EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis

M JL Peters ¹, D PM Symmons ², D McCarey ³, B AC Dijkmans ⁴, P Nicola ⁵, T K Kvien ⁶, I B McInnes ⁷, H Haentzschel ⁸, M A Gonzalez-Gay ⁹, S Provan ¹⁰, A G Semb ¹¹, P Sidiropoulos ¹², G Kitas ¹³, Y M Smulders ¹⁴, M J Soubrier ¹⁵, Z Szekanecz ¹⁶, N G Sattar ¹⁷ and M T Nurmohamed ^18*

¹ VU university medical center, Netherlands
² ARC Epidemiology Unit, United Kingdom
³ Glasgow Royal Infirmary, Glasgow, United Kingdom
⁴ Free University Hospital, Netherlands
⁵ Department of Preventive Medicine, Faculty of Medicine of Lisbon, Lisbon, Portugal
⁶ Diakonhjemmet Hospital, Norway
⁷ Centre for Rheumatic Diseases, University of Glasgow, United Kingdom
⁸ Rheumazentrum am Universitätsklinikum Leipzig, Germany
⁹ Hospital Xeral-Calde, Lugo, Spain, Spain
¹⁰ Department of Rheumatology, Diakonhjemmet Hospital, Norway
¹¹ Diakonhjemmet sykehus, Norway
¹² Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Greece
¹³ Dudley Group of Hospitals NHS Trust Russells Hall Hospital, United Kingdom
¹⁴ Department of Internal Medicine, VU University Medical Center, Netherlands
¹⁵ Service de Rhumatologie. Hopital G Montpied, France
¹⁶ University of Debrecen Medical Center, Hungary
¹⁷ University of Glasgow, Norway
¹⁸ Jan van Breemen Institute & VU University Medical Center, Netherlands

^* To whom correspondence should be addressed. E-mail: m.nurmohamed{at}janvanbreemen.nl.

Accepted 3 September 2009

Abstract

Objectives: To develop evidence-based EULAR recommendations for cardiovascular (CV) risk management in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Methods: A multidisciplinary expert committee was convened as a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), comprising 18 members including rheumatologists, cardiologists, internists and epidemiologists, representing 9 European countries. Problem areas and related keywords for systematic literature research were identified. A systematic literature research was performed using MedLine, Embase and the Cochrane library through to May 2008. Based on this literature review and in accordance with the EULAR's 'standardised operating procedures', the multidisciplinary steering committee formulated evidence-based and expert opinion based recommendations for CV risk screening and management in patients with inflammatory arthritis.

Results: Annual CV risk assessment using National Guidelines is recommended for all RA patients and should be considered for all AS and PsA patients. Any CV risk factors identified should be managed according to local guidelines. If no local guidelines are available, CV risk management should be carried out according to the SCORE function. In addition to appropriate CV risk management, aggressive suppression of the inflammatory process is recommended to further lower the CV risk.

Conclusions: Ten recommendations were made for CV risk management in patients with RA, AS and PsA. The strength of the recommendations differed between RA on the one hand, and AS and PsA on the other hand, as evidence for an increased CV risk is most compelling for RA.