journal reading remato

8/18/2019 Journal Reading Remato

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Journal Reading

Jerry Eddya Putra Boer


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Introduction

• RA increased risk of morbidity and mortality related to

cardiovascular disease (CVD

• !imited study about association of radiogra"#ically detected

vascular calcifications

• Previous study s#o$ed relation bet$een radiogra"#ic

vascular calcifications and mortality in ot#er "o"ulations%

• In t#is study& aut#or soug#t to determine $#et#er commonly

"erformed radiogra"#s& namely 'ray studies of t#e #ands&

mig#t "rovide valuable information relative to CVD risk

assessment in RA%


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)et#ods

• Patients $ere "artici"ants in t#e Veterans Affairs R#eumatoid

Art#ritis (VARA registry& a longitudinal observational study of

*+ veterans $it# RA

• Digiti,ed #and radiogra"#s& $#ic# included vie$s of t#e$rists& $ere e-amined using a sam"le of ./0 RA "artici"ants

$it# at least one radiogra"#ic study "er "atient%

• Demogra"#ic and #ealt#related measures e-amined

included age& race& gender& education smoking status atenrolment (never& former& current and B)I (kg1m2&

Comorbid conditions


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)et#ods

• RArelated factors e-amined included RA disease duration

(years& ACPA and R3 "ositivity& Routine Assessment of

Patient Inde- Data4 (RAPID4 and DA+25 using E+R

scores& CRP concentration& "resence of r#eumatoid nodules&

usage of "rednisone& )6' or biologics

• +tatistical analyses $ere com"leted using +tata version 72


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Results

• Vascular calcifications

$ere observed in #and

radiogra"#s in .. (778of t#e ./0 "atients

studied


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Results


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Result


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Result


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Results


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+trengt#

• +trengt#s of t#is study include t#e uni9ue availability of

radiogra"#ic films from a single integrated #ealt# care

system& t#e availability of longitudinal clinical data

• statistical "o$er afforded by t#e large sam"le si,e%

• 3urt#er strengt#s include a diagnosis of RA made by a

r#eumatologist& as $ell as t#e utili,ation of a single

laboratory for ACPA subty"es and cytokine determinations%


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:eakness

• cardiovascular events and cause s"ecific mortality&

including CVDrelated deat#& $ere not available

• radiogra"#s of t#e feet $ere not routinely available& a

note$ort#y limitation given "revious observations of #ig#er

rates of radiogra"#ic vascular calcifications in t#e feet

com"ared $it# t#e #ands in a RA subco#ort from t#is

"o"ulation

• lack of standardi,ed algorit#ms for measuring calcification

burden& $e did not e-amine t#e effect of calcificationseverity on mortality events%

• 6#e "resent effort $as limited to *%+% veterans& a

"o"ulation t#at is uni9ue relative to ot#er RA "o"ulations

because it com"rises "redominantly older men $it# #ig#


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• t#ese results may not be generali,able to ot#er "o"ulations&

"articularly $omen& $#o account for t#e largest

demogra"#ic grou" affected by RA%


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Conclusion

• In t#is study& vascular calcifications $ere evident on #and

radiogra"#s in a""ro-imately 7 in every 7/ RA "atients& and

t#eir "resence $as associated $it# an ;/8 increase in all

cause mortality risk

• 6#e role t#at vascular calcifications may "lay in mortality&suc# as driving endot#elial dysfunction or t#e conse9uence of

a systemic inflammatory "rocess in RA& #as yet to be

elucidated

•


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6=A>? @*


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• In age and genderadusted models& logtransformed anti

CitA"oE values (but not antiCitvim or antiCitfib $ere

associated $it# allcause mortality (=R 7%70 .8 CI 7%/5&

7%2;%

• 6#is association $as attenuated and nonsignificant in

multivariable models (data not s#o$n%

• )6' and biologic use $ere associated $it# a significantly

lo$er =R for allcause mortality%

• 6o investigate t#e role of diabetes& $e "erformed Co-"ro"ortional #a,ard regression in subects $it# and

• $it#out diabetes%

• :e found vascular calcifications remained significantly

associated $it# allcause mortalityin bot# grou"s

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