Highlights from

EULAR 2019

European Congress of Rheumatology

Madrid 12-15 June 2019

Rheumatoid arthritis remission reduces the risk of cardiovascular disease

Remission of rheumatoid arthritis (RA) strongly predicts a reduced risk of (sub)clinical atherosclerosis. Among cardiovascular risk factors, non-insulin-dependent diabetes mellitus (NIDDM) was significantly linked to (sub)clinical atherosclerosis in RA patients. These were the main findings of a 3-year observational study presented at EULAR 2019 [1].

Cardiovascular disease in patients with RA is known to be higher than what has been observed in the general population. Dr Pierro Ruscitti et al. (University of L’Aquila, Italy) evaluated the occurrence and the predictive factors of (sub)clinical atherosclerosis in 797 RA patients from the GIRRCS trial [2]. Main outcomes were subclinical (carotid and/or peripheral atherosclerotic lesions detected by ultrasound imaging) and clinical atherosclerosis (myocardial infarction and/or congestive heart failure and/or cerebrovascular accidents). Both RA-related and traditional cardiovascular risk factors were assessed.

Continued observation over 3 years showed that RA remission was achieved and maintained in 42.6% of patients. Median RA duration was 8.35 years (range 0.1-35); 73.1% of patients showed rheumatoid factor and/or ACPA. Among cardiovascular risk factors, observed BMI was 27.2 ± 4.05, 33% of patients reported smoking habits, 49.3% were affected by hypertension, and 12.3% by NIDDM. Patients were treated with corticosteroids (75.5%, low dosage 66.8%), methotrexate (86.8%), hydroxychloroquine (28.1%), or biologic DMARDs (60.7%).

Results showed that maintenance of remission was linked to a reduced risk of clinical atherosclerosis (OR 0.20; 95% CI 0.09-0.95; P=0.041). Maintenance of remission was also linked to a reduced risk of subclinical atherosclerosis (OR 0.25, 95% CI, 0.11-0.56, P=0.001).

Multivariate regression identified NIDDM to be associated with clinical atherosclerosis (OR 6.21; 95% CI 2.19-17.71; P=0.001), while NIDDM (OR 4.50; 95% CI1.74-11.62; 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=0.002), and mean values of CRP during the follow-up (OR 1.07; 95% CI 1.03-1.14; P=0.040) were linked to subclinical atherosclerosis. Other well-known cardiovascular risk factors like BMI and smoking were not related to occurrence of (sub)clinical atherosclerosis.

This follow-up study to GIRRCS suggests that systemic inflammatory processes and cardiovascular risk factors act together to increase (sub)clinical atherosclerosis in patients with RA. Maintenance of RA remission is critical to decrease the risk of (sub)clinical atherosclerosis.

  1. Ruscitti P, et al. Abstract OP0090. EULAR 2019

  2. Ruscitti P, et al. Medicine. 2017 Oct;96(42):e8180

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.