Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated or Not with Low-dose Glucocorticoids: A Retrospective Study

2010 ◽  
Vol 37 (11) ◽  
pp. 2232-2236 ◽  
Author(s):  
MAURIZIO MAZZANTINI ◽  
ROSARIA TALARICO ◽  
MARICA DOVERI ◽  
ARIANNA CONSENSI ◽  
MASSIMILIANO CAZZATO ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Retrospective Study ◽  
Arterial Hypertension ◽  
Low Dose ◽  
Fragility Fractures ◽  
The Other ◽  
Prevention Measures ◽  
Accurate Identification ◽  
High Prevalence

Objective.To assess the prevalence of comorbidity in a cohort of patients with rheumatoid arthritis (RA), treated or not with low-dose glucocorticoids (GC) and who have been followed for at least 10 years.Methods.This was a retrospective study by review of medical records.Results.We identified 365 patients: 297 (81.3%) were GC users (4–6 mg methylprednisolone daily) and 68 (18.7%) were nonusers. We found that fragility fractures occurred in 18.2% of GC users and in 6.0% of GC nonusers (p < 0.02); arterial hypertension in 32.3% of GC users and in 10.4% of GC nonusers (p < 0.0005); acute myocardial infarction in 13.1% of GC users and in 1.5% of the nonusers (p < 0.01). Prevalence of diabetes mellitus, cataract, and infections was comparable. We divided GC users into groups of different duration of GC therapy: < 2, 2–5, and > 5 years; the mean duration of GC treatment was 1.3 ± 0.5, 3.6 ± 1.1, and 12.1 ± 5.1 years, respectively. GC treatment for > 5 years was associated with significantly higher prevalence of fragility fractures (26.6%; p < 0.001 vs the other groups), arterial hypertension (36.7%; p < 0.0002 vs nonusers and GC users < 2 years), myocardial infarction (16.1%; p < 0.01 vs nonusers), and infections (9.7%; p < 0.005 vs the other groups). GC treatment for 2–5 years was associated with a significantly higher prevalence of arterial hypertension (30.0%; p < 0.01) compared to nonusers.Conclusion.Patients with RA treated with low-dose GC compared to patients never treated with GC show a higher prevalence of fractures, arterial hypertension, myocardial infarction, and serious infections, especially after 5 years of GC treatment. The high prevalence of myocardial infarction and fractures in patients with RA suggests that a more accurate identification of risk factors and prevention measures should be adopted when longterm GC treatment is needed.

Adverse Events During Longterm Low-dose Glucocorticoid Treatment of Polymyalgia Rheumatica: A Retrospective Study

2012 ◽  
Vol 39 (3) ◽  
pp. 552-557 ◽  
Author(s):  
MAURIZIO MAZZANTINI ◽  
CLAUDIA TORRE ◽  
MARIO MICCOLI ◽  
ANGELO BAGGIANI ◽  
ROSARIA TALARICO ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Retrospective Study ◽  
Adverse Events ◽  
Arterial Hypertension ◽  
Cumulative Dose ◽  
Polymyalgia Rheumatica ◽  
Low Dose ◽  
Univariate Analysis ◽  
Fragility Fractures

Objective.To assess the occurrence of adverse events in a cohort of patients with polymyalgia rheumatica (PMR), treated with low-dose glucocorticoids (GC).Methods.This was a retrospective study by review of medical records.Results.We identified 222 patients who had a mean duration of followup of 60 ± 22 months and a mean duration of GC therapy of 46 ± 22 months. We found that 95 patients (43%) had at least 1 adverse event after a mean duration of GC therapy of 31 ± 22 months and a mean cumulative dose of 3.4 ± 2.4 g. In particular, 55 developed osteoporosis, 31 had fragility fractures; 27 developed arterial hypertension; 11 diabetes mellitus; 9 acute myocardial infarction; 3 stroke; and 2 peripheral arterial disease. Univariate analysis showed that the duration of GC treatment was significantly associated with osteoporosis (p < 0.0001), fragility fractures (p < 0.0001), arterial hypertension (p < 0.005), and acute myocardial infarction (p < 0.05). Cumulative GC dose was significantly associated with osteoporosis (p < 0.0001), fragility fractures (p < 0.0001), and arterial hypertension (p < 0.01). The adverse events occurred more frequently after 2 years of treatment. Multivariate analysis showed that GC duration was significantly associated with osteoporosis (adjusted OR 1.02, 95% CI 1.02–1.05) and arterial hypertension (adjusted OR 1.03, 95% CI 1.01–1.06); GC cumulative dose was significantly associated with fragility fractures (adjusted OR 1.4, 95% CI 1.03–1.8).Conclusion.Longterm, low-dose GC treatment of PMR is associated with serious adverse events such as osteoporosis, fractures, and arterial hypertension; these adverse events occur mostly after 2 years of treatment.

scholarly journals Evaluation of an Isolation Program of Hepatitis C Virus Infected Hemodialysis Patients in Some Hemodialysis Centers in Egypt

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Amin R. Soliman ◽  
Mohamed Momtaz Abd Elaziz ◽  
Mona I. El lawindi
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hemodialysis Patients ◽  
Hcv Infection ◽  
The Other ◽  
Nosocomial Transmission ◽  
Universal Prevention ◽  
Prevention Measures ◽  
High Prevalence ◽  
Regular Hemodialysis

Introduction. Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality in hemodialysis (HD) patients. Several studies demonstrated nosocomial transmission of HCV among HD patients. Aim. We aimed to evaluate the isolation program of HCV seropositive patients among a group of Egyptian haemodialysis patients to decrease the incidence of HCV seroconversion. Methods. One hundred and fourteen HCV seronegative patients who were receiving regular haemodialysis in different four haemodialysis units in Egypt. The first group included forty six patients on regular hemodialysis in two centers following strict isolation of the HCV seropositive patients, and the second group included sixty eight patients on regular hemodialysis in the other two centers not following this strict isolation. All these patients were followed up over a period of 36 months. Results. There was a significantly higher incidence of HCV seroconversion of patients on hemodialysis in units not following strict isolation of HCV seropositive patients (42.9%) than those on regular hemodialysis in units following strict isolation (14.8%). Conclusions. In HD units with a high prevalence of HCV+ patients, strict isolation of HCV+ patients in combination with implementation of universal prevention measures can limit the spread of HCV infection in HD patients.

Efficacy of low-dose tacrolimus added to methotrexate in patients with rheumatoid arthritis in Japan: a retrospective study

2009 ◽  
Vol 19 (1) ◽  
pp. 102-102
Author(s):  
Yoshitaka Morita ◽  
Yumi Sasae ◽  
Takeo Sakuta ◽  
Minoru Satoh ◽  
Tamaki Sasaki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Low Dose

SAT0132 DOES JANUS KINASE INHIBITION INDUCED HYPERLIPIDAEMIA ASSOCIATE WITH AN INCREASE OF AORTIC STIFFNESS IN PATIENTS WITH ARTHRITIS? PRELIMINARY RESULTS OF A PROSPECTIVE PILOT STUDY ON CARDIOVASCULAR RISK

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1003.1-1003
Author(s):  
K. Triantafyllias ◽  
L. E. Thiele ◽  
M. De Blasi ◽  
A. Schwarting
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Arterial Hypertension ◽  
Total Cholesterol ◽  
Aortic Stiffness ◽  
Janus Kinase ◽  
The Other ◽  
Inflammation Markers ◽  
Time Points ◽  
Other Hand

Background:Treatment with Janus Kinase inhibitors (JAK-i) (Tofacitinib, Baricitinib) can cause an increase of serum lipids such as total cholesterol, low- (LDL) and high- (HDL) density lipoproteins in patients with arthritis (1). On the other hand, JAK-i can reduce systemic inflammation and have therefore a beneficial effect on the cardiovascular system of treated patients. However, the effects of JAK-i on the CV system have not been adequately examined. In particular, we are not aware of any ’’real world’’ data concerning CV risk of patients receiving JAK-i treatment.Stiffness of the aortic vasculature is a modifiable, valid and independent surrogate predictor of CV risk and can be measured by carotid femoral pulse wave velocity (cfPWV). Its predicted value has been shown in a series of epidemiological studies and cfPWV is characterized as the gold standard marker for the assessment of aortic stiffness (2)Objectives:Aim of this study was to evaluate for the first time changes of cfPWV, lipid profile and traditional CV risk factors in patients receiving JAK-i therapy.Methods:Measurements of cfPWV, total cholesterol, LDL, HDL and inflammation markers were performed directly before and 5-12 months (median 6.5 months; 5-7, IQR) after initiation of JAK-i therapy. Additionally, traditional CV risk factors such as nicotine, obesity (Body-Mass-Index), diabetes and arterial hypertension were documented for both time points next to clinical activity markers, such as the Disease Activity Score 28 (DAS28). Differences in lipids, DAS28 and inflammation markers between the two time points were examined by paired t-Test. Given the fact that cfPWV can be confounded by mean arterial pressure (MAP), a mixed linear model, with MAP as a covariate, was used in order to test for differences in adjusted cfPWV values between two measurements.Results:29 patients with rheumatoid arthritis (RA) (72.4%,female) with a median age of61.5(51-75, IQR) years and a median DAS28-CRP of5.27(3.62-6.21, IQR) were recruited before (planed) initiation of JAK-i therapy.30.7%of the patients were smokers,38.5%had arterial hypertension and0.4%diabetes. Median BMI was24kg/m2(22-29, IQR).Mean total cholesterol and LDL values increased significantly under treatment with JAK-i (196.76±38.70vs.220.28±40.41mg/dl;p=0.010and119.12±31.88vs.138.72±37.43mg/dl;p=0.032, respectively). Moreover, MAP increased significantly during the same time period (105± 9.82vs.109.91±11.22mmHg; p=0.005). On the other hand, C-reactive protein (CRP) had decreased significantly between the two measurements [15.27(3.82-38.9, IQR) vs.3.82(1.4-15.9) mg/dl;p=0.05]. No statistical significant difference of cfPWV values could be observed under JAK-i treatment[-0,035 95% CI (-0,615 - 0,545); p=0.903].Conclusion:Our results reveal that JAK-i induced hyperlipidaemia did not associate with an increase of a surrogate marker of CV risk, such as aortic stiffness. More data are needed to conclude whether JAK-i could have a (positive or negative) effect on the CV system.An additional examination of the current patients in 12-18 months from treatment initiation and the recruitment of new RA and psoriatic arthritis patients are currently taking place.References:[1]Charles-Schoeman C, et al. Cardiovascular safety findings in patients with rheumatoid arthritis treated with tofacitinib, an oral Januskinase inhibitor.Semin Arthritis Rheum. 2016;46(3):261-271[2]Laurent S, et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. EurHear J 27:2588–2605.Disclosure of Interests:None declared

Efficacy of low-dose tacrolimus added to methotrexate in patients with rheumatoid arthritis in Japan: a retrospective study

2008 ◽  
Vol 18 (4) ◽  
pp. 379-384 ◽  
Author(s):  
Yoshitaka Morita ◽  
Yumi Sasae ◽  
Takeo Sakuta ◽  
Minoru Satoh ◽  
Tamaki Sasaki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Low Dose
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