Background Carotid plaques (CP) in rheumatoid arthritis (RA) are predictive of acute coronary syndrome in RA patients, suggesting that atherosclerotic plaques in RA are vulnerable.(1)
Objectives To characterize vulnerability of CP in RA patients compared to a control population and between RA patients with different levels of disease activity.
Methods Ultrasound of carotid arteries was performed in 152 RA patients and 89 controls. The CP echolucency was evaluated by the Gray-Scale Median (GSM) technique. Lower GSM value indicates higher vulnerability of plaques. CP characteristics were compared between RA patients with active disease and remission, and between patients and controls. All analyses were performed with adjustment for sex, age, smoking and blood pressure. Poisson regression was used for count data, mixed modeling for GSM and area per plaque, and analysis of covariance (ANCOVA) for minimum GSM per patient.
Results Patients with RA were older (p<0.0001), had higher blood pressure (p<0.0001) and had more diabetes (p=0.04) compared to controls. The RA patients also had more frequently CP compared to controls (p<0.0001), after adjustment for confounding factors. Patients with active RA disease according to clinical disease activity index (CDAI) had lower GSM (p=0.03), minimum GSM (p=0.03) and a larger CP area, although not significantly (p=0.27), compared to RA patients in remission.
Conclusions RA patients with active disease assessed by CDAI seem to have more vulnerable CP compared to those in remission, pointing to the importance of obtaining RA remission goals to reach the state of stable atherosclerotic disease. The increased extent of atherosclerosis with numerically more CP was associated with the disease RA and surprisingly not with RA disease activity.
Evans MR, Escalante A, Battafarano DF, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum 2011;63:1211-1220.
Disclosure of Interest None Declared