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FRI0085 The Influence of Disease Activity in the Appearance of the First Cardiovascular Event in A Cohort of Greek Patients with Early Rheumatoid Arthritis
  1. N. Papadopoulos1,
  2. T. Georgios2,
  3. M. Katsounaros3,
  4. G. Asterios4,
  5. V. Galanopoulou1
  1. 1Rheumatology Unit, Papageorgiou General Hospital, Thessaloniki
  2. 2Cardiologist, Private Medicine, Kastoria
  3. 3B' Internal Medicine Clinic, Papanikolaou General Hospital
  4. 4Gastroenterologist, Papageorgiou General Hospital, Thessaloniki, Greece


Background Rheumatoid Arthritis (RA) patients, are at high risk of developing Cardio-Vascular Disease (CVD).

Objectives The aim of our study, was to investigate any possible relation, between disease activity and the appearance of CVD event, in a cohort of Greek patients with early RA.

Methods From 2002 to December 2012, 227 patients with early RA and without a prior history of a CVD, were diagnosed and subsequently followed-up as outpatients at the Rheumatology Unit of our hospital.

Demographic, clinical, laboratory and therapeutic parameters were evaluated during every follow-up. At the end of the study all the above parameters, were re-evaluated, considering the appearance of the first CVD event.

As end point, we considered the time of the appearance of the first CVD event, the death of a patient, or the last follow-up visit during 2012.

Cox regression survival analysis was applied.

Results 72.2% out of 227 patients were females, 51.1% were aCCP positive and 44.9% RF positive. Current smokers were 29.1%. Twenty patients (8.81%) suffered from a CVD event. Five of them suffered from a myocardial infarction, 11 suffered from a coronary artery disease and 2 suffered from an ischemic cerebral vascular disease.

Univariate survival analysis revealed that high age at disease's onset (p<0.0001), aCCP positivity (p=0.001), RF positivity (p=0.001), high CRP on study entry (p=0.01), high DAS-28 on study entry (p=0.003), DAS-28 change (between study entry and time of sensoring) below or above median (p<0.0001), the presence of extra-articular manifestations (p=0.022) and Arterial Hypertension (p0.001), were statistically significant associated with short CVD event-free time.

Multivariate survival analysis revealed that only age at disease's onset and demonstrating a DAS-28 change above the median value were statistically significant determinants of time-to-CVD event. In particular, each 1-year increment of age at disease's onset caused an 8% (95% Cis: 2.8-13.9%) increase of the risk to develop an early CVD event. Similarly, a patient belonging to the upper half of DAS-28 change among study participants was nine-times more likely to have a longer time to event than if he had belonged to the lower half. That means patients with well controlled disease were significantly less likely to appear a CVD event, even after controlling for age, presence of hypertension, aCCP-or RF-positivity, extra-articular disease, baseline CRP and DAS-28.

All other variables (including DAS-28 on study entry, even marginally so) lost their statistical significance in the multivariate analysis.

Conclusions In patients with early RA and without a prior history of CVD, high age at disease's onset and high disease activity seems to be associated with the presence of the first CVD event. A well controlled disease is less likely to arrive at a CVD event.


  1. John H, Kitas G, Toms T, Goodson N Cardiovascular co-morbidity in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2009:23;71-82

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4604

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