Patients with lower MBDA scores tended to be younger, have lower comorbidity burden, and use fewer glucocorticoids—but more biologics.
In all, 452 SIE events, 132 MIs, and 181 CHD events occurred during 16,424 person-years of follow-up.
Higher MBDA scores were significantly associated with SIEs (adjusted hazard ratio, 1.32, per 10-unit MBDA score change). Higher RA disease activity, by MBDA score, was linked with higher adjusted HRs for MI (1.52) and CHD (1.54). Analyses excluding C-reactive protein from MBDA were consistent with the overall results.
Dr. Jonathan Graf, a professor of medicine at the University of California, San Francisco and the director of the Rheumatoid Arthritis Clinic at Zuckerberg San Francisco General Hospital and Trauma Center, tells Reuters Health that the authors used clever means to match disease activity and with claims data.
“This is some of the best data available to suggest a link between RA and heart disease,” Dr. Graf, who also was not involved in the study, notes. “I think these results prove the hypotheses that inflammation drives cardiac disease.”
“These results suggest that we should be treating patients as aggressively as we can,” he advises. “Maybe instead of treating a patient by gestalt, we need to measure the total disease activity present and treat that person to a target.”
“RA is not the only chronic inflammatory disease out there. There are many others. When you add them up—even chronic gum inflammation—if this concept proves to be true and is applicable across all these diseases, maybe the time has come to assess the patient’s total inflammatory burden, and if there is a treatable disease, to lower it,” he adds.
The authors did not respond to requests for comment.
Crescendo Bioscience, a Myriad Genetics Company, partially supported the study. Dr. Curtis has financial relationships with Myriad Genetics.
Reference
- Curtis JR, Xie F, Chen L, et al. Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based study. Ann Rheum Dis. 2017 Dec 21. pii: annrheumdis-2017-211727. doi: 10.1136/annrheumdis-2017-211727. [Epub ahead of print]
