12. Chronic Inflammatory Disease Recommendations

  • There is clear evidence of heightened CVD risk in patients with rheumatoid arthritis (RA) as summarised in recent EULAR consensus document.
  • The JBS3 risk calculator now incorporates the appropriate multiplier for CVD risk, based on the presence of RA.
  • Intensive management of traditional CVD risk factors should be undertaken in patients with RA, taking into account their CVD risk score.
  • Optimisation of inflammation suppression with disease modifying anti-rheumatic drugs may also help reduce CVD risk.
  • CVD risk may be lowered by use of the minimum effective glucocorticoid dose for the shortest possible time.
  • Where anti-inflammatory drugs are indicated for symptoms in those patients with an average gastroduodenal damage risk, the use of a conventional NSAID with gastroprotective agent is preferable to use of a COX-2 selective inhibitor.
  • Clinical judgement may be used to determine whether a risk multiplier should be applied to patients with other autoimmune conditions.