Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Rheumatology, Medicines Evaluation Board, Utrecht, The Netherlands.
Ann Rheum Dis. 2017 Oct;76(10):1693-1699. doi: 10.1136/annrheumdis-2016-210997. Epub 2017 Jun 12.
Systemic inflammation appears to contribute to the excess risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA). The objective of this study was to investigate the effect of different levels of disease activity over time, particularly low disease activity and remission, on CVD risk in patients with RA.
Data from the Nijmegen early RA inception cohort were used. The primary outcome was first CVD events within the first 10 years of follow-up. Cut points of the DAS28 for remission (<2.6) and low (≤3.2), moderate (3.2-5.1) and high (>5.1) disease activity were used. The effect of disease activity on CVD risk was analysed using Cox-proportional hazards regression with DAS28 as a time-dependent covariate and also conventionally with time-averaged DAS28 as the primary dependent variable.
Low DAS28 (≤3.2) was significantly associated with a reduced risk of CVD (HR 0.65, 95% CI 0.43 to 0.99) compared with DAS28 >3.2, both when included as a time-dependent covariate and as time-averaged DAS28 ≤3.2 (HR 0.52, 95% CI 0.33 to 0.81). Remission had a modest, non-significant protective effect against CVD (HR 0.67, 95% CI 0.43 to 1.07).
Results of this study suggest that low disease activity is sufficient to achieve a protective effect against CVD in RA. Apparently, remission defined as DAS28 <2.6 has no additional protective effect against CVD compared with low disease activity. Our results strengthen the use of tight control strategies in daily clinical practice to achieve low stable disease activity or remission in patients with RA as soon as possible.
全身性炎症似乎导致类风湿关节炎（RA）患者的心血管疾病（CVD）风险增加。本研究旨在探讨疾病活动度随时间的变化，尤其是低疾病活动度和缓解，对 RA 患者 CVD 风险的影响。
使用尼美根早期 RA 发病队列的数据。主要结局是在随访的前 10 年内首次发生 CVD 事件。采用 DAS28 的缓解（<2.6）和低（≤3.2）、中（3.2-5.1）和高（>5.1）疾病活动度切点。使用 Cox 比例风险回归分析 DAS28 作为时间依赖性协变量和传统的时间平均 DAS28 作为主要因变量对 CVD 风险的影响。
与 DAS28 >3.2 相比，低 DAS28（≤3.2）与 CVD 风险降低显著相关（HR 0.65，95%CI 0.43-0.99），包括作为时间依赖性协变量和时间平均 DAS28 ≤3.2（HR 0.52，95%CI 0.33-0.81）。缓解对 CVD 有适度但无统计学意义的保护作用（HR 0.67，95%CI 0.43-1.07）。
本研究结果表明，低疾病活动度足以对 RA 患者的 CVD 产生保护作用。显然，与低疾病活动度相比，DAS28 <2.6 定义的缓解对 CVD 没有额外的保护作用。我们的研究结果加强了在日常临床实践中使用严格控制策略，使 RA 患者尽快达到低且稳定的疾病活动度或缓解的重要性。
