EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis
- M J L Peters1,
- D P M Symmons2,
- D McCarey3,
- B A C Dijkmans1,4,
- P Nicola5,
- T K Kvien6,
- I B McInnes7,
- H Haentzschel8,
- M A Gonzalez-Gay9,
- S Provan6,
- A Semb6,
- P Sidiropoulos10,
- G Kitas11,
- Y M Smulders12,
- M Soubrier13,
- Z Szekanecz14,
- N Sattar15,
- M T Nurmohamed1,4,13
- 1Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
- 2University of Manchester, Manchester, UK
- 3Glasgow Royal Infirmary, Glasgow, UK
- 4Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
- 5Department of Preventive Medicine, Faculty of Medicine of Lisbon, Lisbon, Portugal
- 6Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- 7Centre for Rheumatic Diseases, University of Glasgow, UK
- 8Rheumazentrum am Universitätsklinikum Leipzig, Leipzig, Germany
- 9Rheumatology, Hospital Xeral-Calde, Lugo, Spain
- 10Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Greece
- 11Dudley Group of Hospitals NHS Trust Russells Hall Hospital, Dudley, UK
- 12Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
- 13Hôpital Gabriel Montpied, Service de Rhumatologie, Clermont-Ferrand, France
- 14Department of Rheumatology University of Debrecen, Debrecen, Hungary
- 15BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Correspondence to Dr M T Nurmohamed, VU University Medical Center, Departments of Internal Medicine and Rheumatology, PO Box 7057, 1007 MB Amsterdam, The Netherlands; mt.nurmohamed{at}vumc.nl
- Accepted 3 September 2009
- Published Online First 22 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 nine 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 patients with RA and should be considered for all patients with AS and PsA. 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, as evidence for an increased CV risk is most compelling for RA.
Footnotes
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‣ Additional tables are published online only at http://ard.bmj.com/content/vol69/issue2
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Funding This project was financially supported by the European League Against Rheumatism (EULAR).
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Competing interests Hans Bijlsma was the Handling Editor for this article.
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Provenance and Peer review Not commissioned; externally peer reviewed.
