Background/Purpose: Patients with rheumatoid arthritis (RA) are at increased risk of developing cardiovascular disease (CVD). There is growing evidence that serum uric acid plays an important role in CVD in the general population. The purpose of this study was to evaluate whether hyperuricemia is a risk factor for CVD in patients with RA.

Methods: A population-based inception cohort of patients diagnosed between 1980 and 2007 with adult-onset RA according to 1987 ACR guidelines was assembled. A comparison cohort of subjects without RA (non-RA) but with similar age and sex was also assembled. All subjects were followed from inception/index until death, migration, or December 31, 2008. All clinically obtained uric acid values were collected. Per reference ranges, hyperuricemia was defined as serum uric acid >8.0 mg/dl for males and >6.1 mg/dl for females. CVD recorded for each patient included angina, coronary heart disease, revascularization procedures, myocardial infarction (MI) and heart failure (HF). Noncardiac vascular diseases included stroke, thromboembolism, and peripheral arterial disease (PAD). Cox proportional hazards models were used to assess the impact of hyperuricemia on the development of CVD and mortality among RA and non-RA subjects as well as noncardiac vascular disease in RA patients.

Results: The study included 813 patients with RA and 813 subjects without RA (mean age 55.9 years; 68% female in both cohorts). There was no significant difference in the presence of hyperuricemia between the cohorts at baseline (10% in RA vs. 13% in non-RA; p=0.15). Cumulative incidence of hyperuricemia was higher in RA patients (19.1% ± 1.8% at 10 years in RA vs. 12.4% ± 1.5% in non-RA; p=0.005). In patients without RA, after adjusting for traditional cardiovascular risk factors, hyperuricemia was associated with HF (HR: 1.87; 95% CI: 1.08, 3.25) and CVD (HR: 1.79; 95% CI: 1.13, 2.84). In patients with RA, hyperuricemia was not significantly associated with the assessed cardiac outcomes. However, hyperuricemia appeared to be more strongly associated with mortality among RA patients (HR: 1.93; 95% CI: 1.43, 2.60) than among the non-RA subjects (HR: 1.51; 95% CI: 1.06, 2.16). After adjusting for vascular risk factors, in patients with RA, hyperuricemia was significantly associated with PAD (HR: 2.74; 95% CI: 1.28, 5.86). 

Conclusion: Patients with RA were more likely to develop hyperuricemia than patients without RA. In patients with RA, hyperuricemia was a significant predictor of increased mortality and PAD but not CVD. Further studies are needed to improve our understanding of the effects of hyperuricemia in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hyperuricemia-as-a-risk-factor-for-cardiovascular-disease-in-patients-with-rheumatoid-arthritis/