Background/Purpose: Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular (CV) mortality, linked to systemic inflammation and the presence of associated CV risk factors. The DAS28 γGT score has shown interest in assessing both the activity of RA and CV risk (1,2). Our aim was to analyze the CV risk of RA patients selected based on their DAS28-γGT score and evaluated by a cardiologist.

Methods: Prospective observational study involving RA patients referred for cardiology consultation based on a DAS28-γGT score >5.5 (1).
The primary outcome was the diagnosis of coronary and/or carotid atheromatous disease.
Secondary outcomes were 1/ prescription of cardiac examinations by the cardiologist (Doppler ultrasound of the supra-aortic trunks and coronary CT angiography) and 2/ therapeutic intervention by the cardiologist (aspirin or statin initiation, introduction/modification of hypertensive treatment). 

Results: Over a 12-month period, 46 patients (34 females, 74%) were seen in cardiology consultations. Their mean age was 64±8 years, with a disease duration of 17±13 years; 36 had positive rheumatoid factor, 39 had positive ACPA, and 31 had erosions.

Among these patients, 30 (65%) were diabetic and/or had a SCORE >5%. The DAS28-γGT and DAS28-CRP of these patients were 8.4±1.6 and 2.7±0.9, respectively. These patients had 2.5±1.0 traditional CV risk factors, and 14 (47%) had an abnormal ECG. A diagnosis of coronary and/or carotid atheromatous disease was made in 8 patients (27%) in this high-risk population. Further investigations were requested for 20 patients (67%), and a therapeutic intervention by the cardiologist was necessary for 14 patients (47%).

Sixteen patients (35%) had a SCORE < 5%. These patients were younger (59±6 years vs. 67±7 years, p< 0.001), more frequently female (12/16, 75% vs. 18/30, 60%, p=NS), and had more active disease than the previous group (DAS28-CRP 3.8±1.3 vs. 2.7±0.9, p=0.002). They also had a higher use of corticosteroids (13/16, 81% vs. 15/31, 48%, p=0.030), a lower number of traditional CV risk factors (1±0.5 vs. 2.5±1.0, p< 0.001), and fewer ECG abnormalities (3/16, 19% vs. 14/30, 47%, p=0.064). The disease duration and the frequency of use of targeted therapy were not significantly different. In this group, coronary and/or carotid atheromatous disease was diagnosed in 4 patients (25%). Further investigations were requested for 8 patients (50%), and a therapeutic intervention by the cardiologist was prescribed for 3 patients (19%).

Conclusion: Referring patients to a cardiologist with a DAS28-γGT score exceeding 5.5 proved to be significant, identifying 65% of individuals with a SCORE exceeding 5%. This approach also pinpointed a distinct subset of CV risk patients who might not have been referred to a cardiologist based solely on SCORE or the presence of traditional CV risk factors. Their elevated risk could be attributed to the inflammatory activity associated with RA. Thus, the DAS28-γGT score demonstrates its relevance in identifying RA patients at an increased risk of cardiovascular issues.

References:
1/ Vergneault H et al, J rheumatol 2020
2/ Dupont et al, Rheumatology 2023

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/interest-of-das28-%ce%b3gt-in-assessing-cardiovascular-risk-activity-in-rheumatoid-arthritis-in-routine-practice/