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Toxoplasmosis seroprevalence in rheumatoid arthritis patients: A systematic review and meta-analysis.

ABSTRACT: Toxoplasmosis is a cosmopolitan infection caused by an intracellular obligatory protozoan, Toxoplasma gondii. Infection to this parasite in immunocompetent patients is usually asymptomatic, but today it is believed that the infection can be a risk factor for a variety of diseases, including rheumatoid arthritis (RA). RA is an autoimmune disease and the most common type of inflammatory arthritis that is a major cause of disability. The aim of this systematic review and meta-analysis was to address the association between RA and toxoplasmosis in light of the available research.Based on the keywords, a systematic search of eight databases was conducted to retrieve the relevant English-language articles. Then, the studies were screened based on the inclusion and exclusion criteria. The random effect model was used to calculate the odds ratio (OR) using forest plot with 95% confidence interval (CI).Overall, 4168 Individual, extracted from 9 articles were included for systematic review evaluation, with 1369 RA patients (46% positive toxoplasmosis) and 2799 individuals as controls (21% positive toxoplasmosis). Then, eight articles (10 datasets) were used for meta-analysis (1244 rheumatoid arthritis patients and 2799 controls). By random effect model, the combined OR was 3.30 (95% CI: 2.05 to 5.30) with P < 0.0001.Although toxoplasmosis could be considered as a potential risk factor for rheumatoid arthritis, more and better quality studies are needed to determine the effect of T. gondii infection on induction or exacerbation of RA. Our study was registered at the International Prospective Register of Systematic Reviews (PROSPERO; code: CRD42017069384).

SUBMITTER: Hosseininejad Z

PROVIDER: S-EPMC6003687 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Toxoplasmosis seroprevalence in rheumatoid arthritis patients: A systematic review and meta-analysis.

Hosseininejad Zahra Z Sharif Mehdi M Sarvi Shahabeddin S Amouei Afsaneh A Hosseini Seyed Abdollah SA Nayeri Chegeni Tooran T Anvari Davood D Saberi Reza R Gohardehi Shaban S Mizani Azadeh A Sadeghi Mitra M Daryani Ahmad A

PLoS neglected tropical diseases 20180605 6

<h4>Background</h4>Toxoplasmosis is a cosmopolitan infection caused by an intracellular obligatory protozoan, Toxoplasma gondii. Infection to this parasite in immunocompetent patients is usually asymptomatic, but today it is believed that the infection can be a risk factor for a variety of diseases, including rheumatoid arthritis (RA). RA is an autoimmune disease and the most common type of inflammatory arthritis that is a major cause of disability. The aim of this systematic review and meta-ana ...[more]

PMID: 29870527

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Project description:BackgroundPatients with rheumatoid arthritis (RA) have difficulties maintaining employment due to the impact of the disease on their work ability. This review aims to investigate the employment rates at different stages of disease and to identify predictors of employment among individuals with RA.MethodsThe study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines focusing on studies reporting employment rate in adults with diagnosed RA. The literature review included cross-sectional and cohort studies published in the English language between January 1966 and January 2023 in the PubMed, Embase and Cochrane Library databases. Data encompassing employment rates, study demographics (age, gender, educational level), disease-related parameters (disease activity, disease duration, treatment), occupational factors, and comorbidities were extracted. Quality assessment was performed employing Newcastle-Ottawa Scale. Meta-analysis was conducted to ascertain predictors for employment with odds ratios and confidence intervals, and test for heterogeneity, using chi-square and I2-statistics were calculated. This review was registered with PROSPERO (CRD42020189057).ResultsNinety-one studies, comprising of a total of 101,831 participants, were included in the analyses. The mean age of participants was 51 years and 75.9% were women. Disease duration varied between less than one year to more than 18 years on average. Employment rates were 78.8% (weighted mean, range 45.4-100) at disease onset; 47.0% (range 18.5-100) at study entry, and 40.0% (range 4-88.2) at follow-up. Employment rates showed limited variations across continents and over time. Predictors for sustained employment included younger age, male gender, higher education, low disease activity, shorter disease duration, absence of medical treatment, and the absence of comorbidities. Notably, only some of the studies in this review met the requirements for high quality studies. Both older and newer studies had methodological deficiencies in the study design, analysis, and results reporting.ConclusionsThe findings in this review highlight the prevalence of low employment rates among patients with RA, which increases with prolonged disease duration and higher disease activity. A comprehensive approach combining clinical and social interventions is imperative, particularly in early stages of the disease, to facilitate sustained employment among this patient cohort.

Project description:Purpose: Rheumatoid arthritis (RA) is a pervasive inflammatory autoimmune disease that seriously impairs human health and requires more effective non-pharmacologic treatment approaches. This study aims to systematically review and evaluate the efficacy of yoga for patients with RA. Methods: Medline (through PubMed), Cochrane Library, EMBASE (through SCOPUS), and Web of Science database were screened through for articles published until 20 July 2020. Randomized controlled trials (RCTs) of yoga in patients with RA were included. Outcomes measures were pain, physical function, disease activity, inflammatory cytokines, and grip strength. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Result: Ten trials including 840 patients with RA aged 30-70 years were identified, with 86% female participants. Meta-analysis revealed a statistically significant overall effect in favor of yoga for physical function (HAQ-DI) (5 RCTs; SMD = -0.32, 95% CI -0.58 to -0.05, I 2 = 15%, P = 0.02), disease activity (DAS-28) (4 RCTs; SMD = -0.38, 95% CI -0.71 to -0.06, I 2 = 41%, P = 0.02) and grip strength (2 RCTs; SMD = 1.30, 95% CI 0.47-2.13, I 2 = 63%, P = 0.002). No effects were found for pain, tender joints, swollen joints count or inflammatory cytokines (i.e., CRP, ESR, IL-6, and TNF-α). Summary: The findings of this meta-analysis indicate that yoga may be beneficial for improving physical function, disease activity, and grip strength in patients with RA. However, the balance of evidence showed that yoga had no significant effect in improving pain, tender joints, swollen joints count, and inflammatory cytokines in patients suffering from RA. Considering methodological limitations, small sample size, and low-quality, we draw a very cautious conclusion in the results of the estimate of the effect. High-quality and large-scale RCTs are urgently needed in the future, and the real result may be substantially different.

Project description:BackgroundThe chronic course and recurring acute episodes of rheumatoid arthritis (RA) can significantly affect the psychological and mental health of patients. This study aimed to investigate the prevalence of depression in Chinese patients with rheumatoid arthritis (RA) through a systematic review and meta-analysis.MethodsWe conducted a comprehensive literature search on electronic databases from the inception of the database to April 2023. The inclusion criteria included cross-sectional or case-control studies on depression prevalence with a sample size of at least 50 participants. The data was extracted from the included studies and analyzed to calculate the pooled depression prevalence, along with a 95% confidence interval (CI), using Review Manager 5.3 software (Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).ResultsThirteen studies (n = 29,113) were included, with females accounting for over 50% of all participants. Based on the data pooled from all 13 studies, the observed depression prevalence in Chinese individuals with RA was 37% (95% CI: 28-46%; I2 = 95%; p < 0.0001). A subsequent subgroup analysis was conducted on scale types, age, and gender. Regarding scale types, the depression prevalence was assessed using various scales included the Hospital Anxiety and Depression Scale (HAMD), Hamilton Depression Scale (HADS), Center for Epidemiologic Studies Depression (CES-D) scale, Diagnostic and Statistical Manual of Mental Disorder (fourth edition DSM.IV) diagnostic criteria, and Self-rating Depression Scale (SDS) were 50%, 35%, 58%, 39%, and 41%, respectively. Based on mean age, five studies researched RA individuals <50 years old, establishing a depression prevalence of 48% (95% CI: 32-65%). In contrast, eight studies researched RA individuals ≥50 years old, establishing a depression prevalence of 41% (95% CI: 32-51%). Gender-based analysis indicated a depression prevalence in female RA individuals of 45% (95% CI: 37-55%) and 39% (95% CI: 29-48%) among male RA patients. Depression prevalence established significant correlations with specific scales, including the HAMD scale (odds ratio (OR) 4.93, 95% CI: 1.79-10.2), CES-D scale (OR 2.83, 95% CI: 1.71-4.65), DSM.IV criteria (OR 0.75, 95% CI: 0.38-1.51), and SDS (OR 0.95, 95% CI: 0.32-2.16). Additionally, depression prevalence was associated with age categories (age ≥50: OR 1.25, 95% CI: 0.59-2.70; age <50: OR 1.99, 95% CI: 0.93-3.81), as well as gender (female: OR 1.63, 95% CI: 0.64-4.57; male: OR 1.07, 95% CI: 0.38-3.03), although some associations did not reach statistical significance.ConclusionThe depression prevalence was high in Chinese individuals with RA, especially in females and patients under 50 years old. These findings suggest the need for improving detection and management of depression in RA patients.

Project description:Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient's response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81-0.95; p < 0.01; I2 = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79-0.94; p < 0.01; I2 = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05-1.36; p < 0.01; I2 = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68-1.00; p < 0.01; I2 = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.

Dataset Information

Toxoplasmosis seroprevalence in rheumatoid arthritis patients: A systematic review and meta-analysis.

Publications

Toxoplasmosis seroprevalence in rheumatoid arthritis patients: A systematic review and meta-analysis.

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