Assessing cardiovascular risk in rheumatoid arthritis patients on Janus kinase inhibitors: real-world data from the European Alliance of Associations for Rheumatology-adapted CUORE risk algorithm

Janus kinase inhibitors (JAKi) are effective treatments for rheumatoid arthritis (RA), but growing evidence raises cardiovascular (CV) safety concerns. Given the elevated baseline CV risk in RA, appropriate risk stratification is essential. We retrospectively analyzed 116 RA patients treated with JAKi at the University of Naples Federico II (2020-2025), excluding those with previous CV events. Cardiovascular risk was assessed using the CUORE algorithm, adjusted with the European Alliance of Associations for Rheumatology-recommended 1.5 multiplication factor. Patients were stratified into low (37.9%), intermediate (48.3%), and high (13.8%) risk categories. Over a median follow-up of 25.6 months, only one major CV event (myocardial infarction) was recorded, with no CV deaths. Despite the algorithm being developed for the general population, it appears feasible for RA patients on JAKi. Our findings suggest its potential role in guiding CV prevention strategies, although larger, multicenter studies are needed to confirm its predictive value and integrate RA-specific variables.