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Severity, duration of rheumatoid arthritis predict CVD.

COPENHAGEN -- Rheumatoid arthritis patients with higher disease severity and longer disease duration had the highest risk for developing cardiovascular disease during 15 years of follow-up in a study with 107 patients.

In addition, rheumatoid arthritis (RA) patients with a higher level of inflammation, as indicated by elevated serum levels of C-reactive protein (CRP) early in the course of their RA, had the greatest risk for developing arterial stiffness during follow-up, Dr. Sella Aarrestad Provan said at the annual European Congress of Rheumatology.

Because the study enrolled RA patients who had been diagnosed within the prior 4 years, the findings "support the importance of early active disease management in patients with RA," said Dr. Provan of the department of rheumatology at Diakonhjemmet Hospital in Oslo.

The study involved 238 patients enrolled in the EU-RIDISS (European Research on Incapacitating Disease and Social Support) cohort in 1992. Average age at enrollment was 52 years, and three-quarters were women.

At 15 years after enrollment, 107 of these patients underwent a follow-up examination. During follow-up, 44 of the 107 self-reported having cardiovascular disease. Also at 15 years, 102 patients had an applanation tonometry assessment that determined their central arterial stiffness. The analysis correlated these two end points with patients' clinical characteristics at entry.

Patients who developed cardiovascular disease had significantly longer disease duration at entry than did patients who remained free of cardiovascular disease, although none of the patients entered the study having had RA for more than 4 years. Other significant correlates of cardiovascular disease risk were a high CRP level at entry, a high score on the Stanford Health Assessment Questionnaire (HAQ), and a high score on the Ritchie index. In a logistic regression model that also controlled for age, sex, diabetes, and smoking status, the only entry measures that remained significant were disease duration and HAQ score, Dr. Provan said.

The only significant baseline predictor of high central arterial stiffness (augmentation index) at 15 years was a high CRP level in an analysis that controlled for age, sex, mean arterial pressure, height, heart rate, diabetes, smoking status, and current use of antihypertensive medication.

Dr. Provan said that she and her associates had no relationships to disclose.
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Article Details
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Title Annotation:RHEUMATOLOGY; cardiovascular disease
Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:4E
Date:Sep 1, 2009
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