Never apply the 1.5x EULAR multiplier to a QRISK3 score because QRISK3 already encodes rheumatoid arthritis and corticosteroid use natively. Only multiply Framingham, ACC/AHA Pooled Cohort Equations, or SCORE2 outputs.
Guidance basis: Agca et al., EULAR CVD Recommendations (Ann Rheum Dis 2017).
How to Interpret Your Output in Clinic
Standard cardiovascular equations weigh age, blood pressure, smoking, diabetes, and cholesterol ratios, leaving approximately 30.4% of excess rheumatoid cardiac burden unmeasured. When ATACC-RA tested whether a single new RA-only calculator could replace Framingham across 13 cohorts, external calibration failed across regions due to baseline event-rate differences. Consequently, clinical guidelines rely on systematic re-calibration of local calculators rather than a standalone formula.
| Protocol Generation | Who Receives 1.5x Multiplier | Steroid Handling | Borderline (5%-9.9%) Next Step |
|---|---|---|---|
| EULAR 2009/2010 | Only if >= 2 of 3: duration > 10 yrs, RF/ACPA+, or extra-articular | Not explicitly weighted | Risk-factor counseling only |
| EULAR 2015/2016 Update | All RA patients if score excludes RA (Framingham, SCORE) | Document chronic prednisone hazard | Consider carotid duplex plaque screen |
| QRISK3 Native | 1.0x (already weighted inside equation) | Includes regular steroid checkbox | Proceed directly to statin discussion if >= 10% |
Reclassification Thresholds Visualized
Boundary Conditions & Calculation Safeguards
All calculations execute locally inside your browser without network transmission. Results below 0.5% or above 40% baseline are clamped for clinical readability. Patients with established coronary artery disease, prior ischemic stroke, peripheral arterial disease, or diabetes with target-organ damage automatically qualify as secondary/high-risk without applying a primary prevention calculator.