Rheumatoid arthritis (RA) is a chronic autoimmune disease marked by systemic inflammation. While RA primarily affects the joints, its systemic effects may lead to an increased cerebro- and cardiovascular risk. Atherosclerosis of the carotid arteries is a significant risk factor for cerebrovascular events and serves as a surrogate marker for cardiovascular risk. This study explores the link between RA and carotid artery atherosclerosis with data from the Paracelsus 10,000 Study. Baseline assessments were conducted on individuals randomly selected from Salzburg and its surrounding regions. Participants diagnosed with RA based on ACR-EULAR classification criteria and who underwent carotid artery ultrasound were included. Data were gathered from a total of 9729 participants, among whom 299 were diagnosed with RA. Carotid arteries were examined using ultrasound imaging. The primary endpoint was the difference in the prevalence of plaque presence between the RA and non-RA groups. One univariate (Model I) and three multivariate analyses were conducted, with adjustments in Model II incorporating SCORE 2, while Model III accounted for metabolic syndrome, age and sex. Additionally, Model IV included further adjustments for high-sensitivity C-reactive protein (hs-CRP). Plaque presence was defined as the ultrasound detection of plaque formation larger than 0 mm², regardless of whether it was unilateral or bilateral. Additional assessments included carotid stenosis, intima-media thickness (IMT) and total plaque area (TPA). RA patients had a higher prevalence of plaque (50%) compared to non-RA individuals (38%). The odds ratio (OR) for plaque presence in RA patients versus non-RA individuals was 1.64 (95% CI 1.30–2.06). This association persisted after adjusting for SCORE2, with an adjusted odds ratio (aOR) of 1.65 (95% CI 1.26–2.15). The association remained significant when adjusting for metabolic syndrome, age and sex (aOR = 1.32, 95% CI 1.02–1.72) and also in Model IV, which included further adjustment for hs-CRP (OR = 1.33, 95% CI 1.02–1.74). The findings underscore an increased risk of cerebrovascular disease associated with RA. This study highlights the importance of thorough cerebrovascular and cardiovascular risk assessments, along with proactive management, for RA patients to reduce this risk. Recognizing the substantial impact of RA on stroke and cerebrovascular disease is important for enhancing patient care strategies. Carotid ultrasound appears to be an effective method for atherosclerosis screening in RA patients.

Background: Rheumatoid arthritis (RA) is associated with systemic inflammation and increased risk of cardiovascular and metabolic comorbidities. The relationship between RA and metabolic dysfunction-associated steatotic liver disease (MASLD) has not been established in population-based studies. Methods: We conducted a cross-sectional analysis of 6638 participants from the population-based Paracelsus 10,000 cohort in Austria, including 187 individuals with physician-diagnosed RA meeting ACR/EULAR classification criteria. MASLD was defined using the Fatty Liver Index (≥ 60) combined with cardiometabolic risk factors according to 2024 EASL guidelines. We used Poisson regression models with sequential adjustment for demographic factors, metabolic syndrome, lifestyle factors, NSAID use, and cardiovascular risk (SCORE2). Liver fibrosis risk was assessed using the Fibrosis-4 Index (FIB-4). Results: MASLD prevalence was higher in RA patients than controls (41.2% vs. 28.5%, P < 0.001). In sequential regression models, the association between RA and MASLD persisted after adjustment for demographics (IRR, 1.55; 95% CI 1.33–1.82), metabolic and lifestyle factors (IRR, 1.20; 95% CI 1.03–1.40), and cardiovascular risk factors (IRR, 1.35; 95% CI 1.14–1.60; P < 0.001). In addition, RA patients showed elevated liver fibrosis markers (median FIB-4: 1.21 vs. 1.08; P < 0.001). Conclusions: In this population-based cohort, RA was independently associated with a 35% increased risk of MASLD and elevated liver fibrosis markers. These findings suggest that systematic liver assessment should be considered in the routine care of RA patients.

Austria, a country with a high standard of living and a well-developed healthcare system, still experiences socioeconomic status (SES) disparities that impact health outcomes. Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with significant disability and comorbidities. While SES has been linked to RA prevalence and disease severity, its role in a high-income country like Austria remains underexplored. This study investigates the association between SES factors-education, income, employment status and migration background-and RA prevalence and outcomes. This population-based study used data from the Paracelsus 10,000 cohort in Salzburg, Austria and a cross-sectional design. A total of 9,256 participants aged 40-77 years were analyzed, including 289 individuals diagnosed with RA based on the ACR/EULAR classification criteria. SES was assessed through self-reported education, income, employment status and country of birth. Logistic regression models were used to evaluate the association between SES and RA, adjusting for age, sex, metabolic syndrome, smoking and alcohol consumption. RA prevalence was significantly lower among individuals with higher education (OR = 0.55, 95% CI: 0.37-0.82 for medium education; OR = 0.41, 95% CI: 0.25-0.68 for high education). Lower household income correlated with higher RA prevalence. Employment disparities were evident, with RA patients exhibiting higher rates of unemployment and work disability. Despite Austria's high standard of living, SES remains a key determinant of RA prevalence. Lower levels of education, income and employment are associated with higher rates of RA, highlighting the need for targeted public health interventions. Strengthening healthcare access, promoting early screening and offering economic support to vulnerable groups could be important steps toward reducing these disparities. Further research should explore the underlying mechanisms of this association and examine whether socioeconomic disparities also influence disease progression and patient outcomes.

Summary: Objective: Rheumatoid arthritis (RA) is recognized as a chronic autoimmune disorder with systemic inflammation and joint damage. Its potential role as a risk factor for cardiovascular diseases (CVD) is increasingly noted. This review delves into the causal relationship between RA and CVD, with Mendelian randomization (MR) offering a genetic perspective. Methods: An extensive search was conducted in PubMed, Cochrane and Web of Science to identify MR studies addressing the RA-CVD link. Out of 530 studies, 9 met the inclusion criteria, which were rigorously assessed using a critical appraisal checklist. These were further stratified by a sensitivity analysis into categories reflecting the strength of their evidence, from not evaluable to robust. Results: From the nine included studies, eight supported a causal association between RA and an increased risk of CVD, specifically coronary artery disease (CAD) and one did not support a link between RA and heart failure. The results suggest that genetic factors associated with RA may contribute to an elevated risk for CVD. Chronic inflammation, prevalent in RA, emerges as a key mediator in this connection. Conclusion: The systematic review corroborates a genetic causal link between RA and CVD, as evidenced by eight of the nine MR studies reviewed. This suggests a need for integrated cardiovascular risk management in the treatment of RA patients. The findings advocate considering anti-inflammatory treatment that can reduce cardiovascular risk. The overarching evidence signifies a potential direction for new therapeutic strategies aimed at enhancing cardiovascular health in RA patients.

Background: Colorectal neoplasia and diverticulosis are common findings on colonoscopies. While adenomas are precursors to colorectal cancer, diverticulosis is usually asymptomatic but can lead to diverticulitis. Despite their prevalence and coexistence, the relationship between these conditions remains unclear. This study investigates whether diverticulosis is associated with adenomas, considering shared risk factors and potential inflammation-driven mechanisms. Methods: We examined 6154 asymptomatic individuals undergoing colorectal cancer screening in Austria. Diverticulosis and colorectal neoplasia were documented during screenings based on macroscopic definitions. Advanced neoplasia was defined as polyps >1 cm or high-grade dysplasia. Associations between diverticulosis and neoplastic findings were assessed using univariate and multivariable logistic regression models. Results: Although the overall incidence of any polypoid lesion was higher in the diverticulosis group (37% vs. 30%), statistical analysis revealed a comparable rate of advanced neoplasms in both groups. Importantly, no significant link between diverticulosis and advanced neoplasms was found (OR 1.125; 95% CI: 0.933 to 1.357, p = 0.218) even after adjusting for confounding factors. In a univariate analysis, a statistically significant association between diverticulosis and the presence of any colorectal polyps was identified (OR 1.388; 95% CI: 1.244–1.549, p < 0.0001). However, after adjusting for confounding factors in model 2 (OR 1.065, 95% CI: 0.942 to 1.204, p = 0.314) and model 3 (OR 1.071, 95% CI: 0.925 to 1.239, p = 0.360), this effect was also not statistically significant. Conclusions: Patients with diverticulosis share demographic and clinical features with those at risk of colorectal neoplasia, such as older age, male gender, and higher cardiometabolic risk. However, diverticulosis does not independently increase the risk of advanced colorectal neoplasia or unspecified polypoid lesions.