Article Text

AB0394 Cardiovascular risk factors and their association with bone metabolism and disease activity in patients with early arthritis
  1. L. del Olmo1,
  2. P.A. Acín1,
  3. L. Nuño1,
  4. J. Coya2,
  5. L. Oliveira1,
  6. A. Balsa1,
  7. S. Gil1,
  8. E. Martin Mola1
  1. 1Rheumatology
  2. 2Nuclear Medicine, Hospital La Paz, Madrid, Spain


Background Inflammatory activity in patients with rheumatoid arthritis (RA) is associated with an increased risk for cardiovascular complications (CV). Nevertheless, data on CV risk in patients with early arthritis (EA) are limited. In recent years, a possible pathogenic interaction between bone metabolism and cardiovascular risk factors (CVRF) has also been proposed

Objectives To study the prevalence of CVRF in our patients with EA and its possible association with certain aspects of bone metabolism and disease activity

Methods This is a prospective study carried out from February 2009 to October 2011 including 110 patients from our EA Clinic (mean age 53.1±16.5 years, 92 (83.6%) women) with less than one year of disease activity and without prior treatment. Spondyloarthropathies and connective tissues disorders were excluded. At baseline we recorder: sociodemographic and anthropometric data, bone densitometry, FRAX index, inflammatory disease activity and CVRF (hypertension (HT), diabetes, hyperglycemia, hyperlipidemia, hypertriglyceridemia, tobacco use, BMI). Laboratory testing with metabolic bone parameters and lipid profile (total cholesterol, LDL, HDL triglycerides). The LDL/HDL and total cholesterol/HDL atherogenic ratios were calculated. Descriptive analysis and comparison with non-parametric tests were performed

Results Fifty-one patients met the ACR 1987 criteria for RA and fifty-nine had undifferentiated arthritis. The mean DAS 28 mean of the cohorts was 4.65±1.44. Densitometric osteoporosis and osteopenia were found in 27 (24.5%) and 48 (43.6%) respectively. FRAX>3% for hip fracture 20 (20.2%) and global FRAX>20% 6 (6.1%). Vitamin D levels <30ng/ml were found in 93 (85.3%). The CVRF prevalence: 22(20.2%) smokers, 21 HT (19.4%), 4 (3.7%) diabetes, 19 (17.6%) hyperlipidemia, 16 (15.1%) hypertriglyceridemia and 17 (16.5%) BMI>30. LDL/HDL atherogenic ratio >3% (moderate CV risk) was found in 12 (10.3%) and cholesterol/HDL ratio >4.5 (high risk) in 11 (9,9%)

Both atherogenic ratios correlated with ESR (p=0.041, p=0.034 respecty); hyperlipidemia with DAS 28 (p=0.05), SDAI (p=0.015) and CRP (p=0.016) and HT with number of swollen joints (p=0.03). The presence of hyperlipidemia and HT was associated with an increase in global FRAX (p=0.014,p<0.000) and hip FRAX (p=0.016, p=0.002). The hip and lumbar T-scores showed lower a tendency to be lower in patients with hyperlipidemia (p=0.494, p=0.683). Hip T-score was correlated with HT (p=0.047). Serum calcifediol levels were directly associated with total cholesterol (p=0.020), HDL (p=0.04) and LDL (p=0.02). Other hand, we observed that immunologic parameters was associated with CVRF: RF with both atherogenic ratios (p<0.0001, p<0,0001) and RF and anti-CCP with hyperlipidemia (p=0,0015 and p=0.05 respectly)

Conclusions Inmunologic, clinical and laboratory activity parameters were associated with a pro-atherogenic lipid profile. In addition, there appears to be an association between CVRF (TA and hyperlipidemia) and fracture risk that needs to be clarified in order to better understand the pathogenesis in our patients with EA

Disclosure of Interest None Declared

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