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Joint Bone Spine
Volume 84, n° 1
pages 59-64 (janvier 2017)
Doi : 10.1016/j.jbspin.2015.12.003
accepted : 23 December 2015
Gout and rheumatoid arthritis, both to keep in mind in cardiovascular risk management: A primary care retrospective cohort study
 

Hein J.E.M. Janssens a, b, , Paul G.J. Arts a, Bianca W.M. Schalk a, Marion C.J. Biermans a
a Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands 
b Primary health care center Lobede, Lobith-Tolkamer, The Netherlands 

Corresponding author. Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands.
Abstract
Objectives

To assess in one time window cardiovascular risks for both patients with gout and patients with rheumatoid arthritis in a Dutch primary care population.

Methods

Retrospective matched cohort study with data from the electronic health records of 51 Dutch general practices. Participants were patients aged 30 years or older with an incident diagnosis of gout (n =2655) or rheumatoid arthritis (n =513), and matched non-disease controls (n =7891 and n =1850 respectively). At disease incidence date, patients and controls were compared for prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and prior cardiovascular diseases. Patients without prior cardiovascular disease were followed for a first cardiovascular disease, and compared to controls using Kaplan-Meier survival curves and Cox proportional hazard analyses.

Results

Compared to controls, gout patients suffered more from hypertension (44.8%), diabetes (20.1%), hypercholesterolemia (13.7%), and prior cardiovascular disease (30%) (P <0.01), whereas rheumatoid arthritis patients (hypertension 28.5%; diabetes 11.7%; hypercholesterolemia 7.4%; prior cardiovascular disease 11.3%) did not (P >0.05). After adjustment, both gout and rheumatoid arthritis patients without prior cardiovascular disease were more likely to get a cardiovascular disease: hazard ratio (95% confidence interval) 1.44 (1.18 to 1.76), and 2.06 (1.34 to 3.16) respectively.

Conclusions

This primary care study indicates that gout and rheumatoid arthritis are both independent risk factors for cardiovascular diseases, rheumatoid arthritis to some greater extent, whereas gout patients at first diagnosis had already an increased cardiovascular risk profile. It gives strong arguments for implementation of both rheumatic diseases in primary care guidelines on cardiovascular risk management.

The full text of this article is available in PDF format.

Keywords : Gout, Rheumatoid arthritis, Cardiovascular diseases, Primary prevention, Primary health care, Cohort study




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