Sally Koch Kubetin

PHILADELPHIA — Risk of ischemic heart disease but not heart failure has declined recently among patients with rheumatoid arthritis, according to data presented at the annual meeting of the American College of Rheumatology.

The data involved two cohorts of patients with rheumatoid arthritis (RA)—349 who were diagnosed during 1980–1994 and 469 diagnosed in 1995–2007. All were residents of Olmstead County, Minn., Cynthia S. Crowson of the Mayo Clinic in Rochester, Minn., said in a poster session at the meeting.

The patients were followed for a mean of 9.6 years, during which 89 patients developed coronary heart disease (excluding 83 patients with CHD prior to RA incidence) and 82 patients developed heart failure (HF) (excluding 20 patients with HF prior to RA incidence). This translated into a 5-year CHD risk of 7.5% in the 1980–1994 cohort and 4.5% in the 1995–2007 cohort. The 5-year risk for HF was 5.8% in the 1980–1994 cohort and 5.1% in the 1995–2007 cohort.

The 1980–1994 and 1995–2007 cohorts were similar in demographics and disease characteristics: Mean age was 56.2 years and 55.5 years, respectively; 68% and 69% were female; length of follow-up was 15.3 years and 5.6 years; 66% of both groups had ever been positive for rheumatoid factor. Maximum erythrocyte sedimentation rate in the first year after diagnosis was 36.2 mm/hr and 29.9 mm/hr. There were radiologically evident changes or erosions within the first year after diagnosis in 24% and 29%, respectively.

A total of 61% and 50% of each group reported having ever smoked and 28% and 17% were current smokers. The decline in smoking is one piece of good news in the study, Ms. Crowson said in an interview.

On the downside is the increase in obesity: In all, 33% of the members of the 1980–1994 cohort had a body mass index greater than or equal to 30 kg/m

Past or current methotrexate use was reported by 48% and 64% of the cohorts. Hydroxychloroquine use was reported by 52% and 64%. Biologic use was reported by 12% and 21%, respectively, and steroid use was reported by 72% and 81%.

Because ischemic heart disease involves diastolic failure and HF involves systolic dysfunction, strategies need to address both disease mechanisms in order to lower the rate of heart failure in RA patients, Ms. Crowson said during an interview. Patients with RA may be benefiting from earlier diagnosis and treatment, which is translating into less ischemic heart disease, although it seems unlikely that biologic use is contributing to the beneficial effect, given how few patients used them in this study, she said.

According to the American Heart Association, the prevalence of ischemic heart disease in 2007 was 3.7% and the prevalence of heart failure was 2.4% in 2004 (www.americanheart.org/downloadable/heart/1166712318459HS_StatsInsideText.pdf

Ms. Crowson said she had no financial conflicts of interest to disclose.

This CT image of the lungs of a 45-year-old patient with left heart failure show perihilar distribution of airspace pulmonary edema (bat's wing edema), and consolidation and ground-glass opacities in lower lobes. Also noted are mild interlobular septal thickening (arrows) and small pleural effusions.

Source ©Elsevier

PHILADELPHIA — Risk of ischemic heart disease but not heart failure has declined recently among patients with rheumatoid arthritis, according to data presented at the annual meeting of the American College of Rheumatology.

The data involved two cohorts of patients with rheumatoid arthritis (RA)—349 who were diagnosed during 1980–1994 and 469 diagnosed in 1995–2007. All were residents of Olmstead County, Minn., Cynthia S. Crowson of the Mayo Clinic in Rochester, Minn., said in a poster session at the meeting.

The patients were followed for a mean of 9.6 years, during which 89 patients developed coronary heart disease (excluding 83 patients with CHD prior to RA incidence) and 82 patients developed heart failure (HF) (excluding 20 patients with HF prior to RA incidence). This translated into a 5-year CHD risk of 7.5% in the 1980–1994 cohort and 4.5% in the 1995–2007 cohort. The 5-year risk for HF was 5.8% in the 1980–1994 cohort and 5.1% in the 1995–2007 cohort.

The 1980–1994 and 1995–2007 cohorts were similar in demographics and disease characteristics: Mean age was 56.2 years and 55.5 years, respectively; 68% and 69% were female; length of follow-up was 15.3 years and 5.6 years; 66% of both groups had ever been positive for rheumatoid factor. Maximum erythrocyte sedimentation rate in the first year after diagnosis was 36.2 mm/hr and 29.9 mm/hr. There were radiologically evident changes or erosions within the first year after diagnosis in 24% and 29%, respectively.

A total of 61% and 50% of each group reported having ever smoked and 28% and 17% were current smokers. The decline in smoking is one piece of good news in the study, Ms. Crowson said in an interview.

On the downside is the increase in obesity: In all, 33% of the members of the 1980–1994 cohort had a body mass index greater than or equal to 30 kg/m

Past or current methotrexate use was reported by 48% and 64% of the cohorts. Hydroxychloroquine use was reported by 52% and 64%. Biologic use was reported by 12% and 21%, respectively, and steroid use was reported by 72% and 81%.

Because ischemic heart disease involves diastolic failure and HF involves systolic dysfunction, strategies need to address both disease mechanisms in order to lower the rate of heart failure in RA patients, Ms. Crowson said during an interview. Patients with RA may be benefiting from earlier diagnosis and treatment, which is translating into less ischemic heart disease, although it seems unlikely that biologic use is contributing to the beneficial effect, given how few patients used them in this study, she said.

According to the American Heart Association, the prevalence of ischemic heart disease in 2007 was 3.7% and the prevalence of heart failure was 2.4% in 2004 (www.americanheart.org/downloadable/heart/1166712318459HS_StatsInsideText.pdf

Ms. Crowson said she had no financial conflicts of interest to disclose.

This CT image of the lungs of a 45-year-old patient with left heart failure show perihilar distribution of airspace pulmonary edema (bat's wing edema), and consolidation and ground-glass opacities in lower lobes. Also noted are mild interlobular septal thickening (arrows) and small pleural effusions.

Source ©Elsevier

PHILADELPHIA — Risk of ischemic heart disease but not heart failure has declined recently among patients with rheumatoid arthritis, according to data presented at the annual meeting of the American College of Rheumatology.

The data involved two cohorts of patients with rheumatoid arthritis (RA)—349 who were diagnosed during 1980–1994 and 469 diagnosed in 1995–2007. All were residents of Olmstead County, Minn., Cynthia S. Crowson of the Mayo Clinic in Rochester, Minn., said in a poster session at the meeting.

The patients were followed for a mean of 9.6 years, during which 89 patients developed coronary heart disease (excluding 83 patients with CHD prior to RA incidence) and 82 patients developed heart failure (HF) (excluding 20 patients with HF prior to RA incidence). This translated into a 5-year CHD risk of 7.5% in the 1980–1994 cohort and 4.5% in the 1995–2007 cohort. The 5-year risk for HF was 5.8% in the 1980–1994 cohort and 5.1% in the 1995–2007 cohort.

The 1980–1994 and 1995–2007 cohorts were similar in demographics and disease characteristics: Mean age was 56.2 years and 55.5 years, respectively; 68% and 69% were female; length of follow-up was 15.3 years and 5.6 years; 66% of both groups had ever been positive for rheumatoid factor. Maximum erythrocyte sedimentation rate in the first year after diagnosis was 36.2 mm/hr and 29.9 mm/hr. There were radiologically evident changes or erosions within the first year after diagnosis in 24% and 29%, respectively.

A total of 61% and 50% of each group reported having ever smoked and 28% and 17% were current smokers. The decline in smoking is one piece of good news in the study, Ms. Crowson said in an interview.

On the downside is the increase in obesity: In all, 33% of the members of the 1980–1994 cohort had a body mass index greater than or equal to 30 kg/m

Past or current methotrexate use was reported by 48% and 64% of the cohorts. Hydroxychloroquine use was reported by 52% and 64%. Biologic use was reported by 12% and 21%, respectively, and steroid use was reported by 72% and 81%.

Because ischemic heart disease involves diastolic failure and HF involves systolic dysfunction, strategies need to address both disease mechanisms in order to lower the rate of heart failure in RA patients, Ms. Crowson said during an interview. Patients with RA may be benefiting from earlier diagnosis and treatment, which is translating into less ischemic heart disease, although it seems unlikely that biologic use is contributing to the beneficial effect, given how few patients used them in this study, she said.

According to the American Heart Association, the prevalence of ischemic heart disease in 2007 was 3.7% and the prevalence of heart failure was 2.4% in 2004 (www.americanheart.org/downloadable/heart/1166712318459HS_StatsInsideText.pdf

Ms. Crowson said she had no financial conflicts of interest to disclose.

This CT image of the lungs of a 45-year-old patient with left heart failure show perihilar distribution of airspace pulmonary edema (bat's wing edema), and consolidation and ground-glass opacities in lower lobes. Also noted are mild interlobular septal thickening (arrows) and small pleural effusions.

Source ©Elsevier

The prompt addition of infliximab to methotrexate in patients with early rheumatoid arthritis who did not respond to brief monotherapy produced clinically superior results at 1 year, compared with adjuvant therapy with conventional disease-modifying antirheumatic drugs, according to the ongoing SWEFOT trial.

In addition, treating all patients with methotrexate monotherapy for 3-4 months screens out a sizeable proportion who would have been overtreated with the aggressive combination of methotrexate and infliximab, thus sparing them the increased risk for side effects as well as the higher costs of therapy with a tumor necrosis factor inhibitor, according to Dr. Ronald F. van Vollenhoven, a rheumatologist at the Karolinska University Hospital in Stockholm, and his associates.

Some patients may lose important ground to RA during the first 3-4 months of treatment with methotrexate monotherapy. However, findings from a review of clinical trials with anti-TNF agents suggest that only negligible gains are achieved by immediate initiation of such agents, the investigators noted (Lancet 2009;374:459-66).

The trial conducted by Dr. van Vollenhoven and his associates involved 487 patients with rheumatoid arthritis of duration less than 1 year who were treated at any of 15 rheumatology centers in Sweden between October 2002 and December 2005. All patients were treated with methotrexate monotherapy for 3-4 months at a dosage of up to 20 mg/week. At the end of baseline therapy, 145 patients had responded well to methotrexate monotherapy, defined as a DAS28 of no more than 3.2; those patients continued on methotrexate monotherapy.

Of the remaining patients, 128 patients were randomized to receive the addition of infliximab to methotrexate, and 130 patients received sulfasalazine, hydroxychloroquine, and methotrexate. Of the other patients who did not continue in the trial, 27 were intolerant to methotrexate, 9 developed another illness, and 48 cited a variety of other reasons for withdrawing from the study.

At the end of 12 months, 105 of the 128 patients in the infliximab-plus-methotrexate group and 89 of the 130 patients in the sulfasalazine/hydroxychloroquine-plus-methotrexate group remained on their allocated treatment.

Of those, 50 of 128 patients (39%) on infliximab plus methotrexate achieved the primary outcome of a good EULAR response, compared with 32 of 130 patients (25%) on sulfasalazine/hydroxychloroquine plus methotrexate. The differences between the two treatment groups became statistically significant over time. The differences were very small and not statistically significant at 3 months when patients were initially randomized, but they increased at 6 months (P = .0988) and again at 12 months (P = .0160).

More patients in the infliximab-plus-methotrexate group achieved secondary outcomes than did those on sulfasalazine/hydroxychloroquine plus methotrexate. Secondary outcomes were EULAR good to moderate response, ACR 20, ACR 50, and ACR 70.

The study's findings “suggest that the most important information to be gathered from clinical trials in rheumatoid arthritis is not necessarily comparisons of agents, but rather the strategy of tight control, aiming for remission,” Dr. Tuulikki Sokka and Dr. Theodore Pincus stated in an editorial.

Patients with rheumatoid arthritis have substantially better clinical status now than did their peers 2-3 decades ago, they noted. However, most of the improved status cannot be attributed to the use of biologic agents; improved clinical status began in 2000, before the availability of biologic agents, according to Dr. Sokka, a rheumatologist at Jyväskylä (Finland) Central Hospital, and Dr. Pincus of New York University Medical Center (Lancet 2009;374:430-2).

In addition, trials showing the most impressive results do not always involve biologic agents. Finally, findings from earlier trials comparing methotrexate monotherapy to methotrexate used in combination with a biologic suggest that many patients have clinical and radiologic responses to methotrexate that are as favorable as those to biologic agents or combinations, Dr. Sokka and Dr. Pincus said.

The Swedish Rheumatism Association and Schering-Plough provided funding for the SWEFOT study. The investigators declared no financial conflict of interest.

Color-enhanced X-ray of hands showing severe rheumatoid arthritis. Swelling and bone deformation (pink) is seen in finger joints between metacarpal and phalanges bones, and between the phalanges bones themselves. Most joints are ragged due to bone erosion, with the thumbs also affected.

Source ©2009 PHOTO RESEARCHERS, INC.

The prompt addition of infliximab to methotrexate in patients with early rheumatoid arthritis who did not respond to brief monotherapy produced clinically superior results at 1 year, compared with adjuvant therapy with conventional disease-modifying antirheumatic drugs, according to the ongoing SWEFOT trial.

In addition, treating all patients with methotrexate monotherapy for 3-4 months screens out a sizeable proportion who would have been overtreated with the aggressive combination of methotrexate and infliximab, thus sparing them the increased risk for side effects as well as the higher costs of therapy with a tumor necrosis factor inhibitor, according to Dr. Ronald F. van Vollenhoven, a rheumatologist at the Karolinska University Hospital in Stockholm, and his associates.

Some patients may lose important ground to RA during the first 3-4 months of treatment with methotrexate monotherapy. However, findings from a review of clinical trials with anti-TNF agents suggest that only negligible gains are achieved by immediate initiation of such agents, the investigators noted (Lancet 2009;374:459-66).

The trial conducted by Dr. van Vollenhoven and his associates involved 487 patients with rheumatoid arthritis of duration less than 1 year who were treated at any of 15 rheumatology centers in Sweden between October 2002 and December 2005. All patients were treated with methotrexate monotherapy for 3-4 months at a dosage of up to 20 mg/week. At the end of baseline therapy, 145 patients had responded well to methotrexate monotherapy, defined as a DAS28 of no more than 3.2; those patients continued on methotrexate monotherapy.

Of the remaining patients, 128 patients were randomized to receive the addition of infliximab to methotrexate, and 130 patients received sulfasalazine, hydroxychloroquine, and methotrexate. Of the other patients who did not continue in the trial, 27 were intolerant to methotrexate, 9 developed another illness, and 48 cited a variety of other reasons for withdrawing from the study.

At the end of 12 months, 105 of the 128 patients in the infliximab-plus-methotrexate group and 89 of the 130 patients in the sulfasalazine/hydroxychloroquine-plus-methotrexate group remained on their allocated treatment.

Of those, 50 of 128 patients (39%) on infliximab plus methotrexate achieved the primary outcome of a good EULAR response, compared with 32 of 130 patients (25%) on sulfasalazine/hydroxychloroquine plus methotrexate. The differences between the two treatment groups became statistically significant over time. The differences were very small and not statistically significant at 3 months when patients were initially randomized, but they increased at 6 months (P = .0988) and again at 12 months (P = .0160).

More patients in the infliximab-plus-methotrexate group achieved secondary outcomes than did those on sulfasalazine/hydroxychloroquine plus methotrexate. Secondary outcomes were EULAR good to moderate response, ACR 20, ACR 50, and ACR 70.

The study's findings “suggest that the most important information to be gathered from clinical trials in rheumatoid arthritis is not necessarily comparisons of agents, but rather the strategy of tight control, aiming for remission,” Dr. Tuulikki Sokka and Dr. Theodore Pincus stated in an editorial.

Patients with rheumatoid arthritis have substantially better clinical status now than did their peers 2-3 decades ago, they noted. However, most of the improved status cannot be attributed to the use of biologic agents; improved clinical status began in 2000, before the availability of biologic agents, according to Dr. Sokka, a rheumatologist at Jyväskylä (Finland) Central Hospital, and Dr. Pincus of New York University Medical Center (Lancet 2009;374:430-2).

In addition, trials showing the most impressive results do not always involve biologic agents. Finally, findings from earlier trials comparing methotrexate monotherapy to methotrexate used in combination with a biologic suggest that many patients have clinical and radiologic responses to methotrexate that are as favorable as those to biologic agents or combinations, Dr. Sokka and Dr. Pincus said.

The Swedish Rheumatism Association and Schering-Plough provided funding for the SWEFOT study. The investigators declared no financial conflict of interest.

Color-enhanced X-ray of hands showing severe rheumatoid arthritis. Swelling and bone deformation (pink) is seen in finger joints between metacarpal and phalanges bones, and between the phalanges bones themselves. Most joints are ragged due to bone erosion, with the thumbs also affected.

Source ©2009 PHOTO RESEARCHERS, INC.

The prompt addition of infliximab to methotrexate in patients with early rheumatoid arthritis who did not respond to brief monotherapy produced clinically superior results at 1 year, compared with adjuvant therapy with conventional disease-modifying antirheumatic drugs, according to the ongoing SWEFOT trial.

In addition, treating all patients with methotrexate monotherapy for 3-4 months screens out a sizeable proportion who would have been overtreated with the aggressive combination of methotrexate and infliximab, thus sparing them the increased risk for side effects as well as the higher costs of therapy with a tumor necrosis factor inhibitor, according to Dr. Ronald F. van Vollenhoven, a rheumatologist at the Karolinska University Hospital in Stockholm, and his associates.

Some patients may lose important ground to RA during the first 3-4 months of treatment with methotrexate monotherapy. However, findings from a review of clinical trials with anti-TNF agents suggest that only negligible gains are achieved by immediate initiation of such agents, the investigators noted (Lancet 2009;374:459-66).

The trial conducted by Dr. van Vollenhoven and his associates involved 487 patients with rheumatoid arthritis of duration less than 1 year who were treated at any of 15 rheumatology centers in Sweden between October 2002 and December 2005. All patients were treated with methotrexate monotherapy for 3-4 months at a dosage of up to 20 mg/week. At the end of baseline therapy, 145 patients had responded well to methotrexate monotherapy, defined as a DAS28 of no more than 3.2; those patients continued on methotrexate monotherapy.

Of the remaining patients, 128 patients were randomized to receive the addition of infliximab to methotrexate, and 130 patients received sulfasalazine, hydroxychloroquine, and methotrexate. Of the other patients who did not continue in the trial, 27 were intolerant to methotrexate, 9 developed another illness, and 48 cited a variety of other reasons for withdrawing from the study.

At the end of 12 months, 105 of the 128 patients in the infliximab-plus-methotrexate group and 89 of the 130 patients in the sulfasalazine/hydroxychloroquine-plus-methotrexate group remained on their allocated treatment.

Of those, 50 of 128 patients (39%) on infliximab plus methotrexate achieved the primary outcome of a good EULAR response, compared with 32 of 130 patients (25%) on sulfasalazine/hydroxychloroquine plus methotrexate. The differences between the two treatment groups became statistically significant over time. The differences were very small and not statistically significant at 3 months when patients were initially randomized, but they increased at 6 months (P = .0988) and again at 12 months (P = .0160).

More patients in the infliximab-plus-methotrexate group achieved secondary outcomes than did those on sulfasalazine/hydroxychloroquine plus methotrexate. Secondary outcomes were EULAR good to moderate response, ACR 20, ACR 50, and ACR 70.

The study's findings “suggest that the most important information to be gathered from clinical trials in rheumatoid arthritis is not necessarily comparisons of agents, but rather the strategy of tight control, aiming for remission,” Dr. Tuulikki Sokka and Dr. Theodore Pincus stated in an editorial.

Patients with rheumatoid arthritis have substantially better clinical status now than did their peers 2-3 decades ago, they noted. However, most of the improved status cannot be attributed to the use of biologic agents; improved clinical status began in 2000, before the availability of biologic agents, according to Dr. Sokka, a rheumatologist at Jyväskylä (Finland) Central Hospital, and Dr. Pincus of New York University Medical Center (Lancet 2009;374:430-2).

In addition, trials showing the most impressive results do not always involve biologic agents. Finally, findings from earlier trials comparing methotrexate monotherapy to methotrexate used in combination with a biologic suggest that many patients have clinical and radiologic responses to methotrexate that are as favorable as those to biologic agents or combinations, Dr. Sokka and Dr. Pincus said.

The Swedish Rheumatism Association and Schering-Plough provided funding for the SWEFOT study. The investigators declared no financial conflict of interest.

Color-enhanced X-ray of hands showing severe rheumatoid arthritis. Swelling and bone deformation (pink) is seen in finger joints between metacarpal and phalanges bones, and between the phalanges bones themselves. Most joints are ragged due to bone erosion, with the thumbs also affected.

Source ©2009 PHOTO RESEARCHERS, INC.

NEW YORK — Young women bear the greatest relative risk of atherosclerotic disease in lupus. However, advice on managing cardiovascular disease is not evidence based. Rather, rheumatologists must rely largely on data from studies of heart disease in other high-risk groups and on the collective wisdom of rheumatologists who are experienced in managing cardiovascular disease in patients with lupus.

Consider giving lupus patients a baby aspirin a day, as she does, Dr. Susan Manzi suggested at a rheumatology seminar sponsored by New York University Hospital for Joint Diseases. Although the data have not shown it to lessen the MI risk in women as it does in men, it does protect them somewhat against stroke.

Despite the scant data on effective management of cardiovascular disease (CVD) in lupus, there are ample data on CVD prevalence among women in general and those with lupus in particular. About one-third of deaths in lupus occur in patients who are younger than 45 years of age. And one-third of those deaths are due to atherosclerosis. In some of her earlier epidemiologic research, Dr. Manzi, director of the Lupus Center of Excellence at the University of Pittsburgh, compared the rate of MI in a cohort of 498 women with lupus to that reported among 2,208 women in the Framingham heart study who did not have lupus. (Am. J. Epidemiol. 1997;145:408-15). In 35- to 44-year-olds, lupus women had a 50-fold increased risk of MI. After age 44, as women entered menopause, those with lupus were still two to four times more likely to have an MI as were those without lupus, she said.

Subclinical atherosclerotic disease is likewise more prevalent in patients with lupus. In one study of 197 lupus patients and a equal number of controls, findings from carotid ultrasonography showed that 37% of lupus patients vs. 15% of controls had asymptomatic carotid plaque (N. Engl. J. Med. 2003;349:2399-406).

Other data show that women with lupus are more likely than their lupus-free peers to have progressive atherosclerosis. Serial carotid artery ultrasound exams of 217 patients with lupus (mean age at baseline, 45 years) and 104 age- and sex-matched controls showed that plaque was present at baseline in 31% of the lupus patients and 17% of controls. At follow-up, 40% of lupus patients had plaque, compared with 20% of controls; interval between scans was 4 years for patients and 5 years for controls. Plaque had progressed in 27% of the lupus patients and only 10% of controls (Arthritis Rheum. 2008;58:835-42).

The ultimate question has been whether atherosclerotic disease detected on imaging predicts future events in patients with lupus. In a study recently presented at the ACR meeting in 2008, the presence of carotid plaque and greater intima-media thickness predicted the time to incident stroke, MI, cardiovascular accident, or coronary artery bypass graft over a 10-year period in 289 patients with lupus. This suggests that these measures may be used as surrogate end points in future clinical trials.

NEW YORK — Young women bear the greatest relative risk of atherosclerotic disease in lupus. However, advice on managing cardiovascular disease is not evidence based. Rather, rheumatologists must rely largely on data from studies of heart disease in other high-risk groups and on the collective wisdom of rheumatologists who are experienced in managing cardiovascular disease in patients with lupus.

Consider giving lupus patients a baby aspirin a day, as she does, Dr. Susan Manzi suggested at a rheumatology seminar sponsored by New York University Hospital for Joint Diseases. Although the data have not shown it to lessen the MI risk in women as it does in men, it does protect them somewhat against stroke.

Despite the scant data on effective management of cardiovascular disease (CVD) in lupus, there are ample data on CVD prevalence among women in general and those with lupus in particular. About one-third of deaths in lupus occur in patients who are younger than 45 years of age. And one-third of those deaths are due to atherosclerosis. In some of her earlier epidemiologic research, Dr. Manzi, director of the Lupus Center of Excellence at the University of Pittsburgh, compared the rate of MI in a cohort of 498 women with lupus to that reported among 2,208 women in the Framingham heart study who did not have lupus. (Am. J. Epidemiol. 1997;145:408-15). In 35- to 44-year-olds, lupus women had a 50-fold increased risk of MI. After age 44, as women entered menopause, those with lupus were still two to four times more likely to have an MI as were those without lupus, she said.

Subclinical atherosclerotic disease is likewise more prevalent in patients with lupus. In one study of 197 lupus patients and a equal number of controls, findings from carotid ultrasonography showed that 37% of lupus patients vs. 15% of controls had asymptomatic carotid plaque (N. Engl. J. Med. 2003;349:2399-406).

Other data show that women with lupus are more likely than their lupus-free peers to have progressive atherosclerosis. Serial carotid artery ultrasound exams of 217 patients with lupus (mean age at baseline, 45 years) and 104 age- and sex-matched controls showed that plaque was present at baseline in 31% of the lupus patients and 17% of controls. At follow-up, 40% of lupus patients had plaque, compared with 20% of controls; interval between scans was 4 years for patients and 5 years for controls. Plaque had progressed in 27% of the lupus patients and only 10% of controls (Arthritis Rheum. 2008;58:835-42).

The ultimate question has been whether atherosclerotic disease detected on imaging predicts future events in patients with lupus. In a study recently presented at the ACR meeting in 2008, the presence of carotid plaque and greater intima-media thickness predicted the time to incident stroke, MI, cardiovascular accident, or coronary artery bypass graft over a 10-year period in 289 patients with lupus. This suggests that these measures may be used as surrogate end points in future clinical trials.

NEW YORK — Young women bear the greatest relative risk of atherosclerotic disease in lupus. However, advice on managing cardiovascular disease is not evidence based. Rather, rheumatologists must rely largely on data from studies of heart disease in other high-risk groups and on the collective wisdom of rheumatologists who are experienced in managing cardiovascular disease in patients with lupus.

Consider giving lupus patients a baby aspirin a day, as she does, Dr. Susan Manzi suggested at a rheumatology seminar sponsored by New York University Hospital for Joint Diseases. Although the data have not shown it to lessen the MI risk in women as it does in men, it does protect them somewhat against stroke.

Despite the scant data on effective management of cardiovascular disease (CVD) in lupus, there are ample data on CVD prevalence among women in general and those with lupus in particular. About one-third of deaths in lupus occur in patients who are younger than 45 years of age. And one-third of those deaths are due to atherosclerosis. In some of her earlier epidemiologic research, Dr. Manzi, director of the Lupus Center of Excellence at the University of Pittsburgh, compared the rate of MI in a cohort of 498 women with lupus to that reported among 2,208 women in the Framingham heart study who did not have lupus. (Am. J. Epidemiol. 1997;145:408-15). In 35- to 44-year-olds, lupus women had a 50-fold increased risk of MI. After age 44, as women entered menopause, those with lupus were still two to four times more likely to have an MI as were those without lupus, she said.

Subclinical atherosclerotic disease is likewise more prevalent in patients with lupus. In one study of 197 lupus patients and a equal number of controls, findings from carotid ultrasonography showed that 37% of lupus patients vs. 15% of controls had asymptomatic carotid plaque (N. Engl. J. Med. 2003;349:2399-406).

Other data show that women with lupus are more likely than their lupus-free peers to have progressive atherosclerosis. Serial carotid artery ultrasound exams of 217 patients with lupus (mean age at baseline, 45 years) and 104 age- and sex-matched controls showed that plaque was present at baseline in 31% of the lupus patients and 17% of controls. At follow-up, 40% of lupus patients had plaque, compared with 20% of controls; interval between scans was 4 years for patients and 5 years for controls. Plaque had progressed in 27% of the lupus patients and only 10% of controls (Arthritis Rheum. 2008;58:835-42).

The ultimate question has been whether atherosclerotic disease detected on imaging predicts future events in patients with lupus. In a study recently presented at the ACR meeting in 2008, the presence of carotid plaque and greater intima-media thickness predicted the time to incident stroke, MI, cardiovascular accident, or coronary artery bypass graft over a 10-year period in 289 patients with lupus. This suggests that these measures may be used as surrogate end points in future clinical trials.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels would be likely to benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years, but it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although, strictly speaking, the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, associate director of clinical and translational sciences in the division of rheumatology at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a DMARD in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity (Lancet 2004;363:2015-21).

Cardiovascular disease is the leading cause of death in patients with RA, and is estimated to account for 50% of mortality in that group. Mounting evidence suggests that the inflammation of the RA disease process acts on coronary vessels, increasing fatty streak deposition and contributing to the accumulation and possible rupture of plaque, Dr. Greenberg noted.

Findings from recent studies suggest that RA patients are more likely than other patients with CVD to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given RA patients' increased risk for CVD and its propensity for atypical presentation, physicians must increase their vigilance to identify risk factors and intervene to lower them, he said. In addition to statin therapy, RA patients are likely to benefit from smoking cessation. Like other patients with CVD, they also should be advised to lose weight.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels would be likely to benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years, but it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although, strictly speaking, the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, associate director of clinical and translational sciences in the division of rheumatology at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a DMARD in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity (Lancet 2004;363:2015-21).

Cardiovascular disease is the leading cause of death in patients with RA, and is estimated to account for 50% of mortality in that group. Mounting evidence suggests that the inflammation of the RA disease process acts on coronary vessels, increasing fatty streak deposition and contributing to the accumulation and possible rupture of plaque, Dr. Greenberg noted.

Findings from recent studies suggest that RA patients are more likely than other patients with CVD to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given RA patients' increased risk for CVD and its propensity for atypical presentation, physicians must increase their vigilance to identify risk factors and intervene to lower them, he said. In addition to statin therapy, RA patients are likely to benefit from smoking cessation. Like other patients with CVD, they also should be advised to lose weight.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels would be likely to benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years, but it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although, strictly speaking, the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, associate director of clinical and translational sciences in the division of rheumatology at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a DMARD in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity (Lancet 2004;363:2015-21).

Cardiovascular disease is the leading cause of death in patients with RA, and is estimated to account for 50% of mortality in that group. Mounting evidence suggests that the inflammation of the RA disease process acts on coronary vessels, increasing fatty streak deposition and contributing to the accumulation and possible rupture of plaque, Dr. Greenberg noted.

Findings from recent studies suggest that RA patients are more likely than other patients with CVD to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given RA patients' increased risk for CVD and its propensity for atypical presentation, physicians must increase their vigilance to identify risk factors and intervene to lower them, he said. In addition to statin therapy, RA patients are likely to benefit from smoking cessation. Like other patients with CVD, they also should be advised to lose weight.

NEW YORK — Self-administered disease and functional status questionnaires accurately reflect disease activity in rheumatic conditions and—when incorporated in the chart—can be used to document compliance with Medicare Product Quality Research Initiatives.

In 2009, the Centers for Medicare and Medicaid Services added five PQRI measures relevant to the management of patients with rheumatoid arthritis: 176 (tuberculosis screening), 177 (periodic assessment of disease activity), 178 (functional status assessment), 179 (assessment/classification of disease prognosis), and 180 (glucocorticoid measurement). A sixth rheumatology-relevant measure that was introduced this year is 109 (assessment of pain and function in osteoarthritis), according to Dr. Yusuf Yazici, director of the Seligman Center for Advanced Therapeutics at New York University Hospital for Joint Diseases in New York.

Rheumatologists who can document that they have recorded three of these measures in roughly 80% of their patients in the calendar year are entitled to receive an amount equal to 2% of their total Medicare billings for that year. This is a time-limited incentive program. After the third year, rheumatologists must document adherence to these performance measures, and failure to do so may result in a punitive decrease in their Medicare payment, said Dr. Yazici, who made these observations during a presentation at a rheumatology meeting sponsored by New York University.

In addition to the benefits of providing data to the CMS, keeping functional assessment data in the patients' charts helps to document to private insurers that patients on biologics need to continue therapy with those agents. “In New York, and perhaps some other states, private insurers are requiring proof of improved function before they will pay to cover renewal of biologic therapy,” Dr. Yazici said. When the functional assessment shows no improvement, that data can be used to justify switching to another biologic, he noted.

CMS will accept a number of existing, validated disease activity or functional status tools for PQRI. Dr. Yazici praised this decision for its responsiveness to the requests of rheumatologists.

In his practice, Dr. Yazici favors the RAPID 3 (Routine Assessment of Patient Index Data 3), which is derived from the patient-administered MDHAQ (Multidimensional Health Assessment Questionnaire). Information about the MDHAQ and RAPID 3 tests is available at http://mdhaq.org

Dr. Yazici reported that the MDHAQ is reliable and easy to administer at routine patient care. Using the functional score, pain score, and global assessment on the MDHAQ, the clinician can calculate a RAPID 3 score, which can be used to monitor disease activity.

RAPID 3 correlated well with the DAS28 (Disease Activity Score 28). In one study that compared the predictive value of each assessment tool in 274 patients from three clinical sites, only 1 patient who was classified as being in near remission on RAPID 3 was also classified as having high disease activity on DAS28. Conversely, 10 patients who were classified as having high disease severity on RAPID 3 were classified as being in remission on DAS28.

In Dr. Yazici's practice, every patient fills out the MDHAQ at every visit. “If there is a reason to see the patient, there is a reason for the patient to fill out the questionnaire and for physicians to collect the data, even if the patient has come in for a weekly infusion/injection,” he said.

Dr. Yazici reported being a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Roche, and UCB SA.

If patients need to come into the office for any reason, they should fill out the functional assessment form. DR. YAZICI

NEW YORK — Self-administered disease and functional status questionnaires accurately reflect disease activity in rheumatic conditions and—when incorporated in the chart—can be used to document compliance with Medicare Product Quality Research Initiatives.

In 2009, the Centers for Medicare and Medicaid Services added five PQRI measures relevant to the management of patients with rheumatoid arthritis: 176 (tuberculosis screening), 177 (periodic assessment of disease activity), 178 (functional status assessment), 179 (assessment/classification of disease prognosis), and 180 (glucocorticoid measurement). A sixth rheumatology-relevant measure that was introduced this year is 109 (assessment of pain and function in osteoarthritis), according to Dr. Yusuf Yazici, director of the Seligman Center for Advanced Therapeutics at New York University Hospital for Joint Diseases in New York.

Rheumatologists who can document that they have recorded three of these measures in roughly 80% of their patients in the calendar year are entitled to receive an amount equal to 2% of their total Medicare billings for that year. This is a time-limited incentive program. After the third year, rheumatologists must document adherence to these performance measures, and failure to do so may result in a punitive decrease in their Medicare payment, said Dr. Yazici, who made these observations during a presentation at a rheumatology meeting sponsored by New York University.

In addition to the benefits of providing data to the CMS, keeping functional assessment data in the patients' charts helps to document to private insurers that patients on biologics need to continue therapy with those agents. “In New York, and perhaps some other states, private insurers are requiring proof of improved function before they will pay to cover renewal of biologic therapy,” Dr. Yazici said. When the functional assessment shows no improvement, that data can be used to justify switching to another biologic, he noted.

CMS will accept a number of existing, validated disease activity or functional status tools for PQRI. Dr. Yazici praised this decision for its responsiveness to the requests of rheumatologists.

In his practice, Dr. Yazici favors the RAPID 3 (Routine Assessment of Patient Index Data 3), which is derived from the patient-administered MDHAQ (Multidimensional Health Assessment Questionnaire). Information about the MDHAQ and RAPID 3 tests is available at http://mdhaq.org

Dr. Yazici reported that the MDHAQ is reliable and easy to administer at routine patient care. Using the functional score, pain score, and global assessment on the MDHAQ, the clinician can calculate a RAPID 3 score, which can be used to monitor disease activity.

RAPID 3 correlated well with the DAS28 (Disease Activity Score 28). In one study that compared the predictive value of each assessment tool in 274 patients from three clinical sites, only 1 patient who was classified as being in near remission on RAPID 3 was also classified as having high disease activity on DAS28. Conversely, 10 patients who were classified as having high disease severity on RAPID 3 were classified as being in remission on DAS28.

In Dr. Yazici's practice, every patient fills out the MDHAQ at every visit. “If there is a reason to see the patient, there is a reason for the patient to fill out the questionnaire and for physicians to collect the data, even if the patient has come in for a weekly infusion/injection,” he said.

Dr. Yazici reported being a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Roche, and UCB SA.

If patients need to come into the office for any reason, they should fill out the functional assessment form. DR. YAZICI

NEW YORK — Self-administered disease and functional status questionnaires accurately reflect disease activity in rheumatic conditions and—when incorporated in the chart—can be used to document compliance with Medicare Product Quality Research Initiatives.

In 2009, the Centers for Medicare and Medicaid Services added five PQRI measures relevant to the management of patients with rheumatoid arthritis: 176 (tuberculosis screening), 177 (periodic assessment of disease activity), 178 (functional status assessment), 179 (assessment/classification of disease prognosis), and 180 (glucocorticoid measurement). A sixth rheumatology-relevant measure that was introduced this year is 109 (assessment of pain and function in osteoarthritis), according to Dr. Yusuf Yazici, director of the Seligman Center for Advanced Therapeutics at New York University Hospital for Joint Diseases in New York.

Rheumatologists who can document that they have recorded three of these measures in roughly 80% of their patients in the calendar year are entitled to receive an amount equal to 2% of their total Medicare billings for that year. This is a time-limited incentive program. After the third year, rheumatologists must document adherence to these performance measures, and failure to do so may result in a punitive decrease in their Medicare payment, said Dr. Yazici, who made these observations during a presentation at a rheumatology meeting sponsored by New York University.

In addition to the benefits of providing data to the CMS, keeping functional assessment data in the patients' charts helps to document to private insurers that patients on biologics need to continue therapy with those agents. “In New York, and perhaps some other states, private insurers are requiring proof of improved function before they will pay to cover renewal of biologic therapy,” Dr. Yazici said. When the functional assessment shows no improvement, that data can be used to justify switching to another biologic, he noted.

CMS will accept a number of existing, validated disease activity or functional status tools for PQRI. Dr. Yazici praised this decision for its responsiveness to the requests of rheumatologists.

In his practice, Dr. Yazici favors the RAPID 3 (Routine Assessment of Patient Index Data 3), which is derived from the patient-administered MDHAQ (Multidimensional Health Assessment Questionnaire). Information about the MDHAQ and RAPID 3 tests is available at http://mdhaq.org

Dr. Yazici reported that the MDHAQ is reliable and easy to administer at routine patient care. Using the functional score, pain score, and global assessment on the MDHAQ, the clinician can calculate a RAPID 3 score, which can be used to monitor disease activity.

RAPID 3 correlated well with the DAS28 (Disease Activity Score 28). In one study that compared the predictive value of each assessment tool in 274 patients from three clinical sites, only 1 patient who was classified as being in near remission on RAPID 3 was also classified as having high disease activity on DAS28. Conversely, 10 patients who were classified as having high disease severity on RAPID 3 were classified as being in remission on DAS28.

In Dr. Yazici's practice, every patient fills out the MDHAQ at every visit. “If there is a reason to see the patient, there is a reason for the patient to fill out the questionnaire and for physicians to collect the data, even if the patient has come in for a weekly infusion/injection,” he said.

Dr. Yazici reported being a consultant and/or speaker for Bristol-Myers Squibb Co., Celgene Corp., Centocor Inc., Genentech Inc., Roche, and UCB SA.

If patients need to come into the office for any reason, they should fill out the functional assessment form. DR. YAZICI

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels may benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years; however, it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although strictly speaking one might say that the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg. Rheumatologists need to extrapolate what they can from such large and potentially applicable trials, as well as from available and relevant observational studies.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, a rheumatologist at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a disease-modifying antirheumatic drug in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity. About 30% of patients had a 50% reduction in their CRP (Lancet 2004;363:2015-21).

Findings from recent studies suggest that RA patients are more likely than other patients with cardiovascular disease to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given their patients' increased risk for CVD and its propensity for atypical presentation, rheumatologists must increase their vigilance to identify risk factors and intervene to lower them, he said.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels may benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years; however, it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although strictly speaking one might say that the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg. Rheumatologists need to extrapolate what they can from such large and potentially applicable trials, as well as from available and relevant observational studies.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, a rheumatologist at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a disease-modifying antirheumatic drug in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity. About 30% of patients had a 50% reduction in their CRP (Lancet 2004;363:2015-21).

Findings from recent studies suggest that RA patients are more likely than other patients with cardiovascular disease to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given their patients' increased risk for CVD and its propensity for atypical presentation, rheumatologists must increase their vigilance to identify risk factors and intervene to lower them, he said.

NEW YORK — Patients with rheumatoid arthritis and elevated C-reactive protein levels may benefit from treatment with a statin to lower their CRP levels and consequently their risk for a cardiovascular event, regardless of their cholesterol levels, according to Dr. Jeffrey Greenberg.

This insight comes from a review of data from the 2008 JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study of almost 18,000 people, all of whom had high-sensitivity CRP (hs-CRP) levels above 2 mg/L, but relatively normal LDL cholesterol levels of less than 130 mg/dL. They were randomized to either 20 mg rosuvastatin or placebo.

The trial planned to run 5 years; however, it was stopped after 2 years when the statin dropped LDL cholesterol levels by 50% on average, while CRP levels dropped by 37%. Of clinical note, the patients on the statin had significantly fewer episodes of nonfatal myocardial infarction, any MI, nonfatal stroke, and any stroke (N. Engl. J. Med. 2008;359:2195-207).

Although strictly speaking one might say that the findings from JUPITER cannot be extrapolated to rheumatoid arthritis patients, “clinical trials of this magnitude are rarely conducted in RA populations,” noted Dr. Greenberg. Rheumatologists need to extrapolate what they can from such large and potentially applicable trials, as well as from available and relevant observational studies.

Another compelling finding concerning the role of hs-CRP in increasing heart disease risk emerged after Dr. Greenberg's presentation: It was reported from the American College of Cardiology's annual meeting that JUPITER investigators doing subset analysis said that the effect of the statin on lowering the risk for cardiac events stemmed from its hs-CRP-lowering properties, rather than from its effect on cholesterol.

During his presentation, Dr. Greenberg, a rheumatologist at New York University Medical Center, reviewed an earlier trial's findings suggesting that statins can act like a disease-modifying antirheumatic drug in RA. TARA (Trial of Atorvastatin in Rheumatoid Arthritis) involved 116 patients, randomized to placebo or 40 mg atorvastatin for 6 months. All patients were on DMARD therapy and some were taking a corticosteroid. Use of a statin reduced all components of their disease activity score, including erythrocyte sedimentation rate, hs-CRP level, swollen joint count, and plasma viscosity. About 30% of patients had a 50% reduction in their CRP (Lancet 2004;363:2015-21).

Findings from recent studies suggest that RA patients are more likely than other patients with cardiovascular disease to have silent myocardial infarctions and sudden death (Arthritis Rheum. 2005;52:402-11). Another study found that RA patients who present with acute coronary syndrome may be more likely than other patients to have a second event and not to survive it (Ann. Rheum. Dis. 2006;65:348-53).

Given their patients' increased risk for CVD and its propensity for atypical presentation, rheumatologists must increase their vigilance to identify risk factors and intervene to lower them, he said.

SAN FRANCISCO — The majority of vascular events that occur early in the course of systemic lupus erythematosus cannot be attributed to atherosclerosis, judging from the results of an ongoing multinational study.

The inception cohort included 1,249 patients who enrolled in the study within a year of receiving a diagnosis of SLE. During the first 8 years of follow-up, 72 patients had 97 vascular events. Among these were 24 cases of heart failure, 23 strokes, 15 cases of angina, 13 MIs, 13 transient ischemic accidents (TIAs), and 9 cases of peripheral vascular disease (PVD).

Of these 97 events, 31 were attributable to atherosclerosis, said Dr. Murray B. Urowitz, who presented the findings at the annual meeting of the American College of Rheumatology. An event was attributed to atherosclerosis if it occurred when SLE was inactive or if atherosclerotic changes were identified on imaging or pathology.

The events that could not be attributed to atherosclerosis occurred during a phase of active lupus in 50 cases; the remaining 16 vascular events had known causes such as fluid overload, pregnancy, or coagulation disorders. The 31 events attributable to atherosclerosis occurred in 22 of the lupus patients and included 12 cases of angina, 8 MIs, 5 cases of heart failure, 4 PVDs, and 2 TIAs.

The 22 patients who developed symptomatic early ath-erosclerosis during the first 2 years of follow-up were more likely to be male, be older at lupus diagnosis, have hypertension, and be obese than were the 661 cohort members who did not have symptomatic atherosclerosis, said Dr. Urowitz, a rheumatologist at Toronto Western Hospital and a participant in the Systemic Lupus International Collaborating Clinics.

The 22 participants with atherosclerosis were also more likely to have high serum cholesterol levels and/or diabetes, be smokers, and have a family history of coronary artery disease, but these were not significant.

The participants were enrolled between 2000 and 2008; 89% were women. Whites accounted for 49%; 15% were black, 16% Hispanic, 16% Asian, and 4% other. Mean age at lupus diagnosis was 34; disease duration at the end of follow-up was 5.5 years. About 70% had been on steroid therapy, 40% had taken immunosuppressants, and 63% had used antimalarials.

SAN FRANCISCO — The majority of vascular events that occur early in the course of systemic lupus erythematosus cannot be attributed to atherosclerosis, judging from the results of an ongoing multinational study.

The inception cohort included 1,249 patients who enrolled in the study within a year of receiving a diagnosis of SLE. During the first 8 years of follow-up, 72 patients had 97 vascular events. Among these were 24 cases of heart failure, 23 strokes, 15 cases of angina, 13 MIs, 13 transient ischemic accidents (TIAs), and 9 cases of peripheral vascular disease (PVD).

Of these 97 events, 31 were attributable to atherosclerosis, said Dr. Murray B. Urowitz, who presented the findings at the annual meeting of the American College of Rheumatology. An event was attributed to atherosclerosis if it occurred when SLE was inactive or if atherosclerotic changes were identified on imaging or pathology.

The events that could not be attributed to atherosclerosis occurred during a phase of active lupus in 50 cases; the remaining 16 vascular events had known causes such as fluid overload, pregnancy, or coagulation disorders. The 31 events attributable to atherosclerosis occurred in 22 of the lupus patients and included 12 cases of angina, 8 MIs, 5 cases of heart failure, 4 PVDs, and 2 TIAs.

The 22 patients who developed symptomatic early ath-erosclerosis during the first 2 years of follow-up were more likely to be male, be older at lupus diagnosis, have hypertension, and be obese than were the 661 cohort members who did not have symptomatic atherosclerosis, said Dr. Urowitz, a rheumatologist at Toronto Western Hospital and a participant in the Systemic Lupus International Collaborating Clinics.

The 22 participants with atherosclerosis were also more likely to have high serum cholesterol levels and/or diabetes, be smokers, and have a family history of coronary artery disease, but these were not significant.

The participants were enrolled between 2000 and 2008; 89% were women. Whites accounted for 49%; 15% were black, 16% Hispanic, 16% Asian, and 4% other. Mean age at lupus diagnosis was 34; disease duration at the end of follow-up was 5.5 years. About 70% had been on steroid therapy, 40% had taken immunosuppressants, and 63% had used antimalarials.

SAN FRANCISCO — The majority of vascular events that occur early in the course of systemic lupus erythematosus cannot be attributed to atherosclerosis, judging from the results of an ongoing multinational study.

The inception cohort included 1,249 patients who enrolled in the study within a year of receiving a diagnosis of SLE. During the first 8 years of follow-up, 72 patients had 97 vascular events. Among these were 24 cases of heart failure, 23 strokes, 15 cases of angina, 13 MIs, 13 transient ischemic accidents (TIAs), and 9 cases of peripheral vascular disease (PVD).

Of these 97 events, 31 were attributable to atherosclerosis, said Dr. Murray B. Urowitz, who presented the findings at the annual meeting of the American College of Rheumatology. An event was attributed to atherosclerosis if it occurred when SLE was inactive or if atherosclerotic changes were identified on imaging or pathology.

The events that could not be attributed to atherosclerosis occurred during a phase of active lupus in 50 cases; the remaining 16 vascular events had known causes such as fluid overload, pregnancy, or coagulation disorders. The 31 events attributable to atherosclerosis occurred in 22 of the lupus patients and included 12 cases of angina, 8 MIs, 5 cases of heart failure, 4 PVDs, and 2 TIAs.

The 22 patients who developed symptomatic early ath-erosclerosis during the first 2 years of follow-up were more likely to be male, be older at lupus diagnosis, have hypertension, and be obese than were the 661 cohort members who did not have symptomatic atherosclerosis, said Dr. Urowitz, a rheumatologist at Toronto Western Hospital and a participant in the Systemic Lupus International Collaborating Clinics.

The 22 participants with atherosclerosis were also more likely to have high serum cholesterol levels and/or diabetes, be smokers, and have a family history of coronary artery disease, but these were not significant.

The participants were enrolled between 2000 and 2008; 89% were women. Whites accounted for 49%; 15% were black, 16% Hispanic, 16% Asian, and 4% other. Mean age at lupus diagnosis was 34; disease duration at the end of follow-up was 5.5 years. About 70% had been on steroid therapy, 40% had taken immunosuppressants, and 63% had used antimalarials.

SAN FRANCISCO — Proinflammatory HDL cholesterol has promise as a biomarker for atherosclerosis in women with systemic lupus erythematosus.

Findings from a study of 274 women with systemic lupus erythematosus (SLE) and 154 age-matched controls showed that serum levels of proinflammatory HDL cholesterol were likely to be elevated in women found by B-mode ultrasound to have thickened carotid intima, indicative of plaque. Although this association was noted in both the women with SLE and controls, it was stronger in the women with lupus, said Dr. Maureen A. McMahon, a rheumatologist at the Ronald Reagan UCLA Medical Center, Los Angeles.

In particular, carotid artery plaque was found in 16% of the women with lupus and 15% of the women in the control group. Of the women with lupus who had plaque, 80% had measurable proinflammatory HDL cholesterol, compared with 43% of the women with SLE but no plaque. Proinflammatory HDL was found in 44% of the healthy women with plaque, compared with 10% of healthy plaque-free women.

The mean carotid intimal thickness was 0.57 mm

Women with SLE had significantly higher rates of hypertension and diabetes, compared with the controls on univariate analysis. However, age and current cigarette smoking were the only other significant risk factors for plaque in these women, according to multivariate analysis, Dr. McMahon said at the annual meeting of the American College of Rheumatology.

Paraoxonase (PON) activity or apolipoprotein A-I did not predict atherosclerosis. Traditional risk factors for atherosclerosis such as hypertension, LDL cholesterol, and other protective components for HDL cholesterol were found not to be surrogates for proinflammatory HDL.

Women with SLE have long been known to have an unexplained increased risk for atherosclerosis. Until now, the underlying mechanisms have not been explained.

None of the women had taken statins within the 3 months preceding the study.

Levels of proinflammatory HDL cholesterol are “remarkably stable” in women with lupus, Dr. McMahon said. Thus, levels do not increase and decrease depending on disease activity, she added, noting this has is not the case in RA.

Dr. McMahon reported that she has no financial conflicts of interest.

SAN FRANCISCO — Proinflammatory HDL cholesterol has promise as a biomarker for atherosclerosis in women with systemic lupus erythematosus.

Findings from a study of 274 women with systemic lupus erythematosus (SLE) and 154 age-matched controls showed that serum levels of proinflammatory HDL cholesterol were likely to be elevated in women found by B-mode ultrasound to have thickened carotid intima, indicative of plaque. Although this association was noted in both the women with SLE and controls, it was stronger in the women with lupus, said Dr. Maureen A. McMahon, a rheumatologist at the Ronald Reagan UCLA Medical Center, Los Angeles.

In particular, carotid artery plaque was found in 16% of the women with lupus and 15% of the women in the control group. Of the women with lupus who had plaque, 80% had measurable proinflammatory HDL cholesterol, compared with 43% of the women with SLE but no plaque. Proinflammatory HDL was found in 44% of the healthy women with plaque, compared with 10% of healthy plaque-free women.

The mean carotid intimal thickness was 0.57 mm

Women with SLE had significantly higher rates of hypertension and diabetes, compared with the controls on univariate analysis. However, age and current cigarette smoking were the only other significant risk factors for plaque in these women, according to multivariate analysis, Dr. McMahon said at the annual meeting of the American College of Rheumatology.

Paraoxonase (PON) activity or apolipoprotein A-I did not predict atherosclerosis. Traditional risk factors for atherosclerosis such as hypertension, LDL cholesterol, and other protective components for HDL cholesterol were found not to be surrogates for proinflammatory HDL.

Women with SLE have long been known to have an unexplained increased risk for atherosclerosis. Until now, the underlying mechanisms have not been explained.

None of the women had taken statins within the 3 months preceding the study.

Levels of proinflammatory HDL cholesterol are “remarkably stable” in women with lupus, Dr. McMahon said. Thus, levels do not increase and decrease depending on disease activity, she added, noting this has is not the case in RA.

Dr. McMahon reported that she has no financial conflicts of interest.

SAN FRANCISCO — Proinflammatory HDL cholesterol has promise as a biomarker for atherosclerosis in women with systemic lupus erythematosus.

Findings from a study of 274 women with systemic lupus erythematosus (SLE) and 154 age-matched controls showed that serum levels of proinflammatory HDL cholesterol were likely to be elevated in women found by B-mode ultrasound to have thickened carotid intima, indicative of plaque. Although this association was noted in both the women with SLE and controls, it was stronger in the women with lupus, said Dr. Maureen A. McMahon, a rheumatologist at the Ronald Reagan UCLA Medical Center, Los Angeles.

In particular, carotid artery plaque was found in 16% of the women with lupus and 15% of the women in the control group. Of the women with lupus who had plaque, 80% had measurable proinflammatory HDL cholesterol, compared with 43% of the women with SLE but no plaque. Proinflammatory HDL was found in 44% of the healthy women with plaque, compared with 10% of healthy plaque-free women.

The mean carotid intimal thickness was 0.57 mm

Women with SLE had significantly higher rates of hypertension and diabetes, compared with the controls on univariate analysis. However, age and current cigarette smoking were the only other significant risk factors for plaque in these women, according to multivariate analysis, Dr. McMahon said at the annual meeting of the American College of Rheumatology.

Paraoxonase (PON) activity or apolipoprotein A-I did not predict atherosclerosis. Traditional risk factors for atherosclerosis such as hypertension, LDL cholesterol, and other protective components for HDL cholesterol were found not to be surrogates for proinflammatory HDL.

Women with SLE have long been known to have an unexplained increased risk for atherosclerosis. Until now, the underlying mechanisms have not been explained.

None of the women had taken statins within the 3 months preceding the study.

Levels of proinflammatory HDL cholesterol are “remarkably stable” in women with lupus, Dr. McMahon said. Thus, levels do not increase and decrease depending on disease activity, she added, noting this has is not the case in RA.

Dr. McMahon reported that she has no financial conflicts of interest.

SAN FRANCISCO — Systemic lupus erythematosus more than doubles a woman's relative risk for cardiovascular disease beyond the effect of traditional determinants, judging from the Nurses Health Study findings.

Earlier research reports have found a significantly greater than twofold increased risk for cardiovascular disease in women with lupus. However, those studies examined risk in lupus populations receiving care at tertiary care centers. The data from this study came from a study of the general population, according to investigator Dr. A. Elisabeth Hak.

The Nurses Health Study includes 121,700 women who enrolled in the prospective cohort study in 1976, when they were between 30 and 55 years old. They had no cardiovascular disease (CVD) or SLE at enrollment. Over 28 years, 148 developed SLE. Hypertension, diabetes, family history of CVD, and NSAID use were more common in the women with SLE and heart disease than in the SLE-free women with heart disease.

There were 20 cases of CVD (16 cases of heart disease and 4 strokes) among the women with SLE and 8,149 (6,254 cases of heart disease and 1,895 strokes) among the non-SLE group, said Dr. Hak, reporting on the investigation she conducted while at Brigham and Women's Hospital, Boston. Based on follow-up of 2,082 person-years for the women with SLE and 2,932,407 person-years for the SLE-free women, the incidence of CVD was 961 cases per 100,000 person-years for the SLE group and 271 per 100,000 person-years for the non-SLE group.

The age-adjusted relative risk for CVD was 2.75 in the SLE group, versus the non-SLE group. The multivariate-adjusted relative risk was 2.26 in the SLE women relative to the women without SLE after controlling for medication use, age, hypertension, race, diabetes, and serum lipid levels, reported Dr. Hak, now at Erasmus University Medical Centre, Rotterdam (the Netherlands).

The fact that the study enrolled women aged 30–55 years means that it excluded those with younger-onset SLE, in whom CVD may have been more common and severe, she noted at the annual meeting of the American College of Rheumatology. The findings also may have been affected by the fact that the cohort is overwhelmingly white.

Dr. Hak reported having no financial conflicts of interest.

SAN FRANCISCO — Systemic lupus erythematosus more than doubles a woman's relative risk for cardiovascular disease beyond the effect of traditional determinants, judging from the Nurses Health Study findings.

Earlier research reports have found a significantly greater than twofold increased risk for cardiovascular disease in women with lupus. However, those studies examined risk in lupus populations receiving care at tertiary care centers. The data from this study came from a study of the general population, according to investigator Dr. A. Elisabeth Hak.

The Nurses Health Study includes 121,700 women who enrolled in the prospective cohort study in 1976, when they were between 30 and 55 years old. They had no cardiovascular disease (CVD) or SLE at enrollment. Over 28 years, 148 developed SLE. Hypertension, diabetes, family history of CVD, and NSAID use were more common in the women with SLE and heart disease than in the SLE-free women with heart disease.

There were 20 cases of CVD (16 cases of heart disease and 4 strokes) among the women with SLE and 8,149 (6,254 cases of heart disease and 1,895 strokes) among the non-SLE group, said Dr. Hak, reporting on the investigation she conducted while at Brigham and Women's Hospital, Boston. Based on follow-up of 2,082 person-years for the women with SLE and 2,932,407 person-years for the SLE-free women, the incidence of CVD was 961 cases per 100,000 person-years for the SLE group and 271 per 100,000 person-years for the non-SLE group.

The age-adjusted relative risk for CVD was 2.75 in the SLE group, versus the non-SLE group. The multivariate-adjusted relative risk was 2.26 in the SLE women relative to the women without SLE after controlling for medication use, age, hypertension, race, diabetes, and serum lipid levels, reported Dr. Hak, now at Erasmus University Medical Centre, Rotterdam (the Netherlands).

The fact that the study enrolled women aged 30–55 years means that it excluded those with younger-onset SLE, in whom CVD may have been more common and severe, she noted at the annual meeting of the American College of Rheumatology. The findings also may have been affected by the fact that the cohort is overwhelmingly white.

Dr. Hak reported having no financial conflicts of interest.

SAN FRANCISCO — Systemic lupus erythematosus more than doubles a woman's relative risk for cardiovascular disease beyond the effect of traditional determinants, judging from the Nurses Health Study findings.

Earlier research reports have found a significantly greater than twofold increased risk for cardiovascular disease in women with lupus. However, those studies examined risk in lupus populations receiving care at tertiary care centers. The data from this study came from a study of the general population, according to investigator Dr. A. Elisabeth Hak.

The Nurses Health Study includes 121,700 women who enrolled in the prospective cohort study in 1976, when they were between 30 and 55 years old. They had no cardiovascular disease (CVD) or SLE at enrollment. Over 28 years, 148 developed SLE. Hypertension, diabetes, family history of CVD, and NSAID use were more common in the women with SLE and heart disease than in the SLE-free women with heart disease.

There were 20 cases of CVD (16 cases of heart disease and 4 strokes) among the women with SLE and 8,149 (6,254 cases of heart disease and 1,895 strokes) among the non-SLE group, said Dr. Hak, reporting on the investigation she conducted while at Brigham and Women's Hospital, Boston. Based on follow-up of 2,082 person-years for the women with SLE and 2,932,407 person-years for the SLE-free women, the incidence of CVD was 961 cases per 100,000 person-years for the SLE group and 271 per 100,000 person-years for the non-SLE group.

The age-adjusted relative risk for CVD was 2.75 in the SLE group, versus the non-SLE group. The multivariate-adjusted relative risk was 2.26 in the SLE women relative to the women without SLE after controlling for medication use, age, hypertension, race, diabetes, and serum lipid levels, reported Dr. Hak, now at Erasmus University Medical Centre, Rotterdam (the Netherlands).

The fact that the study enrolled women aged 30–55 years means that it excluded those with younger-onset SLE, in whom CVD may have been more common and severe, she noted at the annual meeting of the American College of Rheumatology. The findings also may have been affected by the fact that the cohort is overwhelmingly white.

Dr. Hak reported having no financial conflicts of interest.

SAN FRANCISCO — Proinflammatory high-density lipoprotein has promise as a biomarker for atherosclerosis in women with systemic lupus erythematosus.

Findings from a study of 274 women with systemic lupus erythematosus (SLE) and 154 age-matched controls showed that serum levels of proinflammatory HDL were likely to be elevated in women found by B-mode ultrasound to have thickened carotid intima, indicative of plaque.

Although this association was noted in both the women with SLE and the healthy controls, the association was stronger in the women with lupus, according to one of the investigators, Dr. Maureen A. McMahon, a rheumatologist at the Ronald Reagan UCLA Medical Center, Los Angeles.

In particular, carotid artery plaque was found in 16% of the women with lupus and 15% of the women in the control group. Of the women with lupus who had plaque, 80% had measurable proinflammatory HDL cholesterol, compared with 43% of the women with SLE but no plaque. Proinflammatory HDL was found in 44% of the healthy women with plaque, compared with 10% of the healthy plaque-free women.

The mean carotid intimal thickness was 0.57 mm

Women with SLE were found to have significantly higher rates of hypertension and diabetes, compared with the control group on univariate analysis. However, age and current cigarette smoking were the only other significant risk factors for plaque in these women, according to findings from multivariate analysis, Dr. McMahon reported at the annual meeting of the American College of Rheumatology.

Paraoxonase (PON) activity or apolipoprotein A-I did not predict atherosclerosis in this study. Traditional risk factors for atherosclerosis such as hypertension, LDL cholesterol, and other protective components for HDL cholesterol were found not to be surrogates for proinflammatory HDL.

Women with SLE have long been observed to have an unexplained increased risk for atherosclerosis. Until now, the underlying mechanisms have not been explained.

None of the women had been taking statins within the 3 months preceding the study.

Levels of proinflammatory HDL cholesterol are “remarkably stable” in women with lupus, Dr. McMahon said in response to a question from the audience. Thus, levels do not increase and decrease depending on disease activity, she added, noting this has not been found to be the case in rheumatoid arthritis patients studied by other investigators.

Dr. McMahon reported that she has no financial conflicts of interest.

SAN FRANCISCO — Proinflammatory high-density lipoprotein has promise as a biomarker for atherosclerosis in women with systemic lupus erythematosus.

Findings from a study of 274 women with systemic lupus erythematosus (SLE) and 154 age-matched controls showed that serum levels of proinflammatory HDL were likely to be elevated in women found by B-mode ultrasound to have thickened carotid intima, indicative of plaque.

Although this association was noted in both the women with SLE and the healthy controls, the association was stronger in the women with lupus, according to one of the investigators, Dr. Maureen A. McMahon, a rheumatologist at the Ronald Reagan UCLA Medical Center, Los Angeles.

In particular, carotid artery plaque was found in 16% of the women with lupus and 15% of the women in the control group. Of the women with lupus who had plaque, 80% had measurable proinflammatory HDL cholesterol, compared with 43% of the women with SLE but no plaque. Proinflammatory HDL was found in 44% of the healthy women with plaque, compared with 10% of the healthy plaque-free women.

The mean carotid intimal thickness was 0.57 mm

Women with SLE were found to have significantly higher rates of hypertension and diabetes, compared with the control group on univariate analysis. However, age and current cigarette smoking were the only other significant risk factors for plaque in these women, according to findings from multivariate analysis, Dr. McMahon reported at the annual meeting of the American College of Rheumatology.

Paraoxonase (PON) activity or apolipoprotein A-I did not predict atherosclerosis in this study. Traditional risk factors for atherosclerosis such as hypertension, LDL cholesterol, and other protective components for HDL cholesterol were found not to be surrogates for proinflammatory HDL.

Women with SLE have long been observed to have an unexplained increased risk for atherosclerosis. Until now, the underlying mechanisms have not been explained.

None of the women had been taking statins within the 3 months preceding the study.

Levels of proinflammatory HDL cholesterol are “remarkably stable” in women with lupus, Dr. McMahon said in response to a question from the audience. Thus, levels do not increase and decrease depending on disease activity, she added, noting this has not been found to be the case in rheumatoid arthritis patients studied by other investigators.

Dr. McMahon reported that she has no financial conflicts of interest.

SAN FRANCISCO — Proinflammatory high-density lipoprotein has promise as a biomarker for atherosclerosis in women with systemic lupus erythematosus.

Findings from a study of 274 women with systemic lupus erythematosus (SLE) and 154 age-matched controls showed that serum levels of proinflammatory HDL were likely to be elevated in women found by B-mode ultrasound to have thickened carotid intima, indicative of plaque.

Although this association was noted in both the women with SLE and the healthy controls, the association was stronger in the women with lupus, according to one of the investigators, Dr. Maureen A. McMahon, a rheumatologist at the Ronald Reagan UCLA Medical Center, Los Angeles.

In particular, carotid artery plaque was found in 16% of the women with lupus and 15% of the women in the control group. Of the women with lupus who had plaque, 80% had measurable proinflammatory HDL cholesterol, compared with 43% of the women with SLE but no plaque. Proinflammatory HDL was found in 44% of the healthy women with plaque, compared with 10% of the healthy plaque-free women.

The mean carotid intimal thickness was 0.57 mm

Women with SLE were found to have significantly higher rates of hypertension and diabetes, compared with the control group on univariate analysis. However, age and current cigarette smoking were the only other significant risk factors for plaque in these women, according to findings from multivariate analysis, Dr. McMahon reported at the annual meeting of the American College of Rheumatology.

Paraoxonase (PON) activity or apolipoprotein A-I did not predict atherosclerosis in this study. Traditional risk factors for atherosclerosis such as hypertension, LDL cholesterol, and other protective components for HDL cholesterol were found not to be surrogates for proinflammatory HDL.

Women with SLE have long been observed to have an unexplained increased risk for atherosclerosis. Until now, the underlying mechanisms have not been explained.

None of the women had been taking statins within the 3 months preceding the study.

Levels of proinflammatory HDL cholesterol are “remarkably stable” in women with lupus, Dr. McMahon said in response to a question from the audience. Thus, levels do not increase and decrease depending on disease activity, she added, noting this has not been found to be the case in rheumatoid arthritis patients studied by other investigators.

Dr. McMahon reported that she has no financial conflicts of interest.