Our objective was to compare the cardiovascular safety of tocilizumab and other biological disease-modifying antirheumatic drugs (bDMARD) in rheumatoid arthritis using a network meta-analysis (NMA).
...A systematic literature search through May 2018 identified randomized controlled trials (RCT) or observational studies (cohort only) reporting cardiovascular outcomes of tocilizumab (TCZ) and/or abatacept (ABA) and/or rituximab (RTX) and/or tumor necrosis factor inhibitors (TNFi) in rheumatoid arthritis patients. The composite primary outcome was the rate of major adverse cardiovascular outcomes (MACE, myocardial infarction (MI), peripheral artery disease (PAD) and cardiac heart failure (CHF)).
19 studies were included in the NMA, including 11 RCTs and 8 cohort studies. We found less events with RTX (5.41 1.70;17.26. We found no difference between TCZ and other treatments. Concerning MI, we found no difference between TCZ and csDMARD (4.23 0.22;80.64), no difference between TCZ and TNFi (2.00 0.18;21.84). There was no difference between TCZ and csDMARD (1.510.02;103.50 and between TCZ and TNFi (1.00 0.06;15.85) for stroke event. With cohorts and RCT NMA, we found no difference between TCZ and other treatments for MACE (0.66 0.42;1.03 with ABA, 1.04 0.60;1.81 with RTX, 0.780.53;1.16 and 0.91 0.54;1.51 with csDMARD), but the risk of myocardial infarction was lower with TCZ compared to ABA (0.67 0.47;0.97). We lacked data to compare TCZ and other bDMARD for stoke and MI. Not enough data was available to perform a NMA for CHF and PAD.
Despite an increase in cholesterol levels, TCZ has safe cardiovascular outcomes compared to other bDMARD.
Objective
Rheumatoid arthritis is associated with increased cardiovascular risk. In ankylosing spondylitis (AS), there is a paucity of information concerning this risk. Our objective was to assess ...the incidence of myocardial infarction (MI) or strokes and the cardiovascular risk profile in AS patients.
Methods
We performed a systematic literature review using PubMed, EMBase, and the Cochrane Library up to August 2009. Incidence of MI or stroke was calculated by metaproportion. For cardiovascular risk factors, differences between AS patients and controls were expressed by standardized mean differences using inverse of variance method.
Results
For MI, 8 longitudinal studies were included. In controls (n = 82,745), 1,318 MI cases were observed (4.6%; 95% confidence interval 95% CI 1.2%, 10.0%). In AS patients (n = 3,279), 224 MI cases were reported (incidence 7.4%; 95% CI 5.2%, 10.0%). The increase in MI cases in AS patients was not significant (risk ratio 1.88; 95% CI 0.83, 4.28). For stroke, 7 longitudinal studies reported 327 strokes in AS patients (n = 31,949), which is an incidence of 2.2% (95% CI 1.3%, 3.4%). In controls (n = 7,372), one study reported 170 strokes (2.3%; 95% CI 2.0%, 2.7%). For cardiovascular risk factors, 15 case–control studies and 9 s were included (n = 1,214 for patients and n = 1,000 for controls). AS patients were characterized by a higher weighted mean intima‐media thickness and higher risk of metabolic syndrome. In AS patients, there was a significant decrease in triglycerides, total cholesterol, and high‐density lipoprotein (HDL) cholesterol.
Conclusion
AS patients appear to be at higher risk of MI, which could be due to low HDL cholesterol levels or to systemic inflammation. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS.
Polyunsaturated fatty acid (PUFA) supplementation has been reported to improve disease activity in inflammatory rheumatic diseases (IRDs). However, data are often conflicting and studies ...insufficiently large to draw conclusions. This systematic literature review and meta-analysis aimed to better estimate the effect of oral supplementation with omega (n)-3 and n-6 PUFA on IRD activity in terms of duration, dose, type, and source.
The literature was searched in PubMed, EMBASE, and Cochrane Library databases up to October 2020. Studies were reviewed in accordance with PRISMA guidelines. The effect of PUFA supplementation on disease activity was expressed as the standardized mean difference (95% CI). Metaregression and subgroup analyses involved type of IRD, Jadad score, PUFA source (animal or vegetable), and doses.
We obtained 42 references; 30 randomized controlled studies were included comparing the effects of PUFA versus control on disease activity (710 IRD patients receiving PUFA supplementation and 710 controls, most with rheumatoid arthritis). We found a significant improvement in pain, swollen and tender joint count, Disease Activity Score in 28 joints, and Health Assessment Questionnaire score in IRD patients receiving PUFA supplementation as compared with controls, with a significant decrease in erythrocyte sedimentation rate but not C-reactive protein level. Although meta-regression revealed no difference by IRD type or source or dose of PUFA supplementation, subgroup analysis revealed more parameters significantly improved with animal- than vegetable-derived PUFAs and 3- to 6-month supplementation. Most studies examined high-dose supplementation (>2 g/day).
PUFA consumption, especially omega-3 from animal source >2 g/day, may improve IRD activity and might be an adjuvant therapy in rheumatoid arthritis.
The protocol was registered at PROSPERO ( CRD42021253685 ).
Abstract Objectives Rheumatoid arthritis is associated with increased cardiovascular risk. In the guidelines, ankylosing spondylitis (AS) is considered to have an equally high cardiovascular risk. ...The literature findings remain controversial. This study aims to assess the risk of myocardial infarction (MI) and stroke in AS patients. Methods An updated meta-analysis with a new systematic literature review using PubMed was conducted up to January 2014. Incidence of MI or stroke was calculated by metaproportion. Results In addition to the 11 previously included studies, six new studies assessed the occurrence of MI or stroke in AS patients. (1) MI . A total of 2131 MI were reported in AS patients ( n = 27,532) over a mean follow-up of 15 years: incidence 5.3% (1.6%–11.0%), i.e., 0.36/100 pyrs. Seven studies revealed 17,410 MI 2.5% (95% CI: 1.8%–3.4%) in the control group ( n = 1,349,964). Meta-analysis of the seven longitudinal studies showed a significant increase in MI OR = 1.60 (95% CI: 1.32–1.93) in AS patients. (2) Stroke . In 11 longitudinal studies ( n = 51,990), 1807 strokes were reported in AS patients over 17.6 years of follow-up: incidence 3.6% (1.5%–6.5%), i.e., 0.24/100 pyrs. Three studies reported 22,899 strokes in controls ( n = 1,239,041), giving an incidence of 1.78% (1.75%–1.80%). A significant increase in stroke OR = 1.50 (95% CI: 1.39–1.62) in AS patients was found. Conclusion AS patients appear to have a higher risk of MI and stroke. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS to decrease this high cardiovascular risk.
Abstract
The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, ...infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.
Background
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by increased mortality associated with cardiometabolic disorders including dyslipidaemia, insulin resistance, and ...cachectic obesity. Tumour necrosis factor inhibitors and interleukin 6 receptor blocker licensed for the treatment of RA decrease inflammation and could thus improve cardiovascular risk, but their effects on body composition and metabolic profile need to be clarified. We investigated the effects of tocilizumab (TCZ), a humanized anti‐interleukin 6 receptor antibody, on body composition and metabolic profile in patients treated for RA.
Methods
Twenty‐one active RA patients treated with TCZ were included in a 1 year open follow‐up study. Waist circumference, body mass index, blood pressure, lipid profile, fasting glucose, insulin, serum levels of adipokines and pancreatic/gastrointestinal hormones, and body composition (dual‐energy X‐ray absorptiometry) were measured at baseline and 6 and 12 months of treatment. At baseline, RA patients were compared with 21 non‐RA controls matched for age, sex, body mass index, and metabolic syndrome.
Results
Compared with controls, body composition was altered in RA with a decrease in total and appendicular lean mass, whereas fat composition was not modified. Among RA patients, 28.6% had a skeletal muscle mass index below the cut‐off point for sarcopaenia (4.8% of controls). After 1 year of treatment with TCZ, there was a significant weight gain without changes for fat mass. In contrast, an increase in lean mass was observed with a significant gain in appendicular lean mass and skeletal muscle mass index between 6 and 12 months. Distribution of the fat was modified with a decrease in trunk/peripheral fat ratio and an increase in subcutaneous adipose tissue. No changes for waist circumference, blood pressure, fasting glucose, and atherogenic index were observed.
Conclusions
Despite weight gain during treatment with TCZ, no increase in fat but a modification in fat distribution was observed. In contrast, muscle gain suggests that blocking IL‐6 might be efficient in treating sarcopaenia associated with RA.
In an article published in
, Tański et al. performed a systematic review and concluded that omega-3 fatty acids might contribute to a reduced incidence of rheumatoid arthritis (RA) ....
Conflicting evidence exists concerning the effects of nutrient intake in osteoarthritis (OA). A systematic literature review and meta-analysis were performed using PubMed, EMBASE, and Cochrane ...Library up to November 2021 to assess the effects of nutrients on pain, stiffness, function, quality of life, and inflammation markers. We obtained 52 references including 50 on knee OA. Twelve studies compared 724 curcumin patients and 714 controls. Using the standardized mean difference, improvement was significant with regard to pain and function in the curcumin group compared to placebo, but not with active treatment (i.e., nonsteroidal anti-inflammatory drugs, chondroitin, or paracetamol). Three studies assessed the effects of ginger on OA symptoms in 166 patients compared to 164 placebo controls. Pain was the only clinical parameter that significantly decreased. Vitamin D supplementation caused a significant decrease in pain and function. Omega-3 and vitamin E caused no changes in OA parameters. Herbal formulations effects were significant only for stiffness compared to placebo, but not with active treatment. A significant decrease in inflammatory markers was found, especially with ginger. Thus, curcumin and ginger supplementation can have a favorable impact on knee OA symptoms. Other studies are needed to better assess the effects of omega-3 and vitamin D.
•TIO is often caused by mesenchymal tumors and rarely reported among malignancies.•This is the first case of TIO reported for a pancreatic neuroendocrine tumor.•An elevated FGF23 level may lead to ...the diagnosis of a malignant disease.
Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome characterized by hypophosphatemia associated with elevated fibroblast growth factor 23 (FGF23). TIO is primarily caused by benign mesenchymal tumors of the soft tissue and skeleton. Rarely, it is associated with a solid tumor or hematological malignancy. To date, no case of osteomalacia related to pancreatic cancer has been reported in the literature. Case report: A 77-year-old woman was admitted to the rheumatology department (RD) of the Clermont-Ferrand University Hospital (France) for further evaluation of her hypophosphatemia. The patient reported bone pain, myalgia, and asthenia. Further laboratory tests revealed hyperphosphaturia, normocalcemia, low serum calcitriol, elevated serum alkaline phosphatase (ALP), and elevated plasma parathyroid hormone (PTH). A renal phosphate depletion disorder was suspected as an etiology for this hypophosphatemia. Finally, FGF23 levels were found to be significantly elevated, leading to a definitive diagnosis of pancreatic neuroendocrine tumor. Conclusion: This is the first report of hypophosphatemic osteomalacia related to pancreatic cancer. Therefore, in the setting of hypophosphatemia associated with renal phosphate wasting and low calcitriol level, plasma FGF23 measurement should be considered.
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