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Rheumatoid Arthritis: HELP
Articles by George D. Kitas
Based on 137 articles published since 2008
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Between 2008 and 2019, G. Kitas wrote the following 137 articles about Arthritis, Rheumatoid.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. 2017

Agca, R / Heslinga, S C / Rollefstad, S / Heslinga, M / McInnes, I B / Peters, M J L / Kvien, T K / Dougados, M / Radner, H / Atzeni, F / Primdahl, J / Södergren, A / Wallberg Jonsson, S / van Rompay, J / Zabalan, C / Pedersen, T R / Jacobsson, L / de Vlam, K / Gonzalez-Gay, M A / Semb, A G / Kitas, G D / Smulders, Y M / Szekanecz, Z / Sattar, N / Symmons, D P M / Nurmohamed, M T. ·Departments of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway. · College of Medical, Veterinary and Life Sciences, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Internal and Vascular Medicine, VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Paris Descartes University, Hôpital Cochin. Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France. · Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria. · IRCCS Galeazzi Orthopedic Institute, Milan, Italy. · Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark. · Sygehus Sønderjylland (Hospital of Southern Jutland), Aabenraa, Denmark. · King Christian 10's Hospital for Rheumatic Diseases, Graasten, Denmark. · Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden. · PARE (patient research partners), Sint-Joris-Weert, Belgium. · Romanian League Against Rheumatism (Vice-President) and Board Member (General Secretary) of AGORA, the Platform of S-E organisations for patients with RMDs, Bucharest, Romania. · Oslo University Hospital, Ullevål, Center for Preventive Medicine and Medical Faculty, University of Oslo, Oslo, Norway. · Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg and Section of Rheumatology, Lund, Sweden. · Department of Clinical Sciences Malmö, Lund University, Lund, Sweden. · Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · University of Cantabria, IDIVAL, Santander, Spain. · Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK. · Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary. · Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK. · Department of Rheumatology and Musculoskeletal Epidemiology, Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK. · Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #27697765.

ABSTRACT: Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

2 Guideline EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. 2010

Peters, M J L / Symmons, D P M / McCarey, D / Dijkmans, B A C / Nicola, P / Kvien, T K / McInnes, I B / Haentzschel, H / Gonzalez-Gay, M A / Provan, S / Semb, A / Sidiropoulos, P / Kitas, G / Smulders, Y M / Soubrier, M / Szekanecz, Z / Sattar, N / Nurmohamed, M T. ·Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #19773290.

ABSTRACT: OBJECTIVES: To develop evidence-based EULAR recommendations for cardiovascular (CV) risk management in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). METHODS: A multidisciplinary expert committee was convened as a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), comprising 18 members including rheumatologists, cardiologists, internists and epidemiologists, representing nine European countries. Problem areas and related keywords for systematic literature research were identified. A systematic literature research was performed using MedLine, Embase and the Cochrane library through to May 2008. Based on this literature review and in accordance with the EULAR's "standardised operating procedures", the multidisciplinary steering committee formulated evidence-based and expert opinion-based recommendations for CV risk screening and management in patients with inflammatory arthritis. RESULTS: Annual CV risk assessment using national guidelines is recommended for all patients with RA and should be considered for all patients with AS and PsA. Any CV risk factors identified should be managed according to local guidelines. If no local guidelines are available, CV risk management should be carried out according to the SCORE function. In addition to appropriate CV risk management, aggressive suppression of the inflammatory process is recommended to further lower the CV risk. CONCLUSIONS: Ten recommendations were made for CV risk management in patients with RA, AS and PsA. The strength of the recommendations differed between RA on the one hand, and AS and PsA, on the other, as evidence for an increased CV risk is most compelling for RA.

3 Editorial Platelets in rheumatoid arthritis: exploring the anti-inflammatory and antithrombotic potential of TNF inhibitors. 2016

Gasparyan, Armen Yuri / Kitas, George D. ·Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK. · Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK. ·Ann Rheum Dis · Pubmed #27045106.

ABSTRACT: -- No abstract --

4 Editorial Cardiovascular risk in rheumatoid arthritis and diabetes: how does it compare and when does it start? 2011

Nurmohamed, Michael T / Kitas, George. · ·Ann Rheum Dis · Pubmed #21450751.

ABSTRACT: -- No abstract --

5 Editorial Uric acid and cardiovascular risk in rheumatoid arthritis. 2011

Daoussis, Dimitrios / Kitas, George D. · ·Rheumatology (Oxford) · Pubmed #21115462.

ABSTRACT: -- No abstract --

6 Editorial Inflammation, carotid intima-media thickness and atherosclerosis in rheumatoid arthritis. 2008

Veldhuijzen van Zanten, Jet J C S / Kitas, George D. · ·Arthritis Res Ther · Pubmed #18226183.

ABSTRACT: Carotid intima-media thickness (cIMT) reflects early atherosclerosis and predicts cardiovascular events in the general population. An increased cIMT is present in patients with rheumatoid arthritis, compared with control individuals, from the early stages of the disease and is thought to indicate accelerated atherosclerosis, but direct evidence is not available. Whether cIMT is susceptible to rapid and potentially reversible change depending on the intensity of inflammation in states of high-grade systemic inflammation, such as rheumatoid arthritis, remains unknown. If this is the case, an increased cIMT in such disease states may not reflect structural vessel wall damage, and may not be a good predictor of future cardiovascular events in these particular populations. Prospective, long-term, longitudinal studies are needed to address these questions.

7 Review Systemic Inflammatory Response and Atherosclerosis: The Paradigm of Chronic Inflammatory Rheumatic Diseases. 2018

Arida, Aikaterini / Protogerou, Athanasios D / Kitas, George D / Sfikakis, Petros P. ·First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, GR-115 27 Athens, Greece. aridakater@yahoo.gr. · First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, GR-115 27 Athens, Greece. athanprot@gmail.com. · First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, GR-115 27 Athens, Greece. george.kitas@nhs.net. · First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, GR-115 27 Athens, Greece. psfikakis@med.uoa.gr. ·Int J Mol Sci · Pubmed #29954107.

ABSTRACT: Patients with Chronic Inflammatory Rheumatic diseases (CIRD) are at increased risk of cardiovascular disease (CVD), ascribed not only to classical risk factors, but also to the presence of chronic systemic inflammatory response. Αtherosclerosis, the cornerstone of CVD, is known to be accelerated in CIRD; rheumatoid arthritis promotes atheromatosis and associates with preclinical atherosclerosis equivalent to Diabetes Mellitus, which also seems to apply for systemic lupus erythematosus. Data on ankylosing spondylitis and psoriatic arthritis, albeit more limited, also support an increased CV risk in these patients. The association between inflammation and atherosclerosis, has been thoroughly investigated in the last three decades and the role of inflammation in the pathogenesis and progression of atherogenesis has been well established. Endothelial dysfunction, oxidative stress in vascular endothelial cells and macrophage accumulation, toll-like receptor signaling, NLPR-3 formation and subsequent pro-inflammatory cytokine production, such as TNFa, IL-1β, IL-6, and TNF-like cytokine 1A, are few of the mechanisms implicated in the atherogenic process. Moreover, there is evidence that anti-inflammatory biologic drugs, such as anti-TNF and anti-IL1β agents, can decelerate the atherogenic process, thus setting new therapeutic targets for early and effective disease control and suppression of inflammation, in addition to aggressive management of classical CV risk factors.

8 Review Can cardiovascular magnetic resonance prompt early cardiovascular/rheumatic treatment in autoimmune rheumatic diseases? Current practice and future perspectives. 2018

Mavrogeni, Sophie I / Sfikakis, Petros P / Dimitroulas, Theodoros / Koutsogeorgopoulou, Loukia / Katsifis, Gikas / Markousis-Mavrogenis, George / Kolovou, Genovefa / Kitas, George D. ·Onassis Cardiac Surgery Center, 50 Esperou Street, P. Faliro, 175-61, Athens, Greece. soma13@otenet.gr. · First Department of Propaedeutic and Internal Medicine, National and Kapodisstrian University of Athens Medical School, Athens, Greece. · 4th Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. · Pathophysiology Department, National and Kapodisstrian University of Athens Medical School, Athens, Greece. · Naval Hospital, Athens, Greece. · Onassis Cardiac Surgery Center, 50 Esperou Street, P. Faliro, 175-61, Athens, Greece. · Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK. ·Rheumatol Int · Pubmed #29516170.

ABSTRACT: Life expectancy in autoimmune rheumatic diseases (ARDs) remains lower compared to the general population, due to various comoborbidities. Cardiovascular disease (CVD) represents the main contributor to premature mortality. Conventional and biologic disease-modifying antirheumatic drugs (DMARDs) have considerably improved long-term outcomes in ARDs not only by suppressing systemic inflammation but also by lowering CVD burden. Regarding atherosclerotic disease prevention, EULAR has recommended tight disease control accompanied by regular assessment of traditional CVD risk factors and lifestyle changes. However, this approach, although rational and evidence-based, does not account for important issues such as myocardial inflammation and the long asymptomatic period that usually proceeds clinical manifestations of CVD disease in ARDs before or after the diagnosis of systemic disease. Cardiovascular magnetic resonance (CMR) can offer reliable, reproducible and operator independent information regarding myocardial inflammation, ischemia and fibrosis. Some studies suggest a role for CMR in the risk stratification of ARDs and demonstrate that oedema/fibrosis visualisation with CMR may have the potential to inform cardiac and rheumatic treatment modification in ARDs with or without abnormal routine cardiac evaluation. In this review, we discuss how CMR findings could influence anti-rheumatic treatment decisions targeting optimal control of both systemic and myocardial inflammation irrespective of clinical manifestations of cardiac disease. CMR can provide a different approach that is very promising for risk stratification and treatment modification; however, further studies are needed before the inclusion of CMR in the routine evaluation and treatment of patients with ARDs.

9 Review Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health. 2018

Fenton, Sally A M / Veldhuijzen van Zanten, Jet J C S / Duda, Joan L / Metsios, George S / Kitas, George D. ·School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK. · Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK. · Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK. ·Rheumatology (Oxford) · Pubmed #28398519.

ABSTRACT: RA is a chronic autoimmune disease characterized by high grade-inflammation, and associated with elevated cardiovascular risk, rheumatoid-cachexia and functional impairment. Sedentary behaviour (SB) is linked to heightened inflammation, and is highly pervasive in RA, likely as a result of compromised physical function and persistent fatigue. This high sedentarity may exacerbate the inflammatory process in RA, and hold relevance for disease-related outcomes. The aim of this narrative review is to provide an overview of the definition, measurement and health relevance of SB in the context of RA. Contradictions are highlighted with regard to the manner in which SB is operationalized, and the significance of SB for disease outcomes in RA is outlined. The advantages and disadvantages of SB measurement approaches are also discussed. Against this background, we summarize studies that have reported SB and its health correlates in RA, and propose directions for future research.

10 Review Impact of non-steroidal anti-inflammatory drugs on cardiovascular risk: Is it the same in osteoarthritis and rheumatoid arthritis? 2017

Bournia, Vasiliki-Kalliopi / Kitas, George / Protogerou, Athanasios D / Sfikakis, Petros P. ·a First Department of Propaedeutic and Internal Medicine and Joined Rheumatology Program , Medical School, National and Kapodistrian University of Athens, Laikon Hospital , Athens , Greece. ·Mod Rheumatol · Pubmed #27659504.

ABSTRACT: Although large-scale population studies have shown that non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of myocardial infarction, this is not confirmed in patients with rheumatoid arthritis (RA). Herein, we review the litterature on the differential effects of NSAIDs on cardiovascular risk in osteoarthritis (OA) versus RA and discuss possible explanations for this discrepancy. To assess a potential additive effect of age in non-RA populations, we compared weighted mean age between RA patients and unselected NSAID users included in cohort and case-control studies that estimate the cardiovascular risk of NSAIDs, assuming that the main indication for NSAID usage in elderly populations is OA. Our hypothesis that advanced age in osteoarthtitis compared to RA patients confounds the effect of NSAIDs on cardiovasular risk was not confirmed. Several other hypotheses that can be proposed to explain this counterintuitive effect of NSAIDs on the cardiovascular risk of RA patients are discussed. We conclude that patients with RA have a lower cardiovascular disease risk associated with the use of NSAIDs, probably due to the nature of their disease per se, until further research indicates differently.

11 Review Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature. 2015

Veldhuijzen van Zanten, Jet J C S / Rouse, Peter C / Hale, Elizabeth D / Ntoumanis, Nikos / Metsios, George S / Duda, Joan L / Kitas, George D. ·School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK. veldhujj@bham.ac.uk. · Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK. veldhujj@bham.ac.uk. · School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK. · Department of Health, University of Bath, Bath, UK. · Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK. · School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia. · School of Sport, Performing Arts and Leisure, University of Wolverhampton, Wolverhampton, UK. ·Sports Med · Pubmed #26219268.

ABSTRACT: Rheumatoid arthritis (RA) is an autoimmune disease, which not only affects the joints but can also impact on general well-being and risk for cardiovascular disease. Regular physical activity and exercise in patients with RA have numerous health benefits. Nevertheless, the majority of patients with RA are physically inactive. This indicates that people with RA might experience additional or more severe barriers to physical activity or exercise than the general population. This narrative review provides an overview of perceived barriers, benefits and facilitators of physical activity and exercise in RA. Databases were searched for articles published until September 2014 using the terms 'rheumatoid arthritis', 'physical activity', 'exercise', 'barriers', 'facilitators', 'benefits', 'motivation', 'motivators' and 'enablers'. Similarities were found between disease-specific barriers and benefits of physical activity and exercise, e.g. pain and fatigue are frequently mentioned as barriers, but reductions in pain and fatigue are perceived benefits of physical activity and exercise. Even though exercise does not influence the existence of barriers, physically active patients appear to be more capable of overcoming them. Therefore, exercise programmes should enhance self-efficacy for exercise in order to achieve long-term physical activity and exercise behaviour. Encouragement from health professionals and friends/family are facilitators for physical activity and exercise. There is a need for interventions that support RA patients in overcoming barriers to physical activity and exercise and help sustain this important health behaviour.

12 Review The role of exercise in the management of rheumatoid arthritis. 2015

Metsios, George S / Stavropoulos-Kalinoglou, Antonis / Kitas, George D. ·c 3 Department of Physical Education and Sports Science, University of Thessaly, Thessaly, Greece. · b 2 Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell's Hall Hospital, Dudley, West Midlands, UK. · d 4 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK. · e 5 Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK. ·Expert Rev Clin Immunol · Pubmed #26178249.

ABSTRACT: Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with significant functional impairment and increased risk for cardiovascular disease. Along with pharmacological therapy, exercise seems to be a very promising intervention to improve disease-related outcomes, including functional ability and systemic manifestations, such as the increased cardiovascular risk. In this review, we discuss the physiological mechanisms by which exercise improves inflammation, cardiovascular risk and psychological health in patients with rheumatoid arthritis (RA) and describe in detail how exercise can be incorporated in the management of this disease using real examples from our clinical practice.

13 Review Why currently used diagnostic techniques for heart failure in rheumatoid arthritis are not enough: the challenge of cardiovascular magnetic resonance imaging. 2014

Mavrogeni, Sophie / Dimitroulas, Theodoros / Gabriel, Sherine / Sfikakis, Petros P / Pohost, Gerald M / Kitas, George D. ·Onassis Cardiac Surgery Center, Athens, Greece. · Department of Rheumatology, Russells Hall Hospital, West Midlands, United Kingdom. · Department of Health Sciences Research and Division of Rheumatology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN. · First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece. · Keck School of Medicine, University of Southern California, Los Angeles, CA, Loma Linda University, Loma Linda, CA, Westside Medical Imaging, Beverly Hills, CA. · Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom. ·Rev Cardiovasc Med · Pubmed #25662926.

ABSTRACT: Rheumatoid arthritis (RA) is a multiorgan inflammatory disorder affecting approximately 1% of the population that leads to progressive joint destruction and disability. Patients with RA exhibit a high risk of cardiovascular disease, which results in premature morbidity and mortality and reduced life expectancy, when compared with the general population. Among various guises of myocardial involvement, heart failure (HF) has been recently recognized as an important contributory factor to the excess cardiovascular mortality associated with RA. HF in RA typically presents with occult clinical symptomatology and is mainly associated with structural and functional left ventricular abnormalities leading to diastolic dysfunction, while systolic myocardial performance remains well preserved. As isolated diastolic dysfunction is a predictor of high mortality, the evaluation of patients in early asymptomatic stages, when treatment targeting the heart is more likely to be effective, is of great importance. Although patient history and physical examination remain the cornerstones of HF evaluation, noninvasive imaging of cardiac chambers, coronary arteries, and great vessels may be necessary. Echocardiography, nuclear techniques, and invasive coronary angiography are already established in the routine assessment of HF; however, many aspects of HF pathophysiology in RA remain obscure, due to the limitations of currently used techniques. The capability of cardiovascular magnetic resonance (CMR) to capture early tissue changes allows timely detection of pathophysiologic phenomena of HF in RA, such as myocardial inflammation and myocardial perfusion defects, due to either macrovascular (coronary artery disease) or microvascular (vasculitis) disease. Therefore, CMR may be a useful tool for early, accurate diagnosis and research in patients with RA.

14 Review Autonomic function and rheumatoid arthritis: a systematic review. 2014

Adlan, Ahmed M / Lip, Gregory Y H / Paton, Julian F R / Kitas, George D / Fisher, James P. ·College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2 TT, UK. Electronic address: adlan.ahmed@gmail.com. · University of Birmingham Centre of Cardiovascular Sciences, City Hospital, Birmingham, UK. · School of Physiology and Pharmacology, Bristol CardioVascular Medical Sciences Building, University of Bristol, Bristol, UK. · Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK. · College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2 TT, UK. ·Semin Arthritis Rheum · Pubmed #25151910.

ABSTRACT: OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory condition with increased all-cause and cardiovascular mortality. Accumulating evidence indicates that the immune and autonomic nervous systems (ANS) are major contributors to the pathogenesis of cardiovascular disease. We performed the first systematic literature review to determine the prevalence and nature of ANS dysfunction in RA and whether there is a causal relationship between inflammation and ANS function. METHODS: Electronic databases (MEDLINE, Central and Cochrane Library) were searched for studies of RA patients where autonomic function was assessed. RESULTS: A total of 40 studies were included. ANS function was assessed by clinical cardiovascular reflex tests (CCTs) (n = 18), heart rate variability (HRV) (n = 15), catecholamines (n = 5), biomarkers of sympathetic activity (n = 5), sympathetic skin responses (n = 5), cardiac baroreflex sensitivity (cBRS) (n = 2) and pupillary light reflexes (n = 2). A prevalence of ~60% (median, range: 20-86%) of ANS dysfunction (defined by abnormal CCTs) in RA was reported in 9 small studies. Overall, 73% of studies (n = 27/37) reported at least one of the following abnormalities in ANS function: parasympathetic dysfunction (n = 20/26, 77%), sympathetic dysfunction (n = 16/30, 53%) or reduced cBRS (n = 1/2, 50%). An association between increased inflammation and ANS dysfunction was found (n = 7/19, 37%), although causal relationships could not be elucidated from the studies available to date. CONCLUSIONS: ANS dysfunction is prevalent in ~60% of RA patients. The main pattern of dysfunction is impairment of cardiovascular reflexes and altered HRV, indicative of reduced cardiac parasympathetic (strong evidence) activity and elevated cardiac sympathetic activity (limited evidence). The literature to date is underpowered to determine causal relationships between inflammation and ANS dysfunction in RA.

15 Review Rheumatoid arthritis: an autoimmune disease with female preponderance and cardiovascular risk equivalent to diabetes mellitus: role of cardiovascular magnetic resonance. 2014

Mavrogeni, Sophie / Dimitroulas, Theodoros / Bucciarelli-Ducci, Chiara / Ardoin, Stacy / Sfikakis, Petros P / Kolovou, Genovefa / Kitas, George D. ·MD FESC, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece. soma13@otenet.gr. ·Inflamm Allergy Drug Targets · Pubmed #24479835.

ABSTRACT: Rheumatoid arthritis (RA) is a systemic, inflammatory disease with female preponderance, characterized by severe articular and extraarticular manifestations. Cardiovascular (CV) disease in RA usually occurs a decade earlier than age- and sex-matched controls and patients with RA are twice more likely to develop myocardial infarction irrespective of age, history of prior CVD events and traditional CV risk factors. It has been shown that atherosclerotic CV disease in RA shares similarities with CV disease in diabetes mellitus (DM) in terms of clinical presentation and preclinical atherosclerosis. In addition to atherosclerosis, RA also increases risk of non-ischemic heart failure, valvular disease and myopericardial disease. Therefore, RA is considered at least a cardiovascular equivalent to diabetes mellitus. Cardiovascular magnetic resonance (CMR), a non-invasive, nonradiating technique, and due to its capability to perform tissue characterisation, can effectively identify CVdisease acuity and etiology during the course of RA. CMR, by using a combination of function evaluation, oedema-fibrosis detection and stress perfusion-fibrosis imaging can unveil myocarditis, cardiomyopathy, diffuse subendocardial vasculitis, coronary and peripheral artery disease in RA patients, who usually are oligo-asymptomatic. Additionally, CMR is the ideal technique for operator independent, reproducible diagnostic and follow up assessment. However, lack of availability, expertise and high cost still remain serious drawbacks of CMR.

16 Review Burden of disease in treated rheumatoid arthritis patients: going beyond the joint. 2014

Cutolo, Maurizio / Kitas, George D / van Riel, Piet L C M. ·Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa 16132, Italy. Electronic address: mcutolo@unige.it. · Clinical Rheumatology and R&D Director, Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, United Kingdom; and Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK. · Rheumatology, Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. ·Semin Arthritis Rheum · Pubmed #24080116.

ABSTRACT: OBJECTIVE: The disease burden in rheumatoid arthritis (RA) extends beyond the joint. This article evaluates the physical and psychosocial extra-articular burden of treated RA and relationships among diverse disease manifestations. METHODS: MEDLINE searches identified papers published in English from January 2003 to December 2012 that evaluated systemic complications and psychosocial aspects associated with RA. Preference was given to studies with randomized cohorts and large (>100) sample sizes. Of 378 articles identified in the initial search, 118 were selected for inclusion. RESULTS: RA is associated with multiple comorbidities and psychosocial impairments, including cardiovascular disease, osteoporosis, interstitial lung disease, infection, malignancies, fatigue, depression, cognitive dysfunction, reduced work performance, work disability, and decreased health-related quality of life. The etiology of the extra-articular burden may reflect the systemic inflammation and immune system alteration associated with RA, metabolic imbalances and side effects related to treatment, or the influence of comorbidities. Strategies that may help to reduce the extra-articular disease burden include personalized medicine and the potential introduction of treatments with new mechanisms of action. CONCLUSION: Despite improvements in treating joint disease, the extra-articular burden in RA remains substantial, encompassing multiple comorbidities and psychosocial impairments.

17 Review Heart involvement in rheumatoid arthritis: multimodality imaging and the emerging role of cardiac magnetic resonance. 2013

Mavrogeni, Sophie / Dimitroulas, Theodoros / Sfikakis, Petros P / Kitas, George D. ·Onassis Cardiac Surgery Center, 50 Esperou St, 175-61 P.Faliro, Athens, Greece. Electronic address: soma13@otenet.gr. ·Semin Arthritis Rheum · Pubmed #23786873.

ABSTRACT: OBJECTIVES: Patients with rheumatoid arthritis (RA) exhibit a high risk of cardiovascular disease (CVD). CVD in RA can present in many guises, commonly detected at a subclinical level only. METHODS: Modern imaging modalities that allow the noninvasive assessment of myocardial performance and are able to identify cardiac abnormalities in early asymptomatic stages may be useful tools in terms of screening, diagnostic evaluation, and risk stratification in RA. RESULTS: The currently used imaging techniques are echocardiography, single-photon emission computed tomography (SPECT), and cardiac magnetic resonance (CMR). Between them, echocardiography provides information about cardiac function, valves, and perfusion; SPECT provides information about myocardial perfusion and carries a high amount of radiation; and CMR-the most promising imaging modality-evaluates myocardial function, inflammation, microvascular dysfunction, valvular disease, perfusion, and presence of scar. Depending on availability, expertise, and clinical queries, "right technique should be applied for the right patient at the right time." CONCLUSIONS: In this review, we present a short overview of CVD in RA focusing on the clinical implication of multimodality imaging and mainly on the evolving role of CMR in identifying high-risk patients who could benefit from prevention strategies and early specific treatment targeting the heart. Advantages and disadvantages of each imaging technique in the evaluation of RA are discussed.

18 Review Biologic therapies and systemic bone loss in rheumatoid arthritis. 2013

Dimitroulas, Theodoros / Nikas, Spyros N / Trontzas, Panagiotis / Kitas, George D. ·Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK. dimitroul@hotmail.com ·Autoimmun Rev · Pubmed #23542506.

ABSTRACT: Chronic inflammation affects bone metabolism leading to disequilibrium in the rates of bone resorption and repair and subsequently to local and generalized bone loss. Osteoporosis represents an important co-morbidity of rheumatoid arthritis (RA) patients, which exhibit increased fracture risk. Osteoclasts play a pivotal role in the development and progression of bone loss, while resident synovial cells such as T cells, monocytes and synovial fibroblasts have been identified as sources of osteoclast differentiation signals in RA. This process is mainly mediated through the receptor activator of nuclear-kappa B ligand (RANKL) signalling system, which is upregulated by numerous proinflammatory cytokines involved in the pathogenesis of RA. Improved knowledge of the association between cells and cytokines of the immune system and their relationship to bone remodeling has revealed several promising targets for the treatment of inflammatory bone loss in RA. In this respect, initiation of biologic therapies targeting inflammatory cytokines and/or lymphocyte activation has modified RA therapy not only by blocking local and systemic inflammatory cascades but also by providing beneficial effects against bone and joint degradation. In this article we briefly present the modern view of the mechanisms that govern inflammatory bone loss, highlighting the role of cytokine-induced molecular pathways, and discuss in detail the effects of different biologic treatment strategies on bone mass in RA patients.

19 Review Inflammatory arthritis as a novel risk factor for cardiovascular disease. 2012

John, Holly / Kitas, George. ·Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Russells Hall Hospital, Dudley DY1 2HQ, United Kingdom. ·Eur J Intern Med · Pubmed #22841864.

ABSTRACT: Cardiovascular disease (CVD) comorbidity is a significant issue for the inflammatory arthritides (IA). There is a wealth of mortality studies showing increased cardiovascular mortality in rheumatoid arthritis (RA) and the evidence suggests that the same is likely to be true of psoriatic arthritis (PsA) and ankylosing spondylitis (AS). CVD co-morbidity is due to ischaemic pathologies driven by accelerated atherosclerosis and relates to the increased prevalence and clustering of classical risk factors, which may also be affected by treatments for IA, and their interplay with novel risk factors, namely systemic inflammation. Currently we are unable to quantify the contribution that classical and novel risk factors make to an individuals' CVD risk and specific algorithms need to be developed and validated in RA, PsA and AS to facilitate clinical management. Furthermore, large clinical trials are required to assess the effect of lifestyle modifications, primary prevention strategies and effective immunosuppression on hard CVD endpoints. However, in the meantime, a pragmatic approach should be adopted towards CVD risk management. Consensus opinion has generated guidelines for the management of CVD risk in IA and we discuss the importance of assessing each individual for CVD risk and establishing a system for routine risk factor identification alongside a commitment to treat identified risk factors to specific targets.

20 Review Marine n-3 fatty acids for cardiovascular risk reduction and disease control in rheumatoid arthritis: "kill two birds with one stone"? 2012

Rontoyanni, Victoria G / Sfikakis, Petros P / Kitas, George D / Protogerou, Athanase D. ·First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Ag. Thoma, 17, 11527 Athens, Greece. vic.rontoyanni@gmail.com ·Curr Pharm Des · Pubmed #22364137.

ABSTRACT: Rheumatoid arthritis (RA), the most common chronic systemic inflammatory disease leading to joint destruction and disability, is associated with increased cardiovascular mortality. Systemic inflammation and increased burden of traditional cardiovascular risk factors present in RA are currently considered responsible for the accelerated atherosclerosis in these patients. Herein, we highlight a potential double effect of dietary intake of the n-3 long-chain polyunsaturated fatty acids (LCP) eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3) on cardiovascular risk reduction and disease control in patients with RA. Large studies in non-RA populations provide strong evidence for the beneficial effect of n-3 LCP supplementation in primary and secondary cardiovascular prevention. Cardiovascular risk reduction is at least partly explained by n-3 LCP effects on blood pressure, dyslipidemia, thrombosis and inflammation, all important factors also in RA, whereas abnormalities in vascular function and in vascular morphology similar to those observed in RA patients may even be moderately reversed. On the other hand, there is evidence from 6 of 14 randomized controlled trials supporting a favorable effect of n-3 LCP supplementation in decreasing joint inflammation in RA. Although specific studies in RA patients are currently lacking, a double beneficial effect of n-3 LCP seems likely. The size of any such effect and how it compares with other interventions such as lifestyle changes, biologic therapies, and statin therapy, needs to be investigated prospectively in carefully designed studies.

21 Review Vascular function and morphology in rheumatoid arthritis: a systematic review. 2011

Sandoo, Aamer / Veldhuijzen van Zanten, Jet J C S / Metsios, George S / Carroll, Douglas / Kitas, George D. ·Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK. aamer.sandoo@dgh.nhs.uk ·Rheumatology (Oxford) · Pubmed #21926155.

ABSTRACT: OBJECTIVES: RA associates with significantly increased morbidity and mortality from cardiovascular disease (CVD). This may be due to complex interactions between traditional CVD risk factors, systemic rheumatoid inflammation and the vasculature. We reviewed the current literature to answer: (i) whether there is sufficient evidence that patients with RA have altered vascular function and morphology compared with normal controls; (ii) whether there is sufficient evidence to determine if such changes relate predominantly to systemic inflammation; and (iii) whether any changes of vascular function and morphology in RA can be modified with therapy. METHODS: The MEDLINE database was searched to identify publications from 1974 to 1 November 2010 pertaining to vascular function and morphology in RA. The total number of articles included in the present review was 93. This included 57 cross-sectional studies, 27 longitudinal studies without randomization and 9 longitudinal studies with randomization. RESULTS: Vascular function and morphology was impaired in RA relative to healthy controls. The majority of studies reported no associations between systemic inflammation and vascular function. Treatment with anti-inflammatory medication resulted in both transient and long-term improvements in the vasculature, but only a few studies reported associations between change in inflammation and change in vascular function and morphology. CONCLUSION: The link between systemic inflammation and vascular function and morphology is not wholly supported by the available literature. Long-term studies examining specific predictors (including CVD risk factors) on the vasculature in RA are needed.

22 Review Cardiovascular education for people with rheumatoid arthritis: what can existing patient education programmes teach us? 2011

John, Holly / Carroll, Douglas / Kitas, George D. ·Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK. holly.john@dgoh.nhs.uk ·Rheumatology (Oxford) · Pubmed #21743087.

ABSTRACT: Patient education is an integral component of the management of chronic diseases. Education programmes designed for people with RA have historically aimed to improve their arthritis symptoms and outcomes. Novel educational material is required to address significant comorbidities, particularly cardiovascular disease (CVD) associated with RA. We appraise the components of education programmes incorporated in disease management in people with RA and programmes used for CVD prevention in the general population, including their design and delivery, use of behaviour theory, evaluation and long-term efficacy. We then integrate the findings in order to inform the development of educational material specifically addressing CVD in RA. This approach may be useful for other major comorbidities of RA as well as other musculoskeletal conditions.

23 Review Rheumatoid arthritis: is it a coronary heart disease equivalent? 2011

John, Holly / Toms, Tracey E / Kitas, George D. ·Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK. ·Curr Opin Cardiol · Pubmed #21499088.

ABSTRACT: PURPOSE OF REVIEW: This review examines current evidence to address the question whether rheumatoid arthritis (RA) is a coronary heart disease equivalent, similar to type 2 diabetes mellitus (DM2). RECENT FINDINGS: Cross-sectional and longitudinal epidemiological studies show a two-fold higher risk of cardiovascular disease (CVD) in patients with RA, and the magnitude of this increased risk is comparable to the risk associated with DM2. However, the mechanisms responsible for this appear to be different in the two conditions, with RA-related CVD being attributed to 'high-grade' systemic inflammation as well as classical CVD risk factors. Several classical risk factors are affected by RA or its medications, and there are some paradoxical associations between obesity or lipid abnormalities and CVD death in RA. SUMMARY: Management of RA-related CVD is likely to require both aggressive control of inflammation and systematic screening and management of classical CVD risk factors. It remains unknown whether primary prevention strategies applied successfully in DM2 would be equally easy to implement and demonstrate similar benefits in people with RA.

24 Review Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. 2011

Kitas, George D / Gabriel, Sherine E. ·Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Clinical Research Unit, Russells Hall Hospital, Dudley, West Midlands, UK. gd.kitas@dgoh.nhs.uk ·Ann Rheum Dis · Pubmed #21109513.

ABSTRACT: Rheumatoid arthritis is associated with an increased risk for cardiovascular events, such as myocardial infarction and stroke. Epidemiological evidence suggests that classic cardiovascular risk factors, such as hypertension, dyslipidaemia, insulin resistance and body composition alterations are important but not sufficient to explain all of the excess risk. High-grade systemic inflammation and its interplay with classic risk factors may also contribute. Some associations between classic risk factors and cardiovascular risk in people with rheumatoid arthritis appear counterintuitive but may be explained on the basis of biological alterations. More research is necessary to uncover the exact mechanisms responsible for this phenomenon, develop accurate systems used to identify patients at high risk, design and assess prevention strategies specific to this population of patients.

25 Review Obesity in rheumatoid arthritis. 2011

Stavropoulos-Kalinoglou, Antonios / Metsios, Giorgos S / Koutedakis, Yiannis / Kitas, George D. ·Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley DY1 2HQ, UK. a.stavropouloskalinoglou@bham.ac.uk ·Rheumatology (Oxford) · Pubmed #20959355.

ABSTRACT: Obesity is a major threat for public health and its study has attracted significant attention in the general population, predominantly due to its association with significant metabolic and cardiovascular complications. In RA research, BMI is frequently reported as a demographical variable, but obesity, as such, has received little interest. This is surprising, in view of the clear associations of obesity with other arthritides, particularly OA, but also in view of the now-clear association of RA with increased cardiovascular morbidity and mortality. In this review, we summarize the studies that have looked into obesity in the RA population, evaluate their findings, identify knowledge gaps and propose directions for future research. We also pose a question of high clinical and research significance: is the use of BMI still a valid way of assessing obesity in RA?

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