scholarly journals POS1207 REAL WORLD POPULATION-BASED ASSESSMENT OF COVID-19 OUTCOMES AMONG RHEUMATOID ARTHRITIS PATIENTS USING BIOLOGIC OR SYNTHETIC DMARDs

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 886-886
Author(s):  
L. Wegrzyn ◽  
K. Winthrop ◽  
S. Kim ◽  
Y. Ye ◽  
C. Huisingh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Small Sample Size ◽  
Population Based ◽  
Small Sample ◽  
Sensitivity Analyses ◽  
World Population ◽  
Diagnosis Code ◽  
Research Support ◽  
Logistic Regression Models ◽  
Dmard Treatment

Background:While some risk factors for severe COVID have been identified for patients with rheumatic diseases,1 few studies have investigated whether outcomes differ based on the type of rheumatoid arthritis (RA) treatment. Most existing reports have been limited to individual centers or voluntary reporting registries.2,3Objectives:To compare the occurrence of hospitalizations following COVID-19 diagnosis among patients with RA treated with various classes of DMARDs.Methods:A cohort of patients with confirmed COVID-19 (ICD10 diagnosis code or positive PCR or antigen test result) were identified within a large US electronic health record (EHR) dataset (Optum, Inc.) during the time period Feb 1, 2020 through Oct 14, 2020. From these, we identified RA patients (ICD10 RA diagnosis code) with treatment (most recent of JAK inhibitor [JAKi], biologic [bDMARD] or conventional synthetic [csDMARD] only) within the 12 months prior to COVID-19 diagnosis (i.e., index). The primary outcome was any hospitalization on or within 30 days after COVID-19 diagnosis. Multivariable logistic regression models compared users of JAKi’s to non-TNFi bDMARDs and csDMARDs (separately), as well as users of TNFi’s to non-TNFi bDMARDS and csDMARDs (separately), and were adjusted for age, gender, index month and baseline corticosteroid use. Sensitivity analyses included restriction of prevalent treatment use to within 180 days prior to COVID-19 diagnosis and restriction of csDMARDs to a group without hydroxychloroquine or chloroquine.Results:The study included 910 RA patients on DMARD treatment who were diagnosed with COVID-19 (mean age ± SD: 61±15, 80% female, 62% white. Of those, 26% (n=240) were hospitalized on or within 30 days after COVID-19 diagnosis. The proportion of patients hospitalized was highest in non-TNFi bDMARD users (37/87; 43%), followed by csDMARDs users (161/581; 28%) and lowest in JAKi (13/68; 19%) and TNFi users (29/174; 17%). In multivariable-adjusted models, no differences in risk of hospitalization were found comparing JAKi users to csDMARD users (aOR=0.71; 95% CI 0.37-1.36) or TNFi users to csDMARD users (aOR=0.67; 95%CI 0.43-1.06). Compared to non-TNFi bDMARD users, JAKi use and TNFi use was associated with reduced risk of hospitalization (JAKi aOR=0.32; 95%CI 0.14-0.71; TNFi aOR=0.34; 95%CI 0.18-0.62). Age and corticosteroid use were positively associated with 30-day hospitalization in all models. Results of sensitivity analyses were consistent with the main findings.Conclusion:In this study, roughly a quarter of RA patients with recent DMARD treatment were hospitalized within 30 days after COVID diagnosis. Patients treated with JAKi and TNFi therapies experienced the lowest risk of hospitalization, with risk of hospitalization significantly lower than non-TNFi bDMARDs. However, recent therapy recorded in the EHR may not reflect exposure at time of COVID-19 diagnosis and small sample size per treatment may limit interpretation.References:[1]Hyrich KL, Machado PM. Nat Rev Rheumatol 2020;1-2. doi:10.1038/s41584-020-00562-2[2]Gianfrancesco MA, et al. Lancet Rheumatol 2020;2(5):e250-e253. doi:10.1016/S2665-9913(20)30095-3[3]Veenstra J, et al. J Am Acad Dermatol 2020;83(6):1696-1703.Acknowledgements:Jonathan Johnson of Optum, Inc. provided dataset guidance and conducted data analyses. AbbVie funded this study, contributed to its design, participated in data collection, analysis, and interpretation of the data, and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship.Disclosure of Interests:Lani Wegrzyn Shareholder of: AbbVie, Employee of: AbbVie, Kevin Winthrop Consultant of: Pfizer, AbbVie, UCB, Eli Lilly & Company, Galapagos, GSK, Roche, Gilead, BMS, Regeneron, Sanofi, AstraZeneca, Novartis, Grant/research support from: BMS, Pfizer, Seoyoung Kim Grant/research support from: institutional research grants from Pfizer, AbbVie, Roche, BMS for unrelated studies, Yizhou Ye Shareholder of: AbbVie, Employee of: AbbVie, Carrie Huisingh Shareholder of: AbbVie, Employee of: AbbVie, Whitney Krueger Shareholder of: AbbVie, Employee of: AbbVie, anna maniccia Shareholder of: AbbVie, Employee of: AbbVie, Ryan Kilpatrick Shareholder of: AbbVie, Employee of: AbbVie.

Tea Consumption Is Associated with Decreased Disease Activity of Rheumatoid Arthritis in a Real-World, Large-Scale Study

2020 ◽  
Vol 76 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Jiayang Jin ◽  
Jing Li ◽  
Yuzhou Gan ◽  
Jiajia Liu ◽  
Xiaozhen Zhao ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Real World ◽  
Large Scale ◽  
Small Sample Size ◽  
Small Sample ◽  
Inverse Association ◽  
Tea Consumption ◽  
Logistic Regression Models

Introduction: The role of tea consumption on rheumatoid arthritis (RA) has been studied in recent years, but no clear conclusion has been drawn as a result of small sample size of the studies or the fact that only in vitro studies have been performed. Objectives: The aim of this study was to explore the possible association of tea consumption with RA through a large-scale, real-world study. Methods: A total of 733 RA patients were investigated from June to December, 2016. The disease activity of RA was assessed according to disease activity score 28-erythrocyte sedimentation rate. The amount and types of tea consumption were recorded by on-site self-administered questionnaires. Logistic regression models were applied to analyze the correlation between tea consumption and disease activity, adjusting for demographics, clinical and laboratory factors. Results: There was an inverse association between tea consumption and disease activity in RA patients (OR 0.66, 95% CI 0.46–0.94). Compared with non-tea drinkers, a higher-intake of tea (>750 mL/day) was associated with lower disease activity of RA (OR 0.39, 95% CI 0.19–0.79), but not low-intake (≤750 mL/day; OR 0.83, 95% CI 0.42–1.63). A significant dose-response association was found between the amount of tea consumption and disease activity (p for trend <0.01). Further hierarchical regression analysis showed that such inverse associations were mainly present in female patients (p = 0.004), non-smokers (p = 0.01) or elders (≥60 years; p = 0.01). Conclusion: Tea consumption is associated with decreased disease activity of RA, suggesting the potential beneficial effect of tea in the disease.

scholarly journals POS0210 THE INCIDENCE AND RISK FACTORS OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 322-322
Author(s):  
B. Samhouri ◽  
R. Vassallo ◽  
S. Achenbach ◽  
V. Kronzer ◽  
J. M. Davis ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Cumulative Incidence ◽  
Population Based ◽  
Competing Risk ◽  
Olmsted County ◽  
Research Support ◽  
Risk Of Death

Background:Rheumatoid arthritis (RA) is a systemic inflammatory disease of the joints and other organs, including the lungs.1 Interstitial lung disease (ILD) is a lung injury pattern associated with significant symptom burden and poor outcomes in RA.2 Better understanding of its risk factors could help with disease prevention and treatment.Objectives:Using a population-based cohort, we sought to ascertain the incidence and risk factors of RA-associated ILD (RA-ILD) in recent years.Methods:The study included adult residents of Olmsted County, Minnesota with incident RA between 1999 and 2014 based on the 1987 ACR classification criteria.3 Study subjects were followed until death, migration, or 4/30/2019. ILD was defined by the presence of bilateral interstitial fibrotic changes (excluding biapical scarring) on chest computed tomography (CT). In the absence of chest CT imaging, a physician’s diagnosis of ILD in conjunction with chest X-ray findings suggestive of ILD and a restrictive pattern on pulmonary function testing (defined as a total lung capacity less than the lower limit of normal) was considered diagnostic of ILD. Evaluated risk factors included age, sex, calendar year, smoking status, body mass index (BMI) and presence/absence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). Cumulative incidence of ILD was adjusted for the competing risk of death. Cox models were used to assess the association between potential risk factors and the development of RA-ILD.Results:In Olmsted County, 645 residents were diagnosed with RA between 1999 and 2014. Seventy percent of patients were females, and 30% were males; median age at RA diagnosis was 55.3 [IQR 44.1-66.6] years, and most patients (89%) were white. Fifty-three percent of patients were never-smokers, and 64% had seropositive RA. Forty percent were obese (i.e., BMI ≥30 kg/m2); median BMI was 28.3 [IQR 24.3-33.0] kg/m2.In the cohort, ILD was identified in 73 patients. The ILD diagnosis predated RA diagnosis in 22 patients (3.4%) who were excluded from subsequent analyses. Final analyses included the remaining 623 patients with no ILD preceding, or at the time of RA diagnosis. Over a median follow-up interval of 10.2 [IQR 6.5-14.3] years, 51 patients developed ILD. Cumulative incidence of ILD, adjusted for the competing risk of death, was 4.3% at 5 years; 7.8% at 10 years; 9.4% at 15 years; and 12.3% at 20 years after RA diagnosis (Figure 1).Age, and history of smoking at RA diagnosis correlated with the incidence of ILD; adjusted hazard ratios (HRs) were 1.89 per 10-year increase in age (95% confidence interval 1.52-2.34) and 1.94 (95% confidence interval 1.10-3.42), respectively. On the other hand, sex (HR: 1.21; 95% CI: 0.68-2.17), BMI (HR: 0.99; 95% CI: 0.95-1.04), obesity (HR: 0.89; 95% CI: 0.50-1.58), and seropositivity (HR: 1.15; 95% CI: 0.65-2.03) did not demonstrate significant associations with ILD.Conclusion:This study provides a contemporary estimate of the occurrence of ILD in a well-characterized population-based cohort of patients with RA. Our findings of a lack of association between sex, obesity and seropositivity with ILD may indicate a change in established risk factors for ILD and warrant further investigation.References:[1]Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015;24(135):1-16. doi:10.1183/09059180.00008014[2]Bongartz T, Nannini C, Medina-Velasquez YF, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis - A population-based study. Arthritis Rheum. 2010;62(6):1583-1591. doi:10.1002/art.27405[3]Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-2581. doi:10.1002/art.27584Figure 1.Cumulative incidence of ILD in patients diagnosed with RA between 1999 and 2014, adjusted for the competing risk of death. Abbreviations. ILD: interstitial lung disease; RA: rheumatoid arthritis.Disclosure of Interests:Bilal Samhouri: None declared, Robert Vassallo Grant/research support from: Research grants from Pfizer, Sun Pharmaceuticals and Bristol Myers Squibb, Sara Achenbach: None declared, Vanessa Kronzer: None declared, John M Davis III Grant/research support from: Research grant from Pfizer., Elena Myasoedova: None declared, Cynthia S. Crowson: None declared

scholarly journals Reconstruction of Two Mother-Infant Dyads and Obstetrical Consequences of the Mesolithic-Neolithic Transition: A Case Study from Lepenski Vir and Vlasac (Serbia)

2019 ◽  
Vol 31 (1-2) ◽  
pp. 60-68 ◽  
Author(s):  
J. Jovanović ◽  
P. Frémondière ◽  
S. Stefanović
Keyword(s):  
Brain Size ◽  
Small Sample Size ◽  
Small Sample ◽  
World Population ◽  
Human Species ◽  
Pelvic Morphology ◽  
Neonatal Birth Weight ◽  
Delivery Outcomes ◽  
Lower Protein

The current world population of approximately seven billion people shows that despite the complexities of human birthing, the human species is thriving. Changes in human pelvic morphology resulting from bipedalism and encephalisation, often described as the “obstetric dilemma”, have made the birthing process extremely difficult and risky for both mothers and neonates. The major Mesolithic- Neolithic shift in lifestyle could have had important obstetric consequences. It is often hypothesised that the shift to an agricultural diet, with a lower protein content and higher glycaemic loading than the hunter-gatherer diet, could have led to a decrease in maternal height and an increase in neonatal birth weight, brain size and foetal-pelvic strain, which may have exacerbated the obstetric dilemma. The Mesolithic-Neolithic osteological collection from the Danube Gorges (7400-5500 cal BC, Balkans) provides material (2 pelvises and a neonate skull) to test this hypothesis by virtually reconstructing the fossil dyads and their foetal-pelvic relationship.We compared these dyads with a large obstetrical sample of mother-child dyads with a known birthing history, conducting a lineardiscriminant analysis in order to predict the most probable delivery outcomes for the prehistoric dyads. The results suggest that delivery was dystocic for the Mesolithic motherchild dyad and eutocic for the Neolithic mother-child dyad; obstetrically, the former is notably more efficient. However, due to the small sample size, further research is required with a larger series in order to determine whether the development of obstetrically efficient pelvic bones in the Neolithic was widespread and whether it had an impact on the birthing process and thus potentially contributed to the increasing size of the population.

Lower rates of mortality, readmission and reoperation in patients receiving acupuncture after hip fracture: a population-based analysis

2020 ◽  
Vol 38 (5) ◽  
pp. 352-360
Author(s):  
Jeff Chien-Fu Lin ◽  
Tzu-Chieh Lin ◽  
Chi-Fung Cheng ◽  
Ying-Ju Lin ◽  
Sophia Liang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Lower Risk ◽  
Small Sample Size ◽  
Population Based ◽  
Small Sample ◽  
Acupuncture Group ◽  
Research Database ◽  
Complication Rates ◽  
Using Data ◽  
Reoperation Rates

Background: Studies on the effects of acupuncture on mortality and complication rates in hip fracture patients are limited by small sample size and short follow-up time. We aimed to assess the associations of acupuncture use with mortality, readmission and reoperation rates in hip fracture patients using a longitudinal population-based database. Methods: A retrospective matched cohort study was conducted using data for the years 1996–2012 from Taiwan’s National Health Insurance Research Database. Hip fracture patients were divided into an acupuncture group consisting of 292 subjects who received at least 6 acupuncture treatments within 183 days of hip fracture, and a propensity score matched “no acupuncture” group of 876 subjects who did not receive any acupuncture treatment and who functioned as controls. The two groups were compared using survival analysis and competing risk analysis. Results: Compared to non-treated subjects, subjects treated with acupuncture had a lower risk of overall death (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.24–0.73, p = 0.002), a lower risk of readmission due to medical complications (subdistribution HR (sHR): 0.64, 95% CI: 0.44–0.93, p = 0.019) and a lower risk of reoperation due to surgical complications (sHR: 0.62, 95% CI: 0.40–0.96, p = 0.034). Conclusion: This is the first study to suggest that postoperative acupuncture in hip fracture patients is associated with significantly lower mortality, readmission and reoperation rates compared with those of matched controls.

scholarly journals Treatment Of Patients With Rheumatoid Arthritis: Real World Population-Based Evidence From France

2017 ◽  
Vol 20 (9) ◽  
pp. A541
Author(s):  
G Mercier ◽  
S Marouen ◽  
G Bourel ◽  
V Georgescu
Keyword(s):  
Rheumatoid Arthritis ◽  
Real World ◽  
Population Based ◽  
World Population

P-450 Effects of rheumatoid arthritis and methotrexate therapy on ovarian reserve in infertile women

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
G Vlasova ◽  
S Perminova
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Ovarian Reserve ◽  
Small Sample Size ◽  
Genetic Material ◽  
Main Group ◽  
Small Sample ◽  
Control Group ◽  
Proliferating Cells ◽  
Number Of Patients

Abstract Study question Do patients with infertility and rheumatoid arthritis (RA) treated with methotrexate (MTX) have ovarian reserve alterations? Summary answer Women with infertility and RA treated with MTX were found to have statistically significant decrease of ovarian reserve. What is known already Rheumatoid arthritis (RA) is one of the most prominent inflammatory diseases affecting women of child-bearing age [Brouwer J. et al, 2014]. RA and its treatment may interfere with the female reproductive physiology. The vast majority of patients with RA are treated with methotrexate (MTX) which is a folate antagonist that inhibits DNA synthesis. MTX, which is the anchor drug in RA, targets actively proliferating cells including the oocytes and granulosa cells which may impair the ovarian reserve [Min Tun Kyaw et al, 2020]. Study design, size, duration A prospective case-control study that enrolled 72 female patients with infertility was conducted in the 2-year time period of September 2018 to October 2020. Participants/materials, setting, methods The main group comprised 32 patients with infertility and RA; the control group consisted of 40 women with infertility only. Patients with RA were stratified into subgroups based on whether or not they received MTX. To investigate ovarian reserve measurement of serum anti-Müllerian hormone (AMH) was used. The level of AMH was evaluated concerning RA duration and activity, as well as the age at initiation of MTX therapy, dosage, and treatment duration. Main results and the role of chance The mean age of the study population was 36±3 years. The duration of RA was 4 [3;11] years. The low disease activity based on DAS28-ESR (disease activity score based on 28 joints using the erythrocyte sedimentation rate) prevailed(56.2%). In the main group 19(59.4%) women received MTX therapy. The MTX dosage was 15 [15;20]mg /wk, the duration of MTX therapy by the day of inclusion in the study was 18.7[1;15]months. The AMH level was significantly lower in the main group (2.1 n /ml vs 2.73ng /ml, p = 0.043). The number of patients with decreased ovarian reserve (AMH level&lt;1.0ng/ml) significantly prevailed in the group of patients with RA (25% vs 5%, p = 0.015). When assessing the AMH level in patients with RA who received MTX (n = 19) and patients in the control group, there was a tendency towards a decrease in the indicator in the first subgroup, but no statistically difference was found (p = 0.074). Correlation analysis of the dependence of AMH level on the patient age showed the most significant decrease in AMH in the patients with RA receiving MTX compared to the patients with RA who did not, and compared to all patients with RA regardless of the therapy received (rs=-0.563)(p &lt; 0.05). Limitations, reasons for caution The lack of statistically significant data in certain cases may be due to the small sample size. Wider implications of the findings RA and MTX administration are associated with a significant decrease in AMH levels. The age of initiation of the therapy is negatively correlated with the AMH level. In this regard, patients with already compromised reproductive function who are planning to receive MTX should be advised to preserve the genetic material. Trial registration number 567890

scholarly journals Yoga for Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 ◽  
Author(s):  
Xiangling Ye ◽  
Zehua Chen ◽  
Zhen Shen ◽  
Guocai Chen ◽  
Xuemeng Xu
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Physical Function ◽  
Grip Strength ◽  
Inflammatory Cytokines ◽  
Large Scale ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Cochrane Library

Purpose: Rheumatoid arthritis (RA) is a pervasive inflammatory autoimmune disease that seriously impairs human health and requires more effective non-pharmacologic treatment approaches. This study aims to systematically review and evaluate the efficacy of yoga for patients with RA.Methods: Medline (through PubMed), Cochrane Library, EMBASE (through SCOPUS), and Web of Science database were screened through for articles published until 20 July 2020. Randomized controlled trials (RCTs) of yoga in patients with RA were included. Outcomes measures were pain, physical function, disease activity, inflammatory cytokines, and grip strength. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.Result: Ten trials including 840 patients with RA aged 30–70 years were identified, with 86% female participants. Meta-analysis revealed a statistically significant overall effect in favor of yoga for physical function (HAQ-DI) (5 RCTs; SMD = −0.32, 95% CI −0.58 to −0.05, I2 = 15%, P = 0.02), disease activity (DAS-28) (4 RCTs; SMD = −0.38, 95% CI −0.71 to −0.06, I2 = 41%, P = 0.02) and grip strength (2 RCTs; SMD = 1.30, 95% CI 0.47–2.13, I2 = 63%, P = 0.002). No effects were found for pain, tender joints, swollen joints count or inflammatory cytokines (i.e., CRP, ESR, IL-6, and TNF-α).Summary: The findings of this meta-analysis indicate that yoga may be beneficial for improving physical function, disease activity, and grip strength in patients with RA. However, the balance of evidence showed that yoga had no significant effect in improving pain, tender joints, swollen joints count, and inflammatory cytokines in patients suffering from RA. Considering methodological limitations, small sample size, and low-quality, we draw a very cautious conclusion in the results of the estimate of the effect. High-quality and large-scale RCTs are urgently needed in the future, and the real result may be substantially different.

Twin studies and the heritability of MS: a conclusion

2009 ◽  
Vol 15 (6) ◽  
pp. 661-667 ◽  
Author(s):  
CH Hawkes ◽  
AJ Macgregor
Keyword(s):  
Small Sample Size ◽  
Large Population ◽  
Twin Studies ◽  
Genetic Effect ◽  
Population Based ◽  
Small Sample ◽  
Genetic Contribution ◽  
Research Strategies ◽  
Control Approach ◽  
Genes And Environment

Objective The classical twin study has the potential to evaluate the relative contribution of genes and environment and guide further research strategies, provided the sampling and methods of analysis are correct. We wish to review all the more informative twin studies on multiple sclerosis (MS). Methods We examined six large population-based twin studies in MS and calculated indices of heritability (h2), which is the traditional method of assessing genetic contribution to disease and to allow comparison between studies. Results This index was found to vary widely from 0.25 to 0.76 with large confidence intervals that reflect small sample size and prevent robust interpretation. Conclusion Overall the studies support a genetic contribution to disease; however, the imprecision of the heritability estimates and potential biases that they contain mean that very little inference can be drawn its exact size. Given that the magnitude of genetic effect cannot be measured because of the relative infrequency of MS; the consequent difficulty in collecting an informative sample; and in many countries, the lack of a comprehensive twin register, we suggest that further twin prevalence surveys should not be undertaken. Twin studies could be used more effectively in other ways, such as the co-twin case–control approach.

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