An interesting summary of several abstracts relating to core morbidities and rheumatoid arthritis was presented at EULAR 2015.
It is well-known that CVD is the number one cause of mortality in patients with RA. Our patients have twice the riskof mortality from myocardial infarction and stroke compared to the general population. A research group from the United Kingdom has found that people with early RA who are naïve to treatment have increased arterial stiffness, extracellular volume fraction and focal fibrosis without ischemia, and lower left ventricular mass. This indicates that CV changes occur prior to the diagnosis of RA.
An analysis from a Swedish registry for patients with early RA diagnosed between 1997 and 2012 who had no previous history of acute coronary syndrome were matched to a general population registry. This uncovered an increased incidence of ACS compared to the general population throughout the entire time frame studied.
People with RA are known to be at increased risk of infection, and levels of TNF increase in cases of sepsis. The risk of progressing to sepsis after a serious infection was evaluated using the German RABBIT registry. Patients who were taking biologic DMARD therapy at the time of developing a serious infection had a lower risk of developing sepsis or dying than those who were on synthetic DMARD therapy alone who had previously discontinued their biological treatment. For the patients who were receiving biologic therapy at the time of developing a serious infection, it is not known at what point they may have discontinued their treatment once the serious infection was identified. What is known is that the patients who developed sepsis did so soon after the serious infection was identified. The majority of patients who were taking biologic therapy received subcutaneous preparations. The exact breakdown of which agents were used was not available.
Periodontal disease has been linked to RA. An evaluation of antibodies produced against common periodontal pathogens was assessed in a cohort of first-degree relatives of patients with RA who had not yet been diagnosed with this condition. Those analyzed were classified into four groups. The first had no symptoms or blood markers of RA, the second had no symptoms yet but were RF- and ACPA-positive, the third group was experiencing arthralgia only, and the fourth group had undifferentiated arthritis. There was no association between circulating antibody levels against common periodontal pathogens and specific phases of RA development. Therefore, periodontal pathogens cannot be used as a prognostic tool.
Carolyn Whiskin, BSc. Phm is currently the director of pharmacy programs for the Charlton Centre for Specialized Treatments in Hamilton, Ontario. She also practices pharmacy at Brant Arts Dispensary in Burlington, Ontario and is the pharmacist representative to the Ontario Rheumatology Association’s Model of Care committee.View Full Bio