Rheumatoid factor and anticitrullinated protein antibody status jointly influence the association between disease activity and cardiovascular risk in rheumatoid arthritis
Authors' conclusion
Disease activity may better discriminate inflammation-driven cardiovascular risk in seronegative and double seropositive than single RF-positive or ACPA-positive patients.
Study context
- Population
- CVD-free patients with prevalent rheumatoid arthritis (RA) registered in an international observational consortium between 1985 and 2012
- Participants
- 3,952 patients22,981 patient-years
- Exposure
- Disease activity, rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) status and their interactions
- Outcome
- First MACE:
- MI
- Stroke
- Cardiovascular death
Methodological detailsinternational observational consortium, multivariable Cox models stratified by centre risk
- International observational consortium
- Multivariable Cox models stratified by centre risk
Main finding
As reported in the abstract
First MACE
- Disease activity associated with major adverse cardiovascular event (MACE), HR
- 1.18 (95% CI 1.03 to 1.35)
- RF, HR (0.82 to 1.94), not statistically significant
- 1.26
- ACPA, HR (0.85 to 1.83), not statistically significant
- 1.25
- Three-way interaction disease activity × RF × ACPA on MACE, p for interaction
- 0.044
- RF-negative: RA activity linked to MACE in ACPA-negative but not positive, p for interaction
- 0.003
- ACPA-positive: disease activity linked to MACE in RF-positive but not RF-negative, p for interaction
- 0.040
Observational data: associations, not effects.
Original publication
Rheumatoid factor and anticitrullinated protein antibody status jointly influence the association between disease activity and cardiovascular risk in rheumatoid arthritis. RMD Open. Published 24 June 2026. doi:10.
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