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Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study
  1. Sella A Provan1,
  2. Anne Grete Semb1,
  3. Jonny Hisdal2,
  4. Einar Stranden2,
  5. Stefan Agewall3,
  6. Hanne Dagfinrud1,
  7. Kristin Angel3,
  8. Dan Atar4,
  9. Tore K Kvien1
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Section of Vascular Investigations, Oslo University Hospital Aker and Faculty of Medicine, University of Oslo, Norway
  3. 3Department of Cardiology B, Oslo University Hospital Aker, Oslo, Norway
  4. 4Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Norway
  1. Correspondence to Sella Aarrestad Provan, Department of Rheumatology, Diakonhjemmet Hospital, PB.23 Vindern, N-0319 Oslo, Norway; sellaprovan{at}


Objectives To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls.

Methods 113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations.

Results Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers.

Conclusion Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.

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  • Funding This study was supported by grants from the Eastern Norway Regional Health Authority.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Norwegian Regional Committee for Research Ethics and patients gave their informed consent.

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