Spontaneous Liver Rupture in the Setting of Autoimmune Disease ...
Rheumatoid Arthritis Is A Risk Factor For Aortic Stenosis, Study Finds
Researchers add to evidence suggesting that inflammatory factors contribute to increased risk for valvular heart diseases, such as aortic stenosis, in patients with rheumatoid arthritis.
Heart Vesselsimage credit: grieze - stock.Adobe.Com
Patients with rheumatoid arthritis (RA) were found to have an increased risk for developing aortic stenosis (AS), according to a study published in JAMA Internal Medicine.
The multitude of inflammatory factors brought on by RA has been affiliated with higher risk of cardiovascular disease (CVD). On top of this, CVD is the top contributing factor to mortality in patients with RA.
The authors note that patients with RA endure a 75% increased rate of death at the hands of valvular heart disease. The most common cause of valvular heart disease–related death, and the reason most associated with valve replacement, is AS. Although many past studies have correlated RA with forms of CVD, AS has yet to be sufficiently evaluated.
Given that a patient with RA's vulnerability to developing AS is unknown, the researchers conducted a matched-cohort study to assess the risk of AS-related outcomes—such as aortic valve intervention—and disease development in these individuals.
Data were gathered between January 1, 2000, and December 31, 2019, from the national Veterans Health Administration (VHA) and CMS databases. Patients identified with RA were matched with up to 10 patients without RA (controls) according to age, sex, and year of enrollment in the virtual databases. Individuals were excluded if they had a history of aortic valve intervention or AS, and all were followed until the earliest AS outcome, end of the study period, or death.
AS risk factors were measured with test results for RA-related autoantibodies (rheumatoid factor [RF] and anti-cyclic citrullinated protein [anti-CCP]), erythrocyte sedimentation rates (ESR), and C-reactive protein (CRP) levels. Primary outcomes included AS incidence (official diagnosis, record of related death, or aortic valve intervention); secondary outcomes were concerned with the individual interventions that took place and AS-related death outcomes.
In total, 73,070 patients with RA were identified alongside 639,268 controls. By the end of the study period, 16,109 composite AS outcomes were registered that spanned 6,223,150 person-years. Of these, 2303 events were experienced by patients with RA.
The mean age of RA incidence between the RA group and controls were fairly similar (74.9 vs 75.5 years, respectively). For every 1000 person-years, having RA resulted in a 1.52-fold risk increase for AS-related events: 3.97 (95% CI, 3.81-4.13) vs 2.45 (95% CI, 2.41-2.49). Additionally, RA was associated with higher rates of composite AS (adjusted HR [aHR], 1.48; 95% CI, 1.41-1.55), aortic valve intervention (aHR, 1.34; 95% CI, 1.22-1.48), and AS-related death (aHR, 1.26; 95% CI, 1.04-1.54).
At baseline, 68.9% of patients with RA registered seropositive tests for RF or anti-CPP, and 47% had elevated CRP or ESR levels. In the authors' results, these elevated levels and/or a seronegative test were linked with higher risk of developing AS. They found this important to note; however, they mentioned that these factors were not statistically significant in the outcomes.
The researchers' findings aligned with those of previous RA cohorts that demonstrated these patients carried higher risks for developing other forms of CVD, such as ischemic heart disease. Their study further confirms the RA-CVD association and highlights that "valvular heart disease, specifically AS, may be an overlooked CVD complication in RA."
While their research confirmed the increased risks carried by patients with RA, the authors concluded by expressing the need for further research on this matter to verify the role of conditions like AS in the CVD-related complications that coincide with RA.
Reference
Johnson TM, Mahabir CA, Yang Y, et al. Aortic stenosis risk in rheumatoid arthritis. JAMA Intern Med. 2023;183(9):973-981. Doi:10.1001/jamainternmed.2023.3087
How Does Psoriatic Arthritis Affect The Body?
People with psoriatic arthritis may have symptoms of both psoriasis and arthritis. The condition causes widespread inflammation and can affect the skin, musculoskeletal system, immune system, vision, and more.
Psoriatic arthritis (PsA) affects up to 30% of people who have the skin condition psoriasis.
Here, we describe eight effects of PsA, including the effects on vision, digestion, breathing, and movement. We also explore the treatment options.
Many people with PsA also have psoriasis. Possible symptoms of plaque psoriasis, the most common type, include:
Skin symptoms usually affect the elbows, knees, lower back, and scalp, but they can occur anywhere. Nail symptoms occur in 80–90% of people with PsA, whether or not they have psoriasis.
Psoriasis speeds up the life cycle of skin cells. New cells move to the outer layer of the skin in a few days rather than weeks. These new cells rapidly build up on the skin, forming the itchy, scaly patches that characterize psoriasis.
Around 68% of people who develop PsA already have skin symptoms of psoriasis, and about 15% of people with PsA develop symptoms of psoriasis at the same time.
In about 17% of cases, skin symptoms appear only after symptoms that affect the joints and other areas.
How does psoriasis look on black skin?
The immune reaction involved in psoriasis and PsA causes inflammation of the joints, which can affect the musculoskeletal system in several ways. Inflammation causes pain, stiffness, and swelling in one or more joints, making them difficult to move.
PsA symptoms usually affect up to five small or large joints on one side of the body. By contrast, the symptoms of rheumatoid arthritis often develop on both sides of the body, such as in both knees.
How does it affect cartilage?In arthritis, the cartilage at the end of the bones becomes damaged and breaks down. In PsA, this damage results from persistent inflammation.
As the cartilage erodes, the bones rub together, causing further pain and joint damage. Inflammation can lead to bone erosion and extra bone growth.
Chronic inflammation can also affect the ligaments and tendons around the joint.
Can psoriatic arthritis make your whole body hurt?According to the American Academy of Dermatology, early symptoms of PsA may include:
Swelling often occurs throughout the fingers. The affected fingers and toes may develop a sausage-like appearance (dactylitis), which may be most prominent in the middle joints of the fingers.
The finger bone may change shape, which doctors can recognize using imaging technology. The middle bone in a finger joint becomes narrower, while the end joint becomes wider.
PsA may also cause inflammation in the back and pelvis, known as spondyloarthritis.
PsA is an autoimmune condition, which means it influences the way the immune system works. The immune system fights pathogens, such as bacteria and viruses. But in someone with an autoimmune condition, the immune system mistakenly attacks healthy cells.
In a person with PsA, the immune system attacks the joints, the tendons, and the insertion points of tendons and ligaments. If a person also has psoriasis, this immune system reaction also affects the skin.
Researchers do not fully understand why this happens. They think some bacterial infections, including strep throat, may trigger PsA. In addition, if a person has a genetic susceptibility, they may develop PsA as a result of severe stress, a physical injury, or an event that causes the immune system to react strongly.
Learn more about the relationship between psoriasis and the immune system.
Inflammation in and around the eyes can affect vision. Some 7–20% of people with psoriasis develop uveitis, and it is more common in people who have PsA than in those who have psoriasis alone.
Uveitis is a group of diseases related to eye inflammation. Without treatment, it can lead to vision loss. People with PsA should have regular eye exams for this reason.
PsA may affect the body in other ways, including the following.
Effects on the respiratory systemPeople with PsA appear to have a higher chance of developing chronic obstructive pulmonary disease (COPD), according to a 2016 meta-analysis.
A 2019 review also concluded that there may be a link between COPD and various types of inflammatory arthritis but that more research is necessary to learn more about this.
How can psoriasis affect the lungs?
Effects on the cardiovascular systemPeople with PsA have a greater chance of developing cardiovascular disease than those without PsA. The American College of Cardiology explains that chronic inflammation damages blood vessels by making them thicker and harder and by causing scarring, known as atherosclerosis. This can increase the risk of angina, a heart attack, or a stroke.
Among people with PsA, there are also higher rates of metabolic syndrome. This includes conditions such as obesity, high blood pressure, diabetes, and high cholesterol. These, too, can put added stress on the blood vessels and the cardiovascular system.
Effects on mental healthPsA can affect mental and emotional health in addition to physical health. Symptoms such as pain and fatigue and other related health concerns can increase the risk of anxiety and depression in people with PsA.
Psoriasis and PsA may also reduce self-esteem and cause feelings of embarrassment, especially when treatments do not adequately manage symptoms.
Treatments for PsA aim to:
Some guidelines recommend biologic medication, such as etanercept (Enbrel), for people with a new diagnosis of PsA. However, biologic drugs are not suitable for everyone and can have adverse effects. A person with PsA should discuss the range of treatment options with their doctor.
A doctor may recommend:
The following strategies may also help:
Can changing the diet help?
Living with a chronic inflammatory condition such as PsA can be difficult. The symptoms may come and go, worsening during flares and disappearing during periods of remission. Over time, they may become more severe.
If skin symptoms occur, they can cause physical discomfort. These physical manifestations of PsA can also have a detrimental effect on relationships, both personally and professionally, and increase a person's chances of developing mood disorders such as anxiety and depression.
However, a person's individual experience with PsA will depend on how severe their symptoms are, which parts of the body the condition affects, and whether any comorbidities, such as heart disease, emerge.
In addition to medical treatment, there are a few things a person can do to find relief and manage the condition:
PsA causes inflammation in the joints, which leads to swelling, pain, and stiffness. It can also cause fatigue, nail changes, and other symptoms. People with PsA have a greater chance of developing cardiovascular disease and depression. Many people with PsA also have skin symptoms characteristic of psoriasis.
There is no cure for PsA, but medication can help manage it and prevent progressive joint damage. Alternative therapies and lifestyle strategies, such as engaging in low impact exercise and avoiding smoking, may also help.
Does Rheumatoid Arthritis Increase Parkinson's Disease Risk?
The relationship between the risk of Parkinson's disease among people with rheumatoid arthritis (RA) is not well understood, with a small number of studies reporting conflicting results. The authors of a new study tested whether RA is associated with PD risk and whether seropositivity modifies this risk in a large representative cohort while adjusting for the demographic and lifestyle factors associated with PD risk.
The Bottom LineThis retrospective cohort study recruited participants using National Health Insurance Service (NHIS) data, a service that includes 97% of the Korean population.1 Patients diagnosed with RA between 2010 and 2017 who had a national health checkup within 2 years of a PD diagnosis were eligible for the study. This yielded a cohort of 119,788 RA patients, where 83,064 had seropositive RA (SPRA) and 36,724 had seronegative RA (SNRA).
The study excluded participants younger than 40, those with a diagnosis of another rheumatic disease, those with a PD diagnosis that preceded a RA diagnosis, those with a PD diagnosis within a year of the index date, any participant with missing data, and those that could not be matched with the control group. This yielded a cohort of 54,680 RA patients: 39,010 with SPRA and 15,670 with SNRA. The control group included 273,400 individuals age and sex-matched 1:5 with the RA group. Most of the total sample, which included a total of 328,080 participants, were female (74.9%), with a mean age of 58.6 at the index date. Participants with codes for both SPRA and SNRA were classified as having SPRA.
RA patients were significantly more likely than controls to be current smokers and less likely to be obese, drink alcohol, and do regular physical activity. SPRA patients were significantly more likely to be older, female, current smokers, and less likely to be obese, drink alcohol, and do regular physical activity than SNRA patients. Three models were constructed that adjusted for covariates: the first adjusted for age, sex, smoking, alcohol drinking, physical activity, low income, and BMI; the second included these variables and diabetes, hypertension, hyperlipidemia, and chronic kidney disease; the third model included all previous covariates and myocardial infarction, stroke, and depression. The primary outcome measure was a new diagnosis of PD.
In the study period, 1093 patients developed PD, 803 in the control group and 290 in the RA cohort. RA patients had a 1.84-fold higher risk for PD than the control group when no covariates were included. This enhanced risk was seen across models. Model 1 yielded an adjusted hazard ratio (aHR) of 1.89 (95% CI, 1.65-2.16), model 2 found an aHR of 1.87 (95% CI,1.63-2.14), and model 3 found an aHR of 1.74 (95% CI, 1.52-1.99). SPRA patients had a higher risk of PD than controls (model 3: aHR 1.95; 95% CI, 1.68-2.26). Model 2 found an increased risk of PD in SNRA patients compared to controls (aHR 1.31; 95% CI, 1.00-1.71), however with the addition of variables in model 3, the association weakened (aHR, 1.20; 95% CI, 0.91-1.57). Additional study findings included: a significantly increased PD risk in premenopausal women (aHR 4.43; 95% CI, 2.05-9.59) compared to postmenopausal women aHR (1.75; 95% CI, 1.46-2.10).
Clinically, the authors write that the findings can inform physicians' referral decisions, "The study findings suggest that physicians who care for patients with RA should be aware of the elevated risk of PD, and prompt referral to a neurologist should be considered at the onset of early motor symptoms of PD in patients with RA without synovitis."
Published: September 21, 2023
Erin Kello is a freelance medical writer. She earned her PhD in biological anthropology with a concentration in epigenetics at the University of Pittsburgh.
Comments
Post a Comment