Rheumatoid Arthritis

Key clinical point: The use of combination therapy or biologics was associated with a lower risk for diabetes than methotrexate monotherapy in patients with rheumatoid arthritis (RA), with hydroxychloroquine having a significant protective effect on the development of diabetes.

Major finding: The risk for diabetes was significantly lower in the biologic disease-modifying antirheumatic drug (DMARD) periods (adjusted hazard ratio [aHR] 0.51; 95% CI 0.32-0.83), methotrexate combination periods (aHR 0.50; 95% CI 0.32-0.78), and other conventional DMARD periods (aHR 0.56; 95% CI 0.37-0.84) than in the methotrexate monotherapy periods. Hydroxychloroquine (aHR 0.52; P < .001) and sulfasalazine (aHR 0.69; P  =  .002) had a significant protective effect on diabetes development.

Study details: The data come from a retrospective cohort study that included 5530 adults with RA without diabetes.

Disclosures: This study did not declare any specific funding or conflicts of interest.

Source: Su YJ et al. Disease-modifying anti-rheumatic drugs associated with different diabetes risks in patients with rheumatoid arthritis. RMD Open. 2023;9:e003045 (Jul 17). doi: 10.1136/rmdopen-2023-003045

Key clinical point: The use of combination therapy or biologics was associated with a lower risk for diabetes than methotrexate monotherapy in patients with rheumatoid arthritis (RA), with hydroxychloroquine having a significant protective effect on the development of diabetes.

Major finding: The risk for diabetes was significantly lower in the biologic disease-modifying antirheumatic drug (DMARD) periods (adjusted hazard ratio [aHR] 0.51; 95% CI 0.32-0.83), methotrexate combination periods (aHR 0.50; 95% CI 0.32-0.78), and other conventional DMARD periods (aHR 0.56; 95% CI 0.37-0.84) than in the methotrexate monotherapy periods. Hydroxychloroquine (aHR 0.52; P < .001) and sulfasalazine (aHR 0.69; P  =  .002) had a significant protective effect on diabetes development.

Study details: The data come from a retrospective cohort study that included 5530 adults with RA without diabetes.

Disclosures: This study did not declare any specific funding or conflicts of interest.

Source: Su YJ et al. Disease-modifying anti-rheumatic drugs associated with different diabetes risks in patients with rheumatoid arthritis. RMD Open. 2023;9:e003045 (Jul 17). doi: 10.1136/rmdopen-2023-003045

Key clinical point: The use of combination therapy or biologics was associated with a lower risk for diabetes than methotrexate monotherapy in patients with rheumatoid arthritis (RA), with hydroxychloroquine having a significant protective effect on the development of diabetes.

Major finding: The risk for diabetes was significantly lower in the biologic disease-modifying antirheumatic drug (DMARD) periods (adjusted hazard ratio [aHR] 0.51; 95% CI 0.32-0.83), methotrexate combination periods (aHR 0.50; 95% CI 0.32-0.78), and other conventional DMARD periods (aHR 0.56; 95% CI 0.37-0.84) than in the methotrexate monotherapy periods. Hydroxychloroquine (aHR 0.52; P < .001) and sulfasalazine (aHR 0.69; P  =  .002) had a significant protective effect on diabetes development.

Study details: The data come from a retrospective cohort study that included 5530 adults with RA without diabetes.

Disclosures: This study did not declare any specific funding or conflicts of interest.

Source: Su YJ et al. Disease-modifying anti-rheumatic drugs associated with different diabetes risks in patients with rheumatoid arthritis. RMD Open. 2023;9:e003045 (Jul 17). doi: 10.1136/rmdopen-2023-003045

Key clinical point: Cleaning activities and dusty clothes laundry are underestimated yet potential sources of lifetime silicon dioxide (SiO₂) exposure in women with rheumatoid arthritis (RA); high SiO₂ exposure increases the risk for mediastinal lymphadenopathy.

Major finding: Cleaning activities were the major source of SiO₂ exposure in women with RA and control individuals, with the exposure scores for occupational and non-occupational cleaning activities and occupational dusty work clothes laundry (all P < .05) being higher in women with RA vs control individuals and high SiO₂ exposure was associated with a greater risk for mediastinal lymphadenopathy (adjusted odds ratio 6.3; 95% CI 1.4-27.7).

Study details: This retrospective, case-control study obtained lifetime SiO₂ exposure data from the Dust Exposure Life-Course Questionnaire administered to 97 patients with RA, including 76 women who were matched with 308 control individuals from the general population.

Disclosures: The SILICOSIS Project was sponsored by the European Research Council. The authors declared no conflicts of interest.

Source: Sigaux J et al. Are cleaning activities a source of exposure to crystalline silica in women with rheumatoid arthritis? A case-control study. RMD Open. 2023;9:e003205 (Aug 2). doi: 10.1136/rmdopen-2023-003205

Key clinical point: Cleaning activities and dusty clothes laundry are underestimated yet potential sources of lifetime silicon dioxide (SiO₂) exposure in women with rheumatoid arthritis (RA); high SiO₂ exposure increases the risk for mediastinal lymphadenopathy.

Major finding: Cleaning activities were the major source of SiO₂ exposure in women with RA and control individuals, with the exposure scores for occupational and non-occupational cleaning activities and occupational dusty work clothes laundry (all P < .05) being higher in women with RA vs control individuals and high SiO₂ exposure was associated with a greater risk for mediastinal lymphadenopathy (adjusted odds ratio 6.3; 95% CI 1.4-27.7).

Study details: This retrospective, case-control study obtained lifetime SiO₂ exposure data from the Dust Exposure Life-Course Questionnaire administered to 97 patients with RA, including 76 women who were matched with 308 control individuals from the general population.

Disclosures: The SILICOSIS Project was sponsored by the European Research Council. The authors declared no conflicts of interest.

Source: Sigaux J et al. Are cleaning activities a source of exposure to crystalline silica in women with rheumatoid arthritis? A case-control study. RMD Open. 2023;9:e003205 (Aug 2). doi: 10.1136/rmdopen-2023-003205

Key clinical point: Cleaning activities and dusty clothes laundry are underestimated yet potential sources of lifetime silicon dioxide (SiO₂) exposure in women with rheumatoid arthritis (RA); high SiO₂ exposure increases the risk for mediastinal lymphadenopathy.

Major finding: Cleaning activities were the major source of SiO₂ exposure in women with RA and control individuals, with the exposure scores for occupational and non-occupational cleaning activities and occupational dusty work clothes laundry (all P < .05) being higher in women with RA vs control individuals and high SiO₂ exposure was associated with a greater risk for mediastinal lymphadenopathy (adjusted odds ratio 6.3; 95% CI 1.4-27.7).

Study details: This retrospective, case-control study obtained lifetime SiO₂ exposure data from the Dust Exposure Life-Course Questionnaire administered to 97 patients with RA, including 76 women who were matched with 308 control individuals from the general population.

Disclosures: The SILICOSIS Project was sponsored by the European Research Council. The authors declared no conflicts of interest.

Source: Sigaux J et al. Are cleaning activities a source of exposure to crystalline silica in women with rheumatoid arthritis? A case-control study. RMD Open. 2023;9:e003205 (Aug 2). doi: 10.1136/rmdopen-2023-003205

Key clinical point: Abatacept showed similar efficacy and safety in patients with rheumatoid arthritis (RA) with vs without previous malignancies and did not increase the risk for malignancy or relapse.

Major finding: Patients with RA with and without previous malignancies had no significant differences in the disease activity scores for 28 Joints based on C-reactive protein (up to 60 months after initiating abatacept; P  =  .36), 10-year abatacept continuation rates (P  =  .70), and the incidence rates of malignancies after initiating abatacept (adjusted hazard ratio 0.99; P  =  1.00).

Study details: This retrospective study included 312 patients with RA who received abatacept, of whom 23.4% patients had previous malignancies when initiating abatacept.

Disclosures: This study was partly supported by JSPS KAKENHI and the Japan Rheumatism Foundation. Y Kunishita declared receiving personal fees from Bristol-Myers K.K. and Eisai, which are unrelated to this study. The other authors did not report any conflicts of interest.

Source: Kunishita Y et al. Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy. Ther Adv Musculoskelet Dis. 2023;15 (Aug 1). doi: 10.1177/1759720X231186874

Key clinical point: Abatacept showed similar efficacy and safety in patients with rheumatoid arthritis (RA) with vs without previous malignancies and did not increase the risk for malignancy or relapse.

Major finding: Patients with RA with and without previous malignancies had no significant differences in the disease activity scores for 28 Joints based on C-reactive protein (up to 60 months after initiating abatacept; P  =  .36), 10-year abatacept continuation rates (P  =  .70), and the incidence rates of malignancies after initiating abatacept (adjusted hazard ratio 0.99; P  =  1.00).

Study details: This retrospective study included 312 patients with RA who received abatacept, of whom 23.4% patients had previous malignancies when initiating abatacept.

Disclosures: This study was partly supported by JSPS KAKENHI and the Japan Rheumatism Foundation. Y Kunishita declared receiving personal fees from Bristol-Myers K.K. and Eisai, which are unrelated to this study. The other authors did not report any conflicts of interest.

Source: Kunishita Y et al. Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy. Ther Adv Musculoskelet Dis. 2023;15 (Aug 1). doi: 10.1177/1759720X231186874

Key clinical point: Abatacept showed similar efficacy and safety in patients with rheumatoid arthritis (RA) with vs without previous malignancies and did not increase the risk for malignancy or relapse.

Major finding: Patients with RA with and without previous malignancies had no significant differences in the disease activity scores for 28 Joints based on C-reactive protein (up to 60 months after initiating abatacept; P  =  .36), 10-year abatacept continuation rates (P  =  .70), and the incidence rates of malignancies after initiating abatacept (adjusted hazard ratio 0.99; P  =  1.00).

Study details: This retrospective study included 312 patients with RA who received abatacept, of whom 23.4% patients had previous malignancies when initiating abatacept.

Disclosures: This study was partly supported by JSPS KAKENHI and the Japan Rheumatism Foundation. Y Kunishita declared receiving personal fees from Bristol-Myers K.K. and Eisai, which are unrelated to this study. The other authors did not report any conflicts of interest.

Source: Kunishita Y et al. Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy. Ther Adv Musculoskelet Dis. 2023;15 (Aug 1). doi: 10.1177/1759720X231186874

Key clinical point: The tapering of low-dose prednisolone over a 3-month schedule led to a moderate increase in disease activity to the levels of the placebo group, suggesting the feasibility of withdrawal of low-dose prednisolone in elderly patients with rheumatoid arthritis (RA) after successful completion of 2 years of therapy.

Major finding: After 3 months of tapering, increase in the Disease Activity Score for 28 Joints was moderate and not significantly different for the prednisolone and placebo groups (between-group difference 0.16; P  =  .12), with flares being only numerically higher in the prednisolone vs placebo group (45% vs 33%; P  =  .12).

Study details: This observational controlled cohort study included 191 patients with RA age ≥ 65 years from the GLORIA trial who underwent linear tapering of 5 mg/day prednisolone or placebo after 2 years of administration, to zero over a period of 3 months.

Disclosures: This study was funded by the European Union’s Horizon 2020 research and innovation program. Several authors declared ties with various sources.

Source: Almayali AAH et al. Three-month tapering and discontinuation of long-term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: Placebo-controlled double blind tapering after the GLORIA trial. Ann Rheum Dis. 2023 (Aug 4). doi: 10.1136/ard-2023-223977

Key clinical point: The tapering of low-dose prednisolone over a 3-month schedule led to a moderate increase in disease activity to the levels of the placebo group, suggesting the feasibility of withdrawal of low-dose prednisolone in elderly patients with rheumatoid arthritis (RA) after successful completion of 2 years of therapy.

Major finding: After 3 months of tapering, increase in the Disease Activity Score for 28 Joints was moderate and not significantly different for the prednisolone and placebo groups (between-group difference 0.16; P  =  .12), with flares being only numerically higher in the prednisolone vs placebo group (45% vs 33%; P  =  .12).

Study details: This observational controlled cohort study included 191 patients with RA age ≥ 65 years from the GLORIA trial who underwent linear tapering of 5 mg/day prednisolone or placebo after 2 years of administration, to zero over a period of 3 months.

Disclosures: This study was funded by the European Union’s Horizon 2020 research and innovation program. Several authors declared ties with various sources.

Source: Almayali AAH et al. Three-month tapering and discontinuation of long-term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: Placebo-controlled double blind tapering after the GLORIA trial. Ann Rheum Dis. 2023 (Aug 4). doi: 10.1136/ard-2023-223977

Key clinical point: The tapering of low-dose prednisolone over a 3-month schedule led to a moderate increase in disease activity to the levels of the placebo group, suggesting the feasibility of withdrawal of low-dose prednisolone in elderly patients with rheumatoid arthritis (RA) after successful completion of 2 years of therapy.

Major finding: After 3 months of tapering, increase in the Disease Activity Score for 28 Joints was moderate and not significantly different for the prednisolone and placebo groups (between-group difference 0.16; P  =  .12), with flares being only numerically higher in the prednisolone vs placebo group (45% vs 33%; P  =  .12).

Study details: This observational controlled cohort study included 191 patients with RA age ≥ 65 years from the GLORIA trial who underwent linear tapering of 5 mg/day prednisolone or placebo after 2 years of administration, to zero over a period of 3 months.

Disclosures: This study was funded by the European Union’s Horizon 2020 research and innovation program. Several authors declared ties with various sources.

Source: Almayali AAH et al. Three-month tapering and discontinuation of long-term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: Placebo-controlled double blind tapering after the GLORIA trial. Ann Rheum Dis. 2023 (Aug 4). doi: 10.1136/ard-2023-223977

Key clinical point: The daily administration of prednisolone at a dose of 5 mg or higher increased the risk for major adverse cardiovascular events (MACE) in patients with rheumatoid arthritis (RA), with doses below 5 mg not appearing to increase the cardiovascular risk.

Major finding: Compared with no use of glucocorticoids, the administration of ≥5 mg prednisolone daily led to a nearly twofold increase in the risk for incident MACE (adjusted hazard ratio [aHR] 2.02; P < .001), with the risk increasing by 7% per month (P < .001) over a long-term follow-up. No association was observed between daily use of prednisolone < 5 mg and the risk for MACE (aHR 0.83; 95% CI 0.60-1.14).

Study details: This population-based retrospective cohort study included 12,233 patients with RA and without MACE at baseline.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: So H et al. Time and dose-dependent effect of systemic glucocorticoids on major adverse cardiovascular event in patients with rheumatoid arthritis: A population-based study. Ann Rheum Dis. 2023 (Jul 24). doi: 10.1136/ard-2023-224185

Key clinical point: The daily administration of prednisolone at a dose of 5 mg or higher increased the risk for major adverse cardiovascular events (MACE) in patients with rheumatoid arthritis (RA), with doses below 5 mg not appearing to increase the cardiovascular risk.

Major finding: Compared with no use of glucocorticoids, the administration of ≥5 mg prednisolone daily led to a nearly twofold increase in the risk for incident MACE (adjusted hazard ratio [aHR] 2.02; P < .001), with the risk increasing by 7% per month (P < .001) over a long-term follow-up. No association was observed between daily use of prednisolone < 5 mg and the risk for MACE (aHR 0.83; 95% CI 0.60-1.14).

Study details: This population-based retrospective cohort study included 12,233 patients with RA and without MACE at baseline.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: So H et al. Time and dose-dependent effect of systemic glucocorticoids on major adverse cardiovascular event in patients with rheumatoid arthritis: A population-based study. Ann Rheum Dis. 2023 (Jul 24). doi: 10.1136/ard-2023-224185

Key clinical point: The daily administration of prednisolone at a dose of 5 mg or higher increased the risk for major adverse cardiovascular events (MACE) in patients with rheumatoid arthritis (RA), with doses below 5 mg not appearing to increase the cardiovascular risk.

Major finding: Compared with no use of glucocorticoids, the administration of ≥5 mg prednisolone daily led to a nearly twofold increase in the risk for incident MACE (adjusted hazard ratio [aHR] 2.02; P < .001), with the risk increasing by 7% per month (P < .001) over a long-term follow-up. No association was observed between daily use of prednisolone < 5 mg and the risk for MACE (aHR 0.83; 95% CI 0.60-1.14).

Study details: This population-based retrospective cohort study included 12,233 patients with RA and without MACE at baseline.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: So H et al. Time and dose-dependent effect of systemic glucocorticoids on major adverse cardiovascular event in patients with rheumatoid arthritis: A population-based study. Ann Rheum Dis. 2023 (Jul 24). doi: 10.1136/ard-2023-224185

Key clinical point: The presence of antidrug antibodies was associated with a diminished response to biologic disease-modifying antirheumatic drugs (bDMARD) among patients with rheumatoid arthritis (RA), highlighting the importance of monitoring antidrug antibodies, particularly among nonresponders.

Major finding: At month 12, the prevalence of antidrug antibodies against rituximab (50.0%), anti-tumor necrosis factor monoclonal antibodies (38.2%), and tocilizumab (20.0%) was relatively high, and an inverse association was observed between antidrug antibody positivity for all bDMARD and the European Alliance of Associations for Rheumatology response (odds ratio 0.19; P < .001).

Study details: This cohort study used data from the ABI-RA prospective study to evaluate 230 patients with RA who initiated bDMARD.

Disclosures: The ABI-RA study was a part of ABIRISK, which was funded by the European Union and included financial contribution from the European Union’s Seventh Framework Programme and others. Several authors declared receiving personal fees, grants, or non-financial support from various sources.

Source: Bitoun S et al for the ABIRISK Consortium. Response to biologic drugs in patients with rheumatoid arthritis and antidrug antibodies. JAMA Netw Open. 2023;6(7):e2323098 (Jul 12). doi: 10.1001/jamanetworkopen.2023.23098

Key clinical point: The presence of antidrug antibodies was associated with a diminished response to biologic disease-modifying antirheumatic drugs (bDMARD) among patients with rheumatoid arthritis (RA), highlighting the importance of monitoring antidrug antibodies, particularly among nonresponders.

Major finding: At month 12, the prevalence of antidrug antibodies against rituximab (50.0%), anti-tumor necrosis factor monoclonal antibodies (38.2%), and tocilizumab (20.0%) was relatively high, and an inverse association was observed between antidrug antibody positivity for all bDMARD and the European Alliance of Associations for Rheumatology response (odds ratio 0.19; P < .001).

Study details: This cohort study used data from the ABI-RA prospective study to evaluate 230 patients with RA who initiated bDMARD.

Disclosures: The ABI-RA study was a part of ABIRISK, which was funded by the European Union and included financial contribution from the European Union’s Seventh Framework Programme and others. Several authors declared receiving personal fees, grants, or non-financial support from various sources.

Source: Bitoun S et al for the ABIRISK Consortium. Response to biologic drugs in patients with rheumatoid arthritis and antidrug antibodies. JAMA Netw Open. 2023;6(7):e2323098 (Jul 12). doi: 10.1001/jamanetworkopen.2023.23098

Key clinical point: The presence of antidrug antibodies was associated with a diminished response to biologic disease-modifying antirheumatic drugs (bDMARD) among patients with rheumatoid arthritis (RA), highlighting the importance of monitoring antidrug antibodies, particularly among nonresponders.

Major finding: At month 12, the prevalence of antidrug antibodies against rituximab (50.0%), anti-tumor necrosis factor monoclonal antibodies (38.2%), and tocilizumab (20.0%) was relatively high, and an inverse association was observed between antidrug antibody positivity for all bDMARD and the European Alliance of Associations for Rheumatology response (odds ratio 0.19; P < .001).

Study details: This cohort study used data from the ABI-RA prospective study to evaluate 230 patients with RA who initiated bDMARD.

Disclosures: The ABI-RA study was a part of ABIRISK, which was funded by the European Union and included financial contribution from the European Union’s Seventh Framework Programme and others. Several authors declared receiving personal fees, grants, or non-financial support from various sources.

Source: Bitoun S et al for the ABIRISK Consortium. Response to biologic drugs in patients with rheumatoid arthritis and antidrug antibodies. JAMA Netw Open. 2023;6(7):e2323098 (Jul 12). doi: 10.1001/jamanetworkopen.2023.23098

Key clinical point: Patients with rheumatoid arthritis (RA) are at a significantly higher risk for aortic stenosis (AS) and subsequent aortic valve intervention and AS-related death than those without RA.

Major finding: Patients with vs without RA were at an increased risk for incident AS (adjusted hazard ratio [aHR] 1.48; 95% CI 1.41-1.55), AS-related death (aHR 1.26; 95% CI 1.04-1.54), and undergoing an AS-related aortic valvular intervention (aHR 1.34; 95% CI 1.22-1.48), including both surgical (aHR 1.30; 95% CI 1.16-1.45) and transcatheter (aHR 1.53; 95% CI 1.26-1.85) aortic valve replacements.

Study details: This retrospective cohort study included 73,070 patients with RA who were matched with 639,268 patients without RA.

Disclosures: This study was supported by the Center of Excellence for Suicide Prevention and other sources. TM Johnson declared receiving grants from the Rheumatology Research Foundation. Some authors declared receiving personal or consulting fees, grants, speaking honoraria, or royalties from various sources.

Source: Johnson TM et al. Aortic stenosis risk in rheumatoid arthritis. JAMA Intern Med. 2023 (Jul 31). doi: 10.1001/jamainternmed.2023.3087

Key clinical point: Patients with rheumatoid arthritis (RA) are at a significantly higher risk for aortic stenosis (AS) and subsequent aortic valve intervention and AS-related death than those without RA.

Major finding: Patients with vs without RA were at an increased risk for incident AS (adjusted hazard ratio [aHR] 1.48; 95% CI 1.41-1.55), AS-related death (aHR 1.26; 95% CI 1.04-1.54), and undergoing an AS-related aortic valvular intervention (aHR 1.34; 95% CI 1.22-1.48), including both surgical (aHR 1.30; 95% CI 1.16-1.45) and transcatheter (aHR 1.53; 95% CI 1.26-1.85) aortic valve replacements.

Study details: This retrospective cohort study included 73,070 patients with RA who were matched with 639,268 patients without RA.

Disclosures: This study was supported by the Center of Excellence for Suicide Prevention and other sources. TM Johnson declared receiving grants from the Rheumatology Research Foundation. Some authors declared receiving personal or consulting fees, grants, speaking honoraria, or royalties from various sources.

Source: Johnson TM et al. Aortic stenosis risk in rheumatoid arthritis. JAMA Intern Med. 2023 (Jul 31). doi: 10.1001/jamainternmed.2023.3087

Key clinical point: Patients with rheumatoid arthritis (RA) are at a significantly higher risk for aortic stenosis (AS) and subsequent aortic valve intervention and AS-related death than those without RA.

Major finding: Patients with vs without RA were at an increased risk for incident AS (adjusted hazard ratio [aHR] 1.48; 95% CI 1.41-1.55), AS-related death (aHR 1.26; 95% CI 1.04-1.54), and undergoing an AS-related aortic valvular intervention (aHR 1.34; 95% CI 1.22-1.48), including both surgical (aHR 1.30; 95% CI 1.16-1.45) and transcatheter (aHR 1.53; 95% CI 1.26-1.85) aortic valve replacements.

Study details: This retrospective cohort study included 73,070 patients with RA who were matched with 639,268 patients without RA.

Disclosures: This study was supported by the Center of Excellence for Suicide Prevention and other sources. TM Johnson declared receiving grants from the Rheumatology Research Foundation. Some authors declared receiving personal or consulting fees, grants, speaking honoraria, or royalties from various sources.

Source: Johnson TM et al. Aortic stenosis risk in rheumatoid arthritis. JAMA Intern Med. 2023 (Jul 31). doi: 10.1001/jamainternmed.2023.3087

A daily prednisolone dose of 5 mg or higher is associated with increased risk for major adverse cardiovascular events (MACE) among patients with rheumatoid arthritis (RA), data suggest. Patients taking daily doses below this threshold did not appear to have an increased risk of MACE, compared with those not taking glucocorticoids (GCs).

Chinese University of Hong Kong

Is there a ‘safe’ dose for glucocorticoids?

To analyze this relationship, Dr. Lam and colleagues used the Hospital Authority Data Collaboration Laboratory, a citywide health care database. The investigators recruited patients with RA who had no history of MACE from 2006 to 2015 and followed them until the end of 2018. The primary outcome was the first occurrence of a MACE, defined as a composite of myocardial infarction (MI), unstable angina, ischemic or hemorrhagic cerebrovascular accident, transient ischemic attack, and CV death.

The study was published in Annals of the Rheumatic Diseases.

The analysis included 12,233 patients with RA and had over 105,826 person-years of follow-up. The average follow-up time was 8.7 years. During the study period, 860 patients had their first MACE. After controlling for confounding factors, a daily prednisolone dose of 5 mg or higher doubled the risk for MACE, compared with GC nonusers. MACE risk increased by 7% per month.

University of Wisconsin School of Medicine and Public Health

Long-term glucocorticoid use discouraged

Daily doses of less than 5 mg were not associated with higher MACE risk, but more research is necessary to understand whether these low doses are clinically efficacious, Dr. Tam said. “The study results suggest that a very-low-dose GC (less than 5 mg prednisolone daily) may be cardiovascular risk–neutral. However, further evaluation is needed to determine whether this dose is therapeutic. Other potential side effects, such as bone loss, increased infection risk, dyslipidemia, and hyperglycemia, should also be considered.”

Both the American College of Rheumatology and the European Alliance of Associations for Rheumatology acknowledge that short-term GCs may be necessary for some RA patients, but they emphasize using the smallest necessary dose for the shortest period possible because of the known toxicity of GCs.

“We recommend stopping GCs as soon as it is clinically feasible, in line with previous recommendations, until these issues are investigated further,” Dr. Tam added.

Dr. Bartels agreed that long-term use of GCs should be avoided if possible, even at lower doses, because although CV risk may be less of an issue, studies have shown an increased risk for infection even at GC doses of less than 5 mg a day.
 

How might risk increase with dose?

While the study showed a distinct difference in risk with doses of prednisolone higher and lower than 5 mg, more information on how risk increases with dose could be useful, said Beth Wallace, MD, an assistant professor in internal medicine at the University of Michigan, Ann Arbor, and a staff rheumatologist at the VA Ann Arbor Healthcare Center. She was also unaffiliated with the research. “If someone is on 5-10 mg ... how much better is that than being on 10-20 mg or being on 20-30 mg?” she asked. While these study findings are “very important,” she said, it would be useful to know the risk associated with 7.5 mg vs. a higher dose.

University of Michigan

A version of this article first appeared on Medscape.com.

A daily prednisolone dose of 5 mg or higher is associated with increased risk for major adverse cardiovascular events (MACE) among patients with rheumatoid arthritis (RA), data suggest. Patients taking daily doses below this threshold did not appear to have an increased risk of MACE, compared with those not taking glucocorticoids (GCs).

Chinese University of Hong Kong

Is there a ‘safe’ dose for glucocorticoids?

To analyze this relationship, Dr. Lam and colleagues used the Hospital Authority Data Collaboration Laboratory, a citywide health care database. The investigators recruited patients with RA who had no history of MACE from 2006 to 2015 and followed them until the end of 2018. The primary outcome was the first occurrence of a MACE, defined as a composite of myocardial infarction (MI), unstable angina, ischemic or hemorrhagic cerebrovascular accident, transient ischemic attack, and CV death.

The study was published in Annals of the Rheumatic Diseases.

The analysis included 12,233 patients with RA and had over 105,826 person-years of follow-up. The average follow-up time was 8.7 years. During the study period, 860 patients had their first MACE. After controlling for confounding factors, a daily prednisolone dose of 5 mg or higher doubled the risk for MACE, compared with GC nonusers. MACE risk increased by 7% per month.

University of Wisconsin School of Medicine and Public Health

Long-term glucocorticoid use discouraged

Daily doses of less than 5 mg were not associated with higher MACE risk, but more research is necessary to understand whether these low doses are clinically efficacious, Dr. Tam said. “The study results suggest that a very-low-dose GC (less than 5 mg prednisolone daily) may be cardiovascular risk–neutral. However, further evaluation is needed to determine whether this dose is therapeutic. Other potential side effects, such as bone loss, increased infection risk, dyslipidemia, and hyperglycemia, should also be considered.”

Both the American College of Rheumatology and the European Alliance of Associations for Rheumatology acknowledge that short-term GCs may be necessary for some RA patients, but they emphasize using the smallest necessary dose for the shortest period possible because of the known toxicity of GCs.

“We recommend stopping GCs as soon as it is clinically feasible, in line with previous recommendations, until these issues are investigated further,” Dr. Tam added.

Dr. Bartels agreed that long-term use of GCs should be avoided if possible, even at lower doses, because although CV risk may be less of an issue, studies have shown an increased risk for infection even at GC doses of less than 5 mg a day.
 

How might risk increase with dose?

While the study showed a distinct difference in risk with doses of prednisolone higher and lower than 5 mg, more information on how risk increases with dose could be useful, said Beth Wallace, MD, an assistant professor in internal medicine at the University of Michigan, Ann Arbor, and a staff rheumatologist at the VA Ann Arbor Healthcare Center. She was also unaffiliated with the research. “If someone is on 5-10 mg ... how much better is that than being on 10-20 mg or being on 20-30 mg?” she asked. While these study findings are “very important,” she said, it would be useful to know the risk associated with 7.5 mg vs. a higher dose.

University of Michigan

A version of this article first appeared on Medscape.com.

A daily prednisolone dose of 5 mg or higher is associated with increased risk for major adverse cardiovascular events (MACE) among patients with rheumatoid arthritis (RA), data suggest. Patients taking daily doses below this threshold did not appear to have an increased risk of MACE, compared with those not taking glucocorticoids (GCs).

Chinese University of Hong Kong

Is there a ‘safe’ dose for glucocorticoids?

To analyze this relationship, Dr. Lam and colleagues used the Hospital Authority Data Collaboration Laboratory, a citywide health care database. The investigators recruited patients with RA who had no history of MACE from 2006 to 2015 and followed them until the end of 2018. The primary outcome was the first occurrence of a MACE, defined as a composite of myocardial infarction (MI), unstable angina, ischemic or hemorrhagic cerebrovascular accident, transient ischemic attack, and CV death.

The study was published in Annals of the Rheumatic Diseases.

The analysis included 12,233 patients with RA and had over 105,826 person-years of follow-up. The average follow-up time was 8.7 years. During the study period, 860 patients had their first MACE. After controlling for confounding factors, a daily prednisolone dose of 5 mg or higher doubled the risk for MACE, compared with GC nonusers. MACE risk increased by 7% per month.

University of Wisconsin School of Medicine and Public Health

Long-term glucocorticoid use discouraged

Daily doses of less than 5 mg were not associated with higher MACE risk, but more research is necessary to understand whether these low doses are clinically efficacious, Dr. Tam said. “The study results suggest that a very-low-dose GC (less than 5 mg prednisolone daily) may be cardiovascular risk–neutral. However, further evaluation is needed to determine whether this dose is therapeutic. Other potential side effects, such as bone loss, increased infection risk, dyslipidemia, and hyperglycemia, should also be considered.”

Both the American College of Rheumatology and the European Alliance of Associations for Rheumatology acknowledge that short-term GCs may be necessary for some RA patients, but they emphasize using the smallest necessary dose for the shortest period possible because of the known toxicity of GCs.

“We recommend stopping GCs as soon as it is clinically feasible, in line with previous recommendations, until these issues are investigated further,” Dr. Tam added.

Dr. Bartels agreed that long-term use of GCs should be avoided if possible, even at lower doses, because although CV risk may be less of an issue, studies have shown an increased risk for infection even at GC doses of less than 5 mg a day.
 

How might risk increase with dose?

While the study showed a distinct difference in risk with doses of prednisolone higher and lower than 5 mg, more information on how risk increases with dose could be useful, said Beth Wallace, MD, an assistant professor in internal medicine at the University of Michigan, Ann Arbor, and a staff rheumatologist at the VA Ann Arbor Healthcare Center. She was also unaffiliated with the research. “If someone is on 5-10 mg ... how much better is that than being on 10-20 mg or being on 20-30 mg?” she asked. While these study findings are “very important,” she said, it would be useful to know the risk associated with 7.5 mg vs. a higher dose.

University of Michigan

A version of this article first appeared on Medscape.com.

Two scores, one simple and one comprehensive, may predict inflammatory arthritis (IA) in people who are already at elevated risk for these immune-related conditions, according to new research from England.

If validated in further studies, a new simple score using common biomarkers may help identify individuals who can be managed in primary care as well as higher-risk patients who should be referred to a rheumatologist.

The researchers designed a second comprehensive score adding genetics and ultrasound as a tool to identify patients at highest risk for IA for intervention studies and to guide clinical monitoring and care by specialists.

Richard Mark Kirkner/MDedge News

Though there are blood markers and early symptoms in patients that may signal a higher risk for IA, “we don’t know what to do with those people yet,” said Kevin D. Deane, MD, PhD, associate professor of medicine and chair in rheumatology research at the University of Colorado at Denver, Aurora.

“Understanding how to assess these people and predict who’s going to go on to get full blown IA that we should actually treat is very beneficial to the field,” Dr. Deane said. He was not involved with the research but had reviewed an early draft of the paper.
 

Study seeks to stratify at-risk population

For the study, researchers recruited 455 participants from June 2008 to November 2021, primarily through the UK Primary Care Clinical Research Network. All individuals had new musculoskeletal symptoms, a positive test for anticitrullinated protein antibodies (anti-CCP), and no clinical synovitis.

The researchers selected for anti-CCP positivity because these antibodies are associated with a more aggressive arthritis phenotype. Interventional trials have also found that these anti-CCP–positive individuals are the most responsive to disease-modifying antirheumatic therapy prior to IA development. Patients were followed for at least 48 weeks or until an IA diagnosis.

Using data from this cohort, the team ran statistical analyses guided by potential clinical impact. For the simple score, they aimed to ensure that most people who would go on to develop IA would be identified earlier in clinical practice. For the comprehensive score, they wanted to balance the potential harm of giving preventive treatment to someone who would not develop IA with failing to provide preventive treatment to someone who would develop IA, the authors write.

They developed two scores: a simple score to identify people at lower risk for IA and a comprehensive score to stratify high-risk individuals. The simple score used anti-CCP level, rheumatoid factor value, early morning stiffness, and erythrocyte sedimentation rate to calculate risk.

In addition to these factors, the comprehensive score added smoking history, ultrasound abnormalities, genetic markers for the rheumatoid arthritis shared epitope, as well as patient-reported outcomes from the Health Assessment Questionnaire and the visual analogue scale for global pain.

The study was published in the Annals of Internal Medicine.


 

Simple score rates more than half as low risk

The simple score identified 249 low-risk individuals, defined as having a less than 10% chance of developing IA within 1 year, with a 5% false-negative rate. This score can help determine which individuals do not need to be referred to a specialist even though they have some known risk factors, said Paul Emery, MD, director of the Leeds Biomedical Research Centre and clinical professor at the University of Leeds in England. He is a co–senior author of the research.

“If you had unlimited resources, you’d refer everyone. But in the real world, we would be overloaded in secondary care, and it just wouldn’t work,” he said. “This is a way of making sure the right people are referred into secondary care.”

The comprehensive score identified 119 high-risk individuals, defined as having a 50% chance or greater of developing IA in 5 years, with a false-positive rate of 29%. Of this high-risk group, 40% developed IA within 1 year, and 71% developed IA in 5 years.

Beyond identifying those who should be referred to specialist care, Dr. Emery noted, this score could be used in research studies to find patients for experimental clinical trials aimed at delaying or preventing the onset of IA.

Both Dr. Emery and Dr. Deane agreed that further research is needed to validate these findings in different patient populations as well as to understand how the scores could be integrated into clinical practice.
 

What is the role of anti-CCP tests in primary care?

The study also brings up additional questions about the use of anti-CCP tests in primary care, Dr. Deane said. Though previously considered a “specialty test” 10-15 years ago, “now, we really want primary care to do this test along with the rheumatoid factor test,” he noted.

Because the study only included individuals with anti-CCP antibodies, it did not touch on which patients should be getting tested in the first place. Would all patients coming into primary care with joint pain benefit from these blood-marker tests, Deane asked, or would only certain patients qualify? “I think that’s uncertain, and we need to learn more,” he said.

An additional caveat is that the researchers used abnormal ultrasound findings as a predictor of future IA in the comprehensive model, but many clinicians already use ultrasound to identify arthritis, Dr. Deane said.

“If a rheumatologist sees power Doppler signal or erosions, even if the physical examination of a joint didn’t find swelling or inflammation, then they are likely to say that this person has IA now,” and will start treatment, he said. “Because of that, it could be challenging to use ultrasound as a ‘predictive’ marker in clinical practice,” he added, but additional research could help elucidate when to wait on treatment even with abnormal ultrasound findings.

This study was funded by the UK National Institute for Health and Care Research Leeds Biomedical Research Centre. Dr. Emery disclosed financial relationships with AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, Novartis, and Samsung Bioepis. Dr. Deane reports receiving consulting fees from Werfen.

A version of this article appeared on Medscape.com.

Two scores, one simple and one comprehensive, may predict inflammatory arthritis (IA) in people who are already at elevated risk for these immune-related conditions, according to new research from England.

If validated in further studies, a new simple score using common biomarkers may help identify individuals who can be managed in primary care as well as higher-risk patients who should be referred to a rheumatologist.

The researchers designed a second comprehensive score adding genetics and ultrasound as a tool to identify patients at highest risk for IA for intervention studies and to guide clinical monitoring and care by specialists.

Richard Mark Kirkner/MDedge News

Though there are blood markers and early symptoms in patients that may signal a higher risk for IA, “we don’t know what to do with those people yet,” said Kevin D. Deane, MD, PhD, associate professor of medicine and chair in rheumatology research at the University of Colorado at Denver, Aurora.

“Understanding how to assess these people and predict who’s going to go on to get full blown IA that we should actually treat is very beneficial to the field,” Dr. Deane said. He was not involved with the research but had reviewed an early draft of the paper.
 

Study seeks to stratify at-risk population

For the study, researchers recruited 455 participants from June 2008 to November 2021, primarily through the UK Primary Care Clinical Research Network. All individuals had new musculoskeletal symptoms, a positive test for anticitrullinated protein antibodies (anti-CCP), and no clinical synovitis.

The researchers selected for anti-CCP positivity because these antibodies are associated with a more aggressive arthritis phenotype. Interventional trials have also found that these anti-CCP–positive individuals are the most responsive to disease-modifying antirheumatic therapy prior to IA development. Patients were followed for at least 48 weeks or until an IA diagnosis.

Using data from this cohort, the team ran statistical analyses guided by potential clinical impact. For the simple score, they aimed to ensure that most people who would go on to develop IA would be identified earlier in clinical practice. For the comprehensive score, they wanted to balance the potential harm of giving preventive treatment to someone who would not develop IA with failing to provide preventive treatment to someone who would develop IA, the authors write.

They developed two scores: a simple score to identify people at lower risk for IA and a comprehensive score to stratify high-risk individuals. The simple score used anti-CCP level, rheumatoid factor value, early morning stiffness, and erythrocyte sedimentation rate to calculate risk.

In addition to these factors, the comprehensive score added smoking history, ultrasound abnormalities, genetic markers for the rheumatoid arthritis shared epitope, as well as patient-reported outcomes from the Health Assessment Questionnaire and the visual analogue scale for global pain.

The study was published in the Annals of Internal Medicine.


 

Simple score rates more than half as low risk

The simple score identified 249 low-risk individuals, defined as having a less than 10% chance of developing IA within 1 year, with a 5% false-negative rate. This score can help determine which individuals do not need to be referred to a specialist even though they have some known risk factors, said Paul Emery, MD, director of the Leeds Biomedical Research Centre and clinical professor at the University of Leeds in England. He is a co–senior author of the research.

“If you had unlimited resources, you’d refer everyone. But in the real world, we would be overloaded in secondary care, and it just wouldn’t work,” he said. “This is a way of making sure the right people are referred into secondary care.”

The comprehensive score identified 119 high-risk individuals, defined as having a 50% chance or greater of developing IA in 5 years, with a false-positive rate of 29%. Of this high-risk group, 40% developed IA within 1 year, and 71% developed IA in 5 years.

Beyond identifying those who should be referred to specialist care, Dr. Emery noted, this score could be used in research studies to find patients for experimental clinical trials aimed at delaying or preventing the onset of IA.

Both Dr. Emery and Dr. Deane agreed that further research is needed to validate these findings in different patient populations as well as to understand how the scores could be integrated into clinical practice.
 

What is the role of anti-CCP tests in primary care?

The study also brings up additional questions about the use of anti-CCP tests in primary care, Dr. Deane said. Though previously considered a “specialty test” 10-15 years ago, “now, we really want primary care to do this test along with the rheumatoid factor test,” he noted.

Because the study only included individuals with anti-CCP antibodies, it did not touch on which patients should be getting tested in the first place. Would all patients coming into primary care with joint pain benefit from these blood-marker tests, Deane asked, or would only certain patients qualify? “I think that’s uncertain, and we need to learn more,” he said.

An additional caveat is that the researchers used abnormal ultrasound findings as a predictor of future IA in the comprehensive model, but many clinicians already use ultrasound to identify arthritis, Dr. Deane said.

“If a rheumatologist sees power Doppler signal or erosions, even if the physical examination of a joint didn’t find swelling or inflammation, then they are likely to say that this person has IA now,” and will start treatment, he said. “Because of that, it could be challenging to use ultrasound as a ‘predictive’ marker in clinical practice,” he added, but additional research could help elucidate when to wait on treatment even with abnormal ultrasound findings.

This study was funded by the UK National Institute for Health and Care Research Leeds Biomedical Research Centre. Dr. Emery disclosed financial relationships with AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, Novartis, and Samsung Bioepis. Dr. Deane reports receiving consulting fees from Werfen.

A version of this article appeared on Medscape.com.

Two scores, one simple and one comprehensive, may predict inflammatory arthritis (IA) in people who are already at elevated risk for these immune-related conditions, according to new research from England.

If validated in further studies, a new simple score using common biomarkers may help identify individuals who can be managed in primary care as well as higher-risk patients who should be referred to a rheumatologist.

The researchers designed a second comprehensive score adding genetics and ultrasound as a tool to identify patients at highest risk for IA for intervention studies and to guide clinical monitoring and care by specialists.

Richard Mark Kirkner/MDedge News

Though there are blood markers and early symptoms in patients that may signal a higher risk for IA, “we don’t know what to do with those people yet,” said Kevin D. Deane, MD, PhD, associate professor of medicine and chair in rheumatology research at the University of Colorado at Denver, Aurora.

“Understanding how to assess these people and predict who’s going to go on to get full blown IA that we should actually treat is very beneficial to the field,” Dr. Deane said. He was not involved with the research but had reviewed an early draft of the paper.
 

Study seeks to stratify at-risk population

For the study, researchers recruited 455 participants from June 2008 to November 2021, primarily through the UK Primary Care Clinical Research Network. All individuals had new musculoskeletal symptoms, a positive test for anticitrullinated protein antibodies (anti-CCP), and no clinical synovitis.

The researchers selected for anti-CCP positivity because these antibodies are associated with a more aggressive arthritis phenotype. Interventional trials have also found that these anti-CCP–positive individuals are the most responsive to disease-modifying antirheumatic therapy prior to IA development. Patients were followed for at least 48 weeks or until an IA diagnosis.

Using data from this cohort, the team ran statistical analyses guided by potential clinical impact. For the simple score, they aimed to ensure that most people who would go on to develop IA would be identified earlier in clinical practice. For the comprehensive score, they wanted to balance the potential harm of giving preventive treatment to someone who would not develop IA with failing to provide preventive treatment to someone who would develop IA, the authors write.

They developed two scores: a simple score to identify people at lower risk for IA and a comprehensive score to stratify high-risk individuals. The simple score used anti-CCP level, rheumatoid factor value, early morning stiffness, and erythrocyte sedimentation rate to calculate risk.

In addition to these factors, the comprehensive score added smoking history, ultrasound abnormalities, genetic markers for the rheumatoid arthritis shared epitope, as well as patient-reported outcomes from the Health Assessment Questionnaire and the visual analogue scale for global pain.

The study was published in the Annals of Internal Medicine.


 

Simple score rates more than half as low risk

The simple score identified 249 low-risk individuals, defined as having a less than 10% chance of developing IA within 1 year, with a 5% false-negative rate. This score can help determine which individuals do not need to be referred to a specialist even though they have some known risk factors, said Paul Emery, MD, director of the Leeds Biomedical Research Centre and clinical professor at the University of Leeds in England. He is a co–senior author of the research.

“If you had unlimited resources, you’d refer everyone. But in the real world, we would be overloaded in secondary care, and it just wouldn’t work,” he said. “This is a way of making sure the right people are referred into secondary care.”

The comprehensive score identified 119 high-risk individuals, defined as having a 50% chance or greater of developing IA in 5 years, with a false-positive rate of 29%. Of this high-risk group, 40% developed IA within 1 year, and 71% developed IA in 5 years.

Beyond identifying those who should be referred to specialist care, Dr. Emery noted, this score could be used in research studies to find patients for experimental clinical trials aimed at delaying or preventing the onset of IA.

Both Dr. Emery and Dr. Deane agreed that further research is needed to validate these findings in different patient populations as well as to understand how the scores could be integrated into clinical practice.
 

What is the role of anti-CCP tests in primary care?

The study also brings up additional questions about the use of anti-CCP tests in primary care, Dr. Deane said. Though previously considered a “specialty test” 10-15 years ago, “now, we really want primary care to do this test along with the rheumatoid factor test,” he noted.

Because the study only included individuals with anti-CCP antibodies, it did not touch on which patients should be getting tested in the first place. Would all patients coming into primary care with joint pain benefit from these blood-marker tests, Deane asked, or would only certain patients qualify? “I think that’s uncertain, and we need to learn more,” he said.

An additional caveat is that the researchers used abnormal ultrasound findings as a predictor of future IA in the comprehensive model, but many clinicians already use ultrasound to identify arthritis, Dr. Deane said.

“If a rheumatologist sees power Doppler signal or erosions, even if the physical examination of a joint didn’t find swelling or inflammation, then they are likely to say that this person has IA now,” and will start treatment, he said. “Because of that, it could be challenging to use ultrasound as a ‘predictive’ marker in clinical practice,” he added, but additional research could help elucidate when to wait on treatment even with abnormal ultrasound findings.

This study was funded by the UK National Institute for Health and Care Research Leeds Biomedical Research Centre. Dr. Emery disclosed financial relationships with AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, Novartis, and Samsung Bioepis. Dr. Deane reports receiving consulting fees from Werfen.

A version of this article appeared on Medscape.com.

Adults with rheumatoid arthritis had a significantly higher risk than do those without RA for developing aortic stenosis (AS), according to a large national cohort of patients.

RA has been associated with an increased risk for ischemic cardiovascular disease, but the association of RA with the risk for AS remains unclear, Tate M. Johnson, MD, of VA Nebraska–Western Iowa Health Care System, Omaha, and colleagues wrote. 

In a study published in JAMA Internal Medicine, the researchers identified 73,070 adults with RA and 639,268 matched control individuals without RA using data from Veterans Affairs and Centers for Medicare & Medicaid Services from 2000 to 2019. 

The patients and control individuals were predominantly men (about 87%), and most were White (72.3% of patients and 61.7% of control individuals). The mean ages of the patients and control individuals were similar (63.0 vs. 61.9, respectively). 

The main outcome of incident AS was defined as a composite of inpatient or outpatient AS diagnoses, surgical or transcatheter aortic valve intervention, or AS-related death. 

Over a mean follow-up period of 7.9 years in patients with RA and 8.8 years in control individuals, the researchers found 16,109 composite AS outcomes over a period of 6,223,150 person-years, with 2,303 that occurred in patients with RA. 

The multivariate model adjusted for race, ethnicity, smoking status, body mass index (BMI), rural versus urban residence, comorbidities, and health care use.

Overall, RA was associated with an increased risk for the composite AS outcome (hazard ratio, 1.66).

After adjusting for confounders, RA remained associated with an increased risk for composite AS diagnoses, aortic valve intervention, and AS-related death (adjusted HRs, 1.48, 1.34, and 1.26, respectively). Altogether, the incidence of composite AS events was 3.97 per 1,000 person-years in patients with RA versus 2.45 per 1,000 person-years in control individuals, with an absolute difference of 1.52 composite AS events per 1,000 person-years.

The results “emphasize that valvular heart disease may be an underrecognized contributor to the persistent CVD [cardiovascular disease]-related mortality gap in RA, particularly given the lack of improvement in AS-specific risk over time,” the researchers wrote. 

Several traditional CVD risk factors (for example, smoking status, diabetes, and coronary artery disease) were not independently associated with AS onset in patients with RA. However, male sex, hypertension, stroke, and other noncoronary CVDs were associated with incident AS in the patients with RA, and increasing age and BMI were associated with stepwise increases in AS risk.

The findings were limited by several factors including the infrequency of AS-related events and consequent modest differences in absolute risk, the researchers noted. The predominantly male cohort may limit generalizability of results because RA is more common in women. Other limitations included the predominantly male population and possible misclassification of RA status. 

Overall, the results demonstrate an increased risk for AS, AS-related intervention, and AS-related death in people with RA. More research is needed to examine AS and valvular heart disease as potential complications in this population, they concluded. 

The study was supported by the Center of Excellence for Suicide Prevention, Joint Department of Veterans Affairs, and Department of Defense Mortality Data Repository National Death Index. Dr. Johnson disclosed grants from the Rheumatology Research Foundation during the conduct of the study but had no other financial conflicts to disclose. Other authors disclosed fees and honoraria from pharmaceutical companies outside the submitted work.

A version of this article appeared on Medscape.com.

Adults with rheumatoid arthritis had a significantly higher risk than do those without RA for developing aortic stenosis (AS), according to a large national cohort of patients.

RA has been associated with an increased risk for ischemic cardiovascular disease, but the association of RA with the risk for AS remains unclear, Tate M. Johnson, MD, of VA Nebraska–Western Iowa Health Care System, Omaha, and colleagues wrote. 

In a study published in JAMA Internal Medicine, the researchers identified 73,070 adults with RA and 639,268 matched control individuals without RA using data from Veterans Affairs and Centers for Medicare & Medicaid Services from 2000 to 2019. 

The patients and control individuals were predominantly men (about 87%), and most were White (72.3% of patients and 61.7% of control individuals). The mean ages of the patients and control individuals were similar (63.0 vs. 61.9, respectively). 

The main outcome of incident AS was defined as a composite of inpatient or outpatient AS diagnoses, surgical or transcatheter aortic valve intervention, or AS-related death. 

Over a mean follow-up period of 7.9 years in patients with RA and 8.8 years in control individuals, the researchers found 16,109 composite AS outcomes over a period of 6,223,150 person-years, with 2,303 that occurred in patients with RA. 

The multivariate model adjusted for race, ethnicity, smoking status, body mass index (BMI), rural versus urban residence, comorbidities, and health care use.

Overall, RA was associated with an increased risk for the composite AS outcome (hazard ratio, 1.66).

After adjusting for confounders, RA remained associated with an increased risk for composite AS diagnoses, aortic valve intervention, and AS-related death (adjusted HRs, 1.48, 1.34, and 1.26, respectively). Altogether, the incidence of composite AS events was 3.97 per 1,000 person-years in patients with RA versus 2.45 per 1,000 person-years in control individuals, with an absolute difference of 1.52 composite AS events per 1,000 person-years.

The results “emphasize that valvular heart disease may be an underrecognized contributor to the persistent CVD [cardiovascular disease]-related mortality gap in RA, particularly given the lack of improvement in AS-specific risk over time,” the researchers wrote. 

Several traditional CVD risk factors (for example, smoking status, diabetes, and coronary artery disease) were not independently associated with AS onset in patients with RA. However, male sex, hypertension, stroke, and other noncoronary CVDs were associated with incident AS in the patients with RA, and increasing age and BMI were associated with stepwise increases in AS risk.

The findings were limited by several factors including the infrequency of AS-related events and consequent modest differences in absolute risk, the researchers noted. The predominantly male cohort may limit generalizability of results because RA is more common in women. Other limitations included the predominantly male population and possible misclassification of RA status. 

Overall, the results demonstrate an increased risk for AS, AS-related intervention, and AS-related death in people with RA. More research is needed to examine AS and valvular heart disease as potential complications in this population, they concluded. 

The study was supported by the Center of Excellence for Suicide Prevention, Joint Department of Veterans Affairs, and Department of Defense Mortality Data Repository National Death Index. Dr. Johnson disclosed grants from the Rheumatology Research Foundation during the conduct of the study but had no other financial conflicts to disclose. Other authors disclosed fees and honoraria from pharmaceutical companies outside the submitted work.

A version of this article appeared on Medscape.com.

Adults with rheumatoid arthritis had a significantly higher risk than do those without RA for developing aortic stenosis (AS), according to a large national cohort of patients.

RA has been associated with an increased risk for ischemic cardiovascular disease, but the association of RA with the risk for AS remains unclear, Tate M. Johnson, MD, of VA Nebraska–Western Iowa Health Care System, Omaha, and colleagues wrote. 

In a study published in JAMA Internal Medicine, the researchers identified 73,070 adults with RA and 639,268 matched control individuals without RA using data from Veterans Affairs and Centers for Medicare & Medicaid Services from 2000 to 2019. 

The patients and control individuals were predominantly men (about 87%), and most were White (72.3% of patients and 61.7% of control individuals). The mean ages of the patients and control individuals were similar (63.0 vs. 61.9, respectively). 

The main outcome of incident AS was defined as a composite of inpatient or outpatient AS diagnoses, surgical or transcatheter aortic valve intervention, or AS-related death. 

Over a mean follow-up period of 7.9 years in patients with RA and 8.8 years in control individuals, the researchers found 16,109 composite AS outcomes over a period of 6,223,150 person-years, with 2,303 that occurred in patients with RA. 

The multivariate model adjusted for race, ethnicity, smoking status, body mass index (BMI), rural versus urban residence, comorbidities, and health care use.

Overall, RA was associated with an increased risk for the composite AS outcome (hazard ratio, 1.66).

After adjusting for confounders, RA remained associated with an increased risk for composite AS diagnoses, aortic valve intervention, and AS-related death (adjusted HRs, 1.48, 1.34, and 1.26, respectively). Altogether, the incidence of composite AS events was 3.97 per 1,000 person-years in patients with RA versus 2.45 per 1,000 person-years in control individuals, with an absolute difference of 1.52 composite AS events per 1,000 person-years.

The results “emphasize that valvular heart disease may be an underrecognized contributor to the persistent CVD [cardiovascular disease]-related mortality gap in RA, particularly given the lack of improvement in AS-specific risk over time,” the researchers wrote. 

Several traditional CVD risk factors (for example, smoking status, diabetes, and coronary artery disease) were not independently associated with AS onset in patients with RA. However, male sex, hypertension, stroke, and other noncoronary CVDs were associated with incident AS in the patients with RA, and increasing age and BMI were associated with stepwise increases in AS risk.

The findings were limited by several factors including the infrequency of AS-related events and consequent modest differences in absolute risk, the researchers noted. The predominantly male cohort may limit generalizability of results because RA is more common in women. Other limitations included the predominantly male population and possible misclassification of RA status. 

Overall, the results demonstrate an increased risk for AS, AS-related intervention, and AS-related death in people with RA. More research is needed to examine AS and valvular heart disease as potential complications in this population, they concluded. 

The study was supported by the Center of Excellence for Suicide Prevention, Joint Department of Veterans Affairs, and Department of Defense Mortality Data Repository National Death Index. Dr. Johnson disclosed grants from the Rheumatology Research Foundation during the conduct of the study but had no other financial conflicts to disclose. Other authors disclosed fees and honoraria from pharmaceutical companies outside the submitted work.

A version of this article appeared on Medscape.com.