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AB0257 (2021)
IMPACT OF CONVENTIONAL ANTIRHEUMATIC TREATMENT ON CARDIOVASCULAR RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS
D. Gerasimova1, E. Gerasimova2, T. Popkova2, A. Melkumyan1
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Organization and Economy of Pharmacy, Moscow, Russian Federation
2V.A. Nasonova Research Institute of Rheumatology, Systemic Rheumatic Diseases Laboratory, Moscow, Russian Federation

Background: Cardiovascular diseases (CVD) are the most common and socially significant comorbidities and the main cause of premature mortality in rheumatoid arthritis (RA). Appropriate RA therapy should not only suppress RA activity, but also reduce CVD risk.


Objectives: To evaluate CVD risk and analyze its association with the use of conventional therapy in RA patients (pts).


Methods: The study included 100 pts with RA (92 women and 8 men) aged 30 to 60 without established CVD. The median age was 49.5 [44.5;53] years, duration of RA was 144 [60;240] months, DAS28 was 4.4 [3.3;5.3] points. Eighty six RA pts (86%) treated with disease-modifying antirheumatic drugs (DMARDs) (methotrexate, n=55; leflunomide, n=12; hydroxychloroquine, n=8; sulfasalazine, n=11), including 33 pts (33%) in combination with glucocorticoids (GCs). Fourteen pts (14%) received monotherapy with GCs. Pts were divided into three treatment groups: DMARDs group, n=53; GCs group, n=14; DMARDs+GCs group, n=33. CVD risk was calculated with ASSIGN, QRISK3, and ERS-RA scales.


Results: No differences were found between the groups when calculating CVD risk using ASSIGN ( table 1 ). Estimated CVD risk by QRISK3 was lower in DMARDs group (4.9 [3.0; 7.7]) than in DMARDs+GCs group (7.1 [4.1; 13.6], p<0.05). High CVD risk on the ERS-RA scale was determined less frequently (13%) and median CVD risk was lower in DMARDs group (4.2 [2.2; 5.4]) than in GCs group (57%; 8.9 [4.8; 11.7], p<0.01) and DMARDs+GCs group (39%; 6.6 [3; 9.3], p<0.05, respectively). In DMARDs group, significant differences in CVD risk by ERS-RA were found in pts treated with hydroxychloroquine (2 [1.4; 5.8]) and leflunomid (6.2 [2.8; 12.3], p<0.05).


Conclusion: RA pts treated with DMARDs have a reduced risk for CVD than pts treated with GCs or a combination of DMARDs and GCs. GCs significantly increase CVD risk. To clarify the impact of hydroxychloroquine and leflunomid on CVD risk, a study on a larger number of pts is required.

The impact of conventional antirheumatic therapy on CVD risk.

Treatment ASSIGN QRISK3 ERS-RA
High CVD risk, % median [25-75 percentiles] High CVD risk,% median [25-75 percentiles] High CVD risk,% median [25-75 percentiles]
DMARDs, n=53 6 11 [6.5;14] 2 4.9 [3;7.7] v 13* v 4.2 [2.2;5.4] * v
GCs, n=14 7 9.5 [7;13] 7 6.6 [4.4;15.8] 57* 8.9 [4.8;11.7] *
DMARDs+GCs, n=33 15 10 [5;13.5] 9 7.1 [4.1;13.6] v 39 v 6.6 [3;9.3] v

Note: * - p<0.01 between pts receiving DMARDs and GCs; v - p<0.05 between pts receiving DMARDs and DMARDs+GCs.


Disclosure of Interests: None declared

Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 1155
Session: Rheumatoid arthritis - non biologic treatment and small molecules (Publication Only)