1.5 INCREASED CRP EARLY IN THE RA DISEASE COURSE PREDICTS AN INCREASED RISK OF CARDIOVASCULAR DISEASE AND ARTERIAL STIFFNESS: 15-YEAR FOLLOW-UP OF THE EURIDISS COHORT

• Main Authors: S.A. Provan, K. Angel, A.G. Semb, D. Atar, T.K. Kvien
• Format: Article
• Language: English
• Published: Atlantis Press 2009-12-01
• Series: Artery Research
• Online Access: https://www.atlantis-press.com/article/125927361/view

Background: Patients with rheumatoid arthritis (RA) have increased cardiovascular morbidity and mortality. Objective: To explore whether early markers of RA inflammatory disease activity could predict later cardiovascular disease and arterial stiffness, and to describe the impact of later use of disease-modifying antirheumatic drugs (DMARDs) on arterial stiffness. Methods: Two hundred and thirty eight patients with early RA were comprehensively examined at baseline. At the 15-year follow-up these examinations were repeated and additionally patient-reported cardiovascular disease (CVD) and arterial stiffness, pulse wave velocity (PWV) (Sphygmocor apparatus), recorded. Adjusted logistic and linear regression analyses were performed. Results: Cardiovascular disease was reported by 33% patients at the 15 year follow-up. Baseline RA disease duration, high sensitivity CRP and scores of Stanford Health Assessment Questionnaire (HAQ) and the Ritchie Index predicted patient-reported CVD in separate models adjusted for age, sex, diabetes and smoking (p<0.05 for all variables). Baseline CRP and use of prednisolone were significant independent predictors of PWV in patients without known CVD or diabetes, in models that were adjusted for current cardiovascular risk factors (ß (SE) 0.24 (0.08)) and (1.12 (0.41)) respectively. Current monotherapy use of prednisolone was associated with an increase in PWV, (2.06 (0.42)) improving the adjusted R2 from 0.77 to 0.84. Conclusion: Inflammation early in the disease course predicts increased occurrence of patient-reported CVD and increased arterial stiffness after 15 years supporting the importance of early control of the inflammatory process in patients with RA although use of glucocorticoids may be detrimental.