EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome

George C.  Drosos; Daisy  Vedder; Eline  Houben; Laura  Boekel; Fabiola Atzeni; Sara  Badreh; Dimitrios T.  Boumpas; Nina  Brodin; Ian N. Bruce; Miguel Ángel  González-Gay; Søren  Jacobsen; György  Kerekes; Francesca  Marchiori; Chetan  Mukhtyar; Manuel  Ramos-Casals; Naveed  Sattar; Karen  Schreiber; Savino  Sciascia; Elisabet  Svenungsson; Zoltan  Szekanecz; Anne-Kathrin  Tausche; Alan Tyndall; Vokko  van Halm; Alexandre  Voskuyl; Gary Macfarlane; Michael M. Ward; Michael T.  Nurmohamed; Maria G.  Tektonidou

doi:10.1136/annrheumdis-2021-221733

EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome

George C. Drosos, Daisy Vedder, Eline Houben, Laura Boekel, Fabiola Atzeni, Sara Badreh, Dimitrios T. Boumpas, Nina Brodin, Ian N. Bruce, Miguel Ángel González-Gay, Søren Jacobsen, György Kerekes, Francesca Marchiori, Chetan Mukhtyar, Manuel Ramos-Casals, Naveed Sattar, Karen Schreiber, Savino Sciascia, Elisabet Svenungsson, Zoltan SzekaneczAnne-Kathrin Tausche, Alan Tyndall, Vokko van Halm, Alexandre Voskuyl, Gary Macfarlane, Michael M. Ward, Michael T. Nurmohamed, Maria G. Tektonidou^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective: To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).
Methods: Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion.

Results: Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate lowering therapy in gout has been associated with CVR lowering.

Conclusion: These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.

Original language	English
Pages (from-to)	768-779
Number of pages	12
Journal	Annals of the Rheumatic Diseases
Volume	81
Early online date	2 Feb 2022
DOIs	https://doi.org/10.1136/annrheumdis-2021-221733
Publication status	Published - 16 May 2022

Bibliographical note

Acknowledgements: The committee wishes to acknowledge the support of the EULAR Standing Committee on Clinical Affairs and the EULAR Secretariat.
Funding: This study was funded by European Alliance of Associations for Rheumatology, EULAR. Project number: CLI112

Data Availability Statement

Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi.org/10.1136/annrheumdis2021-221733).

Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Keywords

Recommendations
cardiovascular disease
rheumatic and musculoskeletal disease
traditional cardiovascular risk factors
disease-related risk factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Drosos_etal_EULAR_recommendations_for_AAM
This is the accepted version of EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Drosos et al. In: Annals of the Rheumatic Diseases, Vol. 81, 16.05.2022, p. 768-779. Version of record can be found at DOI: 10.1136/annrheumdis-2021-221733
Accepted author manuscript, 371 KBLicence: CC BY-NC

Cite this

Drosos, G. C., Vedder, D., Houben, E., Boekel, L., Atzeni, F., Badreh, S., Boumpas, D. T., Brodin, N., Bruce, I. N., González-Gay, M. Á., Jacobsen, S., Kerekes, G., Marchiori, F., Mukhtyar, C., Ramos-Casals, M., Sattar, N., Schreiber, K., Sciascia, S., Svenungsson, E., ... Tektonidou, M. G. (2022). EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Annals of the Rheumatic Diseases, 81, 768-779. https://doi.org/10.1136/annrheumdis-2021-221733

Drosos, GC, Vedder, D, Houben, E, Boekel, L, Atzeni, F, Badreh, S, Boumpas, DT, Brodin, N, Bruce, IN, González-Gay, MÁ, Jacobsen, S, Kerekes, G, Marchiori, F, Mukhtyar, C, Ramos-Casals, M, Sattar, N, Schreiber, K, Sciascia, S, Svenungsson, E, Szekanecz, Z, Tausche, A-K, Tyndall, A, van Halm, V, Voskuyl, A, Macfarlane, G, Ward, MM, Nurmohamed, MT & Tektonidou, MG 2022, 'EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome', Annals of the Rheumatic Diseases, vol. 81, pp. 768-779. https://doi.org/10.1136/annrheumdis-2021-221733

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title = "EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome",

abstract = "Objective: To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sj{\"o}gren{\textquoteright}s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods: Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. Results: Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate lowering therapy in gout has been associated with CVR lowering. Conclusion: These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.",

keywords = "Recommendations, cardiovascular disease, rheumatic and musculoskeletal disease, traditional cardiovascular risk factors, disease-related risk factors",

author = "Drosos, {George C.} and Daisy Vedder and Eline Houben and Laura Boekel and Fabiola Atzeni and Sara Badreh and Boumpas, {Dimitrios T.} and Nina Brodin and Bruce, {Ian N.} and Gonz{\'a}lez-Gay, {Miguel {\'A}ngel} and S{\o}ren Jacobsen and Gy{\"o}rgy Kerekes and Francesca Marchiori and Chetan Mukhtyar and Manuel Ramos-Casals and Naveed Sattar and Karen Schreiber and Savino Sciascia and Elisabet Svenungsson and Zoltan Szekanecz and Anne-Kathrin Tausche and Alan Tyndall and {van Halm}, Vokko and Alexandre Voskuyl and Gary Macfarlane and Ward, {Michael M.} and Nurmohamed, {Michael T.} and Tektonidou, {Maria G.}",

note = "Acknowledgements: The committee wishes to acknowledge the support of the EULAR Standing Committee on Clinical Affairs and the EULAR Secretariat. Funding: This study was funded by European Alliance of Associations for Rheumatology, EULAR. Project number: CLI112",

year = "2022",

month = may,

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doi = "10.1136/annrheumdis-2021-221733",

language = "English",

volume = "81",

pages = "768--779",

journal = "Annals of the Rheumatic Diseases",

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TY - JOUR

T1 - EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome

AU - Drosos, George C.

AU - Vedder, Daisy

AU - Houben, Eline

AU - Boekel, Laura

AU - Atzeni, Fabiola

AU - Badreh, Sara

AU - Boumpas, Dimitrios T.

AU - Brodin, Nina

AU - Bruce, Ian N.

AU - González-Gay, Miguel Ángel

AU - Jacobsen, Søren

AU - Kerekes, György

AU - Marchiori, Francesca

AU - Mukhtyar, Chetan

AU - Ramos-Casals, Manuel

AU - Sattar, Naveed

AU - Schreiber, Karen

AU - Sciascia, Savino

AU - Svenungsson, Elisabet

AU - Szekanecz, Zoltan

AU - Tausche, Anne-Kathrin

AU - Tyndall, Alan

AU - van Halm, Vokko

AU - Voskuyl, Alexandre

AU - Macfarlane, Gary

AU - Ward, Michael M.

AU - Nurmohamed, Michael T.

AU - Tektonidou, Maria G.

N1 - Acknowledgements: The committee wishes to acknowledge the support of the EULAR Standing Committee on Clinical Affairs and the EULAR Secretariat. Funding: This study was funded by European Alliance of Associations for Rheumatology, EULAR. Project number: CLI112

PY - 2022/5/16

Y1 - 2022/5/16

N2 - Objective: To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods: Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. Results: Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate lowering therapy in gout has been associated with CVR lowering. Conclusion: These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.

AB - Objective: To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods: Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. Results: Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate lowering therapy in gout has been associated with CVR lowering. Conclusion: These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.

KW - Recommendations

KW - cardiovascular disease

KW - rheumatic and musculoskeletal disease

KW - traditional cardiovascular risk factors

KW - disease-related risk factors

U2 - 10.1136/annrheumdis-2021-221733

DO - 10.1136/annrheumdis-2021-221733

M3 - Article

SN - 0003-4967

VL - 81

SP - 768

EP - 779

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

ER -

EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

Access to Document

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Cite this