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Proportion of patients with comorbidities at baseline (black) and new comorbidity (grey) by time of last follow-up. 66x37mm (600 x 600 DPI)
Source publication
Objectives
To determine outcomes in rheumatoid arthritis with long-term analysis of a real-world inception cohort
Methods
Retrospective cohort analysis of 184 patients with new diagnosis of RA (ACR/EULAR 2010 criteria) between 2009 & 2013. Measured parameters include patient demographics, serological markers, disease activity (DAS28-CRP), treatmen...
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Introduction
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Methods
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Citations
... These features include palpable purpura, salivary gland enlargement, low C4, leukopenia, cryoglobulinemia, monoclonal gammopathy, positive rheumatoid factor (RF), focus score and the total EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI).59 The incidence of lung cancer is increasing among individuals with RA, SLE, and SjS, partly attributed to smoking.60,62,63 In patients with RA, various factors could potentially contribute to the overall risk, encompassing attributes such as male gender, testing positive for RF or anti-citrullinated protein antibody, advanced age, smoking and interstitial lung disease (ILD).64,65 ...
... They found nearly a 40% rate of atherosclerotic CVD in Russian patients [16]. The analysis of the patients from the Basildon Inflammatory Arthritis Cohort in the United Kingdom revealed that the incidences of CVD and cerebrovascular diseases were 11.1% and 5.3% at the last follow-up [33]. Although the number of cases was smaller than those in the current study, the median length of the follow-up was 7.5 years. ...
Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular (CV) comorbidities. The association of CV diseases (CVD) and traditional CV risk factors has been debated, depending on patient and RA characteristics. This study aimed to find the prevalence of CVD and CV risk factors in patients with RA. A multi-center cross-sectional study was performed on RA patients using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) in September 2022. Socio-demographic, clinical, and follow-up data were collected. Myocardial infarction, ischemic heart disease, peripheral vascular disorders, congestive heart failure, ischemic stroke, and transient ischemic attack were regarded as major adverse cardiovascular events (MACEs). CVD was defined as the presence of at least one clinical situation of MACE. Group 1 and Group 2 included patients with and without CVD. Prevalence rates of CVD and traditional CV risk factors were the primary outcomes. Secondary outcomes were the differences in the clinical characteristics between patients with and without CVD. An analysis of 724 patients with a mean age of 55.1 ± 12.8 years diagnosed with RA was conducted. There was a female preponderance (79.6%). The prevalence rate of CVD was 4.6% (n = 33). The frequencies of the diseases in the MACE category were ischemic heart disease in 27, congestive heart failure in five, peripheral vascular disorders in three, and cerebrovascular events in three patients. The patients with CVD (Group 1) were significantly male, older, and had higher BMI (p = 0.027, p < 0.001, and p = 0.041). Obesity (33.4%) and hypertension (27.2%) were the two CV risk factors most frequently. Male sex (HR = 7.818, 95% CI 3.030–20.173, p < 0.001) and hypertension (HR = 4.570, 95% CI 1.567–13.328, p = 0.005) were the independent risk factors for CVD. The prevalence of CVD in RA patients was 4.6%. Some common risk factors for CVD in the general population, including male sex, older age, and hypertension, were evident in RA patients. Male sex and hypertension were the independent risk factors for developing CVD in patients with RA.
... Moreover, patients in the ORAL Surveillance study [19] were all over 50 years and had at least one major cardiovascular risk factor (e.g., smoking) that increases their neoplastic risk. In the rheumatoid arthritis population, malignancy is a leading cause of death [40,41], especially in patients not undergoing immunosuppressive therapy [42]. Nonetheless, this is also supported by our finding on RA indications, which is the only subgroup confirming the slightly increased risk of cancer in patients undergoing tofacitinib vs. anti-TNF. ...
Simple Summary
Tofacitinib is a relatively novel therapy for immune-mediated inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It is a small-molecule drug that exerts its effects by inhibiting Janus kinases. Recently, concerns have been raised about the drug’s safety in terms of cardiovascular side effects and cancer risk. This meta-analysis determined the risk of cancer in patients treated with tofacitinib for different clinical indications, compared to both a placebo and other therapies. We did not find any difference in the cancer risk between tofacitinib and either the placebo or biological drugs overall. In contrast, we found only a slightly higher risk of cancer in patients treated with tofacitinib compared with the patients treated with drugs that inhibit the tumor necrosis factor. Therefore, further studies are needed to better define the cancer risk of tofacitinib therapy.
Abstract
Tofacitinib is approved for several immune-mediated inflammatory diseases, but safety concerns have recently been raised. We searched PubMed (accessed on 27 February 2023) for original articles regarding tofacitinib’s cancer risk when used for rheumatoid arthritis, ulcerative colitis, Crohn’s disease, psoriatic arthritis, and ankylosing spondylitis. Of the 2047 initial records, 22 articles describing 26 controlled studies (including 22 randomized controlled trials) were selected. In the comparison between tofacitinib and any control treatment, the relative risk (RR) for any cancer was 1.06 (95% CI, 0.86–1.31; p = 0.95). In separate comparisons between tofacitinib and either a placebo or biological therapy, no difference was found in the overall cancer risk (vs. placebo, RR = 1.04; 95% CI, 0.44–2.48; p = 0.95; vs. biological drugs, RR = 1.06; 95% CI, 0.86–1.31; p = 0.58). When tofacitinib was compared to tumor necrosis factor (TNF) inhibitors, the overall cancer RR was 1.40 (95% CI, 1.06–2.08; p = 0.02). Similarly, significant results were obtained for all cancers, except for non-melanoma skin cancer (RR = 1.47; 95% CI, 1.05–2.06; p = 0.03), and for this skin cancer alone (RR = 1.30; 95% CI, 0.22–5.83; p = 0.88). In conclusion, no difference in the overall cancer risk was found between tofacitinib and either a placebo or biological drugs, while a slightly higher risk was found in patients treated with tofacitinib than anti-TNF agents. Further studies are needed to better define the cancer risk of tofacitinib therapy.
Extracellular vesicles (EVs) have emerged as promising tools in diagnostics and therapy for chronic diseases, including cancer and Alzheimer's. Small EVs, also called exosomes, are lipid‐bound particles (≈30–150 nm) that play a role in healthy and pathophysiological interactions, including intercellular communication, by transporting bioactive molecules, including proteins, lipids, and nucleic acids. Their ability to cross biological barriers, such as the blood‐brain barrier, makes them ideal candidates for targeted therapeutic interventions. In the context of chronic diseases, exosomes can be engineered to deliver active agents, including small molecules and siRNAs to specific target cells, providing a novel approach to precision medicine. Moreover, exosomes show great promise as repositories for diagnostic biomarkers. Their cargo can reflect the physiological and pathological status of the parent cells, making them valuable indicators of disease progression and response to treatment. This paper presents a comprehensive review of the application of exosomes in four chronic diseases: cancer, cardiovascular disease, neurodegenerative disease, and orthopedic disease, which significantly impact global public health due to their high prevalence and associated morbidity and mortality rates. Furthermore, the potential of exosomes as valuable tools for theranostics and disease management is highlighted. Finally, the challenges associated with exosomes and their demonstrated potential for advancing future nanomedicine applications are discussed.
