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EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis
  1. M J L Peters1,
  2. D P M Symmons2,
  3. D McCarey3,
  4. B A C Dijkmans1,4,
  5. P Nicola5,
  6. T K Kvien6,
  7. I B McInnes7,
  8. H Haentzschel8,
  9. M A Gonzalez-Gay9,
  10. S Provan6,
  11. A Semb6,
  12. P Sidiropoulos10,
  13. G Kitas11,
  14. Y M Smulders12,
  15. M Soubrier13,
  16. Z Szekanecz14,
  17. N Sattar15,
  18. M T Nurmohamed1,4,13
  1. 1 Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
  2. 2 University of Manchester, Manchester, UK
  3. 3 Glasgow Royal Infirmary, Glasgow, UK
  4. 4 Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  5. 5 Department of Preventive Medicine, Faculty of Medicine of Lisbon, Lisbon, Portugal
  6. 6 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  7. 7 Centre for Rheumatic Diseases, University of Glasgow, UK
  8. 8 Rheumazentrum am Universitätsklinikum Leipzig, Leipzig, Germany
  9. 9 Rheumatology, Hospital Xeral-Calde, Lugo, Spain
  10. 10 Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Greece
  11. 11 Dudley Group of Hospitals NHS Trust Russells Hall Hospital, Dudley, UK
  12. 12 Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
  13. 13 Hôpital Gabriel Montpied, Service de Rhumatologie, Clermont-Ferrand, France
  14. 14 Department of Rheumatology University of Debrecen, Debrecen, Hungary
  15. 15 BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  1. 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}


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.

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Supplementary materials


  • ▸ Additional tables are published online only at

  • Funding This project was financially supported by the European League Against Rheumatism (EULAR).

  • Competing interests Hans Bijlsma was the Handling Editor for this article.

  • Provenance and Peer review Not commissioned; externally peer reviewed.