Rheumatoid Arthritis Syndrome Research Articles

Prevalence and contributing factors of metabolic syndrome in rheumatoid arthritis patients

BackgroundPromoting prevalence of metabolic syndrome (MetS) in Rheumatoid arthritis (RA) patients might occur secondary to RA therapy as well as sedentary life style. However, conflicting observations have been reported on the correlation between MetS and RA. This study aimed to determine the frequency of MetS and association of its components in RA.MethodsIn this study, 500 RA patients and 500 age- and gender-matched healthy controls were enrolled. MetS was fulfilled through the International Diabetes Federation (IDF) criteria. A multivariate regression model was used to control for variables independently associated with the risk of MetS in RA patients.ResultsThe prevalence of MetS was 58.8% on IDF criteria in RA patients that was higher than controls (20.4%). Higher incidence of cardiovascular disease (CVD), the familial history of CVD, hypertension, type 2 diabetes mellitus (T2DM), smoking, dyslipidemia, and higher levels of body mass index (BMI), waist circumference (WC), total cholesterol level, fasting blood sugar (FBS), triglyceride (TG) level, low-density lipoprotein (LDL) level, while lower levels of high-density lipoprotein (HDL) were associated with an increased risk of MetS in RA patients. Multivariate regression analysis indicated that age, WC, dyslipidemia, LDL, and DAS28 were independent predictors of MetS in the RA patients.ConclusionsThe prevalence of MetS is higher in RA patients. Our findings suggest an association between cardiovascular risk factors and the increased prevalence of MetS in RA patients.

Verification of grip strength as an evaluation tool for locomotive syndrome in rheumatoid arthritis

ObjectivesLocomotive syndrome (LS) leads to reduced physical function and a high risk of becoming bedridden. Grip strength serves as an indicator of upper limb and overall physical function. Rheumatoid arthritis (RA) patients with reduced grip strength frequently show finger and wrist joint inflammation. The purpose of this study was to verify grip strength as an evaluation tool for physical function and LS in RA patients. MethodsAs part of an ongoing multicenter observational study, 591 consecutive RA patients whose background information was available, including data for the 25-question Geriatric Locomotive Function Scale (GLFS-25) and grip strength, were examined. LS was defined as a GLFS-25 score ≥ 16 points. Finger and wrist joint inflammation were defined as tender or swollen joints. ResultsAmong the 591 patients, 244 (41.3%) patients had LS, and 167 (28.3%) were male. Receiver operating characteristic curve analysis yielded cut-off values of grip strength for LS of 24 kg (specificity 72.2%; sensitivity 62.7%) for males and 17 kg (specificity 65.7%; sensitivity 67.6%) for females. Multivariable logistic regression analysis revealed a significant association of grip strength with LS, even after adjusting for finger and wrist joint inflammation. ConclusionsLS was significantly associated with grip strength, even after adjusting for the presence of finger and wrist joint inflammation. We recommend adopting grip strength measurement as a screening tool for evaluating LS and guiding interventions.

Nerve sonography in the diagnostic evaluation of primary and secondary carpal tunnel syndrome in rheumatoid arthritis.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and extra-articular manifestation of rheumatoid arthritis (RA). However, in patients with RA, it is not always possible to clinically distinguish an actual CTS from other RA-based complaints. We evaluated the diagnostic role of nerve ultrasound (NUS) as supportive tool in the diagnostic process of CTS in patients with RA and tried to provide etiological clarification in cases of secondary CTS. Fifty-eight patients with RA and clinical suspicion of CTS were enrolled. All patients underwent a standardized clinical-neurological, electrophysiological (nerve conduction studies [NCS]), and NUS examination and completed the Boston CTS Questionnaire (BCTQ). In 96 of 116 hands examined, a clinical suspicion of CTS was documented. In 43 of 96 (44.8%) CTS-positive hands, the diagnosis was primarily confirmed by NCS, whereas in another 16 of 96 (30.2%) hands, the diagnosis could only be verified by NUS, leading to a diagnosis of CTS in 59 of 116 (50.8%) hands. In 19 of 59 (32.3%) CTS-positive hands, tenosynovial hypertrophy was observed, and in 7 of 59 (11.8%), a cystic mass was identified as the underlying cause of secondary CTS. A good correlation between NCS and NUS findings was documented, but no significant correlation was found between NCS, NUS, and clinical findings/BCTQ. In people with RA, a diagnosis of CTS purely on a clinical basis is nonspecific and should be supported by NCS and/or NUS. NUS markedly facilitates the diagnosis of CTS in these patients and enables differentiation between primary and secondary causes.

Association of Severe Disease Activity with Metabolic Syndrome in Patients with Early Rheumatoid Arthritis: A Cohort Study from Tertiary Care Hospital of Pakistan

Background: The peripheral joints are particularly vulnerable to the autoimmune disease rheumatoid arthritis. Patients with rheumatoid arthritis often exhibit symptoms of metabolic syndrome. Metabolic syndrome in rheumatoid arthritis is connected with increased morbidity and death. Objective: This study aimed to examine whether or not rheumatoid arthritis patients who had high levels of disease activity also developed metabolic syndrome. Methods: The cohort study was conducted on 64 patients (32 in each group), included via Non-probability convenient sampling. Disease activity score of 28 joints (DAS-28 score) was used to assess the severity of disease activity in patients of rheumatoid arthritis and two groups were developed i.e. group I with score ≥3.2 and group II with score

Carpal Tunnel Syndrome in Rheumatoid Arthritis: Assessment of Different Anatomical Causes in Non-Clinically Deformed Wrist

Carpal Tunnel Syndrome in Rheumatoid Arthritis: Assessment of Different Anatomical Causes in Non-Clinically Deformed Wrist

Locomotive syndrome in rheumatoid arthritis patients during the COVID-19 pandemic.

This study aimed to longitudinally evaluate the development of locomotive syndrome (LS) in rheumatoid arthritis (RA) patients during the COVID-19 pandemic using the 25-question Geriatric Locomotive Function Scale (GLFS-25). Subjects were 286 RA patients (female, 70.6%; mean age, 64.2 years) who had GLFS-25 and Clinical Disease Activity Index (CDAI) data available for a 1-year period during the COVID-19 pandemic and who did not have LS at baseline. Associations between subject characteristics and development of LS were determined using logistic regression analysis. Among the 286 patients, 38 (13.3%, LS group) developed LS at 1 year after baseline. In the LS group, scores of the GLFS-25 categories "GLFS-5" and "Social activities" were significantly increased at 1 year relative to baseline. GLFS-5 is a quick 5-item version of the GLFS-25, including questions regarding the difficulty of going up and down stairs, walking briskly, distance able to walk without rest, difficulty carrying objects weighing 2 kg, and ability to carry out load-bearing tasks and housework. A significant correlation was also observed between changes in "Social activities" and that of "GLFS-5." Multivariable logistic regression analysis revealed that the development of LS was significantly associated with BMI (OR: 1.11 [95% confidence interval (CI): 1.00-1.22]) and CDAI (OR: 1.08 [95%CI: 1.00-1.16]) at baseline. Adequate exercise and tight control of RA disease activity are important for preventing the development of LS in view of restrictions on going out imposed during the COVID-19 pandemic. GLFS-5 is useful for evaluating the physical function of RA patients.

МЕТАБОЛИЧЕСКИЙ СИНДРОМ ПРИ РЕВМАТОИДНОМ АРТРИТЕ КАК КРИТЕРИЙ КАРДИОВАСКУЛЯРНОГО РИСКА

Abstract. Introduction. Rheumatoid arthritis and metabolic syndrome have common pathogenic mechanisms, thus mutually reinforcing each other, creating a higher risk of cardiovascular disease. Objectives: study the effect of metabolic syndrome on the course of rheumatoid arthritis and the formation of cardiovascular risk. Material and methods. The study included a clinical evaluation of 100 patients with rheumatoid arthritis (average age 55±12,4 years). The patients were divided into 2 groups depending on the presence of metabolic syndrome: 1st group – persons with metabolic syndrome (59 people, 59%) and 2nd group - persons without metabolic syndrome (41 patients, 41%). The received data were processed using the program STATISTICA 10. The differences in the indicators were considered statistically significant at p<0,05. Results. In 1st group, the activity of rheumatoid arthritis was higher (DAS-28 was 5.58±0.9) than in 2nd group (DAS-28 was 5.23±0.85) (p=0.02). The daily dose of steroids was higher in the group with metabolic syndrome: in terms of prednisone 7.5 [5; 10] mg versus 5 [5; 10] mg in the group without metabolic syndrome (p=0.013). Verified arterial hypertension was 3.8 times more common in the presence of metabolic syndrome. Left ventricular myocardial hypertrophy was 1.5 times more common in patients in the group with metabolic syndrome (35.9%), and it was noted both in combination with arterial hypertension and without it. In 1st group, left ventricular myocardial hypertrophy, unrelated to hypertension, was found in 9 people (9.78%). In 2nd group, myocardial hypertrophy was associated with arterial hypertension in all patients. Conclusion. The presence of metabolic syndrome in rheumatoid arthritis is associated with a higher activity of rheumatic disease. In patients with rheumatoid arthritis, it contributes to an increase in cardiovascular risk, characterized by a higher incidence of hypertension (3.8 times), an increase n total cholesterol and an increase in left ventricular myocardial mass. In patients with a combination of rheumatoid arthritis and metabolic syndrome, myocardial hypertrophy was detected even in the absence of an increase in blood pressure, which dictates the need for echocardiography in this group of patients.

The course of anemic syndrome in rheumatoid arthritis

This article discusses the course of anemia syndrome in rheumatoid arthritis and its consequences, causes, diagnosis, and prevention. Rheumatoid arthritis (RA) is one of the most common inflammatory diseases of the joints, occupying about 10% in the structure of rheumatological pathology. It is not only a medical but also an economic problem, since the onset of the disease in most cases is observed in people of working age.

Assessment of the frequency of tarsal tunnel syndrome in rheumatoid arthritis.

Objectives In this study, we aimed to determine the frequency of tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients. Patients and methods Thirty RA patients (1 male, 29 females; mean age: 41.9±10.1 years; range, 26 to 65 years) who met the American College Rheumatology (ACR) classification criteria and 20 healthy volunteers (1 male, 19 females; mean age: 39.3±10.8 years; range, 26 to 60 years) without any complaints between August 2006 and October 2007 were included in the study. Demographic characteristics of the study group were assessed and neurological examinations were performed. The Tinel’s sign was checked to provoke the TTS symptoms. Disease severity was measured using Visual Analog Scale (VAS), Disease Activity Score-28 (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The health-related quality of life and disability status were determined using the Health Assessment Questionnaire (HAQ), Short Form 36 (SF-36), Foot Function Index (FFI), and VAS (0-100 mm). The positional relationship of the foot pain was questioned with VAS. The 100-m walking distance of the patient and control groups were calculated. Results Bilateral TTS was detected in 10 of the patients (33.3%) with rheumatoid arthritis. No relationship with the TTS disease duration, seropositivity, rheumatoid nodule, joint deformities, corticosteroid use, and DAS28 score were found. In correlation with TTS, foot and ankle joint were the first involved joints at the beginning of RA disease (p<0.005). The Tinel’s sign was found to be 45% positive in patients with TTS. The 100-m walking time was significantly longer in RA patients compared to the control group (p<0.0001). Conclusion Tarsal tunnel syndrome is commonly seen in RA and its incidence increases in patients with primary foot involvement. Therefore, caution should be taken against the entrapment neuropathies in these patients, and they should be supported by electrophysiological practices, when the diagnosis is necessary.

Occurrence and predictive factors of high blood pressure, type 2 diabetes, and metabolic syndrome in rheumatoid arthritis: findings from a 3-year, multicentre, prospective, observational study.

In rheumatoid arthritis (RA), "traditional" cardiovascular (CV) risk factors continue to be underdiagnosed and undertreated, thus increasing the risk of developing atherosclerosis. In this work, we evaluated the occurrence and predictive factors of "traditional" cardiovascular risk factors, with a focus on high blood pressure (HBP), type 2 diabetes (T2D), and metabolic syndrome (MetS), in participants with RA, in a 3-year, multicentre, prospective, observational study. To assess the occurrence and predictive factors of HBP, T2D, and MetS, consecutive participants with RA, admitted to Italian Rheumatology Units, were evaluated in the GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) cohort, a 3-year, multicentre, prospective, observational study. In the present evaluation, 841 participants, who were fully followed up with 3-year of prospective follow-up were assessed. At the end of follow-up, a significant increased incidence of HBP, T2D, and MetS was recorded. Assessing predictive factors, the mean values of C-reactive protein during the follow-up were independent predictors of occurrence of those comorbidities, whereas participants maintaining remission showed a significant lower risk. Furthermore, therapy with hydroxychloroquine (HCQ) reduced the risk of occurrence of T2D and MetS. An increased incidence of HBP, T2D, and MetS was observed in assessed participants, prospectively followed-up. Furthermore, the analysis of predictive factors suggested that the rheumatoid pro-inflammatory process could increase the occurrence of these comorbidities. Conversely, metabolic and cardiovascular benefits of maintaining remission as well as of therapy with HCQ were reported.

Острый коронарный синдром при ревматоидном артрите

Острый коронарный синдром при ревматоидном артрите

Metabolic Syndrome in Rheumatoid Arthritis and Ankylosing Spondylitis

Objectives: To evaluate and compare the prevalence of insulin resistance and metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to determine the relationship of MetS with disease-activities and the factors associated with MetS. Materials and Methods: The cross-sectional study included a total of 174 patients with RA and AS. MetS was defined according to the International Diabetes Federation (IDF) criteria. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA) Index. The Disease Activity Score including 28 joints (DAS28) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to measure disease activity. Functional status was evaluated using the Health Assessment Questionnaire (HAQ) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Logistic regression analysis was applied to identify predictors of metabolic syndrome. Results: The prevalence of MetS was significantly higher in patients with RA (47%) than in patients with AS (24.56%) (p=0.005). The prevalence of insulin resistance was significantly higher in patients with RA (34.18%) than in patients with AS (17.54%)(p=0.031). No significance difference was found in the disease activity score between RA and AS patients with metabolic syndrome and without metabolic syndrome (p=0.580 and p=0.158, respectively). The number of patients with a higher BASDAI score was greater in AS patients with MetS. Age and body mass index were determined to be predictors for MetS (p=0.015 and p<0.001, respectively). Conclusion : Higher rates of MetS and insulin resistance were seen in RA patients compared to the patients with AS. Better control of the MetS components and disease activity may help to decrease the prevalence of MetS in rheumatic disease.

Comparative analysis of novel autoantibody isotypes against citrullinated-inter-alpha-trypsin inhibitor heavy chain 3 (ITIH3)542–556 peptide in serum from Taiwanese females with rheumatoid arthritis, primary Sjögren's syndrome and secondary Sjögren's syndrome in rheumatoid arthritis

The purpose of this study was to discover and validate inter-alpha-trypsin inhibitor heavy chain H3 (ITIH3) as novel biomarkers, and evaluate autoantibody isotypes against an unmodified and citrullinated ITIH3542–556 peptide among Taiwanese female patients with rheumatoid arthritis (RA), primary Sjögren's syndrome (pSS), secondary Sjögren's syndrome in rheumatoid arthritis (RA-sSS), and healthy controls (HCs). We used concanavalin A (Con A) affinity chromatography, 1-D SDS-PAGE, and label-free nano-LC-MS/MS to screen biomarker candidates (serum-derived Con A-captured proteins) and then identify PTMs of validated biomarkers (serum proteins) using pooled serum from 7 RA-sSS female patients and 7 age-matched HCs (the discovery set). Furthermore, the protein level and autoantibody isotype analyses were further validated against individual serum from 18 HCs, 18 RA, 18 pSS, and 18 RA-sSS patients (the validation set). Con A-bound ITIH3 was identified and validated as the only differentially expressed protein, which was elevated. Additionally, 2 novel PTMs in ITIH3 were identified and included citrullination at arginine-546 and arginine-556, and hexosamine at tryptophan-558. Further, concentrations of anti-citrullinatd-ITIH3542–556 peptide autoantibodies significantly increased in patients with RA, pSS, and RA-sSS compared to HCs. Especially, autoantibody IgM against the citrullinated-ITIH3542–556 peptide showed better diagnostic performance in discriminating both RA versus pSS and pSS versus RA-sSS. SignificanceBy using comparative proteomic analysis of serum samples, the current study discovered and validates differentially expressed Con A-bound ITIH3 as a potential biomarker for secondary Sjögren's syndrome (SS) in rheumatoid arthritis (RA) patients and healthy controls (HCs). Besides, hexosamine and citrullination on ITIH3 were further identified. Through analyzing autoantibody isotypes against the citrullinated ITIH3 peptide, patients with RA, primary SS, and RA-secondary SS, and HCs can be further discriminated. The current strategy can be applied for identifying potential diagnostic and pathologic markers for autoimmune diseases.

Study on the frequency and risk factors of moderate-to-severe sleep apnea syndrome in rheumatoid arthritis

Objectives: We aimed to investigate the frequency of moderate-to-severe sleep apnea syndrome (SAS) that possibly influences long-term prognosis in patients with rheumatoid arthritis (RA), and to analyze the risk factors for this group.Methods: We examined respiratory disturbance index (RDI) by polysomnography in 62 hospitalized RA patients. Risk factors of moderate-to-severe SAS (RDI ≥20) were analyzed using a multivariate logistic regression analysis.Results: RA was complicated by moderate-to-severe SAS in 13/62 (20.9%) cases. The highest stage of temporomandibular joint abnormality (TMJA) and a high value of health assessment questionnaire-disability index (HAQ-DI) were significant risk factors, according to the results of the multivariate logistic regression analysis (p < 0.0001 and p = 0.010, respectively). Contrary to these results, RDI was not related to the disease activity indexes of RA and other clinical characteristics.Conclusion: We clarified that the highest TMJA stage and a high value of HAQ-DI are novel important risk factors for moderate-to-severe SAS in RA patients.

Anemic syndrome in rheumatoid arthritis: Diagnostic approaches and treatment opportunities

Anemia of chronic disease (ACD) is a leading cause of anemic syndrome in patients with rheumatoid arthritis (RA). Enhanced hepcidin production mainly stimulated by excess interleukin-6 levels is a key pathodgentic component of ACD (frequently known as anemia of inflammation) by causing the degradation of the transmembrane protein ferroportin, hepcidin impairs iron metabolism. On the basis of the material of recent publications the review gives present-day views on the pathodgenesis of ACD in RA, approaches to the diagnosis and differential diagnosis of ACD, especially in its concomitance with iron-deficiency anemia, as well as approaches to therapy for the type of anemic syndrome with the complex mechanism for its development.

Differences in the prevalence and characteristics of metabolic syndrome in rheumatoid arthritis and osteoarthritis: a multicentric study.

The purpose of the study was to examine whether rheumatoid arthritis (RA) patients have higher prevalence of metabolic syndrome (MetS) than osteoarthritis (OA) patients in association with a higher level of chronic systemic inflammation in rheumatoid arthritis. A total of 583 RA and 344 OA outpatients were analyzed in this multicentric study. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A 1.6-fold higher prevalence of MetS was found in patients with OA compared with the RA patients. Among the parameters of MetS, patients with OA had significantly higher levels of waist circumference, systolic blood pressure, fasting blood glucose and triglycerides, whereas HDL cholesterol and diastolic blood pressure values were similar in both groups of patients. Higher values of inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)] in MetS than in non-MetS patients and higher prevalence of MetS in patients with CRP level ≥5mg/L in both RA and OA patients were found. In multivariate logistic regression analysis, significant predictors of MetS were type of arthritis (OA vs. RA; OR 2.5 [95% CI 1.82-3.43]), age (OR 1.04 [95% CI 1.03-1.06]) and ESR (OR 1.01; [95% CI 1.00-1.01]). The significant association between OA and MetS was maintained in the regression model that controlled for body mass index (OR 1.87 [95% CI 1.34-2.61]). The present analysis suggests that OA is associated with an increased risk of MetS, which may be due to a common underlying pathogenic mechanism.

Salivary Gland Ultrasonography as a Diagnostic Tool for Secondary Sjögren Syndrome in Rheumatoid Arthritis.

To assess salivary gland ultrasonography (US) as a diagnostic tool for secondary Sjögren syndrome (sSS) in patients with rheumatoid arthritis (RA). Salivary gland US images from 30 patients with RA were graded using a validated semiquantitative scoring system. Sicca symptoms, oral health, and RA disease activity were assessed. US changes consistent with SS were found in 40% of patients. Patients with higher US scores had more sicca symptoms as well as higher RA activity and poorer oral health. Salivary gland US may aid the diagnosis of sSS in patients with RA.

ANALYSIS OF THE PATHOGENETIC MECHANISMS OF CHRONIC JOINT PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND KNEE OSTEOARTHRITIS

Objective: to reveal neurogenic mechanisms in the pathogenesis of chronic pain syndrome in rheumatoid arthritis (RA) and knee osteoarthritis (OA) in order to develop individualized pharmacotherapy. Subjects and methods . One hundred and eighty-three patients with RA and 80 with knee OA were examined. By using the neuropathic pain diagnostic questionnaire (DN4), all the patients were divided into 2 groups with and without a neuropathic pain component (NPC). Results. NPC was found in 43% of the patients with RA and it was connected with involvement of the peripheral somatosensory system. In RA, NPC was common in older patients with longer disease duration, higher X-ray stage, and severe functional insufficiency. 30% of patients with knee OA also had NPC, however the signs of nervous system involvement were absent. In OA, NPC was associated with hyperalgesia, higher pain intensity, more marked joint dysfunction on the WOMAC, and anxiety. Discussion. This investigation revealed a mixed pattern of chronic pain syndrome in patients with RA and knee OA; some patients were found to have a NPC in the presence of predominantly a nociceptive component

Prevalence of the metabolic syndrome in rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) experience a markedly increased prevalence of cardiovascular disease (CVD), but the causal factors have yet to be completely elucidated. Metabolic syndrome (MetS) is a cluster of risk factors of CVD and identifies additional cardiovascular risk beyond the sum of its individual components. In this study, we investigated the prevalence of MetS and its possible relationship with disease-related factors in patients with RA. Fifty-two patients with RA and 30 age- and sex-matched healthy controls were studied. Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATP III) and modified World Health Organization (WHO) criteria were used to define MetS. RA disease activity is assessed by the disease activity score of 28 joints (DAS28), and the functional status of patients was evaluated by Health Assessment Questionnaire (HAQ). Although there was no difference between groups regarding the frequency of MetS according to NCEP-ATP III criteria (17.3% and 6.5% in RA and control groups, respectively (p=0.158)) if modified WHO criteria were used, the prevalence of MetS was significantly higher in patients with RA (28.8%) than in controls (9.7%) (p=0.04). Central obesity and hypertension were found to be more frequent in patients with RA by both NCEP-ATP III and WHO criteria. RA patients with MetS had higher systolic and diastolic blood pressure, BMI and frequency of smoking than patients without MetS. Disease-related factors were similar in RA patients with or without MetS. The evaluation of patients with RA for MetS, which is a multidimensional risk factor of CVD, may be beneficial.

The risk of acute coronary syndrome in rheumatoid arthritis in relation to tumour necrosis factor inhibitors and the risk in the general population: a national cohort study.

IntroductionThe elevated risk of ischaemic heart disease in patients with rheumatoid arthritis (RA) has been linked to inflammation and disease severity. Treatment with tumour necrosis factor inhibitors (TNFis) is often effective in reducing disease activity and could possibly modify cardiovascular risk. Our objective in the study was to evaluate the risk of acute coronary syndrome (ACS) in patients with RA treated with TNFis compared with the risk among biologic-naïve RA patients and the general population.MethodsBy linkage of the Swedish National Patient Register and the Swedish Biologics Register, we identified a cohort of patients who were started on their first biologic, a TNFi, between 2001 and 2010 (N = 7,704), and a cohort comprising matched biologic-naïve RA patient referents at a 3:1 ratio. Furthermore, a matched comparator cohort (5:1 ratio) was extracted from the Swedish population register. The incidence rates of a first ACS event were calculated and compared between cohorts using Cox proportional hazards regression in three different risk windows: ‘ever-exposed’, ‘actively on TNFi’ and ‘short-term exposure’ (active treatment maximized to 2 years). The models were adjusted for disease duration, joint surgery, comorbidity and socioeconomic factors, and, in a sensitivity analysis including a subpopulation started on therapy beginning 1 January 2006 or later, for dispensed drugs.ResultsBased on 221 events in 7,704 patients (comprising 32,621 person-years) treated with TNFi biologics, the hazard ratio ((HR); ever-exposed) for ACS among the TNFi-exposed RA patients compared with biologic-naïve RA patients was 0.8 (95% confidence interval (CI) = 0.7 to 0.95). In comparison with the general population referents, statistical analysis using fully adjusted models resulted in a HR of 2.0 (95% CI = 1.8 to 2.3) for biologic-naïve RA patients and a HR of 1.6 (95% CI = 1.4 to 1.9) for the TNFi-exposed group. Similar risk estimates were obtained using the other two risk windows. A sensitivity analysis in which we compared the TNFi-exposed patients included from 1 January 2006 onward with biologic-naïve patients resulted in a HR (ever-exposed) of 0.7 (95% CI = 0.5 to 1.0).ConclusionsRA patients treated with TNFi had a lower risk of ACS compared with biologic-naïve RA patients. Compared with the general population, the risk among patients with RA was elevated, although the difference was less pronounced among the TNFi-exposed patients. This finding could be attributable to the TNFi as such, or it could correspond to a lower degree of inflammation in the TNFi-treated group.