Background Patients with inflammatory rheumatic diseases die prematurely, largely due to cardiovascular (CV) diseases. In rheumatoid arthritis (RA) patients subclinical atherosclerosis and cardiovascular events (CV) occur 2 to 3 times more frequently and earlier than in the general population. Atherosclerotic plaque vulnerability may be important for the occurrence of clinical events. High-resolution B-mode ultrasonography (US) of the carotid artery provides a noninvasive and reproducible method of identifying and characterizing atherosclerotic plaques. Previous data suggest that heterogeneous and echolucent plaques on US are more unstable and frequently contain a higher amount of lipids which make them hypoechoic.
Objectives The aim of our work was to estimate the prevalence and ultrasonographic morphology of the carotid plaques in a cohort of RA patients without prevalent CV events.
Methods 69 RA women who fulfilled the 1987 American College of Rheumatology (ACR) criteria and 44 controls, age matched, free of clinically evident CV disease underwent clinical evaluation (demographics, CV risk factors, RA characteristics and medication) and ultrasonographic assessment. RA patients with and without plaques were compared and plaque morphology and location was analyzed.
Results The mean age of the RA women was 47.7 ± 13.5 years old, mean disease duration 7.7 ± 6.2 years, 26.1% had hypertension, 23.2% dyslipidemia, 1.4% diabetes, 20.3% were smokers and 37.7% were obese. The mean DAS28 and the mean HAQ score were 4.17 ± 1.41 and 1.01 ± 0.66, respectively.
RA patients with plaques were older than RA patients without plaques (60.0 vs 46.5; p=0.013) and had a higher intima-media thickness (IMT) (0.084 vs. 0.035; p=0.001)
Eleven RA women (15.9%) presented at least one carotid plaque, while in controls plaques were found in 5 cases (11.36%). In both groups the plaques were mainly found in common carotid bifurcation.
Most RA patients had type 4 plaques (homogeneous, hyperechoic); in controls type 2 (heterogeneous hypoechoic, 50%) and 4 (50%) plaques were equally frequent.
Conclusions In this group of young RA women with moderately active disease, subclinical atherosclerosis was mainly determined by traditional CV risk factors, in particular by age. No distinct disease characteristics could be identified among those with plaques. Despite the limitations of our sample size, we found some differences regarding the US type of plaques in RA and controls. Surprisingly, atherosclerotic plaques of RA patients displayed ultrasonographic characteristics of less instability, with higher amount of calcium and lower amount of lipids than controls. This is an interesting finding that is in agreement with the higher content of coronary calcium previously documented by other authors in RA and stresses the need for a tight control of traditional CV risk factors in patients with arthritis.
References Santos, M.J., et al., Cardiovascular risk profile in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of female patients. Acta Reumatol Port, 2010. 35(3): p. 325-32.
Disclosure of Interest None Declared
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