CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS WITHIN THE REMARCA STUDY: PRELIMINARY DATA

Most patients with early rheumatoid arthritis (RA) have a high or very high cardiovascular risk (CVR) before therapy with disease-modifying antirheumatic drugs (DMARDs).
Objective: to evaluate the impact of antirheumatic therapy performed in accordance with the Treat-to-Target strategy on the progression of atherosclerosis and CVR in patients with early RA. 
Subjects and methods. This investigation enrolled 74 patients (72% women; median age, 56 years) with early RA having moderate to high activity (median DAS28, 5.6) who had not previously received DMARDs and glucocorticoids (GCs). All patients were anticyclic citrullinated peptide antibody-positive and 87% of the patients were rheumatoid factor-positive. All patients received methotrexate (MT) subcutaneously with dose escalation up to 25–30 mg/week, in case of its inefficiency at 3 months a biological agent (BA) was added. After 6 months, 39% of the patients achieved remission; 19% had low; 35 and 7% had moderate and high disease activity, respectively. The majority (n = 20 (69%)) who achieved remission received MT monotherapy; 9 (31%) – MT + BA whereas among the patients who did not achieve remission 15 (33%) and 30 (67%) respectively. At baseline and after 6 months of treatment, traditional CVR factors were assessed in all patients, by determining the total coronary risk by the SCORE scale, including that modified by EULAR (mSCORE), carotid artery atherosclerosis (CAA) by duplex scanning data, coronary calcification (CC) by multislice spiral computed tomography and by estimating the degree of CVR.
Results and discussion. The rates of hypertension, overweight, abdominal obesity, low activity, smoking, and type 2 diabetes mellitus did not change significantly after 6 months. There were increases in the levels of total cholesterol by 7% (p < 0.05), low-density lipoprotein cholesterol by 9% (p<0.01), high-density lipoprotein cholesterol by 26% (p < 0.005), and body mass index (BMI) by 1% (p < 0.01) and a decrease in the atherogenic index (p<0.005). The change in blood lipid spectrum concentrations was correlated positively with trends in BMI (p < 0.05) and negatively with those in the levels of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate; p < 0.05). Following 6 months, there was a rise in the total CVR according to the SCORE and mSCORE scales (p < 0.005). The elevations in the rates of CAA from 59 to 72% and CC from 42 to 47% resulted in an increase in the proportion of persons with very high CVR from 67 to 76%; however, the differences failed to attain statistical significance. There was a similar increase in the rates of CAA and CC in the groups of patients receiving monotherapy with MT and MT + BA. In the patients who failed to achieve remission in RA, the rise in the rate of CAA was 18% higher than in those who did (3%) (p = 0.05). A significant progression in CAA was noted in the persons who failed to achieve remission and received no statins (p = 0.05) while the rate of CAA remained unchanged among those who took statins and achieved remission in RA.
Thus, the preliminary data of the REMARCA study have shown that the progression of atherosclerosis can be delayed in patients with early RA if they achieve remission during antirheumatic therapy and simultaneously use statins regularly, which may be further associated with a reduction in CVR.

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