Background Rheumatoid arthritis (RA) is associated with increased cardiovascular mortality due to myocardial infarction, stroke and heart failure. Both, chronic inflammation leading to arterial stiffness, and some of the drugs used to treat RA, such as corticosteroids and leflunomide, are risk factors for developing arterial hypertension (HT). Objectives The aim of this study is to determine the prevalence of HT in outpatients with RA at a rheumatology office in Buenos Aires, and describe their relationship with clinical, laboratory and disease activity Methods We evaluated consecutive outpatients with a diagnosis of RA according ACR 90 criteria that attend to the Rheumatology office of a public hospital in Buenos Aires. Blood pressure (BP) was assessed by 3 protocolized measurements, clinical data was collected and disease activity was evaluated by DAS28-ESD. Statistical analysis was performed to establish prevalence of hypertension and to establish association with clinical and laboratory variables using Mann Whitney and Chi Square test. Significance was p≤0.05. Results We analyzed 99 patients (85.9% female and 14.1% male) with a mean age of 51.3 years old (range 26-80). 79.8% had Functional Class I and II. The prevalence of hypertension in our population was 50.5%. The median time to progression of RA: 9.57 years, DAS 28: 4.06 (range: 1.54 to 7.55), 65.7% of individuals take corticosteroids. HT was associated with age (56.16 years (26-80) the HT patients versus 46.35 years (26-81) for non HT patients(p <0.0001). The abdominal diameter was greater for the HT group (95.74 cm (92.31- 99.17) versus 90.59 cm (86.67 - 94.51) (p=0.035). The other analyzed variables don´t show statistical significance Conclusions Almost a half of RA patients had blood hypertension at the medical office during a standard control. It was significantly related to age and abdominal diameter. It was higher than the prevalence for the general population of Buenos Aires References Solomon D, Karlson E, Rimm E, Cannuscio C, Mandl M. Cardiovascular morbidity and mortality in women diagnosed with Rheumatoid arthritis. Circulation 2003;107:1303–7. Ferrante D, Virgolini M. Encuesta Nacional de Factores de Riesgo 2005: resultados prinicpales. Prevalencia de factores de riesgo de enfermedades cardiovasculares en la Argentina. Rev. Argent Cardiol. 2007; 75; 20-29. Hernandez- Hernandez R, Silva H, Velasco M, et al. Hypertension in seven Latin American cities: the cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study. J. Hypertens 2010; 28; 24-34. Panoulas V, et. al. Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology 2007;46:1477–1482 Disclosure of Interest None Declared
BackgroundThe purpose of the T2T approach in RA is to achieve remission or LDA according to results from objective activity measurements. This strategy has proven clinical benefits, however objective adherence T2T measurement tools are lacked in daily practice.ObjectivesTo evaluate the setting, usage of a T2T adherence measure: T2T70 and T2T100, and its association with sustained low disease activity (LDAS) as a measure of outcome.MethodsProspective study, consecutive patients with RA diagnosis (ACR/EULAR 2010) and follow-up between 1 and 24 months were included. Data from electronic medical record (EHR) were collected. Demographic variables, characteristics of the disease and treatment were recorded. The following T2T characteristics were defined and collected from each patient: number of visits, visits where treatment was adjusted, CDAI measurements, use of ultrasound to measure disease activity and achievement of LDA. Sustained LDA (LDAS) was defined when the patient had 2 or more records of that consecutive state of activity. Measures of adherence to T2T were defined as follows: T2T-70, when therapeutic decisions were accompanied by the measurement of activity by 70% and the interval between visits did not exceed 6 months; And T2T-100, when 100% of the decisions were accompanied with the activity measurement and the interval between each visit did not exceed 6 months. Statistical analysis: a descriptive analysis of the variables was performed and Chi2 test (categorical) and Student or MannWhitney test (continuous) were applied. For multivariate logistic regression analysis we considered as dependent variable LDAs.Results96 patients were included, with a mean follow-up of 15 months (DS 7.8), equivalent to 120.6 patients/year. Eighty percent of the patients were women, mean age 53.7 years (SD 13), disease duration 36 months (RIC, 12–52), 64% had early diagnosis, 85% and 75% positive For FR and ACPA, respectively. According to T2T characteristics, 526 visits were recorded, 270 were treatment adjustment and 208 (78%) of them were performed according to the CDAI value. The frequency of LDAS was 20% (IC95: 12–30). The frequency of T2T-70 compliance was 62.5% (IC95: 52–72) and T2T-100 was 42% (IC95: 32–52). Compliance with T2T-70 and T2T-100 presented a statistically significant association to the achievement of LDAS in the uni and multivariate analysis (p: 0.000). Compliance with T2T-70 and T2T-100 was associated with a shorter time course of disease; And T2T-70 also showed association with early diagnosis.ConclusionsT2T-70 and T2T-100 adherence were 62% and 42%, respectively, patients who met these criteria reached more LDAS. The early diagnosis and shorter time to disease evolution at baseline were variables that were variables that were associated with more compliance of these tools.AcknowledgementsDra Josefina Marcos.Disclosure of InterestNone declared
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