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Golder V, Kandane-Rathnayake R, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Wu YJJ, Navarra SV, Zamora L, Li Z, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake BMDB, Chan M, Kikuchi J, Takeuchi T, Bae SC, Oon S, O'Neill S, Goldblatt F, Ng KPL, Law A, Tugnet N, Kumar S, Tee C, Tee M, Ohkubo N, Tanaka Y, Lau CS, Nikpour M, Hoi A, Morand EF. Comparison of Attainment and Protective Effects of Lupus Low Disease Activity State In Patients With Newly Diagnosed Versus Established Systemic Lupus Erythematosus. J Rheumatol 2024:jrheum.2023-0900. [PMID: 38490668 DOI: 10.3899/jrheum.2023-0900] [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] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To assess whether Lupus Low Disease Activity State (LLDAS) attainment is associated with favorable outcomes in patients with recent onset systemic lupus erythematosus (SLE). METHODS Data from a 13-country longitudinal SLE cohort were collected prospectively between 2013 and 2020. An inception cohort was defined based on disease duration < 1 year at enrollment. Patient characteristics between inception and noninception cohorts were compared. Survival analyses were performed to examine the association between LLDAS attainment and damage accrual and flare. RESULTS Of the total 4106 patients, 680 (16.6%) were recruited within 1 year of SLE diagnosis (inception cohort). Compared to the noninception cohort, inception cohort patients were significantly younger, had higher disease activity, and used more glucocorticoids, but had less organ damage at enrollment. Significantly fewer inception cohort patients were in LLDAS at enrollment than the noninception cohort (29.6% vs 52.3%, P < 0.001), but three-quarters of both groups achieved LLDAS at least once during follow-up. Limiting analysis only to patients not in LLDAS at enrollment, inception cohort patients were 60% more likely to attain LLDAS (hazard ratio 1.37, 95% CI 1.16-1.61, P < 0.001) than noninception cohort patients and attained LLDAS significantly faster. LLDAS attainment was significantly protective against flare in both the inception and noninception cohorts. A total of 88 (13.6%) inception cohort patients accrued organ damage during a median 2.2 years of follow-up. CONCLUSION LLDAS attainment is protective from flare in recent onset SLE. Significant protection from damage accrual was not observed because of low rates of damage accrual in the first years after SLE diagnosis. (ClinicalTrials.gov: NCT03138941).
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Affiliation(s)
- Vera Golder
- V. Golder, MBBS, PhD, Monash University, Melbourne, Australia
| | | | - Worawit Louthrenoo
- W. Louthrenoo, MD, Faculty of Medicine, Chiang Mai University, Chang Mai, Thailand
| | - Yi-Hsing Chen
- Y.H. Chen, MD, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiacai Cho
- J. Cho, MBBS, National University Hospital, Singapore
| | - Aisha Lateef
- A. Lateef, MBBS, National University Hospital, Singapore
| | | | - Shue-Fen Luo
- S.F. Luo, MD, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yeong-Jian J Wu
- Y.J.J. Wu, MD, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sandra V Navarra
- S.V. Navarra, MD, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- L. Zamora, MD, University of Santo Tomas Hospital, Manila, Philippines
| | - Zhanguo Li
- Z. Li, MD, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | | | | | | | - Yanjie Hao
- Y. Hao, MD, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Z. Zhang, MD, Peking University First Hospital, Beijing, China
| | | | | | - Jun Kikuchi
- J. Kikuchi, MD, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- T. Takeuchi, MD, Keio University, Tokyo, and Saitama Medical University, Saitama, Japan
| | - Sang-Cheol Bae
- S.C. Bae, MD, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - Shereen Oon
- S. Oon, MBBS, PhD, Department of Medicine, University of Melbourne at St Vincent's Hospital, Fitzroy, Australia
| | - Sean O'Neill
- S. O'Neill, BMed, PhD, University of New South Wales and Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Fiona Goldblatt
- F. Goldblatt, MBBS, PhD, Royal Adelaide Hospital and Flinders Medical Centre, Bedford Park, Australia
| | | | - Annie Law
- A. Law, MBBS, Singapore General Hospital, Singapore
| | - Nicola Tugnet
- N. Tugnet, MBCHB, Auckland District Health Board, Auckland, New Zealand
| | - Sunil Kumar
- S. Kumar, MBBS, Middlemore Hospital, Auckland, New Zealand
| | - Cherica Tee
- C. Tee, MD, University of the Philippines, Quezon City, Philippines
| | - Michael Tee
- M. Tee, MD, University of the Philippines, Quezon City, Philippines
| | - Naoaki Ohkubo
- N. Ohkubo, MD, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- Y. Tanaka, MD, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Mandana Nikpour
- M. Nikpour, MBBS, PhD, University of Melbourne at St Vincent's Hospital, Fitzroy, Australia
| | - Alberta Hoi
- A. Hoi, MBBS, PhD, Monash University, Melbourne, Australia
| | - Eric F Morand
- E.F. Morand, MBBS, PhD, Monash University, Melbourne, Australia
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Katsumata Y, Inoue E, Harigai M, Cho J, Louthrenoo W, Hoi A, Golder V, Lau CS, Lateef A, Chen YH, Luo SF, Wu YJJ, Hamijoyo L, Li Z, Sockalingam S, Navarra S, Zamora L, Hao Y, Zhang Z, Chan M, Oon S, Ng K, Kikuchi J, Takeuchi T, Goldblatt F, O'Neill S, Tugnet N, Law AHN, Bae SC, Tanaka Y, Ohkubo N, Kumar S, Kandane-Rathnayake R, Nikpour M, Morand EF. Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study. Ann Rheum Dis 2024:ard-2023-225369. [PMID: 38423757 DOI: 10.1136/ard-2023-225369] [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: 12/04/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE). METHODS Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred. RESULTS Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day. CONCLUSIONS In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.
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Affiliation(s)
- Yasuhiro Katsumata
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Jiacai Cho
- National University Hospital of Singapore, Singapore
| | | | - Alberta Hoi
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Vera Golder
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | | | | | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Kuei Shan, Taiwan
| | - Yeong-Jian Jan Wu
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Laniyati Hamijoyo
- Rheumatology Division, Internal Medicine, Padjadjaran University, Bandung, Indonesia
| | - Zhanguo Li
- People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Sargunan Sockalingam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sandra Navarra
- University of Santo Tomas Hospital, Manila, The Philippines
| | - Leonid Zamora
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, The Philippines
| | - Yanjie Hao
- University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Zhuoli Zhang
- Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | | | - Shereen Oon
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Kristine Ng
- Waitemata District Health Board, Auckland, New Zealand
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Saitama Medical University, Saitama, Japan
| | - Fiona Goldblatt
- Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Sean O'Neill
- University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Nicola Tugnet
- Auckland District Health Board, Auckland, New Zealand
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea (the Republic of)
- Hanyang University Institute for Rheumatology Research, Seoul, Korea (the Republic of)
- Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea (the Republic of)
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoaki Ohkubo
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Mandana Nikpour
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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3
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Yeo AL, Kandane-Rathnayake R, Koelmeyer R, Golder V, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Wu YJJ, Navarra SV, Zamora L, Li Z, An Y, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake BMDB, Chan M, Kikuchi J, Takeuchi T, Bae SC, Oon S, O'Neill S, Goldblatt F, Ng KPL, Law A, Tugnet N, Kumar S, Tee C, Tee M, Ohkubo N, Tanaka Y, Lau CS, Nikpour M, Hoi A, Leech M, Morand EF. SMART-SLE: serology monitoring and repeat testing in systemic lupus erythematosus-an analysis of anti-double-stranded DNA monitoring. Rheumatology (Oxford) 2024; 63:525-533. [PMID: 37208196 PMCID: PMC10836977 DOI: 10.1093/rheumatology/kead231] [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: 10/21/2022] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive. METHODS Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare. RESULTS Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P < 0.001) and fluctuating cohort (adjusted HR 1.46; 95% CI: 1.28, 1.66), both for a ratio >3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P = 0.009). CONCLUSION Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing.
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Affiliation(s)
- Ai Li Yeo
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Vera Golder
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Worawit Louthrenoo
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiacai Cho
- Rheumatology Divsion, National University Hospital, Singapore
| | - Aisha Lateef
- Rheumatology Divsion, National University Hospital, Singapore
| | - Laniyati Hamijoyo
- Department of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Shue-Fen Luo
- Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Yeong-Jian J Wu
- Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Sandra V Navarra
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Zhanguo Li
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | | | - Yasuhiro Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yanjie Hao
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | | | - Madelynn Chan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital, Singapore
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - Shereen Oon
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Sean O'Neill
- Rheumatology Department, Level 1 Liverpool Hospital, Liverpool, NSW, Australia
| | - Fiona Goldblatt
- Rheumatology Unit, Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Annie Law
- Singapore General Hospital, Singapore
| | - Nicola Tugnet
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Cherica Tee
- University of the Philippines, Quezon City, Philippines
| | - Michael Tee
- University of the Philippines, Quezon City, Philippines
| | - Naoaki Ohkubo
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, Hong Kong, China
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Alberta Hoi
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Leech
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
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Cho J, Shen L, Huq M, Kandane-Rathnayake R, Golder V, Louthrenoo W, Chen YH, Hamijoyo L, Luo SF, Wu YJJ, Zamora L, Li Z, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake D, Chan M, Kikuchi J, Takeuchi T, Bae SC, Oon S, O'Neill S, Goldblatt F, Ng KPL, Law A, Tugnet N, Kumar S, Tee C, Tee M, Ohkubo N, Tanaka Y, Navarra SV, Lau CS, Hoi A, Morand EF, Nikpour M, Lateef A. Impact of low disease activity, remission, and complete remission on flares following tapering of corticosteroids and immunosuppressive therapy in patients with systemic lupus erythematous: a multinational cohort study. Lancet Rheumatol 2023; 5:e584-e593. [PMID: 38251484 DOI: 10.1016/s2665-9913(23)00209-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Targets of treatment for systemic lupus erythematosus (SLE) include the Lupus Low Disease Activity State (LLDAS), remission, and complete remission. Whether treatment can be tapered after attaining these targets and whether tapering is safer in patients in complete remission compared with LLDAS are unknown. We aimed to assess the odds of disease flares after treatment tapering in stable disease, versus continuing the same therapy. We also aimed to examine whether tapering in complete remission resulted in fewer flares or longer time to flare compared with tapering in LLDAS or remission. METHODS This multinational cohort study was conducted at 25 sites across 13 Asia-Pacific countries. We included adult patients aged 18 years or older with stable SLE who were receiving routine clinical care, had two or more visits and had attained stable disease at one or more visits. We categorised stable disease into: LLDAS (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K] score ≤4, Physician Global Assessment [PGA] ≤1, and prednisolone ≤7·5 mg/day); Definitions of Remission in SLE (DORIS) remission (clinical SLEDAI-2K score 0, PGA <0·5, and prednisolone ≤5 mg/day); or complete remission on therapy (SLEDAI-2K score 0, PGA <0·5, and prednisolone ≤5 mg/day). Stable disease categories were mutually exclusive. Tapering was defined as any decrease in dose of corticosteroids or immunosuppressive therapy (mycophenolate mofetil, calcineurin inhibitors, azathioprine, leflunomide, or methotrexate). Using multivariable generalised estimating equations, we compared flares (SELENA-SLEDAI Flare Index) at the subsequent visit after drug tapering. We used generalised estimating equations and Cox proportional hazard models to compare tapering attempts that had begun in LLDAS, remission, and complete remission. FINDINGS Between May 1, 2013, and Dec 31, 2020, 4106 patients were recruited to the cohort, 3002 (73·1%) of whom were included in our analysis. 2769 (92·2%) participants were female, 233 (7·8%) were male, and 2636 (88·1%) of 2993 with ethnicity data available were Asian. The median age was 39·5 years (IQR 29·0-50·0). There were 14 808 patient visits for patients in LLDAS, or remission or complete remission, of which 13 140 (88·7%) entered the final multivariable model after excluding missing data. Among the 9863 visits at which patients continued the same therapy, 1121 (11·4%) flared at the next visit, of which 221 (19·7%) were severe flares. Of the 3277 visits at which a patient received a tapering of therapy, 557 (17·0%) flared at the next visit, of which 120 (21·5%) were severe flares. Tapering was associated with higher odds of flare compared with continuing the same therapy (odds ratio [OR] 1·24 [95% CI 1·10-1·39]; p=0·0005). Of 2095 continuous tapering attempts, 860 (41·1%) were initiated in LLDAS, 596 (28·4%) in remission, and 639 (30·5%) in complete remission. Tapering initiated in LLDAS (OR 1·37 [95% CI 1·03-1·81]; p=0·029) or remission (1·45 [1·08-1·94]; p=0·013) had higher odds of flare in 1 year compared with complete remission. Tapering in LLDAS (hazard ratio 1·24 [95% CI 1·04-1·48]; p=0·016) or remission (1·30 [1·08-1·56]; p=0·0054) had a significantly shorter time to first flare than tapering initiated in complete remission. Attaining sustained LLDAS, remission, or complete remission for at least 6 months just before the time of taper was associated with lower odds of flare at next visit, flares in 1 year, and longer time to flare. INTERPRETATION Tapering of corticosteroids or immunosuppressive therapy in patients with stable SLE was associated with excess flares. Our findings suggest that drug tapering should be carefully considered, weighing the risks and benefits, and is best exercised in complete (clinical and serological) remission and after maintaining stable disease for at least 6 months. FUNDING AstraZeneca, BMS, Eli Lily, Janssen, Merck Serono, GSK, and UCB.
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Affiliation(s)
- Jiacai Cho
- National University Hospital, Singapore.
| | - Liang Shen
- National University of Singapore, Singapore
| | - Molla Huq
- The University of Melbourne, Melbourne, VIC, Australia
| | | | - Vera Golder
- Monash University, Melbourne, VIC, Australia
| | | | - Yi-Hsing Chen
- Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | - Leonid Zamora
- University of Santo Tomas Hospital, Manila, Philippines
| | - Zhanguo Li
- People's Hospital Peking University Health Sciences Centre, Beijing, China
| | | | | | | | - Yanjie Hao
- Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Peking University First Hospital, Beijing, China
| | | | | | - Jun Kikuchi
- Keio University and Saitama Medical University, Saitama, Tokyo, Japan
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Shereen Oon
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Sean O'Neill
- Department of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Fiona Goldblatt
- Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, SA, Australia
| | | | - Annie Law
- Singapore General Hospital, Singapore
| | - Nicola Tugnet
- Auckland District Health Board, Auckland, New Zealand
| | | | - Cherica Tee
- University of the Philippines, Manila, Philippines
| | - Michael Tee
- University of the Philippines, Manila, Philippines
| | - Naoaki Ohkubo
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Chak Sing Lau
- University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Alberta Hoi
- Monash University, Melbourne, VIC, Australia
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Hsieh YJ, Ho WJ, Lin CP, Luo SF, Yu KH, Chen JY, Hsiao FC, Chang CY. Long-Term Survival of Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension: A Single-Center Cohort. Acta Cardiol Sin 2023; 39:469-479. [PMID: 37229327 PMCID: PMC10203717 DOI: 10.6515/acs.202305_39(3).20221104a] [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] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/04/2022] [Indexed: 05/27/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a rare but severe complication of connective tissue disease (CTD). CTD-associated PAH (CTD-PAH) is the most common subgroup of PAH in East Asia. We prospectively collected 41 patients with CTD-PAH and followed them for a mean period of 43 ± 36 months. The long-term survival rates of the CTD-PAH patients at 1, 2, 3 and 5 years were 90%, 80%, 77%, and 60%, respectively. The non-survivors had more dilated main pulmonary arteries, higher pulmonary artery pressure and pulmonary vascular resistance (PVR). PAH-specific therapy resulted in improvements in functional class, 6-minute walk distance, serum uric acid, right ventricular function and PVR. Increased C-reactive protein during follow-up, indicating inflammatory processes, was also crucial for the management of CTD-PAH. Therefore targeting both PAH and inflammation is important in this specific subgroup of PAH. The results of this study may help develop treatment strategies for CTD-PAH patients.
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Affiliation(s)
| | | | | | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Yih Chen
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Kandane-Rathnayake R, Louthrenoo W, Luo SF, Wu YJJ, Chen YH, Golder V, Lateef A, Cho J, Navarra SV, Zamora L, Hamijoyo L, Sockalingam S, An Y, Li Z, Montes R, Oon S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Chan M, Kikuchi J, Takeuchi T, Goldblatt F, O'Neill S, Bae SC, Lau CS, Hoi A, Karyekar CS, Nikpour M, Morand EF. Patterns of Medication Use in Systemic Lupus Erythematosus: A Multicenter Cohort Study. Arthritis Care Res (Hoboken) 2022; 74:2033-2041. [PMID: 34197023 DOI: 10.1002/acr.24740] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Evidence for the utility of medications in settings lacking randomized trial data can come from studies of treatment persistence. The present study was undertaken to examine patterns of medication use in systemic lupus erythematosus (SLE) using data from a large multicenter longitudinal cohort. METHODS Prospectively collected data from the Asia Pacific Lupus Collaboration cohort including disease activity (SLE Disease Activity Index 2000 [SLEDAI-2K]) and medication details, captured at every visit from 2013-2018, were used. Medications were categorized as glucocorticoids (GCs), antimalarials (AM), and immunosuppressants (IS). Cox regression analyses were performed to determine the time-to-discontinuation of medications, stratified by SLE disease activity. RESULTS Data from 19,804 visits of 2,860 patients were analyzed. Eight medication categories were observed: no treatment; GC, AM, or IS only; GC plus AM; GC plus IS; AM plus IS; and GC plus AM plus IS (triple therapy). Triple therapy was the most frequent pattern (31.4% of visits); single agents were used in 21% of visits, and biologics in only 3%. Time-to-discontinuation analysis indicated that medication persistence varied widely, with the highest treatment persistence for AM and lowest for IS. Patients with a time-adjusted mean SLEDAI-2K score of ≥10 had lower discontinuation of GCs and higher discontinuation of IS. CONCLUSION Most patients received combination treatment. GC persistence was high, while IS persistence was low. Patients with high disease activity received more medication combinations but had reduced IS persistence, consistent with limited utility. These data confirm unmet need for improved SLE treatments.
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Affiliation(s)
| | | | - Shue-Fen Luo
- Chang Gung Memorial Hospital, Taipei and Keelung, Taiwan
| | | | - Yi-Hsing Chen
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Vera Golder
- Monash University, Clayton, Victoria, Australia
| | - Aisha Lateef
- National University Hospital, Singapore, Singapore
| | - Jiacai Cho
- National University Hospital, Singapore, Singapore
| | | | - Leonid Zamora
- University of Santo Tomas Hospital, Manila, Philippines
| | | | | | - Yuan An
- People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Zhanguo Li
- People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Ricardo Montes
- Universidade do Estado Do Rio De Janeiro, Rio De Janeiro, Brazil
| | - Shereen Oon
- The University of Melbourne at St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | | | | | - Yanjie Hao
- Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Peking University First Hospital, Beijing, China
| | | | | | | | - Fiona Goldblatt
- Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, Australia
| | - Sean O'Neill
- University of New South Wales and Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | - Alberta Hoi
- Monash University, Clayton, Victoria, Australia
| | - Chetan S Karyekar
- Janssen Pharmaceutical Companies of Johnson and Johnson, Horsham, Pennsylvania
| | - Mandana Nikpour
- The University of Melbourne at St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Kandane-Rathnayake R, Golder V, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Wu YJJ, Navarra SV, Zamora L, Li Z, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake BMDB, Chan M, Kikuchi J, Takeuchi T, Bae SC, Oon S, O'Neill S, Goldblatt F, Ng KPL, Law A, Tugnet N, Kumar S, Tee C, Tee M, Ohkubo N, Tanaka Y, Yu D, Karyekar CS, Sing Lau C, Monk JA, Nikpour M, Hoi A, Morand EF. Lupus low disease activity state and remission and risk of mortality in patients with systemic lupus erythematosus: a prospective, multinational, longitudinal cohort study. Lancet Rheumatol 2022; 4:e822-e830. [PMID: 38261390 DOI: 10.1016/s2665-9913(22)00304-6] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treat-to-target goals for patients with systemic lupus erythematosus (SLE) have been validated to protect against organ damage and to improve quality of life. We aimed to investigate the association between lupus low disease activity state (LLDAS) and remission and risk of mortality in patients with SLE. We hypothesised that LLDAS has a protective association with mortality risk. METHODS In this prospective, multinational, longitudinal cohort study, we used data from patients with SLE in the Asia Pacific Lupus Collaboration cohort collected between May 1, 2013, and Dec 31, 2020. Eligible patients were adults (aged ≥18 years) who met either the 1997 American College of Rheumatology modified classification criteria for SLE or the 2012 Systemic Lupus International Collaborating Clinics classification criteria. The primary outcome was all-cause mortality, and LLDAS, remission, and variations of remission with lower glucocorticoid thresholds were the primary exposure variables. Survival analyses were used to examine longitudinal associations between these endpoints and risk of mortality. This study is registered with ClinicalTrials.gov, NCT03138941. FINDINGS Among a total of 4106 patients in the cohort, 3811 (92·8%) patients were included in the final analysis (median follow-up 2·8 years [IQR 1·0-5·3]; 3509 [92·1%] women and 302 [7·9%] men), of whom 80 died during the observation period (crude mortality rate 6·4 deaths per 1000 person-years). LLDAS was attained at least once in 43 (53·8%) of 80 participants who died and in 3035 (81·3%) of 3731 participants who were alive at the end of the study (p<0·0001); 22 (27·5%) participants who died versus 1966 (52·7%) who were alive at the end of the study attained LLDAS for at least 50% of observed time (p<0·0001). Remission was attained by 32 (40·0%) of 80 who died and in 2403 (64·4%) of 3731 participants who were alive at the end of the study (p<0·0001); 14 (17·5%) participants who died versus 1389 (37·2%) who were alive at the end of the study attained remission for at least 50% of observed time (p<0·0001). LLDAS for at least 50% of observed time (adjusted hazard ratio 0·51 [95% CI 0·31-0·85]; p=0·010) and remission for at least 50% of observed time (0·52 [0·29-0·93]; p=0·027) were associated with reduced risk of mortality. Modifying the remission glucocorticoid threshold (<5·0 mg/day prednisolone) was more protective against mortality than current remission definitions (0·31 [0·12-0·77]; p=0·012), and glucocorticoid-free remission was the most protective (0·13 [0·02-0·96]; p=0·046). INTERPRETATION LLDAS significantly reduced the risk of mortality in patients with SLE. Remission did not further reduce the risk of mortality compared with LLDAS, unless lower glucocorticoid thresholds were used. FUNDING The Asia-Pacific Lupus Collaboration received funding from Janssen, Bristol Myers Squibb, Eli Lilly, and UCB for this study.
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Affiliation(s)
| | - Vera Golder
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | | | - Yi-Hsing Chen
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiacai Cho
- Rheumatology Division, University Medical Cluster, National University Hospital, Singapore
| | - Aisha Lateef
- Rheumatology Division, University Medical Cluster, National University Hospital, Singapore
| | - Laniyati Hamijoyo
- Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Sumedang, Indonesia
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yeong-Jian J Wu
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Sandra V Navarra
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Zhanguo Li
- People's Hospital Peking University Health Sciences Centre, Bejing, China
| | - Sargunan Sockalingam
- Department of Rheumatology and Immunology, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Yanjie Hao
- Institute of Rheumatology, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Institute of Rheumatology, Peking University First Hospital, Beijing, China
| | | | | | - Jun Kikuchi
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan; Saitama Medical University, Saitama, Japan
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - Shereen Oon
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Sean O'Neill
- Department of Medicine, University of New South Wales, Kensington, NSW, Australia; Musculoskeletal flagship, University of Sydney, Camperdown, NSW, Australia
| | - Fiona Goldblatt
- Royal Adelaide Hospital and Flinders Medical Centre, Bedford Park, SA, Australia
| | | | - Annie Law
- Singapore General Hospital, Singapore
| | - Nicola Tugnet
- Auckland District Health Board, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Cherica Tee
- Department of Medicine, University of the Philippines, Quezon City, Philippines
| | - Michael Tee
- Department of Medicine, University of the Philippines, Quezon City, Philippines
| | - Naoaki Ohkubo
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Chak Sing Lau
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region, China
| | - Julie A Monk
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Alberta Hoi
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia.
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Abstract
OBJECTIVES Rheumatoid arthritis (RA) may adversely influence pregnancy and lead to adverse birth outcomes. This study estimated the risk of adverse fetal-neonatal and maternal pregnancy outcomes in women with RA. DESIGN This was a retrospective cohort study. SETTING We used both the National Health Insurance database and the Taiwan Birth Reporting System, between 2004 and 2014. PARTICIPANTS We identified 2 100 143 singleton pregnancies with 922 RA pregnancies, either live births or stillbirths, delivered by 1 468 318 women. OUTCOME MEASURES ORs with 95% CIs for fetal-neonatal and maternal outcomes were compared between pregnancies involving mothers with and without RA using an adjusted generalised estimating equation model. RESULTS Covariates including age, infant sex, Charlson Comorbidity Index, urbanisation, income, occupation, birth year and maternal nationality were adjusted. Compared with pregnancies in women without RA, pregnancies in women with RA showed that the fetuses/neonates had adjusted ORs (95% CI) of 2.03 (1.66 to 2.50) for low birth weight (n=123), 1.99 (1.64 to 2.40) for prematurity (n=141), 1.77 (1.46 to 2.15) for small for gestational age (n=144) and 1.35 (1.03 to 1.78) for fetal distress (n=60). Pregnancies in women with RA had adjusted ORs (95% CI) of 1.24 (1.00 to 1.52) for antepartum haemorrhage (n=106), 1.32 (1.15 to 1.51) for caesarean delivery (n=398), and 3.33 (1.07 to 10.34) for disseminated intravascular coagulation (n=3), compared with women without RA. Fetuses/neonates born to mothers with RA did not have a higher risk of being stillborn or having fetal abnormalities. Pregnant women with RA did not have increased risks of postpartum death, cardiovascular complications, surgical complications or systemic organ dysfunction. CONCLUSIONS Pregnancies in women with RA were associated with higher risks of multiple adverse fetal-neonatal and maternal outcomes; however, most pregnancies in these women were successful.
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Affiliation(s)
- Yun-Chen Tsai
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Chun Chang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Zuellig Pharma Specialty Solutions Group Pte Ltd, Singapore
| | - Meng-Jiun Chiou
- Corporate Medical Affairs, Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Huang YJ, Lin CH, Yang HY, Luo SF, Kuo CF. Corrigendum: Urine soluble CD163 is a promising biomarker for the diagnosis and evaluation of lupus nephritis. Front Immunol 2022; 13:1003761. [PMID: 36105812 PMCID: PMC9466651 DOI: 10.3389/fimmu.2022.1003761] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yun-Ju Huang
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chiung-Hung Lin
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Thoracic medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Huang-Yu Yang
- Division of Nephrology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chang-Fu Kuo
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- *Correspondence: Chang-Fu Kuo,
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10
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Huang YJ, Lin CH, Yang HY, Luo SF, Kuo CF. Urine Soluble CD163 Is a Promising Biomarker for the Diagnosis and Evaluation of Lupus Nephritis. Front Immunol 2022; 13:935700. [PMID: 35911758 PMCID: PMC9329951 DOI: 10.3389/fimmu.2022.935700] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Urine-soluble CD163 (usCD163) is released from alternatively activated macrophages involved in the resolution of inflammation in glomeruli and plays an important role in glomerulonephritis. This study explored the role of usCD163 in patients with systemic lupus erythematosus (SLE). Materials and Methods usCD163 concentrations were measured cross-sectionally in 261 SLE patients in Taiwan. Clinical and laboratory data were collected, and SLE disease activity scores were calculated to assess the correlation with usCD163. Results SLE patients with high usCD163 levels tended to be younger, with a higher hospital admission rate, higher prednisolone dose, lower estimated glomerular filtration rate, higher urine protein creatinine ratio (UPCR), more pyuria and hematuria, higher levels of inflammatory markers, higher rates of anemia, neutropenia, and lymphopenia, lower complement 3 (C3) levels, higher anti-double-stranded DNA antibody (anti-dsDNA Ab) levels, and higher disease activity scores (p < 0.05). usCD163 levels were significantly higher in patients with active lupus nephritis (LN) than in those with extrarenal or inactive SLE and correlated with UPCR, disease activity, and anti-dsDNA Ab levels. SLE patients with high usCD163 levels tended to have a higher chronic kidney disease stage. Discussion and conclusion The usCD163 level correlates with the severity of LN and disease activity in renal SLE.
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Affiliation(s)
- Yun-Ju Huang
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chiung-Hung Lin
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Thoracic medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Huang-Yu Yang
- Division of Nephrology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chang-Fu Kuo
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- *Correspondence: Chang-Fu Kuo,
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Abstract
Adequate control of autoimmune diseases with an unclear etiology resulting from autoreactivation of the immune system remains a major challenge. One of the factors that trigger autoimmunity is the abnormal induction of cell death and the inadequate clearance of dead cells that leads to the exposure or release of intracellular contents that activate the immune system. Different from other cell death subtypes, such as apoptosis, necroptosis, autophagy, and pyroptosis, ferroptosis has a unique association with the cellular iron load (but not the loads of other metals) and preserves its distinguishable morphological, biological, and genetic features. This review addresses how ferroptosis is initiated and how it contributes to the pathogenesis of autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel diseases. The mechanisms responsible for ferroptosis-associated events are discussed. We also cover the perspective of targeting ferroptosis as a potential therapeutic for patients with autoimmune diseases. Collectively, this review provides up-to-date knowledge regarding how ferroptosis occurs and its significance in autoimmune diseases.
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Affiliation(s)
- Benjamin Lai
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hsiang Wu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jenn-Haung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Jenn-Haung Lai,
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12
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Chen YF, Hsieh AH, Wang LC, Huang YJ, Yun-Chen Tsai, Tseng WY, Kuo YL, Luo SF, Yu KH, Kuo CF. Fecal microbiota changes in NZB/W F1 mice after induction of lupus disease. Sci Rep 2021; 11:22953. [PMID: 34824318 PMCID: PMC8616951 DOI: 10.1038/s41598-021-02422-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/18/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
The association between the gut microbiota and the development of lupus is unclear. We investigated alterations in the gut microbiota after induction of lupus in a murine model using viral peptide of human cytomegalovirus (HCMV). Three treatment arms for the animals were prepared: intraperitoneal injection of HCMVpp65 peptide, adjuvant alone, and PBS injection. Feces were collected before and after lupus induction biweekly for 16S rRNA sequencing. HCMVpp65 peptide immunization induced lupus-like effects, with higher levels of anti-dsDNA antibodies, creatinine, proteinuria, and glomerular damage, compared with mice treated with nothing or adjuvant only. The Simpson diversity value was higher in mice injected with HCMVpp65 peptide, but there was no difference in ACE or Chao1 among the three groups. Statistical analysis of metagenomic profiles showed a higher abundance of various families (Saccharimonadaceae, Marinifiaceae, and Desulfovibrionaceae) and genera (Candidatus Saccharimonas, Roseburia, Odoribacter, and Desulfovibrio) in HCMVpp65 peptide-treated mice. Significant correlations between increased abundances of related genera (Candidatus Saccharimonas, Roseburia, Odoribacter, and Desulfovibrio) and HCMVpp65 peptide immunization-induced lupus-like effects were observed. This study provides insight into the changes in the gut microbiota after lupus onset in a murine model.
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Affiliation(s)
- Yen-Fu Chen
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ao-Ho Hsieh
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lian-Chin Wang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Ju Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Chen Tsai
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Yi Tseng
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Lun Kuo
- Biotools Co., Ltd, New Taipei City, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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13
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Huang YJ, Chen JS, Luo SF, Kuo CF. Comparison of Indexes to Measure Comorbidity Burden and Predict All-Cause Mortality in Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10225460. [PMID: 34830741 PMCID: PMC8618526 DOI: 10.3390/jcm10225460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: To examine the comorbidity burden in patients with rheumatoid arthritis (RA) patients using a nationwide population-based cohort by assessing the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Multimorbidity Index (MMI), and Rheumatic Disease Comorbidity Index (RDCI) scores and to investigate their predictive ability for all-cause mortality. Methods: We identified 24,767 RA patients diagnosed from 1998 to 2008 in Taiwan and followed up until 31 December 2013. The incidence of comorbidities was estimated in three periods (before, during, and after the diagnostic period). The incidence rate ratios were calculated by comparing during vs. before and after vs. before the diagnostic period. One- and 5-year mortality rates were calculated and discriminated by low and high-score groups and modified models for each index. Results: The mean score at diagnosis was 0.8 in CCI, 2.8 in ECI, 0.7 in MMI, and 1.3 in RDCI, and annual percentage changes are 11.0%, 11.3%, 9.7%, and 6.8%, respectively. The incidence of any increase in the comorbidity index was significantly higher in the periods of “during” and “after” the RA diagnosis (incidence rate ratios for different indexes: 1.33–2.77). The mortality rate significantly differed between the high and low-score groups measured by each index (adjusted hazard ratios: 2.5–4.3 for different indexes). CCI was slightly better in the prediction of 1- and 5-year mortality rates. Conclusions: Comorbidities are common before and after RA diagnosis, and the rate of accumulation accelerates after RA diagnosis. All four comorbidity indexes are useful to measure the temporal changes and to predict mortality.
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López-Medina C, Chevret S, Molto A, Sieper J, Duruöz T, Kiltz U, Elzorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compan V, Luo SF, Biglia A, Tae-Jong K, Kishimoto M, Pimentel-Santos FM, Gu J, Muntean L, van Gaalen FA, Geher P, Magrey M, Ibáñez-Vodnizza SE, Bautista-Molano W, Maksymowych W, Machado PM, Landewé R, van der Heijde D, Dougados M. Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study. RMD Open 2021; 7:rmdopen-2021-001728. [PMID: 34750246 PMCID: PMC8576480 DOI: 10.1136/rmdopen-2021-001728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022] Open
Abstract
Objective To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist. Methods Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters. Results The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist‘s diagnosis as well as with the classification criteria was found. Conclusion These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France .,Rheumatology, Reina Sofia University Hospital, Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Sylvie Chevret
- CRESS, Université de Paris, INSERM U-1153, Paris, France
| | - Anna Molto
- Rheumatology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,CRESS, Université de Paris, INSERM U-1153, Paris, France
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Tuncay Duruöz
- PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey
| | - Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Rheumatology, Ruhr University Bochum, Bochum, Germany
| | | | | | - Ruben Burgos-Vargas
- Rheumatology, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
| | - José Maldonado-Cocco
- Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Nelly Ziade
- Rheumatology, Saint Joseph University, Beirut, Lebanon.,Rheumatology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Meghna Gavali
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Alessandro Biglia
- Rheumatology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Kim Tae-Jong
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | | | | | - Jieruo Gu
- Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Laura Muntean
- Rheumatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.,Rheumatology, County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Geher
- Rheumatology, Semmelweis University, Budapest, Hungary
| | - Marina Magrey
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Wilson Bautista-Molano
- Rheumatology, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Robert Landewé
- Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Maxime Dougados
- Rheumatology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,CRESS, Université de Paris, INSERM U-1153, Paris, France
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15
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Kandane-Rathnayake R, Louthrenoo W, Golder V, Luo SF, Wu YJJ, Lateef A, Cho J, Li Z, An Y, Hamijoyo L, Navarra S, Zamora L, Katsumata Y, Harigai M, Sockalingam S, Chan M, Chen YH, O'Neill S, Goldblatt F, Hao Y, Zhang Z, Kikuchi J, Takeuchi T, Lau CS, Nikpour M, Morand E, Hoi A. Independent associations of lymphopenia and neutropenia in patients with systemic lupus erythematosus: a longitudinal, multinational study. Rheumatology (Oxford) 2021; 60:5185-5193. [PMID: 33693676 PMCID: PMC8566254 DOI: 10.1093/rheumatology/keab217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/10/2020] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The prevalence and associations of leucopenia in SLE remain incompletely understood. We evaluated associations of disease activity and medication use with leucopenia (lymphopenia and neutropenia) in a multinational, prospectively followed SLE cohort. METHODS Data from the Asia Pacific Lupus Collaboration cohort, in which disease activity and medications were prospectively captured from 2013 to 2018, were used. Predictors of lymphopenia (lymphocyte count <0.8 × 109/l) and neutropenia (neutrophil count <1.5 × 109/l) were examined using multiple failure, time-dependent survival analyses. RESULTS Data from 2330 patients and 18 287 visits were analysed. One thousand and eighteen patients (43.7%) had at least one episode of leucopenia; 867 patients (37.2%) had lymphopenia, observed in 3065 (16.8%) visits, and 292 (12.5%) patients had neutropenia, in 622 (3.4%) visits. After multivariable analyses, lymphopenia was associated with overall disease activity, ESR, serology, prednisolone, AZA, MTX, tacrolimus, CYC and rituximab use. MTX and ciclosporin were negatively associated with neutropenia. Lupus low disease activity state was negatively associated with both lymphopenia and neutropenia. CONCLUSION Both lymphopenia and neutropenia were common in SLE patients but were differentially associated with disease and treatment variables. Lymphopenia and neutropenia should be considered independently in studies in SLE.
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Affiliation(s)
- Rangi Kandane-Rathnayake
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Worawit Louthrenoo
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University Hospital, Thailand
| | - Vera Golder
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shue-Fen Luo
- Chang Gung Memorial Hospital, Rheumatology, Allergy and Immunology, Taipei and Keelung, Taiwan
| | - Yeong-Jian J Wu
- Chang Gung Memorial Hospital, Rheumatology, Allergy and Immunology, Taipei and Keelung, Taiwan
| | - Aisha Lateef
- National University Hospital, University Medicine Cluster, Singapore, Singapore
| | - Jiacai Cho
- National University Hospital, University Medicine Cluster, Singapore, Singapore
| | - Zhanguo Li
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center, Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center, Beijing, China
| | - Laniyati Hamijoyo
- Division of Rheumatology, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Yasuhiro Katsumata
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Madelynn Chan
- Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sean O'Neill
- Liverpool Hospital and the Ingham Institute for Applied Medical Research, Rheumatology, Liverpool, NSW
| | - Fiona Goldblatt
- Department of Rheumatology, Royal Adelaide Hospital
- Flinders Medical Centre, Department of Rheumatology, Adelaide, South Australia, Australia
| | - Yanjie Hao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Chak Sing Lau
- The University of Hong Kong, Medicine, Hong Kong, Hong Kong
| | - Mandana Nikpour
- The University of Melbourne at St. Vincent's Hospital, Medicine and Rheumatology, Melbourne, Victoria, Australia
| | - Eric Morand
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alberta Hoi
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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16
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Chang CM, Wu PC, Lin JR, Jan Wu YJ, Luo SF, Hsue YT, Lan JL, Pan TL, Wu YT, Yu KH, Wei YH, Chang HH. Herbal Formula SS-1 Increases Tear Secretion for Sjögren's Syndrome. Front Pharmacol 2021; 12:645437. [PMID: 34630072 PMCID: PMC8498214 DOI: 10.3389/fphar.2021.645437] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Sjögren’s syndrome (SS) is an autoimmune inflammatory disease that primarily affects the exocrine glands, leading to glandular dysfunction. The hallmark symptoms of SS are dry eyes and mouth, compromising the quality of life of patients and decreasing their capacity to perform their daily activities. Objective: This study aims to evaluate the efficacy of the herbal formula SS-1 for its potential therapeutic benefits for patients with Sjögren’s syndrome. Materials and Methods: The bioactivity profile of SS-1 was determined using four different SS-1 concentrations across 12 human primary cell systems of the BioMAP profile. After that, a randomized, double-blind, crossover, placebo-controlled trial was performed including 57 patients treated with SS-1 for 28 weeks. Results: Biologically multiplexed activity profiling in cell-based models indicated that SS-1 exerted anti-proliferative activity in B cells and promoted anti-inflammatory and immunomodulatory activity. In the clinical trial, Schirmer’s test results revealed significant improvements in both eyes, with increases of 3.42 mm (95% CI, 2.44–4.41 mm) and 3.45 mm (95% CI, 2.32–4.59 mm), respectively, and a significant reduction in artificial tear use, which was −1.38 times/day, 95% CI, −1.95 to −0.81 times/day. Moreover, the increases in B-cell activating factor (BAFF) and B-cell maturation antigen (BCMA) levels were dampened by 53.20% (295.29 versus 555.02 pg/ml) and 58.33% (99.16 versus 169.99 pg/ml), respectively. Conclusion: SS-1 treatment significantly inhibited B-cell maturation antigen. No serious drug-related adverse effects were observed. Oral SS-1 administration may be a complementary treatment for Sjögren’s syndrome.
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Affiliation(s)
- Ching-Mao Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Chang Wu
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Graduate Institute of Clinical Medical, Chang Gung University, Taoyuan, Taiwan
| | - Yeong-Jian Jan Wu
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Tzu Hsue
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Changhua Christian Hospital, Changhua, Taiwan
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Tai-Long Pan
- School of Traditional Chinese Medicine and Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ting Wu
- Center for Mitochondrial Medicine and Free Radical Research, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuang-Hui Yu
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yau-Huei Wei
- Center for Mitochondrial Medicine and Free Radical Research, Changhua Christian Hospital, Changhua, Taiwan.,Department of Biochemistry and Molecular Biology, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Hen-Hong Chang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
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17
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López-Medina C, Molto A, Sieper J, Duruöz T, Kiltz U, Elzorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compan V, Luo SF, Monti S, Tae-Jong K, Kishimoto M, Pimentel-Santos FM, Gu J, Schiotis R, van Gaalen FA, Geher P, Magrey M, Ibáñez Vodnizza SE, Bautista-Molano W, Maksymowych W, Machado PM, Landewé R, van der Heijde D, Dougados M. Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open 2021; 7:rmdopen-2020-001450. [PMID: 33462157 PMCID: PMC7816910 DOI: 10.1136/rmdopen-2020-001450] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world. METHODS Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated. RESULTS A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%). CONCLUSION These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France .,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.,Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University, Berlin, Germany
| | - Tuncay Duruöz
- PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey
| | - Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Najia Hajjaj-Hassouni
- Rheumatology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Ruben Burgos-Vargas
- Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
| | - José Maldonado-Cocco
- Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University and Mount Lebanon Hospital, Beirut, Lebanon
| | - Meghna Gavali
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Sara Monti
- Rheumatology Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy
| | - Kim Tae-Jong
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - F M Pimentel-Santos
- Rheumatology, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Jieruo Gu
- Rheumatology Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruxandra Schiotis
- Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Rheumatology Department, SCBI, Cluj-Napoca, Romania
| | - Floris A van Gaalen
- Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Geher
- Rheumatology Department, Semmelweis Egyetem, Budapest, Hungary
| | - Marina Magrey
- Rheumatology Department, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Wilson Bautista-Molano
- Rheumatology Department, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College of London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Robert Landewé
- Rheumatology, Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.,Rheumatology Department, Zuyderland MC, Heerlen, The Netherlands
| | | | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.,Rheumatology, Université de Paris Descartes, Paris, France
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18
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Huang YS, Tseng WY, Clanchy FIL, Topping LM, Ogbechi J, McNamee K, Perocheau D, Chiang NY, Ericsson P, Sundstedt A, Xue ZT, Salford LG, Sjögren HO, Stone TW, Lin HH, Luo SF, Williams RO. Pharmacological modulation of T cell immunity results in long-term remission of autoimmune arthritis. Proc Natl Acad Sci U S A 2021; 118:e2100939118. [PMID: 33941676 PMCID: PMC8126779 DOI: 10.1073/pnas.2100939118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 12/16/2022] Open
Abstract
Chronic inflammatory diseases like rheumatoid arthritis are characterized by a deficit in fully functional regulatory T cells. DNA-methylation inhibitors have previously been shown to promote regulatory T cell responses and, in the present study, we evaluated their potential to ameliorate chronic and acute animal models of rheumatoid arthritis. Of the drugs tested, decitabine was the most effective, producing a sustained therapeutic effect that was dependent on indoleamine 2,3-dioxygenase (IDO) and was associated with expansion of induced regulatory T cells, particularly at the site of disease activity. Treatment with decitabine also caused apoptosis of Th1 and Th17 cells in active arthritis in a highly selective manner. The molecular basis for this selectivity was shown to be ENT1, a nucleoside transporter, which facilitates intracellular entry of the drug and is up-regulated on effector T cells during active arthritis. It was further shown that short-term treatment with decitabine resulted in the generation of a population of regulatory T cells that were able to suppress arthritis upon adoptive transfer. In summary, a therapeutic approach using an approved drug is described that treats active inflammatory disease effectively and generates robust regulatory T cells with the IDO-dependent capacity to maintain remission.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Apoptosis/immunology
- Arthritis, Experimental/drug therapy
- Arthritis, Experimental/immunology
- Arthritis, Experimental/metabolism
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/immunology
- Autoimmune Diseases/metabolism
- DNA Demethylation/drug effects
- Decitabine/pharmacology
- Equilibrative Nucleoside Transporter 1/genetics
- Equilibrative Nucleoside Transporter 1/immunology
- Equilibrative Nucleoside Transporter 1/metabolism
- Humans
- Indoleamine-Pyrrole 2,3,-Dioxygenase/genetics
- Indoleamine-Pyrrole 2,3,-Dioxygenase/immunology
- Indoleamine-Pyrrole 2,3,-Dioxygenase/metabolism
- Male
- Mice, Inbred C57BL
- Mice, Inbred DBA
- Mice, Knockout
- Remission Induction
- T-Lymphocytes, Regulatory/cytology
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- Th1 Cells/cytology
- Th1 Cells/drug effects
- Th1 Cells/immunology
- Th17 Cells/cytology
- Th17 Cells/drug effects
- Th17 Cells/immunology
- Mice
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Affiliation(s)
- Yi-Shu Huang
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Wen-Yi Tseng
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Keelung, Keelung 20401, Taiwan
| | - Felix I L Clanchy
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - Louise M Topping
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Joy Ogbechi
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Kay McNamee
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Dany Perocheau
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Nien-Yi Chiang
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Peter Ericsson
- The Rausing Laboratory, Division of Neurosurgery, Department of Clinical Sciences, Lund University, SE-221 85 Lund, Sweden
| | - Anette Sundstedt
- The Rausing Laboratory, Division of Neurosurgery, Department of Clinical Sciences, Lund University, SE-221 85 Lund, Sweden
- Idogen AB, SE-223 81 Lund, Sweden
| | - Zhong-Tian Xue
- The Rausing Laboratory, Division of Neurosurgery, Department of Clinical Sciences, Lund University, SE-221 85 Lund, Sweden
| | - Leif G Salford
- The Rausing Laboratory, Division of Neurosurgery, Department of Clinical Sciences, Lund University, SE-221 85 Lund, Sweden
- Idogen AB, SE-223 81 Lund, Sweden
| | - Hans-Olov Sjögren
- The Rausing Laboratory, Division of Neurosurgery, Department of Clinical Sciences, Lund University, SE-221 85 Lund, Sweden
- Idogen AB, SE-223 81 Lund, Sweden
| | - Trevor W Stone
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom
| | - Hsi-Hsien Lin
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Keelung, Keelung 20401, Taiwan
- Department of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Richard O Williams
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, United Kingdom;
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19
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Wu CY, Yang HY, Luo SF, Lai JH. From Rheumatoid Factor to Anti-Citrullinated Protein Antibodies and Anti-Carbamylated Protein Antibodies for Diagnosis and Prognosis Prediction in Patients with Rheumatoid Arthritis. Int J Mol Sci 2021; 22:ijms22020686. [PMID: 33445768 PMCID: PMC7828258 DOI: 10.3390/ijms22020686] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease mainly involving synovial inflammation and articular bone destruction. RA is a heterogeneous disease with diverse clinical presentations, prognoses and therapeutic responses. Following the first discovery of rheumatoid factors (RFs) 80 years ago, the identification of both anti-citrullinated protein antibodies (ACPAs) and anti-carbamylated protein antibodies (anti-CarP Abs) has greatly facilitated approaches toward RA, especially in the fields of early diagnosis and prognosis prediction of the disease. Although these antibodies share many common features and can function synergistically to promote disease progression, they differ mechanistically and have unique clinical relevance. Specifically, these three RA associating auto-antibodies (autoAbs) all precede the development of RA by years. However, while the current evidence suggests a synergic effect of RF and ACPA in predicting the development of RA and an erosive phenotype, controversies exist regarding the additive value of anti-CarP Abs. In the present review, we critically summarize the characteristics of these autoantibodies and focus on their distinct clinical applications in the early identification, clinical manifestations and prognosis prediction of RA. With the advancement of treatment options in the era of biologics, we also discuss the relevance of these autoantibodies in association with RA patient response to therapy.
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Affiliation(s)
- Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33303, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Huang-Yu Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shue-Fen Luo
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
| | - Jenn-Haung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-8791-8382; Fax: +886-2-8791-8382
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Padua PF, Lin CC, Chien HT, Young CK, Kuo CF, See LC, Luo SF, Huang LH, Huang SF. Familial Aggregation of Head and Neck Cancer in Taiwan. Laryngoscope 2020; 131:806-812. [PMID: 32820835 DOI: 10.1002/lary.28992] [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: 05/28/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Head and neck cancer (HNC) incidence has been increasing worldwide. We investigated the familial aggregation of developing HNC if a first-degree relative (FDR) is affected in a large database. METHODS This retrospective study utilized Taiwan National Health Insurance Database to assemble a cohort of all registered beneficiaries from 1997 to 2013 and identified diagnosed HNC patients with affected FDRs. RESULTS Of the 55,916 individuals diagnosed with HNC, 566 (1.01%) had affected FDRs. There were 525 (0.56%) males and 41 (0.05%) females. Age of onset of HNC was found to be earlier for those with an affected FDR at the fourth decade of life compared to the general population. The adjusted relative risks (RRs) of an individual with an affected FDR to develop HNC is 2.04 (95% confidence interval [CI], 1.85-2.26): 2.07 (95% CI, 1.88-2.29) if the affected relative was male, and 1.74 (95% CI, 1.31-2.30) if the affected relative was female. The greatest risk to develop HNC is if the affected individual is a twin with adjusted RR 33.04 (95% CI, 12.89-84.69). This is followed by an affected sibling at RR (95% CI) 3.46 (1.68-7.13), offspring at RR 2.28 (95% CI, 1.94-2.69), and parent at RR 1.66 (95% CI, 1.48-1.87). CONCLUSION Familial tendency of HNC proves the probable contribution of genetic factors to develop cancer. In areca quid endemic region, there is a high likelihood that both environmental and genetic factors work in synergy to develop HNC. LEVEL OF EVIDENCE 3 Laryngoscope, 131:806-812, 2021.
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Affiliation(s)
- Paula Francezca Padua
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou branch, Taoyuan, Taiwan
| | - Chia-Chen Lin
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou branch, Taoyuan, Taiwan
| | - Hui-Tzu Chien
- Department of Nutrition and Health Sciences, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chi-Kuan Young
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Keelung branch, Keelung, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lu-Hsiang Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou branch, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
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21
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Hsieh AH, Kuo CF, Chou IJ, Tseng WY, Chen YF, Yu KH, Luo SF. Human cytomegalovirus pp65 peptide-induced autoantibodies cross-reacts with TAF9 protein and induces lupus-like autoimmunity in BALB/c mice. Sci Rep 2020; 10:9662. [PMID: 32541894 PMCID: PMC7295797 DOI: 10.1038/s41598-020-66804-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/20/2020] [Accepted: 05/11/2020] [Indexed: 12/30/2022] Open
Abstract
Human cytomegalovirus (HCMV) has been linked to the triggering of systemic lupus erythematosus (SLE). We proposed that B cell epitope region of HCMV phosphoprotein 65 (HCMVpp65)422-439 mimics an endogenous antigen and initiates lupus-like autoimmunity. Amino acid homology between HCMVpp65422-439 and TAF9134-144 (TATA-box binding protein associated factor 9, TAF9) was investigated using a similarity search in NCBI protein BLAST program (BLASTP). A murine model was used to confirm their antigenicity and ability to induce lupus-like symptoms. HCMVpp65422-439 induced immune responses with the presence of specific antibodies against HCMVpp65422-439 and TAF9134-144, as well as anti-nuclear and anti-double-stranded (ds)DNA antibodies that are characteristic of SLE. In addition, the majority of HCMVpp65422-439 and TAF9134-144 immunized mice developed proteinuria, and their renal pathology revealed glomerulonephritis with typical abnormalities, such as mesangial hypercellularity and immune complex deposition. Immunoglobulin eluted from the glomeruli of HCMVpp65422-439 immunized mice showed cross-reactivity with TAF9134-144 and dsDNA. Increased anti-TAF9 antibody activity was also observed in the sera from SLE patients compared with healthy people and disease controls. Molecular mimicry between HCMVpp65 peptide and host protein has the potential to drive lupus-like autoimmunity. This proof-of-concept study highlights the mechanisms underlying the link between HCMV infection and the induction of SLE.
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Affiliation(s)
- Ao-Ho Hsieh
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - I-Jun Chou
- Division of Clinical Neurology, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Yi Tseng
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Kennedy Institute, University of Oxford, Oxford, UK
| | - Yen-Fu Chen
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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22
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Chang YT, Wang HS, Liu JR, Tseng CN, Chou IJ, Luo SF, Kuo CF, See LC. Association of maternal ethnicity and urbanicity on severe pediatric disease: a nationwide cohort study. BMC Pediatr 2019; 19:514. [PMID: 31870333 PMCID: PMC6927117 DOI: 10.1186/s12887-019-1885-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A healthy migrant effect on birth outcomes has been reported, however, whether this protective effect persists throughout childhood is unknown. The effect of urbanicity on child health among an immigrant population is unclear. The objective of this study was to compare the incidence rate and cumulative incidence of severe diseases among urban children of Taiwan-born mothers, rural children of Taiwan-born mothers, urban children of foreign-born mothers, and rural children of foreign-born mothers. METHODS A nationwide cohort study was conducted for children born in Taiwan during 2004-2011 and follow-up till age 4 to 11 years old by linkage the Taiwan Birth Registry 2004-2011, Taiwan Death Registry 2004-2015, and National Health Insurance Research Database 2004-2015. Cox proportional hazards model (multivariable) was used to examine differences among the four study groups. RESULTS There were 682,982 urban children of Taiwan-born mothers, 662,818 rural children of Taiwan-born mothers, 61,570 urban children of foreign-born mothers, 87,473 rural children of foreign-born mothers. Children of foreign-born mothers had a lower incidence of vasculitis, mainly Kawasaki disease. The incidences of congenital disorders did not differ between children of foreign-born mothers and children of Taiwan-born mothers. The incidence of psychotic disorders was higher in urban children. However, children in rural areas had a higher incidence of major trauma/burn and a higher mortality rate. CONCLUSIONS A healthy migrant effect was only seen for Kawasaki disease. The mental health of urban children born to immigrant mothers warrants concern.
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Affiliation(s)
- Ya-Ting Chang
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Huei-Shyong Wang
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Nan Tseng
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiac Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - I-Jun Chou
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan. .,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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23
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Wei JCC, Liu CH, Tseng JC, Hsieh LF, Chen CH, Chen HH, Chen HA, Chen YC, Chou CT, Liao HT, Lin YC, Luo SF, Yang DH, Yeo KJ, Tsai WC. Taiwan Rheumatology Association consensus recommendations for the management of axial spondyloarthritis. Int J Rheum Dis 2019; 23:7-23. [PMID: 31777200 PMCID: PMC7004149 DOI: 10.1111/1756-185x.13752] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/31/2019] [Indexed: 12/16/2022]
Abstract
Aim To establish guidelines for the clinical management of axial spondyloarthritis that take into account local issues and clinical practice concerns for Taiwan. Method Overarching principles and recommendations were established by consensus among a panel of rheumatology and rehabilitation experts, based on analysis of the most up‐to‐date clinical evidence and the clinical experience of panelists. All Overarching Principles and Recommendations were graded according to the standards developed by the Oxford Centre for Evidence Based Medicine, and further evaluated and modified using the Delphi method. Results The guidelines specifically address issues such as local medical considerations, National Health Insurance reimbursement, and management of extra‐articular manifestations. Conclusion It is hoped that this will help to optimize clinical management outcomes for axial spondyloarthritis in Taiwan.
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Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hsiung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-An Chen
- Department of Allergy, Immunology, and Rheumatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Chou Chen
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology, Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chun Lin
- Department of Allergy, Immunology, and Rheumatology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jieh Yeo
- Division of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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24
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Chung TT, Yu KH, Kuo CF, Luo SF, Chiou MJ, Lan WC, Chen JS, Tseng WY, Hsieh AH, Wang LC. Impact of urate-lowering drugs on the progression and recovery from chronic kidney disease among gout patients. Arthritis Res Ther 2019; 21:210. [PMID: 31533805 PMCID: PMC6751683 DOI: 10.1186/s13075-019-1993-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/05/2019] [Indexed: 02/01/2023] Open
Abstract
Background This study investigates the association between exposure to urate-lowering drugs (ULDs) and progression and recovery from chronic kidney disease (CKD). Methods We identified 5860 incident gout patients at Chang Gung Memorial Hospital from 2012 to 2015. Propensity score (PS)-weighted Cox proportional hazards model was used to estimate hazard ratios (HRs) for CKD progression and improvement. A separate analysis was conducted to assess the HR for CKD progression and CKD recovery among those with worsening CKD. Results The incidence of CKD progression among allopurinol, febuxostat and uricosuric agent users were 1.98, 1.88 and 1.64 per 1000 person-days. Compared with allopurinol users, the PS-weighted HR (95% confidence intervals [CIs]) was 1.77 (0.85–1.76) for febuxostat users and 1.37 (0.71–1.37) for uricosuric agent users for CKD progression and 1.43 (1.26–1.62) for febuxostat users and 1.00 (0.88–1.14) for uricosuric agent users for CKD improvement. Compared to allopurinol users, the HRs for CKD progression were 1.14 (0.80–1.66) for febuxostat users and 0.92 (0.67–1.31) for uricosuric agent users. Among 741 patients who had CKD progression, the incidence of CKD recovery was 1.33, 6.21 and 3.53 per 1000 person-days for allopurinol, febuxostat and uricosuric agent users. The HRs (95% CIs) for recovery in febuxostat and uricosuric agent users were 2.17 (1.40–3.47) and 1.80 (1.20–2.83) compared to allopurinol users. Conclusions CKD progression and recovery are common in gout patients using ULDs. Febuxostat and benzbromarone were associated with a similar risk of CKD progression with allopurinol, which has a poorer recovery compared with other ULDs.
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Affiliation(s)
- Ting-Ting Chung
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan.,Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan. .,Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Meng-Jiun Chiou
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan.,Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Ching Lan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Sheng Chen
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan.,Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Yi Tseng
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Ao-Ho Hsieh
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Lian-Chin Wang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
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Kuo CF, Chou IJ, See LC, Chen JS, Yu KH, Luo SF, Hsieh AH, Zhang W, Doherty M. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology (Oxford) 2019; 57:2129-2139. [PMID: 30060176 PMCID: PMC6256332 DOI: 10.1093/rheumatology/key212] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/19/2018] [Indexed: 12/22/2022] Open
Abstract
Objectives To examine whether gout is an independent risk factor for total joint replacement (TJR) and whether urate-lowering treatment (ULT) reduces this risk. Methods Using the Taiwan National Health Insurance database and the UK Clinical Practice Research Datalink, 74 560 Taiwan patients and 34 505 UK patients with incident gout were identified and age and sex matched to people without gout. Cox proportional hazards models and condition logistic regression were used to examine the risk of TJR in gout patients and the association between cumulative defined daily dose (cDDD) of ULT and TJR. Results The prevalence rates of TJR in the patients at the time of diagnosis of gout and in people without gout were 1.16% vs 0.82% in Taiwan and 2.61% vs 1.76% in the UK. After a gout diagnosis, the incidence of TJR was higher in the patients with gout compared with those without (3.23 vs 1.91 cases/1000 person-years in Taiwan and 6.87 vs 4.61 cases/1000 person-years in the UK), with adjusted HRs of 1.56 (95% CI 1.45, 1.68) in Taiwan and 1.14 (1.05, 1.22) in the UK. Compared with patients with gout with <28 cDDD ULT, the adjusted ORs for TJR were 0.89 (95% CI 0.77, 1.03) for 28-90 cDDD, 1.03 (0.85, 1.24) for 90-180 cDDD and 1.12 (0.94, 1.34) for >180 cDDD ULT in Taiwan. In the UK, the respective ORs were 1.09 (0.83, 1.42), 0.93 (0.68, 1.27) and 1.08 (0.94, 1.24). Conclusion This population-based study provides evidence from two nation populations that gout confers significant TJR risk, which was not reduced by current ULT.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - I-Jun Chou
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Sheng Chen
- Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ao-Ho Hsieh
- Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Chang SH, Kuo CF, Chou IJ, See LC, Yu KH, Luo SF, Huang LH, Zhang W, Doherty M, Wen MS, Kuo CT, Yeh YH. Association of a Family History of Atrial Fibrillation With Incidence and Outcomes of Atrial Fibrillation: A Population-Based Family Cohort Study. JAMA Cardiol 2019; 2:863-870. [PMID: 28678986 DOI: 10.1001/jamacardio.2017.1855] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance The heritability of atrial fibrillation (AF), the contribution of genetic and environmental factors, and the association of a family history of AF with prognosis are unclear. Objectives To measure genetic and environmental factors in the familial aggregation of AF and to estimate the association of a family history of AF with major adverse cardiovascular events (MACE). Design, Setting, and Participants In this Taiwanese nationwide population-based study among more than 23 million people, a custom data set was obtained using the data of all patients having a diagnosis of AF recorded between January 1996 and December 2013 in the Taiwan National Health Insurance Research Database. The study population comprised all 23 422 955 individuals registered with the database in 2013, of whom 177 770 had a diagnosis of AF and were included in the heritability estimation. From the latter, a subgroup of patients having newly diagnosed AF with a first-degree relative affected by AF between 2000 and 2010 were selected and matched 1:4 to controls without a family history for estimating MACE-free survival. The dates of analysis were January 2010 to December 2013. Main Outcomes and Measures The prevalence and relative risk of AF in relatives of patients with AF, as well as the relative contributions of heritability and shared and nonshared environmental factors to AF susceptibility. Also measured was MACE-free survival after AF was diagnosed. Results In total, 1510 patients (204 [13.5%] female; mean [SD] age, 57.9 [9.2] years) had newly diagnosed AF with a first-degree relative affected by AF. Individuals with a first-degree relative affected by AF had a relative risk of 1.92 (95% CI, 1.84-1.99) for AF. The accountability for the phenotypic variance of AF was 19.9% for genetic factors (heritability), 3.5% for shared environmental factors, and 76.6% for nonshared environmental factors. After matching for age, sex, hypertension, type 2 diabetes, previous stroke, and anticoagulation, incident AF patients with vs without an affected first-degree relative had similar MACE-free survival. Conclusions and Relevance Genetic and environmental factors were associated with AF, with nonshared environmental factors accounting for three-fourths of the phenotypic variance in Taiwan. Patients having AF with a first-degree relative affected by AF did not have more MACE. Therefore, family history may not be particularly informative in the diagnosis or management of AF.
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Affiliation(s)
- Shang-Hung Chang
- Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Jun Chou
- Division of Pediatric Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lu-Hsiang Huang
- Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Weiya Zhang
- Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England
| | - Michael Doherty
- Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England
| | - Ming-Shien Wen
- Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tai Kuo
- Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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27
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Kishimoto M, Yoshida K, Ichikawa N, Inoue H, Kaneko Y, Kawasaki T, Matsui K, Morita M, Suda M, Tada K, Takizawa N, Tamura N, Taniguchi A, Taniguchi Y, Tsuji S, Haji Y, Rokutanda R, Yanaoka H, Cheung PP, Gu J, Kim TH, Luo SF, Okada M, López Medina C, Molto A, Dougados M, Kobayashi S, van der Heijde D, Tomita T. Clinical Characteristics of Patients with Spondyloarthritis in Japan in Comparison with Other Regions of the World. J Rheumatol 2019; 46:896-903. [DOI: 10.3899/jrheum.180412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 12/21/2022]
Abstract
Objective.To delineate clinical characteristics of patients with spondyloarthritis (SpA) in Japan in comparison to other areas of the world.Methods.Using the ASAS-COMOSPA (Assessment of Spondyloarthritis international Society–COMOrbidities in SPondyloArthritis) data, an international cross-sectional observational study of patients with SpA, we analyzed information on demographics, disease characteristics, comorbidities, and risk factors. Patients were classified by region: Japan, other Asian countries (China, Singapore, South Korea, Taiwan), and non-Asian countries (Europe, the Americas, Africa). Patient characteristics, including diagnosis and treatment, were compared.Results.Among 3984 patients included in the study, 161 were from centers in Japan, 933 from other Asian countries, and 2890 from other regions. Of patients with SpA in Japan, 42 (26.1%) had peripheral SpA, substantially more than in other countries. This trend was explained by the predominance of psoriatic arthritis (PsA) among Japanese patients with SpA. In contrast to the relatively low number in Japan, 54% of patients from other Asian countries had pure axial SpA (axSpA) without peripheral features. HLA-B27 testing, considered an integral part of the classification of axSpA, was performed in only 63.6% of Japanese patients with axSpA. More than half of Japanese patients with axSpA were classified using imaging criteria.Conclusion.In our study, there was a more substantial number of peripheral SpA cases observed in Japan compared to other parts of Asia and other regions of the world. Aside from ethnic differences, increasing recognition of PsA in Japan, as well as a potential underdiagnosis of axSpA due to the insufficient use of HLA-B27 testing, may partly explain regional discrepancies.
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Rovin BH, Solomons N, Pendergraft WF, Dooley MA, Tumlin J, Romero-Diaz J, Lysenko L, Navarra SV, Huizinga RB, Adzerikho I, Mikhailova E, Mitkovskaya N, Pimanov S, Soroka N, Bogov BI, Deliyska B, Ikonomov V, Tilkiyan E, Almeida R, Jimenez F, Teran F, Tchokhonelidze I, Tsiskarishvili N, Herrera Mendez M, Chavez Perez NN, Loaeza AR, Gutierrez Urena SR, Romero Diaz J, Araiza Casillas R, Madero Rovalo M, Niemczyk S, Sokalski A, Wiecek A, Klinger M, Bugrova OV, Chernykh TM, Kameneva TR, Lysenko LV, Raskina TA, ReshEtko OV, Vezikova NN, Kropotina TV, Maksudova AN, Marasaev V, Dobronravov VA, Gordeev I, EssAian AM, Frolov A, Jelacic R, Jovanovic D, Mitic B, Pekovic G, Radovic M, Radunovic G, Carreira P, Diaz Gonzalez F, Fulladosa X, Ucar E, De Silva S, Herath C, Hewageegana A, Nazar ALM, Wazil A, Dudar I, Godlevska O, Korneyeva S, Vasylets V, Sydor N, Kolesnyk M, Parikh SV, Olsen N, Ginzler EM, Tumlin JA, Saxena A, Saxena R, Lafayette RA, Pendergraft WF, Podoll AS, Arrey-Mensah AA, Bubb M, Grossman J, Oporta AI, Nami A, Rahman MM, Haq SA, Chan TMD, Temy MMY, Gomez HMP, Bermas J, Reyes BH, Hao LT, Roberto LC, Amante E, Navarra SV, Lanzon AE, Choe JY, Kang TY, Kim YS, Lee SG, Lee JS, Jun JCC, Vasudevan A, Luo SF, Cheng TT, Satirapoj B, Noppakun K. A randomized, controlled double-blind study comparing the efficacy and safety of dose-ranging voclosporin with placebo in achieving remission in patients with active lupus nephritis. Kidney Int 2019; 95:219-231. [DOI: 10.1016/j.kint.2018.08.025] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
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Kuo CF, Chou IJ, Grainge MJ, Luo SF, See LC, Yu KH, Zhang W, Doherty M, Valdes AM. Familial aggregation and heritability of type 1 diabetes mellitus and coaggregation of chronic diseases in affected families. Clin Epidemiol 2018; 10:1447-1455. [PMID: 30349392 PMCID: PMC6186906 DOI: 10.2147/clep.s172207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the extent of familial aggregation of type 1 diabetes (T1D) and coaggregation of related chronic diseases and assess the relative contribution of environmental and genetic factors on the risks. Patients and methods This population-based study used the Taiwan National Health Insurance database to reconstruct family structure and identify people with T1D and other chronic diseases between 1999 and 2015. Relative risks (RRs) for T1D and other chronic diseases and heritability of T1D were estimated. Heritability was estimated using the polygenic liability model. Results Validation of family structure found the positive predictive value to be 98.7% for maternal links and 98.6% for paternal links. Having an affected twin, first-degree relative, or spouse was associated with an adjusted RR (95% CI) of 553.66 (427.59–716.89), 32.49 (28.66–36.84), and 2.17 (0.31–15.40) for T1D, respectively. Based on the polygenic liability model, heritability, shared and non-shared contributions to T1D, and variances were 66.50%, 10.86%, and 22.64%, respectively. A family history of T1D was associated with an RR (95% CI) of 1.51 (1.20–1.89) for rheumatoid arthritis, 1.66 (1.21–2.26) for Sjögren’s syndrome, 1.48 (1.09–2.01) for systemic lupus erythematosus, 1.24 (1.14–1.35) for simple goiter, 1.16 (1.04–1.31) for non-toxic nodular goiter, 1.61 (1.49–1.74) for thyrotoxicosis, 1.78 (1.57–2.01) for acquired hypothyroidism, 1.66 (1.40–1.98) for thyroiditis, and 1.15 (0.97–1.37) for epilepsy. Conclusion These data highlight the importance of the genetic contribution to T1D and confirm the coaggregation of autoimmune and metabolic diseases with T1D.
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Affiliation(s)
- Chang-Fu Kuo
- Division or Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK, .,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Jun Chou
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Weiya Zhang
- Division or Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK,
| | - Michael Doherty
- Division or Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK,
| | - Ana M Valdes
- Division or Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK,
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Tsai PH, Yu KH, Chou IJ, Luo SF, Tseng WY, Huang LH, Kuo CF. Risk of autism spectrum disorder in children born to mothers with systemic lupus erythematosus and rheumatoid arthritis in Taiwan. Joint Bone Spine 2018; 85:599-603. [DOI: 10.1016/j.jbspin.2017.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/08/2017] [Indexed: 02/09/2023]
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Wu VCC, Chang SH, Kuo CF, Liu JR, Chen SW, Yeh YH, Luo SF, See LC. Suicide death rates in patients with cardiovascular diseases - A 15-year nationwide cohort study in Taiwan. J Affect Disord 2018; 238:187-193. [PMID: 29885608 DOI: 10.1016/j.jad.2018.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 12/08/2017] [Revised: 04/22/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The literature on suicide mortality rates in patients with cardiovascular diseases (CVDs) is limited. METHODS Taiwan National Health Insurance Research Database and Taiwan Death Registry were retrieved for patients with the 5 CVDs: congestive heart failure (CHF), acute myocardial infarction (AMI), ischemic stroke (IS), hemorrhagic stroke (HS), and pacemaker implantation (PMI) between January 1, 2001, and December 31, 2015. We excluded patients younger than 15 years old. The primary outcome was suicidal death. The standardized mortality ratio (SMR) was used to compare the risk of suicidal death in the 5 CVDs to the general population. RESULTS From 2001 to 2015, there were 212,206 patients with CHF, 178,894 patients with AMI, 475,359 patients with IS, 189,555 patients with HS, and 64,173 patients with PMI. The suicide death rate per 100,000 person-year, 95% CI was 59.6 (54.5-64.8) for those with CHF, 44.6 (40.1-49.1) for AMI, 57.6 (54.7-60.5) for IS, 44.6 (40.2-49.0) for HS, 54.0 (45.9-62.0) for PMI, and 20.3 (20.1-20.4) for the general population. Patients with CHF patients had the highest SMR (2.10), followed by IS (1.96), PMI (1.86), HS (1.65), and AMI (1.46). The SMRs for patients with CVDs peaked at year 2 after the diagnosis, declined for patients with AMI, IS, and HS, increased and decreased for PMI alternately, and reached very similar values all five CVDs after 10th year after the diagnosis. CONCLUSIONS Patients with acute CVD with AMI, IS, and HS had suicide death rates peaked early after diagnosis, but patients with chronic CVD with CHF and PMI had suicide death rates that increased progressively. In addition, patients with PMI, CHF, IS had highest association with psychiatric illness and patients with PMI who were of young to middle age had highest suicide death rate.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yung-Hsin Yeh
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
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Abstract
Mitochondria have been recognized as ancient bacteria that contain evolutionary endosymbionts. Metabolic pathways and inflammatory signals interact within mitochondria in response to different stresses, such as viral infections. In this commentary, we address several interesting questions, including (1) how do mitochondrial machineries participate in immune responses; (2) how do mitochondria mediate antiviral immunity; (3) what mechanisms involved in mitochondrial machinery, including the downregulation of mitochondrial DNA (mtDNA), disturbances of mitochondrial dynamics, and the induction of mitophagy and regulation of apoptosis, have been adopted by viruses to evade antiviral immunity; (4) what mechanisms involve the regulation of mitochondrial machineries in antiviral therapeutics; and (5) what are the potential challenges and perspectives in developing mitochondria-targeting antiviral treatments? This commentary provides a comprehensive review of the roles and mechanisms of mitochondrial machineries in immunity, viral infections and related antiviral therapeutics.
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Affiliation(s)
- Jenn-Haung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan, ROC; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Shue-Fen Luo
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Ling-Jun Ho
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Taiwan, ROC.
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Lai JH, Wang MY, Huang CY, Wu CH, Hung LF, Yang CY, Ke PY, Luo SF, Liu SJ, Ho LJ. Infection with the dengue RNA virus activates TLR9 signaling in human dendritic cells. EMBO Rep 2018; 19:embr.201846182. [PMID: 29880709 DOI: 10.15252/embr.201846182] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/14/2018] [Accepted: 05/18/2018] [Indexed: 01/03/2023] Open
Abstract
Toll-like receptors (TLRs) are important sensors that recognize pathogen-associated molecular patterns. Generally, TLR9 is known to recognize bacterial or viral DNA but not viral RNA and initiate an immune response. Herein, we demonstrate that infection with dengue virus (DENV), an RNA virus, activates TLR9 in human dendritic cells (DCs). DENV infection induces release of mitochondrial DNA (mtDNA) into the cytosol and activates TLR9 signaling pathways, leading to production of interferons (IFNs). The DENV-induced mtDNA release involves reactive oxygen species generation and inflammasome activation. DENV infection disrupts the association between transcription factor A mitochondria (TFAM) and mtDNA and activates the mitochondrial permeability transition pores. The side-by-side comparison of TLR9 and cyclic GMP-AMP synthase (cGAS) knockdown reveals that both cGAS and TLR9 comparably contribute to DENV-induced immune activation. The significance of TLR9 in DENV-induced immune response is also confirmed in examination with the bone marrow-derived DCs prepared from Tlr9-knockout mice. Our study unravels a previously unrecognized phenomenon in which infection with an RNA virus, DENV, activates TLR9 signaling by inducing mtDNA release in human DCs.
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Affiliation(s)
- Jenn-Haung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan .,Graduate Institute of Clinical Research, National Defense Medical Center, Taipei, Taiwan
| | - Mei-Yi Wang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
| | - Chuan-Yueh Huang
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Miaoli, Taiwan
| | - Chien-Hsiang Wu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
| | - Li-Feng Hung
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Miaoli, Taiwan
| | - Chia-Ying Yang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
| | - Po-Yuan Ke
- Department of Biochemistry & Molecular Biology, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shue-Fen Luo
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
| | - Shih-Jen Liu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Ling-Jun Ho
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Miaoli, Taiwan
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Chou IJ, Kuo CF, Huang YS, Grainge MJ, Valdes AM, See LC, Yu KH, Luo SF, Huang LS, Tseng WY, Zhang W, Doherty M. Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophr Bull 2017; 43:1070-1078. [PMID: 27872260 PMCID: PMC5581894 DOI: 10.1093/schbul/sbw159] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Strong familial aggregation of schizophrenia has been reported but there is uncertainty concerning the degree of genetic contribution to the phenotypic variance of the disease. This study aimed to examine the familial aggregation and heritability of schizophrenia, and the relative risks (RRs) of other psychiatric diseases, in relatives of people with schizophrenia using the Taiwan National Health Insurance Database. The study population included individuals with affected first-degree or second-degree relatives identified from all beneficiaries (n = 23 422 955) registered in 2013. Diagnoses of schizophrenia made by psychiatrists were ascertained between January 1, 1996 and December 31, 2013. Having an affected co-twin, first-degree relative, second-degree relative, or spouse was associated with an adjusted RR (95% CI) of 37.86 (30.55-46.92), 6.30 (6.09-6.53), 2.44 (1.91-3.12), and 1.88 (1.64-2.15), respectively. Compared with the general population, individuals with one affected first-degree relative had a RR (95% CI) of 6.00 (5.79-6.22) and those with 2 or more had a RR (95% CI) of 14.66 (13.00-16.53) for schizophrenia. The accountability for the phenotypic variance of schizophrenia was 47.3% for genetic factors, 15.5% for shared environmental factors, and 37.2% for non-shared environmental factors. The RR (95% CI) in individuals with a first-degree relative with schizophrenia was 3.49 (3.34-3.64) for mood disorders and 3.91 (3.35-4.57) for delusional disorders. A family history of schizophrenia is therefore associated with a higher risk of developing schizophrenia, mood disorders, and delusional disorders. Heritability and environmental factors each account for half of the phenotypic variance of schizophrenia.
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Affiliation(s)
- I-Jun Chou
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK;,Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;,These authors contributed equally to the article. Joint senior authors: W.Z. and M.D
| | - Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK;,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;,These authors contributed equally to the article. Joint senior authors: W.Z. and M.D
| | - Yu-Shu Huang
- Department of Child Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan;,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ana M Valdes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;,Department of Public Health, College of Medicine and Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;,School of Medicine, Chang Gung University, Taoyuan, Taiwan;,To whom correspondence should be addressed; Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan, Taoyuan City 333, Taiwan; tel: +886-3-3281200 ext 8811, fax: +886-3-3277970, e-mail:
| | - Lu-Shuang Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Yi Tseng
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK;,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
BACKGROUND Congenital heart defects (CHD) are known to cluster within families, but existing evidence varies for the estimates of familial relative risk (RR). We aimed to examine familial aggregation and heritability of CHD in the general population of Taiwan.Methods and Results:We conducted a population-based family study using the Taiwan National Health Insurance (NHI) research database. Individuals with affected first-degree (n=295,636) or second-degree (n=73,985) relatives were identified from all NHI beneficiaries (n=23,422,955) registered in 2012. Diagnoses of CHD for all study subjects were ascertained between January 1, 1996 and December 31, 2012. Having a twin, a first-degree relative and an affected second-degree relative were associated with an adjusted RR of 12.03 (11.59-12.49), 4.91 (4.85-4.97) and 1.21 (1.14-1.28) for CHD, respectively. Individuals with 1 affected first-degree relative had a RR of 4.78 (4.72-4.84), and those with ≥2 had an RR of 7.10 (6.77-7.45) for CHD. The estimated accountability for phenotypic variance of CHD was 37.3% for familial transmission and 62.8% for non-shared environmental factors. CONCLUSIONS Our results indicated that CHD tend to cluster within families, and approximately one-third of phenotypic variance was explained by familial factors.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Yu-Sheng Lin
- Healthcare Center, Chang Gung Memorial Hospital.,Division of Internal Medicine, Chang Gung Memorial Hospital
| | | | - I-Jun Chou
- Division of Pediatric Neurology, Chang Gung Memorial Hospital
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Lai-Chu See
- Department of Public Health, College of Medicine and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Lu-Shuang Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Pao-Hsien Chu
- Healthcare Center, Chang Gung Memorial Hospital.,Division of Cardiology, Chang Gung Memorial Hospital.,Heart Failure Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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Huang SF, Hsiao JH, Young CK, Chien HT, Kuo CF, See LC, Luo SF, Huang LH, Liao CT, Chang TCJ. Familial aggregation of nasopharyngeal carcinoma in Taiwan. Oral Oncol 2017; 73:10-15. [PMID: 28939060 DOI: 10.1016/j.oraloncology.2017.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/13/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of nasopharyngeal carcinoma (NPC) is higher in Chinese than in Caucasian populations. Genetic, viral, and lifestyle factors may explain these ethnic differences in the incidence of NPC. In the present study, we examined the familial aggregation, heritability, and relative risks (RRs) of NPC using a nationwide database in Taiwan. METHODS A population-based family study was conducted using the Taiwan National Health Insurance Research Database. Participants included all individuals (N=23,422,955) registered with that database in 2013; of these, 17,653 had NPC. Among them, 47.45%, 57.45%, 47.29%, and 1.51% had a parent, child, sibling, and twin, respectively, with NPC. RESULTS Among the approximately 23 million Taiwan NHI beneficiaries in 2013, the relative risks (RRs) (95% confidence intervals) for NPC were 34.46 (5.12-231.77) for twins of the patients, 9.23 (6.34-13.43) for siblings, 3.80 (2.97-4.86) for parents, 3.74 (2.60-5.37) for offspring, and 1.78 (1.16-2.74) for spouses without genetic similarity. The mean age of onset in first-degree relative-affected NPC patients was 35.5years compared to 39.0years for NPC patients without affected first-degree relatives (p≤0.0001). Using a threshold liability model, the accountability for phenotypic variance of NPC was estimated to be 61.3% for genetic factors (heritability), 13.9% for shared environmental factors, and 24.8% for non-shared environmental factors. The probability of a patient with NPC to be sporadic was 82.8%. CONCLUSION This population-based analysis suggested a strong familial tendency in the development of NPC. Screening of first-degree relatives of NPC patients is recommended, particularly in endemic regions.
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Affiliation(s)
- Shiang-Fu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou Branch, Taoyuan, Taiwan; Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Jen-Hao Hsiao
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou Branch, Taoyuan, Taiwan
| | - Chi-Kuan Young
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Keelung Branch, Keelung, Taiwan
| | - Hui-Tzu Chien
- Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lu-Hsiang Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Linkou Branch, Taoyuan, Taiwan
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Kuo CF, Grainge MJ, Valdes AM, See LC, Yu KH, Shaw SWS, Luo SF, Zhang W, Doherty M. Familial aggregation of rheumatoid arthritis and co-aggregation of autoimmune diseases in affected families: a nationwide population-based study. Rheumatology (Oxford) 2017; 56:928-933. [PMID: 28160009 DOI: 10.1093/rheumatology/kew500] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 06/30/2016] [Indexed: 11/12/2022] Open
Abstract
Objective The aim was to estimate familial relative risk (RR) for RA and other autoimmune diseases and the genetic contribution to RA phenotypic variance (heritability). Methods This study used the Taiwan National Health Insurance Research Database to identify all National Health Insurance registered beneficiaries (n = 23 658 577) in 2010; among them, 37 482 individuals had RA. We estimated familial RRs and 95% CIs of RA and other autoimmune diseases using marginal Cox proportional models and heritability of RA using a threshold liability model. Results The RR (95% CI) for RA was 328.27 (135.95, 795.63) for twins of RA patients; 11.97 (8.68, 16.52) for siblings; 4.86 (4.16, 5.67) for parents; 4.65 (3.92, 5.50) for offspring; and 2.32 (1.83, 2.95) for spouses. Using a threshold liability model, we estimated that familial transmission was 59.4% (95% CI: 50.3, 69.5%) and that heritability was 43.5% (33.9, 54.1%). The RR (95% CI) in individuals with a first-degree relative with RA was 2.91 (2.49, 3.42) for SLE; 2.92 (1.62, 5.25) for SSc; 3.13 (2.50, 3.93) for primary SS; 0.95 (0.36, 2.51) for idiopathic inflammatory myositis; 1.96 (1.54, 2.48) for type 1 diabetes mellitus; 3.32 (1.82, 5.95) for multiple sclerosis; 1.31 (1.31, 2.43) for IBD; 2.76 (2.46, 3.10) for AS; and 1.65 (1.54, 1.77) for psoriasis. Conclusion The risks of RA and other autoimmune diseases increased in individuals with an RA family history. Approximately two-thirds of RA phenotypic variation is explained by familial factors.
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Affiliation(s)
- Chang-Fu Kuo
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ana M Valdes
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lai-Chu See
- Department of Public Health, College of Medicine.,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - S W Steven Shaw
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
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Kuo CF, Luo SF, Yu KH, See LC, Zhang W, Doherty M. Familial risk of systemic sclerosis and co-aggregation of autoimmune diseases in affected families. Arthritis Res Ther 2016; 18:231. [PMID: 27729087 PMCID: PMC5059914 DOI: 10.1186/s13075-016-1127-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a rare and devastating disease affecting skin and internal organs. Familial aggregation of SSc and co-aggregation with other autoimmune diseases is rarely reported. Methods We identified 23,658,577 beneficiaries registered with the National Health Insurance database in 2010, 1891 of whom had SSc. We identified 21,009,551 parent–child relationships and 17,168,340 full sibling pairs. The familial risks of SSc and other autoimmune diseases and familial transmission were estimated. Results The prevalence of SSc in the general population was 0.008 %. There are 3801 individuals had at least one first-degree relative with SSc, among them 3 people had SSc which was equivalent to a prevalence of 0.08 %. The adjusted relative risk (RR) (95 % CI) for SSc was 81.21 (11.40–579.72) for siblings of SSc patients. The familial transmission (genetic plus shared environmental contribution to total phenotypic variance of SSc) was 0.72. However, 84.1 % of patients were expected to be sporadic cases. The RR (95 % CI) in first-degree relatives of SSc patients was 2.64 (1.46–4.75) for rheumatoid arthritis, 6.51 (4.05–10.46) for systemic lupus erythematosus, 2.77 (1.04–7.35) for Sjögren’s syndrome, 8.05 (2.03–31.92) for idiopathic inflammatory myositis, and 1.52 (1.15–2.01) for psoriasis. Conclusions The risks of SSc and other autoimmune diseases are increased in relatives of people with SSc, and family factors explain over two-thirds of the phenotypic variance of the disease. These findings may be useful in counselling families of patients with SSc and for further genetic studies.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, NG51PD, Academic Rheumatology, Clinical Sciences Building, City Hospital, Nottingham, NG51PB, Nottingham, UK.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine and Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, NG51PD, Academic Rheumatology, Clinical Sciences Building, City Hospital, Nottingham, NG51PB, Nottingham, UK.
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, NG51PD, Academic Rheumatology, Clinical Sciences Building, City Hospital, Nottingham, NG51PB, Nottingham, UK
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Fang YF, Wu YJJ, Kuo CF, Luo SF, Yu KH. Malignancy in dermatomyositis and polymyositis: analysis of 192 patients. Clin Rheumatol 2016; 35:1977-1984. [PMID: 27210465 DOI: 10.1007/s10067-016-3296-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 09/06/2015] [Revised: 04/18/2016] [Accepted: 05/01/2016] [Indexed: 12/15/2022]
Abstract
This study aims to investigate the prevalence and predictive risk factors of malignancy in patients with polymyositis (PM) and dermatomyositis (DM). The medical records of 192 PM/DM patients followed up in a medical center between January 2000 and December 2013 were reviewed. Among the 192 patients, 33 patients (17.2 %) had associated cancer. Both PM and DM are significantly associated with cancer, although the risk of cancer appears to be somewhat higher among patients with DM (23.0 %) than among those with PM (8.9 %). Nasopharyngeal cancer (30.3 %) and breast cancer (18.2 %) comprised the most common malignant diseases associated with PM/DM. Univariate analysis showed that an older age at PM/DM onset, heliotrope rash, Gottron's sign, dysphagia, and low creatine phosphokinase (CPK) level were associated with increased malignancy. Multivariate analysis revealed that independent predictors of malignancy in PM/DM were age >40 years at PM/DM onset (adjusted OR 3.44; 95 % CI 1.08-10.98; p = 0.037) and heliotrope rash (adjusted OR 2.96; 95 % CI 1.04-8.43; p = 0.042). During the follow-up period, 66 (34.4 %) patients died and the overall patient survival rates were 83.1 % at 1 year, 78.9 % at 2 years, 74.2 % at 5 years, and 65.5 % at 10 years. This study demonstrates a high frequency of malignancy (17.2 %) in DM/PM patients. Nasopharyngeal cancer and breast cancer were the most common cancer types in DM/PM patients in our study. Cancer screening should be offered to patients with newly diagnosed DM/PM. Moreover, all patients should be evaluated for the possibility of an underlying malignancy during treatment.
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Affiliation(s)
- Yao-Fan Fang
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan
| | - Yeong-Jian Jan Wu
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan.,Division of Rheumatology, Allergy, and Immunology, Keelung Branch of Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang-Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kuei-Shan (333), Taoyuan, Taiwan.
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Chang HH, Luo SF, Hsue YT, Chang CM, Lee TY, Huang YC, Hsu ML, Chen YJ. Modulation of Endothelial Injury Biomarkers by Traditional Chinese Medicine LC in Systemic Lupus Erythematosus Patients Receiving Standard Treatments. Sci Rep 2016; 6:19622. [PMID: 26847148 PMCID: PMC4742818 DOI: 10.1038/srep19622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/10/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022] Open
Abstract
LC is an herbal remedy effectively reduced therapeutic dosage of glucocorticoid for systemic lupus erythematosus (SLE) patients in clinical trial (ISRCTN81818883). This translational research examined the impact of LC on biomarkers of endothelial injury in the enrolled subjects. Fifty seven patients with SLE were randomized to receive standard treatment without or with LC supplements. Blood samples were taken serially for quantification of endothelial progenitor cells (EPCs), circulating endothelial cells (CECs) and serological factors. The proportion of EPCs in the placebo group continued to increase during trial and was further elevated after withdrawal of standard treatment. The EPC ratio of LC group remained stationary during the entire observation period. The CEC ratio in placebo group exhibited an increasing trend whereas that in LC group declined. The ratio of apoptotic CECs had an increasing trend in both groups, to a lesser extent in LC group. After treatment, the levels of VEGF and IL-18 have a trend declined to a level lower in the LC group than the placebo group. No significant alteration was noted in serum levels of IFN-α, IL-1β and IL-6. The reduction of the steroid dosage by adding LC might be correlated with less extensive endothelial injury in SLE patients.
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Affiliation(s)
- Hen-Hong Chang
- Research Center for Chinese Medicine and Acupuncture, and School of Chinese Medicine, China Medical University, Taichung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou branch, Taoyuan, Taiwan
| | - Yin-Tzu Hsue
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Mao Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzung-Yan Lee
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuen Huang
- Department of Medical Research, China Medial University Hospital, Taichung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Ling Hsu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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Moltó A, Etcheto A, van der Heijde D, Landewé R, van den Bosch F, Bautista Molano W, Burgos-Vargas R, Cheung PP, Collantes-Estevez E, Deodhar A, El-Zorkany B, Erdes S, Gu J, Hajjaj-Hassouni N, Kiltz U, Kim TH, Kishimoto M, Luo SF, Machado PM, Maksymowych WP, Maldonado-Cocco J, Marzo-Ortega H, Montecucco CM, Ozgoçmen S, van Gaalen F, Dougados M. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis 2015; 75:1016-23. [PMID: 26489703 DOI: 10.1136/annrheumdis-2015-208174] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/26/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increased risk of some comorbidities has been reported in spondyloarthritis (SpA). Recommendations for detection/management of some of these comorbidities have been proposed, and it is known that a gap exists between these and their implementation in practice. OBJECTIVE To evaluate (1) the prevalence of comorbidities and risk factors in different countries worldwide, (2) the gap between available recommendations and daily practice for management of these comorbidities and (3) the prevalence of previously unknown risk factors detected as a result of the present initiative. METHODS Cross-sectional international study with 22 participating countries (from four continents), including 3984 patients with SpA according to the rheumatologist. STATISTICAL ANALYSIS The prevalence of comorbidities (cardiovascular, infection, cancer, osteoporosis and gastrointestinal) and risk factors; percentage of patients optimally monitored for comorbidities according to available recommendations and percentage of patients for whom a risk factor was detected due to this study. RESULTS The most frequent comorbidities were osteoporosis (13%) and gastroduodenal ulcer (11%). The most frequent risk factors were hypertension (34%), smoking (29%) and hypercholesterolaemia (27%). Substantial intercountry variability was observed for screening of comorbidities (eg, for LDL cholesterol measurement: from 8% (Taiwan) to 98% (Germany)). Systematic evaluation (eg, blood pressure (BP), cholesterol) during this study unveiled previously unknown risk factors (eg, elevated BP (14%)), emphasising the suboptimal monitoring of comorbidities. CONCLUSIONS A high prevalence of comorbidities in SpA has been shown. Rigorous application of systematic evaluation of comorbidities may permit earlier detection, which may ultimately result in an improved outcome of patients with SpA.
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Affiliation(s)
- Anna Moltó
- Rheumatology B Department, Paris Descartes University, Cochin Hospital, AP-HP, Paris, France INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Adrien Etcheto
- Rheumatology B Department, Paris Descartes University, Cochin Hospital, AP-HP, Paris, France INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | - Robert Landewé
- ARC, Amsterdam & Atrium MC Heerlen, Amsterdam, The Netherlands
| | | | | | - Ruben Burgos-Vargas
- Servicio de Reumatologia, Hospital General de México and Universidad Nacional Autonoma de México, México City, Mexico
| | - Peter P Cheung
- Division of Rheumatology, National University Hospital, Singapore, Singapore
| | - Eduardo Collantes-Estevez
- Rheumatology Department, Reina Sofia Hospital; Maimonides Institute for Biomedical Research of Cordoba/University of Cordoba, Cordoba, Spain
| | - Atul Deodhar
- Div Arthritis/Rheumatic Diseases (OPO9), Oregon Health and Science University, Portland, USA
| | | | | | - Jieruo Gu
- Division of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guanzhou, China
| | - Najia Hajjaj-Hassouni
- Department of Rheumatology, Mohamed Vth University, URAC 30, El Ayachi Hospital, Salé, Morocco Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Mitsumasa Kishimoto
- Immuno-Rheumatology Center, St Luke's International Hospital, St Luke's International University, Tokyo, Japan
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
| | - Pedro M Machado
- Department of Rheumatology, University of Coimbra, Coimbra, Portugal University College London, London, UK
| | | | - José Maldonado-Cocco
- Rheumatology Section, Instituto de Rehabilitacion Psicofisica and Argentine Rheumatologic Foundation "Dr Osvaldo Carcia Morteo", Buenos Aires, Argentina
| | - Helena Marzo-Ortega
- NIHR-Leeds Musculoskeletal Biomedical research Unit, Leeds Institute of Molecular Medicina, University of Leeds, Leeds, UK
| | | | - Salih Ozgoçmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Floris van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maxime Dougados
- Rheumatology B Department, Paris Descartes University, Cochin Hospital, AP-HP, Paris, France INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
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Ko TM, Tsai CY, Chen SY, Chen KS, Yu KH, Chu CS, Huang CM, Wang CR, Weng CT, Yu CL, Hsieh SC, Tsai JC, Lai WT, Tsai WC, Yin GD, Ou TT, Cheng KH, Yen JH, Liou TL, Lin TH, Chen DY, Hsiao PJ, Weng MY, Chen YM, Chen CH, Liu MF, Yen HW, Lee JJ, Kuo MC, Wu CC, Hung SY, Luo SF, Yang YH, Chuang HP, Chou YC, Liao HT, Wang CW, Huang CL, Chang CS, Lee MTM, Chen P, Wong CS, Chen CH, Wu JY, Chen YT, Shen CY. Use of HLA-B*58:01 genotyping to prevent allopurinol induced severe cutaneous adverse reactions in Taiwan: national prospective cohort study. BMJ 2015; 351:h4848. [PMID: 26399967 PMCID: PMC4579807 DOI: 10.1136/bmj.h4848] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the use of prospective screening for the HLA-B*58:01 allele to identify Taiwanese individuals at risk of severe cutaneous adverse reactions (SCARs) induced by allopurinol treatment. DESIGN National prospective cohort study. SETTING 15 medical centres in different regions of Taiwan, from July 2009 to August 2014. PARTICIPANTS 2926 people who had an indication for allopurinol treatment but had not taken allopurinol previously. Participants were excluded if they had undergone a bone marrow transplant, were not of Han Chinese descent, and had a history of allopurinol induced hypersensitivity. DNA purified from 2910 participants' peripheral blood was used to assess the presence of HLA-B*58:01. MAIN OUTCOME MEASURES Incidence of allopurinol induced SCARs with and without screening. RESULTS Participants who tested positive for HLA-B*58:01 (19.6%, n=571) were advised to avoid allopurinol, and were referred to an alternate drug treatment or advised to continue with their prestudy treatment. Participants who tested negative (80.4%, n=2339) were given allopurinol. Participants were interviewed once a week for two months to monitor symptoms. The historical incidence of allopurinol induced SCARs, estimated by the National Health Insurance research database of Taiwan, was used for comparison. Mild, transient rash without blisters developed in 97 (3%) participants during follow-up. None of the participants was admitted to hospital owing to adverse drug reactions. SCARs did not develop in any of the participants receiving allopurinol who screened negative for HLA-B*58:01. By contrast, seven cases of SCARs were expected, based on the estimated historical incidence of allopurinol induced SCARs nationwide (0.30% per year, 95% confidence interval 0.28% to 0.31%; P=0.0026; two side one sample binomial test). CONCLUSIONS Prospective screening of the HLA-B*58:01 allele, coupled with an alternative drug treatment for carriers, significantly decreased the incidence of allopurinol induced SCARs in Taiwanese medical centres.
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Affiliation(s)
- Tai-Ming Ko
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei Faculty of Medicine, National Yang Ming University, Taipei
| | | | | | | | - Chih-Sheng Chu
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Chung-Ming Huang
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan China Medical University Hospital, Taichung
| | | | - Chia-Tse Weng
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chia-Li Yu
- National Taiwan University Hospital, Taipei
| | | | - Jer-Chia Tsai
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Wen-Ter Lai
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Wen-Chan Tsai
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | | | - Tsan-Teng Ou
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Kai-Hung Cheng
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Jeng-Hsien Yen
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Teh-Ling Liou
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei
| | - Tsung-Hsien Lin
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Der-Yuan Chen
- Faculty of Medicine, National Yang Ming University, Taipei Department of Medical Education and Research, and Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, National Chung Hsing University, Taichung
| | - Pi-Jung Hsiao
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Meng-Yu Weng
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ming Chen
- Faculty of Medicine, National Yang Ming University, Taipei Department of Medical Education and Research, and Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, National Chung Hsing University, Taichung
| | | | - Ming-Fei Liu
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsueh-Wei Yen
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Jia-Jung Lee
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung
| | - Chen-Ching Wu
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Shih-Yuan Hung
- Division of Nephrology, E-Da Hospital, Kaohsiung School of Medicine, I-Shou University, Kaohsiung
| | - Shue-Fen Luo
- Chang Gung Memorial Hospital, Taoyuan, Taiwan Chang Gung University, Taoyuan
| | - Ya-Hui Yang
- Department of Occupational Safety and Hygiene, Fooyin University, Kaohsiung Department of Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hui-Ping Chuang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Yi-Chun Chou
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Hung-Ting Liao
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Chia-Wen Wang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Chun-Lin Huang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Chia-Shuo Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Ming-Ta Michael Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan Laboratory for International Alliance on Genomic Research, Core for Genomic Medicine, RIKEN Centre for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Pei Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Chih-Shung Wong
- Department of Anaesthesiology, Cathay General Hospital, Taipei PharmiGene, Taipei
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan School of Chinese Medicine, China Medical University, Taichung
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan School of Chinese Medicine, China Medical University, Taichung
| | - Yuan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Chen-Yang Shen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan College of Public Health, China Medical University Hospital, Taichung Taiwan Biobank, Academia Sinica, Taipei
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Kuo CF, Grainge MJ, Valdes AM, See LC, Luo SF, Yu KH, Zhang W, Doherty M. Familial Risk of Sjögren's Syndrome and Co-aggregation of Autoimmune Diseases in Affected Families: A Nationwide Population Study. Arthritis Rheumatol 2015; 67:1904-12. [PMID: 25940005 PMCID: PMC5034806 DOI: 10.1002/art.39127] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/19/2015] [Indexed: 01/02/2023]
Abstract
Objective To investigate familial aggregation of Sjögren's syndrome (SS) and the relative risks (RRs) of other autoimmune disease in relatives of patients with SS. Methods We identified 23,658,577 beneficiaries enrolled in the Taiwan National Health Insurance system in 2010, of whom 12,754 had SS. We identified 21,009,551 parent–child relationships and 17,168,340 pairs of full siblings. The familial risks of SS and other autoimmune diseases, tetrachoric correlation, and familial transmission were estimated. Results We identified 105 patients with SS who had an affected first‐degree relative. The RR of SS was 18.99 (95% confidence interval [95% CI] 9.76–36.93) in siblings of patients with SS, 11.31 (95% CI 8.34–15.33) in offspring, and 12.46 (95% CI 9.34–16.62) in parents. Tetrachoric correlation coefficients were 0.53 (95% CI 0.41–0.65) for cotwins of affected individuals and 0.21 (95% CI 0.16–0.26) for full siblings. The familial transmission (heritability plus shared environmental contribution) was 0.54 (95% CI 0.44–0.77). In first‐degree relatives of patients with SS, the RRs were 2.95 (95% CI 2.33–3.73) for rheumatoid arthritis, 6.25 (95% CI 5.15–7.58) for systemic lupus erythematosus, 2.39 (95% CI 0.77–7.41) for systemic sclerosis, 0.71 (95% CI 0.10–5.07) for idiopathic inflammatory myopathy, 1.97 (95% CI 1.29–3.02) for type 1 diabetes mellitus, 3.38 (95% CI 1.26–9.05) for multiple sclerosis, 1.67 (95% CI 0.83–3.33) for myasthenia gravis, 1.25 (95% CI 1.04–1.50) for psoriasis, 1.21 (95% CI 0.39–3.76) for inflammatory bowel disease, and 2.29 (95% CI 1.19–4.40) for vasculitis. Conclusion The risk of SS and other autoimmune diseases is increased in relatives of patients with SS, and more than one‐half of phenotypic variance in SS can be explained by familial factors.
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Affiliation(s)
- Chang-Fu Kuo
- University of Nottingham, Nottingham, UK, and Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | | | | | | | - Shue-Fen Luo
- Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kuang-Hui Yu
- Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Lau CS, Chia F, Harrison A, Hsieh TY, Jain R, Jung SM, Kishimoto M, Kumar A, Leong KP, Li Z, Lichauco JJ, Louthrenoo W, Luo SF, Nash P, Ng CT, Park SH, Suryana BPP, Suwannalai P, Wijaya LK, Yamamoto K, Yang Y, Yeap SS. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis 2015; 18:685-713. [DOI: 10.1111/1756-185x.12754] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chak Sing Lau
- Division of Rheumatology and Clinical Immunology; Queen Mary Hospital; University of Hong Kong; Hong Kong
| | - Faith Chia
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Andrew Harrison
- Department of Medicine; University of Otago Wellington; Wellington South New Zealand
| | - Tsu-Yi Hsieh
- Section of Allergy, Immunology and Rheumatology, and Section of Clinical Skills Training; Taichung Veterans General Hospital; Taichung Taiwan
| | | | - Seung Min Jung
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | | | - Ashok Kumar
- Department of Rheumatology; Fortis Flt. Lt Rajan Dhall Hospital; New Delhi India
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Zhanguo Li
- Department of Rheumatology; Peking University People's Hospital; Beijing China
| | | | - Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology; Chang Gung Memorial Hospital and Chang Gung University; Tao-Yuan Taiwan
| | - Peter Nash
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Chin Teck Ng
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Sung-Hwan Park
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | - Bagus Putu Putra Suryana
- Rheumatology Division; Department of Internal Medicine; Brawijaya University; Saiful Anwar General Hospital; Malang Indonesia
| | - Parawee Suwannalai
- Allergy, Immunology and Rheumatology Division; Internal Medicine Department; Faculty of Medicine; Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Linda Kurniaty Wijaya
- Division of Rheumatology; Department of Internal Medicine; University of Indonesia; Jakarta Indonesia
| | - Kazuhiko Yamamoto
- Department of Allergy and Rheumatology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yue Yang
- Department of Rheumatology; Peking University People's Hospital; Beijing China
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Kuo CF, Grainge MJ, Valdes AM, See LC, Luo SF, Yu KH, Zhang W, Doherty M. Familial Aggregation of Systemic Lupus Erythematosus and Coaggregation of Autoimmune Diseases in Affected Families. JAMA Intern Med 2015; 175:1518-26. [PMID: 26193127 DOI: 10.1001/jamainternmed.2015.3528] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Relatives of patients with systemic lupus erythematosus (SLE) appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable. Furthermore, relative contributions of genetic, shared, and unshared environmental factors to SLE susceptibility remain unclear. OBJECTIVE To examine familial aggregation and heritability of SLE and the relative risks (RRs) of other autoimmune diseases in relatives of patients with SLE. DESIGN, SETTING, AND PARTICIPANTS A population-based family study using the Taiwan National Health Insurance Research Database was conducted. Participants included all individuals (N = 23,658,577) registered with that database in 2010; of these, 18,283 had SLE. We identified 21,009,551 parent-child relationships, 17,168,340 full sibling pairs, and 342,066 twin pairs. Diagnoses of SLE were ascertained from March 1, 1995, to December 31, 2010, and analysis was conducted between March 1 and August 15, 2014. MAIN OUTCOMES AND MEASURES The prevalence and RRs of SLE and other autoimmune diseases in relatives and spouses of patients with SLE as well as the relative contributions of heritability, shared, and nonshared environmental factors to SLE susceptibility. RESULTS Among the more than 23 million participants, the RRs (95% CIs) for SLE were 315.94 (210.66-473.82) for twins of the patients, 23.68 (20.13-27.84) for siblings, 11.44 (9.74-13.43) for parents, 14.42 (12.45-16.70) for offspring, and 4.44 (2.38-8.30) for spouses without genetic similarity. The accountability for phenotypic variance of SLE was 43.9% for heritability, 25.8% for shared environmental factors, and 30.3% for nonshared environmental factors. The RRs (95% CIs) in individuals with a first-degree relative with SLE were 5.87 (4.89-7.05) for primary Sjögren syndrome, 5.40 (3.37-8.65) for systemic sclerosis, 2.95 (2.04-4.26) for myasthenia gravis, 2.77 (1.45-5.32) for idiopathic inflammatory myositis, 2.66 (2.28-3.11) for rheumatoid arthritis, 2.58 (1.16-5.72) for multiple sclerosis, 1.68 (1.22-2.32) for type 1 diabetes mellitus, 1.39 (0.66-2.91) for inflammatory bowel diseases, and 0.86 (0.43-1.71) for vasculitis. CONCLUSIONS AND RELEVANCE The individual risks of SLE and other autoimmune diseases were increased in families that included patients with SLE. The heritability of SLE was estimated to be 43.9%. These data should be considered when counseling families with affected members.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, England2Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, England
| | - Ana M Valdes
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, England
| | - Lai-Chu See
- Department of Public Health, College of Medicine and Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, England
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, England
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Ho LJ, Luo SF, Lai JH. Biological effects of interleukin-6: Clinical applications in autoimmune diseases and cancers. Biochem Pharmacol 2015; 97:16-26. [DOI: 10.1016/j.bcp.2015.06.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/09/2015] [Indexed: 01/13/2023]
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Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, Doherty M. Epidemiology and management of gout in Taiwan: a nationwide population study. Arthritis Res Ther 2015; 17:13. [PMID: 25612613 PMCID: PMC4342824 DOI: 10.1186/s13075-015-0522-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [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: 07/03/2014] [Accepted: 01/08/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Gout is the most common inflammatory arthritis worldwide and is the only type of chronic arthritis that potentially can be 'cured'. However, data on gout incidence, prevalence and management, assessed at multiple time points in the same population, are sparse, particularly in Asian populations. The aim of this study was to describe trends in the epidemiology of gout in the general population of Taiwan. METHODS The National Health Insurance Research Database was used to identify patients with gout and to estimate the prevalence and incidence of gout for each calendar year from 2005 to 2010. The pattern of gout management was also examined. RESULTS Of 23,371,362 beneficiaries in 2010, there were 1,458,569 prevalent and 56,595 incident cases of gout, giving a prevalence of 6.24% (95% confidence interval (CI), 6.23% to 6.25%) and an incidence of 2.74 (95% CI, 2.72 to 2.76) per 1,000 person-years. The annual percentage change (APC) of the standardised prevalence was -0.7% (95% CI, -1.7% to 0.3%; P=0.14), suggesting that the prevalence of gout was essentially the same throughout the study period. However, The APC of incidence was -13.4 (95% CI, -16.1 to -10.6) between 2005 and 2007 and -2.1 (95% CI, -10.4 to 7.1) between 2007 and 2010. Regions with the highest prevalence and incidence were eastern coastal counties and offshore islets, where indigenous people are clustered. Among prevalent gout cases in 2010, only 22.93% (95% CI, 22.87% to 23.00%) were prescribed urate-lowering treatment (ULT), which remained unchanged between 2005 and 2010 at an APC of 0.0 (95% CI, -3.8 to 4.0). Uricosuric agents were more commonly prescribed than xanthine oxidase inhibitors in Taiwan. CONCLUSIONS In Taiwan, 1 in 16 people have gout. Whereas the incidence has decreased recently, the prevalence remains unchanged. Management of gout in Taiwan is poor, with only one in five affected people being treated with ULT.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. .,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fuxing street, Taoyuan, 333, Taiwan.
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, 259, Wenhua 1st road, Taoyuan, 333, Taiwan. .,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, 259, Wenhua 1st road, Taoyuan, 333, Taiwan.
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fuxing street, Taoyuan, 333, Taiwan.
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fuxing street, Taoyuan, 333, Taiwan.
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Ho WJ, Lin CP, Wang CL, Hsu LA, Yu KH, Luo SF, Chen JY, Hsu TS. Improvement of Right Ventricular Function in Pulmonary Arterial Hypertension with Disease-Specific Therapy - A Clinical Observational Study. Acta Cardiol Sin 2014; 30:236-244. [PMID: 27122794 PMCID: PMC4804863] [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] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/20/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a serious and progressive disorder that can result in right ventricular (RV) dysfunction and mortality. Consequently, it is important to monitor RV function during management of PAH. The aim of this study was to investigate the change in RV function by echocardiography before and after disease-specific therapy. METHODS We recruited 31 PAH patients with functional class (FC) III or IV. All the patients received a comprehensive assessment before disease-specific therapy was administered, including observation of clinical symptoms, 6-min walk distance (6MWD), serum brain natriuretic peptide (BNP) level, and transthoracic echocardiography. The assessment was repeated 12 weeks after therapy. RESULTS Twenty-eight patients with a mean age of 40 years completed the study, of whom 82% were women. We found that the etiologies were mainly connective tissue disease-associated and idiopathic PAH. Of the patients in our study, 36% received endothelin receptor antagonist and 64% received phosphodiesterase-5 inhibitor. There was a significant improvement in FC after disease-specific therapy (p < 0.001). The 6MWD increased from 326 to 403 m (p < 0.001), and the serum BNP level decreased from 242 to 130 pg/mL (p = 0.008) after treatment. Echocardiography showed significant reduction in the right atrial and RV areas, pulmonary artery pressure, RV free wall thickness, and inferior vena cava diameter. The myocardial performance index and left ventricular eccentricity index were significantly reduced after therapy. CONCLUSIONS For PAH patients in our study, disease-specific therapy for 12 weeks resulted in an improvement in FC, 6MWD, serum BNP levels, and RV function. KEY WORDS Disease-specific therapy; Pulmonary arterial hypertension; Right ventricular function.
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Affiliation(s)
| | | | | | | | - Kuang-Hui Yu
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Yih Chen
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chou CT, Tsai CY, Liang TH, Chang TM, Lai CH, Wei CC, Chen KH, Lin SC, Yu CL, Liou LB, Luo SF, Lee CS, Hsue YT, Huang CM, Chen JH, Lai NS, Cheng HH, Cheng TT, Lai HM, Tsai WC, Yen JH, Lu LY, Chang CP. Better short-term clinical response to etanercept in Chinese than Caucasian patients with active ankylosing spondylitis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0334-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Valdes AM, Zhang W, Doherty M. Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan. Ann Rheum Dis 2013; 74:369-74. [PMID: 24265412 PMCID: PMC4316854 DOI: 10.1136/annrheumdis-2013-204067] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. Methods Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. Results RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. Conclusions This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic.
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Affiliation(s)
- Chang-Fu Kuo
- Department of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ana M Valdes
- Department of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Department of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Department of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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