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Medscape
a day ago
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- Medscape
Multiple Chronic Conditions Tied to Poor Prognosis in RA
TOPLINE: In patients with rheumatoid arthritis (RA), the presence of multiple chronic conditions was associated with an increased likelihood of disease flare and reduced odds of achieving remission. METHODOLOGY: Researchers conducted a retrospective, population-based study to investigate how multiple chronic conditions and adverse social determinants of health influence disease activity in patients with RA. They analyzed the data of 659 patients with incident RA diagnosed between January 1999 and December 2014 (median age, 55.3 years; 69.7% women); each participant was required to have complete medical history of at least 1 year. A list of 55 chronic medical conditions was used to identify multimorbidity (two or more conditions) and substantial multimorbidity (five or more conditions); the burden of adverse social determinants of health was assessed using the Area Deprivation Index and Social Vulnerability Index, considering factors such as socioeconomic status, housing quality, and education, among others. Flare was identified as a worsening of disease requiring initiation, change, or escalation of treatment; remission was identified as having no more than one tender or swollen joint and normal inflammatory markers The patients were followed for a median duration of 10.3 years and had a median number of 13 RA-related visits during the follow-up period. TAKEAWAY: Among the participants, 73.3% of patients had multimorbidity and 36.1% had substantial multimorbidity. Patients with multimorbidity had 29% higher odds of an RA-related visit for disease flare and those with substantial multimorbidity had 26% higher odds (P < .05 for both); multimorbidity and substantial multimorbidity were also associated with significantly lower odds of a visit due to remission (odds ratios, 0.66 and 0.67, respectively; P < .05 for both). Each 0.1 increase in the Social Vulnerability Index above 0.3 was associated with 8% lower odds of achieving remission (P < .05). Female sex, current smoking, younger age, and shorter disease duration were associated with higher odds of a flare visit; on the contrary, male sex, never smoking, and longer disease duration were associated with higher odds of a remission visit. Seropositivity showed no significant association with either outcome. IN PRACTICE: 'Multimorbidity shows potential to act as a prognostic factor for RA disease activity and can be readily adapted to real-world clinical settings. Increased attention to multimorbidity would help identify patients at risk of poor disease control, signaling to clinicians to consider more aggressive intervention early on,' the authors of the study wrote. SOURCE: This study was led by Daniel Montes, MD, Mayo Clinic, Rochester, Minnesota. It was published online on August 5, 2025, in RMD Open. LIMITATIONS: This retrospective study relied on diagnostic codes for identifying comorbidities. The use of disease-modifying antirheumatic drugs could not be accounted for. The study population was predominantly White (88%), limiting generalizability. DISCLOSURES: This study was supported by grants from the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and National Institute on Aging. One author reported receiving intellectual property/patents from Girhilet, NLC Health Ventures, and Remission Medical and grant/research support from Pfizer. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
05-08-2025
- Health
- Medscape
Cushing Syndrome Leaves Lasting Health Effects
TOPLINE: Compared with a matched population-based control group, patients with Cushing syndrome continued to exhibit elevated systolic and diastolic blood pressures along with reduced kidney function at least 14 years after biochemical remission. METHODOLOGY: Researchers in Germany conducted a retrospective cohort study to assess the long-term trajectory of blood pressure and kidney function in patients who achieved remission of Cushing syndrome. They included 81 patients with Cushing syndrome (median age at baseline, 44 years; 75.3% women) and compared them with 243 matched control individuals from a population-based cohort. Data were collected before treatment at baseline and at median follow-up intervals of 7.1 and 14 years after biochemical remission, with assessments of blood pressure, glomerular filtration rate, the prevalence of chronic kidney disease, and the use of antihypertensives. TAKEAWAY: Patients with Cushing syndrome had a significant reduction in blood pressure and required fewer antihypertensives at both 7 and 14 years vs baseline. However, when compared with the control group, patients with Cushing syndrome had significantly elevated systolic and diastolic pressures at baseline and 7 and 14 years post-remission (P ≤ .0002 for all). Although the proportion of patients on antihypertensive medications decreased in the Cushing syndrome group after remission was achieved, the prevalence of uncontrolled hypertension remained higher than in the control group at all follow-up points. In fact, reducing the use of these medications was associated with an increased risk for uncontrolled hypertension. Kidney function assessed via glomerular filtration rate remained consistently lower among patients with Cushing syndrome than among control individuals at baseline and 7 and 14 years post-remission (P = .005, P < .0001, and P = .0359, respectively). IN PRACTICE: "Our findings provide further evidence that cardiovascular effects of hypercortisolism are not entirely reversible with the normalization of cortisol levels and enhance our understanding of the deteriorative long-term cardiovascular consequences of chronic hypercortisolism," the authors wrote. SOURCE: This study was led by Katrin Ritzel, Ludwig-Maximilians-Universität München (LMU Munich), LMU University Hospital in Munich, Germany. It was published online on July 29, 2025, in Journal of Endocrinological Investigation. LIMITATIONS: The retrospective design and single-centre nature of this study could have been considered limitations. DISCLOSURES: This study was supported by Else Kröner-Fresenius Stiftung. Some authors reported being supported by Deutsche Forschungsgemeinschaft, the Munich Clinician Scientist Program, the Clinician Scientist Programme on Rare Important Syndromes in Endocrinology, and other sources. All authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
14-05-2025
- Health
- Medscape
Study Links Pre-COVID Lung Health to Severe COVID-19 Risk
In a large US cohort study, pre-pandemic severe obstructive lung function, as measured by spirometry, was linked to more than a twofold increased risk for severe COVID-19. METHODOLOGY: Researchers analyzed the association of pre-pandemic measures of lung function and structure with the risk for severe COVID-19 using data from 11 prospective US population-based cohorts. Overall, 29,323 participants (mean age, 67.1 years) with valid pre-pandemic lung function and incident COVID-19 data were followed up for a median of 17.3 months from March 1, 2020. Pre-pandemic spirometry data were used to classify lung function: Normal physiology (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio ≥ 0.70 and FVC ≥ 80% of the predicted value). Obstructive physiology (FEV1/FVC ratio < 0.70) and severe obstruction (FEV1 < 50% of the predicted value). Restrictive physiology (FEV1/FVC ratio ≥ 0.70 and FVC < 80% of the predicted value). Structural abnormalities, including emphysema and interstitial lung abnormalities such as lung distortion, honeycombing, traction bronchiectasis, nonemphysematous cysts, and ground-glass or reticular opacities, were assessed on CT scans. The primary outcome was severe COVID-19 (COVID-19 leading to hospitalization or death), and the secondary outcome was nonsevere COVID-19 (SARS-CoV-2 infection not requiring hospitalization). TAKEAWAY: Severe obstructive physiology and restrictive physiology were associated with an increased risk for severe COVID-19 compared with normal spirometry, with adjusted hazard ratios (aHRs) of 2.11 (95% CI, 1.36-3.27) and 1.40 (95% CI, 1.12-1.76), respectively. The risk for severe COVID-19 was 1.64-fold higher risk among those in the highest quartile than among those in the lowest quartile of percent emphysema (95% CI, 1.03-2.61). Higher pre-pandemic FEV1 and FVC levels and being in the highest quartile of percent high attenuation areas (indicative of interstitial lung disease) were associated with an increased risk for nonsevere COVID-19. COVID-19 vaccination was associated with a reduced risk for severe disease across all lung function and structure categories (aHR, 0.19-0.50; P for interaction > .30). IN PRACTICE: 'These findings support enhanced COVID-19 risk mitigation, including COVID-19 vaccination, for individuals with impaired lung health,' the authors wrote. SOURCE: This study was led by Pallavi P. Balte, MBBS, PhD, Division of General Medicine, Columbia University Irving Medical Center, New York City. It was published online on April 16, 2025, in American Journal of Respiratory and Critical Care Medicine . LIMITATIONS: This study primarily collected data during the pre-Omicron period, limiting the generalizability of the findings to current variants. Additionally, some cohort studies recruited participants who were healthier than average, while others oversampled individuals with disease, affecting population representativeness. DISCLOSURES: This study was supported by a grant from the National Heart, Lung, and Blood Institute; reported receiving co-funding from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging; and reported receiving additional funding from the American Lung Association. Six authors reported having financial ties with various pharmaceutical companies and research organizations.
