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SAT0114 (2019)
INCREASED PREVALENCE AND SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH CHEST PAIN AND SEROPOSITIVE RHEUMATOID ARTHRITIS: AN ANALYSIS FROM A LARGE-SCALE POPULATION COHORT REFERRED FOR CARDIAC COMPUTED TOMOGRAPHY
Andreas Bugge Tinggaard1, Annette de Thurah2, Ina Trolle Andersen3, Anders Hammerich Riis3, Josephine Therkildsen2, Simon Winther4, Ellen-Margrethe Hauge2, Morten Böttcher1
1Hospital Unit West, Herning, Department of Cardiology, Herning, Denmark
2Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
3Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
4Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark

Background: Inflammation plays a central role in the development of atherosclerosis and inflammatory disease might promote progression of CAD.


Objectives: To examine the impact of the most frequent systemic inflammatory disease, rheumatoid arthritis (RA), on the prevalence and severity of coronary artery disease (CAD) in patients referred for rule out of CAD by cardiac computed tomography (CCT).


Methods: In total, 39,534 patients from a mandatory national CCT database were included. Patients with a validated RA diagnosis were subgrouped based on serology, treatment with biological disease-modifying anti-rheumatic drugs (DMARDs), and the need for flare treatment with intraarticular and intramuskular glucocorticoid injections (GCIs). Outcomes were coronary artery calcium score (CACS) > 0 and CACS > 400. Differences in prevalences were assessed by odds ratios (OR). Outcomes were adjusted for cardiovascular risk factors and comorbidities.


Results: A total of 337 (0.9%) patients with RA were identified. OR for having CACS > 0 was 1.17 (0.91-1.50) for overall RA and 1.33 (1.00-1.77) for seropositive RA. Patients who had received ≥1 GCI in the period 3 years prior to the CCT had an OR of 1.49 (0.99-2.27) for having CACS > 0. The OR for having CACS > 400 was 1.31 (0.95-1.81) for overall RA and 1.49 (1.04-2.12) for seropositive RA. OR for having CACS > 400 was 1.43 (0.99-2.07) for RA patients treated with conventional synthetic DMARDs, but 1.01 (0.51-1.99) for patients treated with biological DMARDs.


Conclusion: Coronary artery calcifications are more frequent in RA patients being seropositive or needing flare treatment. The occurrence of severe calcification is more frequent in seropositive RA patients and in RA patients not escalated to biological DMARDs. These findings support the hypothesis that systemic inflammation accelerates the atherosclerotic process leading to increased coronary artery calcium, which may explain the increased risk of cardiovascular events among RA patients.


Disclosure of Interests: None declared

DOI: 10.1136/annrheumdis-2019-eular.2551

Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1124
Session: Rheumatoid arthritis - prognosis, predictors and outcome (Scientific Abstracts)