Epidemiology is the study of the distribution and determinants of disease in human populations. Over the past decade there has been considerable progress in our understanding of the fundamental descriptive epidemiology (levels of disease frequency: incidence and prevalence, comorbidity, mortality, trends over time, geographic distributions, and clinical characteristics) of the rheumatic diseases. This progress is reviewed for the following major rheumatic diseases: rheumatoid arthritis (RA), juvenile rheumatoid arthritis, psoriatic arthritis, osteoarthritis, systemic lupus erythematosus, giant cell arteritis, polymyalgia rheumatica, gout, Sjogren's syndrome, and ankylosing spondylitis. These findings demonstrate the dynamic nature of the incidence and prevalence of these conditions – a reflection of the impact of genetic and environmental factors. The past decade has also brought new insights regarding the comorbidity associated with rheumatic diseases. Strong evidence now shows that persons with RA are at a high risk for developing several comorbid disorders, that these conditions may have atypical features and thus may be difficult to diagnose, and that persons with RA experience poorer outcomes after comorbidity compared with the general population. Taken together, these findings underscore the complexity of the rheumatic diseases and highlight the key role of epidemiological research in understanding these intriguing conditions.

/pdf/epidemiological-studies-in-incidence-prevalence-mortality-4xq1rtiol6.pdf

Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases

Organising pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue. Although nonspecific, this histopathological pattern, together with characteristic clinical and imaging features, defines cryptogenic organising pneumonia when no cause or peculiar underlying context is found. Rapid clinical and imaging improvement is obtained with corticosteroid treatment, but relapses are common after stopping treatment.

https://erj.ersjournals.com/content/erj/28/2/422.full.pdf

Cryptogenic organising pneumonia

Objective

Pneumonia is a major cause of mortality and morbidity in rheumatoid arthritis (RA). This study was undertaken to determine the rate and predictors of hospitalization for pneumonia and the extent to which specific RA treatments increase pneumonia risk.



Methods

RA patients (n = 16,788) were assessed semiannually for 3.5 years. Pneumonia was confirmed by medical records or detailed patient interview. Covariates included RA severity measures, diabetes, pulmonary disease, and myocardial infarction. Cox proportional hazards regression was used to determine the multivariable risk associated with RA treatments.



Results

After adjustment for covariates, prednisone use increased the risk of pneumonia hospitalization (hazard ratio [HR] 1.7 [95% confidence interval 1.5–2.0]), including a dose-related increase in risk (≤5mg/day HR 1.4 [95% confidence interval 1.1–1.6], >5–10 mg/day HR 2.1 [95% confidence interval 1.7–2.7], >10 mg/day HR 2.3 [95% confidence interval 1.6–3.2]). Leflunomide also increased the risk (HR 1.2 [95% confidence interval 1.0–1.5]). HRs for etanercept (0.8 [95% confidence interval 0.6–110]) and sulfasalazine (0.7 [95% confidence interval 0.5–1.0]) did not reflect an increased risk of pneumonia. HRs for infliximab, adalimumab, and methotrexate were not significantly different from zero.



Conclusion

There is a dose-related relationship between prednisone use and pneumonia risk in RA. No increase in risk was found for anti–tumor necrosis factor therapy or methotrexate. These data call into question the belief that low-dose prednisone is safe. Because corticosteroid use is common in RA, the results of this study suggest that prednisone exposure may have important public health consequences.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.21568

Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy.

Rheumatoid arthritis (RA) is often characterized by the burden of swollen joints, pain, and decreased physical function, but less understood are the many manifestations of additional health conditions that are associated with RA and its treatments. First brought to light with observations of increased mortality in RA, studies noted the increased rates of cardiovascular and infection events. The chronic, debilitating, autoimmune nature of RA affects the patient directly or indirectly in almost all organ systems, from cardiovascular problems and infections to depression and gastrointestinal ulcers. On average, the established RA patient has two or more comorbid conditions. It should be the responsibility of the rheumatologist to take these and the risk of additional conditions into account when treating the patient. This chapter reviews important comorbidities in patients with RA, their prevalence, and their relation to RA.

Comorbidities in rheumatoid arthritis

[Glucose-6-phosphate dehydrogenase].

Objective: It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength as a determinant of peripheral muscle strength and pulmonary muscle strength in patients with FMS by comparing them with healthy controls. Methods: Forty-one consecutive women with FMS (diagnosed according to the American College of Rheumatology 1990 criteria) were compared with 40 age- and body mass index-matched healthy female controls. Pulmonary function tests were assessed by spirometry. Maximal pulmonary pressures were evaluated using an oral pressure meter. A dyspnea score was obtained. Pain was scored according to visual analogue scale and chest pain was classified (0-9) in fibromyalgia patients. Chest expansion was also measured in the two groups. Tender points were also evaluated in FMS patients. Grip strength (Jamar handheld dynamometer) was also measured in the two groups. Results: The difference in pulmonary function tests was not statistically significant between groups. Maximal respiratory pressures (maximum inspiratory pressure and maximum expiratory pressure) and endurance (maximum ventilatory volume) were significantly lower in patients with FMS than in controls. There was also a statistically significant difference between groups regarding grip strength. There was also significant correlation between maximal inspiratory pressure and maximal expiratory pressure values and handgrip strength in patients with FMS. Conclusion: These data indicate that handgrip strength may be a determinant of pulmonary muscle strength in fibromyalgia patients.

Handgrip strength, pulmonary function tests, and pulmonary muscle strength in fibromyalgia syndrome: is there any relationship?

Pulmonary toxicity and blood dyscrasias are rare side effects of sulfasalazine. Pulmonary pathology is variable, the most common being eosinophilic pneumonia with peripheral eosinophilia, and interstitial inflammation with or without fibrosis. We here present the case of a 68-year-old female patient treated for 6 months with sulfasalazine for rheumatoid arthritis. On laboratory examination, eosinophil count was 97×103 mm3. Thorocoscopic biopsy was performed . Histopathologic diagnosis was bronchiolitis obliterans organizing pneumonia (BOOP). This is the first case in the literature to present with sulfasalazine-induced BOOP in a patient with seronegative RA.

Bronchiolitis obliterans organizing pneumonia associated with sulfasalazine in a patient with rheumatoid arthritis.

Background It has been shown that patients with thoracic kyphosis due to osteoporosis have diminished pulmonary function. The aim of this study was to determine the pulmonary function, respiratory muscle strength, and endurance of patients with osteoporosis who did not have compression fractures. Methods The patient group consisted of 88 recently diagnosed postmenopausal osteoporotic women without spinal fractures. They were matched for age and body mass index with 54 healthy women, who formed the control group. Bone mineral density, pulmonary function test (PFT), maximum voluntary ventilation (MVV), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) measurements of both groups were performed. Results There were no significant differences between the two groups regarding PFT parameters and MIP and MEP. However, osteoporotic patients had significantly lower MW values. Conclusion Women with postmenopausal osteoporosis without spinal compression fractures have normal PFT, MIP, and MEP values, but they have reduced respiratory muscle endurance.

Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.

Objective: The aim of the study was to compare endocrine parameters such as leptin, visfatin, insulin resistance, exercise capacity and body composition change, the pulmonary functions test (PFT) and arterial blood gases (ABG) parameters of chronic obstructive pulmonary disease (COPD) patients and in healthy controls. Materials and method: Fifty-five patients with COPD and without malnutrition and 25 healthy controls were included in our study. The serum leptin, visfatin, tumor necrosis factor alpha (TNF-α) and insulin resistance, body fat-free mass (FFM) and fat mass (FM) were measured in the groups. Additionally, body mass index (BMI) was calculated and the 6-minute walk test (6MWT), PFT and ABG analyses were performed in all of the cases. Results: No difference in BMI between the COPD group and controls was determined. Serum leptin and visfatin levels, FFM and 6MWT distance were significantly lower in the patients with COPD (p < 0.001, p = 0.001, p = 0.032, p < 0.001, respectively). A correlati...

Bahar Ulubaş

Papers

Handgrip strength, pulmonary function tests, and pulmonary muscle strength in fibromyalgia syndrome: is there any relationship?

Bronchiolitis obliterans organizing pneumonia associated with sulfasalazine in a patient with rheumatoid arthritis.

Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.

Leptin, visfatin, insulin resistance, and body composition change in chronic obstructive pulmonary disease

Inspiratory and expiratory HRCT findings in Behçet's disease and correlation with pulmonary function tests.