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2. Use of thiazolidinediones and the risk of elective hip or knee replacement: a population based case-control study

Author

Nielen, Johannes T H, de Vries, Frank, Dagnelie, Pieter C, van den Bemt, Bartholomeus J F, Emans, Pieter J, Lalmohamed, Arief, de Boer, Anthonius, Boonen, Annelies E R C H, Sub Gen. Pharmacoepi and Clinical Pharm, Sub Pharmacotherapy, Theoretical, and Pharmacoepidemiology and Clinical Pharmacology

Subjects
osteoarthritis, diabetes mellitus, Taverne, arthroplasty, glitazones, thiazolidinediones
Abstract

BACKGROUND: Osteoarthritis (OA) is the most common musculoskeletal condition in the elderly population. However, no disease modifying drug exists for this disease. In vivo animal studies have suggested that thiazolidinediones (TZD) may be used as disease modifying osteoarthritis drugs (DMOADs). To our knowledge, this has not yet been examined in humans before. OBJECTIVE: To determine the risk of total joint replacement (TJR) in patients using TZDs compared to diabetic patients using other antidiabetic drugs. METHODS: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years of age who had undergone total knee (TKR) or hip replacement (THR) between 2000 and 2012. Controls were matched by age, gender and practice/surgery. Conditional logistic regression analyses were used to estimate the risk of TKR and THR with the use of TZDs in patients currently using one or more antidiabetic drugs. In order to determine effect with prolonged use, we also stratified TZD users by total number of prescriptions prior to surgery. We statistically adjusted our analyses for lifestyle factory, comorbidities and concomitant drug use. RESULTS: There was no difference in risk of TKR (OR = 1.09 (95% CI = 0.93-1.27)) and THR (OR = 0.92 (95% CI = 0.76-1.10)) when TZD users are compared to other AD users. Furthermore, we did not find an association with prolonged use of TZDs and TJR. CONCLUSION: Despite promising results from animal in vivo studies, this study did not find any evidence for a disease modifying osteoarthritic effect of TZDs.

Published
2016

3. Safety and efficacy of new oral anticoagulants and low-molecular-weight heparins compared with aspirin in patients undergoing total knee and hip replacements

Author

Nielen, Johannes T H, Dagnelie, Pieter C, Emans, Pieter J, Veldhorst-Janssen, Nicole, Lalmohamed, Arief, van Staa, Tjeerd-Pieter, Boonen, Annelies E R C H, van den Bemt, Bart J F, de Vries, Frank, Sub Pharmacotherapy, Theoretical, Sub Pharmacoepidemiology, Sub Gen. Pharmacoepi and Clinical Pharm, Pharmacoepidemiology and Clinical Pharmacology, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Farmacologie en Toxicologie, MUMC+: DA KFT Medische Staf (9), RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, MUMC+: MA Orthopedie (9), Orthopedie, MUMC+: MA Reumatologie (9), Interne Geneeskunde, Sub Pharmacotherapy, Theoretical, Sub Pharmacoepidemiology, Sub Gen. Pharmacoepi and Clinical Pharm, and Pharmacoepidemiology and Clinical Pharmacology

Subjects
Male, pharmacoepidemiology, Arthroplasty, Replacement, Hip, new oral anticoagulants, Administration, Oral, Cohort Studies, 0302 clinical medicine, low-molecular-weight heparins, Hip replacement, Epidemiology, Taverne, Pharmacology (medical), 030212 general & internal medicine, Arthroplasty, Replacement, Knee, Aged, 80 and over, 030222 orthopedics, Aspirin, education.field_of_study, Middle Aged, Pharmacoepidemiology, Female, epidemiology, Gastrointestinal Hemorrhage, medicine.drug, Risk, medicine.medical_specialty, aspirin, Population, venous thromboembolism, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, medicine, Journal Article, Humans, Comparative Study, Medical prescription, education, Aged, Proportional Hazards Models, Retrospective Studies, business.industry, Anticoagulants, Retrospective cohort study, Heparin, Low-Molecular-Weight, Concomitant drug, mortality, Surgery, GI bleeding, business, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

BACKGROUND: There has been much debate recently on the best type of thromboprophylaxis following elective total joint replacement surgery.OBJECTIVE: This study aims to compare rates of venous thromboembolism (VTE), gastro-intestinal (GI) bleeding and mortality events, with use of new oral anticoagulants (NOAC) or low-molecular-weight heparins (LMWHs) compared with aspirin in patients undergoing total joint replacement.METHODS: A population-based retrospective cohort study was performed using the Clinical Practice Research Datalink. Patients ≥18 years of age who had undergone total knee (n = 3261) or hip replacement (THR (n = 4016)) between 2008 and 2012 were included. Within this population, three cohorts were selected, based on their first prescription within the 35-day period after surgery: use of NOACs only, LMWHs only and aspirin only. Incidence rates were calculated, and Cox proportional hazard models were fitted to estimate the risk of VTE, GI bleeding and all-cause mortality with the use of NOACs and LMWHs compared with aspirin use after total knee replacement and THR. We statistically adjusted our analyses for lifestyle factors, comorbidities and concomitant drug use.RESULTS: Total knee replacement and THR patients currently on LMWHs had higher risk of VTE (HR = 17.2 (6.9-43.0) and HR = 39.5 (18.0-87.0), respectively), GI bleeding (HR = 20.9 (1.9-232.3) and HR = 2.0 (0.2-17.2), respectively) and all-cause mortality (HR = 4.3 (1.7-12.4) and HR = 4.0 (2.4-6.7), respectively). NOAC use was associated with an increased risk of GI bleeding in patients undergoing THR surgery.CONCLUSIONS: In contrast to previous studies, we found an increased risk of VTE, GI bleeding and all-cause mortality with the use of LMWHs compared with aspirin. Risk of GI bleeding was increased with the use of NOACs compared with aspirin use after THR surgery. Copyright © 2016 John Wiley & Sons, Ltd.

Published
2016
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5. Use of thiazolidinediones and the risk of elective hip or knee replacement: a population based case–control study

Author

Nielen, Johannes T H, de Vries, Frank, Dagnelie, Pieter C, van den Bemt, Bartholomeus J F, Emans, Pieter J, Lalmohamed, Arief, de Boer, Anthonius, Boonen, Annelies E R C H, Sub Gen. Pharmacoepi and Clinical Pharm, Sub Pharmacotherapy, Theoretical, and Pharmacoepidemiology and Clinical Pharmacology

Subjects
Male, Pharmacoepidemiology, Arthroplasty, Replacement, Hip, Osteoarthritis, Knee, Osteoarthritis, Hip, osteoarthritis, Logistic Models, Treatment Outcome, Elective Surgical Procedures, Case-Control Studies, diabetes mellitus, Taverne, Diabetes Mellitus, arthroplasty, Humans, Hypoglycemic Agents, glitazones, Female, Thiazolidinediones, Arthroplasty, Replacement, Knee, thiazolidinediones, Aged
Abstract

BACKGROUND: Osteoarthritis (OA) is the most common musculoskeletal condition in the elderly population. However, no disease modifying drug exists for this disease. In vivo animal studies have suggested that thiazolidinediones (TZD) may be used as disease modifying osteoarthritis drugs (DMOADs). To our knowledge, this has not yet been examined in humans before. OBJECTIVE: To determine the risk of total joint replacement (TJR) in patients using TZDs compared to diabetic patients using other antidiabetic drugs. METHODS: A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years of age who had undergone total knee (TKR) or hip replacement (THR) between 2000 and 2012. Controls were matched by age, gender and practice/surgery. Conditional logistic regression analyses were used to estimate the risk of TKR and THR with the use of TZDs in patients currently using one or more antidiabetic drugs. In order to determine effect with prolonged use, we also stratified TZD users by total number of prescriptions prior to surgery. We statistically adjusted our analyses for lifestyle factory, comorbidities and concomitant drug use. RESULTS: There was no difference in risk of TKR (OR = 1.09 (95% CI = 0.93-1.27)) and THR (OR = 0.92 (95% CI = 0.76-1.10)) when TZD users are compared to other AD users. Furthermore, we did not find an association with prolonged use of TZDs and TJR. CONCLUSION: Despite promising results from animal in vivo studies, this study did not find any evidence for a disease modifying osteoarthritic effect of TZDs.

Published
2015

6. Work outcome in yet undiagnosed patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis; results of a cross-sectional study among patients with chronic low back pain

Author

van Hoeven, Lonneke, Boonen, Annelies E R C H, Hazes, Johanna M W, Weel, Angelique E A M, van Hoeven, Lonneke, Boonen, Annelies E R C H, Hazes, Johanna M W, and Weel, Angelique E A M

Abstract

BACKGROUND: To understand the impact of yet undiagnosed non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) on work outcomes in a cohort of patients with long-lasting chronic low back pain (CLBP).METHODS: Data were used from a primary care CLBP cohort that was established to understand the prevalence of nr-axSpA and AS. Clinical characteristics comprised measures of back pain (visual analogue scale), inflammation (C-reactive protein) and physical functioning (Roland Morris Disability Questionnaire (RMDQ)). Worker outcomes comprised a question on employment and the Work Productivity and Activity Impairment (WPAI) questionnaire, distinguishing absenteeism, presenteeism, and overall work impairment in those employed and activity impairment in all patients. For each disease subgroup, employment ratio compared to the general population was assessed by indirect standardization. Factors associated with work productivity were explored by zero inflated negative binomial (ZINB) regression models.RESULTS: Patients with CLBP (n = 579) were included (41% male, mean age 36 years), of whom 71 (12%) were identified as having nr-axSpA and 24 (4%) as having AS. The standardized employment ratios were 0.89 (95% CI 0.84-0.94), 0.97 (95% CI 0.85-1.09) and 0.81 (95% CI 0.56-1.06) for patients with CLBP, nr-axSpA and AS, respectively. Scores for the WPAI subdomains were not significantly different between patients with CLBP, nr-axSpA or AS. The ZINB models showed significant associations between visual analog scale (VAS) score for pain and RMDQ and work productivity.CONCLUSION: The impact of yet undiagnosed nr-axSpA and AS on patients' work outcomes was substantial but was not significantly different from those of patients with long-standing CLBP. Variables significantly associated with reduced work productivity were VAS for pain and RMDQ score.

Published
2017

7. Use of thiazolidinediones and the risk of elective hip or knee replacement: a population based case-control study

Author

Sub Gen. Pharmacoepi and Clinical Pharm, Sub Pharmacotherapy, Theoretical, Pharmacoepidemiology and Clinical Pharmacology, Nielen, Johannes T H, de Vries, Frank, Dagnelie, Pieter C, van den Bemt, Bartholomeus J F, Emans, Pieter J, Lalmohamed, Arief, de Boer, Anthonius, Boonen, Annelies E R C H, Sub Gen. Pharmacoepi and Clinical Pharm, Sub Pharmacotherapy, Theoretical, Pharmacoepidemiology and Clinical Pharmacology, Nielen, Johannes T H, de Vries, Frank, Dagnelie, Pieter C, van den Bemt, Bartholomeus J F, Emans, Pieter J, Lalmohamed, Arief, de Boer, Anthonius, and Boonen, Annelies E R C H

Published
2016

8. Safety and efficacy of new oral anticoagulants and low-molecular-weight heparins compared with aspirin in patients undergoing total knee and hip replacements

Author

Sub Pharmacotherapy, Theoretical, Sub Pharmacoepidemiology, Sub Gen. Pharmacoepi and Clinical Pharm, Pharmacoepidemiology and Clinical Pharmacology, Nielen, Johannes T H, Dagnelie, Pieter C, Emans, Pieter J, Veldhorst-Janssen, Nicole, Lalmohamed, Arief, van Staa, Tjeerd-Pieter, Boonen, Annelies E R C H, van den Bemt, Bart J F, de Vries, Frank, Sub Pharmacotherapy, Theoretical, Sub Pharmacoepidemiology, Sub Gen. Pharmacoepi and Clinical Pharm, Pharmacoepidemiology and Clinical Pharmacology, Nielen, Johannes T H, Dagnelie, Pieter C, Emans, Pieter J, Veldhorst-Janssen, Nicole, Lalmohamed, Arief, van Staa, Tjeerd-Pieter, Boonen, Annelies E R C H, van den Bemt, Bart J F, and de Vries, Frank

Published
2016

9. Safety and efficacy of new oral anticoagulants and low-molecular-weight heparins compared with aspirin in patients undergoing total knee and hip replacements

Author

Apotheek Opleiding, Nielen, Johannes T H, Dagnelie, Pieter C, Emans, Pieter J, Veldhorst-Janssen, Nicole, Lalmohamed, Arief, van Staa, Tjeerd-Pieter, Boonen, Annelies E R C H, van den Bemt, Bart J F, de Vries, Frank, Apotheek Opleiding, Nielen, Johannes T H, Dagnelie, Pieter C, Emans, Pieter J, Veldhorst-Janssen, Nicole, Lalmohamed, Arief, van Staa, Tjeerd-Pieter, Boonen, Annelies E R C H, van den Bemt, Bart J F, and de Vries, Frank

Published
2016

10. Neuropathic-like pain symptoms in inflammatory hand osteoarthritis lower quality of life and may not decrease under prednisolone treatment.

Author

van der Meulen C, van de Stadt LA, Kroon FPB, Kortekaas MC, Boonen AERCH, Böhringer S, Niesters M, Reijnierse M, Rosendaal FR, Riyazi N, Starmans-Kool M, Turkstra F, van Zeben J, Allaart CF, and Kloppenburg M

Subjects
Female, Humans, Male, Middle Aged, Pain complications, Pain etiology, Pain Measurement, Prednisolone therapeutic use, Quality of Life, Osteoarthritis, Knee complications, Peripheral Nervous System Diseases
Abstract

Background: Pain is common in hand osteoarthritis (OA) and multiple types may occur. We investigated the prevalence, associated patient characteristics, influence on health-related quality of life (HR-QoL) and response to anti-inflammatory treatment of neuropathic-like pain in inflammatory hand OA., Methods: Data were analysed from a 6-week, randomized, double-blind, placebo-controlled trial investigating prednisolone treatment in 92 patients with painful inflammatory hand OA. Neuropathic-like pain was measured with the painDETECT questionnaire. Associations between baseline characteristics and baseline neuropathic-like pain were analysed with ordinal logistic regression, association of baseline neuropathic-like pain symptoms with baseline HR-QoL with linear regression, painDETECT and visual analogue scale (VAS) change from baseline to week 6 and interaction of painDETECT with prednisolone efficacy on VAS pain change from baseline to week 6 with generalized estimating equations (GEE)., Results: Of 91 patients (79% female, mean age 64) with complete painDETECT data at baseline, 53% were unlikely to have neuropathic-like pain, 31% were indeterminate and 16% were likely to have neuropathic-like pain. Neuropathic-like pain was associated with female sex, less radiographic damage and more comorbidities. Patients with neuropathic-like pain had lower HR-QoL (PCS-6.5 [95% CI -10.4 to -2.6]) than those without. Neuropathic-like pain symptoms remained under prednisolone treatment and no interaction was seen between painDETECT and prednisolone efficacy on VAS pain., Conclusions: In this study, 16% of inflammatory hand OA patients had neuropathic-like pain. They were more often female, had more comorbidities and had lower QoL than those without. Neuropathic-like pain symptoms remained despite prednisolone treatment and did not seem to affect the outcome of prednisolone treatment., Significance: Pain is the dominant symptom in hand OA, with an unclear aetiology. In this study, we found that neuropathic-like pain may play a role in hand OA, that it showed associations with female sex, younger age and more comorbidities and that it lowered health-related quality of life in hand OA. Neuropathic-like pain in hand OA seems resistant to prednisolone therapy but did not seem to interfere with the treatment of inflammatory pain with prednisolone., (© 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.)

Published
2022
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11. Geriatric syndromes in patients with rheumatoid arthritis: a literature overview.

Author

Cleutjens FAHM, Boonen AERCH, and van Onna MGB

Subjects
Aged, Aged, 80 and over, Cognition Disorders etiology, Comorbidity, Depression etiology, Disease Management, Humans, Incidence, Malnutrition etiology, Prevalence, Syndrome, Urinary Incontinence etiology, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid psychology
Abstract

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease of unknown aetiology which principally affects the small joints of the hands and feet. The incidence of RA increases with age and peaks within the age range of 70 to 79 years. In the ageing population, therefore, it is expected that the number of patients with RA will grow proportionally and more patients will have comorbidities but also so-called geriatric syndromes (GS). GS are clinical and multifactorial conditions in older persons that are associated with poor health outcomes, do not fit into disease categories (comorbidities) and require a multidimensional treatment approach. Patients suffering from RA may be at increased risk for GS. Therefore, it is important that rheumatologists are knowledgeable about the constructs represented by GS, understand the main risk factors, and gain insight in how to recognise these syndromes. Limited awareness of the (risk for) GS in patients with RA among rheumatologists may lead to ineffective management of RA. Our objective was to provide a comprehensive overview about the prevalence, aetiologic factors and health consequences of the most important GS in patients with RA.

Published
2019

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