Patterns and risk of cardiovascular disease in rheumatoid arthritis and psoriatic arthritis: a nationwide cohort study in the UK

Abstract Objective Patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA) and psoriatic arthritis (PsA), have an elevated cardiovascular disease (CVD) risk. It is unclear whether this persists in the modern treat-to-target era, particularly in early disease. This study evaluates CVD risk and mortality in a contemporary early RA and PsA cohort. Method Adults (≥18 years) with newly diagnosed RA or PsA registered in the National Early Inflammatory Arthritis Audit (NEIAA) from 2018 to 2023 were included. Incidence rates of CVD events, major adverse cardiovascular events (MACE), all-cause and CVD mortality were calculated. Standardized incidence and mortality ratios compared outcomes with the general population. Competing-risk regression assessed factors associated with CVD outcomes. Results 1,012/17,669 RA and 104/3,271 PsA participants had CVD hospitalizations. The incidence of MACE hospitalizations was 2.4/100 person-years (95%CI, 2.2–2.7) in RA and 0.6/100 person-years (0.4–1.0) in PsA. The risk of CVD hospitalizations was approximately 25% higher in IA participants. Compared with the general population, all-cause mortality was 1.1-times higher in RA. CVD incidence and mortality were consistently higher in males. Hypertension, diabetes and smoking associated with an increased CVD risk. Early corticosteroid use did not predict CVD, while better early RA treatment response was linked to lower CVD risk. Conclusion A greater incidence of CVD and MACE exists in early IA, though less than previously reported. Traditional CVD risk factors are the dominant explanation for the risk increase, with disease control contributing a smaller but significant contributor to risk. Routine cardiovascular risk assessment in early IA remains justified.