Background Atherosclerosis is accelerated in rheumatoid arthritis (RA). Cardiovascular disease has become a major cause of morbidity and mortality in RA. Carotid intima media thickness (IMT) is considered as a noninvasive surrogate marker of early atherosclerosis. Studies in RA showed an accelerated progression of IMT and plaques in carotid arteries . Recent studies showed a negative correlation between IMT and duration of anti-inflammatory therapy .
Objectives To assess the influence of disease modifying anti-rheumatic drugs (DMARDs) on IMT in RA.
Methods 232 RA patients and 145 healthy controls were included in this study. IMT of the common carotid artery (cIMT) and superficial femoral artery (fIMT) was determined by B-mode ultrasound imaging. Detailed information on RA course and treatment was obtained from patients’ medical records (47.84% have been treated continuously with DMARDs- cDMARDs group, in 52.16% of patients DMARDs have not been used or have been used discontinuously- dDMARDs group). Adjustment for age was used in all statistical analyses.
Results Mean cIMT (McIMT), mean fIMT (MfIMT), maximal cIMT (MAXcIMT) and maximal fIMT (MAXfIMT) were significantly greater in dDMARDs group than in controls (0.743mm vs. 0.706mm, p=0.049; 0.555mm vs. 0.499mm, p=0.017; 0.890mm vs. 0.816mm, p=0.022; 0.662mm vs. 0.574mm, p=0.002, respectively). In contrast, no significant differences were observed for cDMARDs group. In analyses of subgroups we found that differences in IMT parameters between cDMARDs and dDMARDs groups were limited to smoking patients and males. In smoking patients a mean difference in McIMT, MfIMT, MAXcIMT and MAXfIMT between dDMARDs and cDMARDs was 0.085mm (p=0.048), 0.085mm (p=0.047), 0.162mm (p=0.025) and 0.146mm (p=0.015), respectively; in males: 0.072mm (p>0.05), 0.182mm (p=0.013), 0.131mm (p>0.05) and 0.225mm (p=0.023), respectively. The greatest differences were observed in smoking male patients: 0.158mm (p=0.039), 0.203mm (p=0.028), 0.315mm (p=0.025) and 0.247mm (p=0.049), respectively.
Conclusions Our study suggests that continuous use of DMARDs decreases IMT progression, which is in agreement with previous studies. However, we found that this effect is strongly pronounced in patients with other (than RA) atherosclerosis risk factors (i.e. male sex, smoking). Cardiovascular disease is a major cause of morbidity and mortality in RA patients. Thus it seems important to monitor closely compliance with DMARDs (especially in atherosclerosis high-risk patients) to diminish cardiovascular morbidity and mortality in RA.
Tyrrell PN, Beyene J, Feldman BM et al. Rheumatic Disease and Carotid Intima-Media Thickness. A Systematic Review and Meta-Analysis. Arterioscler Thromb Vasc Biol 2010; 30(5): 1014-26.
Ristić GG, Lepić T, Glišić B et al. Rheumatoid arthritis is an independent risk factor for increased carotid intima media thickness: impact of anti-inflammatory treatment. Rheumatology 2010; 49:1076-1081.
Disclosure of Interest None Declared