Skip to main content
Top
Published in: Clinical Rheumatology 5/2019

01-05-2019 | Stroke | Original Article

Exploring metabolic and inflammatory abnormalities in rheumatoid arthritis patients developing stroke disease: a case-control study using electronic medical record data in northern China

Authors: Fangran Xin, Lingyu Fu, Haina Liu, Yunwei Xu, Tingting Wei, Meng Chen

Published in: Clinical Rheumatology | Issue 5/2019

Login to get access

Abstract

Objectives

Intend to investigate the roles of serum lipids, inflammatory markers, and serological status in rheumatoid arthritis and stroke patients by using case-control study.

Materials and methods

Clinical data were retrieved from the electronic medical record of the First Affiliated Hospital of China Medical University during January 2011 to March 2018. The obtained data were categorized into case groups and three control groups, in the ratios of 1:2, respectively, with all matching age and gender. Multinomial logistic regression analysis and restricted cubic spline were conducted examining the associations between serum lipids, inflammatory markers, serological status, and the risk of stroke among RA patients.

Results

The present studies included 1057 study subjects. The elevated ESR, LDL-C levels, and much higher CRP levels ≥ 230 mg/L were independent risk factors for RA patients in developing stroke. Furthermore, we found that ESR and LDL-C levels could exhibit a linear association with the risk of comorbid stroke while CRP level had a nonlinearity association with stroke risk among RA patients.

Conclusions

A close monitoring is required for RA patients with dyslipidemia and elevated inflammatory markers, and the primary stroke preventive strategies should be directed against these risk factors.
Appendix
Available only for authorised users
Literature
1.
go back to reference Junbo Ge YX (2013) Internal Medicine. 8 ed. People’s Medical Publishing House, BeiJing Junbo Ge YX (2013) Internal Medicine. 8 ed. People’s Medical Publishing House, BeiJing
2.
go back to reference Zhanguo Li F (2009) Rheumatoid arthritis. 1 ed: People’s Medical Publishing House Zhanguo Li F (2009) Rheumatoid arthritis. 1 ed: People’s Medical Publishing House
3.
go back to reference Lévy LFB, Barnetche T, Schaeverbeke T (2008) Incidence and risk of fatal myocardial infarction and stroke events in rheumatoid arthritis patients: a systematic review of the literature. Clin Exp Rheumatol 26:67 Lévy LFB, Barnetche T, Schaeverbeke T (2008) Incidence and risk of fatal myocardial infarction and stroke events in rheumatoid arthritis patients: a systematic review of the literature. Clin Exp Rheumatol 26:67
5.
go back to reference Mackey RH, Kuller LH, Deane KD, Walitt BT, Chang YF, Holers VM et al (2015) Rheumatoid arthritis, anti-cyclic citrullinated peptide positivity, and cardiovascular disease risk in the women’s health initiative. Arthritis Rheumatol 67:92311–92322. https://doi.org/10.1002/art.39198 Mackey RH, Kuller LH, Deane KD, Walitt BT, Chang YF, Holers VM et al (2015) Rheumatoid arthritis, anti-cyclic citrullinated peptide positivity, and cardiovascular disease risk in the women’s health initiative. Arthritis Rheumatol 67:92311–92322. https://​doi.​org/​10.​1002/​art.​39198
6.
go back to reference Lindhardsen J, Gislason GH, Ahlehoff O, Madsen OR, Hansen PR.(2010) Increased risk of stroke and atrial fibrillation in rheumatoid arthritis - a nationwide cohort study. Eur Heart J 31156 Lindhardsen J, Gislason GH, Ahlehoff O, Madsen OR, Hansen PR.(2010) Increased risk of stroke and atrial fibrillation in rheumatoid arthritis - a nationwide cohort study. Eur Heart J 31156
8.
go back to reference Navarro-Millan I, Yang S, DuVall SL, Chen L, Baddley J, Cannon GW et al (2016) Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration. Ann Rheum Dis 75:2341–2347. https://doi.org/10.1136/annrheumdis-2013-204987 CrossRef Navarro-Millan I, Yang S, DuVall SL, Chen L, Baddley J, Cannon GW et al (2016) Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration. Ann Rheum Dis 75:2341–2347. https://​doi.​org/​10.​1136/​annrheumdis-2013-204987 CrossRef
10.
12.
go back to reference Goodson NJ, Symmons DP, Scott DG (2005) Baseline levels of C reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year follow up study of a primary care-based inception cohort. Arthritis Rheum 52:2293–2299CrossRefPubMed Goodson NJ, Symmons DP, Scott DG (2005) Baseline levels of C reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year follow up study of a primary care-based inception cohort. Arthritis Rheum 52:2293–2299CrossRefPubMed
13.
go back to reference Huijun Sun TK, Ichikawa T, Hatakeyama K, Shiomi M, Zhang B, Kitajima S, Morimoto M, Watanabe T, Asada Y, Chen YE, Fan J (2005) C-reactive protein in atherosclerotic lesions: its origin and pathophysiological significance. Am J Pathol 167(4):1139–1148CrossRefPubMedPubMedCentral Huijun Sun TK, Ichikawa T, Hatakeyama K, Shiomi M, Zhang B, Kitajima S, Morimoto M, Watanabe T, Asada Y, Chen YE, Fan J (2005) C-reactive protein in atherosclerotic lesions: its origin and pathophysiological significance. Am J Pathol 167(4):1139–1148CrossRefPubMedPubMedCentral
14.
go back to reference Arnett FC, Edworthy SM, Bloch DA (1988) The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis. Arthritis Rheum p. 315–24 Arnett FC, Edworthy SM, Bloch DA (1988) The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis. Arthritis Rheum p. 315–24
15.
go back to reference Association CN.(2013) Diagnosis of various cerebrovascular diseases(1995). J Clin Exp Med 12:71 Association CN.(2013) Diagnosis of various cerebrovascular diseases(1995). J Clin Exp Med 12:71
16.
go back to reference adults TjcopacoabliC (2012) Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. The joint committee on prevention and control of abnormal blood lipids in Chinese adults adults TjcopacoabliC (2012) Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. The joint committee on prevention and control of abnormal blood lipids in Chinese adults
17.
go back to reference adults. TjcopacoabliC (2016) Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults(2016 Revised). Guidelines and consensus. Chinese Circulation Journal: The joint committee on prevention and control of abnormal blood lipids in Chinese adults adults. TjcopacoabliC (2016) Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults(2016 Revised). Guidelines and consensus. Chinese Circulation Journal: The joint committee on prevention and control of abnormal blood lipids in Chinese adults
18.
go back to reference Wolfe F, Freundlich B, Straus WL (2003) Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 30:136–140 Wolfe F, Freundlich B, Straus WL (2003) Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 30:136–140
19.
go back to reference Ku IA, Imboden JB, Hsue PY, Ganz P (2009) Rheumatoid arthritis a model of systemic inflammation driving atherosclerosis. Circ J 73:6977–6985CrossRef Ku IA, Imboden JB, Hsue PY, Ganz P (2009) Rheumatoid arthritis a model of systemic inflammation driving atherosclerosis. Circ J 73:6977–6985CrossRef
20.
23.
go back to reference Jurcut C, Jurcut R, Tanasescu C (2004) Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach. Rom J Int Med 42:4659–4669 Jurcut C, Jurcut R, Tanasescu C (2004) Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach. Rom J Int Med 42:4659–4669
24.
go back to reference Combe B, Cantagrel A, Goupille P, Bozonnat MC, Sibilia J, Eliaou JF et al (2003) Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol 30:112344–112349 Combe B, Cantagrel A, Goupille P, Bozonnat MC, Sibilia J, Eliaou JF et al (2003) Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol 30:112344–112349
25.
go back to reference Guillemin F, Gerard N, van Leeuwen M, Smedstad LM, Kvien TK, van den Heuvel W (2003) Prognostic factors for joint destruction in rheumatoid arthritis: a prospective longitudinal study of 318 patients. J Rheumat 30:122585–122589 Guillemin F, Gerard N, van Leeuwen M, Smedstad LM, Kvien TK, van den Heuvel W (2003) Prognostic factors for joint destruction in rheumatoid arthritis: a prospective longitudinal study of 318 patients. J Rheumat 30:122585–122589
26.
28.
go back to reference Otterness IG (1994) The value of C-reactive protein measurement in rheumatoid arthritis. Semin Arthritis Rheum 24:291–104CrossRef Otterness IG (1994) The value of C-reactive protein measurement in rheumatoid arthritis. Semin Arthritis Rheum 24:291–104CrossRef
29.
go back to reference Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M et al (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:3499–3511 Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M et al (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:3499–3511
30.
go back to reference Hjeltnes G, Hollan I (2011) Anti-CCP and RF IgM: predictors of impaired endothelial function in rheumatoid arthritis patients. Scand J Rheumatol 40:6422–6427CrossRef Hjeltnes G, Hollan I (2011) Anti-CCP and RF IgM: predictors of impaired endothelial function in rheumatoid arthritis patients. Scand J Rheumatol 40:6422–6427CrossRef
33.
go back to reference Hansson GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352:1685–1695CrossRefPubMed Hansson GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352:1685–1695CrossRefPubMed
39.
go back to reference Xie F, Yun H, Levitan EB, Muntner P, Curtis JR (2018) Tocilizumab and the risk for cardiovascular disease: a direct comparison among biologic disease-modifying antirheumatic drugs for rheumatoid arthritis patients. Arthritis Care Res. https://doi.org/10.1002/acr.23737 Xie F, Yun H, Levitan EB, Muntner P, Curtis JR (2018) Tocilizumab and the risk for cardiovascular disease: a direct comparison among biologic disease-modifying antirheumatic drugs for rheumatoid arthritis patients. Arthritis Care Res. https://​doi.​org/​10.​1002/​acr.​23737
Metadata
Title
Exploring metabolic and inflammatory abnormalities in rheumatoid arthritis patients developing stroke disease: a case-control study using electronic medical record data in northern China
Authors
Fangran Xin
Lingyu Fu
Haina Liu
Yunwei Xu
Tingting Wei
Meng Chen
Publication date
01-05-2019
Publisher
Springer London
Published in
Clinical Rheumatology / Issue 5/2019
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-019-04440-5

Other articles of this Issue 5/2019

Clinical Rheumatology 5/2019 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.