Continued low disease activity in patients with rheumatoid arthritis (RA) is associated with atherosclerosis and heart dysfunction, according to a study published in Rheumatology International.1

Patients with RA have a 2-fold higher risk for death compared with the general population, mainly because of cardiovascular disease (CVD).1 Traditional risk factors do not fully explain this increased CVD risk, and therefore, RA is considered to be an independent risk factor for CVD.2-4 High disease activity is associated with a higher incidence of CVD,5 but few data are available concerning CVD risk and heart function in patients with low disease activity.6-9 Therefore, researchers in Poland compared 70 patients with RA with continued low disease activity from 2 to 7 years and no clinically evident CVD with 33 healthy control patients of comparable age.1

The researchers found significantly greater values of carotid intima media thickness in patients with RA compared with control patients (0.83 vs 0.62 mm; P <.001), as well as a higher incidence of atherosclerotic plaques (61.4% vs 30.3%; P =.003) and prolonged corrected QT interval (439.6 vs 414.0 ms; P <.001). A high or very high risk for cardiovascular death according to the multiplied Systemic Coronary Risk Evaluation system was reported in one-third of patients with RA, and serum amino-terminal pro-brain natriuretic peptide was elevated above the normal range in almost one-fourth of patients with RA.

In addition, a strong relationship was noted between cardiovascular parameters, patient age, and disease duration. A deterioration of cardiovascular parameters was noted in patients with a higher Disease Activity Score in 28 joints, erythrocyte sedimentation rate, immunoglobulin M-rheumatoid factor concentration, and bone erosions.


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“In conclusion, features of accelerated atherosclerosis and heart dysfunction were found in the group of RA patients with continued low disease activity,” stated the authors.1

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References

  1. Biskup M, Biskup W, Majdan M, et al. Cardiovascular system changes in rheumatoid arthritis patients with continued low disease activity [published online May 17, 2018]. Rheumatol Int. doi: 10.1007/s00296-018-4053-x
  2. Dalbeni A, Giollo A, Tagetti A, et al. Traditional cardiovascular risk factors or inflammation: which factors accelerate atherosclerosis in arthritis patients?Int J Cardiol. 2017;236:488-492.
  3. Lazzerini PE, Capecchi PL, Acampa M, Galeazzi M, Laghi-Pasini F. Arrhythmic risk in rheumatoid arthritis: the driving role of systemic inflammation. Autoimmun Rev. 2014;13:936-944.
  4. Corrales A, Dessein PH, Tsang L, et al. Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study. Arthritis Res Ther. 2015;17:55.
  5. Avouac J, Meune C, Chenevier-Gobeaux C, et al. Inflammation and disease activity are associated with high circulating cardiac markers in rheumatoid arthritis independently of traditional cardiovascular risk factors. J Rheumatol. 2014;41:248-255.
  6. Dehghan P, Rajaei A, Moeineddin R, Alizadeh AM. Prevalence of atherosclerosis in patients with inactive rheumatoid arthritis. Clin Rheumatol. 2015;34:1363-1366.
  7. Arida A, Protogerou AD, Konstantonis G, Fragiadaki K, Kitas GD, Sfikakis PP. Atherosclerosis is not accelerated in rheumatoid arthritis of low activity or remission, regardless of antirheumatic treatment modalities. Rheumatology. 2017;56:934-939.
  8. van Breukelen-van der Stoep DF, van Zeben D, Klop B, et al. Association of cardiovascular risk factors with carotid intima media thickness in patients with rheumatoid arthritis with low disease activity compared to controls: a cross-sectional study. PLoS One. 2015;10(10):e0140844.
  9. Arts EE, Fransen J, Den Broeder AA, van Riel PLCM, Popa CD. Low disease activity (DAS28 ≤ 3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis. 2017;76:1693-1699.