Objective Because carotid plaques predict the development of cardiovascular events in RA, we aimed to assess if the combined use of the systematic coronary risk evaluation (SCORE) and the QRISK3 algorithms allows for the identification of RA patients with carotid plaques in a defined population-based RA inception cohort. Methods A set of consecutive RA patients without a history of diabetes, chronic kidney disease or cardiovascular events were studied by carotid US between 2012 and 2019. Modified SCORE (mSCORE) for RA based on the 2015/2016 updated EULAR recommendations and QRISK3 algorithms were retrospectively tested using baseline data obtained at the time of the carotid US assessment. Results A total of 466 (54%) of 865 patients had carotid plaques. Using dichotomized QRISK3 and EULAR mSCORE, 73.2% (95% CI: 68.4.8, 77.6) of patients with QRISK ≥ 10% and EULAR mSCORE < 5% had plaque. In this group, the diagnostic odds ratio was 5.79 (95% CI: 4.14, 8.10). However, if both algorithms were above their thresholds of high cardiovascular risk (QRISK ≥ 10% and EULAR mSCORE ≥ 5%), the sensitivity increased up to 83.3% (95% CI: 72.1, 91.4) and the diagnostic odds ratio up to 10.6 (95% CI: 5.13, 22.0). When the risk charts scales were used as continuous variables, both QRISK3 and EULAR mSCORE were found positively associated with plaque. For each 1% QRISK3 or EULAR mSCORE increase, the probability of having plaques multiplied by 1.14 and 1.22, respectively. However, the effects of both algorithms did not multiply by each other. Conclusions . The combined use of QRISK3 and EULAR mSCORE allows for the identification of most RA patients at high risk of carotid plaques.
BackgroundCOVID-19 may present different degrees of severity. Viral infections in patients with rheumatic inflammatory diseases (R-IMID) trend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce.ObjectivesTo compare predisposing factors, clinical, serological features, and severity of COVID-19 infection in patients with and without R-IMID.MethodsCase-control study in a single University Hospital. We included all consecutive patients with a diagnosis of an R-IMID and COVID-19 infection up to March 31st, 2021. This cohort was compared to patients without R-IMID and not receiving immunosuppressive therapy, matched for sex and age (±5 years). Confirmed infection was defined if a patient had a positive nasopharyngeal swab for SARS-CoV-2. Severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) guidelines.ResultsWe included 274 R-IMID patients (185 women/89 men), mean age 59.1 ± 18 years. More frequent R-IMID were: Rheumatoid arthritis (28.8%), Psoriatic Arthritis (20.1%), axial Spondyloarthritis (12.4%), Polymyalgia Rheumatica (8%) and Systemic Lupus Erythematosus (8%). Hypertension and dyslipidemia were more frequent in patients with R-IMID. Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID. When adjusted by comorbidities, no statistical differences were observed.ConclusionR-IMID have a very similar clinical presentation when compared to the general population. There is a trend to an increased severity of the disease in patients with R-IMID.
Background: COVID19 may present different degrees of severity. Viral infections in patients with rheumatic inflammatory diseases (R-IMID) tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce.Objectives: To compare predisposing factors, clinical, serological features, and severity of COVID-19 infection in patients with and without R-IMID.Methods: Case-control study in a single University Hospital. We included all consecutive patients with a diagnosis of an R-IMID and COVID-19 infection up to March 31st, 2021. This cohort was compared with patients without R-IMID and not receiving immunosuppressive therapy matched for sex and age (± 5 years). Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines.Results: We included 274 R-IMID patients (185 women/89 men), mean age 59.1± 18 years. More frequent R-IMID were: Axial spondyloarthritis/ Psoriatic arthritis (32.5%), Rheumatoid arthritis (28.8%), Polymyalgia Rheumatica (8%) and Systemic Lupus Erythematosus (8%). Hypertension and dyslipidemia were more frequent in patients with R-IMID. In the R-IMID group, dyspnea was more frequent. Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID. When adjusted by comorbidities, no statistical differences were observed.Conclusion: R-IMID have a very similar clinical presentation when compared to the general population. There is a trend to an increased severity of the disease in patients with R-IMID.
BackgroundRheumatoid Arthritis (RA) and Gout are associated with an increase of cardiovascular (CV) disease (1,2). Carotid plaques and increased carotid intima-media thickness (cIMT) are surrogate markers of CV mortality (3). The association of serum uric acid (SUA) levels as an independent factor of subclinical Atherosclerosis and mortality in RA remains not fully clarified (4,5).ObjectivesIn a wide cohort of patients with RA our aims were to assess the relationship of SUA with a) CV risk factors and b) presence of atherosclerosis.MethodsCross-sectional study including 1005 patients with RA from a Single University Center. The presence of Atherosclerosis (c-IMT and carotid plaque) was explored by Carotid Ultrasonography. The relationship between SUA and markers of subclinical atherosclerosis was studied through linear regression and logistic multivariate analysis.ResultsWe studied 1005 RA patients (741 women, 74%), mean age 61±13. The main general features, CV risks factors, RA activity data and current therapy are summarized in Table 1.Table 1.Main features of 1005 RA patientsGENERAL FEATURESRESULTSGENERAL FEATURES (CONTINUATION)RESULTS (CONTINUATION) Age, years, mean±SD60±13RA features Female/ Male, n (%)741 (74) / 264 (26)RA duration, years; mean±SD17±12CRP, mg/L, median, [IQR]3.0 [0.9-7.5]CV risk factorsESR, mm/ 1st hour; median, [IQR]14 [6-24] Past or Current smoker, n (%)539 (54)Rheumatoid factor, n (%)528 (53) Obesity/ Dyslipidemia, n (%)307 (31)/ 560 (56)ACPA, n (%)492 (50) Hypertension, n (%)453 (45)DAS28-ESR; mean±SD3.3 ± 1.5 Diabetes Mellitus, n (%)127 (13)DAS28-CRP; mean±SD3.1 ± 1.3 BMI, kg/m2, mean±SD28±5/93±15Uric acid Abdominal circumference cm; mean±SDUric acid level (mg/dl); mean±SD4.8 ± 1.4 Previous CV Events, n (%)125 (12) Chronic Kidney Disease, n (%)58 (6)Carotid Ultrasonography Gout / using drugs for hyperuricemia; n (%)20 (2)cIMT microns; mean±SD708 ± 157 Total cholesterol, mg/dl; mean±SD201±39Carotid plaque¸ n (%)617 (62) HDL cholesterol, mg/dl; mean±SD61±17 LDL cholesterol, mg/dl; mean±SD119 ± 32Abbreviations: ACPA: Anti–citrullinated protein antibody; BMI: Body mass index; CV: Cardiovascular; cIMT: carotid intima-media thickness; cm: centimeter; CRP: C Reactive protein; DAS28-ESR: Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate; DAS28-PCR: Disease Activity Score-28 for Rheumatoid Arthritis with C reactive protein; dl: deciliter; ESR: Erythrocyte Sedimentation Rate; HDL: high-density lipoprotein; IQR: Interquartile range; Kg: kilogram; LDL: Low-density lipoprotein; mg: milligram; m2: square meter; n: number; RA: Rheumatoid Arthritis; SD: Standard Deviation.SUA as a dependent variable was significantly correlated with age, male gender and most of CV risk factors (body mass index, abdominal circumference and obesity) (single-variable analysis). Similarly, a significative beta coef. [95%CI] positive relationship with SUA was observed with hypertension (0.7 [0.5-0.8], p<0.001), diabetes (0.5 [0.2-0.7], p<0.001), dyslipidemia (0.2 [0.04-0.4], p=0.016), renal chronic insufficiency (1.5 [95CI 1.1-0.8], p<0.001) and previous CV events (0.8 [0.4-1.2], p<0.001).Subclinical Atherosclerosis, as dependent variable, was significantly correlated with SUA (single-variable analysis). In addition, SUA showed a positive significative beta coef. [95%CI] relationship with cIMT (18 [12-25], p<0.001) and the presence of carotid plaques (1.29 [17-1.42], p<0.001). However, statistical significance was not observed in the multivariable analysis adjusted by Classic CV Risk Factors.ConclusionIn RA, SUA is related with most of CV risk factors. However, SUA is not associated with Subclinical Atherosclerosis.References[1]Aviña-Zubieta JA, et al. Arthritis Rheum. 2008,15;59:1690-7.[2]Klein R, et al. Arch Intern Med 1973, 132:401–410.[3]de Groot E, et al. Circulation, 2004,109:33–38.[4]Lauren Shahin, et al Cureus 2021. 5; 13.:e14855.[5]Chiou A, et al. Arthritis Care Res (Hoboken). 2020, 72:950-958.Disclosure of InterestsNone declared
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