Delay in Diagnosis of Rheumatoid Arthritis Increases the Cardiovascular Risk

Abstract

Background/Purpose: Patients with rheumatoid arthritis (RA) are known to be at increased risk for cardiovascular diseases. Inflammation as well as traditional risk factors contributes to this risk and adequate control of the disease activity of RA will decrease it. We investigated whether earlier diagnosis and earlier initiation of treatment would decrease the risk of cardiovascular diseases in patients with RA.

Methods: RA patients from the KORONA (Korean Observational Study Network for Arthritis) prospective multicenter cohort were assessed. Information on RA onset to diagnosis, disease duration, disease activity, functional impairment, smoking status, cardiovascular comorbidities, and cardiovascular risk using SCORE (Systematic Coronary Risk Evaluation) risk chart were obtained from questionnaires and medical records. Regression models were used to assess the association between delay in diagnosis of RA and cardiovascular risk, adjusting for disease duration, disease activity, radiographic damage, functional impairment, body-mass index, and methotrexate, steroids, NSAIDs, and biologics use.

Results: The mean delay from RA onset to diagnosis was 1.8 ± 4.1 years. A total of 2,465 patients were diagnosed within a year from onset with a mean delay of 0.2 ± 0.3 years and diagnosis was delayed more than a year in 1,023 patients with a mean of 5.5 ± 6.1 years. Patients with delayed diagnosis were significantly older at assessment, younger at diagnosis, and had longer disease duration. There was no difference in current disease activity assessed by DAS28, but patients with delayed diagnosis showed significantly higher functional impairment (p < 0.01). Proportion of patients smoking, taking corticosteroids and/or NSAIDs were significantly lower in the delayed diagnosis group (p < 0.01, p = 0.03, p <0.01, respectively). SCORE risk score was significantly higher in patients with delayed diagnosis with 1.3 ± 1.7 compared to 1.1 ± 1.7 in patients with diagnosis within a year (p < 0.01). The association between delay in diagnosis of RA and increase in cardiovascular risk calculated by SCORE risk score remained significant in women after adjustment (p < 0.01), but it was lost in men (p = 0.12).

Conclusion: Delay in diagnosis of rheumatoid arthritis can lead to increase in major cardiovascular risk, especially in women.