Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritisReportar como inadecuado

Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritis - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Arthritis Research and Therapy

, 18:183

First Online: 05 August 2016Received: 26 March 2016Accepted: 15 July 2016


BackgroundThe aim was to estimate the impact of individual risk factors and treatment with various disease-modifying antirheumatic drugs DMARDs on the incidence of myocardial infarction MI in patients with rheumatoid arthritis RA.

MethodsWe analysed data from 11,285 patients with RA, enrolled in the prospective cohort study RABBIT, at the start of biologic b or conventional synthetic cs DMARDs. A nested case–control study was conducted, defining patients with MI during follow-up as cases. Cases were matched 1:1 to control patients based on age, sex, year of enrolment and five cardiovascular CV comorbidities. Generalized linear models were applied Poisson regression with a random component, conditional logistic regression.

ResultsIn total, 112 patients developed an MI during follow-up. At baseline, during the first 6 months of follow-up and prior to the MI, inflammation markers erythrocyte sedimentation rate ESR and C-reactive protein CRP but not 28-joint-count disease activity score DAS28 were significantly higher in MI cases compared to matched controls and the remaining cohort. Baseline treatment with DMARDs was similar across all groups. During follow-up bDMARD treatment was significantly more often discontinued or switched in MI cases. CV comorbidities were significantly less often treated in MI cases vs. matched controls 36 % vs. 17 %, p < 0.01. In the adjusted regression model, we found a strong association between higher CRP and MI OR for log-transformed CRP at follow-up: 1.47, 95 % CI 1.00; 2.16. Furthermore, treatment with prednisone ≥10 mg-day OR 1.93, 95 % CI 0.57; 5.85, TNF inhibitors OR 0.91, 95 % CI 0.40; 2.10 or other bDMARDs OR 0.85, 95 % CI 0.27; 2.72 was not associated with higher MI risk.

ConclusionsCRP was associated with risk of MI. Our results underline the importance of tight disease control taking not only global disease activity, but also CRP as an individual marker into account. It seems irrelevant with which class of biologic or conventional DMARD effective control of disease activity is achieved. However, in some patients the available treatment options were insufficient or insufficiently used - regarding DMARDs to treat RA as well as regarding the treatment of CV comorbidities.

KeywordsMyocardial infarction Cardiovascular disease Inflammation Disease activity Tumour necrosis factor inhibitors Biologicals Electronic supplementary materialThe online version of this article doi:10.1186-s13075-016-1077-z contains supplementary material, which is available to authorized users.

Download fulltext PDF

Autor: Yvette Meissner - Angela Zink - Jörn Kekow - Karin Rockwitz - Anke Liebhaber - Silke Zinke - Kerstin Gerhold - Adrian Ric


Documentos relacionados