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1.
With regard to rheumatoid arthritis, remission as currently used in the literature can have two meanings: either a state with
persistent absence of clinical and radiological signs of disease activity without being treated for a specific time period,
or it may point to a disease state with minimal disease activity during antirheumatic treatment. A risk factor for the first
is absence of autoantibodies, with the anti-CCP-antibodies as best predictors, whereas risk factors for achieving a drug-induced
state of minimal disease activity are not well defined. These definitions of remission refer to different disease states;
therefore, we propose that the term remission is reserved for patients that are not treated with antirheumatic drugs. 相似文献
2.
Jon T Giles Moyses Szklo Wendy Post Michelle Petri Roger S Blumenthal Gordon Lam Allan C Gelber Robert Detrano William W Scott Jr Richard A Kronmal Joan M Bathon 《Arthritis research & therapy》2009,11(2):R36
Introduction
Although cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients.Methods
Using computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis.Results
The prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category.Conclusions
Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors. 相似文献3.
Nadir Chabane Nadia Zayed Mohamed Benderdour Johanne Martel-Pelletier Jean-Pierre Pelletier Nicolas Duval Hassan Fahmi 《Arthritis research & therapy》2009,11(2):1-12
Introduction
Although cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients.Methods
Using computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis.Results
The prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category.Conclusions
Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors. 相似文献4.
For female patients with rheumatoid arthritis, the availability of a host of new disease modifying antirheumatic drugs has
raised important questions about fetal safety if a woman becomes pregnant while she is being treated. In addition, there is
limited safety information regarding many of the older medications commonly used to treat rheumatoid arthritis in women of
reproductive age. Current summary pregnancy risk information for selected medications used to treat rheumatoid arthritis is
reviewed in the context of the pregnancy label category. In addition, the strengths and weaknesses of post-marketing strategies
for developing new pregnancy safety information are described. 相似文献
5.
Objective
To evaluate the risk of cardiovascular disease in patients with rheumatoid arthritis exposed to glucocorticoids.Methods
Retrospective analysis of exposure to glucocorticoids in a prospective cohort of 353 patients with rheumatoid arthritis followed from June 2001 up to November 2011 for incident cardiovascular disease in a hospital-based outpatient cohort in the Netherlands. Hazard ratios with 95%-confidence intervals were calculated for the association between different types of exposure to glucocorticoids and incident cardiovascular disease. Associations were adjusted for demographics, cardiovascular risk factors and disease related parameters.Results
Recent and current exposure to glucocorticoids were associated with incident cardiovascular disease, as was a longer duration of exposure and cumulative exposure to glucocorticoids. Adjustment for disease activity and severity negated the association.Conclusion
In observational studies the finding of incident cardiovascular disease in patients with rheumatoid arthritis exposed to glucocorticoids is strongly confounded by indication due to high disease activity. The adverse cardiovascular effects of glucocorticoids might be balanced by positive effects working through inflammation control. 相似文献6.
Fernanda Genre Raquel López-Mejías Mercedes García-Bermúdez Santos Casta?eda Carlos González-Juanatey Javier Llorca Alfonso Corrales Bego?a Ubilla José A. Miranda-Filloy Trinitario Pina Carmen Gómez-Vaquero Luis Rodríguez-Rodríguez Benjamín Fernández-Gutiérrez Alejandro Balsa Dora Pascual-Salcedo Francisco J. López-Longo Patricia Carreira Ricardo Blanco Isidoro González-álvaro Javier Martín Miguel A. González-Gay 《PloS one》2014,9(9)
Introduction
Rheumatoid arthritis is an inflammatory disease with high incidence of cardiovascular disease due to accelerated atherosclerosis. Osteoprotegerin (OPG) has been associated with increased risk of atherosclerotic disease in the general population. Several polymorphisms in the OPG gene with functional effects on cardiovascular disease in non-rheumatic individuals have been described. Therefore, we aimed to analyze the effect of three of these functional OPG polymorphisms on the risk of cardiovascular disease in a large and well-characterized cohort of Spanish patients with rheumatoid arthritis.Methods
Three OPG gene variants (rs3134063, rs2073618 and rs3134069) were genotyped by TaqMan assays in 2027 Spanish patients with rheumatoid arthritis. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing was positive in 997 of 1714 tested. Also, 18.3% of the whole series had experienced cardiovascular events, including 5.4% with cerebrovascular accidents. The relationship between OPG variants and cardiovascular events was assessed using Cox regression.Results
No association between OPG gene variants and cardiovascular disease was observed in the whole group of rheumatoid arthritis patients or in anti-CCP positive patients. Nevertheless, a protective effect of CGA haplotype on the risk of cardiovascular disease in general, and specifically in the risk of cerebrovascular complications after adjusting for sex, age at disease diagnosis and traditional cardiovascular risk factors was disclosed in anti-CCP negative patients (HR = 0.54; 95%CI: 0.31–0.95; p = 0.032 and HR = 0.17; 95%CI: 0.04–0.78; p = 0.022, respectively).Conclusion
Our results indicate a protective effect of the OPG CGA haplotype on cardiovascular risk, mainly due to a protective effect against cerebrovascular events in anti-CCP negative rheumatoid arthritis patients. 相似文献7.
Hsien-Yi Chiu Hui-Ling Huang Chien-Hsun Li Hung-An Chen Chia-Lun Yeh Shih-Hsiang Chiu Wei-Chun Lin Yu-Pin Cheng Tsen-Fang Tsai Shinn-Ying Ho 《PloS one》2015,10(9)
Background and Objectives
There have been few large population-based studies of the association between rheumatoid arthritis (RA) and chronic kidney disease (CKD) and glomerulonephritis. This nationwide cohort study investigated the risks of developing CKD and glomerulonephritis in patients with RA, and the associated risks for cardiovascular complications.Methods
From the Taiwan National Health Insurance Research Database, we identified a study cohort of 12,579 patients with RA and randomly selected 37,737 subjects without RA as a control cohort. Each subject was individually followed for up for 5 years, and the risk of CKD was analyzed using Cox proportional hazards regression models.Results
During the follow-up period, after adjusting for traditional cardiovascular risk factors RA was independently associated with a significantly increased risk of CKD (adjusted hazard ratio [aHR] 1.31; 95% confidence interval [CI] 1.23–1.40) and glomerulonephritis (aHR 1.55; 95% CI 1.37–1.76). Increased risk of CKD was also associated with the use of non-steroidal anti-inflammatory drugs, cyclosporine, glucocorticoids, mycophenolate mofetil, and cyclophosphamide. Patients with comorbidities had even greater increased risk of CKD. Moreover, RA patients with concurrent CKD had significantly higher likelihood of developing ischemic heart disease and stroke.Conclusions
RA patients had higher risk of developing CKD and glomerulonephritis, independent of traditional cardiovascular risk factors. Their increased risk of CKD may be attributed to glomerulonephritis, chronic inflammation, comorbidities, and renal toxicity of antirheumatic drugs. Careful monitoring of renal function in RA patients and tight control of their comorbid diseases and cardiovascular risk factors are warranted. 相似文献8.
Ronenn Roubenoff 《Arthritis research & therapy》2009,11(2):108
Rheumatoid cachexia, loss of muscle mass and strength and concomitant increase in fat mass, is very common in patients with
rheumatoid arthritis (RA). Despite great advances in the treatment of RA, it appears that rheumatoid cachexia persists even
after joint inflammation improves. Rheumatoid cachexia may be an important risk factor for cardiovascular disease and excess
mortality in RA. In this issue of Arthritis Research & Therapy, Elkan and colleagues demonstrate a link between rheumatoid cachexia and metabolic syndrome, further reinforcing the need
for therapy directed beyond inflammation and at the metabolic consequences of RA. 相似文献
9.
Pineda-Tamayo R Arcila G Restrepo P Anaya JM 《Biomédica : revista del Instituto Nacional de Salud》2004,24(4):366-374
The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5+/-6 days. The mean total cost was 1,277 US dollars, and the mean cost per day of hospitalization was 235 US dollars. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs (p<0.01). In conclusion, the direct costs for inpatients with rheumatoid arthritis were considerable, and arose mainly from organic complications. Prevention and treatment of cardiovascular disease are indispensable not only to reduce the economic burden of rheumatoid arthitis, but also to diminish the risk of mortality. These data assist in the estimation of health care resources and in the selection of public health policies for the improvement of patient outcomes. 相似文献
10.
In the previous issue of Arthritis Research & Therapy data are presented showing that circulating immune complexes containing citrullinated fibrin(ogen) are present in anti-citrullinated
protein antibody-positive rheumatoid arthritis patients, and that such immune complexes co-localize with complement factor
C3 in the rheumatoid synovium. These results corroborate the idea that citrullination is intimately involved in the pathophysiology
of rheumatoid arthritis and complete our model (the rheumatoid arthritis cycle) for the development and chronic nature of
this disease. 相似文献
11.
Cardiovascular event rates are markedly increased in rheumatoid arthritis (RA), and RA atherogenesis remains poorly understood.
The relative contributions of traditional and nontraditional risk factors to cardiovascular disease in RA await elucidation.
The present study comprises three components. First, we compared biomarkers of endothelial dysfunction (vascular cell adhesion
molecule [VCAM]-1, intercellular adhesion molecule [ICAM]-1 and endothelial leucocyte adhesion molecule [ELAM]-1) in 74 RA
patients and 80 healthy control individuals before and after controlling for traditional and nontraditional cardiovascular
risk factors, including high-sensitivity C-reactive protein (hs-CRP), IL-1, IL-6 and tumor necrosis factor-α. Second, we investigated
the potential role of an extensive range of patient characteristics in endothelial dysfunction in the 74 RA patients. Finally,
we assessed associations between biomarkers of endothelial dysfunction and ultrasonographically determined common carotid
artery intima–media thickness and plaque in RA. The three biomarkers of endothelial dysfunction, as well as hs-CRP, IL-1,
IL-6 and tumor necrosis factor-α, were higher in patients than in control individuals (P < 0.0001). Patients were also older, exercised less and had a greater waist circumference, blood pressure and triglyceride
levels (P ≤ 0.04). Five patients had diabetes. Differences in endothelial function were no longer significant between patients and
controls (P = 0.08) only after both traditional and nontraditional cardiovascular risk factors were controlled for. In the 74 RA patients,
IL-6 predicted levels of all three biomarkers (P ≤ 0.03), and rheumatoid factor titres and low glomerular filtration rate (GFR) both predicted levels of VCAM-1 and ICAM-1,
independent of traditional cardiovascular risk factors (P ≤ 0.02). VCAM-1 was associated with common carotid artery intima–media thickness (P = 0.02) and plaque (P = 0.04) in RA. Patients had impaired endothelial function, less favourable traditional cardiovascular risk factor profiles,
and higher circulating concentrations of hs-CRP and cytokines compared with healthy control individuals. Both traditional
and nontraditional cardiovascular risk factors contributed to the differences in endothelial function between RA patients
and healthy control individuals. IL-6, rheumatoid factor titres and low GFR were independently predictive of endothelial dysfunction
in RA. Disease-modifying agents that effectively suppress both cytokine and rheumatoid factor production, and interventions
aimed at preserving renal function may attenuate cardiovascular risk in RA. 相似文献
12.
Warrington KJ Kent PD Frye RL Lymp JF Kopecky SL Goronzy JJ Weyand CM 《Arthritis research & therapy》2005,7(5):R984-R991
The risk for cardiovascular (CV) disease is increased in rheumatoid arthritis (RA) but data on the burden of coronary atherosclerosis
in patients with RA are lacking. We conducted a retrospective case-control study of Olmsted County (MN, USA) residents with
RA and new-onset coronary artery disease (CAD) (n = 75) in comparison with age-and sex-matched controls with newly diagnosed CAD (n = 128). Angiographic scores of the first coronary angiogram and data on CV risk factors and CV events on follow-up were obtained
by chart abstraction. Patients with RA were more likely to have multi-vessel coronary involvement at first coronary angiogram
compared with controls (P = 0.002). Risk factors for CAD including diabetes, hypertension, hyperlipidemia, and smoking history were not significantly
different in the two cohorts. RA remained a significant risk factor for multi-vessel disease after adjustment for age, sex
and history of hyperlipidemia. The overall rate of CV events was similar in RA patients and controls; however, there was a
trend for increased CV death in patients with RA. In a nested cohort of patients with RA and CAD (n = 27), we measured levels of pro-inflammatory CD4+CD28null T cells by flow cytometry. These T cells have been previously implicated in the pathogenesis of CAD and RA. Indeed, CD4+CD28null T cells were significantly higher in patients with CAD and co-existent RA than in controls with stable angina (P = 0.001) and reached levels found in patients with acute coronary syndromes. Patients with RA are at increased risk for multi-vessel
CAD, although the risk of CV events was not increased in our study population. Expansion of CD4+CD28null T cells in these patients may contribute to the progression of atherosclerosis. 相似文献
13.
The increased burden of cardiovascular disease in patients with rheumatoid arthritis and systemic lupus erythematosus has
recently become the focus of intense investigation. Proatherogenic risk factors and dysregulated inflammation are the main
culprits, leading to enhanced atherosclerosis in subgroups of patients with inflammatory diseases. Common molecular pathways
shared by atherosclerosis and inflammatory disease may be involved. In this review we map the key determinants of the increased
incidence of cardiovascular disease in patients with inflammatory diseases at each step of the atherogenesis. 相似文献
14.
Teresa A Simon Johan Askling Diane Lacaille Jarrod Franklin Frederick Wolfe Allison Covucci Samy Suissa Marc C Hochberg the Abatacept Epidemiology Study Group 《Arthritis research & therapy》2010,12(2):R67
Introduction
Patients with rheumatoid arthritis (RA) have an increased risk of infection and this risk appears to be higher with anti-TNF (tumor necrosis factor) agents. We pooled data from the cumulative abatacept RA clinical development program, both double-blind and open-label periods, to estimate the incidence rates (IRs) of infections requiring hospitalization including pneumonia and opportunistic infections, in comparison with RA patients treated with non-biologic disease-modifying antirheumatic drugs (DMARDs) from several reference cohorts. 相似文献15.
Chihiro Fujimaki Hideki Hayashi Seiji Tsuboi Taiji Matsuyama Kazuhiro Kosuge Hiroshi Yamada 《Biomarkers》2013,18(1):49-54
Hyperhomocysteinemia is a known risk factor of cardiovascular disease. Homocysteine has been also linked to inflammation in rheumatoid arthritis (RA). In this study, we investigated the relationship between plasma homocysteine levels and single nucleotide polymorphism (SNP) of the gene coding for methylenetetrahydrofolate reductase (MTHFR), an enzyme involved in the biosynthesis of homocysteine, and the correlation between the plasma homocysteine levels and generally used inflammatory markers (C-reactive protein, erythrocyte sedimentation rate and matrix metalloproteinase-3) in 96 Japanese patients with RA. Plasma homocysteine levels in patients with the MTHFR 677TT genotype were significantly higher than in those with the 677CC genotype (p < 0.05). In addition, plasma homocysteine levels were increased along with the elevation of general inflammatory markers. Therefore, we conclude that homocysteine might affect the inflammatory status of patients, and the MTHFR 677C>T SNP could be a predictive factor of hyperhomocysteinemia in patients with RA. 相似文献
16.
Rheumatoid arthritis may be associated with generalised as well as periarticular osteoporosis. To assess the extent of bone loss and the influence of corticosteroid treatment total body calcium was measured by in-vivo neutron activation analysis in 63 patients with rheumatoid arthritis treated with non-steroidal anti-inflammatory drugs alone and 31 treated with additional low-dose corticosteroids. The results were compared with those in 40 normal controls matched for age, sex, and menopausal state. There were significant reductions in mean total body calcium in the group treated with non-steroidal anti-inflammatory drugs (5.3% in men; 6.8% in women) and greater reductions in the corticosteroid-treated patients (11.5% in men, 15.5% in women). The reduction was correlated with disease duration and activity in the patients treated with non-steroid anti-inflammatory drugs alone. Measured total body calcium was significantly less than the values predicted when this relation was used in the corticosteroid-treated patients. The data suggest that increased bone loss in patients with rheumatoid arthritis treated with corticosteroids is attributable to drug treatment rather than disease activity. Many patients with rheumatoid arthritis treated with low-dosage corticosteroids and some postmenopausal women with the disease are likely to be at risk from the complications of osteoporosis. 相似文献
17.
Patients with rheumatoid arthritis (RA) experience excess cardiovascular disease (CVD). We investigated the effects of disease-modifying antirheumatic drugs (DMARD) and dietary intervention on CVD risk in inflammatory arthritis. Twenty-two patients (17 women; 15 with RA and seven with spondyloarthropathy) who were insulin resistant (n = 20), as determined by the Homeostasis Model Assessment, and/or were dyslipidemic (n = 11) were identified. During the third month after initiation of DMARD therapy, body weight, C-reactive protein (CRP), insulin resistance, and lipids were re-evaluated. Results are expressed as median (interquartile range). DMARD therapy together with dietary intervention was associated with weight loss of 4 kg (0–6.5 kg), a decrease in CRP of 14% (6–36%; P < 0.006), and a reduction in insulin resistance of 36% (26–61%; P < 0.006). Diet compliers (n = 15) experienced decreases of 10% (0–20%) and 3% (0–9%) in total and low-density lipoprotein cholesterol, respectively, as compared with increases of 9% (6–20%; P < 0.05) and 3% (0–9%; P < 0.05) in diet noncompliers. Patients on methotrexate (n = 14) experienced a reduction in CRP of 27 mg/l (6–83 mg/l), as compared with a decrease of 10 mg/l (3.4–13 mg/l; P = 0.04) in patients not on methotrexate. Improved cardiovascular risk with DMARD therapy includes a reduction in insulin resistance. Methotrexate use in RA may improve CVD risk through a marked suppression of the acute phase response. Dietary intervention prevented the increase in total and low-density lipoprotein cholesterol upon acute phase response suppression. 相似文献
18.
J. N. McArthur P. D. Dawkins M. J. H. Smith E. B. D. Hamilton 《BMJ (Clinical research ed.)》1971,2(5763):677-679
The concentrations of free and protein-bound L-tryptophan were measured in sera from normal subjects, patients with rheumatoid arthritis, pregnant women, and patients with jaundice. In the patients with rheumatoid arthritis receiving treatment with one or more antirheumatic drugs the percentage of the amino-acid bound to the circulating proteins was significantly depressed and in one patient returned to normal when therapy was stopped. Pregnancy and jaundice were also associated with raised free tryptophan and decreased bound tryptophan concentrations and bilirubin displaced the amino-acid from its binding sites on human serum proteins in vitro. It is suggested the behaviour of tryptophan mimics that of certain peptides which protect susceptible tissues against chronic inflammatory insults. 相似文献
19.
The present case–control study was conducted to investigate the relationship between smoking and rheumatoid arthritis, and
to investigate formally the interaction between sex, smoking, and risk for developing rheumatoid arthritis. The study was
performed in the Central District of Finland. Cases were patients with rheumatoid arthritis and the control group was a random
sample of the general population. Logistic regression models were used to evaluate the effect of smoking on risk for rheumatoid
arthritis, after adjusting for the effects of age, education, body mass index, and indices of general health and pain. Overall,
1095 patients with rheumatoid arthritis and 1530 control individuals were included. Patients were older, less well educated,
more disabled, and had poorer levels of general health as compared with control individuals (all P < 0.01). Preliminary analyses revealed the presence of substantial statistical interaction between smoking and sex (P < 0.001). In separate multivariable analyses, past history of smoking was associated with increased risk for rheumatoid arthritis
overall in men (odds ratio 2.0, 95% confidence interval 1.2–3.2) but not in women. Among men, this effect was seen only for
rheumatoid factor-positive rheumatoid arthritis. There were significant interactions between smoking and age among women but
not among men. We conclude that sex is a biologic effect modifier in the association between smoking and rheumatoid arthritis.
The role of menopause in the etiology of rheumatoid arthritis merits further research. 相似文献
20.
Innala L Möller B Ljung L Magnusson S Smedby T Södergren A Öhman ML Rantapää-Dahlqvist S Wållberg-Jonsson S 《Arthritis research & therapy》2011,13(4):R131