Although extremely elevated ferritin levels may be associated with rheumatologic diseases, more often they are found in patients with other conditions such as malignancy or infection. In addition, extremely high ferritin levels can be found in patients with seemingly indolent disease or levels of chronic inflammation.
IntroductionGlycA is a novel inflammatory biomarker measured using nuclear magnetic resonance (NMR). Its NMR signal primarily represents glycosylated acute phase proteins. GlycA was associated with inflammation and development of cardiovascular disease in initially healthy women. We hypothesized that GlycA is a biomarker of disease activity and is associated with coronary artery atherosclerosis in patients with rheumatoid arthritis (RA).MethodsWe conducted a cross-sectional study of 166 patients with RA and 90 control subjects. GlycA was measured from an NMR signal originating from N-acetylglucosamine residues on circulating glycoproteins. The relationship between GlycA and RA disease activity (Disease Activity Score based on 28 joints (DAS28)) and coronary artery calcium score was determined.ResultsGlycA concentrations were higher in patients with RA (median (interquartile range): 398 μmol/L (348 to 473 μmol/L)) than control subjects (344 μmol/L (314 to 403 μmol/L) (P < 0.001). In RA, GlycA was strongly correlated with DAS28 based on erythrocyte sedimentation rate (DAS28-ESR) and DAS28 based on C-reactive protein (DAS28-CRP) and their components, including tender and swollen joint counts, global health score, ESR and CRP (all P < 0.001). The area under the receiver operating characteristic curve for GlycA’s ability to differentiate between patients with low versus moderate to high disease activity based on DAS28-CRP was 0.75 (95 % confidence interval (CI): 0.68, 0.83). For each quartile increase in GlycA, the odds of having coronary artery calcium increased by 48 % (95 % CI: 4 %, 111 %), independent of age, race and sex (P = 0.03).ConclusionGlycA is a novel inflammatory marker that may be useful for assessment of disease activity and is associated with coronary artery atherosclerosis in patients with RA.
Background Inflammation may contribute to incident heart failure ( HF ). Rheumatoid arthritis ( RA ), a prototypic inflammatory condition, may serve as a model for understanding inflammation‐related HF risk. Methods and Results Using the Vanderbilt University Medical Center electronic health record, we retrospectively identified 9889 patients with RA and 9889 control patients without autoimmune disease matched for age, sex, and race. Prevalent HF at entry into the electronic health record or preceding RA diagnosis was excluded. Incident HF was ascertained using International Classification of Diseases, Ninth Revision (ICD‐9), codes and medications. Over 177 566 person‐years of follow‐up, patients with RA were at 21% greater risk of HF (95% CI, 3–42%) independent of traditional cardiovascular risk factors. Among patients with RA , higher CRP (C‐reactive protein) was associated with greater HF risk ( P <0.001), while the anti‐inflammatory drug methotrexate was associated with ≈25% lower HF risk ( P =0.021). In a second cohort (n=115) of prospectively enrolled patients with and without RA , we performed proteomics and cardiac magnetic resonance imaging to discover circulating markers of inflammation associated with cardiac structure and function. Artemin levels were higher in patients with RA compared with controls ( P =0.009), and higher artemin levels were associated with worse ventricular end‐systolic elastance and ventricular‐vascular coupling ratio ( P =0.044 and P =0.031, respectively). Conclusions RA , a prototypic chronic inflammatory condition, is associated with increased risk of HF . Among patients with RA , higher levels of CRP were associated with greater HF risk, while methotrexate was associated with lower risk.
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