Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between Sudan and Sweden

Objective.To compare clinical characteristics and treatment between simultaneously investigated Sudanese and Swedish outpatients with rheumatoid arthritis (RA).Methods.Outpatients with RA from Sudan (n = 281) and Sweden (n = 542) diagnosed according to the 1987 American College of Rheumatology criteria were recruited between December 2008 and September 2010 and compared concerning clinical presentation, treatment, and laboratory findings, including immunoglobulin M with rheumatoid factor (IgM-RF).Results.Sudanese patients had lower inclusion age (median 49 vs 68 yrs), disease duration (48 vs 107 mos), and disease onset age (43 vs 56 yrs) as compared with Swedish patients (p < 0.0001 for all). When stratified concerning the age of inclusion, Swedish patients between 41–50 years had, however, a significantly lower age of onset, with a similar trend for all age groups above 30 years. The female preponderance was higher among Sudanese patients (89.3% vs 72.5%, p < 0.0001), and smoking was nonexistent among Sudanese female patients (p < 0.0001). Erythrocyte sedimentation rate levels and number of tender joints were significantly higher among Sudanese patients. The proportion of IgM-RF positivity was lower among Sudanese patients with RA (52.4% vs 75.5%, p < 0.0001). Higher proportions of Sudanese patients with RA were treated with methotrexate (MTX) and disease-modifying antirheumatic drug combinations, but none of them used biologics. Sudanese patients used lower doses of MTX and sulfasalazine (p < 0.0001) and higher doses of prednisolone (p < 0.0001) than Swedish patients.Conclusion.Sudanese patients with RA have significantly higher disease activity and are often IgM-RF–seronegative. Together with reports from Uganda and Cameroon, our data indicate a cluster of highly active and often seronegative RA in central Africa.

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Association between Hypothyroidism Onset and Alzheimer Disease Onset in Adults with Down Syndrome

Brain Sciences ◽

10.3390/brainsci11091223 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1223

Author(s):

Florence Lai ◽

Nathaniel D. Mercaldo ◽

Cassandra M. Wang ◽

Micaela S. Hersch ◽

Giovi G. Hersch ◽

...

Keyword(s):

Down Syndrome ◽

Alzheimer Disease ◽

Age Of Onset ◽

Disease Onset ◽

Age Groups ◽

Positive Association ◽

Early Age ◽

Thyroid Function Tests ◽

Logistic Regression Models ◽

Chi Squared

Adults with Down syndrome (DS) have an exceptionally high frequency of Alzheimer disease (AD) with a wide variability in onset, from 40 to 70 years of age. Equally prevalent in DS is hypothyroidism. In this study, we sought to quantify the relationship between the two. A total of 232 adults with DS and AD were stratified into three AD onset age groups: early (<47 years), typical (48–59), and late (>59). Among patients with available data, differences in the distributions of demographics, hypothyroidism variables (presence, age of onset), thyroid function tests, thyroid autoantibodies, and APOE genotypes were assessed (e.g., chi-squared, Mann–Whitney tests). Spearman and partial Spearman correlations and ordinal logistic regression models were constructed to quantify the association between ages of AD and hypothyroidism onset with and without covariate adjustments. We observed a positive association between the ages of AD and hypothyroidism onset after accounting for APOE-Ɛ4 (correlation: 0.44, 0.24, 0.60; odds ratio: 1.09, 1.05–1.14). However, an early age of hypothyroidism onset and the presence of the APOE-Ɛ4 allele were independently associated with the early age of AD onset. Similar findings were observed when accounting for other factors. Our study provides evidence for the importance of hypothyroidism and associated pathological mechanisms for risk of AD in DS.

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Phenotype and treatment of elderly onset compared to younger onset rheumatoid arthritis patients in international daily practice

Rheumatology ◽

10.1093/rheumatology/keab102 ◽

2021 ◽

Author(s):

Johanna M Maassen ◽

Sytske Anne Bergstra ◽

Arvind Chopra ◽

Nimmisha Govind ◽

Elizabeth A Murphy ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Initial Treatment ◽

Cox Regression ◽

Disease Onset ◽

Age Groups ◽

International Study ◽

Daily Practice ◽

Disease Diagnosis ◽

Response To Treatment ◽

Age Group

Abstract Objective To identify possible differences in baseline characteristics, initial treatment and treatment response between rheumatoid arthritis (RA) patient subgroups based on age at disease onset. Methods Daily practice data from the worldwide METEOR registry were used. Patients (7,912) were stratified into three age-groups (age at disease diagnosis <45 years; 45-65 years; >65 years). Initial treatment was compared between the different age-groups. With Cox regression analyses the effect of age-group on time-to-switch from first to second treatment was investigated, and with linear mixed models differences in response to treatment (DAS and HAQ) between the age-groups were assessed, after correction for potential confounders. Results The >65 years age-group included more men, more seronegative RA with somewhat higher inflammatory markers. Initial treatment choices differed only slightly between the age-groups, and the time-to-switch from initial treatment to the next was similar. DAS and HAQ improvement were dependent on the age-group, reflected by a significant interaction between age-group and outcome. The stratified analysis showed a difference of -0.02 and -0.05 DAS points and, -0.01 and 0.02, HAQ points per month in the <45y and 45-65y age-groups as compared to the >65y age group. A difference that did not seem clinically relevant. Conclusion In this international study on worldwide clinical practice, patients with RA onset >65 years include more men and seronegative arthritis, and were initially treated slightly different than younger patients. We observed no clinically relevant differences in timing of a next treatment step, or response to treatment measured by DAS and HAQ.

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Frequency of extra-articular manifestations in cohort of Pakistani patients presented with RA at Independent University Hospital Faisalabad.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.06.6289 ◽

2021 ◽

Vol 28 (06) ◽

pp. 819-827

Author(s):

Zafar Ali Zafar ◽

Muhammad Absar Alam ◽

Muhammad Sarfraz ◽

Touseef Ahmad ◽

Hafiz Salman Saeed ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Age Groups ◽

Cross Sectional Study ◽

University Hospital ◽

P Value ◽

Early Assessment ◽

Chi Square ◽

Cross Sectional ◽

American College Of Rheumatology ◽

Independent University

Objective: To determine the frequency of extra articular manifestations in Rheumatoid Arthritis patients at independent university hospital Faisalabad. Study Design: Cross Sectional study. Setting: Rheumatology Division of Internal Medicine Independent University Hospital Faisalabad. Period: January 2019 to December 2019. Material & Methods: Consecutive Three hundred and twenty-three adult patients of either sex, of age between 20-60 years with baseline RA fulfilling the 2010 criteria of American College of Rheumatology. Extra articular manifestations were assessed. Chi square test was used to compare the frequency of extra articular manifestations among different disease duration, age groups, seropositivity and disease score. A p-value ≤ 0.05 was considered statistically significant. Results: 323 patients with RA were assessed in this study. Extra articular manifestations were assessed according to clinical presentation. 15.2% (49) patients were found to have lung involvement with predominant interstitial lung disease. Rheumatoid nodules were found in 9.9% (32) patients. 3rd most common extra-articular manifestation was sicca syndrome, seen in 3.7% (12) patients followed by neurological 2.2% and cardiac was 1.5%. Other extra-articular manifestations were seen in 2.8% of patients. Conclusion: it is very important to assess the extra articular manifestations in rheumatoid arthritis. Early assessment and early intervention can decrease the disease morbidity and mortality.

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Disease Factors in Early Rheumatoid Arthritis Are Associated with Differential Risks for Cardiovascular Events and Mortality Depending on Age at Onset: A 10-year Observational Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.130365 ◽

2013 ◽

Vol 40 (12) ◽

pp. 1958-1966 ◽

Cited By ~ 50

Author(s):

Sofia Ajeganova ◽

Maria L.E. Andersson ◽

Johan Frostegård ◽

Ingiäld Hafström

Keyword(s):

Rheumatoid Arthritis ◽

Cox Regression ◽

Age At Onset ◽

Disease Onset ◽

Age Groups ◽

Area Under The Curve ◽

The Elderly ◽

Cvd Risk ◽

Risk Of Death ◽

Early Ra

Objective.To investigate, within the first 2 years of diagnosis with rheumatoid arthritis (RA), associations between disease-related measures and cardiovascular disease (CVD) and mortality in patients with RA onset before and after 65 years of age.Methods.The study population (n = 741; 67.5% women) was derived from the Better Anti-Rheumatic Pharmaco Therapy (BARFOT) early RA cohort, recruited 1993–1999. The mean age was 55 years (SD 14.7). The outcomes were incident CVD events and all-cause mortality until 2010. Area under the curve (AUC) for disease measures at inclusion, 1 and 2 years, and decrease in measures after 1 year were calculated.Results.In all, 177 CVD events and 151 deaths occurred over 10 years of observation. In adjusted Cox regression analyses, seropositivity for rheumatoid factor (RF) or anticitrullinated protein antibodies (ACPA); white blood (cell) count at diagnosis; and AUC of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and visual analog scale (VAS)-pain were associated with higher CVD risk among patients with disease onset before 65 years of age. Among patients with disease onset after 65 years, larger decreases in CRP, ESR, health assessment questionnaire (HAQ), and use of methotrexate decreased CVD risk, whereas use of glucocorticoids heightened CVD risk. AUC of CRP, ESR, HAQ, and HAQ after 2 years was related to risk of death in both age groups. Seropositivity and AUC for VAS-pain in the younger group and use of glucocorticoids in the elderly were associated with poorer survival.Conclusion.Early treatment of RA may improve longterm outcomes. Presence of RF or ACPA associates with CVD and mortality among RA patients with disease onset before 65 years. Age stratification may improve evaluation of risk for CVD and mortality in early RA.

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Safety and efficacy of interleukin inhibitors in elderly patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis

Arhiv za farmaciju ◽

10.5937/arhfarm71-30505 ◽

2021 ◽

Vol 71 (2) ◽

pp. 101-119

Author(s):

Jasmina Đuretić ◽

Biljana Bufan

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Adverse Events ◽

Elderly Patients ◽

Disease Onset ◽

Age Groups ◽

Susceptibility To Infection ◽

Age Related ◽

Interleukin Inhibitors ◽

Efficient Option

Elderly patients with rheumatoid arthritis, psoriasis and psoriatic arthritis encompass those with elderly-onset disease, over 60 years of age, but also those with earlier disease onset who entered old age. Considering the age-related changes of the immune system, possible frailty, susceptibility to infection and concomitant comorbidity that implies multiple medicines, the treatment of these diseases in elderly patients can be challenging. Interleukin inhibitors have been shown to be an efficient and safe treatment for these diseases. However, elderly patients with these diseases were often included in the pivotal clinical trials for interleukin inhibitors in numbers insufficient to determine whether they responded differently from younger subjects. The aim of this paper was to review the findings on the efficacy and safety of interleukin inhibitor treatment in elderly patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis. The findings suggest that, for all the interleukin inhibitors reviewed herein, used in elderly patients with rheumatoid arthritis, or with psoriasis and psoriatic arthritis, the efficacy was comparable to younger patients. Furthermore, the incidence of reported adverse events was similar in these two age groups. Severe adverse events, which were related to sarilumab treatment for rheumatoid arthritis and secukinumab treatment for psoriasis, were higher in elderly patients. The reviewed findings suggest that the interleukin inhibitors approved and currently in use in clinical practice for the treatment of rheumatoid arthritis, psoriasis, and psoriatic arthritis can be considered a safe and efficient option for these diseases in elderly patients.

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Mortality and Incidence of Malignancy in Korean Patients with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.110704 ◽

2011 ◽

Vol 39 (2) ◽

pp. 226-232 ◽

Cited By ~ 18

Author(s):

YUN JUNG KIM ◽

JEE-SEON SHIM ◽

CHAN-BUM CHOI ◽

SANG-CHEOL BAE

Keyword(s):

Rheumatoid Arthritis ◽

Respiratory Disease ◽

Health Assessment ◽

Incidence Rates ◽

Functional Class ◽

Standardized Mortality Ratio ◽

Laboratory Findings ◽

Korean Patients ◽

American College Of Rheumatology ◽

Mortality Ratio

Objective.To determine the standardized mortality ratio (SMR) and standardized incidence ratio (SIR) for malignancy in Korean patients with rheumatoid arthritis (RA).Methods.We enrolled 1534 patients with RA who fulfilled the American College of Rheumatology criteria, from October 2001 to December 2007. Baseline assessment included sociodemographic variables, laboratory findings including rheumatoid factor, anticitrullinated protein antibody, functional class, radiological stage, medication, and the Korean version of the Health Assessment Questionnaire. We used the national mortality rate from 2001 to 2007 from the Korean National Statistical Office (KNSO) and the incidence rate from the Korean Central Cancer Registry (KCCR) from 2001 to 2007 as comparison data for estimates of SMR and SIR. Confidence intervals were calculated based on the Poisson distribution.Results.There were 57 deaths in 6683 person-years of followup. The number of expected deaths (derived from the KNSO) was 42.33 and the SMR for patients with RA was 1.35 (95% CI 1.02–1.74). The main causes of death were malignancy, cardiovascular disease, and respiratory disease. In the cause-specific SMR, deaths from respiratory disease, especially from interstitial lung disease (ILD) and pneumonia, were significantly higher than expected: 4.66 (95% CI 2.13–8.85) for all respiratory disease, 18.18 (95% CI 2.20–65.64) for ILD, and 10.26 (95% CI 2.79–26.26) for pneumonia. Thirty malignancies had occurred in 1501 patients. The number of expected malignancies derived from the KCCR was 34.91, yielding a SIR for cancer of 0.86 (95% CI 0.58–1.23).Conclusion.Our study demonstrates that the SMR was slightly higher in patients with RA, but the incidence rates of malignancies were not significantly different from the general population. But deaths from respiratory diseases were significantly higher.

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AB0303 PREDICTORS OF SERIOUS INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TARGET THERAPY.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6227 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1451.2-1451

Author(s):

E. Koltsova ◽

G. Lukina ◽

E. Shmidt ◽

K. Lytkina ◽

E. Zhilyaev

Keyword(s):

Rheumatoid Arthritis ◽

Age Of Onset ◽

Target Therapy ◽

Infectious Complications ◽

Observation Time ◽

Second Step ◽

Serious Infections ◽

Forward Stepwise ◽

The Mean ◽

Higher Doses

Background:The problem of infectious complications in patients receiving bDMARDs deserves special attention. Serious infectious adverse events (SIAE) are a most important issue. To develop measures for their prevention it is necessary to know the predisposing factors.Objectives:to detect predictors of serious infections among patients with rheumatoid arthritis receiving targeted therapyMethods:The study includes patients with rheumatoid arthritis from the Moscow Unified Arthritis Registry (MUAR), receiving treatment with biologics or tofacitinib. Search for predictors was carried out in two steps. At first step we selected patient related predictors (confounders) that significantly correlate with risk of SIAE. At the second step in the Cox risk regression model by forward stepwise selection were identified independent significant predictors of risk. which demonstrated significant correlation with development of serious infections. Then data about the treatment was added to the generated model: used targeted DMARDs, doses of glucocorticoids (GC), doses of methotrexate (MTX).Results:Analysis includes 1052 treatment events in 772 patients. There were 44 serious infections. The mean age was 57,1 ± 12,8 years. The mean observation time – 5.3 years. Independent patient related predictors of SIAE risk were the age RR - 1.12 per year (CI: 1.06-1.19), the age of onset disease RR - 0.94 per year (CI: 0.90-0.98), the year of inclusion in the registry RR - 0.64 per year (CI: 0.49-0.85). The dose of MTX and the doses of GC positively correlate with SIAE risk. RR for MTX is 1.05 per mg (CI: 1.005-1.109), RR for GC - 1.11 per mg (CI: 1.004-1.236).Used targeted DMARD didn’t show any significant correlation with SIAE risk.Conclusion:Higher doses of methotrexate and glucocorticoids are independent significant predictors of serious infections in RA patients receiving targeted DMARDs.Disclosure of Interests:Ekaterina Koltsova: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Evgeniya Shmidt Speakers bureau: MSD, Novartis, Pfizer, Karine Lytkina Speakers bureau: Novartis, Eli Lilly, Pfizer, UCB, Abbvie, Biocad, MSD, Jonson&Jonson, Evgeniy Zhilyaev Speakers bureau: Novartis, UCB, Pfizer, Biocad, Abbvie, MSD, Roche

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Five reasons COVID-19 is less severe in younger age groups

Evolution Medicine and Public Health ◽

10.1093/emph/eoaa050 ◽

2020 ◽

Author(s):

Paul W Turke

Keyword(s):

Life History ◽

Life History Theory ◽

Age Of Onset ◽

Age Groups ◽

Medical Community ◽

System Function ◽

The Third ◽

Immune System Function ◽

Age Related ◽

Younger Age

Abstract The severity of COVID-19 is age-related, with the advantage going to younger age groups. Five reasons are presented. The first two are well-known, are being actively researched by the broader medical community, and therefore are discussed only briefly here. The third, fourth, and fifth reasons derive from evolutionary life history theory, and potentially fill gaps in current understanding of why and how young and old age groups respond differently to infection with SARS-CoV-2. Age of onset of generalized somatic aging, and the timing of its progression, are identified as important causes of these disparities, as are specific antagonistic pleiotropic tradeoffs in immune system function.

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Adult systemic lupus erythematosus in Egypt: The nation-wide spectrum of 3661 patients and world-wide standpoint

Lupus ◽

10.1177/09612033211014253 ◽

2021 ◽

pp. 096120332110142

Author(s):

Tamer A Gheita ◽

Rasha Abdel Noor ◽

Esam Abualfadl ◽

Osama S Abousehly ◽

Iman I El-Gazzar ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Age Of Onset ◽

Wide Spectrum ◽

Age At Onset ◽

Disease Onset ◽

Clinical Manifestations ◽

Population Based ◽

Systemic Lupus ◽

Cross Sectional

Objective The aim of this study was to present the epidemiology, clinical manifestations and treatment pattern of systemic lupus erythematosus (SLE) in Egyptian patients over the country and compare the findings to large cohorts worldwide. Objectives were extended to focus on the age at onset and gender driven influence on the disease characteristics. Patients and method This population-based, multicenter, cross-sectional study included 3661 adult SLE patients from Egyptian rheumatology departments across the nation. Demographic, clinical, and therapeutic data were assessed for all patients. Results The study included 3661 patients; 3296 females and 365 males (9.03:1) and the median age was 30 years (17–79 years), disease duration 4 years (0–75 years) while the median age at disease onset was 25 years (4–75 years). The overall estimated prevalence of adult SLE in Egypt was 6.1/100,000 population (1.2/100,000 males and 11.3/100,000 females).There were 316 (8.6%) juvenile-onset (Jo-SLE) and 3345 adult-onset (Ao-SLE). Age at onset was highest in South and lowest in Cairo (p < 0.0001). Conclusion SLE in Egypt had a wide variety of clinical and immunological manifestations, with some similarities with that in other nations and differences within the same country. The clinical characteristics, autoantibodies and comorbidities are comparable between Ao-SLE and Jo-SLE. The frequency of various clinical and immunological manifestations varied between gender. Additional studies are needed to determine the underlying factors contributing to gender and age of onset differences.

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Is it time to administer acellular pertussis vaccine to childbearing age/pregnant women in all areas using whole-cell pertussis vaccination schedule?

Therapeutic Advances in Vaccines and Immunotherapy ◽

10.1177/25151355211015842 ◽

2021 ◽

Vol 9 ◽

pp. 251513552110158

Author(s):

Abdoulreza Esteghamati ◽

Shirin Sayyahfar ◽

Yousef Alimohamadi ◽

Sarvenaz Salahi ◽

Mahmood Faramarzi

Keyword(s):

Pregnant Women ◽

Age Groups ◽

Vaccination Schedule ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Childbearing Age ◽

Cross Sectional ◽

Whole Cell ◽

Childbearing Age Women ◽

The Mean

Background: Whole-cell pertussis (wP) vaccine administration is still advocated for children under 7 years of age in Iran. However, there is no recommendation for the administration of a dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to childbearing age/pregnant women in the Iranian vaccination program and it has increased the risk of infection through waning immunity during women’s childbearing age life. The study aimed to assess the levels of anti- Bordetella pertussis antibodies in childbearing age women of different ages in Iran. Methods: A cross-sectional study was conducted on a total number of 360 childbearing age women divided into six age groups, with 5-year intervals from 15 to 45 years old, in 2018–2019. Then, the levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) antibodies against B. pertussis were evaluated using enzyme-linked immunosorbent assay (ELISA). The IBM SPSS Statistics software (version 16.0) (SPSS Inc., Chicago, IL, USA) was used for data analysis. Results: The mean age of the participants was 30.01 ± 8.35 years (range 14–45 years). All the cases were IgM negative, but two IgA-positive individuals (in the age groups of 14–19 and 30–34 years) were reported. Overall, 239 (66.4%) cases were IgG positive. The mean age of IgG-positive cases was 30.37 ± 8.37 years. The IgG-positive cases were mostly in the age groups of 30–34 and 35–39 years [43 (71.1%)]. The odds of IgG positivity were 1.97. The highest odds of IgG positivity were seen in 30–34 and 35–39 years groups (2.52) and the lowest odds were seen in the 20–24 and 25–29 years groups (1.60). Using the Jonckheere–Terpstra test, the increasing trend of IgG changes in different age groups was not statistically significant (Tπ=5.78, p = 0.09). Conclusion: The infants of women of childbearing age might be prone to pertussis in countries using the wP vaccination schedule. It is suggested to administer a dose of Tdap to women before or during pregnancy to increase the immunity of their infants against this disease during early infancy.

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