DAS28 using GGT delivers dual assessment of joint activity, CV risk

Serum gamma-glutamyltransferase (GGT) shows potential as a reliable marker of systemic inflammation and cardiovascular (CV) risk in patients with rheumatoid arthritis (RA), suggests a study.

The authors included 129 RA patients in this cross-sectional monocentric study over a 12-month period and systematically obtained data on liver function, RA disease activity, and hepatotoxic and CV risk factors. Additionally, they constructed the Disease Activity Score in 28 joints (DAS28)-GGT composite index by replacing erythrocyte sedimentation rate (ESR) with GGT to provide a simple tool to assess both joint disease activity and CV risk factors.

Thirty-two patients (25 percent) had isolated GGT increase. GGT was associated with age, C-reactive protein (CRP) levels, and body weight and was significantly increased in patients with alcohol intake, type 2 diabetes mellitus, hypertension, dyslipidaemia, and metabolic syndrome. Gradually, GGT levels also increased with the number of CV risk factors and correlated with the Framingham CV risk score.

The composite index DAS28-GGT was a consistently reliable marker of RA disease activity. In addition, it accurately identified patients with CV risk factors.

In contrast to the DAS28 and the DAS28-CRP, the DAS28-GGT steadily increased according to the number of CV risk factors. It also demonstrated higher diagnostic value than the DAS28 and DAS28-CRP for the presence of at least two CV risk factors and a Framingham CV risk score >10 percent.

“Based on these findings, we herein propose an original index, the DAS28-GGT, which is able to evaluate both joint disease activity and CV risk,” the authors said. “This index … deserve[s] further validation in prospective cohorts.”