Background Cardiovascular disease and osteoporosis are two major causes of morbidity in rheumatoid arthritis (RA) patients. Vertebral fracture assessment (VFA) by dual-energy X ray absorptiometry (DXA) is a validated tool for the diagnosis of vertebral fracture. Studies show that lateral VFA image is an accurate method for the diagnosis of abdominal aortic calcifications (AAC), which is a relevant risk factor for cardiovascular disease. Studies in postmenopausal women are conflicting about the association between AAC and presence of vertebral fractures (VFs) and there is no study in RA.
Objectives The aim of the study was to assess the prevalence of AAC in RA patients and the relationships between AAC, cardiovascular diseases and bone status (osteoporosis, VFs).
Methods This study was performed in 132 patients who consulted for a bone mineral density (BMD) measurement in a tertiary department of Rheumatology. Demographic data, disease duration, activity and severity, RA therapies, cardiovascular risk factors and diseases, low trauma fractures and presence of osteoporosis (T score≤-2.5 at either lumbar spine and/or hip) were assessed. Diagnosis of VF was performed using the Genant semiquantitative analysis on VFA and severity of VF was quantified from grades 1 to 3. AAC were assessed on lateral VFA images of spine by two readers experts in this field, using a 24 and 8 point scale for scored AAC (1) with a good Inter-observer reliability (ICC) (0.845 (95% CI 0.702-0.923) and 0.882 (95% CI 0.769-0.942) for the 24 and 8-AAC scores, respectively). Univariate and multivariate analyses were performed to investigate associations between presence of AAC and disease-related factors. The accuracy of the multivariate model was measured by the area under the curve (AUC).
Results 132 RA patients (114 women, mean age of 56.6±12.7) with a mean duration of RA of 15.1±9.1 years were included in the study. 107 (83.0%), 66 (51.2%) and 85 (64.4%) received DMARDs, corticosteroids and biological therapies respectively. Presence of AAC was observed in 32 (24.2%) patients. AAC were significantly associated with the presence of hypertension (p=0.043) and coronaropathy (p=0.0045). 35 patients (26.5%) were osteoporotic and 20 (15.2%) had at least one VF. There was a significant association between presence of AAC and osteoporosis (p=0.003), and between AAC and prevalent VF (p=0.019). Severity of AAC is correlated with VF severity (r= 0.27, p=0.003 and r= 0.23, p=0.011, for the 24 and 8-AAC scores, respectively) Age, male gender, menopause, calcium intake were significantly associated with presence of AAC in univariate analysis (p≤0.05). In multivariate analysis, age was the single variable associated with the presence of AAC (OR=1.24, CI 95% 1.1-1.4, p=0.0004) and calcium intake had a protective effect (0R=0.02, IC 95%0.0001-0.33, p=0.007) (AUC= 0.915).
Conclusions This study conducted in severe RA patients suggests that presence of AAC is associated with cardiovascular diseases and vertebral fractures. RA patients with VF should have a systematic cardiovascular assessment.
Schousboe JT, et Al. Detection of aortic calcification during vertebral fracture assessment (VFA) compared to digital radiography. PLoS One.2007;2:e715
Disclosure of Interest None Declared