Subclinical and clinical atherosclerosis in rheumatoid arthritis: results from the 3-year, multicentre, prospective, observational GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study

Abstract

Background: Rheumatoid arthritis (RA) is associated with an increased risk of morbidity and mortality, when compared with general population, largely due to enhanced atherosclerotic disease. In this work, we aimed at assessing both occurrence and predictive factors of subclinical and clinical atherosclerosis in RA. Methods: From January 1, 2015, to December 31, 2015, consecutive participants with RA, admitted to Italian Rheumatology Units, were assessed in the GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) cohort. After that, those participants were followed up in a 3-year, prospective, observational study, assessing the occurrence of subclinical and clinical atherosclerosis and possible predictive factors. McNemar test was employed to assess the changes in subclinical and clinical atherosclerosis, and regression analyses exploited the ORs for the occurrence of those comorbidities. Results: We analysed 841 participants, mostly female (82.2%) and with median age of 60 years (range 21-90). The remission was achieved and maintained by 41.8% of participants during the follow-up. We observed an increased rate of subclinical atherosclerosis at the end of follow-up (139 vs 203 participants, p < 0.0001), particularly in participants with a disease duration less than 5 years at baseline (70 participants vs 133 participants, p < 0.0001). Type 2 diabetes (T2D) (OR 4.50, 95%CI 1.74-11.62, p = 0.002), high blood pressure (OR 2.03, 95%CI 1.04-4.14, p = 0.042), ACPA (OR 2.36, 95%CI 1.19-4.69, p = 0.014) and mean values of CRP during the follow-up (OR 1.07, 95%CI 1.03-1.14, p = 0.040) were significantly associated with higher risk of subclinical atherosclerosis. We observed an increased rate of clinical atherosclerosis at the end of follow-up (48 vs 76 participants, p < 0.0001). T2D (OR 6.21, 95%CI 2.19-17.71, p = 0.001) was associated with a significant risk of clinical atherosclerosis. The achievement and the maintenance of remission reduced the risk of subclinical (OR 0.25, 95%CI 0.11-0.56, p = 0.001) and clinical atherosclerosis (OR 0.20, 95%CI 0.09-0.95, p = 0.041).

Effect of methotrexate use on the development of type 2 diabetes in rheumatoid arthritis patients: A systematic review and meta-analysis

“…The country of publication differed between the included studies. There were six studies conducted among RA patients in North America (the USA) [ 16 , 19 , 33 , 34 , 37 , 40 ], two studies in Latin America (Mexico, Colombia, and Brazil) [ 12 , 14 ], two in Asia Pacific (Australia and Taiwan) [ 25 , 35 ] and six in Europe (France, Sweden and Netherlands) [ 11 , 15 , 17 , 36 , 38 , 39 ].…”

“…However, no standard criteria were used when selecting the RA patients [ 37 ], ascertaining exposure to MTX [ 15 , 39 ], or the occurrence of T2D [ 17 , 25 , 37 , 38 , 40 ]. Five studies recruited RA patients with incident T2D [ 16 , 19 , 34 , 37 , 40 ] while other studies included RA patients with prevalent T2D [ 11 , 12 , 14 , 15 , 17 , 25 , 33 , 35 , 36 , 38 , 39 ]. All included studies reported the use of DMARDs and provided details of the drug names except one study [ 12 ].…”

Features of Cardiovascular Lesions in Rheumatoid Arthritis Depending on the Age of Onset of the Disease

“…Литературные данные также демонстрируют факт кумуляции структурных сосудистых нарушений у больных РА с метаболическим синдромом [12]. Вместе с тем в недавнем проспективном исследовании показано, что наибольший прирост частоты субклинического и клинического атеросклероза был зафиксирован в первые 5 лет РА [13]. Эти особенности требуют более внимательного подхода к выявлению и модификации факторов риска ССЗ, а также диагностике и раннему лечению атеросклероза у больных с началом РА после 45 лет, особенно в дебюте заболевания.…”

Vascular Involvement in Rheumatoid Arthritis

“…Skeoch et al demonstrated in their study the increased prevalence of atherosclerosis in RA, providing data to confirm that atheroma plaques are at high risk of complications [38]. Ruscitti et al have shown increased incidence and prevalence of subclinical and clinical atherosclerosis in RA patients, but reaching and maintaining remission had positive effect on the atherogenesis development [39].…”