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FRI0121 Treat to target strategy in early rheumatoid arthritis: necessity of achieving tight control of disease and aggressive monitoring of cardiovascular risk
  1. D. S. Novikova1,
  2. Y. N. Gorbunova1,
  3. T. V. Popkova1,
  4. E. I. Markelova1,
  5. D. E. Karateev1,
  6. E. L. Nasonov1
  1. 1Research Institute of Rheumatology, Moscow, Russian Federation

Abstract

Background The risk of cardiovascular events (CVE) in rheumatoid arthritis (RA) is significantly higher than in general population, however at what stage it increases remains unclear.

Objectives To determine the level of cardiovascular risk (CVR) in patients with early RA prior to therapy with basic anti-inflammatory drugs (BAID).

Methods A total of 62 patients (pts) with a valid diagnosis of RA (ACR criteria,1987): 46 women (74.2%)/16 men (25.8%) were included, median (Me) age - 56 years [interquartile range (IR) 46;61 years], Me disease duration-7 [IR 4;8] months; seropositive for IgM RF (87%) and/or ACCP(100%) without any experience of administration of BAID and glucocorticoides. All pts were assessed for traditional risk factors (TRF) of cardiovascular disease (CVD) according to recommendations by European Society of Cardiology (ESC, 2007), ECG, 24-h ECG and BP monitoring, echocardiography, carotid artery ultrasound. The coronary arteries were examined using a GE LightSpeed VCT 64-slice computed tomograph. Coronary calcium index was determined by the Agatston score. According to indications, stress echocardiography and coronarography were performed.

Results All pts with early RA demonstrated a high disease activity (Me DAS28–5.54, IR 5.0;6.16). Besides, in RA pts there was observed a high prevalence of arterial hypertension-38 (61.3%); central obesity - 34 (54%); dyslipidemia-40 (65.6%): hypercholesterolemia-37(59.7%), reduced HDL cholesterol-21(33.8%), hypertriglyceridemia-12(19.4%); as well as menopause-33 women (71.7%), physical inactivity-30 (49.2%), family history of CVD–24 (38.7%) and smoking status: ex-smoker-14 (22,6%), smoker-13 (21%). Raised fasting plasma glucose was identified in 11 (18%) RA pts, diabetes mellitus (DM) type 2-in 4 (6.6%). Combination ≥3 TRF was recorded in 31 (50%) pts, however, only 7 pts (11.3%) showed a high total risk of CVE development by SCORE (>5%). The use of the amendment (×1.5) recommended by EULAR did not result in increased percentage of patients with a higher cardiovascular risk. Left ventricle hypertrophy (LVH) was revealed in 22 (36.1%) RA pts, atherosclerotic plaques in carotid arteries - 26 (41.9%), calcinosis of carotid arteries-30(48.4%). Ischemic heart disease (IHD) was diagnosed in 12 (19.4%) RApts (postmyocardial infarction-2 (3.2%), angina pectoris-3 (4.9%), dyspnea as an equivalent of angina-9 (11%)). In 5 (8.2%) RA pts paroxysmal atrial fibrillation was revealed, in 10 (16.4%)–frequent supraventricular extrasystoles with runs of supraventricular tachycardia and in 5 (8.2%)–high-grade ventricular extrasystoles. Congestive heart failure (CHF) I/II functional classby NYHA was diagnosed in 7(11.1%) and 1(1.6%) pts, respectively. According to examination results, 4 male pts received revascularization of the myocardium (2-coronary artery bypass graft, 2-percutaneous coronary intervention). In general, 31 (50%) pts with early RA had a high and very high risk of CVE development (≥3 TFR of CVD, SCORE>5%, DM, LVH, atherosclerosis of carotid and coronary arteries, IHD, CHF).

Conclusions Our finding that 50% patients with early RA had a high CVR confirms the need to administer not only efficient therapy inhibiting inflammation and preventing the disease advancement but also to aggressively monitor the comorbid state in these patients.

Disclosure of Interest None Declared

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