Blessed by disaster?! Rheumatoid arthritis can reduce the risk of breast cancer. A week of wind and clouds.

A week of information, waiting for you to see! Does heart failure prefer young patients with systemic lupus erythematosus? Can rheumatoid arthritis reduce the risk of breast cancer? Air pollution increases the risk of rheumatoid arthritis! Do heart failure prefer young patients with systemic lupus erythematosus? Systemic lupus erythematosus (SLE) is an autoimmune mediated connective tissue disease. Multiple system involvement is its main clinical feature.the damage of systemic lupus erythematosus to cardiovascular system may involve pericardium, myocardium, endocardium, pulmonary artery and coronary artery.therefore, SLE patients have a higher risk of cardiovascular disease.previous studies have shown that the relative risk of heart failure (HF) in young male SLE patients is the highest [65.2 (35.3-120.5) for 20-24 years old], and the overall trend of absolute risk has also increased. Whether male or female, the relative risk of HF decreases with age [1].why is the relative risk of HF increased in young SLE patients? Recently, a study published in the Journal of Semin Arts rheu explored this problem. The study identified the risk factors of HF in children and adults with SLE, and evaluated the association between SLE and HF [2].SLE patients without HF were selected from the US health insurance database (2000-2015) and divided into three groups according to the age of onset: children (5-17 years old), young people (18-24 years old) and adults (25-44 years old).the main outcome of the study was the first HF, which was classified as early onset (6 months) or delayed onset.the study showed that among 1466 children with SLE, 2163 young SLE patients and 19349 adult SLE patients, a total of 523 (2.3%) patients developed HF.incidence rate of early-onset HF in children with SLE and young SLE patients was 50% and 60% respectively, and adult SLE patients were 35%.there was a time-dependent relationship between the diagnosis of myocarditis and valvular disease and early-onset HF, while nephritis and hypertension had a stronger correlation with late-onset HF.black people were independently associated with a 1.5-fold increase in HF risk at any time.according to the researchers, hypertension is a cardiovascular risk factor for SLE patients of all ages, so young SLE patients should also actively control their blood pressure.SLE patients with acute heart disease caused by heart dysfunction is the reason for relatively high incidence rate of HF in early stage.therefore, it is urgent to solve the heterogeneity of HF type and severity in the future, so as to provide basis for patient monitoring.can rheumatoid arthritis reduce the risk of breast cancer? At present, breast cancer is the most common malignant tumor in women.according to the prediction of the American Cancer Association, 42000 women will die of breast cancer in 2019, 82% of them are women over 50 years old, and the median age is 62 years old [3]. According to epidemiological investigation,also shows that rheumatoid arthritis (RA) is prevalent in women, and the incidence rate of 0.5%~1% is around the world. The prevalence rate of male and female rheumatoid arthritis is about 1: 4[4]. to understand the risk of breast cancer in women with RA and the risk of RA in women with a history of breast cancer, Swedish researchers conducted a case-control study, which was recently published in the annals of the rheumatic diseases [5]. in this study, 15921 female patients with newly diagnosed RA from 2006 to 2016 were selected from the Swedish national health care database, and 5 subjects were randomly selected from the general population according to the age, gender and residence of RA patients (a total of 79441). the researchers used Cox regression to assess the relative risk of breast cancer in RA patients, and conditional logistic regression was used to assess the relative risk of RA in women with a history of breast cancer. the results showed that RA patients had a lower risk of breast cancer (HR = 0.80, 95% CI 0.68-0.93), and the association was not weakened after adjusting for breast cancer risk factors; the risk of RA in women with a history of breast cancer was also reduced (or = 0.87, 95% CI 0.79-0.95). in addition, there was no increased risk of RA in breast cancer patients treated with tamoxifen (or = 0.86, 95% CI 0.62-1.20) or aromatase inhibitors (or = 0.97, 95% CI 0.69-1.37). the researchers said that the risk of breast cancer in patients with RA was lower, and the risk of RA in patients with breast cancer was also reduced. This correlation cannot be explained for the time being. in addition, anti hormone therapy to prevent recurrence of breast cancer does not seem to increase the risk of RA. air pollution can increase the disease risk of rheumatoid arthritis. Air pollution is one of the high risk factors of global disease burden. in 2016, the World Health Organization (who) released air pollution: global assessment of exposure and disease burden, according to which 92% of the world's population lives in areas where air quality exceeds who limits. air pollution has caused a heavy cost to human beings. Every year, about 3 million deaths are related to exposure to outdoor air pollution, of which about 87% occur in low - and middle-income countries. the harm of air pollution to human body is self-evident. Is it related to RA? There has always been controversy. in order to clarify the relationship between air pollution and RA, Chinese scholars conducted a systematic evaluation and meta-analysis, which was recently published in the Journal of Semin arthritis rheu [6]. the researchers searched databases such as PubMed, EMBASE and web of Science (last retrieved, 21 may 2019) for meta-analysis using a random effects model and representing the combined effects with relative risks (RRs). after screening, eight studies were identified from 1296 studies. the results showed that the pooled RR of the association between ozone (O3) exposure and RA was 1.16 (95% CI 1.15-1.18). the pooled RR of the association between RA risk and proximity to the highway was 1.34 (95% CI 1.11-1.62) for those who lived less than 50m away from the highway. on the contrary, PM2.5 exposure was associated with RA. Subgroup analysis of serum positive RA showed similar results for PM10. in addition, there is no clear evidence between PM10, Co, NO2 and NO2 (10 years ago) exposure and increased RA risk. the researchers indicated that there was a significant correlation between RA and some indicators of air pollution (O3, proximity to roads and PM2.5). in order to make the evidence generalizable, the research should be extended to developing countries with serious air pollution (including indoor) in order to understand the risk factors of RA more comprehensively. References: [1] Kim ch, Al Kindi SG, jandali B, et al incidence and risk of heart failure in systemic lupus erythematosus heart 2017; [2] Joyce c.chang. A population based study of risk factors for heart failure in pediatric and adult onset systemic lupus erythematosus. Semin arthritis rheu. May 2020. [3] Zhou Xingtong, Shen Songjie, sun Qiang. Current status and progress of breast cancer screening in China [J]. Chinese Journal of medical frontier (Electronic Edition), 2020, Chinese Journal of internal medicine, 2018,57 (4): 242-251. [5] wadstr ü m h, Pettersson a, Smedby Ke, et al risk of breast cancer before and after rheumatoid arthritis, and the impact of hormonal factors.Annals of the Rheumatic Diseases 2020; 79:581-586.[6]Dongsheng Di. Long-term exposure to outdoor air pollution and the risk of development of rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheu. April 2020.