Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose
We aimed to investigate whether the 10-year cardiovascular risk (CV) differs between patients with RA treated with Biologic Disease Modifiers (BDMARDs) and Methotrexate (MTX) and with MTX only.
Methods
Patients with RA receiving MTX and BDMARDs were prospectively followed-up from January 2011 to March 2014. Cardiovascular risk was assessed using the Framingham Risk Score (CCS 2009 Guidelines) and compared between cohorts. The presence of traditional CV risk factors was ascertained at the baseline and at every six months of observation up to 24 months.
Results
From 515 patients enrolled at the baseline, 15 patients dropped out of the study. Total 500 patients (75.2% females) with median age 57 years (Q1-Q3=50-65) were prospectively followed for at least 24 months. The mean (SD) age at RA diagnosis was 46.7 (13.5) years with the mean (SD) duration of RA symptoms 10.0 (8.6) years. Overall, females were significantly younger (p (95%CI)=0.016 (0.6-5.7)) while more males were obese (61.3% vs. 49.5%, p=0.023). Forty (8.0%) patients with documented MI and 12 (2.4%) patients with TIA/Stroke had their CV events prior to the study. Twelve patients (2.4%) experienced MI during the observation period with median age for males 68 years and for females 75 years. Significant differences in age, disease duration and activity indices were detected between cohorts. However, no significant changes were found in gender distribution, smoking status, and mean Atherogenic Index (AI) values. RA patients treated with MTX were older at the time of RA diagnosis and enrollment into the study but with significantly shorter duration of disease. 50.2% of patients were treated by Prednisone; 95.8% by MTX. 10-year CV risk was strongly correlated with Prednisone (r=0.122, p=0.006) and MTX only (r=0.178, p<0.001) therapy, and with total number of comorbidities in RA patients (r=0.569, p<0.001). Men had a significantly higher risk for CV event than women at the baseline and 24 months later.
|
|
|
BASELINE |
|
|
24-MONTH |
|
|
|
MTX |
BIO + MTX |
P (95%CI) |
MTX |
BIO + MTX |
P (95%CI) |
|
CRP |
7.0 (15.5) |
14.7 (28.1) |
<0.001(-11.9-(-3.4)) |
5.5 (8.6) |
8.4 (13.9) |
0.009(-5.1-(-0.7)) |
|
DAS28 |
3.1 (1.1) |
4.0 (1.2) |
<0.001(-1.1-(-0.7)) |
2.8 (1.1) |
3.4 (1.2) |
<0.001(-0.8-(-0.4)) |
|
CDAI |
11.9 (9.4) |
18.1 (10.0) |
<0.001(-8.0-(-4.5)) |
9.9 (7.4) |
13.6 (9.7) |
<0.001(-5.2-(-2.0)) |
|
HAQ |
0.7 (0.9) |
1.1 (0.8) |
<0.001(-0.6-(-0.3)) |
0.6 (0.7) |
1.0 (0.8) |
<0.001(-0.5-(-0.3)) |
|
TC |
4.1 (1.9) |
3.3 (2.6) |
<0.001(0.4-1.2)) |
3.8 (2.0) |
3.5 (2.5) |
0.107(-0.1-0.7) |
|
HDL-C |
1.2 (0.7) |
1.1 (1.2) |
0.656(-0.1-0.2) |
1.2 (0.7) |
1.2 (1.1) |
0.703(-0.2-0.1) |
|
LDL-C |
2.5 (1.3) |
1.7 (1.4) |
<0.001(0.6-1.1) |
2.2 (1.3) |
1.2 (1.3) |
<0.001(0.8-1.2) |
|
AI (TC/HDL-C) |
3.7 (1.2) |
3.6 (1.9) |
0.408(-0.2-0.5) |
3.4 (1.1) |
3.3 (1.4) |
0.434(-0.2-0.4) |
|
10-year CV Risk |
14.8 (9.0) |
12.3 99.3) |
0.003(0.9-4.2) |
13.7 (8.6) |
11.8 (8.9) |
0.016(0.4-3.5) |
Conclusion
Our findings demonstrated significant difference in the 10-year cardiovascular risk at 24 months between the two treatment modalities. The combination of BDMARDs and MTX treatment modality seems to be more beneficial in the reducing patients’ risk for CV events. Intensive treatment of chronic inflammation positively affects both patients’ arthritis and their RA-dependent CV risk.
Disclosure:
M. Khraishi,
Research grants,
2;
R. Aslanov,
None.
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