Journal Article

AB0356 EVALUATION OF CARDIOVASCULAR RISK AND OSTEOMETABOLIC ALTERATIONS IN A POPULATION OF PATIENTS AFFECTED BY RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS OF A MULTIDISCIPLINARY PROSPECTIVE STUDY

Beccuti, G., Parisi, S., Ditto, M.C., Lopez, C., Broglio, F., Ghigo, E., Fusaro, E.

2023

Overview

Rheumatoid Arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality and osteometabolic alterations risk, associated with chronic inflammation, the use of glucocorticoids (GC) and the reduced physical exercise.[1] The objective of the study is to cross-sectionally estimate cardiovascular risk and osteometabolic status in patients (pts) with RA and to evaluate the association with some disease parameters such as positivity of autoantibodies, disease activity and steroid therapy. At the current time, 61 consecutive pts with diagnosis of RA, admitted to the Rheumatology Unit of the University Hospital of Turin, were prospectively recruited and assessed for cardiometabolic risk by the Endocrinology Unit, by undergoing laboratory and instrumental tests. The following prevalences were observed: arterial hypertension (52%), type 2 diabetes mellitus (7%), dyslipidemia (56%), osteoporosis (42%), and vertebral fracture (30%). At the univariate analysis, the enrolled pts were divided according to serodiagnosis, GC therapy and disease remission. No statistically significant results were highlighted stratifying population by serodiagnosis. Pts with high disease activity showed lower bone mineral density (BMD) values [BMD femoral trochanter: 0.53± 0.08 vs 0.60 ± 0.08 (g/m2), p=0.031] and T-score value on bone densitometry [T-score Femoral total: -1.88 ± 0.53 vs -1.07 ± 0.83, p=0.005], higher percentage of osteoporosis [67% vs 27%, p=0.047] and vertebral fractures [60% vs 12%, p=0.001], and higher sarcopenia score [SARC-F: 5 (3-7) vs 2 (2-4), p=0.020], in comparison with pts with remission disease. These differences were not confirmed when the population was divided according to the use of GC therapy. For CV risk factors, disease activity group showed a trend of higher prevalence compared to remission group, but without reaching statistical significance. At the multivariate analysis, advanced age (p=0.001), GC therapy (p=0.021) and copeptin (p=0.002) showed an inverse association and lumbar T-score (p=0.002) a direct one with lumbar trabecular bone score (TBS). Moreover, male gender (p=0.001) revealed a direct and significant association, while copeptin (p=0.086) an inverse and not significant one with percentage of lean mass on total densitometry, correcting for advanced age, duration of disease, GC therapy, and disease activity. In the last model, advanced age (p<0.001) and copeptin (p<0.001) showed a direct and significant association with HeartSCORE, correcting for parameters of disease while serodiagnosis, duration of disease, GC therapy, and disease activity. At univariate analysis osteometabolic alterations were associated with disease activity, but not with GC therapy and serodiagnosis. At the multivariate analysis, the association of disease activity and TBS values, did not reach the statistical significance, probably for the loss of statistical power. However, GC therapy, as well as advanced age, low lumbar T-score and high value of copeptin, remained independently associated with lower TBS value. Disease parameters were not associated with lower percentage of lean mass at total body densitometry and higher HeartSCORE values, while advanced age and copeptin were associated with bone health and cardiovascular risk. [1] Mackey RH et al. Rheum Dis Clin North Am 2018. NIL. None Declared. Table 1Multivariate linear regression analysisCovariates associated with lumbar TBSB-coefficientCI 95%p-valueAge-0.005(-0.007- -0.002)0.001GC-0.068(-0.125- -0.011)0.021T-Score0.049(0.020-0.079)0.002Copeptin-0.014(-0.023- -0.006)0.002Covariates associated with HeartSCORE cardiovascular risk scoreB-coefficientCI 95%p-valueAge0.242(0.180-0.304)<0.001Duration of disease-0.045(-0.099-0.008)0.096RF and/or ACPA +-0.224(-1.855-1.407)0.782GC0.840(-0.454-2.135)0.195Copeptin0.345(0.172-0.518)<0.001Remission0.502(-0.848-1.853)0.454

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Age / Autoantibodies / Bone mineral density / Cancellous bone / Cardiovascular diseases / Comorbidities / Densitometry / Diabetes mellitus (non-insulin dependent) / Dyslipidemia / Endocrinology / Femur / Fractures / Morbidity / Multivariate analysis / Osteoporosis / Real-world evidence / Remission / Remission (Medicine) / Rheumatoid arthritis / Rheumatology / Risk factors / Sarcopenia / Statistical analysis / Statistical significance / Statistics / Trochanter / Vertebrae