Page 108 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

CHAPTER 5
change in heart rate. In our study, every 10-point increase in CRP or ESR was associated with an increase in heart rate of 2 bpm, which remained after correction for the VAS pain. This could imply an increased CV mortality of about 7%(14;15). This relationship between disease activity and heart rate is remarkable because it would imply a 10-year CV risk difference of 24% between no/least improvement and substantial improvement in DAS28 score(14;15). Patients with higher inflammation markers also had higher blood pressure, of which every 10-point increase in CRP or ESR was associated with an increase in systolic blood pressure of 1.7 mmHg. However, according to Ward, et al., this increase in CV risk has less clinical relevance(37).
Our present study shows that patients with early arthritis have the same prevalence of conduction disorders as the general population before anti-rheumatic treatment. Hence, in this population a mandatory screening ECG appears unnecessary. In contrast, in patients with chronic arthritis a prolonged QTc time is proven and therefore a standard ECG could be considered in established arthritis(1;4;8;12;13). For further research it would be interesting to match the patients with a healthy control group and repeat the ECG several years after rheumatic treatment, to investigate whether longer exposure to systemic inflammation increases conduction times and hence, conduction disorders.
Strengths of this study are the large number of consecutive patients and that the population reflects a heterogeneous population from a tertiary center. A limitation is that in addition to β-blockers and calcium channel blockers (verapamil and diltiazem), there are other medications that could affect conduction times (such as antibiotics, antipsychotics, or antidepressants). Unfortunately no data were available on these medications.
In early arthritis patients the prevalence of conduction disorders is comparable to the general population. However, the prevalence of traditional CV risk factors was increased in patients with a higher inflammatory load and the factors were associated with an increased QRS time. CV risk factors improved after inflammatory treatment. In particular, the difference in pulse rates between patients with persistent inflammation and patients with low disease activity or remission is remarkable. Therefore, the focus in patients with early arthritis should be on both CV risk management and optimizing antiinflammatory treatment.
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