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| Allan Gelber, M.D., M.P.H
Abstract 1068 The Effect of Low-dose Glucocorticoid Treatment on Weight in Newly Diagnosed Early Onset Rheumatoid Arthritis Patients The issue of potential weight gain associated with use of steroid therapy is an important concern when beginning steroid medication, particularly to patients. This study, by Henderson et al, specifically assessed the extent of weight change among 18 patients with early diagnosed rheumatoid arthritis, who were assigned in an alternating fashion to receive either steroid (< 10 mg per day) or to an NSAID. Results:After two months of therapy, the patients treated with steroids gained, on average, 0.9 kg compared to a mean loss of 1.8 kg in those receiving an NSAID. The difference, however, in mean percent change in weight was not statistically significant. Nevertheless, these findings in a relatively small number of patients suggest greater weight gain in those receiving steroid therapy. Editorial Comments: It does not appear likely that lack of randomization, in terms of treatment assignment, preclude drawing such an inference from this study. Of note, we do not know on the basis of the abstract, what NSAID drug(s) was used nor which steroid preparation was prescribed. We are also not informed if the patients with early diagnosed rheumatoid arthritis satisfied the American College of Rheumatology criteria for rheumatoid arthritis. Abstract 1201 Vitamin D is Associated With a Lower Risk of Rheumatoid Arthritis in Older Women: Results from the Iowa Womens Health Study There is much interest, particularly in the general population, about the role of nutrition and of vitamin therapy in the development and progression of arthritis. In this report, Merlino et al investigated the risk of developing (incident) rheumatoid arthritis associated with dietary and supplemental intake of vitamin D. The investigator studied 29,369 women, aged 55-69 years in the Iowa Womens Health Study cohort, through 11 years of follow-up. Results: Among this cohort, 152 women developed rheumatoid arthritis. Greater intake of vitamin D was associated with a reduced risk of developing rheumatoid arthritis. Those who consumed the highest levels of vitamin D experienced one-third less risk of developing rheumatoid arthritis. Editorial Comments: Strengths of the study include the validation of rheumatoid arthritis diagnoses against medical record and the prospective design. We are not informed, however, about the follow-up rate among the participants in the Iowa Study nor about what quantities of vitamin D were consumed. In addition, the racial make-up of the cohort may be relatively homogeneous, limiting the generalizability of the findings to other racial groups, as well as to men. Importantly, the analytic results were of borderline statistical significance. Abstract 1662 The Synergistic Impact of Rheumatoid arthritis and Myocardial Infarction on Mortality Over the last decade, an increasing number of reports have linked rheumatoid arthritis to an increased risk of all-cause and cardiovascular mortality. In the present report, Maradit Kremers et al add to this body of reports by examining the combined impact of having both rheumatoid arthritis and a heart attack on risk of mortality. This relationship was examined using the Rochester Epidemiology Project. The mortality of 609 residents of Rochester, Minnesota who developed rheumatoid arthritis was compared to 609 age- and gender-matched residents without rheumatoid arthritis. Results: Whereas rheumatoid arthritis was associated with a 68% increased risk and myocardial infarction with a nearly 5-fold greater risk, having both rheumatoid arthritis and a myocardial infarction led to an 11-fold increase in risk of mortality. Editorial Comments: These data provide a strong quantitative basis to invoke a synergistic relationship between rheumatoid arthritis and myocardial infarction on risk of mortality. Stated differently, the combined risk of rheumatoid arthritis and of a heart attack is greater than the sum of the component parts. However, the mechanism by which this synergy in mortality risk is produced is still undefined. Abstract 1204 Population-Based Study of Methotrexate Use and Risk of Lymphoma in Patients With Rheumatoid Arthritis Several autoimmune rheumatic disorders, including rheumatoid arthritis, are known to be associated with an increase in incidence of lymphoma. What is not known, however, is whether it is rheumatoid arthritis (itself) or therapy for rheumatoid arthritis (such as methotrexate) that contributes to this excess risk. To address this issue, Watterson et al, utilizing a Medicaid administrative database, examined the incidence of lymphoma among 10,700 persons with, in comparison to 557,242 Medicaid enrollees without, rheumatoid arthritis. Results: The analyses revealed no increase in rate of lymphoma between those enrollees with and without rheumatoid arthritis. Editorial Comments: We are not, however, informed about how well the administrative database captured information regarding use of methotrexate medication. Another limitation of the study relates to generalizability. A Medicaid population may, as a result of its socioeconomic composition and other factors, not necessarily be representative of the pattern of methotrexate use or harbor a rheumatoid arthritis and overall lymphoma profile of the general population. Abstract 453 Antibodies against Citrullinated Peptides (CCP) Predict the Development of Rheumatoid Arthritis Prior studies have shown a high specificity association of antibodies against citrullinated peptides with RA. Furthermore, anti-CCP antibodies appear early in disease. In this study, the investigators examined sera from RA patients who had donated blood at least once to the Blood Bank of Sweden. Methods: 83 patients with RA were identified who had donated blood before the diagnosis of RA. Four non-RA controls for each patient were identified and matched for age, gender, time of blood donation and geographic location. Sera were assayed for the presence of anti-CCP antibodies as well as RF (both IgG and IgM). Results: 35% of the RA patients had anti-CCP antibodies before onset of RA symptoms, and 15% had IgG-RF and 23% IgM-RF. The sensitivity and positive predictive value (PPV) for each antibody more than 1 year before symptoms of RA are shown below:
By the time of presentation with symptoms of RA, 72% had anti-CCP antibodies, 48% had IgG-RF and 75% IgM-RF. The longest interval between blood donation to onset of disease with positive anti-CCP antibodies was 9 years. Conclusions: Anti-CCP antibodies and RF (IgM and IgG) antedated onset of RA by several years. The presence of anti-CCP antibodies predicts the development of RA better than IgG/IgM-RF. Editorial Comments: These data indicate that citrullination and anti-CCP autoantibody production are very early processes in RA (at least in some individuals). This might suggest that the process is important in the pathogenesis of disease. However, this point remains controversial. A wide variety of autoantibodies have been identified in RA but their role as cause or epiphenomenon has yet to be clarified.
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