Retrospektive Analyse des Therapieverlaufs und kardiovaskulären Risikoprofils bei Patienten mit Rheumatoider Arthritis unter immunsuppressiver Therapie

Abstract

Objective: Previous studies have shown that the cardiovascular risk in patients with rheumatoid arthritis (RA) is higher than among the general population. This study assesses the prevalence of cardiovascular events such as myocardial infarction and stroke in RA patients treated with a DMARD or a biologic. In contrast to many studies that use a preselected group of patients this study specifically aims to reflect the typical RA patient with a variety of comorbidities and comedication. Methods: In this retrospective analysis data from 275 patients who received immunosuppressive RA treatment between April 1994 and August 2016 were evaluated for disease progression, comorbidities, cardiovascular risk factors and scores and occurrence of cardiovascular events. Subgroups were formed according to the leading basic medication. This involved the use of the classic DMARDs methotrexate and leflunomide and the biologics adalimumab, etanercept, rituximab and tocilizumab. Results: All six basic therapeutics studied achieved a significant reduction in DAS28 (average baseline 4.67) by about one point after 6 months (3.65) and towards the end of observation (3.78). This trend was reflected in the analysis of the erythrocyte sedimentation rate (20.1; 13.1; 15.6 [mm/1h]) and the C-reactive protein level (11.1; 5.7; 6.9 [mg/l]). All three calculated scores for the evaluation of cardiovascular risk increased during the course of the study. The Framingham score rose by 0.9 points, the PROCAM score for calculating the risk of myocardial infarction by 0.4 points. The risk of stroke increased by 0.5 points according to the PROCAM score. During the observation period 13 cardiovascular events occurred, eight of them related to a myocardial infarction, five to a stroke. Discussion and conclusion: The analysis of rheumatological parameters can prove good efficacy for all six drugs studied. The result of cardiovascular risk calculation is in contrast to this. According to the results of previous studies an optimized cardiovascular risk profile could be expected from the successful treatment of the underlying rheumatic disease. However, the present work cannot prove this tendency. It must be questioned whether the current score systems for the evaluation of cardiovascular risk in RA patients are suitable. Ultimately, none of them are directly correlated with disease activity. Further investigations could be carried out at this point.