EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis

Peters, Mike J L; Symmons, Deborah; McCarey, David; Dijkmans, Ben A. C.; Nicola, Paulo; Kvien, Tore K; McInnes, Iain B.; Haentzschel, H; González-Gay, Miguel Á.; Provan, Sella Aarrestad; Semb, Anne Grete; Sidiropoulos, Prodromos; Kitas, George D.; Smulders, Yvo M.; Soubrier, Martin; Szekanecz, Zoltán; Sattar, Naveed; Nurmohamed, Michael T.

doi:10.1136/ard.2009.113696

Cited by 1,204 publications

(1,078 citation statements)

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“…The chart review, which was performed in this period, reflected the practice patterns of rheumatologists up to 2009. The EULAR guidelines for cardiac risk assessment in RA patients, however, have not been rigorously tested in a prospective, multicentered study to determine their utility in cardiovascular risk stratification [25]. Moreover, uptake of any guidelines in clinical practice will be variable amongst practicing rheumatologists.…”

Section: Discussionmentioning

confidence: 99%

“…Attempts to correct this have been made with the EULAR guideline that suggested a multiplicative factor of 1.5, which is applied to whichever cardiac risk score is used for certain RA populations [25]. While the multiplicative factor does not apply to the SLE patient at this time, an annual CV risk assessment is recommended in the 2010 EULAR guidelines for monitoring SLE patients [26].…”

Section: Discussionmentioning

confidence: 99%

“…The European League Against Rheumatism (EULAR) has already reflected this in their recent recommendations put forth by two different panels suggesting annual CV risk assessment for both RA patients and SLE patients respectively [25,26].…”

Section: Introductionmentioning

confidence: 99%

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Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

2011

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The purpose of this study is to evaluate cardiovascular risk assessment at a Canadian rheumatology center and describe the cardiovascular risk of inflammatory arthritis (IA) and systemic lupus erythematosus (SLE) patients using the Framingham risk score. A retrospective chart review of 504 patients attending nine rheumatology practices at the University of Alberta Hospital was performed. A pre-specified case report form detailed patient demographics, cardiac risk factors, variables for the Framingham 2008 score, disease activity, and medication use. In this group of 504 patients, 64 (12.7%) had SLE (male (M) to female (F) ratio=60:4) and 440 (87.3%) had an IA (M to F ratio=117:323). Of the SLE patients, 31 (48.4%) met four or more American College of Rheumatology (ACR) criteria, 33 (51.6%) had less than four ACR criteria. Of the IA patients, 156 (35.5%) were CCP positive and 257 (58.4%) were RF positive. Utilizing the chart data, retrospective Framingham risk scores were calculable for one (1.6%) SLE patient and three (0.68%) IA patients. The most common cardiac risk factors not documented in the medical records of both the SLE and IA patients included: (1) positive family history of MI, (2) diabetes, and (3) lipid status. The blood pressure was more frequently documented in the SLE patients (93.8%) compared to the IA patients (56.1%). While traditional cardiac risk factors only partially contribute to the increased cardiovascular risk in these patients, cardiovascular risk assessment was suboptimally performed amongst a large group of rheumatologists. A dedicated cardiovascular risk reduction clinic for inflammatory rheumatic diseases has been established at this site to fulfill this need and evaluate treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

2011

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“…Increased body fat in RA could be especially detrimental, since these patients have an incidence of cardiovascular diseases at least twice as high as the general public (3), with worse outcomes and reduced life expectancy (2,4 -6). This in-creased incidence is attributed to traditional risk factors for cardiovascular disease, such as obesity, as well as to RA-specific factors, such as inflammation (7).…”

Section: Introductionmentioning

confidence: 99%

Increase of body mass index in a tight controlled methotrexate‐based strategy with prednisone in early rheumatoid arthritis: Side effect of the prednisone or better control of disease activity?

Jurgens

Jacobs

Geenen

et al. 2012

Arthritis Care & Research

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Objective. To clarify whether increase of body weight in patients with early rheumatoid arthritis (RA) upon administration of prednisone is a side effect of prednisone or a result of better control of disease activity, we examined the association of prednisone and disease activity with a subsequent change in body mass index (BMI). Methods. In the Computer Assisted Management in Early Rheumatoid Arthritis Trial-II, patients ages >18 years with early RA (disease duration <1 year and no prior use of disease-modifying antirheumatic drugs) had been randomized to a methotrexate (MTX)-based tight control strategy with either 10 mg of prednisone (MTX ؉ prednisone) or placebo (MTX ؉ placebo). The MTX ؉ prednisone group had lower disease activity, but gained more weight than the MTX ؉ placebo group (mean ؎ SD 2.9 ؎ 4.2 kg versus 1.3 ؎ 5.3 kg; P ‫؍‬ 0.03). Data from patients with monthly measurements of disease activity (Disease Activity Score in 28 joints [DAS28]) and BMI were analyzed with a longitudinal regression (mixed model) analysis with BMI as the dependent variable and treatment strategy and DAS28 as the independent variables, correcting for baseline BMI and possible confounders (sex, age, and rheumatoid factor status). Results. There was no independent association of glucocorticoid therapy with a change in BMI, but a lower DAS28 was associated with an increased BMI 6 months later. The association of the DAS28 with BMI was most strongly present in postmenopausal women. Clinical cutoff points showed a clear association between DAS28 level and the change in BMI 6 months later. Conclusion. Weight gain during treatment with prednisone seems attributable to a reduction of disease activity and is probably, at least partly, regained weight.

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“…The most recent EULAR guidelines for cardiovascular risk management in patients with rheumatoid arthritis recommend using the lowest possible prednisone dosage. 94 From the recent 2010 recommendations for prevention of glucocorticoid-induced osteoporosis, it is clear that there is no "safe" dosage of prednisone insofar as bone density and structure are concerned. 95 Thus, beyond the first 1 to 2 years of disease, the use of prednisone should be primarily as bridge therapy for flare-ups while awaiting the efficacy of nonbiologic and biologic DMARD therapy.…”

Section: Beyond the First 6 To 12 Months Of Diseasementioning

confidence: 99%

My Treatment Approach to Rheumatoid Arthritis

Davis

Matteson

2012

Mayo Clinic Proceedings

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The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival.

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EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis

Abstract: Objectives: To develop evidence-based EULAR

Cited by 1,204 publications

References 88 publications

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

Increase of body mass index in a tight controlled methotrexate‐based strategy with prednisone in early rheumatoid arthritis: Side effect of the prednisone or better control of disease activity?

My Treatment Approach to Rheumatoid Arthritis

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