What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatoid arthritis (n=238). Intervention: Elevated baseline C-reactive protein (CRP) vs. CRP below the median. Primary outcome: Increased pulse-wave velocity (PWV) at 15 years (OR 4.84, 95% CI 1.39-16.83).

January 15, 2011Open Access

Early Prediction of Increased Arterial Stiffness in Patients with Chronic Inflammation: A 15-year Followup Study of 108 Patients with Rheumatoid Arthritis

SPSella Aarrestad ProvanUniversity of Inland Norway KAKristin AngelOslo University Hospital ASAnne Grete SembDiakonhjemmet Hospital

Key Result

Elevated baseline C-reactive protein above the median in patients with early rheumatoid arthritis predicted increased pulse-wave velocity (OR 4.84) and augmentation index (OR 3.52) after 15 years.

Study Design

Type

Cohort (n=238)

Structured PICO

Does early inflammation (elevated CRP) predict increased arterial stiffness after 15 years in patients with rheumatoid arthritis?

Population

238 patients with early rheumatoid arthritis (disease duration < 4 years) followed longitudinally for 15 years to assess the impact of baseline inflammation on arterial stiffness.

Outcome

Increased arterial stiffness at 15-year followup, measured as augmentation index (AIx) and pulse-wave velocity (PWV) above the 75th percentilesurrogate

Elevated inflammation early in the course of rheumatoid arthritis independently predicts increased arterial stiffness 15 years later, highlighting the importance of early inflammatory control to mitigate cardiovascular risk.

Main Result

Odds Ratio: 4.84 (95% CI 1.39–16.83)

Limitations

Lack of information concerning baseline cardiovascular risk factors, including arterial stiffness measurements
Inability to define pathological levels of biomarkers due to lack of community controls
Insufficient data on intercurrent use of antirheumatic therapies to explore treatment effects

Abstract

OBJECTIVE: Patients with rheumatoid arthritis (RA), a chronic inflammatory disease, have increased cardiovascular morbidity and mortality. We investigated whether early markers of RA inflammatory disease activity could predict later increased levels of pulse-wave velocity (PWV) and augmentation index (AIx), 2 measures of arterial stiffness. METHODS: In total 238 patients with early RA were followed longitudinally and 108 were available for the 15-year followup examination. Comprehensive baseline clinical and radiographic data were collected in 1992. Arterial stiffness, measured as AIx and PWV (Sphygmocor apparatus), was recorded at the 15-year followup. Adjusted logistic univariate and multivariate analyses were performed with levels of AIx and PWV as the dependent variables, and variables reflecting baseline RA disease activity as possible predictors. The validity of the final models was examined in linear regression analyses. RESULTS: Baseline C-reactive protein (CRP) above the median predicted increased AIx (OR 3.52, 95% CI 1.04-11.90) and PWV (OR 4.84, 95% CI 1.39-16.83) at the 15-year assessment in multivariate models. Patients with elevated baseline CRP had significantly higher AIx (ß = 2.67, 95% CI 0.06-5.31, p = 0.045) and lnPWV (ß = 0.08, 95% CI 0.01-0.14, p = 0.02) after 15 years, after adjustments for age, sex, heart rate (AIx only) and mean arterial pressure. CONCLUSION: Inflammation early in the RA disease course was associated with increased AIx and PWV after 15 years. These findings support the importance of early control of the inflammatory process in patients with RA.

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