Comparing Cardiovascular Event risk prediction tools in Nigerians with Rheumatoid Arthritis

Abstract

Background

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease with increased cardiovascular mortality. Chronic inflammation, physical inactivity, depression, stress, and side effects of drugs worsen the risk of cardiovascular diseases in RA patients. The Framingham risk calculator, which has long been used to predict cardiovascular events in the general population, is considered less accurate for RA patients as it does not account for it as an independent risk factor. The QRISK calculator and ERS-RA calculator were developed in response to these issues but have never been used by Nigerians. This study compared all three calculators to estimate the 10-year cardiovascular event risk of patients with rheumatoid arthritis attending the rheumatology clinic of Jos University Teaching Hospital.

Methods

This was a hospital-based cross-sectional study carried out between 2019 and 2022 in the rheumatology clinic of Jos University Teaching Hospital (JUTH). Eighty-five rheumatoid arthritis patients 30 years and above who met the inclusion criteria were recruited consecutively. Relevant history, physical examination and investigations were obtained. Framingham risk, QRISK3 and the ERS-RA scores were calculated for each patient. Data was analyzed using STATA version 14; a P value < 0.05 was considered significant.

Result

There were 60 females and 25 males with a mean age of 52.5±12.5, and the mean duration of RA was 2.2±0.6. The median (IQR) Framingham score was 6.3% (8.9%), while that of QRISK3 was 4.8% (10.8%). QRISK3 agreed with Framingham in 93% of the low-risk estimates, 73.3% at intermediate risk and 92.3% at high-risk estimates. The ERS-RA calculator predicted 36 (42.4%) patients to have a high 10-year CVD risk, in fair to moderate agreement with the Framingham and the QRISK calculators.

Conclusion

The RA-specific ERS-RA calculator predicted more CVD risk than the general population's QRISK3 and Framingham risk scores. We therefore recommend the ERS-RA calculator for use in our RA population.