Cardiovascular comorbidity burden similar in RA, systemic sclerosis
The burden of cardiovascular comorbidities is similar between rheumatoid arthritis and systemic sclerosis, despite dyslipidemia and diabetes mellitus being nearly half as prevalent in systemic sclerosis than in rheumatoid arthritis, according to data published in Arthritis Research & Therapy.
“Despite the impact of the disease in survival and quality of life, data on the epidemiology and clinical expression of comorbidities in [systemic sclerosis] so far are limited,” Dimitrios Vassilopoulos, MD, of the National and Kapodistrian University of Athens School of Medicine, and colleagues wrote. “Conversely, the interactions between disease-related inflammatory processes and development of several comorbidities has been thoroughly investigated in rheumatoid arthritis. This is particularly the case for cardiovascular disease (CVD), where RA is considered to be an independent predictor of the development of CVD with comparable CV risk to diabetes mellitus.”
In an interview with Healio Rheumatology, Vassilopoulos said “This is the first study to our knowledge that directly compared the prevalence of the most frequent comorbidities in two large and well-matched cohorts of patients with systemic sclerosis and RA.”
For their study, Vassilopoulos and colleagues recruited 408 patients with systemic sclerosis — 55% of whom had diffuse systemic sclerosis — and 408 with RA, from six academic rheumatology departments across Greece, between 2016 and 2017. Patients in each group were matched for age and gender.
The researchers compared rates of cardiovascular risk factors, coronary artery disease, stroke, chronic obstructive pulmonary disease (COPD), osteoporosis, neoplasms and depression between the two groups.
According to the researchers, prevalence of dyslipidemia was 18.4% in systemic sclerosis, compared with 30.1% for RA (P=.001). Meanwhile, the prevalence of diabetes mellitus was 5.6% among patients with systemic sclerosis and 11.8% for those with RA (P=.007).
Given the comparable frequency of cardiovascular events between systemic sclerosis and RA, despite the nearly twofold prevalence of dyslipidemia and diabetes mellitus in patients with RA, Vassilopoulos told Healio Rheumatology “this finding suggests that CVD in systemic sclerosis is complex and multifactorial and, in addition to chronic inflammation, other disease-related factors such as microangiopathy and vasospasm may play a role.”
In addition, BMI was lower among patients with systemic sclerosis, compared with those with RA (P=.001). However, there was no difference in arterial hypertension or smoking between the two groups. In addition, although there was a trend for lower prevalence of ischemic stroke in patients with systemic sclerosis than in those with RA — 1.1% compared to 3.2% (P=.085) — coronary artery disease was comparable, with prevalence rates of 2.7% for systemic sclerosis and 3.7% for RA.
Similarly, the researchers found no differences patients with systemic sclerosis and patients with RA regarding the prevalence of COPD, osteoporosis or neoplasms overall. Lung cancer was the most prevalent cancer in systemic sclerosis, accounting for 41% of cases, whereas hematologic malignancies and breast cancer predominated in RA, with each representing 36%. Depression was more prevalent among patients with systemic sclerosis — and especially diffuse systemic sclerosis — with a prevalence of 22% compared to 12% in those with RA (P = .001).
“Patients with systemic sclerosis have a comparable to RA cardiovascular risk that currently represents one of the major causes of morbidity and mortality in systemic autoimmune disorders,” Vassilopoulos said. “In addition, more patients with systemic sclerosis develop depression that has a greater negative impact on their quality of life.”– by Jason Laday
Disclosure: Vassilopoulos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.