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05-01-2018 | Rheumatology | News | Article

Disease activity linked to adverse outcomes in RA patients

medwireNews: Higher disease activity is associated with an increased risk for serious infection, myocardial infarction (MI), and coronary heart disease (CHD) among patients with rheumatoid arthritis (RA), US study results suggest.

“These findings add to the growing body of evidence that further strengthens the argument to strive for lower disease activity in RA,” say Jeffrey Curtis (University of Alabama at Birmingham) and study co-authors.

As reported in the Annals of the Rheumatic Diseases, the researchers analyzed the association between disease activity and hospitalization for infection and cardiovascular events using multibiomarker disease activity (MBDA) laboratory test scores linked to Medicare data from 17,433 RA patients aged a mean of 69 years.

In all, 452 primary hospitalizations for pneumonia or sepsis occurred over 16,424 person–years of follow-up. When compared with patients with a low MBDA score (<30 points), those with a moderate score (30–44 points) had a 2.18-fold increased risk for serious infection after adjustment for factors including age, sex, race, and comorbidities, while patients with a high score (>44 points) had a 3.56-fold increased risk.

“A strong dose–response gradient existed between MBDA scores and hospitalised infections,” say Curtis and colleagues.

However, “[t]he patterns for MI and CHD events suggested more of a threshold effect, where those with the lowest level of disease activity and inflammation were at lowest risk, but gradations with higher levels of the biomarker were relatively absent,” they explain.

Indeed, for the patients in the cardiac outcome analysis, who experienced 132 MIs and 181 CHD events over 16,037 person–years of follow-up, those with moderate and high MBDA scores had a corresponding 1.53- and 1.52-fold increased risk for MI and a 1.34- and 1.42-fold increased risk for CHD relative to those with low scores.

The researchers caution that their analysis did not take DMARD therapy use into account, meaning that “the true associations may be stronger” than those reported, and acknowledge that the “results may not be generalizable to younger patients with RA,” considering the predominantly older study population.

“However, given that the prevalence of infectious and CHD risk factors generally increases with age, we would speculate that the associations between RA disease activity and the outcomes that we studied might be even stronger in younger patients with RA,” they add.

And the team concludes: “Use of the MBDA score to risk-stratify patients to identify those with high levels of inflammatory activity and are at high risk for [serious adverse events] may be possible to help clinicians identify those at greatest risk and targets for early intervention including intensive RA management.”

By Claire Barnard

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