Deformation analysis by speckle-tracking echocardiography is a valuable tool to detect early development of myocardial dysfunction despite normal ejection fraction in RA.

IntroductionCardiovascular morbidity is a major burden in patients with rheumatoid arthritis (RA). In this study, we compare the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment of modifiable risk factors for cardiovascular disease (CVD) in patients with early RA fulfilling the 2010 American College of Rheumatology European League Against Rheumatism (ACR/EULAR) criteria.Methods and analysisThe study is a prospective, randomised, open label trial with blinded end point assessment and balanced randomisation (1:1) conducted in 10 outpatient clinics in Denmark. The primary end point after 5 years of follow-up is a composite of death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke and cardiac revascularisation. Secondary outcomes are: the proportion of patients achieving low-density lipoprotein cholesterol <2.5 mmol/L, glycated haemoglobin <48 mmol/mol, blood pressure <140/90 mm  Hg for patients without diabetes and <130/80 mm Hg for patients with diabetes and normoalbuminuria (urinary albumin creatinine ratio <30 mg/g) after 1 year of follow-up and the proportion of patients in each treatment group achieving low RA disease activity after 1 year, defined as a disease activity score C-reactive protein (DAS28-CRP) <3.2 and a DAS28-CRP score <2.6 after 12, 24 and 60 months. Furthermore, all hospitalisations for acute and elective reasons will be adjudicated by the event committee after 12, 24 and 60 months. Three hundred treatment-naive patients with early RA will be randomly assigned (1:1) to receive either conventional treatment administered and monitored by their general practitioner according to national guidelines (control group) or a stepwise implementation administered and monitored in a quarterly rheumatological nurse-administered set-up of behaviour modification and pharmacological therapy targeting (1) hyperlipidaemia, (2) hypertension, (3) hyperglycaemia and (4) microalbuminuria (intervention group).Ethics and disseminationThis protocol is approved by the local ethics committee (DK-S-2014007) and The Danish Health and Medicines Authority. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals.Trial registration numberNCT02246257

No abstract

BackgroundIn patients with rheumatoid arthritis (RA) the role of autoimmunity and especially auto antibody status and the time-course of left ventricular (LV) function is unknown.ObjectivesTo assess LV function as well as the amount of coronary calcium by coronary computer tomography (CCT) in relation to anti-cyclic citrullinated peptide antibody (anti-CCP) status in a cohort of treatment-naive RA patients. Furthermore to assess changes in these parameters during a 2-year follow-up period.MethodsSixty-six steroid- and DMARD-naive RA patients (42 women) were included and treated with methotrexate according to the national guidelines. We assessed both the LV function by conventional echocardiography and speckle-tracking echocardiography. Furthermore, we performed CCT to estimate the amount and progression of coronary calcium. Patients were examined at he time of diagnosis and after 2-years of efficient anti-inflammatory treatment.ResultsAll patients fulfilled the international criteria for RA. We found no clinical significant differences in LV function parameters during the 2-year follow-up period in the total population. However, we found that patients with a persistently elevated anti-CCP both had a significantly lack of improvement in S'(1±1.4 cm/s versus 0.2±0.9 cm/s; p=0.04) and had a worsening in global longitudinal systolic strain (GLS) (0.6±1.8% versus -1±2.8%; p=0.04) compared to patients with non-persistently elevated anti-CCP over a 2-year time period. Furthermore, we observed a significant correlation between ΔGLS over 2 years and anti-CCP at 2-year follow-up (r=0.36;p=0.006). It remained significantly correlated (p=0.008) after correction for relevant cofounders (age, gender, blood pressure, heart rate, and baseline GLS). The circumferential strain improved in the group with non-persistently elevated anti-CCP compared to the group with persistently elevated anti-CCP (-4.2±3.8% versus 0.3±1.9%; p=0.009). We observed a mean progression of calcium score during the 2-year follow-up period of 22.4±68.9. We observed no differences in progression in calcium score in patients with persistently elevated anti-CCP (n=12) versus not persistently elevated (n=32) (23.8±40.3 versus 22.6±68.9; p=0.96).ConclusionsLV function and deformation is reduced in treatment-naive RA patients with persistently elevated anti-CCP. Deformation abnormalities is associated with the degree of anti-CCP positivity in a 2-year follow-up period. No differences in the amount of coronary calcium was observed according to inflammatory burden.Disclosure of InterestNone declared

No abstract