Risk for cardiovascular disease development in rheumatoid arthritis

Effects of 17β estradiol on blood pressure elevation in ovariectomized rats with collagen-induced arthritis via modulation of oxidative stress, inflammation, fibrosis, and apoptosis in the aorta involving TLR4/NOX4/NF-kβ and TGFβ1/fibronectin/α-SMA pathways

Rheumatoid arthritis (RA) can cause blood pressure (BP) elevation in estrogen-deficient, post-menopausal women; however, the underlying mechanisms are not well understood. In this study, the aortic involvement and its underlying mechanisms that contribute to the BP elevation in estrogen-deficient, RA condition were identified. Ovariectomy was performed to create a state of estrogen deficiency and RA was then induced in ovariectomized rats by using incomplete Freund's adjuvant and immune-mediated collagen type-II. Ovariectomized, RA-induced rats (Ovx + RA) were given either 17β-estradiol, baricitinib, or losartan. Direct blood pressure (BP) monitoring was made via cannulation of the carotid artery. Rats were then sacrificed and the aorta was harvested followed by H&E and Picrosirius staining to evaluate histological changes and collagen deposition. Oxidative stress, inflammation, apoptosis, growth, and fibrosis levels in the aorta were assessed by using molecular biological techniques. Mean arterial pressure (MAP) was significantly elevated in Ovx + RA rats when compared to sham and Ovx rats (p < 0.05). 17β-estradiol and losartan treatment significantly reduced the MAP and heart rate in Ovx + RA rats when compared to untreated Ovx + RA rats. Expression of iNOS, Nox2 and Nox4, TLR4, NF-ĸB, TNF-α, VEGF, FGF-2, αSMA, eNOS, and caspase-3 were elevated in the aorta of Ovx + RA rats and were reduced upon 17β-estradiol treatment. However, expression of TGFβ1, Bax-2, fibronectin, and Smad2 in the aorta of Ovx + RA rats was increased following 17β-estradiol treatment (p < 0.05 compared to without treatment). The presence of RA with estrogen deficiency enhanced the BP elevation due to changes in the aorta which could be ameliorated by estrogen.

Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis

BACKGROUND

Patients with rheumatoid arthritis (RA) have a significantly elevated risk of developing cardiovascular disease (CVD), the leading cause of their death. However, the impact of environmental factors on RA progression remains unclear. This study aimed to explore the link between long-term air pollution exposure and the multi-stage progression from a healthy status to RA onset, then CVD development, and finally death.

METHODS

Utilizing data from 326,059 participants in the UK Biobank, we used a unidirectional multi-state Markov proportional hazards model to analyze the associations between long-term exposure to air pollutants (PM2.5, PM10, NO2, and NOx) and disease progression. The models included transitions from baseline healthy state to RA onset, to subsequent CVD, and to death. Air pollution exposure was assessed using land use regression models, and hazard ratios (HRs) were calculated per interquartile range (IQR) increase in pollutant concentrations.

RESULTS

During a median follow-up of 12.69 years, 3422 participants developed RA, of whom 424 subsequently developed CVD. PM2.5 and NO2 showed the most extensive effects across transition stages. Per IQR increase in PM2.5 was associated with increased risks of RA onset (HR: 1.08; 95 %CI: 1.03, 1.12) and RA to death (HR: 1.20; 95 %CI: 1.06, 1.37), while NO2 was associated with increased risks of RA onset (HR: 1.10; 95 %CI: 1.06, 1.15) and subsequent CVD development (HR: 1.13; 95 %CI: 1.01, 1.28). Notably, valve disorders showed associations with multiple pollutants, and these effects were more pronounced in women and elderly participants.

CONCLUSION

Long-term exposure to air pollutants was significantly associated with increased risks at multiple transition stages, from RA onset to subsequent CVD development and death, although effect sizes were modest for some transitions. Considering the widespread global exposure to air pollution, these findings emphasize the importance of air pollution control in preventing RA and its cardiovascular complications, especially among susceptible populations.

Assessment of Carotid Stiffness and Strain Parameters Using Speckle Tracking Strain Ultrasonography in Rheumatoid Arthritis Patients

Background

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by progressive joint deformity and increased mortality. RA patients typically exhibit elevated plasma levels of inflammatory markers, contributing to endothelial dysfunction and increased arterial wall stiffness-a recognized marker of subclinical atherosclerosis and heightened cardiovascular risk. This study aimed to evaluate carotid arterial wall stiffness in RA patients using ultrasound (US) imaging modality with speckle tracking carotid strain (STCS) software, a non-invasive method for assessing subclinical cardiovascular disease indicators.

Methods

This analytical case-control study was conducted at Aydin Adnan Menderes University Hospital Department of Radiology and Department of Rheumatology. Patients who met the inclusion criteria were enrolled in the study. Data collection tools included an 11-item case report form developed by the researcher based on relevant literature and carotid US examinations performed.

Results

The study included 143 participants: 75 RA patients (60 female and 15 male) and 68 control subjects (54 female and 14 male). The mean age was 50.9 ± 11.4 years (range: 25.0-74.0) for the RA group and 53.1 ± 12.6 years (range: 20.0-77.0) for the control group. Systolic blood pressure (SBP) and C-reactive protein (CRP) levels (mean ± SD) were 7.4 ± 11.5 in the RA group and 8.6 ± 22.2 in the control group. However, due to a few outliers in the control group, the median CRP was 3.3 mg/L (range: 2.0-71.9) in the RA group versus 2.0 mg/L (range: 0.8-145.0) in the controls. This nonparametric comparison showed significantly higher typical CRP levels in the RA group (p < 0.05). All stiffness and strain parameters in axial and longitudinal planes showed statistically significant differences between the two groups (p < 0.05), except the circumferential strain parameter "displacement (DP)" (p = 0.074). Although no significant correlation was found between the disease activity score (DAS) and any strain or stiffness parameter, the carotid intima-media thickness (CIMT) exhibited a significant positive correlation with disease duration (p = 0.001). After adjusting for confounding factors (age, gender, body mass index (BMI), and smoking status) using multivariate linear regression analysis, RA remained a significant predictor for all stiffness and strain parameters, except for the circumferential strain parameter DP.

Conclusion

Applying functional parameters to assess arterial wall stiffness and tension levels provides valuable insights for early detection of cardiovascular disease risk, preceding classical US findings such as increased intima-media thickness (IMT) and plaque formation. While preliminary, our findings from STCS measurements in RA patients show promise in evaluating cardiovascular disease risk in this population and potentially improving long-term outcomes through timely interventions.

Correlation between myocardial work and disease activity in rheumatoid arthritis patients with preserved left ventricular ejection fraction: a retrospective study based on non-invasive pressure-strain loop：

BACKGROUND

Early cardiac damage is very common in RA patients, but it is usually subclinical. Therefore, finding a non-invasive method for the early detection and treatment of cardiac damage in autoimmune diseases is particularly important.diac dam RA ，。，。 OBJECTIVE: To evaluate left ventricular function changes in rheumatoid arthritis (RA) patients with preserved left ventricular ejection fraction (LVEF) using left ventricular pressure-strain loop (LV-PSL) technology and to explore the correlation between myocardial work (MW) and disease activity.- （LV-PSL） （LVEF） （RA） ， （MW） 。 METHODS: A total of 62 RA patients with preserved LVEF, treated at Wujin Hospital Affiliated with Jiangsu University from January 2021 to September 2023, were included. Patients were categorized into low (25), medium (18), and high (19) disease activity groups based on the 28 joint disease activity score (DAS28). A control group of 29 healthy individuals was also established. LV-PSL technology assessed left ventricular global longitudinal strain (GLS) and MW parameters: global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Correlations between MW parameters, GLS, LVEF, and DAS28 scores were analyzed. 2021 1 20239 62 LVEF RA 。 28 （DAS28） （25） 、 （18） （19） 。 29 。LV-PSL （GLS） MW ： （GCW）、 （GWW）、 （GWI） （GWE）。 MW 、 GLS 、 LVEF DAS28 。 RESULTS: There were no significant differences in general data between study and control groups (p > 0.05). However, laboratory indicators (RF, CRP, ESR) showed significant differences (p < 0.05). GWI, GCW, GWE, and GLS were significantly lower in the high disease activity group compared to controls (p < 0.05). GWI, GCW, and GWE were positively correlated with LVEF and absolute GLS, while GWW correlated negatively with LVEF (p < 0.05). （p > 0.05）。， （RF、CRP、ESR） （p < 0.05）。， GWI、GCW、GWE GLS （p < 0.05）。GWI、GCW GWE LVEF GLS ， GWW LVEF （p < 0.05）。 （p > 0.05）。， （RF、CRP、ESR） （p < 0.05）。， GWI、GCW、GWE GLS （p < 0.05）。GWI、GCW GWE LVEF GLS ， GWW LVEF （p < 0.05）。 CONCLUSION: RA disease activity is closely associated with impaired myocardial work. LV-PSL technology effectively monitors myocardial function abnormalities in RA patients, providing valuable insights for clinical management. Key Points • Myocardial work is significantly impaired in RA patients with high disease activity. • Left ventricular pressure-strain loop (LV-PSL) technology effectively assesses cardiac function in this patient population. • Increased disease activity correlates with reduced myocardial work parameters.

A review on the epidemiology of rheumatoid arthritis: An update and trends from current literature

Rheumatoid arthritis (RA) is a systemic, chronic autoimmune disease affecting mainly the joints, often with extra articular manifestations. This review provides an update on RA epidemiological trends and management. PubMed and EMBASE were searched from 2014 to 2024 using rheumatoid arthritis as keyword, combined with incidence, prevalence, diagnosis, classification, and management. Emphasis was on papers published in the past 5 years. Globally, the age-standardised prevalence and incidence rate (ASPR and ASIR) of RA increased with varying figures. The ASPR increased by 0.37%, 14.1%, and 6.4% from 1990 to 2019, 2020 and 2017 respectively; and 9% from 1980 to 2019. The ASIR increased by 0.3% and 8.2% from 1990 to 2019 and 2017 respectively; the disability-adjusted life years (DALY) figures increased 0.12% and decreased 0.36% in the same period from different authors. Reduction in ASIR were reported while ASPR varies. Disease modifying anti-rheumatic drugs (DMARDs) remain the cornerstone of treatment.

Interleukin-27 and Autoimmune Disorders: A Compressive Review of Immunological Functions

Autoimmune disorders (ADs) pose significant health and economic burdens globally, characterized by the body's immune system mistakenly attacking its own tissues. While the precise mechanisms driving their development remain elusive, a combination of genetic predisposition(s) and environmental triggers is implicated. Interleukin-27 (IL-27), among numerous cytokines involved, has emerged as a key regulator, exhibiting dual roles in immune modulation. This review delves into the molecular structure and signaling mechanisms of IL-27, highlighting its diverse effects on various immune cells. Additionally, it explores the involvement of IL-27 in autoimmune diseases, such as multiple sclerosis (MS) and rheumatoid arthritis (RA), offering insights into its potential therapeutic implications. Moreover, its involvement in autoimmune diseases like type 1 diabetes (T1D), inflammatory bowel disease (IBD), myasthenia gravis (MG), Sjögren's syndrome (SS), and Guillain-Barré syndrome (GBS) is multifaceted, with potential diagnostic and therapeutic implications across these conditions. Further research is essential to fully understand IL-27's mechanisms of action and therapeutic potential in autoimmune diseases.

The Treatment with Xinfeng Capsule Can Reduce the Risk of Readmission for Patients with Rheumatoid arthritis:A Cohort Study of Approximately 10000 Individuals

Objective

The present study aimed to investigate the potential association between the treatment with Xinfeng Capsule (XFC) and the risk of readmission among patients with rheumatoid arthritis (RA).

Methods

Through a retrospective approach, data were collected from all hospitalized patients diagnosed with RA at the First Affiliated Hospital of Anhui University of Chinese Medicine between 2013 and 2021. To mitigate selection bias and confounding factors, patients were stratified into an XFC group and a Non-XFC (Non-XFC) group based on their treatment status using propensity score matching with a 1:2 ratio. Variables such as age, gender, and baseline medications were adjusted. Subsequently, the Cox proportional hazards model was employed to calculate the hazard ratio (HR) for readmission among RA patients, while Kaplan-Meier curves were utilized to depict the incidence of readmission.

Results

A total of 9987 RA patients were included in this study. Following rigorous inclusion/exclusion criteria and propensity score matching, the XFC group comprised 2036 patients, while the Non-XFC group contained 4072 patients. The Cox proportional hazards model analysis revealed that XFC acted as a protective factor, significantly reducing the risk of readmission among RA patients. Further examination of Kaplan-Meier curves demonstrated that XFC use not only effectively lowered the frequency of readmissions but also exhibited a more pronounced effect in diminishing the risk of readmission with extended usage durations (beyond 12 months). Additionally, association rule analysis underscored the strong link between XFC and freedom from readmission, as well as the robust correlation between XFC usage and significant improvements in multiple laboratory indicators, including C3, C4, CRP, ESR, and others.

Conclusion

This study underscores a robust and long-term association between XFC usage and lower readmission rates among RA patients. As a protective factor against readmission risk in these patients, the clinical value of XFC merits further promotion and investigation.

Prospects for the use of anti-inflammatory therapy in patients with coronary artery disease

Coronary atherosclerosis is the primary cause of coronary artery disease, one of the world’s greatest causes of death. Inflammation plays a major role in atherosclerosis formation and progression. Cardiovascular disease risk factors such as dyslipidemia, hyperglycemia, smoking, hypertension and others contribute to endothelial injury. This sets off a cascade of inflammatory reactions accompanied by the release of cytokines and other inflammatory mediators, ultimately leading to rupture or erosion of the atherosclerotic plaque and atherothrombosis. Large studies such as CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study); COLCOT (Colchicine Cardiovascular Outcomes Trial) and LoDoCo2 (Low Dose Colchicine 2) demonstrated that the use of anti-inflammatory drugs improves the prognosis of patients with coronary atherosclerosis. At present, the most convincing evidence of the effectiveness of anti-inflammatory therapy was obtained only for colchicine and canakinumab. However, despite these promising results, there are still many issues to be addressed. Firstly, more research is needed to determine the optimal dosage and duration of these drugs. Secondly, the safety of their prolonged use should be carefully assessed, especially in the context of possible side effects. For example, anti-inflammatory drugs can potentially pose infectious risks that require special monitoring and follow-up. The review presents current views on the possibilities immunomodulatory drugs using in the complex treatment of atherosclerosis.