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1.
Medicine (Baltimore) ; 98(40): e17153, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577706

RESUMO

The present study evaluated the association between appendectomy and rheumatoid arthritis (RA) using a national sample cohort of the Korean population. In this cohort study, the Korean National Health Insurance Service-National Sample Cohort of individuals ≥20 years old was collected from 2002 to 2013. A total of 14,995 appendectomy participants were 1:4 matched with 59,980 control subjects for age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the occurrence of RA in both the appendectomy and control groups. Appendectomies were identified using operation codes for appendicitis only. RA was defined by International Classification of Disease-10 codes (M05 or M06) and medication histories. Crude and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. Subgroup analyses were performed on groups stratified by age and sex. The adjusted HR for RA was 1.02 (95% confidence interval = 0.76-1.38) in the appendectomy group (P = .883). In all of the subgroup analyses according to age and sex, the adjusted HRs for RA were not higher in the appendectomy group than those in the control group. We could not identify any significant relationship between appendectomy and RA.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Artrite Reumatoide/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Depressão/epidemiologia , Dislipidemias/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Características de Residência , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
2.
J Assoc Physicians India ; 67(7): 22-24, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559763

RESUMO

Background: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Along with traditional cardiovascular risk factors and systemic inflammation, metabolic syndrome (MetS) contributes to CVD and increased mortality in patients with RA. In this study we determine the prevalence of MetS in RA patients presenting to a tertiary care centre in north India. Methods: This is a case control study involving 114 patients of RA with disease duration of ≥1 year and 114 healthy controls who are age and sex matched. Components of MetS were assessed in all the subjects and disease activity of RA was determined by DAS28-ESR. MetS was defined according to modified ATP-III criteria and consensus definition of metabolic syndrome for adult Asian Indians. Results: Women constituted 81.6% in RA group and 80.5% in control group. Mean age of subjects was 44.81±12.7 years in RA group and 43.27±12.6 years in control group. According to modified ATP-III criteria, 36 (31.6%) RA subjects and 17 (14.9%) controls had MetS (p=0.03). According to the consensus definition of metabolic syndrome for adult Asian Indian criteria, 40 (35.1%) RA subjects and 18 (15.8%) controls had MetS (P=0.01). There was no significant difference in disease activity between subjects of RA with or without MetS (p=0.276). Conclusion: The prevalence of MetS was higher in RA subjects compared to controls. There is no association of MetS with disease activity in our cohort. Larger studies are needed to determine the relation between MetS and disease activity.


Assuntos
Artrite Reumatoide/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Centros de Atenção Terciária
3.
Z Rheumatol ; 78(5): 422-428, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31049664

RESUMO

Treat to target (T2T) strategies and comorbidities are closely related. Strong evidence exists for reducing the risk and extent of comorbidities, such as cardiovascular (CV) diseases, depression and infections by implementing T2T concepts and inducing good disease control of rheumatoid arthritis (RA) in this way. On the other hand existing comorbidities may hinder implementation of T2T concepts by aggravating RA or influencing rheumatologists to overcautiously use DMARD treatment. Among a long list of potentially relevant comorbidities with RA, in this review two particularly relevant accompanying diseases with respect to T2T, CV diseases and infections, are selected for discussion in detail. The CV comorbidities are the main cause of death for RA patients and are triggered by RA-associated inflammatory mechanisms. Their negative influence on implementation of T2T strategies can be stopped or at least reduced by optimal control of RA activity with the help of selecting drugs with cardioprotective properties (such as biologicals, methotrexate and hydroxychloroquine) as well as assessing and treating traditional CV risk factors. Infections are among most important adverse events of DMARD treatment and can disturb the optimal use of these drugs and so hinder the success of the T2T strategy. Optimal infection prophylaxis and identification of high risk patients are particularly important and minimization of glucocorticoid use is critical to reduce the risk of infections. In summary, comorbidities are important potential risk factors for the success of T2T strategies.


Assuntos
Antirreumáticos , Artrite Reumatoide , Produtos Biológicos , Doenças Cardiovasculares/epidemiologia , Infecção/epidemiologia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/prevenção & controle , Produtos Biológicos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Comorbidade , Humanos , Controle de Infecções , Metotrexato , Indução de Remissão
4.
Autoimmun Rev ; 18(7): 679-690, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059840

RESUMO

Patients with rheumatoid arthritis (RA) suffer cardiovascular events 1.5-2 fold than the general population, and cardiovascular (CV) events are leading cause of death in patients with RA. It is known that patients with RA have endothelial dysfunction, related with impaired function of endothelial progenitor cells (EPCs). The mechanistic pathways leading to endothelial function are complicated, but understanding these mechanisms may open new frontiers of management and therapies to patients suffering from atherosclerosis. Inflammation is a key factor in atherosclerosis, including endothelial function, plaque stabilization and post infarct remodeling; thus, inhibition of TNF-α may affect the inflammatory burden and plaque vulnerability leading to less cardiovascular events and myocardial infarctions. An aggressive management of inflammation may lead to a significant improvement in the clinical cardiovascular outcome of patients with RA. The clinical evidence that showed a reduced risk of CV events following treatment with anti-inflammatory agents may suggest a new approach to treat atherosclerosis, i.e., inhibition of inflammation using biological medications that were primarily aimed to treat the high scale inflammation of RA and other autoimmune-inflammatory diseases, but may be useful also to prevent progression of atherosclerosis.


Assuntos
Anti-Inflamatórios/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Doenças Cardiovasculares/tratamento farmacológico , Animais , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Humanos
5.
Drug Discov Ther ; 13(2): 96-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080209

RESUMO

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.


Assuntos
Artrite Infecciosa/epidemiologia , Artrite/classificação , Doenças não Transmissíveis/epidemiologia , Adolescente , Adulto , Artrite/diagnóstico , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Brucelose/diagnóstico , Brucelose/epidemiologia , Feminino , Humanos , Índia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose/epidemiologia , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
6.
ScientificWorldJournal ; 2019: 6940401, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31015823

RESUMO

Objective: The aim of this study is to demonstrate if routine assessment of patient index data 3 has a correlation with disease's activity as much as disease activity score 28, clinical disease activity index, and simplified disease activity index in Ecuadorian patients with rheumatoid arthritis seen in Unidad de Enfermedades Reumáticas y Autoinmunes [UNERA] from December 2016 to December 2017. Methods: This is a retrospective study in 200 patients that fulfill the American College of Rheumatology 2010 criteria for diagnosis of rheumatoid arthritis. The patients were evaluated from December 2016 to December 2017. Descriptive analyses were carried out, also Pearson correlation was used, and, to give a better clinical significance, a chi-square test was conducted. Whenever assumptions of chi-square test were violated, a Fisher's exact test was reported. Results: RAPID3 correlated best with DAS28 (r.83, p < 0.001), followed by CDAI (r.80, p < 0.001) and then SDAI (r.77, p < 0.001). Conclusion: RAPID3 is a questionnaire that only takes 10 seconds to calculate and correlates in a significant way with traditional clinical measures that require more time to perform, saving time in busy health facilities.


Assuntos
Artrite Reumatoide/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão
7.
Artigo em Inglês | MEDLINE | ID: mdl-30959862

RESUMO

Environmental factors may play roles in the development of rheumatoid arthritis (RA), and some studies have shown that air pollution was associated with the development of autoimmune disease. This study was designed to investigate the effect of air pollutants on the development of adult RA. A nested case-control cohort study was performed using the National Health Insurance Service-National Sample Cohort during 2002⁻2014 in Korea. Air pollution data were collected from the National Ambient Air Monitoring System (NAMIS), and exposure levels were extrapolated using geographic information systems. The group with RA (n = 444) was compared with a propensity score-matched control group (n = 1776), and one-year average concentrations of air pollution were predicted at each patient's residence. The adjusted binary logistic regression analysis showed a positive association between O3 exposure and the incidence risk of RA for the third (odds ratios (OR) = 1.45, 95% confidence intervals (CI): 1.08⁻1.96) and fourth (OR = 1.35, 95% CI: 1.00⁻1.83) quartiles in adults over 20 years of age. The third quartile CO exposure was also associated with an increased risk of RA (OR = 1.57, 95% CI: 1.16⁻2.12). The results of this nationwide population-based study showed that a one-year exposure to CO and O3 in adults was associated with an increased risk of RA.


Assuntos
Poluentes Atmosféricos/análise , Artrite Reumatoide/epidemiologia , Exposição Ambiental/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/análise , Monóxido de Carbono/análise , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Ozônio/análise , Material Particulado/análise , República da Coreia/epidemiologia , Adulto Jovem
8.
Scand J Rheumatol ; 48(4): 266-270, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31012365

RESUMO

Objectives: Inadequate response to adalimumab can be caused by insufficient blockade of the target tumour necrosis factor (TNF) at low serum concentrations. In such cases, patients may respond to another TNF inhibitor. We investigated whether the serum adalimumab concentration is related to the efficacy of a second TNF inhibitor, etanercept, in rheumatoid arthritis (RA). Methods: Patients with RA starting etanercept treatment were prospectively observed in the Reade Rheumatology Registry. In patients previously on adalimumab, serum concentrations were determined before treatment discontinuation. According to this concentration, three subgroups were formed: < 0.5 µg/mL, 0.5-5.0 µg/mL, and ≥ 5.0 µg/mL. The European League Against Rheumatism (EULAR) good/moderate response rate after 52 weeks of etanercept was compared between the switcher subgroups and biologic-naive patients. Results: In total, 449 consecutive patients were included, of whom 69 switched from adalimumab (15%) and 380 were biologic naive (85%). EULAR good or moderate response was achieved by 74% of the biologic-naive patients and by 72%, 50%, and 52% of switchers with adalimumab concentration < 0.5 µg/mL, 0.5-5.0 µg/mL, and ≥ 5.0 µg/mL, respectively (p = 0.15). Patients with an adalimumab concentration ≥ 0.5 µg/mL were significantly less likely to achieve EULAR good/moderate response on etanercept compared to biologic-naive patients, whereas patients with a concentration < 0.5 µg/mL did not significantly differ from patients starting etanercept without prior biologic treatment. Conclusion: RA patients with an inadequate response to adalimumab, in the presence of sufficient drug concentrations, benefit less from switching to another TNF inhibitor, etanercept.


Assuntos
Adalimumab , Artrite Reumatoide , Substituição de Medicamentos/métodos , Etanercepte , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Adalimumab/sangue , Adulto , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Antirreumáticos/sangue , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Monitoramento de Medicamentos/métodos , Etanercepte/administração & dosagem , Etanercepte/efeitos adversos , Etanercepte/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Seleção de Pacientes , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
9.
Biomed Res Int ; 2019: 3265847, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032342

RESUMO

Objective: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods: The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results: Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions: In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors.


Assuntos
Artrite Reumatoide/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Medição de Risco , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Fatores de Risco , Caracteres Sexuais , Volume Sistólico/fisiologia
10.
Diabetes Res Clin Pract ; 150: 245-252, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30880092

RESUMO

AIMS: The mechanism underlying the association of diabetes mellitus (DM) and periodontitis is not clear. This study aimed to investigate the correlation between DM and periodontitis. METHODS: This study was a retrospective cohort study, which conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 39,384 new-onset DM patients who aged above 20 years old from 2005 to 2012. To avoid selection bias, we applied propensity score matching to obtain patients without DM, as the control group. Cox proportional hazard model was used to analyze the risk of periodontitis in patients with DM. RESULTS: After controlling for related variables, Patients with DM had a higher risk for periodontitis compared with the patients without DM (adjusted hazard ratios [aHR] = 1.04, 95% confidence interval [CI]: 1.01-1.08). Patients with hypertension (HTN) had no higher risk for periodontitis (aHR = 0.96, 95% CI: 0.92-1.00). Patients with dyslipidemia and rheumatoid arthritis (RA) patients both had a higher risk for periodontitis (aHR = 1.26, 95% CI: 1.19-1.34; aHR = 1.41, 95% CI: 1.19-1.67). CONCLUSIONS: There is a correlation between DM and periodontitis. Patients with DM may have a higher risk of incident periodontitis. Besides, age, HTN, dyslipidemia, and RA are also associated with incident periodontitis.


Assuntos
Artrite Reumatoide/epidemiologia , Bases de Dados Factuais , Diabetes Mellitus/fisiopatologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Periodontite/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
11.
Biomed Res Int ; 2019: 7987529, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30915358

RESUMO

We aimed to investigate the prescribing trend of antirheumatic drugs and assess the risk of cardiovascular disease in patients with rheumatoid arthritis in Taiwan. This study was a retrospective cohort study, conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 15,366 new rheumatoid arthritis patients from 2003 to 2010. To avoid selection bias, we applied propensity score matching to obtain general patients, as the control group. Cox proportional hazard model was used to evaluate the risk of cardiovascular disease in rheumatoid arthritis patients. The most common prescriptions of rheumatoid arthritis were nonsteroidal anti-inflammatory drugs. After controlling for related variables, rheumatoid arthritis patients had a higher risk of cardiovascular disease than general patients (adjusted hazard ratio [aHR] = 1.31; 95% confidence interval [CI]: 1.23-1.39). Age was the most significantly associated risk factor with the cardiovascular disease. Other observed risk factors for cardiovascular disease included hypertension (aHR = 1.57, 95% CI: 1.48-1.65), diabetes mellitus (aHR = 1.47, 95% CI: 1.38-1.57), and chronic kidney disease (aHR = 1.48, 95% CI: 1.31-1.66). Patients with rheumatoid arthritis indeed had a higher risk of incident cardiovascular diseases. Besides, age, hypertension, diabetes mellitus, and chronic kidney disease were also associated with a higher risk of cardiovascular disease.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide , Doenças Cardiovasculares , Bases de Dados Factuais , Prescrições de Medicamentos , Adulto , Idoso , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia
12.
J Pak Med Assoc ; 69(3): 389-398, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30890833

RESUMO

OBJECTIVE: The study aimed to evaluate literature on rheumatoid arthritis disease in Pakistani patients, to have an understanding about its epidemiology, clinical aspects and socio-economic determinants. METHODS: The review study was conducted from December 2017, to May 2018. An online search was conducted in international and local health databases using appropriate search keywords as well as scanning reference lists of related articles. Literature published after year 2000 that reported epidemiological, demographic, clinical and socioeconomic data of Pakistani rheumatoid arthritis patients was included. Meta-analysis was performed where possible. This systematic review was registered on the international prospective register of systematic reviews PROSPERO (CRD42018090582). RESULTS: Of the 334 research articles found, 29 (8.7%) were selected. Patients were mostly females, but no study explored impact of disease on household and family role functioning of rheumatoid arthritis-affected women in Pakistan. Most patients were uneducated (55%) and unemployed; had low disease knowledge (N = 149, 74.5%) and poor adherence to disease-modifying anti-rheumatic drugs (N = 23, 23%). Point prevalence of rheumatoid arthritis reported from Karachi was high at 26.9%. Moderate disease activity, i.e., 4.5}0.7 and mild functional disability (N = 66, 51.6%) were seen in RA patients. Almost half (N = 799, 46.9%) had comorbidities. Almost a fifth proportion of RA patients had dyslipidaemia as a comorbidity (N = 134, 16.77%) and higher cardiovascular risk score as modifiable risk factor. Undiagnosed depression (N = 134, 58.3%) and low bone mineral density (N = 93, 40.6%) were reported in RA patients. Direct monthly treatment cost of disease was significantly high considering patients' socio-economic status, i.e., USD 16.47 - 100.68. Most commonly used drug was methotrexate. CONCLUSIONS: There is a paucity of data on Pakistani rheumatoid arthritis patients' demographic and socio-economic parameters, especially the gender element.


Assuntos
Artrite Reumatoide/epidemiologia , Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/economia , Doenças Ósseas Metabólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Efeitos Psicossociais da Doença , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Fibromialgia/epidemiologia , Metotrexato/economia , Metotrexato/uso terapêutico , Osteoporose/epidemiologia , Paquistão/epidemiologia , Prevalência , Fatores de Risco , Classe Social
13.
Z Rheumatol ; 78(3): 228-235, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30887119

RESUMO

Pulmonary involvement in patients with rheumatoid arthritis, in particular interstitial lung diseases (RA-ILD) is of great clinical importance. Patients should be asked about symptoms of pulmonary involvement and the lungs should be clinically examined even during the diagnostic procedure and regularly during the course of the disease. Before initiation of a basic pharmacological treatment an X­ray examination of thoracic organs is obligatory. In cases of conspicuous clinical or radiological findings, extended diagnostic procedures with lung function testing (body plethysmography with diffusion measurement) and high resolution computed tomography (CT) should be performed, depending on the findings. The differential diagnosis of interstitial lung alterations in patients with RA is broad and should consider side effects of the basis medication in addition to infectious causes. The optimal pharmacological treatment of RA-ILD is not sufficiently clarified. The value of methotrexate (MTX) has changed because, in contrast to previous assumptions, a better course could be observed under MTX treatment, at least in mild to moderate courses of RA-ILD. In the case of a clinically relevant RA-ILD, tumor necrosis factor (TNF) blockers should be avoided because a dramatic deterioration of pulmonary function has sometimes been observed. Among biological disease-modifying antirheumatic drugs (DMARD), rituximab and abatacept are currently preferred. The role of Janus kinase (JAK) inhibitors in RA-ILD is currently being discussed but limited data are available. Patients with RA-ILD benefit from a close collaboration between pulmonologists and rheumatologists.


Assuntos
Antirreumáticos , Artrite Reumatoide , Doenças Pulmonares Intersticiais , Abatacepte , Antirreumáticos/uso terapêutico , Artrite Reumatoide/epidemiologia , Comorbidade , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Metotrexato
14.
JAMA Netw Open ; 2(3): e190606, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30874779

RESUMO

Importance: Knowing the future condition of a patient would enable a physician to customize current therapeutic options to prevent disease worsening, but predicting that future condition requires sophisticated modeling and information. If artificial intelligence models were capable of forecasting future patient outcomes, they could be used to aid practitioners and patients in prognosticating outcomes or simulating potential outcomes under different treatment scenarios. Objective: To assess the ability of an artificial intelligence system to prognosticate the state of disease activity of patients with rheumatoid arthritis (RA) at their next clinical visit. Design, Setting, and Participants: This prognostic study included 820 patients with RA from rheumatology clinics at 2 distinct health care systems with different electronic health record platforms: a university hospital (UH) and a public safety-net hospital (SNH). The UH and SNH had substantially different patient populations and treatment patterns. The UH has records on approximately 1 million total patients starting in January 2012. The UH data for this study were accessed on July 1, 2017. The SNH has records on 65 000 unique individuals starting in January 2013. The SNH data for the study were collected on February 27, 2018. Exposures: Structured data were extracted from the electronic health record, including exposures (medications), patient demographics, laboratories, and prior measures of disease activity. A longitudinal deep learning model was used to predict disease activity for patients with RA at their next rheumatology clinic visit and to evaluate interhospital performance and model interoperability strategies. Main Outcomes and Measures: Model performance was quantified using the area under the receiver operating characteristic curve (AUROC). Disease activity in RA was measured using a composite index score. Results: A total of 578 UH patients (mean [SD] age, 57 [15] years; 477 [82.5%] female; 296 [51.2%] white) and 242 SNH patients (mean [SD] age, 60 [15] years; 195 [80.6%] female; 30 [12.4%] white) were included in the study. Patients at the UH compared with those at the SNH were seen more frequently (median time between visits, 100 vs 180 days) and were more frequently prescribed higher-class medications (biologics) (364 [63.0%] vs 70 [28.9%]). At the UH, the model reached an AUROC of 0.91 (95% CI, 0.86-0.96) in a test cohort of 116 patients. The UH-trained model had an AUROC of 0.74 (95% CI, 0.65-0.83) in the SNH test cohort (n = 117) despite marked differences in the patient populations. In both settings, baseline prediction using each patients' most recent disease activity score had statistically random performance. Conclusions and Relevance: The findings suggest that building accurate models to forecast complex disease outcomes using electronic health record data is possible and these models can be shared across hospitals with diverse patient populations.


Assuntos
Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Aprendizado Profundo , Diagnóstico por Computador/métodos , Registros Eletrônicos de Saúde/classificação , Adulto , Idoso , Estudos de Coortes , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
15.
Scand J Rheumatol ; 48(4): 300-307, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30836033

RESUMO

Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.


Assuntos
Artrite Juvenil , Artrite Psoriásica , Artrite Reumatoide , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Espondilartrite , Adulto , Artrite Juvenil/economia , Artrite Juvenil/epidemiologia , Artrite Psoriásica/economia , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/economia , Artrite Reumatoide/epidemiologia , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Espondilartrite/economia , Espondilartrite/epidemiologia
16.
Medicine (Baltimore) ; 98(6): e14361, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732168

RESUMO

Rheumatoid arthritis (RA) has been related to an impairment of the nutritional status. Body mass index (BMI) has been used but questions arise about how to properly evaluate nutritional status in RA patients. Few studies have evaluated it by dual-energy X-ray absorptiometry.In women with RA, to analyze:Case-control study including 89 women with RA. The control group was composed by 100 patients affected by non-inflammatory rheumatic disorders. Study variables included age, RA duration, history, activity and disability, and in relation to nutritional status: BMI, serum albumin (ALB), whole body DXA assessment, and skeletal muscle index (SMI).Mean age of patients was 62 ±â€Š8 years, mean duration of RA was 14 ±â€Š9 years, mean disease activity score (DAS28) was 3.7 ±â€Š1.4 and mean Health Assessment Questionnaire was 0.88 ±â€Š0.77. BMI was 27.43 ±â€Š5.16 Kg/m in patients and 27.78 ±â€Š3.98 Kg/m in controls (P: ns). ALB was within normal range in all patients.By whole body DXA, RA patients presented a statistically significant lower lean mass in all locations and lower fat mass in limbs than controls. Patients had a redistribution of fat mass to trunk. Lean mass directly correlated with fat mass.Neither BMI nor ALB correlated with DXA parameters.BMI, appendicular lean mass and SMI correlated inversely with disease duration. Trunk lean mass correlated inversely, and fat mass directly, with RA disability parameters.RA patients fulfilled criteria of sarcopenia in 44% of cases versus 19% of controls (P <.001). In RA patients, regarding SMI, BMI showed a high specificity to detect sarcopenia (94% of the patients with low BMI had sarcopenia) but low sensitivity (47% of the patients with normal BMI or overweight had sarcopenia).RA patients have an impairment of nutritional status associated to disease duration that looks like sarcopenia and that is not predicted by BMI.


Assuntos
Absorciometria de Fóton/métodos , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/patologia , Estado Nutricional , Idoso , Composição Corporal , Índice de Massa Corporal , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Sobrepeso/epidemiologia , Fatores de Risco , Sarcopenia/epidemiologia , Albumina Sérica/análise , Fatores Socioeconômicos , Espanha
17.
Medicine (Baltimore) ; 98(7): e14587, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762811

RESUMO

Recently, it has been shown that some well-known pathogenic mediators in rheumatoid arthritis (RA), such as interleukin-1ß (IL-1ß) and tumor necrosis factor (TNF), could play a pathogenic role in insulin resistance and (IR) and type 2 diabetes (T2D).In this 6-month longitudinal study, we aimed at investigating if the inhibition of IL-1 or TNF is associated with an improvement of IR in RA patients with comorbid T2D and the possible effects on selected serum adipokines. RA patients with comorbid T2D were recruited among those undergoing treatment with anakinra (ANA) or with TNF inhibitor (TNFi). The 1998-updated version of the Homeostasis Model Assessment (HOMA2) was used to calculate surrogate indexes of IR (HOMA2-IR) and steady-state beta cell function (%B) from fasting values of glucose and C-peptide. Glucagon, adiponectin, adipsin, leptin, and resistin were also measured. All these parameters were collected at baseline, after 3 and 6 months of treatment.ANA-treated patients showed a significant improvement in HOMA2-%ß, HOMA2-IR, and glucagon. In TNFi-treated patients, no significant difference was observed analyzing these metabolic parameters. Adipsin and resistin decreased after 6 months in ANA-treated patients whereas, no difference was recognized analyzing adiponectin and leptin. In TNFi-treated patients, leptin and resistin significantly increased, whereas no difference was found analyzing adiponectin and adipsin, during the follow-up.Our data may suggest a beneficial effect of IL-1 inhibition on measures of metabolic derangement in RA-associated T2D. If further confirmed by larger studies, IL-1 targeting therapies may represent a tailored approach in these patients.


Assuntos
Adipocinas/metabolismo , Artrite Reumatoide/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Resistência à Insulina/fisiologia , Proteína Antagonista do Receptor de Interleucina 1/farmacologia , Interleucina-1/antagonistas & inibidores , Idoso , Artrite Reumatoide/fisiopatologia , Glicemia/efeitos dos fármacos , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/antagonistas & inibidores
18.
Restor Neurol Neurosci ; 37(1): 41-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30714983

RESUMO

BACKGROUND: Recovery of patients with rheumatoid arthritis (RA) depends on several physical and psychological factors, besides pharmacological treatment. Co-morbid depression adversely affects the outcome in RA. Usual medical therapies have a limited scope and fail to cure the psychological component of the disease. With advanced therapeutic options, achieving a state of remission has become the treatment goal, yoga based mind body intervention (MBI) may provide a holistic approach in its treatment dimension. Hence, MBIs are the need of hour as majority of diseases have a psychosomatic component. OBJECTIVE: To explore the effect of Yoga based MBI on disease specific inflammatory markers and depression severity in active RA patients on routine disease modifying anti-rheumatic drugs (DMARDs) therapy. METHODS: A total of 72 RA patients were randomized into 2 groups: yoga group (yoga with DMARDs) and control group (DMARDs only). Blood samples were collected pre and post intervention for primary outcome measurements of systemic biomarkers. Disease activity score 28, erythrocyte sedimentation rate (DAS28ESR) and health assessment questionnaire disability index (HAQ-DI) were used to assess disease activity and functional status respectively at pre and post intervention time-points. Secondary outcome, depression severity, was assessed by Beck Depression Inventory II scale (BDI-II) at 2 weekly intervals during 8 weeks of the study interventional plan. RESULTS: After 8 weeks of yoga based MBI, there was significant decrease in the severity of RA as seen by reduction in levels of various systemic inflammatory markers as well as in DAS28ESR (p-value <0.0001; effect size = 0.210) and HAQ-DI (p-value 0.001; effect size = 0.159). Also, yoga group experienced a statistically significant time dependent step-wise decline in depression symptoms over the period of 8 weeks as compared to control group (p-value <0.0001; effect size = 0.5). Regression analysis showed greater reduction in the scores of BDI-II with DAS28ESR (R2 = 0.426; p <  0.0001) and HAQ-DI (R2 = 0.236; p = 0.003) in yoga group. CONCLUSIONS: Yoga, a mind body intervention re-established immunological tolerance by aiding remission at molecular and cellular level along with significant reduction in depression. Thus in this severe autoimmune inflammatory arthritis with a major psychosomatic component, yoga can be used as a complementary/adjunct therapy.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/terapia , Depressão/terapia , Ioga , Adulto , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Artrite Reumatoide/psicologia , Biomarcadores/sangue , Terapia Combinada , Comorbidade , Depressão/epidemiologia , Depressão/imunologia , Feminino , Humanos , Inflamação/epidemiologia , Inflamação/imunologia , Inflamação/psicologia , Inflamação/terapia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento
19.
Turk J Med Sci ; 49(1): 20-26, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30761837

RESUMO

Background/aim: We aimed to assess the association between retinal vascular caliber (RVC) scores and disease activity in rheumatoid arthritis (RA) patients. Materials and methods: Forty-seven RA patients, 32 systemic lupus erythematosus (SLE) patients, and 45 healthy people were enrolled. RA and SLE patients were subdivided into groups according to C-reactive protein (CRP) levels. RA patients were also grouped according to Disease Activity Score-28 (DAS-28). Fundus photography was performed for all patients. RVC was summarized as the central retinal artery and vein equivalents (CRAE and CRVE). Results: Mean CRVE for RA patients was 213.3 ± 17.8 µm compared with 209.2 ± 14.1 µm for SLE and 217.5 ± 26.2 µm for the control group (P = 0.17). RVC scores did not differ between the CRP-high and CRP-low groups. As the RA disease activity increased, the widening of CRVE became more prominent and statistically significant. When the DAS-28 > 5.1 (CRVE, 220.4 (211.8­246.5) µm) group and DAS-28 ≤ 3.2 (CRVE, 214.4 (172.4­242.3) µm) group were compared, statistical significance was more pronounced (P = 0.03) than when comparing the DAS-28 > 3.2 and DAS-28 ≤ 3.2 groups (P = 0.05). Conclusions: CRVE, which reflects systemic inflammation and possibly increased cardiovascular risk, was significantly increased in active RA patients. The association between retinal venular widening and disease activity, regardless of CRP, may be a sign that RA-related inflammation may have systemic vascular effects even with normal levels of CRP.


Assuntos
Artrite Reumatoide/epidemiologia , Microvasos/patologia , Veia Retiniana/patologia , Adulto , Artrite Reumatoide/patologia , Proteína C-Reativa/análise , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/patologia , Masculino , Microvasos/diagnóstico por imagem , Pessoa de Meia-Idade , Fotografação , Estudos Prospectivos , Veia Retiniana/diagnóstico por imagem
20.
Biomed Res Int ; 2019: 6107217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30733963

RESUMO

Introduction: To retrospectively evaluate the impact of comorbidities on treatment choice, 12-month clinical response, and 24-month retention rate in a cohort of patients with rheumatoid arthritis (RA) treated with a first-line tumor necrosis factor alpha inhibitor (TNFi), by using for the first time the Rheumatic Disease Comorbidity Index (RDCI). Methods: The study population was extracted from a local registry of RA patients receiving adalimumab or etanercept as first-line biologics between January 2001 and December 2013. The prevalence of comorbidities was computed, and patients were stratified according to RDCI for evaluating the role of comorbidities on TNFi choice, concomitant methotrexate, clinical response (1-year DAS28-ESR remission and low disease activity [LDA] and EULAR good-moderate response), and the 24-month retention rate. Results: 346 patients (172 adalimumab and 174 etanercept) were included. A significantly higher EULAR good/moderate response (P = 0.020) and DAS28-ESR remission (P = 0.003) were obtained according to RDCI (0, 1, 2, or ≥3). Lower RDCI (P = 0.022), male sex (P = 0.006), higher baseline DAS28-ESR (P = 0.001), ETN (P < 0.001), and concomitant methotrexate (P = 0.016) were predictors of EULAR good/moderate response. Elevated RDCI was a predictor of discontinuation of biologics (P = 0.036), whereas treatment with etanercept (P < 0.001) and methotrexate (P = 0.007) was associated with a lower risk of TNFi withdrawal. Conclusions: Multimorbidity, measured by RDCI, is a negative predictor of TNFi persistence on treatment and of achieving a good clinical response. The use of RDCI may be very useful for identifying patients with RA carrying those comorbid conditions associated with poor prognostic outcomes and for defining new treatment targets in multimorbid RA patients.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Resultado do Tratamento
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