Research article

The association between disease activity and NT-proBNP in 238 patients with rheumatoid arthritis: a 10-year longitudinal study

Sella A Provan¹ , Kristin Angel^2,3 , Sigrid Ødegård¹ , Petter Mowinckel¹ , Dan Atar^2,3 and Tore K Kvien^1,2

¹Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vindern, N-0319 Oslo, Norway

²Faculty of Medicine, University of Oslo, Pb1018 0316 Oslo, Norway

³Aker University Hospital, Division of Cardiology, University of Oslo, Trondheimsveien 235, 0514 Oslo, Norway

author email corresponding author email

Arthritis Research & Therapy 2008, 10:R70doi:10.1186/ar2442

Published:	23 June 2008

Abstract

Introduction

Disease activity in patients with rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality, of which N-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. Our objective was to examine the cross-sectional and longitudinal associations between markers of inflammation, measures of RA disease activity, medication used in the treatment of RA, and NT-proBNP levels (dependent variable).

Methods

Two hundred thirty-eight patients with RA of less than 4 years in duration were followed longitudinally with three comprehensive assessments of clinical and radiographic data over a 10-year period. Serum samples were frozen and later batch-analyzed for NT-proBNP levels and other biomarkers. Bivariate, multivariate, and repeated analyses were performed.

Results

C-reactive protein (CRP) levels at baseline were cross-sectionally associated with NT-proBNP levels after adjustment for age and gender (r² adjusted = 0.23; P < 0.05). At the 10-year follow-up, risk factors for cardiovascular disease were recorded. Duration of RA and CRP levels were independently associated with NT-proBNP in the final model that was adjusted for gender, age, and creatinine levels (r² adjusted = 0.38; P < 0.001). In the longitudinal analyses, which adjusted for age, gender, and time of follow-up, we found that repeated measures of CRP predicted NT-proBNP levels (P < 0.001).

Conclusion

CRP levels are linearly associated with levels of NT-proBNP in cross-sectional and longitudinal analyses of patients with RA. The independent associations of NT-proBNP levels and markers of disease activity with clinical cardiovascular endpoints need to be further investigated.