Occurrence of rheumatoid arthritis is not increased in the first degree relatives of a population based inception cohort of inflammatory polyarthritis.

Objective. To investigate the incidence of atrial fibrillation (AF) among patients with rheumatoid arthritis (RA) compared to the general population.Methods. A population-based inception cohort of Olmsted County, Minnesota, residents with incident RA in 1980–2007 and a cohort of non-RA subjects from the same population base were assembled and followed until 12/31/2008. The occurrence of AF was ascertained by medical record review.Results. The study included 813 patients with RA and 813 non-RA subjects (mean age 55.9 (SD:15.7) years, 68% women in both cohorts). The prevalence of AF was similar in the RA and non-RA cohorts at RA incidence/index date (4% versus 3%;P=0.51). The cumulative incidence of AF during follow-up was higher among patients with RA compared to non-RA subjects (18.3% versus 16.3% at 20 years;P=0.048). This difference persisted after adjustment for age, sex, calendar year, smoking, and hypertension (hazard ratio: 1.46; 95% CI: 1.07, 2.00). There was no evidence of a differential impact of AF on mortality in patients with RA compared to non-RA subjects (hazard ratio 2.5 versus 2.8; interactionP=0.31).Conclusion. The incidence of AF is increased in patients with RA, even after adjustment for AF risk factors. AF related mortality risk did not differ between patients with and without RA.

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The Influence of Early Menopause on Cardiovascular Risk in Women with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.131234 ◽

2014 ◽

Vol 41 (7) ◽

pp. 1270-1275 ◽

Cited By ~ 5

Author(s):

Emily C. Pfeifer ◽

Cynthia S. Crowson ◽

Shreyasee Amin ◽

Sherine E. Gabriel ◽

Eric L. Matteson

Keyword(s):

Rheumatoid Arthritis ◽

Hormone Replacement ◽

Population Based ◽

Proportional Hazard ◽

Inception Cohort ◽

Early Menopause ◽

American College Of Rheumatology ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Models

Objective.Early menopause is associated with an increased risk for developing rheumatoid arthritis (RA). The risk for cardiovascular disease (CVD) in women increases following menopause. Because RA is associated with an increased risk of CVD, this study was undertaken to determine whether early menopause affects the risk of developing CVD in women with RA.Methods.A population-based inception cohort of 600 women with RA who fulfilled 1987 American College of Rheumatology criteria for RA between 1955 and 2007 and were age ≥ 45 years at diagnosis was assembled and followed. Age at menopause and duration of hormone replacement therapy, along with occurrence of CVD, was ascertained by review of medical records. Cox proportional hazard models compared women who underwent early menopause (natural or artificial menopause at age ≤ 45 yrs) to those within the cohort who did not undergo early menopause.Results.Of 600 women, 79 experienced early menopause. Women who underwent early menopause were at significantly higher risk for developing CVD when compared to women who did not (HR 1.56; 95% CI 1.08–2.26).Conclusion.The risk of CVD in women with RA was higher in those who experienced early menopause, and like other known risk factors should increase clinician concern for development of CVD in these patients.

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Functional disability to evaluate the risk of arthritis in First-degree relatives of Rheumatoid Arthritis patients

The Journal of Rheumatology ◽

10.3899/jrheum.210614 ◽

2021 ◽

pp. jrheum.210614

Author(s):

Dana Wiens ◽

Irene Smolik ◽

Xiaobo Meng ◽

Vidyanand Anaparti ◽

Hani S. El-Gabalaw ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

At Risk ◽

First Nations ◽

Functional Disability ◽

Population Based ◽

Direct Role ◽

First Degree Relatives ◽

Increased Risk ◽

Joint Symptoms ◽

Acpa Level

Objective The events that occur prior to the onset of rheumatoid arthritis (RA) continue to be delineated. We examined the relationship between self-reported joint symptoms, functional disability, and anticitrullinated protein antibody (ACPA) status in a cohort of first-degree relatives (FDR) of RA patients who are at risk of future disease development. Methods We studied a cohort of 607 FDR of First Nations (FN) RA patients who are at increased risk for future RA development, and analyzed data collected at their enrollment study visit. In parallel, we analyzed data from 279 FN People with no family history of RA. A subset of FDR developed inflammatory arthritis and we analyzed longitudinal data in this group. Results The prevalence of joint symptoms and functional disability was higher in FDR compared to non- FDR (all p<0.001). Difficulty walking (37.3% vs 18.0%) and mHAQ were higher in ACPA positive FDR compared to ACPA negative FDR, and mHAQ was independently associated with ACPA seropositivity (OR: 2.79, 1.56-5.00). Longitudinally, in individuals who developed ACPA+ RA, ACPA level and mHAQ score were significantly associated (R = 0.43, p< 0.001) in the preclinical period. Conclusion Compared to population-based controls, FDR have a high burden of joint symptoms and functional disability. Functional disability was most closely associated with ACPA seropositivity in the FDR, suggesting a direct role for ACPA outside of the context of clinically detectable synovitis. mHAQ appears to be particularly valuable in the assessment of individuals at risk for future RA development.

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Trends in Serious Infections in Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.121075 ◽

2013 ◽

Vol 40 (5) ◽

pp. 611-616 ◽

Cited By ~ 18

Author(s):

Orla M. Ni Mhuircheartaigh ◽

Eric L. Matteson ◽

Abigail B. Green ◽

Cynthia S. Crowson

Keyword(s):

Rheumatoid Arthritis ◽

Geographical Area ◽

Population Based ◽

Infection Rates ◽

Inception Cohort ◽

Serious Infection ◽

Intravenous Antibiotics ◽

Serious Infections ◽

History Of ◽

Gi Infections

Objective.To examine trends in the rates of serious infections among patients diagnosed with rheumatoid arthritis (RA) in 1995–2007 compared to rates previously reported from the same geographical area diagnosed 1955–1994.Methods.A population-based inception cohort of patients with RA in 1995–2007 was assembled and followed through their complete medical records until death, migration, or December 31, 2008. All serious infections (requiring hospitalization or intravenous antibiotics) were recorded. Person-year (py) methods were used to compare rates of infection.Results.Among 464 patients with incident RA in 1995–2007, 54 had ≥ 1 serious infection (178 total). These were compared to 609 patients with incident RA in 1955–1994 (290 experienced ≥ 1 serious infection; 740 total). The rate of serious infections declined from 9.6 per 100 py in the 1955–1994 cohort to 6.6 per 100 py in the 1995–2007 cohort. Serious gastrointestinal (GI) infection rates increased from 0.5 per 100 py in the 1955–1994 cohort to 1.25 per 100 py in the 1995–2007 cohort. Among patients with a history of serious infection, the rate of subsequent infection increased from 16.5 per 100 py in 1955–1994 to 37.4 per 100 py in 1995–2007. There was an increase in the rate of serious infections in patients who received biologic agents, but this did not reach significance.Conclusion.Aside from GI infections, the rate of serious infections in patients with RA has declined in recent years. However, the rate of subsequent infections was higher in recent years than previously reported.

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Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.243.pag ◽

2015 ◽

Vol 24 (3) ◽

pp. 287-292 ◽

Cited By ~ 5

Author(s):

Petra A. Golovics ◽

Laszlo Lakatos ◽

Michael D. Mandel ◽

Barbara D. Lovasz ◽

Zsuzsanna Vegh ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cox Regression ◽

Diagnostic Procedures ◽

Population Based ◽

Disease Course ◽

Inception Cohort ◽

Disease Extent ◽

Cox Regression Analysis ◽

Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

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Faculty Opinions recommendation of The effectiveness of leflunomide as a co-therapy of tumour necrosis factor inhibitors in rheumatoid arthritis: a population-based study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1104777.560749 ◽

2008 ◽

Author(s):

Geoff Littlejohn

Keyword(s):

Rheumatoid Arthritis ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Population Based ◽

Population Based Study ◽

Tumour Necrosis Factor Inhibitors ◽

Necrosis Factor

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Fracture Risk in Patients with Myasthenia Gravis: A Population-Based Cohort Study

Journal of Neuromuscular Diseases ◽

10.3233/jnd-200612 ◽

2021 ◽

pp. 1-8

Author(s):

Charles Kassardjian ◽

Jessica Widdifield ◽

J. Michael Paterson ◽

Alexander Kopp ◽

Chenthila Nagamuthu ◽

...

Keyword(s):

Myasthenia Gravis ◽

Lower Risk ◽

Cox Regression ◽

Large Population ◽

Population Based ◽

Osteoporosis Prevention ◽

Inception Cohort ◽

Hazard Ratios ◽

Multiple Covariates ◽

Region Of Residence

Background: Prednisone is a common treatment for myasthenia gravis (MG), and osteoporosis is a known potential risk of chronic prednisone therapy. Objective: Our aim was to evaluate the risk of serious fractures in a population-based cohort of MG patients. Methods: An inception cohort of patients with MG was identified from administrative health data in Ontario, Canada between April 1, 2002 and December 31, 2015. For each MG patient, we matched 4 general population comparators based on age, sex, and region of residence. Fractures were identified through emergency department and hospitalization data. Crude overall rates and sex-specific rates of fractures were calculated for the MG and comparator groups, as well as rates of specific fractures. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results: Among 3,823 incident MG patients (followed for a mean of 5 years), 188 (4.9%) experienced a fracture compared with 741 (4.8%) fractures amongst 15,292 matched comparators. Crude fracture rates were not different between the MG cohort and matched comparators (8.71 vs. 7.98 per 1000 patient years), overall and in men and women separately. After controlling for multiple covariates, MG patients had a significantly lower risk of fracture than comparators (HR 0.74, 95% CI 0.63–0.88). Conclusions: In this large, population-based cohort of incident MG patients, MG patients were at lower risk of a major fracture than comparators. The reasons for this finding are unclear but may highlight the importance osteoporosis prevention.

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