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Frequency and Predictors of Communication About High Blood #Pressure in #Rheumatoid Arthritis Visits
https://journals.lww.com/jclinrheum/Fulltext/2018/06000/Frequency_and_Predictors_of_Communication_About.8.aspx
Compared with peers, patients with rheumatoid arthritis (RA) have higher rates of cardiovascular disease (CVD) events including myocardial infarction, stroke, and heart failure,1 conditions causally linked to hypertension. Hypertension (HTN) affects 50% of people older than 55 years, yet nearly half of adults with known HTN do not have it under control.2 Hypertension is the most frequent comorbidity in RA3,4 and is a major determinant of organ damage and mortality
Among 1267 RA patients, 40% experienced BP elevations meeting the definition of uncontrolled HTN. Of 2677 eligible RA visits, 22% contained any documented BP communication. After adjustment, models predicted only 31% of visits with markedly high BPs 160/100 mm Hg or greater would contain BP communication. Compared with stage I, stage II elevation did not significantly increase communication (odds ratio, 2.0 95% confidence interval, 1.4–2.8 vs. 1.5 1.2–2.2), although both groups' odds exceeded pre-HTN and normotension. Less than 10% of eligible visits resulted in documented action steps recommending follow-up of high BP.
Conclusions Regardless of BP magnitude, most RA clinic visits lacked documented communication about BP despite compounded CVD risk. Future work should study how rheumatology clinics can facilitate follow-up of high BPs to address HTN as the most common and reversible CVD risk factor.
Frequency and Predictors of Communication About High Blood #Pressure in #Rheumatoid Arthritis Visits
https://journals.lww.com/jclinrheum/Fulltext/2018/06000/Frequency_and_Predictors_of_Communication_About.8.aspx
Compared with peers, patients with rheumatoid arthritis (RA) have higher rates of cardiovascular disease (CVD) events including myocardial infarction, stroke, and heart failure,1 conditions causally linked to hypertension. Hypertension (HTN) affects 50% of people older than 55 years, yet nearly half of adults with known HTN do not have it under control.2 Hypertension is the most frequent comorbidity in RA3,4 and is a major determinant of organ damage and mortality
Among 1267 RA patients, 40% experienced BP elevations meeting the definition of uncontrolled HTN. Of 2677 eligible RA visits, 22% contained any documented BP communication. After adjustment, models predicted only 31% of visits with markedly high BPs 160/100 mm Hg or greater would contain BP communication. Compared with stage I, stage II elevation did not significantly increase communication (odds ratio, 2.0 95% confidence interval, 1.4–2.8 vs. 1.5 1.2–2.2), although both groups' odds exceeded pre-HTN and normotension. Less than 10% of eligible visits resulted in documented action steps recommending follow-up of high BP.
Conclusions Regardless of BP magnitude, most RA clinic visits lacked documented communication about BP despite compounded CVD risk. Future work should study how rheumatology clinics can facilitate follow-up of high BPs to address HTN as the most common and reversible CVD risk factor.
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The importance of measuring hand and foot #function over the disease course in #rheumatoid arthritis: An eight‐year follow‐up study
https://onlinelibrary.wiley.com/doi/10.1002/acr.23764
To assess function using the Signals of Functional Impairment (SOFI) instrument over eight years and to study clinical variables associated with the change. Also to study change over time of the SOFI items.
During the first year, there was a mean improvement in SOFI of 2.7 (SD 5.7) (p<0.001). Worse scores in DAS28 and HAQ at baseline were associated with this improvement (r2≤ 0.11). During the next seven years, there was a mean deterioration in SOFI of 1.5 (SD 4.9) (p<0.001). Based on change scores, finger flexion, pincer grip, and toe‐standing were the most important items to measure, explaining 58–61% of the total SOFI score and were also associated with radiographic changes at the eight‐year follow‐up.
Conclusion
Function as assessed with SOFI improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot tasks were associated with joint destruction at the eight‐year follow‐up. Measures of hand and foot function will complement self‐reported and medical data both in clinical work and in long‐term research studies.
The importance of measuring hand and foot #function over the disease course in #rheumatoid arthritis: An eight‐year follow‐up study
https://onlinelibrary.wiley.com/doi/10.1002/acr.23764
To assess function using the Signals of Functional Impairment (SOFI) instrument over eight years and to study clinical variables associated with the change. Also to study change over time of the SOFI items.
During the first year, there was a mean improvement in SOFI of 2.7 (SD 5.7) (p<0.001). Worse scores in DAS28 and HAQ at baseline were associated with this improvement (r2≤ 0.11). During the next seven years, there was a mean deterioration in SOFI of 1.5 (SD 4.9) (p<0.001). Based on change scores, finger flexion, pincer grip, and toe‐standing were the most important items to measure, explaining 58–61% of the total SOFI score and were also associated with radiographic changes at the eight‐year follow‐up.
Conclusion
Function as assessed with SOFI improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot tasks were associated with joint destruction at the eight‐year follow‐up. Measures of hand and foot function will complement self‐reported and medical data both in clinical work and in long‐term research studies.
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Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to #Rheumatoid Arthritis in Clinically Tested #CCP‐Positive Patients Without RA
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23820
We identified 340 CCP+ patients who were without RA or other rheumatic disease at baseline. During 1047 person‐years of follow‐up, 73 (21.5%) patients developed RA. Risk of progression to RA increased with CCP level, with 46.0% (95%CI 34.7‐55.3) of high level CCP patients progressing to RA by 5 years. Compared to low CCP, medium (HR 3.00, 95%CI 1.32‐6.81) and high (HR 4.83, 95%CI 2.51‐9.31) CCP levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level.
Conclusion
Among CCP+ patients without RA, risk for progression to RA increased substantially with increasing CCP level. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk
Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to #Rheumatoid Arthritis in Clinically Tested #CCP‐Positive Patients Without RA
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23820
We identified 340 CCP+ patients who were without RA or other rheumatic disease at baseline. During 1047 person‐years of follow‐up, 73 (21.5%) patients developed RA. Risk of progression to RA increased with CCP level, with 46.0% (95%CI 34.7‐55.3) of high level CCP patients progressing to RA by 5 years. Compared to low CCP, medium (HR 3.00, 95%CI 1.32‐6.81) and high (HR 4.83, 95%CI 2.51‐9.31) CCP levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level.
Conclusion
Among CCP+ patients without RA, risk for progression to RA increased substantially with increasing CCP level. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk
Wiley Online Library
Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to Rheumatoid Arthritis in Clinically Tested Cyclic Citrullinated…
Objective
To investigate the risk of progression to rheumatoid arthritis (RA) in patients who were cyclic citrullinated peptide (CCP) antibody positive without RA at initial presentation.
Methods
...
To investigate the risk of progression to rheumatoid arthritis (RA) in patients who were cyclic citrullinated peptide (CCP) antibody positive without RA at initial presentation.
Methods
...
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Cost‐effectiveness of combination disease‐modifying antirheumatics vs. tumour necrosis factor inhibitors in active #rheumatoid arthritis: TACIT trial
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23830
205 participants were recruited, 104 in the #cDMARDs arm, 101 in the TNFis arm. cDMARD arm participants with poor response at 6 months were offered TNFis; 46 (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6 month follow‐up and 91‐92% at 12 month follow‐up. The cDMARDs arm had significantly lower total costs from all perspectives (6 month H&SC adjusted mean difference ‐£3615 (95% confidence interval ‐£4104 to ‐£3182); 12 month H&SC adjusted mean difference ‐£1930 (95% confidence interval ‐£2599 to ‐£1301)). The HAQ showed benefit to the cDMARDs arm at 12 months (‐0.16; 95% CI‐0.32 to ‐0.01); other outcomes/follow‐ups showed no differences.
Conclusion
Starting treatment with cDMARDs, rather than TNFis, achieves similar outcomes at significantly lower costs. Patients with active rheumatoid arthritis and meeting NICE criteria for expensive biologics can cost‐effectively be treated with combinations of intensive synthetic disease modifying drugs.
Cost‐effectiveness of combination disease‐modifying antirheumatics vs. tumour necrosis factor inhibitors in active #rheumatoid arthritis: TACIT trial
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23830
205 participants were recruited, 104 in the #cDMARDs arm, 101 in the TNFis arm. cDMARD arm participants with poor response at 6 months were offered TNFis; 46 (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6 month follow‐up and 91‐92% at 12 month follow‐up. The cDMARDs arm had significantly lower total costs from all perspectives (6 month H&SC adjusted mean difference ‐£3615 (95% confidence interval ‐£4104 to ‐£3182); 12 month H&SC adjusted mean difference ‐£1930 (95% confidence interval ‐£2599 to ‐£1301)). The HAQ showed benefit to the cDMARDs arm at 12 months (‐0.16; 95% CI‐0.32 to ‐0.01); other outcomes/follow‐ups showed no differences.
Conclusion
Starting treatment with cDMARDs, rather than TNFis, achieves similar outcomes at significantly lower costs. Patients with active rheumatoid arthritis and meeting NICE criteria for expensive biologics can cost‐effectively be treated with combinations of intensive synthetic disease modifying drugs.
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Impact and timing of #smoking cessation on reducing risk for #rheumatoid arthritis among women in the Nurses’ Health Studies
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23837
Compared to never smoking, current smoking increased risk for all RA (multivariable HR 1.47, 95%CI 1.27‐1.72) and seropositive RA (HR 1.67, 95%CI 1.38‐2.01), but not seronegative RA (HR 1.20, 95%CI 0.93‐1.55). Increasing smoking pack‐years was associated with increased trend of risk for all RA (p<0.0001) and seropositive RA (p<0.0001). With increasing duration of smoking cessation, a decreased trend was observed in risk for all RA (p=0.009) and seropositive RA (p=0.002). Compared to recent quitters (<5 years), those who quit ≥30 years ago had HR of 0.63 (95%CI 0.44‐0.90) for seropositive RA. However, a modestly elevated RA risk was still detectable 30 years after quitting smoking (all RA: HR 1.25, 95%CI 1.02‐1.53; seropositive RA: HR 1.30, 95%CI 1.01‐1.68; reference: never smoking).
Conclusions
These results confirm smoking as a strong risk factor for seropositive RA and demonstrate for the first time that a behavior change of sustained smoking cessation could delay or even prevent seropositive RA.
Impact and timing of #smoking cessation on reducing risk for #rheumatoid arthritis among women in the Nurses’ Health Studies
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23837
Compared to never smoking, current smoking increased risk for all RA (multivariable HR 1.47, 95%CI 1.27‐1.72) and seropositive RA (HR 1.67, 95%CI 1.38‐2.01), but not seronegative RA (HR 1.20, 95%CI 0.93‐1.55). Increasing smoking pack‐years was associated with increased trend of risk for all RA (p<0.0001) and seropositive RA (p<0.0001). With increasing duration of smoking cessation, a decreased trend was observed in risk for all RA (p=0.009) and seropositive RA (p=0.002). Compared to recent quitters (<5 years), those who quit ≥30 years ago had HR of 0.63 (95%CI 0.44‐0.90) for seropositive RA. However, a modestly elevated RA risk was still detectable 30 years after quitting smoking (all RA: HR 1.25, 95%CI 1.02‐1.53; seropositive RA: HR 1.30, 95%CI 1.01‐1.68; reference: never smoking).
Conclusions
These results confirm smoking as a strong risk factor for seropositive RA and demonstrate for the first time that a behavior change of sustained smoking cessation could delay or even prevent seropositive RA.
Risk for Serious #Infection With Low-Dose #Glucocorticoids in Patients With #Rheumatoid Arthritis
https://2medical.news/2020/09/26/risk-for-serious-infection-with-low-dose-glucocorticoids-in-patients-with-rheumatoid-arthritis/
Low-dose glucocorticoids are frequently used for the management of rheumatoid arthritis (RA) and other chronic conditions, but the safety of long-term use remains uncertain.. ..Associations between glucocorticoid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability–weighted analyses, with 1-year cumulative incidence predicted from weighted models. Results: 247 297 observations were identified among 172 041 patients …
https://2medical.news/2020/09/26/risk-for-serious-infection-with-low-dose-glucocorticoids-in-patients-with-rheumatoid-arthritis/
Low-dose glucocorticoids are frequently used for the management of rheumatoid arthritis (RA) and other chronic conditions, but the safety of long-term use remains uncertain.. ..Associations between glucocorticoid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability–weighted analyses, with 1-year cumulative incidence predicted from weighted models. Results: 247 297 observations were identified among 172 041 patients …
Finger Joint #Cartilage Evaluated by Semiquantitative #Ultrasound Score in Patients With #Rheumatoid Arthritis
https://2medical.news/2021/02/09/finger-joint-cartilage-evaluated-by-semiquantitative-ultrasound-score-in-patients-with-rheumatoid-arthritis/
Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using radiography, we aimed to examine the validity of ultrasound (US) cartilage evaluation using a semiquantitative method in patients with RA. Methods We enrolled 103 patients with RA who were in remission or showing low disease activity and 42 healthy subjects. …
https://2medical.news/2021/02/09/finger-joint-cartilage-evaluated-by-semiquantitative-ultrasound-score-in-patients-with-rheumatoid-arthritis/
Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using radiography, we aimed to examine the validity of ultrasound (US) cartilage evaluation using a semiquantitative method in patients with RA. Methods We enrolled 103 patients with RA who were in remission or showing low disease activity and 42 healthy subjects. …
#Pain and fatigue are longitudinally and bi-directionally associated with more #sedentary time and less standing time in #rheumatoid arthritis
https://2medical.news/2021/02/19/pain-and-fatigue-are-longitudinally-and-bi-directionally-associated-with-more-sedentary-time-and-less-standing-time-in-rheumatoid-arthritis/
The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. Methods People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to …
https://2medical.news/2021/02/19/pain-and-fatigue-are-longitudinally-and-bi-directionally-associated-with-more-sedentary-time-and-less-standing-time-in-rheumatoid-arthritis/
The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. Methods People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to …
The oral #microbiome in early #rheumatoid arthritis patients and individuals at risk differs from healthy controls
https://2medical.news/2021/05/09/the-oral-microbiome-in-early-rheumatoid-arthritis-patients-and-individuals-at-risk-differs-from-healthy-controls/
https://2medical.news/2021/05/09/the-oral-microbiome-in-early-rheumatoid-arthritis-patients-and-individuals-at-risk-differs-from-healthy-controls/
2Medical.News
The oral #microbiome in early #rheumatoid arthritis patients and individuals at risk differs from healthy controls
It has been suggested that rheumatoid arthritis (RA) may originate at the oral mucosa. Our aim was to assess the oral microbiome and the periodontal condition in patients with early rheumatoid arth…
OP0012 ASSOCIATION BETWEEN PASSIVE #SMOKING IN CHILDHOOD AND ADULTHOOD, AND #RHEUMATOID ARTHRITIS: RESULTS FROM THE FRENCH E3N-EPIC COHORT STUDY
https://2medical.news/2021/06/07/op0012%E2%80%85association-between-passive-smoking-in-childhood-and-adulthood-and-rheumatoid-arthritis-results-from-the-french-e3n-epic-cohort-study/
https://2medical.news/2021/06/07/op0012%E2%80%85association-between-passive-smoking-in-childhood-and-adulthood-and-rheumatoid-arthritis-results-from-the-french-e3n-epic-cohort-study/
2Medical.News
OP0012 ASSOCIATION BETWEEN PASSIVE #SMOKING IN CHILDHOOD AND ADULTHOOD, AND #RHEUMATOID ARTHRITIS: RESULTS FROM THE FRENCH E3N…
Rheumatoid arthritis (RA) is a systemic autoimmune disease of multifactorial aetiology, which preferentially affects women. To date, active smoking has been the most reproducibly reported risk fact…