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High Disease Activity in RA: A Danger Zone for Heart Disease and Infection

Good management of rheumatoid arthritis may also prevent serious infection, myocardial infarction, and even death related to comorbid disease.

Key points
• High multi-biomarker disease activity (MBDA) test scores in patients with rheumatoid arthritis (RA) are associated with serious cardiovascular events such as myocardial infarction.

• High MBDA test scores are also associated with serious infections that require hospitalization in patients with RA.

• The impact of disease activity in RA is not limited to the joints.

It is well established that low disease activity or remission is the goal of treatment for RA. Although the primary pathogenesis of RA is joint pain and damage, prior evidence suggests that reductions in disease activity in RA may lead to lower rates of infection.

Curtis and fellow researchers1 from the University of Alabama point out that elevated C-reactive protein (CRP) levels have been correlated with worse cardiovascular disease. Furthermore, trials have shown cardiac risk is lowered when CRP levels are reduced.

The researchers sought to quantify the association between MBDA scores and serious adverse events in patients with RA. They recently presented their findings in Annals of the Rheumatic Diseases.

The study
The researchers conducted a longitudinal cohort study that looked at older Americans on Medicare who received MBDA tests for RA. Ultimately, 17,433 were included in the serious infectious disease analysis cohort and 16,796 in the coronary heart disease and myocardial infarction cohort.

The results
• High MBDA scores were associated with higher rates of serious infections, myocardial infarctions, and coronary heart disease (CHD) events.

• Higher MBDA scores without CRP were associated with increased rates of myocardial infarction and CHD in a dose-dependent fashion.

• Leptin was a covariate and a part of the MBDA scoring that was associated with a cardiovascular protective effect for myocardial infarction and CHD.

Implications for clinicians
• Older patients with RA are at greater risk for infection-related hospitalization, myocardial infarction, and other CHD events while their disease activity is high.

• Keep in mind the repercussions of unchecked disease activity in RA on extra-articular outcomes, specifically related to cardiovascular disease.

• Good management of RA may also prevent serious infection, myocardial infarction, and even death related to comorbid disease.

• The researchers suggest that MBDA scoring may be used to risk-stratify your patients with high disease activity and target early interventions.


Crescendo Bioscience and the Patient-Centered Outcomes Research Institute provided funding for this study.


1. Curtis JR, Xie F, Chen L, et al. Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based study. Ann Rheum Dis. Published online first: December 21, 2017. doi:10.1136/ annrheumdis-2017-211727.