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Remission in Rheumatoid Arthritis Is Associated With Reduced Risk of Poor Cardiovascular Outcomes
Individuals with rheumatoid arthritis (RA) in remission have a reduced risk of developing adverse cardiovascular outcomes, according to new research presented at the Annual European Congress of Rheumatology.1
To analyze the incidence and predictive factors for atherosclerosis in RA, the researchers identified individuals enrolled in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) study who were admitted to Italian rheumatology units during 2015.
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Data on 797 participants were evaluated to assess for subclinical atherosclerosis—atherosclerotic lesions in the carotid or peripheral arteries—and clinical atherosclerosis—myocardial infarction, congestive heart failure, or cerebrovascular accidents—over 3 years of follow-up.
The participants had a median RA duration of 8.35 years (range, 0.1-35), with 70.9% having rheumatoid factor and 55.7% having anti-citrullinated protein antibodies (ACPAs).
Among the participants, 75.5% received treatment with corticosteroids, 86.8% received treatment with methotrexate, 28.15% received treatment with hydroxychloroquine, and 60.7% received treatment with biologic disease-modifying antirheumatic drugs.
Overall, 33% of participants reported being smokers, 49.3% had hypertension, and 12.3% had type 2 diabetes.
During follow-up, 42.6% of participants reached and maintained remission of RA.
Maintaining remission was associated with a reduced risk of both subclinical atherosclerosis (odds ratio [OR], 0.25; 95% CI, 0.11-0.56) and clinical atherosclerosis (OR, 0.20; 95% CI, 0.09-0.95).
Multivariate regression analysis showed that type 2 diabetes, hypertension, the presence of ACPAs, and mean values of C-reactive protein were associated with subclinical atherosclerosis. Type 2 diabetes was also associated with clinical atherosclerosis.
“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,” study lead author Piero Ruscitti, MD, from the University of L’Aquila, L’Aquila, Italy, said in a press release. “This 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.”
—Colleen Murphy
References:
1. Ruscitti P, Cipriani P, Liakouli V, et al. The occurrence of subclinical and clinical atherosclerosis in rheumatoid arthritis, results from the 3-year, multicenter, prospective, observational, GIRRCS study [EULAR OP0090]. Ann Rheum Dis. 2019;78(suppl2):A117. https://scientific.sparx-ip.net/archiveeular/?c=a&view=1&searchfor=OP0090&item=2019OP0090. Accessed June 17, 2019.
2. Disease remission associated with 80% reduction in risk of cardiovascular outcomes in patients with rheumatoid arthritis [press release]. Madrid, Spain: Annual European Congress of Rheumatology; June 12, 2019. https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/03_abstract_op0090_atherosclerosis_in_ra_final.pdf. Accessed June 17, 2019.
