Drs. Weber and Liao reply

To the Editor:

We are pleased to provide a brief response on comments to “The Association Between Major Adverse Cardiovascular Events and High-Sensitivity Cardiac Troponin T in Rheumatoid Arthritis.”¹

Drs. Wang and Liu commented on a need for morphologic assessments of cardiac function or asymptomatic coronary artery ischemia such as cardiac magnetic resonance imaging and coronary angiography.² The objective of the study¹ was to determine whether high-sensitivity cardiac troponin T (hs-cTnT) can potentially improve the accuracy of general population risk estimators (ie, American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease [ASCVD] risk) for predicting ASCVD outcomes³ in RA. Since actual cardiovascular (CV) events are needed to test this hypothesis, major adverse CV events were used rather than imaging findings related to CV risk. However, further assessments with cardiac imaging will be useful in future studies to understand the pathophysiology associated with detectable hs-cTnT in these individuals.

The comment² also referenced studies suggesting that levels of another clinical assay for high-sensitivity cardiac troponin, hs-cTnI, are falsely elevated among patients with seropositive rheumatoid arthritis (RA) compared to those with seronegative RA. In our study,¹ we observed no significant difference in the proportion of detectable hs-cTnT in seropositive (37%) compared to seronegative (45%) RA (P = 0.28; data not shown).

Finally, Drs. Wang and Liu² raised concerns regarding the rigor of the Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP) as a measurement of RA disease activity compared to the Clinical Disease Activity Index (CDAI) or the Simplified Disease Activity Index (SDAI). The DAS28-CRP is a validated instrument for assessing RA disease activity that is widely used in clinical studies.⁴ The CDAI and SDAI were developed not to replace DAS28-CRP but rather to provide alternative options to assess disease activity using simpler equations; in the case of CDAI, it was developed to enable assessments of disease activity without the need for blood tests.⁵ Validation studies have demonstrated that the 3 disease activity measures are highly correlated.⁵ In our study,¹ the DAS28-CRP was used to provide the readers with a general sense of the median disease activity in the cohort.

We hope this helps to clarify a few important points and we appreciate the interest in our study.

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