The effect of rheumatoid arthritis-associated autoantibodies on the incidence of cardiovascular events in a large inception cohort of early inflammatory arthritis

Authors

Lillian J. Barra, Western UniversityFollow
Janet E. Pope, Western University
Carol Hitchon, University of Manitoba
Gilles Boire, Université de Sherbrooke
Orit Schieir, University of Toronto
Daming Lin, University of Toronto
Carter J. Thorne, Arthritis Program Southlake Regional Health Center
Diane Tin, Arthritis Program Southlake Regional Health Center
Edward C. Keystone, University of Toronto
Boulos Haraoui, University of Montreal
Shahin Jamal, Vancouver Coastal Health
Vivian P. Bykerk, University of Toronto
V. Ahluwalia, Hospital for Special Surgery - New York
P. Akhavan, Hospital for Special Surgery - New York
L. Barra, Hospital for Special Surgery - New YorkFollow
C. Barber, Hospital for Special Surgery - New York
C. Barnabe, Hospital for Special Surgery - New York
S. Bartlett, Hospital for Special Surgery - New York
M. Baron, Hospital for Special Surgery - New York
L. Bessette, Hospital for Special Surgery - New York
G. Boire, Hospital for Special Surgery - New York
V. Bykerk, Hospital for Special Surgery - New York
I. Colmegna, Hospital for Special Surgery - New York
S. Fallavollita, Hospital for Special Surgery - New York
D. Haaland, Hospital for Special Surgery - New York

Document Type

Article

Publication Date

5-1-2017

Journal

Rheumatology (United Kingdom)

First Page

768

Last Page

776

URL with Digital Object Identifier

10.1093/rheumatology/kew474

Abstract

© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Objective. RA is associated with an increased risk of cardiovascular events (CVEs). The objective was to estimate independent effects of RA autoantibodies on the incident CVEs in patients with early RA. Methods. Patients were enrolled in the Canadian Early Inflammatory Arthritis Cohort, a prospective multicentre inception cohort. Incident CVEs, including acute coronary syndromes and cerebrovascular events, were self-reported by the patient and partially validated by medical chart review. Seropositive status was defined as either RF or ACPA positive. Multivariable Cox proportional hazards survival analysis was used to estimate the effects of seropositive status on incident CVEs, controlling for RA clinical variables and traditional cardiovascular risk factors. Results. A total of 2626 patients were included: the mean symptom duration at diagnosis was 6.3 months (S.D. 4.6), the mean age was 53 years (S.D. 15), 72% were female and 86% met classification criteria for RA. Forty-six incident CVEs occurred over 6483 person-years [incidence rate 7.1/1000 person-years (95% confidence interval 5.3, 9.4)]. The CVE rate did not differ in seropositive vs seronegative subjects and seropositivity was not associated with incident CVEs in multivariable Cox regression models. Baseline covariates independently associated with incident CVEs were older age, a history of hypertension and a longer duration of RA symptoms prior to diagnosis. Conclusion. The rate of CVEs early in the course of inflammatory arthritis was low; however, delays in the diagnosis of arthritis increased the rate of CVEs. Hypertension was the strongest independent risk factor for CVEs. Results support early aggressive management of RA disease activity and co-morbidities to prevent severe complications.

Notes

Article is freely available at the journal