Incidence of noncardiac vascular disease in rheumatoid arthritis and relationship to extraarticular disease manifestations

Abstract

Objective: To investigate the incidence of noncardiac vascular disease in patients with rheumatoid arthritis (RA) and its relationship to systemic extraarticular disease in a community-based cohort.

Methods: A retrospective medical record review of 609 patients with incident RA diagnosed during 1955-1994 was carried out in Olmsted County, Minnesota. Patients were followed up from 1955 to 2000 (median followup 11.8 years). Incident noncardiac vascular disease and severe extraarticular RA manifestations (including pericarditis, pleuritis, and vasculitis) were recorded according to predefined criteria, and incidence rates were estimated. Using Cox proportional hazards models, the risk (hazard ratio [HR]) of developing vascular events was assessed in patients with and without severe extraarticular RA.

Results: Cerebrovascular and peripheral arterial events occurred in 139 patients (22.8%). The 30-year cumulative incidence rates of peripheral arterial events, cerebrovascular events, and venous thromboembolic events were estimated to be 19.6%, 21.6%, and 7.2%, respectively. The presence of severe extraarticular RA manifestations was found to be associated with all subgroups of noncardiac vascular disease except cerebrovascular disease alone (HR 2.3, 95% confidence interval [95% CI] 1.2-4.3 for peripheral arterial events; HR 3.7, 95% CI 1.3-10.3 for venous thromboembolic events; HR 1.5, 95% CI 0.7-3.2 for cerebrovascular events) after adjusting for age, sex, body mass index, smoking, and rheumatoid factor status.

Conclusion: This is the first study to assess the incidence of noncardiac vascular disease in RA. Severe extraarticular RA was associated with all forms of noncardiac vascular disease except cerebrovascular disease alone. Similar to cardiac disease, the excess risk of noncardiac vascular disease in RA is likely to be related, in part, to the systemic inflammation associated with the extraarticular manifestations of RA.

Figure 1

Survival curves in relation to the development of noncardiac vascular disease in patients with mild extraarticular rheumatoid arthritis (ExRA) or severe extraarticular RA as compared with those without extraarticular RA. A, Survival free of cerebrovascular and peripheral arterial disease (events 1–8 in Table 1). B, Survival free of venous thromboembolic events (events 9 and 10 in Table 1). C, Survival free of cerebrovascular disease (events 1–4 in Table 1). D, Survival free of peripheral arterial disease (events 5–8 in Table 1). The presence of severe extraarticular RA was associated with worse disease-free survival for all noncardiac vascular disease subgroups except cerebrovascular disease.