non-RA Subjects Research Articles

Increased NAFLD risk in newly diagnosed patients with RA during the first 4 years of follow-up: a nationwide, population-based cohort study

BackgroundAlthough the non-alcoholic fatty liver disease (NAFLD) is prevalent in the general population, NAFLD risk in newly diagnosed rheumatoid arthritis (RA) has rarely been explored. In this population-based cohort, we...

Life satisfaction, generalized sense of self-efficacy and acceptance of illness in rheumatoid arthritis patients depending on age and severity of the disease.

Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by periods of exacerbation (physical limitations, depressed mood, depressive states and decreased life satisfaction) and remission (hope of health improvement). Our objective was to present social functioning of RA patients taking into consideration their age and employing selected determinants: satisfaction with life, generalized sense of self-efficacy and acceptance of illness. Standardized tools were employed: the Satisfaction with Life Scale, Generalized Self Efficacy Scale and Acceptance of Illness Scale. The study group included 46 RA patients aged 18-45 years and 54 RA patients aged over 60 years. The control group consisted of 24 non-RA subjects in every group. Rheumatoid arthritis patients in the period of disease exacerbation reported low and moderate levels of satisfaction with life, in the patients in remission period the score was moderate, while the control group subjects described their level of satisfaction with life as high and moderate. The level of acceptance of illness was described by the RA patients in the period of disease exacerbation as 20.4/40 points; the patients in remission defined their level of acceptance of illness as 29.38/40 points. The patients with RA exacerbation showed a low sense of self-efficacy, yet a large group of such patients also presented high self-efficacy levels and the majority of the RA subjects in remission reported a high sense of self-efficacy. In the RA patients, satisfaction with life, generalized sense of self-efficacy and acceptance of illness were closely related and affected their general psychosocial functioning.

Modification of the structural stability of human serum albumin in rheumatoid arthritis.

Differential scanning calorimetry (DSC) can indicate changes in structure and/or concentration of the most abundant proteins in a biological sample via heat denaturation curves (HDCs). In blood serum for example, HDC changes result from either concentration changes or altered thermal stabilities for 7-10 proteins and has previously been shown capable of differentiating between sick and healthy human subjects. Here, we compare HDCs and proteomic profiles of 50 patients experiencing joint-inflammatory symptoms, 27 of which were clinically diagnosed with rheumatoid arthritis (RA). The HDC of all 50 subjects appeared significantly different from expected healthy curves, but comparison of additional differences between the RA and the non-RA subjects allowed more specific understanding of RA samples. We used mass spectrometry (MS) to investigate the reasons behind the additional HDC changes observed in RA patients. The HDC differences do not appear to be directly related to differences in the concentrations of abundant serum proteins. Rather, the differences can be attributed to modified thermal stability of some fraction of the human serum albumin (HSA) proteins in the sample. By quantifying differences in the frequency of artificially induced post translational modifications (PTMs), we found that HSA in RA subjects had a much lower surface accessibility, indicating potential ligand or protein binding partners in certain regions that could explain the shift in HSA melting temperature in the RA HDCs. Several low abundance proteins were found to have significant changes in concentration in RA subjects and could be involved in or related to binding of HSA. Certain amino acid sites clusters were found to be less accessible in RA subjects, suggesting changes in HSA structure that may be related to changes in protein-protein interactions. These results all support a change in behavior of HSA which may give insight into mechanisms of RA pathology.

Importance of STAT3 Polymorphisms on the Risk and Clinical Characteristics of Rheumatoid Arthritis.

Signal transducer and activator of transcription 3 (STAT3) has been introduced as one of the critical genetic factors in the pathogenesis of rheumatoid arthritis (RA). Single nucleotide polymorphisms (SNPs) in microRNA binding sites, known as miRSNPs, are a class of common variants in the 3' untranslated regions of genes targeted by miRNAs. miRSNPs unbalance gene expression by disrupting the binding regions of microRNAs. In this study, we intended to evaluate the association of two miRSNPs with the risk of RA development and its clinical features. We studied 120 Iranian patients with RA and 125 non-RA subjects as controls. The genotypes and alleles of rs1053005 and rs1053023 in each individual were assessed by the high-resolution melting method. The distribution of STAT3 variants did not differ markedly in RA patients compared to healthy controls. Stratification analysis revealed that rs1053005 was linked with a higher concentration of C-reactive protein and an increased erythrocyte sedimentation rate, two indicators of inflammation and disease activity in RA patients. The rs1053023 variant was correlated with higher levels of creatinine as an indicator of renal involvement. Our data demonstrate an association between STAT3 variants and clinical characteristics of RA, such as disease activity and probably kidney impairment. However, we did not observe a significant relationship between the two targeted variants and a predisposition to RA.

Comprehensive assessment of multimorbidity burden in a population-based cohort of patients with rheumatoid arthritis

ObjectiveTo comprehensively assess multimorbidity burden in patients with rheumatoid arthritis (RA) in order to unify the multimorbidity definition for RA research and clinical practice.MethodsIn this population-based study, residents of eight...

Rheumatoid Arthritis and Cardiovascular Risk: Retrospective Matched-Cohort Analysis Based on the RECORD Study of the Italian Society for Rheumatology.

Background: Rheumatoid arthritis (RA) is associated with an increase in cardiovascular (CV) risk. This issue maybe not only explained by a genetic component, as well as by the traditional CV risk factors, but also by an underestimation and undertreatment of concomitant CV comorbidities.Method: This was a retrospective matched-cohort analysis in the Italian RA real-world population based on the healthcare-administrative databases to assess the CV risk factors and incidence of CV events in comparison with the general population. Persistence and adherence to the CV therapy were also evaluated in both groups.Results: In a RA cohort (N = 21,201), there was a greater prevalence of hypertension and diabetes with respect to the non-RA subjects (N = 249,156) (36.9 vs. 33.4% and 10.2 vs. 9.6%, respectively), while dyslipidemia was more frequent in the non-RA group (15.4 vs. 16.5%). Compared with a non-RA cohort, the patients with RA had a higher incidence of atrial fibrillation (incidence rate ratio, IRR 1.28), heart failure (IRR 1.53), stroke (IRR 1.19), and myocardial infarction (IRR 1.48). The patients with RA presented a significantly lower persistence rate to glucose-lowering and lipid-lowering therapies than the controls (odds ratio, OR 0.73 [95% CI 0.6–0.8] and OR 0.82 [0.8–0.9], respectively). The difference in the adherence to glucose-lowering therapy was significant (OR 0.7 [0.6–0.8]), conversely no statistically significant differences emerged regarding the adherence to lipid-lowering therapy (OR 0.89 [95% CI 0.8–1.0]) and anti-hypertensive therapy (OR 0.96 [95% CI 0.9–1.0]).Conclusion: The patients with RA have a higher risk of developing CV events compared with the general population, partially explained by the excess and undertreatment of CV risk factors.

Body mass index trend and variability in rheumatoid arthritis.

To characterize and compare trends in body mass index (BMI) and variability in BMI between subjects with rheumatoid arthritis (RA) and matched non-RA subjects and to determine predictors of BMI trends and variability within RA subjects. This retrospective population-based cohort study included 1114 Olmsted County, Minnesota residents, 558 with incident RA (age≥18years, 1987 ACR criteria met in 1995-2009) and 556 non-RA subjects from the same underlying population with similar age, sex, and index calendar year. All subjects were followed until death, migration, or 12/31/2018. Generalized linear models with smoothing splines and random effects to account for multiple measurements per subject were used to examine trends in BMI measurements over time. Mean BMI of patients with incident RA (28.8kg/m2) was not significantly different from that of non-RA subjects (28.9kg/m2). There was no significant difference in BMI trends over time between RA and non-RA cohorts, or between seropositive for rheumatoid factor (RF) and/or citrullinated antibody (CCP-antibody) and seronegative RA patients, or between male and female subjects. RA subjects were noted to have significantly higher BMI variability following diagnosis compared to non-RA subjects [difference in standard deviation between RA and non-RA subjects prior to index (p = 0.12), 0-5years after index (p = 0.044), and 5-15years after index (p = 0.013)]. The BMI trajectory of the RA population is not significantly different compared to that of the non-RA population, but patients with RA demonstrate higher variability in BMI following diagnosis compared to the non-RA population. Key Points • This study uniquely characterizes longitudinal trajectory in BMI measures and their variability in the RA population versus the non-RA population • This study suggests that RA patients have greater BMI variability compared to the non-RA population, which is highly relevant as BMI variability is increasingly understood as a cardiovascular risk factor.

Subgingival microbiome of deep and shallow periodontal sites\xa0in patients with rheumatoid arthritis: a pilot study

BackgroundSubgingival microbiome in disease-associated subgingival sites is known to be dysbiotic and significantly altered. In patients with rheumatoid arthritis (RA), the extent of dysbiosis in disease- and health-associated subgingival sites is not clear.Methods8 RA and 10 non-RA subjects were recruited for this pilot study. All subjects received full oral examination and underwent collection of subgingival plaque samples from both shallow (periodontal health-associated, probing depth ≤ 3mm) and deep subgingival sites (periodontal disease-associated, probing depth ≥ 4 mm). RA subjects also had rheumatological evaluation. Plaque community profiles were analyzed using 16 S rRNA sequencing.ResultsThe phylogenetic diversity of microbial communities in both RA and non-RA controls was significantly higher in deep subgingival sites compared to shallow sites (p = 0.022), and the overall subgingival microbiome clustered primarily according to probing depth (i.e. shallow versus deep sites), and not separated by RA status. While a large number of differentially abundant taxa and gene functions was observed between deep and shallow sites as expected in non-RA controls, we found very few differentially abundant taxa and gene functions between deep and shallow sites in RA subjects. In addition, compared to non-RA controls, the UniFrac distances between deep and shallow sites in RA subjects were smaller, suggesting increased similarity between deep and shallow subgingival microbiome in RA. Streptococcus parasanguinis and Actinomyces meyeri were overabundant in RA subjects, while Gemella morbillorum, Kingella denitrificans, Prevotella melaninogenica and Leptotrichia spp. were more abundant in non-RA subjects.ConclusionsThe aggregate subgingival microbiome was not significantly different between individuals with and without rheumatoid arthritis. Although the differences in the overall subgingival microbiome was driven primarily by probing depth, in contrast to the substantial microbiome differences typically seen between deep and shallow sites in non-RA patients, the microbiome of deep and shallow sites in RA patients were more similar to each other. These results suggest that factors associated with RA may modulate the ecology of subgingival microbiome and its relationship to periodontal disease, the basis of which remains unknown but warrants further investigation.

Multimorbidity Burden in Rheumatoid Arthritis: A Population-based Cohort Study.

To estimate the prevalence and incidence of multimorbidity (MM) in a population-based cohort of patients with rheumatoid arthritis (RA) compared to subjects without RA. Between 1999-2013, residents of Olmsted County, Minnesota with incident RA who met the 1987 American College of Rheumatology criteria were compared to age- and sex-matched non-RA subjects from the same population. Twenty-five chronic comorbidities from a combination of the Charlson, Elixhauser, and Rheumatic Disease Comorbidity Indices were included, excluding rheumatic comorbidities. The Aalen-Johansen method was used to estimate the cumulative incidence of MM (MM2+; ≥ 2 chronic comorbidities) or substantial MM (MM5+; ≥ 5), adjusting for the competing risk of death. The study included 597 patients with RA and 594 non-RA subjects (70% female, 90% White, mean age 55.5 yrs). At incidence/index date, the prevalence of MM2+ was higher in RA than non-RA subjects (38% RA vs 32% non-RA, P = 0.02), whereas prevalence of MM5+ was similar (5% RA vs. 4% non-RA, P = 0.68). During follow-up (median 11.6 yrs RA, 11.3 yrs non-RA), more patients with RA developed MM2+ (214 RA vs 188 non-RA; adjusted HR 1.39, 95% CI 1.14-1.69). By 10 years after RA incidence/index, the cumulative incidence of MM2+ was 56.5% among the patients with RA (95% CI 56.5-62.3%) compared with 47.9% among the non-RA (95% CI 42.8-53.7%). Patients with RA showed no evidence of increase in incidence of MM5+ (adjusted HR 1.17, 95% CI 0.93-1.47). Patients with RA have both a higher prevalence of MM at the time of RA incidence as well as increased incidence thereafter.

Improved Incidence of Cardiovascular Disease in Patients With Incident Rheumatoid Arthritis in the 2000s: A Population-based Cohort Study.

To assess trends in incidence of cardiovascular disease (CVD) and mortality following incident CVD events in patients with rheumatoid arthritis (RA) onset in 1980-2009 vs non-RA subjects. We studied Olmsted County, Minnesota residents with incident RA (aged > 18 yrs, 1987 American College of Rheumatology criteria met in 1980-2009) and non-RA subjects from the same source population with similar age, sex, and calendar year of index. All subjects were followed until death, migration, or December 31, 2016. Incident CVD events included myocardial infarction and stroke. Patients with CVD before RA incidence/index date were excluded. Cox models were used to compare incident CVD events by decade, adjusting for age, sex, and CVD risk factors. The study included 905 patients with RA and 904 non-RA subjects. Cumulative incidence of any CVD event was lower in patients with incident RA in the 2000s vs the 1980s. The HR for any incident CVD in the 2000s vs 1980s was 0.53 (95% CI 0.31-0.93). The strength of association attenuated after adjustment for anti-rheumatic medication use (HR 0.64, 95% CI 0.34-1.22). Patients with RA in the 2000s had no excess in CVD over non-RA subjects (HR 0.71, 95% CI 0.42-1.19). Risk of death after a CVD event was somewhat lower in patients with RA after the 1980s with an HR of 0.54 (95% CI 0.33-0.90) in the 1990s vs 1980s and 0.68 (95% CI 0.33-1.41) in the 2000s vs 1980s. The incidence of major CVD events in RA has declined in recent decades. The gap in CVD occurrence between patients with RA and the general population is closing. Mortality after CVD events in RA may be improving.

Incidence of congestive heart failure in rheumatoid arthritis: a review of literature and meta-regression analysis.

AimsRheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder that not only affects peripheral joints but also increases the risk for cardiovascular disease (CVD) and mortality. Heart failure (HF) appears to be one of the most important contributors to the excess mortality risk among patients with RA. We assessed the incidence of HF in patients with RA compared with age‐matched and sex‐matched non‐RA subjects, after accounting for traditional cardiovascular risk factors and clinical ischemic heart disease.Methods and resultsWe performed an aggregate analysis on three studies of RA patients having listed manifestations of HF. We performed a meta‐regression analysis to evaluate the incidence of HF in RA patients with increased age and noted for any gender correlation. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using both fixed‐effects and random‐effects models. In the cumulative analysis of 5, 220, 883 patients, the incidence of HF was noted to be almost two‐fold higher in patients with RA compared with a matched control population (OR 1.78, 95% CI 1.22–2.60, P < 0.003), HTN (OR 1.66, 95% CI 1.24–2.23, P < 0.001), and diabetes (OR 1.57, 95% CI 1.36–1.81, P < 0.001). Women had three‐fold higher incidence of HF with RA (OR 3.38, 95% CI 2.59–4.40, P < 0.001). On meta‐regression, the incidence of HF increased further with older age (coefficient = 0.12, P = 0.0004).ConclusionsOur systematic review that included over 5 million subjects confirms the suspected increased incidence of HF in RA patients. Women have the greatest risk for HF. Our analysis advocates the need for updating the current guidelines to incorporate screening and preventive methods for HF in RA patients.

Incidence of Heart Failure In Rheumatoid Arthritis A Review of Literature And Meta-regression Analysis

Introduction Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder that not only affects peripheral joints, but also increases risk for cardiovascular disease (CVD) and mortality. Heart failure (HF) appears to be one of the most important contributors to the excess mortality risk among patients with RA. We assessed the incidence of HF in patients with RA compared with age- and sex-matched non-RA subjects, after accounting for traditional CV risk factors and clinical ischemic heart disease. Methods We performed aggregate analysis on three studies of RA patients having listed manifestations of HF. We performed a meta-regression analysis to evaluate the incidence of HF in RA patients with increased age and noted for any gender correlation. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using both fixed- and random-effects models. Results In the cumulative analysis of 5,220,883 patients, the incidence of HF was noted to be almost 2-fold higher in patients with RA compared to a matched control population (OR 1.78, 95% CI 1.22-2.60, p Conclusions Our systematic review included over 5 million subjects confirms the suspected increased incidence of HF in RA patients. Women have the greatest risk for HF. Our analysis advocates the need for updating the current guidelines to incorporate screening and preventive methods for HF in RA patients.

THU0133 DIAGNOSES AND COMORBIDITIES IN PRE-RHEUMATOID ARTHRITIS: COMPARISON BETWEEN SEROPOSITIVE AND SERONEGATIVE PATIENTS AND MATCHED NON-RA SUBJECTS

Background:Previous studies have suggested that comorbidities accumulate before the clinical diagnosis of RA, i.e., ‘pre-RA’ (1). Understanding patterns of diagnoses and comorbidities during the pre-RA period may provide new insights into pathogenesis.Objectives:To elucidate diagnoses and comorbidities before the onset of clinically apparent RA compared to non-RA subjects, and for seropositive (RF and/or CCP positive) compared to seronegative (RF and CCP negative) patients with RA.Methods:Adult residents of Olmsted County, Minnesota, with incident RA in 1999-2013 fulfilling the 1987 ACR classification criteria were identified by medical record review. Patients were age- and sex-matched 1:1 to non-RA controls from the same underlying population. The index date for each control corresponded to the incidence date of the matched RA patient. ICD9/10 diagnosis codes (≥2 codes ≥30 days apart prior to index date) were categorized using 161 chronic conditions identified by Clinical Classification Software. Logistic regression models adjusted for age and sex were used to estimate odds ratios (OR) and 95% confidence intervals (CI).Results:The study included 597 RA patients (388 seropositive, 209 seronegative) and 594 controls. The median (range) age was 55 (19-91) years and 70% were female. The median (IQR) of total comorbidities at index was higher among RA patients at 3 (1-6) than controls at 2 (1-5) (p&lt;.001). The median (IQR) of total comorbidities at index was higher in seronegative RA at 4 (2-7) compared to seropositive RA at 3 (1-5) (p=.001); the proportion with six or more was 37% vs. 24% respectively (p&lt;.001). The Table shows the ORs (95% CI) for comorbidities with statistically significant associations with RA overall. The magnitude of the association between total comorbidities and RA peaked at 5+ comorbidities (OR 1.84; 95% CI 1.4-2.43). Spondylosis, intervertebral disc disorders, and back problems (OR 2.38; 95% CI 1.31-4.34); polymyalgia (OR 3.84; 95% CI 1.71-9.16); and systemic lupus erythematosus or other connective tissue disorders (OR 5.3; 95% CI 1.78-19.4) were more prevalent than among seronegative than seropositive patients.Table.Statistically significant associations between comorbidity categories and RA, adjusting for age and sex.Comorbidity Category DescriptionNon-RAN (%)RAN (%)Odds Ratio(95% CI)Polymyalgia1 (0.2%)30 (5%)35.8 (7.51-643)Systemic lupus erythematosus and connective tissue disorders0 (0%)15 (2.5%)31.7 (4.25-4051)Other respiratory disease1 (0.2%)6 (1.0%)6.17 (1.03-118)Hypertension with complications and secondary hypertension2 (0.3%)9 (1.5%)4.57 (1.16-30.2)Anemia (including pregnancy)3 (0.5%)11 (1.8%)3.7 (1.15-16.4)Other circulatory disease4 (0.7%)12 (2.0%)3.03 (1.05-10.9)Osteoarthritis67 (11.3%)138 (23.1%)2.6 (1.87-3.67)Other connective tissue disease17 (2.9%)35 (5.9%)2.19 (1.21-4.12)Fibromyalgia16 (2.7%)34 (5.7%)2.19 (1.21-4.11)Other nervous system disorders43 (7.2%)82 (13.7%)2.04 (1.39-3.04)Other upper respiratory disease23 (3.9%)41 (6.9%)1.83 (1.09-3.14)Asthma37 (6.2%)63 (10.6%)1.78 (1.17-2.74)Coronary atherosclerosis and other heart disease44 (7.4%)63 (10.6%)1.56 (1.01-2.43)Thyroid disorders78 (13.1%)107 (17.9%)1.46 (1.06-2.02)Conclusion:The findings provide new insights about diagnoses and comorbidities preceding clinically apparent RA. Future studies of retrospective medical records for patients with particular comorbidities may provide new insights into the pathogenesis and clinical features of the transition from pre-RA to clinically overt RA, especially for seronegative disease.

Siblings of patients with rheumatoid arthritis have an increased mortality rate: a Swedish cohort study

ObjectivesTo estimate the mortality among siblings of patients with rheumatoid arthritis (RA) and put any excess mortality among these in relation to the mortality among patients with RA.MethodsUsing prospective nation-wide...

Sensitivity and specificity of Interleukin 29 in patients with rheumatoid arthritis and other rheumatic diseases

BackgroundRheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic and progressive inflammation that can cause a high degree of disability in affected individuals. Proinflammatory cytokines play central roles in the development of degradative and inflammatory responses in RA. IL-29 has been identified in RA and reported as a biomarker of the disease. ObjectiveTo analyze serum levels and accuracy of IL-29 in RA patients compared to healthy subjects and patients with other rheumatic diseases. MethodsIL-29 serum levels were measured in 121 patients with RA, 53 patients with systemic lupus erythematosus (SLE), 60 patients with systemic sclerosis (SSc), 29 patients with fibromyalgia (FM), 50 patients with osteoarthritis (OA) and 68 healthy individuals as controls. IL-29 levels in serum were investigated by ELISA. Sensitivity, specificity and likelihood ratios (LR) for having RA were calculated. ResultsSerum levels of IL-29 were increased in RA patients 113.6 (IQR = 31.25–308.5) pg/ml compared to non-RA patients (SLE, SSc, OA, and FM) (31.25 pg/ml) and healthy controls (31.25 pg/ml, p < 0.001). The IL-29 cut-off values to distinguish patients with RA from non-RA patients were 61.11 pg/ml (sensitivity 57.02, specificity 92.71, LR: 7.82) and for all subjects 32.96 pg/ml (sensitivity 64.46, specificity 87.31, LR: 5.08). Additionally, IL-29 correlated negatively with age (r=-0189, p = 0.038) and disease duration (-0.192, p = 0.037). Interestingly, IL-29 correlated positively with neutrophil count in RA patients positive for rheumatoid factor (r = 0.259, p = 0.022). ConclusionIL-29 is higher in the serum of patients with RA compared to non-RA subjects and may have potential for use as a biological marker.

Pharmacokinetics and Safety of a Single Oral Dose of Peficitinib (ASP015K) in Japanese Subjects With Normal and Impaired Hepatic Function

Peficitinib (ASP015K) is a novel Janus kinase inhibitor developed for the treatment of rheumatoid arthritis (RA). The impact of hepatic impairment on the peficitinib pharmacokinetic (PK) and safety profile was investigated in non‐RA subjects (n = 24) in an open‐label, parallel‐group, multicenter comparative study in Japan. Subjects received a single, clinically relevant, oral dose of a peficitinib 150 mg tablet under fasting conditions. Plasma PK parameters were measured for peficitinib and its metabolites H1 (sulfate and methylated metabolite), H2 (sulfate metabolite), and H4 (methylated metabolite) in subjects with normal hepatic function, mild hepatic impairment, or moderate hepatic impairment. The peficitinib area under the plasma‐concentration–time curve from time 0 to infinity (AUCinf) and maximum observed concentration (Cmax) were not markedly different in subjects with mild hepatic impairment versus normal hepatic function. In subjects with moderate hepatic impairment versus normal hepatic function, the geometric mean ratios for peficitinib AUCinf and Cmax, were 1.92 (90% CI: 1.39, 2.66) and 1.82 (90% CI: 1.24, 2.69), respectively. Five treatment‐emergent adverse events (TEAEs) were experienced by 3 subjects, 1 in each group. There were no deaths, no serious TEAEs, and no TEAEs leading to withdrawal. In summary, the PK profile was unaltered in subjects with mild hepatic impairment after a single clinically relevant dose of peficitinib, but exposure almost doubled in subjects with moderate hepatic impairment. Peficitinib dose reduction may be considered in RA patients with moderate hepatic impairment.

Rheumatoid Arthritis in the Lebanese Adults: Impact on Health-Related Quality of Life

Rheumatoid Arthritis (RA) is a chronic inflammatory disabling disease with significant impact on the Quality of Life (QOL) of patients. Information on the effects of RA on Health-related Quality of Life (HRQoL) is lacking in the Lebanese population. The objective of this study was to evaluate QOL of RA patients compared with non-RA subjects and to suggest possible predictors of their QOL in Lebanon. We conducted a case–control observational study among individuals visiting the external clinics at three hospitals and different private clinics; the QOL was measured using the SF-36 questionnaire administered face to face to the study population, applied to RA (N = 90) and non-RA (N = 180) groups. RA presented lower Physical Component Scores (PCS) and Mental Component Scores (MCS) as well as overall QOL scores. Among RA patients, MCS and QOL were significantly decreased with morning stiffness duration (β = −9.211, p = 0.013 and β = −9.190, p = 0.009, respectively). The frequency of practicing sport per week increases PCS and QOL (β = 6.692, p = 0.002 and β = 6.148, p = 0.003, respectively). Workability has a positive effect on PCS (β = 5.546, p = 0.022) and time between blood transfusion and the onset of the disease has a positive impact on MCS (β = 8.415, p = 0.007). To improve QOL of patients with RA, health professionals have to take these results into consideration while treating their patients.

Increased Risk of Thyroid Dysfunction Among Patients With Rheumatoid Arthritis.

Background: Thyroid dysfunction seems to be common among rheumatoid arthritis (RA) patients, but the risk of thyroid dysfunction in RA has not been well-defined.Methods: We performed a case-control study of 65 RA patients and 550 matched non-RA subjects to assess the risk of thyroid dysfunction among Chinese RA patients. A systematic review and meta-analysis was also conducted to comprehensively define the relationship between RA and thyroid dysfunction.Results: The case-control study indicated that the prevalence of thyroid dysfunction was significantly higher in RA patients than controls (OR = 2.89, P < 0.001). Further subgroup analyses revealed positive correlations of RA with hypothyroidism (OR = 2.28, P = 0.006) and hyperthyroidism (OR = 8.95, P < 0.001). Multivariate logistic regression analysis revealed an independent association between RA and thyroid dysfunction (Adjusted OR = 2.89, 95%CI 1.63–5.12, P < 0.001). Meta-analysis of 15 independent studies also showed an obviously increased risk of thyroid dysfunction among RA patients (RR = 2.86, 95%CI 1.78–4.58, P < 0.001). Further subgroup analysis showed RA could obviously increase risk of hyperthyroidism (RR = 2.73, 95%CI 1.29–5.77, P = 0.043) and hypothyroidism (RR = 2.02, 95%CI 1.49–2.74, P < 0.001).Conclusion: Our study provides strong evidence for the increased risk of thyroid dysfunction among RA patients. Screening of thyroid dysfunction may be recommended for RA patients.

Risks of hepatocellular carcinoma and cirrhosis-associated complications in patients with rheumatoid arthritis: a 10-year population-based cohort study in Taiwan.

Although rheumatoid arthritis (RA) has been linked to several important malignancies, data for the risks of hepatocellular carcinoma (HCC) in patients with RA are scarce. We aimed to examine the risk of HCC and cirrhosis-associated complications and the use of biologics in a national representative RA sample in Taiwan. All study subjects aged ≥ 18years in the Taiwan National Health Insurance program between January 1, 2000, and December 31, 2009 were enrolled. We matched RA and non-RA subjects by propensity scores in a 1:1 ratio. Our primary outcome was a diagnosis of HCC and cirrhosis-associated complications during a 10-year follow-up period. The risk of outcomes was represented as a hazard ratio (HR) calculated in Cox proportional hazard regression models. 24,245 RA and 24,245 non-RA subjects were included in the primary outcome analysis. Mean overall person-years (PY) of follow-up were 116,608 PY for the RA cohort, and 234,280 PY for the non-RA cohort. The overall incidence of HCC and cirrhosis-associated complications was lower in the RA cohort than in the non-RA cohort (0.66% vs. 1.41% HCC events and 1.45% vs. 1.95% cirrhosis-associated complications events during 10-year follow-up). The HRs adjusted for age, sex, the frequency of medical visits, and CCI were 0.57 (0.46-0.71) for HCC and 0.67 (0.59-0.76) for HCC and cirrhosis-associated complications. Although immunomodulatory agents may alter the risk of malignancy, use of biologics did not increase HCC risk in RA patients. RA is associated with a reduced risk of developing HCC and cirrhosis-associated complications. ClinicalTrials.gov identifier NCT02880306.

Nocturnal blood pressure dipping is similar in rheumatoid arthritis patients as compared to anormal population.

Rheumatoid arthritis (RA) is asystemic autoimmune inflammatory disorder which further doubles the risk of developing cardiovascular disease. Some studies suggest that in RA patients, the prevalence of hypertension increases due to prednisolone use, clinical status, genetic factors, and physical inactivity. On the other hand, dipper and non-dipper status in RA patients compared to non-RA subjects has not been investigated to our knowledge. Purpose of the study is to investigate whether non-dipper status is more deteriorated in RA patients. Sixty-five RA patients and 61age-sex-matched control patients were evaluated in this cross-sectional study. Patients were classified according to 24-h ambulatory blood pressure monitoring results. Patients with previous hypertension diagnosis, coronary artery disease, and abnormal kidney function were excluded. Mean age of the study sample was 53.7 ± 12.3years and 40.5% were male. There was no significant difference between groups in terms of basic demographic characteristics. Leukocyte counts (p = 0.001), neutrophil counts (p = 0.001), and red cell distribution width (p = 0.000) were significantly higher in the RA group. ABPM results indicate no significant difference between RA patients and the control group in terms of daytime systolic and diastolic blood pressure, nighttime systolic and diastolic blood pressure, and average systolic and diastolic blood pressure results (p > 0.05). There was no statistical difference regarding the non-dipper status of patient groups (p = 0.412). Nocturnal blood pressure dipping was significantly similar between groups (p = 0.980). In conclusion, RA patients have similar values in terms of nocturnal blood pressure dipping and hypertension diagnosis as compared to normal population.