RA remission and CV protection go hand in hand
Patients with rheumatoid arthritis (RA) who maintained their disease remission had a significantly reduced risk of clinical and subclinical atherosclerosis, according to the 3-year follow-up data of the GIRRCS* study presented at EULAR 2019.
Previous studies have shown that patients with RA have a higher risk of premature death, mainly driven by cardiovascular (CV) disease-related death, compared with the general population.
“The heightened risk of CV disease in patients with RA is in large part a consequence of uncontrolled inflammation,” said Professor John Isaacs, Chairperson of the EULAR Abstract Selection Committee.
“By demonstrating that remission of RA is associated with a reduction in CV complications, these results really emphasize the importance of more effective control of disease, beyond symptom management alone,” he said.
Over 3 years of follow-up, patients with RA who maintained disease remission were 80 percent less likely to have clinical atherosclerosis, defined as congestive heart failure, myocardial infarction, or cerebrovascular events, compared with those who did not have sustained remission (odds ratio [OR], 0.20; p=0.041). [EULAR 2019, abstract OP0090]
Patients in remission maintenance also had a significantly reduced risk of subclinical atherosclerosis than those without sustained remission, as indicated by atherosclerotic lesions in the carotid and/or peripheral arteries based on ultrasound imaging (OR, 0.25; p=0.001).
The multicentre, prospective, observational study followed 797 patients (median age 60 years, 82.7 percent female) with RA (median duration 8.35 years) in the GIRRCS cohort, of whom 70.9 percent showed rheumatoid factor and 55.7 percent tested positive for anti-citrullinated protein antibodies (ACPA; biomarkers for RA) in their blood. Nearly half of the participants (42.6 percent) had achieved and maintained remission during the study.
At the end of follow-up, the rates of both clinical (p<0.001) and subclinical atherosclerosis (p<0.0001) had increased significantly compared with baseline.
When the researchers analysed the various traditional CV risk factors in these patients by multivariate regression, they found that having type 2 diabetes (T2D) was significantly associated with an increased risk of both clinical (OR, 6.21; p=0.001) and subclinical atherosclerosis (OR, 4.50; p=0.002).
In addition, other risk factors such as high blood pressure (OR, 2.03; p=0.042), C-reactive protein (OR, 1.07; p=0.040), and ACPA (OR, 2.36; p=0.002) were also associated with an increased risk of subclinical atherosclerosis during follow-up.
“Our study supports the idea that systemic inflammatory processes and more traditional CV risk factors work together to increase the CV risk in patients with RA,” said lead investigator Dr Piero Ruscitti of University of L’Aquila in L’Aquila, Italy.
“This is important because it highlights the need for the effective coordination of care between rheumatologists, internists, cardiologists and primary-care physicians to optimize management of CV risk in patients with RA,” he said.