Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study

A. Ogdie et al. Ann Rheum Dis doi:10.1136/annrheumdis-2014-205675

Authors studied the risk of major adverse cardiovascular events among patients with psoriatic arthritis, rheumatoid arthritis and psoriasis compared with the general population after adjusting for traditional cardiovascular risk factors.

Patients from UK aged 18–89 years of age with psoriatic arthritis, rheumatoid arthritis or psoriasis were included between 1994 and 2010. Up to 10 untreated controls  were selected for each patient with psoriatic arthritis.

Patients with psoriatic arthritis (N=8706), rheumatoid arthritis (N=41 752), psoriasis (N=138 424) and unexposed controls (N=81 573) were identified. After adjustment for traditional risk factors, the risk of major cardiovascular events was higher in patients with psoriatic arthritis not prescribed a DMARD, patients with rheumatoid arthritis, patients with psoriasis not prescribed a DMARD and patients with severe psoriasis.

The conclusion was that  traditional cardiovascular risks should be addressed with all patients affected by psoriasis, psoriatic arthritis or rheumatoid arthritis.


“Being overweight or obese and risk of developing rheumatoid arthritis among women: a prospective cohort study”.

Lu B. et al. Ann Rheum Dis doi:10.1136/annrheumdis-2014-205459

Authors examined the relationship between being overweight or obese and developing rheumatoid arthritis (RA).  They followed 109 896 women enrolled in the US Nurses’s Health Study (NHS) and 108 727 in Nurse’s Health Study II (NHSII) who provided lifestyle, environmental exposure and weight information through questionnaires every 6 months.

During 2 765 195 person-years of follow-up (1976–2008) in NHS and 1 934 518 person-years (1989–2009) in NHSII, they validated 1181 cases of Rheumatoid arthritis (826 in NHS, 355 in NHSII).

There was a trend toward increased risk of Rheumatoid arthritis among overweight and obese women. This association was stronger for patients 55 years of age and younger. Ten cumulative years of being obese, carried a 37% increased risk of Rheumatoid arthritis at younger ages.

Authors concluded that risk of Rheumatoid arthritis was elevated among overweight and obese women, particularly among women diagnosed with Rheumatoid arthritis at earlier ages.



“Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial”.

Saevarsdottir S. et al.  Ann Rheum Dis published online first 4 April 2014.

Authors started DMARD naive patients with rheumatoid arthritis on methotrexate. At 3 months responders (n=147) continued with methotrexate alone and non responders received sulafsalazine+plaquenil (n=130) or infliximab (n=128) in addition to methotrexate.  XRs were reviewed at baseline and at 1 year.

The following factors were independent predictors of radiographic (XR) progression: erosions on the baseline XRs, elevated inflammatory markers (ESR and CRP) and current smoking status.

In a secondary exploratory analysis, both Rheumatoid factor and anti-CCP positivity were significant predictors for the XR progression (development of erosions).



“The patient perspective on remission in rheumatoid arthritis: ‘You’ve got limits, but you’re back to being you again’”.

van Tuyl L, Hewlett S et al.  Ann Rheum Dis doi:10.1136/annrheumdis-2013-204798 I

The authors explored the patient perspective on remission in Rheumatoid arthritis.

47 patients with rheumatoid arthritis were involved in the 9 focus-group discussions in Austria, The Netherlands and UK. The patients were in ACR/EULAR remission, self-declared remission or had moderate/high disease activity.

There were three major themes of remission discussions:

  • symptoms would either be absent or strongly reduced
  • impact of the disease on daily life would diminish by increased independence, ability to do valued activities, improved mood and ability to cope
  • leading to a return to normality, including work, family role and perception of others
Patient’s perspective of remission was influenced by ageing, side effects of medication, comorbidities, accrued damage to joints and disease duration. Patients  described  remission as the absence or reduction of symptoms.  More specifically they related it with decreased daily impact of their condition and the feeling of a return to normality.

“Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis (RA)”.  Stavropolous-Kalinoglou et al.

Ann Rheum Dis, 2013 Nov 1;72(11):1819.

40 matched RA patients  were allocated to exercise (6 months of individualized aerobic and resistance high intensity exercise, three times per week) or control (advice on exercise and lifestyle changes).

The groups were similar at the baseline. They were assessed at 0, 3 and 6 months for aerobic capacity (VO2max), cardiovascular risk factors (BP, lipid levels, insulin resistance, body composition), 10 year probability of cardiovascular events, and RA characteristics.

All measures significantly improved in the exercise group versus control. The aerobic capacity was the strongest predictor of all improvements.



“Discontinuation of adalimumab after achieving remission in patients with established RA: 1 year outcome of HONOR study.” Tanaka et al. AA Rheum Dis 2013 Nov 28; epub ehead of print.
The authors investigated the possibility of discontinuation of adalimumab (Humira) for 1 year without flaring.
Out of 197 patients with RA who took adalimumab and methotrexate, 75 patients with 6 month stable remission were selected.  It was demonstrated that proportion of patients who sustained remission was significantly higher in the group who continued adalimumab+ methotrexate combination compared to those who stopped adalimumab. But it was also demonstrated that there was a high proportion of patients (79%) who stayed in remission if on the moment of the adalimumab discontinuation remission was deep.