ABERDEEN, Scotland—Rheumatoid arthritis (RA) patients with a “high inflammatory burden” are more likely to have stiff arteries, independent of other known cardiovascular (CV) risk factors. The new findings, which appear on-line in Rheumatology, raise important questions about more aggressively targeting inflammation in RA to reduce the risk of cardiovascular events in these patients.1

“RA patients are already known to be at increased risk of CV events, but research evidence is lacking as how best to manage CV risk in RA patients.”—Michael A. Crilly, MD, MPH
“RA patients are already known to be at increased risk of CV events, but research evidence is lacking as how best to manage CV risk in RA patients,” lead researcher Michael A. Crilly, MD, MPH, a senior lecturer in clinical epidemiology at the University of Aberdeen Medical School in Aberdeen, Scotland, tells MSKreport.com. “It is sensible to assess CV risk using a validated risk score based on the general population such as the Framingham risk score, but on average, RA patients will be at higher risk than their Framingham risk score,” he says. Doctors need to “advise all RA patients to stop smoking, keep active, eat a sensible diet and treat high blood pressure and high lipids,” he says.

Arterial stiffness is a proxy for atherosclerosis

In the study, the cumulative inflammatory burden was measured as erythrocyte sedimentation rate (ESR) area-under-the-curve (ESR-years), and was extracted from medical records, while arterial stiffness was measured via the augmentation index (AIX), which is based on the reflected arterial pulse-wave that increases as arteries stiffen.

The study comprised 114 RA patients totaling 1,040 RA person-years. Cholesterol, glucose, and body mass index were similar in women and men in the study. Women had RA for longer and were more likely to be seropositive than their male counterparts. In addition, blood pressure levels, smoking, and alcohol consumption were lower for females than males. Overall, there was an increase of 100 ESR-years associated with an increase in AIX@75 of 0.51, the study showed. When this analysis only included females, the increase in AIX@75 was 0.43.

Translating research into practice: measure inflammatory burden in RA

“Our findings have some important implications for clinical practice since ESR is widely used to monitor disease activity in patients with RA,” the researchers write. ”If the levels of inflammatory burden in RA is linked with the development of significant arterial disease, then the assessment of previous inflammatory burden from routinely available clinical data may be useful for CV risk stratification for RA patients.”

References
1. Crilly MA, Kumar V, Clark HJ, et al. Arterial stiffness and cumulative inflammatory burden in rheumatoid arthritis: a dose-response relationship independent of established cardiovascular risk factors. Rheumatology. [epub ahead of print Oct. 25, 2009].