IntroductionOur objective was to determine which one of the two function charts available in Spain to calculate cardiovascular (CV) risk, Systematic COronary Risk Evaluation (SCORE) or Framingham-REgistre GIroní del COR (REGICOR), should be used in patients with rheumatoid arthritis (RA).MethodsA series of RA patients seen over a one-year period without history of CV events were assessed. SCORE, REGICOR, modified (m)SCORE and mREGICOR according to the European League Against Rheumatism (EULAR) recommendations were applied. Carotid ultrasonography (US) was performed. Carotid intima-media thickness (cIMT) > 0.90 mm and/or carotid plaques were used as the gold standard test for severe subclinical atherosclerosis and high CV risk (US+). The area under the receiver operating curves (AUC) for the predicted risk for mSCORE and mREGICOR were calculated according to the presence of severe carotid US findings (US+).ResultsWe included 370 patients (80% women; mean age 58.9 ± 13.7 years); 36% had disease duration of 10 years or more; rheumatoid factor (RF) and/or anticyclic citrullinated peptide (anti-CCP) were positive in 68%; and 17% had extra-articular manifestations. The EULAR multiplier factor was used in 122 (33%) of the patients. The mSCORE was 2.16 ± 2.49% and the mREGICOR 4.36 ± 3.46%. Regarding US results, 196 (53%) patients were US+. The AUC mSCORE was 0.798 (CI 95%: 0.752 to 0.844) and AUC mREGICOR 0.741 (95% CI; 0.691 to 0.792). However, mSCORE and mREGICOR failed to identify 88% and 91% of US+ patients. More than 50% of patients with mSCORE ≥1% or mREGICOR >1% were US+.ConclusionsNeither of these two function charts was useful in estimating CV risk in Spanish RA patients.
Objective:
To analyze the association between serum levels of osteoprotegerin (OPG) and Dickkopf-related
protein 1 (DKK-1) and the annual percent change (%) in bone mineral density (BMD) in patients with tightly controlled
rheumatoid arthritis (RA).
Methods:
Observational mixed-study. RA patients followed-up with a tight-control strategy were included. Bone
densitometries were performed at baseline (T0) and follow-up (T1) and serum levels of OPG and DKK-1 were measured
by ELISA also in T0 and T1; additional clinical variables included disease activity measures, and treatment for RA and
osteoporosis. Descriptive bivariate and multivariate analyses, stratified by gender, were performed.
Results:
We included 97 RA patients (70% female, with a mean age of 53 years, and 76% with low activity by DAS28);
95% were treated with DMARDs and 37% with anti-osteoporotic drugs. Mean time between T0 and T1 was 2.7 years.
Most patients had their BMD improved. The mean %BMD was +0.42% for lumbar spine, +0.15% for femoral neck and
+0.91% for total femur. In men, baseline OPG was significantly associated with higher BMD loss (β coefficient -0.64) at
femoral neck. In women, DKK-1 was associated with higher BMD loss at femoral neck (β coefficient -0.09), and total
femur (β coefficient -0.11); however, DKK-1 was associated with lower BMD loss at lumbar spine (β coefficient 0.06).
Conclusion:
In tightly controlled RA patients, we have found no evidence of bone loss. The role of DKK1 and OPG
seems small and might be related to sex and to location.
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