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Atherosclerosis boosts mortality in RA patients: patients diagnosed with rheumatoid arthritis should also undergo screening for peripheral atherosclerosis.

NEW ORLEANS -- Patients with rheumatoid arthritis and peripheral arterial atherosclerosis are about twice as likely to die as are rheumatoid arthritis patients with no sign of peripheral atherosclerosis, based on a study of more than 2,400 patients.

The study also found that about 13% of patients with rheumatoid arthritis have evidence of peripheral atherosclerosis, Dr. Matthew A. Kaminski said at the annual meeting of the American College of Cardiology. A likely explanation for the frequency of this confluence is the inflammatory nature of rheumatoid arthritis; inflammation is also believed to play a causal role in atherosclerotic disease.

The implication is that all patients diagnosed with rheumatoid arthritis should be screened for peripheral arterial disease by a simple, noninvasive test, such as an ankle-brachial index, said Dr. Kaminski, a physician at the Cleveland Clinic. Another vascular screen to consider using on rheumatoid arthritis patients is an ultrasound examination for an abdominal aortic aneurysm, he said.

The study reviewed the medical records of all patients seen with a primary diagnosis of rheumatoid arthritis at the Cleveland Clinic during January 2000 to July 2006, a total of 2,428 patients. Patients were identified as having peripheral arterial disease based on an indication in their record of having claudication, an abnormal ankle-brachial index, a history of stroke or transient ischemic attack, a history of peripheral arterial revascularization, or repair of an abdominal aortic aneurysm. This identified 312 patients (13%) with peripheral arterial disease.

During the 6.5 years of the study, 33 of the patients with peripheral arterial disease died (11%), compared with 64 deaths among the 2,116 patients without peripheral atherosclerotic disease (3%).

In a multivariate analysis that controlled for baseline differences in age, gender, hypertension, dyslipidemia, coronary artery disease, peripheral arterial disease, and statin use, patients with rheumatoid arthritis and peripheral arterial disease were 2.1-fold more likely to die of any cause, compared with rheumatoid arthritis patients without peripheral atherosclerosis, a statistically significant difference, Dr. Kaminski said.

The analysis also showed that patients with rheumatoid arthritis who were treated with a statin had a 57% statistically significant reduced risk of dying, compared with rheumatoid arthritis patients not treated with a statin. This finding suggested that the threshold for starting statin therapy could possibly be set lower in patients with rheumatoid arthritis, but before this is done the benefits of statins in these patients should be assessed in additional studies, Dr. Kaminski said.


Philadelphia Bureau
Mortality in Rheumatoid Arthritis Patients

Peripheral atherosclerosis (n = 312) 11%
No peripheral atherosclerosis (n = 2,116) 3%

Note: Based on a 6.5-year study.
Source: Dr. Kaminski

Note: Table made from bar graph.
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Title Annotation:Rheumatology
Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jun 1, 2007
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