Genetic and environmental risk factors for rheumatoid arthritis Deane, Kevin D.; Demoruelle, M. Kristen; Kelmenson, Lindsay B. ...
Best practice & research. Clinical rheumatology,
February 2017, 2017-02-00, 20170201, Letnik:
31, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Multiple genetic and environmental factors have been associated with an increased risk for rheumatoid arthritis (RA). Of these, the strongest associations have been seen with female sex, a family ...history of RA, the genetic factor the “shared epitope,” and exposure to tobacco smoke. There is also renewed interest in mucosal inflammation and microbial factors as contributors to the development of RA. However, the identification of a “preclinical” period of RA that can be defined as local or systemic autoimmunity as measured by autoantibodies and other biomarkers prior to the development of clinically apparent synovitis suggests that the risk factors for RA are acting long prior to first clinical evidence of IA. As such, a major challenge to the field will be to investigate the full spectrum of the development of RA, from initiation and propagation of autoimmunity during preclinical RA and transition to clinically apparent synovitis and classifiable RA, to determine which genetic and environmental factors are important at each stage of disease development. Understanding the exact role and timing of action of risk factors for RA is especially important given the advent of prevention trials in RA, and the hope that a full understanding of genetic and environmental factors in RA could lead to effective preventive interventions.
Arthritis has a high prevalence globally and includes over 100 different types, the most common of which are rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and inflammatory arthritis. The ...exact etiology of arthritis remains unclear and no cure exists. Anti-inflammatory drugs are commonly used in the treatment of arthritis but are associated with significant side effects. Novel modes of therapy and additional prognostic biomarkers are urgently needed for arthritis patients. This book summarizes and discusses the global picture of the current understanding of arthritis.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
The primary objective is to compare the benefits and harms of different disease‐modifying anti‐rheumatic drugs ...(DMARDs) as initial therapy and after failure of conventional synthetic DMARDs or biologic or targeted synthetic DMARDs in adults with rheumatoid arthritis through a network meta‐analysis (NMA). A secondary objective is to rank the interventions for both benefits and harms.
This protocol describes the approach for separate NMAs for the three populations of interest (described below), which we intend to publish as three separate Cochrane Reviews.
1) Disease‐modifying anti‐rheumatic drugs for rheumatoid arthritis as initial therapy: a systematic review and network meta‐analysis
2) Disease‐modifying anti‐rheumatic drugs for rheumatoid arthritis after failure of conventional synthetic disease‐modifying anti‐rheumatic drugs: a systematic review and network meta‐analysis
3) Disease‐modifying anti‐rheumatic drugs for rheumatoid arthritis after failure of biologic or targeted synthetic therapy: a systematic review and network meta‐analysis
Long-term glucocorticoids for rheumatoid arthritis McKenzie, Bayden J; Whittle, Samuel L; Johnston, Renea V ...
Cochrane database of systematic reviews,
12/2021, Letnik:
2021, Številka:
12
Journal Article
Recenzirano
Odprti dostop
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To evaluate the benefits and harms of long‐term glucocorticoid therapy (longer than six months) for adults with ...rheumatoid arthritis.
•The importance of employing diverse methodologies to assess the health effects of flavonoids for rheumatoid arthritis.•Total flavonoids and flavanones were significantly associated with reduced ...rheumatoid arthritis risk for the American adult population.•Flavonoids intake protected against rheumatoid arthritis, and the risk of developing rheumatoid arthritis decreased significantly with increasing intake of total flavonoids.•Investigating potential dietary interventions for RA helps prevent the onset and progression of the disease.
Basic research shows that flavonoids have anti-inflammatory effects that influence rheumatoid arthritis (RA) in rats. Investigating potential dietary interventions for RA helps prevent the onset and progression of the disease. Clinical evidence on the association of- flavonoid and subclass intake with RA is lacking.
Using three survey cycles of 2007–2008, 2009–2010 and 2017–2018 from the National Health and Nutrition Survey and the United States Department of Agriculture's Food and Nutrient Database for Dietary Studies (FNDDS), we analyzed 7,419 American adults (≥20 years old). The values of flavonoid and subclass intake were calculated using FNDDS. The status questions for self-reported RA were from the NHANES codebook.
Weighted analyses, revealed that among the 7,419 participants included in this study (mean age of 44.69 years standard error, 0.40 and3,584 48.31% were female), 408 met the classification criteria for RA. According to the multivariable logistic regression model, compared with the risk of RA in the first quartile (Q1), the risks of RA in the second quartile (Q2), the third quartile (Q3) and the fourth quartile (Q4))were lower (Q2: OR=0.55, 95% CI: 0.38–0.80; Q3: OR=0.66, 95% CI: 0.44–0.97; Q4: OR=0.64, 95% CI: 0.46–0.89;trend: P=0.03). The association between total flavonoids and RA remained significant after full consideration of confounding factors. With regard to the subclasses of flavonoids, high flavanones intake was associated with low RA prevalence in Model 3 (Q3: OR= 0.60, 95% CI:0.39–0.92; Q4: OR = 0.56 95% CI: 0.32–0.99, trend:P =0.02) but no such association was found in the other subclasses. Total flavonoids intake protected against RA, and the risk of developing RA decreased significantly with increasing intake of total flavonoids.
Total flavonoids and flavanones were significantly associated with reduced RA risk for the American adult population. We highlighted the importance of employing diverse methodologies to assess the health effects of flavonoids.
PDF
