The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease.

OBJECTIVE: To examine the role of rheumatoid arthritis (RA) flare, remission and RA severity burden in cardiovascular disease (CVD). METHODS: In a population-based cohort of patients with RA without CVD (age ≥30 years; 1987 American College of Rheumatology criteria met in 1988-2007), we performed medical record review at each clinical visit to estimate flare/remission status. The previously validated RA medical Records-Based Index of Severity (RARBIS) and Claims-Based Index of RA Severity (CIRAS) were applied. Age- and sex-matched non-RA subjects without CVD comprised the comparison cohort. Cox models were used to assess the association of RA activity/severity with CVD, adjusting for age, sex, calendar year of RA, CVD risk factors and antirheumatic medications. RESULTS: Study included 525 patients with RA and 524 non-RA subjects. There was a significant increase in CVD risk in RA per time spent in each acute flare versus remission (HR 1.07 per 6-week flare, 95% CI 1.01 to 1.15). The CVD risk for patients with RA in remission was similar to the non-RA subjects (HR 0.90, 95% CI 0.51 to 1.59). Increased cumulative moving average of daily RARBIS (HR 1.16, 95% CI 1.03 to 1.30) and CIRAS (HR 1.38, 95% CI 1.12 to 1.70) was associated with CVD. CVD risk was higher in patients with RA who spent more time in medium (HR 1.08, 95% CI 0.98 to 1.20) and high CIRAS tertiles (HR 1.18, 95% CI 1.06 to 1.31) versus lower tertile. CONCLUSIONS: Our findings show substantial detrimental role of exposure to RA flare and cumulative burden of RA disease severity in CVD risk in RA, suggesting important cardiovascular benefits associated with tight inflammation control and improved flare management in patients with RA.

Juvenile Idiopathic Arthritis in Olmsted County, Minnesota, 1960-2013.

OBJECTIVE: To evaluate the incidence and prevalence of juvenile idiopathic arthritis (JIA) in Olmsted County, Minnesota in 1994-2013 and trends in juvenile rheumatoid arthritis (JRA) in 1960-2013. METHODS: Cases of arthritis in 1994-2013 were identified by diagnosis code with medical chart review to confirm diagnosis separately for JIA and JRA. Overall incidence rates with 95% confidence intervals (95% CIs) were age and sex adjusted to the 2010 US white population. Comparisons were made with an earlier (1960-1993) cohort from this same population. RESULTS: Seventy-one incident cases of JIA in 1994-2013 were identified, with an overall age- and sex-adjusted incidence rate of 10.3 per 100,000 (95% CI 7.9-12.7). Forty-two (59%) were female, with an incidence of 12.4 per 100,000 (95% CI 8.6-16.2), as compared to 8.3 per 100,000 (95% CI 5.2-11.3) in males. The most common subtype was oligoarthritis (63%). The mean ± SD age at diagnosis was 8.2 ± 5.3 years. The prevalence of JIA on January 1, 2000 and January 1, 2010 was 51.0 per 100,000 (95% CI 25.2-76.8) and 57.6 per 100,000 (95% CI 31.0-94.5), respectively. When the annual incidence of JRA was compared over time from 1960 to 2013, there was no significant change in incidence overall; however, the incidence decreased among females (P = 0.003). A cyclic pattern of incidence was observed, with peaks approximately every 10 years. Similar to the findings with regard to incidence, prevalence did not change overall, but decreased among females (P = 0.048). There were 4 deaths in the cohort of JRA patients diagnosed in 1960-2013; the standardized mortality ratio was 1.50 (95% CI 0.41-3.83). CONCLUSION: Incidence of juvenile arthritis overall in Olmsted County, Minnesota has not changed significantly in the past 53 years. A consistent cyclic pattern was noted.

Hospitalization rates and utilization among patients with rheumatoid arthritis: a population-based study from 1987 to 2012 in Olmsted County, Minnesota.

OBJECTIVE: To examine whether all-cause hospitalization rates for patients with rheumatoid arthritis (RA) differ from those for patients without RA. PATIENTS AND METHODS: This was a retrospective population-based cohort study focused on Olmsted County, Minnesota. The RA cohort consisted of patients 18 years and older who first fulfilled 1987 American College of Rheumatology criteria for RA in the 1980 to 2007 period, and was compared with a cohort of similar age, sex, and calendar year without RA. Data on all hospitalizations were retrieved electronically for the 1987 to 2012 period. Analyses used person-year methods and rate ratios (RRs) comparing patients with and without RA. RESULTS: The 799 patients with RA experienced 2968 hospitalizations, and the 797 patients without RA experienced 2069 hospitalizations. Patients with RA were hospitalized at a greater rate than were patients without RA (RR, 1.51; 95% CI, 1.42-1.59). This increased rate of hospitalization was found in both sexes, all age groups, all calendar years studied, and throughout disease duration. Men with RA were hospitalized for depression at a greater rate than were men without RA (RR, 7.16; 95% CI, 2.78-30.67). Patients with RA were hospitalized at a greater rate for diabetes mellitus than were subjects without RA (RR, 2.45; 95% CI, 1.34-4.89). In patients with RA, the indicators of disease severity (eg, seropositivity, erosions, and nodules) in the first year after RA incidence were associated with higher rates of hospitalization. CONCLUSION: Patients with RA were hospitalized for all causes at a greater rate than were patients without RA. Increased rates of hospitalization were true for several disease categories and patient subgroups.