LAUSR

Background Inflammation plays a central role in the development of atherosclerosis and inflammatory disease might promote progression of CAD. Objectives To examine the impact of the most frequent systemic inflammatory disease, rheumatoid arthritis (RA), on the prevalence and severity of coronary artery disease (CAD) in patients referred for rule out of CAD by cardiac computed tomography (CCT). Methods In total, 39,534 patients from a mandatory national CCT database were included. Patients with a validated RA diagnosis were subgrouped based on serology, treatment with biological disease-modifying anti-rheumatic drugs (DMARDs), and the need for flare treatment with intraarticular and intramuskular glucocorticoid injections (GCIs). Outcomes were coronary artery calcium score (CACS) > 0 and CACS > 400. Differences in prevalences were assessed by odds ratios (OR). Outcomes were adjusted for cardiovascular risk factors and comorbidities. Results A total of 337 (0.9%) patients with RA were identified. OR for having CACS > 0 was 1.17 (0.91-1.50) for overall RA and 1.33 (1.00-1.77) for seropositive RA. Patients who had received ≥1 GCI in the period 3 years prior to the CCT had an OR of 1.49 (0.99-2.27) for having CACS > 0. The OR for having CACS > 400 was 1.31 (0.95-1.81) for overall RA and 1.49 (1.04-2.12) for seropositive RA. OR for having CACS > 400 was 1.43 (0.99-2.07) for RA patients treated with conventional synthetic DMARDs, but 1.01 (0.51-1.99) for patients treated with biological DMARDs. Conclusion Coronary artery calcifications are more frequent in RA patients being seropositive or needing flare treatment. The occurrence of severe calcification is more frequent in seropositive RA patients and in RA patients not escalated to biological DMARDs. These findings support the hypothesis that systemic inflammation accelerates the atherosclerotic process leading to increased coronary artery calcium, which may explain the increased risk of cardiovascular events among RA patients. Disclosure of Interests None declared