, O'Rourke A, Young F, Callanan I, Feeney E, Veale DJ. A quality improvement intervention failed to significantly increase pneumococcal and influenza vaccination rates in immunosuppressed inflammatory arthritis patients. Clin Rheumatol 2019; 39:747-754. [PMID: 31820135 DOI: 10.1007/s10067-019-04841-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Pneumococcal and influenza vaccination rates have been suboptimal in studies of immunosuppressed patients. We aimed to assess barriers to and increase rates of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and influenza vaccination in this group. The primary endpoint was a statistically significant increase in adequate PPSV23 and influenza vaccination. METHODS In 2017, rheumatology outpatients completed an anonymous questionnaire recording vaccination knowledge, status, and barriers. Simultaneously, a low-cost multifaceted quality improvement (QI) intervention was performed. All outpatients on oral steroids, immunosuppressant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologics disease-modifying antirheumatic drugs (bDMARDs) were included in the study. In 2018, post-intervention, the clinic was re-assessed. Demographics, diagnosis, medications, smart phone access, and willingness to use this for vaccination reminders were assessed for independent vaccination predictors using binary logistic regression analysis. RESULTS Four hundred twenty-five patients were included (72.6% rheumatoid arthritis, 74% women, 45.6% ≥ 60 years old). From 2017 to 2018, PPSV23 vaccination rates changed from 41.0 to 47.2% (P = 0.29) and influenza from 61.8 to 62.1% (P = 0.95). The most common reason for non-vaccination was lack of awareness. Following the intervention, this changed for influenza (36.7 to 34.2%) and PPSV23 (82.1 to 76.4%). General practitioners performed most vaccinations, only 3.6% were delivered in the hospital. Significant predictors of PPSV23 vaccination were older age {≥ 80 years had an OR 41.66 (95% CI 3.69-469.8, P = 0.003), compared with ≤ 39 years}, bDMARD use (OR 2.80, 95% CI 1.24-6.32, P = 0.013), and adequate influenza vaccination (OR 9.01, 95% CI 4.40-18.42, P < 0.001). Up-to-date PPSV23 vaccination (OR 8.93, 95% CI 4.39-18.17, P < 0.001) predicted influenza vaccination. CONCLUSIONS PPSV23 and influenza vaccination rates were suboptimal. The intervention did not cause a statistically significant change in vaccination rates. Point-of-care vaccination may be more effective.Key Points• Low vaccination rates amongst immunosuppressed inflammatory arthritis outpatients• Less than 5% of vaccinations occurred in hospital• There was no statistically significant difference in the rates of adequate PPSV23 (41.0 to 47.2%) or influenza (61.8 to 62.1%) vaccination following our intervention.
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Affiliation(s)
- Kieran Murray
- Department of Rheumatology, Saint Vincent's University Hospital, Dublin 4, Ireland.
| | - Candice Low
- Department of Rheumatology, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Anna O'Rourke
- Department of Infectious Diseases, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Francis Young
- Department of Rheumatology, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Ian Callanan
- Clinical Audit, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Eoin Feeney
- Department of Infectious Diseases, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Douglas James Veale
- Department of Rheumatology, Saint Vincent's University Hospital, Dublin 4, Ireland
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Cardiovascular Disease Risk in Older Adults and Elderly Patients with Rheumatoid Arthritis: What Role Can Disease-Modifying Antirheumatic Drugs Play in Cardiovascular Risk Reduction? Drugs Aging 2019; 36:493-510. [PMID: 30953327 DOI: 10.1007/s40266-019-00653-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of rheumatoid arthritis (RA), the most common autoimmune inflammatory arthritis, is increasing, partly due to the aging of the general population. RA is an independent risk factor for the development of cardiovascular disease (CVD). Older adults and elderly patients with RA develop CVD at a younger age compared with their general population peers. Both the traditional cardiovascular risk factors (age, sex, smoking, diabetes mellitus, hypertension), and systemic inflammation (i.e. high disease activity) are contributors to accelerated CVD in people with RA. Of the disease-modifying antirheumatic drugs (DMARDs) used for RA treatment, methotrexate, triple combination oral therapy (methotrexate, sulfasalazine, and hydroxychloroquine), tumor necrosis factor inhibitor biologicals, and abatacept have the strongest data in favor of the reduction of cardiovascular events in patients with RA. A treat-to-target strategy should be employed in older adults and elderly patients with RA to ensure appropriate reduction in cardiovascular risk, which can also prevent short- and long-term musculoskeletal disability. Our review findings are in line with the 2016 European League Against Rheumatism guideline recommendations, specifically: (1) RA disease activity should be controlled with an optimal DMARD regimen using a treat-to-target approach; (2) the lipid profile should be assessed and monitored in every older adult and elderly RA patient; (3) CVD risk factors, including smoking cessation, blood pressure, and blood glucose control, should be optimized; (4) RA treatment should be initiated as soon as possible; and (5) shared decision making regarding the treatment of patients with RA should include a discussion on the potential amelioration of increased cardiovascular risk.
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Fernández-Garcés M, Haro G, Micó ML. Predisposing factors to nonfatal cardiovascular events in women with systemic lupus erythematosus. An observational, cross-sectional, multicenter study in Spain from the risk/systemic lupus erythematosus thematic network. Medicine (Baltimore) 2019; 98:e17489. [PMID: 31651851 PMCID: PMC6824671 DOI: 10.1097/md.0000000000017489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Very few studies have been published on cardiovascular morbidity in Spanish patients diagnosed with systemic lupus erythematosus (SLE). Moreover, knowledge of the predictive factors for the occurrence of nonfatal events in this group of patients is scarce.This was a multicenter, observational, cross-sectional study designed to ascertain the prevalence of nonfatal cardiovascular risk factors and cardiovascular events (CVEs) in 335 Spanish women diagnosed with SLE between 2003 and 2013.The average patient age was 36.0 years (range: 26.4-45.6); 35 patients (10.7%) experienced at least 1 CVE, which most frequently affected the brain, followed by the heart, and finally, the peripheral vasculature. Both the number of admissions because of SLE (95% confidence interval [CI] odds ratio [OR] = 1.024-1.27, P = .017) and the systemic lupus international collaborating clinics (SLICC) chronicity index score (95% CI OR = 1.479-2.400, P = .000) resulted in an increase in the OR of these patients presenting a CVE. Regarding the classic risk factors, only the interaction between hypertension (HT) and treatment with antihypertensive drugs influenced the presence of CVEs (95% CI OR = 2.165-10.377, P = .000). The presence of a family history of early cardiovascular disease was also related to CVEs (95% CI OR = 2.355-40.544, P = .002). Binary logistic regression including the above factors resulted in a model in which the 3 main variables in each group persisted, implying that they must be independent of each other. However, the weight of the interaction between the family history of early cardiovascular disease and the interaction between HT and the use of antihypertensives was higher than for the number of admissions for SLE.The SLE disease activity over time (measured using the SLICC) and the number of hospital admissions due to the disease itself, both increase the risk of women with SLE presenting a CVE. Classic cardiovascular risk factors, especially HT and its treatment, as well as a family history of early CVEs, should be considered when assessing the risk of nonfatal CVEs in women with SLE.
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Affiliation(s)
| | - Gonzalo Haro
- TXP Research Group, Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón
- Provincial Hospital of Castellón
| | - María Luisa Micó
- Internal Medicine Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Bernardes M, Madureira A, Oliveira A, Martins MJ, Lucas R, Costa L, Pereira JG, Ventura F, Ramos I, Martins E. Coronary artery calcium score in female rheumatoid arthritis patients: Associations with apolipoproteins and disease biomarkers. Int J Rheum Dis 2019; 22:1841-1856. [DOI: 10.1111/1756-185x.13685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 06/02/2019] [Accepted: 08/05/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Miguel Bernardes
- Department of Rheumatology São João Hospital Center Porto Portugal
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
| | - António Madureira
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
- Department of Radiology São João Hospital Center Porto Portugal
| | - Ana Oliveira
- Department of Nuclear Medicine São João Hospital Center Porto Portugal
| | - Maria João Martins
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina Universidade do Porto Porto Portugal
- Instituto de Investigação e Inovação em Saúde (i3s) Universidade do Porto Porto Portugal
| | - Raquel Lucas
- EPI Unit‐Institute of Public Health University of Porto Porto Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine University of Porto Porto Portugal
| | - Lúcia Costa
- Department of Rheumatology São João Hospital Center Porto Portugal
| | - Jorge G. Pereira
- Department of Nuclear Medicine São João Hospital Center Porto Portugal
| | | | - Isabel Ramos
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
- Department of Radiology São João Hospital Center Porto Portugal
| | - Elisabete Martins
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
- Instituto de Investigação e Inovação em Saúde (i3s) Universidade do Porto Porto Portugal
- Department of Cardiology São João Hospital Center Porto Portugal
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Genovese MC, van der Heijde D, Lin Y, St John G, Wang S, van Hoogstraten H, Gómez-Reino JJ, Kivitz A, Maldonado-Cocco JA, Seriolo B, Stanislav M, Burmester GR. Long-term safety and efficacy of sarilumab plus methotrexate on disease activity, physical function and radiographic progression: 5 years of sarilumab plus methotrexate treatment. RMD Open 2019; 5:e000887. [PMID: 31452928 PMCID: PMC6691511 DOI: 10.1136/rmdopen-2018-000887] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 01/12/2023] Open
Abstract
Objective In MOBILITY (NCT01061736), sarilumab significantly reduced disease activity, improved physical function and inhibited radiographic progression at week 52 versus placebo in patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate. We report 5-year safety, efficacy and radiographic outcomes of sarilumab from NCT01061736 and the open-label extension (EXTEND; NCT01146652), in which patients received sarilumab 200 mg every 2 weeks (q2w) + methotrexate. Methods Patients (n=1197) with moderately to severely active RA were initially randomised to placebo, sarilumab 150 mg or sarilumab 200 mg subcutaneously q2w plus weekly methotrexate for 52 weeks. Completers were eligible to enrol in the open-label extension and receive sarilumab 200 mg q2w + methotrexate. Results Overall, 901 patients entered the open-label extension. The safety profile remained stable over 5-year follow-up and consistent with interleukin-6 receptor blockade. Absolute neutrophil count <1000 cells/mm3 was observed but not associated with increased infection rate. Initial treatment with sarilumab 200 mg + methotrexate was associated with reduced radiographic progression over 5 years versus sarilumab 150 mg + methotrexate or placebo + methotrexate (mean±SE change from baseline in van der Heijde-modified Total Sharp Score: 1.46±0.27, 2.35±0.28 and 3.68±0.27, respectively (p<0.001 for each sarilumab dose versus placebo)). Clinical efficacy was sustained through 5 years according to Disease Activity Score (28-joint count) using C reactive protein, Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire-Disability Index. The number of patients achieving CDAI ≤2.8 at 5 years was similar among initial randomisation groups (placebo, 76/398 (19%); sarilumab 150 mg, 68/400 (17%); sarilumab 200 mg, 84/399 (21%)). Conclusion Clinical efficacy, including inhibition of radiographic progression, reduction in disease activity and improvement in physical function, was sustained with sarilumab + methotrexate over 5 years. Safety appeared stable over the 5-year period.
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Affiliation(s)
- Mark C Genovese
- Stanford University Medical Center, Palo Alto, California, USA
| | | | - Yong Lin
- Sanofi Genzyme, Bridgewater, New Jersey, USA
| | | | | | | | - Juan José Gómez-Reino
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | | | - Bruno Seriolo
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nasonova, Moscow, Russia
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
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168
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Affiliation(s)
| | - David Newby
- Professor of Cardiology (D.N.), University of Edinburgh, Centre for Cardiovascular Science, Scotland, United Kingdom
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169
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Wallace BI, Wallace DM, Waljee AK, Clauw DJ. Evidence to support or guide glucocorticoid tapering in rheumatoid arthritis is lacking. Ann Rheum Dis 2019; 78:1733-1734. [DOI: 10.1136/annrheumdis-2019-216009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/04/2022]
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170
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Hokstad I, Deyab G, Wang Fagerland M, Lyberg T, Hjeltnes G, Førre Ø, Agewall S, Mollnes TE, Hollan I. Tumor necrosis factor inhibitors are associated with reduced complement activation in spondylarthropathies: An observational study. PLoS One 2019; 14:e0220079. [PMID: 31335881 PMCID: PMC6650069 DOI: 10.1371/journal.pone.0220079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/07/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The complement system is involved in pathogenesis of cardiovascular disease, and might play a role in accelerated atherogenesis in spondylarthropathies (SpA). Hence, we examined complement activation in SpA, and its relationship to antirheumatic treatment, inflammatory and cardiovascular markers. METHODS From PSARA, a prospective observational study, we examined 51 SpA patients (31 psoriatic arthritis (PsA), and 20 ankylosing spondylitis (AS)), starting tumor necrosis factor (TNF) inhibitor alone (n = 25), combined with methotrexate (MTX) (n = 10), or MTX monotherapy (n = 16). Complement activation was determined by the soluble terminal complement complex (sC5b-9), inflammation by erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and endothelial function by finger plethysmography (Endopat) at baseline, after 6 weeks and 6 months of treatment. RESULTS SpA patients had sC5b-9 levels at (PsA) or above (AS) the upper limit of the estimated reference range. Median sC5b-9 levels decreased significantly from baseline to 6 weeks, with no significant difference between the AS and PsA group. Notably, a significant reduction in sC5b-9 was observed after administration of TNF inhibitor ± MTX, whereas no significant changes were observed in patients treated with MTX alone. Between 6 weeks and 6 months, sC5b-9 remained stable across all subgroups. Reduction in sC5b-9 was independently related to decreased ESR and CRP, and to increased high density cholesterol and total cholesterol. Reduction in sC5b-9 from baseline to 6 weeks was associated with improved EF in age and gender adjusted analyses. CONCLUSION TNF-inhibition, but not MTX monotherapy, led to rapid and sustained reduction of complement activation in SpA. Thus, the observed decrease in cardiovascular morbidity in patients treated with TNF-inhibitors might be partly due to its beneficial effect on complement. TRIAL REGISTRATION Clinical Trials (NCT00902005), retrospectively registered on the 14th of May 2009.
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Affiliation(s)
- Ingrid Hokstad
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Gia Deyab
- Department of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torstein Lyberg
- Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Øystein Førre
- Department of Rheumatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Stefan Agewall
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
- Oslo University Hospital Ullevål, Oslo, Norway
| | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ivana Hollan
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Department of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Pagkopoulou E, Arvanitaki A, Daoussis D, Garyfallos A, Kitas G, Dimitroulas T. Comorbidity burden in systemic sclerosis: beyond disease-specific complications. Rheumatol Int 2019; 39:1507-1517. [PMID: 31300848 DOI: 10.1007/s00296-019-04371-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/04/2019] [Indexed: 01/10/2023]
Abstract
Systemic sclerosis (SSc) is a chronic, systemic disease characterized by fibrosis of the skin and internal organs, vasculopathy, and auto-immune activation. On the top of severe organ involvement such as interstitial lung and myocardial fibrosis, pulmonary hypertension, and renal crisis, individuals diagnosed with SSc may suffer from a number of comorbidities. This is a narrative review according to published recommendations and we searched the online databases MEDLINE and EMBASE using as key words the following terms: systemic sclerosis, scleroderma, myocardial fibrosis in combination with micro- and macro-vascular disease, cardiac involvement, atherosclerosis, cardiovascular disease and coronary arteries, infections, cancer, depression, osteoporosis, and dyslipidemia. Although data are usually inconclusive it appears that comorbidities with significant impact on life expectancy, namely cardiovascular disease, infections, and cancer as well as phycological disorders affecting emotional and mental health are highly prevalent in SSc population. Thereafter, the aim of this review is to summarize the occurrence and the clinical significance of such comorbidities in SSc population and to discuss how rheumatologists can incorporate the management of these conditions in daily clinical practice.
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Affiliation(s)
- Eleni Pagkopoulou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Daoussis
- Department of Rheumatology, Faculty of Medicine, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - George Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK.,Arthritis Research UK, Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
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Chouk M, Bordy R, Moretto J, Wendling D, Totoson P, Demougeot C. Pristane-induced arthritis in dark Agouti rat is a relevant model for mimicking vascular dysfunction and lipid paradox in rheumatoid arthritis. Joint Bone Spine 2019; 86:483-490. [DOI: 10.1016/j.jbspin.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 12/25/2022]
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Vascular Inflammation and Oxidative Stress: Major Triggers for Cardiovascular Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:7092151. [PMID: 31341533 PMCID: PMC6612399 DOI: 10.1155/2019/7092151] [Citation(s) in RCA: 357] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023]
Abstract
Cardiovascular disease is a leading cause of death and reduced quality of life, proven by the latest data of the Global Burden of Disease Study, and is only gaining in prevalence worldwide. Clinical trials have identified chronic inflammatory disorders as cardiovascular risks, and recent research has revealed a contribution by various inflammatory cells to vascular oxidative stress. Atherosclerosis and cardiovascular disease are closely associated with inflammation, probably due to the close interaction of inflammation with oxidative stress. Classical therapies for inflammatory disorders have demonstrated protective effects in various models of cardiovascular disease; especially established drugs with pleiotropic immunomodulatory properties have proven beneficial cardiovascular effects; normalization of oxidative stress seems to be a common feature of these therapies. The close link between inflammation and redox balance was also supported by reports on aggravated inflammatory phenotype in the absence of antioxidant defense proteins (e.g., superoxide dismutases, heme oxygenase-1, and glutathione peroxidases) or overexpression of reactive oxygen species producing enzymes (e.g., NADPH oxidases). The value of immunomodulation for the treatment of cardiovascular disease was recently supported by large-scale clinical trials demonstrating reduced cardiovascular mortality in patients with established atherosclerotic disease when treated by highly specific anti-inflammatory therapies (e.g., using monoclonal antibodies against cytokines). Modern antidiabetic cardiovascular drugs (e.g., SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 analogs) seem to share these immunomodulatory properties and display potent antioxidant effects, all of which may explain their successful lowering of cardiovascular risk.
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Bavière W, Deprez X, Houvenagel E, Philippe P, Deken V, Flipo RM, Paccou J. Association Between Comorbidities and Quality of Life in Psoriatic Arthritis: Results from a Multicentric Cross-sectional Study. J Rheumatol 2019; 47:369-376. [PMID: 31203223 DOI: 10.3899/jrheum.181471] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In psoriatic arthritis (PsA), comorbidities add to the burden of disease, which may lead to poorer quality of life. The purpose of this study was to evaluate the relationship between comorbidities and quality of life (QOL). METHODS Patients from a multicentric, cross-sectional study on comorbidities in PsA were included in the analysis. Data on comorbidities were collected and were subsequently used to compute the modified Rheumatic Disease Comorbidity Index (mRDCI). The Medical Outcomes Study Short Form-36 questionnaire physical (PCS) and mental component summary (MCS) scales were used to assess QOL. RESULTS In total, 124 recruited patients fulfilled the ClASsification for Psoriatic ARthritis criteria (CASPAR): 62.1% were male; mean age and mean disease duration were 52.6 ± 12.6 years and 11.3 ± 9.6 years, respectively. The number of comorbid conditions was 2.0 ± 1.3, with 30.6% of the sample having currently or a history of 3 or more comorbidities. In the multivariate linear regression analysis, only anxiety remained significantly related to mental health (p < 0.0001). Anxiety alone accounted for 28.7% of the variance in MCS scores. Moreover, MCS was also significantly associated with the mRDCI score, which explained 4.9% of the variance in MCS [β = -1.56 (standard error 0.64), R2 = 0.049, p = 0.0167]. In contrast, PCS was not significantly associated either with type or number of comorbidities. CONCLUSION In this study, the type of comorbidity appeared to have a greater effect than the number of comorbidities. Indeed, anxiety in PsA was independently associated with QOL and would thus be an important factor to take into account in daily clinical practice.
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Affiliation(s)
- Wallis Bavière
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France.,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille
| | - Xavier Deprez
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France.,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille
| | - Eric Houvenagel
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France.,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille
| | - Peggy Philippe
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France.,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille
| | - Valerie Deken
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France.,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille
| | - Rene-Marc Flipo
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France.,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille
| | - Julien Paccou
- From Service de rhumatologie, Centre Hospitalier Universitaire (CHU) Lille, Lille; Service de rhumatologie, CH de Valenciennes, Valenciennes; Service de rhumatologie, Hôpital Saint-Philibert, Lomme; Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille, Lille, France. .,W. Bavière, MD, Service de rhumatologie, CHU Lille; X. Deprez, MD, Service de rhumatologie, CH de Valenciennes; E. Houvenagel, MD, Service de rhumatologie, Hôpital Saint-Philibert; P. Philippe, MD, Service de rhumatologie, CHU Lille; V. Deken, PhD, Département de Biostatistiques, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, CHU Lille; R.M. Flipo, MD, Service de rhumatologie, CHU Lille; J. Paccou, MD, PhD, Service de rhumatologie, CHU Lille.
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175
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Gossec L, Soubrier M, Foissac F, Molto A, Richette P, Beauvais C, Ruyssen-Witrand A, Perdriger A, Chary-Valckenaere I, Mouterde G, Dernis E, Euller-Ziegler L, Flipo RM, Gilson M, Guis S, Mariette X, Pouplin S, Marhadour T, Schaeverbeke T, Sordet C, Fayet F, Dougados M. Screening for and management of comorbidities after a nurse-led program: results of a 3-year longitudinal study in 769 established rheumatoid arthritis patients. RMD Open 2019; 5:e000914. [PMID: 31275607 PMCID: PMC6579559 DOI: 10.1136/rmdopen-2019-000914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/03/2019] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
Background/purpose Cardiovascular (CV) risk, cancer, infections and osteoporosis should be screened for in rheumatoid arthritis (RA). The objective was to assess 3-year effects of a nurse visit for comorbidity counselling. Methods This was an open long-term (3 years) extension of the Comorbidities and Education in Rheumatoid Arthritis 6-month randomised controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling. Comorbidity status was assessed and nurses provided advice on screening and management, at baseline and 3 years later. A score was developed to quantify comorbidity screening and management: 0–100, where lower scores indicate better screening and management. The score was compared between baseline and 3-year assessment using a Wilcoxon test for paired data. Results Of the 970 recruited patients, 776 (80%) were followed-up at 2–4 years and 769 (79%) had available data for comorbidities at both time points: mean (±SD) age 58 (±11) years and mean disease duration 14 (±10) years; 614 (80%) were women, the mean Disease Activity Score 28 was 3.0±1.3, and 538 (70%) were receiving a biologic. At baseline, the mean comorbidity screening score was 36.6 (±19.9) and it improved at 3 years to 24.3 (±17.8) (p<0.0001), thus with a relative improvement of 33% (improvement of 12 points). CV risk screening, vaccination status and bone densitometry performance improved the most. Conclusions Comorbidity screening was suboptimal but improved notably over 3 years, after a nurse-led programme aiming at checking systematically for comorbidity screening and giving patient advice. This long-term efficacy pleads in favour of nurse-led interventions to better address comorbidities in RA. Trial registration number NCT01315652
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Affiliation(s)
- Laure Gossec
- Sorbonne Universite, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Paris, France.,Rheumatology, Pitie Salpetriere Hospital, AP-HP, Paris, France
| | - Martin Soubrier
- Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Frantz Foissac
- Clinical Research Unit Necker-Cochin, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Anna Molto
- Rheumatology, Cochin Hospital, AP-HP, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Pascal Richette
- Rheumatology, Lariboisiere Hospital AP-HP, Paris, France.,Inserm UMR1132 Bioscar, Universite Paris Diderot, Paris, France
| | - Catherine Beauvais
- Rheumatology, Sorbonne Université and Hopital Saint-Antoine AP-HP, Paris, France
| | - Adeline Ruyssen-Witrand
- Rheumatology, UMR 1027 Inserm, Paul Sabatier University and Purpan Hospital, Toulouse, France
| | - Aleth Perdriger
- Rheumatology, South Hospital, Rennes 1 University, Rennes, France
| | | | - Gael Mouterde
- Immuno-rhumatologie, Lapeyronie Hospital and Montpellier University, Montpellier, France
| | | | | | - René-Marc Flipo
- Rheumatology, R Salengro Hospital, University of Lille, Lille, France
| | - Mélanie Gilson
- Rheumatology, GREPI-CNRS, Grenoble Hospital and Université Joseph Fourier, Echirolles, France
| | - Sandrine Guis
- Rheumatology, University Hospital, AP-HM, Marseille, France
| | - Xavier Mariette
- Rheumatology, HôpitauxUniversitaires Paris-Sud, Université Paris-Sud, INSERM UMR1184, Le Kremlin Bicetre, France
| | | | - Thierry Marhadour
- Rheumatology, Cavale Blanche Hospital and INSERM 1227, Université Bretagne Occidentale, Brest, France
| | - Thierry Schaeverbeke
- Rheumatology, Pellegrin Hospital, Bordeaux University, CNRS 5164, Bordeaux, France
| | - Christelle Sordet
- Rheumatology, Hautepierre Hospital, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France
| | - Françoise Fayet
- Rheumatology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Maxime Dougados
- Rheumatology, Cochin Hospital, AP-HP, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
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Abstract
The advent of biologic therapy has enhanced our ability to augment disease in an increasingly targeted manner. The use of biologics in cardiovascular disease (CVD) has steadily increased over the past several decades. Much of the early data on biologics and CVD were derived from their use in rheumatologic populations. Atherosclerosis, myocardial infarction, and heart failure have been closely linked to the inflammatory response. Accordingly, cytokines such as tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 have been targeted. Noninflammatory mediators, such as proprotein convertase subtilisin kexin type 9 (PCSK9), have been selected for therapeutic intervention as well. Furthermore, RNA interference (RNAi) therapy has emerged and may serve as another targeted therapeutic mechanism. Herein, we will review the history, obstacles, and advances in using biologic therapy for CVD.
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177
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Argollo M, Gilardi D, Peyrin-Biroulet C, Chabot JF, Peyrin-Biroulet L, Danese S. Comorbidities in inflammatory bowel disease: a call for action. Lancet Gastroenterol Hepatol 2019; 4:643-654. [PMID: 31171484 DOI: 10.1016/s2468-1253(19)30173-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition. Previously, the focus has been on extraintestinal manifestations of IBD, including arthritis, psoriasis, and uveitis. Although comorbidities have long been the subject of intensive research in other chronic inflammatory diseases such as rheumatoid arthritis, the concept of comorbidities is only beginning to emerge in IBD. Several comorbid conditions have been proposed to be related to IBD, including cardiovascular disease, neuropsychological disorders, and metabolic syndrome. Recognition of these conditions and their treatment could lead to better management of IBD. This Review aims to explore current knowledge regarding classic and emerging comorbidities related to IBD.
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Affiliation(s)
- Marjorie Argollo
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Centre, Milan, Italy; Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniela Gilardi
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Centre, Milan, Italy
| | | | - Jean-Francois Chabot
- Department of Pneumology, Nancy University Hospital, Lorraine University, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, Nancy, France
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Centre, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
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178
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Løppenthin K, Esbensen BA, Østergaard M, Ibsen R, Kjellberg J, Jennum P. Morbidity and mortality in patients with rheumatoid arthritis compared with an age- and sex-matched control population: A nationwide register study. JOURNAL OF COMORBIDITY 2019; 9:2235042X19853484. [PMID: 31211114 PMCID: PMC6547169 DOI: 10.1177/2235042x19853484] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 05/04/2019] [Indexed: 12/19/2022]
Abstract
Objective: The aim of this study was to examine the prevalence of morbidity and mortality in patients with seropositive rheumatoid arthritis (RA). Methods: Data were obtained from national population-based registries in the period 1998–2009. Prior to the seropositive RA diagnosis (International Classification of Disorders 10th revision M05), we identified a total of 21,558 patients and 87,384 age- and sex-matched control subjects. Odds for morbidity were calculated before and after the RA diagnosis. We estimated the overall survival based on the Kaplan–Meier method. Results: Patients with RA had statistically significantly higher odds for a number of co-morbidities prior to the onset of RA including diseases of the musculoskeletal system (odds ratio (OR) 3.10, 95% confidence interval (CI) 3.00–3.21), diseases involving the immune system (OR 1.45, 95% CI 1.29–1.64), endocrine diseases (OR 1.09, 95% CI 1.01–1.17), diseases of the circulatory system (OR 1.08, 95% CI 1.03–1.14) and diseases of the respiratory system (OR 1.30, 95% CI 1.22–1.38), compared with age- and sex-matched control subjects. After the RA diagnosis, the same trend was seen with higher odds for the same co-morbidities. We found a 5-year survival of 80% (95% CI 78–81%) for patients with RA, while for control subjects it was 88% (95% CI 88–89%). Conclusion: Compared with age- and sex-matched controls, patients with seropositive RA have higher odds for several co-morbidities prior to and, particularly, after the diagnosis of RA. Furthermore, patients with RA have a lower overall survival compared with age- and sex-matched controls.
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Affiliation(s)
- Katrine Løppenthin
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Denmark
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Poul Jennum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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179
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Shi N, Zhang S, Silverman G, Li M, Cai J, Niu H. Protective effect of hydroxychloroquine on rheumatoid arthritis-associated atherosclerosis. Animal Model Exp Med 2019; 2:98-106. [PMID: 31392302 PMCID: PMC6600633 DOI: 10.1002/ame2.12065] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease. We examined the effect of gut microbiota in a mouse model of RA that develops atherosclerosis. METHODS We created three groups of K/BxN female mice that were positive for the anti-glucose-6-phosphate isomerase (GPI) antibody: control diet (CD), high fat diet (HFD), and HFD with hydroxychloroquine (HFD + HCQ). Serological tests were used to detect the serum levels of total cholesterol (TCHO), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), anti-GPI antibody titers, and serum cytokines. Atherosclerotic plaque was determined by histological analysis, and gut microbiota were determined by 16sV4 sequencing. RESULTS Relative to mice given the CD, those receiving the HFD had increased serum levels of LDL-C, TCHO, and TG, decreased serum levels of HDL-C, increased atherosclerotic lesions in the aortic root, and altered gut microbiota. Addition of HCQ to HFD decreased the serum levels of LDL-C, TCHO, and TG, increased serum levels of HDL-C, and decreased the atherosclerotic lesions in the aortic root. Mice receiving HFD + HCQ also had the greatest bacterial diversity among the three experimental groups. Moreover, HCQ treatment significantly increased the abundance of Akkermansia and Parabacteroides, and decreased the abundance of Clostridium sensu stricto cluster 1, and therefore may be responsible for the reduced RA-associated atherosclerosis and dyslipidemia. CONCLUSION Our mouse model of RA indicated that HFD increased ankle width and aggravated atherosclerosis and dyslipidemia, and that HCQ alleviated the dyslipidemia and atherosclerosis, but had no effect on ankle width.
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Affiliation(s)
- Na Shi
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Shuangyue Zhang
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Gregg Silverman
- Department of Rheumatology, Langone Medical CenterNew York UniversityNew York CityNew York
| | - Mengtao Li
- Peking Union Medical College HospitalBeijingChina
| | - Jun Cai
- Fuwai HospitalChinese Academy of Medical SciencesBeijingChina
| | - Haitao Niu
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
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180
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Tomic-Smiljanic M, Vasiljevic D, Lucic-Tomic A, Andjelkovic N, Jakovljevic V, Bolovich S, Veselinovic M. Influence of different supplementation on platelet aggregation in patients with rheumatoid arthritis. Clin Rheumatol 2019; 38:2443-2450. [PMID: 31076942 DOI: 10.1007/s10067-019-04569-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs; eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) have been reported to reduce platelet aggregation. Our aim was to prospectively assess the potential influence of different supplementation omega-3 PUFA on the antiplatelet effects in rheumatoid arthritis (RA) patients. METHODS The study included 60 patients with RA at the Department of Rheumatology, Clinical Center Kragujevac. Patients were divided into three groups depending on who used concentrated fish oil only or concentrated fish oil in combination with evening primrose oil or control group without supplementation in a period of 3 months. Platelet aggregation was measured using the multiplate analyzer and expressed through the value of adenosine diphosphate (ADP) test, aranchidonic acid-induced aggregation (ASPI) test, thrombin receptor-activating peptide (TRAP) test (to assess baseline platelet aggregation), and the ratio of ADP/TRAP and ASPI/TRAP representing the degree of inhibition of platelet aggregation compared to the basal value. The platelet function analysis in whole blood was performed 18-24 h before starting supplementation and after 90 days. Considerations were taken in the representation of demographic, clinical characteristics, and laboratory parameters between the groups. RESULTS Patients who used concentrated fish oil only had a significantly lower value of the ratio of ADP/TRAP (0.68 ± 0.20) compared to patients without supplementation (0.83 ± 0.12; p = 0.008), while there was no statistically significant difference in values of other laboratory parameters of platelet function between other groups. CONCLUSIONS Co-administration of supplementation-concentrated fish oil may reduce platelet aggregation in adults with RA. KEY POINTS • Omega-3 PUFAs are essential for health and are known to possess anti-inflammatory properties, improving cardiovascular health as well as benefiting inflammatory diseases.. • In this paper, we report on anti-aggregation effects n-3 PUFAs and ɤ-linolenic acid in RA. • The risk of cardiovascular morbidity and mortality is increased in RA, and dietary supplementation of n-3 PUFA may have preventive potential for the cardiovascular management in rheumatoid arthritis.
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Affiliation(s)
| | - Dragan Vasiljevic
- Faculty of Medical Sciences, Department of Hygiene and Ecology, University of Kragujevac, 69 Svetozara Markovica, 34000, Kragujevac, Serbia
| | - Aleksandra Lucic-Tomic
- Faculty of Medical Sciences, Department of Internal medicine, University of Kragujevac, 69 Svetozara Markovica, 34000, Kragujevac, Serbia
| | - Nebojsa Andjelkovic
- Faculty of Medical Sciences, Department of Internal medicine, University of Kragujevac, 69 Svetozara Markovica, 34000, Kragujevac, Serbia
| | - Vladimir Jakovljevic
- Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, 69 Svetozara Markovica, 34000, Kragujevac, Serbia.,Department of Human Pathology, 1st Moscow State Medical, University IM Sechenov, Trubetskaya Street 8, Str. 2, Moscow, Russia, 119991
| | - Sergey Bolovich
- Department of Human Pathology, 1st Moscow State Medical, University IM Sechenov, Trubetskaya Street 8, Str. 2, Moscow, Russia, 119991
| | - Mirjana Veselinovic
- Faculty of Medical Sciences, Department of Internal medicine, University of Kragujevac, 69 Svetozara Markovica, 34000, Kragujevac, Serbia.
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181
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Zherebtsova AI, Dremin VV, Makovik IN, Zherebtsov EA, Dunaev AV, Goltsov A, Sokolovski SG, Rafailov EU. Multimodal Optical Diagnostics of the Microhaemodynamics in Upper and Lower Limbs. Front Physiol 2019; 10:416. [PMID: 31057417 PMCID: PMC6477060 DOI: 10.3389/fphys.2019.00416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/27/2019] [Indexed: 12/28/2022] Open
Abstract
The introduction of optical non-invasive diagnostic methods into clinical practice can substantially advance in the detection of early microcirculatory disorders in patients with different diseases. This paper is devoted to the development and application of the optical non-invasive diagnostic approach for the detection and evaluation of the severity of microcirculatory and metabolic disorders in rheumatic diseases and diabetes mellitus. The proposed methods include the joint use of laser Doppler flowmetry, absorption spectroscopy and fluorescence spectroscopy in combination with functional tests. This technique showed the high diagnostic importance for the detection of disturbances in peripheral microhaemodynamics. These methods have been successfully tested as additional diagnostic techniques in the field of rheumatology and endocrinology. The sensitivity and specificity of the proposed diagnostic procedures have been evaluated.
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Affiliation(s)
- Angelina I Zherebtsova
- Research and Development Center of Biomedical Photonics, Orel State University, Oryol, Russia
| | - Viktor V Dremin
- Research and Development Center of Biomedical Photonics, Orel State University, Oryol, Russia
| | - Irina N Makovik
- Research and Development Center of Biomedical Photonics, Orel State University, Oryol, Russia
| | - Evgeny A Zherebtsov
- Research and Development Center of Biomedical Photonics, Orel State University, Oryol, Russia.,Optoelectronics and Measurement Techniques Unit, University of Oulu, Oulu, Finland.,Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, School of Engineering and Applied Science, Aston University, Birmingham, United Kingdom
| | - Andrey V Dunaev
- Research and Development Center of Biomedical Photonics, Orel State University, Oryol, Russia
| | - Alexey Goltsov
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Sergei G Sokolovski
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, School of Engineering and Applied Science, Aston University, Birmingham, United Kingdom.,International Center of Critical Technologies in Medicine, Saratov State University, Saratov, Russia
| | - Edik U Rafailov
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, School of Engineering and Applied Science, Aston University, Birmingham, United Kingdom.,International Center of Critical Technologies in Medicine, Saratov State University, Saratov, Russia
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182
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Suh CH, Jung JY, Oh H, Boo S. Evaluation of factors affecting the levels of physical activity in patients with rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 2019; 38:2483-2491. [DOI: 10.1007/s10067-019-04559-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/08/2019] [Accepted: 04/10/2019] [Indexed: 01/10/2023]
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183
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The improvement in aerobic capacity, disease activity, and function in patients with rheumatoid arthritis following cardiac rehabilitation program: A single-center, controlled study. Turk J Phys Med Rehabil 2019; 66:121-133. [PMID: 32760888 DOI: 10.5606/tftrd.2020.3250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/15/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the effect of cardiac rehabilitation (CR) on disease activity, functional status, fitness, and modified cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA) with a moderate disease activity. Patients and methods This single-center, controlled study included a total of 60 female RA patients (mean age 57.5 years; range, 50 to 64 years) with moderate disease activity according to the Disease Activity Score-28 (DAS28) between January 2014 and June 2015. The patients were divided into two equal groups as those receiving CR program (n=30) and those receiving home exercise program (HEP; n=30). The patients were evaluated at baseline, at Weeks 10 and 24 using exercise tolerance test (i.e., The Metabolic Equivalent of Task [MET] and maximal oxygen uptake [VO2 max]), Six-Minute Walk Test (6MWT), DAS28, Health Assessment Questionnaire (HAQ), modified Systematic Coronary Risk Evaluation (mSCORE), Short Form Health Survey-36 (SF-36), and Beck Depression Inventory (BDI). Results There was a significant improvement in the VO2 max (p<0.001), MET (p<0.001), DAS28 (p<0.001), HAQ (p<0.001), BDI (p=0.005), SF-36 physical function (p=0.039), pain (p<0.001) and vitality subscale scores (p=0.008), and 6MWT (p<0.001), after the initial and repetitive exercise programs in the CR group compared to the HEP group. At the end of Week 24, full compliance with HEP was higher in the patients with CR group, compared to the HEP group (p<0.001). There was no significant effect of supervised exercise program on the mSCORE, although systolic blood pressure (p=0.033) and resting heart rate (p=0.049) were significantly improved in the CR group versus HEP group. Conclusion Based on our study results, supervised exercise program cannot reduce CVD risk as assessed by the mSCORE, although it improves physical fitness, disease activity, and functional outcomes which may reduce traditional CVD risk factors in patients with RA.
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Martin U, O'Gradaig D, Nolan DF, Sheehy C. Development of a methotrexate educational guide/information/monitoring booklet for inflammatory arthritis. Musculoskeletal Care 2019; 17:234-241. [PMID: 30993834 DOI: 10.1002/msc.1398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION There are over 40,000 people living in Ireland with inflammatory arthritis (IA), a condition that is potentially destructive in nature and can have personal, social and economic consequences. Although we have witnessed dramatic changes in the treatment of IA in the last two decades, methotrexate (MTX) remains the first-line treatment for patients with a diagnosis of IA. Despite the fact that MTX is so commonly prescribed, there is a lack of educational materials both for healthcare professionals (HCPs) and patients. The aim of the present study was to develop a suite of MTX material for patients. METHODS A comprehensive literature review of MTX (evidence, educational materials and practice guidelines) in the treatment of IA was undertaken. The content of the documents was developed, and the format and structure of the documents were agreed. A tailored patient educational guide, information/monitoring booklet and alert card were designed to address the lack of educational materials for this condition. A national pilot study of the documents was conducted (a postal questionnaire for patients and electronic survey for clinical nurse specialists). Results and recommendations were incorporated into the final documents. These documents were also incorporated into the National Clinical Care Programme-rheumatology-methotrexate pathway. RESULTS A 26-page evidence-based educational guide was produced to support the HCP in educating patients taking MTX, in conjunction with a patient information/monitoring booklet and alert card to support the patient. CONCLUSIONS These documents are now widely available and used in clinical practice in Ireland, providing patients with standardized, evidence-based information about MTX.
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Affiliation(s)
- Una Martin
- Department of Rheumatology, University Hospital Waterford, Waterford, Ireland
| | - Donncha O'Gradaig
- Department of Rheumatology, University Hospital Waterford, Waterford, Ireland
| | - Darragh Foley Nolan
- Department of Rheumatology, University Hospital Waterford, Waterford, Ireland
| | - Claire Sheehy
- Department of Rheumatology, University Hospital Waterford, Waterford, Ireland
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Gu MM, Wang XP, Cheng QY, Zhao YL, Zhang TP, Li BZ, Ye DQ. A Meta-Analysis of Cardiovascular Events in Systemic Lupus Erythematosus. Immunol Invest 2019; 48:505-520. [PMID: 30961407 DOI: 10.1080/08820139.2019.1567534] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: To identify accurate occurrence and risk of cardiovascular (CV) events (stroke and myocardial infarction [MI]) in patients with systemic lupus erythematosus (SLE). Methods: Systemic literature search in PubMed and additional manual search were performed to obtain interested studies until March 31, 2018. The pooled incidences and risk of stroke and MI were calculated. Results: A total of 24 studies were included in this meta-analysis. For MI, a total of 1,516 SLE patients were reported to had MI (n = 96,154) over a mean follow-up of 9.98 years: incidence 2.0% (95% CI: 1.7-2.4%), i.e. 0.20/100 pyrs; in the five studies, 360 SLE patients (n = 18,943) and 817 controls had MI (n = 111,525), revealing that the risk of MI in SLE population was 3.04 times higher than in the general population (RR = 3.04, 95% CI: 1.81-5.11). For stroke, the incidence of 17 studies during the 10.09 follow-up period using random model was 4.4% (95% CI: 3.6-5.1%), i.e. 0.44/100 pyrs; in the 7 studies, 694 SLE patients (n = 22,594) and 4,034 controls had stroke (n = 255,023), indicating that the risk of MI in SLE population was 1.95 times higher than that in the general population (RR = 1.95, 95% CI: 1.52-2.53). Conclusion: Based on the findings from previous reports, our meta-analysis showed that patients with SLE have been at higher risk of CV events.
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Affiliation(s)
- Ming-Ming Gu
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
| | - Xue-Ping Wang
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
| | - Qian-Yao Cheng
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
| | - Yu-Lan Zhao
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
| | - Tian-Ping Zhang
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
| | - Bao-Zhu Li
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
| | - Dong-Qing Ye
- a Department of Epidemiology and Health Statistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University , Hefei , Anhui , China
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Zavodovsky BV, Sivordova LE. Cardiovascular safety of non-steroidal anti-inflammatory drugs in chronic inflammatory rheumatic diseases. TERAPEVT ARKH 2019; 90:101-106. [PMID: 30701944 DOI: 10.26442/terarkh2018908101-106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatic diseases (RD), such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, vasculitis, gout are associated with increase in cardiovascular morbidity and mortality. The main causes of increased cardiovascular risk are inflammatory heart and vascular lesions, accelerated progression of atherosclerosis and side effects of drug therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in clinical practice and are on the list of the most prescribed medications. It is known that NSAIDs have a negative effect on the cardiovascular system (CVS). However NSAIDs may decrease the intensity of inflammation, which is an independent risk risk factor for CVS pathology. Therefore in patients with RD it is theoretically possible to reduce the severity of cardiovascular side effects when using NSAIDs. The article discusses the issues of NSAID's cardiovascular safety, the molecular mechanisms underlying the negative effect of them on CVS, critically evaluated the results of main studies concerning the cardiovascular safety of NSAIDs in chronic inflammatory diseases.
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Affiliation(s)
- B V Zavodovsky
- A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology, Volgograd, Russia
| | - L E Sivordova
- A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology, Volgograd, Russia
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Gender Differences in Cardiovascular Risk Profile in Rheumatoid Arthritis Patients with Low Disease Activity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3265847. [PMID: 31032342 PMCID: PMC6458929 DOI: 10.1155/2019/3265847] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/17/2019] [Indexed: 01/08/2023]
Abstract
Objective Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors.
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Balsa A, Lojo-Oliveira L, Alperi-López M, García-Manrique M, Ordóñez-Cañizares C, Pérez L, Ruiz-Esquide V, Corrales A, Narváez J, Rey-Rey J, Rodríguez-Lozano C, Ojeda S, Muñoz-Fernández S, Nolla JM, García-Torrón J, Gamero F, García-Vicuña R, Hernández-Cruz B, Campos J, Rosas J, García-Llorente JF, Gómez-Centeno A, Cáliz R, Sanmartí R, Bermúdez A, Abasolo-Alcázar L, Fernández-Nebro A, Rodríguez-Rodríguez L, Marras C, González-Gay MÁ, Hmamouchi I, Martín-Mola E. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring in clinical practice: the spanish cohort of the COMORA study. ACTA ACUST UNITED AC 2019; 15:102-108. [DOI: 10.1016/j.reuma.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
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Kaplanoglu H, Özişler C. Evaluation of subclinical atherosclerosis using ultrasound radiofrequency data technology in patients diagnosed with ankylosing spondylitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:703-711. [PMID: 30182506 DOI: 10.1002/jum.14754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The present study aims to identify the cardiovascular risk associated with chronic inflammation and disease activity in patients with ankylosing spondylitis (AS) using noninvasive ultrasonographic radiofrequency data technology. METHODS In this study, a total of 87 participants, 38 patients with AS and 49 healthy controls, were evaluated by Doppler ultrasonography. Intima-media thickness (IMT) and arterial stiffness were measured from the bilateral common carotid artery using the radiofrequency method. RESULTS No statistically significant difference was found between the AS patients and healthy controls concerning the right common carotid artery, left common carotid artery, IMT, distensibility coefficient, elasticity coefficient, α and β stiffness indexes, and pulse wave velocities (P > .05). The symptom duration of the AS patients had a positive correlation that was moderate and was detected with the α stiffness index and pulse wave velocity (P < .05). The duration of diagnosis and treatment of the AS patients had a positive correlation that was moderate, was detected with the α stiffness index, the β stiffness index, and pulse wave velocity (P < .05). The mean IMT and elasticity coefficient values of the AS patients whose Bath Ankylosing Spondylitis Disease Activity Index score was 4 and above, were substantially higher than the values in the patients with scores lower than 4 (P = .038 and P = .33, respectively). CONCLUSIONS Subclinical atherosclerosis is not accelerated in AS patients with low disease activity, although insufficiently controlled disease activity may result in increased carotid IMT and atheromatosis. Radiofrequency data technology provides a noninvasive method for accurately and quantitatively demonstrating CCA-IMT elevation and the decrease in vascular elasticity in patients with AS.
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Affiliation(s)
- Hatice Kaplanoglu
- Department of Radiology, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey
| | - Cem Özişler
- Department of Rheumatology, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey
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Skagen K, Hetlevik SO, Zamani M, Lilleby V, Skjelland M. Preclinical Carotid Atherosclerosis in Patients With Juvenile-Onset Mixed Connective Tissue Disease. J Stroke Cerebrovasc Dis 2019; 28:1295-1301. [PMID: 30772156 DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/25/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study investigated preclinical atherosclerosis in patients with juvenile mixed connective tissue disease (JMCTD), which is a chronic inflammatory disease with a varied phenotype. Mixed connective tissue disease (MCTD) has well known associations with other autoimmune diseases known to have increased risk of cardiovascular disease. However, the cardiovascular risk for patients with the juvenile form remains unclear. MATERIALS AND METHODS Forty-nine patients with JMCTD and 45 age-and sex-matched controls took part in this study. They underwent blood tests, clinical examination, and ultrasound measurement of the carotid arteries. RESULTS We found that patients had significantly higher average carotid intima-media thickness (IMT) as compared to controls (mean 0.57 ± 0.09 versus 0.53 ± 0.06, P = .03). IMT also increased with both increasing disease duration (years from diagnosis), and severity as assessed by the physicians global assessment score, after adjustment for age. CONCLUSIONS This is the first study to demonstrate increased preclinical atherosclerosis in juvenile MCTD. Our findings suggest that the atherosclerotic burden in this patient group, which was independent of traditional cardiovascular risk factors, might be secondary to the underlying connective tissue disease.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Siri Opsahl Hetlevik
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Mahtab Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Vibke Lilleby
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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191
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Giles JT. On Needles and Haystacks: The Perils of Cardiovascular Risk Screening in Rheumatoid Arthritis. J Rheumatol 2019; 46:121-123. [PMID: 30709999 DOI: 10.3899/jrheum.180933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jon T Giles
- Division of Rheumatology, Columbia University, College of Physicians and Surgeons, 630 West 168th St., Physicians and Surgeons Building, Suite 3-450, New York, New York 10032, USA.
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Rheumatoid Arthritis: Atherosclerosis Imaging and Cardiovascular Risk Assessment Using Machine and Deep Learning-Based Tissue Characterization. Curr Atheroscler Rep 2019; 21:7. [PMID: 30684090 DOI: 10.1007/s11883-019-0766-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REVIEW Rheumatoid arthritis (RA) is a chronic, autoimmune disease which may result in a higher risk of cardiovascular (CV) events and stroke. Tissue characterization and risk stratification of patients with rheumatoid arthritis are a challenging problem. Risk stratification of RA patients using traditional risk factor-based calculators either underestimates or overestimates the CV risk. Advancements in medical imaging have facilitated early and accurate CV risk stratification compared to conventional cardiovascular risk calculators. RECENT FINDING In recent years, a link between carotid atherosclerosis and rheumatoid arthritis has been widely discussed by multiple studies. Imaging the carotid artery using 2-D ultrasound is a noninvasive, economic, and efficient imaging approach that provides an atherosclerotic plaque tissue-specific image. Such images can help to morphologically characterize the plaque type and accurately measure vital phenotypes such as media wall thickness and wall variability. Intelligence-based paradigms such as machine learning- and deep learning-based techniques not only automate the risk characterization process but also provide an accurate CV risk stratification for better management of RA patients. This review provides a brief understanding of the pathogenesis of RA and its association with carotid atherosclerosis imaged using the B-mode ultrasound technique. Lacunas in traditional risk scores and the role of machine learning-based tissue characterization algorithms are discussed and could facilitate cardiovascular risk assessment in RA patients. The key takeaway points from this review are the following: (i) inflammation is a common link between RA and atherosclerotic plaque buildup, (ii) carotid ultrasound is a better choice to characterize the atherosclerotic plaque tissues in RA patients, and (iii) intelligence-based paradigms are useful for accurate tissue characterization and risk stratification of RA patients.
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Colaci M, Giuggioli D, Spinella A, Vacchi C, Lumetti F, Mattioli AV, Coppi F, Aiello V, Perticone M, Malatino L, Ferri C. Established coronary artery disease in systemic sclerosis compared to type 2 diabetic female patients: a cross-sectional study. Clin Rheumatol 2019; 38:1637-1642. [DOI: 10.1007/s10067-019-04427-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/24/2018] [Accepted: 01/01/2019] [Indexed: 12/13/2022]
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Luque Ramos A, Redeker I, Hoffmann F, Callhoff J, Zink A, Albrecht K. Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey. J Rheumatol 2019; 46:564-571. [PMID: 30647170 DOI: 10.3899/jrheum.180668] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the prevalence of comorbidities in a population-based cohort of persons with rheumatoid arthritis (RA) compared to matched controls and to examine their association with patient-reported outcomes in a survey sample. METHODS Data of 96,921 persons with RA [International Classification of Diseases, 10th ed (ICD-10) M05/M06] and 484,605 age- and sex-matched controls without RA of a German statutory health fund were studied regarding 26 selected comorbidities (ICD-10). A self-reported questionnaire, comprising joint counts [(tender joint count (TJC), swollen joint count (SJC)], functional status (Hannover Functional Ability Questionnaire), effect of the disease (Rheumatoid Arthritis Impact of Disease), and well-being (World Health Organization 5-item Well-Being Index; WHO-5) was sent to a random sample of 6193 persons with RA, of whom 3184 responded. For respondents who confirmed their RA (n = 2535), associations between comorbidities and patient-reported outcomes were analyzed by multivariable linear regression. RESULTS Compared to controls, all investigated comorbidities were more frequent in persons with RA (mean age 63 yrs, 80% female). In addition to cardiovascular risk factors, the most common were osteoarthritis (44% vs 21%), depression (32% vs 20%), and osteoporosis (26% vs 9%). Among the survey respondents, 87% of those with 0-1 comorbidity but only 77% of those with ≥ 8 comorbidities were treated by rheumatologists. Increasing numbers of comorbidities were associated with poorer values for TJC, SJC, function, and WHO-5. CONCLUSION Compared to a matched population, persons with RA present with increased prevalence of numerous comorbidities. Patients with RA and multimorbidity are at risk of insufficient rheumatological care and poorer patient-reported outcomes.
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Affiliation(s)
- Andres Luque Ramos
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany. .,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre.
| | - Imke Redeker
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Falk Hoffmann
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Johanna Callhoff
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Angela Zink
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Katinka Albrecht
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
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Daiber A, Xia N, Steven S, Oelze M, Hanf A, Kröller-Schön S, Münzel T, Li H. New Therapeutic Implications of Endothelial Nitric Oxide Synthase (eNOS) Function/Dysfunction in Cardiovascular Disease. Int J Mol Sci 2019; 20:ijms20010187. [PMID: 30621010 PMCID: PMC6337296 DOI: 10.3390/ijms20010187] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 02/07/2023] Open
Abstract
The Global Burden of Disease Study identified cardiovascular risk factors as leading causes of global deaths and life years lost. Endothelial dysfunction represents a pathomechanism that is associated with most of these risk factors and stressors, and represents an early (subclinical) marker/predictor of atherosclerosis. Oxidative stress is a trigger of endothelial dysfunction and it is a hall-mark of cardiovascular diseases and of the risk factors/stressors that are responsible for their initiation. Endothelial function is largely based on endothelial nitric oxide synthase (eNOS) function and activity. Likewise, oxidative stress can lead to the loss of eNOS activity or even “uncoupling” of the enzyme by adverse regulation of well-defined “redox switches” in eNOS itself or up-/down-stream signaling molecules. Of note, not only eNOS function and activity in the endothelium are essential for vascular integrity and homeostasis, but also eNOS in perivascular adipose tissue plays an important role for these processes. Accordingly, eNOS protein represents an attractive therapeutic target that, so far, was not pharmacologically exploited. With our present work, we want to provide an overview on recent advances and future therapeutic strategies that could be used to target eNOS activity and function in cardiovascular (and other) diseases, including life style changes and epigenetic modulations. We highlight the redox-regulatory mechanisms in eNOS function and up- and down-stream signaling pathways (e.g., tetrahydrobiopterin metabolism and soluble guanylyl cyclase/cGMP pathway) and their potential pharmacological exploitation.
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Affiliation(s)
- Andreas Daiber
- Center for Cardiology, Cardiology I-Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany.
| | - Ning Xia
- Department of Pharmacology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
| | - Sebastian Steven
- Center for Cardiology, Cardiology I-Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
| | - Matthias Oelze
- Center for Cardiology, Cardiology I-Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
| | - Alina Hanf
- Center for Cardiology, Cardiology I-Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
| | - Swenja Kröller-Schön
- Center for Cardiology, Cardiology I-Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
| | - Thomas Münzel
- Center for Cardiology, Cardiology I-Laboratory of Molecular Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany.
| | - Huige Li
- Department of Pharmacology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
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196
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Ikdahl E, Wibetoe G, Rollefstad S, Salberg A, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Fevang BTS, Gulseth HC, Haugeberg G, Semb AG. Guideline recommended treatment to targets of cardiovascular risk is inadequate in patients with inflammatory joint diseases. Int J Cardiol 2019; 274:311-318. [DOI: 10.1016/j.ijcard.2018.06.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 01/08/2023]
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197
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Weijers JM, Rongen-van Dartel SAA, van Riel PLCM. Exercise participation has increased in patients with Rheumatoid Arthritis: A cross-sectional comparison between two Dutch RA cohorts. Mediterr J Rheumatol 2018; 29:199-206. [PMID: 32185327 PMCID: PMC7045938 DOI: 10.31138/mjr.29.4.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/01/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Objective: This study evaluates exercise participation in patients with rheumatoid arthritis (RA) and the percentage of patients that meet the recommended level of physical activity (at least 150 minutes per week moderate-intensity physical activity) in two cross-sectional questionnaires in 2013 and 2016 in two Dutch RA cohorts. Methods: In 2013, a cross-sectional study was performed among 740 patients with RA from seven outpatient clinics from the Dutch DREAM registry. Subsequently in 2016, 498 patients with RA of the outpatient clinic of the Bernhoven Hospital (member of the DREAM registry) participated in a similar study. In both years, patients filled in an identical questionnaire about exercise participation (frequency and duration). In 2016, items about self-efficacy to become more physically active were added to the questionnaire. Results: In 2016, patients with RA spent significantly more minutes per week in exercise activities compared to 2013: 180 (150–450) and 120 (60–225) minutes per week, respectively (P<0.001). The percentage of patients with RA who met the recommended physical activity level increased from 25% in 2013 to 57% in 2016. Almost half (44%) of the non-exercisers reported feeling confident to become more physically active. Conclusion: Compared to 2013, RA patients participated in 2016 more frequently and spent more minutes per week in exercise activities. This resulted in a higher percentage of patients who met the recommended physical activity level. A personalized physical activity program, with a focus on identifying barriers and setting personal goals, might further increase the physical activity level of patients with RA.
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Affiliation(s)
- Julia M Weijers
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Sanne A A Rongen-van Dartel
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands
| | - Piet L C M van Riel
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands
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198
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Peluso R, Caso F, Tasso M, Ambrosino P, Dario Di Minno MN, Lupoli R, Criscuolo L, Caso P, Ursini F, Puente AD, Scarpa R, Costa On Behalf Of CaRRDs Study Group L. Cardiovascular Risk Markers and Major Adverse Cardiovascular Events in Psoriatic Arthritis Patients. Rev Recent Clin Trials 2018. [PMID: 29542417 PMCID: PMC6691775 DOI: 10.2174/1574887113666180314105511] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Psoriatic arthritis is a chronic inflammatory arthropathy that affects 14%- 30% of patients with skin and/or nail psoriasis, leading to severe physical limitations and disability. It has been included in the group of spondyloarthropathy with which it shares clinical, radiologic, and serologic features in addition to familial and genetic relationship. Beyond skin and joint involvement, psoriatic arthritis is characterized by a high prevalence of extra-articular manifestation and comorbidities, such as autoimmune, infectious and neoplastic diseases. In particular, an increased risk of cardiovascular comorbidity has been observed in psoriatic arthritis patients. METHODS A systematic search was performed in the electronic databases (PubMed, Web of Science, Scopus, EMBASE) up until January 2017. Studies were included if they contained data on CV disease and/or risk factors in PsA and each article was then reviewed for quality and clinical relevance. After completing the literature search all screened literature was summarized and discussed in our study group (CaRDDs study group). All literature and comments were included in the systematic review. RESULTS The initial search produced 278 abstracts, which were narrowed to 83 potentially relevant articles by preliminary review of the titles and by excluding review articles and case report (n = 195). Thirty articles were deemed ineligible after examining the abstracts. Full texts of the remaining 53 articles were retrieved. The majority of articles excluded were due to only providing data on patients with psoriasis or due to being not relevant to the CV risk in PsA. In the end, 32 articles were deemed eligible for this review. CONCLUSION Psoriatic arthritis appeared significantly associated with subclinical atherosclerosis and endothelial dysfunction and, in turn, with an increased cardiovascular risk. Thus, patients with psoriatic arthritis may benefit from a periodic assessment of surrogate markers of cardiovascular risk. This could help to establish more specific cardiovascular prevention strategies for these patients.
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Affiliation(s)
- Rosario Peluso
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Marco Tasso
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Livio Criscuolo
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Paolo Caso
- Geriatric Unit, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonio Del Puente
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery - Rheumatology Research Unit - Federico II University, Naples, Italy
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199
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Targońska-Stępniak B, Biskup M, Biskup W, Majdan M. Diastolic dysfunction in rheumatoid arthritis patients with low disease activity. Clin Rheumatol 2018; 38:1131-1137. [PMID: 30539352 DOI: 10.1007/s10067-018-4369-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/OBJECTIVES Patients with rheumatoid arthritis (RA) are at increased risk for congestive heart failure (CHF) and left ventricular diastolic dysfunction (LVDD), as compared to the general population. High disease activity is to be associated with higher incidence of cardiovascular disease (CVD), CHF, and mortality in RA patients. LVDD is not anticipated in RA patients without CVD symptoms and may be underdiagnosed especially in those with low disease activity. METHOD The study group consisted of 70 RA patients (54 women, 16 men) with no CVD and 33 healthy controls, of comparable age. All RA patients had low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. Laboratory and imaging assessments included metabolic, RA-related, and cardiovascular parameters. Echocardiographic and Doppler studies were conducted in patients and controls with assessment of ejection fraction (EF) and diastolic dysfunction (assessed as E/A ratio). RESULTS The mean E/A ratio did not differ significantly between RA patients and healthy controls (1.08 (0.28) vs 0.99 (0.21), NS); comparable numbers of patients and controls had abnormal E/A (< 1.0) (26 (37.1%) vs 10 (30.3%), NS). Patients with decreased E/A were significantly older and had higher disease duration, activity, and presence of bone erosions than their RA counterparts with normal E/A. The mean EF was not significantly different in patients and controls. CONCLUSIONS The prevalence of DD as expressed by E/A ratio in RA patients with continued low disease activity was not different from that of controls. Higher disease duration and severity may predispose to DD occurrence in patients with preserved EF.
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Affiliation(s)
- Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| | | | | | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland
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200
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Bissell LA, Erhayiem B, Fent G, Hensor EMA, Burska A, Donica H, Plein S, Buch MH, Greenwood JP, Andrews J. Carotid artery volumetric measures associate with clinical ten-year cardiovascular (CV) risk scores and individual traditional CV risk factors in rheumatoid arthritis; a carotid-MRI feasibility study. Arthritis Res Ther 2018; 20:266. [PMID: 30509325 PMCID: PMC6278168 DOI: 10.1186/s13075-018-1761-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Common carotid artery intima-media thickness (CIMT), as measured by ultrasound, has utility in stratification of the accelerated cardiovascular risk seen in rheumatoid arthritis (RA); however, the technique has limitations. Carotid magnetic resonance imaging (MRI) is emerging as a useful research tool in the general population, but has yet to be applied in RA populations. Our objectives were to describe the utility of carotid artery MRI (carotid-MRI) in patients with RA in comparison to healthy controls and to describe the association with RA disease phenotype. METHODS Sixty-four patients with RA and no history of cardiovascular (CV) disease/diabetes mellitus were assessed for RA and CV profile, including homeostasis model assessment-estimated insulin resistance (HOMA-IR) and N-terminal pro-brain natriuretic peptide (NT-proBNP). All underwent carotid-MRI (3 T), and were compared to 24 healthy controls. Univariable analysis (UVA) and multivariable linear regression models (MVA) were used to determine associations between disease phenotype and carotid-MRI measures. RESULTS There were no significant differences in carotid arterial wall measurements between patients with RA and controls. Wall and luminal volume correlated with 10-year CV risk scores (adjusted as per 2017 European League Against Rheumatism (EULAR) guidance); rho = 0.33 (p = 0.012) and rho = 0.35 (p = 0.008), respectively, for Joint British Societies-2 risk score. In UVA, carotid-MRI volumetric measures predominantly were associated with traditional CV risk factors including age, ever-smoking and HOMA-IR (p < 0.05). Lower body mass index was associated with wall maximum thickness (r = - 0.25 p = 0.026). In MVA, age was independently associated with wall volume (B 1.13 (95% CI 0.32, 1.93), p = 0.007) and luminal volume (B 3.69 (95% CI 0.55, 6.83, p = 0.022), and RA disease duration was associated with luminal volume (B 3.88 (95% CI 0.80, 6.97), p = 0.015). CONCLUSIONS This study demonstrates the utility of carotid-MRI in RA, reporting an association between three-dimensional measures in particular and CV risk scores, individual traditional CV risk factors and RA disease duration. Carotid-MRI in RA is a promising research tool in the investigation of CVD.
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Affiliation(s)
- Lesley-Anne Bissell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham Fent
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Agata Burska
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jacqueline Andrews
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
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