No abstract

No abstract

No abstract

No abstract

BackgroundRheumatoid arthritis (RA), which is an autoimmune chronic arthritis, leads to elevated rates of disability and mortality.The main causes of mortality identified among RA patients are increased incidences of cardiovascular (CV) disease, which accounts for one-third to one-half of the premature deaths, infection and cancer.In our previous study, we identified that cumulative inflammatory burden contributes to the development of carotid atherosclerosis through a synergistic interaction with conventional CV risk factors in patients with RA.During the 2 years follow-up period, the mortality rate was 2.4% (10/412), and the main causes of death were infection (4/10) and CV disease (3/10).ObjectivesTo investigate the incidences of mortality and CV disease in patients with RA in the 5 year Kyungpook National University Hospital Atherosclerosis Risk in Rheumatoid Arthritis (KARRA) prospective study.MethodsA total of 372 patients with RA and 162 healthy controls were followed up for 5 years or until deaths in a prospective KARRA cohort study (412 patients and 221 controls at baseline).To detect the presence and progression of carotid atherosclerosis, we performed carotid ultrasound at baseline and 5 year.We analysed the incidence of CVD, conventional CV risk factors, RA disease activity and severity markers, medication histories, mortality rate, and causes of death.ResultsDuring 5 year follow-up period, the mortality rate was 10.7% (44/412) in RA patients and 1.4% (3/221) in healthy controls (p<0.001), while the incidence of CVD were 11.4% (47/412) in RA patients and 0.9% (2/221) in healthy controls (p<0.001).Among CVD in RA patients, cerebrovascular accident (CVA) and cardiovascular event (CVE) were 17 (36.2%) and 30 (63.8%) events, respectively.Major causes of death included infection (21/44, 47.7%), CVD (12/44, 27.3%), and others (11/44, 25%).The mean age, presence and number of carotid plaques, functional class, modified Korean version of the HAQ (mKHAQ), tender joint count (TJC), swollen joint count (SJC), ESR and CRP, and conventional CV risk factors at baseline and cumulative ESR (ESR area under the curve), DAS28-ESR and DAS28-CRP at year 5 were significantly associated with mortality in RA patients.Multivariate logistic regression analysis showed that the presence of carotid plaque (OR 6.22 [95% CI 1.08–24.99; p=0.031]), mKHAQ (OR 1.04 [95% CI 1.01–1.12; p=0.014]), and ESR (OR 1.09 [95% CI 1.03–1.16; p<0.001]) at baseline and cumulative ESR (ESR area under the curve) (OR 1.047 [95% CI 1.01–1.13; p=0.048]) and DAS28-ESR (OR 1.55 [95% CI 1.08–2.21; p=0.016]) at year 5 were independent risk factors for mortality of RA patients.ConclusionsDuring the follow-up period of 5 years, the mortality rate and prevalence of CV disease were significantly increased in RA patients, compared to the controls. Furthermore, main causes of death were infectious disease and CV disease. Furthermore the risk factor for CVD and mortality is carotid plaque which is determined by disease activity and CV risk factors.Disclosure of Inte...