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Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis
  1. Lotta Ljung1,2,
  2. Solbritt Rantapää-Dahlqvist2,
  3. Lennart T H Jacobsson3,
  4. Johan Askling1,4
  5. for the ARTIS Study Group
    1. 1Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
    2. 2Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
    3. 3Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
    4. 4Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
    1. Correspondence to Dr Lotta Ljung, Department of Rheumatology, University Hospital, Umeå SE-901 87, Sweden; lotta.ljung{at}


    Objectives Whether the increased risk of comorbidities, such as cardiovascular disease, in rheumatoid arthritis (RA) can be reverted by particular antirheumatic therapies, or response to these, is unclear but of critical clinical importance. We wanted to investigate whether response to tumour necrosis factor inhibitors (TNFi) translates into a reduced risk for acute coronary syndrome (ACS).

    Methods A cohort of patients with RA initiating a first TNFi 2001–2012 was identified in the Swedish Biologics Register. The association between European League Against Rheumatism (EULAR) response after 3–8 months of treatment (assessed using the first, the best and the measurement closest to 5 months, respectively), and the risk of incident ACS during the subsequent year was analysed in Cox regression models. Adjustments included cardiovascular risk factors, joint surgery, RA duration, education and work disability.

    Results During 6592 person-years among TNFi initiators (n=6864, mean age 55 years, 77% women), 47 ACS occurred. The adjusted HRs (95% CI), which were similar to the crude HRs, of the 1-year risk of ACS among EULAR good responders compared with non-responders were 0.5 (0.2 to 1.4), 0.4 (0.2 to 0.9) and 0.5 (0.2 to 1.2), for the first, the best and the evaluation closest to 5 months, respectively. EULAR moderate responders had equal risk to that of EULAR non-responders, who, compared with the general population referents (n=34 229), had a more than twice the risk of ACS. For good responders, there was no statistically significant difference in risk versus the general population.

    Conclusions Optimised RA disease control has the potential to revert otherwise increased risks for ACS in RA.

    • Rheumatoid Arthritis
    • DMARDs (biologic)
    • Cardiovascular Disease

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