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      Renal dysfunction among rheumatoid arthritis patients: A retrospective cohort study

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          Abstract

          Background

          Rheumatoid arthritis (RA) is a common rheumatological disease which can involve a variety of different renal manifestations. This may be explained by disease effect itself or by medications used for treatment that may lead to renal dysfunction and its complications.

          We aimed to identify the prevalence and factors that played a role in renal dysfunction among RA Jordanian patients.

          Method

          285 patients with RA visiting outpatient clinic between March 2016 and March 2017 were included in a retrospective study design. Age, gender, comorbidities, duration of the disease, medications and laboratory results were gathered and scoring of RA activity was done.

          Results

          Data gathered from the 285 patients showed a female predominance with 88.4% female and 11.6% male. The average disease duration was 6.7 years. Age, DM, HTN, and serum CRP were associated with worse renal function on univariate analysis. 44 patients (18.8%) presented with microscopic hematuria, 16 (6.9%) with proteinuria and only 5 (2.1%) patients presented with both microscopic hematuria and proteinuria. Patients with eGFR <60 ml/min had longer disease duration with a mean of 11 years (±7.7) in comparison to 6.4 years (±6.1) for those with eGFR>90 ml/min (P = 0.001).

          Conclusion

          Renal dysfunction is not common in RA Jordanian population and has variable presentations. Age and the duration of illness play a major role in the progression of CKD if present. Future prospective studies evaluating renal biopsies in RA patients are needed.

          Highlights

          • First study in the country to discuss the prevalence of renal involvement in rheumatoid arthritis.

          • Renal involvement is rare in rheumatoid arthritis patients.

          • Different drugs can affect renal outcome in a different ways.

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          Most cited references35

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          2018 ESC/ESH Guidelines for the management of arterial hypertension

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            The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

            The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
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              STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery

              The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                Elsevier
                2049-0801
                04 November 2020
                December 2020
                04 November 2020
                : 60
                : 280-284
                Affiliations
                [a ]Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan
                [b ]Division of Rheumatology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan
                [c ]Division of Nephrology, Department of Medicine, The University of Jordan, Amman, Jordan
                [d ]Division of Rheumatology, Department of Medicine, The University of Jordan, Amman, Jordan
                [e ]Department of Medicine, University of Missouri, Kansas City, MO, USA
                [f ]Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
                Author notes
                []Corresponding author. aooweis@ 123456just.edu.jo
                Article
                S2049-0801(20)30438-6
                10.1016/j.amsu.2020.11.011
                7649584
                33204418
                1cbcf34e-23b8-4f95-bee6-e83a694115ab
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 27 September 2020
                : 1 November 2020
                Categories
                Original Research

                rheumatoid arthritis,renal involvement,drugs,proteinuria,hematuria

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