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Li G, Stampas A, Komatsu Y, Gao X, Huard J, Pan S. Proteomics in orthopedic research: Recent studies and their translational implications. J Orthop Res 2024. [PMID: 38897819 DOI: 10.1002/jor.25917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Abstract
Proteomics is a growing field that offers insights into various aspects of disease processes and therapy responses. Within the field of orthopedics, there are a variety of diseases that have a poor prognosis due to a lack of targeted curative therapy or disease modifying therapy. Other diseases have been difficult to manage in part due to lack of clinical biomarkers that offer meaningful insight into disease progression or severity. As an emerging technology, proteomics has been increasingly applied in studying bone biology and an assortment of orthopedics related diseases, such as osteoarthritis, osteosarcoma and bone tumors, osteoporosis, traumatic bone injury, spinal cord injury, hip and knee arthroplasty, and fragile healing. These efforts range from mechanistic studies for elucidating novel insights in tissue activity and metabolism to identification of candidate biomarkers for diagnosis, prognosis, and targeted treatment. The knowledge gained from these proteomic and functional studies has provided unique perspectives in studying orthopedic diseases. In this review, we seek to report on the current state of the proteomic study in the field of orthopedics, overview the advances in clinically applicable discoveries, and discuss the opportunities that may guide us for future research.
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Affiliation(s)
- George Li
- School of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Physical Medicine and Rehabilitation, TIRR Memorial Hermann Hospital, Houston, Texas, USA
| | - Yoshihiro Komatsu
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Graduate Program in Genetics & Epigenetics, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Xueqin Gao
- Linda and Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Johnny Huard
- Linda and Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Sheng Pan
- Graduate Program in Genetics & Epigenetics, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Bedeković D, Bošnjak I, Bilić-Ćurčić I, Kirner D, Šarić S, Novak S. Risk for cardiovascular disease development in rheumatoid arthritis. BMC Cardiovasc Disord 2024; 24:291. [PMID: 38834973 DOI: 10.1186/s12872-024-03963-3] [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: 09/01/2023] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis have significant cardiovascular mortality and morbidity. OBJECTIVE To investigate the effects of chronic inflammation in rheumatoid arthritis on cardiovascular morbidity association with cardiovascular risk factors risk factors. Mortality report is secondary just to show trends without sufficient statistical power as it is accidental endpoint. METHODS A total of 201 individuals without previous cardiovascular disease, 124 with rheumatoid arthritis (investigation group) and 77 with osteoarthritis (control group), were included in the study and followed up for an average of 8 years to assess the development of fatal or non-fatal cardiovascular diseases. The incidence and prevalence of cardiovascular risk factors were also investigated. RESULTS The total incidence of one or more fatal or nonfatal cardiovascular events was 43.9% in the investigation group and 37.5% in the control group. Of these patients, 31.7% and 30.9% survived cardiovascular events in the investigation and control groups, respectively. The most common cardiovascular disease among participants who completed the study and those who died during the study was chronic heart failure. The results of the subgroup analysis showed that strict inflammation control plays a central role in lowering cardiovascular risk. CONCLUSION A multidisciplinary approach to these patients is of paramount importance, especially with the cooperation of immunologists and cardiologists for early detection, prevention, and management of cardiovascular risks and diseases.
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Affiliation(s)
- Dražen Bedeković
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Ivica Bošnjak
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia.
| | - Ines Bilić-Ćurčić
- Department for Pharmacology, Faculty of Medicine, J. J. Strossmayer University of Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, J. Huttlera 4, Osijek, 31000, Croatia
| | - Damir Kirner
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Sandra Šarić
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Rijeka, Rijeka, Croatia
- Faculty of Medicine Rijeka, Department of Internal Medicine, University of Rijeka, Braće Branchetta 20/1, Rijeka, 51000, Croatia
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Mori S, Soejima H, Hokamaki J, Tsujita K. Clinical disease activity is a major determinant of plasma D-dimer elevation in outpatients with rheumatoid arthritis: A hospital-based cross-sectional study. Mod Rheumatol 2024; 34:313-321. [PMID: 36726243 DOI: 10.1093/mr/road018] [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: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify factors associated with plasma D-dimer levels in outpatients with rheumatoid arthritis (RA). METHODS We consecutively recruited 460 RA patients who visited our hospital for routine follow-ups between June and October 2021. Plasma D-dimer, RA-related characteristics, comorbidities, and cardiovascular and venous thromboembolism (VTE) risk factors were examined at enrolment. Patients with elevated D-dimer levels underwent whole-leg venous ultrasonography to diagnose deep vein thrombosis (DVT). RESULTS Participants had no DVT signs or symptoms. Among them, 252 (54.8%) were positive for plasma D-dimer (≥0.5 μg/ml) and 40 (8.7%) had high D-dimer levels (≥3 μg/ml). The mean was 1.07 μg/ml. After adjustments, age [odds ratio (OR) 1.88 per additional 10 years, P = .003], high and moderate clinical disease activity index (OR 8.79, P < .001), and the presence of comorbidities or cardiovascular/VTE risk factors (OR 2.94, P = .017) were identified as the factors independently associated with high D-dimer levels. Among patients with D-dimer levels ≥3 μg/ml, 10 (25%) had DVT in their lower limbs, and D-dimer levels were significantly higher in patients with DVT compared with those without it (mean 6.0 vs. 4.1 μg/ml, P < .001). CONCLUSIONS Clinical disease activity is a major contributor to plasma D-dimer elevation in RA outpatients.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences and Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Jun Hokamaki
- Department of Cardiovascular Medicine, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences and Center of Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto, Japan
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Delcoigne B, Provan SA, Kristianslund EK, Askling J, Ljung L. How does current disease activity in rheumatoid arthritis affect the short-term risk of acute coronary syndrome? A clinical register based study from Sweden and Norway. Eur J Intern Med 2023; 115:55-61. [PMID: 37355347 DOI: 10.1016/j.ejim.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES To estimate short-term risks of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA) as a function of current RA disease activity including remission. METHODS Data from clinical visits of RA patients in Sweden (SE) and Norway (NO) between January 1st 2012 until December 31st 2020 were used. At each visit, patient's disease activity was assessed including remission status (measured with several metrics). Through linkage to national health and death registers, patients were followed up for incident ACS up to six months from each visit. We compared the short-term risk of ACS in patients not in remission vs. in remission using Cox regression analyses with robust standard errors, adjusted for country and covariates (e.g., age, sex, prednisolone use, comorbidities). We also explored disease activity categories as exposure. RESULTS We included 212,493 visits (10,444 from Norway and 202,049 from Sweden) among 41,250 patients (72% women, mean age at visit 62 years). During the 6-month follow-ups, we observed 524 incident ACS events. Compared to patients in remission, patients currently not in remission had an increased rate of ACS: adjusted hazard ratio (95% confidence interval) 1.52 (1.24-1.85) with DAS28 metric. The crude absolute six-month risks were 0.2% for patients in remission vs. 0.4% for patients with DAS28 high disease activity. The use of alternative RA disease activity and remission metrics provided similar results. CONCLUSION Failure to reach remission is associated with elevated short-term risks of ACS, underscoring the need for CV risk factor optimization in these patients.
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Affiliation(s)
- Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Sella A Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik K Kristianslund
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm Sweden
| | - Lotta Ljung
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
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Bedeković D, Bošnjak I, Šarić S, Kirner D, Novak S. Role of Inflammatory Cytokines in Rheumatoid Arthritis and Development of Atherosclerosis: A Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1550. [PMID: 37763669 PMCID: PMC10534747 DOI: 10.3390/medicina59091550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Uncontrolled chronic inflammation results in cardiovascular disease and early death. In this review, we studied the impact of rheumatoid arthritis on the cardiovascular system, including the early and accelerated development of atherosclerosis and its clinical manifestations, focusing on the inflammatory mechanisms leading to arterial wall damage, rapid atherosclerotic plaque formation, and thrombosis. Furthermore, the effect of medications used to treat rheumatoid arthritis on the cardiovascular system was studied. The effect of chronic inflammation and medication on traditional cardiovascular risk factors is not the main subject of this review. We observed that uncontrolled chronic inflammation and some medications directly impact all the stages of atherosclerosis. In conclusion, reducing inflammation and maintaining long-term remission in rheumatoid arthritis may prevent early atherosclerosis. We believe that this review will encourage a better interdisciplinary approach to the management of these patients and further research in this field.
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Affiliation(s)
- Dražen Bedeković
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
- Faculty of Medicine Osijek, Department of Internal Medicine, Josip Juraj Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Ivica Bošnjak
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
| | - Sandra Šarić
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
- Faculty of Medicine Osijek, Department of Internal Medicine, Josip Juraj Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Damir Kirner
- Department of Cardiovascular Diseases Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, 31000 Osijek, Croatia; (I.B.); (S.Š.); (D.K.)
- Faculty of Medicine Osijek, Department of Internal Medicine, Josip Juraj Strossmayer University, J. Huttlera 4, 31000 Osijek, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia;
- Faculty of Medicine Rijeka, Department of Internal Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
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Cao G, Zhang S, Wang Y, Xu H, Quan S, Cai L, Feng W, Yao J, Tan H, Pei F. The efficacy and safety of tranexamic acid in rheumatoid arthritis patients undergoing simultaneous bilateral total knee arthroplasty: a multicenter retrospective study. BMC Musculoskelet Disord 2023; 24:379. [PMID: 37189066 DOI: 10.1186/s12891-023-06485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The efficacy and safety of tranexamic acid (TXA) in reducing blood loss following total knee arthroplasty (TKA) in patients with osteoarthritis have been widely confirmed. However, there is still a paucity of the evidences regarding the effectiveness of TXA in patients with rheumatoid arthritis (RA). The purpose of the study is to explore the efficacy and safety of intravenous TXA on blood loss and transfusion risk following simultaneous bilateral TKA (SBTKA) in patients with RA. METHODS As a multicenter retrospective study, a total of 74 patients diagnosed with RA who underwent SBTKA were assigned into TXA group (15 mg/kg intravenous TXA before skin incision, n = 50) and control group (no TXA use, n = 24). The primary outcomes were total blood loss (TBL) and intraoperative blood loss (IBL). The secondary outcomes were hemoglobin (Hb) and hematocrit (Hct) drop on postoperative day 3, transfusion rate and volume, ambulation time, length of stay, hospitalization expenses and the incidence of complications. RESULTS The mean TBL, IBL and transfusion volume in TXA group were significantly lower than those in control group. The Hb and Hct drop on postoperative day 3 in control group were higher than those in TXA group (p<0.05). The similar trend was detected on transfusion rate, ambulation time and length of stay. The incidence of complications and hospitalization expenses did not differ significantly between the two groups (p>0.05). CONCLUSIONS TXA could effectively reduce blood loss, decrease transfusion risk, shorten ambulation time and length of stay following SBTKA in patients with RA, without increasing the risk of complications.
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Affiliation(s)
- Guorui Cao
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, 82 Qiming South Road, Luoyang, Henan Province, People's Republic of China
- Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, SiChuan Province, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, People's Republic of China
- Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, SiChuan Province, People's Republic of China
| | - Yixuan Wang
- Hunan University of Chinese Medicine, Changsha, Hunan Province, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, SiChuan Province, People's Republic of China
| | - Songtao Quan
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, 82 Qiming South Road, Luoyang, Henan Province, People's Republic of China
| | - Litao Cai
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, 82 Qiming South Road, Luoyang, Henan Province, People's Republic of China
| | - Wei Feng
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, 82 Qiming South Road, Luoyang, Henan Province, People's Republic of China
| | - Junna Yao
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, 82 Qiming South Road, Luoyang, Henan Province, People's Republic of China
| | - Honglue Tan
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, 82 Qiming South Road, Luoyang, Henan Province, People's Republic of China.
| | - Fuxing Pei
- Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, SiChuan Province, People's Republic of China.
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Atzeni F, Maiani S, Corda M, Rodríguez-Carrio J. Diagnosis and management of cardiovascular risk in rheumatoid arthritis: main challenges and research agenda. Expert Rev Clin Immunol 2023; 19:279-292. [PMID: 36651086 DOI: 10.1080/1744666x.2023.2170351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) exhibit a cardiovascular (CV) risk that is 1.5-2.0 times higher compared to the general population. This CV risk excess is likely caused by the involvement of chronic inflammation and immune dysregulation. Therefore, conventional algorithms and imaging techniques fail to fully account for this risk excess and provide a suboptimal risk stratification, hence limiting clinical management in this setting. AREAS COVERED Compelling evidence has suggested a role for adaptations of conventional algorithms (Framingham, SCORE, AHA, etc) or the development of RA-specific algorithms, as well as the use of a number of several, noninvasive imaging techniques to improve CV risk assessment in RA populations. Similarly, in-depth analyses of atherosclerosis pathogenesis in RA patients have shed new light into a plethora of soluble biomarkers (such as inflammatory cytokines, vascular remodeling mediators or autoantibodies) that may provide incremental value for CV risk stratification. EXPERT OPINION Extensive research has demonstrated a lack of performance of chart adaptations in capturing real CV risk in RA population, as well as for RA-specific algorithms. Similarly, limitations have been detected in the use of soluble mediators. The development of a novel, RA-specific algorithm including classical and non-traditional risk factors may be advisable.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Silvia Maiani
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Marco Corda
- S.C. Cardiologia UTIC, ARNAS, G.Brotzu, Cagliari, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain.,Area of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Gualtierotti R, Ruscica M. Editorial: The molecular mechanisms and therapeutic targets of atherosclerosis. Front Cardiovasc Med 2023; 9:1127693. [PMID: 36704475 PMCID: PMC9872130 DOI: 10.3389/fcvm.2022.1127693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Roberta Gualtierotti
- Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, S.C. Medicina - Emostasi e Trombosi, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
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Weitz JI, Szekanecz Z, Charles-Schoeman C, Vranic I, Sahin B, Paciga SA, Wang Z, Hyde C, Martin DA. Biomarkers to predict risk of venous thromboembolism in patients with rheumatoid arthritis receiving tofacitinib or tumour necrosis factor inhibitors. RMD Open 2022; 8:rmdopen-2022-002571. [PMID: 36323490 PMCID: PMC9639150 DOI: 10.1136/rmdopen-2022-002571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE In the ORAL (Oral Rheumatoid Arthritis triaL) Surveillance study of patients with rheumatoid arthritis aged ≥50 years with ≥1 additional cardiovascular risk factor, incidence of pulmonary embolism was higher with tofacitinib 10 mg two times per day than with tumour necrosis factor inhibitors (TNFi). This exploratory post hoc analysis examined whether biomarkers explained the associations of tofacitinib versus TNFi with venous thromboembolism (VTE). METHODS ORAL Surveillance was a prospective, open-label, event-driven, non-inferiority, postauthorisation safety study. Patients were randomised 1:1:1 to receive tofacitinib 5 mg or 10 mg two times per day or a TNFi. For this analysis, 294 soluble, proteomic, genetic and antibody biomarkers (of which 79 had a known role in inflammation, coagulation, vascular biology or Janus kinase signalling) were quantified in serum collected at baseline, month 12 and study end. RESULTS Overall, 4362 patients were randomised and treated. The exploratory biomarker data set included 285 patients (57 VTE cases; 228 matched controls). D-dimer was quantified in 3732 patients (54 VTE cases; 3678 controls). No biomarker demonstrated a clear mechanistic association with the increased risk of VTE for tofacitinib versus TNFi. Month 12 D-dimer levels were positively associated with risk of a subsequent VTE within the tofacitinib 5 mg and 10 mg two times per day arms. CONCLUSIONS Overall, this post hoc analysis did not identify biomarkers that explained the increased VTE risk for tofacitinib versus TNFi. Individual VTE risk should be considered when making decisions about initiation or maintenance of tofacitinib treatment. TRIAL REGISTRATION NUMBER NCT02092467; ClinicalTrials.gov.
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Affiliation(s)
- Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada,The Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Christina Charles-Schoeman
- Division of Rheumatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Burak Sahin
- Immunology & Inflammation Medical Affairs, Pfizer Inc, Istanbul, Turkey
| | | | - Zhenyu Wang
- Immunology & Inflammation Research, Pfizer Inc, Cambridge, Massachusetts, USA
| | - Craig Hyde
- Biostatistics, Pfizer Inc, Groton, Connecticut, USA
| | - David A Martin
- Immunology & Inflammation Research, Pfizer Inc, Cambridge, Massachusetts, USA
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Endothelial dysfunction markers and immune response indices in cosmonauts' blood after long-duration space flights. NPJ Microgravity 2022; 8:46. [PMID: 36323692 PMCID: PMC9630277 DOI: 10.1038/s41526-022-00237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/12/2022] [Indexed: 12/01/2022] Open
Abstract
Space flight factors are known to cause a malfunction in the human immune system and lead to damage to blood vessels. The hemostatic function of endothelium during space missions and its interaction with human immunity has not been determined so far. In this work, we investigated the markers of endothelial activation and damage (plasma concentrations of soluble thrombomodulin fraction (sTM), von Willebrand factor (vWF), highly sensitive C-reactive protein (hs-CRP)), as well as the level of D-dimer and compared them to the immunological parameters characterizing the state of human humoral and cellular immunity. The immune status of long-duration ISS crewmembers was assessed by whole-blood testing, and comprehensive postflight immune assessment included the analysis of leukocyte distribution. Flow cytometry was applied to determine the absolute counts and the percentage of lymphocyte subsets: B cells (CD19+), T cells (CD3+, CD3+CD4+, CD3+CD8+), NK cells (CD3-CD16+CD56+, CD11b+CD56+), and activated subsets (CD3+CD25+ and CD3+HLA-DR+). The in vitro basal cytokine production was investigated in whole blood cell culture. The cytokines IFN-gamma, IL-1-beta, IL-4, IL-6, IL-10, IL-18, and TNF-alpha were measured in plasma and the 24-h supernatants by a sensitive enzyme-linked immunosorbent assay. A significant increase in the plasma levels of vWF and hs-CRP and a decrease in the concentration of sTM after spaceflights were detected. Divergent changes in the parameters characterizing the state of the immune system were observed. We propose that the changes revealed may lead to an increase in the procoagulant activity of blood plasma, suppression of protein C activation and thrombin inhibition, as well as to an increase in the adhesive-aggregate potential of platelets, especially in case of changes in the rheological characteristics of blood flow during re-adaptation to ground conditions. We also speculate that the immune system might play an important role in vessel damage during long-duration missions.
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Berthe P, Scailteux LM, Lescoat A, Staumont D, Coiffier G, Guéret P, Dupuy A, Oger E, Droitcourt C. Oral Janus kinase inhibitors and venous thromboembolic events in atopic dermatitis: protocols for a case-time control study and a nested case-control study based on the French national health insurance (SNDS) cohort. BMJ Open 2022; 12:e059979. [PMID: 36130766 PMCID: PMC9494565 DOI: 10.1136/bmjopen-2021-059979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a highly prevalent, chronic, inflammatory skin disease. Several orally administered Janus kinase inhibitors (JAKis, including baricitinib, upadacitinib and abrocitinib) have received a marketing authorisation for AD.Clinical trials in rheumatoid arthritis (RA) have flagged up a potential risk of JAKi-induced venous thromboembolic events (VTEs). Accordingly, the summary of product characteristics for a JAKi must mention VTEs as potential adverse drug reactions. In contrast to RA, AD per se is not associated with an elevated risk of VTEs. Assessing this potential risk among patients with AD would shed further light on the putative underlying relationship between JAKis and VTEs.Our research question is to investigate whether JAKi administration increases the risk of VTEs in adults with AD. Our primary objective is to assess the risk of VTEs in adults with AD exposed to JAKis compared to AD adults not exposed to JAKis, and our secondary objective is to evaluate whether JAKi initiation acts as a trigger of VTEs in adults with AD within 3 months. METHODS AND ANALYSIS Hence, we have designed (1) a nested case-control study and (2) a case-time control study in a cohort of adults with AD with data from the French national health insurance system (2017-2025).Here, we describe the study protocol, our methodological choices and certain novel aspects, including the combined value of the two assumptions and the use of an exhaustive national health insurance database with potentially greater statistical power for studying rare events in the population of patients with AD at a low risk of VTEs (thus limiting the influence of confounding factors). ETHICS AND DISSEMINATION The protocol has been approved by an independent ethics committee and registered with the French National Data Protection Commission. The study's findings will be published in peer-reviewed scientific journals and presented at international conferences.
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Affiliation(s)
| | - Lucie-Marie Scailteux
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Alain Lescoat
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
- Internal Medicine and Clinical Immunology, CHU Rennes, Rennes, France
| | - Delphine Staumont
- Department of Dermatology, Lille University Hospital Center, Lille, France
| | - Guillaume Coiffier
- Department of Rheumatology, CH Dinan, Dinan, France
- INSERM, INRA, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | | | - Alain Dupuy
- Department of Dermatology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
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12
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Vedder D, Gerritsen M, Meijers JCM, Nurmohamed MT. Coagulation in gout: is there a link with disease activity? Clin Rheumatol 2022; 41:1809-1815. [PMID: 35102534 PMCID: PMC9119879 DOI: 10.1007/s10067-022-06047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/24/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
Objective To investigate the coagulation system in gout patients and associations between disease activity and levels of coagulation markers. Methods A prospective cohort study was performed with data from 30 Dutch gout patients. Levels of coagulation markers including APTT, PT, D-dimer, prothrombin F1 + 2, von Willebrand factor, and thrombin generation parameters were analyzed at baseline and 1-year visit. These markers were related to clinical markers of gout disease activity including the Gout Activity Score (GAS). Our hypothesis was that patients with gout and active disease have increased levels of coagulation markers and that a decrease in disease activity would lead to normalization of coagulation activity. Results A higher GAS was associated with increased levels of thrombin generation parameters including ETP (ß = 0.48, p = 0.01), peak thrombin (ß = 0.60, p = 0.001), and velocity index (ß = 0.57, p = 0.002). Tophaceous gout and higher SUA levels were associated with thrombin generation parameters. After 1 year, thrombin generation parameters showed a small procoagulant trend despite a moderate decrease in disease activity. Prospectively measured changes in disease activity according to the GAS were not associated with any of the coagulation markers. Conclusion Patients with active gout have higher levels of thrombin generation markers, indicating a link between disease activity and coagulation. A change in disease activity after 1 year was not associated with significant changes in coagulation markers, probably due to prolonged low-grade inflammation. Future studies should focus on levels of coagulation markers in comparison with the general population and the effect of adequate gout treatment.Key Points • Patients with gout have an increased risk of cardiovascular events. • High disease activity was associated with higher levels of thrombin generation markers. • Over time, small decreases in inflammation were associated with a decrease in D-dimer and thrombin generation. |
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Affiliation(s)
- Daisy Vedder
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands. .,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands.
| | - Martijn Gerritsen
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Molecular Hematology, Sanquin Research, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands.,Department of Rheumatology, Amsterdam UMC, Amsterdam, the Netherlands
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13
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Conforti A, Berardicurti O, Pavlych V, Di Cola I, Cipriani P, Ruscitti P. Incidence of venous thromboembolism in rheumatoid arthritis, results from a "real-life" cohort and an appraisal of available literature. Medicine (Baltimore) 2021; 100:e26953. [PMID: 34414960 PMCID: PMC8376311 DOI: 10.1097/md.0000000000026953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/24/2021] [Indexed: 11/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with an increased risk of venous thromboembolism (VTE) occurrence. In this work, we assessed the incidence and predictive factors of VTE in our "real-life" cohort of RA patients. To contextualize our results, we reviewed the available literature about this topic.We performed a retrospective analysis of prospectively followed-up patients with RA attending our Rheumatologic Clinic between January 2010 and December 2020. Each patient was investigated for VTE occurrence. Incident cases were reported as incidence proportion and incidence rate per 1000 person-years at risk. Possible predictive factors were also exploited by regression analyses. Available literature about this topic was also assessed.In this evaluation, 347 consecutive patients without previous evidence of VTE, attending our Rheumatologic Clinic from 2010 to 2020, were studied. In our "real-life" cohort, the incidence proportion of VTE was 3.7% (2.7-4.7%) and considering over 1654 person-years, an incidence rate of 7.8 × 1000 (2.5-11.7). Exploratively assessing predictive factors in our cohort, older age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01-1.14, p = .015), higher body mass index (HR 1.37, 95% CI 1.04-1.80, P = .026), and longer disease duration (HR 1.11, 95% CI 1.03-1.20, P = .006) resulted to be significant predictors of VTE occurrence during the follow-up.In our "real-life" cohort, VTE burden has been suggested in patients with RA. Comparing our results with previous data derived from randomized controlled trials and administrative data, some different findings were retrieved about incidence of VTE. Assessing predictive factors, older age, higher body mass index, and longer disease duration resulted to be significant predictors of VTE occurrence during the follow-up. Taking together these observations, a further evaluation of this issue on specific designed studies is needed to provide more generalizable results to the daily clinical practice.
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14
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Plasma fibrinogen, D-dimer, and fibrin degradation product as biomarkers of rheumatoid arthritis. Sci Rep 2021; 11:16903. [PMID: 34413382 PMCID: PMC8377052 DOI: 10.1038/s41598-021-96349-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022] Open
Abstract
This study aimed to assess the association of coagulation-related indicators such as plasma fibrinogen (FIB), d-dimer, and fibrin degradation product (FDP) in rheumatoid arthritis (RA) with the disease activity. Data from 105 RA patients and 102 age- and gender-matched healthy controls were collected in the retrospective study. Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) was used to divide RA patients into low activity group (DAS28-CRP ≤ 2.7) and active group (DAS28-CRP > 2.7). Receiver operating characteristic (ROC) curve was applied to determine area under the curve (AUC). The association between plasma FIB, d-dimer, and FDP and DAS28-CRP was evaluated by spearman correlation. Logistical regression analysis was used to identify the independent variables associated with RA disease activity. RA patients showed higher levels of plasma FIB, d-dimer, and FDP than the controls (P < 0.01). Plasma FIB, d-dimer, and FDP were also increased in active groups of RA patients than those in inactive groups (P < 0.001). ROC curve analyses revealed that the AUC of d-dimer was higher than erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF), and that of FDP was higher than RF in RA patients. In addition, the optimal cut-off value of plasma FIB, d-dimer, and FDP for RA diagnosis was 286 mg/dL, 470 μg/L, and 1.45 mg/L, respectively. Spearman analysis showed that plasma FIB, d-dimer, and FDP were positively related with DAS28-CRP (P < 0.001) in RA patients. Logistical regression analysis showed that d-dimer (odds ratio 2.862, 95% confidence interval 1.851–5.426, P < 0.001) was an independent variable associated with RA disease activity. FIB, d-dimer, and FDP were increased in RA patients and positively correlated with the disease activity of RA. d-dimer may act as a novel inflammatory indice for indicating disease activity in RA patients.
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15
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Kang BX, Xu H, Gao CX, Zhong S, Zhang J, Xie J, Sun ST, Ma YH, Xu XR, Zhao C, Zhai WT, Xiao LB, Gao XJ. Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study. BMC Musculoskelet Disord 2021; 22:425. [PMID: 33962594 PMCID: PMC8105956 DOI: 10.1186/s12891-021-04307-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P < 0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).
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Affiliation(s)
- Bing-Xin Kang
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Hui Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Chen-Xin Gao
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Sheng Zhong
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Jing Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Jun Xie
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Song-Tao Sun
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Ying-Hui Ma
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Xi-Rui Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Chi Zhao
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Wei-Tao Zhai
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China
| | - Lian-Bo Xiao
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China. .,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, CN, China.
| | - Xiao-Jun Gao
- Shanghai University of Traditional Chinese Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, CN, China.
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16
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Atzeni F, Rodríguez-Carrio J, Popa CD, Nurmohamed MT, Szűcs G, Szekanecz Z. Cardiovascular effects of approved drugs for rheumatoid arthritis. Nat Rev Rheumatol 2021; 17:270-290. [PMID: 33833437 DOI: 10.1038/s41584-021-00593-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
The risk of cardiovascular disease is increased in patients with rheumatoid arthritis compared with the general population owing to the influence of traditional and non-traditional risk factors. Inflammation has a pivotal contribution and can accelerate the atherosclerotic process. Although dampening inflammation with DMARDs should theoretically abrogate this process, evidence suggests that these drugs can also promote atherosclerosis directly and indirectly, hence adding to an increased cardiovascular burden. However, the extent and direction of the effects largely differ across drugs. Understanding how these drugs influence endothelial damage and vascular repair mechanisms is key to understanding these outcomes. NSAIDs and glucocorticoids can increase the cardiovascular risk. Conversely, conventional, biologic and targeted DMARDs control inflammation and reduce this risk, although some of these drugs can also aggravate traditional factors or thrombotic events. Given these data, the fundamental objective for clinicians should be disease control, in an individualized approach that considers the most appropriate drug for each patient, taking into account joint and cardiovascular outcomes. This Review provides a comprehensive analysis of the effects of DMARDs and other approved drugs on cardiovascular involvement in rheumatoid arthritis, from a clinical and mechanistic perspective, with a roadmap to inform the research agenda.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy.
| | - Javier Rodríguez-Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Călin D Popa
- Department of Rheumatology, Sint Maartenskliniek Nijmegen, Nijmegen, The Netherlands
| | - Michael T Nurmohamed
- Deptartment of Rheumatology, Amsterdam University Medical Center & Reade, Amsterdam, The Netherlands
| | - Gabriella Szűcs
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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17
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The incidence and risk factors for venous thromboembolic events in patients with psoriasis and psoriatic arthritis. Semin Arthritis Rheum 2021; 51:547-552. [PMID: 33895651 DOI: 10.1016/j.semarthrit.2021.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The risk of arterial vascular events is increased in patients with psoriatic disease (PsD), however, limited information exists about the risk of venous thromboembolism (VTE) in these patients. We assessed the incidence and risk factors for VTE in patients with PsD. METHODS A multicentre cohort study was conducted involving patients with PsD followed prospectively from 1994 to 2020. Information about VTE, including pulmonary embolism (PE) and deep venous thrombosis (DVT), was obtained from provincial hospitalization databases. The incidence rate and cumulative probability of developing VTE were computed. Cox proportional hazards models were used to assess the association between risk factors, including comorbidities and disease-related factors, and the first VTE. RESULTS A total 2,433 patients with PsD were analysed with 26 incident VTE (7 DVT alone, 12 PE alone, and 7 both PE and DVT). The incidence rates of the first VTE, DVT, and PE were 12, 6.5, and 8.8 events per 10,000 patient-years, respectively. The cumulative proportion of individuals developing VTE was 4.6% by 80 years of age. Independent predictors for VTE included older age, diabetes mellitus, and corticosteroid usage (all p<0.05). CONCLUSION Older patients with PsD, those with diabetes, and those using corticosteroids are at a higher risk of developing VTE. Risk stratification of patients with these identified risk factors for VTE will allow for more individualized patient management and improved medication selection.
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18
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Yalta K, Yetkin E, Yalta T. Systemic inflammation in patients with Takotsubo syndrome: a review of mechanistic and clinical implications. Monaldi Arch Chest Dis 2021; 91. [PMID: 33728882 DOI: 10.4081/monaldi.2021.1718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022] Open
Abstract
Over recent decades, systemic inflammation as quantified with inflammation markers or indices has been extensively investigated in the setting of various cardiovascular conditions including heart failure (HF), acute coronary syndromes (ACS). In contrast, systemic inflammation in patients with takotsubo syndrome (TTS) has been an underrated phenomenon in clinical practice. On the other hand, experimental and clinical data have been rapidly accumulating in the recent years regarding pathogenetic, prognostic as well as therapeutic implications of systemic inflammation in TTS. Accordingly, the present article aims to provide a general perspective on mechanistic and clinical aspects of systemic inflammation in the setting of TTS.
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Affiliation(s)
- Kenan Yalta
- CardiologyDepartment, Trakya University, Edirne.
| | - Ertan Yetkin
- Cardiology Department, Derindere Hospital, Istanbul.
| | - Tulin Yalta
- Pathology Department, Trakya University, Edirne.
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19
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Bell J, Sequeira S, Kamalapathy P, Puvanesarajah V, Hassanzadeh H. Rheumatoid Arthritis Increases Risk of Medical Complications Following Posterior Lumbar Fusion. World Neurosurg 2021; 149:e729-e736. [PMID: 33548531 DOI: 10.1016/j.wneu.2021.01.110] [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: 09/21/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic disease with prominent musculoskeletal manifestations that is associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in patients with RA following lumbar surgery. The aim of this study was to evaluate whether patients with RA who underwent posterior lumbar fusion experienced increased postoperative complications and economic burden compared with patients without RA. METHODS Patients <85 years old who underwent elective 1- or 2-level instrumented posterior lumbar fusion for degenerative lumbar pathology between 2006 and 2012 were identified in the Medicare insurance claims database. Same-day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with RA before fusion and patients without RA (controls). All outcomes of interest were compared using multivariate regression. Reoperation-free survival at 1- and 2-year follow-up was analyzed used log-rank test. Significance was defined as P < 0.05. RESULTS RA patients had significantly higher risk of 90-day readmission (odds ratio [OR] = 1.27, P < 0.001), thromboembolic events (OR = 1.39, P = 0.010), sepsis (OR = 2.32, P < 0.001), pneumonia (OR = 1.57, P = 0.001), and wound complications (OR = 1.41, P < 0.001). Reoperation-free survival was significantly lower in RA patients at 2-year follow-up (90.4% vs. 92.4%, P < 0.001). Following adjusted regression, RA independently contributed to a $1491 increase in additional 90-day costs (P < 0.001). CONCLUSIONS Preexisting RA may increase risk for short-term postoperative medical complications following posterior lumbar fusion, specifically infectious events. In addition, patients with RA have higher rates of subsequent reoperation following index surgery. Patients with RA be should counseled regarding these risks.
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Affiliation(s)
- Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sean Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
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20
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Hansildaar R, Vedder D, Baniaamam M, Tausche AK, Gerritsen M, Nurmohamed MT. Cardiovascular risk in inflammatory arthritis: rheumatoid arthritis and gout. THE LANCET. RHEUMATOLOGY 2021; 3:e58-e70. [PMID: 32904897 PMCID: PMC7462628 DOI: 10.1016/s2665-9913(20)30221-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The increased risk of cardiovascular morbidity and mortality in rheumatoid arthritis and gout has been increasingly acknowledged in past decades, with accumulating evidence that gout, just as with rheumatoid arthritis, is an independent cardiovascular risk factor. Although both diseases have a completely different pathogenesis, the underlying pathophysiological mechanisms in systemic inflammation overlap to some extent. Following the recognition that systemic inflammation has an important causative role in cardiovascular disease, anti-inflammatory therapy in both conditions and urate-lowering therapies in gout are expected to lower the cardiovascular burden of patients. Unfortunately, much of the existing data showing that urate-lowering therapy has consistent beneficial effects on cardiovascular outcomes in patients with gout are of low quality and contradictory. We will discuss the latest evidence in this respect. Cardiovascular disease risk management for patients with rheumatoid arthritis and gout is essential. Clinical guidelines and implementation of cardiovascular risk management in daily clinical practice, as well as unmet needs and areas for further investigation, will be discussed.
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Affiliation(s)
- Romy Hansildaar
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Daisy Vedder
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Milad Baniaamam
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Martijn Gerritsen
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
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NFAT5 directs hyperosmotic stress-induced fibrin deposition and macrophage infiltration via PAI-1 in endothelium. Aging (Albany NY) 2020; 13:3661-3679. [PMID: 33410782 PMCID: PMC7906158 DOI: 10.18632/aging.202330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/31/2020] [Indexed: 12/12/2022]
Abstract
Although stress can significantly promote atherosclerosis, the underlying mechanisms are still not completely understood. Here we successfully unveiled that high salt-induced nuclear factor of activated T cells 5 (NFAT5) control the endothelial-dependent fibrinolytic activity and the inflammatory adhesion-related molecules expression through regulation of plasminogen activator inhibitor-1 (PAI-1). We first observed that high salt diets instigated the expression of NFAT5 and PAI-1 in the endothelium which brought about the fibrin deposition and macrophage infiltration in the atherosclerotic arteries of ApoE-/- mice. Overexpression of NFAT5 increased PAI-1-mediated antifibrinolytic activity and activated inflammatory adhesion-related genes in endothelial cells. Knockdown of NFAT5 by siRNA inhibited the expression of PAI-1, antifibrinolytic and adhesive molecules. Moreover, chromatin immunoprecipitation assay demonstrated that high salt intake significantly promoted the binding of NFAT5 to PAI-1 promoter (TGGAATTATTT) in endothelial cells. Our study identified that NFAT5 has great potential to activate the PAI-1-mediated fibrinolytic dysfunction and inflammatory cell adhesion, thus promoting high salt-induced atherosclerosis disease.
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22
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Peshkova AD, Evdokimova TA, Sibgatullin TB, Ataullakhanov FI, Litvinov RI, Weisel JW. Accelerated Spatial Fibrin Growth and Impaired Contraction of Blood Clots in Patients with Rheumatoid Arthritis. Int J Mol Sci 2020; 21:ijms21249434. [PMID: 33322373 PMCID: PMC7764115 DOI: 10.3390/ijms21249434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 01/14/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease associated with thrombotic complications. To elucidate pathogenic mechanisms, hemostatic disorders in RA were correlated with other laboratory and clinical manifestations. Hemostasis was assessed using relatively new complementary tests, the spatial growth of a plasma clot (Thrombodynamics assay), and contraction of whole blood clots. Platelet functionality was assessed with flow cytometry that quantified the expression of P-selectin and the fibrinogen-binding capacity of platelets before and after activation with a thrombin receptor-activating peptide. Parameters of fibrin clot growth and the kinetics of contraction of blood clots were significantly altered in patients with RA compared to the control group. In Thrombodynamics measurements, an increase in the clot growth rate, size, and optical density of plasma clots altogether indicated chronic hypercoagulability. The rate and extent of blood clot contraction in patients with RA was significantly reduced and associated with platelet dysfunction revealed by an impaired response to activation. Changes in the parameters of clot growth and contraction correlated with the laboratory signs of systemic inflammation, including hyperfibrinogenemia. These results confirm the pathogenic role of hemostatic disorders in RA and support the validity of fibrin clot growth and the blood clot contraction assay as indicators of a (pro)thrombotic state.
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Affiliation(s)
- Alina D. Peshkova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (A.D.P.); (T.A.E.); (R.I.L.)
| | - Tatiana A. Evdokimova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (A.D.P.); (T.A.E.); (R.I.L.)
| | - Timur B. Sibgatullin
- Department of Rheumatology, University Hospital, Kazan Federal University, Kazan 420008, Russia;
| | - Fazoil I. Ataullakhanov
- Center for Theoretical Problems of Physico-Chemical Pharmacology, Russian Academy of Sciences, Moscow 119991, Russia;
| | - Rustem I. Litvinov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia; (A.D.P.); (T.A.E.); (R.I.L.)
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - John W. Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- Correspondence:
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23
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Visman I, Heslinga M, van Denderen C, van der Horst-Bruinsma I, Miltenburg A, Meijers J, Nurmohamed M. Favorable effects on the hemostatic system in ankylosing spondylitis patients treated with golimumab. Joint Bone Spine 2020; 88:105102. [PMID: 33166729 DOI: 10.1016/j.jbspin.2020.105102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ingrid Visman
- Amsterdam Rheumatology and immunology Center
- Reade, Amsterdam, Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
| | - Maaike Heslinga
- Amsterdam Rheumatology and immunology Center
- Reade, Amsterdam, Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands
| | - Christiaan van Denderen
- Amsterdam Rheumatology and immunology Center
- Reade, Amsterdam, Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands
| | - Irene van der Horst-Bruinsma
- Amsterdam Rheumatology and immunology Center
- Amsterdam University Medical Center location VUmc, Amsterdam, The Netherlands
| | | | - Joost Meijers
- Amsterdam UMC, University of Amsterdam, Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, The Netherlands
| | - Michael Nurmohamed
- Amsterdam Rheumatology and immunology Center
- Reade, Amsterdam, Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands; Amsterdam Rheumatology and immunology Center
- Amsterdam University Medical Center location VUmc, Amsterdam, The Netherlands
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24
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Carbone F, Bonaventura A, Liberale L, Paolino S, Torre F, Dallegri F, Montecucco F, Cutolo M. Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents. Clin Rev Allergy Immunol 2020; 58:1-14. [PMID: 30259381 DOI: 10.1007/s12016-018-8714-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Substantial epidemiological data identified cardiovascular (CV) diseases as a main cause of mortality in patients with rheumatoid arthritis (RA). In light of this, RA patients may benefit from additional CV risk screening and more intensive prevention strategies. Nevertheless, current algorithms for CV risk stratification still remain tailored on general population and are burdened by a significant underestimation of CV risk in RA patients. Acute CV events in patients with RA are largely related to an accelerated atherosclerosis. As pathophysiological features of atherosclerosis overlap those occurring in the inflamed RA synovium, the understanding of those common pathways represents an urgent need and a leading challenge for CV prevention in patients with RA. Genetic background, metabolic status, gut microbiome, and systemic inflammation have been also suggested as additional key pro-atherosclerotic factors. The aim of this narrative review is to update the current knowledge about pathophysiology of atherogenesis in RA patients and potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs.
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Affiliation(s)
- Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952, Schlieren, Switzerland
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy
| | - Francesco Torre
- IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy.,Clinic of Emergency Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Maurizio Cutolo
- IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy. .,Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy.
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25
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Li Y, Zhang Y, Xu W, Liang J, Luo X, Han X, Shi X, Jie H, Li X, He Y, Sun E. Activated coagulation is associated with the disease activity of axial spondyloarthritis. Int Immunopharmacol 2020; 88:106979. [PMID: 33182036 DOI: 10.1016/j.intimp.2020.106979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Activation of the coagulation system has been related to disease activity in some inflammatory diseases. Here, we aimed to investigate the relationship between coagulation function and the disease activity of axial spondyloarthritis (axSpA). METHODS This study retrospectively recruited 144 axSpA patients and 55 healthy controls. The patients were divided into an active group (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI ≥ 4) and a remission group (BASDAI < 4). The coagulation, inflammatory and clinical parameters were detected. The correlations between these parameters were analyzed with Spearman's correlation analysis. Receiver operating characteristic (ROC) curve analysis was performed to compare the values of these variables in discriminating disease activity. Furthermore, binary logistic regression analysis was used to assess the risk factors for axSpA disease activity. RESULTS Fibrinogen (FIB) was increased in the axSpA group compared to healthy controls (P < 0.001). Additionally, FIB and D-dimer were higher in the active group than in the remission group (P < 0.05, respectively). FIB and D-dimer were positively correlated with ESR, CRP, BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) (P < 0.05, respectively). The area under the curve (AUC) of FIB was higher than that of ESR, CRP and D-dimer. The optimal cut-off value of FIB was 3.23 g/L, with a specificity of 62.0% and sensitivity of 75.0%. FIB (OR = 4.335, 95% CI: 1.262-14.888, P = 0.020) and BASFI score (OR = 1.878, 95% CI: 1.441-2.448, P < 0.001) were independent risk factors affecting disease activity. CONCLUSION Activated coagulation is closely related to the disease activity of axSpA. FIB and D-dimer might be novel indicators for monitoring the disease activity of axSpA.
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Affiliation(s)
- Yehao Li
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Yanan Zhang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Wenchao Xu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Jianheng Liang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Xiaoqing Luo
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Xinai Han
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Xingliang Shi
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Hongyu Jie
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Xing Li
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Yi He
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China.
| | - Erwei Sun
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China.
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26
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Mease P, Charles-Schoeman C, Cohen S, Fallon L, Woolcott J, Yun H, Kremer J, Greenberg J, Malley W, Onofrei A, Kanik KS, Graham D, Wang C, Connell C, Valdez H, Hauben M, Hung E, Madsen A, Jones TV, Curtis JR. Incidence of venous and arterial thromboembolic events reported in the tofacitinib rheumatoid arthritis, psoriasis and psoriatic arthritis development programmes and from real-world data. Ann Rheum Dis 2020; 79:1400-1413. [PMID: 32759265 PMCID: PMC7569391 DOI: 10.1136/annrheumdis-2019-216761] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
Objectives Tofacitinib is a Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ulcerative colitis, and has been investigated in psoriasis (PsO). Routine pharmacovigilance of an ongoing, open-label, blinded-endpoint, tofacitinib RA trial (Study A3921133; NCT02092467) in patients aged ≥50 years and with ≥1 cardiovascular risk factor identified a higher frequency of pulmonary embolism (PE) and all-cause mortality for patients receiving tofacitinib 10 mg twice daily versus those receiving tumour necrosis factor inhibitors and resulted in identification of a safety signal for tofacitinib. Here, we report the incidence of deep vein thrombosis (DVT), PE, venous thromboembolism (VTE; DVT or PE) and arterial thromboembolism (ATE) from the tofacitinib RA (excluding Study A3921133), PsA and PsO development programmes and observational studies. Data from an ad hoc safety analysis of Study A3921133 are reported separately within. Methods This post-hoc analysis used data from separate tofacitinib RA, PsO and PsA programmes. Incidence rates (IRs; patients with events per 100 patient-years’ exposure) were calculated for DVT, PE, VTE and ATE, including for populations stratified by defined baseline cardiovascular or VTE risk factors. Observational data from the US Corrona registries (including cardiovascular risk factor stratification), IBM MarketScan research database and the US FDA Adverse Event Reporting System (FAERS) database were analysed. Results 12 410 tofacitinib-treated patients from the development programmes (RA: n=7964; PsO: n=3663; PsA: n=783) were included. IRs (95% CI) of thromboembolic events among the all tofacitinib cohorts’ average tofacitinib 5 mg and 10 mg twice daily treated patients for RA, respectively, were: DVT (0.17 (0.09–0.27) and 0.15 (0.09–0.22)); PE (0.12 (0.06–0.22) and 0.13 (0.08–0.21)); ATE (0.32 (0.22–0.46) and 0.38 (0.28–0.49)). Among PsO patients, IRs were: DVT (0.06 (0.00–0.36) and 0.06 (0.02–0.15)); PE (0.13 (0.02–0.47) and 0.09 (0.04–0.19)); ATE (0.52 (0.22–1.02) and 0.22 (0.13–0.35)). Among PsA patients, IRs were: DVT (0.00 (0.00–0.28) and 0.13 (0.00–0.70)); PE (0.08 (0.00–0.43) and 0.00 (0.00–0.46)); ATE (0.31 (0.08–0.79) and 0.38 (0.08–1.11)). IRs were similar between tofacitinib doses and generally higher in patients with baseline cardiovascular or VTE risk factors. IRs from the overall Corrona populations and in Corrona RA patients (including tofacitinib-naïve/biologic disease-modifying antirheumatic drug-treated and tofacitinib-treated) with baseline cardiovascular risk factors were similar to IRs observed among the corresponding patients in the tofacitinib development programme. No signals of disproportionate reporting of DVT, PE or ATE with tofacitinib were identified in the FAERS database. Conclusions DVT, PE and ATE IRs in the tofacitinib RA, PsO and PsA programmes were similar across tofacitinib doses, and generally consistent with observational data and published IRs of other treatments. As expected, IRs of thromboembolic events were elevated in patients with versus without baseline cardiovascular or VTE risk factors, and were broadly consistent with those observed in the Study A3921133 ad hoc safety analysis data, although the IR (95% CI) for PE was greater in patients treated with tofacitinib 10 mg twice daily in Study A3921133 (0.54 (0.32–0.87)), versus patients with baseline cardiovascular risk factors treated with tofacitinib 10 mg twice daily in the RA programme (0.24 (0.13–0.41)).
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Affiliation(s)
- Philip Mease
- Rheumatology Clinical Research Division, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA
| | | | | | - Lara Fallon
- Inflammation and Immunology - Global Medical Affairs, Pfizer Inc, Kirkland, Quebec, Canada
| | - John Woolcott
- Inflammation and Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Huifeng Yun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joel Kremer
- Albany Medical College and The Center for Rheumatology, Albany, New York, USA
| | | | | | | | - Keith S Kanik
- Inflammation and Immunology TA, Pfizer Inc, Groton, Connecticut, USA
| | - Daniela Graham
- Inflammation and Immunology TA, Pfizer Inc, Groton, Connecticut, USA
| | - Cunshan Wang
- Statistics, Global Product Development, Pfizer Inc, Groton, Connecticut, USA
| | - Carol Connell
- Clinical Development & Operations, Pfizer Inc, Groton, Connecticut, USA
| | - Hernan Valdez
- Global Product Development, Inflammation and Immunology, Pfizer Inc, New York, New York, USA
| | - Manfred Hauben
- Worldwide Safety, Pfizer Inc, New York, New York, USA.,Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Eric Hung
- Worldwide Safety, Pfizer Inc, New York, New York, USA
| | - Ann Madsen
- Global Medical Epidemiology, Pfizer Inc, New York, New York, USA
| | - Thomas V Jones
- Worldwide Medical and Safety, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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GlycA Levels during the Earliest Stages of Rheumatoid Arthritis: Potential Use as a Biomarker of Subclinical Cardiovascular Disease. J Clin Med 2020; 9:jcm9082472. [PMID: 32752190 PMCID: PMC7463667 DOI: 10.3390/jcm9082472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
This study aimed at evaluating the clinical relevance of glycoprotein profiles during the earliest phases of rheumatoid arthritis (RA) as biomarkers of cardiovascular (CV) risk and treatment response. Then, GlycA and GlycB serum levels were measured using 1H-nuclear magnetic resonance in 82 early RA patients, 14 clinically-suspect arthralgia (CSA), and 28 controls. Serum glycosyltransferase activity was assessed by a colorimetric assay. Subclinical CV disease was assessed by Doppler-ultrasound. We found that GlycA and GlycB serum levels were increased in RA (both p < 0.001), but not in CSA, independently of cardiometabolic risk factors. Increased serum glycosyltransferase activity paralleled GlycA (r = 0.405, p < 0.001) and GlycB levels (r = 0.327, p = 0.005) in RA. GlycA, but not GlycB, was associated with atherosclerosis occurrence (p = 0.012) and severity (p = 0.001). Adding GlycA to the mSCORE improved the identification of patients with atherosclerosis over mSCORE alone, increasing sensitivity (29.7 vs. 68.0%) and accuracy (55.8 vs. 76.6%) and allowing reclassification into more appropriate risk categories. GlycA-reclassification identified patients with impaired lipoprotein metabolism. Finally, baseline GlycA levels predicted poor clinical response upon anti-rheumatic treatment at 6 and 12 months in univariate and multivariate analysis. In sum, increased GlycA levels during the earliest stage of RA can be considered a powerful biomarker for CV risk stratification and treatment response.
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28
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Fuchs PÖ, Calitz C, Pavlović N, Binet F, Solbak SMØ, Danielson UH, Kreuger J, Heindryckx F, Gerwins P. Fibrin fragment E potentiates TGF-β-induced myofibroblast activation and recruitment. Cell Signal 2020; 72:109661. [PMID: 32334027 DOI: 10.1016/j.cellsig.2020.109661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
Fibrin is an essential constituent of the coagulation cascade, and the formation of hemostatic fibrin clots is central to wound healing. Fibrin clots are over time degraded into fibrin degradation products as the injured tissue is replaced by granulation tissue. Our goal was to study the role of the fibrin degradation product fragment E (FnE) in fibroblast activation and migration. We present evidence that FnE is a chemoattractant for fibroblasts and that FnE can potentiate TGF-β-induced myofibroblast formation. FnE forms a stable complex with αVβ3 integrin, and the integrin β3 subunit is required both for FnE-induced fibroblast migration and for potentiation of TGF-β-induced myofibroblast formation. Finally, subcutaneous infusion of FnE in mice results in a fibrotic response in the hypodermis. These results support a model where FnE released from clots in wounded tissue promote wound healing and fibrosis by both recruitment and activation of fibroblasts. Fibrin fragment E could thus represent a therapeutic target for treatment of pathological fibrosis.
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Affiliation(s)
- Peder Öhman Fuchs
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden
| | - Carlemi Calitz
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden
| | - Nataša Pavlović
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden
| | - François Binet
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden
| | | | - U Helena Danielson
- Dept. of Chemistry-BMC, Uppsala University, P.O. Box 576, SE-751 23 Uppsala, Sweden; Science for Life Laboratory, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Johan Kreuger
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden
| | - Femke Heindryckx
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden.
| | - Pär Gerwins
- Dept. of Medical Cell Biology, Uppsala University, P.O. Box 571, SE-751 23 Uppsala, Sweden; Dept. of Radiology, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
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Tsuji S, Mukai T, Hirano H, Morita Y. In vivo analysis of thrombus formation in arthritic mice. Mod Rheumatol 2020; 31:498-503. [PMID: 32149538 DOI: 10.1080/14397595.2020.1740401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is characterized by inflammation in multiple joints. In addition to causing joint destruction, the persistent systemic inflammation with RA increases the risk of cardiovascular disease. Although there are in vitro studies showing the prothrombotic effect of inflammatory cytokines, especially TNF, in vivo experimental evidence is lacking due to the complexity of in vivo modeling and observation. In this study, we aimed to model in vivo thrombus formation in arthritic mice and to determine whether the arthritic condition would further promote thrombotic formation. METHODS Human TNF-transgenic mice were used as the arthritis model. Thrombus formation was observed on the testicular arterioles. Thrombus formation was induced by reactive oxygen species generated from hematoporphyrin under laser irradiation. RESULTS Platelet thrombus formation was observed in real-time using a laser confocal microscopy in both wild-type and arthritic mice. Quantitative analyses revealed that no significant differences were observed in thrombus formation, represented by platelet attachment time and vascular obstruction time, in our experimental setting. CONCLUSION Although we confirmed the usefulness of this novel technique for in vivo studies, further investigation is required to conclude the possible mechanism of prothrombotic phenotypes under inflammatory conditions.
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Affiliation(s)
- Shoko Tsuji
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Tomoyuki Mukai
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroyasu Hirano
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshitaka Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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30
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Mansour R, Azrielant S, Watad A, Tiosano S, Yavne Y, Comaneshter D, Cohen AD, Amital H. Venous thromboembolism events among RA patients. Mediterr J Rheumatol 2020; 30:38-43. [PMID: 32185341 PMCID: PMC7045915 DOI: 10.31138/mjr.30.1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/29/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is associated with an increased risk for venous thromboembolism. However, so far, relatively few and small size-based studies have been conducted. We aimed to investigate the link between RA and venous thromboembolism utilizing a large sample of subjects originating from a large data base. Materials and methods: The study was performed utilizing the medical database of Clalit Health Services, the largest healthcare provider in Israel. We enrolled all patients with RA and age- and gender-matched controls. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for a multivariate analysis. RA patients were compared to controls regarding the proportion of venous thromboembolic events (defined as deep vein thrombosis, pulmonary embolism or both). Multivariate logistic regression was employed to assess factors associated with thromboembolic events. Results: The study included 11,782 patients with RA and 57,973 age- and gender-matched controls. RA patients had a higher rate of venous thromboembolism events compared with controls (6.92% vs. 3.18%, respectively, p<0.001). RA and mean C-reactive protein levels were found to be independently associated with the proportion of thromboembolic events (OR 2.27 for RA and 1.07 for each 1 mg/dL increment of mean C-reactive protein, respectively). Conclusion: RA and C-reactive protein levels are independently associated with venous thromboembolic events. Physicians should be aware of such findings and have a lower threshold for suspecting detecting such events in patients with RA, mainly those with mean high levels of C-reactive protein.
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Affiliation(s)
- Ribhi Mansour
- Department of Medicine 'B', Sheba Medical Center, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shir Azrielant
- Department of Medicine 'B', Sheba Medical Center, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shmuel Tiosano
- Department of Medicine 'B', Sheba Medical Center, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yarden Yavne
- Department of Medicine 'B', Sheba Medical Center, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Doron Comaneshter
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Demoruelle MK, Wilson TM, Deane KD. Lung inflammation in the pathogenesis of rheumatoid arthritis. Immunol Rev 2020; 294:124-132. [DOI: 10.1111/imr.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Affiliation(s)
| | - Timothy M. Wilson
- Division of Rheumatology University of Colorado Denver Aurora CO USA
| | - Kevin D. Deane
- Division of Rheumatology University of Colorado Denver Aurora CO USA
- Denver Veterans Affairs Medical Center Denver CO USA
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Ogdie A, Kay McGill N, Shin DB, Takeshita J, Jon Love T, Noe MH, Chiesa Fuxench ZC, Choi HK, Mehta NN, Gelfand JM. Risk of venous thromboembolism in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a general population-based cohort study. Eur Heart J 2019; 39:3608-3614. [PMID: 28444172 DOI: 10.1093/eurheartj/ehx145] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/07/2017] [Indexed: 01/31/2023] Open
Abstract
Aims To determine the risk of venous thromboembolism (VTE) defined as the combined endpoint of deep venous thrombosis (DVT) and pulmonary embolism (PE) among patients with psoriatic arthritis (PsA), psoriasis and rheumatoid arthritis (RA) compared with population controls. Methods and results A cohort study was conducted in a primary care medical record database in the UK with data from 1994-2014 among patients with PsA, RA, or psoriasis. Cox proportional hazards models were used to calculate the relative hazards for DVT, PE, and VTE. An interaction with disease modifying anti-rheumatic drugs (DMARD) was hypothesized a priori and was significant. Patients with PsA (n = 12 084), RA (n = 51 762), psoriasis (n = 194 288) and controls (n = 1 225 571) matched on general practice and start date were identified. Patients with RA (with and without a DMARD prescription) and patients with mild psoriasis had significantly elevated risks of VTE (HR 1.35, 1.29, and 1.07, respectively) after adjusting for traditional risk factors. Severe psoriasis and PsA prescribed a DMARD had an elevated but not statistically significant risk for VTE. Findings were similar for DVT. The age-and-sex-adjusted risk of PE was elevated in RA, severe psoriasis and PsA patients prescribed a DMARD. Conclusion While systemic inflammation is a risk factor for VTE, the risk of VTE compared with controls is different among patients with three different inflammatory disorders: RA, PsA, and psoriasis.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, White Building, Room 5024, 3400 Spruce St, Philadelphia, PA, USA
| | - Neilia Kay McGill
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, South Tower, 7th Floor, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Junko Takeshita
- Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Thorvardur Jon Love
- Division of Rheumatology/Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Science, Landspitali University Hospital, Reykjavik, Iceland
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, South Tower, 7th Floor, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Zelma C Chiesa Fuxench
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, South Tower, 7th Floor, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Hyon K Choi
- Division of Rheumatology and Allergy/Immunology, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 165, Boston, MA, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, South Tower, 7th Floor, 3400 Civic Center Blvd, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA
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Gualtierotti R, Ingegnoli F, Boscolo M, Griffini S, Grovetti E, Cugno M. Tocilizumab Effects on Coagulation Factor XIII in Patients with Rheumatoid Arthritis. Adv Ther 2019; 36:3494-3502. [PMID: 31654331 PMCID: PMC6860466 DOI: 10.1007/s12325-019-01118-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 12/19/2022]
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic systemic auto-immune disease associated with a prothrombotic state. Tocilizumab, an interleukin-6 receptor inhibitor, is highly effective in controlling disease activity and thrombotic risk. Factor XIII (FXIII), involved in thrombotic complications, has been reported to be reduced in RA patients during maintenance treatment with tocilizumab, but no data are available before and after the drug administration. Thus, we investigated the effects of tocilizumab on FXIII, thrombin generation and inflammation in patients with RA naïve for the drug. Methods We studied 15 consecutive adult patients with RA at baseline and 4 weeks after the onset of parenteral administration of tocilizumab, measuring disease activity and plasma levels of C-reactive protein (CRP), FXIII, and prothrombin fragments F1+2 by immunoenzymatic methods. Fifteen healthy subjects, sex-and age-matched with patients, served as normal controls for laboratory measurements. Results At baseline, patients with established RA had a median DAS28 of 4.8 (3.2–8.3) and, compared to healthy controls, had higher plasma levels of CRP (p < 0.0001), FXIII (p = 0.017) and F1+2 (p < 0.0001). Four weeks after starting treatment with tocilizumab, based on the EULAR response criteria, eight patients were classifiable as responders and seven as non-responders. In responders, we observed a statistically significant reduction not only of the values of DAS28 and CRP (p = 0.012 for both), ut also of plasma levels of FXIII (p = 0.05) and F1+2 (p = 0.025). In non-responders, all the studied parameters were unchanged. Conclusion The decrease of FXIII and F1+2 levels after tocilizumab treatment observed only in those patients who responded to the drug indicates that the effect of tocilizumab on the prothrombotic state is linked to the control of inflammation and disease activity and not to a direct effect of the drug, thus contributing to the reduction of the cardiovascular risk.
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The Giants (biologicals) against the Pigmies (small molecules), pros and cons of two different approaches to the disease modifying treatment in rheumatoid arthritis. Autoimmun Rev 2019; 19:102421. [PMID: 31733368 DOI: 10.1016/j.autrev.2019.102421] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that, if untreated, can lead to disability and reduce the life expectancy of affected patients. Over the last two decades the improvement of knowledge of the pathogenetic mechanisms leading to the development of the disease has profoundly changed the treatment strategies of RA through the development of biotechnological drugs (bDMARDs) directed towards specific pro-inflammatory targets involved in the RA network. To date, the therapeutic armamentarium for RA includes ten bDMARDs able to produce the depletion B-cells, the blockade of three different pro-inflammatory cytokines (tumour necrosis factor alpha, interleukin-6 and interleukin-1), or the inhibition of T-cell co-stimulation. The introduction of these new compounds has dramatically improved outcomes in the short and long term, although still a significant proportion of patients are unable to reach or maintain the treatment target over time. The identification of the fundamental role of Janus kinases in the process of transduction of the inflammatory signal within the immune cells has recently provided the opportunity to use the new pharmacological class of small molecules for the therapy of RA, further increasing the number of treatment options. In this review the PROS and CONS of these two drug classes will be discussed, trying to provide the evidence currently available to make the right choice based on the analysis of the efficacy and safety profile of the different drugs on the market and close to marketing.
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Do DMARDs and biologic agents protect from cardiovascular disease in patients with inflammatory arthropathies? Autoimmun Rev 2019; 18:102401. [PMID: 31655302 DOI: 10.1016/j.autrev.2019.102401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
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Xue M, Dervish S, McKelvey KJ, March L, Wang F, Little CB, Jackson CJ. Activated protein C targets immune cells and rheumatoid synovial fibroblasts to prevent inflammatory arthritis in mice. Rheumatology (Oxford) 2019; 58:1850-1860. [DOI: 10.1093/rheumatology/key429] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
AbstractObjectivesTo investigate whether activated protein C (APC), a physiological anticoagulant can inhibit the inflammatory/invasive properties of immune cells and rheumatoid arthritis synovial fibroblasts (RASFs) in vitro and prevent inflammatory arthritis in murine antigen-induced arthritis (AIA) and CIA models.MethodsRASFs isolated from synovial tissues of patients with RA, human peripheral blood mononuclear cells (PBMCs) and mouse thymus cells were treated with APC or TNF-α/IL-17 and the following assays were performed: RASF proliferation and invasion by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and cell invasion assays, respectively; cytokines and signalling molecules using ELISA or western blot; Th1 and Th17 phenotypes in human PBMCs or mouse thymus cells by flow cytometry. The in vivo effect of APC was evaluated in AIA and CIA models.ResultsIn vitro, APC inhibited IL-1β, IL-17 and TNF-α production, IL-17-stimulated cell proliferation and invasion and p21 and nuclear factor κB activation in RASFs. In mouse thymus cells and human PBMCs, APC suppressed Th1 and Th17 phenotypes. In vivo, APC inhibited pannus formation, cartilage destruction and arthritis incidence/severity in both CIA and AIA models. In CIA, serum levels of IL-1β, IL-6, IL-17, TNF-α and soluble endothelial protein C receptor were significantly reduced by APC treatment. Blocking endothelial protein C receptor, the specific receptor for APC, abolished the early or preventative effect of APC in AIA.ConclusionAPC prevents the onset and development of arthritis in CIA and AIA models via suppressing inflammation, Th1/Th17 phenotypes and RASF invasion, which is likely mediated via endothelial protein C receptor.
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Affiliation(s)
- Meilang Xue
- Sutton Arthritis Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research
| | - Suat Dervish
- Sutton Arthritis Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research
| | - Kelly J McKelvey
- Sutton Arthritis Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research
| | - Lyn March
- Department of Rheumatology, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Fang Wang
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chris B Little
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Christopher J Jackson
- Sutton Arthritis Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research
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Vranic A, Pruner I, Veselinovic M, Soutari N, Petkovic A, Jakovljevic V, Antovic A. Assessment of hemostatic disturbances in women with established rheumatoid arthritis. Clin Rheumatol 2019; 38:3005-3014. [PMID: 31209709 DOI: 10.1007/s10067-019-04629-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study was aimed to assess hemostatic disturbances in female patients with established rheumatoid arthritis (RA) in relation to menopausal status and disease activity. METHOD Ninety women were included in the study, 42 patients and 48 age-matched healthy controls. There were no differences between the investigated groups regarding the presence of traditional cardiovascular risk factors. Two global hemostatic assays were employed, namely endogenous thrombin potential (ETP) and overall hemostasis potential (OHP). The parameters of the ETP assay (ETP, C-max, t-lag, t-max) and OHP assay (overall coagulation potential (OCP) and overall fibrinolytic potential (OFP)) were assessed. Moreover, the parameters of the fibrin clot (lag time, Max Abs, and slope) were measured by clot turbidity and scanning electron microscopy (SEM). Both patients and controls were divided into four subgroups according to menopause status. RESULTS The premenopausal controls differed significantly from all other subgroups in terms of diminished levels of ETP (p = 0.02), C-max (p = 0.01), OCP (p = 0.02), OHP (p = 0.001), and Max Abs (p = 0.008), while OFP (p = 0.0001) was increased. This tendency was not seen in the premenopausal RA patients compared with the postmenopausal RA patients. SEM images showed denser clots composed of thinner fibers in samples from RA patients. The disease activity measured by DAS28 correlated with OCP and OHP (r = 0.54; p = 0.001 and r = 0.44; p = 0.003, respectively) indicating persistent hypercoagulable condition in the whole group of RA patients. CONCLUSIONS Our results point towards coagulation activation in premenopausal women with established RA. The patients were well characterized, which enabled assessment in a real-life setting. Key Points • Extensive assessment points towards persistent coagulation activation in premenopausal women with established rheumatoid arthritis. • Impaired thrombin generation and fibrin formation are associated with menopause in healthy women, while rheumatoid arthritis closes the gap within patients regarding menopause. • Fibrin morphology is unfavorably altered and fibrinolysis is decreased in patients with established rheumatoid arthritis. • Increased activity of thrombin activatable fibrinolysis inhibitor (TAFI) may contribute to impaired fibrinolysis in patients with rheumatoid arthritis.
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Affiliation(s)
- Aleksandra Vranic
- Faculty of Medical Sciences, Department of Pharmacy, University of Kragujevac, Kragujevac, Serbia
| | - Iva Pruner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mirjana Veselinovic
- Faculty of Medical Sciences, Department of Internal Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Nida Soutari
- Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Anica Petkovic
- Faculty of Medical Sciences, Department of Pharmacy, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Jakovljevic
- Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia.,1st Moscow State Medical, University IM Sechenov, Department of Human Pathology, Moscow, Russia
| | - Aleksandra Antovic
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden. .,Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden.
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Boissier MC, Semerano L. From coagulation to inflammation: novel avenues for treating rheumatoid arthritis with activated protein C. Rheumatology (Oxford) 2019; 58:1710-1711. [DOI: 10.1093/rheumatology/kez200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
- Marie-Christophe Boissier
- INSERM U1125, Bobigny
- Li2P, UFR SMBH, University of Paris 13, Bobigny
- Department of Rheumatology, GH HUPSSD, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Luca Semerano
- INSERM U1125, Bobigny
- Li2P, UFR SMBH, University of Paris 13, Bobigny
- Department of Rheumatology, GH HUPSSD, Assistance Publique Hôpitaux de Paris, Bobigny, France
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Vonderlin N, Siebermair J, Kaya E, Köhler M, Rassaf T, Wakili R. Critical inflammatory mechanisms underlying arrhythmias. Herz 2019; 44:121-129. [DOI: 10.1007/s00059-019-4788-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Can we predict thrombotic tendency in rheumatoid arthritis? A thromboelastographic analysis (with ROTEM). Clin Rheumatol 2018; 37:2341-2349. [PMID: 29736870 DOI: 10.1007/s10067-018-4134-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/05/2018] [Accepted: 05/01/2018] [Indexed: 01/05/2023]
Abstract
The higher incidence of arterial and venous events is well established in patients with rheumatoid arthritis (RA). Our aim here was to investigate whether there is a prothrombotic state in RA patients by using rotational thromboelastometry (ROTEM) method and to demonstrate whether the disease variables play a role in this process. A total of 85 patients who met the 2010 RA classification criteria were consecutively included in the study. The patients with RA who have been using antiaggregant, anticoagulant, or nonsteroidal anti-inflammatory drugs (NSAIDs) and had a history of arterial or venous thromboembolism were excluded from the study. Their complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, D-dimer, and lipid profiles were measured, DAS-28 disease activation scores were calculated, and simultaneous ROTEM analysis was performed to determine the predisposition to thrombosis. Of the ROTEM parameters, clotting time (CT, seconds (s)), clot formation time (CFT, s), and maximum clot firmness (MCF) were evaluated. Having a shorter CT and/or CFT in intrinsic (I) or extrinsic (E) pathway and/or a longer MCF compared to the healthy controls was considered as "predisposition to hypercoagulability". The mean age of the 85 RA patients were 54.12 ± 13 years, and 77.6% of the patients were female (n = 66). Of the patients, 52.9% (n = 45) were using methotrexate (MTX) ± hydroxychloroquine (HCQ) ± corticosteroid (CS), while 43.5% (n = 37) were using anti-tumor necrosis factor (TNF) ± MTX. Active steroid usage was ongoing in 64.7% of the patients (n = 55). When evaluated according to DAS-28, in those with higher disease activity, a shorter I-CFT and greater I-MCF were determined (p = 0.020 and p = 0.033, respectively). In those with higher disease activity based on the correlation analysis, I-CFT and E-CFT were shorter and I-MCF and E-MCF were longer, indicating a higher predisposition to thrombosis. Using linear regression, variables with a major effect on ROTEM parameters were identified as DAS-28, CRP, and platelet count. As the first study in the literature, we identified that disease activation is the most important risk factor for prothrombotic state in RA patients irrespective of the drugs used. ROTEM can be used in clinical practice to predict thrombotic events in RA patients.
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Gualtierotti R, Ughi N, Marfia G, Ingegnoli F. Practical Management of Cardiovascular Comorbidities in Rheumatoid Arthritis. Rheumatol Ther 2017; 4:293-308. [PMID: 28752316 PMCID: PMC5696280 DOI: 10.1007/s40744-017-0068-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular (CV) comorbidities are a frequent extra-articular manifestation of rheumatoid arthritis (RA). Cardiovascular disease (CVD) with accelerated atherosclerosis is a major cause of morbidity and mortality in patients with RA. Subclinical CVD may be present since the early phase of RA. Not only traditional but also non-traditional CV risk factors are involved in the pathogenesis of RA-related CVD. Due to the lack of specifically designed randomized clinical trials, it is still unclear which tools to use to perform CV risk assessment, how to interpret the results and which interventions are appropriate in RA patients both to prevent and to manage CVD. Based on the available evidence, we propose a practical approach.
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Affiliation(s)
- Roberta Gualtierotti
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Marfia
- Neurosurgery Unit, Laboratory of Experimental Neurosurgery and Cell Therapy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Wakabayashi H, Hasegawa M, Niimi R, Yamaguchi T, Naito Y, Sudo A. The risk factor of preoperative deep vein thrombosis in patients undergoing total knee arthroplasty. J Orthop Sci 2017; 22:698-702. [PMID: 28478964 DOI: 10.1016/j.jos.2017.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/04/2017] [Accepted: 04/18/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The objective of this retrospective study was to investigate the prevalence of asymptomatic deep vein thrombosis (DVT) and the risk of DVT in patients admitted to hospital for total knee arthroplasty (TKA). METHODS From September of 2003 to December of 2013, 322 patients admitted for TKA were eligible for this retrospective study. A diagnosis of DVT was confirmed by Doppler ultrasonography. The prevalence of silent DVT in the lower limbs in patients before TKA was assessed. The risk factors for preoperative DVT were investigated, as well as the correlation of DVT in the patient's background and medical history. RESULTS Preoperative DVT was diagnosed in 56 patients (17.4%) including 3 patients with proximal DVT. Significantly elevated risks of DVT were found in patients undergoing revision TKA (p < 0.01), patients with rheumatoid arthritis (RA) (p < 0.005), patients with connective tissue diseases (CTDs) (p < 0.05), and female patients (p < 0.05) on univariate analyses. Multiple linear regression analysis showed that RA, CTDs and admission for revision TKA were independent risk factors for preoperative DVT. CONCLUSIONS A high prevalence of preoperative DVT was found in patients admitted to hospital for TKA. Admission to the hospital for RA, CTDs and revision TKA were risk factors for preoperative DVT.
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Affiliation(s)
- Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Japan.
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Japan
| | - Rui Niimi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Japan
| | - Toshio Yamaguchi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Japan
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Yalta T, Yalta K. Systemic Inflammation and Arrhythmogenesis: A Review of Mechanistic and Clinical Perspectives. Angiology 2017; 69:288-296. [DOI: 10.1177/0003319717709380] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the recent decades, systemic inflammation, as a clinical phenomenon, has been the focus of extensive research particularly with regard to its potential association with a variety of cardiovascular diseases including atherogenesis and acute coronary syndromes. Within this context, there also exists a potential link between systemic inflammation and cardiac arrhythmogenesis in various aspects. Accordingly, systemic inflammation response as measured with inflammation markers (cytokines, etc) has been investigated in the setting of well-known cardiac arrhythmias including atrial fibrillation and ventricular tachycardia. Based on current literature, clinical utility of these markers might potentially yield important prognostic implications in the setting of certain arrhythmogenic conditions. On the other hand, there exists limited data regarding therapeutic implications including clinical benefit of primary anti-inflammatory agents (corticosteroids, colchicine, etc) in the setting of arrhythmia management. The present review primarily aims to discuss potential triggers and fundamental mechanisms of inflammation-related arrhythmias along with a particular emphasis on clinical implications of systemic inflammation in the setting of cardiac arrhythmogenesis.
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Affiliation(s)
- Tulin Yalta
- Pathology Department, Trakya Üniversity, Edirne, Turkey
| | - Kenan Yalta
- Cardiology Department, Trakya Üniversity, Edirne, Turkey
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Understanding cardiovascular risk in rheumatoid arthritis: Still a long way to go. Atherosclerosis 2016; 256:123-124. [PMID: 27993384 DOI: 10.1016/j.atherosclerosis.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/09/2016] [Indexed: 01/22/2023]
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46
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Avouac J, Amrouche F, Meune C, Rey G, Kahan A, Allanore Y. Mortality profile of patients with rheumatoid arthritis in France and its change in 10 years. Semin Arthritis Rheum 2016; 46:537-543. [PMID: 27908535 DOI: 10.1016/j.semarthrit.2016.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the mortality profile of patients with rheumatoid arthritis (RA) in France. METHODS Data were collected between 2000 and 2011 from the French Epidemiological Center for the Medical Causes of Death database; all death certificates from adults that either mentioned RA as an underlying cause of death (UCD) or as an associated cause of death (ACD) were evaluated using multiple-cause-of-death analysis. The different causes of death and their frequency were reported, together with the ratio of observed/expected number of death (O/E ratio) to measure the strength of association between RA listed as an ACD and the corresponding UCD. RESULTS During the study period, 13,208 deaths related to RA were identified. The mean ± SD age at death was 79 ± 9 years (51% with ≥80 years) and the female/male ratio was 3.2. When RA was the UCD (n = 4597), the main causes of death were cardiovascular (29%) and infectious diseases (22%). When RA was an ACD (n = 8611), the most common UCDs were cardiovascular diseases (35%), neoplasms (14%), respiratory disease (9%), and infectious diseases (7%). The overall O/E ratio was >1 for infectious (3.58), respiratory (1.38), and cardiovascular diseases (1.25), but was <1 for neoplasms. CONCLUSION We provide the most recent national multiple-cause-of-death analysis assessing the mortality profile of RA patients. Our results show that mortality related to cardiovascular, respiratory, and infectious diseases is highly associated with RA. These data support the need to expand new strategies to prevent infectious and cardiovascular diseases in order to improve survival of RA patients.
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Affiliation(s)
- Jérôme Avouac
- Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France.
| | - Fazia Amrouche
- Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France
| | - Christophe Meune
- Cardiology Department, Paris 13 University, University Hospital of Paris-Seine-Saint-Denis, Bobigny, France; INSERM UMR 942, Paris, France
| | | | - André Kahan
- Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France
| | - Yannick Allanore
- Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris, France
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Kelmenson LB, Demoruelle MK, Deane KD. The Complex Role of the Lung in the Pathogenesis and Clinical Outcomes of Rheumatoid Arthritis. Curr Rheumatol Rep 2016; 18:69. [DOI: 10.1007/s11926-016-0618-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Popkova TV, Novikova DS, Nasonov EL. [Interleukin-6 inhibition and cardiovascular disease in patients with rheumatoid arthritis]. TERAPEVT ARKH 2016; 88:93-101. [PMID: 27458623 DOI: 10.17116/terarkh201688593-101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is a' disease conferring high risk for cardiovascular events (CVE). Systemic inflammation underlying RA favors development of CVE. The safety of biological agents, acting on the cardiovascular system has been inadequately investigated. On the one hand, they decrease RA activity and, on the other, may increase the risk of CVE. This review analyzes' the literature data predominantly published in recent years on the effect of an IL-6 receptor inhibitor on the cardiovascular system. Tocilizumab is shown to be a promising agent to reduce cardiovascular risk the findings need to be clinically verified. Long-term prospective investigations should be conducted to determine more exactly the impact of IL-6 receptor inhibition on. the development of CVE.
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Affiliation(s)
- T V Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - D S Novikova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - E L Nasonov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Sun Z, Hesler BD, Makarova N, Dalton JE, Doan M, Moraska A, De Oliveira G, Turan A. The Association Between Rheumatoid Arthritis and Adverse Postoperative Outcomes. Anesth Analg 2016; 122:1887-93. [DOI: 10.1213/ane.0000000000001066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Comprehensive, up-to-date review of RA-associated lung diseases including pathogenesis and managementhttp://ow.ly/FBaNZ
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Affiliation(s)
- Megan Shaw
- Division of Rheumatology, UW Medical Centre, University of Washington, Seattle, WA, USA
| | - Bridget F Collins
- Division of Pulmonary and Critical Care Medicine, UW Medical Centre, University of Washington, Seattle, WA, USA
| | - Lawrence A Ho
- Division of Pulmonary and Critical Care Medicine, UW Medical Centre, University of Washington, Seattle, WA, USA
| | - Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, UW Medical Centre, University of Washington, Seattle, WA, USA
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