Showing papers by "Matthew J. Grainge published in 2019"

Temporal relationships between systemic lupus erythematosus and comorbidities

Abstract: Objective To examine the burden of comorbidities prior to and after the diagnosis of SLE and its impact on mortality. Methods We identified 1605 incident cases of SLE and 6284 matched controls from the UK primary care. The risks of comorbidities before (prevalence; odds ratios) and after SLE diagnosis (incidence; hazard ratios) and the impact of comorbidities at diagnosis on all-cause mortality were estimated. Results At diagnosis, SLE was associated with adjusted odds ratios (95% CI) of 2.25 (1.97-2.56), 3.37 (2.49-4.57) and 3.54 (1.89-6.63) for a Charlson comorbidity index of 1-2, 3-4 and ≥5, respectively. Following diagnosis, SLE also associated with increased risk of developing any comorbidity with an adjusted hazard ratio (95% CI) of 1.30 (95% CI, 1.13-1.49). At diagnosis, SLE was associated with a greater risk of cancer, cardiovascular, renal, liver, rheumatological and neurological diseases as well as depression, anaemia and psoriasis. Risks of developing incident comorbidity in the categories of neoplasm, cardiovascular, genitourinary, metabolic/endocrine, gastrointestinal and hepatic diseases, chronic pulmonary diseases, musculoskeletal/connective tissue and neurological diseases were higher in SLE patients. People with SLE had higher mortality risk compared with controls, with adjusted hazard ratio of 1.91 (95% CI, 1.62-2.26); after further adjusting for comorbidities this reduced to 1.64 (1.37-1.97). Comorbidities at SLE diagnosis accounted for 27.6% of the apparent difference in mortality between SLE patients and matched controls. Conclusion People with SLE have increased risks of multiple comorbidities both prior to and after diagnosis and this contributes significantly to all-cause mortality.

Association between inactivated influenza vaccine and primary care consultations for autoimmune rheumatic disease flares: a self-controlled case series study using data from the Clinical Practice Research Datalink.

Abstract: Objectives To examine the association between inactivated influenza vaccine (IIV) administration and primary care consultation for joint pain, rheumatoid arthritis (RA) flare, corticosteroid prescription, vasculitis and unexplained fever in people with autoimmune rheumatic diseases (AIRDs). Methods We undertook within-person comparisons using self-controlled case-series methodology. AIRD cases who received the IIV and had an outcome of interest in the same influenza cycle were ascertained in Clinical Practice Research Datalink. The influenza cycle was partitioned into exposure periods (1–14 days prevaccination and 0–14, 15–30, 31–60 and 61–90 days postvaccination), with the remaining time-period classified as non-exposed. Incidence rate ratios (IRR) and 95% CI for different outcomes were calculated. Results Data for 14 928 AIRD cases (69% women, 80% with RA) were included. There was no evidence for association between vaccination and primary care consultation for RA flare, corticosteroid prescription, fever or vasculitis. On the contrary, vaccination associated with reduced primary care consultation for joint pain in the subsequent 90 days (IRR 0.91 (95% CI 0.87 to 0.94)). Conclusion This study found no evidence for a significant association between vaccination and primary care consultation for most surrogates of increased disease activity or vaccine adverse-effects in people with AIRDs. It adds to the accumulating evidence to support influenza vaccination in AIRDs.

Mortality in people with coeliac disease: Long-term follow-up from a Scottish cohort.

Abstract: BackgroundFew studies have determined the very long-term mortality risks in adult and childhood-diagnosed coeliac disease.ObjectiveWe quantified mortality risks in coeliac disease and determined wh...

Do β-adrenoreceptor Blocking Drugs Associate With Reduced Risk of Symptomatic Osteoarthritis and Total Joint Replacement in the General Population? A Primary Care-Based, Prospective Cohort Study Using the Clinical Practice Research Datalink

Abstract: Introduction To investigate if β-adrenoreceptor blocking drug (β-blocker) prescription reduces the risk of knee or hip osteoarthritis, total joint replacement and analgesic prescription. Setting Primary care. Methods and analysis This is a cohort study using data from the Clinical Practice Research Datalink. Two separate analyses will be performed. Study 1 will be on the association between β-blocker prescription and incident knee/hip osteoarthritis. Inclusion criteria will be age ≥40 years. Exposed participants will be those with ≥2 continuous β-blocker prescriptions, and the index date will be the date of the first prescription of β-blocker. Unexposed participants will include up to four controls matched for age, sex, general practice surgery and propensity score for β-blocker prescription. Exclusion criteria will include contraindications to β-blockers, consultations for osteoarthritis or potent analgesic prescription before the index date. Outcomes will be knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain and hip pain. Study 2 will be on the association between β-blocker prescription and total joint replacement and analgesic prescription in people with osteoarthritis. Inclusion criteria will be age ≥40 years, knee or hip osteoarthritis, and index date will be as in study 1. Unexposed participants will be as in study 1, additionally matched for consultation for knee or hip osteoarthritis prior to the index date. Exclusion criteria will include contraindications to β-blockers and osteoarthritis in other joints prior to the index date. Outcomes will be total knee replacement (primary outcome), total hip replacement and new analgesic prescription. Statistical analysis Kaplan-Meier curves will be plotted, and Cox proportional HRs and 95% CIs will be calculated. Stratified analysis will be performed by class of β-blocker, intrinsic sympathomimetic effect and indication(s) for prescription. Ethics and dissemination This study was ethically approved by the Independent Scientific Advisory Committee of the Medicines and Healthcare Authority (Ref 18_227R). The results of this study will be published in peer-reviewed journals and presented at conferences. Summary This prospective cohort study will evaluate the analgesic potential of commonly used drugs for osteoarthritis pain.

Letter: different risks of venous thromboembolism in subsets of patients with inflammatory bowel diseases - authors' reply.

Abstract: EDITORS, We are delighted by the interest shown in our paper by Ding et al. We would agree with Ding et al that having identified patients from records of healthcare in the UK for our analysis, our results are only generalisable to this population with certainty. We would expect, however, that they could be generalised to populations with similar features and living in areas with comparable healthcare systems. Increasing adoption of European guidelines in the UK in managing IBD patients may well mean that generalisability of our findings is wider. We recognise that re‐examining the hypothesis of persistent elevation of venous thromboembolic risk after discharge in IBD patients in other populations may also be valuable. As Ding et al pointed out, we indeed had not broken down our cohort by IBD type. The reason for this is that subdivision of available follow‐up time by hospitalisation, surgery and disease activity resulted in very small number of events for some comparisons, and we did not have enough power for a more granular analysis. There is of course no reason for not providing the breakdown of IBD types, and we confirm that among the 23 046 IBD patients, 11 472 had ulcerative colitis (233 of whom developed thromboembolic events), 7085 had Crohn's disease (110 of whom had thromboembolic events) and 4489 had IBD we could not classify (87 of whom had thromboembolic events). We are less inclined to agree with the proposed benefit of anti‐TNF drugs as a mechanism explaining our results. Patients with severe active IBD are likely to receive corticosteroids (whether the activity is a first flare, or a breakthrough from anti‐TNF treatment), and attribution of a causal effect to corticosteroid use or IBD activity is therefore unlikely to be possible. We could not provide any direct evidence on the role of anti‐TNF drugs since we were unable to report their use in our cohort accurately, but we would contend that most anti‐TNF users were in remission most of the time. One would therefore expect that corticosteroids would be associated with venous thromboembolism and anti‐ TNF drugs would not be, even if neither were causally related, when disease activity itself was the cause. We would caution against considering anti‐TNF use as protective of venous thromboembolism beyond its ability to abolish disease activity without more direct evidence.