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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (6): 1040-1047. doi: 10.19723/j.issn.1671-167X.2020.06.009

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Clinical characteristics and risk factors of cardiovascular disease in patients with elderly-onset rheumatoid arthritis: A large cross-sectional clinical study

Jia-li CHEN,Yue-bo JIN,Yi-fan WANG,Xiao-ying ZHANG,Jing LI,Hai-hong YAO,Jing HE,Chun LI()   

  1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2020-07-10 Online:2020-12-18 Published:2020-12-13
  • Contact: Chun LI E-mail:13811190098@163.com
  • Supported by:
    National Natural Science Foundation of China(81701598);National Natural Science Foundation of China(81801618);Beijing Natural Science Foundation(7192211)

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Abstract:

Objective: To investigate the clinical characteristics of patients with elderly-onset rheumatoid arthritis (EORA), and the risk factors of EORA complicated with cardiovascular disease (CVD). Methods: A cross-sectional study was conducted in Peking University People’s Hospital from July 2009 to December 2014 and 1 116 patients were recruited. The patients’ characteristics and CVD, including ischemic heart disease, cerebral and peripheral vascular disease, were recorded. The patients were divided into EORA group (n=212) and younger-onset rheumatoid arthritis (YORA) group (n=904) according to the age of onset ≥60 years and <60 years. Then, the differences between the groups were analyzed by Student’s t test, Mann-Whitney U test or χ2test, and risk influencing CVD were analyzed using Logistic regression. Results: There was no significant difference in the disease activity between the EORA and YORA groups. The proportion of male, pulmonary interstitial disease (ILD), and numbers of deformity joint count (DJC) were significantly higher in the EORA group compared with the YORA group [32.1% vs. 18.5%, χ2=19.11, P<0.001; 23.6% vs. 13.6%, χ2=16.50, P<0.001; 6 (2, 12) vs. 3 (2, 7), Z=-3.60, P<0.001], while the prevalence of Sj?gren’s syndrome was lower than that of the YORA group (13.5% vs. 5.2%, χ2=11.29, P=0.001). Moreover, there were lower prevalences in the patients treated with disease-modifying antirheumatic drugs (DMARDs) in EORA group (35.4%) than in YORA group (26.7%) (χ2=6.43, P=0.011), especially in methotrexate (MTX), hydroxychloroquine (HCQ) and sulfasalazine (SSZ). In addition, the patients with EORA had a higher prevalence of CVD (27.8%) than the YORA group (11.6%, χ2=40.46, P<0.001), accompanied with higher prevalence of smoking, hypertension, and hyperlipidemia. Multivariate Logistic regression analysis showed that elder age (OR=1.10, 95%CI: 1.00-1.20), DJC (OR=3.17, 95%CI: 1.04-9.68), rheumatoid nodules (OR=3.56, 95%CI: 1.03-12.23), hypertension (OR=2.37, 95%CI: 1.09-5.13) and hyperlipidemia (OR=8.85, 95%CI: 2.50-31.27) were independent risk factors, while HCQ (OR=0.22, 95%CI: 0.07-0.70) and MTX (OR=0.32, 95%CI: 0.14-0.73) were protective factors of EORA complicated with CVD. Conclusion: Compared with YORA, patients with EORA have higher ratio of male, ILD and DJC, which may be attributed to inappropriate therapies. EORA is more likely to be complicated with CVD than YORA. Elder age, DJC, rheumatoid nodules, hypertension, and hyperlipidemia are independent risk factors, while HCQ and MTX are protective factors of EORA complicated with CVD.

Key words: Rheumatoid arthritis, Aged, Cardiovascular diseases, Risk factors

CLC Number: 

  • R593.22

Table 1

Clinical characteristics of RA patients"

Items All patients (n=1 116) EORA (n=212) YORA (n=904) Z/χ2 P value
Male 235 (21.1) 68 (32.1) 167 (18.5) 19.11 <0.001
Age/years 57 (48, 66) 72 (68, 77) 53 (45, 59) -19.84 <0.001
Age of RA onset/years 47 (37, 57) 68 (63, 71) 43 (34, 51) -22.69 <0.001
Disease duration/years 6 (2, 14) 2 (1, 6) 7 (2, 15) -10.31 <0.001
SJCs 3 (1, 9) 4 (1, 10) 3 (1, 9) -1.00 0.319
TJCs 5 (2, 14) 7 (2, 18) 5 (2, 13) -1.41 0.159
DJCs 5 (2, 12) 6 (2, 12) 3 (2, 7) -3.60 <0.001
ESR/(mm/h) 41 (22, 69) 48 (25, 69) 46 (25, 76) -0.42 0.673
CRP/(mg/L) 11.4 (2.6, 39.0) 12.5 (2.3, 46.7) 10.8 (2.6, 38.2) -0.09 0.927
DAS28-ESR 4.53 (3.54, 5.60) 4.57 (3.70, 5.73) 4.53 (3.51, 5.70) -0.30 0.550
≤2.6 98 (8.8) 16 (9.4) 82 (9.1) 0.50 0.481
>2.6, ≤3.2 97 (8.7) 15 (7.1) 82 (9.1) 0.86 0.353
>3.2, ≤5.1 512 (45.9) 104 (47.2) 408 (45.1) 1.07 0.302
>5.1 409 (36.6) 77 (36.3) 332 (36.7) 0.01 0.912
Rheumatoid factor (positive) 799/929 (86.0) 145/170 (85.3) 654/759 (86.2) 0.09 0.767
Rheumatoid factor (positive) 799/929 (86.0) 145/170 (85.3) 654/759 (86.2) 0.09 0.767
Anti-CCP antibody (positive) 506/620 (81.6) 86/107 (80.4) 420/513 (81.9) 0.13 0.716
Extra-articular manifestations
Interstitial lung disease 164 (14.7) 50 (23.6) 114 (12.6) 16.50 <0.001
Pleural effusion 13 (1.2) 3 (1.4) 10 (1.1) 0.14 0.721
Pericardial effusion 2 (0.2) 1 (0.5) 1 (0.1) 1.25 0.344
Rheumatoid nodules 69 (6.2) 13 (6.1) 56 (6.2) 0.00 0.973
Cutaneous vasculitis 8 (0.7) 1 (0.5) 7 (0.8) 0.22 >0.999
Anemia 201 (18.0) 34 (16.0) 167 (18.5) 0.69 0.406
Peri-neuropathy 6 (0.5) 1 (0.5) 5 (0.6) 0.02 >0.999
Sj?gren’s syndrome 133 (11.9) 11 (5.2) 122 (13.5) 11.29 0.001
Medications
Non-DMARDs 316 (28.3) 75 (35.4) 241 (26.7) 6.43 0.011
Methotrexate 306 (27.4) 45 (21.2) 261 (28.9) 5.04 0.025
Hydroxychloroquine 349 (31.3) 39 (18.4) 310 (34.3) 20.19 <0.001
Leflunomide 433 (38.8) 86 (40.6) 347 (38.4) 0.34 0.560
Sulfasalazine 341 (30.6) 49 (23.1) 292 (32.3) 6.83 0.009
Prednisone 252 (22.6) 50 (23.6) 202 (22.3) 0.15 0.698
Celecoxib 28 (2.5) 9 (4.2) 19 (2.1) 3.23 0.072
Biological agents 128 (11.5) 20 (9.4) 108 (11.9) 1.07 0.301

Table 2

The prevalence of CVD and traditional risk factors in patients with EORA and YORA"

Items All patients (n=1 116) EORA (n=212) YORA (n=904) Z/χ2 P value
CVD 164 (14.7) 59 (27.8) 105 (11.6) 40.46 <0.001
Coronary heart disease 107 (9.6) 38 (17.9) 69 (7.6) 20.21 <0.001
Cerebral arterial disease 76 (6.8) 27 (12.7) 49 (5.4) 13.90 <0.001
Peripheral arterial disease 87 (7.8) 35 (16.5) 52 (5.8) 27.65 <0.001
BMI/(kg/m2) 22.8 (20.3, 25.3) 22.6 (20.2, 24.7) 22.9 (20.4, 25.5) -0.77 0.440
BMI≥24 365/972 (37.6) 69/180 (38.3) 296/792 (37.4) 0.06 0.810
Smoking 180 (16.1) 50 (23.6) 130 (14.4) 10.75 <0.001
Hypertension 294 (26.3) 95 (44.8) 199 (22.0) 45.86 <0.001
Diabetes mellitus 136 (12.2) 47 (22.2) 89 (9.8) 24.31 <0.001
Hyperlipidemia 72 (6.5) 23 (10.8) 49 (5.4) 8.03 0.005

Table 3

Clinical characteristics of EORA patients with or without CVD"

Items CVD (n=59) Without CVD (n=153) Z/χ2 P value
Male 22 (37.3) 46 (30.1) 1.02 0.313
Age/years 74 (70, 78) 70 (67, 75) -3.12 0.002
Disease duration/years 4 (1, 8) 2 (1, 5) -1.83 0.068
SJCs 3 (1, 8) 4 (1, 10) -0.50 0.620
TJCs 6 (2, 15) 6 (2, 17) -0.77 0.444
DJCs 28 (47.5) 51 (33.3) 3.63 0.057
ESR/(mm/h) 47 (30, 65) 43 (23, 71) -0.36 0.716
CRP/(mg/L) 10.4 (2.8, 37.7) 14.0 (1.8, 46.7) -0.77 0.442
DAS28-ESR 4.6 (3.7, 5.7) 4.5 (3.7, 5.8) -0.47 0.636
≤2.6 6 (8.5) 10 (6.5) 0.81 0.369
>2.6, ≤3.2 4 (6.8) 11 (7.2) 0.01 >0.999
>3.2, ≤5.1 29 (49.2) 75 (49.0) 0.00 0.986
>5.1 20 (33.9) 57 (37.3) 0.21 0.649
Rheumatoid factor (positive) 14/49 (28.6) 11/121 (9.1) 10.55 0.001
Anti-CCP antibody (positive) 10/30 (33.3) 13/79 (16.5) 3.72 0.054
Extra-articular manifestations
Interstitial lung disease 16 (27.1) 34 (22.2) 0.57 0.452
Pleural effusion 2 (3.4) 1 (0.6) 2.29 0.188
Pericardial effusion 1 (1.7) 0 (0) 2.606 0.278
Rheumatoid nodules 7 (11.9) 6 (3.9) 4.67 0.050
Cutaneous vasculitis 0 (0) 1 (0.6) 0.387 >0.999
Anemia 10 (16.9) 24 (15.7) 0.050 0.822
Peri-neuropathy 0 (0) 1 (0.6) 0.387 >0.999
Sj?gren’s syndrome 4 (6.8) 7 (4.6) 0.421 0.503
Medications
Non-DMARDs 16 (27.1) 59 (38.6) 2.44 0.118
Methotrexate 9 (15.3) 54 (35.3) 10.09 0.004
Hydroxychloroquine 4 (6.8) 35 (22.9) 7.35 0.007
Leflunomide 25 (42.4) 61 (39.9) 0.11 0.739
Sulfasalazine 9 (15.3) 40 (26.1) 2.84 0.092
Prednisone 18 (3.1) 32 (20.9) 2.17 0.140
Celecoxib 2 (3.3) 7 (4.6) 0.15 0.701
Biological agents 3 (5.1) 17 (11.1) 1.81 0.179

Table 4

Traditional risk factors of EORA patients with or without CVD"

Items CVD (n=59) Without CVD (n=153) Z/χ2 P value
BMI (kg/m2) 22.7 (19.9, 25.3) 22.6 (20.7, 24.6) -0.11 0.916
BMI<24 34/53 (64.2) 77/127 (60.6) 0.196 0.658
24≤BMI≤28 18/53 (34.0) 44/127 (34.6) 0.008 0.930
BMI>28 1/53 (1.9) 6/127 (4.7) 0.806 0.675
Smoking 19 (32.2) 31 (20.3) 3.37 0.066
Hypertension 38 (64.4) 57 (37.3) 12.69 <0.001
Diabetes mellitus 18 (30.5) 29 (19.0) 3.29 0.070
Hyperlipidemia 18 (30.5) 5 (3.3) 31.93 <0.001

Table 5

Risk factors of CVD in patients with EORA"

Risk factors OR (95%CI) P value
Male 0.73 (0.27, 1.97) 0.536
Age 1.10 (1.00, 1.20) 0.040
Disease duration 0.99 (0.87, 1.12) 0.819
SJCs 0.91 (0.24, 3.53) 0.894
TJCs 0.90 (0.20, 3.99) 0.889
DJCs 3.17 (1.04, 9.68) 0.043
ESR 1.92 (0.50, 7.39) 0.344
CRP 0.62 (0.21, 1.84) 0.386
Anti-CCP antibody 0.48 (0.14, 1.65) 0.243
DAS28-ESR
>2.6, ≤3.2 0.11 (0.01, 1.50) 0.098
>3.2, ≤5.1 0.59 (0.07, 4.92) 0.629
>5.1 0.67 (0.23, 1.98) 0.473
ILD 0.77 (0.38, 1.57) 0.464
Anemia 1.19 (0.48, 2.93) 0.712
Rheumatoid nodules 3.56 (1.03, 12.23) 0.044
Hydroxychloroquine 0.22 (0.07, 0.70) 0.011
Methotrexate 0.32 (0.14, 0.73) 0.007
Sulfasalazine 0.69 (0.28, 1.75) 0.440
Leflunomide 1.03 (0.46, 2.31) 0.949
Corticosteroid 1.09 (0.46, 2.59) 0.854
Celecoxib 0.66 (0.12, 3.55) 0.628
Biological 0.39 (0.10, 1.58) 0.188
24≤BMI<28 3.41 (0.27, 42.55) 0.341
BMI≥28 3.42 (0.26, 44.26) 0.347
Smoking 1.66 (0.58, 4.80) 0.347
Hypertension 2.37 (1.09, 5.13) 0.029
Diabetes 0.94 (0.37, 2.40) 0.900
Hyperlipemia 8.85 (2.50, 31.27) 0.001
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