Re: RESEARCH - Immunosuppressive medications and hospitalization for cardiovascular events in patients with RA

[Guest guest]

UGH! I just typed a reply to you, hit send, and dumped my

response while asking for my password! :-/

I did agree to the TB test study... there really was no down-side.

I just had to answer some questions, get a new TB test (which he

wanted me to have anyway) and get an extra tube of blood drawn while

I was having my regular bloodwork done. Then I just had to call

them a couple of days later to read my TB test results for them.

(negative) My understanding is that this new test is supposed to be

more accurate, and better at picking up cased of latent TB than the

skin test.

As far as getting there is concerned, after having been there once,

I think there is a valet service you can use from the hospital main

entrance, though I have no idea how much it costs, or how long it

takes. I'll have to check it out.

As far as the idea of a wheel chair inside the building is

concerned, I'm not sure if I'm ready for that yet. I still haven't

had the guts to ask for a handicapped placcard, even though I kick

myself every time I have to add that extra distance to the amount of

walking I have to do inside a store. I keep thinking this is

temporary, (not the RA, but the fatigue and pain) and that when we

finally find the right meds, I'll be one of those people in the TV

commercials, hiking in the mountains again. Then I'd feel stupid

with a handicapped placcard!<g>

> >>

> >> Arthritis Rheum. 2006 Nov 29;54(12):3790-3798 [Epub ahead of

print]

> >>

> >>

> >> Immunosuppressive medications and hospitalization for

> > cardiovascular events

> >> in patients with rheumatoid arthritis.

> >>

> >>

> >> DH, Avorn J, Katz JN, Weinblatt ME, Setoguchi S, Levin

R,

> >> Schneeweiss S.

> >>

> >> Brigham and Women's Hospital, Harvard Medical School, Boston,

> > Massachusetts.

> >>

> >> OBJECTIVE: The risk of cardiovascular disease (CVD) is increased

> > in patients

> >> with rheumatoid arthritis (RA), most likely because of increased

> > systemic

> >> inflammation. Prior research suggests that immunosuppressive

> > medications may

> >> reduce the risk of CVD among RA patients. This study was

> > undertaken to

> >> investigate the effects of various immunosuppressive medications

> > on the risk

> >> of cardiovascular events among a group of older patients with

RA.

> > METHODS:

> >> In this nested case-control study, the source cohort was derived

> > from

> >> Medicare beneficiaries receiving a drug benefit from the state

of

> >> Pennsylvania. These individuals were required to have been

> > diagnosed as

> >> having RA on at least 2 visits and to have filled a prescription

> > for an

> >> immunosuppressive agent. Cases were defined as those patients

who

> > were

> >> hospitalized for a cardiovascular event such as myocardial

> > infarction or

> >> stroke, and 10 control subjects were matched to each case by

age,

> > sex, and

> >> calendar year of the index date (the time of the first

> > cardiovascular event

> >> in each case). Current use of an immunosuppressive medication

was

> > defined as

> >> having filled a prescription for these agents within the 90 days

> > prior to

> >> the index date. Multivariate logistic regression models that

> > included

> >> important covariates were assessed to determine the risk of

> > cardiovascular

> >> events associated with immunosuppressive agents and their

> > combinations.

> >> RESULTS: Among the study cohort, we identified 3,501 RA patients

> > who

> >> fulfilled our eligibility criteria. During followup of this

> > cohort, 946

> >> patients were hospitalized for a cardiovascular event. Although

> > the 95%

> >> confidence intervals (95% CIs) were wide in adjusted risk

> > regression models

> >> with methotrexate (MTX) monotherapy as the reference group,

> > biologic

> >> immunosuppressive agents showed neither protective nor

deleterious

> > effects

> >> (with biologics monotherapy, odds ratio [OR] 1.0, 95% CI 0.5-

1.9;

> > with

> >> biologics plus MTX combination therapy, OR 0.8, 95% CI 0.3-2.0;

> > and with

> >> biologics plus other immunosuppressive agents, OR 1.2, 95% CI

0.7-

> > 2.2).

> >> Monotherapy with oral glucocorticoids was associated with an

> > increased risk

> >> of cardiovascular events (OR 1.5, 95% CI 1.1 - 2.1), and a

similar

> > trend in

> >> the direction of risk was seen with glucocorticoid combination

> > therapy (OR

> >> 1.3, 95% CI 0.8-2.0). Cytotoxic immunosuppressive agents other

> > than MTX

> >> (azathioprine, cyclosporine, and leflunomide) were also

associated

> > with an

> >> increased risk of cardiovascular events (with both monotherapy

and

> >> combination treatment, OR 1.8, 95% CI 1.1-3.0).

> >>

> >> CONCLUSION: When compared with RA patients receiving MTX

> > monotherapy, those

> >> receiving biologic immunosuppressive agents had neither an

> > increased nor

> >> decreased risk of experiencing a cardiovascular event, whereas

use

> > of oral

> >> glucocorticoids and cytotoxic immunosuppressive agents was

> > associated with

> >> significant increases in the risk of cardiovascular events.

> >>

> >> PMID: 17136752

> >>

> >> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

> > cmd=Retrieve & db=PubMed & list_uids=17136752

> >>

> >>

> >>

> >>

> >>

> >> Not an MD

> >>

> >> I'll tell you where to go!

> >>

> >> Mayo Clinic in Rochester

> >> http://www.mayoclinic.org/rochester

> >>

> >> s Hopkins Medicine

> >> http://www.hopkinsmedicine.org

> >>

> >

> >

> >

> >

> >