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RA disease remission linked to reduced risk for CV outcomes
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Achieving remission in rheumatoid arthritis was associated with an 80% decrease in atherosclerosis incidence, according to findings presented at the EULAR Annual Congress.
“Our study supports the idea that systemic inflammatory processes and more traditional cardiovascular risk factors work together to increase the cardiovascular risk in patients with rheumatoid arthritis,” Piero Ruscitti, MD, of the University of L’Aquila, in Italy, said in a press release.
Ruscitti and colleagues assessed prognostic factors and incidence rates of clinical and subclinical atherosclerosis in a cohort of 795 patients from the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort.
The prospective, observational study included 3 years of follow-up. Participants had a median duration of RA of 8.35 years (range 0.1-35 years). In terms of traditional risk factors for cardiovascular disease, one-third of the cohort was smokers, while almost half had high blood pressure and 12% had type 2 diabetes. The BMI was 27.21 ± 4.05. The sustained remission rate was 42.6%.
Subclinical atherosclerosis incidence increased from 70 to 130 patients from the beginning of the study to the end of follow-up (P < .0001). A similar outcome was reported for clinical atherosclerosis, 30 vs. 46 patients (P < .001).
Multivariable analysis results showed associations between subclinical atherosclerosis and type 2 diabetes (OR = 4.5; P = .002), high blood pressure (OR = 2.03; P = .042), anti-citrullinated protein antibodies (OR = 2.36; P = .002), and mean values of C-reactive protein (OR = 1.07; P = .04). However, maintaining remission reduced the incidence of subclinical atherosclerosis by three-quarters (OR = 0.25; P = .001).
Looking at clinical atherosclerosis, type 2 diabetes was the one factor associated with this outcome (OR = 6.21; P = .001). Conversely, maintaining remission provided a decrease in clinical atherosclerosis risk (OR = 0.2; P = .041).
The researchers noted that three-quarters of patients were treated with corticosteroids, while nearly 87% received methotrexate, 28% received hydroxychloroquine and 60% received biologic DMARDS.
Ruscitti also commented on the importance of interdisciplinary collaboration in order to achieve effective management in this patient population.
“This [study] is important because it highlights the need for the effective coordination of care between rheumatologists, internists, cardiologists and primary care physicians to optimize management of cardiovascular risk in patients with rheumatoid arthritis,” he said. – by Rob Volansky
Reference:
Ruscitti P, et al. OP0090. Presented at: EULAR Annual Congress; June 12-15; Madrid, Spain.
Disclosure: Ruscitti reports receiving grant or research support from Pfizer Innovare and being on the speakers’ bureau of BMS, Lilly, MSD, Pfizer, and Sobi.