1
|
Sugano E, Tanaka E, Inoue E, Honda S, Abe M, Saka K, Sugitani N, Ochiai M, Yamaguchi R, Ikari K, Harigai M. Impact of interstitial lung disease on clinical remission and unfavourable events of rheumatoid arthritis: results from the IORRA cohort. Rheumatology (Oxford) 2024; 63:1022-1029. [PMID: 37379132 DOI: 10.1093/rheumatology/kead317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/18/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVES We aimed to examine the impact of concomitant interstitial lung disease (ILD) on achieving clinical remission and the occurrence of unfavourable clinical events in patients with RA. METHODS Among the participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort from 2011 to 2012, patients not achieving remission of 28-joint disease activity score (DAS28) at baseline and those with chest CT images were enrolled. Based on the chest CT images, the patients were divided into two groups: the ILD group and non-ILD group. The associations among the presence of ILD with time to achieving DAS28 remission and development of death, hospitalized infection, major adverse cardiac events (MACE), or malignancy within 5 years were evaluated using time-dependent Cox regression models. RESULTS We enrolled 287 patients in the ILD group and 1235 in the non-ILD group. DAS28 remission was achieved at least once in 55.7% and 75.0% of the ILD and non-ILD groups within 5 years, respectively. Presence of ILD was significantly associated with failure to achieve DAS28 remission (adjusted hazard ratio [aHR]: 0.71; 95% CI: 0.58, 0.89). ILD was also a significant factor associated with death (aHR: 3.24; 95% CI: 2.08, 5.03), hospitalized infection (aHR 2.60; 95% CI: 1.77, 3.83), MACE (aHR: 3.40; 95% CI: 1.76, 6.58), and lung cancer (aHR: 16.0; 95% CI: 3.22, 79.2), but not with malignant lymphoma (aHR: 2.27; 95% CI: 0.59, 8.81). CONCLUSION Concomitant ILD was a significant factor associated with failure to achieve clinical remission and the occurrence of the unfavourable clinical events in patients with RA.
Collapse
Affiliation(s)
- Eri Sugano
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Suguru Honda
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mai Abe
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kumiko Saka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naohiro Sugitani
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Moeko Ochiai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Rei Yamaguchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsunori Ikari
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Brunner S, Covtun O, Moccetti F, Loretz L, Bossard M, Attinger‐Toller A, Cuculi F, Wolfrum M, Kurmann R, Toggweiler S. Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients With Chronic Inflammatory Disease. J Am Heart Assoc 2024; 13:e032250. [PMID: 38390801 PMCID: PMC10944066 DOI: 10.1161/jaha.123.032250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chronic inflammatory disease (CID) accelerates atherosclerosis and the development of aortic stenosis. Data on long-term outcomes after transcatheter aortic valve implantation (TAVI) in those patients are missing. The aim of this study was to investigate the clinical long-term outcomes of patients with and without autoimmune-related CID undergoing TAVI for the treatment of severe aortic stenosis. METHODS AND RESULTS From a prospective registry, consecutive patients with TAVI were included. Baseline clinic and imaging data (echocardiographic and computed tomography) were analyzed. Long-term (up to 5 years) clinical and echocardiographic outcomes were studied. Of 1000 consecutive patients (mean age 81±6 years, 46% female), 107 (11%) had CID; the most frequent entities included polymyalgia rheumatica (31%) and rheumatoid arthritis (28%). Patients with CID were predominantly female (60% versus 44%, P=0.002) and more often had pulmonary disorders (21% versus 13%, P=0.046) and atrial fibrillation (32% versus 20%, P=0.003). The presence of CID was associated with a higher rate of postinterventional infection (5% versus 1%, P=0.007) and further emerged as a risk factor for rehospitalization for bleeding or infection (hazard ratio, 1.93 and 1.62, respectively). Premature valve degeneration, endocarditis, and all-cause mortality were not increased among patients with CID. CONCLUSIONS This real-world analysis found that patients with CID undergoing TAVI were associated with a higher risk of postinterventional infectious complications and rehospitalization due to infection. However, valve durability and survival seem not to differ between patients with TAVI with versus without CID.
Collapse
Affiliation(s)
- Stephanie Brunner
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Olga Covtun
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Federico Moccetti
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Lucca Loretz
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | | | - Florim Cuculi
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Reto Kurmann
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| | - Stefan Toggweiler
- Heart Center Lucerne, Cardiology Division, Luzerner KantonsspitalLucerneSwitzerland
| |
Collapse
|
3
|
Witczak BN, Schwartz T, Barth Z, Taraldsrud E, Lund MB, Aaløkken TM, Flatø B, Sjaastad I, Sanner H. Associations between cardiac and pulmonary involvement in patients with juvenile dermatomyositis-a cross-sectional study. Rheumatol Int 2022; 42:1213-1220. [PMID: 34984516 PMCID: PMC9203373 DOI: 10.1007/s00296-021-05071-3] [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: 11/16/2021] [Accepted: 12/14/2021] [Indexed: 10/27/2022]
Abstract
This study aimed at exploring the association between detectable cardiac and pulmonary involvement in long-term juvenile dermatomyositis (JDM) and to assess if patients with cardiac and pulmonary involvement differ with regard to clinical characteristics. 57 JDM patients were examined mean 17.3 (10.5) years after disease onset; this included clinical examination, myositis specific/associated autoantibodies (immunoblot), echocardiography, pulmonary function tests and high-resolution computed tomography. Cardiac involvement was defined as diastolic and/or systolic left ventricular dysfunction and pulmonary involvement as low diffusing capacity for carbon monoxide, low total lung capacity and/or high-resolution computed tomography abnormalities. Patients were stratified into the following four groups: (i) no organ involvement, (ii) pulmonary only, (iii) cardiac only, and (iv) co-existing pulmonary and cardiac involvement. Mean age was 25.7 (12.4) years and 37% were males. One patient had coronary artery disease, seven had a history of pericarditis, seven had hypertension and three had known interstitial lung disease prior to follow-up. There was no association between cardiac (10/57;18%) and pulmonary (41/57;72%) involvement (p = 0.83). After stratifying by organ involvement, 21% of patients had no organ involvement; 61% had pulmonary involvement only; 7% had cardiac involvement only and 11% had co-existing pulmonary or cardiac involvement. Patients with co-existing pulmonary or cardiac involvement had higher disease burden than the remaining patients. Patients with either cardiac or pulmonary involvement only, differed in clinical and autoantibody characteristics. We found no increased risk of developing concomitant cardiac/pulmonary involvement in JDM. Our results shed light upon possible different underlying mechanisms behind pulmonary and cardiac involvement in JDM.
Collapse
Affiliation(s)
- Birgit Nomeland Witczak
- Institute for Experimental Medical Research and KG Jebsen Center for Cardiac Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Thomas Schwartz
- Institute for Experimental Medical Research and KG Jebsen Center for Cardiac Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Zoltan Barth
- Institute for Experimental Medical Research and KG Jebsen Center for Cardiac Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Eli Taraldsrud
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - May Brit Lund
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Trond Mogens Aaløkken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Berit Flatø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research and KG Jebsen Center for Cardiac Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Helga Sanner
- Oslo New University College, Oslo, Norway. .,Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| |
Collapse
|
4
|
Gupta S, Padhan P, Subhankar S, Singh P. Cardiovascular complications in patients with interstitial lung disease and their correlation with 6-minute walk test and spirometry: A single-center study. J Family Med Prim Care 2021; 10:3330-3335. [PMID: 34760753 PMCID: PMC8565147 DOI: 10.4103/jfmpc.jfmpc_350_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Pulmonary hypertension and other cardiac complications occur frequently due to chronic hypoxia induced by interstitial lung diseases (ILD) or due to connective tissue disorder itself. Two-dimensional (2D) echocardiography is ideal for identifying abnormalities at a given time. In this study, we tried to detect cardiovascular complications in patients with ILD using 2D echocardiography and correlate them with a 6-minute walk test (6 MWT) and spirometry. Materials and Methods This study was carried out for 18 months including 100 consecutive cases of ILD. The diagnosis was made using the latest criteria as per the disease and high-resolution computed tomography (HRCT) thorax. All patients were evaluated with 2D echocardiography, 6 MWT, and spirometry along with routine investigations. Their results were analyzed using STATA 15.1 software. Result Cardiovascular involvement was detected in 68% of cases. Pulmonary hypertension predominated with a prevalence of 50%. In spirometry, mean Forced expiratory volume in first second (FEV1)and Forced vital capacity (FVC) were found to be 54.96 (L) and 53.49 (L), respectively, with a predominant restrictive pattern (89%). There was a significant correlation between baseline saturation of oxygen (SpO2) and pulmonary arterial systolic pressure (PASP) with a P value of <0.05. Baseline SpO2 and distance covered in 6 MWT had a significant correlation (P = 0.014). Conclusion A baseline or nighttime hypoxia is responsible for developing PAH. Pulmonary arterial hypertension should be suspected in patients unable to perform 6 MWT or having low baseline SpO2. A routine follow-up with a 6 MWT and baseline SpO2 should be performed in each visit to identify early deterioration of the disease.
Collapse
Affiliation(s)
- Saurabh Gupta
- Department of Pulmonary Medicine, Kalinga Institute of Medical Sciences, KIIT University, Patia, Bhubaneswar, Odisha, India
| | - Prasanta Padhan
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Patia, Bhubaneswar, Odisha, India
| | - Saswat Subhankar
- Department of Pulmonary Medicine, Kalinga Institute of Medical Sciences, KIIT University, Patia, Bhubaneswar, Odisha, India
| | - Pratima Singh
- Department of Pulmonary Medicine, Kalinga Institute of Medical Sciences, KIIT University, Patia, Bhubaneswar, Odisha, India
| |
Collapse
|
5
|
Paschalaki KE, Jacob J, Wells AU. Monitoring of Lung Involvement in Rheumatologic Disease. Respiration 2016; 91:89-98. [PMID: 26735151 DOI: 10.1159/000442890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The monitoring of lung involvement in patients with connective tissue diseases is central to optimal long-term management and is directed towards: (a) the detection of supervening lung involvement not present at presentation and (b) the identification of disease progression in established lung disease. For both goals, accurate surveillance requires multi-disciplinary evaluation with the integration of symptomatic change, serial pulmonary function trends and imaging data. Evaluated in isolation, each of these monitoring domains has significant limitations. Symptomatic change may be confounded by a wide variety of systemic factors. Pulmonary function tests provide the most reliable data, but are limited by measurement variability, the heterogeneity of functional patterns and the confounding effects of non-pulmonary factors. Chest radiography is insensitive to change but may provide rapid confirmation of major disease progression or alert the clinician to respiratory co-morbidities. Although high-resolution computed tomography has a central role in assessing disease severity, it should be used very selectively as a monitoring tool due to the associated radiation burden. Ancillary tests include echocardiography and exercise testing to proactively identify cases of pulmonary hypertension and worsening of oxygenation. In summary, a multi-disciplinary approach is essential for the identification of disease progression and prompt treatment of comorbidities that severely impact on the morbidity and mortality of disease.
Collapse
Affiliation(s)
- Koralia E Paschalaki
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | | | | |
Collapse
|