From the Department of Rheumatology, Radboud University Medical Centre; Department of Rheumatology, St. Maartenskliniek, Nijmegen; Department of Rheumatology, Bernhoven Hospital, Uden, the Netherlands.
M.L. Berendsen, MSc, Department of Rheumatology, Radboud University Medical Centre; M.C. van Maaren, MSc, Department of Rheumatology, Radboud University Medical Centre; E.E. Arts, MD, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, PhD, Department of Rheumatology, St. Maartenskliniek; C.D. Popa, MD, PhD, Department of Rheumatology, Radboud University Medical Centre, and Department of Rheumatology, Bernhoven Hospital; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre.
J Rheumatol. 2017 Sep;44(9):1325-1330. doi: 10.3899/jrheum.160670. Epub 2017 Jul 1.
To determine whether anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) are risk factors for 10-year cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA).
Analyses were performed using data from the Nijmegen early RA inception cohort, in which patients with newly diagnosed RA, consecutively included since 1985, were regularly followed up. Anti-CCP and RF were determined at baseline (diagnosis). Outcome was the first cardiovascular disease (CVD) event [ischemic heart disease, nonhemorrhagic cerebrovascular accident (CVA), or peripheral artery disease (PAD)] after baseline as retrieved from physician diagnosis. Fatality was checked against death certificates. Cox regression including correction for baseline confounders was performed to estimate the effect of anti-CCP, RF, and their interaction on 10-year CVD-free survival.
Of 929 patients included, 628 were anti-CCP-positive and 697 were RF-positive. During followup, with a median of 7.5 years, 162 CV events were observed (101 ischemic heart disease, 45 CVA, and 16 PAD), of which 15 were fatal. The HR for anti-CCP was 1.17 (95% CI 0.82-1.67) and the HR for RF was 1.52 (95% CI 1.00-2.30). The association of RF positivity with CVD was even stronger in the anti-CCP-negative patients: HR 2.09 (95% CI 1.18-3.71). There was no significant interaction (p = 0.098) between anti-CCP and RF.
Rather than anti-CCP, presence of RF was associated with CVD in this cohort of patients with RA.
确定抗环瓜氨酸肽抗体（抗-CCP）和类风湿因子（RF）是否是类风湿关节炎（RA）患者 10 年心血管疾病（CVD）的危险因素。
使用来自尼美根早期 RA 发病队列的数据分析。该队列中，连续纳入了自 1985 年以来新诊断的 RA 患者，对其进行定期随访。在基线（诊断时）时测定抗-CCP 和 RF。结局为基线后首次心血管疾病（CVD）事件[缺血性心脏病、非出血性脑卒中和（或）外周动脉疾病]，结局从医生诊断中获得。对死亡情况进行核查，以确认是否与死亡证明相符。采用 Cox 回归，包括对基线混杂因素进行校正，以评估抗-CCP、RF 及其相互作用对 10 年 CVD 无事件生存的影响。
在纳入的 929 例患者中，628 例为抗-CCP 阳性，697 例为 RF 阳性。在中位随访时间为 7.5 年期间，观察到 162 例 CV 事件（101 例缺血性心脏病、45 例卒中和 16 例 PAD），其中 15 例为致命性事件。抗-CCP 的 HR 为 1.17（95%CI 0.82-1.67），RF 的 HR 为 1.52（95%CI 1.00-2.30）。在抗-CCP 阴性患者中，RF 阳性与 CVD 的相关性更强：HR 为 2.09（95%CI 1.18-3.71）。抗-CCP 和 RF 之间无显著交互作用（p=0.098）。
在本 RA 患者队列中，与 CVD 相关的是 RF 的存在，而不是抗-CCP。
