Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

Ferguson, Lyn D; Siebert, Stefan; McInnes, Iain B.; Sattar, Naveed

doi:10.1038/s41584-019-0256-0

Cited by 123 publications

(98 citation statements)

References 135 publications

(140 reference statements)

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“…It comprises both musculoskeletal as well as non-musculoskeletal manifestations; the latter particularly include the skin and the nails, but also potentially the gut (inflammatory bowel disease) or the eyes (uveitis). Active chronic PsA also associates with cardiovascular, psychological and metabolic comorbidities, [1][2][3][4][5][6][7] which, together with the musculoskeletal manifestations, impose a significant patient burden with impact on quality of life and also accelerated mortality. [8][9][10] The day-to-day management of patients with PsA includes non-pharmacological as well as pharmacological interventions.…”

Section: Introductionmentioning

confidence: 99%

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

et al. 2020

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ObjectiveTo update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA).MethodsAccording to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined.ResultsThe updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed.ConclusionThese recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.

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Section: Introductionmentioning

confidence: 99%

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

et al. 2020

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“…However, obesity and sarcopenia are also frequently reported [39,40]; CV risk is increased, although less established than in RA. Due to the high prevalence of obesity and type 2 diabetes, PsA is considered to be more related to metabolic comorbidities than RA [41].…”

Section: Cardiometabolic Comorbidities In Other Rheumatic Diseasesmentioning

confidence: 99%

Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

2020

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Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a high prevalence of death due to cardiometabolic diseases. As observed during the aging process, several comorbidities, such as cardiovascular disorders (CVD), insulin resistance, metabolic syndrome and sarcopenia, are frequently associated to RA. These abnormalities could be closely linked to alterations in lipid metabolism. Indeed, RA patients exhibit a lipid paradox, defined by reduced levels of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol whereas the CVD risk is increased. Moreover, the accumulation of toxic lipid mediators (i.e., lipotoxicity) in skeletal muscles can induce mitochondrial dysfunctions and insulin resistance, which are both crucial determinants of CVD and sarcopenia. The prevention or reversion of these biological perturbations in RA patients could contribute to the maintenance of muscle health and thus be protective against the increased risk for cardiometabolic diseases, dysmobility and mortality. Yet, several studies have shown that omega 3 fatty acids (FA) could prevent the development of RA, improve muscle metabolism and limit muscle atrophy in obese and insulin-resistant subjects. Thereby, dietary supplementation with omega 3 FA should be a promising strategy to counteract muscle lipotoxicity and for the prevention of comorbidities in RA patients.

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“…Прерывание лечения, связанное с НЛР, у пациентов, получавших БАРИ, наблюдалось редко (≤11%) и не зависело от того, получали ли пациенты монотерапию БАРИ или БАРИ в комбинации с МТ или другими сБПВП [22,25,27,29,[40][41][42][43][44][45]. Для пациентов с РА характерна высокая частота коморбидных заболеваний, включая инфекции, кардиоваскулярную и легочную патологию [46][47][48]. Неудивительно, что инфекционные осложнения, включая бронхит, инфекцию верхних дыхательных путей, назофарингит, фарингит, синусит и мочеполовые инфекции, были самыми частыми НЛР во всех РКИ БАРИ [9].…”

Section: безопасностьunclassified

Baricitinib: New Pharmacotherapy Options for Rheumatoid Arthritis and Other Immune-Mediated Inflammatory Rheumatic Diseases

Nasonov

Лила

2020

Naučno-praktičeskaâ revmatologiâ

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Deciphering the mechanisms of the pathogenesis of immune-mediated inflammatory rheumatic diseases (IMIRDs) in conjunction with designing a wide range of biological agents is one of the major medical advances in the 21st century. A new promising area of pharmacotherapy for IMIRDs is associated with the design of the so-called targeted oral medications that primarily include Janus kinase (JAK) inhibitors. The review presents new data on the efficacy and safety of the new JAK inhibitor baricitinib in treating rheumatoid arthritis and other IMIRDs.

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Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

Abstract: There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.

Cited by 123 publications

References 135 publications

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

Baricitinib: New Pharmacotherapy Options for Rheumatoid Arthritis and Other Immune-Mediated Inflammatory Rheumatic Diseases

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