GUIDELINES - EULAR issues guidelines for management in patients with inflammatory arthritis

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October 7, 2009 — The European League Against Rheumatism (EULAR) has

issued 10 recommendations for cardiovascular risk management in

patients with rheumatoid arthritis (RA), ankylosing spondylitis, and

psoriatic arthritis. The new guidelines are published in the September

22 Online First issue of the ls of the Rheumatic Diseases. The

statement primarily targets rheumatologists but also a broad spectrum

of other healthcare providers, reflecting " best practice " for patients

with inflammatory arthritis.

....

The 10 recommendations, and their accompanying level of evidence

rating and strength of recommendation, are as follows:

1.RA should be considered as a disease in which cardiovascular risk is

elevated, because of both an increased prevalence of traditional

cardiovascular risk factors and the inflammatory burden. Although the

evidence base is less, this may also apply to ankylosing spondylitis

and psoriatic arthritis (level of evidence and strength of

recommendation, 2b-3 .

2.To lower cardiovascular risk, adequate control of arthritis disease

activity is necessary (level of evidence and strength of

recommendation, 2b-3 .

3.All patients with RA should undergo annual cardiovascular risk

evaluation with use of national guidelines. This should also be

considered for all patients with ankylosing spondylitis and psoriatic

arthritis. When antirheumatic treatment has been changed, risk

assessments should be repeated (level of evidence and strength of

recommendation, 3-4 C).

4.For patients with RA, risk score models should be adapted by

introducing a 1.5 multiplication factor when the patient meets 2 of

the following 3 criteria: disease duration of more than 10 years,

rheumatoid factor or anti-cyclic citrullinated peptide positivity, and

the presence of certain extra-articular manifestations (level of

evidence and strength of recommendation, 3-4 C).

5.When using the Systematic Coronary Risk Evaluation model for

determination of cardiovascular risk, triglyceride/high-density

lipoprotein cholesterol ratio should be used (level of evidence and

strength of recommendation, 3 C).

6.Intervention for cardiovascular risk factor management should be

performed according to national guidelines (level of evidence and

strength of recommendation, 3 C).

7.Preferred treatment options are statins, angiotensin-converting

enzyme inhibitors, and/or angiotensin-II blockers (level of evidence

and strength of recommendation, 2a-3 C-D).

8.The effect of cyclooxygenase-2 inhibitors and most nonsteroidal

anti-inflammatory drugs (NSAIDs) on cardiovascular risk is not

completely determined and should be studied further. Clinicians should

therefore be very cautious in prescribing these drugs, especially to

patients with cardiovascular risk factors or with documented

cardiovascular disease (level of evidence and strength of

recommendation, 2a-3 C).

9.When corticosteroids are prescribed, this should be at the lowest

possible dose (level of evidence and strength of recommendation, 3 C).

10.Patients should be actively encouraged to stop smoking (level of

evidence and strength of recommendation, 3 C).

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Read the full article here:

http://www.medscape.com/viewarticle/710102

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