scholarly journals Increased Incidence and Impact of Upper and Lower Gastrointestinal Events in Patients with Rheumatoid Arthritis in Olmsted County, Minnesota: A Longitudinal Population-based Study

2012 ◽  
Vol 39 (7) ◽  
pp. 1355-1362 ◽  
Author(s):  
ELENA MYASOEDOVA ◽  
ERIC L. MATTESON ◽  
NICHOLAS J. TALLEY ◽  
CYNTHIA S. CROWSON
Keyword(s):  
Rheumatoid Arthritis ◽  
Rate Ratio ◽  
Population Based ◽  
Incidence Rates ◽  
Olmsted County ◽  
Calendar Time ◽  
Upper Gi ◽  
American College Of Rheumatology ◽  
Increased Risk ◽  
Incidence And Mortality

Objective.To assess the incidence and mortality impact of upper and lower gastrointestinal (GI) events in rheumatoid arthritis (RA) compared to non-RA subjects.Methods.We identified incident upper and lower GI events and estimated their incidence rates using person-year methods in a population-based incident RA cohort of residents of Olmsted County, Minnesota, USA (1987 American College of Rheumatology criteria first fulfilled between January 1, 1980, and January 1, 2008) and non-RA subjects from the same population.Results.The study included 813 patients with RA and 813 non-RA subjects (mean followup 10.3 and 10.8 yrs, respectively); 68% women; mean age 55.9 yrs in both cohorts. The rate of upper GI events/100 person-years was 2.9 in RA versus 1.7 in the non-RA cohort (rate ratio 1.7, 95% CI 1.4, 2.2); for lower GI events, the rates were 2.1 in RA versus 1.4 in the non-RA cohort (rate ratio 1.5, 95% CI 1.1, 1.9). The incidence of upper GI bleed, perforation, ulcer, obstruction, and any upper GI event in RA declined over calendar time; the incidence of lower GI events remained unchanged. Exposure to glucocorticoids, prior upper GI disease, abdominal surgery, and smoking were associated with lower GI events in RA. Both upper and lower GI events were associated with increased mortality risk in RA.Conclusion.There is increased risk of serious upper and lower GI events in RA compared to non-RA subjects, and increased GI-related mortality in RA. Prominent declines in incidence of upper, but not lower GI events in RA highlight the need for studies investigating lower GI disease in patients with RA.

scholarly journals Incidence of Extraarticular Rheumatoid Arthritis in Olmsted County, Minnesota, in 1995–2007 Versus 1985–1994: A Population-based Study

2011 ◽  
Vol 38 (6) ◽  
pp. 983-989 ◽  
Author(s):  
ELENA MYASOEDOVA ◽  
CYNTHIA S. CROWSON ◽  
CARL TURESSON ◽  
SHERINE E. GABRIEL ◽  
ERIC L. MATTESON
Keyword(s):  
Rheumatoid Arthritis ◽  
Cumulative Incidence ◽  
Statistical Significance ◽  
Population Based ◽  
Olmsted County ◽  
Disease Modifying Antirheumatic Drugs ◽  
Population Based Study ◽  
American College Of Rheumatology ◽  
Systemic Corticosteroids ◽  
Incidence And Mortality

Objective.To assess incidence and mortality effects of extraarticular rheumatoid arthritis (ExRA) in patients with incident RA in 1995–2007 compared to 1985–1994, in Olmsted County, Minnesota, USA.Methods.Data on incident ExRA were abstracted from medical records of patients with RA — Olmsted County residents who first met the 1987 American College of Rheumatology criteria for RA between January 1, 1995, and December 31, 2007. Patients were followed until death, migration from Olmsted County, or December 31, 2008. ExRA were classified using the predefined criteria and compared to the corresponding 1985–1994 inception RA cohort (n = 147).Results.The 1995–2007 cohort included 463 patients with RA followed for a mean of 6.3 years; mean age was 55.6 years, 69% were women, 67% were positive for rheumatoid factor (RF). The 10-year cumulative incidence of any ExRA (50.1%) and severe ExRA (6.7%) in the 1995–2007 cohort was similar to the 1985–1994 cohort (46.2% and 9.7%, respectively). The 10-year cumulative incidence of vasculitis, but not other features of ExRA, was significantly lower in the 1995–2007 cohort (0.6%) compared to the 1985–1994 cohort (3.6%). RF positivity, erosions/destructive changes, and use of methotrexate, other disease-modifying antirheumatic drugs and systemic corticosteroids were significantly associated with ExRA in the 1995–2007 cohort. ExRA was associated with mortality risk (HR 2.1, 95% CI 1.2, 3.7) in the 1995–2007 cohort. The decrease in mortality following ExRA in the 1995–2007 cohort versus the 1985–1994 cohort did not reach statistical significance (HR 0.6, 95% CI 0.3, 1.2, p = 0.16).Conclusion.ExRA remains a common complication associated with increased mortality in RA. The occurrence of vasculitis appears to be decreasing in recent years.

Serum Uric Acid and the Risk of Incident and Recurrent Gout: A Systematic Review

2017 ◽  
Vol 44 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Aki Shiozawa ◽  
Shelagh M. Szabo ◽  
Anna Bolzani ◽  
Antoinette Cheung ◽  
Hyon K. Choi
Keyword(s):  
Systematic Review ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Population Based ◽  
Causal Link ◽  
Incidence Rates ◽  
American College Of Rheumatology ◽  
Epidemiologic Evidence ◽  
Cochrane Database ◽  
Increased Risk

Objective.Lowering serum uric acid (SUA) levels can essentially cure gout; however, this is not widely practiced. To summarize epidemiologic evidence related to this causal link, we conducted a systematic review of the published literature reporting the association between SUA level and incident and recurrent gout (i.e., gout flares).Methods.We systematically searched Medline, EMBASE, and the Cochrane Database of Systematic Reviews using separate search strategies for incident gout and recurrent gout. We screened 646 abstracts to identify 8 eligible articles reporting gout incidence and 913 abstracts to identify 18 articles reporting recurrent gout.Results.For both gout incidence and recurrence, a graded trend was observed where the risk was increased with higher SUA levels. Gout incidence rates per 1000 person-years from population-based studies ranged from 0.8 (SUA ≤ 6 mg/dl) to 70.2 cases (SUA ≥ 10 mg/dl). Recurrent gout risk in clinical cohorts ranged from 12% (SUA ≤ 6 mg/dl) to 61% (SUA ≥ 9 mg/dl) among those receiving urate-lowering therapy (ULT), and 3.7% (SUA 6–7 mg/dl) to 61% (SUA > 9.3 mg/dl) after successful ULT. Retrospective database studies also showed a graded relationship, although the strength of the association was weaker. Studies reporting mean flares or time-to-flare according to SUA showed similar findings.Conclusion.This systematic review confirms that higher SUA levels are associated with increased risk of incident and recurrent gout in a graded manner. Although few prospective cohorts have evaluated incident and recurrent gout according to SUA, the existing evidence underscores the need to treat to SUA targets, as recommended by the American College of Rheumatology and the European League Against Rheumatism.

scholarly journals Longterm Blood Pressure Variability in Patients with Rheumatoid Arthritis and Its Effect on Cardiovascular Events and All-cause Mortality in RA: A Population-based Comparative Cohort Study

2014 ◽  
Vol 41 (8) ◽  
pp. 1638-1644 ◽  
Author(s):  
Elena Myasoedova ◽  
Cynthia S. Crowson ◽  
Abigail B. Green ◽  
Eric L. Matteson ◽  
Sherine E. Gabriel
Keyword(s):  
Rheumatoid Arthritis ◽  
Blood Pressure ◽  
Population Based ◽  
Significant Decline ◽  
American College Of Rheumatology ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Comparative Cohort Study ◽  
The Mean ◽  
Incident Cohort

Objective.To examine longterm visit-to-visit blood pressure (BP) variability in patients with rheumatoid arthritis (RA) versus non-RA subjects and to assess its effect on cardiovascular (CV) events and mortality in RA.Methods.Clinic BP measures were collected in a population-based incident cohort of patients with RA (1987 American College of Rheumatology criteria met between January 1, 1995, and January 1, 2008) and non-RA subjects. BP variability was defined as within-subject SD in systolic and diastolic BP.Results.The study included 442 patients with RA (mean age 55.5 yrs, 70% females) and 424 non-RA subjects (mean age 55.7 yrs, 69% females). Patients with RA had higher visit-to-visit variability in systolic BP (13.8 ± 4.7 mm Hg) than did non-RA subjects (13.0 ± 5.2 mm Hg, p = 0.004). Systolic BP variability declined after the index date in RA (p < 0.001) but not in the non-RA cohort (p = 0.73), adjusting for age, sex, and calendar year of RA. During the mean followup of 7.1 years, 33 CV events and 57 deaths occurred in the RA cohort. Visit-to-visit systolic BP variability was associated with increased risk of CV events (HR per 1 mm Hg increase in BP variability 1.12, 95% CI 1.01–1.25). Diastolic BP variability was associated with all-cause mortality in RA (HR 1.14, 95% CI 1.03–1.27), adjusting for systolic and diastolic BP, body mass index, smoking, diabetes, dyslipidemia, and use of antihypertensives.Conclusion.Patients with RA had higher visit-to-visit systolic BP variability than did non-RA subjects. There was a significant decline in systolic BP variability after RA incidence. Higher visit-to-visit BP variability was associated with adverse CV outcomes and all-cause mortality in RA.

scholarly journals Is the epidemiology of rheumatoid arthritis changing? Results from a population-based incidence study, 1985–2014

2020 ◽  
Vol 79 (4) ◽  
pp. 440-444 ◽  
Author(s):  
Elena Myasoedova ◽  
John Davis ◽  
Eric L Matteson ◽  
Cynthia S Crowson
Keyword(s):  
Rheumatoid Arthritis ◽  
Population Based ◽  
Incidence Rates ◽  
Regression Methods ◽  
Incidence Trends ◽  
American College Of Rheumatology ◽  
Acr Criteria ◽  
Previous Decade ◽  
The Usa ◽  
Adjusted Incidence

ObjectivesTo examine trends in the incidence of rheumatoid arthritis (RA) from 2005 to 2014 overall and by serological status as compared with 1995–2004 and 1985–1994.MethodsWe evaluated RA incidence trends in a population-based inception cohort of individuals aged ≥18 years who first fulfilled the 1987 American College of Rheumatology (ACR) criteria for RA between 1 January 1985 and 31 December 2014. Incidence rates were estimated and were age-adjusted and sex-adjusted to the white population in the USA in 2010. Trends in incidence were examined using Poisson regression methods.ResultsThe 2005–2014 incidence cohort comprised 427 patients: mean age 55.4 years, 68% female, 51% rheumatoid factor (RF) positive and 50% anti-cyclic citrullinated peptide antibody positive. The overall age-adjusted and sex-adjusted annual RA incidence in 2005–2014 was 41/100 000 population (age-adjusted incidence: 53/100 000 in women and 29/100 000 in men). While these estimates were similar to the 1995–2004 decade, there was a decline in the incidence of RF-positive RA in 2005–2014 compared with the previous two decades (p=0.004), with a corresponding increase in RF-negative cases (p<0.001). Smoking rates declined and obesity rates increased from earlier decades to more recent years.ConclusionsSignificant increase in incidence of RF-negative RA and decrease in RF-positive RA in 2005–2014 compared with previous decades was found using 1987 ACR criteria. The incidence of RA overall during this period remained similar to the previous decade. The changing prevalence of environmental factors, such as smoking, obesity and others, may have contributed to these trends. Whether these trends represent a changing serological profile of RA requires further investigation.

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

2014 ◽  
Vol 41 (7) ◽  
pp. 1270-1275 ◽  
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.

scholarly journals The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study

2020 ◽  
Vol 29 ◽  
Author(s):  
D. Pettersson ◽  
M. Gissler ◽  
J. Hällgren ◽  
U. Ösby ◽  
J. Westman ◽  
...  
Keyword(s):  
General Population ◽  
Population Based ◽  
Incidence Rates ◽  
Age Group ◽  
Calendar Time ◽  
Population Based Study ◽  
Risk Of Death ◽  
Increased Risk ◽  
Prevention Programmes ◽  
Cancer Types

Abstract Aims Decades of research show that people with schizophrenia have an increased risk of death from cancer; however, the relationship between schizophrenia and cancer incidence remains less clear. This population-based study investigates the incidence of seven common types of cancer among people with a hospital diagnosis of schizophrenia and accounting for the effects of age, sex and calendar time. Methods This population-based study used 1990–2013 data from three nationwide Swedish registries to calculate the incidence (in total, by age group and by sex) of any cancer and of lung, oesophageal, pancreatic, stomach, colon, (in men) prostate and (in women) breast cancer in 111 306 people with a hospital diagnosis of schizophrenia. The incidence in people with diagnosed schizophrenia was compared with the incidence in the general population. Risk estimates accounted for the effects of calendar time. Results In 1 424 829 person-years of follow-up, schizophrenia did not confer an overall higher cancer risk (IRR 1.02, 95% CI 0.91–1.13) but was associated with a higher risk for female breast (IRR 1.19, 95% CI 1.12–1.26), lung (IRR 1.42, 95% CI 1.28–1.58), oesophageal (IRR 1.25, 95% CI 1.07–1.46) and pancreatic (IRR 1.10, 95% CI 1.01–1.21) and a lower risk of prostate (IRR 0.66, 95% CI 0.55–0.79) cancer. Some age- and sex-specific differences in risk were observed. Conclusions People with schizophrenia do not have a higher overall incidence of cancer than people in the general population. However, there are significant differences in the risk of specific cancer types overall and by sex calling for efforts to develop disease-specific prevention programmes. In people with schizophrenia, higher risk generally occurs in those <75 years.

The risk of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a UK population-based outpatient cohort study

2012 ◽  
Vol 72 (7) ◽  
pp. 1182-1187 ◽  
Author(s):  
Hyon K Choi ◽  
Young-Hee Rho ◽  
Yanyan Zhu ◽  
Lucia Cea-Soriano ◽  
Juan Antonio Aviña-Zubieta ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Pulmonary Embolism ◽  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
General Population ◽  
Population Based ◽  
Incidence Rates ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein

BackgroundRecent hospital-based studies have suggested a sixfold increased risk of pulmonary embolism (PE) in rheumatoid arthritis (RA) in the year following admission. We evaluated the risk of PE and deep vein thrombosis (DVT) and associated time trend among RA patients (84.5% without a history of hospitalisation during the past year) derived from the general population.MethodsWe conducted a cohort study using an electronic medical records database representative of the UK general population, collected from 1986 to 2010. Primary definitions of the RA cohort (exposure) and PE/DVT outcomes required physician diagnoses followed by corresponding treatments. We estimated relative risks (RRs) of PE and DVT compared with a matched non-RA comparison cohort, adjusting for age, sex, smoking, body mass index, comorbidities and hospitalisations.ResultsAmong 9589 individuals with RA (69% female, mean age of 58 years), 82 developed PE and 110 developed DVT (incidence rates, 1.5 and 2.1 per 1000 person-years). Compared with non-RA individuals (N=95 776), the age-, sex- and entry-time-matched RRs were 2.23 (95% CI 1.75 to 2.86) for PE and 2.20 (CI 1.78 to 2.71) for DVT. Adjusting for other covariates, the corresponding RRs were 2.16 (CI 1.68 to 2.79) and 2.16 (CI 1.74 to 2.69). The time-specific RRs for PE were 3.27, 1.88 and 2.35 for follow-up times of <1 year, 1–4.9 years, and ≥5 years, and corresponding RRs for DVT were 3.16, 1.82 and 2.32.ConclusionsThis population-based study indicates an increased risk of PE and DVT in RA, supporting increased monitoring of venous-thromboembolic complications and risk factors in RA, regardless of hospitalisation.

Are patients with rheumatoid arthritis still at an increased risk of tuberculosis and what is the role of biological treatments?

2014 ◽  
Vol 74 (6) ◽  
pp. 1212-1217 ◽  
Author(s):  
Elizabeth V Arkema ◽  
Jerker Jonsson ◽  
Eva Baecklund ◽  
Judith Bruchfeld ◽  
Nils Feltelius ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Population Based ◽  
Calendar Time ◽  
Cox Models ◽  
Increased Risk ◽  
National Cohort ◽  
Biologics Register

ObjectiveTo estimate the risk of tuberculosis (TB) in patients with rheumatoid arthritis (RA) both with and without exposure to biological therapy and to directly compare the risks between therapies.MethodsData from the Swedish National Population Registers, Tuberculosis Register and the Swedish Biologics Register were used to conduct a prospective population-based national cohort study (2002–2011). We estimated the rate of incident TB in the general population and in a cohort of biological-naïve and biological-exposed patients diagnosed with RA. Cox models were used to estimate HRs with particular attention to risks by calendar and follow-up time and individual biologics.ResultsCompared to the general population, RA patients not exposed to biologicals had a fourfold increased risk of TB (HR 4.2; 95% CI 2.7 to 6.7), which did not decline over calendar time. In contrast, the risk of TB in the biological-exposed RA population decreased since 2002 compared with biological-naïve; from HR=7.9 (95% CI 3.3 to 18.9) in 2002–2006 to HR=2.4 (95% CI 0.9 to 6.1) in 2007–2011. The HRs for most recent exposure to adalimumab and infliximab compared with etanercept were 3.1 (95% CI 0.8 to 12.5) and 2.7 (95% CI 0.7 to 10.9), respectively, and the HR for etanercept compared with biological-naïve RA was 1.7 (95% CI 0.6 to 4.6).ConclusionsIn the past decade, the risk of TB has decreased among biological-exposed RA patients but remains higher than in biological-naïve RA patients. Most cases of TB in RA occur in biological-naïve RA patients, underscoring the elevated risk also in these patients.

Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis?

2016 ◽  
Vol 76 (2) ◽  
pp. 364-370 ◽  
Author(s):  
Jonas K Eriksson ◽  
Lennart Jacobsson ◽  
Karin Bengtsson ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
Ankylosing Spondylitis ◽  
General Population ◽  
Proportional Hazards ◽  
Population Based ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Relative Risks ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

AimsTo assess and compare the incidence of cardiovascular (CV) events, by CV phenotype, between patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and the general population.MethodsUsing linkages of national and population-based registers, we identified one cohort of prevalent patients with AS (n=5358), one with RA (n=37 245) and one with matched general population subjects (n=25 006). These cohorts were identified in 2006 through 2011 and were followed in 31 December 2012, for first ever occurrence of acute coronary syndromes (ACS), deep venous thromboembolism, pulmonary embolism and stroke, respectively. For each outcome, we calculated incidence rates standardised to the age and sex distribution of the AS cohort, as well as relative risks using Cox proportional hazards models.ResultsBased on 69 ACS events during 20 251 person-years of follow-up of the patients with AS, and 966 events during 127 014 person-years in the RA cohort, the age/sex-adjusted relative risks for ACS compared with the general population was 1.3 (95% CI 1.0 to 1.7) for AS and 1.7 (1.4 to 2.0) for RA. For thromboembolic events, the corresponding risks were 1.4 (1.1 to 1.9) in AS and 1.8 (1.5 to 2.1) in RA. Finally, for stroke, the relative risks were 1.5 (1.1 to 2.0) in AS and 1.5 (1.2 to 1.8) in RA, compared with the general population.ConclusionsPrevalent patients with AS are at a 30%–50% increased risk of incident CV events. When compared with patients with RA, this level of increase was similar for stroke, but only half as high for ACS and thrombotic events.

scholarly journals Occurrence and Effect of Lower Extremity Ulcer in Rheumatoid Arthritis — A Population-based Study

2014 ◽  
Vol 41 (3) ◽  
pp. 437-443 ◽  
Author(s):  
Adlene J. Jebakumar ◽  
Prabhu D. Udayakumar ◽  
Cynthia S. Crowson ◽  
Sherine E. Gabriel ◽  
Eric L. Matteson
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Lower Extremity ◽  
Cumulative Incidence ◽  
Premature Mortality ◽  
Population Based ◽  
Olmsted County ◽  
Population Based Study ◽  
Rheumatoid Nodules ◽  
American College Of Rheumatology

Objective.To assess the occurrence, risk factors, morbidity, and mortality associated with lower extremity (LE) ulcers in patients with rheumatoid arthritis (RA).Methods.Retrospective review of Olmsted County, Minnesota, USA, residents who first fulfilled the 1987 American College of Rheumatology criteria for RA in 1980–2007 with followup to death, migration, or April 2012. Only LE ulcers that developed after the diagnosis of RA were included.Results.The study included 813 patients with 9771 total person-years of followup. Of them, 125 developed LE ulcers (total of 171 episodes), corresponding to a rate of occurrence of 1.8 episodes per 100 person-years (95% CI: 1.5, 2.0 per 100 person-yrs). The cumulative incidence of first LE ulcers was 4.8% at 5 years after diagnosis of RA and increased to 26.2% by 25 years. Median time for the LE ulcer to heal was 30 days. Ten of 171 episodes (6%) led to amputation. LE ulcers in RA were associated with increased mortality (HR 2.42; 95% CI 1.71, 3.42), adjusted for age, sex, and calendar year. Risk factors for LE ulcers included age (HR 1.73 per 10-yr increase; 95% CI 1.47, 2.04), rheumatoid factor positivity (HR 1.63; 95% CI 1.05, 2.53), presence of rheumatoid nodules (HR 2.14; 95% CI 1.39, 3.31), and venous thromboembolism (HR 2.16; 95% CI 1.07, 4.36).Conclusion.LE ulcers are common among patients with RA. The cumulative incidence increased by 1% per year. A significant number require amputation. Patients with RA who have LE ulcers are at a 2-fold risk for premature mortality.

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