TY - JOUR T1 - Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based study JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 386 LP - 392 DO - 10.1136/annrheumdis-2017-211727 VL - 77 IS - 3 AU - Jeffrey R Curtis AU - Fenglong Xie AU - Lang Chen AU - Kenneth G Saag AU - Huifeng Yun AU - Paul Muntner Y1 - 2018/03/01 UR - http://ard.bmj.com/content/77/3/386.abstract N2 - 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. ER -