Cardiometabolic multimorbidity may identify a more severe subset of rheumatoid arthritis, results from a "real-life" study.


Journal

Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R

Informations de publication

Date de publication:
07 Apr 2023
Historique:
medline: 11 4 2023
entrez: 7 4 2023
pubmed: 8 4 2023
Statut: ppublish

Résumé

This "real-life" cross-sectional study has been designed to describe disease features of rheumatoid arthritis (RA) participants affected by cardiometabolic multimorbidity than those without. Our purpose was also the identification of possible associations between these cardiometabolic diseases and RA clinical characteristics. Consecutive RA participants with and without cardiometabolic multimorbidity were assessed and their clinical characteristics were recorded. Participants were grouped and compared by the presence or not of cardiometabolic multimorbidity (defined as ≥ 2 out of 3 cardiovascular risk factors including hypertension, dyslipidemia, and type 2 diabetes). The possible influence of cardiometabolic multimorbidity on RA features of poor prognosis was assessed. The positivity of anti-citrullinated protein antibodies, presence of extra-articular manifestations, lack of clinical remission, and biologic Disease-Modifying anti-Rheumatic Drugs (bDMARDs) failure were considered as RA features of poor prognosis. In the present evaluation, 757 consecutive RA participants were evaluated. Among them, 13.5% showed cardiometabolic multimorbidity. These were older (P < .001) and characterized by a longer disease duration (P = .023). They were more often affected by extra-articular manifestations (P = .029) and frequently displayed smoking habit (P = .003). A lower percentage of these patients was in clinical remission (P = .048), and they showed a more frequent history of bDMARD failure (P < .001). Regression models showed that cardiometabolic multimorbidity was significantly correlated with RA features of disease severity. They were predictors of anti-citrullinated protein antibodies positivity, of extra-articular manifestations, and of lack of clinical remission, in both univariate and multivariate analyses. Cardiometabolic multimorbidity was significantly associated with a history of bDMARD failure. We described disease features of RA participants with cardiometabolic multimorbidity, identifying a possible more difficult to treat subset, which may need a new management approach to achieve the treatment goal.

Identifiants

pubmed: 37026953
doi: 10.1097/MD.0000000000033362
pii: 00005792-202304070-00054
pmc: PMC10082232
doi:

Substances chimiques

Anti-Citrullinated Protein Antibodies 0
Antirheumatic Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e33362

Informations de copyright

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

Déclaration de conflit d'intérêts

The authors have no funding and conflicts of interest to disclose.

Références

Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388:2023–38.
Romano S, Salustri E, Ruscitti P, et al. Cardiovascular and metabolic comorbidities in rheumatoid arthritis. Curr Rheumatol Rep. 2018;20:81.
Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol. 2015;11:390–400.
Ruscitti P, Cipriani P, Liakouli V, et al. Occurrence and predictive factors of high blood pressure, type 2 diabetes, and metabolic syndrome in rheumatoid arthritis: findings from a 3-year, multicentre, prospective, observational study. Clin Exp Rheumatol. 2021;39:995–1002.
Ferguson LD, Siebert S, McInnes IB, et al. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol. 2019;15:461–74.
Glynn LG. Multimorbidity: another key issue for cardiovascular medicine. Lancet. 2009;374:1421–2.
Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition--multimorbidity. JAMA. 2012;307:2493–4.
England BR, Thiele GM, Anderson DR, et al. Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. BMJ. 2018;361:k1036.
Ruscitti P, Cipriani P, Liakouli V, et al. Subclinical and clinical atherosclerosis in rheumatoid arthritis: results from the 3-year, multicentre, prospective, observational GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Arthritis Res Ther. 2019;21:204.
Pincus T, Sokka T. Should contemporary rheumatoid arthritis clinical trials be more like standard patient care and vice versa? Ann Rheum Dis. 2004;63(Suppl 2):ii32–ii39.
Blonde L, Khunti K, Harris SB, et al. Interpretation and impact of real-world clinical data for the practicing clinician. Adv Ther. 2018;35:1763–74.
Barnish MS, Turner S. The value of pragmatic and observational studies in health care and public health. Pragmat Obs Res. 2017;8:49–55.
Fortin M, Dionne J, Pinho G, et al. Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Ann Fam Med. 2006;4:104–8.
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81.
Di Angelantonio E, Kaptoge S, Wormser D, et al. Association of cardiometabolic multimorbidity with mortality. JAMA. 2015;314:52–60.
Kivimäki M, Kuosma E, Ferrie JE, et al. Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health. 2017;2:e277–85.
Dibato JE, Montvida O, Zaccardi F, et al. Association of cardiometabolic multimorbidity and depression with cardiovascular events in early-onset adult type 2 diabetes: a multiethnic study in the U.S. Diabetes Care. 2021;44:231–9.
Dove A, Guo J, Marseglia A, et al. Cardiometabolic multimorbidity and incident dementia: the Swedish twin registry. Eur Heart J. 2023;44:573–82.
Maddaloni E, D’Onofrio L, Alessandri F, et al. Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II). Cardiovasc Diabetol. 2020;19:164.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Hypertension. 2018;71:1269–324.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42:S13–28.
Choy E, Ganeshalingam K, Semb AG, et al. Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatol (Oxford). 2014;53:2143–54.
Robertson J, Peters MJ, McInnes IB, et al. Changes in lipid levels with inflammation and therapy in RA: a maturing paradigm. Nat Rev Rheumatol. 2013;9:513–23.
Ruscitti P, Margiotta DPE, Macaluso F, et al. Subclinical atherosclerosis and history of cardiovascular events in Italian patients with rheumatoid arthritis: results from a cross-sectional, multicenter GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Medicine (Baltim). 2017;96:e8180.
Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76:17–28.
Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, et al. Obesity in rheumatoid arthritis. Rheumatology (Oxford). 2011;50:450–62.
Kerekes G, Nurmohamed MT, González-Gay MA, et al. Rheumatoid arthritis and metabolic syndrome. Nat Rev Rheumatol. 2014;10:691–6.
Klabunde CN, Potosky AL, Legler JM, et al. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53:1258–67.
Turesson C, O’Fallon WM, Crowson CS, et al. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62:722–7.
Duru N, van der Goes MC, Jacobs JW, et al. EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2013;72:1905–13.
Albrecht K, Zink A. Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies. Arthritis Res Ther. 2017;19:68.
Smolen JS, Aletaha D, Barton A, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001.
Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82:3–18.
Rasch EK, Hirsch R, Paulose-Ram R, et al. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: effect of different methods of case classification. Arthritis Rheum. 2003;48:917–26.
Serhal L, Lwin MN, Holroyd C, et al. Rheumatoid arthritis in the elderly: characteristics and treatment considerations. Autoimmun Rev. 2020;19:102528.
Nurmohamed MT, Heslinga M, Kitas GD. Cardiovascular comorbidity in rheumatic diseases. Nat Rev Rheumatol. 2015;11:693–704.
Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015;162:123–32.
Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet. 2017;389:2338–48.
Gerli R, Bartoloni Bocci E, Sherer Y, et al. Association of anti-cyclic citrullinated peptide antibodies with subclinical atherosclerosis in patients with rheumatoid arthritis. Ann Rheum Dis. 2008;67:724–5.
Barbarroja N, Pérez-Sanchez C, Ruiz-Limon P, et al. Anticyclic citrullinated protein antibodies are implicated in the development of cardiovascular disease in rheumatoid arthritis. Arterioscler Thromb Vasc Biol. 2014;34:2706–16.
Conforti A, Di Cola I, Pavlych V, et al. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev. 2021;20:102735.
Nagy G, Roodenrijs NMT, Welsing PM, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021;80:31–5.
Nagy G, Roodenrijs NMT, Welsing PMJ, et al. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2022;81:20–33.
Watanabe R, Okano T, Gon T, et al. Difficult-to-treat rheumatoid arthritis: current concept and unsolved problems. Front Med (Lausanne). 2022;9:1049875.
de Hair MJH, Jacobs JWG, Schoneveld JLM, et al. Difficult-to-treat rheumatoid arthritis: an area of unmet clinical need. Rheumatology. 2018;57:1135–44.
Roodenrijs NMT, de Hair MJH, van der Goes MC, et al. Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey. Ann Rheum Dis. 2018;77:1705–9.
van den Oever IAM, Heslinga M, Griep EN, et al. Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the implementation of cardiovascular risk management in rheumatoid arthritis project. Rheumatology (Oxford). 2017;56:1472–8.
Ikdahl E, Wibetoe G, Rollefstad S, et al. Guideline recommended treatment to targets of cardiovascular risk is inadequate in patients with inflammatory joint diseases. Int J Cardiol. 2019;274:311–8.
Semb AG, Ikdahl E, Wibetoe G, et al. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol. 2020;16:361–79.
Ferguson LD, Sattar N, McInnes IB. Managing cardiovascular risk in patients with rheumatic disease. Rheum Dis Clin North Am. 2022;48:429–44.
Aviña-Zubieta JA, Choi HK, Sadatsafavi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59:1690–7.
Avina-Zubieta JA, Thomas J, Sadatsafavi M, et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71:1524–9.
Innala L, Möller B, Ljung L, et al. Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five-year prospective study. Arthritis Res Ther. 2011;13:R131.
van Breukelen-van der SDF, van Zeben D, Klop B, et al. Marked underdiagnosis and undertreatment of hypertension and hypercholesterolaemia in rheumatoid arthritis. Rheumatology (Oxford). 2016;55:1210–6.
Baghdadi LR, Woodman RJ, Shanahan EM, et al. The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis. PLoS One. 2015;10:e0117952.
Giacomelli R, Afeltra A, Alunno A, et al. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev. 2019;18:93–106.
Ursini F, D’Angelo S, Russo E, et al. Serum complement C3 strongly correlates with whole-body insulin sensitivity in rheumatoid arthritis. Clin Exp Rheumatol. 2017;35:18–23.
Scrivo R, Vasile M, Müller-Ladner U, et al. Rheumatic diseases and obesity: adipocytokines as potential comorbidity biomarkers for cardiovascular diseases. Mediators Inflamm. 2013;2013:808125.
Ruscitti P, Ursini F, Cipriani P, et al. Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: a 1-year, single-centre, longitudinal study. PLoS One. 2017;12:e0181203.
Ruscitti P, Ursini F, Cipriani P, et al. Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis: results from a cross-sectional study. Medicine (Baltim). 2017;96:e7896.
Arts EE, Fransen J, Den Broeder AA, et al. Low disease activity (DAS28≤3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis. 2017;76:1693–9.
Arts EE, Fransen J, den Broeder AA, et al. The effect of disease duration and disease activity on the risk of cardiovascular disease in rheumatoid arthritis patients. Ann Rheum Dis. 2015;74:998–1003.
Provan SA, Semb AG, Hisdal J, et al. Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study. Ann Rheum Dis. 2011;70:812–7.
Burggraaf B, van Breukelen-van der Stoep DF, de Vries MA, et al. Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2019;78:335–41.
Ursini F, Ruscitti P, Caio GPI, et al. The effect of non-TNF-targeted biologics on vascular dysfunction in rheumatoid arthritis: a systematic literature review. Autoimmun Rev. 2019;18:501–9.
Atzeni F, Rodríguez-Carrio J, Popa CD, et al. Cardiovascular effects of approved drugs for rheumatoid arthritis. Nat Rev Rheumatol. 2021;17:270–90.
Ursini F, Mauro D, Naty S, et al. Improvement in insulin resistance after short-term treatment with abatacept: case report and short review. Clin Rheumatol. 2012;31:1401–2.
Lillegraven S, Greenberg JD, Reed GW, et al. Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. PLoS One. 2019;14:e0210459.
de Rotte MC, de Jong PH, den Boer E, et al. Effect of methotrexate use and erythrocyte methotrexate polyglutamate on glycosylated hemoglobin in rheumatoid arthritis. Arthritis Rheumatol. 2014;66:2026–36.
Rempenault C, Combe B, Barnetche T, et al. Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2018;77:98–103.
Shapiro M, Levy Y. The association between hydroxychloroquine treatment and cardiovascular morbidity among rheumatoid arthritis patients. Oncotarget. 2017;9:6615–22.
Ruscitti P, Masedu F, Alvaro S, et al. Anti-interleukin-1 treatment in patients with rheumatoid arthritis and type 2 diabetes (TRACK): a multicentre, open-label, randomised controlled trial. PLoS Med. 2019;16:e1002901.
Ruscitti P, Ursini F, Cipriani P, et al. IL-1 inhibition improves insulin resistance and adipokines in rheumatoid arthritis patients with comorbid type 2 diabetes: An observational study. Medicine (Baltim). 2019;98:e14587.
Lurati A, Laria A, Mazzocchi D, et al. Improvement of HbA1c in patients with type 2 diabetes mellitus and rheumatoid arthritis treated with bDMARDs. Open Access Rheumatol. 2021;13:73–8.
Genovese MC, Burmester GR, Hagino O, et al. Interleukin-6 receptor blockade or TNFα inhibition for reducing glycaemia in patients with RA and diabetes: post hoc analyses of three randomised, controlled trials. Arthritis Res Ther. 2020;22:206.
Otsuka Y, Kiyohara C, Kashiwado Y, et al. Effects of tumor necrosis factor inhibitors and tocilizumab on the glycosylated hemoglobin levels in patients with rheumatoid arthritis; an observational study. PLoS One. 2018;13:e0196368.

Auteurs

Piero Ruscitti (P)

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Claudia Di Muzio (C)

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Alessandro Conforti (A)

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Ilenia Di Cola (I)

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Viktoriya Pavlych (V)

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Luca Navarini (L)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Damiano Currado (D)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Alice Biaggi (A)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Stefano Di Donato (S)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Annalisa Marino (A)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Sebastiano Lorusso (S)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Francesco Ursini (F)

Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.

Roberto Giacomelli (R)

Rheumatology and Immunology Unit, Department of Medicine, University of Rome "Campus Biomedico", Rome, Italy.

Paola Cipriani (P)

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

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