AB0198 BASELINE FUNCTIONAL CAPACITY IN RHEUMATOID ARTHRITIS PREDICTS SUBCLINICAL ATHEROSCLEROSIS ON FOLLOW-UP

Abstract

BackgroundThe main cause of death in patients with rheumatoid arthritis (RA) is due to cardiovascular disease1. Cardiovascular mortality is strongly associated with the cumulative severity of the disease. Functional disability, as measured by the Health Assessment Questionnaire (HAQ), has been used to predict premature mortality in RA2. There are no studies relating its baseline score to the development of subclinical atherosclerosis by carotid ultrasound.ObjectivesTo determine whether baseline HAQ score is an independent factor for the development of subclinical atherosclerosis assessed by carotid ultrasound.MethodsProspective, observational study. Patients with a diagnosis of RA who met ACR/EULAR 2010 criteria and who were recruited at the Cardio-Rheumatic Clinic in 2014-2015 were included. Patients underwent a clinical history and physical examination and completed the HAQ. The presence of subclinical atherosclerosis was identified by carotid Doppler ultrasound at the end of follow-up. Subclinical atherosclerosis was defined by the presence of carotid plaque or carotid intima-media thickness (c-IMT) ≥0.8mm. Distribution was assessed with the Kolmogorov-Smirnov test. Correlation between cIMT value and baseline HAQ score was determined using Spearman’s correlation coefficient. Binary logistic regression was used to determine the independent factor for the development of subclinical atherosclerosis.ResultsA total of 48 patients were followed up. The median follow-up was 4.5 years (4.3-4.9). The baseline characteristics of the patients are shown in Table 1. A correlation was found between the GIMc value and the baseline HAQ score statistically significant (r=0.625, p=<0.001). In multivariate analysis that included scales to assess disease activity (DAS28-CPR, DAS28-ESR, CDAI, HAQ) and disease duration, and HAQ score was found to be an independent factor with MR 5.94 95% CI (1.65-21.41) (p=<0.001). DAS28-CRP with MR 1.52 95% CI (0.39-5.87), DAS28-ESR MR 0.27 95% CI (0.05-1.41), CDAI with MR 0.66 95% CI (0.82-1.12), disease duration 0.32 95% CI (0.07-1.49), but these were not statistically significant.Table 1.Baseline characteristics.Basal (n=48)Age, years ± SD55.8 ± 9.7Female, n (%)44 (91.7)Disease duration, years (IQR)9.5 (4.3-16.5)DAS28-ESR ± SD4.4 ± 1.2DAS28-CPR ± SD3.3 ± 1.1CDAI ± SD13.0 ± 10.2HAQ, (IQR)0.87 (0.25-1.25)HT, n (%)19 (39.6)DM, n (%)2 (4.2)Active tabaquism, n (%)4 (8.3)Obesity, n (%)19 (39.6)BMI, kg/m2 ± SD29.1 ± 4.6Methotrexate, n (%)40 (83.3)Glucocorticoids, n (%)30 (62.5)DAS28, disease activity score using 28 joints; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; CDAI, clinical disease activity index; HAQ, Health Assessment Questionnaire; HT, hypertension; DM, diabetes mellitus; BMI, body mass index.ConclusionOur data show that at 4.5 years of follow-up, baseline HAQ score is a significant independent predictor of the presence of subclinical atherosclerosis by carotid ultrasound in patients with rheumatoid arthritis.References[1]Semb AG, Ikdahl E, Wibetoe G, Crowson C, Rollefstad S. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol. 2020;16(7):361-79.[2]Wolfe F, Michaud K, Gefeller O, Choi HK. Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum. 2003;48(6):1530-42.Disclosure of InterestsNone declared