Background Rheumatoid arthritis (RA) disease activity and associated systemic inflammation has been associated with serious infection (SIEs), myocardial infarction (MI) and coronary heart disease (CHD) events based on a few registry studies or clinical trials. There are few data from large-scale population-based studies given feasibility challenges in conducting such investigations.
Methods Multibiomarker disease activity (MBDA) test scores (n=77 641) were linked to Medicare for US patients with RA. Outcomes of interest were hospitalised pneumonia/sepsis (SIE), MI and a composite CHD outcome. The MBDA score ranges from 1 to 100 and was analysed as time-varying. Cox proportional hazards models evaluated the association between MBDA score and SIEs, MI and CHD events, controlling for potential confounders. A sensitivity analysis excluded C reactive protein (CRP) from the MBDA score.
Results There were 17 433 and 16 796 patients eligible for the SIE and MI/CHD analyses, respectively. Mean (SD) age was 69 (11) years, 79% were women, 81% were white and 38% were disabled. Over 16 424 person-years of follow-up, there were 452 SIE events, 132 MIs and 181 CHD events. Higher MBDA scores were associated with SIEs (HR=1.32, 95% CI 1.23 to 1.41 per 10 unit MBDA score change). For MI/CHD events, a threshold effect was present; higher disease activity by MBDA score was associated with increased MI (HR=1.52, 95% CI 0.92 to 2.49) and CHD rates (HR=1.54, 95% CI 1.01 to 2.34, comparing scores ≥30 vs <30). Analyses of the MBDA score without CRP yielded similar results.
Conclusion Higher MBDA scores were associated with hospitalised infection, MI and CHD events in a large, predominantly older, US RA population.
- rheumatoid arthritis
- cardiovascular disease
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Handling editor Tore K Kvien
Contributors JRC has full access to the data and takes responsibility for all aspects of the analysis, including drafting the manuscript. All coauthors edited the manuscript for content and approved submission of the final version.
Funding This analysis was supported in part by Crescendo Bioscience, a Myriad Genetics Company. JRC receives support from the Patient-Centered Outcomes Research Institute (PCORI).
Competing interests JRC: consultant and research grants from Myriad Genetics.
Ethics approval UAB Institutional Review Board for Human Use.
Provenance and peer review Not commissioned; externally peer reviewed.