Expanded Risk Score in Rheumatoid Arthritis (ERS-RA) Predicts Subclinical Atherosclerosis

This study aimed to identify a CVD risk calculator for clinical use to identify patients with RA who are also at risk of developing CVD.

Among several cardiovascular disease (CVD) risk measurement tools assessed for their ability to predict atherosclerosis in patients with rheumatoid arthritis (RA), the Expanded Risk Score in Rheumatoid Arthritis (ERS-RA) was correlated most highly with patients’ coronary artery calcium (CAC) score, according to study findings published in BMC Rheumatology.

Researchers recruited patients with RA who visited a tertiary hospital from March to December 2020. CAC scores were measured using computed tomography (CT). In all, 6 scoring systems were used to calculate patients’ 10-year CVD risk including the Framingham risk score, Systemic Coronary Risk Evaluation (SCORE), Atherosclerotic Cardiovascular Disease (ASCVD) risk estimator plus, QRISK3, ERS-RA, and Reynolds risk score. Correlation between CVD risk scores and CAC scores were calculated.

A total of 54 patients were enrolled in the study. Correlation coefficients between the CVD risk scores and CAC scores ranged from 0.290 to 0.430. The highest correlation coefficient was for ERS-RA (r=0.430; P =.001). In multivariate linear regression analysis, the ERS-RA scored showed the only significant positive association with the CAC score (β=10.01; 95% CI, 3.78-16.23).

Limitations of the study included a small sample size of only Korean patients, the cross-sectional study design, lacking information that could affect CVD risk management, and absence of a healthy control group.

The researchers concluded, “We demonstrated that ERS-RA highly correlated with the CAC score in RA patients. This finding could strengthen the clinical usefulness of ERS-RA in predicting CVD risk in RA patients and suggest ERS-RA as the most suitable CVD risk predictor in these patients.”


Kim SH, Lee S-H, Kim H-R, Min HK. Cardiovascular disease risk calculators to reflect the subclinical atherosclerosis of coronary artery in rheumatoid arthritis: a pilot study. BMC Rheumatology. Published online August 30, 2021. doi:10.1186/s41927-021-00213-3