scholarly journals Moderate and High Disease Activity Predicts the Development of Carotid Plaque in Rheumatoid Arthritis Patients without Classic Cardiovascular Risk Factors: Six Years Follow-Up Study

2021 ◽  
Vol 10 (21) ◽  
pp. 4975
Author(s):  
Iván Ferraz-Amaro ◽  
Alfonso Corrales ◽  
Belén Atienza-Mateo ◽  
Nuria Vegas-Revenga ◽  
Diana Prieto-Peña ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Disease Activity ◽  
Risk Score ◽  
Future Development ◽  
Carotid Plaque ◽  
Subclinical Atherosclerosis ◽  
Low Risk ◽  
Carotid Ultrasound

Patients with rheumatoid arthritis (RA) have a higher incidence of subclinical atherosclerosis and cardiovascular (CV) disease. It is postulated that the appearance of accelerated atherosclerosis in these patients is a consequence of the inflammation present in the disease. In this study, we aim to determine if baseline disease activity in patients with RA predicts the future development of carotid plaque. A set of consecutive RA patients without a history of CV events, cancer or chronic kidney disease, who did not show carotid plaque in a carotid ultrasound assessment, were prospectively followed up for at least 5 years. At the time of recruitment, CV risk factors and disease-related data, including disease activity scores, were assessed. At the end of the follow-up, a carotid ultrasound was repeated and patients were divided into two groups; those who developed carotid plaque, and those who did not. A multivariable regression analysis was performed to define the predictors for the development of carotid plaque. One hundred and sixty patients with RA were followed up for an average of 6 ± 1 years. After this time, 66 (41%) of the patients had developed carotid plaque, and 94 (59%) did not. Patients with carotid plaque were significantly older (47 ± 13 vs. 55 ± 9 years, p < 0.001) at baseline, were more frequently diabetic (0% vs. 6%, p = 0.028), and had higher total cholesterol (197 ± 36 vs. 214 ± 40 mg/dL, p = 0.004) and LDL cholesterol (114 ± 35 vs. 126 ± 35 mg/dL, p = 0.037) at the beginning of the study. After multivariable adjustment, patients who were in the moderate and high disease activity (DAS28-CRP) categories displayed a higher odds ratio for the appearance of carotid plaque (OR 2.26 [95% CI 1.02–5.00], p = 0.044) compared to those in the DAS-28-CRP remission category. Remarkably, when patients were divided in patients within the low-risk SCORE category, and patients included in the remaining SCORE categories (moderate, high and very high), the relation between DAS28-CRP and the development of carotid plaque was only significant in the low-risk SCORE category. In conclusion, disease activity predicts the future development of subclinical atherosclerosis in patients with RA.

The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls

2015 ◽  
Vol 42 (6) ◽  
pp. 935-942 ◽  
Author(s):  
Anna Södergren ◽  
Kjell Karp ◽  
Christine Bengtsson ◽  
Bozena Möller ◽  
Solbritt Rantapää-Dahlqvist ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Linear Regression ◽  
Prospective Study ◽  
Risk Score ◽  
Subclinical Atherosclerosis ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
A Prospective Study ◽  
Reynolds Risk Score

Objective.This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls.Methods.Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included.Results.In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent.Conclusion.This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.

A Risk Score Integrating BAALC, ERG and WT1 Expression Can Be Used To Improve Risk Stratification In Acute Promyelocytic Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1323-1323
Author(s):  
Anna Hecht ◽  
Florian Nolte ◽  
Daniel Nowak ◽  
Verena Nowak ◽  
Benjamin Hanfstein ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Expression Levels ◽  
Improve Risk Stratification

Abstract Introduction With current therapy regimens over 75% of patients with de novo acute promyelocytic leukemia (APL) can be cured. Approaches to further improve patient outcome by stratifying patients at the time of initial diagnosis according to their individual risk and to adjust therapy accordingly have been based on clinical features only. Molecular markers have not been established for risk stratification as yet. Recently, we have shown that high expression levels of the genes brain and acute leukemia, cytoplasmic (BAALC) and ets related gene (ERG) are associated with inferior outcome in APL patients. In addition, data indicate that aberrant expression of the gene Wilms’ tumor 1 (WT1) is a negative prognostic factor with regard to overall survival (OS) after complete remission (CR) and relapse free survival (RFS) in APL. In this study we evaluated the prognostic relevance of a combined score integrating the expression levels of the above mentioned genes to further improve risk stratification in APL patients. Methods Expression levels of BAALC, ERG and WT1 of 62 patients with newly diagnosed APL were retrospectively analyzed in bone marrow mononuclear cells using multiplex reverse transcriptase quantitative real-time PCR (qRT-PCR). Median age of patients was 47 years (range: 19 to 82y). All patients gave informed consent. Patients were diagnosed and treated in the German AML Cooperative Group (AMLCG) study with a treatment of simultaneous ATRA and double induction chemotherapy including high-dose ara-C, consolidation and maintenance chemotherapy. The following gene expression levels were identified as negative risk factors in preceding studies: BAALC expression ≥25th percentile (BAALChigh), ERG expression >75th percentile (ERGhigh) and WT1 expression ≤25th percentile or ≥75th percentile (WT1low/high). A risk score was developed as follows: for the presence of one of the mentioned risk factors one scoring point was assigned to a respective patient, i.e. a maximum of 3 points (one point for BAALChigh, ERGhigh and WT1low/high, respectively) and a minimum of 0 points (i.e. presenting with none of the aforementioned risk factors) could be allocated to one patient. Accordingly, patients were divided into four risk groups: 7 patients scored 0 points (= low risk), 27 patients scored 1 point (= intermediate 1 risk), 19 patients scored 2 points (= intermediate 2 risk) and 9 patients scored 3 points (= high risk). Subsequently, OS, RFS and relapse free interval (RFI) were calculated using the Kaplan-Meier method and a log-rank test was used to compare differences between the four risk groups (p<0.05). Results The integrative risk score divided patients into four groups with significantly different outcome. The low risk group showed a RFS of 100% at 10 years of follow-up compared to the intermediate 1 risk group with 81%, the intermediate 2 risk group with 58% and the high risk group with a RFS of 42% only (median survival: 4.6y) (p=0.02). In accordance, the RFI differed significantly between the four groups: low risk 100%, intermediate 1 risk 100%, intermediate 2 risk 89% and high risk 71% (p=0.049). There was no statistically significant difference between the 4 groups with regard to OS in the entire patient cohort. However, there was a clear trend towards a difference in OS in patients who achieved a CR after induction therapy: low risk 100%, intermediate 1 risk 81%, intermediate 2 risk 68% and high risk 53% survival at 10 years of follow-up (p=0.09). Conclusion Integration of expression levels of the genes BAALC, ERG and WT1 into a scoring system identifies 4 risk groups with significantly different outcome with regard to RFS and RFI. It might be a promising approach to guide therapeutic decisions in patients with APL. However, multivariate analyses and validation of these data in an independent patient cohort is warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Similar progression of carotid intima–media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients

2020 ◽  
Vol 7 (1) ◽  
pp. e000362 ◽  
Author(s):  
Sofia Ajeganova ◽  
Thomas Gustafsson ◽  
Linnea Lindberg ◽  
Ingiäld Hafström ◽  
Johan Frostegård
Keyword(s):  
Risk Factors ◽  
Lupus Nephritis ◽  
Carotid Plaque ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Average Dose ◽  
Media Thickness ◽  
History Of

ObjectiveTo compare progression of subclinical atherosclerosis and factors promoting it in patients with SLE and controls.MethodsConsecutive patients with SLE and age-matched, sex-matched population controls from the SLEVIC cohort were assessed at inclusion and after 7 years with standardised data collection and carotid ultrasound. Effect of risk factors on carotid intima–media thickness (cIMT) progression was examined with adjusted linear mixed models.ResultsA total of 77 patients and 74 controls, 68% and 61% of the original cohort, completed follow-up. The patients were (mean) 47 years old, 90% were women, and controls were 51 years old, 92% women. Patients had disease duration of (mean) 11 years, mild disease activity and low severity at both assessments. Baseline cIMT did not differ between the groups. An average absolute cIMT progression was 0.009 mm/year in patients and 0.011 mm/year in controls, intergroup difference p=0.9.Of factors at inclusion, dyslipidaemia, lower levels of high-density lipoprotein (HDL) and carotid plaque in patients and controls, and higher systolic blood pressure, total cholesterol:HDL and LDL:HDL ratios and triglycerides in patients were associated with cIMT progression. Of factors at follow-up, hypertension and blood lipids in patients and HDL in controls were significantly associated with cIMT progression. History of lupus nephritis and a higher average dose of prednisolone used since diagnosis were associated with cIMT progression in patients. Associations of risk factors with cIMT progression were stronger in presence of plaques.ConclusionWe observed a statistically comparable progression of cIMT in patients with mild SLE and controls over 7 years, which implies that progression of subclinical atherosclerosis in some patients with SLE could follow that of the general population. Traditional cardiovascular (CV) risk factors, history of lupus nephritis and higher use of corticosteroids promote cIMT progression in SLE. Detection of carotid plaque may add to CV risk stratification.

Abstract P370: Utility of Cardiovascular Risk Algorithms in Prediction of Subclinical Atherosclerosis in the Young

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Alexi Geevarghese ◽  
Michael Garshick ◽  
Eugenia Gianos ◽  
Ricardo Benenstein
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Family History ◽  
Risk Score ◽  
Carotid Plaque ◽  
Cardiac Risk ◽  
Carotid Ultrasound ◽  
Younger Patients ◽  
Cardiac Risk Factors ◽  
History Of

Background: Prediction of cardiovascular risk in younger patients is particularly challenging. Most current risk estimators underestimate risk potentially leading to under-treatment in younger patients with significant risk factors for atherosclerosis. Methods: A retrospective analysis of patients age 20 to 50 (n = 274) referred to a cardiology clinic between 2013 and 2016 and undergoing carotid ultrasound for risk stratification and statin initiation was conducted. A medical history was obtained by chart review at the time of carotid ultrasound. The 2008 Framingham general risk score was used to calculate a 10-year cardiac risk. Carotid plaque was defined using standard definitions as carotid artery focal wall thickening 50% or greater than the surrounding vessel wall or a focal region > 1.5 mm protruding into the lumen. Results: Average age was 41 ± 7.9 years, 60% male, 77% Caucasian, 4% diabetes. Ten percent (n = 27) had carotid plaque noted on ultrasound. Those with plaque compared to those without were older (46 ± 4.3 vs. 41 ± 7.5, p < 0.01), more likely to have hypertension (HTN) (52% vs. 20%, p < 0.01), more likely to be active smokers (19% vs. 6%, p = 0.02) and had higher total cholesterol (222 ± 53 mg/dl vs. 202 ± 45 mg/dl, p = 0.04) and LDL-C (140 ± 40 mg/dl vs. 121 ± 43 mg/dl, p = 0.04). No differences were noted in gender, race, body mass index, diabetes or family history of early heart disease. The average cardiac risk score was 5.9 ± 3.5% for those with plaque and 4.2 ± 3.2% for those without (p < 0.01). When assessing the same population by number of risk factors, 93% (n = 25) of individuals with carotid plaque had ≥ 2 cardiac risk factors (one point each for age 40 to 50, smoking, family history of heart early disease, obesity, LDL > 160 mg/dl, DMII or HTN). This compared to 37% (n=10) who had carotid plaque on imaging and a risk score ≥ 7.5%. Receiver operator curve characteristics to predict plaque were similar for the cardiac risk score (AUC 0.674) and number of cardiac risk factors (AUC 0.674, p = 0.96). Conclusion: In patients 50 years or younger, ≥ 2 cardiac risk factors revealed a higher percentage of carotid plaque than a Framingham cardiac risk score cut off value of ≥ 7.5%. In younger patients with cardiac risk factors, novel algorithms are needed to more accurately guide medication therapy.

scholarly journals POS0096 SPLENIC METABOLIC UPTAKE IN FDG-PET/CT PREDICTS RISK OF FUTURE CARDIOVASCULAR THROMBOSIS EVENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 258.2-259
Author(s):  
S. J. Lee ◽  
C. M. Hong ◽  
Y. M. Kang
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Disease Activity ◽  
Fdg Pet ◽  
Cvd Risk ◽  
Positron Emission ◽  
Increased Risk ◽  
Pet Ct ◽  
Fdg Pet Ct

Background:Patients with the rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) compared to general population. However there are insufficient modality to predict future CVD risk in RA.Objectives:This study assessed whether splenic and arterial activity measured by positron emission tomography/ computed tomography (PET/CT) predict the risk of CVD thrombosis events beyond conventional risk factors in patients with RA.Methods:We enrolled 84 patients with active RA who underwent fluorine-18-fluorodeoxyglucose (FDG) PET/CT and disease activity evaluation at the same time. CVD thrombosis events were independently evaluated, while blinded to activity of PET/CT, during follow up periods. FDG uptake by nuclear medicine physician was examined in the spleen and ascending aorta and blood pool activity of superior vena cava as SUV (standardized uptake values) and target-to-background-ratio (TBR) while blinded to CVD events.Results:During follow-up periods, 19 patients developed CVD thrombosis events. Both splenic and arterial TBR were significantly increased in patients with subsequent CVD events compared to in patients without (2.19 ± 0.60 vs 1.80 ± 0.34, p < 0.013, 1.72 ± 0.22 vs 1.57 ± 0.22, p< 0.012). Splenic TBR was associated with an increased risk of CVD events after adjustment for conventional CVD risk factors [hazard ratio (HR): 3.15; 95% confidence interval (CI): 1.46 to 6.79; p = 0.003]. Moreover, the association between splenic TBR and CVD events remained significant after adjustment for disease activity (HR: 3.00; CI: 1.36 to 6.63; p = 0.007) and after adjustment for arterial TBR (HR: 3.00; CI: 1.36 to 6.63; p = 0.007).Conclusion:Our results show splenic metabolic uptake in FDG-PET/CT in patients with RA provide information for subsequent CVD events beyond conventional risk factors.References:[1]Lee SJ, Jeong JH, Lee CH, et al. Development and validation of an (18) F-fluorodeoxyglucose-positron emission tomography with computed tomography-based tool for the evaluation of joint counts and disease activity in patients with rheumatoid arthritis. Arthritis Rheumatol. 2019;71:1232-1240.Disclosure of Interests: :None declared

scholarly journals Prevalence and associated factors of subclinical atherosclerosis in rheumatoid arthritis at the university hospital of Kinshasa

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Christophe Mulumba ◽  
Pierrot Lebughe ◽  
Jean-Marie Mbuyi-Muamba ◽  
Jean-Robert Makulo ◽  
François Lepira ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Logistic Regression ◽  
Cardiovascular Risk ◽  
Disease Activity ◽  
Cardiovascular Risk Factors ◽  
Subclinical Atherosclerosis ◽  
University Hospital ◽  
Factors Associated ◽  
The University

Abstract Background Rheumatoid arthritis (RA) is associated with a 5 to 10 years reduction in life expectancy due to premature atherosclerosis. This reduction is the consequence of traditional cardiovascular risk factors (TCRF) as well as systemic inflammation. The aim of the present study was to describe the prevalence and factors associated with subclinical atherosclerosis in RA at the University Hospital of Kinshasa (UHK). Methods Patients with a diagnosis of RA based on the 2010 ACR/EULAR criteria were included in this cross-sectional study from 1 June 2014 to 31 May 2015 at the UHK. RA disease activity was measured using the DAS28-ESR. Active RA was defined by a DAS 28 > 2.6. Severe RA was defined by the presence of extra-articular manifestation, joint erosions on X-rays or HAQ ≥0.5. An assessment of subclinical atherosclerosis was performed by the measurement of the carotid intima-media thickness (cIMT) using two-dimensional ultrasonography. Subclinical atherosclerosis was defined by a cIMT ≥0.9 mm. A diagnosis of atheroma plaque was retained when the cIMT was ≥1.5 mm. The association between subclinical atherosclerosis and potential risk factors was modeled using logistic regression analysis. Results We recruited 75 patients. The average age was 51.8 ± 14.6 years, with a sex ratio F/M of 4. The prevalence of subclinical atherosclerosis was 32%. In logistic regression being a woman of ≥55 years old (aOR 10.6, 95% CI [2.087–53.82], p = 0.028), DAS28-ESR > 2.6 (aOR 3.5,95% CI [1.55–10.38], p = 0.044), severe RA (aOR 32.6,95% CI [1.761–60.37],p = 0.035), high blood pressure (aOR 22.4,95% CI [5.04–99.41], p = 0.005) and obesity (aOR 32.3, 95% CI [2.606–40.73], p = 0.026) emerged as factors associated with subclinical atherosclerosis. Conclusion Subclinical atherosclerosis is common in RA patients attending the UHK. It appears to be associated with RA disease activity and severity apart from traditional cardiovascular risk factors. These results suggest that early management of subclinical atherosclerosis targeting remaining RA disease activity and cardiovascular risk factors could slow down progression to clinical cardiovascular disease.

scholarly journals Risk Factors for Low Back Pain Increase in Rheumatoid Arthritis: Analysis of a 7-year Follow-up Study

2021 ◽  
Author(s):  
Kentaro Yamada ◽  
Akinobu Suzuki ◽  
Shinji Takahashi ◽  
Kentaro Inui ◽  
Tatsuya Koike ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Disease Activity ◽  
Mental Status ◽  
Psychological Status ◽  
Low Back ◽  
Poor Control

Abstract Objective Several studies have demonstrated that low back pain (LBP) is related to disease activity in patients with rheumatoid arthritis (RA). However, there is no longitudinal research. This study aimed to determine the impacts and risk factors for LBP increase in RA in a longitudinal cohort study. Methods The study evaluated 113 patients with RA who completed the secondary survey. LBP increase was defined as ≥1 standard deviation of mean change in visual analog scale (VAS) between the baseline and secondary surveys. The impacts of LBP increase on quality of life (QOL) and psychological status were evaluated. Risk factors were assessed among patient demographic characteristics, radiological changes. Results Mean change in VAS for LBP was −0.8±30.4 mm during a mean 7-year follow-up. LBP increase was defined as ≥30-mm increase in VAS for LBP. Patients with LBP increase had significantly lower QOL and worse mental status than patients without. Poor control of RA was identified as an independent risk factor for LBP increase (odds ratio, 9.82, p=0.001). Conclusion Patients with poor control of RA were likely to experience LBP increase in the long-term. Control of RA disease activity is important for control of LBP, QOL, and mental status.

scholarly journals Disease activity influences the reclassification of rheumatoid arthritis into very high cardiovascular risk

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Iván Ferraz-Amaro ◽  
Alfonso Corrales ◽  
Juan Carlos Quevedo-Abeledo ◽  
Nuria Vegas-Revenga ◽  
Ricardo Blanco ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Carotid Plaque ◽  
Multivariable Analysis ◽  
Risk Category ◽  
Carotid Ultrasound ◽  
Risk Reclassification ◽  
Ultrasound Assessment ◽  
Multivariable Regression ◽  
Very High

Abstract Background Previous studies have shown that risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the actual cardiovascular (CV) risk of patients with rheumatoid arthritis (RA). In contrast, carotid ultrasound was found to be useful to identify RA patients at high CV. In the present study, we aimed to determine if specific disease features influence the CV risk reclassification of RA patients assessed by SCORE risk charts and carotid ultrasound. Methods 1279 RA patients without previous CV events, diabetes, or chronic kidney disease were studied. Disease characteristics including disease activity scores, CV comorbidity, SCORE calculation, and the presence of carotid plaque by carotid ultrasound were assessed. A multivariable regression analysis was performed to evaluate if the reclassification into very high CV risk category was independently associated with specific features of the disease including disease activity. Additionally, a prediction model for reclassification was constructed in RA patients. Results After carotid ultrasound assessments, 54% of the patients had carotid plaque and consequently fulfilled definition for very high CV risk. Disease activity was statistically significantly associated with reclassification after fully multivariable analysis. A predictive model containing the presence of dyslipidemia and hypertension, an age exceeding 54 years, and a DAS28-ESR score equal or higher than 2.6 yielded the highest discrimination for reclassification. Conclusion Reclassification into very high CV risk after carotid ultrasound assessment occurs in more than the half of patients with RA. This reclassification can be independently explained by the activity of the disease.

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