Samina A Turk1,2, Sjoerd C Heslinga3,4, Jill Dekker3,4, Linda Britsemmer3,4, Véronique van der Lugt3,4, Willem F Lems3,4, Dirkjan van Schaardenburg3,4, Michael T Nurmohamed3,4. 1. From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; Department of Cardiology, VUmc; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VUmc; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, AMC, Amsterdam, the Netherlands. s.turk@reade.nl. 2. S.A. Turk, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; S.C. Heslinga, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; J. Dekker, MD, Department of Cardiology, VUmc; L. Britsemmer, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; V. van der Lugt, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; W.F. Lems, Professor, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VUmc; D. van Schaardenburg, Professor, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, AMC; M.T. Nurmohamed, Professor, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VUmc. s.turk@reade.nl. 3. From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; Department of Cardiology, VUmc; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VUmc; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, AMC, Amsterdam, the Netherlands. 4. S.A. Turk, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; S.C. Heslinga, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; J. Dekker, MD, Department of Cardiology, VUmc; L. Britsemmer, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; V. van der Lugt, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade; W.F. Lems, Professor, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VUmc; D. van Schaardenburg, Professor, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, AMC; M.T. Nurmohamed, Professor, MD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VUmc.
Abstract
OBJECTIVE: To investigate the prevalence of conduction disorders in patients with early arthritis and the relationship with inflammation and traditional cardiovascular (CV) risk factors. METHODS: Patients with rheumatoid arthritis (RA) have a 2-fold higher risk of sudden cardiac death, possibly owing to conduction disorders. This increased risk might already be present at the clinical onset of arthritis. Therefore, we assessed electrocardiography, blood pressure, 28-joint Disease Activity Score (DAS28), lipid profile, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level in 480 patients with early arthritis at baseline and after 1 year. RESULTS: The prevalence of conduction disorders was 12.5%. Conduction times at baseline were not associated with DAS28, ESR, or CRP levels and did not change during antirheumatic treatment. Baseline and the improvement in DAS28 (European League Against Rheumatism response), ESR, and CRP were significantly associated with heart rate, lipid profile, and blood pressure. Elevated total cholesterol and blood pressure were associated with an increased QRS time. The change in heart rate differed 7.3 bpm between patients with the least versus largest DAS improvement. CONCLUSION: The prevalence of conduction disorders in patients with early arthritis was 12.5%, which is similar to the general population and was not associated with changes in inflammation markers. However, a high cholesterol was associated with a prolonged QRS time. Therefore, the emphasis of CV risk management in arthritis should not be only on treatment of disease activity but also on traditional CV risk factors. The relationship between the improvement in disease activity and heart rate is remarkable because this could imply a 10-year CV mortality risk difference of 24%.
OBJECTIVE: To investigate the prevalence of conduction disorders in patients with early arthritis and the relationship with inflammation and traditional cardiovascular (CV) risk factors. METHODS:Patients with rheumatoid arthritis (RA) have a 2-fold higher risk of sudden cardiac death, possibly owing to conduction disorders. This increased risk might already be present at the clinical onset of arthritis. Therefore, we assessed electrocardiography, blood pressure, 28-joint Disease Activity Score (DAS28), lipid profile, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level in 480 patients with early arthritis at baseline and after 1 year. RESULTS: The prevalence of conduction disorders was 12.5%. Conduction times at baseline were not associated with DAS28, ESR, or CRP levels and did not change during antirheumatic treatment. Baseline and the improvement in DAS28 (European League Against Rheumatism response), ESR, and CRP were significantly associated with heart rate, lipid profile, and blood pressure. Elevated total cholesterol and blood pressure were associated with an increased QRS time. The change in heart rate differed 7.3 bpm between patients with the least versus largest DAS improvement. CONCLUSION: The prevalence of conduction disorders in patients with early arthritis was 12.5%, which is similar to the general population and was not associated with changes in inflammation markers. However, a high cholesterol was associated with a prolonged QRS time. Therefore, the emphasis of CV risk management in arthritis should not be only on treatment of disease activity but also on traditional CV risk factors. The relationship between the improvement in disease activity and heart rate is remarkable because this could imply a 10-year CV mortality risk difference of 24%.