Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty‐Six Years of Prospective Followup

Objective

To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality.

Methods

We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976–2012). Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking.

Results

Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non‐RA comparators. Among current smokers, 40.0% with RA permanently quit smoking in the early RA period, compared to 36.1% of comparators (odds ratio for sustained cessation 1.18 [95% confidence interval (95% CI) 0.88, 1.58]). There were 313 deaths (33.4%) in the RA cohort and 2,042 (22.8%) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95% CI 0.33, 1.01]) and comparison (HR 0.47 [95% CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post‐RA pack‐years (HR 3.67 [95% CI 2.80, 4.81]) than comparators with >5 post‐index pack‐years (HR 1.88 [95% CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever‐smoker non‐RA women with 0 post‐index pack‐years).

Conclusion

Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non‐RA comparators. Smoking >5 pack‐years after RA diagnosis significantly increased mortality beyond the risk of non‐RA comparators.     

Etiology and outcomes of acute kidney disease in children: a cohort study

Clinical and Experimental Nephrology - There is paucity of information regarding the etiology and outcomes of Acute Kidney Disease (AKD) in children. The objectives of this cohort study were to...     

Therapeutic voyage of synthetic and natural xanthine oxidase inhibitors

Xanthine oxidase (XO) inhibitors are commonly used to treat gout, nephropathy, and renal stone diseases related to hyperuricemia. However, recent research has shown that these inhibitors may also have potential benefits in preventing vascular diseases, including those affecting the cerebrovasculature. This is due to emerging evidence suggesting that serum uric acid is involved in the growth of cardiovascular disease, and XO inhibition can reduce oxidative stress in the vasculature. There is a great interest in the development of new XO inhibitors for the treatment of hyperuricemia and gout. The present review discusses the many synthetic and natural XO inhibitors that have been developed which are found to have greater potency.