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Tharwat S, Nassar MK, Salem KM, Nassar MK. Extraarticular manifestations of juvenile idiopathic arthritis and their impact on health-related quality of life. Clin Rheumatol 2024:10.1007/s10067-024-07008-0. [PMID: 38797812 DOI: 10.1007/s10067-024-07008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The objective of this study is to investigate extraarticular manifestations (EAMs) in patients with juvenile idiopathic arthritis (JIA) and assess their impact on health-related quality of life (HRQoL) among these patients. METHODS This cross-sectional analytic study was carried out on 117 patients with JIA. EAMs were identified clinically by history and examination. Sicca symptoms, peripheral neuropathy, enthesitis, and skin lesions were picked up during clinical examination. Pulmonary involvement was evaluated by high-resolution CT chest. Patients were assessed by abdominal ultrasonography to assess the size of liver and spleen. Atlantoaxial subluxation was evaluated by cervical spine x-rays. Patients were evaluated by Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL-3 arthritis module. RESULTS The median age of patients was 14 years with a median disease duration 4 years, 82.9% were females. Of the studied 117 JIA patients, 85 patients (72.6%) had at least one EAM. Persistent fatigue (51.3%) was the most prevalent EAM, followed by recurrent skin rash (16.2%), enthesitis (15.4%), recurrent fever (13.7%), and uveitis (12%). Patients with EAMs scored significantly lower in physical functioning (p = 0.001), emotional functioning (p < 0.001), social functioning (p = 0.005), and school functioning (p = 0.001). Regarding PedsQL arthritis module, patients with EAM had also significantly lower scores than did patients without EAM on the domains of pain and hurt (p < 0.001), daily activities (p = 0.008), and worry (p = 0.001). RESULTS EAMs are prevalent among JIA patients and have a negative impact on their HRQoL. So, early identification and treatment are highly recommended. Key Points • A large percentage of JIA patients experienced at least one extraarticular manifestation (EAM). • Persistent fatigue and recurrent skin rash are the most prevalent EAMs in JIA patients. • JIA patients with EAMs have worse scores in almost all domains of HRQoL.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Dakahlia Governorate, Mansoura University Hospital, El Gomhouria St, Mansoura, 35511, Egypt.
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura, Egypt
| | - Karem Mohamed Salem
- Department of Internal Medicine, Faculty of Medicine, Nephrology Unit, Fayoum University, Fayoum, Egypt
| | - Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review. Biomedicines 2022; 10:biomedicines10082041. [PMID: 36009588 PMCID: PMC9405697 DOI: 10.3390/biomedicines10082041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.
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Yu KH, Chen HH, Cheng TT, Jan YJ, Weng MY, Lin YJ, Chen HA, Cheng JT, Huang KY, Li KJ, Su YJ, Leong PY, Tsai WC, Lan JL, Chen DY. Consensus recommendations on managing the selected comorbidities including cardiovascular disease, osteoporosis, and interstitial lung disease in rheumatoid arthritis. Medicine (Baltimore) 2022; 101:e28501. [PMID: 35029907 PMCID: PMC8735742 DOI: 10.1097/md.0000000000028501] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA)-related comorbidities, including cardiovascular disease (CVD), osteoporosis (OP), and interstitial lung disease (ILD), are sub-optimally managed. RA-related comorbidities affect disease control and lead to impairment in quality of life. We aimed to develop consensus recommendations for managing RA-related comorbidities. METHODS The consensus statements were formulated based on emerging evidence during a face-to-face meeting of Taiwan rheumatology experts and modified through three-round Delphi exercises. The quality of evidence and strength of recommendation of each statement were graded after a literature review, followed by voting for agreement. Through a review of English-language literature, we focused on the existing evidence of management of RA-related comorbidities. RESULTS Based on experts' consensus, eleven recommendations were developed. CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and at changes in DMARDs therapy. Considering the detrimental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on CVD risks, we recommend using the lowest possible dose of corticosteroids and prescribing NSAIDs cautiously. The OP/fragility fracture risk assessment includes dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA. The FRAX-based approach with intervention threshold is a useful strategy for managing OP. RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging and a multidisciplinary decision approach to determine RA-ILD severity. A treat-to-target strategy would limit RA-related comorbidities. CONCLUSIONS These consensus statements emphasize that adequate control of disease activity and the risk factors are needed for managing RA-related comorbidities, and may provide useful recommendations for rheumatologists on managing RA-related comorbidities.
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Affiliation(s)
- Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Biomedicine Science, National Chung Hsing University, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yeong-Jian Jan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Meng-Yu Weng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital
| | - Yeong-Jang Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-An Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jui-Tseng Cheng
- Division of Allergy, Immunology and Rheumatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Kuang-Yung Huang
- Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital
- College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Jih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology and Immunology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Yuan Chen
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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Fujiwara T, Tokuda K, Momii K, Shiomoto K, Tsushima H, Akasaki Y, Ikemura S, Fukushi JI, Maki J, Kaku N, Akahoshi T, Taguchi T, Nakashima Y. Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units. BMC Rheumatol 2020; 4:64. [PMID: 33292831 PMCID: PMC7716508 DOI: 10.1186/s41927-020-00164-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU. Results Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22, 27, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission. Conclusion Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.
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Affiliation(s)
- Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan. .,Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka-shi, Japan.
| | - Kentaro Tokuda
- Intensive Care Unit, Kyushu University Hospital, Fukuoka-shi, Japan
| | - Kenta Momii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan.,Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka-shi, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan
| | - Jun Maki
- Intensive Care Unit, Kyushu University Hospital, Fukuoka-shi, Japan
| | - Noriyuki Kaku
- Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka-shi, Japan
| | - Tomohiko Akahoshi
- Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka-shi, Japan
| | - Tomoaki Taguchi
- Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka-shi, Japan.,Intensive Care Unit, Kyushu University Hospital, Fukuoka-shi, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka prefecture, 812-8582, Japan
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Myasoedova E, Davis JM, Matteson EL, Achenbach SJ, Setoguchi S, Dunlay SM, Roger VL, Gabriel SE, Crowson CS. Increased hospitalization rates following heart failure diagnosis in rheumatoid arthritis as compared to the general population. Semin Arthritis Rheum 2019; 50:25-29. [PMID: 31376995 DOI: 10.1016/j.semarthrit.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/18/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the frequency of and trends in hospitalizations after heart failure (HF) diagnosis in patients with and without rheumatoid arthritis (RA) during 1987-2015. METHODS The study included a retrospectively identified population-based cohort of patients with incident HF and prior RA (age≥18 years, 1987 ACR criteria) and a cohort of incident HF patients without RA matched 3:1 on age, sex, and year of HF diagnosis. Hospitalizations at the time of HF diagnosis were excluded. All subjects were followed until death, migration, or 12/31/2015. RESULTS The study included 212 patients with RA (mean age at HF diagnosis 78.3 years; 68% female) and 636 non-RA patients (mean age at HF diagnosis 78.6 years; 68% female). The hospitalization rate after HF diagnosis was higher in RA vs non-RA (rate ratio [RR] 1.17; 95%CI 1.08-1.26). Hospitalization rates in both groups have been declining since 2005 and the difference between patients with and without RA may be decreasing after 2010. The magnitude of the increase was similar in both sexes and across all ages. Patients with RA were more likely to be hospitalized for non-cardiovascular causes (RR 1.26; 95%CI 1.14-1.39), but not for HF or other cardiovascular causes compared to non-RA patients. CONCLUSIONS The hospitalization rate following HF diagnosis was higher in RA versus non-RA patients regardless of sex and age. Increased hospitalization risk in patients with RA was driven by increased rates of non-cardiovascular hospitalization.
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Affiliation(s)
- Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - John M Davis
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sara J Achenbach
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Soko Setoguchi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Disease, Division of Circulatory Failure, Mayo Clinic, Rochester, MN, USA
| | - Veronique L Roger
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Disease, Division of Circulatory Failure, Mayo Clinic, Rochester, MN, USA
| | | | - Cynthia S Crowson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Aslam F, Khan NA. Tools for the Assessment of Comorbidity Burden in Rheumatoid Arthritis. Front Med (Lausanne) 2018; 5:39. [PMID: 29503820 PMCID: PMC5820312 DOI: 10.3389/fmed.2018.00039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/02/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Comorbidities influence the prognosis, clinical outcomes, disease activity, and treatment response in rheumatoid arthritis (RA). RA patients have a high-comorbidity burden necessitating their study. Comorbidity indices are used to measure comorbidities and to study their impacts on different outcomes. A large number of such indices are used in clinical research. Some indices have been specifically developed in RA patients. Aim This review aims to provide an overview of generic and specific comorbidity indices commonly used in RA research. Methods We performed a critical literature review of comorbidity indices in RA using the PubMed database. Results/discussion This non-systematic literature review provides an overview of generic and specific comorbidity indices commonly used in RA studies. Some of the older but commonly used comorbidity indices like the Charlson comorbidity index and the Elixhauser comorbidity measure were primarily developed to estimate mortality risk from comorbid diseases. They were not specifically developed for RA patients but have been widely used in rheumatology comorbidity measurement. Of the many comorbidity indices available, only the rheumatic disease comorbidity index (RDCI) and the multimorbidity index have been specifically developed in RA patients. The functional comorbidity index was developed to look at functional disability and has been used in RA patients considering that morbidity is more important than mortality in such patients. While there is limited data comparing these indices, available evidence seems to favor the use of RDCI as it predicts mortality, hospitalization, disability, and healthcare utilization. The choice of the index, however, depends on several factors such as the population under study, outcome of interest, and sources of data. More research is needed to study the RA-specific comorbidity measures to make evidence-based recommendations for the choice of a comorbidity measure.
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Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ, United States
| | - Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences & Central Arkansas Veterans Health Care System, Little Rock, AR, United States
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Co-morbidity index in rheumatoid arthritis: time to think. Clin Rheumatol 2015; 34:1995-2000. [PMID: 26497664 DOI: 10.1007/s10067-015-3101-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/06/2015] [Accepted: 10/14/2015] [Indexed: 12/19/2022]
Abstract
Rheumatoid arthritis patients are clinically complex, and the interplay of their disease activity together with the other associated conditions may lead to increased morbidity and mortality. The recent advances in the disease management attracted the attention to its associated co-morbidities and highlighted the need for a tool to provide clinicians and potential payers with a clinically powerful measure of the disease burden and prognosis. Predicting outcome or co-morbidity probability has been previously implemented successfully for calculating 10-year fracture probability (FRAX) as well as for predicting 1-year patient mortality using co-morbidity data obtained (Charlson index). Developing a specific rheumatoid arthritis-independent tool able to predict morbidity, mortality, cost and hospitalization would be a step forward on the way to achieve full disease remission. The co-morbidity index should be used both at baseline as well as a continuous variable in analyses. It should be implemented regularly in the clinical assessment as a confounder of outcomes. This article will review the redefined health outcomes in rheumatoid arthritis and the concept of co-morbidity index for patients with inflammatory arthritis. It will also present a proposed co-morbidity index for rheumatoid arthritis patients.
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