RESEARCH - Severe extra-articular disease manifestations are associated with first ever CVD events in RA

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Ann Rheum Dis. 2006 Jul 28; [Epub ahead of print]

Severe extra-articular disease manifestations are associated with an

increased risk of first ever cardiovascular events in patients with

rheumatoid arthritis.

Turesson C, McClelland RL, Christianson TJ, Matteson EL.

Mayo Clinic, United States.

OBJECTIVE: Rheumatoid arthritis (RA) is associated with increased

cardiovascular mortality and morbidity. The purpose of this study was to

assess the effect of severe extra-articular RA (ExRA) manifestations on the

risk of cardiovascular disease (CVD) in patients with RA. METHODS: Patients

with ExRA (N=81) according to predefined criteria, and controls (N=184)

without evidence of extra-articular disease were identified from a large

research database of patients with RA. In a structured review of the medical

records, the occurrence and the date of onset of clinically diagnosed CVD

events were noted. proportional hazards models were used to estimate the

effect of ExRA on the risk of first ever CVD events after RA diagnosis. ExRA

manifestations were modeled as time dependent covariates, with adjustment

for age, sex, and smoking at RA diagnosis. Furthermore, onset of erosive

disease and RF seropositivity were entered as time dependent variables.

Patients were followed until onset of CVD, death or loss to follow up.

RESULTS: ExRA was associated with a significantly increased risk of first

ever CVD events (p<0.001), and also with an increased risk of new onset

coronary artery disease, adjusted for age, sex and smoking (Hazard ratio

(HR): 3.16; 95 % confidence interval (95 % CI): 1.58- 6.33). The association

between ExRA and any first ever CVD event remained significant when

controlling for age, sex, smoking, RF and erosive disease (HR: 3.25; 95 %

CI: 1.59-6.64).

CONCLUSION: Severe ExRA manifestations are associated with an increased risk

of CVD events in patients with RA. This association is not due to

differences in age, sex, smoking, RF or erosive joint damage. We suggest

that systemic extra-articular disease is a major determinant of

cardiovascular morbidity in RA.

PMID: 16877533

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6877533

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org