Disease factors in early rheumatoid arthritis are associated with differential risks for cardiovascular events and mortality depending on age at onset: a 10-year observational cohort study.
OBJECTIVE
To investigate, within the first 2 years of diagnosis with rheumatoid arthritis (RA), associations between disease-related measures and cardiovascular disease (CVD) and mortality in patients with RA onset before and after 65 years of age.


METHODS
The study population (n = 741; 67.5% women) was derived from the Better Anti-Rheumatic Pharmaco Therapy (BARFOT) early RA cohort, recruited 1993-1999. The mean age was 55 years (SD 14.7). The outcomes were incident CVD events and all-cause mortality until 2010. Area under the curve (AUC) for disease measures at inclusion, 1 and 2 years, and decrease in measures after 1 year were calculated.


RESULTS
In all, 177 CVD events and 151 deaths occurred over 10 years of observation. In adjusted Cox regression analyses, seropositivity for rheumatoid factor (RF) or anticitrullinated protein antibodies (ACPA); white blood (cell) count at diagnosis; and AUC of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and visual analog scale (VAS)-pain were associated with higher CVD risk among patients with disease onset before 65 years of age. Among patients with disease onset after 65 years, larger decreases in CRP, ESR, health assessment questionnaire (HAQ), and use of methotrexate decreased CVD risk, whereas use of glucocorticoids heightened CVD risk. AUC of CRP, ESR, HAQ, and HAQ after 2 years was related to risk of death in both age groups. Seropositivity and AUC for VAS-pain in the younger group and use of glucocorticoids in the elderly were associated with poorer survival.


CONCLUSIONS
Early treatment of RA may improve longterm outcomes. Presence of RF or ACPA associates with CVD and mortality among RA patients with disease onset before 65 years. Age stratification may improve evaluation of risk for CVD and mortality in early RA.
From the Unit of Rheumatology, Department of Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm; R and D Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström and Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund; Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institute, Stockholm; Unit of Rheumatology, Department of Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
Sofia
S
Ajeganova
Maria L E
ML
Andersson
Johan
J
Frostegård
Ingiäld
I
Hafström
D000328:Adult; D017668:Age of Onset; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010456:Peptides, Cyclic / Q000276:immunology; D011379:Prognosis; D016016:Proportional Hazards Models; D012217:Rheumatoid Factor / Q000097:blood; D012307:Risk Factors
D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
AUTOANTIBODY; CARDIOVASCULAR EVENT; DISEASE MEASURES; MORTALITY RISK; PROGNOSIS; RHEUMATOID ARTHRITIS