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.
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
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