The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease

Abstract

Objective To examine the role of rheumatoid arthritis (RA) flare, remission, and RA severity burden in cardiovascular disease (CVD). Methods In a population-based cohort of RA patients without CVD (age ≥30 years; 1987 ACR criteria met in 1988-2007) we performed medical records review at each clinical visit to estimate flare/remission status. The previously validated RA medical Records-Based Index of Severity (RARBIS) and Claims-based Index of RA Severity (CIRAS) were applied. Age- and sex-matched non-RA subjects without CVD comprised the comparison cohort. Cox models were used to assess the association of RA activity/severity with CVD, adjusting for age, sex, calendar year of RA, CVD risk factors, antirheumatic medications. Results Study included 525 RA patients and 524 non-RA subjects. There was a significant increase in CVD risk in RA per time spent in each acute flare vs remission (HR 1.07 per 6-week flare; 95% CI 1.01-1.15). The CVD risk for RA patients in remission was similar to the non-RA subjects (HR 0.90; 95% CI 0.51-1.59). Increased cumulative moving average of daily RARBIS (HR 1.16, 95% CI 1.03-1.30) and CIRAS (HR 1.38, 95% CI 1.12-1.70) was associated with CVD. CVD risk was higher in RA patients who spent more time in medium (HR 1.08, 95% CI 0.98-1.20) and high CIRAS tertiles (HR 1.18, 95%CI 1.06-1.31) vs lower tertile. Conclusions Our findings show substantial detrimental role of exposure to RA flare and cumulative burden of RA disease severity in CVD risk in RA suggesting important cardiovascular benefits associated with tight inflammation control and improved flare management in RA patients.

Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives

“…In patients with CIDs, including RA, psoriasis, IBD, and SLE, life expectancy is reduced and mortality related to CVD is increased by approximately 50 %, with minor variations between the different disease entities [1][2][3][4][5][6][7][8][9][10][11][22][23][24]. Among the individual CV outcomes, the excess risk of myocardial infarction (MI) seems to be the most pronounced and consistently reported CVD manifestation in patients with CID.…”

“…An interesting link seems to be emerging between cardiovascular disease (CVD) and chronic inflammatory diseases (CID), e.g., rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE) [1][2][3][4][5][6][7][8][9][10][11]. The combination of a markedly increased incidence and prevalence of CVDs and the reduced life expectancy in these conditions has stimulated considerable research in this area, and it is becoming increasingly clear that the heightened CVD risk cannot be explained through the classical cardiovascular (CV) risk factors.…”

According to the Materials of the 2015/2016 New European League Against Rheumatism (Eular) Guidelines for Reducing Cardiovascular Risk in Patients With Inflammatory Arthritis: General Characterization and Discussion Problems

“…Новые данные по-прежнему демонстрируют связь между высокой сум-марной воспалительной нагрузкой и повышенным риском ССЗ при РА [38][39][40][41]. Длительность заболевания не являет-ся независимым ФР ССЗ [39].…”

“…Длительность заболевания не являет-ся независимым ФР ССЗ [39]. В то же время кумулятивная активность болезни существенно влияет на риск ССЗ [38][39][40][41]. В настоящее время имеются дополнительные дан-ные, свидетельствующие о снижении риска ССЗ у пациен-тов, получающих противоревматические препараты.…”

“…В настоящее время имеются дополнительные дан-ные, свидетельствующие о снижении риска ССЗ у пациен-тов, получающих противоревматические препараты. При-менение традиционных базисных противовоспалительных препаратов (БПВП), в частности метотрексата (МТ), а так-же генно-инженерных биологических препаратов (ГИБП), таких как ингибиторы фактора некроза опухоли α (ФНОα), связано со значительным снижением риска ССЗ у пациен-тов с РА [35,38,40,[42][43][44][45]. В пилотных исследованиях по-казано, что снижение активности РА коррелирует с сурро-гатными маркерами риска развития ССЗ: уменьшением толщины комплекса интима-медиа на фоне терапии тоци-лизумабом или ритуксимабом (РТМ) [46][47][48]; улучшением артериальной ригидности и жесткости аорты на фоне лече-ния МТ и ингибиторами ФНОα [49][50][51][52].…”