SAT0083 Abdominal Aortic Calcifications are Associated with Cardiovascular Diseases and Vertebral Fractures in Patients with Rheumatoid Arthritis.
Authors: S. Neveu, J. Fechtenbaum, S. Paternotte, S. Breban, S. Kolta, M. Dougados, C. Roux, K. Briot
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Cardiovascular disease and osteoporosis are two major causes of morbidity in rheumatoid arthritis (RA) patients. Vertebral fracture assessment (VFA) by dual-energy X ray absorptiometry (DXA) is a validated tool for the diagnosis of vertebral fracture. Studies show that lateral VFA image is an accurate method for the diagnosis of abdominal aortic calcifications (AAC), which is a relevant risk factor for cardiovascular disease. Studies in postmenopausal women are conflicting about the association between AAC and presence of vertebral fractures (VFs) and there is no study in RA. <h3>Objectives</h3> The aim of the study was to assess the prevalence of AAC in RA patients and the relationships between AAC, cardiovascular diseases and bone status (osteoporosis, VFs). <h3>Methods</h3> This study was performed in 132 patients who consulted for a bone mineral density (BMD) measurement in a tertiary department of Rheumatology. Demographic data, disease duration, activity and severity, RA therapies, cardiovascular risk factors and diseases, low trauma fractures and presence of osteoporosis (T score≤-2.5 at either lumbar spine and/or hip) were assessed. Diagnosis of VF was performed using the Genant semiquantitative analysis on VFA and severity of VF was quantified from grades 1 to 3. AAC were assessed on lateral VFA images of spine by two readers experts in this field, using a 24 and 8 point scale for scored AAC (1) with a good Inter-observer reliability (ICC) (0.845 (95% CI 0.702-0.923) and 0.882 (95% CI 0.769-0.942) for the 24 and 8-AAC scores, respectively). Univariate and multivariate analyses were performed to investigate associations between presence of AAC and disease-related factors. The accuracy of the multivariate model was measured by the area under the curve (AUC). <h3>Results</h3> 132 RA patients (114 women, mean age of 56.6±12.7) with a mean duration of RA of 15.1±9.1 years were included in the study. 107 (83.0%), 66 (51.2%) and 85 (64.4%) received DMARDs, corticosteroids and biological therapies respectively. Presence of AAC was observed in 32 (24.2%) patients. AAC were significantly associated with the presence of hypertension (p=0.043) and coronaropathy (p=0.0045). 35 patients (26.5%) were osteoporotic and 20 (15.2%) had at least one VF. There was a significant association between presence of AAC and osteoporosis (p=0.003), and between AAC and prevalent VF (p=0.019). Severity of AAC is correlated with VF severity (r= 0.27, p=0.003 and r= 0.23, p=0.011, for the 24 and 8-AAC scores, respectively) Age, male gender, menopause, calcium intake were significantly associated with presence of AAC in univariate analysis (p≤0.05). In multivariate analysis, age was the single variable associated with the presence of AAC (OR=1.24, CI 95% 1.1-1.4, p=0.0004) and calcium intake had a protective effect (0R=0.02, IC 95%0.0001-0.33, p=0.007) (AUC= 0.915). <h3>Conclusions</h3> This study conducted in severe RA patients suggests that presence of AAC is associated with cardiovascular diseases and vertebral fractures. RA patients with VF should have a systematic cardiovascular assessment. <h3>References</h3> Schousboe JT, et Al. Detection of aortic calcification during vertebral fracture assessment (VFA) compared to digital radiography. PLoS One.2007;2:e715 <h3>Disclosure of Interest</h3> None Declared