Kids Who Grew Up With Smokers Have Higher Odds for Rheumatoid Arthritis

While breathing in secondhand smoke is known to harm kids’ lungs, new research suggests that children whose parents smoked are also more prone to developing rheumatoid arthritis later in life.

“Our findings give more depth and gravity to the negative health consequences of smoking in relation to [rheumatoid arthritis], one of the most common autoimmune diseases,” said lead author Dr. Kazuki Yoshida, of the division of rheumatology, inflammation and immunity at Brigham and Women’s Hospital, in Boston.

Rheumatoid arthritis is an inflammatory disease characterized by arthritis in multiple joints. Several genetic and environmental factors contribute to rheumatoid arthritis risk, and personal smoking is the most well-established environmental risk factor. But research into the link between secondhand smoke and rheumatoid arthritis risk has been limited.

To learn more, the researchers analyzed data from nearly 91,000 U.S. women in a long-term health study.

Those with childhood exposure to parents’ secondhand smoke had a 75% higher risk of rheumatoid arthritis, and the risk was even higher among those who became smokers themselves.

A mother’s smoking during pregnancy and years lived with smokers after age 18 were not significantly linked with rheumatoid arthritis risk, according to the report published in the journal Arthritis & Rheumatology.

“This relationship between childhood parental smoking and adult-onset [rheumatoid arthritis] may go beyond rheumatology,” Yoshida said in a hospital news release. “Future studies should investigate whether childhood exposure to inhalants may predispose individuals to general autoimmunity later in life.”

The researchers noted that their study was limited because it did not include men. They plan to continue their research with both men and women.

Source: HealthDay

Is Rheumatoid Arthritis Two Different Diseases?

While disease activity improves over time for most rheumatoid arthritis (RA) patients, long-term outcomes only improve in RA patients with autoantibodies, according to a new study published this week in PLOS Medicine by Xanthe Matthijssen of Leiden University Medical Center, Netherlands, and colleagues. The findings add to a growing body of evidence that RA with and without autoantibodies are two distinct conditions.

Rheumatoid arthritis is the most common type of autoimmune arthritis, caused when the immune system attacks healthy cells in the linings of joints. Over the last decade it has become clear that there are differences in RA patients with and without RA-associated autoantibodies detectable in their blood. In the new study, researchers followed 1,285 RA patients between 1993 and 2016 through the Leiden Early Arthritis Clinic cohort. Data on patients’ symptoms, treatments, autoantibody status, disability and mortality was collected annually.

In total, 823 patients had autoantibody-positive RA and 462 patients had autoantibody-negative RA. In both groups, disease activity decreased significantly over time. Sustained drug-free remission rates increased, as a new treat-to-target treatment strategy became common in 2006 to 2010, in patients with autoantibody-positive, but not autoantibody-negative, RA. Moreover, mortality and functional disability rates decreased with treat-to-target adjustments only in autoantibody-positive patients.

“The disconnection between improvement in disease activity and subsequent improvement in long-term outcomes in RA without autoantibodies suggests that the underlying pathogenesis of RA with and without autoantibodies is different,” the authors say. “We propose that it is time to formally divide RA into type 1, with autoantibodies, and type 2, without autoantibodies, in the hope that it leads to stratified treatment in autoantibody-positive and autoantibody-negative RA.”

Dr. Matthijssen notes “In the last decennia research in RA has largely focused on the autoantibody-positive subset. More research on autoantibody-negative RA is urgently needed to identify methods to also improve their long-term outcomes.”

Source: Science Daily


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Study: Started Early, Drug Combo Eases Fatigue of Rheumatoid Arthritis

Early and intensive treatment with methotrexate and prednisone can ease fatigue in people with rheumatoid arthritis (RA), according to a new study.

RA causes chronically inflamed joints and that inflammation can lead to severe fatigue that isn’t relieved by resting, according to the European League Against Rheumatism (EULAR).

“In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints,” EULAR’s president, Iain McInnes, said in a league news release. He’s a professor of rheumatology at the University of Glasgow in Scotland.

But doctors often don’t pay enough attention to patients’ fatigue, he added.

“Up to 90% of patients with rheumatoid arthritis report profound fatigue,” said study author Diederik De Cock, a researcher at KU Leuven in Belgium.

His two-year study included 80 RA patients who began a drug regimen immediately after their diagnosis. They received either 15 mg of methotrexate a week (control group) or a combination therapy. The combo included 15 mg of methotrexate and 30 mg of cortisone (prednisone) weekly, which was eventually reduced to 5 mg a week.

Methotrexate suppresses RA-related inflammation, while prednisone eases joint pain and inflammation.

Patients who had intensive treatment with the drug combo for two years were less tired than those in the control group, even though both groups had similar disease activity over time, the study found.

Differences in fatigue levels between the two groups appeared to increase over time, according to the study.

“The early course of the disease could provide an opportunity to manage fatigue,” De Cock said in the release.

The study was presented as an abstract online for EULAR’s E-Congress 2020, which began earlier this month. Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

Based on the findings, EULAR recommends early consideration of intensive treatment even in low-risk patients with RA.

RA affects about 1% people worldwide, according to EULAR.

Source: HealthDay

Rheumatoid Arthritis, Low Folate Levels Raise Heart Risks

Low folate levels are associated with an increased risk of heart disease death in patients with rheumatoid arthritis (RA), a new study suggests.

People with RA have a 60% increased risk of dying from heart disease, but the reasons have been unclear.

“Our study is the first to show an association between serum folate and increased cardiovascular mortality in patients with rheumatoid arthritis,” lead author Kalyani Sonawane said in a University of Texas news release. She is an assistant professor at UTHealth’s School of Public Health.

This study included 683 RA patients who were divided into three groups based on their blood levels of folate, a B vitamin also known as folic acid.

One group had levels below 4.3 nanograms per milliliter, the second group had levels between 4.3 and 8.2 nanograms per milliliter, and the third group had levels greater than 8.2 nanograms per milliliter.

Over 17 years, 258 of the participants died of heart disease. A folate level below 4.3 nanograms per milliliter was associated with 50% higher risk of death from heart disease, according to the study.

“Our findings suggest that serum folate level might be a useful indicator to assess [the] cardiovascular mortality risk of a rheumatoid arthritis patient in clinical practice,” said study senior author Dr. Maria Suarez-Almazor, a professor in the University of Texas MD Anderson Cancer Center. But the study did not prove that low folate levels cause heart risks to rise.

“If future clinical studies validate a causal link, taking folate supplements could be an affordable way to reduce this risk in patients with rheumatoid arthritis,” Suarez-Almazor said in the release.

Folate is essential in the creation of new cells and lowers levels of homocysteine, an amino acid found in blood. High homocysteine levels have been linked to an increased risk of heart disease.

Many people with RA have elevated homocysteine levels. This may be due to medications prescribed for rheumatoid arthritis, such as methotrexate, which decrease folate levels, the researchers explained.

“It’s particularly important for patients taking disease-modifying anti-rheumatic drugs to understand this increased risk,” Sonawane noted.

Folic acid is found in many foods such as eggs, broccoli, citrus fruits and leafy greens. Supplements can also be taken to boost folate levels.

The study was published in the journal JAMA Network Open.

Source: HealthDay

Study: Ties Between Rheumatoid Arthritis and Other Diseases

People with inflammatory bowel disease, type 1 diabetes or blood clots may be at increased risk for rheumatoid arthritis — and people with rheumatoid arthritis are at added risk for heart disease, blood clots and sleep apnea, researchers say.

Their findings could improve understanding of how rheumatoid arthritis (RA) develops and also lead to earlier detection and screening for other conditions.

The study included 821 RA patients and 2,455 people without the disease. Researchers identified 11 health conditions associated with rheumatoid arthritis, including epilepsy and pulmonary fibrosis.

They also found that blood clots occurred more commonly in people with RA before diagnosis, suggesting that systemic inflammation may begin before RA symptoms appear.

People with type 1 diabetes were also at increased risk for RA, showing the importance of monitoring for it in people with autoimmune diseases, and vice versa, according to study authors.

Other illnesses often “accumulate in an accelerated fashion after diagnosis of rheumatoid arthritis,” said corresponding author Dr. Vanessa Kronzer, a fellow in rheumatology at the Mayo Clinic in Rochester, Minn.

“We also found that autoimmune diseases and epilepsy may predispose to development of rheumatoid arthritis, while heart disease and other conditions may develop as a result of rheumatoid arthritis,” she added in a clinic news release.

RA is a chronic inflammatory disorder that affects not only the joints, but can also damage parts of the body such as the lungs, heart and blood vessels.

“Our findings suggest that people with certain conditions, such as type 1 diabetes or inflammatory bowel disease, should be carefully monitored for rheumatoid arthritis,” Kronzer said. “In addition, people who have rheumatoid arthritis, and their health care providers, should have heightened suspicion and a low threshold to screen for cardiovascular disease, blood clots and sleep apnea.”

The study was published in the journal Mayo Clinic Proceedings.

Source: HealthDay


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