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EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update
  1. R Agca1,
  2. S C Heslinga1,
  3. S Rollefstad2,
  4. M Heslinga1,
  5. I B McInnes3,
  6. M J L Peters4,
  7. T K Kvien5,
  8. M Dougados6,
  9. H Radner7,
  10. F Atzeni8,
  11. J Primdahl9,10,11,
  12. A Södergren12,
  13. S Wallberg Jonsson12,
  14. J van Rompay13,
  15. C Zabalan14,
  16. T R Pedersen15,
  17. L Jacobsson16,17,
  18. K de Vlam18,
  19. M A Gonzalez-Gay19,
  20. A G Semb20,
  21. G D Kitas21,
  22. Y M Smulders4,
  23. Z Szekanecz22,
  24. N Sattar23,
  25. D P M Symmons24,
  26. M T Nurmohamed25
  1. 1Departments of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
  3. 3College of Medical, Veterinary and Life Sciences, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  4. 4Internal and Vascular Medicine, VU University Medical Center, Amsterdam, The Netherlands
  5. 5Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  6. 6Department of Rheumatology, Paris Descartes University, Hôpital Cochin. Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
  7. 7Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
  8. 8IRCCS Galeazzi Orthopedic Institute, Milan, Italy
  9. 9Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
  10. 10Sygehus Sønderjylland (Hospital of Southern Jutland), Aabenraa, Denmark
  11. 11King Christian 10's Hospital for Rheumatic Diseases, Graasten, Denmark
  12. 12Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
  13. 13PARE (patient research partners), Sint-Joris-Weert, Belgium
  14. 14Romanian League Against Rheumatism (Vice-President) and Board Member (General Secretary) of AGORA, the Platform of S-E organisations for patients with RMDs, Bucharest, Romania
  15. 15Oslo University Hospital, Ullevål, Center for Preventive Medicine and Medical Faculty, University of Oslo, Oslo, Norway
  16. 16Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg and Section of Rheumatology, Lund, Sweden
  17. 17Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
  18. 18Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
  19. 19University of Cantabria, IDIVAL, Santander, Spain
  20. 20Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
  21. 21Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK
  22. 22Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
  23. 23Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
  24. 24Department of Rheumatology and Musculoskeletal Epidemiology, Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
  25. 25Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Michael T Nurmohamed, Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, P. O. Box 7057, Amsterdam 1007 MB, The Netherlands; mt.nurmohamed{at}vumc.nl

Abstract

Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

  • Cardiovascular Disease
  • Rheumatoid Arthritis
  • Ankylosing Spondylitis
  • Psoriatic Arthritis

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Footnotes

  • Handling editor Hans WJ Bijlsma

  • RA, SCH, SR and MH are co-first authors.

  • DPMS and MTN are senior authors.

  • Contributors All authors participated in the activities of the EULAR task force and have provided important contributions to the manuscript.

  • Funding European League Against Rheumatism.

  • Competing interests All the participants in this initiative have disclosed any conflicts of interest. FA has received personal remuneration from BMS, Pfizer, MSD. IBM has received research funding or honoraria from AbbVie, BMS, Pfizer, Janssen, Novartis, Celgene, MSD, UCB and Roche. LJ has received consultancy fees or speaker honoraria from AbbVie, Actavis, Celgene, Novartis and Pfizer. GDK has received honoraria for lectures or advisory boards or hospitality from Pfizer, AbbVie, Novartis, UCB, Genesis, Roche, BMS, GSK, Eli Lilly and AstraZeneca. TKK has received fees for speaking and/or consulting from AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Epirus, Hospira, Merck-Serono, MSD, Novartis, Orion Pharma, Pfizer, Roche, Sandoz and UCB and received research funding to Diakonhjemmet Hospital from AbbVie, BMS, MSD, Pfizer, Roche and UCB. NS has consulted for Roche, Amgen, Sanofi, AstraZeneca and received grant funding from Roche. SWJ has received speaker honoraria from MSD and Pfizer. MTN has received research funding or speaking/consultancy honoraria from Abbvie, Pfizer, Merck, Roche, BMS, UCB, Eli Lilly and Janssen.

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

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