Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Vascular Calcification on Hand and Feet X-rays, VFA imaging of the spine, and Cardiovascular Disease in Rheumatoid Arthritis
Background/Purpose: Patients with rheumatoid arthritis (RA) are at increased risk of osteoporosis (OP) and cardiovascular disease (CVD), and have increased cardiovascular mortality compared with the general population. Vascular calcification (VC) is independent predictor of incident CVD and mortality in RA patients. While VC may be present on plain films of the hands and feet, little is known about the significance of this entity in RA patients. We evaluated the prevalence of VC on hands and feet radiographs, the association with VFA-detected abdominal aortic calcification (AAC) and other CVD risk factors, and the prevalence of CVD in RA patients.
Methods: We conducted a cross-sectional study on our RA subjects ≥40 years of age, who met 1987 ACR criteria for RA classification, and had hands and feet radiographs available for analysis. Risk factors and details of CVD were recorded, and DXA and VFA scans were reviewed where available. Study was approved by local I.R.B. Two blinded musculoskeletal radiologists examined all radiographs for the presence of VC as either “present” or “absent”, and VFA scans to detect and quantify the presence of AAC. We compared the prevalence of VC between RA patients with and without CVD using multivariable logistic regression, and determined if VC on hands and feet radiographs was independently associated with VFA-detected AAC and prevalent CVD.
Results: 854 RA patients met the inclusion criteria, 603 of whom also had a VFA scan available for analysis: 69% female mean age 59 years and 77% seropositive (Table 1). 230 subjects had ≥1 documented CVD event. VC was observed on radiographs in 94(11%) and a higher proportion of subjects had prevalent CVD (49% Vs 24%). Of the 603 who had a VFA scan available, 211(35%) of the subjects had AAC. A greater proportion of those with VC on plain films had AAC on VFA (36% Vs 23%). In multivariable analyses, VC presence was significantly and independently associated with AAC (OR 1.80; 95% CI 1.55 to 1.98; p< 0.05) and prevalent CVD (OR 2.30; 95% CI 1.8 to 2.8; p<0.05).
Conclusion: We found a significant association between VC on hands and feet radiographs and abdominal aortic calcification and CVD in our RA cohort. The presence of VC should alert physicians to the presence of CVD in patients with RA.
Table 1: Demographics and Clinical Features of 854 RA Patients According to the Presence of VC on Hand and Feet X-rays
|
Variables |
VC positive (n = 94) |
VC negative (n = 760) |
p Value |
|
Age (years) Women – n (%) Smokers – n (%) RA duration (years) Family history of CVD – n (%) Diabetes – n (%) Dyslipidemia – n (%) Prevalent CVD Hypertension – n (%) Glucocorticoid use – n (%) RF positive – n (%) Anti-CCP positive – n (%) C-reactive protein (mg/l) DAS28, mean ± SD AAC on VFA – n (%) |
59 ± 12.74 65 (69) 60 (64) 15 ± 9 39 (41) 15 (16) 41 (43) 46 (49) 45 (48) 23 (24) 69 (73) 71 (76) 5.50 ± 3.52 2.98 ± 0.90 34 (36) |
56 ± 9.67 525 (69) 396 (52) 13 ± 6 200 (26) 112 (15) 260 (34) 184 (24) 167 (22) 120 (16) 590 (78) 540 (71) 3.31 ± 1.86 1.92 ± 0.86 177 (23) |
0.012 0.890 0.003 0.006 0.003 0.540 0.003 <0.001 <0.001 0.017 0.021 0.013 <0.001 <0.001 0.034 |
Disclosure:
A. Mohammad,
None;
C. English,
None;
D. Lohan,
None;
D. Bergin,
None;
S. Mooney,
None;
J. Newell,
None;
M. O’Donnell,
None;
R. J. Coughlan,
None;
J. J. Carey,
None.
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