Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


A Comparison of Cardiovascular Risk in Patients with Spondyloarthropathies and Rheumatoid Arthritis

Grant1,  Laura, Bailey1,  Kimberley A., Kumar2,  Namita

Medical School, University of Newcastle, Newcastle upon Tyne, United Kingdom,
University Hospital of North Durham, Durham, United Kingdom

Purpose:

The management of cardiovascular disease (CVD) and its risk factors play an important role in the multi-factorial management of patients with inflammatory arthritis (IA). The British Society for Rheumatology and NICE all recommend that patients with IA should be offered annual CVD review.

A suggested multiplier of risk in Rheumatoid Arthritis (RA) is 1.5 greater than the general population and we have shown this significantly increases numbers of patients requiring primary prevention (1). This is also a fair estimate of CVD burden in Seronegative Spondylarthropathies (SpA) also (2). We wished to establish the number of SpA patients who reached primary prevention treatment threshold prior to establishing a CVD screening service.

Method:

Consecutive RA patients and SpA patients, both without diabetes or CVD were recruited over a five week period in 2 consecutive years. Ten year CVD risk was calculated using the Joint British Societies risk calculator and comparisons were made between the 2 groups. Both sets of data were multiplied by 1.5. Paired t tests were then used to compare risk scores within each disease group.

Results:

45 RA patients were assessed 26 female, 18 male. Mean age was 57.53 years (range 39–74 years). Mean systolic BP 136.4mmHg (SD 13.6), diastolic 86.3mmHg (SD 14.0) 51 SpA patients were assessed, 20 male, 31 female. The mean age was 49.5 years (range 30–72 years). Mean systolic BP was 140.4 mmHg (SD 18.3) and mean diastolic BP was 86.1 (SD 10.7). All patients had a diagnosis of one year or longer.

Table 1. Projection of 10 Year Cardiovascular Risk

 RASpAP
N4551 
 Actual risk greater than 20%Risk ×1.5Actual risk greater than 20%Risk ×1.5 
 6*18*7#15#*#0.001

Conclusion:

CVD is an important cause of mortality and morbidity in IA. Disease burden is underestimated by standard risk assessment. Multiplying by 1.5 is an acceptable estimation of true risk. This however significantly increases the number of patients requiring primary prevention in this work twofold. This should be recognised when establishing such services and results of studies such as TRACE RA will guide Rheumatologists in whether primary prevention has a significant impact in patients with IA.

References:

(1)Bailey, K.A. & Kumar, N.2009). The Impact of adjusting Cardiovascular risk scores to known ratios in Rheumatoid Arthritis. Rheumatology (Vol 48)pi130.

(2)Gladman, DD, Ang, M, Su, Li, Tom, B Dm, Schentag, CT & Farewell, VTCardiovascular morbidity in psoriatic arthritis (PsA) Annals of the rheumatic diseases. 09/2008 ARD Online First, 10.1136/ard.2008.094839

To cite this abstract, please use the following information:
Grant, Laura, Bailey, Kimberley A., Kumar, Namita; A Comparison of Cardiovascular Risk in Patients with Spondyloarthropathies and Rheumatoid Arthritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :547
DOI: 10.1002/art.25629

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