Impact of disease duration on proteomic bioprofile and prognosis in rheumatoid arthritis patients.

OBJECTIVES: Cardiovascular disease worsens the prognosis of rheumatoid arthritis (RA) and vice-versa. Inflammation may be a common pathway for both conditions. It is expected that a longer RA duration leads to a greater inflammatory cumulative exposure burden; however, studies on the association between RA disease duration and outcomes are scarce. Our aim is to compare the characteristics, biomarker expression and outcomes according to the duration of RA. METHODS: Prospective cohort study including 399 RA patients, with detailed clinical, echocardiographic, and proteomic phenotyping that were compared across tertiles of RA disease duration. Cox proportional models were used to study the association of disease duration with cardiovascular outcomes. RESULTS: RA duration tertiles were: tertile 1 with median of 3.2; tertile 2 with median of 8.8; and tertile 3 with median of 21.8 years. Compared to tertile 1, patients in tertile 3 were older, had more erosive disease, more frequent echocardiographic alterations, lower haemoglobin and walked a shorter distance on the 6MWT. Natriuretic peptides, cathepsin L1, galectin 9, matrix metalloproteinase-12, adrenomedullin and tumour necrosis factor receptor 11A were higher in patients with longer disease duration. Compared to patients in tertile 1, those in tertile 3 had higher risk of a subsequent cardiovascular hospitalisation or cardiovascular death (HR 2.71, 95%CI 1.06-6.92, p=0.04). CONCLUSIONS: RA patients with longer disease duration had more organ damage and worse outcomes than those with shorter disease duration. Biomarker expression suggested that patients with longer RA duration had activation of pathways related to inflammation, extracellular matrix organisation, fibrosis and congestion.

[Patency of Coronary Artery Bypass Graft]. / Permeabilidade dos Bypass Aorto-Coronários.

INTRODUCTION: Coronary heart disease is the leading cause of death and disability in the U.S. and Europe. When significant, the coronary disease can be treated medically or surgically. The medical treatment is performed in the catheterization laboratory and consists in the re-permeabilization of the coronary arteries by percutaneous approach, whereas the surgical myocardial revascularization consists in performing aorto-coronary bypass using arterial or venous conduits. OBJECTIVE: This study is sought to assess the patency and longevity of bypass in patients requiring new catheterization after surgery for recurrence of ischemic heart disease and to evaluate its relationship with factors such as the type of bypass, cardiovascular risk factors and left ventricular ejection fraction. METHODS: This study retrospectively analysed a sample of 260 surgically revascularized patients who required a new catheterization at the Hospital of Vila Nova de Gaia - Espinho between 2007 and 2012, for recurrence of ischemic heart disease. The degree of patency of the bypass was evaluated and sought a relationship with other variables such as gender, age, cardiovascular risk factors, left ventricular ejection fraction, the time interval between bypass surgery and the new catheterization. RESULTS: The patency of the arterial bypass using the left internal mammary artery proved to be superior to the venous conduit bypass. There was no statistically significant relationship between the patency of the bypass, the cardiovascular risk factors and the left ventricle ejection fraction. CONCLUSION: In this study we found a greater patency of the arterial bypass compared to the venous bypass.