Background RA is reported to be an independent risk factor for morbidity and mortality, but there is little data from inception cohorts. Part of this excess risk appears to be driven by systemic inflammation. This MD thesis is divided into two parts. The first is an analysis of eo-morbidity and mortality in RA, especially cardiovascular disease (CVD), in an established inception cohort. The second is a study to examine clinical and sub clinical features of CVD in early RA in greater detail. Methods The Early RA Study (ERAS) is an inception cohort (n=1460) with up to 23yrs follow up. Clinical, laboratory and radiological assessments were made yearly. Outcomes included functional and work disability, joint damage, disease activity, treatment effects, extra-articular manifestations, eo-morbidity and mortality. 50 early RA patients were recruited into a separate study using the ERAS model, but additionally included clinical CVD risk factors and laboratory CRP and endothelial biomarkers. Results Increased and early mortality was found in the ERAS cohort (573, 39%), mainly due to CVD (40%). Baseline prevalence of major co-morbidities was 32% (respiratory 7.5%, CVD 5%). Cumulative incidence of several eo morbid conditions was increased, especially CVD and respiratory (2111000 each). The main risk factors for all cause and cardiovascular mortality were similar and included older age, men, disease activity and worse HAQ. Cc-morbidity was associated with functional and work disability. In the sub study, only one endothelial biomarker was elevated (E- Selectin) and was associated with disease activity. Conclusion Cc-morbidity and mortality were increased and manifested early in the course of RA, mainly due to CVD and respiratory conditions. Co-morbidity was associated with disease activity and severity, and worse outcomes. Endothelial cell activation was not expressed at disease onset. Assessment of eo-morbidity and CVD risk should be part of an annual review in RA.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:588762 |
| Date | January 2011 |
| Creators | Koduri, Gouri |
| Publisher | University of East Anglia |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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