Cardiovascular risk assessment using the DAS28-GGT score in rheumatoid arthritis patients initiating JAK inhibitors: Results from the MAJIK-SFR registry

OBJECTIVES: Cardiovascular disease is the leading cause of death in rheumatoid arthritis (RA). By replacing C-reactive protein (CRP) with gamma-glutamyl transferase (GGT), the DAS28-GGT was developed to integrate both inflammatory disease activity and cardiovascular (CV) risk into a single score. We evaluated its ability to classify CV risk in RA patients initiating Janus kinase inhibitors (JAKi) and compared its performance with DAS28-CRP. METHODS: This cross-sectional study used data from the MAJIK-SFR observational registry. RA patients initiating a JAKi with available GGT were included. CV risk was estimated using the SCORE2 and Framingham equations. The discriminative performance of the DAS28-GGT was assessed using ROC curves and compared with the DeLong test. DAS28-GGT discrimination across DAS28-CRP disease activity categories was assessed. RESULTS: We included 185 RA patients (72% women, mean age 58 ± 13 years). Mean DAS28-CRP was 4.07 ± 1.27 and mean DAS28-GGT 8.88 ± 1.83. According to SCORE2, 54.3% patients were at low, 38.9% at moderate, and 6.8% at high CV risk and 34.8%, 44.7%, and 20.5%, according to Framingham, respectively. DAS28-GGT better discriminated patients with at least moderate CV risk than DAS28-CRP (SCORE2 AUC 0.59 vs 0.52, p <0.05; Framingham AUC 0.63 vs 0.53, p <0.01). DAS28-GGT significantly discriminated DAS28-CRP remission, low, and high disease activity (AUCs 0.91, 0.70, and 0.83 respectively). CONCLUSION: This study supports the DAS28-GGT as a simple and practical tool to capture both cardiovascular risk and inflammatory activity in RA patients initiating JAKi. Prospective studies are needed to confirm its value for predicting cardiovascular events.