Incidence and outcome of cardiovascular disease in patients with inflammatory joint diseases

Concept

Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have a 1.5- to 2-fold increased risk of cardiovascular disease (CVD) compared to the general population. To be able to prevent CVD in patients with inflammatory joint diseases (IJD), it is of great importance to provide up-to-date evidence on the prevalence of CVD and the effect of medication on CVD outcome. The project is conducted within the Norwegian Cardio-Rheuma register, which is a nationwide register linkage study with data on the whole Norwegian population and all patients with RA, PsA and AS from 2008 – 2017, as well as similar Finnish register data.

Facts and figures

Project lead
A Kerola
University of Helsinki
anne.kerola@helsinki.fi
FOREUM reserach grant: € 50.000
2020–2021

Meet the team

A Kerola
University of Helsinki
A Semb
Diakonhjemmet Hospital
M Kauppi
Päijät-Häme Central Hospital
T Nieminen
Päijät-Häme Central Hospital
E Haarvardsholm
Diakonhjemmet Hospital
S Rollefstad
Department of Rheumatology, Diakonhjemmet Hospital
G Wibetoe
Department of Rheumatology, Diakonhjemmet Hospital
A Palomäki
Turku University Hospital
V Kytö
Turku University Hospital

Objectives

  • To explore contemporary incidence and prevalence of RA, PsA and AS in Norway
  • To evaluate all-cause and cause-specific mortality in patients with RA, AS and PsA compared to the general population
  • To study prevalence, incidence and outcome of CVDs in IJDs compared to the general population
  • To compare the risk of CVD among users and non-users of biologic disease-modifying antirheumatic drugs in patients with IJD
  • To explore sex differences in CVD event rates in patients with IJD compared to the general population
  • To compare the use of secondary preventive medication in patients with IJD and general population controls after acute coronary syndrome (ACS)
  • To study similar research questions among Finnish IJD patients based on Finnish register data

The results from this project may facilitate the establishment of CVD prevention recommendations/guidelines specifically developed for patients with IJD.

Patient voice

Two patient representatives, one from the patient user council of Diakonhjemmet hospital and one from the National Association of Rheumatology, are involved in all stages of the project. The aim is to have regular meetings and communication with the patient representatives to include them in the development of protocol writing, choice of outcome measures, final analyses and presentation and dissemination of results. The project group will actively seek to disseminate results from the projects to patients through lay summaries and presentations at patient organization meetings.

Interim results

The register-based incidence estimates of RA and PsA in Norway are slightly higher than in previous Norwegian studies, and it was found that risk of RA and PsA was higher among persons with lower education level. Even in the 2010s, Norwegian RA patients suffer from excess mortality compared to the general population. In contrast, mortality among PsA patients was similar to the general population, which may relate to an overall milder disease course and/or improved treatment. In addition to effective suppression of disease activity, our findings warrant further attention to comorbidity prevention in RA.

Among Finnish RA patients, long-term outcomes after myocardial infarction (MI) compared to the general population are impaired. Glucocorticoid use before MI is associated with higher mortality and recurrent MI. Secondary prevention of CVD among RA patients should be prioritized.

Publications

Original article from Finnish research collaboration: Palomäki A*, Kerola AM*, Malmberg M, Rautava P, Kytö V. Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction - a nationwide case-control registry study. Rheumatology (Oxford). 2021 Mar 1:keab204. doi: 10.1093/rheumatology/keab204. Epub ahead of print. PMID: 33667301.
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EULAR Abstracts

2021

POS0029 Incidence and treatment penetration of rheumatoid arthritis in Norway – a nationwide register linkage study
POS1041 Prevalence, incidence and antirheumatic drug use in psoriatic arthritis (PsA) in Norway

Goals/Milestones

  • October 2020: Linkage of data across registers
  • November 2020 - February 2021: Preparation of the Norwegian Cardio-Rheuma register database and initial analyses
  • March - October 2021: Statistical analyses, preparation of first manuscripts and their submission to international peer-reviewed journals