Key result
Early rheumatoid arthritis shows no difference in subclinical atherosclerosis progression over 5 years vs controls.
Why the study?
The relationship between subclinical atherosclerosis, traditional cardiovascular risk factors, and inflammation in patients with rheumatoid arthritis from diagnosis was not fully understood.
Cohort (n=111)
Yes
Absolute Event Rate: 14.2% vs 13.4%
p-value: p=>0.05
No difference in 5-year IMT progression between early RA and controls; leaves open whether cumulative inflammation augments traditional risk prediction.
OBJECTIVE: This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls. METHODS: Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included. RESULTS: In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent. CONCLUSION: This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.
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Södergren et al. (2015) conducted a cohort in Rheumatoid arthritis (n=111). Early rheumatoid arthritis vs. Age- and sex-matched controls was evaluated on Percent progression of intima-media thickness (IMT) (p=>0.05). Over 5 years, the progression of subclinical atherosclerosis measured by intima-media thickness did not differ significantly between patients with early rheumatoid arthritis and matched controls (14.2% vs 13.4%, p>0.05).
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