Table 1

Overarching principles and recommendations

Level of evidenceStrength of recommendationLevel of agreement (SD)
Overarching principles

  1. Clinicians should be aware of the higher risk for CVD in patients with RA compared with the general population. This may also apply to AS and PsA.

  2. The rheumatologist is responsible for CVD risk management in patients with RA and other IJD.

  3. The use of NSAIDs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and ASAS

Recommendations
1. Disease activity should be controlled optimally in order to lower CVD risk in all patients with RA, AS or PsA2b-3B9.1 (1.3)
2. CVD risk assessment is recommended for all patients with RA, AS or PsA at least once every 5 years and should be reconsidered following major changes in antirheumatic therapy3–4C8.8 (1.1)
3. CVD risk estimation for patients with RA, AS or PsA should be performed according to national guidelines and the SCORE CVD risk prediction model should be used if no national guideline is available3–4C–D8.7 (2.1)
4. TC and HDLc should be used in CVD risk assessment in RA, AS and PsA and lipids should ideally be measured when disease activity is stable or in remission. Non-fasting lipids measurements are also perfectly acceptable3C8.8 (1.2)
5. CVD risk prediction models should be adapted for patients with RA by a 1.5 multiplication factor, if this is not already included in the model3–4C7.5 (2.2)
6. Screening for asymptomatic atherosclerotic plaques by use of carotid ultrasound may be considered as part of the CVD risk evaluation in patients with RA3–4C–D5.7 (3.9)
7. Lifestyle recommendations should emphasise the benefits of a healthy diet, regular exercise and smoking cessation for all patients3C9.8 (0.3)
8. CVD risk management should be carried out according to national guidelines in RA, AS or PsA, antihypertensives and statins may be used as in the general population3–4C–D9.2 (1.3)
9. Prescription of NSAIDs in RA and PsA should be with caution, especially for patients with documented CVD or in the presence of CVD risk factors2a-3C8.9 (2.1)
10. Corticosteroids: for prolonged treatment, the glucocorticoid dosage should be kept to a minimum and a glucocorticoid taper should be attempted in case of remission or low disease activity; the reasons to continue glucocorticoid therapy should be regularly checked3–4C9.5 (0.7)

  • AS, ankylosing spondylitis; ASAS, Assessment of Spondyloarthritis International Society; CVD, cardiovascular disease; EULAR, European League against Rheumatism; HDLc, high-density lipoprotein cholesterol; IJD, inflammatory joint disorder; NSAID, non-steroidal anti-inflammatory drug; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SCORE, Systematic Coronary Risk Evaluation; TC, total cholesterol.