EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis.
OBJECTIVE
To develop evidence-based EULAR recommendations for cardiovascular (CV) risk management in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA).


METHODS
A multidisciplinary expert committee was convened as a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), comprising 18 members including rheumatologists, cardiologists, internists and epidemiologists, representing nine European countries. Problem areas and related keywords for systematic literature research were identified. A systematic literature research was performed using MedLine, Embase and the Cochrane library through to May 2008. Based on this literature review and in accordance with the EULAR's "standardised operating procedures", the multidisciplinary steering committee formulated evidence-based and expert opinion-based recommendations for CV risk screening and management in patients with inflammatory arthritis.


RESULTS
Annual CV risk assessment using national guidelines is recommended for all patients with RA and should be considered for all patients with AS and PsA. Any CV risk factors identified should be managed according to local guidelines. If no local guidelines are available, CV risk management should be carried out according to the SCORE function. In addition to appropriate CV risk management, aggressive suppression of the inflammatory process is recommended to further lower the CV risk.


CONCLUSIONS
Ten recommendations were made for CV risk management in patients with RA, AS and PsA. The strength of the recommendations differed between RA on the one hand, and AS and PsA, on the other, as evidence for an increased CV risk is most compelling for RA.
Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands.
M J L
MJ
Peters
D P M
DP
Symmons
D
D
McCarey
B A C
BA
Dijkmans
P
P
Nicola
T K
TK
Kvien
I B
IB
McInnes
H
H
Haentzschel
M A
MA
Gonzalez-Gay
S
S
Provan
A
A
Semb
P
P
Sidiropoulos
G
G
Kitas
Y M
YM
Smulders
M
M
Soubrier
Z
Z
Szekanecz
N
N
Sattar
M T
MT
Nurmohamed
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D012308:Risk Management / Q000379:methods; D013167:Spondylitis, Ankylosing / Q000150:complications*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol