Lower limb arterial incompressibility and obstruction in rheumatoid arthritis

Inmaculada del Rincon ^1*, Roy W Haas ¹, Samvuel Pogosian ¹ and Agustin Escalante ¹

¹ University of Texas Health Science Center, USA

^* To whom correspondence should be addressed. E-mail: delrincon{at}uthscsa.edu.

Accepted 11 July 2004

Abstract

OBJECTIVE: Despite increased cardiovascular (CV) morbidity and mortality in rheumatoid arthritis (RA), the peripheral arteries remain understudied. We examined the lower limb arteries in age- and sex-matched, non- smoking RA patients and people without RA.

METHODS: We measured the ankle/brachial index (ABI) at the posterior tibial and dorsal pedal arteries. We classified arteries as obstructed if the ABI 0.9, normal if ABI > 0.9 and 1.3, and incompressible if ABI > 1.3. We used multinomial logistic regression to estimate differences in ABI between RA and controls, adjusting for CV risk factors, RA manifestations, inflammation markers and glucocorticoid dose.

RESULTS: We studied 234 RA patients and 102 controls. Among the RA patients, 66 of 931 arteries (7%) were incompressible and 30 (3%) were obstructed. Among the controls, 3 of 408 arteries (0.7%) were incompressible (P = 0.002) and 4 (1%) were obstructed (P = 0.06). At the person level, one or more abnormal artery occurred among 45 RA patients (19%), vs. 5 controls (5%, P = 0.001). The greater frequency of arterial incompressibility and obstruction in RA was independent of age, sex, and CV risk factors. Adjustment for inflammation markers, joint damage, rheumatoid factor and glucocorticoid use, reduced RA vs. control differences. Most arterial impairments occurred in RA patients with 20 or more deformed joints. This subgroup had more frequent incompressible (15%, P £ 0.001) and obstructed (6%, P = 0.005) arteries than the controls, independent of covariates.

CONCLUSION: Peripheral arterial incompressibility and obstruction are increased in RA. Their propensity for patients with advanced joint damage suggests shared pathogenic mechanisms.

Keywords: ankle-brachial Index, atherosclerosis, peripheral vascular disease, rheumatoid arthritis

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