Journal ArticleDOI
HLA-DRB1 and persistent chronic inflammation contribute to cardiovascular events and cardiovascular mortality in patients with rheumatoid arthritis.
Miguel A. Gonzalez-Gay,Carlos González-Juanatey,Maria J. Lopez-Diaz,Angela Piñeiro,Carlos Garcia-Porrua,José A. Miranda-Filloy,William E R Ollier,Javier Martin,Javier Llorca +8 more
TLDR
The results suggest that a chronically high inflammatory response in genetically predisposed individuals promotes an increased risk of CV events and CV mortality in RA.Abstract:
Objective
Cardiovascular (CV) disease is the most common cause of mortality in patients with rheumatoid arthritis (RA). We assessed the contribution of epidemiologic features, clinical features, routine laboratory markers of inflammation, and HLA–DRB1 alleles to CV mortality in patients with RA prospectively followed at a single referral center in Spain.
Methods
Patients fulfilling the 1987 American College of Rheumatology classification criteria for RA seen at the rheumatology outpatient clinic of Hospital Xeral-Calde, Lugo between March and September 1996 were included. HLA–DRB1 phenotype, epidemiologic data, and clinical data were assessed at that time. Patients were prospectively followed and clinical records were examined until patient's death or September 1, 2005.
Results
A total of 182 consecutive patients were assessed. Compared with the general Spanish population, the age- and sex-standardized mortality ratio by CV cause was 1.78. CV mortality adjusted by age at disease onset and sex was associated with chronic inflammation determined by C-reactive protein level (CRP; hazard ratio [HR] 1.14, P < 0.001) and erythrocyte sedimentation rate (ESR; HR 1.05, P = 0.003). Patients with HLA–DRB1*04 shared epitope alleles (HR 4.15, P = 0.030), in particular those HLA–DRB1*0404 positive (HR 6.65, P = 0.002), had increased risk of CV mortality. Increased risk of CV events was also associated with CRP level (HR 1.09, P = 0.001), ESR (HR 1.03, P = 0.003), and HLA–DRB1*0404 (HR 4.47, P = 0.002).
Conclusion
Our results suggest that a chronically high inflammatory response in genetically predisposed individuals promotes an increased risk of CV events and CV mortality in RA.read more
Citations
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Journal ArticleDOI
EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis
Mike J L Peters,Deborah P M Symmons,D McCarey,Ben A. C. Dijkmans,Paulo Nicola,Tore K Kvien,Iain B. McInnes,H Haentzschel,Miguel A. Gonzalez-Gay,Sella Aarrestad Provan,Anne Grete Semb,Prodromos Sidiropoulos,George D. Kitas,Yvo M. Smulders,Martin Soubrier,Zoltán Szekanecz,Naveed Sattar,Michael T. Nurmohamed +17 more
TL;DR: Ten recommendations were made for CV risk management in patients with rheumatoid arthritis, and the strength of the recommendations differed between RA on the one hand, and AS and PsA, on the other, as evidence for an increased CV risk is most compelling for RA.
Journal Article
Mortality in rheumatoid arthritis: 2008 update.
TL;DR: All clinical measures indicating more severe clinical status appear prognostic of premature mortality, with rheumatoid factor and the shared epitope significant for progressive RA.
Journal ArticleDOI
Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications.
Bryant R. England,Bryant R. England,Geoffrey M. Thiele,Geoffrey M. Thiele,Daniel R Anderson,Ted R. Mikuls +5 more
TL;DR: Understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.
Journal ArticleDOI
Cardiovascular comorbidity in rheumatic diseases
TL;DR: Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs.
Journal ArticleDOI
Role for TNF in atherosclerosis? Lessons from autoimmune disease.
TL;DR: Key epidemiologic, physiologic and model data suggest that tumor necrosis factor, a pivotal cytokine in the inflammatory cascade, is directly involved in vascular pathophysiology and that its inhibition might confer an overall advantage to the recipient.
References
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Journal ArticleDOI
The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
Frank C. Arnett,Steven M. Edworthy,Daniel A. Bloch,Dennis J. McShane,James F. Fries,Norman S. Cooper,L. A. Healey,Stephen R. Kaplan,Matthew H. Liang,Harvinder S. Luthra,Thomas A. Medsger,Donald M. Mitchell,David H. Neustadt,Robert S. Pinals,Jane G. Schaller,John T. Sharp,Ronald L. Wilder,Gene G. Hunder +17 more
TL;DR: The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA).
Journal Article
Revised criteria for the classification of rheumatoid arthritis.
TL;DR: The Bulletin on the Rheumatic Diseases has published all of the classification criteria for the rheumatic diseases to date, and these new revised classified criteria for rheumatoid arthritis are very important as they should provide understanding of the possibly changing face of rheumatism.
Journal ArticleDOI
Revised criteria for the classification of rheumatoid arthritis.
TL;DR: The Bulletin on the Rheumatic Diseases has published all of the classification criteria for rheumatic diseases to date as mentioned in this paper, and these new revised classification criteria are very important as they should provide understanding of the possibly changing face of rheumatoid arthritis.
Journal ArticleDOI
The shared epitope hypothesis. An approach to understanding the molecular genetics of susceptibility to rheumatoid arthritis.
TL;DR: Relation entre risque de pemphigus et DW1eme et DRW6eme, et relation entre susceptibilite a la polyarthrite rhumatoide and un groupe d'epitopes trouves dans les sous-types non DW10 de DR4.
Journal ArticleDOI
High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors
TL;DR: The increased incidence of CV events in RA patients is independent of traditional CV risk factors, which suggests that additional mechanisms are responsible for CV disease in RA.
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The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
Frank C. Arnett,Steven M. Edworthy,Daniel A. Bloch,Dennis J. McShane,James F. Fries,Norman S. Cooper,L. A. Healey,Stephen R. Kaplan,Matthew H. Liang,Harvinder S. Luthra,Thomas A. Medsger,Donald M. Mitchell,David H. Neustadt,Robert S. Pinals,Jane G. Schaller,John T. Sharp,Ronald L. Wilder,Gene G. Hunder +17 more
EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis
Mike J L Peters,Deborah P M Symmons,D McCarey,Ben A. C. Dijkmans,Paulo Nicola,Tore K Kvien,Iain B. McInnes,H Haentzschel,Miguel A. Gonzalez-Gay,Sella Aarrestad Provan,Anne Grete Semb,Prodromos Sidiropoulos,George D. Kitas,Yvo M. Smulders,Martin Soubrier,Zoltán Szekanecz,Naveed Sattar,Michael T. Nurmohamed +17 more