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Singh N, Gold LS, Lee J, Wysham KD, Andrews JS, Makris UE, England BR, George MD, Baker JF, Jarvik J, Heagerty PJ, Singh S. Frailty and Risk of Serious Infections in Patients With Rheumatoid Arthritis Treated With Biologic or Targeted-Synthetic Disease-Modifying Antirheumatic Drugs. Arthritis Care Res (Hoboken) 2024; 76:627-635. [PMID: 38116680 PMCID: PMC11039374 DOI: 10.1002/acr.25282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE It remains unknown whether frailty status portends an increased risk of adverse outcomes in patients with rheumatoid arthritis (RA) initiating biologic or targeted-synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs). The objective of our study was to evaluate the association between frailty and serious infections in a younger population of patients (<65 years old) with RA who initiated b/tsDMARDs. METHODS Using MarketScan data, we identified new users of tumor necrosis factor inhibitors (TNFi), non-TNFi biologic DMARDs, or Janus kinase inhibitors (JAKi) between 2008 and 2019 among those with RA. Patients' baseline frailty risk score was calculated using a Claims-Based Frailty Index (≥0.2 defined as frail) 12 months prior to drug initiation. The primary outcome was time to serious infection; secondarily, we examined time-to-any infection and all-cause hospitalizations. We used Cox proportional hazards to estimate adjusted hazard ratios and 95% confidence intervals (95% CIs) and assessed the significance of interaction terms between frailty status and drug class. RESULTS A total of 57,980 patients, mean (±SD) age 48.1 ± 10.1 were included; 48,139 (83%) started TNFi, 8,111 (14%) non-TNFi biologics, and 1,730 (3%) JAKi. Among these, 3,560 (6%) were categorized as frail. Frailty was associated with a 50% increased risk of serious infections (adjusted hazard ratio [95% CI] 1.5, 1.2-1.9) and 40% higher risk of inpatient admissions (1.4 [1.3-1.6]) compared with nonfrail patients among those who initiated TNFi. Frailty was also associated with a higher risk of any infection relative to nonfrail patients among those on TNFi (1.2 [1.1-1.3]) or non-TNFi (1.2 [1.0-1.4]) or JAKi (1.4 [1.0-2.0]). CONCLUSION Frailty is an important predictor for the risk of adverse outcomes among patients with RA treated with biologic or targeted-synthetic DMARDs.
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Affiliation(s)
- Namrata Singh
- Division of Rheumatology, University of Washington, Seattle, WA
- VA Puget Sound Health Care System, Seattle, WA
| | - Laura S. Gold
- Department of Radiology, University of Washington, Seattle, WA
| | - Jiha Lee
- University of Michigan, Ann Arbor, MI
| | - Katherine D Wysham
- Division of Rheumatology, University of Washington, Seattle, WA
- VA Puget Sound Health Care System, Seattle, WA
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Una E. Makris
- Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, TX
| | - Bryant R. England
- University of Nebraska Medical Center & VA Nebraska-Western Iowa Healthcare System, Omaha, NE
| | - Michael D. George
- Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joshua F. Baker
- Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jeffrey Jarvik
- Department of Radiology, University of Washington, Seattle, WA
| | - Patrick J. Heagerty
- Department of Radiology, University of Washington, Seattle, WA
- Department of Biostatistics, University of Washington
| | - Siddharth Singh
- Division of Gastroenterology, University of California at San Diego, San Diego, CA
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Baker JF, Zueger P, Ali M, Bennett D, Yu M, Munoz Maldonado Y, McLean RR. Real-World Use and Effectiveness Outcomes in Patients with Rheumatoid Arthritis Treated with Upadacitinib: An Analysis from the CorEvitas Registry. Rheumatol Ther 2024; 11:363-380. [PMID: 38345715 PMCID: PMC10920593 DOI: 10.1007/s40744-024-00639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Data assessing longer-term real-world effectiveness and treatment patterns with upadacitinib (UPA), a Janus kinase inhibitor, in rheumatoid arthritis (RA) are lacking. We assessed improvement in clinical and patient-reported outcomes and treatment patterns for up to 12 months among adult patients with RA initiating UPA. METHODS Data were collected from the CorEvitas® RA Registry (08/2019-04/2022). Eligible patients had moderate to severe RA (Clinical Disease Activity Index [CDAI] > 10) and follow-up visits at 6 or 12 months after UPA initiation. Outcomes were mean change from baseline, percentage achieving minimal clinically important differences (MCID) in clinical and patient-reported outcomes, and disease activity at follow-up. We evaluated clinical outcomes and therapy changes among patients with tumor necrosis factor inhibitor (TNFi) experience and among those receiving UPA as first-line therapy, as well as those receiving UPA as monotherapy versus as part of combination therapy. We further evaluated whether outcomes were similar among those that remained on therapy. RESULTS Patients treated with UPA (6-month cohort, N = 469; 12-month cohort, N = 263) had statistically significant improvements (p < 0.001) in mean CDAI, tender/swollen joint counts, pain, and fatigue at follow-up. At 12 months, 46.0% achieved MCID in CDAI and 40.0% achieved low disease activity/remission. Overall, 43.0% discontinued UPA at 12 months; of those receiving combination treatment (N = 90) with conventional therapies and UPA, 42.2% (N = 38) discontinued conventional therapy. Findings were similar in the 6-month cohort and among subgroups. Changes from baseline and proportions of patients achieving MCID or clinical outcomes tended to be numerically lower among patients with TNFi experience and numerically higher among those receiving UPA as first-line therapy. CONCLUSIONS UPA initiation was associated with improvements in clinical and patient-reported outcomes, with meaningful clinical improvements regardless of prior TNFi experience, line of therapy, or concomitant use of conventional therapies. Further research is needed to better understand sustained response of UPA over longer treatment periods.
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Affiliation(s)
- Joshua F Baker
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mira Ali
- AbbVie, Inc, North Chicago, IL, USA
| | | | - Miao Yu
- CorEvitas, LLC, Waltham, MA, USA
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Song S, England BR, Sauer B, George MD, Riley TR, Wallace B, Cannon GW, Mikuls TR, Baker JF. Changes in Characteristics of Patients Initiating and Discontinuing Advanced Therapies for Rheumatoid Arthritis Following the Release of Safety Data. Arthritis Care Res (Hoboken) 2024; 76:463-469. [PMID: 37909392 DOI: 10.1002/acr.25268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The objective of this study was to determine the impact of emerging safety data on practice patterns by describing the characteristics of patients initiating and discontinuing advanced therapies for rheumatoid arthritis (RA) before and after January 2021. METHODS This cohort study evaluated US veterans with RA between April 2019 and September 2022. This period was divided into two 664-day periods before and after January 2021. Eligible patients had ≥1 diagnosis code for RA and initiated a tumor necrosis factor inhibitor (TNFi), non-TNFi biologic, or JAK inhibitor (JAKi). We tested for interaction within regression models to determine whether changes in patient characteristics for tofacitinib recipients were different from changes observed for other therapies. We also evaluated factors associated with therapy discontinuation in Cox models adjusted for age, sex, and duration on therapy, including assessment for effect modification. RESULTS When comparing patients with RA initiating tofacitinib before (n = 2,111) with those initiating tofacitinib after (n = 1,664) January 2021, there was a decrease in mean age (64.1 vs 63.0 years) and in the proportion with cardiovascular comorbidities (all P < 0.01). These changes were significantly different from those observed for patients initiating TNFi or non-TNFi biologics. Among active advanced therapy recipients, the likelihood of discontinuation was higher for tofacitinib than TNFi (hazard ratio 1.18, 95% confidence interval 1.10-1.26, P < 0.001). The higher rate of tofacitinib discontinuation was more pronounced in the presence of cardiovascular comorbidities (P < 0.05). CONCLUSION Recent safety data significantly affected prescribing practices for advanced therapies, with a reduction in JAKi initiation and an increase in JAKi discontinuation among older patients and those at high cardiovascular risk.
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Affiliation(s)
- Stephanie Song
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | | | - Brian Sauer
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City
| | - Michael D George
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Thomas R Riley
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Beth Wallace
- Center for Clinical Management Research, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor
| | - Grant W Cannon
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City
| | | | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Rhee RL, Rebello R, Tamhankar MA, Banerjee S, Liu F, Cao Q, Kurtz R, Baker JF, Fan Z, Bhatt V, Amudala N, Chou S, Liang R, Sanchez M, Burke M, Desiderio L, Loevner LA, Morris JS, Merkel PA, Song JW. Combined Orbital and Cranial Vessel Wall Magnetic Resonance Imaging for the Assessment of Disease Activity in Giant Cell Arteritis. ACR Open Rheumatol 2024; 6:189-200. [PMID: 38265177 PMCID: PMC11016572 DOI: 10.1002/acr2.11649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Acute visual impairment is the most feared complication of giant cell arteritis (GCA) but is challenging to predict. Magnetic resonance imaging (MRI) evaluates orbital pathology not visualized by an ophthalmologic examination. This study combined orbital and cranial vessel wall MRI to assess both orbital and cranial disease activity in patients with GCA, including patients without visual symptoms. METHODS Patients with suspected active GCA who underwent orbital and cranial vessel wall MRI were included. In 14 patients, repeat imaging over 12 months assessed sensitivity to change. Clinical diagnosis of ocular or nonocular GCA was determined by a rheumatologist and/or ophthalmologist. A radiologist masked to clinical data scored MRI enhancement of structures. RESULTS Sixty-four patients with suspected GCA were included: 25 (39%) received a clinical diagnosis of GCA, including 12 (19%) with ocular GCA. Orbital MRI enhancement was observed in 83% of patients with ocular GCA, 38% of patients with nonocular GCA, and 5% of patients with non-GCA. MRI had strong diagnostic performance for both any GCA and ocular GCA. Combining MRI with a funduscopic examination reached 100% sensitivity for ocular GCA. MRI enhancement significantly decreased after treatment (P < 0.01). CONCLUSION In GCA, MRI is a sensitive tool that comprehensively evaluates multiple cranial structures, including the orbits, which are the most concerning site of pathology. Orbital enhancement in patients without visual symptoms suggests that MRI may detect at-risk subclinical ocular disease in GCA. MRI scores decreased following treatment, suggesting scores reflect inflammation. Future studies are needed to determine if MRI can identify patients at low risk for blindness who may receive less glucocorticoid therapy.
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Affiliation(s)
| | - Ryan Rebello
- St Joseph's Hospital and McMaster UniversityHamiltonOntarioCanada
| | | | | | - Fang Liu
- University of PennsylvaniaPhiladelphia
| | - Quy Cao
- University of PennsylvaniaPhiladelphia
| | | | | | | | | | | | | | - Rui Liang
- University of PennsylvaniaPhiladelphia
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Baker JF, Bakewell C, Dikranian A, Lam G, O'Brien J, Moore PC, Yu M, Hur P, Masri KR. Characteristics and 6-Month Outcomes in Patients with Rheumatoid Arthritis Initiating Infliximab Biosimilar IFX-dyyb in a Real-World Setting. Rheumatol Ther 2024:10.1007/s40744-024-00653-6. [PMID: 38507187 DOI: 10.1007/s40744-024-00653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Real-world studies describing biosimilar initiation or switching in patients with rheumatoid arthritis (RA) are limited. The aim of this study was to assess treatment patterns and effectiveness of real-world patients with RA initiating infliximab biosimilar IFX-dyyb (CT-P13; Inflectra®) in the USA. METHODS This observational study evaluated patients with RA from the CorEvitas RA Registry who initiated IFX-dyyb and had Clinical Disease Activity Index (CDAI) recorded at baseline and 6 months. The primary outcome was reaching low disease activity (LDA; CDAI ≤ 10) at 6 months in patients with moderate or high disease activity (CDAI > 10) at baseline. Secondary outcomes were change at 6 months in CDAI and certain patient-reported outcomes (PROs). Patient data were stratified by prior treatment: biologic/targeted synthetic disease-modifying antirheumatic drug (tsDMARD)-naïve, reference infliximab (IFX-REF) or IFX biosimilar, or a non-IFX biologic or tsDMARD. RESULTS Of 318 patients initiating IFX-dyyb, 176 had baseline and 6-month CDAI scores; 73 (41%) switched from IFX, 61 (35%) switched from another non-IFX/biologic/tsDMARD, 32 (18%) were naïve to biologics/tsDMARDs, and 10 (6%) switched from an IFX biosimilar. Among patients with moderate or high disease activity at baseline, 32.9% (95% CI 22.9, 42.9) achieved LDA at 6 months. Mean 6-month change from baseline in CDAI was - 1.8 (95% CI - 3.3, - 0.3) overall; - 4.7 (- 7.6, - 1.7) in patients who switched from a non-IFX biologic/tsDMARD, - 4.1 (- 7.8, - 0.3) in biologic/tsDMARD-naïve patients, and 1.1 (- 0.4, 2.6) in patients who switched from IFX-REF/IFX biosimilar. Other clinical outcomes/PROs improved at 6 months. Of the IFX-dyyb initiators, 68% remained on IFX-dyyb at 6 months. CONCLUSION In this real-world population of patients with RA initiating IFX-dyyb, the majority switched from IFX-REF or a non-IFX biologic/tsDMARD. CDAI remained stable in patients switching from IFX-REF/IFX biosimilar and improved in patients switching from a non-IFX biologic/tsDMARD and in biologic/tsDMARD-naïve patients.
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Affiliation(s)
- Joshua F Baker
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ara Dikranian
- Cabrillo Center for Rheumatic Disease, San Diego, CA, USA
| | - Gordon Lam
- Arthritis and Osteoporosis Consultants of the Carolinas, Charlotte, NC, USA
- Atrium Health Wake Forest Baptist, Charlotte, NC, USA
| | | | | | - Miao Yu
- CorEvitas, LLC, Waltham, MA, USA
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Baker JF, ODell JR, England BR, Giles JT, Newcomb JA, George MD, Thiele G, Moreland L, Bridges SL, Curtis JR, Mikuls TR. Lower body mass and lower adiposity are associated with differential responses to two treatment strategies for rheumatoid arthritis. Ann Rheum Dis 2024; 83:429-436. [PMID: 38171598 PMCID: PMC11019773 DOI: 10.1136/ard-2023-225014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To determine if body mass index (BMI) and adipokine levels identify rheumatoid arthritis (RA) patients most likely to benefit from initiation of tumour necrosis factor inhibitors (TNFi) after methotrexate inadequate response. METHODS This is a secondary analysis of the Rheumatoid Arthritis Comparison of Active Treatments (RACAT) trial and the (TEAR) trial. Both studies compared treatment strategies starting with conventional disease-modifying anti-rheumatic drugs (DMARDs) (triple therapy) versus etanercept plus methotrexate. We compared response rates between TNFi and triple therapy among patients with different BMI. Adipokines were measured at enrolment and associations with treatment response were examined using regression, adjusting for age, sex, BMI and baseline disease activity. RESULTS In RACAT (n=306), participants who were normal/underweight were more likely to benefit from TNFi versus triple therapy, with greater change in Disease Activity Score in 28 and greater ACR20 response (ACR 20: 64% vs 23%, p=0.001). In contrast, overweight/obese participants had similar response to TNFi versus triple therapy (p-for-interaction=0.001). Similarly, but modest patterns were observed in TEAR (n=601; ACR20: 67% vs 52%, p=0.05). In RACAT, adipokine scores consistent with lower adiposity also predicted greater response to TNFi (ACR20: 58% vs 37%, p=0.01) with better model fit compared with BMI alone. CONCLUSIONS Lower BMI and evidence of lower adiposity based on adipokine profiles were associated with a superior response to TNFi compared with triple therapy. There was no difference between treatments among overweight/obese participants. The results support TNFi being a particularly important therapeutic among normal/underweight patients, with implications for clinical decisions and trial design.
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Affiliation(s)
- Joshua F Baker
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R ODell
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Bryant R England
- Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Rheumatology, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Jon T Giles
- Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Jefferey A Newcomb
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Geoffrey Thiele
- Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Research Services, 151, Omaha VA Medical Center, Omaha, Nebraska, USA
| | - Larry Moreland
- Orthopedics, University of Colorado, Denver, Colorado, USA
| | | | - Jeffrey R Curtis
- University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, USA
| | - Ted R Mikuls
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. Erratum to "2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective" [The Journal of Arthroplasty 38 (2023) 2193-2201]. J Arthroplasty 2024; 39:851-852. [PMID: 38049357 DOI: 10.1016/j.arth.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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Abstract
Dr Schumacher was a force in rheumatology for more than half a century through his multiple roles as a researcher, clinician, mentor, and educator. He is not likely to be soon forgotten by the rheumatology community; however, it is hoped that this chapter can provide a faithful recollection that will help bring his memory to life for some and that rings true to those who knew him and learned from him.
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Affiliation(s)
- Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Daniel G Baker
- Kira Biotech Pty Ltd, Fortitude Valley, Queensland, Australia
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Luedders BA, Wheeler AM, Ascherman DP, Baker JF, Duryee MJ, Yang Y, Roul P, Wysham KD, Monach P, Reimold A, Kerr GS, Kunkel G, Cannon GW, Poole JA, Thiele GM, Mikuls TR, England BR. Plasma Matrix Metalloproteinase Concentrations and Risk of Interstitial Lung Disease in a Prospective Rheumatoid Arthritis Cohort. Arthritis Rheumatol 2024. [PMID: 38268499 DOI: 10.1002/art.42812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To evaluate the associations of plasma matrix metalloproteinases (MMPs) with prevalent and incident interstitial lung disease (ILD) in people with rheumatoid arthritis (RA). METHODS Within a multicenter, prospective cohort of US veterans with RA, we performed a cross-sectional study of prevalent ILD and cohort study of incident ILD. ILD diagnoses were validated by medical record review of provider diagnoses and chest imaging and/or pathology reports. MMP-1, 3, 7, and 9 concentrations were measured in plasma samples, then standardized and categorized into quartiles. The associations of MMPs with prevalent and incident ILD were assessed with logistic (prevalent) and Cox (incident) regression models adjusted for RA-ILD risk factors. RESULTS Among 2,312 participants (88.9% male; mean age 63.8 years), 96 had prevalent ILD. Incident ILD developed in 130 participants over 17,378 person-years of follow-up (crude incidence rate 7.5/1,000 person-years). Participants with the highest quartile of MMP-7 concentrations had a nearly four-fold increased odds of prevalent ILD (adjusted odds ratio 3.78 [95% confidence interval (95% CI) 1.86-7.65]) and over two-fold increased risk of incident ILD (adjusted hazard ratio 2.33 [95% CI 1.35-4.02]). Higher MMP-9 concentrations were also associated with prevalent and incident ILD, as well as negatively correlated with forced vital capacity among those with prevalent ILD (r = -0.30, P = 0.005). CONCLUSION MMP-7 and MMP-9 were strongly associated with both prevalent and incident ILD in this large, multicenter RA cohort after adjustment for other RA-ILD risk factors. These population-level findings further support a potential pathogenic role for MMPs in RA-ILD and suggest that their measurement could facilitate RA-ILD risk stratification.
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Affiliation(s)
- Brent A Luedders
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Austin M Wheeler
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Dana P Ascherman
- Pittsburgh VA and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania, Philadelphia
| | - Michael J Duryee
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | | | | | | | - Gail S Kerr
- Washington, DC VA, Howard University, and Georgetown University, Washington, DC
| | - Gary Kunkel
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City
| | - Grant W Cannon
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City
| | | | - Geoffrey M Thiele
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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Wheeler AM, Baker JF, Riley T, Yang Y, Roul P, Wysham KD, Cannon GW, Kunkel G, Kerr G, Ascherman DP, Monach P, Reimold A, Poole JA, Merriman TR, Mikuls TR, England BR. Development and Internal Validation of a Clinical and Genetic Risk Score for Rheumatoid Arthritis-Associated Interstitial Lung Disease. Rheumatology (Oxford) 2024:keae001. [PMID: 38243706 DOI: 10.1093/rheumatology/keae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Although clinical and genetic risk factors have been identified for rheumatoid arthritis-associated interstitial lung disease (RA-ILD), there are no current tools allowing for risk stratification. We sought to develop and validate an ILD risk model in a large, multicentre, prospective RA cohort. METHODS Participants in the Veterans Affairs RA (VARA) registry were genotyped for 12 single nucleotide polymorphisms (SNPs) associated with idiopathic pulmonary fibrosis. ILD was validated through systematic record review. A genetic risk score (GRS) was computed from minor alleles weighted by effect size with ILD, using backward selection. The GRS was combined with clinical risk factors within a logistic regression model. Internal validation was completed using bootstrapping, and model performance was assessed by the area under the receiver operating curve (AUC). RESULTS Of 2,386 participants (89% male, mean age 69.5 years), 9.4% had ILD. Following backward selection, five SNPs contributed to the GRS. The GRS and clinical factors outperformed clinical factors alone in discriminating ILD (AUC 0.675 vs 0.635, p< 0.001). The shrinkage-corrected performance for combined and clinical-only models was 0.667 (95% CI 0.628, 0.712) and 0.623 (95% CI 0.584, 0.651), respectively. Twenty percent of the cohort had a combined risk score below a cut-point with >90% sensitivity. CONCLUSION A clinical and genetic risk model discriminated ILD in a large, multicentre RA cohort better than a clinical-only model, excluding 20% of the cohort from low-yield testing. These results demonstrate the potential utility of a GRS in RA-ILD and support further investigation into individualized risk stratification and screening.
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Affiliation(s)
- Austin M Wheeler
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Joshua F Baker
- University of Pennsylvania & Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Thomas Riley
- University of Pennsylvania & Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Yangyuna Yang
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Punyasha Roul
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Katherine D Wysham
- VA Puget Sound Health Care System & University of Washington, Seattle, WA, USA
| | - Grant W Cannon
- VA Salt Lake City & University of Utah, Salt Lake City, UT, USA
| | - Gary Kunkel
- VA Salt Lake City & University of Utah, Salt Lake City, UT, USA
| | - Gail Kerr
- Washington D.C. VA, Howard University, & Georgetown University, Washington D.C., USA
| | | | | | - Andreas Reimold
- Dallas VA & University of Texas Southwestern, Dallas, TX, USA
| | - Jill A Poole
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- University of Nebraska Medical Center, Omaha, NE, USA
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11
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Baker JF, England BR, Wysham KD, Sauer B, Joseph AM, Lenert A, Roul P, Xiao R, Gillcrist R, Johnson T, Cannon GW, Duryee M, Thiele GM, Mikuls TR. Associations between Adiponectin and the Development of Diabetes in Rheumatoid Arthritis. J Clin Endocrinol Metab 2024:dgae010. [PMID: 38189426 DOI: 10.1210/clinem/dgae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE We evaluated associations between adiponectin and the risk of diabetes among patients with rheumatoid arthritis (RA), a systemic inflammatory disease associated with metabolic disturbance. METHODS This prospective cohort study included adults with RA from the Veteran's Affairs Rheumatoid Arthritis Registry. Adiponectin and inflammatory cytokines/chemokines were measured at enrollment on stored serum samples. Adiponectin levels were categorized and clinical variables were described across categories (<10 μg/mL; 10-40 μg/mL; > 40 μg/mL. Multivariable Cox proportional hazard models evaluated associations between adiponectin and incident diabetes adjusting for age, sex, race, smoking status, body mass index (BMI), disease-modifying therapy use, calendar year, and comorbidity. Testing for modification of effect in the context of elevated cytokines/chemokines was performed. RESULTS Among 2595 patients included in the analysis, those with adiponectin levels >40 μg/mL (N = 379; 15%) were older and had lower BMI. There were 125 new cases of diabetes among 1,689 patients without prevalent disease at enrollment. There was an inverse association between adiponectin and incident diabetes, however, the association was positive among patients with adiponectin levels >40 μg/mL. Patients with levels >40 μg/mL were at higher risk compared to those with levels 10-40 μg/mL [HR: 1.70 (1.34,2.16) p < 0.001]. Those with adiponectin levels >40 μg/mL had significantly higher levels of inflammatory cytokines with evidence of a modified effect of adiponectin on diabetes risk in the setting of inflammation. CONCLUSIONS The relationship between adiponectin and incident diabetes risk is U-shaped in RA. Patients with very high adiponectin levels have greater systemic inflammation and an altered relationship between adiponectin and diabetes risk.
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Affiliation(s)
- Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bryant R England
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Katherine D Wysham
- VA Puget Sound Health Care System, Seattle, WA & University of Washington School of Medicine, Seattle, WA
| | - Brian Sauer
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT
| | | | | | - Punyasha Roul
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel Gillcrist
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Tate Johnson
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Grant W Cannon
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT
| | - Michael Duryee
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Geoffrey M Thiele
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Ted R Mikuls
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
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12
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England BR, Roul P, Yang Y, Hershberger D, Sayles H, Rojas J, Cannon GW, Sauer BC, Curtis JR, Baker JF, Mikuls TR. Extracting forced vital capacity from the electronic health record through natural language processing in rheumatoid arthritis-associated interstitial lung disease. Pharmacoepidemiol Drug Saf 2024; 33:e5744. [PMID: 38112272 PMCID: PMC10872496 DOI: 10.1002/pds.5744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To develop a natural language processing (NLP) tool to extract forced vital capacity (FVC) values from electronic health record (EHR) notes in patients with rheumatoid arthritis-interstitial lung disease (RA-ILD). METHODS We selected RA-ILD patients (n = 7485) in the Veterans Health Administration (VA) between 2000 and 2020 using validated ICD-9/10 codes. We identified numeric values in proximity to FVC string patterns from clinical notes in the EHR. Subsequently, we performed processing steps to account for variability in note structure, related pulmonary function test (PFT) output, and values copied across notes, then assigned dates from linked administrative procedure records. NLP-derived FVC values were compared to values recorded directly from PFT equipment available on a subset of patients. RESULTS We identified 5911 FVC values (n = 1844 patients) from PFT equipment and 15 383 values (n = 4982 patients) by NLP. Among 2610 date-matched FVC values from NLP and PFT equipment, 95.8% of values were within 5% predicted. The mean (SD) difference was 0.09% (5.9), and values strongly correlated (r = 0.94, p < 0.001), with a precision of 0.87 (95% CI 0.86, 0.88). NLP captured more patients with longitudinal FVC values (n = 3069 vs. n = 1164). Mean (SD) change in FVC %-predicted per year was similar between sources (-1.5 [30.0] NLP vs. -0.9 [16.6] PFT equipment; standardized response mean = 0.05 for both). CONCLUSIONS NLP of EHR notes increases the capture of accurate, longitudinal FVC values by three-fold over PFT equipment. Use of this NLP tool can facilitate pharmacoepidemiologic research in RA-ILD and other lung diseases by capturing this critical measure of disease severity.
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Affiliation(s)
- Bryant R. England
- VA Nebraska-Western Iowa Health Care System & Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System & Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System & Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Daniel Hershberger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | | | | | - Brian C. Sauer
- VA Salt Lake City & University of Utah, Salt Lake City, UT
| | | | - Joshua F. Baker
- Corporal Michael J. Crescenz VA & University of Pennsylvania, Philadelphia, PA
| | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System & Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
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13
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. J Arthroplasty 2023; 38:2193-2201. [PMID: 37778918 DOI: 10.1016/j.arth.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). METHODS We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. RESULTS The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. CONCLUSION This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.
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Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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14
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Rheumatol 2023; 75:1877-1888. [PMID: 37746897 DOI: 10.1002/art.42630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). METHODS We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. RESULTS The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. CONCLUSION This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.
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Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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15
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Care Res (Hoboken) 2023; 75:2227-2238. [PMID: 37743767 DOI: 10.1002/acr.25175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). METHODS We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. RESULTS The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. CONCLUSION This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.
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Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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16
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Poole JA, England BR, Sayles H, Johnson TM, Duryee MJ, Hunter CD, Baker JF, Kerr GS, Kunkel G, Cannon GW, Sauer BC, Wysham KD, Joseph AM, Wallace BI, Thiele GM, Mikuls TR. Serum alarmins and the risk of incident interstitial lung disease in rheumatoid arthritis. Rheumatology (Oxford) 2023:kead535. [PMID: 37812235 DOI: 10.1093/rheumatology/kead535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES To quantify associations of serum alarmins with risk of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). METHODS Using serum collected at enrolment, three alarmins (interleukin [IL]-33, thymic stromal lymphopoietin [TSLP], and IL-25) were measured in a multicentre prospective RA cohort. ILD was classified using systematic medical record review. Cross-sectional associations of log-transformed (IL-33, TSLP) or quartile (IL-25) values with RA-ILD at enrolment (prevalent RA-ILD) were examined using logistic regression, while associations with incident RA-ILD developing after enrolment were examined using Cox proportional hazards. Covariates in multivariate models included age, sex, race, smoking status, RA disease activity score, and anti-cyclic citrullinated antibody positivity. RESULTS Of 2,835 study participants, 115 participants (4.1%) had prevalent RA-ILD at baseline and an additional 146 (5.1%) developed incident ILD. There were no associations between serum alarmin concentrations and prevalent ILD in unadjusted or adjusted logistic regression models. In contrast, there was a significant inverse association between IL-33 concentration and the risk of developing incident RA-ILD in unadjusted (HR 0.73 per log-fold increase; 95% CI 0.57-0.95; p= 0.018) and adjusted (HR 0.77; 95% CI 0.59-1.00, p= 0.047) models. No significant associations of TSLP or IL-25 with incident ILD were observed. CONCLUSIONS In this study, we observed a significant inverse association between serum IL-33 concentration and the risk of developing incident RA-ILD, but no associations with prevalent ILD. Additional investigation is required to better understand the mechanisms driving this relationship and how serum alarmin IL-33 assessment might contribute to clinical risk stratification in patients with RA.
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Affiliation(s)
- Jill A Poole
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryant R England
- University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Harlan Sayles
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Tate M Johnson
- University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Michael J Duryee
- University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Carlos D Hunter
- University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Joshua F Baker
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and School of Medicine and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USAand
| | - Gail S Kerr
- Washington, D.C. VA, Georgetown and Howard University, Washington, DC, USA
| | - Gary Kunkel
- George E. Wahlen Veterans Affairs Medical Center and the University of Utah, Salt Lake City, UT, US
| | - Grant W Cannon
- George E. Wahlen Veterans Affairs Medical Center and the University of Utah, Salt Lake City, UT, US
| | - Brian C Sauer
- George E. Wahlen Veterans Affairs Medical Center and the University of Utah, Salt Lake City, UT, US
| | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington, Seattle, WA, US
| | - Amy M Joseph
- VA St. Louis Health Care System and Washington University School of Medicine, St. Louis, MO, USA
| | - Beth I Wallace
- VA Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Geoffrey M Thiele
- University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Ted R Mikuls
- University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
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Jeong S, George MD, Mikuls TR, England BR, Sauer B, Cannon GW, Baker JF. Changes in Patterns of Use of Advanced Therapies Following Emerging Data About Adverse Events in Patients With Rheumatoid Arthritis From the Veterans Affairs Health System. ACR Open Rheumatol 2023; 5:563-567. [PMID: 37658632 PMCID: PMC10570666 DOI: 10.1002/acr2.11602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/01/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To determine whether prescribing practices for Janus kinase inhibitors (JAKi), tumor necrosis factor inhibitors (TNFi), and non-TNFi biologic agents changed after the results of the Oral Rheumatoid Arthritis Trial (ORAL) Surveillance trial were released in January 2021. METHODS This is a retrospective study in adult patients with rheumatoid arthritis (RA) receiving advanced therapies within the Veterans Affairs Health System from January 2012 through September 2022. Eligible patients were required to have at least one diagnosis code for RA and to have received a biologic disease-modifying antirheumatic drug or JAKi. Treatment courses were defined from pharmacy dispensing data and the number of new courses of each advanced therapy was quantified over time. We assessed changes in the use of each therapy before and after the release of safety data (January 2021). RESULTS A total of 88,253 individual drug courses (in 34,656 unique patients) were included in the study. There was a consistent increase in the number and proportion of new courses of JAKi leading up to January 2021, which was followed by a significant net decrease in JAKi use through September 2022. There was significantly less tofacitinib use after the release of safety data, with a significant difference in the slope of change in use with time. In contrast, whereas TNFi use declined leading up to 2021, its use significantly increased after January 2021. CONCLUSION Changes in prescribing in response to new evidence emphasize the impact that safety trials have on prescribing practices. Ongoing study in this area, with attention to specific patient characteristics and risk profiles, will help characterize these changes in practice.
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Affiliation(s)
| | - Michael D. George
- University of Pennsylvania School of Medicine and University of Pennsylvania Center for Clinical Epidemiology and BiostatisticsPhiladelphiaPennsylvania
| | | | | | - Brian Sauer
- Salt Lake City Veteran Affairs Medical Center and University of UtahSalt Lake CityUtah
| | - Grant W. Cannon
- Salt Lake City Veteran Affairs Medical Center and University of UtahSalt Lake CityUtah
| | - Joshua F. Baker
- University of Pennsylvania School of Medicine, University of Pennsylvania Center for Clinical Epidemiology and Biostatistcs, and Corporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPennsylvania
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Dolomisiewicz A, Ali H, Roul P, Yang Y, Cannon GW, Sauer B, Baker JF, Mikuls TR, Michaud K, England BR. Updating and Validating the Rheumatic Disease Comorbidity Index to Incorporate ICD-10-CM Diagnostic Codes. Arthritis Care Res (Hoboken) 2023; 75:2199-2206. [PMID: 36951260 PMCID: PMC10517070 DOI: 10.1002/acr.25116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To update and validate the Rheumatic Disease Comorbidity Index (RDCI) utilizing International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. METHODS We defined ICD-9-CM (n = 1,068) and ICD-10-CM (n = 1,425) era cohorts (n = 862 in both) spanning the ICD-9-CM to ICD-10-CM transition in a multicenter, prospective rheumatoid arthritis registry. Information regarding comorbidities was collected from linked administrative data over 2-year assessment periods. An ICD-10-CM code list was generated from crosswalks and clinical expertise. ICD-9- and ICD-10-derived RDCI scores were compared using intraclass correlation coefficients (ICC). The predictive ability of the RDCI for functional status and death during follow-up was assessed using multivariable regression models and goodness-of-fit statistics (Akaike's information criterion [AIC] and quasi information criterion [QIC]) in both cohorts. RESULTS Mean ± SD RDCI scores were 2.93 ± 1.72 in the ICD-9-CM cohort and 2.92 ± 1.74 in the ICD-10-CM cohort. RDCI scores had substantial agreement in individuals who were in both cohorts (ICC 0.71 [95% confidence interval 0.68-0.74]). Prevalence of comorbidities was similar between cohorts with absolute differences <6%. Higher RDCI scores were associated with a greater risk of death and poorer functional status during follow-up in both cohorts. Similarly, in both cohorts, models including the RDCI score had the lowest QIC (functional status) and AIC (death) values, indicating better model performance. CONCLUSION The newly proposed ICD-10-CM codes for the RDCI-generated comparable RDCI scores to those derived from ICD-9-CM codes and are highly predictive of functional status and death. The proposed ICD-10-CM codes for the RDCI can be used in rheumatic disease outcomes research spanning the ICD-10-CM era.
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Affiliation(s)
- Anthony Dolomisiewicz
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Hanifah Ali
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Yangyuna Yang
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | | | - Brian Sauer
- Salt Lake City VA & University of Utah, Salt Lake City, UT
| | - Joshua F. Baker
- Corporal Michael J. Crescenz VA & University of Pennsylvania, Philadelphia, PA
| | - Ted R. Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Kaleb Michaud
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
- FORWARD, The National Data Bank for Rheumatic Diseases, Wichita, KS
| | - Bryant R. England
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE
- Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
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Baker JF, Olave M, Leach W, Doherty CR, Gillcrist RL, White DK, Ogdie A, England BR, Wysham K, Quinones M, Xiao R, Neogi T, Scanzello CR. Corticosteroid Injections for Symptomatic Treatment of Osteoarthritis of the Knee: A Pilot Blinded Randomized Trial. ACR Open Rheumatol 2023; 5:529-535. [PMID: 37740448 PMCID: PMC10570668 DOI: 10.1002/acr2.11596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To quantify the effect of corticosteroids compared to lidocaine-only injections over 12 weeks among patients with knee osteoarthritis (KOA). METHODS Participants with KOA were randomized to receive a knee injection of methylprednisolone acetate 1 mL (40 mg) plus 2 mL lidocaine (1%) or 1 mL saline and 2 mL lidocaine. Participants and providers were blinded to treatment allocation using an opacified syringe. The outcome was the average change from baseline of the total Knee Injury and Osteoarthritis Outcome Score (KOOS) (range 0-100) assessed at 2-week intervals over 12 weeks. Participants received KOOS questionnaires on their smartphones through a web-based platform. We used linear mixed-effects regressions with robust variance estimators to evaluate the association between the intervention and change in KOOS total and subscales (ClinicalTrials.gov identifier NCT03835910; registered 2019-02-11). RESULTS Of the 33 randomized participants, 31 were included in the final analysis. The predicted mean (SE) change in total KOOS over the 12-week follow-up was 9.4 (3.2) in the corticosteroids arm versus -1.3 (1.4) in the control arm (P = 0.003). Of participants, 47% achieved change as large as the minimal clinically important difference (16 units) in the intervention arm compared to 6% of participants in the lidocaine arm. Further, there were greater improvements in the intervention arm for KOOS subscales and for Patient Reported Outcomes Measurement Information System (PROMIS) assessments of pain intensity, behavior, and interference. CONCLUSION Corticosteroid injections demonstrated clinically meaningful improvements in KOA symptoms over 12 weeks of follow-up. These data support larger studies to better quantify short-term benefits.
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Affiliation(s)
- Joshua F. Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvania
| | - Marianna Olave
- Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
| | - William Leach
- Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
| | | | | | | | - Alexis Ogdie
- Perelman School of Medicine, University of PennsylvaniaPhiladelphia
| | - Bryant R. England
- Medicine Service, VA Nebraska‐Western Iowa Health Care System and University of Nebraska Medical CenterOmahaNebraska
| | - Katherine Wysham
- VA Puget Sound Health Care System and University of WashingtonSeattleWashington
| | | | - Rui Xiao
- Perelman School of Medicine, University of PennsylvaniaPhiladelphia
| | - Tuhina Neogi
- Boston University School of MedicineBostonMassachusetts
| | - Carla R. Scanzello
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvania
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Baker JF, Wipfler K, Olave M, Pedro S, Katz P, Michaud K. Obesity, Adipokines, and Chronic and Persistent Pain in Rheumatoid Arthritis. J Pain 2023; 24:1813-1819. [PMID: 37207978 DOI: 10.1016/j.jpain.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
We aimed to determine whether adipokines are associated with pain and polysymptomatic distress in patients with rheumatoid arthritis (RA) over time in a large patient registry. The cohort study was conducted in a subset of Forward; a patient-based multi-disease, multipurpose rheumatic disease registry with patients enrolled from community-based rheumatology practices across the U.S. Adipokines (adiponectin, leptin, and fibroblast growth factor[FGF]-21) were measured on stored serum as part of a multi-analyte panel. Body mass index (BMI), pain, polysymptomatic distress, and other patient-reported outcomes (PROs) were reported on biannual questionnaires. Linear regression was used to evaluate independent associations between BMI, adipokines, and PROs. Cox proportional hazards models evaluated independent associations between adipokines and clinically meaningful changes in pain over time (change in numerical rating>1.1 [range 0-10], sustained over 1 year). Among 645 patients included in these analyses, there were significant differences in RA characteristics, comorbidity, PROs, and adipokines across obesity categories. Of note, severely obese patients were more likely to experience greater pain, polysymptomatic distress, and fatigue. Patients with higher FGF-21 levels had higher pain and polysymptomatic stress at baseline, were more likely to use opioids, and were more likely to have sustained worsening pain over time [HR (per 1 SD) (95% CI): 1.22 (1.02,1.46) P = .03] independent of BMI. Obesity and elevated levels of FGF-21 are associated with pain and polysymptomatic distress in RA. Elevated FGF-21 levels may help identify those at risk of worsening pain trajectories over time, independent of BMI. PERSPECTIVE: This study characterizes the relationship between severe obesity and pain and polysymptomatic distress in patients with rheumatoid arthritis and demonstrates that the adipocytokine fibroblast growth factor-21 is independently associated with pain and predicts a worsening trajectory over time. Further mechanistic studies are needed.
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Affiliation(s)
- Joshua F Baker
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kristin Wipfler
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Marianna Olave
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Sofia Pedro
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Patricia Katz
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Kaleb Michaud
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas; Medicine Service, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
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Abstract
INTRODUCTION Sarcopenia is a condition characterized by decreased muscle strength and muscle mass, which can impact physical function. Sarcopenia develops as a consequence of age-related decline (primary sarcopenia) and has a major impact on physical, social, and emotional well-being. In addition, patients with rheumatic diseases may suffer from sarcopenia independently of aging (secondary sarcopenia). Exercise, pharmacological treatments, and nutritional supplementation are some of the strategies used for the management of sarcopenia in the general population. The aim of this review is to summarize the evidence around the prevalence and impact of sarcopenia in patients with rheumatic diseases. CONCLUSIONS From our review, we can state that sarcopenia is a common and prevalent condition among the rheumatic diseases. Furthermore, the impacts of sarcopenia are not well-appreciated, and the implementation of treatment strategies has not been widespread. Strategies such as exercise and some pharmacological treatments are effective in improving physical and functional impairment related to these conditions. FUTURE RESEARCH DIRECTIONS IN THE FIELD New pharmacological treatments are being actively studied and may contribute in the future to the management of sarcopenia.
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Affiliation(s)
- Rafaela Cavalheiro do Espírito Santo
- From the Laboratório de Doenças Auto Imunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, Philadelphia, PA
| | - Leonardo Peterson Dos Santos
- From the Laboratório de Doenças Auto Imunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Ricardo Machado Xavier
- From the Laboratório de Doenças Auto Imunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Pappas DA, O'Brien J, Guo L, Shan Y, Baker JF, Kricorian G, Stryker S, Collier DH. Treatment patterns and clinical outcomes in patients with rheumatoid arthritis initiating etanercept, adalimumab, or Janus kinase inhibitor as first-line therapy: results from the real-world CorEvitas RA Registry. Arthritis Res Ther 2023; 25:166. [PMID: 37689684 PMCID: PMC10492389 DOI: 10.1186/s13075-023-03120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/19/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Real-world studies assessing the comparative effectiveness of biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) as first-line targeted therapy are scarce. We analyzed the real-world persistence and effectiveness of etanercept (ETN), adalimumab (ADA), and Janus kinase inhibitors (JAKis) as first-line therapy in b/tsDMARD-naïve patients with rheumatoid arthritis (RA). METHODS Adults (≥ 18 years) enrolled in the CorEvitas RA Registry and initiating ETN, ADA, or a JAKi (alone or in combination with csDMARDs) between November 2012 and June 2021 were included if they had 6 and/or 12 months' follow-up. Treatment persistence and effectiveness outcomes including the change in Clinical Disease Activity Index (CDAI) and patient-reported outcomes (PROs) were evaluated at follow-up, adjusting for covariates using linear and logistic regression models. An exploratory analysis for patients on monotherapy was also conducted. RESULTS Of 1059 ETN, 1327 ADA, and 581 JAKi initiators; 803 ETN, 984 ADA, and 361 JAKi initiators had 6 months' follow-up. JAKi initiators were older and had a relatively longer disease duration than ETN or ADA initiators (mean age: 61.3 vs 54.5 and 55.5 years; mean duration of RA: 8.1 vs 5.7 and 5.6 years). Unadjusted mean improvements in CDAI and PROs were similar between the groups at 6 months, except the proportion achieving LDA, remission, and MCID in CDAI, which were numerically higher in the ETN and ADA groups vs JAKi group (LDA: 43.4% and 41.9% vs 32.5%; remission: 18.2% and 15.1% vs 11.5%; MCID: 46.5% and 47.8% vs 38.0%). Adjusted effectiveness results did not reveal statistically significant differences between treatment groups at 6 months, with an exception in MCID (odds ratio [95% CI] for JAKi vs ETN: 0.65 [0.43-0.98]). At 6 months, 68.2% of ETN, 68.5% of ADA, and 66.5% of JAKi initiators remained on therapy. The findings at 12 months' follow-up and sensitivity analysis among monotherapy initiators also showed no differences in effectiveness outcomes between the groups. CONCLUSIONS This analysis of real-world data from the CorEvitas RA Registry did not show differences in clinical effectiveness and treatment persistence rates in b/tsDMARD-naïve patients initiating ETN, ADA, or JAKi as first-line targeted therapy either alone or in combination with csDMARDs.
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Affiliation(s)
- Dimitrios A Pappas
- CorEvitas LLC, Waltham, MA, USA.
- Corrona Research Foundation, Albany, NY, USA.
| | | | - Lin Guo
- CorEvitas LLC, Waltham, MA, USA
| | | | - Joshua F Baker
- Department of Rheumatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Wallace BI, England BR, Baker JF, Rojas J, Sauer BC, Roul P, Kunkel GA, Braaten TJ, Petro A, Mikuls TR, Cannon GW. Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy. ACR Open Rheumatol 2023; 5:437-442. [PMID: 37491906 PMCID: PMC10502811 DOI: 10.1002/acr2.11584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/17/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE In the Steroid EliMination In Rheumatoid Arthritis (SEMIRA) trial, 65% of patients with rheumatoid arthritis (RA) in low disease activity (LDA) on stable biologic therapy successfully tapered glucocorticoids. We aimed to evaluate real-world rates of glucocorticoid tapering among similar patients in the Veterans Affairs Rheumatoid Arthritis registry. METHODS Within a multicenter, prospective RA cohort, we used registry data and linked pharmacy claims from 2003 to 2021 to identify chronic prednisone users achieving LDA after initiating a new biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD). We defined the index date as first LDA occurring 60 to 180 days after b/tsDMARD initiation. The primary outcome of successful tapering, assessed at day 180 after LDA, required a 30-day averaged prednisone dose both less than or equal to 5mg/day and at least 50% lower than at the index date. The secondary outcome was discontinuation, defined as a prednisone dose of 0 mg/day at days 180 through 210. We used univariate statistics to compare patient characteristics by fulfillment of the primary outcome. RESULTS We evaluated 100 b/tsDMARD courses among 95 patients. Fifty-four courses resulted in successful tapering; 33 resulted in discontinuation. Positive rheumatoid factor, higher erythrocyte sedimentation rate, more background DMARDs, shorter time from b/tsDMARD initiation to LDA, and higher glucocorticoid dose 30 days before LDA were associated with greater likelihood of successful tapering. CONCLUSION In a real-world RA cohort of chronic glucocorticoid users in LDA, half successfully tapered and a third discontinued prednisone within 6 months of initiating a new b/tsDMARD. Claims-based algorithms of glucocorticoid tapering and discontinuation may be useful to evaluate predictors of tapering in administrative data sets.
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Affiliation(s)
- Beth I. Wallace
- Center for Clinical Management ResearchVA Ann Arbor Healthcare System and University of MichiganAnn Arbor
| | - Bryant R. England
- University of Nebraska Medical Center and Veterans Affairs Nebraska‐Western Iowa Health Care SystemOmaha
| | - Joshua F. Baker
- Hospital of the University of Pennsylvania and Philadelphia VA Medical CenterPhiladelphia
| | - Jorge Rojas
- VA Salt Lake City Healthcare System, Salt Lake City, Utah, and VA Puget Sound Healthcare SystemSeattleWashington
| | | | | | - Gary A. Kunkel
- VA Salt Lake City Healthcare System and University of UtahSalt Lake City
| | - Tawnie J. Braaten
- VA Salt Lake City Healthcare System and University of UtahSalt Lake City
| | | | - Ted R. Mikuls
- University of Nebraska Medical Center and Veterans Affairs Nebraska‐Western Iowa Health Care SystemOmaha
| | - Grant W. Cannon
- VA Salt Lake City Healthcare System, Salt Lake City, Utah, and VA Puget Sound Healthcare SystemSeattleWashington
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Baker JF. Invited Commentary: A Step Toward Safer and More Precise Management of Osteoarthritis Pain. Am J Epidemiol 2023; 192:1449-1451. [PMID: 37083976 DOI: 10.1093/aje/kwad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/22/2023] Open
Abstract
In this issue of the Journal, Wei et al. (Am J Epidemiol. 2023;192(9):1432-1448); demonstrate the modification of effect of nonselective nonsteroidal antiinflammatory drugs in the setting of aspirin use for the outcome of cardiovascular events. This study is distinctive in its aim to compare 2 similar therapies in the setting of 2 clinical scenarios (aspirin use vs. not) based on some mechanistic rationale. The use of an active comparator design with a prehypothesized evaluation of treatment heterogeneity can provide compelling evidence to support relevant clinical decisions for which clinical trial evidence is not likely or possible.
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Johnson TM, Yang Y, Roul P, Sauer BC, Cannon GW, Kunkel G, Michaud K, Baker JF, Mikuls TR, England BR. A Narrowing Mortality Gap: Temporal Trends of Cause-Specific Mortality in a National Matched Cohort Study in US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:1648-1658. [PMID: 36331101 PMCID: PMC10275614 DOI: 10.1002/acr.25053] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine temporal trends in all-cause and cause-specific mortality in patients with rheumatoid arthritis (RA) in the Veterans Health Administration (VHA). METHODS We conducted a matched cohort study in the VHA from January 1, 2000 to December 31, 2017. Incident RA patients were matched up to 1:10 on age, sex, and VHA enrollment year to non-RA patients, then followed until death or end of study period. Cause of death was obtained from the National Death Index. Multivariable Cox regression models stratified by RA diagnosis years were used to examine trends in RA-related risk of all-cause and cause-specific mortality. RESULTS Among 29,779 incident RA patients (matched to 245,226 non-RA patients), 9,565 deaths occurred. RA patients were at increased risk of all-cause (adjusted hazard ratio [HRadj ] 1.23 [95% confidence interval (95% CI) 1.20-1.26]), cardiovascular (HRadj 1.19 [95% CI 1.14-1.23]), cancer (HRadj 1.19 [95% CI 1.14-1.24]), respiratory (HRadj 1.46 [95% CI 1.38-1.55]), and infection-related mortality (HRadj 1.59 [95% CI 1.41-1.80]). Interstitial lung disease was the cause of death most strongly associated with RA (HRadj 3.39 [95% CI 2.88-3.99]). Nearly 70% of excess deaths in RA were attributable to cardiopulmonary disease. All-cause mortality risk related to RA was lower among those diagnosed during 2012-2017 (HRadj 1.10 [95% CI 1.05-1.15]) compared to 2000-2005 (HRadj 1.31 [95% CI 1.26-1.36]), but still higher than for non-RA controls (P < 0.001). Cause-specific mortality trends were similar. CONCLUSION Excess RA-related mortality was driven by cardiovascular, cancer, respiratory, and infectious causes, particularly cardiopulmonary diseases. Although our findings support that RA-related mortality risk is decreasing over time, a mortality gap remains for all-cause and cause-specific mortality in RA.
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Affiliation(s)
- Tate M Johnson
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Brian C Sauer
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City
| | - Grant W Cannon
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City
| | - Gary Kunkel
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, the National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania, Philadelphia
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
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Johnson TM, Mahabir CA, Yang Y, Roul P, Goldsweig AM, Binstadt BA, Baker JF, Sauer BC, Cannon GW, Mikuls TR, England BR. Aortic Stenosis Risk in Rheumatoid Arthritis. JAMA Intern Med 2023; 183:2807944. [PMID: 37523173 PMCID: PMC10391353 DOI: 10.1001/jamainternmed.2023.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/20/2023] [Indexed: 08/01/2023]
Abstract
Importance Although an increased risk of ischemic cardiovascular disease has been associated with rheumatoid arthritis (RA), the risk of aortic stenosis (AS) is unknown. Objective To examine the risk of incident AS, aortic valve intervention, AS-related death, and risk factors for AS development in patients with RA. Design, Setting, and Participants This cohort study linked data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services from 2000 to 2019. Patients with RA were matched by age, sex, and VHA enrollment year with up to 10 patients without RA. The cohort was followed until incident AS, aortic valve intervention, or death. Data were analyzed from August 23, 2022, to March 3, 2023. Exposures the primary exposure was the presence of RA, defined using validated RA algorithms. Main Outcomes and Measures Aortic stenosis was defined as a composite of inpatient or outpatient diagnoses, surgical or transcatheter aortic valve replacement, or AS-related death using diagnostic and procedural codes. Risk of AS development was assessed with multivariable Cox proportional hazards models adjusted for race, ethnicity, smoking status, body mass index, rurality, comorbidities, and health care use. Results The cohort included 73 070 patients with RA (64 008 [87.6%] males; mean [SD] age, 63.0 [11.9] years) matched with 639 268 patients without RA (554 182 [86.7%] males; mean [SD] age, 61.9 [11.7] years) and 16 109 composite AS outcomes that occurred over 6 223 150 person-years. The AS incidence rate was 3.97 (95% CI, 3.81-4.13) per 1000 person-years in patients with RA and 2.45 (95% CI, 2.41-2.49) per 1000 person-years in the control patients (absolute difference, 1.52 per 1000 person-years). Rheumatoid arthritis was associated with an increased risk of composite AS (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.41-1.55), aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48), and AS-related death (AHR, 1.26; 95% CI, 1.04-1.54). Conclusions and Relevance In this cohort study, RA was associated with a higher risk of developing AS and the subsequent risks of undergoing aortic valve intervention and suffering from AS-related death. Future studies are needed to confirm whether valvular heart disease, specifically AS, may be an overlooked cardiovascular disease complication in RA.
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Affiliation(s)
- Tate M. Johnson
- Medicine & Research Service, VA Nebraska-Western Iowa Health Care System, Omaha
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Chetaj A. Mahabir
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Yangyuna Yang
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Punyasha Roul
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Andrew M. Goldsweig
- Department of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Bryce A. Binstadt
- Division of Pediatric Rheumatology, Allergy, and Immunology, University of Minnesota, Minneapolis
| | - Joshua F. Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian C. Sauer
- Division of Rheumatology, Salt Lake City VA Medical Center, Salt Lake City, Utah
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City
| | - Grant W. Cannon
- Division of Rheumatology, Salt Lake City VA Medical Center, Salt Lake City, Utah
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City
| | - Ted R. Mikuls
- Medicine & Research Service, VA Nebraska-Western Iowa Health Care System, Omaha
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Bryant R. England
- Medicine & Research Service, VA Nebraska-Western Iowa Health Care System, Omaha
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Reddy N, Raynor WY, Werner TJ, Baker JF, Alavi A, Revheim ME. 18F-FDG and 18F-NaF PET/CT Global Assessment of Large Joint Inflammation and Bone Turnover in Rheumatoid Arthritis. Diagnostics (Basel) 2023; 13:2149. [PMID: 37443544 DOI: 10.3390/diagnostics13132149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Rheumatoid arthritis (RA) involves chronic inflammation of synovial joints, causing pain, stiffness, and limited mobility. 18F-sodium fluoride (NaF) is a PET tracer whose uptake reflects bone turnover, while 18F-fludeoxyglucose (FDG) shows glucose metabolism and can serve as a marker for inflammation. The aim of this study is to determine the feasibility of calculating the FDG and NaF mean standardized uptake value (SUVmean) in the knee joint, hip joint, and sacroiliac (SI) joint of RA patients and to determine their association with patient characteristics. Prospective FDG-PET/CT as well as NaF-PET/CT imaging was performed on 18 RA patients. The global SUVmean was calculated on FDG-PET/CT and NaF-PET/CT images using a semiautomated CT-based method of segmentation. FDG and NaF uptake were found to be significantly correlated in the knee (r = 0.77, p < 0.001), but not in the hip and SI joints. In the knee, both NaF SUVmean and FDG SUVmean were significantly correlated with body weight, BMI, leptin, and sclerostin levels (p < 0.05). NaF SUVmean was significantly positively correlated with BMI and leptin for both the hip and SI joints (p < 0.05). No significant correlation was observed between either PET parameter and age, height, erythrocyte sedimentation rate (ESR), and interleukins 1 and 6 (IL-1 and IL-6); however, FDG was correlated with inflammatory markers such as C-reactive protein (CRP) and patient global visual analogue scale (VAS-PtGlobal) in some joints. In this study, both FDG and NaF uptake were quantified in large joints of patients with RA using CT segmentation. NaF and FDG SUVmean were correlated with clinical variables related to body weight and adiposity, suggesting that degenerative joint disease may play a larger role in influencing the uptake of these tracers in large joints than RA disease activity. FDG and its correlation with markers of inflammation such as CRP and VAS-PtGlobal suggests that this tracer may serve as a more specific marker for RA disease activity than NaF. Larger prospective and longitudinal data are necessary to gain a better understanding of the roles of FDG and NaF in evaluating RA joint activity in these joints.
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Affiliation(s)
- Natasha Reddy
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Joshua F Baker
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
- Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
- Department of Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway
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Baker JF, Reed G, Kremer J. Reply. Arthritis Care Res (Hoboken) 2023; 75:1384-1385. [PMID: 36250408 DOI: 10.1002/acr.25041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center, and University of Pennsylvania, Philadelphia, Pennsylvania
| | - George Reed
- Corrona Research Foundation, Albany, New York
| | - Joel Kremer
- Corrona Research Foundation, and Albany Medical College and the Center for Rheumatology, Albany, New York
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McMenamin KJ, Harris TB, Baker JF. Weight variability, physical functioning and incident disability in older adults. J Cachexia Sarcopenia Muscle 2023. [PMID: 37254658 PMCID: PMC10401525 DOI: 10.1002/jcsm.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/16/2023] [Accepted: 04/02/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND This study aimed to determine if greater variability in body mass index (BMI) is associated with declines in physical functioning and incident disability in older adults. METHODS Included were participants from the Health, Aging and Body Composition Study who had semi-annual BMI data during the first 3 years of follow-up. Participants were categorized into quintiles of BMI variability, using two methods. The first method used average successive variability, whereas the second method adjusted these values to remove the variability due to net change in BMI over the 3-year period. Linear regression was used to assess the relationship between the two measures of BMI variability and net changes in BMI, fat mass index, appendicular lean mass index, and Health, Aging and Body Composition Physical Performance Score during the first 3 years of the study. Cox proportional hazard models were used to assess the relationship of BMI variability with the subsequent incidence of new disability, adjusting for confounding factors. RESULTS Among 2121 participants, those in the highest BMI variability quintile were more likely to lose both body mass (β: -0.086 [95% confidence interval, CI: -0.133, -0.040], P < 0.01) and fat mass (β: -0.059 [95% CI: -0.117, -0.002], P = 0.04) and had greater declines in physical performance score (β: -0.094 [95% CI: -0.162, -0.026], P < 0.01) compared to participants with the least variability in BMI. Participants with high BMI variability also had higher rates of incident disability (hazard ratio: 1.36 [95% CI: 1.07, 1.72], P = 0.01), independent of net BMI change. CONCLUSIONS BMI variability in older adults is associated with decline in physical performance and incident disability. This relationship cannot be explained by net weight loss alone, supporting it as an independent feature of frailty.
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Affiliation(s)
- Katie J McMenamin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, NIA, NIH, Bethesda, MD, USA
| | - Joshua F Baker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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Baker JF, England BR, Mikuls TR. Response to: 'Correspondence on 'Disease activity, cytokines, chemokines and the risk of incident diabetes in rheumatoid arthritis'' by Ruscitti et al. Ann Rheum Dis 2023; 82:e120. [PMID: 33619163 DOI: 10.1136/annrheumdis-2021-220114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Joshua F Baker
- Medicine, Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryant R England
- Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Rheumatology, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Ted R Mikuls
- Department of Medicine, University of Nebraska System, Lincoln, Nebraska, USA
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Luedders BA, Cope BJ, Hershberger D, DeVries M, Campbell WS, Campbell J, Roul P, Yang Y, Rojas J, Cannon GW, Sauer BC, Baker JF, Curtis JR, Mikuls TR, England BR. Enhancing the identification of rheumatoid arthritis-associated interstitial lung disease through text mining of chest computerized tomography reports. Semin Arthritis Rheum 2023; 60:152204. [PMID: 37058847 PMCID: PMC10148909 DOI: 10.1016/j.semarthrit.2023.152204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Algorithms have been developed to identify rheumatoid arthritis-interstitial lung disease (RA-ILD) in administrative data with positive predictive values (PPVs) between 70 and 80%. We hypothesized that including ILD-related terms identified within chest computed tomography (CT) reports through text mining would improve the PPV of these algorithms in this cross-sectional study. METHODS We identified a derivation cohort of possible RA-ILD cases (n = 114) using electronic health record data from a large academic medical center and performed medical record review to validate diagnoses (reference standard). ILD-related terms (e.g., ground glass, honeycomb) were identified in chest CT reports by natural language processing. Administrative algorithms including diagnostic and procedural codes as well as specialty were applied to the cohort both with and without the requirement for ILD-related terms from CT reports. We subsequently analyzed similar algorithms in an external validation cohort of 536 participants with RA. RESULTS The addition of ILD-related terms to RA-ILD administrative algorithms increased the PPV in both the derivation (improvement ranging from 3.6 to 11.7%) and validation cohorts (improvement 6.0 to 21.1%). This increase was greatest for less stringent algorithms. Administrative algorithms including ILD-related terms from CT reports exceeded a PPV of 90% (maximum 94.6% derivation cohort). Increases in PPV were accompanied by a decline in sensitivity (validation cohort -3.9 to -19.5%). CONCLUSIONS The addition of ILD-related terms identified by text mining from chest CT reports led to improvements in the PPV of RA-ILD algorithms. With high PPVs, use of these algorithms in large data sets could facilitate epidemiologic and comparative effectiveness research in RA-ILD.
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Affiliation(s)
- Brent A Luedders
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States
| | - Brendan J Cope
- University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Matthew DeVries
- University of Nebraska Medical Center, Omaha, NE, United States
| | | | - James Campbell
- University of Nebraska Medical Center, Omaha, NE, United States
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States
| | - Jorge Rojas
- VA Puget Sound Health Care System, Seattle, WA, United States
| | - Grant W Cannon
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States
| | - Brian C Sauer
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; University of Nebraska Medical Center, Omaha, NE, United States.
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Federico LE, Johnson TM, England BR, Wysham KD, George MD, Sauer B, Hamilton BC, Hunter CD, Duryee MJ, Thiele GM, Mikuls TR, Baker JF. Circulating Adipokines and Associations With Incident Cardiovascular Disease in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:768-777. [PMID: 35313088 PMCID: PMC10588673 DOI: 10.1002/acr.24885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess whether circulating levels of adiponectin, leptin, and fibroblast growth factor 21 (FGF-21) are associated with incident cardiovascular disease (CVD) in rheumatoid arthritis (RA). METHODS Adipokines were measured using banked enrollment serum from patients with RA and dichotomized above/below the median value. Incident CVD events (coronary artery disease [CAD], stroke, heart failure [HF] hospitalization, venous thromboembolism, CVD-related deaths) were identified using administrative data and the National Death Index. Covariates were derived from medical record, biorepository, and registry databases. Multivariable Cox models were generated to quantify associations between adipokine concentrations and CVD incidence. Five-year incidence rates were predicted. RESULTS Among 2,598 participants, 639 (25%) had at least 1 CVD event over 19,585 patient-years of follow-up. High adiponectin levels were independently associated with HF hospitalization (hazard ratio [HR] 1.39 [95% confidence interval (95% CI) 1.07-1.79], P = 0.01) and CVD-related death (HR 1.49 [95% CI 1.16-1.92], P = 0.002) but not with other CVD events. High leptin was independently associated with CVD-related death (HR 1.44 [95% CI 1.05-1.97], P = 0.02). High FGF-21 levels were independently associated with lower rates of CAD (HR 0.75 [95% CI 0.58-0.97], P = 0.03). In subgroup analyses, associations between high adiponectin and leptin levels with CVD-related death were driven by strong associations in nonobese patients. CONCLUSION Adipokines are associated with HF hospitalization and CVD-related death in patients with RA, with stronger associations in nonobese participants. These findings suggest that adipokines effectively predict clinically important outcomes in RA perhaps through an association with body composition and metabolic health. Further study is needed to determine whether adipokine measures might augment existing tools to identify RA patients at increased risk of CVD.
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Affiliation(s)
| | - Tate M. Johnson
- Tate M. Johnson, MD, Bryant R. England, MD, PhD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH: Veterans Affairs Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryant R. England
- Tate M. Johnson, MD, Bryant R. England, MD, PhD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH: Veterans Affairs Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Katherine D. Wysham
- Katherine D. Wysham, MD: Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle
| | - Michael D. George
- Michael D. George, MD, MSCE: University of Pennsylvania, Philadelphia
| | - Brian Sauer
- Brian Sauer, PhD: University of Utah Medical Center and Veterans Affairs Salt Lake City Health Care System, Salt Lake City
| | - Bartlett C. Hamilton
- Bartlett C. Hamilton, MPH, Carlos D. Hunter, BS, Michael J. Duryee, MS: University of Nebraska Medical Center, Omaha
| | - Carlos D. Hunter
- Bartlett C. Hamilton, MPH, Carlos D. Hunter, BS, Michael J. Duryee, MS: University of Nebraska Medical Center, Omaha
| | - Michael J. Duryee
- Bartlett C. Hamilton, MPH, Carlos D. Hunter, BS, Michael J. Duryee, MS: University of Nebraska Medical Center, Omaha
| | - Geoffrey M. Thiele
- Tate M. Johnson, MD, Bryant R. England, MD, PhD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH: Veterans Affairs Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Ted R. Mikuls
- Tate M. Johnson, MD, Bryant R. England, MD, PhD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH: Veterans Affairs Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Joshua F. Baker
- Joshua F. Baker, MD, MSCE: University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia
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Wheeler AM, Roul P, Yang Y, Brittan KM, Sayles H, Singh N, Sauer BC, Cannon GW, Baker JF, Mikuls TR, England BR. Risk of Prostate Cancer in US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:785-792. [PMID: 35612872 PMCID: PMC9532468 DOI: 10.1002/acr.24890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have an increased risk of select cancers, including lymphoma and lung cancer. Whether RA influences prostate cancer risk is uncertain. We aimed to determine the risk of prostate cancer in patients with RA compared to patients without RA in the Veterans Health Administration (VA). METHODS We performed a matched (up to 1:5) cohort study of male patients with and without RA in the VA from 2000 to 2018. RA status, as well as covariates, were obtained from national VA databases. Prostate cancer was identified through linked VA cancer databases and the National Death Index. Multivariable Cox models compared prostate cancer risk between patients with RA and patients without RA, including models that accounted for retention in the VA system. RESULTS We included 56,514 veterans with RA and 227,284 veterans without RA. During 2,337,104 patient-years of follow-up, 6,550 prostate cancers occurred. Prostate cancer incidence (per 1,000 patient-years) was 3.50 (95% confidence interval [95% CI] 3.32-3.69) in patients with RA and 2.66 (95% CI 2.58-2.73) in patients without RA. After accounting for confounders and censoring for attrition of VA health care, RA was modestly associated with a higher prostate cancer risk (adjusted HR [HRadj ] 1.12 [95% CI 1.04-1.20]). There was no association between RA and prostate cancer mortality (HRadj 0.92 [95% CI 0.73-1.16]). CONCLUSION RA was associated with a modestly increased risk of prostate cancer, but not prostate cancer mortality, after accounting for relevant confounders and several potential sources of bias. However, even minimal unmeasured confounding could explain these findings.
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Affiliation(s)
- Austin M. Wheeler
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Yangyuna Yang
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Kaitlyn M. Brittan
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Harlan Sayles
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | | | - Brian C. Sauer
- Salt Lake City VA Healthcare System & University of Utah, Salt Lake City, UT
| | - Grant W. Cannon
- Salt Lake City VA Healthcare System & 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
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bryant R. England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
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Baker JF, Katz P, Weber DR, Gould P, George MD, Long J, Zemel BS, Giles JT. Adipocytokines and Associations With Abnormal Body Composition in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:616-624. [PMID: 34558809 PMCID: PMC8942864 DOI: 10.1002/acr.24790] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We determined associations between adipokines and abnormal body composition in patients with rheumatoid arthritis (RA). METHODS Combining data from three RA cohorts, whole-body dual-energy absorptiometry measures of appendicular lean mass and fat mass indices were converted to age-, sex-, and race- and ethnicity-specific Z scores. Lean mass relative to fat mass was determined based on prior methods. Independent associations between body composition profiles and circulating levels of adiponectin, leptin, and fibroblast growth factor (FGF)-21 were assessed using linear and logistic regression models adjusting for demographic characteristics and study cohort. We also determined the improvement in the area under the curve (AUC) for prediction of low lean mass when adipokines were added to predictive models that included clinical factors such as demographic characteristics, study, and body mass index (BMI). RESULTS Among 419 participants, older age was associated with higher levels of all adipokines, whereas higher C-reactive protein level was associated with lower adiponectin levels and higher FGF-21 levels. Greater fat mass was strongly associated with lower adiponectin levels and higher leptin and FGF-21 levels. Higher levels of adiponectin, leptin, and FGF-21 were independently associated with low lean mass. The addition of adiponectin and leptin levels to regression models improved prediction of low lean mass when combined with demographic characteristics, study, and BMI (AUC 0.75 vs. 0.66). CONCLUSION Adipokines are associated with both excess adiposity and low lean mass in patients with RA. Improvements in the prediction of body composition abnormalities suggest that laboratory screening could help identify patients with altered body composition who may be at greater risk of adverse outcomes.
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Affiliation(s)
- Joshua F. Baker
- Philadelphia VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Katz
- University of California San Francisco, San Francisco, CA, USA
| | - David R. Weber
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick Gould
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Jin Long
- Stanford University, Palo Alto, CA, USA
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England BR, Yang Y, Roul P, Haas C, Najjar L, Sayles H, Yu F, Sauer BC, Baker JF, Xie F, Michaud K, Curtis JR, Mikuls TR. Identification of Multimorbidity Patterns in Rheumatoid Arthritis Through Machine Learning. Arthritis Care Res (Hoboken) 2023; 75:220-230. [PMID: 35588095 PMCID: PMC10009900 DOI: 10.1002/acr.24956] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recognizing that the interrelationships between chronic conditions that complicate rheumatoid arthritis (RA) are poorly understood, we aimed to identify patterns of multimorbidity and to define their prevalence in RA through machine learning. METHODS We constructed RA and age- and sex-matched (1:1) non-RA cohorts within a large commercial insurance database (MarketScan) and the Veterans Health Administration (VHA). Chronic conditions (n = 44) were identified from diagnosis codes from outpatient and inpatient encounters. Exploratory factor analysis was performed separately in both databases, stratified by RA diagnosis and sex, to identify multimorbidity patterns. The association of RA with different multimorbidity patterns was determined using conditional logistic regression. RESULTS We studied 226,850 patients in MarketScan (76% female) and 120,780 patients in the VHA (89% male). The primary multimorbidity patterns identified were characterized by the presence of cardiopulmonary, cardiometabolic, and mental health and chronic pain disorders. Multimorbidity patterns were similar between RA and non-RA patients, female and male patients, and patients in MarketScan and the VHA. RA patients had higher odds of each multimorbidity pattern (odds ratios [ORs] 1.17-2.96), with mental health and chronic pain disorders being the multimorbidity pattern most strongly associated with RA (ORs 2.07-2.96). CONCLUSION Cardiopulmonary, cardiometabolic, and mental health and chronic pain disorders represent predominant multimorbidity patterns, each of which is overrepresented in RA. The identification of multimorbidity patterns occurring more frequently in RA is an important first step in progressing toward a holistic approach to RA management and warrants assessment of their clinical and predictive utility.
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Affiliation(s)
- Bryant R England
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | | | | | - Christian Haas
- University of Nebraska, Omaha, and Vienna University of Economics and Business, Vienna, Austria
| | | | | | - Fang Yu
- University of Nebraska Medical Center, Omaha
| | - Brian C Sauer
- University of Utah and Veterans Affairs Salt Lake City, Salt Lake City
| | - Joshua F Baker
- Philadelphia Veterans Affairs and University of Pennsylvania, Philadelphia
| | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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Santo RCDE, Baker JF, dos Santos LP, Silva JMDS, Filippin LI, Portes JKS, Brenol CV, Chakr RMDS, Xavier RM. Changes in physical function over time in rheumatoid arthritis patients: A cohort study. PLoS One 2023; 18:e0280846. [PMID: 36689423 PMCID: PMC9870154 DOI: 10.1371/journal.pone.0280846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Self-reported disability is potentially influenced by many factors in patients with rheumatoid arthritis (RA). In this sense, we evaluated the association between self-reported disability and (1) clinical features, (2) muscle strength and (3) physical performance over time among patients with RA from two distinct patient cohorts. MATERIALS AND METHODS Two independent prospective RA cohorts were analyzed. The Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 Joints (DAS28), handgrip test, chair stand test, timed-up-and-go (TUG) test and Short Physical Performance Battery (SPPB) were performed at baseline and in follow-up. T test for independent samples, Mann-Whitney U test, Spearman correlation coefficients and linear regression with generalized estimating equations were performed to assess associations between individual constructs at baseline and over time. RESULTS A total of 205 total RA patients were included [North American Cohort (n = 115); Brazilian Cohort (n = 90)]. At enrollment, Brazilian men had better HAQ than North American men (p<0.001). Brazilian patients overall had lower muscle strength than North American patients (p<0.05). HAQ was associated with DAS28, handgrip test, chair stand test, TUG and SPPB (p<0.001) in both cohorts. Worsening of the DAS28 and chair stand test were each associated with worsening in HAQ in longitudinal analysis over time. Worsening of handgrip was also associated in with worsening HAQ in both cohorts (p<0.05). A worse TUG test was associated with worsening in HAQ in Brazilian cohort (p<0.05) and a worse SPPB was associated with worsening in HAQ in North American cohort (p<0.05). CONCLUSION Greater disability measured by HAQ is closely associated with disease activity, pain, muscle strength, and physical performance among RA. Worsening in self-reported disability correlate with worsening clinical factors including objectively-observed physical function.
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Affiliation(s)
- Rafaela Cavalheiro do Espírito Santo
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joshua F. Baker
- Philadelphia Veterans Affairs Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Leonardo Peterson dos Santos
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jordana Miranda de Souza Silva
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Juliana Katarina Schoer Portes
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Claiton Viegas Brenol
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Mendonça da Silva Chakr
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo Machado Xavier
- Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil
- Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Desai N, Baker JF, Bucci J, Kissin EY. Ultrasound evaluation of the Achilles enthesis in inflammatory and non-inflammatory processes: a systematic review and meta-analysis. Clin Exp Rheumatol 2023; 41:24-31. [PMID: 35238759 DOI: 10.55563/clinexprheumatol/6vg24c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/09/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Ultrasound evaluation of the Achilles tendon has been utilised to assess involvement at the entheses in the setting of various inflammatory, metabolic, and mechanical processes. The purpose of this systematic review was to evaluate the differences in ultrasound findings at the Achilles enthesis between inflammatory tendinopathy (IT) versus non-inflammatory tendinopathy (NIT). METHODS A review of all studies involving ultrasound evaluation of IT or NIT (mechanical or metabolic) affecting the Achilles enthesis was performed by searching the Embase, PubMed and Medline databases from start until October 2020. We assessed study quality and extracted summary data from each individual study. We used random-effects meta-analysis to determine the average proportion of affected anatomic sites across all studies for each abnormality, weighting the analysis based on the size of each individual study. RESULTS Achilles enthesis thickening was more frequent in the symptomatic IT (sIT) group (37.8%) compared to the unspecified IT (25%), NIT (11.2%) and healthy control (2.7%) groups. Increased vascularity at the enthesis was more common in the NIT (23.4%) group compared to the IT (9%), sIT (8.6%) and healthy control (0.1%) groups. Erosions were more common among the IT (17.3%) and sIT (14%) groups compared to the NIT (2.2%) and healthy controls (0.3%) groups. CONCLUSIONS While Achilles enthesis thickening, Doppler signal and calcaneal erosions discriminate IT from healthy subjects, erosions are more likely to distinguish IT from NIT than thickening or Doppler signal. Additional study is needed to quantify the diagnostic performance of ultrasound at this location given the frequency of abnormalities in NIT.
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Affiliation(s)
- Nancy Desai
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua F Baker
- Department of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Justin Bucci
- Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Eugene Y Kissin
- Department of Medicine, Boston University Medical Center, Boston, MA, USA.
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Baker JF, Weber DR, Neogi T, George MD, Long J, Helget LN, England BR, Mikuls TR. Associations Between Low Serum Urate, Body Composition, and Mortality. Arthritis Rheumatol 2023; 75:133-140. [PMID: 35974440 PMCID: PMC10600587 DOI: 10.1002/art.42301] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/09/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Controversy remains as to whether low serum urate or uric acid (UA) levels contribute to adverse outcomes. We evaluated the relation between low serum UA levels and sarcopenia and assessed whether sarcopenia confounds associations between these low levels and mortality. METHODS We utilized data from the National Health and Nutrition Examination Survey (1999-2006). Participants with available whole-body dual x-ray absorptiometry body composition measurements and serum UA concentrations were included. Body composition assessments included body mass index (BMI), waist circumference, maximum lifetime BMI, and age-, sex-, and race-specific appendicular lean mass index (ALMI) and fat mass index (FMI) Z scores. We also calculated Z scores for ALMI relative to FMI (ALMIFMI ). We evaluated associations between serum UA levels and body composition using logistic regression and assessed associations between serum UA levels and mortality before and after adjusting for differences in body composition using Cox proportional hazards regression. RESULTS Among the 13,979 participants, low serum UA concentrations (<2.5 mg/dl in women, <3.5 mg/dl in men) were associated with low lean mass (ALMI and ALMIFMI Z scores), underweight BMI (<18.5 kg/m2 ), and higher rates of weight loss. The proportion of patients with low ALMI Z scores was 29% in the low serum UA group and 16% in the normal serum UA group (P = 0.001). Low serum UA levels were associated with increased mortality before we adjusted for body composition (hazard ratio 1.61 [95% confidence interval 1.14-2.28]; P = 0.008) but was attenuated and not significant after adjustment for body composition and weight loss (hazard ratio 1.30 [95% confidence interval 0.92-1.85], P = 0.13). CONCLUSION Sarcopenia and weight loss are more common among patients with low serum UA concentrations. Differences in body composition may help to explain associations between low levels of serum UA and higher mortality.
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Affiliation(s)
- Joshua F. Baker
- Joshua F. Baker, MD, MSCE: Corporal Michael J. Crescenz Veterans Affairs Medical Center and School of Medicine and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R. Weber
- David R. Weber, MD, MSCE: School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tuhina Neogi
- Tuhina Neogi, MD, PhD: Boston University School of Medicine, Boston, Massachusetts
| | - Michael D. George
- Michael D. George, MD, MSCE: School of Medicine and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jin Long
- Jin Long, PhD: Department of Pediatrics and Medicine, Stanford University, Stanford, California
| | - Lindsay N. Helget
- Lindsay N. Helget, MD, Bryant R. England, MD, PhD, Ted R. Mikuls, MD, MPSH: Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryant R. England
- Lindsay N. Helget, MD, Bryant R. England, MD, PhD, Ted R. Mikuls, MD, MPSH: Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ted R. Mikuls
- Lindsay N. Helget, MD, Bryant R. England, MD, PhD, Ted R. Mikuls, MD, MPSH: Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, Nebraska
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Wheeler AM, Baker JF, Poole JA, Ascherman DP, Yang Y, Kerr GS, Reimold A, Kunkel G, Cannon GW, Wysham KD, Singh N, Lazaro D, Monach P, Bridges SL, Mikuls TR, England BR. Genetic, social, and environmental risk factors in rheumatoid arthritis-associated interstitial lung disease. Semin Arthritis Rheum 2022; 57:152098. [PMID: 36155967 PMCID: PMC10123759 DOI: 10.1016/j.semarthrit.2022.152098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE MUC5B and TOLLIP single nucleotide polymorphisms (SNPs) and cigarette smoking were associated with rheumatoid arthritis-interstitial lung disease (RA-ILD) in a predominantly Northern European population. We evaluated whether RA-ILD is associated with these genetic variants and HLA-DRB1 shared epitope (SE) alleles in a large RA cohort stratified by race and smoking history. METHODS HLA-DRB1 SE alleles and MUC5B rs35705950 and TOLLIP rs5743890 SNPs were genotyped in U.S. veterans with RA. ILD was validated through medical record review. Genetic associations with ILD were assessed in logistic regression models overall and in subgroups defined by race and smoking status, with additive interactions assessed by the relative excess risk of interaction (RERI). RESULTS Of 2,556 participants (88% male, 77% White), 238 (9.3%) had ILD. The MUC5B variant was associated with ILD (OR 2.25 [95% CI 1.69, 3.02]), whereas TOLLIP and HLA-DRB1 SE were not. The MUC5B variant was less frequent among Black/African American participants (5.8% vs. 22.6%), though its association with RA-ILD was numerically stronger (OR 4.23 [1.65, 10.86]) compared to all other participants (OR 2.32 [1.70, 3.16]). Those with the MUC5B variant and a smoking history had numerically higher odds of ILD (OR 4.18 [2.53, 6.93]) than non-smokers (OR 2.41 [1.16, 5.04]). Additive interactions between MUC5B-race and MUC5B-smoking were not statistically significant. CONCLUSION In this large RA cohort, the MUC5B promoter variant was associated with >2-fold higher odds of RA-ILD. While this variant is less common among Black/African American patients, its presence in this population carried >4-fold higher odds of RA-ILD.
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Affiliation(s)
- Austin M Wheeler
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA; University of Nebraska Medical Center, Omaha, NE, USA
| | - Joshua F Baker
- University of Pennsylvania and VA Medical Center, Philadelphia, PA, USA
| | - Jill A Poole
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Yangyuna Yang
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Gail S Kerr
- Washington D.C. VA, Howard University, & Georgetown University, Washington D.C., USA
| | - Andreas Reimold
- Dallas VA & University of Texas Southwestern, Dallas, TX, USA
| | - Gary Kunkel
- VA Salt Lake City & University of Utah, Salt Lake City, UT, USA
| | - Grant W Cannon
- VA Salt Lake City & University of Utah, Salt Lake City, UT, USA
| | - Katherine D Wysham
- VA Puget Sound Health Care System & University of Washington, Seattle, WA, USAca
| | - Namrata Singh
- VA Puget Sound Health Care System & University of Washington, Seattle, WA, USAca
| | | | | | | | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA; University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA; University of Nebraska Medical Center, Omaha, NE, USA.
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Baker JF, Reed G, Poudel DR, Harrold LR, Kremer JM. Obesity and Response to Advanced Therapies in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2022; 74:1909-1916. [PMID: 35143117 DOI: 10.1002/acr.24867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We performed a study of tumor necrosis factor inhibitors (TNFi) compared to non-TNFi biologic therapies in rheumatoid arthritis to test whether body mass index (BMI) modified the effect of each therapy. METHODS We utilized data from CorEvitas. We studied 3 clinical outcomes based on the Clinical Disease Activity Index (CDAI) at 6 months from therapy initiation: 1) achievement of low disease activity (LDA); 2) a change as large as the minimum clinically important difference (MCID); and 3) the absolute change. We categorized BMI and utilized restricted cubic splines to consider nonlinear associations. We used linear and logistic regression to evaluate associations with response, adjusting for confounders. To determine if comparative effectiveness of therapy varied by BMI, we tested for interactions between BMI and class of therapy. RESULTS The sample included 2,891 TNFi and 3,010 non-TNFi initiators. Among all initiators, those with severe obesity experienced lower odds of achieving LDA or MCID and less improvement in CDAI score, although associations were attenuated with adjustment. Low BMI was associated with reduced response rates in adjusted models including lower odds of LDA (odds ratio 0.32 [95% confidence interval (95% CI) 0.15, 0.71], P = 0.005). Analyses stratified by TNFi and non-TNFi therapies demonstrated no differences in clinical response rates for TNFi versus non-TNFi across BMI categories (all P for interaction >0.05). Estimates for non-TNFi biologics fit within the 95% CI for TNFi. CONCLUSION This study observed lower response rates among obese and underweight patients and no evidence of a superior effect of non-TNFi therapy over TNFi therapy in particular BMI categories.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | - George Reed
- Corrona Research Foundation, Albany, New York
| | | | - Leslie R Harrold
- Corrona Research Foundation, Albany, New York, and University of Massachusetts Medical School, Worcester
| | - Joel M Kremer
- Corrona Research Foundation and Albany Medical College and the Center for Rheumatology, Albany, New York
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Desai N, Federico L, Baker JF. Lifestyle, Hormonal, and Metabolic Environmental Risks for Rheumatoid Arthritis. Rheum Dis Clin North Am 2022; 48:799-811. [PMID: 36332996 DOI: 10.1016/j.rdc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although there is a substantial body of literature focused on understanding noninhalational risk-factors for rheumatoid arthritis, the data are mixed and often conflicting. Given the other health benefits for certain lifestyle modifications, it seems reasonable for clinicians to promote healthy lifestyle habits related to diet, exercise, maintenance of health weight, and maintenance of good dental hygiene. Overall, however, these lifestyle modifications may be expected to have modest benefit, and other strategies to prevent rheumatoid arthritis in high-risk patients are needed.
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Affiliation(s)
- Nancy Desai
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA
| | - Lydia Federico
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA
| | - Joshua F Baker
- Division of Rheumatology, University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104, USA; Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA; Department of Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA.
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Natalini JG, England BR, Baker JF, Chen Q, Singh N, Mahajan TD, Roul P, Thiele GM, Sauer BC, Mikuls TR, Johnson FB, Kawut SM. Associations between shortened telomeres and rheumatoid arthritis-associated interstitial lung disease among U.S. Veterans. Respir Med 2022; 201:106943. [PMID: 35947933 PMCID: PMC10120870 DOI: 10.1016/j.rmed.2022.106943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shortened telomeres are associated with several different subtypes of interstitial lung disease (ILD), although studies of telomere length and ILD in rheumatoid arthritis (RA) are lacking. METHODS Within the Veterans Affairs Rheumatoid Arthritis (VARA) registry, we performed cross-sectional and case-control studies of prevalent and incident ILD, respectively. We randomly selected a subset of RA patients with ILD and individually matched them to RA patients without ILD according to age, sex, and VARA enrollment date. Telomere length was measured on peripheral blood leukocytes collected at registry enrollment using quantitative PCR (T/S ratio). Short telomeres were defined as a T/S ratio in the lowest 10th percentile of the cohort. RESULTS Our cross-sectional study cohort was comprised of 54 RA-ILD patients and 92 RA-non-ILD patients. T/S ratios significantly differed between patients with and without prevalent ILD (1.56 [IQR 1.30, 1.78] vs. 1.96 [IQR 1.65, 2.27], p < 0.001). Similarly, prevalence of ILD was significantly higher in patients with short vs. normal-length telomeres (73.3% vs. 32.8%, p = 0.002). Short telomeres were independently associated with an increased odds of prevalent ILD compared to normal-length telomeres (adjusted OR 6.60, 95% CI 1.78-24.51, p = 0.005). In our case-control analysis, comprised of 22 incident RA-ILD cases and 36 RA-non-ILD controls, short telomeres were not associated with incident RA-ILD (adjusted OR 0.90, 95% CI 0.06-13.4, p = 0.94). CONCLUSION Short telomeres were strongly associated with prevalent but not incident ILD among patients with RA. Additional studies are needed to better understand telomere length dynamics among RA patients with and without ILD.
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Affiliation(s)
- Jake G Natalini
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States.
| | - Bryant R England
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States; VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Joshua F Baker
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Qijun Chen
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Tina D Mahajan
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Punyasha Roul
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Geoffrey M Thiele
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Brian C Sauer
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Ted R Mikuls
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States; VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - F Bradley Johnson
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Steven M Kawut
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Cordisco AJ, Olave M, George MD, Baker JF. Identifying Factors Associated With Treatment Response in Rheumatoid Arthritis Clinical Trials. ACR Open Rheumatol 2022; 4:811-818. [PMID: 35770613 PMCID: PMC9469477 DOI: 10.1002/acr2.11468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Despite a wealth of studies evaluating rheumatoid arthritis (RA) therapies, it remains difficult to compare efficacies across trials due to heterogeneous study populations. We sought to identify patient/trial characteristics associated with clinical response to enable fairer comparisons. Methods We reviewed 565 disease‐modifying antirheumatic drug studies compiled for American College of Rheumatology (ACR) management guidelines. Seventy‐two articles on randomized controlled phase II/III trials from 1995 to 2018 reporting the proportion of patients achieving 20%, 50% or 70% improvement in the ACR's RA disease score (ACR20/50/70) or Disease Activity Score‐28 with erythrocyte sedimentation rate or C‐reactive protein (DAS28‐ESR or DAS28‐CRP) with follow‐up more than 3 months were included. We explored associations between 34 patient/trial characteristics and ACR responses. We constructed multivariable models using these factors to compute expected response rates and to compare observed with expected response rates across therapies. Results Among eligible clinical trials, later publication year, baseline DAS28‐CRP score, methotrexate/biologic naivety, baseline ESR, follow‐up of 52 weeks or more, number of subjects enrolled, and anticitrullinated peptide antibody seropositivity were associated with greater ACR response. Greater age, longer disease duration, higher baseline Sharp score, and steroid use were associated with lower response rates. Predictive models incorporating these factors explained 29%, 37%, and 53% of variance in ACR20, ACR50, and ACR70, respectively. Overall, comparing observed versus expected rates of response across trials more closely approximated results of head‐to‐head trials. For example, although observed responses numerically favored adalimumab to tofacitinib, comparison of observed versus expected results across trials more closely approximated the results from a head‐to‐head trial (“Oral Rheumatoid Arthritis triaL [ORAL] Strategy”). Conclusion We identified factors associated with ACR response in RA trials. Adjusting for expected outcomes yielded therapy comparisons somewhat more similar to head‐to‐head trials. These findings could inform other across‐trial comparisons, particularly when head‐to‐head trials are lacking.
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Affiliation(s)
- Anthony J. Cordisco
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Marianna Olave
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Michael D. George
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Joshua F. Baker
- Philadelphia VA Medical Center Philadelphia Pennsylvania USA
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Abstract
People with rheumatoid arthritis (RA) have both disease-specific risk factors for osteoporosis and fractures in addition to those that affect the general population. Disease specific risks include directly pathogenic auto-antibodies, chronic exposure to systemic inflammation, and joint damage causing early disability. Risk factors that affect the general population which may have a higher prevalence in RA include smoking, calcium and vitamin D deficiency as well as hypogonadism. Additionally, chronic exposure to glucocorticoids results in reduced bone mineral density and body composition changes which can further increase fracture risk. In this review we discuss these risk-factors for osteoporosis as well as factors that may impact fall and fracture risk in people with RA.
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Affiliation(s)
- Rahaf Baker
- PGY-2, Internal Medicine, Alameda Health System Internal Medicine Residency, 1411 E 13th St, Oakland, CA, USA.
| | - Radhika Narla
- Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System, University of Washington, 1660 South Columbian Way, UW Mailbox, 358280, Seattle, WA, USA.
| | - Joshua F Baker
- Rheumatology and Epidemiology, Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania, 5 White Building, 3600 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Katherine D Wysham
- Rheumatology Section, VA Puget Sound Health Care System, University of Washington, Division of Rheumatology, 1660, South Columbian Way, S-151-A, 98108, Seattle, WA, USA.
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Baker JF, England BR, George MD, Wysham K, Johnson T, Lenert A, Kunkel G, Sauer B, Duryee MJ, Monach P, Kerr G, Reimold A, Thiele GM, Mikuls TR. Adipocytokines and achievement of low disease activity in rheumatoid arthritis. Semin Arthritis Rheum 2022; 55:152003. [PMID: 35472662 PMCID: PMC11000859 DOI: 10.1016/j.semarthrit.2022.152003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine if adipocytokines are independently associated with the achievement of low disease activity (LDA) over long-term follow-up in a large rheumatoid arthritis (RA) registry. METHODS This cohort study evaluated adults with RA from the Veteran's Affairs RA Registry. Adipocytokines (adiponectin, leptin, and fibroblast growth factor [FGF]-21) and inflammatory cytokines were measured as part of a multi-analyte panel on banked serum from enrollment. Covariates were derived from medical record, biorepository, and registry databases. Multivariable Cox proportional hazard models evaluated associations between adipocytokines and rates of 1) DAS28 LDA and remission, 2) individual Boolean remission criteria and 3) initiation of a new bDMARD or tsDMARD. RESULTS There were 1,276 participants with a DAS28 >3.2 at enrollment. Of these, 827 achieved LDA and 598 achieved remission over 2,287 and 4,096 person-years, respectively. Patients in the highest quartile of adiponectin had lower rates LDA before and after adjustment [aHR Q4: 0.68 (0.53,0.87) p<0.001]. Those in the highest quartile of leptin and FGF-21 also had lower rates of LDA. Higher quartiles of adipocytokines were also associated with lower rates of achieving a low patient/evaluator global scores and low tender joint counts. Among 1,236 biologic-naïve participants, values above the median for adiponectin [HR: 1.67 (1.23,1.26) p = 0.001] and FGF-21 [HR: 1.27 (1.09,1.47) p = 0.002] were associated with a greater likelihood of initiating a b/tsDMARD. CONCLUSIONS Adipocytokines may serve as prognostic biomarkers of a more severe RA disease course. Additional study is needed to determine whether adipocytokines are phenotypic markers or whether they actively promote disease progression.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center, Philadelphia, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Bryant R England
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael D George
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Tate Johnson
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Gary Kunkel
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, United States
| | - Brian Sauer
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, United States
| | - Michael J Duryee
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Paul Monach
- VA Boston Healthcare System, Boston, MA, United States
| | - Gail Kerr
- Washington DC VA Medical Center, Washington, DC, United States
| | | | - Geoffrey M Thiele
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ted R Mikuls
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, United States
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Leach W, Doherty C, Olave M, England BR, Wysham K, Kerr G, Quinones M, Ogdie A, White D, Neogi T, Scanzello CR, Baker JF. Protocol for a multi-center randomized controlled trial to evaluate the benefits of exercise incentives and corticosteroid injections in osteoarthritis of the knee (MOVE-OK). Trials 2022; 23:604. [PMID: 35897080 PMCID: PMC9327347 DOI: 10.1186/s13063-022-06529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a high-priority problem among the aging population. While exercise has been shown to be beneficial in management of the disease, scalable and low-cost interventions to improve exercise in this population are lacking. Recent controversy over the value of corticosteroid injections for palliation has also arisen. Therefore, we designed a randomized, double-blind, placebo-controlled clinical trial with a 2-period crossover design to study (1) behavioral incentives to promote exercise and (2) corticosteroid injections to reduce pain and improve function in patients with KOA when compared to lidocaine only. METHODS The study design is a pragmatic factorial and crossover randomized clinical trial. Patients with KOA who are deemed eligible by their provider to receive knee injections and are able to walk without assistive devices will be recruited from clinical practices at four sites within the Veterans Affairs (VA) Health System in the USA. In total, 220 participants will be randomized to receive social incentives with gamification (i.e., incorporation of game elements) to promote exercise and compared to controls that receive a Fitbit but no incentive. Each patient will also be assigned to receive a blinded corticosteroid injection and a lidocaine-only injection in random order. The primary outcomes are the change in average daily step counts from baseline and the change in Knee Osteoarthritis Outcome Score (KOOS) from baseline. The study team will continuously collect step count, heart rate, and sleep data using activity monitors and patient-reported outcomes using the Way to Health (WTH) platform at two four-week intervals over eight months of follow-up. Mixed effects regression incorporating all available data points will be used for analysis. DISCUSSION The "Marching on for Veterans with Osteoarthritis of the Knee" (MOVE-OK) trial will take a pragmatic approach to evaluate (1) whether incentives based on behaviorally enhanced gamification can improve physical activity in this patient population and (2) whether corticosteroids injections reduce pain and disability in patients with KOA. Results of this trial will help to direct clinical practice and inform management guidelines. TRIAL REGISTRATION ClinicalTrials.gov NCT05035810 . Registered on 5 September 2021.
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Affiliation(s)
- William Leach
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Caleigh Doherty
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Marianna Olave
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Bryant R England
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Katherine Wysham
- VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Gail Kerr
- Washington DC VA Medical Center, Washington, D.C, USA
| | | | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Dan White
- University of Delaware, Newark, DE, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, USA
| | - Carla R Scanzello
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Dharia T, Venkatachalam S, Baker JF, Banerjee S, Curtis D, Danila MI, Gavigan K, Gordon J, Merkel PA, Shaw DG, Young K, Curtis JR, Nowell WB, George MD. Medication Interruptions and Subsequent Disease Flares During the COVID-19 Pandemic: A Longitudinal Online Study of Patients With Rheumatic Disease. Arthritis Care Res (Hoboken) 2022; 74:733-740. [PMID: 34890121 PMCID: PMC9011588 DOI: 10.1002/acr.24837] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to assess trends in anxiety and interruptions in disease-modifying antirheumatic drug (DMARD) use among patients with rheumatic diseases during the COVID-19 pandemic and to evaluate whether DMARD interruptions were associated with disease flares. METHODS ArthritisPower, the Vasculitis Patient-Powered Research Network, and other patient organizations invited members to join a 52-week longitudinal study, with baseline surveys completed March 29 to June 30, 2020, with follow-up through May 2021. Logistic regression incorporating generalized estimating equations evaluated associations between interruptions in DMARD use and self-reported disease flares at the next survey, adjusting for demographic characteristics, medications, disease, and calendar time. RESULTS Among 2,424 patients completing a median of 5 follow-up surveys, the mean age was 57 years, 87% were female, and the most common conditions were rheumatoid arthritis, vasculitis, and psoriatic arthritis. Average Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety T scores decreased from April 2020 (58.7) to May 2021 (53.7) (P < 0.001 for trend). Interruptions in DMARD use decreased from April (11.2%) to December 2020 (7.5%) (P < 0.001) but increased through May 2021 (14.0%) (P < 0.001). Interruptions in DMARD use were associated with a significant increase in severe flares (rated ≥6 of 10) at the next survey (12.9% versus 8.0% [odds ratio (OR) 1.71 (95% confidence interval [95% CI 1.23, 2.36]) although not any flare (OR 1.18 [95% CI 0.89, 1.58])]. CONCLUSION Anxiety and interruptions in DMARD use initially decreased over time, but DMARD interruptions increased during 2021, possibly related to an increase in COVID-19 cases or vaccine availability. Interruptions in DMARD use were associated with increased rates of severe disease flares, highlighting the importance of avoiding unnecessary DMARD interruptions.
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Affiliation(s)
| | | | | | | | - David Curtis
- Global Healthy Living FoundationUpper NyackNew York
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Brooks R, Baker JF, Yang Y, Roul P, Kerr GS, Reimold AM, Kunkel G, Wysham KD, Singh N, Lazaro D, Monach PA, Poole JA, Ascherman DP, Mikuls TR, England BR. The impact of disease severity measures on survival in U.S. veterans with rheumatoid arthritis-associated interstitial lung disease. Rheumatology (Oxford) 2022; 61:4667-4677. [PMID: 35377443 PMCID: PMC9960484 DOI: 10.1093/rheumatology/keac208] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/26/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To determine whether RA and interstitial lung disease (ILD) severity measures are associated with survival in patients with RA-ILD. METHODS We studied US veterans with RA-ILD participating in a multicentre, prospective RA cohort study. RA disease activity (28-joint DAS [DAS28-ESR]) and functional status (multidimensional HAQ [MDHAQ]) were collected longitudinally while pulmonary function tests (forced vital capacity [FVC], diffusing capacity for carbon monoxide) were obtained from medical records. Vital status and cause of death were determined from the National Death Index and administrative data. Predictors of death were assessed using multivariable Cox regression models adjusting for age, sex, smoking status, ILD duration, comorbidity burden and medications. RESULTS We followed 227 RA-ILD participants (93% male and mean age of 69 years) over 1073 person-years. Median survival after RA-ILD diagnosis was 8.5 years. Respiratory diseases (28%) were the leading cause of death, with ILD accounting for 58% of respiratory deaths. Time-varying DAS28-ESR (adjusted hazard ratio [aHR] 1.21; 95% CI: 1.03, 1.41) and MDHAQ (aHR 1.85; 95% CI: 1.29, 2.65) were separately associated with mortality independent of FVC and other confounders. Modelled together, the presence of either uncontrolled disease activity (moderate/high DAS28-ESR) or FVC impairment (<80% predicted) was significantly associated with mortality risk. Those with a combination of moderate/high disease activity and FVC <80% predicted had the highest risk of death (aHR 4.43; 95% CI: 1.70, 11.55). CONCLUSION Both RA and ILD disease severity measures are independent predictors of survival in RA-ILD. These findings demonstrate the prognostic value of monitoring the systemic features of RA-ILD.
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Affiliation(s)
- Rebecca Brooks
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA and Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Gail S Kerr
- Division of Rheumatology, Washington DC VA, Howard University and Georgetown University, Washington, DC
| | - Andreas M Reimold
- Dallas VA and Division of Rheumatic Diseases, University of Texas Southwestern, Dallas, TX
| | - Gary Kunkel
- VA Salt Lake City and Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Katherine D Wysham
- VA Puget Sound Health Care System and Division of Rheumatology, University of Washington, Seattle, WA
| | - Namrata Singh
- VA Puget Sound Health Care System and Division of Rheumatology, University of Washington, Seattle, WA
| | | | | | - Jill A Poole
- Division of Allergy & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Dana P Ascherman
- Pittsburgh VA and Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Bryant R England
- Correspondence to: Bryant R. England, VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA. E-mail:
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Baker JF, England BR, George MD, Wysham K, Johnson T, Kunkel G, Sauer B, Hamilton BC, Hunter CD, Duryee MJ, Monach P, Kerr G, Reimold A, Xiao R, Thiele GM, Mikuls TR. Elevations in adipocytokines and mortality in rheumatoid arthritis. Rheumatology (Oxford) 2022; 61:4924-4934. [PMID: 35325041 PMCID: PMC9707328 DOI: 10.1093/rheumatology/keac191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/17/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES This study assessed whether circulating levels of adiponectin and leptin are associated with higher mortality in patients with RA. METHODS Participants were adults from the Veterans Affairs RA Registry. Adipokines and inflammatory cytokines were measured as part of a multi-analyte panel on banked serum at enrolment. Dates and causes of death were derived from the Corporate Data Warehouse and the National Death Index. Covariates were derived from medical record, biorepository and registry databases. Multivariable Cox proportional hazard models evaluated associations between biomarkers and all-cause and cause-specific mortality. RESULTS A total of 2583 participants were included. Higher adiponectin levels were associated with older age, male sex, white race, lower BMI, autoantibody seropositivity, radiographic damage, longer disease duration, prednisone use and osteoporosis. Higher adiponectin concentrations were also associated with higher levels of inflammatory cytokines but not higher disease activity at enrolment. Leptin was primarily associated with greater BMI and comorbidity. The highest quartile of adiponectin (vs lowest quartile) was associated with higher all-cause mortality [hazard ratio (HR): 1.46 (95% CI: 1.11, 1.93), P = 0.009] and higher cardiovascular mortality [HR: 1.85 (95% CI: 1.24, 2.75), P = 0.003], after accounting for covariates. Higher leptin levels were also associated with greater all-cause and cancer mortality. CONCLUSIONS Elevations in adipokines are associated with age, BMI, comorbidity and severe disease features in RA and independently predict early death. Associations between adiponectin and inflammatory cytokines support the hypothesis that chronic subclinical inflammation promotes metabolic changes that drive elevations in adipokines and yield adverse health outcomes.
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Affiliation(s)
- Joshua F Baker
- Correspondence to: Joshua F. Baker, Division of Rheumatology, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. E-mail:
| | - Bryant R England
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Michael D George
- Perelman School of Medicine,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Katherine Wysham
- VA Puget Sound Healthcare System,University of Washington School of Medicine, Seattle, WA
| | - Tate Johnson
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Gary Kunkel
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT
| | - Brian Sauer
- Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT
| | - Bartlett C Hamilton
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Carlos D Hunter
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Michael J Duryee
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | | | - Gail Kerr
- Washington DC VA Medical Center, Washington, DC
| | | | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Geoff M Thiele
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Ted R Mikuls
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
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