Session Title: Rheumamtoid Arthritis - Human Etiology and Pathogenesis
Session Type: Abstract Submissions (ACR)
Patients with the inflammatory autoimmune disease Rheumatoid Arthritis (RA) have a higher mortality and morbidity than the general population, predominantly related to cardiovascular disease (CVD). RA patients experience a 2-fold increased risk of myocardial infarction, due to the effects of traditional risk factors combined with inflammation. Since systemic inflammation, as determined by increases in multiple serum cytokines and chemokines, is evident prior to the onset of clinical RA but not osteoarthritis (OA), we hypothesized that cardiovascular events and risk factors would also occur more frequently prior to diagnosis of RA.
The HUNT population-based surveys were conducted in the county of Nord-Trøndelag in Norway. Detailed information pertaining to RA and OA diagnosis were obtained from 36493 subjects at baseline (HUNT 2, 1995-1997) and at 10-year follow-up (HUNT 3, 2006-2008). In subjects who did not have RA or OA at baseline, we evaluated the effects of cardiovascular and other relevant risk factors on the likelihood of developing RA or OA at follow-up. The risk factors included age, sex, smoking, BMI, blood pressure, diabetes and previous CVD.
The 33567 individuals studied without RA or OA at baseline were mean (SD) age 46 (13) years old, 54% female, 50% current or ex-smokers, had BMI 26.1 (3.8) kg/m2, 3.2% had previous CVD (angina, myocardial infarction or stroke), 1.4% had diabetes and 36% had hypertension. In this cohort, 786 (2.3%) individuals self-reported RA and 3586 (10.7%) self-reported OA at follow-up. Female were 41% and 136% more likely to develop RA and OA respectively. Individuals with previous CVD were 41% more likely to develop RA (p=0.03), but not OA. Current and previous smoking, and increased BMI, but not hypertension or diabetes, were significantly associated with both conditions. We evaluated the cardiovascular outcomes and associated risk factors in patients diagnosed with RA (n=429) or OA (n=2497) at baseline and follow-up. Adjusted for the cardiovascular risk factors, individuals with RA had 69% increased risk of stroke (p=0.02) and 45% increased risk of myocardial infarction (p=0.12) during follow-up. Individuals with OA had 35% increased risk of angina (p=0.003), but no increased risk of vascular events.
Although diagnosis was self-reported and not confirmed by chart review, these data suggest that individuals developing OA and RA among the Norwegian population share common cardiovascular risk factors, but only RA is pre-dated and associated with increased cardiovascular events. The development of RA at population level is associated with previous cardiovascular events and suggests the need for screening individuals with events for auto-antibodies and inflammatory features of RA.
H. Pahau Sr.,
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