Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae

© 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: RA flares are common and disabling. They are described in terms of worsening inflammation but pain and inflammation are often discordant. To inform treatment decisions, we investigated whether inflammatory and pain flares are discrete entities. Methods: People from the Early RA Network (ERAN) cohort were assessed annually up to 11 years after presentation (n = 719, 3703 person-years of follow up). Flare events were defined in 2 different ways that were analysed in parallel; DAS28 or Pain Flares. DAS28 Flares satisfied OMERACT flare criteria of increases in DAS28 since the previous assessment (≥1.2 points if active RA or ≥ 0.6 points if inactive RA). A ≥ 4.8-point worsening of SF36-Bodily Pain score defined Pain Flares. The first documented episode of each of DAS28 and Pain Flare in each person was analysed. Subgroups within DAS28 and Pain Flares were determined using Latent Class Analysis. Clinical course was compared between flare subgroups. Results: DAS28 (45%) and Pain Flares (52%) were each common but usually discordant, with 60% of participants in DAS28 Flare not concurrently in Pain Flare, and 64% of those in Pain Flare not concurrently in DAS28 Flare. Three discrete DAS28 Flare subgroups were identified. One was characterised by increases in tender/swollen joint counts (14.4%), a second by increases in symptoms (13.1%), and a third displayed lower flare severity (72.5%). Two discrete Pain Flare subgroups were identified. One occurred following low disease activity and symptoms (88.6%), and the other occurred on the background of ongoing active disease and pain (11.4%). Despite the observed differences between DAS28 and Pain Flares, each was associated with increased disability which persisted beyond the flare episode. Conclusion: Flares are both common and heterogeneous in people with RA. Furthermore our findings indicate that for some patients there is a discordance between inflammation and pain in flare events. This discrete flare subgroups might reflect different underlying inflammation and pain mechanisms. Treatments addressing different mechanisms might be required to reduce persistent disability after DAS28 and Pain Flares.Peer reviewedFinal Published versio

Association of E-Cigarette Use with Coronary Heart Disease Among U.S. Adults

Background: Smoking continues to be the leading cause of preventable disease, disability and death in the United States attributing to more than 480,000 deaths every year. An estimated 36.5 million US adults (15% of US population) currently smoke, and more than 16 million live with a smoking-related disease. Since recent years, there has been a surge of alternate tobacco products in the US markets, and one such product that has gained importance was electronic cigarettes. Studies have demonstrated a rapid increase in e-cigarette use among US adults. However, research is limited on the effects of e-cigarette on human health. Thus, using a nationally representative sample of US adults, we investigated the association of e-cigarette use with coronary heart disease (CHD) among adults aged ≥18-years in the US. Methods: Data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to conduct this study. BRFSS is a cross-sectional survey administered to 486,303 adults in all 50 states to collect information about their health-related risk behaviors, chronic health conditions and the use of preventive services. Participants’ self-reported responses were used to define study outcome (CHD), exposure (current e-cigarette use) and covariates (demographics [sex and race], behaviors [cigarette smoking, alcohol consumption, marijuana use, physical activity], and physical conditions [overweight or obesity]). Multiple logistic regression analysis was conducted to determine the association between e-cigarette use and CHD. Adjusted odds ratio and corresponding 95% confidence intervals were presented. Results: Approximately 6.19% of US adults reported CHD events and 3.1% of US adults were current e-cigarette users. Approximately 5.42% of e-cigarette smoking US adults reported CHD outcomes in 2016. Overall, the odds of CHD events was 34.9% less among e-cigarette users than those who were not e-cigarette users (adjusted odds ratio (aOR): 0.65, 95% confidence interval (CI): 0.60-0.70, p Conclusion: The study found out that e-cigarette user was less likely associated with CHD outcomes in US adults. Given the limitations of cross-sectional study nature and self-reported bias of responses, longitudinal studies with objective measures are needed to further investigate the association between e-cigarette use and CHD