Clinical and epidemiologic aspects of Rheumatoid Arthritis. Special emphasis on cardiovascular outcome and risk factors

Abstract: Rheumatoid arthritis (RA) is a systemic disease, with an increased risk of co-morbidity from cardiovascular disease (CVD), in particular among those with severe disease. Environmental risk factors are of potential interest for both prevention and treatment of RA. Our aim was to examine changes in the occurrence of CVD over time and, using immunohistochemistry, study markers of inflammation in vascular endothelial cells during treatment with a TNF-inhibitor. We also investigated predictors of RA. Two community based of RA cohorts were established in 1978 and 1995 and compared to the corresponding background population regarding CVD. Patients were followed for 8 years, and fatal and non-fatal cardiovascular first events were identified. To investigate markers of endothelial activation, we used fourteen patients with active RA who started anti-TNF treatment. Muscle biopsies were taken at baseline and 3 months after start of treatment. To identify incident cases of RA for evaluation of predictors of RA, we used two large surveys, the Malmö Preventive Medicine Program and the Malmö Diet Cancer Study. Cardiovascular morbidity and mortality in the two community based RA cohorts was increased compared to the background population. Treatment with adalimumab was associated with decreased expression of endothelial markers previously associated with severe systemic inflammation in RA. Smoking and a low level of formal education were independent risk factors for RA. Moderate alcohol consumption was associated with a reduced risk of RA. Reduced pulmonary function was not associated with future RA, but smoking and low socioeconomic status were independent predictors of RA.