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Patients with RA show increased subclinical atherosclerosis over time
Patients with rheumatoid arthritis were more likely to display symptoms of subclinical atherosclerosis as disease duration increased, and the symptoms were not associated with disease activity, according to researchers in Sweden.
The Swedish Rheumatoid Arthritis Registry was used to identify 71 patients newly diagnosed with rheumatoid arthritis (RA) who were symptomatic for no longer than 12 months and completed follow-up at 5 years (T5); 40 control participants who also completed follow-up and were matched for age and sex were also enrolled.
All patients were examined at study entry (T0) and at 3, 6, 12, 18 months and T5 for 28 swollen and tender joints and the patient’s global assessment. The disease activity score for 28 joints (DAS28) was calculated at each time point, and C-reactive protein levels, the erythrocyte sedimentation rate (ESR) and blood pressure (BP) were measured. The European Systematic Coronary Risk Evaluation (SCORE), BMI and Reynolds Risk Score were calculated at T0 and T5.
Ultrasound was performed using a Siemens 512 system with a 15L8 transducer used to measure the brachial artery and an 8L5 transducer to examine the carotid artery. Image analysis was performed by the same observer.
After 5 years of follow-up, patients with RA had significantly higher carotid intima media thickness (cIMT) and poorer flow-mediated vascular dilation (FMD) than at T0, according to the researchers. Systolic BP increased in both patient and control groups, despite a decrease in disease activity in the patient group. Disease activity was not associated with progression of cIMT, but age, BP, SCORE, Reynold’s Risk Score were associated with cIMT in patients with RA at T0 and T5. At T5, only BMI was associated with cIMT, the researchers found.
Worsening FMD was associated with disease duration and ever-smoking status, as well as age, smoking and other traditional CVD risk factors; however, disease activity was not correlated with FMD. - by Shirley Pulawski
Disclosure: The authors report their research was supported by grants from the Swedish Research Council (grant number K 2007-52X-20307-01-3), the Swedish Rheumatism Association, the Swedish Rheumatism Association in the Västerbotten County, Visare Norr, Norrlandstingens regionförbund (Northern County Councils), the Swedish Heart-Lung Foundation, the King Gustaf V’s 80-Year Fund and the Swedish Society for Medical Research.
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This study, an extension of a 5-year investigation by Södergren and colleagues from Sweden, examined these biomarkers in a cohort of new onset RA (less than 1 year) and matched controls during a 5-year period. Not surprisingly, they found both IMT and FMD correlated with traditional risk factors. Importantly, modeling was palpably enhanced with the addition of measurements of RA disease activity as assessed by the serial DAS28, where the best fitting model which used using traditional risks explained only 30% of the variance of IMT and but increased to 71% when adding on DAS28 measurements. Thus as expected, atherosclerosis is driven by both traditional risks and inflammation. The bottom line is that early and aggressive use of statins makes ever-increasing sense and early and aggressive treatment of RA does as well for both CVD and joint perspectives.