THU0158 Increased progression of atherosclerosis in patients with rheumatoid arthritis is partially reflected by disease severity at the time of diagnosis- 11-year prospective follow-up
Authors: I. Björsenius, S. Rantapää-Dahlqvist, S. Wållberg-Jonsson, A. Södergren
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Patients with Rheumatoid arthritis (RA) have increased mortality and morbidity due to cardiovascular disease (CVD) compared to general population. While it has been established that atherosclerosis is increased, there is much yet to reveal about the underlying cause. Contributing factors, such as inflammation, traditional CVD risk factors and metabolic disease have been suggested, but no full explanation is currently present. <h3>Objectives</h3> In this prospective case-control study, we investigated how the progression of subclinical atherosclerosis is associated with CVD risk factors and parameters of inflammation in patients with RA compared with matched controls. <h3>Methods</h3> By the time of diagnosis, patients from northern Sweden diagnosed with early RA are consecutively recruited into an ongoing prospective study. From these, a subgroup aged ≤60 years was consecutively included for ultrasound measurements of intima media thickness (IMT) of a. carotis communis at inclusion (T0) (n=79), after 5 years (T5) (n=71) and after 11 years (T11) (n=55). 44 age-sex-matched controls were included and 31 could be revaluated at T11. Pharmacological treatment, previous CVD, markers of inflammation, lipid status, blood pressure, body mass index as well as measurements of disease activity were registered. Any previous CV events were verified by medical records. European Systematic Coronary Risk Evaluation (SCORE) and Reynolds Risk Score were calculated and Larsen score (of hands and feet) were registered. IMT progression rate (ΔIMT T0-T11) was calculated by subtracting baseline values from IMT after eleven years follow up. <h3>Results</h3> IMT increased significantly between T0 and T11 among patients with RA (IMT T0: 0.51 (0.12) T11: 0.68 (0.16) p&lt;0.0001) and controls (IMT T0: 0.54 (0.12) T11: 0.63 (0.13) p&lt;0.0001). There was a higher progression rate between T0 and T11 in the RA group compared with the controls (p&lt;0.05). In simple regression models, IMT T11 was significantly associated with several traditional CVD risk factors as well as Larsen score at T0 among RA patients (table 1). Moreover, in simple regression models ΔIMT T0-T11 was significantly associated with Larsen score and age at T0 (both p&lt;0.01) among patients with RA. A multiple regression model, with ΔIMT T0-T11 as dependent variable, including traditional CVD risk factors at T0 (age, systolic blood pressure (BP), cholesterol and smoking), resulted in a R2 of 0.32 where age and cholesterol (p&lt;0.01 for both) were significantly associated with ΔIMT T0-T11. When also adding CRP and Larsen score the R2 increased to 0.50 and age (p&lt;0.05) and Larsen score (p&lt;0.01) were significantly associated with IMT T11. <h3>Conclusions</h3> In this prospective study, we found that there was an increased progression of atherosclerosis among RA patients, compared with controls, eleven years after diagnosis, and that this increase is associated with Larsen score and age at baseline. <h3>Disclosure of Interest</h3> None declared