The evolution of early arthritis and cardiovascular risk

Abstract

This thesis is devoted to the early phase of rheumatoid arthritis (RA) and focused on three areas: (rheumatoid) arthritis development, cardiovascular comorbidity and remission from the perspective of the patient. From part I we conclude that there are many risk factors of varying strength for the development of RA. Risk factors include genetic factors as well as lifestyle factors also known to increase the risk for other chronic diseases. Part II showed that the body composition of arthritis patients was already unfavorable at the moment of diagnosis in comparison with the general population. Furthermore, the prevalence of cardiac conduction disorders was not increased at diagnosis. As sudden cardiac death is increased in RA patients, conduction disorders might develop after a longer period of inflammation after diagnosis. Our data show that different cardiovascular risk results are obtained, depending on which cardiovascular risk prediction tool is used. The advice for preventive cardiovascular risk medication, according to the Dutch SCORE and risk management guidelines, changed in 13% of the patients after four weeks of anti-rheumatic treatment. Part III demonstrates that after three months of treatment, one-third of the RA patients did not agree with the physician about being in remission. Patients take other domains of disease activity into account (e.g. pain, sleep and emotional wellbeing) than physicians. A possible new definition of remission, with more patient-reported outcomes, could be the normality scale. Patients indicate returning back to normality as important, and the normality scale is able to discriminate between remission and non-remission