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Chen S, Dan L, Xiang L, He Q, Hu D, Gao Y. The role of gut flora-driven Th cell responses in preclinical rheumatoid arthritis. J Autoimmun 2025; 154:103426. [PMID: 40300482 DOI: 10.1016/j.jaut.2025.103426] [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: 12/03/2024] [Revised: 03/24/2025] [Accepted: 04/22/2025] [Indexed: 05/01/2025]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with an immune pathogenesis that evolves over decades. Preclinical RA (PreRA) represents a dynamic immune phase preceding clinical RA, marked by the loss of autoimmune tolerance, the appearance of tissue-invasive effector T cells, and the production of autoantibodies (such as antibodies against citrullinated proteins and rheumatoid factors). Extensive research has demonstrated that gut microbiota influence mucosal T-cell responses, driving the progression of PreRA through multiple mechanisms, including altered intestinal permeability, gene-environment interactions, bacterial antigenic specificity, molecular mimicry, and metabolite production. Environmental risk factors such as smoking, hormonal changes, and high-sodium (Na) diets, may contribute to RA pathogenesis via the gut microbiome. The next challenge in RA research lies in developing therapeutic strategies to intervene during the asymptomatic autoimmune phase, where dietary adjustments, natural compounds, probiotics, and other approaches could effectively modulate gut flora to prevent or delay RA onset.
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Affiliation(s)
- Shuanglan Chen
- Department of Rheumatology and Immunology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Lijuan Dan
- Department of Infection, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Li Xiang
- Department of Rheumatology and Immunology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Qingman He
- Department of Rheumatology and Immunology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Dongsen Hu
- Sichuan Jinxin Xi'nan Women's and Children's Hospital Co., Ltd, Chengdu, 610023, China
| | - Yongxiang Gao
- Department of Rheumatology and Immunology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
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Marino A, Currado D, Berardicurti O, Vomero M, Kun L, Di Corcia LP, Corberi E, Trunfio F, Saracino F, Lamberti L, Frascà L, Battista A, Alfano M, Pietramale M, Schiavone S, Giacomelli R, Navarini L. Association Between the Use of Oral Contraceptives and the Development of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. J Clin Med 2025; 14:2710. [PMID: 40283539 PMCID: PMC12027927 DOI: 10.3390/jcm14082710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 04/01/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025] Open
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that significantly impacts quality of life, particularly among women. Previous studies have suggested that oral contraceptive (OC) use may influence RA risk, but conflicting findings from earlier meta-analyses necessitate an updated analysis incorporating more recent data. Methods: We conducted a systematic review and meta-analysis of observational studies on OC use and RA risk by searching MedLine (via PubMed), Scopus, and Cochrane Databases up to September 2024. Results: Our analysis demonstrated that current or prior use of OCs is associated with a statistically significant reduction in RA risk (OR 0.80, 95% CI 0.70-0.91). In contrast, the associations for current use (OR 0.59, 95% CI 0.34-1.02) and past use (OR 0.83, 95% CI 0.69-1.01) were less definitive, likely due to substantial heterogeneity among studies. Cumulative meta-analysis revealed a modest temporal trend toward a protective effect of OC use. Conclusions: This meta-analysis supports a protective association between current or prior OC use and the development of RA, highlighting the potential role of hormonal factors in RA pathogenesis.
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Affiliation(s)
- Annalisa Marino
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.); (O.B.); (R.G.); (L.N.)
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Damiano Currado
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.); (O.B.); (R.G.); (L.N.)
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Onorina Berardicurti
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.); (O.B.); (R.G.); (L.N.)
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Marta Vomero
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Lyubomyra Kun
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Letizia Pia Di Corcia
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Erika Corberi
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Francesca Trunfio
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Francesca Saracino
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Ludovica Lamberti
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Leonardo Frascà
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Angelo Battista
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Marta Alfano
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Manuela Pietramale
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Silvia Schiavone
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Roberto Giacomelli
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.); (O.B.); (R.G.); (L.N.)
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
| | - Luca Navarini
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.M.); (O.B.); (R.G.); (L.N.)
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Biomedico”, School of Medicine, 00128 Rome, Italy; (M.V.); (L.K.); (L.P.D.C.); (E.C.); (F.T.); (F.S.); (L.L.); (L.F.); (A.B.); (M.A.); (M.P.); (S.S.)
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Goulden B, Woodward G, Leiner S, Ahmed Z, Covington S, Nzelu D, Dolhain R, Giles I. The impact of pregnancy on future health in Rheumatoid Arthritis: A systematic review of the literature. Autoimmun Rev 2025; 24:103808. [PMID: 40209970 DOI: 10.1016/j.autrev.2025.103808] [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: 02/04/2025] [Revised: 03/19/2025] [Accepted: 03/25/2025] [Indexed: 04/12/2025]
Abstract
OBJECTIVES To assess whether obstetric history predicts future rheumatoid arthritis (RA) diagnosis, severity, and/or maternal health beyond the immediate postpartum period. METHODS A systematic literature search was conducted on 01/07/24 (PubMed, Embase); PROSPERO ID CRD42024559893. Primary research examining health outcomes in RA-affected females, stratified on obstetric history pre- or post-RA onset, were selected for inclusion. Studies of overlapping cohorts were included if differing exposures/outcomes reported. RESULTS Out of 3333 articles screened, 95 studies were selected. Future health outcomes analysed included RA diagnosis (n = 66 studies), severity (n = 11), cardiovascular disease (n = 2), immunity (n = 9), and microchimerism (n = 7). Parity/gravidity (n = 67), infertility (n = 7), and pregnancy loss (n = 22) were not reliable predictors of subsequent RA. High parity (n = 2) was linked to increased cardiovascular disease risk in RA-affected females. Both pre-eclampsia (n = 4) and delivery of a low birthweight infant (n = 2) were associated with RA diagnosis/severity. A trend suggested increased RA risk after preterm birth (n = 3) and severe hyperemesis gravidarum (n = 3), but not for gestational diabetes (n = 1). No significant differences in post-translational modification of serum proteins were noted beyond 6 months postpartum, though persistent differences in anti-HLA antibodies and microchimerism were observed. CONCLUSIONS Research indicates that parity, gravidity, infertility, and pregnancy loss do not adversely affect RA development. Conversely, low birthweight delivery was associated with RA diagnosis and severity, while pre-eclampsia correlated with subsequent RA diagnosis. Differences in immune responses, as indicated by anti-HLA and microchimerism, may indicate immune sensitisation relevant to RA pathogenesis. The predictive impact of pre-eclampsia and gestational diabetes on cardiovascular health in RA-affected females remains unstudied.
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Affiliation(s)
- Bethan Goulden
- Department of Ageing, Rheumatology and Regenerative Medicine, University College London, Rayne Building, 5 University Street, WC1E 6JF London, UK.
| | - George Woodward
- Department of Ageing, Rheumatology and Regenerative Medicine, University College London, Rayne Building, 5 University Street, WC1E 6JF London, UK
| | - Sophie Leiner
- Medical School, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Zahra Ahmed
- Department of Ageing, Rheumatology and Regenerative Medicine, University College London, Rayne Building, 5 University Street, WC1E 6JF London, UK
| | - Sophie Covington
- Department of Ageing, Rheumatology and Regenerative Medicine, University College London, Rayne Building, 5 University Street, WC1E 6JF London, UK
| | - Diane Nzelu
- Department of Obstetrics, Elizabeth Garrett Anderson Wing, University College London Hospital, 25 Grafton Way, WC1E 6DB London, UK
| | - Radboud Dolhain
- Erasmus Medical Centre, Dept. of Rheumatology, Nb-852 Dr. Molewaterplein, 40 3015, GD, Rotterdam, the Netherlands
| | - Ian Giles
- Department of Ageing, Rheumatology and Regenerative Medicine, University College London, Rayne Building, 5 University Street, WC1E 6JF London, UK
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Cui H, Huang C, Ye Y, Guo T, Yu W, Niu P, Gao K, Liu J, Liu A. Association between age at first birth and risk of rheumatoid arthritis in women: Evidence from NHANES 2011-2020. PLoS One 2025; 20:e0317443. [PMID: 39820142 PMCID: PMC11737699 DOI: 10.1371/journal.pone.0317443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 12/28/2024] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVE This study focused on investigating the relation of age at first birth (AFB) with rheumatoid arthritis (RA) risk in women based on the 2011-2020 NHANES (National Health and Nutrition Examination Survey) data. METHODS Women were analyzed using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2020 in the US. Both AFB and RA diagnoses were obtained through self-reported questionnaires. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined using logistic regression models. RESULTS Among the 7,449 women included in this study, 552 (7%) were diagnosed with RA. In comparison with women who had an AFB of 30-32 years (reference group), those who had an AFB < 18, 18-20, 21-23, 24-26, and > 35 years had the fully adjusted ORs and 95% CIs of 4.00 (95% CI 1.70, 9.40), 2.90 (95% CI 1.25, 6.73), 3.00 (95% CI 1.32, 6.80), 3.18 (95% CI 1.36-7.42), and 3.36 (95% CI 1.04-10.7), respectively. Due to the limitations inherent in cross-sectional studies, we have not observed significant differences in the risk of RA between women aged 27-29 and 33-35 at the AFB. Further research is warranted to refine these findings. CONCLUSION Women with an AFB < 26, or > 35 years have a higher risk of developing RA later in life. Policymakers may consider focusing more on women in these AFB age ranges in screening RA and making preventive measures.
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Affiliation(s)
- Hang Cui
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chenyang Huang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuntian Ye
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Tianci Guo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weijie Yu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Puyu Niu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Kuiliang Gao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jiajin Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Aifeng Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Niu Q, Hao J, Li Z, Zhang H. Helper T cells: A potential target for sex hormones to ameliorate rheumatoid arthritis? (Review). Mol Med Rep 2024; 30:215. [PMID: 39370806 PMCID: PMC11450432 DOI: 10.3892/mmr.2024.13339] [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] [Received: 07/17/2024] [Accepted: 09/06/2024] [Indexed: 10/08/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease whose etiology is not fully understood. Defective peripheral immune tolerance and subsequent mis‑differentiation and aberrant infiltration of synovium by various immune cells, especially helper T (Th) cells, play an important role in the development of RA. There are significant sex differences in RA, but the results of studies on the effects of sex hormones on RA have been difficult to standardize and hormone replacement therapy has been limited by the potential for serious side effects. Existing research has amply demonstrated that cellular immune responses are largely determined by sex and that sex hormones play a key role in Th cell responses. Based on the aforementioned background and the plasticity of Th cells, it is reasonable to hypothesize that the action of sex hormones on Th cells will hopefully become a therapeutic target for RA. The present review discussed the role of various Th cell subsets in the pathogenesis of RA and also explored the role of sex hormones on the phenotype and function of these aberrantly regulated immune cells in RA as well as other pathologic effects on RA.
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Affiliation(s)
- Quanjun Niu
- Department of Orthopedics IV, Handan Hospital of Traditional Chinese Medicine, Handan, Hebei 056001, P.R. China
| | - Junhang Hao
- Department of Orthopedics IV, Handan Hospital of Traditional Chinese Medicine, Handan, Hebei 056001, P.R. China
| | - Zhen Li
- Department of Orthopedics IV, Handan Hospital of Traditional Chinese Medicine, Handan, Hebei 056001, P.R. China
| | - Huiping Zhang
- Department of Orthopedics IV, Handan Hospital of Traditional Chinese Medicine, Handan, Hebei 056001, P.R. China
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Ranjbaran ME, Kazemi M. Reproductive health and rheumatoid arthritis. BMC Rheumatol 2024; 8:53. [PMID: 39402633 PMCID: PMC11475594 DOI: 10.1186/s41927-024-00429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 10/10/2024] [Indexed: 10/19/2024] Open
Abstract
INTRODUCTION The prevalence of Rheumatoid Arthritis (RA) has been steadily increasing over the last thirty years, particularly among women. Due to the conflicting results of various studies on the link between rheumatoid arthritis and reproductive health, we have undertaken this study to explore their relationship. METHODS This cross-sectional study utilized primary data from5557 women involved in the Fasa Persian Cohort in the years 2013 to 2018. The study examined the frequency of RA and its association with various factors related to reproductive health, including age at first pregnancy, number of alive children, history of abortion, and infertility. SPSS software was utilized for data analysis, with the significance level set at p < 0.05. RESULTS 5557 women with an average age of 48.6 ± 9.5 years participated. Of these women, 7.2% were diagnosed with rheumatoid disease, with an average onset age of 38.2 ± 15.2. The study did not find a significant correlation between RA and factors such as number of pregnancies, age at first pregnancy, duration of breastfeeding and number of children. CONCLUSION The study suggests that the experience of RA is independent of gynecological, obstetric factors, or reproductive life. This finding may provide reassurance to women affected by RA.
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Affiliation(s)
| | - Maryam Kazemi
- Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran.
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Gu H, Yan D, Li J, Long X, Wang K. Trends and future projections of incidence rate and mortality of rheumatoid arthritis in China: a systematic analysis based on GBD 2021 data. Clin Rheumatol 2024; 43:2799-2806. [PMID: 39073512 DOI: 10.1007/s10067-024-07083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/09/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
This study aims to evaluate the trends in rheumatoid arthritis (RA) in China from 1990 to 2021 by analyzing data from the Global Burden of Disease (GBD) 2021 study and to predict the trends for the next 25 years. Age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) were calculated, and the estimated annual percentage change was used to illustrate differences in age distribution among various populations. Age-period-cohort (APC) analysis and Bayesian APC (BAPC) models were employed to forecast the burden of RA in China from 2022 to 2046. From 1990 to 2021, the ASIR of RA in China increased from 11.6 to 13.7, with a significantly higher ASIR in females than in males. Despite the increase in incidence, the ASMR related to RA decreased from 0.7 to 0.5. Predictions using the BAPC model indicate that the incidence of RA will continue to rise, with an expected ASIR of approximately 16.4 by 2046, and the total number of RA cases is projected to reach around 342,000. In terms of mortality, the ASMR is expected to decline to 0.3 by 2046, although the total number of deaths might reach about 40,000. The incidence of RA in China has significantly increased over the past 30 years. Although the incidence rate and the total number of RA cases may continue to rise in the future, the mortality rate of RA has been consistently declining. Key Points • Over the past 30 years, the incidence of RA in China has significantly increased; although the incidence rate and total number of cases may continue to rise, the mortality rate has been consistently declining.
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Affiliation(s)
- Haiping Gu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Dandan Yan
- Department of Rheumatology and Immunology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223001, China
| | - Ju Li
- Department of Rheumatology and Immunology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223001, China
| | - Xianming Long
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
| | - Kai Wang
- Department of Rheumatology and Immunology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223001, China
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Hadizadeh F, Johansson T, Johansson Å, Karlsson T, Ek WE. Effects of oral contraceptives and menopausal hormone therapy on the risk of rheumatoid arthritis: a prospective cohort study. Rheumatology (Oxford) 2024; 63:2101-2108. [PMID: 37773999 PMCID: PMC11292047 DOI: 10.1093/rheumatology/kead513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES Oral contraceptives (OC) and menopausal hormone therapy (MHT) contain exogenous sex hormones and are used by millions of women around the world. However, their effect on the development of rheumatoid arthritis (RA) is still debated and the current literature suggests that they may exert opposite effects on the risk of RA. The present study aimed to estimate the effects of exogenous hormones on the development of RA, both during the reproductive lifespan and later in life. METHODS The association between OC and RA, as well as between MHT and late-onset RA (LORA), was investigated using time-dependent Cox regression modelling in white British women from the UK Biobank (n = 236 602 and n = 102 466, respectively) and replicated in women from all ethnic groups. RESULTS OC use was associated with a decreased risk of RA in ever-users [hazard ratio (HR) = 0.89; 95% CI = 0.82-0.96], as well as in current (HR = 0.81; 0.73-0.91) and former users (HR = 0.92; 0.84 -1.00), compared with never-users. In contrast, MHT use was associated with an increased risk of LORA in ever-users (HR = 1.16; 1.06-1.26) as well as in former users (HR = 1.13; 1.03-1.24) compared with never-users. CONCLUSION OC use appears to protect against RA, while MHT may increase the risk of LORA. This study provides new insights into the possible inverse effect of exposure to different exogenous sex hormones on the risk of RA.
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Affiliation(s)
- Fatemeh Hadizadeh
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Therese Johansson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Torgny Karlsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Weronica E Ek
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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Beydon M, McCoy S, Nguyen Y, Sumida T, Mariette X, Seror R. Epidemiology of Sjögren syndrome. Nat Rev Rheumatol 2024; 20:158-169. [PMID: 38110617 DOI: 10.1038/s41584-023-01057-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
Sjögren syndrome is a phenotypically varied autoimmune disorder that can occur alone in primary Sjögren syndrome or in association with other connective tissue diseases (CTDs), including rheumatoid arthritis, systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). The estimation of the prevalence and incidence of Sjögren syndrome varies depending on diagnostic criteria and study design, making it difficult to estimate geographical and temporal trends. Nonetheless, disease phenotype is influenced by geographical origin, which is a risk factor for systemic activity. Whether mortality in primary Sjögren syndrome is increased compared with that of the general population is not yet known, but extra-glandular manifestations, in particular lymphomas, are clear risk factors for mortality. In CTDs associated with Sjögren syndrome, lymphoma risk seems higher than that of patients with CTD alone, and there is potentially lower disease activity in SLE with Sjögren syndrome and in SSc with Sjögren syndrome than in SLE or SSc alone.
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Affiliation(s)
- Maxime Beydon
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
| | - Sara McCoy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yann Nguyen
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Takayuki Sumida
- Department of Internal Medicine, University of Tsukuba, Tsukuba, Japan
| | - Xavier Mariette
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France.
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France.
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10
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Jiang LQ, Zhang RD, Musonye HA, Zhao HY, He YS, Zhao CN, He T, Tian T, Gao ZX, Fang Y, Wang P, Ni J, Pan HF. Hormonal and reproductive factors in relation to the risk of rheumatoid arthritis in women: a prospective cohort study with 223 526 participants. RMD Open 2024; 10:e003338. [PMID: 38195516 PMCID: PMC10826586 DOI: 10.1136/rmdopen-2023-003338] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/11/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE This study aimed to examine rheumatoid arthritis (RA) risk associated with hormonal and reproductive factors in women from the large cohort of the UK Biobank. METHODS Data on hormonal and reproductive factors in women were collected from a prospective cohort of 223 526 UK Biobank participants. The potential relationship between reproductive factors and RA risk was assessed using restricted cubic spline. Hazard ratios (HR) were estimated using Cox proportional hazard regressions. RESULTS During a median follow-up of 12.39 years, 3313 women with RA were identified. Age at menarche >14 years was associated with a greater RA risk (HR 1.13, 95% CI 1.02 to 1.26) compared with menarche at 13. The multiple adjusted HR for RA in women with menopause at <45 years was 1.46. Reproductive years <33 increased the risk of RA (HR 1.39, 95% CI 1.21 to 1.59). Compared with those with 2 children, women with ≥4 children were associated with a higher risk of RA (HR 1.18, 95% CI 1.04 to 1.34). Women who had a hysterectomy (HR 1.40, 95% CI 1.25 to 1.56) or oophorectomy (HR 1.21, 95% CI 1.08 to 1.35) had a higher risk of RA than those without a hysterectomy or oophorectomy. Both hormone replacement therapy (HRT) use (HR 1.46, 95% CI 1.35 to 1.57) and HRT duration (HR 1.02, 95% CI 1.01 to 1.03) were associated with a higher risk of RA. CONCLUSIONS Some hormonal and reproductive factors were associated with a higher risk of RA. Hormonal and reproductive factors should be considered in risk assessment and formulating management plans in female patients with RA.
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Affiliation(s)
- Ling-Qiong Jiang
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruo-Di Zhang
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Harry Asena Musonye
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hao-Yun Zhao
- Department of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Yi-Sheng He
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chan-Na Zhao
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tian He
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tian Tian
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
| | - Zhao-Xing Gao
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yang Fang
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng Wang
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China
| | - Jing Ni
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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11
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Ishigaki H, Ito S, Sasamura T, Ishida H, Nakayama M, Nguyen CT, Kinoshita T, Suzuki S, Iwatani C, Tsuchiya H, Yamanaka H, Kulski JK, Itoh Y, Shiina T. MHC-DRB alleles with amino acids Val11, Phe13, and the shared epitopes promote collagen-induced arthritis and a rapid IgG1 response in Filipino cynomolgus macaques. HLA 2024; 103:e15316. [PMID: 38226402 DOI: 10.1111/tan.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 11/04/2023] [Accepted: 11/24/2023] [Indexed: 01/17/2024]
Abstract
Macaques are useful animal models for studying the pathogenesis of rheumatoid arthritis (RA) and the development of anti-rheumatic drugs. The purpose of this study was to identify the major histocompatibility complex (MHC) polymorphisms associated with the pathology of collagen-induced arthritis (CIA) and anti-collagen IgG induction in a cynomolgus macaque model, as MHC polymorphisms affect the onset of CIA in other animal models. Nine female Filipino cynomolgus macaques were immunized with bovine type II collagen (b-CII) to induce CIA, which was diagnosed clinically by scoring the symptoms of joint swelling over 9 weeks. MHC polymorphisms and anti-b-CII antibody titers were compared between symptomatic and asymptomatic macaques. Four of 9 (44%) macaques were defined as the CIA-affected group. Anti-b-CII IgG in the affected group increased in titer approximately 3 weeks earlier compared with the asymptomatic group. The mean plasma IgG1 titer in the CIA-affected group was significantly higher (p < 0.05) than that of the asymptomatic group. Furthermore, the cynomolgus macaque MHC (Mafa)-DRB1*10:05 or Mafa-DRB1*10:07 alleles, which contain the well-documented RA-susceptibility five amino acid sequence known as the shared epitope (SE) in positions 70 to 74, with valine at position 11 (Val11, V11) and phenylalanine at position 13 (Phe13, F13), were detected in the affected group. In contrast, no MHC polymorphisms specific to the asymptomatic group were identified. In conclusion, the presence of V11 and F13 along with SE in the MHC-DRB1 alleles seems essential for the production of IgG1 and the rapid induction of severe CIA in female Filipino cynomolgus macaques.
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Affiliation(s)
- Hirohito Ishigaki
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Sayaka Ito
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Takako Sasamura
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Hideaki Ishida
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Misako Nakayama
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Cong Thanh Nguyen
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Takaaki Kinoshita
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Shingo Suzuki
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Chizuru Iwatani
- Research Center for Animal Life Science, School of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hideaki Tsuchiya
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
- Research Center for Animal Life Science, School of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hisashi Yamanaka
- Research Center for Animal Life Science, School of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Jerzy K Kulski
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
- School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Yasushi Itoh
- Division of Pathogenesis and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Shiina
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
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12
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Yuk JS, Seo YS, Im YH, Kim JH. Menopausal hormone therapy and risk of seropositive rheumatoid arthritis: A nationwide cohort study in Korea. Semin Arthritis Rheum 2023; 63:152280. [PMID: 37857046 DOI: 10.1016/j.semarthrit.2023.152280] [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] [Received: 08/13/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES This retrospective cohort study aimed to investigate the impact of menopausal hormone therapy (MHT) on the incidence of rheumatoid arthritis (RA) in postmenopausal women and to examine the effects of each specific MHT drug. METHODS In this Korean population-based cohort study, 452,124 women aged > 40 years who consulted a healthcare provider for menopause were evaluated from January 1, 2011, to December 31, 2014. After propensity score matching, 138,991 pairs were included in the MHT and non-MHT groups. Participants were followed up until December 31, 2020. RA was defined according to the International Classification of Diseases, 10th edition, limited to seropositive RA (M05). RESULTS RA developed in 567 (0.4 %) of the 138,424 patients in the MHT group. The RA risk in the MHT group was not significantly increased compared with that of controls (hazard ratio [HR] 1.12, 95 % confidence interval [CI] 0.998-1.256). However, MHT use for ≤ 3 years was associated with an increased risk of RA (HR 1.277, 95 % CI 1.127-1.447). When estrogen/progestogen was used, the HR was 1.24 (95 % CI 1.05-1.46), whereas when tibolone was used, the HR was 1.33 (95 % CI 1.13-1.57). CONCLUSION The use of MHT did not show a significant impact on the development of RA in postmenopausal women. However, a subanalysis that specifically examined the duration of MHT revealed a noteworthy increase in the risk of RA during the initial 3 years of MHT use.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, School of Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Yong-Soo Seo
- Department of Obstetrics and Gynecology, School of Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Yo Han Im
- Department of Internal Medicine, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28644, Republic of Korea
| | - Ji Hyoun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28644, Republic of Korea.
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13
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Beydon M, Pinto S, De Rycke Y, Fautrel B, Mariette X, Seror R, Tubach F. Risk of cancer for patients with rheumatoid arthritis versus general population: a national claims database cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100768. [PMID: 37954220 PMCID: PMC10637983 DOI: 10.1016/j.lanepe.2023.100768] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
Background Older studies uncovered an increased risk of cancer in patients with rheumatoid arthritis between 10% and 30% compared to the general population, with a lack of data concerning infrequent cancers. In recent year, major therapeutic breakthroughs might have affected this risk of cancer by mitigating disease activity or on the contrary by impairing antitumoral immune response. The objectives of this study are to compare cancer risk in patients with treated rheumatoid arthritis to the general population, in all treated patients and according to treatment exposure. Methods This is a nationwide population-based study within the French national claims database "Système National des Données de Santé" (SNDS) between January 1st 2010 and December 31st 2020, to estimate the age and sex-standardized incidence ratios of cancer (all sites and site specific) of treated rheumatoid arthritis patients, with the French population as reference (by use of the French Network of Population-Based Cancer Registries [FRANCIM]). Findings During the study period, 257,074 treated patients with rheumatoid arthritis contributed to a total of 2,098,238 person-years for the main analysis. The all-cancer risk was increased in rheumatoid arthritis patients, with a SIR (Standardized Incidence Ratio) of 1.20 (95% CI [1.17-1.23]). This risk was increased particularly for lung (SIR 1.41, 95% CI [1.36-1.46], bladder (SIR 2.38 95% CI [2.25-2.51]), cervix (SIR 1.80, 95% CI [1.62-2.01]), prostate (SIR 1.08, 95% CI [1.04, 1.13]) cancers, melanoma (SIR 1.37, 95% CI [1.29-1.46]), diffuse large B cell lymphoma (SIR 1.79, 95% CI [1.63-1.96], multiple myeloma (SIR 1.42, 95% CI [1.27-1.60]) and Hodgkin's lymphoma (SIR 2.73, 95% CI [2.31-3.23]). Some cancers were less frequent than in the general population such as pancreatic (SIR 0.90, 95% CI [0.83-0.97]) as well as breast and endometrial cancers (SIR 0.91, 95% CI [0.88-0.94] and SIR 0.77, 95% CI [0.71-0.84] respectively). Although we observed a modest but significant relative increase of all-cancer risk over-time in rheumatoid arthritis patients, there was a trend towards a decrease in risk of non-Hodgkin's lymphoma. Patients treated with rituximab were the patients displaying the highest risk of cancer. Interpretation Compared to the general population, treated rheumatoid arthritis patients were at greater risk of all-cancer and some site specific cancers, except for breast, pancreatic and endometrial cancers which were less frequent than in the general population. Funding This work was supported by unrestricted grants from the InCA (national institute against cancer) and AP-HP (Assistance Publique des Hôpitaux de Paris).
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Affiliation(s)
- Maxime Beydon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Sandrine Pinto
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, F75013, Paris, France
| | - Bruno Fautrel
- Département de Rhumatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Xavier Mariette
- Département de Rhumatologie, Université Paris-Saclay, INSERM U1184, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Raphaèle Seror
- Département de Rhumatologie, Université Paris-Saclay, INSERM U1184, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, F75013, Paris, France
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14
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Zhang X, Huangfu Z, Wang S. Review of mendelian randomization studies on age at natural menopause. Front Endocrinol (Lausanne) 2023; 14:1234324. [PMID: 37766689 PMCID: PMC10520463 DOI: 10.3389/fendo.2023.1234324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Menopause marks the end of the reproductive phase of life. Based on epidemiological studies, abnormal age at natural menopause (ANM) is thought to contribute to a number of adverse outcomes, such as osteoporosis, cardiovascular disease, and cancer. However, the causality of these associations remains unclear. A powerful epidemiological method known as Mendelian randomization (MR) can be used to clarify the causality between ANM and other diseases or traits. The present review describes MR studies that included ANM as an exposure, outcome and mediator. The findings of MR analyses on ANM have revealed that higher body mass index, poor educational level, early age at menarche, early age at first live birth, early age at first sexual intercourse, and autoimmune thyroid disease appear to be involved in early ANM etiology. The etiology of late ANM appears to be influenced by higher free thyroxine 4 and methylene tetrahydrofolate reductase gene mutations. Furthermore, early ANM has been found to be causally associated with an increased risk of osteoporosis, fracture, type 2 diabetes mellitus, glycosylated hemoglobin, and the homeostasis model of insulin resistance level. In addition, late ANM has been found to be causally associated with an increased systolic blood pressure, higher risk of breast cancer, endometrial cancer, endometrioid ovarian carcinoma, lung cancer, longevity, airflow obstruction, and lower risk of Parkinson's disease. ANM is also a mediator for breast cancer caused by birth weight and childhood body size. However, due to the different instrumental variables used, some results of studies are inconsistent. Future studies with more valid genetic variants are needed for traits with discrepancies between MRs or between MR and other types of epidemiological studies.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaowei Wang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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15
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Park EH, Kang EH, Lee YJ, Ha YJ. Impact of early age at menopause on disease outcomes in postmenopausal women with rheumatoid arthritis: a large observational cohort study of Korean patients with rheumatoid arthritis. RMD Open 2023; 9:rmdopen-2022-002722. [PMID: 36792311 PMCID: PMC9933755 DOI: 10.1136/rmdopen-2022-002722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To assess the differences in clinical outcomes between patients with rheumatoid arthritis (RA) with early menopause (EM) (<45 years) and usual menopause (UM) (≥45 years) and to identify the impact of EM on longitudinal changes in RA activity and patient-reported outcomes (PROs). METHODS We recruited 2878 postmenopausal women with RA from the Korean Observational Study Network for Arthritis. Patients were examined at baseline and for 5 consecutive years using the Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire-Disability Index (HAQ-DI) and other PROs. Generalised estimating equation (GEE) analyses were performed among patients with a baseline SDAI of >11 to evaluate the impact of EM on longitudinal changes in RA activity and PROs. RESULTS The EM group (n=437) was younger than the UM group (n=2441), but the RA duration was similar between the two groups. The EM group was more educated and more likely to be seronegative at enrolment. Moreover, the EM group demonstrated higher disease activity and worse PROs for global assessment, fatigue, sleep disturbance and health-related quality of life (HRQoL) (all p<0.05) at baseline. The GEE model revealed that EM significantly influenced the rate of SDAI change (β=1.265, p=0.004) after adjusting for age, RA duration, biologics use and SDAI at baseline. The EM group was also significantly associated with increased HAQ-DI scores and decreased EQ-5D-utility values during the 5-year follow-up period. CONCLUSION Patients with RA and EM demonstrate higher disease activity and poorer HRQoL. Furthermore, EM significantly affects the longitudinal changes in disease activity and PROs in patients with RA.
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Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea,Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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16
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Jing W, Liu C, Su C, Liu L, Chen P, Li X, Zhang X, Yuan B, Wang H, Du X. Role of reactive oxygen species and mitochondrial damage in rheumatoid arthritis and targeted drugs. Front Immunol 2023; 14:1107670. [PMID: 36845127 PMCID: PMC9948260 DOI: 10.3389/fimmu.2023.1107670] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation, pannus formation, and bone and cartilage damage. It has a high disability rate. The hypoxic microenvironment of RA joints can cause reactive oxygen species (ROS) accumulation and mitochondrial damage, which not only affect the metabolic processes of immune cells and pathological changes in fibroblastic synovial cells but also upregulate the expression of several inflammatory pathways, ultimately promoting inflammation. Additionally, ROS and mitochondrial damage are involved in angiogenesis and bone destruction, thereby accelerating RA progression. In this review, we highlighted the effects of ROS accumulation and mitochondrial damage on inflammatory response, angiogenesis, bone and cartilage damage in RA. Additionally, we summarized therapies that target ROS or mitochondria to relieve RA symptoms and discuss the gaps in research and existing controversies, hoping to provide new ideas for research in this area and insights for targeted drug development in RA.
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Affiliation(s)
- Weiyao Jing
- Department of Acupuncture-Moxibustion and Tuina, Gansu University of Chinese Medicine, Lanzhou, China
| | - Cui Liu
- Department of Acupuncture-Moxibustion and Tuina, Gansu University of Chinese Medicine, Lanzhou, China
| | - Chenghong Su
- Department of Acupuncture-Moxibustion and Tuina, Gansu University of Chinese Medicine, Lanzhou, China
| | - Limei Liu
- Department of Acupuncture-Moxibustion and Tuina, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ping Chen
- Department of Rheumatic and Bone Disease, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Xiangjun Li
- Department of Rheumatic and Bone Disease, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Xinghua Zhang
- Department of Acupuncture, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Bo Yuan
- Department of Acupuncture and Pain, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Haidong Wang
- Department of Rheumatic and Bone Disease, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Xiaozheng Du
- Department of Acupuncture-Moxibustion and Tuina, Gansu University of Chinese Medicine, Lanzhou, China
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17
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Raine C, Giles I. What is the impact of sex hormones on the pathogenesis of rheumatoid arthritis? Front Med (Lausanne) 2022; 9:909879. [PMID: 35935802 PMCID: PMC9354962 DOI: 10.3389/fmed.2022.909879] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common inflammatory rheumatic disease and has a female predominance of around 3:1. The relationship between sex hormones and RA has been of great interest to researchers ever since Philip Hench's observations in the 1930's regarding spontaneous disease amelioration in pregnancy. Extensive basic scientific work has demonstrated the immunomodulatory actions of sex hormones but this therapeutic potential has not to date resulted in successful clinical trials in RA. Epidemiological data regarding both endogenous and exogenous hormonal factors are inconsistent, but declining estrogen and/or progesterone levels in the menopause and post-partum appear to increase the risk and severity of RA. This review assimilates basic scientific, epidemiological and clinical trial data to provide an overview of the current understanding of the relationship between sex hormones and RA, focusing on estrogen, progesterone and androgens.
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Kowalski EN, Qian G, Vanni KMM, Sparks JA. A Roadmap for Investigating Preclinical Autoimmunity Using Patient-Oriented and Epidemiologic Study Designs: Example of Rheumatoid Arthritis. Front Immunol 2022; 13:890996. [PMID: 35693829 PMCID: PMC9175569 DOI: 10.3389/fimmu.2022.890996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background & Aims Rheumatoid arthritis (RA) is a prototypic autoimmune disease causing inflammatory polyarthritis that affects nearly 1% of the population. RA can lead to joint destruction and disability along with increased morbidity and mortality. Similar to other autoimmune diseases, RA has distinct preclinical phases corresponding to genetic risk, lifestyle risk factors, autoantibody development, and non-specific symptoms prior to clinical diagnosis. This narrative review will detail observational studies for RA risk and clinical trials for RA prevention as a roadmap to investigating preclinical autoimmunity that could be applied to other diseases. Methods In this narrative review, we summarized previous and ongoing research studies investigating RA risk and prevention, categorizing them related to their design and preclinical phases. Results We detailed the following types of studies investigating RA risk and prevention: retrospective population-based and administrative datasets; prospective studies (case-control and cohort; some enrolling based on genetics, first-degree relative status, elevated biomarkers, or early symptoms/arthritis); and randomized clinical trials. These correspond to all preclinical RA phases (genetic, lifestyle, autoimmunity, early signs/symptoms). Previous and ongoing randomized controlled trials have enrolled individuals at very elevated risk for RA based on biomarkers, symptoms, imaging abnormalities, or early signs/symptoms. Conclusion We detailed the rich variety of study designs that is necessary to investigate distinct preclinical phases of an autoimmune disease such as RA. However, further progress is needed to fully elucidate the pathogenesis of RA that may ultimately lead to prevention or delay of disease onset.
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Affiliation(s)
- Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
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Lifetime female hormonal exposure and risk of rheumatoid arthritis in postmenopausal women: results from the French E3N cohort. Joint Bone Spine 2022; 89:105374. [DOI: 10.1016/j.jbspin.2022.105374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022]
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Salliot C, Nguyen Y, Mariette X, Boutron-Ruault MC, Seror R. Anthropometric Measures and Risk of Rheumatoid Arthritis in the French E3N Cohort Study. Nutrients 2022; 14:934. [PMID: 35267910 PMCID: PMC8912452 DOI: 10.3390/nu14050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to assess the relationships between anthropometric measures and risk of rheumatoid arthritis (RA). The E3N cohort included 98,995 women (aged 40−65 years at the recruitment) who completed mailed questionnaires on reproductive factors, lifestyle, and health-related information, including anthropometric measures, every 2−3 years. Cox proportional hazards regression models with age as the time scale and adjusted on known RA risk factors were used to estimate hazard ratios (HRs) and 95% confidence intervals for the risk of incident RA in the overall population (n = 78,452) and after stratification on smoking exposure. Incident RA diagnosis was validated in 698 women. Abdominal obesity (waist circumference >88 cm) was associated with RA (HR = 1.2 (1.0−1.5)), independent of BMI; whereas obesity, defined as BMI ≥ 30 kg/m2, was marginally associated with RA (HR = 1.26 (0.9−1.5), ptrend = 0.0559). Taking lean body shape (BS) as reference, medium BS at puberty (HR = 1.3 (1.0−1.7)) and medium-large BS at perimenopausal period (HR = 1.5 (1.1−1.9)) were associated with the risk of RA among never-smoker women, independent of BMI. Regarding BS trajectory, taking constantly lean BS as reference, constantly large BS from puberty to perimenopause was associated with RA among non-smokers (HR = 2.10 (1.2−3.6)), independent of BMI.
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Affiliation(s)
- Carine Salliot
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, 94800 Villejuif, France; (C.S.); (Y.N.)
- Rheumatology Department, Centre Hospitalier Régional d’Orleans, 45067 Orléans, France
- Centre of Immunology of Viral Infections and Auto-Immune Diseases (IMVA), INSERM U1184, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France; (X.M.); (R.S.)
| | - Yann Nguyen
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, 94800 Villejuif, France; (C.S.); (Y.N.)
- Department of Internal Medicine, AP-HP-Hôpital Beaujon, Paris University, 92110 Clichy, France
| | - Xavier Mariette
- Centre of Immunology of Viral Infections and Auto-Immune Diseases (IMVA), INSERM U1184, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France; (X.M.); (R.S.)
- Rheumatology Department, AP-HP-Hôpital Bicêtre, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France
| | - Marie-Christine Boutron-Ruault
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, 94800 Villejuif, France; (C.S.); (Y.N.)
| | - Raphaèle Seror
- Centre of Immunology of Viral Infections and Auto-Immune Diseases (IMVA), INSERM U1184, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France; (X.M.); (R.S.)
- Rheumatology Department, AP-HP-Hôpital Bicêtre, Paris-Saclay University, 94270 Le Kremlin Bicêtre, France
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Prolactin Increases the Frequency of Follicular T Helper Cells with Enhanced IL21 Secretion and OX40 Expression in Lupus-Prone MRL/lpr Mice. J Immunol Res 2021; 2021:6630715. [PMID: 33763492 PMCID: PMC7963914 DOI: 10.1155/2021/6630715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
Systemic lupus erythematosus is characterized by high levels of IgG class autoantibodies that contribute to the pathophysiology of the disease. The formation of these autoantibodies occurs in the germinal centers, where there is cooperation between follicular T helper cells (TFH) and autoreactive B cells. Prolactin has been reported to exacerbate the clinical manifestations of lupus by increasing autoantibody concentrations. The objective of this study was to characterize the participation of prolactin in the differentiation and activation of TFH cells, by performing in vivo and in vitro tests with lupus-prone mice, using flow cytometry and real-time PCR. We found that TFH cells express the long isoform of the prolactin receptor and promoted STAT3 phosphorylation. Receptor expression was higher in MRL/lpr mice and correlative with the manifestations of the disease. Although prolactin does not intervene in the differentiation of TFH cells, it does favor their activation by increasing the percentage of TFH OX40+ and TFH IL21+ cells, as well as leading to high serum concentrations of IL21. These results support a mechanism in which prolactin participates in the emergence of lupus by inducing overactive TFH cells and perhaps promoting dysfunctional germinal centers.
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