Abstract
BackgroundRheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs.MethodsCross-sectional study conducted based on the real-life rheumatoid arthritis study database – REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher’s Exact tests.ResultsWe assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003).ConclusionsThe presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.
Highlights
Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease
RA patients show a higher prevalence of cardiovascular risk comorbidities compared to the general population [6, 16], which was confirmed in our study [22] by high rates of systemic arterial hypertension (SAH) (49.9%) and diabetes mellitus (DM) (14.9%), higher than those described in other cohorts [6, 23,24,25]
There was found in this cohort a higher prevalence of SAH when comparing to the prevalence of this commorbity in the Brazilian population, this fact may be explained by the fact that RA patients experience a higher cardiovascular risk explained by the systemic inflammation experienced by these patients, that contributes for a higher prevalence of cardiovascular commorbities
Summary
Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. The most common and serious comorbidities are cardiovascular diseases (CVD) [5,6,7], being the main cause of increased premature mortality in this group [1, 8] This fact is attributed to: the higher prevalence of traditional cardiovascular risk factors in these individuals, such as systemic arterial hypertension (SAH), diabetes mellitus (DM), dyslipidemia and obesity; the side effects of drugs used for treatment; and, mainly, the systemic inflammatory activity of RA, which determines endothelial injury and accelerated atherogenesis [5, 6, 8, 9]. It is possible to infer that the RA behaves as an independent risk factor for CVD [10]
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