TY - JOUR
T1 - Albuminuria in Rheumatoid Arthritis
T2 - Associations With Rheumatoid Arthritis Characteristics and Subclinical Atherosclerosis
AU - Sammut, Amanda
AU - Shea, Steven
AU - Blumenthal, Roger S.
AU - Szklo, Moyses
AU - Bathon, Joan M.
AU - Polak, Joseph F.
AU - Tracy, Russell
AU - Giles, Jon T.
N1 - Funding Information:
We would like to thank the Johns Hopkins Bayview Medical Center General Clinical Research Center and staff, the field center of the Baltimore MESA cohort, and the MESA Coordinating Center at the University of Washington, Seattle. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. We are indebted to the dedication and hard work of the ESCAPE RA staff: Marilyn Towns, Michelle Jones, Patricia Jones, Marissa Hildebrandt, Shawn Franckowiak, and Brandy Miles and to the participants of the ESCAPE RA study who graciously agreed to take part in this research. Drs. Uzma Haque, Clifton Bingham III, Carol Ziminski, Jill Ratain, Ira Fine, Joyce Kopicky-Burd, David McGinnis, Andrea Marx, Howard Hauptman, Achini Perera, Peter Holt, Alan Matsumoto, Megan Clowse, Gordon Lam, and others generously recommended their patients for this study.
Funding Information:
Supported by the NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases grants AR-050026-01 to Dr. Bathon and 1K23-AR-054112-01 to Dr. Giles), Johns Hopkins Bayview Medical Center General Clinical Research Center (grant M01-RR-02719), National Heart, Lung, and Blood Institute (grants HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 to Drs. Shea, Blumenthal, Szklo, Polak, and Tracy) and the National Center for Research Resources (grants UL1-TR-000040 and UL1-TR-001079).
Publisher Copyright:
© 2017, American College of Rheumatology
PY - 2017/12
Y1 - 2017/12
N2 - Objective: Albuminuria is a marker for subclinical cardiovascular disease (CVD) in the general population. It is uncertain whether this association is present in patients with rheumatoid arthritis (RA), a population with increased atherosclerosis and CVD events. Methods: Urine albumin from a spot morning collection was measured, and the urine albumin-to-creatinine ratio (uACR) was calculated for RA patients and a population-based sample of demographically matched non-RA controls. Associations of elevated uACR (≥25 mg/gm for women and ≥17 mg/gm for men) with CVD risk factors and measures of atherosclerosis (coronary artery calcification, ultrasound-determined maximal intima-media thickness of the common carotid artery and internal carotid artery [ICA], and the presence of focal plaque in the ICA) were compared cross-sectionally according to RA status. Results: We compared 196 RA patients with 271 non-RA controls. Elevated uACR was found in 18% of the RA patients compared with 17% of the controls (P = 0.89). After adjustment, RA was associated with 57% lower odds of elevated uACR (P = 0.016). Higher serum creatinine levels and hypertension were both strongly and significantly associated with elevated uACR in the control group but not in the RA group (both P for interaction < 0.05). Among RA characteristics, the adjusted prevalence of elevated uACR among those treated with tumor necrosis factor inhibitors was less than half that among those not so treated (9% versus 20%, respectively; P = 0.047). Conclusion: There was no association in the RA group of elevated uACR with measures of atherosclerosis or with several key cardiometabolic risk factors, which suggests a lower usefulness of elevated uACR as an indicator of subclinical CVD in RA.
AB - Objective: Albuminuria is a marker for subclinical cardiovascular disease (CVD) in the general population. It is uncertain whether this association is present in patients with rheumatoid arthritis (RA), a population with increased atherosclerosis and CVD events. Methods: Urine albumin from a spot morning collection was measured, and the urine albumin-to-creatinine ratio (uACR) was calculated for RA patients and a population-based sample of demographically matched non-RA controls. Associations of elevated uACR (≥25 mg/gm for women and ≥17 mg/gm for men) with CVD risk factors and measures of atherosclerosis (coronary artery calcification, ultrasound-determined maximal intima-media thickness of the common carotid artery and internal carotid artery [ICA], and the presence of focal plaque in the ICA) were compared cross-sectionally according to RA status. Results: We compared 196 RA patients with 271 non-RA controls. Elevated uACR was found in 18% of the RA patients compared with 17% of the controls (P = 0.89). After adjustment, RA was associated with 57% lower odds of elevated uACR (P = 0.016). Higher serum creatinine levels and hypertension were both strongly and significantly associated with elevated uACR in the control group but not in the RA group (both P for interaction < 0.05). Among RA characteristics, the adjusted prevalence of elevated uACR among those treated with tumor necrosis factor inhibitors was less than half that among those not so treated (9% versus 20%, respectively; P = 0.047). Conclusion: There was no association in the RA group of elevated uACR with measures of atherosclerosis or with several key cardiometabolic risk factors, which suggests a lower usefulness of elevated uACR as an indicator of subclinical CVD in RA.
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U2 - 10.1002/acr.23234
DO - 10.1002/acr.23234
M3 - Article
C2 - 28257609
AN - SCOPUS:85035096995
SN - 2151-464X
VL - 69
SP - 1799
EP - 1808
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 12
ER -