Objective-To investigate the influence of breast feeding, use of the oral contraceptive pill (OCP), and parity on rheumatoid arthritis (RA). Methods-One hundred and seventy six women with RA were compared with 145 control subjects; all had at least one child. RA patients were classified as having severe (n = 82) or mild disease (n = 89) according to clinical joint evaluation, radiological score, biological inflammation, and the presence of HLA-DR1 or -DR4 alleles. Results-The mean age ofRA patients was 58 years, and the mean age at the time of diagnosis of RA was 46 years. The mean time between onset of RA and the first birth was 23-6 (SD 3.8) years. The OCP user rates were 33% in the RA group and 47-6% in the control group (p < 0.02). OCP use was related to the mother's year of birth. The relative risk for developing RA was 0-598 (95% confidence interval (CI) 0-33 to 1
A total of 453 rheumatoid arthritis (RA) patients were followed up for 35.2 +/- 27.9 months (range 3-106). The clinical parameters decreased significantly after 6 months. Twenty-eight patients were in remission (6.4%). Rheumatoid factor (RF) positivity was less common in the group of patients in remission, with a higher frequency of visits and methotrexate (MTX) onset after 65 yr. There was a significant degradation of radiographic lesions (n = 60). A total of 101 patients (23.1%) stopped MTX, for toxicity (n = 61) and failure (n = 20). The onset of MTX after 65 yr, a low number of visits and the occurrence of side-effects were predictive of MTX withdrawal. A total of 259 patients (59.3%) had side-effects. A Ritchie's index < or = 10, a lower polymorphonuclear cell count and the absence of RF were predictive of side-effects. The probability of being on MTX at 5 yr was 73%. This study confirms the high efficacy of MTX in RA.
Objective-To report cancer cases in 426 rheumatoid arthritis patients treated with methotrexate, and determine whether there was an increased incidence of cancer compared with patients never treated with methotrexate (rheumatoid controls) and to the whole regional population. Methods-The duration of methotrexate treatment was 37.4 (SD 27.9) months. This population was compared with 420 rheumatoid arthritis controls and with a regional population of 812 344 people. Life table analysis was performed to compare the cancer incidence in the two rheumatoid populations. Adjustment for potentially confounding factors was done. The indirect standardisation method was used to compare each rheumatoid population with the regional population. Results-Eight cases of cancer (1.88%; 4.04 cases/1000 person years) were diagnosed in the methotrexate population v six (1.43%; 58.8 cases/1000 person years) in the rheumatoid controls. The life table method showed a higher incidence of cancer in the rheumatoid controls (P = 0.0001). In a multivariate analysis (Cox model), the only significant factor explaining this diVerence in the cancer incidence was age (P = 0.02). In the regional population there were 6418 new cases of cancer (0.79%; 2.85 cases/1000 person years). By the indirect standardisation method, the ratio of observed cases to expected cases of cancer in each of the rheumatoid populations was not significantly diVerent from 1. Conclusions-In these eight cases, methotrexate was not found to be responsible for generating cancers. However, because of data regarding lymphomas and methotrexate, and because of the short follow up, especially in the control group, longer prospective studies are warranted.
BackgroundPatients with chronic inflammatory rheumatic disease have a greater risk of cardiovascular (CV) diseases. European recommendations of cardiology propose to classify patients with asymptomatic atheromatous plaques as high CV risk patients. New EULAR recommendations about CV risk management propose the use of supra-aortic vessel ultrasound for atheromatous plaques detection and total CV risk estimation. Moreover, EULAR-2015 recommendations suggest multiplying by a 1.5 factor the global CV risk for all patients with Rheumatoid Arthritis (RA) unlike 2010 recommendations.ObjectivesThe objective of our study was to evaluate the impact of these new recommendations on CV management, especially on indication of statin use, in patients with RA in daily practice, in comparison to EULAR-2010 recommendations.MethodsTotal CV risk estimation included physical examination, glucidic and lipidic blood tests, supra-aortic and abdominal vessels ultrasound, echocardiography and global risk SCORE calculation. Heart-SCORE was multiplied according to EULAR-2010 (mSCORE2010) or EULAR-2015 (mSCORE2015) recommendations. For EULAR-2015 recommendations, patients with ultrasound carotid plaques were classified at high CV risk. LDL targets and immediate need of statin use were defined according to European cardiology recommendations with need of statin when LDL >0.7 g/L for patients at very high CV risk and >1 g/L for those at high risk. In moderate and low risk patients, statins are not immediately recommended.Results157 RA patients underwent the screening with a mean disease duration of 13 (6–19) ± 9 years and mean age of 61 ± 11 years. 56/76 (73.7%) of patients classified as moderate risk with Heart-SCORE and 3/12 (25%) of patients with low risk had asymptomatic carotid plaques. Application of the EULAR 2010 recommendations should lead to immediate statin prescription in 42 patients (28%) whereas applications of the EULAR 2015 recommendations should lead to statin prescription in 92 (61%) patients.ConclusionsIn our experience, the use of carotid ultrasound to estimate total CV risk and thus to define LDL targets led to prescribe statins in 61% of patients with RA.Disclosure of InterestNone declared
ObjectivesEULAR proposes to screen multimorbidities in chronic inflammatory rheumatic diseases. The aim of the study was to assess i) multimorbidities in patients with chronic inflammatory diseases, ii) how patients follow recommendations given after a systematic standardised multimorbidity screening.MethodsExams were performed during a 1 day multimorbidity clinic. Diabetes, hypertension, CVD damage, chronic respiratory diseases, osteoporosis and preventive measures were assessed. Advice, complementary exams and prescriptions were provided to patient and general practitioner after this check-up if needed. Patients were called 3 months later to assess the applications of the given recommendations.ResultsAmong the 541 patients screened, hypertension was present in 28.1% patients, dyslipidemia in 19.2%, chronic respiratory tract diseases in 12.8% and diabetes in 9.6%. Screening led to the following recommendations: blood pressure monitoring (22.6% patients), dietary advice (56.8%), cardiologist referral (35.5%), intensification of physical activity (27.0%), cancer screening (50.5%), vaccinations (60.6%) and vitamino-calcium supplementation (30.3%). On the 237 patients called back, 72.3% underwent blood pressure monitoring, 58.6% followed dietary advice, 64.4% took vitamino-calcium supplementation, 55.2% had vaccinations done, 52.1% saw a cardiologist, 42.7% increased physical activity and 31.4% performed cancer screening. No specific gender, age, pathology, or psychological factors were associated with adherence to recommendations.ConclusionsThis study underlines the relevance of a systematic screening of multimorbidities in chronic inflammatory rheumatic diseases, and the good patient’s adherence rate to the recommendations.Disclosure of InterestNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.