Rheumatoid Arthritis Flare Ups Increase Cardiovascular Disease Risk

Rheumatoid arthritis (RA) patients have a greater risk for cardiovascular disease (CVD) — especially after flare up episodes, according to research published in the journal Annals of the Rheumatic Diseases.

Researchers from the Mayo Clinic in Rochester, Minnesota compared patients aged less than 30 years with confirmed RA — according to the 1987 American College of Rheumatology criteria between 1988 and 2007 – to non RA subjects without CVD in order to evaluate the role of RA flare, remission, and severity in CVD. The 525 RA patients were matched by age and sex to 524 non RA patients in order to adjust for risk factors for CVD and anti rheumatic medications, and more than two thirds of the participants were female.

CVD was defined by the investigators as all typical CVD events, such as myocardial infarction, angina, heart failure, stroke, intermittent claudication, and cardiovascular death.

The researchers found that there was an increase in CVD risk in RA per time spent in each acute flare, when compared to RA remission. The CVD risk for RA patients in remission was similar to non RA participants.

“Our findings show substantial detrimental role of exposure to RA flare and cumulative burden of RA disease severity in CVD risk in RA, suggesting important cardiovascular benefits associated with tight inflammation control and improved flare management in patients with RA,” the authors concluded.

The investigators also concluded that there was an increased cumulative moving average of daily RA medical Records Based Index of Severity (RABIS), which includes data on bone erosions, joint surgeries, morning stiffness, rheumatoid factor positivity, acute phase reactants, and use of anti rheumatic drugs, and Claims Based Index of RA Severity (CIRAS), which includes data about the number of visits to rheumatology and rehabilitation centers, and rheumatoid factors, platelets, and chemistry panel results, was associated with increased CVD risk. Patients who spent more time in medium and high CIRAS tertiles versus low tertiles were more likely to have a higher CVD risk.

“This study confirmed that disease control is really important for decreasing the morbidity associated with CVD,” study co author Eric Matteson, MD, told the media. “It was particularly important during the first year. This finding emphasizes the importance of tight control for preventing the morbidity of CVD.”