FRI0070 SHORT-TERM INFLAMMATORY AND LIPIDS CHANGES IN RHEUMATOID ARTHRITIS PATIENTSINFLUENCE CARDIOVASCULAR RISK ALGORITHMS: A MONOCENTRIC RETROSPECTIVE STUDY
Authors: vincenzo venerito, Marco Fornaro, Giuseppe Lopalco, Anna Abbruzzese, Sergio Colella, Maria Grazia Anelli, Giovanni Lapadula, Florenzo Iannone, Fabio Cacciapaglia
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Chronic inflammation may change lipid profile, thus current EULAR recommendations for cardiovascular (CV) management in polyarthritis suggest to assess cholesterol status when disease activity is stable or in remission<sup>1</sup>. To date it is still unclear whether inflammation mediated changes in lipids profile could impact on CV risk algorithms and what score should be considered the reference one for any disease activity status. <h3>Objectives:</h3> The aim of this study was to evaluate the influence of lipid profile, disease activity and inflammation modifications on four CV risk calculators during Treat to Target strategy with biologic agents. <h3>Methods:</h3> In this monocentric study we retrospectively evaluated all data recorded from Rheumatoid Arthritis (RA) patients with moderate/high CDAI disease activity, who had started for the first time and maintained a bDMARD agent for at least 6 months, in our Outpatient Clinic from the 1<sup>st</sup> January 2010 to 31<sup>st</sup> December 2017. Patients with a prior CV event have been excluded from the analysis. For each patient, we assessed the CV risk in a short time period (within 6 months) to estimate the specific weight of lipids and disease activity related variables, using the Italian CV "Progetto Cuore" score<sup>2</sup>, the QRISK3-2018 score<sup>3</sup>, the Reynolds Risk Score (RRS)<sup>4</sup> and the Expanded Risk Score in RA (ERS-RA)<sup>5</sup>. The results of the "Progetto CUORE" and RRS algorithms were multiplied by 1.5, in accordance to the EULAR recommendations for algorithms that do not include specifically RA among variables. Wilcoxon signed-rank test was used to compare CV risk scores during follow-up. <h3>Results:</h3> One-hundred thirteen RA patients (female n. 86 (76.8%), mean age (SD) 52.8 (12.9) years, median disease duration (IQR) 26 (13-72) months) were eligible for the analysis. CDAI and C-reactive protein levels decreased significantly either at 3 and 6 months follow-up (p&lt;0.001). At 3 months, we observed a statistically significant increase in mean total cholesterol (TC) from 197.3±38.2 mg/dl to 205.8±37.3 mg/dl (p&lt;0.01), which returned close to baseline levels at 6 months (201.1±34.5 mg/dl - p=0.22 vs baseline). High density lipoprotein (HDL), TC/HDL ratio and triglycerides changes did not reach the statistically significance. The estimated CV risk assessed by the "Progetto Cuore" and QRisk3-2018 did not change during the 6 months' follow-up. RRS showed a decrease either at 3 and 6 months (p=0.04). Similarly, ESR-RA highlighted a decrease of CV risk either at 3 and 6 months (p&lt;0.01) (see Table I). <h3>Conclusion:</h3> All evaluated "Scores" are not influenced by short term lipid changes observed during bDMARDs treatment, being applicable at any status of disease activity. Interestingly, the RRS and ESR-RA scores, evaluating RA inflammatory items, are susceptible to disease activity changes. These results should be taken into account by rheumatologists choosing a CV risk algorithm in daily clinical practice. <h3>References:</h3> [1] Agca R, et al. Ann Rheum Dis 2017;76:17–28. [2] Palmieri L, et al. Ann Ist Super Sanita. 2004;40(4):393-9. [3] Hippisley-Cox J, et al. BMJ. 2017 May 23;357:j2099. [4] Ridker PM, et al. JAMA. 2007;297(6):611–9. [5] Solomon DH, et al. Arthritis Rheumatol. 2015;67(8):1995–2003. <h3>Disclosure of Interests:</h3> vincenzo venerito: None declared, Marco Fornaro: None declared, Giuseppe Lopalco Speakers bureau: SOBI, BMS, Anna Abbruzzese: None declared, Sergio Colella: None declared, Maria Grazia Anelli: None declared, Giovanni Lapadula: None declared, Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Fabio Cacciapaglia: None declared