REMISSION IS THE MISSION: A POPULATION CONTROLLED STUDY OF CVD RISK MARKERS IN RHEUMATOID ARTHRITIS (RA): 1B.04

Abstract

Background: Patients with RA have an increased risk of CVD. Brachial pressure, central pressure, and measures of arterial stiffness are predictors of CVD. Objectives: To assess markers of CVD risk in patients with high and minimal RA disease activity, compared with population controls. Methods: 113 patients with RA and 74 population controls were assessed across a panel of biomarkers for CVD. The RA patients derived from the 15-year follow-up of the EURIDISS cohort (n = 80), and 10-year follow-up of the Oslo RA register (n = 33). The population controls were randomly selected by Statistics Norway after stratification of the patient cohort for age, sex and area, and had no history of inflammatory arthritis. Blood pressure (BP) was measured after 5 minute supine rest. Arterial stiffness measurements, augmentation index (AIx) and pulse wave velocity (PWV) were performed with a Sphygmocor apparatus. A study-nurse performed clinical examinations to determine the number of swollen and tender joints. Blood samples and demographic variables were collected. RA disease activity was assessed by CDAI (Clinical Disease Activity Index), patients with CDAI ≤ 2.8 were considered to be in remission. Biomarker levels were compared across the following groups: Population controls, RA patients in remission and RA patients with active disease. Adjustments were made for age, sex, level of education and heart rate (AIx and PWV only) using ANCOVA analyses (SPSS14). Results: Population controls were younger (54.2 vs 57.2 p = 0.04) and less frequently female (60% vs 76.5% p = 0.02). Patients with active RA (n = 82) had significantly higher levels of all biomarkers compared to patients in remission (n = 31) and significantly increased AIx, pulse pressure and systolic BP compared to populations controls. There was no difference in biomarker levels between patients in RA remission and controls, except that patients had significantly lower levels of PWV. (Figure) Conclusion: Patients with active RA, but not those in remission, have significantly increased levels of biomarkers for CVD. These results support the association of inflammatory activity and markers of CVD risk in patients with RA.