Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
A Pilot Cardiovascular Risk Reduction Clinic for Inflammatory Rheumatic Diseases.
Martell, Kevin, McMurtry, Michael Sean, McAlister, Finlay, Gyenes, Gabor, Keeling, Stephanie O.
A recent practice audit of 9 rheumatologists at a tertiary care site demonstrated poor cardiovascular (CV) risk management of inflammatory rheumatic disease (IRD) patients. Therefore the utility of a CV risk reduction clinic for these patients warrants investigation. This study established a new model-of-care independent of the standard rheumatology clinic and describes the original inception cohort.
Patients with moderate to severe inflammatory arthritis (IA) were invited to attend the "CV Risk Reduction Clinic for IRD" as part of a biologics surveillance program in northern Alberta. After initial postal screening of traditional CV risk factors & fasting labs (lipid panel, glucose), clinic attendees were evaluated with pre-specified case report forms including IA activity and traditional CV risk factors. Framingham & Reynold's risk scores were calculated & the European League Against Rheumatism (EULAR) CV risk multiplicative factor of 1.5 applied when criteria were met. Carotid intima media thickness (CIMT) measurements were measured on a separate visit for all consenting patients. Patients were offered dietician counseling, smoking cessation therapies, physiotherapy referrals, lipid lowering (according to 2009 Canadian Cardiovascular Society guidelines) & antihypertensive treatments. RA disease management was left for the attending rheumatologist. Descriptive statistics were calculated with Microsoft excel & the study approved by the University of Alberta ethics.
Twenty-five patients (M:F 7:18) attended the clinic to date, mean age 55.8 (±13.5) years, with the following diagnoses: 19 (76%) RA; 2 (8%) juvenile idiopathic arthritis; 4 (16%) psoriatic arthritis. Fifteen (60%) patients were RF positive, 17 (68%) anti-CCP positive and 9 (36%) had rheumatoid nodules. Mean disease duration was 18±14 years, ESR 15 ± 12 mm/hr, CRP 5 ±4 mg/l & DAS28 2.5 ± 2.2. Radiographic erosions were noted in the hand and feet x-rays of 14 (58%) and 8 (38%) patients respectively. Traditional cardiovascular risk assessment confirmed four (16%) patients as active smokers, 10 (40%) with high cholesterol (LDL > 3.5 mmol/L), 2 (8%) with diabetes, 7 (28%) treated for systolic hypertension, 11 (44%) with family history of premature heart disease & 5 (20%) with personal history of CVD. The mean Framingham and Reynolds risk score of a CV event in the next 10-years was 10% and 2.2% & the mean Framingham applying the EULAR multiplicative factor (8 patients) was 8.0%. Mean CIMT measurement for any observed carotid artery was 0.70 mm (± 0.21; n=74 arteries), & number of arteries with significant thickness (>0.75 mm) was 27 with mean thickness of 0.96 ± 0.15 mm. Plaques were noted in 6 patients.
The CRRC-IRD provides a new model-of-care to evaluate and manage CV risk in a high-risk patient population. Future evaluations from this clinic model include (1) reviewing prospective CV outcomes from the clinic compared to standard-of-care, (2) applicability of different risk scores in IA (given the discrepancy of mean Framingham & Reynold's scores in this study) & (3) contributions of treat-to-target RA disease approach & (4) CIMT to CV risk assessment.
To cite this abstract, please use the following information:
Martell, Kevin, McMurtry, Michael Sean, McAlister, Finlay, Gyenes, Gabor, Keeling, Stephanie O.; A Pilot Cardiovascular Risk Reduction Clinic for Inflammatory Rheumatic Diseases. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2078