Abstract Background Inflammatory joint diseases (IJD) like rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are linked to higher cardiovascular disease (CVD) risk. It is assumed that IJD patients have worse myocardial infarctions (MI) outcomes due to atypical presentations, greater myocardial damage, higher rates of in-hospital complications and less effective treatment, but supporting is limited. Purpose To provide a clearer understanding of whether IJD patients face different clinical presentations, cardiac involvement, treatment approaches and outcomes following an initial MI compared to those without IJD. Methods We analyzed register data covering the entire adult Norwegian population, focusing on MI events sourced from the Norwegian MI register between January 2013 and December 2017. Only patients without known atherosclerotic CVD were analyzed. Analyses were stratified by sex and adjusted for age using inverse probability weights. Results Between January 2013 and December 2017, we identified 981 RA, 314 axSpA, 434 PsA and 34,783 non-IJD patients experiencing their first MI. As illustrated in Figure 1, only 65.6% of female non-IJD patients reported chest pain as the dominating symptom, which was significantly lower than in female patients with axSpA (77.4%, p0.01) and PsA (78.8%, p0.001). Among males, chest pain was common in all groups. ST-elevation MI (STEMI) rates were consistent across groups, varying from 22.2% to 25.4% in female patients and 34.3% to 36.7% in males. IJD groups did not receive less acute thrombolysis, coronary angiography or percutaneous coronary intervention (PCI) than non-IJD. In fact, male PsA patients received thrombolysis (8.8% vs 5.1%, p=0.03) and coronary angiography (82.7% vs 78.3%, p=0.02) more often than non-IJD. The rates of multiple or left coronary artery involvement were also comparable across all groups. Additionally, there were no signs of higher Troponin T levels in any IJD sub-group compared to non-IJD, regardless of STEMI or non-STEMI status (data not shown). As shown in Figure 2, none of the in-hospital complications following an initial MI were more common in the IJD sub-entities compared to the non-IJD group. PsA patients had lower rates of atrial fibrillation and flutter (p0.001 for both sexes), and female axSpA patients experienced fewer net adverse cardiovascular events than their non-IJD counterparts (p0.001). There was also no indication of higher in-hospital or short-term mortality in IJD patients compared to non-IJD patients. Female axSpA patients had the lowest in-hospital and short-term (30-day) mortality, at 1.7% (p0.001). Conclusion Our comprehensive study demonstrates that IJD patients showed comparable MI presentations, disease courses and short-term outcomes to those without IJD. These findings should provide reassurance about the short-term prognosis of IJD patients experiencing MI.Figure 1. Figure 2.
Ikdahl et al. (2025) studied this question.