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Cuesta-López L, Escudero-Contreras A, Hanaee Y, Pérez-Sánchez C, Ruiz-Ponce M, Martínez-Moreno JM, Pérez-Pampin E, González A, Plasencia-Rodriguez C, Martínez-Feito A, Balsa A, López-Medina C, Ladehesa-Pineda L, Rojas-Giménez M, Ortega-Castro R, Calvo-Gutiérrez J, López-Pedrera C, Collantes-Estévez E, Arias-de la Rosa I, Barbarroja N. Exploring candidate biomarkers for rheumatoid arthritis through cardiovascular and cardiometabolic serum proteome profiling. Front Immunol 2024; 15:1333995. [PMID: 38420123 PMCID: PMC10900234 DOI: 10.3389/fimmu.2024.1333995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction RA patients are at higher risk of cardiovascular disease, influenced by therapies. Studying their cardiovascular and cardiometabolic proteome can unveil biomarkers and insights into related biological pathways. Methods This study included two cohorts of RA patients: newly diagnosed individuals (n=25) and those with established RA (disease duration >25 years, n=25). Both cohorts were age and sex-matched with a control group (n=25). Additionally, a longitudinal investigation was conducted on a cohort of 25 RA patients treated with methotrexate and another cohort of 25 RA patients treated with tofacitinib for 6 months. Clinical and analytical variables were recorded, and serum profiling of 184 proteins was performed using the Olink technology platform. Results RA patients exhibited elevated levels of 75 proteins that might be associated with cardiovascular disease. In addition, 24 proteins were increased in RA patients with established disease. Twenty proteins were commonly altered in both cohorts of RA patients. Among these, elevated levels of CTSL1, SORT1, SAA4, TNFRSF10A, ST6GAL1 and CCL18 discriminated RA patients and HDs with high specificity and sensitivity. Methotrexate treatment significantly reduced the levels of 13 proteins, while tofacitinib therapy modulated the expression of 10 proteins. These reductions were associated with a decrease in DAS28. Baseline levels of SAA4 and high levels of BNP were associated to the non-response to methotrexate. Changes in IL6 levels were specifically linked to the response to methotrexate. Regarding tofacitinib, differences in baseline levels of LOX1 and CNDP1 were noted between non-responder and responder RA patients. In addition, response to tofacitinib correlated with changes in SAA4 and TIMD4 levels. Conclusion In summary, this study pinpoints molecular changes linked to cardiovascular disease in RA and proposes candidate protein biomarkers for distinguishing RA patients from healthy individuals. It also highlights how methotrexate and tofacitinib impact these proteins, with distinct alterations corresponding to each drug's response, identifying potential candidates, as SAA4, for the response to these therapies.
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Affiliation(s)
- Laura Cuesta-López
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Alejandro Escudero-Contreras
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Yas Hanaee
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
- Scientific department, Cobiomic Bioscience S.L, Cordoba, Spain
| | - Carlos Pérez-Sánchez
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
- Scientific department, Cobiomic Bioscience S.L, Cordoba, Spain
- Department of Cell Biology, Immunology and Physiology, Agrifood Campus of International Excellence, University of Córdoba, Córdoba, Spain
| | - Miriam Ruiz-Ponce
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | | | - Eva Pérez-Pampin
- Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigación Sanitaria - Hospital Clínico Universitario de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
| | - Antonio González
- Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigación Sanitaria - Hospital Clínico Universitario de Santiago (IDIS), Santiago de Compostela, Galicia, Spain
| | - Chamaida Plasencia-Rodriguez
- Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Ana Martínez-Feito
- Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Alejandro Balsa
- Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Clementina López-Medina
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Lourdes Ladehesa-Pineda
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Marta Rojas-Giménez
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Rafaela Ortega-Castro
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Jerusalem Calvo-Gutiérrez
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Chary López-Pedrera
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Eduardo Collantes-Estévez
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Iván Arias-de la Rosa
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Nuria Barbarroja
- Rheumatology Service, Department of Medical and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
- Scientific department, Cobiomic Bioscience S.L, Cordoba, Spain
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2
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Zachou K, Azariadis K, Lytvyak E, Snijders RJ, Takahashi A, Gatselis NK, Robles M, Andrade RJ, Schramm C, Lohse AW, Tanaka A, Drenth JP, Montano-Loza AJ, Dalekos GN. Treatment responses and outcomes in patients with autoimmune hepatitis and concomitant features of non-alcoholic fatty liver disease. JHEP Rep 2023; 5:100778. [PMID: 37456672 PMCID: PMC10339258 DOI: 10.1016/j.jhepr.2023.100778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023] Open
Abstract
Background & Aims Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) affect 17-46% of Western countries, making coexistence with other liver diseases inevitable. We investigated the prevalence and clinical significance of NAFLD/NASH or the components of metabolic syndrome (MetS) in a large multicentric cohort of patients with autoimmune hepatitis (AIH). Methods Data from six academic centres (Greece, Canada, Japan, Germany, The Netherlands, and Spain) were evaluated. The presence of NAFLD/NASH in liver biopsy, MetS components, and clinical and laboratory parameters were recorded. Results A total of 640 patients (474 females, age 49 [4-87] years; follow-up 78 [1-521] months) were included. NAFLD was present in 146 (22.8%) patients (AIH/non-alcoholic fatty liver [NAFL] 115 [18%], AIH/NASH 31 [4.8%]). AIH/NAFL patients were older (p = 0.017), more frequently overweight or obese (p = 0.002), had hypertension (p = 0.001), and had diabetes (p = 0.016), whereas they less frequently had acute presentation (p = 0.002) and soluble liver antigen/liver pancreas positivity (p <0.05), lower transaminases (p <0.001), ALP (p = 0.028) and IgG (p = 0.004) and higher albumin (p <0.001) than patients with AIH only. Patients with AIH/NASH more frequently had cirrhosis at diagnosis (p = 0.036) and higher IgG (p = 0.009). Response to treatment did not differ between groups. Patients with cirrhosis with AIH/NAFL had higher frequency of decompensation compared with patients with AIH only (p <0.05). Patients with type 2 diabetes mellitus and dyslipidaemia had increased hazard of disease progression (p <0.05 for each). Conclusions The prevalence of NAFLD in AIH is similar to the general population. Concurrence of NASH in patients with AIH signifies a more severe disease, whereas that of NAFL may indicate a worse prognosis in patients with cirrhosis. T2DM and dyslipidaemia in AIH patients are associated with dismal parameters of outcome. Our findings suggest that NAFLD presence or even components of MetS in patients with AIH may affect prognosis, so closer follow-up of such patients is warranted. Impact and implications Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) affect many people, making coexistence with other liver diseases inevitable. We investigated the prevalence and clinical significance of NAFLD/NASH or the components of metabolic syndrome (MetS) in patients with autoimmune hepatitis (AIH). NAFLD and NASH presence in patients with AIH is as frequent as in the general population. The concurrence of NASH in patients with AIH seems to signify a more severe disease, whereas that of non-alcoholic fatty liver may indicate a worse prognosis in a specific subgroup of patients who already have cirrhosis at diagnosis. Diabetes or dyslipidaemia in patients with AIH were associated with worse prognosis. Therefore, it seems that closer follow-up of patients with concurrent AIH and NAFLD or AIH and components of MetS is needed.
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Affiliation(s)
- Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Kalliopi Azariadis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Ellina Lytvyak
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Romée J.A.L.M. Snijders
- Department of Gastroenterology and Hepatology, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Radboud UMC, Nijmegen, The Netherlands
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Mercedes Robles
- Unidad De Gestión Clínica De Aparato Digestivo, Servicio De Farmacología Clínica, Hospital Universitario Virgen De La Visctoria, Universidad De Malaga, Malaga, Spain
| | - Raul J. Andrade
- Unidad De Gestión Clínica De Aparato Digestivo, Servicio De Farmacología Clínica, Hospital Universitario Virgen De La Visctoria, Universidad De Malaga, Malaga, Spain
| | - Christoph Schramm
- Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ansgar W. Lohse
- Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Atsushi Tanaka
- Department of Medicine, Tokyo University, School of Medicine, Itabashi-Ku, Tokyo, Japan
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Radboud UMC, Nijmegen, The Netherlands
| | - Aldo J. Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
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3
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Dutt S, Roul P, Yang Y, Johnson TM, Michaud K, Sauer B, Cannon GW, Baker JF, Curtis JR, Mikuls TR, England BR. Multimorbidity Patterns and Rheumatoid Arthritis Disease Outcomes: Findings From a Multicenter, Prospective Cohort. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25184. [PMID: 37394710 PMCID: PMC10758525 DOI: 10.1002/acr.25184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To determine whether unique multimorbidity patterns are associated with long-term rheumatoid arthritis (RA) disease severity. METHODS We conducted a cohort study within the Veterans Affairs Rheumatoid Arthritis registry. We applied previously derived multimorbidity patterns based on the presence of diagnostic codes for relevant conditions prior to enrollment using linked administrative data. Disease activity and functional status were assessed longitudinally up to 5 years after enrollment. The association of multimorbidity patterns with disease activity and functional status were assessed using generalized estimating equations models adjusting for relevant confounders. RESULTS We studied 2,956 participants, of which 88.2% were male, 76.9% reported white race, and 79.3% had a smoking history. Mental health and substance abuse (β 0.12 [95% confidence interval {CI} 0.00, 0.23]), cardiovascular (β 0.25 [95% CI 0.12, 0.38]), and chronic pain (β 0.21 [95% CI 0.11, 0.31]) multimorbidity were associated with higher Disease Activity Score in 28 joints (DAS28) scores. Mental health and substance abuse (β 0.09 [0.03, 0.15]), cardiovascular (β 0.11 [95% CI 0.04, 0.17]), and chronic pain multimorbidity (β 0.15 [95% CI 0.10, 0.20]) were also associated with higher Multidimensional Health Assessment Questionnaire (MDHAQ) scores. The metabolic pattern of multimorbidity was not associated with DAS28 or MDHAQ. The number of multimorbidity patterns present was highly associated with DAS28 and MDHAQ (P trend < 0.001), and patients with all four multimorbidity patterns had the highest DAS28 (β 0.59 [95% CI 0.36, 0.83]) and MDHAQ (β 0.27 [95% CI 0.16, 0.39]) scores. CONCLUSION Mental health and substance abuse, chronic pain, and cardiovascular multimorbidity patterns are associated with increased RA disease activity and poorer functional status. Identifying and addressing these multimorbidity patterns may facilitate achieving RA treatment targets.
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Affiliation(s)
- Sarah Dutt
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Tate M. Johnson
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE
- FORWARD, the National Data Bank for Rheumatic Disease, Wichita, KS
| | - Brian Sauer
- VA Salt Lake City & University of Utah, Salt Lake City, UT
| | | | - Joshua F. Baker
- Corporal Michael J. Crescenz VA Medical Center & University of Pennsylvania, Philadelphia, PA
| | | | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
| | - Bryant R. England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- University of Nebraska Medical Center, Omaha, NE
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4
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Oh H, Park J, Kim J, Jang S, Ryu Y, Jeong Y, Kwon S, Suh S, Lee H, Choi D, Lee H, Cho G, Seo W. Temporal Changes in Metabolic Syndrome Indices and Factors of Metabolic Syndrome Development in Patients With Rheumatic Disease: A Prospective Cohort Study. Orthop Nurs 2023; 42:251-261. [PMID: 37494906 DOI: 10.1097/nor.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Patients with rheumatic disease have a high prevalence of metabolic syndrome. The purpose of this study was to investigate temporal changes in metabolic syndrome indices and to identify factors influencing metabolic syndrome development. A prospective cohort study design was adopted. The study participants were 68 outpatients with a rheumatic disease at an outpatient clinic of a university hospital. Data on demographics, health-related characteristics, steroid use, serum C-reactive protein levels, and metabolic syndrome indices were collected between December 2017 and March 2021. Temporal changes in body mass indices, serum triglyceride, and cholesterol levels were significant. Body mass indices, diastolic blood pressure, serum triglyceride, high-density lipoprotein, and fasting blood glucose levels at time of diagnosis were found to influence metabolic syndrome development. Temporal changes in serum triglyceride, cholesterol, and fasting blood glucose levels were significantly influenced by inflammatory status. The findings demonstrate the importance of controlling inflammatory activities in the context of inhibiting the progression of metabolic syndrome and rheumatic diseases.
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Affiliation(s)
- HyunSoo Oh
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - JiSuk Park
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - JiYoung Kim
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - SungKyung Jang
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - Yeona Ryu
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - YeoJu Jeong
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - SuYeon Kwon
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - SoHyun Suh
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - HaYoung Lee
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - DaHee Choi
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - HanNa Lee
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - GaWon Cho
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
| | - WhaSook Seo
- HyunSoo Oh, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
- JiSuk Park, PhD, RN, Nurse, Inha University Hospital, Incheon, Republic of Korea
- JiYoung Kim, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SungKyung Jang, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- Yeona Ryu, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- YeoJu Jeong, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SuYeon Kwon, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- SoHyun Suh, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HaYoung Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- DaHee Choi, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- HanNa Lee, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- GaWon Cho, BSN, RN, Graduate student, Department of Nursing, Inha University, Incheon, Republic of Korea
- WhaSook Seo, PhD, RN, Professor, Department of Nursing, Inha University, Incheon, Republic of Korea
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5
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Li B, Huang H, Zhao J, Deng X, Zhang Z. Discrepancy in Metabolic Syndrome between Psoriatic Arthritis and Rheumatoid Arthritis: a Direct Comparison of Two Cohorts in One Center. Rheumatol Ther 2023; 10:135-148. [PMID: 36264448 PMCID: PMC9931969 DOI: 10.1007/s40744-022-00502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE We aimed to investigate the discrepancy in metabolic syndrome (MS) and cardiovascular disease (CVD) between patients with psoriatic arthritis (PsA) and those with rheumatoid arthritis (RA). METHODS Patients with PsA and RA were enrolled between 1 December 2018 and 31 December 2021. Data on their demographics, height, weight, waist circumference, clinical and laboratory data, and comorbidities were collected. Disease activities of patients with RA and PsA were assessed. Prevalence was estimated by dividing cases (such as MS and CVD) of PsA and RA individually. Propensity score matching and inverse probability of treatment weighting were used for further validation. RESULTS Consecutively, 197 patients with PsA and 279 patients with RA were enrolled in this study. Both MS [36.0% versus 23.3%, p = 0.002, OR 1.54 (1.16, 2.05)] and CVD [6.6% versus 1.1%, p = 0.001, OR 6.13 (1.77, 21.25)] were more frequently observed in patients with PsA compared with patients with RA. The frequency of abdominal obesity was also higher in patients with PsA [61.9% versus 33.0%, OR 1.87 (1.53, 2.29), p < 0.001]. After 1:1 propensity score matching for age, sex, smoking history, serum lipids, and disease activity, MS remained more common in 117 patients with PsA than in 117 patients with RA (37.6% versus 23.1%, p = 0.016) These findings remained after the inverse probability of treatment weighting in 196 patients with PsA and 288 patients with RA. A positive linear relationship between MS with disease activity was found in patients with PsA, but not in patients with RA. CONCLUSION Considerable discrepancies in MS and CVD were observed between patients with PsA and those with RA. The greater odds of MS and CVD emphasize the need to pay more attention to metabolic and cardiovascular conditions in patients with PsA.
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Affiliation(s)
- Borui Li
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China.
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6
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Bolla E, Tentolouris N, Sfikakis PP, Tektonidou MG. Metabolic syndrome in antiphospholipid syndrome versus rheumatoid arthritis and diabetes mellitus: Association with arterial thrombosis, cardiovascular risk biomarkers, physical activity, and coronary atherosclerotic plaques. Front Immunol 2023; 13:1077166. [PMID: 36700208 PMCID: PMC9868803 DOI: 10.3389/fimmu.2022.1077166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the foremost cause of morbidity and deaths in antiphospholipid syndrome (APS), driven by thrombo-inflammation and atherothrombosis mechanisms. Metabolic syndrome (MetS) is a proinflammatory and prothrombotic state characterized by increased CVD risk. We aimed to evaluate the prevalence of MetS in APS patients compared to rheumatoid arthritis (RA) and diabetes mellitus (DM) and its associations with clinical and laboratory patient characteristics and vascular ultrasound (US) markers of subclinical atherosclerosis. Methods We included 414 patients in our study: 138 patients with APS (median age: 44.9 years, females 70%) and matched 1:1 for age and sex RA and DM subjects. Three sets of criteria were used for MetS diagnosis: Joint Interim Statement (JIS), International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). The demographic, clinical and laboratory characteristics of all participants were recorded and carotid and femoral US was performed in patients with APS. Multivariate regression models were applied. Results Prevalence of MetS was 23.9%, 23.2%, 20.3% (based on JIS, IDF, modified NCEP-ATPIII criteria, respectively) in APS versus 17.4%, 17.4%, 13% in RA (p=0.181, p=0.231, p=0.106, respectively), and 44.2%, 44.2%, 40.6% in DM patients. In multivariate analysis, patients with systemic lupus erythematosus- related APS had an approximately 2.5-fold higher risk of MetS versus RA patients. MetS in APS was independently associated with arterial thrombosis (Odds ratio 3.5, p=0.030). Odds ratio for MetS was 1.16 for each one unit increase in C-reactive protein levels according to JIS and IDF criteria, and 1.49 and 1.47 for each one unit increase in uric acid levels using the IDF and modified NCEP-ATPIII models, respectively. APS patients with atherosclerotic carotid plaques had 4 to 6.5-fold increased risk of MetS. Odds for MetS were decreased by 26% with an increase in physical activity by one hour per week. Conclusions MetS is present in approximately one-fourth of APS patients at a comparable prevalence to that observed in patients with RA. MetS in APS is associated with arterial thrombosis, cardiovascular risk biomarkers, physical activity, and subclinical atherosclerosis, supporting its role in cardiovascular risk stratification and management in APS.
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Affiliation(s)
- Eleana Bolla
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Petros P. Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Maria G. Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece,*Correspondence: Maria G. Tektonidou, ;
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7
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Cai W, Tang X, Pang M. Prevalence of Metabolic Syndrome in Patients With Rheumatoid Arthritis: An Updated Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:855141. [PMID: 35462993 PMCID: PMC9024100 DOI: 10.3389/fmed.2022.855141] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) due to systemic inflammation and insulin resistance increases the risk of cardiovascular disease and reduces life expectancy. In order to develop cardiac death prevention strategies, it is necessary to estimate the prevalence of metabolic syndrome (MetS) in these patients. Methods This systematic review and meta-analysis was performed to estimate the prevalence of MetS among patients with RA. International databases (i.e., Scopus, PubMed, Web of Science, and Google Scholar) were searched during the period of October 1 and October 10, 20121. Heterogeneity among the included studies was assessed through the Cochrane Q test statistics and I2 test. Finally, a random-effects meta-analysis model was computed to estimate the pooled prevalence of MetS. Results Sixty-one articles with 96 groups and a sample size of 13,644 people were analyzed. The pooled prevalence of MetS was 32% (95% CI: 29.6–34.4). The highest prevalence of MetS is related to studies conducted in Asia (32.7%, 95% CI: 29–36.3) and Europe (32.7%, 95% CI: 27.5.37.9) and the lowest Prevalence was also related to studies conducted in Africa (28%, 95% CI: 28.8–32.2). The prevalence of MetS in men was 33% (95% CI: 26–39) and 34% (95% CI: 29–40) in women. Findings by diagnostic criteria showed that the highest and lowest prevalence of MetS was related to ATP III (37.5%, 95% CI: 30.9–44.2) and EGIR (14.4%, 95% CI: 10.5–18.5), respectively. Conclusions MetS is highly prevalent in patients with RA and identification of high-risk patients is necessary to prevent cardiovascular mortality.
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Affiliation(s)
- Wei Cai
- Pediatric Department, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- *Correspondence: Wei Cai
| | - Xuemi Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Min Pang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China
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8
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Autoimmune Rheumatic Diseases and Vascular Function: The Concept of Autoimmune Atherosclerosis. J Clin Med 2021; 10:jcm10194427. [PMID: 34640445 PMCID: PMC8509415 DOI: 10.3390/jcm10194427] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022] Open
Abstract
Autoimmune rheumatic diseases (AIRDs) with unknown etiology are increasing in incidence and prevalence. Up to 5% of the population is affected. AIRDs include rheumatoid arthritis, system lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. In patients with autoimmune diseases, the immune system attacks structures of its own body, leading to widespread tissue and organ damage, which, in turn, is associated with increased morbidity and mortality. One third of the mortality associated with autoimmune diseases is due to cardiovascular diseases. Atherosclerosis is considered the main underlying cause of cardiovascular diseases. Currently, because of finding macrophages and lymphocytes at the atheroma, atherosclerosis is considered a chronic immune-inflammatory disease. In active inflammation, the liberation of inflammatory mediators such as tumor necrotic factor alpha (TNFa), interleukine-6 (IL-6), IL-1 and other factors like T and B cells, play a major role in the atheroma formation. In addition, antioxidized, low-density lipoprotein (LDL) antibodies, antinuclear antibodies (ANA), and rheumatoid factor (RF) are higher in the atherosclerotic patients. Traditional risk factors like gender, age, hypercholesterolemia, smoking, diabetes mellitus, and hypertension, however, do not alone explain the risk of atherosclerosis present in autoimmune diseases. This review examines the role of chronic inflammation in the etiology-and progression-of atherosclerosis in autoimmune rheumatic diseases. In addition, discussed here in detail are the possible effects of autoimmune rheumatic diseases that can affect vascular function. We present here the current findings from studies that assessed vascular function changes using state-of-the-art techniques and innovative endothelial function biomarkers.
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9
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A Pilot Study: Hypertension, Endothelial Dysfunction and Retinal Microvasculature in Rheumatic Autoimmune Diseases. J Clin Med 2021; 10:jcm10184067. [PMID: 34575178 PMCID: PMC8467719 DOI: 10.3390/jcm10184067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The etiology of autoimmune rheumatic diseases is unknown. Endothelial dysfunction and premature atherosclerosis are commonly seen in these patients. Atherosclerosis is considered one of the main causes of cardiovascular diseases. Hypertension is considered the most important traditional cardiovascular risk. This case-control study aimed to investigate the relationship between autoimmune diseases and cardiovascular risk. Methods: This study was carried out in patients with rheumatoid arthritis, RA (n = 10), primary Sjögren syndrome, PSS (n = 10), and healthy controls (n = 10). Mean blood pressure (MBP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse wave velocity (PWV, an indicator of arterial stiffness) were assessed via a Vicorder device. Asymmetric dimethylarginine (ADMA) was measured via ELISA. Retinal photos were taken via a CR-2 retinal camera, and retinal microvasculature analysis was carried out. T-tests were conducted to compare the disease and control groups. ANOVA and ANOVA—ANCOVA were also used for the correction of covariates. Results: A high prevalence of hypertension was seen in RA (80% of cases) and PSS (40% of cases) compared to controls (only 20% of cases). Significant changes were seen in MBP (RA 101 ± 11 mmHg; PSS 93 ± 10 mm Hg vs. controls 88 ± 7 mmHg, p = 0.010), SBP (148 ± 16 mmHg in RA vs. 135 ± 16 mmHg in PSS vs. 128 ± 11 mmHg in control group; p = 0.007), DBP (77 ± 8 mmHg in RA, 72 ± 8 mmHg in PSS vs. 67 ± 6 mmHg in control; p = 0.010 in RA compared to the controls). Patients with PSS showed no significant difference as compared to controls (MBP: p = 0.240, SBP: p = 0.340, DBP: p = 0.190). Increased plasma ADMA was seen in RA (0.45 ± 0.069 ng/mL) and PSS (0.43 ± 0.060 ng/mL) patients as compared to controls (0.38 ± 0.059 ng/mL). ADMA in RA vs. control was statistically significant (p = 0.022). However, no differences were seen in ADMA in PSS vs. controls. PWV and retinal microvasculature did not differ across the three groups. Conclusions: The prevalence of hypertension in our cohort was very high. Similarly, signs of endothelial dysfunction were seen in autoimmune rheumatic diseases. As hypertension and endothelial dysfunction are important contributing risk factors for cardiovascular diseases, the association of hypertension and endothelial dysfunction should be monitored closely in autoimmune diseases.
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Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by tumor-like hyperplasia and inflammation of the synovium, which causes synovial cell invasion into the bone and cartilage. In RA pathogenesis, various molecules in effector cells (i.e., immune cells and mesenchymal cells) are dysregulated by genetic and environmental factors. Consistent with the early stages of RA, these pathogenic cells cooperate and activate each other directly by cell-to-cell contact or indirectly via humoral factors. Recently, growing evidence has revealed essential role of adipokines, which are multifunctional signal transduction molecules, in the immune system. In this review, we summarize the current understanding of the cross-talk between leptin, one of the most well-known and best-characterized adipokines, and osteoimmunology. Furthermore, we discuss the contribution of leptin to the pathogenesis of RA and its potential mechanisms.
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Affiliation(s)
- Haruka Tsuchiya
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Liu C, Meng X, Zhang H, Yang F, Pan X, Tang K. Early-life famine exposure and rheumatoid arthritis in Chinese adult populations: a retrospective cohort study. BMJ Open 2021; 11:e043416. [PMID: 34226211 PMCID: PMC8258564 DOI: 10.1136/bmjopen-2020-043416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to explore the association between famine exposure in early life and the odds of rheumatoid arthritis (RA) in adulthood. DESIGN A population-based retrospective cohort study. SETTING China. PARTICIPANTS A total of 111 706 participants (1775 with RA) born from 1956 to 1964 were selected from the baseline survey of a large cohort in China. PRIMARY AND SECONDARY OUTCOME MEASURES Four famine exposure groups were generated based on dates of birth, namely prenatal-exposed, infant-exposed, preschool-exposed and non-exposed groups. Logistic regressions were used to explore the association between famine exposure and self-reported RA in adulthood, adjusting for sex, region, monthly income, highest education, alcohol consumption, tobacco use, body mass index (BMI) and metabolic equivalent tasks. Analyses were also performed with stratification for sex (female or male), residing region (urban or rural), famine severity (severe or non-severe) and BMI (≥24 or <24). RESULTS The study included 1775 (1.59%) RA cases and 109 931 (98.41%) non-RA controls. Among them, 22 413 (20.06%) were prenatal-exposed, 14 899 (13.34%) were infant-exposed and 34 356 (30.76%) were preschool-exposed. Prenatal exposure to famine was not associated with onset of RA in adulthood. Infant-exposed group and preschool-exposed group had significantly elevated odds of getting RA compared with non-exposed group (infant-exposed: OR=1.44, 95% CI 1.24 to 1.67; preschool-exposed: OR=1.38, 95% CI 1.22 to 1.57, p<0.001), and the relationship was stronger among women, urban residents and participants with BMI ≥24. Similar results were additionally observed when an age-balanced control group was used. CONCLUSIONS Exposure to the Great Chinese Famine in early life after birth especially in infancy may be associated with a higher risk of RA in adulthood. Strengthening early-life nutrition could be an implication to prevent future RA.
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Affiliation(s)
- Chunyu Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Xiangrui Meng
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Hao Zhang
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fan Yang
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Xiaoyu Pan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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12
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Kong CY, Wang CL, Niu KJ, Qi W. Prevalence of metabolic syndrome in patients with rheumatoid arthritis in eastern China-A hospital based study. Int J Rheum Dis 2021; 24:1121-1126. [PMID: 34080783 DOI: 10.1111/1756-185x.14148] [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] [Received: 12/31/2020] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this hospital clinic based study was to evaluate the potential risk factors associated with the prevalence of MetS in RA population. METHODS From January 2015 to October 2018, 717 patients with RA and 717 healthy controls who were treated or performed physical examination in Tianjin First Central Hospital were enrolled in this study. The basic disease diagnoses were recorded. A questionnaire was performed on all participants to assess the demographic details of the RA cohort. Moreover, laboratory indicators related to glucose and lipid metabolism in patients with RA were also detected. The potential risk factors for MetS were also analyzed. RESULTS The prevalence of MetS were 31.2% and 34.2% in case and control groups, respectively (P = .22). There were lower levels of HDL-C, obesity, TG, LDL-C and TC in case group than control group (all P < .05). The hypertension levels in healthy controls was decreased in compared with patients with RA (P < .05). Nevertheless, in patients with RA, complement 3 (OR: 1.02; 95% CI: 1.01-1.03, P = .007) and less glucocorticoids use (OR: 0.63, 95% CI: 0.39-0.99, P = .046) were associated with MetS. CONCLUSION The prevalence of MetS was not associated with RA. Complement 3 may be associated with the higher prevalence of MetS in patients with RA. Glucocorticoids treatment may be associated with MetS.
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Affiliation(s)
| | - Chang-Lei Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Kai-Jun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.,Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Wufang Qi
- Tianjin First Center Hospital, Tianjin, China
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13
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Turgunova LG, Shalygina AA, Zalkalns JP, Klyuyev DA, Akhmaltdinova LL, Dosmagambetova RS. Assessment of Adipokines, CXCL16 Chemokine Levels in Patients With Rheumatoid Arthritis Combined With Metabolic Syndrome. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:1179544120985860. [PMID: 33613035 PMCID: PMC7868477 DOI: 10.1177/1179544120985860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022]
Abstract
Objective: Rheumatoid arthritis (RA), which is a chronic systemic inflammatory disease, is associated with accelerated atherosclerosis and an increased risk of cardiovascular disease (CVD), but the causal factors have yet to be completely elucidated. The studies show that the prevalence of metabolic syndrome (MtS) was significantly higher in RA patients compared to the population. In RA and MetS inflammation and atherosclerosis are closely linked. The level of chemokines and adipokines, which may play a role in the development of atherogenesis in RA with MetS patients is currently unknown. In this study, we investigated the level of chemokine C-X-C motif chemokine ligand 16 (CXCL16) and adipokine in RA with MetS patients and assessed the association of biomarkers with clinical and biochemical activity scores of RA and components of MetS. Methods: Blood serum of 298 people (48—patients with RA and MetS, 82—with RA without MetS, 105—with MetS, 63—control group without both RA and MetS) was tested for (CXCL16), Resistin, Leptin and Fibroblast Growth Factor 21 (FGF21) levels by fluorescent antibody technique. Statistical analysis was performed using SPSS version 18.0. Results: The biomarker study showed the highest level in the RA with MetS patient group; but as compared with the RA group the differences were insignificant. CXCL16 (Me = 426.2 pg/ml (Q25-75 250.5-527.6), resistin (Me = 8685.4 pg/ml (Q25-75 6480.8-13 629.1), and FGF21 (Me = 443.6 pg/ml (Q25-75 772.9-916.3) proved to be significantly augmented in RA with MetS patients group, and in RA without MetS patients group (Me = 312.7 (Q25-75 199.4-517.7) pg/ml; Me = 8265.3 (Q25-75 5779.7-13 340.5) pg/ml; Me = 412.4 (Q25-75 300.4-497.4) pg/ml, respectively) as compared with MetS patients group (Me = 189.4 (Q25-75 130.3-280.6) pg/ml; Me = 5364.8 (Q25-75 2368.9-10 160.9) pg/ml; Me = 133.2 (Q25-75 76.2-268.6) pg/ml, respectively; P = <.001). Leptin level in all groups was higher than in the control group, but there were no differences between groups. The correlation analysis found a positive relationship between the leptin level and the waist circumference (rs = 0.39; P = .007) in the RA with MetS patients, the association of biomarkers with DAS28 score and ESR did not have any statistical significance. Conclusions: The augmented chemokine, resistin and FGF21 in the RA with MetS patients proves the systemic inflammation which is the basis of RA; the augmented leptin is linked to the abdominal obesity. These data are somewhat of an explanation of the increased risk of the CVD development in RA with MetS people. A differentiated specification can be useful to assess the cardiovascular risk of patients and justify prompt personalized treatment.
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García-Chagollán M, Hernández-Martínez SE, Rojas-Romero AE, Muñoz-Valle JF, Sigala-Arellano R, Cerpa-Cruz S, Morales-Núñez JJ, Lomelí-Nieto JA, Macedo Ojeda G, Hernández-Bello J. Metabolic syndrome in rheumatoid arthritis patients: Relationship among its clinical components. J Clin Lab Anal 2020; 35:e23666. [PMID: 33231330 PMCID: PMC7957969 DOI: 10.1002/jcla.23666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) prevalence in rheumatoid arthritis (RA) patients is known to vary considerably across the world. This study aimed to determine the prevalence of MetS in RA patients from western Mexico and to analyze the interrelation of the MetS components with the clinical variables of RA. METHODS This case-control study included 216 RA patients and 260 control subjects (CS). MetS prevalence was determined according to the NCEP/ATP III and the Latin American Consensus of the Latin American Diabetes Association (ALAD) criteria. RESULTS MetS was observed in 30.6% RA patients and 33.3% of controls (p > 0.05) according to NCEP/ATP III and 28.7% in RA patients and 31.1% for controls using ALAD criteria. Total cholesterol, LDL-C, and Castelli's I-II indexes were lower in RA (p < 0.001) than in CS. The RA patients with MetS had more swollen joints than those without MetS (p = 0.018). In RA patients with MetS, DAS-28 score correlated with smoking index (rho = 0.4601, p = 0.0004) and VLDL-C (rho = 0.3108, p = 0.0056); similarly, rheumatoid factor (RF) correlated with age (rho = 0.2031, p = 0.0027), smoking index (rho = 0.3404, p < 0.0001), triglycerides (rho = 0.1958, p = 0.0039), and VLDL-C (rho = 0.1761, p = 0.0162). CONCLUSIONS The MetS prevalence in RA patients from western Mexico is not higher than controls; however, in RA patients with MetS, some inflammatory markers are associated with MetS components; thus, the control of MetS in RA could be beneficial to regulate disease activity.
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Affiliation(s)
- Mariel García-Chagollán
- Institute of Research in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, México
| | | | - Alma Elizabeth Rojas-Romero
- University Center for Exact Sciences and Engineering (CUCEI), University of Guadalajara, Guadalajara, México
| | - José Francisco Muñoz-Valle
- Institute of Research in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, México
| | | | - Sergio Cerpa-Cruz
- Rheumatology Service, O.P.D. Civil Hospital of Guadalajara "Fray Antonio Alcalde", Guadalajara, México
| | - José Javier Morales-Núñez
- Institute of Research in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, México
| | - José Alvaro Lomelí-Nieto
- Institute of Research in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, México
| | - Gabriela Macedo Ojeda
- Department of Public Health, University Center of Health Sciences (CUCS), University of Guadalajara (UdG), Guadalajara, Mexico
| | - Jorge Hernández-Bello
- Institute of Research in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, México
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Gisondi P, Bellinato F, Bruni M, De Angelis G, Girolomoni G. Methotrexate vs secukinumab safety in psoriasis patients with metabolic syndrome. Dermatol Ther 2020; 33:e14281. [DOI: 10.1111/dth.14281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine University of Verona Verona Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine University of Verona Verona Italy
| | - Manfredo Bruni
- Section of Dermatology and Venereology, Department of Medicine University of Verona Verona Italy
| | - Giulia De Angelis
- Section of Dermatology and Venereology, Department of Medicine University of Verona Verona Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine University of Verona Verona Italy
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Effect of methotrexate treatment on the expression of epidermal-fatty acid-binding protein (E-FABP) and apolipoproteins in patients with psoriasis. Postepy Dermatol Alergol 2020; 37:401-406. [PMID: 32792883 PMCID: PMC7394159 DOI: 10.5114/ada.2020.96109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Epidermal-fatty acid-binding protein (E-FABP) is a marker of transiently amplifying cells which are formed from stem cells in epidermis. Their role is an uptake of fatty acids and metabolism. Psoriatic keratinocytes overexpress E-FABPs, which leads to acanthosis and may explain the lipid’s disturbances in psoriasis. Aim Assessment of FABP and apolipoprotein expression in patients treated with methotrexate (MTX). Material and methods FABP expression in the lesional and perilesional psoriatic skin from 11 male patients compared to 5 healthy skin samples were evaluated by immunohistochemistry. FABP, apolipoprotein A1 (ApoA1) and B (ApoB) serum levels were assessed by ELISA. These parameters were evaluated before and after treatment with subcutaneous MTX (15 mg/wk for 12 weeks). Results Expression of E-FABP was lower in the control group than in the lesional and perilesional psoriatic skin, before and after treatment. After treatment the expression decreased in the lesional and perilesional skin. Serum E-FABP was higher in the control group (482.855 ±240.550 pg/ml) compared to patients, but not statistically significantly. After MTX treatment, a statistically significant reduction was observed in psoriatic patients. ApoA1 levels did not differ in the control and patients groups, both before and after treatment. In contrast, ApoB levels did not differ statistically between the control group (1447.126 ±311.11 ng/ml) and patients before treatment, while they were the lowest after treatment (1081.67 ±117.83 ng/ml vs. 808.306 ±103.72 ng/ml; p < 0.01). Conclusions Our study confirms the beneficial effect of MTX, not only as an anti-proliferative effect, but also reducing the cardiovascular risk by decreasing atherogenic ApoB.
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Metabolic Syndrome and Atherogenic Indices in Rheumatoid Arthritis and their Relationship with Disease Activity: A Hospital-based Study from Northeast India. J Transl Int Med 2020; 8:99-105. [PMID: 32983932 PMCID: PMC7500118 DOI: 10.2478/jtim-2020-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Objective Metabolic syndrome (MetS), a constellation of metabolic abnormalities including hypertension, obesity, glucose intolerance, and dyslipidemia, is highly prevalent in patients with rheumatoid arthritis (RA). Our aim was to assess the magnitude of MetS and its determinants in RA patients and to evaluate different atherogenic indices that are reflective of the risk for future cardiovascular disease. Patients and Methods The study was conducted on 104 RA patients and 103 age- and sex-matched healthy controls. The frequency of MetS was assessed using the guidelines recommended for Asian Indians. Results A total of 104 RA patients participated with majority being females (85.6%), with a mean age of 43.82 ± 13.32 years. The frequency of MetS in patients with RA (36.5%) was significantly higher than in controls (15.5%). The atherogenic indices were found to be significantly higher in RA patients than controls (P < 0.01). On logistic regression, disease activity score (DAS28) scale for 28 joints and disease duration remained significant independent predictors of the presence of MetS in RA patients (P < 0.01 and 0.05, respectively). Conclusions RA is a kind of chronic disease of long course, and MetS and atherogenic indices are often concomitant in these patients. The study showed that the frequency of MetS was higher in patients with RA than in controls, and that DAS28 and disease duration remained significant independent predictors of the presence of MetS in RA patients.
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Basal metabolic rate and Charlson Comorbidity Index are independent predictors of metabolic syndrome in patients with rheumatoid arthritis. Joint Bone Spine 2020; 87:455-460. [PMID: 32278813 DOI: 10.1016/j.jbspin.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To prospectively analyze predictors of metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) during 2years of follow-up. METHODS We recruited 319 consecutive patients with RA who did not have MetS. MetS was defined in accordance with the modified National Cholesterol Education Program/Adult Treatment Panel III 2005 for Asian populations. Sociodemographic data, laboratory findings, disease activity data, and medication history were collected during face-to-face interviews at baseline and follow-up. Independent predictors of MetS were assessed by univariate and multivariate logistic regression analyses. RESULTS Of the 247 patients with RA who completed the 2-year follow-up, 37 (15.0%) developed MetS. At baseline, these patients were older and had higher body mass index, waist circumference, waist-hip ratio, skeletal muscle mass, body fat mass, percent body fat, and Charlson Comorbidity Index scores, as well as lower basal metabolic rate (BMR). Moreover, these patients with MetS took less hydroxychloroquine and more oral hypoglycemic agents; they also had lower European Quality of Life Health-state Questionnaire scores. After exclusion of variables associated with MetS composition, multivariate analysis identified BMR (odds ratio [OR]=0.205, 95% confidence interval [CI]: 0.078-0.541, P=0.001) and Charlson Comorbidity Index score (OR=2.191, 95% CI: 1.280-3.751, P=0.004) as significant predictors of MetS. CONCLUSIONS Our study showed that the annual incidence rate of MetS was 11.5% in patients with RA. Moreover, the development of MetS was associated with BMR and Charlson Comorbidity Index score at baseline.
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Increased Prevalence of Metabolic Syndrome and Adipocytokine Levels in a Psoriatic Arthritis Cohort. J Clin Rheumatol 2019; 24:302-307. [PMID: 29708516 DOI: 10.1097/rhu.0000000000000721] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate the prevalence of metabolic syndrome (MetS) in psoriatic arthritis (PsA) patients according to the most recent definition in a Mediterranean population and to determine its association with biomarkers of inflammation and serum adipocytokine levels. METHODS Demographic, clinical, and laboratory data were collected on 74 patients with PsA and 82 control subjects. The presence of MetS was determined according to the current "harmonization" definition. Serum adipocytokines were analyzed. Continuous variables were compared by t test and discrete variables by χ test. Multivariate regression models compared the association between the presence of MetS and the blood levels of adipocytokines. RESULTS The prevalence of MetS was higher in PsA patients compared with the control group: 54.8% versus 36.6%, respectively (P = 0.02; odds ratio, 2.33; 95% confidence interval, 1.16-4.69). The main difference between the 2 groups was waist circumference. No association was found between MetS and parameters of articular and skin disease activity or treatment. Leptin levels and leptin/adiponectin ratio were higher in PsA patients compared with control subjects: 83.4 versus 51.7 ng/mL (P = 0.001) and 6.3 × 10 versus 4.1 × 10 (P = 0.015), respectively. There was no significant difference in the adiponectin levels between the groups. CONCLUSIONS The prevalence of MetS was higher in PsA patients compared with non-PsA control subjects in this Mediterranean population. Clinicians caring for PsA patients ought to be aware of the increased risk of MetS in PsA patients, confirmed in different regions worldwide. The increased MetS seems to be linked to central obesity in these patients, and appropriate treatment recommendations are advised.
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Sidiropoulos P, Sfikakis PP, Boumpas DD, Vassilopoulos D. Twenty Years of Targeted Treatment in Rheumatoid Arthritis in the Greek Databases: Achievements and Unmet Needs. Mediterr J Rheumatol 2019; 30:141-146. [PMID: 32185356 PMCID: PMC7045862 DOI: 10.31138/mjr.30.3.141] [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: 03/30/2019] [Revised: 06/05/2019] [Accepted: 06/22/2019] [Indexed: 11/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with substantial morbidity and mortality especially in difficult to treat cases. Biologic agents were introduced 20 years ago in Greece and RA management has paralleled the European experience. Several publications from the country have captured important aspects of the disease from its epidemiology to the clinical use of biologics and management of comorbidities. In this communication we review the management of RA and its evolution over the last 20 years in Greece, discussing the major achievements and the unmet needs of the disease in an effort to put this into a perspective. We conclude that introduction of biologic therapy has substantially changed the treatment of difficult to treat rheumatoid arthritis in-spite of the multiple unmet needs. While striving for even better outcomes, we cannot lose sight of the major impact of biologic therapies on the lives of patients with rheumatoid arthritis.
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Affiliation(s)
- Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, School of Medicine, University of Crete, Greece
- Laboratory of Rheumatology, Inflammation and Autoimmunity, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology, Heraklion, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic and Internal Medicine & Rheumatology Unit, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios D. Boumpas
- 4th Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Francisco V, Ruiz-Fernández C, Pino J, Mera A, González-Gay MA, Gómez R, Lago F, Mobasheri A, Gualillo O. Adipokines: Linking metabolic syndrome, the immune system, and arthritic diseases. Biochem Pharmacol 2019; 165:196-206. [DOI: 10.1016/j.bcp.2019.03.030] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/19/2019] [Indexed: 12/12/2022]
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22
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Zaragoza-García O, Navarro-Zarza JE, Maldonado-Anicacio JY, Castro-Alarcón N, Rojas IP, Guzmán-Guzmán IP. Hypertriglyceridaemic waist is associated with hyperuricaemia and metabolic syndrome in rheumatoid arthritis patients. Diabetes Metab Syndr 2019; 13:722-729. [PMID: 30641795 DOI: 10.1016/j.dsx.2018.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND /Aim: The hypertriglyceridaemic waist (HTGW) phenotype has been described and suggested in general population as a cardiovascular risk marker. The aim of the present study was to evaluate the HTGW phenotype as a marker related to HUC and MetS in rheumatoid arthritis (RA). MATERIALS AND METHODS This was a cross-sectional study was designed in 250 RA Mexicans patients. The HTGW phenotype was defined as elevated waist circumference and elevated triglyceride concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype, HUC and MetS in its traditional NCEP/ATPIII versions and modified (HTGWm and MetSm). RESULTS The prevalence of HTGW and HTGWm it was 20.4% and 32%, respectively. All patients with HTGW presented MetS (P < 0.001), and in a multivariate model, the HTGW phenotype was the marker most closely related to HUC in comparison to components of MetS. CONCLUSION The HTGW may represent a marker for screening of cardiometabolic risk in RA patients, so in clinical practice can be implemented as a low-cost marker in the evaluation of the patient regardless of clinical characteristics of disease.
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Affiliation(s)
- Oscar Zaragoza-García
- Maestría en Ciencias Biomédicas, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Mexico
| | | | | | - Natividad Castro-Alarcón
- Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
| | - Isela Parra Rojas
- Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
| | - Iris Paola Guzmán-Guzmán
- Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico.
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Small HY, Migliarino S, Czesnikiewicz-Guzik M, Guzik TJ. Hypertension: Focus on autoimmunity and oxidative stress. Free Radic Biol Med 2018; 125:104-115. [PMID: 29857140 DOI: 10.1016/j.freeradbiomed.2018.05.085] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022]
Abstract
Understanding the causal role of the immune and inflammatory responses in hypertension has led to questions regarding the links between hypertension and autoimmunity. Immune pathology in primary hypertension mimics several autoimmune mechanisms observed in the pathogenesis of systemic lupus erythematosus, psoriasis, systemic sclerosis, rheumatoid arthritis and periodontitis. More importantly, the prevalence of hypertension in patients with these autoimmune diseases is significantly increased, when compared to control populations. Clinical and epidemiological evidence is reviewed along with possible mechanisms linking hypertension and autoimmunity. Inflammation and oxidative stress are linked in a self-perpetuating cycle that significantly contributes to the vascular dysfunction and renal damage associated with hypertension. T cell, B cell, macrophage and NK cell infiltration into these organs is essential for this pathology. Effector cytokines such as IFN-γ, TNF-α and IL-17 affect Na+/H+ exchangers in the kidney. In blood vessels, they lead to endothelial dysfunction and loss of nitric oxide bioavailability and cause vasoconstriction. Both renal and vascular effects are, in part, mediated through induction of reactive oxygen species-producing enzymes such as superoxide anion generating NADPH oxidases and dysfunction of anti-oxidant systems. These mechanisms have recently become important therapeutic targets of novel therapies focused on scavenging oxidative (isolevuglandin) modification of neo-antigenic peptides. Effects of classical immune targeted therapies focused on immunosuppression and anti-cytokine treatments are also reviewed.
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Affiliation(s)
- Heather Y Small
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Serena Migliarino
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marta Czesnikiewicz-Guzik
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Department of Dental Prophylaxis and Experimental Dentistry, Dental School of Jagiellonian University, Krakow, Poland
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Department of Internal and Agricultural Medicine, Jagiellonian University Collegium Medicum, Krakow, Poland.
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Abdelmonem S, Eltanawy R, Ismail Y, Baraka E, Shoshan A. Association between microalbuminuria and metabolic syndrome in patients with rheumatoid arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_37_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Arias de la Rosa I, Escudero-Contreras A, Rodríguez-Cuenca S, Ruiz-Ponce M, Jiménez-Gómez Y, Ruiz-Limón P, Pérez-Sánchez C, Ábalos-Aguilera MC, Cecchi I, Ortega R, Calvo J, Guzmán-Ruiz R, Malagón MM, Collantes-Estevez E, Vidal-Puig A, López-Pedrera C, Barbarroja N. Defective glucose and lipid metabolism in rheumatoid arthritis is determined by chronic inflammation in metabolic tissues. J Intern Med 2018. [PMID: 29532531 DOI: 10.1111/joim.12743] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients are at increased risk of insulin resistance (IR); however, the specific mechanisms mediating this association are currently unknown. OBJECTIVE To investigate whether the inflammatory activity associated with RA accounts for the observed defective glucose metabolism and lipid metabolism in these patients. METHODS We followed two main strategies: (i) extensive metabolic profiling of a RA cohort of 100 patients and 50 healthy control subjects and (ii) mechanistic studies carried out in both a collagen-induced arthritis mouse model and 3T3-L1 adipocytes treated with conditioned serum from RA patients. RESULTS Following the exclusion of obese and diabetic subjects, data from RA patients demonstrated a strong link between the degree of systemic inflammation and the development of IR. These results were strengthened by the observation that induction of arthritis in mice resulted in a global inflammatory state characterized by defective carbohydrate and lipid metabolism in different tissues. Adipose tissue was most susceptible to the RA-induced metabolic alterations. These metabolic effects were confirmed in adipocytes treated with serum from RA patients. CONCLUSIONS Our results show that the metabolic disturbances associated with RA depend on the degree of inflammation and identify inflammation of adipose tissue as the initial target leading to IR and the associated molecular disorders of carbohydrate and lipid homeostasis. Thus, we anticipate that therapeutic strategies based on tighter control of inflammation and flares could provide promising approaches to normalize and/or prevent metabolic alterations associated with RA.
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Affiliation(s)
- I Arias de la Rosa
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - A Escudero-Contreras
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - S Rodríguez-Cuenca
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbroke's Hospital, University of Cambridge, Cambridge, UK
| | - M Ruiz-Ponce
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Y Jiménez-Gómez
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - P Ruiz-Limón
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - C Pérez-Sánchez
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - M C Ábalos-Aguilera
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - I Cecchi
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain.,Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Turin, Italy
| | - R Ortega
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - J Calvo
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - R Guzmán-Ruiz
- Department of Cell Biology, Physiology and Immunology, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - M M Malagón
- Department of Cell Biology, Physiology and Immunology, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - E Collantes-Estevez
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - A Vidal-Puig
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbroke's Hospital, University of Cambridge, Cambridge, UK
| | - Ch López-Pedrera
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - N Barbarroja
- Rheumatology Service, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Kesikburun B, Ekşioğlu E, Çakcı A. Metabolic Syndrome in Rheumatoid Arthritis and Ankylosing Spondylitis. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.435258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cardiovascular Safety of Biologics and JAK Inhibitors in Patients with Rheumatoid Arthritis. Curr Rheumatol Rep 2018; 20:42. [DOI: 10.1007/s11926-018-0752-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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28
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Thomas K, Lazarini A, Kaltsonoudis E, Drosos A, Papalopoulos I, Sidiropoulos P, Katsimbri P, Boumpas D, Tsatsani P, Gazi S, Fragkiadaki K, Tektonidou M, Sfikakis PP, Pantazi L, Boki KA, Grika EP, Vlachoyiannopoulos PG, Karagianni K, Sakkas LI, Dimitroulas T, Garyfallos A, Kassimos D, Evangelatos G, Iliopoulos A, Areti M, Georganas C, Melissaropoulos K, Georgiou P, Vounotrypidis P, Ntelis K, Mavragani CP, Bournazos I, Katsifis G, Mavrommatis C, Kitas GD, Vassilopoulos D. Multicenter Cross-sectional Study of Patients with Rheumatoid Arthritis in Greece: Results from a cohort of 2.491 patients. Mediterr J Rheumatol 2018; 29:27-37. [PMID: 32185294 PMCID: PMC7045959 DOI: 10.31138/mjr.29.1.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/12/2018] [Indexed: 11/21/2022] Open
Abstract
Aim of the study: To evaluate the current disease characteristics, treatment and comorbidities of rheumatoid arthritis (RA) in Greece. Methods: Multicenter, cross-sectional study with a 9-month recruitment period between 2015 and 2016. Demographics, disease characteristics, treatment and comorbidities were collected via a web-based platform. Results: 2.491 RA patients were recruited: 96% from tertiary referral centers, 79% were females with a mean age of 63.1 years and disease duration of 9.9 years. Fifty-two percent were rheumatoid factor and/or anti-CCP positive, while 41% had erosive disease. Regarding treatment, 82% were on conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), 42% on biologic DMARDs (TNFi: 22%, non-TNFi: 20%) and 40% on corticosteroids (mean daily dose: 5.2 mg). Despite therapy, 36% of patients had moderate and 12% high disease activity. The most frequent comorbidities were hypertension (42%), hyperlipidemia (33%), osteoporosis (29%), diabetes mellitus (15%) and depression (12%). Latent tuberculosis infection (positive tuberculin skin test or interferon gamma release assay) was diagnosed in 13 and 15.3% of patients, respectively. Regarding chronic viral infections, 6.2% had history of herpes zoster while 2% and 0.7% had chronic hepatitis B and C virus infection, respectively. A history of serious infection was documented in 9.6%. Only 36% and 52% of the participants had ever been vaccinated against pneumococcus and influenza virus, respectively. Conclusion: This is one of the largest epidemiologic studies providing valuable data regarding the current RA characteristics in Greece. Half of patients were seropositive but despite therapy, half displayed residual disease activity, while preventive vaccination was limited.
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Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Argiro Lazarini
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | - Ioannis Papalopoulos
- Clinical Immunology and Allergy Department, University of Crete, Heraklion, Greece
| | | | - Pelagia Katsimbri
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Boumpas
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | - Kalliopi Fragkiadaki
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Tektonidou
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Petros P Sfikakis
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lina Pantazi
- Rheumatology Unit, Sismanoglio Hospital, Athens, Greece
| | | | - Eleftheria P Grika
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | - Lazaros I Sakkas
- Department of Rheumatology, University of Thessaly, Larissa, Greece
| | | | | | | | | | | | | | | | | | | | | | | | - Clio P Mavragani
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | | | - George D Kitas
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.,Hygeia Hospital, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Owczarczyk-Saczonek A, Drozdowski M, Maciejewska-Radomska A, Choszcz D, Placek W. The effect of subcutaneous methotrexate on markers of metabolic syndrome in psoriatic patients - preliminary report. Postepy Dermatol Alergol 2018; 35:53-59. [PMID: 29599672 PMCID: PMC5872240 DOI: 10.5114/ada.2017.71358] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Methotrexate (MTX) has anti-proliferative and anti-inflammatory effects in psoriasis. Moreover, low doses can reduce the risk of developing cardiovascular diseases. It turns out that psoriasis and atherosclerosis have a similar pathogenetic mechanism: the same pro-inflammatory cytokines, Th1 and Th17, are involved in both diseases. AIM To evaluate the effects of metabolic markers, protective cytokines (interleukin 10 (IL-10), transforming growth factor β (TGF-β)) and a marker of endothelial damage (endocan) in patients with plaque psoriasis. MATERIAL AND METHODS The study included 24 patients aged 27-69 years (9 female, 15 male) with plaque psoriasis. The metabolic syndrome according to the International Diabetes Federation (IDF) was evaluated. The laboratory tests were performed under fasting conditions: C-reactive protein (CRP), glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, endocan, IL-10, and TGF-β. After 12 weeks of treatment with MTX injections 15 mg/week, every patient was assessed with the same laboratory tests. RESULTS After treatment we observed a statistically significant increase of endocan and IL-10, but no significant differences in the titer of TGF-β. C-reactive protein was reduced by approximately 54.7%. No improvement of lipid profile was observed, and even a significant increase in triglycerides was noted. Similarly, no significant difference was seen in the case of glucose and uric acid prior to and after treatment. CONCLUSIONS Methotrexate in low doses in short-term treatment decreases CRP (anti-inflammatory effect) and increases endocan and IL-10 (potential protective role). Methotrexate is characterized by good efficacy and tolerability in therapy of patients with psoriasis.
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Affiliation(s)
- Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, Olsztyn, Poland
| | - Marek Drozdowski
- Department of Laboratory Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Agata Maciejewska-Radomska
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, Olsztyn, Poland
| | - Dariusz Choszcz
- Department of Machines and Research Methodology, Faculty of Technical Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Waldemar Placek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, Olsztyn, Poland
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Kang EH, Jin Y, Brill G, Lewey J, Patorno E, Desai RJ, Kim SC. Comparative Cardiovascular Risk of Abatacept and Tumor Necrosis Factor Inhibitors in Patients With Rheumatoid Arthritis With and Without Diabetes Mellitus: A Multidatabase Cohort Study. J Am Heart Assoc 2018; 7:e007393. [PMID: 29367417 PMCID: PMC5850244 DOI: 10.1161/jaha.117.007393] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND We examined the cardiovascular risk of abatacept compared with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis with and without diabetes mellitus (DM). METHODS AND RESULTS We conducted a cohort study of patients with rheumatoid arthritis who newly started abatacept or TNF inhibitors using claims data from Medicare and MarketScan. The primary outcome was a composite cardiovascular end point of myocardial infarction (MI), stroke/transient ischemic attack, and coronary revascularization. To account for >60 baseline characteristics, abatacept initiators were 1:1 propensity score (PS) matched to TNF initiators in each database. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) in the PS-matched cohort per database. A fixed-effects meta-analysis pooled database-specific HRs. We included a total of 13 039 PS-matched pairs of abatacept and TNF inhibitor initiators (6103 pairs in Medicare and 6936 pairs in MarketScan). A total of 34.7% in Medicare and 19.8% in MarketScan had baseline DM. The HR (95% CI) for the primary outcome associated with abatacept use versus TNF inhibitor was 0.81 (0.66-0.99) in Medicare and 0.95 (0.74-1.23) in MarketScan, with a pooled HR of 0.86 (95% CI, 0.73-1.01; P=0.3 for heterogeneity). The risk of the primary outcome was lower in abatacept initiators versus TNF inhibitors in the DM subgroup, with a pooled HR of 0.74 (95% CI, 0.57-0.96; P=0.7 for heterogeneity), but not in the non-DM subgroup, with a pooled HR of 0.94 (95% CI, 0.77-1.14; P=0.4 for heterogeneity). CONCLUSIONS In this large population-based cohort of patients with rheumatoid arthritis, abatacept use appeared to be associated with a modestly reduced cardiovascular risk when compared with TNF inhibitor use, particularly in patients with DM.
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Affiliation(s)
- Eun Ha Kang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jennifer Lewey
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Bartoloni E, Alunno A, Gerli R. Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases. Nat Rev Cardiol 2017; 15:33-44. [PMID: 28836617 DOI: 10.1038/nrcardio.2017.118] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Evidence for the increased risk of cardiovascular morbidity and mortality in patients with chronic inflammatory and systemic autoimmune diseases has accumulated during the past 15 years. In these patients, an interplay between several mechanisms, including premature acceleration of subclinical atherosclerotic damage, inflammation, and dysregulation of the immune system, is involved in the induction and progression of atherosclerosis. Moreover, traditional cardiovascular risk factors are also likely to contribute, at least in part, to the excess cardiovascular risk. Among traditional cardiovascular risk factors, hypertension is an important predictor of cardiovascular events in the general population and in patients with chronic inflammatory and autoimmune diseases. Evidence supports the idea that the pathogenic mechanisms underlying the increased blood pressure in these diseases are multifactorial and not only related to the mechanical injury of the arterial wall. In particular, chronic inflammation and immune-mediated mechanisms have been demonstrated to affect blood-pressure control in patients with systemic autoimmune disease. In this Review, we discuss the available evidence on the relationship between hypertension and autoimmune diseases, and describe the multiple factors that might affect blood-pressure control in patients with chronic inflammatory and systemic autoimmune diseases. We also discuss the effect of hypertension and antirheumatic therapies on cardiovascular outcome.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, P.le Menghini 1, Perugia 06129, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, P.le Menghini 1, Perugia 06129, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, P.le Menghini 1, Perugia 06129, Italy
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Bajraktari IH, Rexhepi S, Berisha I, Lahu A, Kryeziu A, Durmishi B, Bajraktari H, Bahtiri E. Prevalence of Asymptomatic Arterial Hypertension and Its Correlation with Inflammatory Activity in Early Rheumatoid Arthritis. Open Access Maced J Med Sci 2017; 5:641-644. [PMID: 28932306 PMCID: PMC5591595 DOI: 10.3889/oamjms.2017.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that worsens during the course of the disease and can cause disability. Early RA refers to the onset of symptoms within the past 3 months. In RA, increased levels of mediators of inflammation may cause arterial stiffness consequently leading to arterial hypertension. AIM: The aim of this cross-sectional study was to assess the prevalence of asymptomatic arterial hypertension in early RA patients as well as the correlation with parameters of inflammation. METHODS: One hundred and seventy-nine early RA patients diagnosed in agreement with ACR/EULAR (American College of Rheumatology/ European League against Rheumatism) 2010 criteria were consecutively included in the study. CRP (C-reactive protein) and anti CCP (Antibodies to cyclic citrullinated peptides) serum levels, WBC (white blood cells) count and ESR (Erythrocyte sedimentation rate), likewise DAS-28 (28-joint disease activity score) were determined in all included patients. Parametric tests were used to compare the characteristics of the groups and to test the correlation of the variables. RESULTS: Statistical data analysis revealed that a majority of the patients were females (n = 141; 78.7%); the mean age at RA onset was 49.13 ± 12.13 years. Overall prevalence of hypertension was 44.13 % (n = 79). In comparison with the normotensive patients, the hypertensive patients were older and had significantly higher values of CRP, ESR, anti-CCP and DAS-28. A highly significant positive correlation between all the study parameters and systolic and diastolic blood pressure was observed. CONCLUSION: Presence of significantly higher values of CRP, ESR, anti-CCP and DAS-28 in hypertensive patients indicate that inflammation is associated with an increased risk of hypertension. In this context, early screening for arterial hypertension and adequate therapeutic measures should be considered in early RA patients.
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Affiliation(s)
- Ismet H Bajraktari
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Sylejman Rexhepi
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Idriz Berisha
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Ali Lahu
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Avni Kryeziu
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Bastri Durmishi
- Clinic of Rheumatology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Halit Bajraktari
- Emergency Center, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Elton Bahtiri
- Clinic of Endocrinology, University Clinical Center of Kosovo, Prishtina, Kosovo.,Department of Pharmacology, Faculty of Medicine, University of Prishtina, Kosovo
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Bartoloni E, Alunno A, Valentini V, Luccioli F, Valentini E, La Paglia G, Bistoni O, Gerli R. Role of Inflammatory Diseases in Hypertension. High Blood Press Cardiovasc Prev 2017; 24:353-361. [PMID: 28597352 DOI: 10.1007/s40292-017-0214-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/30/2017] [Indexed: 12/24/2022] Open
Abstract
Chronic inflammatory diseases (CID) are characterized by an increased risk of cardiovascular (CV) morbidity and mortality. Several mechanisms, including early acceleration of subclinical atherosclerotic damage, inflammatory markers and immune system deregulation factors, have been demonstrated to strictly interplay for development and progression of atherosclerosis. Moreover, traditional CV risk factors are likely to explain at least some of the excess of CV risk in these patients. Among traditional CV risk factors, compelling evidence suggests a higher incidence and prevalence of hypertension in patients with CID in comparison to the general population. Moreover, hypertension represents an important predictor of CV events in these patients. Pathogenic mechanisms underlying the rise of blood pressure in CID are multifactorial and still poorly investigated. Indeed, multiple disease-related factors may affect blood pressure control in these patients and hypertension may affect disease prognosis and increase CV risk. Better knowledge of the complex interplay between hypertension and CID will be important to elucidate pathogenic mechanisms and to improve CV outcome in these patients. Aim of this review is to highlight available evidence on the relationship between hypertension and CID and to elucidate the multiple factors that may affect blood pressure control in these disorders.
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Affiliation(s)
- E Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - A Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - V Valentini
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - F Luccioli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - E Valentini
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - G La Paglia
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - O Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
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Hallajzadeh J, Safiri S, Mansournia MA, Khoramdad M, Izadi N, Almasi-Hashiani A, Pakzad R, Ayubi E, Sullman MJM, Karamzad N. Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis. PLoS One 2017; 12:e0170361. [PMID: 28333949 PMCID: PMC5363810 DOI: 10.1371/journal.pone.0170361] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/03/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Estimating the current global prevalence of metabolic syndrome (MetS), and its components, among rheumatoid arthritis (RA) patients is necessary in order to formulate preventative strategies and to ensure there are adequate community resources available for these patients. Furthermore, the association between RA and MetS is controversial and has not previously been comprehensively assessed. Therefore, the present study aimed to: 1) determine the prevalence of MetS, and its components, among RA patients across the world 2) update the odds ratio of MetS in RA patients, compared to healthy controls, using a comprehensive systematic review and meta-analysis. METHODS International databases, including: the Web of Science, PubMed, Scopus, Embase, CINAHL and other relevant databases were searched to identify English language articles which reported the prevalence and risk of MetS in RA patients between January 2000 and August 2016. The meta-analysis only included studies which clearly described the time and location of the study, utilised adequate sampling strategies, and appropriate statistical analyses. RESULTS The meta-analyses of prevalence (70 studies [n = 12612]) and risk (43 studies [n = 35220]) of MetS in RA patients were undertaken separately. The overall pooled prevalence of MetS was 30.65% (95% CI: 27.87-33.43), but this varied from 14.32% (95% CI: 10.59-18.05) to 37.83% (95% CI: 31.05-44.61), based upon the diagnostic criteria used. The prevalence of MetS also varied slightly between males (31.94%, 95% CI: 24.37-39.51) and females (33.03%, 95% CI: 28.09-37.97), but this was not statistically significant. The overall pooled odds ratio (OR) of MetS in RA patients, compared to healthy controls, was 1.44 (95% CI: 1.20-1.74), but this ranged from 0.70 (95% CI: 0.27-1.76) to 4.09 (95% CI: 2.03-8.25), depending on the criteria used. The mean age and diagnostic criteria of MetS were identified as sources of heterogeneity in the estimated odds ratios between studies (P<0.05). CONCLUSIONS According to the high prevalence of MetS in RA patients, and high risk of MetS, measuring metabolic syndrome in RA patients is strongly recommended. Furthermore, as high waist circumference (WC) is the most common metabolic syndrome component, more attention must be paid to nutrition and weight loss among those with RA.
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Affiliation(s)
- Jamal Hallajzadeh
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Khoramdad
- Department of Epidemiology and Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Neda Izadi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Erfan Ayubi
- Department of Public Health, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mark J. M. Sullman
- Driving Research Group, Cranfield University, Bedfordshire, United Kingdom
| | - Nahid Karamzad
- Vice-Chancellery for Food and Drug, Maragheh University of Medical Sciences, Maragheh, Iran
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Prevalence of Metabolic Syndrome in Treatment Naïve Rheumatoid Arthritis and Correlation With Disease Parameters. Arch Rheumatol 2016; 32:46-52. [PMID: 30375525 DOI: 10.5606/archrheumatol.2017.5949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/26/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the prevalence of metabolic syndrome (MetS) in treatment naïve rheumatoid arthritis (RA) in an Indian population and correlate RA disease characteristics with presence of MetS. Patients and methods The study included 84 RA patients (18 males, 66 females; mean age 44.8±12.5 years; range 18 to 72 years) diagnosed according to 2010 American College of Rheumatology-European League Against Rheumatism classification criteria who were treatment naïve or did not receive disease modifying antirheumatic drugs for more than six weeks and 120 age and sex-matched apparently healthy controls (35 males, 85 females; mean age 44.1±12.7 years; range 18 to 75 years). The frequency of MetS was assessed using National Cholesterol Education Program- Adult Treatment Panel III 2004 revised criteria. Patients were also assessed in terms of disease activity, using disease activity score 28 erythrocyte sedimentation rate. Logistic regression was used to identify predictors of MetS in RA. Results Metabolic syndrome was found in 39.28% of RA group and 20% of control group according to National Cholesterol Education Program- Adult Treatment Panel III 2004 (p<0.005). MetS was most commonly detected in the 51 to 60 age group (65%). RA group was significantly more likely to have low high-density lipoprotein (63.09%), high triglyceride (53.57%), elevated blood pressure (41.66%) levels, and elevated waist circumference (38.09%). In RA group, disease activity score 28 (odds ratio: 6.51, confidence interval: 1.19-35.46 p=0.03), C-reactive protein (odds ratio: 1.13, confidence interval: 1.05-1.21 p<0.001), and duration of disease (odds ratio: 1.82, confidence interval: 1.04-3.18 p=0.03) remained independent predictors for presence of MetS in RA. Conclusion The frequency of MetS was higher in RA group compared to control group. Higher systemic inflammatory marker, disease duration, and disease activity score 28 remained independent predictors associated with presence of MetS. These findings suggest that RA patients should be screened early for presence of MetS to check for and reduce risk of atherosclerotic vascular diseases.
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Tantayakom P, Koolvisoot A, Arromdee E, Chiowchanwisawakit P, Muangchan C, Katchamart W. Metabolic syndrome is associated with disease activity in patients with rheumatoid arthritis. Joint Bone Spine 2016; 83:563-7. [PMID: 27238198 DOI: 10.1016/j.jbspin.2015.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/21/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the association between metabolic syndrome (MS) and disease activity in patients with rheumatoid arthritis (RA). METHODS Siriraj Rheumatoid Arthritis registry is a prospective cohort study establishing since May 2011. A total of 267 patients who had complete data in February 2015 were included in these analyses. All clinical and laboratory data related to disease activity, functional status, and parameters of MS according to the 2001 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were collected. Univariate and backward stepwise multivariate analyses were performed to identify factors associated with MS. RESULTS Most (88%) were female with the mean age±standard deviation of 59±11.1 years old. MS was found in 43 patients (16%). Patients with MS had a significantly lower proportion of patients with remission (time-adjusted mean of disease activity score 28 or DAS28<2.6) than those with non-MS (2.3% vs. 16.5%, P=0.02). Multiple logistic regression analysis identified 3 independent factors associated with MS including body mass index [OR 1.2, 95% CI 1.1 to 1.3], educational level≤12 years [OR 5.92, 95% CI 1.47 to 23.83], and disease remission [OR 0.11, 95% CI 0.01 to 0.93]. This model correctly predicted 84% of cases. CONCLUSION Remission rate is significantly lower in RA patients with MS. Disease activity of RA, body mass index, and educational level are associated with metabolic syndrome in patients with RA.
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Affiliation(s)
- Pongchirat Tantayakom
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand
| | - Ajchara Koolvisoot
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand
| | - Emvalee Arromdee
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand
| | - Praveena Chiowchanwisawakit
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand
| | - Chayawee Muangchan
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand.
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van Onna M, Boonen A. The challenging interplay between rheumatoid arthritis, ageing and comorbidities. BMC Musculoskelet Disord 2016; 17:184. [PMID: 27118031 PMCID: PMC4845363 DOI: 10.1186/s12891-016-1038-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of rheumatoid arthritis (RA) is expected to increase over the next 10 years in the European Union because of the increasing proportion of elderly people. As both RA and ageing are associated with emerging comorbidities such as cardiovascular disease, malignancies and osteoporosis, these factors will have a profound effect on the management of RA. In addition, both increasing age and comorbidities may independently alter commonly used RA-specific outcome measures. Discussion Age-related decline in immune cell functions (immunosenescence), such as a decrease in T-cell function, may contribute to the development of RA, as well as comorbidity. The chronic immune stimulation that occurs in RA may also lead to premature ageing and comorbidity. The interplay between RA, ageing and (emerging) comorbidities is interesting but complex. Cardiovascular disease, lung disease, malignancies, bone and muscle wasting and neuropsychiatric disease all occur more frequently in RA patients as compared to the general population. It is unclear how RA should be managed in ‘today’s world of multiple comorbidities’. Evidence that treatment of RA improves comorbidities is currently lacking, although some promising indirect observations are available. On the other hand, there is limited evidence that medication regularly prescribed for comorbidities, such as statins, might improve RA disease activity. Both ageing and comorbidity have an independent effect on commonly used outcome measures in the RA field, such as the Health Assessment Questionnaire (HAQ) and the clinical disease activity index (CDAI). Prospective studies, that also account for the presence of comorbidity in (elderly) RA patients are therefore urgently needed. To address gaps in knowledge, future research should focus on the complex interdependencies between RA, ageing and comorbidity. In addition, these findings should be integrated into daily clinical practice by developing and testing integrated and coordinated health care services. Adaptation of management recommendations is likely required. Summary The elderly RA patient who also deals with (emerging) comorbidities presents a unique challenge to treating clinicians. A paradigm shift from disease-centered to goal-oriented approach is needed to develop adequate health care services for these patients.
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Affiliation(s)
- Marloes van Onna
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands.
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands
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Hugo M, Mehsen-Cetre N, Pierreisnard A, Schaeverbeke T, Gin H, Rigalleau V. Energy expenditure and nutritional complications of metabolic syndrome and rheumatoid cachexia in rheumatoid arthritis: an observational study using calorimetry and actimetry. Rheumatology (Oxford) 2016; 55:1202-9. [PMID: 27009826 DOI: 10.1093/rheumatology/kew038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Altered energy expenditure may contribute to the nutritional complications of RA, metabolic syndrome (MS) and rheumatoid cachexia (RC). The main aim of this study was to evaluate whether the altered resting energy expenditure (REE) and physical activity (PA)-related energy expenditure (EE) are related to the duration of RA and inflammatory activity and nutritional complications in RA. METHODS Among patients with well-characterized RA (duration, activity: DAS28 ESR), we measured REE by indirect calorimetry, and PA-EE by actimetry (SenseWear Armband). MS was defined according to the International Diabetes Federation criteria and RC from DXA body composition analysis. The relations between the characteristics and nutritional complications, and EE were analysed by linear regression. RESULTS Fifty-seven patients were included [73% women, age 57 (10) years] with a wide range of disease duration: 3.8 (3.0) years, and DAS28 ESR: 3.9 (1.4). The mean REE was 1486 (256) kcal/day, associated with the DAS28 ESR (β = +0.21, P = 0.02 after adjusting for gender and fat free mass). The prevalence of MS and RC was, respectively, 24 and 18%, and they were unrelated to each other. The patients with MS and/or RC had double the longstanding RA score (P < 0.05), twice the homeostasis model assessment of insulin resistance values (P = 0.052) and halved levels of PA (P < 0.05 for metabolic equivalent tasks (METs) and number of steps/day). Two modifiable factors were associated with the presence of MS and/or RC: a low level of PA as METs [exp(B) = 0.03, P = 0.009] and the use of glucocorticoids [exp(B) = 4.08, P = 0.046]. CONCLUSION Low levels of PA and treatment by glucocorticoids are associated with the nutritional complications of RA, suggesting the potential for therapeutic interventions.
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Oliveira BMGBD, Medeiros MMDC, Cerqueira JVMD, Quixadá RTDS, Oliveira ÍMXD. Síndrome metabólica em pacientes com diagnóstico de artrite reumatoide acompanhados em um Hospital Universitário do Nordeste brasileiro. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Feagins LA, Flores A, Arriens C, Park C, Crook T, Reimold A, Brown G. Nonalcoholic fatty liver disease: a potential consequence of tumor necrosis factor-inhibitor therapy. Eur J Gastroenterol Hepatol 2015; 27:1154-60. [PMID: 26148245 PMCID: PMC5157831 DOI: 10.1097/meg.0000000000000421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although tumor necrosis factor inhibitors (TNFi) might be expected to protect against nonalcoholic fatty liver disease (NAFLD), we have seen patients who appeared to develop NAFLD during TNFi treatment. We aimed to explore risk factors for this TNFi complication in a case-control study. METHODS We reviewed clinic records at our VA hospital to identify patients with inflammatory diseases who developed aminotransferase elevations during TNFi therapy and who had liver biopsies showing NAFLD. These patients were matched with patients in each of three control groups: (i) inflammatory disease controls: patients on TNFi treatment with normal aminotransferase levels, (ii) nonalcoholic steatohepatitis (NASH) controls: patients with biopsy-proven NASH with no other inflammatory disease, and (iii) healthy controls. Genotyping was performed for PNPLA3, a gene predisposing to NASH. RESULTS We identified eight cases (five steatohepatitis, three steatosis); elevated aminotransferase levels were first observed 1-63 months into TNFi therapy (average 12 months). TNFi therapy was stopped in five patients, whose aminotransferase levels then normalized within 2-8 months. There were no significant differences between cases and inflammatory disease controls in the frequency of features of metabolic syndrome. Cases had more methotrexate exposure than inflammatory controls (50 vs. 12.5%, P=0.28). PNPLA3 genotyping revealed mutations in 75% of cases, 38% of inflammatory controls, 88% of NASH controls, and 63% of healthy controls (P=NS). CONCLUSION Our findings suggest that NAFLD can be a side effect of TNFi therapy, and that methotrexate exposure and PNPLA3 gene mutations might be risk factors. Further studies are needed to determine how TNFi causes NAFLD and to confirm these risk factors.
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Affiliation(s)
- Linda A. Feagins
- Division of Gastroenterology and Hepatology, VA North Texas Healthcare System, Texas, USA,Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avegail Flores
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cristina Arriens
- Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christina Park
- Division of Gastroenterology and Hepatology, VA North Texas Healthcare System, Texas, USA
| | - Terri Crook
- Department of Pathology, VA North Texas Healthcare System, Texas, USA,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andreas Reimold
- Division of Rheumatology, VA North Texas Healthcare System, Texas, USA,Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geri Brown
- Division of Gastroenterology and Hepatology, VA North Texas Healthcare System, Texas, USA,Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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The interplay between inflammation and metabolism in rheumatoid arthritis. Cell Death Dis 2015; 6:e1887. [PMID: 26379192 PMCID: PMC4650442 DOI: 10.1038/cddis.2015.246] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/29/2015] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by extensive synovitis resulting in erosions of articular cartilage and marginal bone that lead to joint destruction. The autoimmune process in RA depends on the activation of immune cells, which use intracellular kinases to respond to external stimuli such as cytokines, immune complexes, and antigens. An intricate cytokine network participates in inflammation and in perpetuation of disease by positive feedback loops promoting systemic disorder. The widespread systemic effects mediated by pro-inflammatory cytokines in RA impact on metabolism and in particular in lymphocyte metabolism. Moreover, RA pathobiology seems to share some common pathways with atherosclerosis, including endothelial dysfunction that is related to underlying chronic inflammation. The extent of the metabolic changes and the types of metabolites seen may be good markers of cytokine-mediated inflammatory processes in RA. Altered metabolic fingerprints may be useful in predicting the development of RA in patients with early arthritis as well as in the evaluation of the treatment response. Evidence supports the role of metabolomic analysis as a novel and nontargeted approach for identifying potential biomarkers and for improving the clinical and therapeutical management of patients with chronic inflammatory diseases. Here, we review the metabolic changes occurring in the pathogenesis of RA as well as the implication of the metabolic features in the treatment response.
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de Oliveira BMGB, Medeiros MMDC, de Cerqueira JVM, de Souza Quixadá RT, de Oliveira ÍMX. Metabolic syndrome in patients with rheumatoid arthritis followed at a University Hospital in Northeastern Brazil. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:117-25. [PMID: 27267524 DOI: 10.1016/j.rbre.2015.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/29/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) are 30-60% more likely to develop cardiovascular disease (CV) than the general population. Metabolic syndrome (MS), defined by a number of cardiovascular risk factors, confers a greater risk of CVdisease and diabetes. The association of MS with RA is not yet fully understood and its prevalence varies from 19 to 63% across studies. OBJECTIVES To assess the prevalence of MS in a population of RA patients followed in a hospital in Northeastern Brazil and analyze associations of demographic and clinical factors with MS. METHODS Outpatients with RA were evaluated in a cross-sectional study regarding demographic, clinical, laboratory and anthropometric data. The criteria for defining MS were those adopted by NCEPIII (2005) and IDF (2006). RESULTS 110 patients with RA were studied; 97.3% were female, with a mean age of 55.5 years (SD=12.9) and duration of illness of 11.2 years (SD=7.3). The MS prevalence from NCEPIII (2005) and IDF (2005) were, respectively, 50% and 53.4%. Advanced age (57.9±11.9 versus 52.9±13.5; p=0.04) and smoking load >20 packs/year (29% versus 9%, p=0.008) were associated with MS. The major components of the metabolic syndrome were abdominal obesity (98.1%), hypertension (80%) and low HDL cholesterol (72.2%). CONCLUSIONS RA patients in a tertiary center in Northeastern Brazil showed high prevalence of MS. It is worth noting that almost all patients had MS and abdominal obesity, which has important practical implications. In addition to the components of MS, age and smoking were associated with this syndrome.
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Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, Siu S, Kraft J, Lynde C, Pope J, Gulliver W, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B. Evidence-based Recommendations for the Management of Comorbidities in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis: Expert Opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol 2015; 42:1767-80. [DOI: 10.3899/jrheum.141112] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
Objective.Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.Methods.Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960–12/2012), together with abstracts from major rheumatology and dermatology congresses (2010–2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.Results.A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.Conclusion.These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.
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Differences in the prevalence and characteristics of metabolic syndrome in rheumatoid arthritis and osteoarthritis: a multicentric study. Rheumatol Int 2015; 35:2047-57. [DOI: 10.1007/s00296-015-3307-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/02/2015] [Indexed: 01/16/2023]
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Ursini F, Russo E, Letizia Hribal M, Mauro D, Savarino F, Bruno C, Tripolino C, Rubino M, Naty S, Grembiale RD. Abatacept improves whole-body insulin sensitivity in rheumatoid arthritis: an observational study. Medicine (Baltimore) 2015; 94:e888. [PMID: 26020396 PMCID: PMC4616417 DOI: 10.1097/md.0000000000000888] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rheumatoid arthritis (RA) is characterized by increased insulin resistance, a well-known risk factor for diabetes and cardiovascular diseases. The aim of the present study was to evaluate the effect of abatacept on insulin sensitivity in RA patients with moderate to severe disease despite treatment with methotrexate. Fifteen RA patients were recruited for the present study. Patients were evaluated at time 0 and after 6 months of the treatment with i.v. abatacept at the dosage recommended for weight range. Evaluation included oral glucose tolerance test (OGTT) at both time points. Insulin sensitivity was estimated with insulin sensitivity index (ISI) by Matsuda, a measure of whole-body insulin sensitivity. ISI significantly increased after the treatment with abatacept from 3.7 ± 2.6 to 5.0 ± 3.2 (P = 0.003) with a mean difference of 1.23. Analysis of glucose and insulin values during OGTT revealed a reduction of both glucose (303.9 ± 73.4 mg/dL min versus 269.2 ± 69.5 mg/dL min, P = 0.009) and insulin (208.4 ± 119.7 mg/dL min versus 158.0 ± 95.3 mg/dL min, P = 0.01) area under the curves (AUCs). Accordingly also glycated hemoglobin significantly improved (5.5 ± 0.4% versus 5.3 ± 0.3%, P = 0.04). No significant differences were found for measures of β-cell function insulinogenic index (1.11 ± 1.19 versus 1.32 ± 0.82, P = 0.77) and oral disposition index (2.0 ± 5.4 versus 6.0 ± 6.0, P = 0.25). Treatment with abatacept seems to be able to improve whole-body insulin sensitivity in RA patients without affecting β-cell function.
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Affiliation(s)
- Francesco Ursini
- From the Department of Medical and Surgical Sciences (FU, MLH, DM, FM, CB, CT, MR, SN, RDG); Science of Health Department, University of Catanzaro, Catanzaro, Italy (ER)
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Effectiveness of methotrexate therapy with occasional corticosteroid in rheumatoid arthritis. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Parra-Salcedo F, Contreras-Yáñez I, Elías-López D, Aguilar-Salinas CA, Pascual-Ramos V. Prevalence, incidence and characteristics of the metabolic syndrome (MetS) in a cohort of Mexican Mestizo early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs: the complex relationship between MetS and disease activity. Arthritis Res Ther 2015; 17:34. [PMID: 25889060 PMCID: PMC4362822 DOI: 10.1186/s13075-015-0549-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/03/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction A higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity. Objectives were to describe prevalence of MetS at RA diagnosis in a cohort of Mexican Mestizo early RA patients, and to define a causal association between MetS and disease activity. Methods The study population was a prospective cohort. At baseline and at fixed 6-months-intervals, patients had medical evaluations, fasting serum glucose, triglycerides, high-density lipoprotein cholesterol and acute reactant-phase determinations. MetS was defined according to international criteria and body mass index (BMI) ≥30 kg/m2 was used as a surrogate of the waist circumference. The study was approved by the internal review board. Appropriated statistics and Cox regression analysis were used. All statistical tests were two-sided and evaluated at the 0.05 significance level. Results Up to March 2014, data from 160 patients were analyzed. At baseline, they were more frequently middle-aged females and had moderate to high disease activity. Prevalence of MetS varied from 11.3% to 17.5% in patients and was lower to that from matched controls (versus 26.3% to 30%, P ≤0.01). Up to last follow-up, 39 patients (34.5%) developed incidental MetS. In the Cox regression analysis, cumulative disease activity score (DAS) 28 (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.346 to 2.433, P = 0.000) and baseline BMI (OR: 1.13, 96% CI: 1.035 to 1.236, P = 0.007) were the only predictors for incidental MetS. RA patients with incidental MetS accumulated more disease activity and had less frequent remission than their counterparts. Logistic regression analysis showed that incidental MetS (OR: 0.2, 95% CI: 0.01 to 0.99, P = 0.052) and baseline DAS28 (OR: 0.4, 95% CI: 0.2 to 0.9, P = 0.02) were the only predictors for achieving or maintaining sustained (≥6 months) remission. Conclusions MetS prevalence in a cohort of early RA patients was lower than that from matched controls. Cumulative disease activity and higher BMI were risk factors for incidental Mets; higher baseline disease activity and incidental MetS prevented sustained remission. In addition to disease activity, MetS needs to be controlled to impact disease outcomes.
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Affiliation(s)
- Federico Parra-Salcedo
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Irazú Contreras-Yáñez
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Daniel Elías-López
- Department of Metabolism and Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Carlos A Aguilar-Salinas
- Department of Metabolism and Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Virginia Pascual-Ramos
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
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Bilecik NA, Tuna S, Samancı N, Balcı N, Akbaş H. Prevalence of metabolic syndrome in women with rheumatoid arthritis and effective factors. Int J Clin Exp Med 2014; 7:2258-65. [PMID: 25232418 PMCID: PMC4161578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/10/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Metabolic syndrome (MS), which is framed by cardiovascular risk factors such as hypertension, obesity, glucose intolerance and dyslipidemia, is thought to be associated with the rheumatic diseases. The aim of this study is to examine the frequency of metabolic syndrome (MS) and insulin resistance in patients with rheumatoid arthritis (RA) and to examine the effect of the inflammation symptoms, disease activity and drugs used in treating RA on insulin resistance and presence MS. METHOD One hundred women patients diagnosed with RA according to the American College of Rheumatology (ACR) diagnosis criteria and 100 healthy women were included in the study as controls. Insulin resistance were evaluated using the homeostasis model assessment for insulin resistance (HOMA-IR) method and MS was diagnosed according to two Metabolic Syndrome definitions (National Cholesterol Education Programme 2004, International Diabetes Federation). The disease activity of RA was evaluated by the disease activity score including 28 joints (DAS28). RESULTS In total, 27% and 33% of the RA patients and 28% and 44% of the control group patients according to the diagnostic criteria used were also MS patients. There was no significant difference between the RA and control groups in MS frequency and insulin resistance according to two diagnostic criteria used. The DAS28, erythrocyte sedimentation speed (ESS) and serum uric acid levels in the RA patients with MS were significantly higher than those of the RA patients without MS. The prevalence of MS İn patients with RA using methotrexate (MTX) was significantly lower than without RA. Other drugs used in treatment of RA had no effect on the prevalence of MS in patients with RA. CONCLUSION Controlling inflammation and disease activity can reduce the MS frequency of RA patients and MTX treatment also may be a protective factor against MS.
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Affiliation(s)
- Nilüfer Aygün Bilecik
- Department of Physical Medicine and Rehabilitation, Sinop Ataturk State Hospital Sinop, Turkey
| | - Serpil Tuna
- Department of Physical Medicine and Rehabilitation, Sinop Ataturk State Hospital Sinop, Turkey
| | - Nehir Samancı
- Department of Physical Medicine and Rehabilitation, Sinop Ataturk State Hospital Sinop, Turkey
| | - Nilüfer Balcı
- Department of Physical Medicine and Rehabilitation, Sinop Ataturk State Hospital Sinop, Turkey
| | - Halide Akbaş
- Department of Biochemistry, Akdeniz University Medical School Antalya, Turkey
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Labitigan M, Bahče-Altuntas A, Kremer JM, Reed G, Greenberg JD, Jordan N, Putterman C, Broder A. Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2014; 66:600-7. [PMID: 24115739 DOI: 10.1002/acr.22185] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We compared the prevalence and the clustering of the metabolic syndrome (MetS) components (obese body mass index [BMI; ≥30 kg/m(2) ], hypertriglyceridemia, low high-density lipids, hypertension, and diabetes mellitus) in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. METHODS We included CORRONA participants with a rheumatologist-confirmed clinical diagnosis of PsA or RA with complete data. We used a modified definition of MetS that did not include insulin resistance, waist circumference, or blood pressure measurements. Logistic regression models were adjusted for age, sex, and race. RESULTS In the overall CORRONA population, the rates of diabetes mellitus and obesity were significantly higher in PsA compared with RA. In 294 PsA and 1,162 RA participants who had lipids measured, the overall prevalence of MetS in PsA versus RA was 27% versus 19%. The odds ratio (OR) of MetS in PsA versus RA was 1.44 (95% confidence interval [95% CI] 1.05-1.96, P = 0.02). The prevalence of hypertriglyceridemia was higher in PsA compared with RA (38% versus 28%; OR 1.51 [95% CI 1.15-1.98], P = 0.003). The prevalence of type 2 diabetes mellitus was also higher in PsA compared with RA (15% versus 11%; OR 1.56 [95% CI 1.07-2.28], P = 0.02) in the adjusted model. Similarly, higher rates of hypertriglyceridemia and diabetes mellitus were observed in the subgroup of PsA and RA patients with obese BMI. CONCLUSION Compared with RA, PsA is associated with higher rates of obesity, diabetes mellitus, and hypertriglyceridemia.
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Prevalence of metabolic syndrome in patients with rheumatoid arthritis in Morocco: a cross-sectional study of 179 cases. Clin Rheumatol 2014; 33:1549-55. [DOI: 10.1007/s10067-014-2570-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/22/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022]
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