Cardiovascular risk in persons at risk of developing rheumatoid arthritis

Laurette van Boheemen, Marian H van Beers-Tas, Johanna M Kroese, Lotte A van de Stadt, Dirkjan van Schaardenburg, Michael T Nurmohamed

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.

METHODS: In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.

RESULTS: Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.

CONCLUSION: Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.

Original languageEnglish
Article numbere0237072
Pages (from-to)1-11
Number of pages11
JournalPLoS ONE
Issue number8
Early online date3 Aug 2020
Publication statusPublished - Aug 2020


  • Adult
  • Anti-Citrullinated Protein Antibodies
  • Arthralgia
  • Arthritis, Rheumatoid/complications
  • Autoantibodies/immunology
  • Cardiovascular Diseases/complications
  • Cohort Studies
  • Disease Progression
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rheumatoid Factor/immunology
  • Risk Factors


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