Marked underdiagnosis and undertreatment of hypertension and hypercholesterolaemia in rheumatoid arthritis

Stoep, D. F. Van Breukelen-van der; Zeben, Derkjen van; Klop, Boudewijn; Geijn, Gert‐Jan M. van de; Janssen, Hans W.; Meulen, N. van der; Vries, Marijke A. de; Hazes, M.; Birnie, Erwin; Cabezas, Manuel Castro

doi:10.1093/rheumatology/kew039

Cited by 54 publications

(38 citation statements)

References 29 publications

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“…Related to the present findings, researchers from the Dutch Trial Registry recently found that RA patients were undertreated for both hyperlipidemia and hypertension due to no treatment or insufficient therapy to meet recommended target goals [26]. In contrast, more patients with RA are prescribed inhaled corticosteroids and antiasthma drugs than their non-RA counterparts, which may indirectly suggest a higher prevalence of obstructive lung disease as both lungs and pleura are common sites for extraarticular involvement in these patients [27].…”

Section: Discussionmentioning

confidence: 57%

Drug prescribing trends in adults with rheumatoid arthritis: a population-based comparative study from 2005 to 2014

et al. 2016

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Objective To examine drug prescribing trends for patients with rheumatoid arthritis (RA) over recent years and compare them to matched non-RA subjects. Methods Retrospective prescription data were examined from 2005–2014 in a population-based incidence cohort of patients with RA and comparable non-RA subjects. Drugs for or related to the treatment of RA were excluded. Comparisons between cohorts of percentages of patients with at least 1 prescription in a specific drug category/class were performed using Poisson regression models adjusted for age and sex. Results The study included 497 RA (71% female) and 527 non-RA subjects (70% female). The overall observed percentage of subjects who were prescribed at least 1 drug over the ten-year period was somewhat higher among the RA compared to non-RA subjects (relative risk [RR]: 1.04; 95% confidence interval [CI]: 0.99, 1.08). Over the study period, both groups demonstrated significant increases in the percentages of patients with at least 1 prescription (age and sex adjusted 7% increase over 10 years in RA, p<0.001; 11% increase in non-RA, p<0.001). Drugs that were more common among RA than non-RA included gastrointestinal drugs, antimicrobials, calcium metabolism modifiers, thyroid hormone replacement therapy, tricyclic antidepressants, antiasthma/inhaled corticosteroids, proton pump inhibitors, contraceptives, anti-hypertensives and some others. Prescription drugs that were less common in RA than non-RA were statins and other antilipemic drugs. Conclusion Excluding drug prescriptions specifically for treatment of RA, there was a marked overall increase in prescriptions for drugs for both RA and non-RA cohorts over the study period.

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Section: Discussionmentioning

confidence: 57%

Drug prescribing trends in adults with rheumatoid arthritis: a population-based comparative study from 2005 to 2014

et al. 2016

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“…At present, available SDMARDs did not show any positive effect in controlling systemic blood pressure; on the contrary, NSAIDs and may rise the systemic blood pressure [23,26]. Furthermore, it must be pointed out that, as recently reported, SAH may not be optimally identified, in RA patients [27], thus contributing to the increase of CVEs risk.…”

Section: Discussionmentioning

confidence: 83%

Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study

et al. 2017

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ObjectivesSeveral studies showed the close relationship between Rheumatoid Arthritis (RA) and cerebro-cardiovascular events (CVEs) and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV) and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis.MethodsWe designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis.ResultsWe enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH), type 2 diabetes mellitus and metabolic syndrome (MS), at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis.ConclusionsOur study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.

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“…Despite of the European League Against Rheumatism (EULAR) provided different sets of recommendations for the management of cardiovascular risk in inflammatory arthritis patients [18,19], cardiometabolic comorbidity remains still underdiagnosed and undertreated in RA patients [20]. Although these comorbidities are frequently occurring in RA patients, the evidence deriving from randomized clinical trials does not fully elucidate this topic.…”

Section: Introductionmentioning

confidence: 99%

Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study

et al. 2017

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ObjectivesDespite of the European League Against Rheumatism (EULAR) provided different sets of recommendations for the management of cardiovascular risk in inflammatory arthritis patients, it must be pointed out that cardiometabolic comorbidity, such as type 2 diabetes (T2D), remains still underdiagnosed and undertreated in patients affected by rheumatoid arthritis (RA).MethodsIn this work, we designed a single centre, prospective study in order to better investigate the occurrence of T2D during the course of 1 year of follow-up. Furthermore, we evaluated the role of both traditional cardiovascular and RA-specific related risk factors to predict the occurrence of new T2D.ResultsIn this study, we evaluated 439 consecutive RA patients and we observed that 7.1% of our patients (31/439) developed T2D, after 12 month of prospective follow-up. The regression analysis showed that the presence of high blood pressure, the impaired fasting glucose (IFG) at the first observation and the poor EULAR-DAS28 response, after 12 months of follow–up, were significantly associated with an increased likelihood of being classified as T2D. Similarly, we observed that 7.7% of our patients (34/439) showed IFG after 12 months of prospective follow-up. The regression analysis showed that the presence of high blood pressure and the poor EULAR-DAS28 response after 12 months of follow-up, were significantly associated with an increased likelihood of showing IFG.ConclusionsOur study supports the hypothesis of a significant short-term risk of T2D in RA patients and of a close associations between uncontrolled disease activity and glucose metabolism derangement. Further multicentre, randomised-controlled studies are surely needed in order to elucidate these findings and to better ascertain the possible contribution of different therapeutic regimens to reduce this risk.

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Marked underdiagnosis and undertreatment of hypertension and hypercholesterolaemia in rheumatoid arthritis

Abstract: The Dutch Trial Register, www.trialregister.nl, NTR3873.

Cited by 54 publications

References 29 publications

Drug prescribing trends in adults with rheumatoid arthritis: a population-based comparative study from 2005 to 2014

Drug prescribing trends in adults with rheumatoid arthritis: a population-based comparative study from 2005 to 2014

Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study

Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study

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