COMMENTARY

New EULAR Guidelines for Managing Cardiovascular Disease Risk in Rheumatoid Arthritis

Kevin Deane, MD

Disclosures

September 09, 2010

EULAR Evidence-based Recommendations for Cardiovascular Risk Management in Patients With Rheumatoid Arthritis and Other Forms of Inflammatory Arthritis

Peters MJL, et al
Ann Rheum Dis. 2010;69:325-331

Introduction

Cardiovascular disease (CVD) accounts for approximately more than 50% of deaths in patients with rheumatoid arthritis (RA).[1,2] However, there are no clear universal guidelines for modifying this risk in patients with RA, or other forms of inflammatory arthritis. To address this gap in knowledge, European League Against Rheumatism (EULAR) investigators reviewed the literature regarding CVD risk in patients with RA as well as ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Study Summary

The EULAR investigators arrived at the following 10 recommendations based on literature review and expert consensus: (1) RA, and likely AS and PsA, are associated with increased risk for CVD; (2) controlling disease activity may improve risk; (3) CVD risk assessment using national guidelines should be performed yearly; (4) CVD risk scores should be increased by a factor of 1.5 in patients with RA, particularly if they have disease for longer than10 years, RF or CCP positivity and extra-articular manifestations; (5) total cholesterol/high density lipoprotein ratio should be used for the cholesterol component of the Systemic Coronary Risk Evaluation (SCORE) model for CVD risk (the SCORE model is similar to the Framingham score used in the United States); (6) risk modification should be performed using local guidelines; (7) statins and angiotensin-converting enzyme (ACE) inhibitors (including ACE-receptor blockers) should be considered given potential anti-inflammatory action of these medications; (8) nonsteroidal anti-inflammatory agents (including COX-2 selective agents) should be used cautiously; (9) corticosteroids should be used in lowest-doses possible; and (10) smoking cessation should be advised. Of note, the level of evidence for all of these recommendations was only moderate (ranging from 4 to 2b) and the strength of recommendations was also relatively low (ranging from D to B).

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