Herpes Zoster Risk Factors in a National Cohort of Veterans with Rheumatoid Arthritis

BackgroundUpadacitinib (UPA) is an oral Janus kinase (JAK) inhibitor approved for the treatment of rheumatoid arthritis (RA). JAK inhibitors have been associated with an increased risk of herpes zoster (HZ) in patients with RA.ObjectivesTo evaluate the incidence and risk factors for HZ in UPA-treated patients with RA from the UPA phase III clinical trial programme.MethodsExposure-adjusted incidence/event rates for HZ were determined in patients receiving UPA (monotherapy or combination therapy) in six randomised phase III trials (data cut-off on 30 June 2020). HZ incidence and event rates were also determined in patients receiving methotrexate (MTX) monotherapy or adalimumab (ADA) + MTX. Multivariable Cox regression analysis was used to identify HZ risk factors in UPA-treated patients.ResultsA total of 5306 patients were included in this analysis. The incidence rate of HZ/100 patient-years (95% CI) was 0.8 (0.3 to 1.9), 1.1 (0.5 to 1.9), 3.0 (2.6 to 3.5) and 5.3 (4.5 to 6.2), in the MTX monotherapy, ADA + MTX, UPA 15 mg and UPA 30 mg groups, respectively. The majority of HZ cases with UPA (71%) involved a single dermatome. Prior history of HZ and Asian region were HZ risk factors in UPA-treated patients.ConclusionIn the UPA phase III RA clinical programme, HZ incidence and event rates were higher with UPA versus ADA + MTX or MTX monotherapy, and higher with the 30 mg versus 15 mg dose. Patients from Asia and those with a history of HZ may be at increased risk of HZ while receiving UPA.

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Risk of herpes zoster in patients with rheumatoid arthritis in the biologics era from 2011 to 2015 and its association with methotrexate, biologics, and corticosteroids

Modern Rheumatology ◽

10.1093/mr/roab026 ◽

2021 ◽

Author(s):

Rei Yamaguchi ◽

Eiichi Tanaka ◽

Ayako Nakajima ◽

Eisuke Inoue ◽

Mai Abe ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Herpes Zoster ◽

Incidence Rate ◽

Medical Records ◽

Cox Regression ◽

Health Assessment ◽

Japanese Version ◽

Cox Regression Analysis ◽

Assessment Questionnaire

ABSTRACT Objectives To elucidate the incidence and risk factors of herpes zoster (HZ) in patients with rheumatoid arthritis (RA) in the biologics era. Methods We determined the rate of HZ occurrence among the RA patients that participated in the Institute of Rheumatology, Rheumatoid Arthritis surveys from 2011 to 2015, by assessing medical records. The standardised incidence rate per 1000 patient-years with a 95% confidence interval (CI) was calculated, and risk factors for HZ were analysed using a time-dependent Cox regression analysis. Results Among 7815 patients (female, 84.7%) contributing to 25,863 patient-years of observation, 340 HZ events in 309 patients were confirmed. The standardised incidence rate (95% CI) per 1000 patient-years was 8.5 (6.9–10.5) in total, 6.0 (3.7–9.2) in men, and 11.0 (8.7–13.7) in women. Risk factors for HZ were age per 10 years (hazard ratio 1.14, 95% CI 1.03–1.26, p < .05), Japanese version of the Health Assessment Questionnaire (J-HAQ) score of 0.5–1.5 (versus J-HAQ = 0; 1.51, 1.09–2.10, p < .05), methotrexate use (1.58, 1.06–2.36, p < .05), and biologic use (1.88, 1.44–2.47, p < .01). Conclusions In the era when biologics were frequently used and corticosteroid use and doses were decreasing, methotrexate and biologics increased the risk for HZ.

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Herpes Zoster: Risk Factors, Complications and Special Situations

Case Medical Research ◽

10.31525/ct1-nct03903237 ◽

2019 ◽

Author(s):

Keyword(s):

Risk Factors ◽

Herpes Zoster

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Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

Current Vascular Pharmacology ◽

10.2174/1570161117666190619143842 ◽

2020 ◽

Vol 18 (5) ◽

pp. 431-446 ◽

Cited By ~ 3

Author(s):

George E. Fragoulis ◽

Ismini Panayotidis ◽

Elena Nikiphorou

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Current Evidence ◽

Pharmacological Intervention ◽

Cvd Risk ◽

The Past ◽

Increased Risk ◽

Cv Disease ◽

Obesity Hypertension ◽

Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

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Effect of Dietary Education on Cardiovascular risk Factors in Rheumatoid Arthritis Patients

Current Rheumatology Reviews ◽

10.2174/1573397116666200907112338 ◽

2020 ◽

Vol 16 ◽

Author(s):

Rahil Taheri ◽

Shahram Molavynejad ◽

Parvin Abedi ◽

Elham Rajaei ◽

Mohammad Hosein Haghighizadeh

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Statistical Tests ◽

Intervention Group ◽

Serum Levels ◽

Control Group ◽

Dietary Education

Aim: The aim of this study was to investigate the effect of dietary education on cardiovascular risk factors in patients with rheumatoid arthritis. Method: In this randomized clinical trial, 112 patients with rheumatoid arthritis were randomly assigned into two groups, intervention and control. Dietary education was provided for the intervention group in 4 sessions; anthropometric measurements, serum levels of RF, triglycerides, cholesterol, HDL, LDL, and fasting blood sugar were measured before and three months after intervention. Data was analyzed using SPSS software and appropriate statistical tests. Results: The mean of total cholesterol (p <0.001), triglycerides (p = 0.004), LDL (p <0.001), systolic blood pressure (p = 0.001), diastolic blood pressure (p = 0.003), FBS and BMI (p <0.001) were decreased significantly in the intervention group after education compared the control group. Conclusion: Traditional care for rheumatoid arthritis patients is not enough. Patients need more education in order to improve their situation.

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SAT0037 INCREASED CARDIOMETABOLIC RISK FACTORS ARE RELATED TO THE ABNORMAL ADIPOCYTOKINE PROFILE AND AUTOIMMUNITY IN RHEUMATOID ARTHRITIS. MODULATION BY TNFALPHA AND IL6R INHIBITORS

10.1136/annrheumdis-2019-eular.5532 ◽

2019 ◽

Author(s):

Iván Arias de la Rosa ◽

Maria del Carmen Abalos-Aguilera ◽

Rafaela Ortega Castro ◽

Jerusalem Calvo Gutierrez ◽

Carlos Perez-Sanchez ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Cardiometabolic Risk ◽

Cardiometabolic Risk Factors

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POS0441 DEVELOPMENT OF RHEUMATOID ARTHRITIS AMONG ANTI-CITRULLINATED PROTEIN ANTIBODIES POSITIVE ASYMPTOMATIC INDIVIDUALS: A PROSPECTIVE OBSERVATIONAL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.344 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 449.1-449

Author(s):

S. Mizuki ◽

K. Horie ◽

K. Imabayashi ◽

K. Mishima ◽

K. Oryoji

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Observational Study ◽

Rheumatoid Factor ◽

Prospective Observational Study ◽

Enzyme Linked Immunosorbent Assay ◽

P Value ◽

Healthy Population ◽

Asymptomatic Individuals ◽

Citrullinated Protein

Background:In the idividuals with genetic and enviromental risk factors, immune events at mucosal surfaces occur and may precede systemic autoimmunity. Anti-citrullinated protein antibodies (ACPA) are present in the serum for an average of 3-5 years prior to the onset of rheumatoid arthritis (RA) during an asymptomatic period. In ACPA-positivite individuals, the additional presence of RA-related risk factors appears to add significant power for the development of RA. To date, there have been few reports in which clinical courses of ACPA-positive asymptomatic individuals were investigated prospectively.Objectives:To observe the clinical time course of ACPA-positive healthy population for the development of RA.Methods:Healthy volunteers without joint pain or stiffness, who attended the comprehensive health screening of our hospital, were enrolled in this prospective observational study. The serum ACPA levels were quantified by Ig-G anti-cyclic citrullinated peptide enzyme-linked immunosorbent assay with levels > 4.4 U/mL considered positive. ACPA-positive subjects were followed by rheumatologists of our department clinically or a questionnaire sent by mail for screening to detect arthritis.Results:5,971 healthy individuals without joint symptons were included. Ninty-two (1.5%) were positive for ACPA. Of these, 19 (20.7%) developed RA and two were suspected as RA by mail questionnaire. Their average age were 58-years, and women were 68%. The average duration between the date of serum sampling and diagnosis was 10.7 months. ACPA-positive individuals who developed to RA had higher serum ACPA and Ig-M rheumatoid factor levels than ACPA-positive individuals who did not (P value by Mann-Whitney U test: 0.002, 0.005, respectively).Conclusion:Among ACPA-positive asymptomatic individuals, 20% developed RA. The higher titer of ACPA and Ig-M rheumatoid factor levels are risk factors for devoloping RA.Disclosure of Interests:None declared

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Prevalence and risk factors for bone loss in rheumatoid arthritis patients from South China: modeled by three methods

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04403-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhuoran Hu ◽

Lei Zhang ◽

Zhiming Lin ◽

Changlin Zhao ◽

Shuiming Xu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Lumbar Spine ◽

Bone Loss ◽

South China ◽

Serum Vitamin ◽

Tumor Necrosis Factor Inhibitor ◽

Healthy Controls ◽

Mineral Density ◽

Serum Vitamin D

Abstract Background To explore the prevalence of bone loss among patients with rheumatoid arthritis (RA) and healthy controls (HC) and further explored the risk factors for osteopenia and osteoporosis of RA patients. Methods A cross-sectional survey was undertaken in four hospitals in different districts in South China to reveal the prevalence of bone loss in patients. Case records, laboratory tests, and bone mineral density (BMD) results of patients were collected. Traditional multivariable logistic regression analysis and two machine learning methods, including least absolute shrinkage selection operator (LASSO) and random forest (RF) were for exploring the risk factors for osteopenia or osteoporosis in RA patients. Results Four hundred five patients with RA and 198 HC were included. RA patients had lower BMD in almost BMD measurement sites than healthy controls; the decline of lumbar spine BMD was earlier than HC. RA patients were more likely to comorbid with osteopenia and osteoporosis (p for trend < 0.001) in the lumbar spine than HC. Higher serum 25-hydroxyvitamin D3 level and using tumor necrosis factor inhibitor in the last year were protective factors; aging, lower body mass index, and increased serum uric acid might be risk factors for bone loss. Conclusions RA patients were more prone and earlier to have bone loss than HC. More attention should be paid to measuring BMD in RA patients aging with lower BMI or hyperuricemia. Besides, serum vitamin D and all three measurement sites are recommended to check routinely. TNFi usage in the last year might benefit bone mass.

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