类风湿关节炎发病风险人群的心血管风险。
Cardiovascular risk in persons at risk of developing rheumatoid arthritis.
机构信息
Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
Departments of Orofacial Pain and Dysfunction, Periodontology, and Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
出版信息
PLoS One. 2020 Aug 3;15(8):e0237072. doi: 10.1371/journal.pone.0237072. eCollection 2020.
BACKGROUND
Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.
METHODS
In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.
RESULTS
Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.
CONCLUSION
Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.
背景
类风湿关节炎（RA）与心血管疾病（CVD）风险增加相关，这种风险可能早在诊断之前就已经存在。为了在 RA 之前探索这种 CVD 风险，我们在一组有 RA 风险的人群中确定了多个风险因素和两个 10 年临床风险评分。我们还分析了与关节炎发展和自身抗体状态的关联，并将一部分有风险的个体与年龄和性别匹配的血清阴性对照组进行了比较。
方法
在 555 例连续的类风湿因子（RF）和/或抗瓜氨酸蛋白抗体（ACPA）阳性的关节痛患者队列中，我们回顾性地确定了有临床前关节炎（即发生关节炎的患者）和无关节炎患者（在 5 年的随访期间无关节炎发展的患者）。在基线时确定了 CVD 危险因素和 10 年心血管风险，根据 SCORE 和 QRISK3 系统进行评估。
结果
临床前关节炎患者（n = 188）的心率（68 次/分比 63 次/分，p = 0.048）和胆固醇（5.2 mmol/L 比 5.5 mmol/L，p = 0.006）、HDL（1.0 mmol/L 比 1.1 mmol/L，p0.003）和 ApoB（0.85 g/L 比 0.91 g/L，p = 0.011）较低，而无关节炎患者（n = 367）则较高。在临床前关节炎和无关节炎组中，血脂水平与 ACPA 状态均相关。总共有 7%（SCORE）和 8%（QRISK3）的血清阳性关节痛患者被归类为高危。血清阳性有风险的患者（n = 71）的总胆固醇（5.4 比 4.9，p<0.001）、TC/HDL 比值（4.0 比 3.0，p<0.001）、三酰甘油（1.4 比 1.0，p = 0.001）、ApoB（1.0 比 0.9，p = 0.019）和 10 年风险评分（中位数 SCORE 1.0 比 0.0，p = 0.030，中位数 QRISK3 4.4 比 3.1，p<0.001）均高于血清阴性对照组。
结论
我们的结果表明，血脂变化在 RA 诊断之前就已经开始，而 ACPAs 可能发挥作用。
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