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

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ls of the Rheumatic Diseases 2007;66:70-75

© 2007 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Severe extra-articular disease manifestations are associated with an

increased risk of first ever cardiovascular events in patients with

rheumatoid arthritis

C Turesson1, R L McClelland2, T J H Christianson2 and E L Matteson1

1 Division of Rheumatology, Mayo Clinic College of Medicine, Rochester,

Minnesota, USA

2 Department of Health Sciences Research, Mayo Clinic College of Medicine,

Rochester, Minnesota, USA

Background: Rheumatoid arthritis is associated with increased cardiovascular

mortality and morbidity.

Objective: To assess the effect of severe extra-articular rheumatoid

arthritis (ExRA) manifestations on the risk of cardiovascular disease (CVD)

in patients with rheumatoid arthritis.

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 rheumatoid

arthritis. 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 the diagnosis of rheumatoid arthritis.

ExRA manifestations were modelled as time-dependent covariates, with

adjustment for age, sex and smoking at the diagnosis of rheumatoid

arthritis. Onset of erosive disease and rheumatoid factor 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 to 6.33). The association

between ExRA and any first ever CVD event remained significant when

controlling for age, sex, smoking, rheumatoid factor and erosive disease

(HR: 3.25; 95% CI: 1.59 to 6.64).

Conclusion: Severe ExRA manifestations are associated with an increased risk

of CVD events in patients with rheumatoid arthritis. This association is not

due to differences in age, sex, smoking, rheumatoid factor or erosive joint

damage. It is suggested that systemic extra-articular disease is a major

determinant of cardiovascular morbidity in rheumatoid arthritis.

http://ard.bmj.com/cgi/content/abstract/66/1/70?etoc

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