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
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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
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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.
Background:Routine assessment of patient index data 3 (RAPID3) is a simplified measure of disease activity in Rheumatoid Arthritis (RA) constituting an index that is based only upon patient ...self-reported outcomes and so is simpler in terms of administration. So closely spaced domicilliary monitoring using RAPID 3 may allow the early detection of relapses.Objectives:1. To assess the disease activity in rheumatoid arthritis on fortnightly basis using RAPID 3.2. To assess disease activity using DAS 28 (disease activity score), CDAI (clinical disease activity index) every 2 monthsMethods:The present study was a follow up study done on ninety four RA patients (as per American college of Rheumatology criteria ACR criteria) who presented between February 2019 to February 2020 in Rheumatology clinic at our institution Pandit B.D.Sharma PGIMS, Rohtak in. Patients were assessed in the clinic for disease activity using Disease activity score-28 (DAS28) and Clinical disease activity index (CDAI) at baseline, two months and four months. In addition, RAPID 3 score was assessed by subjects themselves fortnightly (on domicillary basis) till four months.Results:Mean age of the subjects was 41.37 ± 11.09 years with 88 females and 6 males. At baseline the mean DAS28, CDAI and RAPID 3 scores were 4.98±0.7, 26.48±8.2and 15.03±4.9; at two months were 4.87±0.8, 25.14±10.0 and 14.01±4.8; at four months 4.48±0.9, 19.12±8.9 and 9.66±3.3 respectively. Pearson’s Correlation Coefficients of RAPID 3 score with DAS28 and CDAI scores at baseline were 0.651 and 0.795, at two months were 0.755 and 0.808 and at four months were 0.796 and 0.805 respectively (all p-value <0.001). Reliability index (as assessed by Cronbach’s alpha) for RAPID 3 score, DAS28 and CDAI were 0.769, 0.50, 0.744 at baseline and 0.78, 0.58, 0.80 at two months and 0.642, 0.659, 0.654 at four months respectively. The mean values of RAPID 3 score and its domains fluctuated till 2 months (not identified by conventional DAS 28 & CDAI) thereafter decreased with treatment in four months of followup.Conclusion:RAPID 3 score was found having significant correlation with DAS28 and CDAI. The fortnightly assessment of disease activity done at home identified the subtle changes in disease activity which were not identified during routine checkups in the clinic. So, RAPID 3 Score as a patient reported outcome in disease activity assessment in RA proved to be a good tool and its use on domiciliary basis helps the patient and physician in targeting the disease effectively.REFERENCES:NIL.Table 1.Mean values of Routine assessment of patient index data 3 (RAPID 3) score and its individual variablesTIMEVARIABLESRAPID 3 (Mean ± SD)Physical functionPainPatient global assessmentMean ± SDMean± SDMean ± SDBaseline3.9915 ± 2.435655.069 ± 1.91015.98 ± 1.51715.0394 ± 4.9383615 days3.8851 ± 2.299184.457 ± 2.16734.373 ± 2.052012.7266 ± 5.810731month3.9617 ± 2.492404.489 ± 2.04384.452 ± 2.001412.9191 ± 5.816041m15 days3.8968 ± 2.402984.431 ± 2.00894.457 ± 1.953312.7851 ± 5.689002months3.9223 ± 2.365814.723 ± 1.68905.73 ± 1.78514.0128 ± 4.888882m15 days3.3510 ± 1.940704.074 ± 1.83453.80 ± 1.80011.3074 ± 5.365273months3.0702 ± 1.604623.748 ± 1.63573.707 ± 1.564710.5117 ± 4.469443m 15 days2.8862 ± 1.692533.57 ± 1.6163.489 ± 1.49919.9713 ± 4.324914months2.5862 ± 1.610423.60 ± 1.6023.47 ± 1.1339.6606 ± 3.39871P VALUES0.002<0.001<0.001<0.001Table 2.Correlation coefficients for DAS28 and CDAI with RAPID3 scoreDisease activity scoreCorrelation coefficientsAt BaselineAt 2 monthsAt 4 monthsP valueDAS28 & RAPID 30.6710.7550.796<0.001CDAI & RAPID 30.7950.8080.805Acknowledgements:I would like to express my sincere gratitude first to almighty and my parents. Special thanks to my mentor Dr Harpreet Singh who was always there from the beginning to execution. Additionally, I extend my appreciation to my colleagues, juniors and seniors who provided support and resources. Their contributions have significantly enriched the quality of this work.Disclosure of Interests:None declared.
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.BACKGROUNDBasic 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.METHODSUsing 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.RESULTSWeighted 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.CONCLUSIONTotal 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.
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