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Ikdahl E, Rollefstad S, Kazemi A, Provan SA, Larsen TL, Semb AG. Non-steroidal anti-inflammatory drugs and risk of pulmonary embolism in patients with inflammatory joint disease-results from the nationwide Norwegian Cardio-rheuma registry. Eur Heart J Cardiovasc Pharmacother 2024; 10:27-34. [PMID: 37881093 PMCID: PMC10766907 DOI: 10.1093/ehjcvp/pvad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023]
Abstract
AIMS Patients with inflammatory joint diseases (IJD), including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) have increased rates of pulmonary embolism (PE). Non-steroidal anti-inflammatory drugs (NSAIDs) use is associated with PE in the general population. Our aim was to evaluate the association between NSAIDs use and PE in IJD patients. METHODS AND RESULTS Using individual-level registry data from the whole Norwegian population, including data from the Norwegian Patient Registry and the Norwegian Prescription Database, we: (1) evaluated PE risk in IJD compared to non-IJD individuals, (2) applied the self-controlled case series method to evaluate if PE risks were associated with use of traditional NSAIDs (tNSAIDs) and selective cox-2 inhibitors (coxibs). After a one-year wash-out period, we followed 4 660 475 adults, including 74 001 with IJD (RA: 39 050, PsA: 20 803, and axSpA: 18 591) for a median of 9.0 years. Crude PE incidence rates per 1000 patient years were 2.02 in IJD and 1.01 in non-IJD individuals. Age and sex adjusted hazard ratios for PE events were 1.57 for IJD patients compared to non-IJD. Incidence rate ratios (IRR) [95% confidence interval (CI)] for PE during tNSAIDs use were 0.78 (0.64-0.94, P = 0.010) in IJD and 1.68 (1.61-1.76, P < 0.001) in non-IJD. IRR (95% CI) for PE during coxibs use was 1.75 (1.10-2.79, P = 0.018) in IJD and 2.80 (2.47-3.18, P < 0.001) for non-IJD. CONCLUSION Pulmonary embolism rates appeared to be higher in IJD than among non-IJD subjects in our study. Traditional NSAIDs may protect against PE in IJD patients, while coxibs may associated with increased PE risk.
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Affiliation(s)
- Eirik Ikdahl
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Silvia Rollefstad
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Amirhossein Kazemi
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Sella A Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
- Department Public Health and Sport Sciences, Inland Norway University of Applied Sciences, 2406 Elverum, Norway
| | - Trine-Lise Larsen
- Department Hematology, Medical Division, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Anne Grete Semb
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
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Ullensvang G, Kringeland E, Ikdahl E, Provan S, Berg IJ, Rollefstad S, Dagfinrud H, Gerdts E, Semb AG, Midtbø H. Cardiovascular organ damage in relation to hypertension status in patients with ankylosing spondylitis. Blood Press 2023; 32:2205956. [PMID: 37132420 DOI: 10.1080/08037051.2023.2205956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE Hypertension is a major cardiovascular (CV) risk factor in ankylosing spondylitis (AS) patients. Less is known about the prevalence of CV organ damage in relation to hypertension status in AS patients. MATERIALS AND METHODS CV organ damage was assessed by echocardiography, carotid ultrasound and pulse wave velocity (PWV) by applanation tonometry in 126 AS patients (mean age 49 ± 12 years, 39% women) and 71 normotensive controls (mean age 47 ± 11 years, 52% women). CV organ damage was defined as presence of abnormal left ventricular (LV) geometry, LV diastolic dysfunction, left atrial (LA) dilatation, carotid plaque or high pulse wave velocity (PWV). RESULTS Thirty-four percent of AS patients had hypertension. AS patients with hypertension were older and had higher C-reactive protein (CRP) levels compared to AS patients without hypertension and controls (p < 0.05). The prevalence of CV organ damage was 84% in AS patients with hypertension, 29% in AS patients without hypertension and 30% in controls (p < 0.001). In multivariable logistic regression analyses, having hypertension was associated with a fourfold increased risk of CV organ damage independent of age, presence of AS, gender, body mass index, CRP, and cholesterol (odds ratio (OR) 4.57, 95% confidence interval (CI) 1.53 to 13.61, p = 0.006). In AS patients, presence of hypertension was the only covariable significantly associated with presence of CV organ damage (OR 4.40, 95% CI 1.40 to 13.84, p = 0.011). CONCLUSIONS CV organ damage in AS was strongly associated with hypertension, pointing to the importance of guideline-based hypertension management in AS patients.
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Affiliation(s)
- Gyda Ullensvang
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ester Kringeland
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Sella Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Inger Jorid Berg
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eva Gerdts
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Helga Midtbø
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Kerola AM, Rollefstad S, Kazemi A, Wibetoe G, Sexton J, Mars N, Kauppi M, Kvien TK, Haavardsholm EA, Semb AG. Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents. Scand J Rheumatol 2023; 52:42-50. [PMID: 35014920 DOI: 10.1080/03009742.2021.1997436] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.
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Affiliation(s)
- A M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - N Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - M Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Clinicum, University of Helsinki, Helsinki, Finland
| | - T K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Semb AG, Rollefstad S, Sexton J, Ikdahl E, Crowson CS, van Riel P, Kitas G, Graham I, Kerola AM. Oral anticoagulant treatment in rheumatoid arthritis patients with atrial fibrillation results of an international audit. Int J Cardiol Heart Vasc 2022; 42:101117. [PMID: 36118256 PMCID: PMC9479366 DOI: 10.1016/j.ijcha.2022.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Objective To describe the prevalence of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA), and to evaluate the proportion of patients with AF receiving guideline-recommended anticoagulation for prevention of stroke, based on data from a large international audit. Methods The cohort was derived from the international audit SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) which collected data from 17 countries during 2014-2019. We evaluated the prevalence of AF across world regions and explored factors associated with the presence of AF with multivariable logistic regression models. The proportion of AF patients at high risk of stroke (CHA2DS2-VASc ≥ 2 in males and ≥ 3 in females) receiving anticoagulation was examined. Results Of the total SURF-RA cohort (n = 14,503), we included RA cases with data on whether the diagnosis of AF was present or not (n = 7,665, 75.1% women, mean (SD) age 58.7 (14.1) years). A total of 288 (3.8%) patients had a history of AF (4.4% in North America, 3.4% in Western Europe, 2.8% in Central and Eastern Europe and 1.5% in Asia). Factors associated with the presence of AF were older age, male sex, atherosclerotic cardiovascular disease, heart failure and hypertension. Two-hundred and fifty-five (88.5%) RA patients had a CHA2DS2-VASc score indicating recommendation for oral anticoagulant treatment, and of them, 164 (64.3%) were anticoagulated. Conclusion Guideline-recommended anticoagulant therapy for prevention of stroke due to AF may not be optimally implemented among RA patients, and requires special attention.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, REMEDY, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Cynthia S Crowson
- Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, MN, USA
| | - Piet van Riel
- IQ Healthcare, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - George Kitas
- Department of Rheumatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Ian Graham
- Cardiology, The University of Dublin Trinity College, Dublin, Ireland
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson CS, van Riel P, Kitas GD, Graham I, Dahlqvist SR, Karpouzas G, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon CA, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg A, Mu R, Mirrakhimov EM, Gheta D, Myasoedova S, Krougly L, Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horák P, Medková H, Semb AG. An international audit of the management of dyslipidaemia and hypertension in patients with rheumatoid arthritis: results from 19 countries. European Heart Journal - Cardiovascular Pharmacotherapy 2022; 8:539-548. [PMID: 34232315 DOI: 10.1093/ehjcvp/pvab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 01/05/2023]
Abstract
AIMS To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions and to evaluate the management and goal attainment of lipids and blood pressure (BP). METHODS AND RESULTS The survey of CVD risk factors in patients with RA was conducted in 14 503 patients from 19 countries during 2014-19. The treatment goal for BP was <140/90 mmHg. CVD risk prediction and lipid goals were according to the 2016 European guidelines. Overall, 21% had a very high estimated risk of CVD, ranging from 5% in Mexico, 15% in Asia, 19% in Northern Europe, to 31% in Central and Eastern Europe and 30% in North America. Of the 52% with indication for lipid-lowering treatment (LLT), 44% were using LLT. The lipid goal attainment was 45% and 18% in the high and very high risk groups, respectively. Use of statins in monotherapy was 24%, while 1% used statins in combination with other LLT. Sixty-two per cent had hypertension and approximately half of these patients were at BP goal. The majority of the patients used antihypertensive treatment in monotherapy (24%), while 10% and 5% as a two- or three-drug combination. CONCLUSION We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.
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Affiliation(s)
- Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Joe Sexton
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - George D Kitas
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
| | | | | | - George Karpouzas
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Lazarini
- Joint Rheumatology Program, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bindee Kuriya
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Simona Stoenoiu
- Rheumatology Department, Cliniques Universitaires Saint Luc, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Patrick Durez
- Rheumatology Department, Cliniques Universitaires Saint Luc, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | | | | | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | | | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | | | - Diane Gheta
- Tallagh University Hospital, Dublin, Ireland
| | | | - Lev Krougly
- Center of Cardiology of Russian Ministry of Healthcare, Moscow, Russia
| | - Tatiana Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Alena Tuchyňová
- National Institute of Rheumatic Diseases, 92101 Piešťany, Slovensko, Slovakia
| | - Michal Tomcik
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, First Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Jiri Lastuvka
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, First Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic
- First Medical Faculty, Charles University, Prague, Czech Republic
| | - Pavel Horák
- Iii Interna klinika fn Olomouc, Olomouc, Czech Republic
| | - Helena Medková
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
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Hammer HB, Rollefstad S, Semb AG, Jensen G, Karoliussen LF, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Urate crystal deposition is associated with inflammatory markers and carotid artery pathology in patients with intercritical gout: results from the NOR-Gout study. RMD Open 2022; 8:rmdopen-2022-002348. [PMID: 35863863 PMCID: PMC9310249 DOI: 10.1136/rmdopen-2022-002348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Gout is of unknown reason associated with cardiovascular disease. Ultrasound is sensitive for detecting crystal deposition and plasma calprotectin is a sensitive inflammatory marker. This study explores the associations between crystal deposition, inflammation and carotid artery pathology. METHOD A cross-sectional analysis of baseline assessments from the NOR-Gout study was undertaken. Crystal deposition was assessed by ultrasound (double contour, tophi, aggregates) and dual-energy CT (DECT) and laboratory assessments included plasma calprotectin. The carotid arteries were bilaterally examined for carotid intima-media thickness (cIMT) and presence of plaques. Spearman correlations, Mann-Whitney tests and linear regression analyses were used to explore associations between crystal deposition, inflammatory markers,and carotid pathology. RESULTS 202 patients with intercritical gout (95.5% men, mean (SD) age 56.5 (13.8) years, disease duration 7.9 (7.7) years) were included. Calprotectin was correlated with all scores of crystal deposition by ultrasound (r=0.26-0.32, p<0.001) and DECT (r=0.15, p<0.05). cIMT was correlated with sum score aggregates (r=0.18-0.22, p<0.05). Patients with large tophi had higher levels of calprotectin as well as more frequent carotid plaque (p<0.05). CONCLUSIONS Study findings point towards crystal deposition contributing to subclinical inflammation with subsequent vascular implications. However, future longitudinal studies are needed to confirm such causal relationships.
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Affiliation(s)
- Hilde Berner Hammer
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silvia Rollefstad
- Peventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Peventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Gro Jensen
- Clinical chemical laboratory, Diakonhjemmet Hospital, Oslo, Norway
| | | | - L Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Espen A Haavardsholm
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Semb AG, Ikdahl E, Kerola AM, Wibetoe G, Sexton J, Crowson CS, van Riel P, Kitas G, Graham I, Rollefstad S. A Clinical Audit of Cardiovascular Risk Factors and Disease in Patients with Rheumatoid Arthritis - SURF-RA. Mediterr J Rheumatol 2022; 33:201-217. [PMID: 36128215 PMCID: PMC9450194 DOI: 10.31138/mjr.33.2.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022] Open
Abstract
Background and aims Rheumatoid arthritis (RA) patients are at a high risk of atherosclerotic cardiovascular disease (ASCVD). This implies a need for meticulous CVD risk factor recording and control. Objectives The aim was to evaluate the international prevalence of ASCVD in RA patients and to audit the prevalence and control of CVD risk factors. Methods A SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) was performed at 53 centres in 19 countries in three continents between 2014 and 2019. CVD risk factors, medication, and physical and laboratory measurements were recorded. CVD risk was estimated using the ESC's SCORE system. Results Among 14503 RA patients in Western (n=8493) and Central and Eastern (n=923) Europe, Mexico (n=407), North America (n=4030) and Asia (n=650) (mean age 59.9 years, 74.5% female), ASCVD was present in 15%, varying from 2.5% in Mexico to 21% in Central and Eastern Europe. Sixty-two percent reported hypertension and 63% had a LDL-c of > 2.5 mmol/L. Mean BMI was 27.4 kg/m2 in the total cohort, highest in North America (29.7 kg/m2), and lowest in Asia (23.8 kg/m2). A sixth of patients were current smokers, and 13% had diabetes mellitus. Approximately 45% had an estimated high or very high risk of fatal CVD according to SCORE algorithm, and ¾ of patients had only ≤4/6 CVD risk factors at recommended target. Conclusion Among RA patients across three continents, established CVD and CVD risk factors are common, although geographical variation exists. Furthermore, CVD risk factors often remain inadequately controlled.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Anne M. Kerola
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Cynthia S. Crowson
- Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Piet van Riel
- IQ Healthcare, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - George Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom
| | - Ian Graham
- Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
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Kerola AM, Kazemi A, Rollefstad S, Lillegraven S, Sexton J, Wibetoe G, Haavardsholm EA, Kvien TK, Semb AG. All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study. Rheumatology (Oxford) 2022; 61:4656-4666. [PMID: 35377442 PMCID: PMC9707036 DOI: 10.1093/rheumatology/keac210] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/24/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To explore mortality and causes of death among Norwegian patients with RA, PsA and axial spondyloarthritis (axSpA) compared with the general population by conducting a nationwide registry-based cohort study. METHODS Patients with RA, PsA and axSpA were identified from the Norwegian Patient Registry based on ICD-10 codes between 2008 and 2017. Using age as the time variable, all-cause and cause-specific mortality were estimated between 2010 and 2017 with the Kaplan-Meier estimator and the cumulative incidence competing risk method, respectively. Sex-, education level-, health region- and age group-adjusted hazard ratios (HRs) for mortality were estimated using Cox regression models. RESULTS We identified 36 095 RA, 18 700 PsA and 16 524 axSpA patients (70%, 53% and 45% women, respectively). RA and axSpA were associated with increased all-cause mortality (HR 1.45 [95% CI: 1.41, 1.48] and HR 1.38 [95% CI: 1.28, 1.38], respectively). Women but not men with PsA had a slightly increased mortality rate (HR 1.10 [95% CI: 1.00, 1.21] among women and 1.02 [95% CI: 0.93, 1.11] among men). For all patient groups as well as for the general population, the three leading causes of death were cardiovascular diseases, neoplasms and respiratory diseases. RA patients had increased mortality from all of these causes, while axSpA patients had increased mortality from cardiovascular and respiratory diseases. CONCLUSION Even in the era of modern treatments for IJDs, patients with RA and axSpA still have shortened life expectancy. Our findings warrant further attention to the prevention and management of comorbidities.
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Affiliation(s)
- Anne M Kerola
- Correspondence to: Anne Kerola, Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway. E-mail:
| | | | - Silvia Rollefstad
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Semb AG, Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson C, van Riel P, Kitas G, Graham I, Rantapää-Dahlqvist S, Karpouzas GA, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MGG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon C, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg AA, Mu R, Mirrakhimov EM, Gheta D, Douglas K, Agarwal V, Myasoedova S, Krougly L, Valentinovna Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horak P, Medkova HK, Kerola AM. Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit. RMD Open 2021; 7:rmdopen-2021-001724. [PMID: 34244381 PMCID: PMC8268901 DOI: 10.1136/rmdopen-2021-001724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/20/2021] [Indexed: 01/21/2023] Open
Abstract
Aim The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention. Methods The cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM. Results The study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM. Conclusion CVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cindy Crowson
- Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Piet van Riel
- Rheumatology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - George Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Ian Graham
- Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Solbritt Rantapää-Dahlqvist
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå Universitet Medicinska Fakulteten, Umea, Sweden
| | | | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Petros P Sfikakis
- First Department of Propedeutic Medicine, Medical School of University of Athens, Athens, Greece
| | - Maria G G Tektonidou
- First Department of Propaedeutic Internal Medicine, University of Athens, Athens, Greece
| | - Argyro Lazarini
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Bindee Kuriya
- Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carol Hitchon
- Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Patrick Durez
- Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Virginia Pascual-Ramos
- Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Pompilio Faggiano
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Durga Prasanna Misra
- Krajska zdravotni a.s, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Andrew A Borg
- First Medical Faculty, Charles University, Praha, Czech Republic
| | - Rong Mu
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Olomoucký, Czech Republic
| | - Erkin M Mirrakhimov
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Diane Gheta
- Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Karen Douglas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Svetlana Myasoedova
- Rheumatology, Ivanovo State Medical Academy, Ivanovo, Ivanovskaa oblast', Russian Federation
| | - Lev Krougly
- Rheumatology, FSBI National Medical and Surgical Center named after N I Pirogov of the Ministry of Healthcare of the Russian Federation, Moskva, Moskva, Russian Federation
| | | | - Alena Tuchyňová
- Rheumatology, Narodny Ustav Reumatickych Chorob, Piestany, Slovakia
| | - Michal Tomcik
- Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Jiri Lastuvka
- Krajska zdravotni a.s, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,First Medical Faculty, Charles University, Praha, Czech Republic
| | - Pavel Horak
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Olomoucký, Czech Republic
| | - Helena Kaspar Medkova
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Kerola AM, Sexton J, Wibetoe G, Rollefstad S, Crowson CS, Mars N, Kazemi A, Haavardsholm EA, Kvien TK, Semb AG. Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway. Semin Arthritis Rheum 2021; 51:1081-1088. [PMID: 34450506 DOI: 10.1016/j.semarthrit.2021.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate nationwide incidence, sociodemographic associations and treatment penetration of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in Norway. METHODS The study combined data from nationwide registries on the total Norwegian adult population (age ≥ 18). From the Norwegian Patient Registry, incident RA and PsA cases during 2011-2015 were identified with records of first and second healthcare episodes listing RA/PsA diagnostic codes, and ≥ 1 episode in an internal medicine or rheumatology unit with RA/PsA code during the two-year period after the first episode. Dispensed DMARD prescriptions were obtained from the Norwegian Prescription Database. Persons with dispensed DMARD prescriptions or biologic DMARDs given in hospitals > 12 months before the index date were excluded. RESULTS Incidence of RA/PsA in Norway was 42/26 per 100,000 person-years (55/28 among women and 28/23 among men). RA peak incidence was observed at ages 70-79 in both sexes, whereas the peak incidence of PsA occurred at ages 50-59. Age- and sex-standardized incidences of RA and PsA were lower among persons with higher education levels. Within a year from the index date, 82.4/57.4% of RA/PsA patients used synthetic DMARDs while 9.4/9.5% used biologic DMARDs. CONCLUSIONS Register-based incidence estimates for RA and PsA in Norway are similar to other Nordic countries, but slightly higher than in previous Norwegian studies. Furthermore, we found that higher socioeconomic status was associated with lower incidence of both RA and PsA. Although conventional synthetic DMARDs were less often used in early PsA than RA, frequency of biologic DMARD prescriptions was comparable.
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Affiliation(s)
- Anne M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway; Department of Rheumatology, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland.
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Grunde Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Silvia Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Cynthia S Crowson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Amirhossein Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Espen A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Anne Grete Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
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Föhse FK, Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Hisdal J, Semb AG. Degree of arterial stiffness is comparable across inflammatory joint disease entities. Scand J Rheumatol 2021; 51:186-195. [PMID: 34132621 DOI: 10.1080/03009742.2021.1920169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Inflammatory joint disease (IJD) is associated with an increased risk of developing cardiovascular disease (CVD). Arterial stiffness is both a risk factor and a surrogate marker for CVD. This study aims to compare arterial stiffness across patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, and, by extension, to explore the relationship between arterial stiffness and the estimated CVD risk by the Systematic COronary Risk Evaluation (SCORE) algorithm.Method: During the study period, from April 2017 to June 2018, 196 patients with IJD visited the Preventive Cardio-Rheuma Clinic in Oslo, Norway. A CVD risk stratification was performed, including the assessment of traditional risk factors and the measurement of arterial stiffness.Results: Thirty-six patients (18.4%) had elevated aortic pulse wave velocity (aPWV) (≥ 10 m/s). After adjustment for age and heart rate, arterial stiffness was comparable across the IJD entities (p = 0.69). Associated factors, revealed by regression analysis, were age, blood pressure, heart rate, presence of carotid plaques, establis hed CVD, non-steroidal anti-inflammatory drugs, and statin use. Furthermore, aPWV was positively correlated with estimated CVD risk (r = 0.7, p < 0.001) and patients with a very high predicted CVD risk (SCORE ≥ 10%) had significantly higher aPWV than patients at lower CVD risk (9.2 vs 7.5 m/s, p < 0.001).Conclusion: The degree of arterial stiffness was comparable across the IJD entities and was highly associated with the estimated CVD risk. Our findings support the need for an increased focus on prevention of CVD in all patients with IJD.
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Affiliation(s)
- F K Föhse
- Department of Vascular Surgery, Oslo University Hospital-Aker, Oslo, Norway.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Hisdal
- Department of Vascular Surgery, Oslo University Hospital-Aker, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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12
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Kerola A, Sexton J, Rollefstad S, Wibetoe G, Crowson CS, Haavardsholm E, Kvien TK, Semb AG. POS1041 PREVALENCE, INCIDENCE AND ANTIRHEUMATIC DRUG USE IN PSORIATIC ARTHRITIS (PsA) IN NORWAY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Incidence estimates of PsA in Norway have varied from 6.9/100,000 person-years (pyrs) in Northern Norway to 41.3/100,000 pyrs in Central Norway, and point prevalence estimates have ranged from 1.3 to 6.9 per 1,000 adult inhabitants1,2, while nationwide epidemiologic data on PsA in Norway have been lacking.Objectives:To estimate prevalence, incidence and use of disease-modifying antirheumatic drugs (DMARDs) among PsA patients in Norway.Methods:The Norwegian Cardio-Rheuma register includes pseudonymized data from the total Norwegian population ≥18 years of age during 2008-2017, identified from the National Population register. Demographic and socioeconomic data were retrieved from Statistics Norway. Data on public or private somatic specialized care episodes were collected from the Norwegian Patient register (NPR) [ICD-10 codes for diagnoses and medical procedure codes for biologic DMARD infusions]. Information on dispensed DMARD prescriptions was captured from the Norwegian Prescription Database. Based on NPR data, PsA cases were defined as persons fulfilling three criteria: 1) 1st episode with ICD-10 code M07.0-M07.3 or L40.5 as main or contributory diagnosis (index date), 2) 2nd episode with code M07.0-M07.3 or L40.5 within 2-year period following index date, 3) an episode in internal medicine or rheumatology clinic with recorded M07.0-M07.3 or L40.5 within 2 years from index date. Years 2008-2010 served as a look-back period to identify prevalent PsA cases. To estimate pyrs at risk, we calculated number of individuals aged ≥ 18 years living in Norway on the 1st of January of each year 2011-2015 multiplied by one year (prevalent PsA cases excluded). Age- and sex-standardized incidence rates were calculated with 5-year age groups using the Norwegian adult population on January 1st 2015 as the standard.Results:During the look-back period 2008-2010, 7,697 cases fulfilled the PsA definition. In total, 6,183 incident PsA cases were identified during 2011-2015 (incidence 32/100,000 pyrs, 28 among men and 35 among women). Based on a sensitivity analysis comprising 5,065 PsA cases with no dispensed DMARD prescriptions ≥12 months before index date, incidence was slightly lower (26/100,000 pyrs). Patient characteristics and DMARD use are shown in Table 1. The incidence was highest among those aged 50-59 years in both sexes (Figure 1). PsA incidence was lower among those with higher education level (crude/age- and sex-standardized incidence per 100,000 pyrs for those below upper secondary education 34/38, upper secondary or post-secondary non-tertiary education 36/36, higher education 26/25). Point prevalence of PsA was 3.3/1,000 adult inhabitants on January 1st 2016.Table 1.Characteristics and treatment penetration of incident PsA patients 2011-2015AllExcluding cases with DMARDs >1 yr prior to index dateN61835065Women, n (%)3442 (55.7)2783 (54.9)Age at index date, median (IQR)50.5 (40.7 - 59.8)49.9 (40.2 - 59.3)Use of DMARDs after index date, n (%)12 months24 months12 months24 months Any conventional DMARD3706 (59.9)4048 (65.4)2894 (57.1)3184 (62.9) Methotrexate3313 (53.6)3650 (59.0)2638 (52.1)2933 (57.9) Sulfasalazine440 (7.1)586 (9.5)330 (6.5)457 (9.0) Any biologic DMARD842 (13.6)1197 (19.4)485 (9.6)771 (15.2) TNF-inhibitors810 (13.1)1154 (18.7)477 (9.4)758 (15.0) Oral glucocorticoids1773 (28.7)2240 (36.2)1449 (28.6)1807 (35.7) Any DMARD or glucocorticoids4365 (70.6)4742 (76.7)3384 (66.8)3725 (73.5)Conclusion:Our estimate of PsA incidence and prevalence are in the mid-range compared to studies from smaller regions in Norway. Methotrexate was initiated for more than half of PsA cases within one year from index date, whereas 19% had used biologic DMARDs within two years.References:[1]Hoff M, Gulati A, Romundstad P et al. Prevalence and incidence rates of psoriatic arthritis in central Norway: data from the Nord-Trondelag health study. Ann Rheum Dis 2015;74:60-64.[2]Nossent J & Gran J. Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway. Scand J Rheumatol 2009; 8:251-5.Acknowledgements:This work has been supported by a research grant from FOREUM Foundation for Research in Rheumatology.Disclosure of Interests:Anne Kerola Speakers bureau: Boehringer-Ingelheim, Consultant of: Pfizer, Gilead and Boehringer-Ingelheim, Joseph Sexton: None declared, Silvia Rollefstad: None declared, Grunde Wibetoe: None declared, Cynthia S. Crowson: None declared, Espen Haavardsholm: None declared, Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: AbbVie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: research funding to Diakonhjemmet Hospital from AbbVie, Amgen, BMS, MSD, Pfizer and UCB, Anne Grete Semb Speakers bureau: AbbVie, Bayer, Lilly, Novartis, Sanofi, Consultant of: Sanofi, Grant/research support from: Collaborative research support from Lilly, outside the submitted work.
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Kerola A, Sexton J, Wibetoe G, Rollefstad S, Crowson CS, Haavardsholm E, Kvien TK, Semb AG. POS0029 INCIDENCE AND TREATMENT PENETRATION OF RHEUMATOID ARTHRITIS IN NORWAY – A NATIONWIDE REGISTER LINKAGE STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Incidence of rheumatoid arthritis (RA) in Norway has not been evaluated in a nationwide setting.Objectives:To estimate the incidence of RA and real-life penetration of disease-modifying antirheumatic drug (DMARD) use in Norway.Methods:The Norwegian Cardio-Rheuma register comprises pseudonymized data from nationwide registries including the total Norwegian population ≥18 years during 2008-2017. Demographic and socioeconomic data were retrieved from the National Population Register and Statistics Norway. Data on public or private somatic specialized care episodes were collected from the Norwegian Patient register (NPR) (ICD-10 codes for diagnoses and medical procedure codes for biologic DMARD infusions). Dispensed DMARD prescriptions were captured from the Norwegian Prescription Database. RA cases were defined as persons with NPR records of all of the following: 1) 1st episode with ICD-10 code M05/M06 as main or contributory diagnosis (index date), 2) 2nd episode with code M05/M06 within 2-year period following index date, 3) M05/M06 recorded in an internal medicine or rheumatology department during the 2-year period. Years 2008-2010 served as a look-back period to identify prevalent RA cases. To estimate person-years (pyrs) at risk, we calculated number of persons aged ≥ 18 living in Norway on the 1st of January of each year 2011-2015 and multiplied it by one year (prevalent RA cases excluded). Standardized estimates were calculated with 5-year age groups using Norwegian adult population 1st of January 2015 as the standard.Results:Between 2011 and 2015, 9,493 persons fulfilled the RA definition (62.4% seropositive based on ICD-10 codes). Incidence rate was 49/100,000 pyrs (32 in men and 65 in women). A sensitivity analysis excluding cases who had dispensed DMARDs >12 months before index date yielded 8,125 RA cases (incidence 42/100,000 pyrs). Whereas absolute number of incident cases was highest among those aged 60-69 in both sexes, incidence was highest among those aged 70-79 (Figure 1). Both crude and age- and sex-standardized incidences were lower among persons with higher education level (crude/standardized incidence per 100,000 pyrs for those below upper secondary education 60/57; upper secondary or post-secondary non-tertiary education 53/52; higher education 36/39). Of incident cases, 94% received any DMARD treatment or glucocorticoids, 78% methotrexate, and 17% biologic DMARDs within 2 years after index date (Table 1).Conclusion:Contemporary register-based estimate of RA incidence in Norway is comparable to other Nordic countries.1,2 In line with treatment recommendations, methotrexate is the most commonly used DMARD in the initial treatment strategy in Norway. One in six patients used a biologic DMARD within 2 years from 1st recorded RA diagnosis.References:[1]Eriksson JK, Neovius M, Ernestam S et al. Incidence of rheumatoid arthritis in Sweden: a nationwide population-based assessment of incidence, its determinants, and treatment penetration. Arthritis Care Res 2013;65:870-878.[2]Puolakka K, Kautiainen H, Pohjolainen T et al. Rheumatoid arthritis remains a threat to work productivity: a nationwide register-based incidence study from Finland. Scand J Rheumatol 2010;39:436-438.Figure 1.Table 1.Characteristics and treatment penetration of incident RA patients 2011-2015AllExcluding cases with DMARDs >12 months before index dateN94938125Women, n (%)6339 (66.8)5379 (66.2)Age at index date, median (IQR)60.5 (48.5 - 70.5)60.8 (48.8 - 70.9)RF positive, n (%)5927 (62.4)5193 (63.9)Use of DMARDs after index date, n (%)12 months24 months12 months24 months Any conventional DMARD7797 (82.1)8023 (84.5)6682 (82.2)6855 (84.4) Methotrexate7133 (75.1)7402 (78.0)6228 (76.7)6436 (79.2) Sulfasalazine902 (9.5)1218 (12.8)745 (9.2)1034 (12.7) Any biologic DMARD1102 (11.6)1642 (17.3)754 (9.3)1219 (15.0) TNF-inhibitors1006 (10.6)1513 (15.9)690 (8.5)1130 (13.9) Oral glucocorticoids6524 (68.7)6974 (73.5)5858 (72.1)6199 (76.3) Any DMARD or glucocorticoids8789 (92.6)8957 (94.4)7498 (92.3)7639 (94.0)Acknowledgements:This work has been supported by a research grant from FOREUM Foundation for Research in Rheumatology.Disclosure of Interests:Anne Kerola Speakers bureau: Boehringer-Ingelheim, Consultant of: Pfizer, Gilead, Boehringer-Ingelheim, Joseph Sexton: None declared, Grunde Wibetoe: None declared, Silvia Rollefstad: None declared, Cynthia S. Crowson: None declared, Espen Haavardsholm: None declared, Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofimgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: AbbVie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: research funding to Diakonhjemmet Hospital from AbbVie, Amgen, BMS, MSD, Pfizer and UCB, Anne Grete Semb Speakers bureau: AbbVie, Bayer, Lilly, Novartis, and Sanofi, Consultant of: Sanofi, Grant/research support from: collaborative research support from Lilly, outside the submitted work.
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Kerola AM, Rollefstad S, Semb AG. Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment. Eur Cardiol 2021; 16:e18. [PMID: 34040652 PMCID: PMC8145075 DOI: 10.15420/ecr.2020.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation. Rheumatoid synovitis and unstable atherosclerotic plaques share common inflammatory mechanisms, such as expression of proinflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6. RA patients are undertreated in terms of CVD prevention, and structured CVD prevention programmes are warranted. Alongside management of traditional risk factors, suppressing systemic inflammation with antirheumatic medication is fundamental for the reduction of CVD risk among this high-risk patient group. Many antirheumatic drugs, especially methotrexate, TNF-α-inhibitors and IL-6-inhibitors are associated with reduced risk of CVD in observational studies among RA patients, but randomised controlled trials with hard CVD endpoints are lacking. In patients without rheumatic disease, anti-inflammatory therapies targeting nucleotide-binding oligomerisation domain, leucine-rich repeat and pyrin domain-containing protein 3 inflammasome and the IL-1/IL-6 pathway arise as potential therapies after an atherosclerotic CVD event.
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Affiliation(s)
- Anne Mirjam Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway.,Department of Rheumatology, Päijät-Häme Joint Authority for Health and Wellbeing Lahti, Finland
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway
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Roelsgaard IK, Ikdahl E, Rollefstad S, Wibetoe G, Esbensen BA, Kitas GD, van Riel P, Gabriel S, Kvien TK, Douglas K, Wållberg-Jonsson S, Rantapää Dahlqvist S, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon CA, Pascual-Ramos V, Contreras-Yáñez I, Sfikakis PP, González-Gay MA, Crowson CS, Semb AG. Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients. Rheumatology (Oxford) 2021; 59:1997-2004. [PMID: 31782789 PMCID: PMC7382591 DOI: 10.1093/rheumatology/kez557] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status. Results Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5–6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P < 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P < 0.001, respectively]. The CVD event rates for former and never smokers were comparable. Conclusion Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.
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Affiliation(s)
- Ida K Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bente A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark.,Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK.,Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Sherine Gabriel
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karen Douglas
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | | | | | - George Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick H Dessein
- Vrije Universiteit Brussel, Brussels, Belgium.,Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Linda Tsang
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Irazú Contreras-Yáñez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Petros P Sfikakis
- First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miguel A González-Gay
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Universidad de Cantabria, Spain
| | - Cynthia S Crowson
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Os HA, Rollefstad S, Gerdts E, Kringeland E, Ikdahl E, Semb AG, Midtbø H. Preclinical cardiac organ damage during statin treatment in patients with inflammatory joint diseases: the RORA-AS statin intervention study. Rheumatology (Oxford) 2020; 59:3700-3708. [PMID: 32386421 PMCID: PMC7946801 DOI: 10.1093/rheumatology/keaa190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Statin treatment has been associated with reduction in blood pressure and arterial stiffness in patients with inflammatory joint diseases (IJD). We tested whether statin treatment also was associated with regression of preclinical cardiac organ damage in IJD patients. METHODS Echocardiography was performed in 84 IJD patients (52 RA, 20 ankylosing spondylitis, 12 psoriatric arthritis, mean age 61 (9) years, 63% women) without known cardiovascular disease before and after 18 months of rosuvastatin treatment. Preclinical cardiac organ damage was identified by echocardiography as presence of left ventricular (LV) hypertrophy, LV concentric geometry, increased LV chamber size and/or dilated left atrium. RESULTS At baseline, hypertension was present in 63%, and 36% used biologic DMARDs (bDMARDs). Preclinical cardiac organ damage was not influenced by rosuvastatin treatment (44% at baseline vs 50% at follow-up, P = 0.42). In uni- and multivariable logistic regression analyses, risk of preclinical cardiac organ damage at follow-up was increased by higher baseline body mass index [odds ratio (OR) 1.3, 95% CI: 1.1, 1.5, P = 0.01] and presence of preclinical cardiac organ damage at baseline (OR 6.4, 95% CI: 2.2, 18.5, P = 0.001) and reduced by use of bDMARDs at follow-up (OR 0.3, 95% CI: 0.1, 0.9, P = 0.03). CONCLUSION Rosuvastatin treatment was not associated with a reduction in preclinical cardiac organ damage in IJD patients after 18 months of treatment. However, use of bDMARDS at follow-up was associated with lower risk of preclinical cardiac organ damage at study end, pointing to a possible protective cardiac effect of bDMARDs in IJD patients. CLINICALTRIALS.GOV https://clinicaltrials.gov/NCT01389388.
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Affiliation(s)
- Hanna A Os
- Department of Clinical Science, University of Bergen, Bergen
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen
| | | | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Semb A, Ikdahl E, Sexton J, Kitas G, Van Riel P, Crowson C, Graham I, Rollefstad S. Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across 5 world regions: results from the SURF-RA. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD).
Purpose
The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA.
Methods
The audit is termed SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) and was performed in 53 centres/19 countries/5 world regions in 2014–2019. SURF-RA have been performed in patients with coronary heart disease, in primary care, and now in patients with stroke, SLE and antiphophlipid syndrome. The survey was approved by the Data Protection Officer (2017/7243) and a GDPR evaluation has been performed (10/10–2018).
Results
Among 14 503 patients with RA in West (n=8 493) and East (n=923) Europe, Latin (n=407) and North (n=4 030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol >2.5 mmol/L: 63.3%. Overall, 29% used antihypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index >30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2%, lowest in Asia (7.8%) and highest in East Europe (28.5%).
Conclusion
The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Lilly
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Affiliation(s)
| | - E Ikdahl
- Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Diakonhjemmet Hospital, Oslo, Norway
| | - G Kitas
- Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom
| | - P Van Riel
- Medical Centre, Leiden, Netherlands (The)
| | - C Crowson
- Mayo Clinic, Rochester, United States of America
| | - I Graham
- Trinity College Dublin, Dublin, Ireland
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Rollefstad S, Ikdahl E, Sexton J, Kitas G, Van Riel P, Crowson C, Graham I, Semb A. Management of dyslipidaemia and hypertension in patients with rheumatoid arthritis in 19 countries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain.
Purpose
To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment.
Methods
The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP >140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP <140/90 mmHg. The 10-year risk of a fatal CVD event was calculated by the European CVD risk calculator, the Systematic COronary Risk Evaluation (SCORE), and was thereafter multiplied with 1.5 as recommended by the European League Against Rheumatism. Patients were classified in a high or very high CVD risk group according to the 2012 European Society of Cardiology guidelines, with low density lipoprotein cholesterol (LDL-c) goal at <2.6 and <1.8 mmol/L, respectively.
Results
In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, most of whom (74%) were female. Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8–43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these only 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%).
Conclusion(s)
This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Only one half of subjects were at blood pressure goals, and achievement of lipid goals was even poorer at one third of those eligible for treatment, which is lower than what is reported for subjects with coronary heart disease. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted research collaboration with Lilly
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Affiliation(s)
- S Rollefstad
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - E Ikdahl
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - J Sexton
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - G.D Kitas
- Russels Hall, Dudley, United Kingdom
| | - P Van Riel
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - C.S Crowson
- Mayo Clinic, Rochester, United States of America
| | - I Graham
- Trinity College Dublin, Dublin, Ireland
| | - A.G Semb
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
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Semb A, Rollefstad S, Sexton J, Kitas G, Van Riel P, Crowson C, Graham I, Ikdahl E. Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis in a large international audit. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalence's of DM in RA patients, little is known about how this affects their CVD risk.
Objectives
To examine indications for, and use of antihypertensive treatment (a-HT) and lipid-lowering therapy (LLT) in RA patients with DM (RA-DM) and RA patients without DM (RAwoDM). Further, to compare the prevalence of various types of CVD across RA-DM and RAwoDM.
Methods
The cohort was derived from the SUrvey of cardiovascular disease Risk Factor in patients with Rheumatoid Arthritis (SURF-RA), which was performed in 53 centres/17 countries in 5 world regions (West and East Europe; North and Latin America; and Asia) from 2014 - 2019. Indication for a-HT was defined as: 1) systolic/diastolic blood pressure (BP) ≥140/90 mm Hg, 2) self-reported hypertension, and/or 3) current use of a-HT. Indication for LLT was defined according to ESC guidelines. CVD risk estimates (by SCORE) were multiplied by 1.5 according to EULAR recommendations. Target treatment targets for BP and lipids were defined according to ESC guidelines applicable at the time data were recorded.
Results
Presence of comorbid DM was available in 10 602 (73.1%) of the 14 503 RA patients included in SURF-RA, of whom 75 and 1262 patients reported DM type 1 and type 2, respectively (total 1337 patients, 12.6%). Although less often current smokers, RA-DM patients were more often previous smokers, male sex and had higher body mass index compared to RAwoDM (p<0.0001 for all). a-HT (84.7% vs 62.3%) and LLT (100% vs 47.2%) were more frequently indicated in RA-DM than in RAwoDM patients (p<0.0001 for both). RA-DM were more likely than RAwoDM to receive a-HT on indication (60.4% vs 57.6%, p<0.0001), while the difference in LLT use on indication was not significantly different (45.7% vs 42.5%, p=0.06). Moreover, RA-DM compared to RAwoDM patients had more often reached treatment goals when on a-HT (60.7% vs 54.1%, p<0.0001) and LLT (62.8% vs 48.9%, p<0.0001). Finally, the risk of all recorded established CVD (coronary heart disease, stroke, peripheral artery disease and atrial fibrillation) was increased by a factor of 2 to 3 in RA-DM compared to RAwoDM (Figure).
Conclusion
The effect of RA and comorbid DM on CVD risk appears to be additive. While CVD preventive medications are more often indicated in RA-DM than in RAwoDM patients, they are also more likely to receive such therapy and to reach CVD preventive treatment goals. The latter finding may be due to more developed CVD preventive care in DM compared to RA patients. Improved CVD preventive systems for patients with RA are warranted.
CVD in RA patients with and without DM
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Lilly
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Affiliation(s)
| | | | - J Sexton
- Diakonhjemmet Hospital, Oslo, Norway
| | - G Kitas
- Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom
| | - P Van Riel
- Medical Centre, Leiden, Netherlands (The)
| | - C Crowson
- Mayo Clinic, Rochester, United States of America
| | - I Graham
- Trinity College Dublin, Dublin, Ireland
| | - E Ikdahl
- Diakonhjemmet Hospital, Oslo, Norway
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Rollefstad S, Ikdahl E, Sexton J, Kitas G, Van Riel P, Crowson CS, Graham I, Semb AG. OP0121 MANAGEMENT OF DYSLIPIDAEMIA AND HYPERTENSION IN PATIENTS WITH RHEUMATOID ARTHRITIS – DATA FROM 19 COUNTRIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. In subjects with coronary heart disease (CHD), audits of CVD risk factor control are regularly performed, which makes it possible to evaluate guideline implementation over time.1Updated surveys on CVD risk management in patients with RA are needed.Objectives:To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment.Methods:The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP ≥140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP <140/90 mmHg. The 10-year risk of a fatal CVD event was calculated by the European CVD risk calculator, the Systematic COronary Risk Evaluation (SCORE), and was thereafter multiplied with 1.5 as recommended by the European League Against Rheumatism. Patients were classified in a high or very high CVD risk group according to the 2012 European Society of Cardiology guidelines, with low density lipoprotein cholesterol (LDL-c) goal at <2.6 and <1.8 mmol/L, respectively.2Results:In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, and it was a strong female preponderance (74%). Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8-43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%).Conclusion:This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Lower goal attainment for LLT than reported for subjects with CHD was observed. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients.References:[1]De Backer G, Jankowski P, Kotseva K,et al.Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries.Atherosclerosis. 2019;285:135-146.[2]Perk J, De Backer G, Gohlke H,et al.European Guide-lines on cardiovascular disease prevention in clinical practice.Eur Heart J.2012:1635-701.Disclosure of Interests:Silvia Rollefstad: None declared, Eirik Ikdahl: None declared, Joe Sexton: None declared, Georeg Kitas: None declared, Piet van Riel: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Ian Graham: None declared, Anne Grete Semb: None declared
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Semb AG, Ikdahl E, Sexton J, Kitas G, Van Riel P, Crowson CS, Graham I, Rollefstad S. SAT0091 SURVEY OF CARDIOVASCULAR DISEASE AND RISK FACTOR MANAGEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS ACROSS 5 WORLD REGIONS: RESULTS FROM THE SURF-RA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD).Observational data suggest a need for improved risk factor recording and management in such subjects.Objectives:The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA and CVD preventive medication in patient with RA.Methods:The audit is termedSUrvey of cardiovascular diseaseRiskFactors in patients withRheumatoidArthritis (SURF-RA) and was performed in 53 centres in 19 countries across 5 world regions during 2014 and 2019. SURF-RA is part of the SURF family of audits which have been performed in patients with CHD, in primary care2, and now in patients with stroke and SLE. Data including demographics, RA disease characteristics, CVD, risk factors and medications was collected. The survey was approved by the Data Protection Officer (2017/7243) and a General Data Protection evaluation has been performed (10/10-2018).Results:Among 14 503 patients with RA in West (n= 8 493) and East (n=923) Europe, Latin (n=407) and North (n=4030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The average disease activity was low [disease activity score including 28 joints and C-reactive protein; DAS28CRP: mean (SD): 2.6 (1.2)]. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol > 2.5 mmol/L: 63.3%. Overall, 29% used anti-hypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index > 30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2 %, lowest in Asia (7.8%) and highest in East Europe (28.5%).Conclusion:The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population.References:[1] Cooney MTet al. SURF-Survey of Risk Factor management: First report of an international audit. Eur J Prev cardiol 2014[2] Zao M, Cooney MT, Klipstein-Grobush K, et al. Simplifying the audit of risk factor recording and control: A report from an international study in 11 countries. Eur J Prev Cardiol 2016AllWest EuropeEastEuropeLatinAmericaNorth AmericaAsiap-valueNumber of patients1450384939234074030650Age mean(SD)59.8 (13.6)60.7 (13.2)58.8 (11.8)52.8 (11.6)59.4 (14.8)55.7 (13.1)<0.001Sex female (%)74.574.178.592.472.277.3Disease duration (yrs) mean(SD)10.8 (9.5)10.5 (9.5)12.1 (9.3)9.9 (7.5)12.6 (9.8)10.5 (9.8)<0.001DAS28-CRP mean(SD)2.6 (1.2)2.5 (1.1)2.9 (1.2)2.8 (1.3)2.8 (1.2)2.8 (1.4)<0.001Atherosclerotic CVD (%)13.311.421.42.516.210.3<0.001Lipid lowering medication (%)26.425.128.522.431.17.2<0.001Any anti-hypertensive (%)29.017.457.024.846.831.8<0.001Disclosure of Interests:Anne Grete Semb: None declared, Eirik Ikdahl: None declared, Joe Sexton: None declared, Georeg Kitas: None declared, Piet van Riel: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Ian Graham: None declared, Silvia Rollefstad: None declared
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Wibetoe G, Sexton J, Ikdahl E, Rollefstad S, Kitas GD, van Riel P, Gabriel S, Kvien TK, Douglas K, Sandoo A, Arts EE, Wållberg-Jonsson S, Dahlqvist SR, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon CA, Pascual-Ramos V, Contreas-Yañes I, Sfikakis PP, González-Gay MA, Colunga-Pedraz IJ, Galarza-Delgado DA, Azpiri-Lopez JR, Crowson CS, Semb AG. Prediction of cardiovascular events in rheumatoid arthritis using risk age calculations: evaluation of concordance across risk age models. Arthritis Res Ther 2020; 22:90. [PMID: 32326974 PMCID: PMC7178602 DOI: 10.1186/s13075-020-02178-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics. METHODS RA patients aged 30-70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up. RESULTS A total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15-32% of patients. C-statistics ranged 0.68-0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results. CONCLUSIONS The cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.
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Affiliation(s)
- Grunde Wibetoe
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway.
| | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet van Riel
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sherine Gabriel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karen Douglas
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Aamer Sandoo
- Dudley Group NHS Foundation Trust, West Midlands, UK
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Elke E Arts
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | | | - George Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick H Dessein
- Vrije Universiteit Brussel, Brussels, Belgium
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Linda Tsang
- Rheumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Virginia Pascual-Ramos
- Instituto Nactional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Irazu Contreas-Yañes
- Instituto Nactional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Petros P Sfikakis
- First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miguel A González-Gay
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | | | | | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway
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Weijers JM, Semb AG, Rollefstad S, Kitas GD, van Riel PLCM. Strategies for implementation of guideline recommended cardiovascular risk management for patients with rheumatoid arthritis: results from a questionnaire survey of expert rheumatology centers. Rheumatol Int 2020; 40:523-527. [PMID: 32088752 DOI: 10.1007/s00296-020-04533-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
The aim was to study the different strategies used to implement cardiovascular risk evaluation and management for patients with rheumatoid arthritis (RA) in daily clinical practice. A questionnaire survey was performed among both the members of the international Trans-Atlantic Cardiovascular Risk Consortium for Rheumatoid Arthritis (ATACC-RA) as well as the Survey of cardiovascular disease risk factors (CVD-RF) in patients with RA (SURF-RA) group. The questionnaire included 18 questions with the overarching topics: (1) organization and responsibility of cardiovascular risk management (CVRM); (2) screening of CVD-RFs; (3) overview current CVRM status; and (4) availability of data regarding CVRM. Based on the answers, two researchers (JW, PR) independently categorized the different strategies. Thirteen out of 27 rheumatology centers responded to the questionnaire. One rheumatology center did not have organized CVRM for their RA patients. Among the other centers, three strategies to organize CVRM in daily practice were distinguished: (1) the rheumatologist performs CVRM during outpatient visits (n = 6); (2) cardiologists and rheumatologists co-operate in a cardio-rheuma-clinic/team with different tasks and responsibilities (n = 3); and (3) the general practitioner screens and intervenes on CVD-RFs (n = 3). Each CVRM strategy was based on agreements between medical professionals and was also dependent on the national healthcare system and available financial resources. Three strategies were identified for CVRM implementation in daily clinical practice based on who is primarily responsible for performing CVRM. More research is warranted to compare their relative merits and effectiveness in relation to CVRM.
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Affiliation(s)
- Julia M Weijers
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud university medical center, Radboud Institute for Health Sciences, PO box 9101 (114), 6500 HB, Nijmegen, The Netherlands.
| | - Anne G Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, Dudley, United Kingdom
| | - Piet L C M van Riel
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud university medical center, Radboud Institute for Health Sciences, PO box 9101 (114), 6500 HB, Nijmegen, The Netherlands.,Department of Rheumatology, Bernhoven, Uden, The Netherlands
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Svanteson M, Rollefstad S, Kløw NE, Hisdal J, Ikdahl E, Sexton J, Haig Y, Semb AG. Effects of long-term statin-treatment on coronary atherosclerosis in patients with inflammatory joint diseases. PLoS One 2019; 14:e0226479. [PMID: 31830762 PMCID: PMC6908439 DOI: 10.1371/journal.pone.0226479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background The effect of statins over time on coronary atherosclerosis in patients with inflammatory joint diseases (IJD) is unknown. Our aim was to evaluate the change in coronary plaque morphology and volume in long-term statin-treated patients with IJD. Methods Sixty-eight patients with IJD and carotid artery plaque(s) underwent coronary computed tomography angiography before and after a mean of 4.7 (range 4.0–6.0) years of statin treatment. The treatment target for low density lipoprotein cholesterol (LDL-c) was ≤1.8 mmol/L. Changes in plaque volume (calcified, mixed/soft and total) and coronary artery calcification (CAC) from baseline to follow-up were assessed using the 17-segment American Heart Association-model. Results Median (IQR) increase in CAC after statin treatment was 38 (5–236) Agatston units (p<0.001). Calcified and total plaque volume increased with 5.6 (0.0–49.1) and 2.9 (0.0–23.5) mm3, respectively (p<0.001 for both). The median (IQR) change in soft/mixed plaque volume was -10 (-7.1–0.0), p = <0.001. Patients who had obtained the LDL-c treatment target at follow-up, experienced reduced progression of both CAC and total plaque volume compared to patients with LDL-c >1.8mmol/L (21 [2–143] vs. 69 [16–423], p = 0.006 and 0.65 [-1.0–13.9] vs. 13.0 [0.0–60.8] mm3, p = 0.019, respectively). Conclusions A progression of total atherosclerotic plaque volume in statin-treated patients with IJD was observed. However, soft/mixed plaque volume was reduced, suggesting an alteration in plaque composition. Patients with recommended LDL-c levels at follow-up had reduced atherosclerotic progression compared to patients with LDL-c levels above the treatment target, suggesting a beneficial effect of treatment to guideline-recommended lipid targets in IJD patients.
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Affiliation(s)
- Mona Svanteson
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Nils-Einar Kløw
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Investigations, Oslo University Hospital, Aker, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ylva Haig
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Roelsgaard IK, Esbensen BA, Østergaard M, Rollefstad S, Semb AG, Christensen R, Thomsen T. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database Syst Rev 2019; 9:CD012958. [PMID: 31476270 PMCID: PMC6718206 DOI: 10.1002/14651858.cd012958.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic inflammatory joint diseases (IJDs) affect 1% to 2% of the population in developed countries. IJDs include rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and other forms of spondyloarthritis (SpA). Tobacco smoking is considered a significant environmental risk factor for developing IJDs. There are indications that smoking exacerbates the symptoms and worsens disease outcomes. OBJECTIVES The objective of this review was to investigate the evidence for effects of smoking cessation interventions on smoking cessation and disease activity in smokers with IJD. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library; PubMed/MEDLINE; Embase; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and three trials registers to October 2018. SELECTION CRITERIA We included randomised controlled trials testing any form of smoking cessation intervention for adult daily smokers with a diagnosis of IJD, and measuring smoking cessation at least six months after baseline. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included two studies with 57 smokers with a diagnosis of rheumatoid arthritis (RA). We identified no studies including other IJDs. One pilot study compared a smoking cessation intervention specifically for people with RA with a less intensive, generic smoking cessation intervention. People included in the study had a mean age of 56.5 years and a disease duration of 7.7 years (mean). The second study tested effects of an eight-week cognitive-behavioural patient education intervention on cardiovascular disease (CVD) risk for people with RA and compared this with information on CVD risk only. The intervention encouraged participants to address multiple behaviours impacting CVD risk, including smoking cessation, but did not target smoking cessation alone. People included in the study had a mean age of 62.2 years (intervention group) and 60.8 years (control group), and disease duration of 11.6 years (intervention group) and 14.1 years (control group). It was not appropriate to perform a meta-analysis of abstinence data from the two studies due to clinical heterogeneity between interventions. Neither of the studies individually provided evidence to show benefit of the interventions tested. Only one study reported on adverse effects. These effects were non-serious, and numbers were comparable between trial arms. Neither of the studies assessed or reported disease activity or any of the predefined secondary outcomes. We assessed the overall certainty of evidence as very low due to indirectness, imprecision, and high risk of detection bias based on GRADE. AUTHORS' CONCLUSIONS We found very little research investigating the efficacy of smoking cessation intervention specifically in people with IJD. Included studies are limited by imprecision, risk of bias, and indirectness. Neither of the included studies investigated whether smoking cessation intervention reduced disease activity among people with IJD. High-quality, adequately powered studies are warranted. In particular, researchers should ensure that they measure disease markers and quality of life, in addition to long-term smoking cessation.
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Affiliation(s)
- Ida K Roelsgaard
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
| | - Bente A Esbensen
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
- University of CopenhagenDepartment of Clinical MedicineCopenhagenDenmark
| | - Mikkel Østergaard
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
| | | | - Anne G Semb
- Diakonhjemmet HospitalPreventive Cardio‐Rheuma ClinicOsloNorway
| | - Robin Christensen
- Bispebjerg and Frederiksberg HospitalMusculoskeletal Statistics Unit, The Parker InstituteCopenhagenDenmark
- Odense University HospitalDepartment of RheumatologyOdenseDenmark
| | - Thordis Thomsen
- Copenhagen University Hospital Herlev‐GentofteHerlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of AnesthesiologyCopenhagenDenmark
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Agca R, Heslinga SC, Rollefstad S, Heslinga S, Södergren A, Semb AG, Kitas GD, Sattar N, Nurmohamed MT. Response to: "Influence of changes in cholesterol levels and disease activity on the 10-year cardiovascular risk estimated with different algorithms in rheumatoid arthritis patients" by Fornaro et al. Ann Rheum Dis 2019; 79:e105. [PMID: 31413003 DOI: 10.1136/annrheumdis-2019-215748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Rabia Agca
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands .,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Sjoerd C Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - S Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinical, Diakonhjemmet Hospital, Oslo, Norway
| | - S Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rhematology, University of Umeå and Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
| | - A G Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinical, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
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Provan SA, Rollefstad S, Ikdahl E, Mathiessen A, Berg IJ, Eeg I, Wilkinson IB, McEniery CM, Kvien TK, Hammer HB, Østerås N, Haugen IK, Semb AG. Biomarkers of cardiovascular risk across phenotypes of osteoarthritis. BMC Rheumatol 2019; 3:33. [PMID: 31410391 PMCID: PMC6686275 DOI: 10.1186/s41927-019-0081-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/24/2019] [Indexed: 01/19/2023] Open
Abstract
Background The objective of this study was to explore the associations between ultrasonographic and radiographic joint scores and levels of arterial CVD risk markers in patients with osteoarthritis (OA). Secondly, to compare the levels of arterial CVD risk markers between OA phenotypes and controls. Method The "Musculoskeletal pain in Ullensaker" Study (MUST) invited residents of Ullensaker municipality with self-reported OA to a medical examination. OA was defined according to the American College of Rheumatology (ACR) criteria and phenotyped based on joint distribution. Joints of the hands, hips and knees were examined by ultrasonography and conventional radiography, and scored for osteosteophytes. Hands were also scored for inflammation by grey scale (GS) synovitis and power Doppler (PD) signal. Control populations were a cohort of inhabitants of Oslo (OCP), and for external validation, a UK community-based register (UKPC).Pulse pressure augmentation index (AIx) and pulse wave velocity (PWV) were measured using the Sphygmocor apparatus (Atcor®). Ankel-brachial index (ABI) was estimated in a subset of patients. In separate adjusted regression models we explored the associations between ultrasonography and radiograph joint scores and AIx, PWV and ABI. CVD risk markers were also compared between phenotypes of OA and controls in adjusted analyses. Results Three hundred and sixty six persons with OA were included (mean age (range); 63.0 (42.0-75.0)), (females (%); 264 (72)). Of these, 155 (42.3%) had isolated hand OA, 111 (30.3%) had isolated lower limb OA and 100 (27.3%) had generalized OA. 108 persons were included in the OCP and 963 persons in the UKPC; (mean age (range); OCP: 57.2 (40.4-70.4), UKPC: 63.9 (40.0-75.0), females (%); OCP: 47 (43.5), UKPC: 543 (56.4%). Hand osteophytes were associated with AIx while GS and PD scores were not related to CVD risk markers. All OA phenotypes had higher levels of AIx compared to OCP in adjusted analyses. External validation against UKPC confirmed these findings. Conclusions Hand osteophytes might be related to higher risk of CVD. People with OA had higher augmented central pressure compared to controls.Words 330.
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Affiliation(s)
- S A Provan
- Department of Rheumatology, Oslo, Norway
| | - S Rollefstad
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - I J Berg
- Department of Rheumatology, Oslo, Norway
| | - I Eeg
- Department of Rheumatology, Oslo, Norway
| | - I B Wilkinson
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - C M McEniery
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - T K Kvien
- Department of Rheumatology, Oslo, Norway
| | - H B Hammer
- Department of Rheumatology, Oslo, Norway
| | - N Østerås
- 4National Resource Centre for rehabilitation in Rheumatology. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Oslo, Norway
| | - A G Semb
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Midtbø H, Semb AG, Matre K, Rollefstad S, Berg IJ, Gerdts E. Left Ventricular Systolic Myocardial Function in Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2019; 71:1276-1283. [PMID: 30242984 DOI: 10.1002/acr.23765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/18/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Subclinical left ventricular (LV) myocardial dysfunction is associated with an increased risk of cardiovascular disease (CVD), but it is not known whether subclinical LV myocardial dysfunction is present in patients with ankylosing spondylitis (AS) independent of CVD risk factors. METHODS Conventional and speckle tracking echocardiography were performed in 106 patients with AS (mean ± SD age 48 ± 12 years; 59% men) and 106 matched controls (mean ± SD age 51 ± 12 years; 59% men). LV systolic myocardial function was assessed by peak systolic global longitudinal strain (GLS). RESULTS CVD risk factors were similarly distributed in patients with AS and controls, but more controls received statin therapy (P = 0.05). GLS was significantly lower in patients with AS compared to controls (mean ± SD -17.7 ± 2.5% versus -18.4 ± 2.3%; P = 0.03). In univariable linear regression analyses in the total study population, lower GLS was associated with having AS, male sex, higher body mass index, higher LV mass index, and lower LV ejection fraction (all P < 0.05). Having AS retained an independent association with lower GLS when adjusted for these factors in multivariable analyses (β = 0.16, P = 0.02). In patients with AS, lower GLS was independently associated with larger aortic root diameter in multivariable analyses (β = 0.24, P = 0.02), while no association with AS disease activity, disease duration, or use of antirheumatic medication was observed. CONCLUSION Patients with AS had lower GLS compared with controls, independent of confounders. In AS patients, lower GLS was associated with larger aortic root diameter. Prospective studies should test whether lower GLS contributes to the observed higher CVD risk in patients with AS.
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Sveaas SH, Bilberg A, Berg IJ, Provan SA, Rollefstad S, Semb AG, Hagen KB, Johansen MW, Pedersen E, Dagfinrud H. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports Med 2019; 54:292-297. [DOI: 10.1136/bjsports-2018-099943] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/04/2022]
Abstract
BackgroundExercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.ObjectiveTo investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA).MethodAssessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.Results97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: −0.6 [–0.8 to –0.3], p<0.001 and BASDAI: −1.2 [–1.8 to –0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.ConclusionHigh intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA.Trial registration numberNCT02356874.
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Ikdahl E, Wibetoe G, Rollefstad S, Salberg A, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Fevang BTS, Gulseth HC, Haugeberg G, Semb AG. Guideline recommended treatment to targets of cardiovascular risk is inadequate in patients with inflammatory joint diseases. Int J Cardiol 2019; 274:311-318. [DOI: 10.1016/j.ijcard.2018.06.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 01/08/2023]
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Ikdahl E, Rollefstad S, Wibetoe G, Salberg A, Krøll F, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Gjesdal CG, Gulseth C, Haugeberg G, Semb AG. Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: experiences from the nationwide NOCAR project. RMD Open 2018; 4:e000737. [PMID: 30305931 PMCID: PMC6173264 DOI: 10.1136/rmdopen-2018-000737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 01/01/2023] Open
Abstract
Objective The European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits. Methods The NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures. Results Data collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres. Conclusion Patients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.
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Affiliation(s)
- Eirik Ikdahl
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Grunde Wibetoe
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Anne Salberg
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Frode Krøll
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Drammen Hospital, Drammen, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Rheumatology, Martina Hansen's Hospital, Bærum, Norway
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
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Fagerhøi MG, Rollefstad S, Olsen SU, Semb AG. The effect of brief versus individually tailored dietary advice on change in diet, lipids and blood pressure in patients with inflammatory joint disease. Food Nutr Res 2018; 62:1512. [PMID: 30202399 PMCID: PMC6127379 DOI: 10.29219/fnr.v62.1512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/15/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Patients with inflammatory joint diseases (IJD) have an increased risk of cardiovascular disease (CVD) compared to the general population. Nutritional advice has been shown to influence CVD risk factors. Our objective was to evaluate whether an individually tailored dietary counselling versus a brief standardised advice on heart-friendly diet had comparable effect on change in diet, lipids and blood pressure (BP) in patients with IJD. METHODS Thirty-one patients with IJD aged 40-80 years received a brief standardised advice (4 min) on heart-friendly diet by a physician. Sixteen of the patients were randomised to receive an additional, individually tailored, heart-friendly dietary counselling session (60 min) by a dietitian. Change in dietary habits, measured by a validated questionnaire (SmartDiet), lipids, BP and C-reactive protein (CRP) were assessed after 8 weeks of follow-up. RESULTS After 8 weeks, the average increase in SmartDiet score was 5.1 and 5.7 points in the diet group (DG) and the control group (CG), respectively ( p = 0.65). Low-density lipoprotein cholesterol (LDL-c) was reduced by 12.6% in the DG versus 2.4% in the CG ( p = 0.05). There were no significant differences between the two groups regarding change in BP, lipids or CRP. CONCLUSION Individually tailored dietary counselling resulted in more heart-friendly food choices in patients with IJD. However, the change in SmartDiet score was comparable for IJD patients receiving a brief nutritional advice and individually tailored heart-friendly dietary counselling. Further studies evaluating the longitudinal effects of dietary advice on CVD outcome in patients with IJD are warranted.
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Affiliation(s)
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sissel Urke Olsen
- Department of Clinical Service, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Rollefstad S, Svanteson M, Kloew NE, Hisdal J, Ikdahl E, Sexton J, Haig Y, Semb AG. P3488Effects of statin treatment on coronary plaques in patients with inflammatory joint diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Rollefstad
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - M Svanteson
- Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway
| | - N E Kloew
- Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital, Department of Vascular investigations, Oslo, Norway
| | - E Ikdahl
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - J Sexton
- Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway
| | - Y Haig
- Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway
| | - A G Semb
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
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Midtbø H, Gerdts E, Berg IJ, Rollefstad S, Jonsson R, Semb AG. Ankylosing Spondylitis Is Associated with Increased Prevalence of Left Ventricular Hypertrophy. J Rheumatol 2018; 45:1249-1255. [PMID: 29858235 DOI: 10.3899/jrheum.171124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is associated with increased risk for cardiovascular disease (CVD). Left ventricular (LV) hypertrophy is a strong precursor for clinical CVD. The aim of our study was to assess whether having AS was associated with increased prevalence of LV hypertrophy. METHODS Clinical and echocardiographic data from 139 AS patients and 126 age- and sex-matched controls was used. LV mass was calculated according to guidelines and indexed to height2.7. LV hypertrophy was considered present if LV mass index was > 49.2 g/m2.7 in men and > 46.7 g/m2.7 in women. RESULTS Patients with AS were on average 49 ± 12 years old, and 60% were men. The prevalence of hypertension (HTN; 35% vs 41%) and diabetes (5% vs 2%) was similar among patients and controls, while patients with AS had higher serum C-reactive protein level (CRP; p < 0.001). The prevalence of LV hypertrophy was higher in patients with AS compared to controls (15% vs 6%, p = 0.01). In multivariable logistic regression analysis, having AS was associated with OR 6.3 (95% CI 2.1-19.3, p = 0.001) of having LV hypertrophy independent of the presence of HTN, diabetes, and obesity. In multivariable linear regression analyses, having AS was also associated with higher LV mass (β 0.15, p = 0.007) after adjusting for CVD risk factors including sex, body mass index, systolic blood pressure, diabetes, and serum CRP (multiple R2 = 0.41, p < 0.001). CONCLUSION Having AS was associated with increased prevalence of LV hypertrophy independent of CVD risk factors. This finding strengthens the indication for thorough CVD risk assessment in patients with AS.
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Affiliation(s)
- Helga Midtbø
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
| | - Eva Gerdts
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Inger Jorid Berg
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Silvia Rollefstad
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Roland Jonsson
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Anne Grete Semb
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
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Gulati AM, Salvesen Ø, Thomsen RS, Kavanaugh A, Semb AG, Rollefstad S, Haugeberg G, Hoff M. Change in cardiovascular risk factors in patients who develop psoriatic arthritis: longitudinal data from the Nord-Trøndelag Health Study (HUNT). RMD Open 2018; 4:e000630. [PMID: 29556420 PMCID: PMC5856915 DOI: 10.1136/rmdopen-2017-000630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/13/2018] [Accepted: 02/21/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The aim of this population-based study was to compare changes in cardiovascular (CV) risk factors over a decade-long period in patients who developed psoriatic arthritis (PsA) and the background population. Methods Patients diagnosed with PsA (n=151) between 1998 and 2008 and matched controls (n=755) who participated in both the Nord-Trøndelag Health Study (HUNT) 2 (1995–1997) and HUNT3 (2006–2008) were included. Mixed linear and logistic models were used to analyse the difference in mean change between HUNT2 and HUNT3 in patients and controls for body mass index (BMI), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and blood pressure (BP). Results At baseline (HUNT2), the patients who developed PsA compared with controls had higher BMI (27.2 vs 25.9 kg/m2, p<0.001) and lower HDL-c (1.32 vs 1.40 mmol/L, p<0.03) and more were smokers (41.1 vs 28.5%, p<0.01). Seventy-eight per cent had skin psoriasis. The mean PsA disease duration at HUNT3 was 4.8 (+/–3.0) years. The patients who developed PsA gained less weight from HUNT2 to HUNT3 compared with the control group (2.1 vs 3.9 kg, difference in mean change −1.8 kg, 95% CI −3.9 to −0.5, p<0.01). TC, triglycerides, LDL-c or HDL-c values and BP declined in both groups, with no significant differences between groups. Conclusion Longitudinal 10-year data did not show an increase in CV risk factors in patients who developed PsA compared with controls. This study implies that unfavourable CV risk factors in PsA were present before the diagnosis was established.
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Affiliation(s)
- Agnete Malm Gulati
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement science, Norwegian university of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ruth Stoklund Thomsen
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Department of Rheumatology, Allergy and Immunology, University of California San Diego, San Diego, California, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Glenn Haugeberg
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.,Research Department, Hospital of Southern Norway Trust, Arendal, Norway
| | - Mari Hoff
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Roelsgaard IK, Esbensen BA, Østergaard M, Rollefstad S, Semb AG, Christensen R, Thomsen T. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Hippokratia 2018. [DOI: 10.1002/14651858.cd012958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ida K Roelsgaard
- Rigshospitalet, Centre of Head and Orthopaedics; Copenhagen Center for Arthritis Research, Department of Rheumatology and Spine Diseases; Glostrup Denmark
| | - Bente A Esbensen
- Rigshospitalet, Centre of Head and Orthopaedics; Copenhagen Center for Arthritis Research, Department of Rheumatology and Spine Diseases; Glostrup Denmark
| | - Mikkel Østergaard
- Rigshospitalet, Centre of Head and Orthopaedics; Copenhagen Center for Arthritis Research, Department of Rheumatology and Spine Diseases; Glostrup Denmark
| | - Silvia Rollefstad
- Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic; Oslo Norway
| | - Anne G Semb
- Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic; Oslo Norway
| | - Robin Christensen
- Copenhagen University Hospital, Bispebjerg og Frederiksberg; Musculoskeletal Statistics Unit, The Parker Institute; Nordre Fasanvej 57 Copenhagen Denmark DK-2000
| | - Thordis Thomsen
- Rigshospitalet, The Abdominal Centre; Department of Nursing Research; Blegdamsvej 9 Copenhagen Denmark 2200
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Wibetoe G, Ikdahl E, Rollefstad S, Olsen IC, Bergsmark K, Kvien TK, Salberg A, Soldal DM, Bakland G, Lexberg Å, Fevang BT, Gulseth HC, Haugeberg G, Semb AG. Discrepancies in risk age and relative risk estimations of cardiovascular disease in patients with inflammatory joint diseases. Int J Cardiol 2018; 252:201-206. [PMID: 29249429 DOI: 10.1016/j.ijcard.2017.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/05/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The European guidelines on cardiovascular disease (CVD) prevention advise use of relative risk and risk age algorithms for estimating CVD risk in patients with low estimated absolute risk. Patients with inflammatory joint diseases (IJD) are associated with increased risk of CVD. We aimed to estimate relative risk and risk age across IJD entities and evaluate the agreement between 'cardiovascular risk age' and 'vascular age models'. METHODS Using cross-sectional data from a nationwide project on CVD risk assessment in IJD, risk age estimations were performed in patients with low/moderate absolute risk of fatal CVD. Risk age was calculated according to the cardiovascular risk age and vascular age model, and risk age estimations were compared using regression analysis and calculating percentage of risk age estimations differing ≥5years. RESULTS Relative risk was increased in 53% and 20% had three times or higher risk compared to individuals with optimal CVD risk factor levels. Furthermore, 20-42% had a risk age ≥5years higher than their actual age, according to the specific risk age model. There were only minor differences between IJD entities regarding relative risk and risk age. Discrepancies ≥5years in estimated risk age were observed in 14-43% of patients. The largest observed difference in calculated risk age was 24years. CONCLUSION In patients with low estimated absolute risk, estimation of relative CVD risk and risk age may identify additional patients at need of intensive CVD preventive efforts. However, there is a substantial discrepancy between the risk age models.
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Affiliation(s)
- Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Salberg
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Dag M Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Vestre Viken Hospital, Drammen, Norway
| | - Bjørg-Tilde Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Roelsgaard IK, Thomsen T, Østergaard M, Christensen R, Hetland ML, Jacobsen S, Andersen L, Tønnesen H, Rollefstad S, Semb AG, Esbensen BA. The effect of an intensive smoking cessation intervention on disease activity in patients with rheumatoid arthritis: study protocol for a randomised controlled trial. Trials 2017; 18:570. [PMID: 29183347 PMCID: PMC5706378 DOI: 10.1186/s13063-017-2309-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, inflammatory rheumatic disease with the potential to induce significant disability. Patients with RA are at increased risk of cardiovascular diseases (CVD). Smokers with RA tend to experience more pain and fatigue, higher disease activity, more erosive joint destruction and a lower health-related quality of life (HR-QoL) than non-smokers. It remains to be determined whether these effects can be reduced by smoking cessation. This randomised controlled trial (RCT) in patients with RA aims to examine the effect of intensive smoking cessation intervention (motivational counselling combined with tailored nicotine replacement therapy) versus standard care on smoking cessation, and consequently on disease activity. Secondary objectives are to explore the effect on flare, risk factors for CVD, lung function, physical function, HR-QoL, pain and fatigue in patients with RA. METHODS This will be a multicentre, open label, two arm, parallel group, RCT, including 150 daily smokers with RA, being in remission or having low-moderate disease activity (DAS28 ≤ 5.1). The intervention group (n = 75) will receive five counselling sessions with a trained smoking cessation counsellor based on the principles of motivational counselling. Furthermore, intervention patients will be offered nicotine replacement therapy tailored to individual needs. Participants randomised to the control group will receive standard care. The co-primary outcome is a hierarchical endpoint, which will be evaluated at 3 months follow-up and will include (1) self-reported smoking cessation biochemically validated by exhaled carbon monoxide and (2) achievement of EULAR clinical response (an improvement in DAS28 of > 0.6). Follow-up visits will be performed at 3, 6 and 12 months post-intervention. DISCUSSION This trial will reveal whether intensive smoking cessation counselling helps smokers with RA to achieve continuous smoking cessation and whether, as a concomitant benefit, it will reduce their RA disease activity. The trial aims to generate high quality evidence for the feasibility of a health promotion intervention for smokers with RA. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02901886 . Registered on 10 September 2016. Recruitment status updated on 10th October 2016.
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Affiliation(s)
- Ida Kristiane Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.
| | - Thordis Thomsen
- Abdominal Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,DANBIO Registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Søren Jacobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Lena Andersen
- The Danish Rheumatism Association, Gentofte, Denmark
| | - Hanne Tønnesen
- WHO-CC, Bispebjerg-Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark.,Clinical Health Promotion Centre, Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Health, Faculty of Medicine, University of Southern Denmark, Odense, Denmark
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Svanteson M, Rollefstad S, Kløw NE, Hisdal J, Ikdahl E, Semb AG, Haig Y. Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases. RMD Open 2017; 3:e000544. [PMID: 28955501 PMCID: PMC5604717 DOI: 10.1136/rmdopen-2017-000544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/11/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques. METHODS Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables. RESULTS Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p<0.05. CONCLUSION Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD. TRIAL REGISTRATION NUMBER NCT01389388, Results.
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Affiliation(s)
- Mona Svanteson
- Department of Radiology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Nils Einar Kløw
- Department of Radiology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Investigations, Oslo University Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Ylva Haig
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Crowson CS, Rollefstad S, Ikdahl E, Kitas GD, van Riel PLCM, Gabriel SE, Matteson EL, Kvien TK, Douglas K, Sandoo A, Arts E, Wållberg-Jonsson S, Innala L, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon C, Ramos VP, Yáñez IC, Sfikakis PP, Zampeli E, Gonzalez-Gay MA, Corrales A, Laar MVD, Vonkeman HE, Meek I, Semb AG. Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. Ann Rheum Dis 2017; 77:48-54. [PMID: 28877868 DOI: 10.1136/annrheumdis-2017-211735] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/30/2017] [Accepted: 08/04/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. METHODS In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. RESULTS 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). CONCLUSIONS In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.
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Affiliation(s)
- Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet L C M van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tore K Kvien
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karen Douglas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Aamer Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Wales, UK
| | - Elke Arts
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Solveig Wållberg-Jonsson
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
| | - Lena Innala
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
| | - George Karpouzas
- Division of Rheumatology, Harbor UCLA Medical Center RHU, Torrance, California, USA
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Rheumatology Division, UniversitairZiekenhuis and Vrije Universiteit, Brussel, Belgium
| | - Linda Tsang
- Rheumatology Division, UniversitairZiekenhuis and Vrije Universiteit, Brussel, Belgium
| | - Hani El-Gabalawy
- Institute of Musculoskeletal Health and Arthritis, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol Hitchon
- Institute of Musculoskeletal Health and Arthritis, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virginia Pascual Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Petros P Sfikakis
- First Department of Propedeutic Medicine, University of Athens, Athens, Greece
| | - Evangelia Zampeli
- First Department of Propedeutic Medicine, University of Athens, Athens, Greece
| | - Miguel A Gonzalez-Gay
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain
| | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain
| | - Mart van de Laar
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Inger Meek
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Midtboe H, Gerdts E, Berg I, Rollefstad S, Jonsson R, Semb A. P6363Abnormal left ventricular geometry in ankylosing spondylitis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wibetoe G, Ikdahl E, Rollefstad S, Olsen IC, Bergsmark K, Kvien TK, Salberg A, Soldal DM, Bakland G, Lexberg Å, Fevang BT, Gulseth HC, Haugeberg G, Semb AG. Cardiovascular disease risk profiles in inflammatory joint disease entities. Arthritis Res Ther 2017; 19:153. [PMID: 28673314 PMCID: PMC5496163 DOI: 10.1186/s13075-017-1358-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/01/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patients with inflammatory joint diseases (IJD) have increased risk of cardiovascular disease (CVD). Our aim was to compare CVD risk profiles in patients with IJD, including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) and evaluate the future risk of CVD. Methods The prevalence and numbers of major CVD risk factors (CVD-RFs) (hypertension, elevated cholesterol, obesity, smoking, and diabetes mellitus) were estimated in patients with RA, axSpA and PsA. Relative and absolute risk of CVD according to Systematic Coronary Risk Evaluation (SCORE) was calculated. Results In total, 3791 patients were included. CVD was present in 274 patients (7.2%). Of those without established CVD; hypertension and elevated cholesterol were the most frequent CVD-RFs, occurring in 49.8% and 32.8% of patients. Patients with PsA were more often hypertensive and obese. Overall, 73.6% of patients had a minimum of one CVD-RF, which increased from 53.2% among patients aged 30 to <45 years, to 86.2% of patients aged 60 to ≤80 years. Most patients (93.5%) had low/moderate estimated risk of CVD according to SCORE. According to relative risk estimations, 35.2% and 24.7% of patients had two or three times risk or higher, respectively, compared to individuals with no CVD-RFs. Conclusions In this nationwide Norwegian project, we have shown for the first time that prevalence and numbers of CVD-RFs were relatively comparable across the three major IJD entities. Furthermore, estimated absolute CVD risk was low, but the relative risk of CVD was markedly high in patients with IJD. Our findings indicate the need for CVD risk assessment in all patients with IJD. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1358-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Salberg
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Vestre Viken Hospital, Drammen, Norway
| | - Bjørg-Tilde Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
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Crowson CS, Rollefstad S, Kitas GD, van Riel PLCM, Gabriel SE, Semb AG. Correction: Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis. PLoS One 2017; 12:e0175605. [PMID: 28388688 PMCID: PMC5384765 DOI: 10.1371/journal.pone.0175605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Crowson CS, Rollefstad S, Kitas GD, van Riel PLCM, Gabriel SE, Semb AG. Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis. PLoS One 2017; 12:e0174656. [PMID: 28334012 PMCID: PMC5363942 DOI: 10.1371/journal.pone.0174656] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/13/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Cardiovascular disease (CVD) risk calculators designed for use in the general population do not accurately predict the risk of CVD among patients with rheumatoid arthritis (RA), who are at increased risk of CVD. The process of developing risk prediction models involves numerous issues. Our goal was to develop a CVD risk calculator for patients with RA. METHODS Thirteen cohorts of patients with RA originating from 10 different countries (UK, Norway, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico) were combined. CVD risk factors and RA characteristics at baseline, in addition to information on CVD outcomes were collected. Cox models were used to develop a CVD risk calculator, considering traditional CVD risk factors and RA characteristics. Model performance was assessed using measures of discrimination and calibration with 10-fold cross-validation. RESULTS A total of 5638 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female). During a mean follow-up of 5.8 years (30139 person years), 389 patients developed a CVD event. Event rates varied between cohorts, necessitating inclusion of high and low risk strata in the models. The multivariable analyses revealed 2 risk prediction models including either a disease activity score including a 28 joint count and erythrocyte sedimentation rate (DAS28ESR) or a health assessment questionnaire (HAQ) along with age, sex, presence of hypertension, current smoking and ratio of total cholesterol to high-density lipoprotein cholesterol. Unfortunately, performance of these models was similar to general population CVD risk calculators. CONCLUSION Efforts to develop a specific CVD risk calculator for patients with RA yielded 2 potential models including RA disease characteristics, but neither demonstrated improved performance compared to risk calculators designed for use in the general population. Challenges encountered and lessons learned are discussed in detail.
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Affiliation(s)
- Cynthia S. Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research and Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - George D. Kitas
- Dudley Group NHS Foundation Trust, West Midlands, United Kingdom
| | - Piet L. C. M. van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Sherine E. Gabriel
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research and Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DPM, Nurmohamed MT. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2016; 76:17-28. [DOI: 10.1136/annrheumdis-2016-209775] [Citation(s) in RCA: 683] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/24/2016] [Accepted: 09/08/2016] [Indexed: 12/28/2022]
Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.
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Semb AG, Ikdahl E, Hisdal J, Olsen IC, Rollefstad S. Exploring cardiovascular disease risk evaluation in patients with inflammatory joint diseases. Int J Cardiol 2016; 223:331-336. [PMID: 27543704 DOI: 10.1016/j.ijcard.2016.08.129] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Cardiovascular disease (CVD) risk calculators developed for the general population have been shown to inaccurately predict CVD events in patients with inflammatory joint disease (IJD). European guidelines for CVD prevention recognize the presence of carotid plaques (CP) as a very high CVD risk factor, equivalent of coronary artery disease. Patients with IJD have a high prevalence of CP. We evaluated if CP resulted in reclassification of patients with IJD into a more appropriate CVD risk class and recommended lipid lowering treatment. METHODS CVD risk evaluation was performed in patients with IJD using SCORE and ACC/AHA risk calculators to predict CVD events. RESULTS Of the 335 IJD patients evaluated (including rheumatoid arthritis n=201, ankylosing spondylitis n=85 and psoriatic arthritis n=49), 183 and 159 IJD patients had a calculated CVD risk by SCORE and ACC/AHA <5%, indicating no need of lipid lowering treatment (LLT). However, of patients with low to moderate risk calculated by SCORE and ACC/AHA, 67 (36.6%) and 48 (30.2%) had CP and should according to guidelines receive intensive LLT. For patients with high risk, in the LLT considered group, 54.9% and 58.1% were reclassified to correct treatment when adding information on the presence of CP. Our results reveal a considerable reclassification into correct CVD risk category when adding CP in female patients. CONCLUSION The high frequency of asymptomatic atherosclerosis in patients with IJD has a notable impact on CVD risk stratification. Identification of CP will reclassify patients into recommended CVD preventive treatment group, which may be clinically important.
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Affiliation(s)
- A G Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - E Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Hisdal
- Department of Vascular Medicine, Oslo University Hospital Aker, Oslo, Norway
| | - I C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - S Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Ikdahl E, Rollefstad S, Wibetoe G, Semb AG. Chronic kidney disease reduces risk of cardiovascular disease in patients with rheumatoid arthritis according to the QRISK lifetime cardiovascular risk calculator: Table 1. Rheumatology (Oxford) 2016; 55:1528-9. [DOI: 10.1093/rheumatology/kew002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ikdahl E, Rollefstad S, Wibetoe G, Olsen IC, Berg IJ, Hisdal J, Uhlig T, Haugeberg G, Kvien TK, Provan SA, Semb AG. Predictive Value of Arterial Stiffness and Subclinical Carotid Atherosclerosis for Cardiovascular Disease in Patients with Rheumatoid Arthritis. J Rheumatol 2016; 43:1622-30. [DOI: 10.3899/jrheum.160053] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/31/2022]
Abstract
Objective.We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD.Methods.In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses.Results.Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline.Conclusion.CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.
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Ikdahl E, Rollefstad S, Wibetoe G, Krøll F, Soldal D, Olsen I, Kvien T, Haugeberg G, Semb A. FRI0125 Exploring The Inadequate Cardiovascular Disease Prevention in Inflammatory Joint Diseases: Results from The NOCAR Project. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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