Higher scores on a multi-biomarker disease activity system are associated with hospital infection, myocardial infarction, and coronary heart disease events in older patients with rheumatoid arthritis, according to recent research published in Annals of the Rheumatic Disease (doi:10.1136/annrheumdis-2017-211727).
Previous research has shown rheumatoid arthritis disease activity and associated systemic inflammation to correlate with serious infections, myocardial infarction, and coronary heart disease events. However, limited data exist in large-scale population-based studies, and further research is needed to validate this correlation.
The 100-point multi-biomarker disease activity system Vectra DA is based on a set of 12 protein biomarkers that correlate with disease activity in several rheumatoid arthritis cohorts. Scores lower than 30 are considered low-risk, scores 30-44 are considered moderate-risk, and scores over 44 are considered high-risk.
Jeffrey R Curtis, MD, MS, MPH, division of clinical immunology and rheumatology, University of Alabama at Birmingham, and colleagues conducted a study to better understand the relationship between the Vectra DA system scores and risk of cardiovascular events. A total of 77,641 test scores were linked to national Medicare fee-for-service claims from 2010 to 2014. Outcomes of particular interest were hospitalized pneumonia/sepsis, myocardial infarction, and a composite coronary heart disease outcome.
There were 17,433 and 16,796 patients eligible for the pneumonia/sepsis and myocardial infarction/coronary heart disease analyses, respectively. The mean age of all patients included the study was 69 years.
After 16,424 person-years of follow-up, a total of 452 pneumonia/sepsis events, 132 myocardial infarction events, and 181 coronary heart disease events were recorded. Researchers found that higher Vectra DA scores were associated with pneumonia/sepsis (HR, 1.32; 95% CI, 1.23-1.41) and higher disease activity by Vectra DA score was associated with increased myocardial infarction (HR, 1.52; 95% CI, 0.92-2.49) and coronary heart disease rates (HR, 1.54; 95% CI, 1.01-2.34).
Dr Curtis and colleagues concluded that higher Vectra DA scores were associated with hospitalized infection, myocardial infarction, and coronary heart disease events in a large, predominantly older, rheumatoid arthritis population. "However, given that the prevalence of infectious and coronary heart disease risk factors generally increases with age, we would speculate that the associations between rheumatoid arthritis disease activity and the outcomes that we studied might be even stronger in younger patients with rheumatoid arthritis," they wrote.—Zachary Bessette