Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
RMD Open. 2024 Jan 10;10(1):e003488. doi: 10.1136/rmdopen-2023-003488.
To elucidate the association between different disease activity levels over time on long-term vascular outcomes in patients with early rheumatoid arthritis (ERA).
This was a 5-year prospective study. Patients with consecutive ERA without overt cardiovascular disease (CVD) were recruited to receive 1 year of tight-control treatment followed by standard-of-care management. High-resolution carotid ultrasound was assessed at baseline and year 5. The primary outcome was subclinical atherosclerosis progression (AP+), defined as the occurrence of incident plaque, increased region harbouring plaques and/or maximum carotid intima-media thickness progression ≥0.9 mm at year 5. Inflammatory burden during the follow-up period was represented by the cumulative average Disease Activity Score 28-erythrocyte sedimentation rate (ca-DAS28-ESR). Persistent low disease activity (LDA) or remission state was defined as ca-DAS28-ESR≤3.2.
One-hundred and four patients with ERA (age: 52±11 years, 81 (77.9%) female) were included in this analysis. Fifty-two (50%) patients achieved persistent LDA or remission and 42 patients (40.4%) had AP+. Patients in the AP+ group were older and had more traditional cardiovascular risk factors at baseline. Multivariate logistic regression analysis revealed that patients with persistent moderate or high disease activity (ca-DAS28-ESR>3.2) had a significantly increased risk of AP+ (OR 5.05, 95% CI 1.53, 16.64, p=0.008) compared with those who achieved persistent remission. The risk of AP+ was similar in patients who achieved persistent LDA and remission.
Achieving persistent LDA or remission may prevent progression of atherosclerosis in ERA. A treat-to-target approach aiming at sustained LDA or remission may reduce the risk of CVD by preventing AP+.
阐明早期类风湿关节炎（ERA）患者随时间推移不同疾病活动水平与长期血管结局之间的关系。
这是一项为期 5 年的前瞻性研究。招募了连续患有 ERA 且无明显心血管疾病（CVD）的患者，他们接受了 1 年的严格控制治疗，然后接受标准治疗。在基线和第 5 年进行高分辨率颈动脉超声检查。主要结局是亚临床动脉粥样硬化进展（AP+），定义为第 5 年时发生新斑块、斑块区域增加和/或最大颈动脉内膜中层厚度进展≥0.9mm。随访期间的炎症负担由累积平均疾病活动评分 28-红细胞沉降率（ca-DAS28-ESR）表示。持续低疾病活动（LDA）或缓解状态定义为 ca-DAS28-ESR≤3.2。
这项分析共纳入了 104 例 ERA 患者（年龄：52±11 岁，81 例[77.9%]为女性）。52 例（50%）患者达到持续 LDA 或缓解，42 例（40.4%）患者发生 AP+。AP+组患者年龄较大，基线时存在更多传统心血管危险因素。多变量逻辑回归分析显示，与达到持续缓解的患者相比，持续中高度疾病活动（ca-DAS28-ESR>3.2）的患者发生 AP+的风险显著增加（OR 5.05，95%CI 1.53，16.64，p=0.008）。达到持续 LDA 和缓解的患者发生 AP+的风险相似。
达到持续 LDA 或缓解可能预防 ERA 患者动脉粥样硬化的进展。针对持续 LDA 或缓解的治疗目标方法可能通过预防 AP+来降低 CVD 风险。
