Mortality in Inflammatory Rheumatic Diseases: Lithuanian National Registry Data and Systematic Review

Despite significant improvement in survival, rheumatic diseases (RD) are associated with premature mortality rates comparable to cardiovascular and neoplastic disorders. The aim of our study was to assess mortality, causes of death, and life expectancy in an inflammatory RD retrospective cohort and compare those with the general population as well as with the results of previously published studies in a systematic literature review. Patients with the first-time diagnosis of inflammatory RD during 2012–2019 were identified and cross-checked for their vital status and the date of death. Sex- and age-standardized mortality ratios (SMR) as well as life expectancy for patients with inflammatory RDs were calculated. The results of a systematic literature review were included in meta-standardized mortality ratio calculations. 11,636 patients with newly diagnosed RD were identified. During a total of 43,064.34 person-years of follow-up, 950 death cases occurred. The prevailing causes of death for the total cohort were cardiovascular diseases and neoplasms. The age- and sex-adjusted SMR for the total cohort was calculated to be 1.32 (1.23; 1.40). Patients with rheumatoid arthritis if diagnosed at age 18–19 tend to live for 1.63 years less than the general population, patients with spondyloarthritis—for 2.7 years less, patients with connective tissue diseases—for almost nine years less than the general population. The findings of our study support the hypothesis that patients with RD have a higher risk of mortality and lower life expectancy than the general population

Adaptation of health–related quality of life (“SF-36”) questionnaire, its validation and assessment of performance for control group and patients with rheumatoid arthritis

and acceptable for the respondents. Reliability and validity of the questionnaire is rather high. For the exception of emotional status, quality of life in almost all spheres was considered as bad by patients with rheumatoid arthritis. The control group had more complaints about the emotional status

Ultragarsinio tyrimo reikšmė sergant temporaliniu arteritu

Introduction. Temporal arteritis (TA) is usually diagnosed according to clinical criteria, and temporal artery biopsy is considered as a golden standard for the diagnosis. Temporal artery biopsy is a surgical intervention on a head site and is not well-tolerated by the patients. As an alternative for temporal artery investigation, ultrasound examination may be used. The aim of this pilot study was to evaluate the performance of ultrasound examination of a temporal artery of patients with and without TA, but with similar clinical findings. Materials and results. Thirteen patients seen at Vilnius University Hospital Santariškių Klinikos during 2006–2009 with suspicion of TA were included into this study, and ultrasound examination of their both right and left superficial temporal arteries was performed. Eight patients were diagnosed with TA according to clinical criteria, and 5 patients had headaches of another origin. Two patients had a biopsy-proven diagnosis. The thickened wall (“halo” sign) and / or stenosis / occlusion were found on ultrasound examination in three patients. The presence of abnormality was found in five patients from the setting of TA patients, and no abnormalities were detected in the control group. Although the groups were very small and the data scanty, we consider the sensitivity of the abnormalities detected by ultrasound to be 62.5%, and the specifi city was close to 100% in this pilot study. Conclusions. Authors recommend bilateral ultrasound examination of temporal arteries for patients with suspicion of giant cell arteritis (temporal arteritis). Our pilot study showed a suffi cient sensitivity of this diagnostic test, although it greatly depends on the experience and skills of the performer

Comparison of health-related quality of life between patients with rheumatic diseases and a control group

To compare the health-related quality of life between patients with rheumatoid arthritis and systemic lupus erythematosus and a control group. Eighty-eight patients with rheumatoid arthritis, 40 patients with systemic lupus erythematosus and 40 women who did not suffer from any inflammatory joint disease (control group) participated in this comparative study. The questionnaires they completed included information about their sociodemographic status and comorbidities. Patients with rheumatoid arthritis and systemic lupus erythematosus were assessed for pain (visual analogical scale), extra-articular manifestations, and disease activity; also they completed questionnaires for the evaluation of physical function (Health Assessment Questionnaire – HAQ) and burden of arthritis (Arthritis Impact Measurement Scale). All groups under investigation completed the health-related quality questionnaire SF-36 (Medical Outcomes Study Short Form-36) validated in Lithuania. Results. The study of health-related quality of life of women with rheumatic disease showed that patients with systemic lupus erythematosus had stronger pain (p=0.017). It was also found that the activity of patients with rheumatoid arthritis was more limited because of emotional problems (p=0.038). No significant differences were found in other areas of life quality. It was recognized that in comparison to other groups, the quality of life of the control group was better (p=0.000) from the point of view of physical activity, limitations of activity because of physical problems, pain, overall health status and social relations. The psychological status of the latter was undoubtedly worse. Conclusions. In this study it was found that all patients with rheumatoid arthritis and systemic lupus erythematosus had evaluated most of the aspects of health-quality very similarly. Significant differences have been determined when assessing pain and limitation of activity because of emotional problems

Multiple cranial neuropathies in Churg-Strauss syndrome: case report

Churg-Strauss syndrome (CSS), known as eosinophilic granulomatosis with polyangiitis, is a systemic small- to medium-sized vasculitis, characterized by chronic rhinosinusitis, asthma and eosinophilia. Churg and Strauss first described this syndrome in 1951. Histology of CSS usually discloses eosinophil-rich infiltrates, necrotising vasculitis, and eosinophilic-granulomatous inflammation. There are no clear pathophysiologic mechanisms that explain the development of CSS but association between CSS and HLA-DRB4 has been reported. Because of the frequent positivity of antineutrophil cytoplasmic antibodies (ANCAs), which are found in 30–40% of the cases, CSS has been grouped with ANCA-associated vasculitis. Nervous system manifestations are found in up to 70% of CSS patients, while cranial neuropathies are rarely diagnosed. Patients are treated with glucocorticoids and immunosuppressants. We describe a case report of a 68-year-old woman with a clinical diagnosis of Churg-Strauss syndrome and multiple cranial neuropathies

Clinical characteristics and long-term outcomes of 35 patients with Wegener’s granulomatosis followed up at two rheumatology centers in Lithuania

Objective. The aim of this study was to investigate the survival of Lithuanian patients with Wegener’s granulomatosis, who were followed up at two tertiary rheumatology centers, and to find the factors possibly influencing the outcomes of this disease. Material and methods. Thirty-five patients were followed up prospectively from the onset of disease (the first patient was enrolled in 1994) at Vilnius University Hospital and the Center of Rheumatology of Kaunas University of Medicine (17 and 18 patients, respectively). All patients in both the centers were followed up on a routine basis, and their records contained necessary information about laboratory and biopsy data; the censoring date (end of follow-up) was stated in June 2006. Results. Among the patients, the most frequent organs involved were ear, nose, throat (ENT) (82.6%), lungs (74.3%), and kidney (renal involvement was defined by proteinuria/abnormal urine sediment) (45.7%). Renal insufficiency was present in 20.6% of all the patients. At the end of the study, 32.4% of patients had simultaneously all three organ systems involved, namely upper respiratory tract, pulmonary, and renal. ANCA positivity was found for 26 (74.3%) of all the patients. Overall mortality rate was 25.7% (9/35). The mean survival was 99.4 months (95% CI, 73.6; 125.3) limited to 149 months for the longest-surviving patient. Conclusions. Female gender and all three specific organ involvements being present at the same time and higher vasculitis damage index were associated with poor outcome. Overall mortality rate was 25.7% (9/35) during the 12-year follow-up, and it is similar to the data from other European countries

Mortality in inflammatory rheumatic diseases: Lithuanian national registry data and systematic review

Despite significant improvement in survival, rheumatic diseases (RD) are associated with premature mortality rates comparable to cardiovascular and neoplastic disorders. The aim of our study was to assess mortality, causes of death, and life expectancy in an inflammatory RD retrospective cohort and compare those with the general population as well as with the results of previously published studies in a systematic literature review. Patients with the first-time diagnosis of inflammatory RD during 2012-2019 were identified and cross-checked for their vital status and the date of death. Sex- and age-standardized mortality ratios (SMR) as well as life expectancy for patients with inflammatory RDs were calculated. The results of a systematic literature review were included in meta-standardized mortality ratio calculations. 11,636 patients with newly diagnosed RD were identified. During a total of 43,064.34 person-years of follow-up, 950 death cases occurred. The prevailing causes of death for the total cohort were cardiovascular diseases and neoplasms. The age- and sex-adjusted SMR for the total cohort was calculated to be 1.32 (1.23; 1.40). Patients with rheumatoid arthritis if diagnosed at age 18-19 tend to live for 1.63 years less than the general population, patients with spondyloarthritis for 2.7 years less, patients with connective tissue diseases for almost nine years less than the general population. The findings of our study support the hypothesis that patients with RD have a higher risk of mortality and lower life expectancy than the general population. Keywords: rheumatic diseases; mortality; standardized mortality ratio; life expectancy; systematic review

Association between androgen deprivation therapy and the risk of inflammatory rheumatic diseases in men with prostate cancer: nationwide cohort study in Lithuania

Background: The aim of this study was to assess the association between androgen deprivation therapy (ADT) and the risk of inflammatory rheumatic diseases in men with prostate cancer. Methods: Patients with prostate cancer between 2012 and 2016 were identified from the Lithuanian Cancer Registry and the National Health Insurance Fund database, on the basis of rheumatic diseases diagnoses and information on prescriptions for androgen deprivation therapy. Cox proportional hazard models were used to estimate hazard ratios (HR) to compare the risks of rheumatic diseases caused by androgen deprivation therapy exposure in groups of prostate cancer patients. Results: A total of 12,505 prostate cancer patients were included in this study, out of whom 3070 were ADT users and 9390 were ADT non-users. We observed a higher risk of rheumatic diseases in the cohort of prostate cancer patients treated with ADT compared with ADT non-users (HR 1.55, 95% confidence interval (CI) 1.01–2.28). Detailed risk by cumulative use of ADT was performed for rheumatoid arthritis, and a statistically significant higher risk was found in the group with longest cumulative ADT exposure (>105 weeks) (HR 3.18, 95% CI 1.39–7.29). Conclusions: Our study suggests that ADT usage could be associated with increased risk of rheumatoid arthritis, adding to the many known side effects of ADT

How Did the Two Years of the COVID-19 Pandemic Affect the Outcomes of the Patients with Inflammatory Rheumatic Diseases in Lithuania?

Background and objectives: the COVID-19 pandemic globally caused more than 18 million deaths over the period of 2020–2021. Although inflammatory rheumatic diseases (RD) are generally associated with premature mortality, it is not yet clear whether RD patients are at a greater risk for COVID-19-related mortality. The aim of our study was to evaluate mortality and causes of death in a retrospective inflammatory RD patient cohort during the COVID-19 pandemic years. Methods: We identified patients with a first-time diagnosis of inflammatory RD and followed them up during the pandemic years of 2020–2021. Death rates, and sex- and age-standardized mortality ratios (SMRs) were calculated for the prepandemic and pandemic periods. Results: We obtained data from 11,636 patients that had been newly diagnosed with inflammatory RD and followed up until the end of 2021 or their death. The mean duration of the follow-up was 5.5 years. In total, 1531 deaths occurred between 2013 and 2021. The prevailing causes of death in the prepandemic period were cardiovascular diseases, neoplasms, and diseases of the respiratory system. In the pandemic years, cardiovascular diseases and neoplasms remained the two most common causes of death, with COVID-19 in third place. The SMR of the total RD cohort was 0.83. This trend was observed in rheumatoid arthritis and spondyloarthropathy patients. The SMR in the group of connective-tissue diseases and vasculitis was higher at 0.93, but did not differ from that of the general population. The excess of deaths in the RD cohort during the pandemic period was negative (−27.2%), meaning that RD patients endured the pandemic period better than the general population did. Conclusions: The COVID-19 pandemic did not influence the mortality of RD patients. Strict lockdown measures, social distancing, and early vaccination were the main factors that resulted in reduced mortality in this cohort during the pandemic years

Vitamin D, cardiovascular and bone health in postmenopausal women with metabolic syndrome

Background. The evidence highlights the importance of improving vitamin D levels in the general population for the prevention of adverse long-term health risks, including cardiovascular events, metabolic syndrome, cancer, anxiety and depression, and overall mortality, although controversies in the research are common. Objectives. The purpose of this study was to investigate the relationship between vitamin D and vascular and bone health among postmenopausal metabolic women, controlling for traditional cardiovascular factors, and thus seeking to explore their plausible relation. The secondary aim was to look specifically for the relation between artery stiffness and bone health. Material and methods. This is a cross-sectional study designed to evaluate the relation between vitamin D level and vascular and bone health among women with metabolic syndrome. Two hundred and ten women visiting a cardiologist were recruited consecutively into the study. The study variables included clinical examination, laboratory findings, measurements of vascular stiffness, and bone turnover markers. Results. We found 126 (60%) metabolic women with a vitamin D deficiency (50 nmol/L) among the study group. We discovered no statistically significant correlation between vitamin D and vascular stiffness. Vitamin D was not associated neither with femoral neck bone mineral density (BMD) and T score, nor with lumbar spine BMD and T score. Nevertheless, there was an indirect weak correlation between vascular stiffness, in particular the augmentation index (AIx), and all bone health markers, including BMD and T score in both the femur head and lumbar spine. Conclusions. We showed a high proportion of postmenopausal metabolic women with a vitamin D deficiency, but there was no relation between vitamin D and vascular health or vitamin D and bone health. Nevertheless, the relation between vascular health and bone health exists, although the role of vitamin D in this link has not yet been established