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Luciano N, Barone E, Timilsina S, Gershwin ME, Selmi C. Tumor Necrosis Factor Alpha Inhibitors and Cardiovascular Risk in Rheumatoid Arthritis. Clin Rev Allergy Immunol 2023; 65:403-419. [PMID: 38157095 DOI: 10.1007/s12016-023-08975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by an increased risk of cardiovascular events, due to the complex interplay between traditional and disease-related risk factors. Chronic inflammation and persistent disease activity are the key determinants of this risk, but despite great improvement in the disease management and prognosis, cardiovascular events are still the main cause of morbidity and mortality in RA cohorts1. In the last decades, the advent of new biological and targeted-synthetic DMARDs was accompanied by an improvement in disease activity control, but the role of each class of drugs on CVD risk is still a matter a debate. Since their approval for RA treatment, tumor necrosis factor alpha (TNFα) inhibitors have been widely investigated to better understand their effects on cardiovascular outcomes. The hypothesis that the reduction of chronic inflammation with any treatment may reduce the cardiovascular risk has been recently confuted by the direct comparison of TNFα-inhibitors and JAK inhibitors in patients with RA and coexisting risk factors for cardiovascular disease. The aim of this literature review is to add to the available evidence to analyze the relationship between TNFα-inhibitors and CVD risk in patients with RA and also provide some clinical scenarios to better explain the treatment dilemmas. In particular, while data on major cardiovascular events and thromboembolism seem consistent with an inflammation-mediated benefit with TNFα-inhibitors, there remain concerns about the use of this class of bDMARDs in patients with chronic heart failure.
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Affiliation(s)
- Nicoletta Luciano
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elisa Barone
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Suraj Timilsina
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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2
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Gialouri CG, Fragoulis GE. Is there room for better screening for lung cancer in rheumatoid arthritis? RMD Open 2022; 8:rmdopen-2022-002774. [PMID: 36597974 PMCID: PMC9730398 DOI: 10.1136/rmdopen-2022-002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Chrysoula G Gialouri
- Joint Academic Rheumatology Program, 2nd Department of Medicine and Laboratory, General Hospital of Athens “Hippokration”, National and Kapodistrian University of Athens, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Exploring potential shared genetic influences between rheumatoid arthritis and blood lipid levels. Atherosclerosis 2022; 363:48-56. [PMID: 36455308 DOI: 10.1016/j.atherosclerosis.2022.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/11/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIMS The association between rheumatoid arthritis (RA) and blood lipid levels has often been described as paradoxical, despite the strong association between RA and cardiovascular disease (CVD) risk. We aimed to clarify the genetic architecture that would explain the relationship between RA and blood-lipid levels, while considering inflammation as measured by C-reactive protein (CRP). METHODS Genome-wide association study (GWAS) summary statistics were collected from the CHARGE Consortium and Global Lipids Genetics Consortium. Blood-lipid levels includes HDL-C, LDL-C, triglycerides (TG), and total cholesterol (TC). Causality was examined by assessing Mendelian Randomization (MR) analysis. Pleiotropy, the identification of shared causal variants between traits, was assessed by conducting colocalization analyses. RESULTS Using the MR Egger method, RA did not appear to causally predict alterations in lipid factors, rather the MR Egger intercept revealed that the genetic relationship between RA and HDL-C, LDL-C and TC may be explained by horizontal pleiotropy (p=0.003, 0.006, and 0.018, respectively). MR was suggestive of a horizontally pleiotropic relationship between CRP and lipid factors, while a causal relationship could not be ruled out. Recurring genes arising from shared causal genetic variants between RA and varying lipid factors included NAT2/PSD3, FADS2/FADS1, SH2B3, and YDJC. CONCLUSIONS Horizontal pleiotropy appears to explain the genetic relationship between RA and blood-lipid levels. In addition, blood-lipid levels appear to suggest a horizontally pleiotropic relationship to CRP, if not mediated through RA as well. Consideration of the pleiotropic genes between RA and blood lipid levels may aid in enhancing diagnostic means to predict CVD.
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Chatzidionysiou K, di Giuseppe D, Soderling J, Catrina A, Askling J. Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking. RMD Open 2022; 8:rmdopen-2022-002465. [PMID: 36270743 PMCID: PMC9594582 DOI: 10.1136/rmdopen-2022-002465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Lung cancer is a common malignancy in rheumatoid arthritis (RA). Since smoking is a risk factor for both (seropositive) RA and lung cancer, it remains unclear whether RA, in itself, increases lung cancer risk. METHODS We performed a population-based cohort study of patients with RA and individually matched general population reference individuals identified in Swedish registers and from the Epidemiological Investigation of RA early RA study, prospectively followed for lung cancer occurrence 1995-2018. We calculated incidence rates and performed Cox regression to estimate HRs including 95% CIs of lung cancer, taking smoking and RA serostatus into account. RESULTS Overall, we included 44 101 patients with RA (590 incident lung cancers, 56 per 100 000), and 216 495 matched general population individuals (1691 incident lung cancers, 33 per 100 000), corresponding to a crude HR (95% CI) of 1.76 (1.60 to 1.93). In subset analyses, this increased risk remained after adjustment for smoking (HR 1.77, 95% CI 1.06 to 2.97). Compared with general population subjects who were never smokers, patients with RA who were ever smokers had almost seven times higher risk of lung cancer. In RA, seropositivity was a significant lung cancer risk factor, even when adjusted for smoking, increasing the incidence 2-6 times. At 20 years, the risk in patients with RA was almost 3%, overall and over 4% for patients who were ever smokers and had at least one RA autoantibody. CONCLUSIONS Seropositive RA is a risk factor for lung cancer over and above what can be explained by smoking, although residual confounding by smoking or other airway exposures cannot be formally excluded. There is a need for increased awareness and potentially for regular lung cancer screening, at least in a subset of patients with RA.
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Affiliation(s)
| | - Daniela di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Soderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anca Catrina
- Rheumatology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Sharma S, Plant D, Bowes J, Macgregor A, Verstappen S, Barton A, Viatte S. HLA-DRB1 haplotypes predict cardiovascular mortality in inflammatory polyarthritis independent of CRP and anti-CCP status. Arthritis Res Ther 2022; 24:90. [PMID: 35468805 PMCID: PMC9036773 DOI: 10.1186/s13075-022-02775-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Haplotypes defined by amino acids at HLA-DRB1 positions 11, 71 and 74 associated with susceptibility to rheumatoid arthritis (RA) are associated with radiological outcome, anti-TNF response and all cause-mortality in RA. RA is associated with cardiovascular (CV) morbidity and mortality, but the increased prevalence of risk factors of CV disease in RA only partially explains this association. The aim of this study was to investigate whether amino acids at positions 11, 71 and 74 of HLA-DRB1 are associated with cardiovascular (CV) mortality in inflammatory polyarthritis (IP). METHODS The Norfolk Arthritis Register (NOAR) is an incidence register of IP: recruitment 1990-2007, final follow-up 2011. Two thousand five hundred fourteen patients had available genetic and mortality data. Amino acids at positions 11, 71 and 74 of HLA-DRB1 were determined. Univariate Cox proportional hazard models were applied to assess the association of genetic markers and both all-cause mortality and cardiovascular mortality. RESULTS Among 2514 participants, 643 (25.6%) died during the study, and 343 (53.3%) of these deaths were attributed to CV causes. One thousand six hundred fifty (65.6%) participants were female, 709 (32.3%) were anti-CCP-positive and the median age of participants was 54. HLA-DRB1 haplotypes associated with susceptibility to rheumatoid arthritis (RA) consistently show the same magnitude and direction of association for overall and CV mortality in IP. For example, the SEA-haplotype, associated with the lowest susceptibility to RA, and the best radiographic outcome, was found to be associated with decreased CV mortality (HR 0.67, 95% CI 0.47, 0.91, p=0.023). Mediation analysis revealed associations were independent of anti-CCP status. CONCLUSIONS HLA-DRB1 haplotypes associated with susceptibility to RA also predispose to increased risk of CV mortality in IP, independent of known CV risk factors. Associations were independent of anti-CCP status, which suggests in the future, genetic factors will add to the prediction of risk of cardiovascular mortality beyond serological markers.
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Affiliation(s)
- Seema Sharma
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Darren Plant
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Alex Macgregor
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, NR4 7TJ, UK
| | - Suzanne Verstappen
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Grafton Street, Manchester, M13 9WL, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Grafton Street, Manchester, M13 9WL, UK
| | - Sebastien Viatte
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, Oxford Road, Manchester, M13 9PT, UK.
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
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Konishi A, Abe M, Yamaoka M, Satake A, Ito T, Nomura S. Analysis of HLA haplotype and clinical factors during hematopoietic stem cell transplantation. Transpl Immunol 2021; 66:101376. [PMID: 33610676 DOI: 10.1016/j.trim.2021.101376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/03/2021] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The human leukocyte antigen (HLA) haplotype of the recipient in hematopoietic stem cell transplantation (HSCT) is a key factor in its success or failure. We analyzed the relationship between HLA haplotype frequency and associated clinical factors in HSCT patients. METHODS Patients who underwent allogeneic HSCT between 2000 and 2019 at our institution were enrolled in this study. The HSCT composition was 77 bone marrow transplantations (BMT), 38 peripheral blood stem cell transplantations (PBSCT), and 36 cord blood transplantations (CBT). Patients were classified into three groups according to their donor HLA haplotype frequency in the Japan Population: group A, top 1-10 haplotypes; group B, top 11-100 haplotypes; and group C, haplotype 101-. We then compared various items including clinical biomarkers with the HLA haplotype frequency. RESULTS A significant negative correlation was identified between older persons and length of survival. There are also significant correlations between survival and levels of immunoglobulin G, D-dimer, and C-reactive protein, as well as the platelet-large cell ratio before transplantation. A total of 96, 30, and 25 patients were classified into groups A, B, and C, respectively. The HSCT match rate was significantly higher in group A patients than in those of groups B and C. In contrast, the death rate, D-dimer level, and length of time for engraftment were significantly higher in group B and C patients than in those of group A. CONCLUSION An assessment of transplant-related complications is important in improving the performance of HSCT. The present data suggest that a special therapeutic strategy is necessary for HSCT using low-frequency HLA haplotypes.
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Affiliation(s)
- Akiko Konishi
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Misao Abe
- Division of Blood Transfusion, Kansai Medical University, Japan
| | - Manabu Yamaoka
- Division of Blood Transfusion, Kansai Medical University, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Japan.
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Fragoulis GE, Chatzidionysiou K. Lung cancer in rheumatoid arthritis. Is there a need for better risk assessment and screening? Clin Rheumatol 2019; 39:957-961. [DOI: 10.1007/s10067-019-04882-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
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Zhao M, Mauer L, Sayles H, Cannon GW, Reimold A, Kerr GS, Baker JF, Thiele GM, England BR, Mikuls TR. HLA-DRB1 Haplotypes, Shared Epitope, and Disease Outcomes in US Veterans with Rheumatoid Arthritis. J Rheumatol 2019; 46:685-693. [PMID: 30824656 DOI: 10.3899/jrheum.180724] [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] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate associations of HLA-DRB1 haplotypes and shared epitope (SE) with rheumatoid arthritis (RA) severity and all-cause mortality in RA. METHODS Patients with RA from the Veterans Affairs Rheumatoid Arthritis (VARA) registry were followed from enrollment until death or December 31, 2013. Clinical characteristics, DNA, and serum were collected at enrollment. Radiographic damage, the presence or absence of subcutaneous nodules, disease activity measures, and functional status were assessed at enrollment and updated during followup. Sixteen HLA-DRB1 haplotypes and SE status were determined from banked DNA. Associations between HLA-DRB1 haplotypes, RA disease characteristics, and mortality were assessed in multivariable regression models. RESULTS Within VARA, 1443 participants had genotyping and accrued 6150 patient-years of followup. Haplotypes VKA, VRA, LRA, SRA, SRE, SKR, and SEA, and SE alleles were significantly associated with seropositivity for rheumatoid factor (RF) and/or anticyclic citrullinated peptide (anti-CCP). Haplotypes VKA and SKR were associated with higher RF concentrations, while VRA, DRE, and GRQ were associated with lower RF concentrations. Haplotypes VKA, VRA, and LRA were associated with higher concentrations of anti-CCP antibody, while haplotypes SRA, SRE, LEA, SKR, and SEA were significantly associated with lower anti-CCP concentrations. Haplotype VKA (OR 1.39, 95% CI 1.08-1.80) was associated with increased frequency of radiographic damage at enrollment but none of the haplotypes were associated with the presence of subcutaneous nodules. Haplotypes SKA (HR 1.52, 95% CI 1.26-1.83) was associated with higher mortality. CONCLUSION HLA-DRB1 haplotypes are independently and variably associated with seropositivity, autoantibody concentrations, and outcomes in RA.
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Affiliation(s)
- Ming Zhao
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Lilli Mauer
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Harlan Sayles
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Grant W Cannon
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Andreas Reimold
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Gail S Kerr
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Joshua F Baker
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Geoffrey M Thiele
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Bryant R England
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Ted R Mikuls
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA. .,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC.
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Cardiac and vascular complications in rheumatoid arthritis. Reumatologia 2019; 57:27-36. [PMID: 30858628 PMCID: PMC6409824 DOI: 10.5114/reum.2019.83236] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is an independent risk factor for the development of a variety of cardiovascular diseases, with a 1.5-factor increase in risk. This literature review aims to provide a global overview of the pathogenesis, effects of anti-rheumatoid treatment on cardiovascular risk, a description of the cardiovascular complications associated with RA, and current opinion on cardiovascular risk assessment and management in patients with RA. Author conducted a literature search in PubMed, Scopus, Web of Science and Embase regarding RA and associated cardiovascular complications. The mechanism of increased risk of cardiovascular disease in patients with RA is complex. There are specific genetic factors associated with both diseases, and traditional cardiovascular risk factors may be more prevalent in patients with RA. Most anti-rheumatic drugs decrease cardiovascular risk, and general recommendations focus on reduction of disease activity and strict management of cardiovascular risk as per the general population.
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10
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Abstract
Purpose of review Persuasive statistics support the clinical observation that because of cardiovascular comorbidities patients with inflammatory joint disease die significantly earlier despite anti-inflammatory therapy. Recent findings The reason for this earlier death is multifactorial and involves a combination of a complex genetic background, environmental influences, classical cardiovascular risk factors and the impact of anti-inflammatory therapy. We will describe the importance of several new mechanisms, especially the diverse intercellular communication routes including extracellular vesicles and microRNAs that support the development of cardiovascular comorbidities. Summary The aim of this review is to give an updated overview about the known risk factors in the development of cardiovascular comorbidities with the latest insights about their mechanism of action. Furthermore, the impact of newly identified risk factors and significance will be discussed.
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Adawi M, Pastukh N, Saaida G, Sirchan R, Watad A, Blum A. Inhibition of endothelial progenitor cells may explain the high cardiovascular event rate in patients with rheumatoid arthritis. QJM 2018; 111:525-529. [PMID: 29788448 DOI: 10.1093/qjmed/hcy099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/30/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients may suffer cardiovascular (CV) events much more than the general population, and CV disease is the leading cause of death in patients with RA. Our hypothesis was that impaired function of endothelial progenitor cells may contribute to endothelial dysfunction and the clinical CV events of patients with RA. METHODS About 27 RA patients (9 males and 18 females) with an active disease and 13 healthy subjects who served as the control group (nine males and four females) were enrolled to this prospective study. The ability to grow in culture colony-forming units of endothelial progenitor cells (CFU-EPCs) was measured, as well as their endothelial function using high-resolution ultrasonography of the brachial artery, and levels of C reactive protein (CRP) in the serum. For statistical analysis, we used the Student's t-test. RESULTS As a group, patients with RA were older (P < 0.0001), had severe endothelial dysfunction (P<0.0001), with impaired ability to grow CFU-EPCs (P<0.0001), and a higher inflammatory state (P = 0001). No difference was observed in BMI. All RA patients had an active disease (DAS28 3.9 ± 0.9) for 9.2 ± 6.5 years. The same differences were observed in both genders. CONCLUSIONS Patients with RA had an impaired ability to grow EPCs and severe endothelial dysfunction. Inability to grow colonies of EPCs reflects the impaired regenerative capacity of patients with RA and may explain the endothelial dysfunction and the high CV event rate among patients with RA.
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Affiliation(s)
- M Adawi
- Department of Medicine and the Rheumatology Unit, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
- Azrieli Faculty of Medicine, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - N Pastukh
- The Vascular Research Laboratory, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - G Saaida
- Azrieli Faculty of Medicine, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - R Sirchan
- Department of Medicine and the Rheumatology Unit, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - A Watad
- Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - A Blum
- Department of Medicine and the Rheumatology Unit, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
- Azrieli Faculty of Medicine, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
- The Vascular Research Laboratory, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
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12
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Human MHC-II with Shared Epitope Motifs Are Optimal Epstein-Barr Virus Glycoprotein 42 Ligands-Relation to Rheumatoid Arthritis. Int J Mol Sci 2018; 19:ijms19010317. [PMID: 29361739 PMCID: PMC5796260 DOI: 10.3390/ijms19010317] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder of unknown etiology, which is characterized by inflammation in the synovium and joint damage. Although the pathogenesis of RA remains to be determined, a combination of environmental (e.g., viral infections) and genetic factors influence disease onset. Especially genetic factors play a vital role in the onset of disease, as the heritability of RA is 50–60%, with the human leukocyte antigen (HLA) alleles accounting for at least 30% of the overall genetic risk. Some HLA-DR alleles encode a conserved sequence of amino acids, referred to as the shared epitope (SE) structure. By analyzing the structure of a HLA-DR molecule in complex with Epstein-Barr virus (EBV), the SE motif is suggested to play a vital role in the interaction of MHC II with the viral glycoprotein (gp) 42, an essential entry factor for EBV. EBV has been repeatedly linked to RA by several lines of evidence and, based on several findings, we suggest that EBV is able to induce the onset of RA in predisposed SE-positive individuals, by promoting entry of B-cells through direct contact between SE and gp42 in the entry complex.
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13
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Cho SK, Kim D, Won S, Lee J, Park B, Jang EJ, Bae SC, Sung YK. Impact of anti-rheumatic treatment on cardiovascular risk in Asian patients with rheumatoid arthritis. Semin Arthritis Rheum 2017; 47:501-506. [PMID: 28863826 DOI: 10.1016/j.semarthrit.2017.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/01/2017] [Accepted: 08/01/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To estimate the incidence of cardiovascular disease (CVD) in Asian patients with rheumatoid arthritis (RA) and to evaluate the impact of anti-rheumatic treatment on the development of CVD. METHODS A retrospective cohort of Asian patients with RA was established to identify the incidence rate (IR) of CVD in RA patients. The cohort was generated using the Korean National Healthcare claims database, which contained claims from Jan 2009 to Dec 2013. A total of 137,512 RA patients were identified; individuals with a history of CVD for 6 months or more before the index date were excluded. Nested case-control samples were drawn from the full study population with a case:control ratio of 1:4 (n = 7102 cases; n = 27,018 controls without CVD). A conditional multivariate regression model was used to evaluate the impact of anti-rheumatic treatment on the development of CVD in RA patients after matching for age, sex, RA index date, comorbidities, and drug use (e.g., antiplatelet agents and cholesterol-lowering agents). RESULTS The IR for development of overall CVD in RA patients was 182.1 (95% CI: 178.4-185.9) per 10,000 person-years. In models adjusted for other CVD risk factors, disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.79) were protective against CVD, and biologic DMARDs were not significantly associated with CVD risk (OR = 0.85). Corticosteroids (OR = 1.26) and NSAIDs (nonselective NSAIDs: OR = 1.32, Cox-2 inhibitors: OR = 1.31) were risk factors for CVD in RA patients. CONCLUSIONS The use of DMARDs is protective against CVD, while corticosteroids and NSAIDs increased the risk of CVD in RA patients.
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Affiliation(s)
- Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
| | - Soyoung Won
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
| | - Jiyoung Lee
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
| | - ByeongJu Park
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong-si, South Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
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Birru Talabi M, Mackey RH, Kuller LH, Dorman JS, Deane KD, Robinson WH, Walitt BT, Chang Y, Holers VM, Liu S, Moreland LW. Human Leukocyte Antigen Shared Epitope and Inflammation, Cardiovascular Disease, Cancer, and Mortality Among Postmenopausal Women in the Women's Health Initiative Rheumatoid Arthritis Study. Am J Epidemiol 2017; 186:245-254. [PMID: 28459968 DOI: 10.1093/aje/kwx087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/31/2016] [Indexed: 12/17/2022] Open
Abstract
Specific alleles of the human leukocyte antigen (HLA)-DRB1 gene (HLA-DRB1) encode a "shared epitope" (SE) associated with rheumatoid arthritis (RA), especially more severe cyclic-citrullinated peptide antibody-positive (anti-CCP+) RA. We evaluated associations of number of SE alleles (0, 1, or 2) with total and cardiovascular disease (CVD) mortality and incident coronary heart disease (CHD), CVD, and cancer over a mean 8.9 (standard deviation, 3.5) years of follow-up, stratifying by baseline anti-CCP status (positive (+) vs. negative (-)). A longitudinal study, the Women's Health Initiative RA Study (1993-2010), sampled postmenopausal women who reported RA at baseline (1993-1998) or follow-up in the Women's Health Initiative, classified as anti-CCP+ RA (n = 556) or anti-CCP- non-RA (n = 1,070). Among anti-CCP+ RA women, SE alleles were not related to age-adjusted risks of CHD, CVD, or cancer or to total or CVD mortality. Among anti-CCP- non-RA women, age-adjusted hazard ratios for 1 and 2 SE alleles versus 0 SE alleles were 0.41 (95% confidence interval (CI): 0.34, 0.50) and 0.44 (95% CI: 0.27, 0.72), respectively, for CVD; 0.43 (95% CI: 0.37, 0.53) and 0.30 (95% CI: 0.16, 0.64), respectively, for CHD; and 0.62 (95% CI: 0.53, 0.73) and 0.52 (95% CI: 0.33, 0.83), respectively, for cancer. Associations persisted after adjustment for CVD risk factors, joint pain, rheumatoid factor positivity, and inflammatory markers (white blood cell count or cytokine level). In future studies, investigators should evaluate SE associations among anti-CCP- adults without RA and potential mechanisms.
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15
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Danila MI, Laufer VA, Reynolds RJ, Yan Q, Liu N, Gregersen PK, Lee A, Kern M, Langefeld CD, Arnett DK, Bridges SL. Dense Genotyping of Immune-Related Regions Identifies Loci for Rheumatoid Arthritis Risk and Damage in African Americans. Mol Med 2017; 23:177-187. [PMID: 28681901 DOI: 10.2119/molmed.2017.00081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 12/29/2022] Open
Abstract
Over 100 risk loci for rheumatoid arthritis (RA) have been identified in individuals of European and Asian descent, but the genetic basis for RA in African Americans is less well understood. We genotyped 610 African Americans with autoantibody positive RA and 933 African American controls on the ImmunoChip (iChip) array. Using multivariable regression we evaluated the association between iChip markers and the risk of RA and radiographic severity. The single nucleotide polymorphism (SNP) rs1964995 (OR = 1.97, p = 1.28 × 10-15) near HLA-DRB1 was the most strongly associated risk SNP for RA susceptibility; SNPs in AFF3, TNFSF11, and TNFSF18 loci were suggestively associated (10-4 < p < 3.1 × 10-6). Trans-ethnic fine mapping of AFF3 identified a 90% credible set containing previously studied variants including rs9653442, rs7608424, and rs6712515 as well as the novel candidate variant rs11681966; several of these likely influence AFF3 gene expression level. Variants in TNFRSF9, CTLA4, IL2RA, C5/TRAF1, and ETS1 - but no variants within the major histocompatibility complex - were associated with RA radiographic severity. Conditional regression and pairwise linkage disequilibrium (LD) analyses suggest that additional pathogenic variants may be found in ETS1 and IL2RA beyond those found in other ethnicities. In summary, we use the dense genotyping of the iChip array and unique LD structure of African Americans to validate known risk loci for RA susceptibility and radiographic severity, and to better characterize the associations of AFF3, ETS1, and IL2RA.
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Affiliation(s)
- Maria I Danila
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
| | - Vincent Albert Laufer
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
| | - Richard J Reynolds
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
| | - Qi Yan
- University of Pittsburgh, Division of Pulmonary Medicine, Allergy and Immunology; Department of Pediatrics
| | - Nianjun Liu
- Indiana University School of Public Health - Bloomington, Department of Epidemiology and Biostatistics
| | | | | | | | | | | | - S Louis Bridges
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
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Humphreys J, Hyrich K, Symmons D. What is the impact of biologic therapies on common co-morbidities in patients with rheumatoid arthritis? Arthritis Res Ther 2016; 18:282. [PMID: 27906042 PMCID: PMC5134078 DOI: 10.1186/s13075-016-1176-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biologic therapies have revolutionised disease control in patients with rheumatoid arthritis (RA). Theoretically, they have the potential to influence co-morbid disease associated with RA through better control of systemic inflammation. Conversely, co-morbidity may occur as an adverse effect of the drugs. The latest evidence from observational data shows an increased risk of infection in the first 6 months of treatment with tumour necrosis factor inhibitor (TNFi) therapies and potentially other biologic therapies. Rates of infection after the first 6 months decrease and become comparable to patients with RA treated with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs). TNFi also appear to reduce the risk of cardiovascular disease in these patients, in particular ischaemic heart disease. TNFi treatment may be associated with a small increase in the risk of developing squamous cell carcinoma of the skin; in terms of other cancers, rates appears to be no different to those seen in patients treated with csDMARDs. There is a paucity of data on the impact of other biologic therapies and the effect of all biologic therapies on other common co-morbidities.
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Affiliation(s)
- Jenny Humphreys
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Deborah Symmons
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK. .,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. .,Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
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17
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Cardiovascular risk assessment in patients with rheumatoid arthritis: The relevance of clinical, genetic and serological markers. Autoimmun Rev 2016; 15:1013-1030. [DOI: 10.1016/j.autrev.2016.07.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 12/11/2022]
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18
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Joseph RM, Movahedi M, Dixon WG, Symmons DPM. Smoking-Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink. Arthritis Care Res (Hoboken) 2016; 68:1598-1606. [PMID: 26990778 PMCID: PMC5091627 DOI: 10.1002/acr.22882] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/17/2016] [Accepted: 03/08/2016] [Indexed: 12/16/2022]
Abstract
Objective To investigate the association between smoking status and smoking cessation with mortality in patients with rheumatoid arthritis (RA). Methods An incident cohort of patients with RA was identified using the Clinical Practice Research Datalink, a database of UK primary care electronic medical records. Time‐varying smoking status, years of cessation, and amount smoked were determined from patients' medical records. The date and underlying cause of death were identified by linkage with Office for National Statistics records. The associations between smoking status and smoking cessation with all‐cause and cause‐specific mortality (circulatory disease, all cancers, lung cancer, respiratory disease, and respiratory infection) were investigated using adjusted Cox (all‐cause mortality) and Fine‐Gray (cause‐specific mortality) regression. Results The cohort comprised 5,677 patients (median age 61.4 years, 68% women), with 40% as never smokers, 34% former smokers, and 26% current smokers at baseline. Compared to never smoking, current smoking was associated with an increased risk of all‐cause mortality (hazard ratio 1.98 [95% confidence interval (95% CI) 1.56, 2.53]), and mortality due to circulatory disease (subdistribution hazard ratio [SHR] 1.96 [95% CI 1.33, 2.90]) and lung cancer (SHR 23.2 [95% CI 5.15, 105]). Each year of smoking cessation was associated with a decreased risk of all‐cause mortality (former heavy smokers SHR 0.85 [95% CI 0.77, 0.94], former light smokers SHR 0.90 [95% CI 0.84, 0.97]). Conclusion Current smoking is associated with an increased risk of all‐cause, cardiovascular, and lung cancer mortality in patients with RA. Each year of cessation is associated with a reduced risk of all‐cause mortality. This information may prove helpful in smoking cessation programs for patients with RA.
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Affiliation(s)
- Rebecca M Joseph
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Mohammad Movahedi
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Deborah P M Symmons
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospital NHS Foundation Trust, and Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
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19
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England BR, Sayles H, Michaud K, Caplan L, Davis LA, Cannon GW, Sauer BC, Solow EB, Reimold AM, Kerr GS, Schwab P, Baker JF, Mikuls TR. Cause-Specific Mortality in Male US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:36-45. [PMID: 26097231 DOI: 10.1002/acr.22642] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/29/2015] [Accepted: 06/16/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE There has been limited investigation into cause-specific mortality and the associated risk factors in men with rheumatoid arthritis (RA). We investigated all-cause and cause-specific mortality in men with RA, examining determinants of survival. METHODS Men from a longitudinal RA registry were followed from enrollment until death or through 2013. Vital status and cause of death were determined using the National Death Index. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all-cause, cardiovascular disease (CVD), cancer, and respiratory mortality. Associations with all-cause and cause-specific mortality were examined using multivariable Cox proportional hazards and competing-risks regression. RESULTS There were 1,652 men with RA and 332 deaths. The leading causes of death were CVD (31.6%; SMR 1.77 [95% confidence interval (95% CI) 1.46-2.14]), cancer (22.9%; SMR 1.50 [95% CI 1.20-1.89]), and respiratory disease (15.1%; SMR 2.90 [95% CI 2.20-3.83]). Factors associated with all-cause mortality included older age, white race, smoking, low body weight, comorbidity, disease activity, and prednisone use. Rheumatoid factor concentration and nodules were associated with CVD mortality. There were no associations of methotrexate or biologic agent use with all-cause or cause-specific mortality. CONCLUSION Men in this RA cohort experienced increased all-cause and cause-specific mortality, with a 3-fold risk of respiratory-related deaths compared to age-matched men in the general population. Further studies are needed in order to examine whether interventions targeting potentially modifiable correlates of mortality might lead to improved long-term survival in men with RA.
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Affiliation(s)
- Bryant R England
- Veterans Affairs Nebraska-Western Iowa Health Care System, and University of Nebraska Medical Center, Omaha
| | - Harlan Sayles
- Veterans Affairs Nebraska-Western Iowa Health Care System, and University of Nebraska Medical Center, Omaha
| | - Kaleb Michaud
- Veterans Affairs Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | | | - Lisa A Davis
- Denver VAMC, University of Colorado, and Denver Health Medical Center, Denver, Colorado
| | - Grant W Cannon
- Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | - Brian C Sauer
- Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | - Elizabeth B Solow
- Dallas Veterans Affairs and University of Texas Southwestern, Dallas
| | - Andreas M Reimold
- Dallas Veterans Affairs and University of Texas Southwestern, Dallas
| | - Gail S Kerr
- Washington, DC, Veterans Affairs Medical Center and Georgetown and Howard Universities, Washington, DC
| | - Pascale Schwab
- Portland Veterans Affairs Health Care System and Oregon Health and Sciences University, Portland
| | - Josh F Baker
- Philadelphia VAMC and University of Pennsylvania School of Medicine, Philadelphia
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System, and University of Nebraska Medical Center, Omaha
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20
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Marrie RA, Fisk J, Tremlett H, Wolfson C, Warren S, Blanchard J, Patten SB. Differing trends in the incidence of vascular comorbidity in MS and the general population. Neurol Clin Pract 2016; 6:120-128. [PMID: 27104065 PMCID: PMC4828682 DOI: 10.1212/cpj.0000000000000230] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the adverse effects of vascular comorbidities are increasingly recognized in multiple sclerosis (MS), the epidemiology of these conditions remains poorly understood. METHODS Using population-based administrative data, we identified 44,452 Canadians with MS and 220,849 age-, sex- and geographically matched controls. We applied validated definitions to estimate the incidence of diabetes, hypertension, hyperlipidemia, and ischemic heart disease (IHD) from 1995 to 2005. RESULTS Of the MS cases, 31,757 (71.4%) were in female participants, with a mean (SD) age at the index date of 43.8 (13.7) years. Over time, the age-standardized incidence of diabetes rose more in the MS population (incidence rate ratio [IRR] per year 1.06; 95% confidence interval [CI] 1.03-1.08) than in the matched population (IRR per year 1.02; 95% CI 1.01-1.03). Temporal trends in the age-standardized incidence of hyperlipidemia, hypertension, and IHD were similar in both populations. Among those aged 20-44 years, the incidence of IHD was higher in the MS population (IRR 1.59; 95% CI 1.19-2.11). The increased incidence of IHD in the MS population was attenuated among those aged 60 years and older (IRR 1.01; 95% CI 0.97-1.06). CONCLUSIONS The incidence rates of diabetes, hypertension, and hyperlipidemia are rising within the MS population. Programs to systematically prevent and treat these conditions are needed.
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Affiliation(s)
- Ruth Ann Marrie
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
| | - John Fisk
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
| | - Helen Tremlett
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
| | - Christina Wolfson
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
| | - Sharon Warren
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
| | - James Blanchard
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
| | - Scott B Patten
- Departments of Internal Medicine (RAM) and Community Health Sciences (RAM, JB), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (JF), Dalhousie University, Halifax; Department of Medicine (Neurology) (HT), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (CW), McGill University, Montreal; Faculty of Rehabilitation Medicine (SW), University of Alberta, Edmonton; and Department of Community Health Sciences (SBP), University of Calgary, Canada
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Mantel Ä, Holmqvist M, Nyberg F, Tornling G, Frisell T, Alfredsson L, Askling J. Risk Factors for the Rapid Increase in Risk of Acute Coronary Events in Patients With New-Onset Rheumatoid Arthritis: A Nested Case-Control Study. Arthritis Rheumatol 2015; 67:2845-54. [DOI: 10.1002/art.39267] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 06/25/2015] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Fredrik Nyberg
- University of Gothenburg, Gothenburg, Sweden, and AstraZeneca Research and Development; Mölndal Sweden
| | | | | | | | - Johan Askling
- Karolinska Institute and Karolinska University Hospital; Stockholm Sweden
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22
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Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol 2015; 11:390-400. [PMID: 25825281 DOI: 10.1038/nrrheum.2015.40] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) has long been associated with increased cardiovascular risk, but despite substantial improvements in disease management, mortality remains high. Atherosclerosis is more prevalent in RA than in the general population, and atherosclerotic lesions progress at a faster rate and might be more prone to rupture, causing clinical events. Cells and cytokines implicated in RA pathogenesis are also involved in the development and progression of atherosclerosis, which is generally recognized as an inflammatory condition. The two diseases also share genetic and environmental risk factors, which suggests that patients who develop RA might also be predisposed to developing cardiovascular disease. In RA, inflammation and atherosclerosis are closely linked. Inflammation mediates its effects on atherosclerosis both through modulation of traditional risk factors and by directly affecting the vessel wall. Treatments such as TNF inhibitors might have a beneficial effect on cardiovascular risk. However, whether this benefit is attributable to effective control of inflammation or whether targeting specific cytokines, implicated in atherosclerosis, provides additional risk reduction is unclear. Further knowledge of the predictors of cardiovascular risk, the effects of early control of inflammation and of drug-specific effects are likely to improve the recognition and management of cardiovascular risk in patients with RA.
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Affiliation(s)
- Sarah Skeoch
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Brunswick Street, Manchester M13 9PL, UK
| | - Ian N Bruce
- NIHR Manchester Musculoskeletal Biomedical Research Unit, and Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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23
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Niu X, Lu C, Xiao C, Zhang Z, Jiang M, He D, Bian Y, Zhang G, Bian Z, Lu A. The shared crosstalk of multiple pathways involved in the inflammation between rheumatoid arthritis and coronary artery disease based on a digital gene expression profile. PLoS One 2014; 9:e113659. [PMID: 25514790 PMCID: PMC4267808 DOI: 10.1371/journal.pone.0113659] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/26/2014] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) and coronary artery disease (CAD) are both complex inflammatory diseases, and an increased prevalence of CAD and a high rate of mortality have been observed in RA patients. But the molecular mechanism of inflammation that is shared between the two disorders is unclear. High-throughput techniques, such as transcriptome analysis, are becoming important tools for genetic biomarker discovery in highly complex biological samples, which is critical for the diagnosis, prognosis, and treatment of disease. In the present study, we reported one type of transcriptome analysis method: digital gene expression profiling of peripheral blood mononuclear cells of 10 RA patients, 10 CAD patients and 10 healthy people. In all, 213 and 152 differently expressed genes (DEGs) were identified in RA patients compared with normal controls (RA vs. normal) and CAD patients compared with normal controls (CAD vs. normal), respectively, with 73 shared DEGs between them. Using this technique in combination with Ingenuity Pathways Analysis software, the effects on inflammation of four shared canonical pathways, three shared activated predicted upstream regulators and three shared molecular interaction networks were identified and explored. These shared molecular mechanisms may provide the genetic basis and potential targets for optimizing the application of current drugs to more effectively treat these diseases simultaneously and for preventing one when the other is diagnosed.
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Affiliation(s)
- Xuyan Niu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Cheng Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Cheng Xiao
- China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhiguo Zhang
- Institute of Basic Theory, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Miao Jiang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Dan He
- E-Institute of Chinese Traditional Internal Medicine, Shanghai Municipal Education Commission, Shanghai, 201203, China
| | - Yanqin Bian
- E-Institute of Chinese Traditional Internal Medicine, Shanghai Municipal Education Commission, Shanghai, 201203, China
| | - Ge Zhang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Zhaoxiang Bian
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Aiping Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
- E-Institute of Chinese Traditional Internal Medicine, Shanghai Municipal Education Commission, Shanghai, 201203, China
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
- * E-mail:
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24
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Chiu YM, Lang HC, Lin HY, Yang MT, Fang CH, Yang YW, Schabert VF, Tang B. Risk of tuberculosis, serious infection and lymphoma with disease-modifying biologic drugs in rheumatoid arthritis patients in Taiwan. Int J Rheum Dis 2014; 17 Suppl 3:9-19. [DOI: 10.1111/1756-185x.12539] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Ying-Ming Chiu
- Division of Allergy Immunology & Rheumatology; Changhua Christian Hospital; Changhua Taiwan
- Department of Nursing; College of Medicine & Nursing; HungKuang University; Taichung Taiwan
| | - Hui-Chu Lang
- Institute of Hospital and Health Care Administration; National Yang-Ming University; Taipei Taiwan
| | - Hsiao-Yi Lin
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Veterans General Hospital; Taipei Taiwan
| | - Ming-Ta Yang
- IMS Health; Taipei Taiwan
- IMS Health; New York New York USA
| | - Chi-Hui Fang
- Pfizer Inc.; Taipei Taiwan
- Pfizer Inc.; New York New York USA
| | - Ya-Wen Yang
- Pfizer Inc.; Taipei Taiwan
- Pfizer Inc.; New York New York USA
| | | | - Boxiong Tang
- Pfizer Inc.; Taipei Taiwan
- Pfizer Inc.; New York New York USA
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25
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Hajeer AH, Al Balwi MA, Aytül Uyar F, Alhaidan Y, Alabdulrahman A, Al Abdulkareem I, Al Jumah M. HLA-A, -B, -C, -DRB1 and -DQB1 allele and haplotype frequencies in Saudis using next generation sequencing technique. ACTA ACUST UNITED AC 2014; 82:252-8. [PMID: 24461004 DOI: 10.1111/tan.12200] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 08/01/2013] [Accepted: 08/24/2013] [Indexed: 11/30/2022]
Abstract
Next generation sequencing (NGS) is a promising technique that can reveal the entire gene sequences and to the highest possible resolution without any phase ambiguities. We have used this technique to investigate the frequencies of HLA-A, -B, -C, -DRB1 and -DQB1 in a Saudi cohort of healthy individuals. We used NGS using the 454 genome sequence (GS) FLX System and Conexio assign atf 454 software to human leukocyte antigen (HLA) genotype eight class I and class II loci. A total of 158 healthy Saudi adults were analyzed. The most frequently observed allele for HLA-A was HLA-A*02:01:01:01 (13.6%); for HLA-B, HLA-B*50:01:01 (15.8%); for HLA-C, HLA-C*06:02:01:01 (18.7%); for HLA-DRB1, HLA-DRB1*07:01:01:01 (26.6%); and for HLA-DQB1, HLA-DQB1*02:01:01 (20.3%). The most common four loci haplotypes in the Saudi population were HLA-A*24:02:01:01-B*08:01:01-C*07:02:01:01-DRB1*03:01:01:01 and HLA-A*23:01:01-B*50:01:01-C*06:02:01:01-DRB1*07:01:01:01.. We have used a highly informative technique for HLA typing of a Saudi healthy cohort to establish allele and haplotype frequencies. These results should prove useful for population studies, disease associations and future planning of the unrelated bone marrow donor registry.
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Affiliation(s)
- A H Hajeer
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
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Amaya-Amaya J, Montoya-Sánchez L, Rojas-Villarraga A. Cardiovascular involvement in autoimmune diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:367359. [PMID: 25177690 PMCID: PMC4142566 DOI: 10.1155/2014/367359] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/01/2014] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases (AD) represent a broad spectrum of chronic conditions that may afflict specific target organs or multiple systems with a significant burden on quality of life. These conditions have common mechanisms including genetic and epigenetics factors, gender disparity, environmental triggers, pathophysiological abnormalities, and certain subphenotypes. Atherosclerosis (AT) was once considered to be a degenerative disease that was an inevitable consequence of aging. However, research in the last three decades has shown that AT is not degenerative or inevitable. It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT. Several risk factors, known as classic risk factors, have been described. Interestingly, the excessive cardiovascular events observed in patients with ADs are not fully explained by these factors. Several novel risk factors contribute to the development of premature vascular damage. In this review, we discuss our current understanding of how traditional and nontraditional risk factors contribute to pathogenesis of CVD in AD.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Laura Montoya-Sánchez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
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PADI4 haplotypes in association with RA Mexican patients, a new prospect for antigen modulation. Clin Dev Immunol 2013; 2013:383681. [PMID: 24454473 PMCID: PMC3881379 DOI: 10.1155/2013/383681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/05/2013] [Accepted: 09/23/2013] [Indexed: 01/08/2023]
Abstract
Peptidyl arginine deiminase IV (PAD 4) is the responsible enzyme for a posttranslational modification called citrullination, originating the antigenic determinant recognized by anti-cyclic citrullinated peptide antibodies (ACPA). Four SNPs (single nucleotide polymorphisms) have been described in PADI4 gene to form a susceptibility haplotype for rheumatoid arthritis (RA); nevertheless, results in association studies appear contradictory in different populations. The aim of the study was to analyze if the presence of three SNPs in PADI4 gene susceptibility haplotype (GTG) is associated with ACPA positivity in patients with RA. This was a cross-sectional study that included 86 RA patients and 98 healthy controls. Polymorphisms PADI4_89, PADI4_90, and PADI4_92 in the PADI4 gene were genotyped. The susceptibility haplotype (GTG) was more frequent in RA patients; interestingly, we found a new haplotype associated with RA with a higher frequency (GTC). There were no associations between polymorphisms and high scores in Spanish HAQ-DI and DAS-28, but we did find an association between RARBIS index and PADI4_89, PADI4_90 polymorphisms. We could not confirm an association between susceptibility haplotype presence and ACPA positivity. Further evidence about proteomic expression of this gene will determine its participation in antigenic generation and autoimmunity.
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28
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Sen D, González-Mayda M, Brasington RD. Cardiovascular disease in rheumatoid arthritis. Rheum Dis Clin North Am 2013; 40:27-49. [PMID: 24268008 DOI: 10.1016/j.rdc.2013.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RA can manifest in a variety of cardiac complications, including pericarditis, valvular disease, cardiomyopathy, and amyloidosis. Subclinical involvement is higher than anticipated. CVD is also prevalent in patients with RA, with onset in early disease. Several disease-specific risk factors, like seropositivity, disease activity, and medications, are implicated in the pathogenesis of CVD in RA. Cardiovascular risk assessment in RA varies from the general population. Some traditional risk factors like BMI and lipid levels apply differently to the RA population. Statins are useful in managing dyslipidemia in RA. There is good evidence to support cardiovascular risk reduction with methotrexate and TNF-I use if good disease control is achieved.
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Affiliation(s)
- Deepali Sen
- Division of Rheumatology, Department of Medicine, Campus Box 8045, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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29
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Norton S, Sacker A, Dixey J, Done J, Williams P, Young A. Trajectories of functional limitation in early rheumatoid arthritis and their association with mortality. Rheumatology (Oxford) 2013; 52:2016-24. [DOI: 10.1093/rheumatology/ket253] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Amaya-Amaya J, Sarmiento-Monroy JC, Mantilla RD, Pineda-Tamayo R, Rojas-Villarraga A, Anaya JM. Novel risk factors for cardiovascular disease in rheumatoid arthritis. Immunol Res 2013; 56:267-86. [DOI: 10.1007/s12026-013-8398-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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32
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Mercer LK, Davies R, Galloway JB, Low A, Lunt M, Dixon WG, Watson KD, Symmons DPM, Hyrich KL. Risk of cancer in patients receiving non-biologic disease-modifying therapy for rheumatoid arthritis compared with the UK general population. Rheumatology (Oxford) 2013; 52:91-8. [PMID: 23238979 PMCID: PMC3521445 DOI: 10.1093/rheumatology/kes350] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To quantify the risk of cancer and compare it with that for the general population in a modern cohort of UK patients with RA and to identify risk factors for cancer among this cohort. METHODS The study population comprised biologic-naïve RA subjects receiving non-biologic disease-modifying therapy recruited to the British Society for Rheumatology Biologics Register from 2002 to 2009. Standardized incidence ratios (SIRs) for cancers were calculated using age- and gender-specific cancer rates in the English population. Poisson regression models adjusted for age and gender using England general population data were used to determine the association of other predictors with incident malignancy. RESULTS The cohort comprised 3771 individuals with RA contributing 13 315 person-years of follow-up. One hundred and eighty-two cancers were reported: 156 solid and 26 myelo- or lymphoproliferative cancers. The overall SIR was 1.28 (95% CI 1.10, 1.48). Risks of lung cancer (SIR 2.39, 95% CI 1.75, 3.19), Hodgkin lymphoma (SIR 12.82, 95% CI 4.16, 29.92) and non-Hodgkin lymphoma (SIR 3.12, 95% CI 1.79, 5.07) were higher compared with the general population and risks of prostate cancer (SIR 0.35, 95% CI 0.11, 0.82) and cancers of the female genital organs (SIR 0.35, 95% CI 0.10, 0.90) were reduced. Within the cohort, cancer risk was more than 2-fold higher in current or ex-smokers than in non-smokers. CONCLUSION The overall incidence of cancer was increased in this national cohort of subjects with RA. The association of RA with certain cancers needs to be considered when studying the effects of biologic therapy, such as anti-TNF, on cancer risk.
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Affiliation(s)
- Louise K Mercer
- Arthritis Research UK Epidemiology Unit, Stopford Building, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PT, UK
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Söderlund J, Forsblom C, Ilonen J, Thorn LM, Wadén J, Parkkonen M, Groop PH. HLA class II is a factor in cardiovascular morbidity and mortality rates in patients with type 1 diabetes. Diabetologia 2012; 55:2963-9. [PMID: 22898764 DOI: 10.1007/s00125-012-2670-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 06/22/2012] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Patients with type 1 diabetes and kidney disease have a higher risk of cardiovascular events. HLA class II genes are expressed on infiltrated inflammatory cells and smooth-muscle cells in atherosclerotic plaques. We hypothesised that HLA class II haplotypes or genotypes might influence the risk of cardiovascular complications and death in Finnish type 1 diabetic patients. METHODS We included 3,082 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. We analysed the 12 and ten most common HLA II haplo- and genotypes, respectively, using χ (2) tests. The positive findings were analysed with three differently adjusted regression models with cardiovascular morbidity and death as endpoints. Different kidney status groups were analysed separately. RESULTS At baseline, the common (DR1/10)-DQB1*05:01 haplotype (20.4%) and the (DR1/10)-DQB1*05:01/DRB1*04:01-DQB1*03:02 genotype (8.7%) were independently associated with cardiovascular disease in all kidney status groups, except in patients with normal AER. At follow-up (9.45 years; range 0.1-16.1 years), the (DR1/10)-DQB1*05:01/DRB1*04:01-DQB1*03:02 genotype was associated with cardiovascular mortality rates in patients with normal AER and microalbuminuria. CONCLUSIONS/INTERPRETATION The (DR1/10)-DQB1*05:01 haplotype and the (DR1/10)-DQB1*05:01/DRB1*04:01-DQB1*03:02 genotype are independently associated with cardiovascular events and death in Finnish type 1 diabetic patients.
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Affiliation(s)
- J Söderlund
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
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Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome. Rheumatology (Oxford) 2012; 52:99-110. [DOI: 10.1093/rheumatology/kes262] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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35
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García-Bermúdez M, López-Mejías R, González-Juanatey C, Corrales A, Robledo G, Castañeda S, Miranda-Filloy JA, Blanco R, Fernández-Gutiérrez B, Balsa A, González-Alvaro I, Gómez-Vaquero C, Llorca J, Martín J, González-Gay MA. Analysis of the interferon gamma (rs2430561, +874T/A) functional gene variant in relation to the presence of cardiovascular events in rheumatoid arthritis. PLoS One 2012; 7:e47166. [PMID: 23077565 PMCID: PMC3471910 DOI: 10.1371/journal.pone.0047166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/10/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increased cardiovascular (CV) morbidity and mortality. Since interferon-gamma (IFN-γ) has a direct effect on inflammation, in this study we assessed the potential association of the IFNG functional gene variant rs2430561 with CV disease in patients with RA. METHODS One thousand six hundred and thirty-five patients fulfilling the 1987 American College of Rheumatology classification criteria for RA were genotyped for the IFNG (rs2430561, +874T/A) gene polymorphism using TaqMan genotyping assay. Patients were stratified according to the presence of CV events or not. Logistic regression models to explain the presence of CV disease according to the IFNG rs2430561 allele distribution were performed. The potential influence of this variant in the development of subclinical atherosclerosis was also analyzed in a subgroup of patients with no history of CV events to determine carotid artery intima-media thickness (IMT) (n = 286) and presence of carotid plaques. Levels of the cytokine were determined in a subgroup of patients by ELISA. RESULTS Adjusted logistic regression model disclosed that presence of the minor allele A was not associated with increased risk of suffering CV events in RA patients. Besides, differences did not achieve statistical significance regarding carotid IMT and presence of carotid plaques in RA patients carrying IFNG rs2430561 variant allele. Levels of IFN-γ were higher in patients who had suffered CV events compared to patients who did not. CONCLUSION Our results do not support a role of IFNG rs2430561 (+874T/A) functional gene variant in the development of CV disease in RA patients.
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Affiliation(s)
- Mercedes García-Bermúdez
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, IPBLN-C.S.I.C., Granada, Spain
| | - Raquel López-Mejías
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
| | | | - Alfonso Corrales
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
| | - Gema Robledo
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, IPBLN-C.S.I.C., Granada, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | | | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
| | | | - Alejandro Balsa
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carmen Gómez-Vaquero
- Department of Rheumatology, Hospital Universitario de Bellvitge, IDIBELL, ĹHospitalet del Llobregat, Barcelona, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IFIMAV, Santander, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, IPBLN-C.S.I.C., Granada, Spain
| | - Miguel A. González-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
- * E-mail:
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Boechat NDO, Ogusku MM, Boechat AL, Sadahiro A. Interaction between smoking and HLA-DRB1*04 gene is associated with a high cardiovascular risk in Brazilian Amazon patients with rheumatoid arthritis. PLoS One 2012; 7:e41588. [PMID: 22912672 PMCID: PMC3418250 DOI: 10.1371/journal.pone.0041588] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/22/2012] [Indexed: 12/14/2022] Open
Abstract
Background Rheumatoid Arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints that affects approximately 1% of the population worldwide. The HLA-DRB1 gene locus plays a major role in genetic susceptibility to RA, a condition that has been associated with a high cardiovascular morbidity and mortality in many studies. Methodology/Principal Findings The aim of this work was to investigate which types of HLA class II genes are associated with RA in patients from the Brazilian Amazon and their influence on high cardiovascular risk status in this population. For this purpose, a case-control study was carried out with a total of 350 non-Indian individuals made up of a cohort of 132 consecutive RA sufferers and 218 healthy controls. A χ2 test showed that HLADRB1*04 (p<0.0016; OR = 1.89; 95% CI = 1.29–2.79) and HLADRB1*10 (p = 0.0377; OR = 3.81; 95% CI = 1.16–12.50) are the major HLA genes associated with susceptibility to RA. A logistic regression model also showed that the interaction between HLADRB1*04 (p = 0.027; OR = 6.02; 95% CI = 1.21–29.7), age (p = 0.0001; OR = 1.26; 95% CI = 1.13–1.39) and smoking (p = 0.0001; OR = 23.6; 95% CI = 4.25–32.1) is associated with a probability of a high cardiovascular risk status at an early age. Conclusions/Significance The results of this study show for the first time that HLA class II type is associated with RA in Brazilian Amazon populations and that a specific interaction between the HLA-DRB1*04 gene and smoking is associated with a high cardiovascular risk status, as initially reported in the European population. This study therefore contributes to an understanding of gene-environment interactions in RA patients.
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Affiliation(s)
- Narjara de Oliveira Boechat
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brasil
- Clínica de Artrite Reumatoide, Hospital Geral Adriano Jorge, Manaus, Brasil
| | - Mauricio Morish Ogusku
- Laboratório de Micobacteriologia, Instituto Nacional de Pesquisas da Amazônia (INPA), Manaus, Amazonas, Brasil
| | - Antonio Luiz Boechat
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brasil
- Clínica de Artrite Reumatoide, Hospital Geral Adriano Jorge, Manaus, Brasil
- * E-mail:
| | - Aya Sadahiro
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brasil
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Genetic markers of cardiovascular disease in rheumatoid arthritis. Mediators Inflamm 2012; 2012:574817. [PMID: 22927710 PMCID: PMC3419432 DOI: 10.1155/2012/574817] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/28/2012] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular (CV) disease is the most common cause of premature mortality in patients with rheumatoid arthritis (RA). It is the result of an accelerated atherosclerotic process. Both RA and atherosclerosis are complex polygenic diseases. Besides traditional CV risk factors and chronic inflammation, a number of studies have confirmed the role of genetic factors in the development of the atherogenesis observed in RA. In this regard, besides a strong association between the HLA-DRB1∗04 shared epitope alleles and both endothelial dysfunction, an early step in the atherosclerotic process, and clinically evident CV disease, other polymorphisms belonging to genes implicated in inflammatory and metabolic pathways, located inside and outside the HLA region, such as the 308 variant (G > A, rs1800629) of the TNFA locus, the rs1801131 polymorphism (A > C; position + 1298) of the MTHFR locus, or a deletion of 32 base pairs on the CCR5 gene, seem to be associated with the risk of CV disease in patients with RA. Despite considerable effort to decipher the genetic basis of CV disease in RA, further studies are required to better establish the genetic influence in the increased risk of CV events observed in patients with RA.
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Chen Y, Dawes PT, Packham JC, Mattey DL. Interaction between smoking and functional polymorphism in the TGFB1 gene is associated with ischaemic heart disease and myocardial infarction in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2012; 14:R81. [PMID: 22513132 PMCID: PMC3446455 DOI: 10.1186/ar3804] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/15/2012] [Accepted: 04/18/2012] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Transforming growth factor-beta1 (TGF-beta1) is a pleiotropic cytokine that plays important roles in immunity and inflammation. Some studies have suggested that polymorphism in the TGFB1 gene is associated with heart disease in the general population. The purpose of the present study was to determine whether common single-nucleotide polymorphisms (SNP) in the TGFB1 gene are associated with ischaemic heart disease (IHD) and/or myocardial infarction (MI) in patients with rheumatoid arthritis (RA), and to investigate the influence of smoking on any association. METHODS PCR-based assays were used to determine the genotypes of TGFB1 SNPs including TGFB1-509 C/T (rs1800469, in the promoter region), +868 T/C (rs1800470, in exon 1) and +913 G/C (rs1800471, in exon 1) in 414 subjects with established RA. Genotyping for the +868 SNP was also carried out on a second study population of RA patients (n = 259) with early disease. Serum levels of TGF-beta1 were measured using a commercial ELISA kit. Smoking history and IHD/MI status were obtained on each patient. Associations with IHD/MI were assessed using contingency tables and logistic regression analyses. RESULTS The heterozygous genotype of TGFB+868 was associated with an increased risk of IHD (OR 2.14, 95% CI 1.30 - 3.55) and MI (OR 2.42, 95% CI 1.30-4.50), compared to the homozygous genotypes combined. Smoking was an independent risk for IHD and MI, and evidence of interaction between smoking and TGFB+868 was found. Multivariate analyses indicated that the strongest associations with IHD and MI were due to the combined effect of the TGFB1+868 TC genotype and smoking (OR 2.75, 95% CI 1.59-4.75; and OR 2.58 95% CI 1.33-4.99, respectively), independent of other cardiovascular risk factors. The association of the +868 TC genotype and evidence of +868 TC-smoking interaction with IHD were replicated in a second population of RA patients with early disease. Serum TGF-beta1 levels were not associated with TGFB1 genetic variations, smoking or IHD/MI status. CONCLUSIONS Interaction between smoking and polymorphism in the TGFB1 gene may influence the risk of IHD and MI in patients with RA.
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Affiliation(s)
- Ying Chen
- Haywood Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-on-Trent, Staffordshire, ST6 7AG, UK
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ÄRLESTIG LISBETH, RANTAPÄÄ-DAHLQVIST SOLBRITT. Polymorphisms of the Genes EncodingCD40and Growth Differentiation Factor 15 and in the 9p21.3 Region in Patients with Rheumatoid Arthritis and Cardiovascular Disease. J Rheumatol 2012; 39:939-45. [DOI: 10.3899/jrheum.111336] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective.Genes or gene products associated with coronary artery disease in the general population were analyzed in rheumatoid arthritis (RA) patients with atherothrombotic manifestations (ATM).Methods.A cross-sectional study of 681 individuals (498 women; 183 men) with RA (American College of Rheumatology criteria), a mean age of 60.6 ± 13.2 years, and mean disease duration of 15.5 ± 12.6 years who were consecutively recruited and followed for 6 years. The prevalence of ATM [i.e., myocardial infarction, angina pectoris with intervention, deep vein thrombosis/pulmonary embolism (DVT/PE), and/or stroke/transient ischemic attack (TIA)] was recorded. Polymorphisms were analyzed in the genes coding for growth differentiation factor 15 (GDF15)/monocyte inhibitory cytokine-1 (MIC-1; rs1058587),CD40(rs1535045 and rs3765459), and the 9p21.3 locus (rs1333049). Controls were randomly selected (n = 687; matched for age and sex).Results.The distribution of genotypes ofGDF15/MIC-1differed significantly between patients with RA and controls (chi-squared = 6.40, 2 df, p = 0.041). ATM were associated with polymorphism of theGDF15/MIC-1G allele (OR 2.21, 95% CI 1.17–4.18), and with CC genotype of the 9p21.3 locus (rs1333049; OR 1.92, 95% CI 1.15–3.19). Stroke/TIA in women was associated withGDF15/MIC-1GG genotype (OR 3.75, 95% CI 1.06–13.33), while stroke/TIA in men was associated withCD40homozygous major alleles (OR 6.48, 95% CI 1.31–32.0 and OR 2.78, 95% CI 0.78–9.91, respectively). DVT/PE was associated with polymorphism in theGDF15/MIC-1gene (rs1058587) minor allele (OR 3.53, 95% CI 1.30–9.58).Conclusion.The gene polymorphisms analyzed were associated with different ATM in RA. TheGDF15/MIC-1gene polymorphism was also associated with RAper se, suggesting a common etiology for RA and ATM.
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Jayakumar K, Norton S, Dixey J, James D, Gough A, Williams P, Prouse P, Young A. Sustained clinical remission in rheumatoid arthritis: prevalence and prognostic factors in an inception cohort of patients treated with conventional DMARDS. Rheumatology (Oxford) 2011; 51:169-75. [PMID: 22096011 DOI: 10.1093/rheumatology/ker250] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Clinical remission is now a realistic goal in managing RA following the introduction of biologic agents. As there are limited data on sustained remission in conventionally treated RA, this study examines prevalence and predictive factors of sustained remission in a pre-biologic inception cohort of RA. METHODS Patients with recent onset RA and before use of DMARDs were recruited from nine centres. Standard clinical and radiological assessments were recorded at baseline and yearly. Point remission was defined by DAS of <1.6, and sustained remission if DAS was <1.6 at all 3-, 4- and 5-year follow-ups. Sustained remission was compared with baseline features, with mortality and with radiological and functional progression in 704 patients. RESULTS Point remission at 3, 4 and 5 years was 25, 26 and 22%, respectively. Eleven per cent (n = 78) had sustained remission. Male sex, short duration of symptoms and less tender joints at baseline were independent predictors of sustained remission. These patients had fewer DMARD therapies and less radiographic progression by 5 years. Mean HAQ decreased from 0.79 to 0.13 (P < 0.001) in sustained remission, compared with an increase from 0.92 to 1.1 (P < 0.001) in the non-remission group. CONCLUSION Sustained clinical remission by 5 years with conventional DMARDs was 11%, half as likely as point remission. Prognostic factors were similar to comparable studies and simple to measure. Patients in sustained clinical remission showed less structural damage and better functional outcomes.
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Affiliation(s)
- Keeranur Jayakumar
- ERAS, c/o Rheumatology Department, St Albans City Hospital, Waverley Road, St Albans AL3 5PN, UK.
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Abstract
Cardiovascular disease represents a major source of extra-articular comorbidity in patients with rheumatoid arthritis (RA). A combination of traditional cardiovascular risk factors and RA-related factors accounts for the excess risk in RA. Among RA-related factors, chronic systemic inflammation has been implicated in the pathogenesis and progression of atherosclerosis. A growing body of evidence--mainly derived from observational databases and registries--suggests that specific RA therapies, including methotrexate and anti-TNF biologic agents, can reduce the risk of future cardiovascular events in patients with RA. The cardiovascular profile of other biologic therapies for the treatment of RA has not been adequately studied, including of investigational drugs that improve systemic inflammation but alter traditional cardiovascular risk factors. In the absence of large clinical trials adequately powered to detect differences in cardiovascular events between biologic drugs in RA, deriving firm conclusions on cardiovascular safety is challenging. Nevertheless, observational research using large registries has emerged as a promising approach to study the cardiovascular risk of emerging RA biologic therapies.
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Verstappen SMM, Lunt M, Bunn DK, Scott DGI, Symmons DPM. In patients with early inflammatory polyarthritis, ACPA positivity, younger age and inefficacy of the first non-biological DMARD are predictors for receiving biological therapy: results from the Norfolk Arthritis Register. Ann Rheum Dis 2011; 70:1428-32. [PMID: 21551505 PMCID: PMC3128326 DOI: 10.1136/ard.2010.148106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives To identify baseline disease-related predictors in patients with early inflammatory polyarthritis (IP) for starting subsequent biological therapy and to determine if patients who failed their first non-biological disease-modifying antirheumatic drug (DMARD) within 6 months were more likely to need biological therapy. Methods Patients with early IP recruited between 1990 and 1994 (cohort 1) and between 2000 and 2004 (cohort 2) in the Norfolk Arthritis Register were included in this study. The association between possible predictors with the start of biological therapy was assessed using Cox proportional hazards regression models. Results 32/407 (7.9%) patients in cohort 1 and 45/416 (10.8%) patients in cohort 2 received biological therapy during follow-up. In both cohorts, anti-citrullinated protein antibody (ACPA) positivity (cohort 1, HR 7.62, 95% CI 2.46 to 23.58; cohort 2, HR 4.68, 95% CI 2.23 to 9.78) was the strongest predictor for starting biological therapy. In cohort 2, younger patients (HR 0.97, 95% CI 0.95 to 0.99) and patients who failed their first non-biological DMARD within 6 months due to inefficacy were also more likely to receive biological therapy (HR 2.35, 95% CI 1.05 to 5.27). Conclusion Patients with early IP who are ACPA positive, are younger or who fail their first non-biological DMARD due to inefficacy within 6 months are more likely to need biological therapy.
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Affiliation(s)
- Suzanne M M Verstappen
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Ji J, Liu X, Sundquist K, Sundquist J. Survival of cancer in patients with rheumatoid arthritis: a follow-up study in Sweden of patients hospitalized with rheumatoid arthritis 1 year before diagnosis of cancer. Rheumatology (Oxford) 2011; 50:1513-8. [PMID: 21498553 DOI: 10.1093/rheumatology/ker143] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Patients diagnosed with RA have an increased risk of some cancers. However, limited data are available on the important issue of prognosis of RA patients with cancer. METHODS RA patients were identified from the Swedish Hospital Discharge Register by linkage to the Cancer Registry. Follow-up of patients was started from the date of diagnosis of cancer through year 2006. Hazard ratios (HRs) were calculated in cancer patients with RA compared with subjects without RA. RESULTS A total of 1,411,163 cancer patients were identified in the database, of whom 6309 had a previous hospitalization for RA. Compared with all cancer patients without RA, patients with RA had a worse prognosis, with an HR of 1.29 and 1.31 for cause-specific and overall survival, respectively. For specific cancer sites, skin and breast cancers and non-Hodgkin's lymphoma showed worst survival. Age stratification did not change the results. CONCLUSION Cancer patients with a previous hospitalization for RA had a worse prognosis for all and many site-specific cancers compared with patients without RA, independent of age at diagnosis and tumour staging. Improvement of survival for cancer patients with RA may require a multidisciplinary approach to accommodate the comorbidity.
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Affiliation(s)
- Jianguang Ji
- Center for Primary Health Care Research, Lund University, UMAS, 205 02 Malmö, Sweden.
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Bartoloni E, Alunno A, Luccioli F, Moscatelli S, Biscontini D, Santoboni G, Gerli R. Atherosclerotic vascular damage and rheumatoid arthritis: a complex but intriguing link. Expert Rev Cardiovasc Ther 2010; 8:1309-16. [PMID: 20828353 DOI: 10.1586/erc.10.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Rheumatoid arthritis is a chronic inflammatory disease characterized by a reduced life expectancy mainly due to cardiovascular disease. In long-standing disease, it has been widely demonstrated that both traditional cardiovascular risk and disease-related factors, including chronic inflammation and immune-mediated mechanisms, play a key role in accelerating atherosclerotic damage of the arterial wall. The short- and long-term effects of immunosuppressive treatment on cardiovascular disease outcome is, however, uncertain and a multidisciplinary approach appears to represent the best management of cardiovascular risk in these patients.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Perugia, Perugia 06100, Italy
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Cardiovascular complications of rheumatoid arthritis: assessment, prevention, and treatment. Rheum Dis Clin North Am 2010; 36:405-26. [PMID: 20510241 DOI: 10.1016/j.rdc.2010.02.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbidity and mortality rates are higher in individuals with rheumatoid arthritis (RA) than in the general population. Ischemic heart disease and heart failure now represent one of the most common causes of death in RA. Indeed, RA appears to represent an independent risk factor for ischemic heart disease, similar to diabetes mellitus. However, no clear guidelines with regard to cardiovascular disease diagnosis and prevention in RA have been developed. This review highlights recent investigations on the assessment, prevention, and treatment of cardiovascular disease in RA.
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Bartoloni E, Alunno A, Bistoni O, Gerli R. How early is the atherosclerotic risk in rheumatoid arthritis? Autoimmun Rev 2010; 9:701-7. [DOI: 10.1016/j.autrev.2010.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 06/02/2010] [Indexed: 12/25/2022]
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Koduri G, Norton S, Young A, Cox N, Davies P, Devlin J, Dixey J, Gough A, Prouse P, Winfield J, Williams P. Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort. Rheumatology (Oxford) 2010; 49:1483-9. [DOI: 10.1093/rheumatology/keq035] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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van Nies JAB, Marques RB, Trompet S, de Jong Z, Kurreeman FAS, Toes REM, Jukema JW, Huizinga TWJ, van der Helm-van Mil AHM. TRAF1/C5 polymorphism is not associated with increased mortality in rheumatoid arthritis: two large longitudinal studies. Arthritis Res Ther 2010; 12:R38. [PMID: 20205706 PMCID: PMC2888185 DOI: 10.1186/ar2947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/18/2010] [Accepted: 03/05/2010] [Indexed: 12/27/2022] Open
Abstract
Introduction Recently an association between a genetic variation in TRAF1/C5 and mortality from sepsis or cancer was found in rheumatoid arthritis (RA). The most prevalent cause of death, cardiovascular disease, may have been missed in that study, since patients were enrolled at an advanced disease stage. Therefore, we used an inception cohort of RA patients to investigate the association between TRAF1/C5 and cardiovascular mortality, and replicate the findings on all-cause mortality. As TRAF1/C5 associated mortality may not be restricted to RA, we also studied a large cohort of non-RA patients. Methods 615 RA patients from the Leiden Early Arthritis Clinic (EAC) (mean follow-up 7.6 years) were genotyped for rs10818488. In addition 5634 persons enrolled in the PROspective Study of Pravastatin in the Elderly at Risk (mean follow-up 3.2 years) were genotyped for rs2416808 (R2 >0.99 with rs10818488). The life/death status was determined and for the deceased persons the cause of death was ascertained. Cox proportional hazards and regression models were used to assess hazard ratios (HR) and 95% confidence intervals (CI). Results Seventy-seven RA patients died. The main death causes in RA patients were cardiovascular diseases (37.7%), cancer (28.6%) and death due to infections (9.1%). No association was observed between the rs10818488 susceptible genotype AA and cardiovascular mortality (HR 1.08 95%CI 0.54 to 2.15) and all-cause mortality (HR 0.81 95%CI 0.27 to 2.43). Similar findings were observed for rs2416808 susceptible genotype GG in the non-RA cohort (HR 0.99; 95%CI 0.79 to 1.25 and HR 0.89; 95%CI 0.64 to 1.25, respectively). Conclusions The TRAF1/C5 region is not associated with an increased mortality risk.
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Affiliation(s)
- Jessica A B van Nies
- Department of Rheumatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Kobayashi H, Giles JT, Polak JF, Blumenthal RS, Leffell MS, Szklo M, Petri M, Gelber AC, Post W, Bathon JM. Increased prevalence of carotid artery atherosclerosis in rheumatoid arthritis is artery-specific. J Rheumatol 2010; 37:730-9. [PMID: 20110515 DOI: 10.3899/jrheum.090670] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Cardiovascular (CV) morbidity and mortality are increased in rheumatoid arthritis (RA). Prior investigations of the association of RA with measures of carotid atherosclerosis have yielded conflicting results. We compared carotid intima-media thickness (IMT) of both the common carotid (CCA) and proximal internal carotid (bulb-ICA) arteries, and plaque prevalence, between RA and non-RA participants. METHODS Subjects with RA were participants in a cohort study of subclinical CV disease in RA. Non-RA controls were selected from the Multi-Ethnic Study of Atherosclerosis. Both groups underwent B-mode ultrasonography of the right and left CCA and bulb-ICA. Linear regression was used to model the association of RA status with CCA and bulb-ICA-IMT, and logistic regression for the association of RA status with plaque. RESULTS We compared 195 RA patients to 198 non-RA controls. CV risk factors were similarly distributed, except for a higher prevalence of hypertension in the RA group. Mean adjusted bulb-ICA-IMT was higher in RA patients than controls (1.16 vs 1.02 mm, respectively; p < 0.001), while mean adjusted CCA-IMT did not differ significantly. After adjusting for CV risk factors, the odds of plaque were significantly increased in RA participants compared to controls (OR 2.41, 95% CI 1.26-4.61). The association of gender, age, smoking, and hypertension with bulb-ICA-IMT and plaque did not significantly differ by RA status. Interleukin 6 was strongly associated with bulb-ICA-IMT and plaque in controls but not in RA patients. In the RA group, shared epitope was associated with an increased prevalence of plaque. CONCLUSION Compared to controls, RA was associated with a higher prevalence and higher severity of atherosclerosis in the bulb-ICA but not the CCA. Our data suggest that future studies in RA that utilize carotid artery measurements should include assessment of the bulb-ICA.
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Affiliation(s)
- Hitomi Kobayashi
- Divisions of Rheumatology, Cardiology, and Immunogenetics, Department of Medicine, and Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA
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ABELSON BENJAMIN, SOKKA TUULIKKI, PINCUS THEODORE. Declines in Erythrocyte Sedimentation Rates in Patients with Rheumatoid Arthritis Over the Second Half of the 20th Century. J Rheumatol 2009; 36:1596-9. [DOI: 10.3899/jrheum.081255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To analyze baseline erythrocyte sedimentation rates (ESR) in cohorts of patients with rheumatoid arthritis (RA), which had been included in a review concerning longterm mortality, in reports published between 1973 and 2008, with baseline observations between 1954 and 2000.Methods.A computer search and complementary review of the literature had identified 84 unique cohorts with RA for which mortality over 5–40 years was reported. Baseline ESR data were available for 23 of the 84 cohorts. Mean and median ESR, age, disease duration, and rheumatoid factor (RF) status were compiled and analyzed in tertiles according to first year of patient recruitment.Results.Among 7 cohorts recruited initially between 1954 and 1980, median ESR at baseline was 47 mm/h (mean 50 mm/h, range 43–66), compared to median 38 mm/h (mean 41 mm/h, range 34–64) among 8 cohorts recruited between 1981 and 1984, and median 36 mm/h (mean 35 mm/h, range 28–42) among 8 cohorts recruited between 1985 and 1996. The lowest mean ESR among 7 cohorts with baseline in 1980 or earlier was 43 mm/h, and the highest reported mean ESR among 8 cohorts recruited after 1985 was 42 mm/h. In 3 cohorts recruited after 1985 from Sweden, Finland, and Spain, mean baseline ESR was < 30 mm/h.Conclusion.Mean ESR fell by 30% in cohorts of patients with RA recruited before 1981 compared to cohorts recruited after 1984. This decline may reflect changes in both the natural history and approaches to therapy of RA.
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