Background Rheumatoid arthritis (RA) is associated with excess mortality, which can be attributed to increased cardiovascular (CV) death. Evidence suggests that traditional cardiovascular disease risk factors cannot fully explain the increased CV mortality observed in RA patients. The important role of inflammatory and autoimmunity processes in the development and progression of atherosclerosis is discussed. There are contradictory data on the involvement of antiphospholipid antibodies (aPL) in the development of atherosclerosis and its relationship to the inflammatory process.
Objectives The aim of our study was to detect the presence of aPL and their association with carotid atherosclerosis in female patients with RA.
Methods The study included 37 female patients with RA (ACR 1987 diagnostic criteria), mean age 45,0 (33,0; 51,0) years old, disease duration 9,0 (3,0; 14,0) years, and high disease activity (DAS28=5,37 (4,69; 5,86) points).
We assessed the presence of several traditional risk factors (arterial hypertension, obesity, smoking, physical inactivity, family history of CAD, hypercholesterolemia, hypertriglyceridemia, hyperhomocysteinemia). The levels of homocysteine, high sensitive C- reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor - α (TNF-α), IgG/IgM anticardiolipin antibodies (aCL), anti-β2-glycoprotein 1 antibodies (aβ2-GP1), antibodies to annexin V (aAnV) and prothrombin (aPT) were determined with ELISA according to the instruction of manufacturer.
The atherosclerotic changes of carotid artery were verified with the help of ultrasound, which were measured at three points along posterior wall approximately of bifurcation. The intima-media thickness (IMT) of common carotid artery (CCA) 0,9 – 1,5 mm and the presence of plaques (IMT ≥1,5 mm) corresponded to atherosclerotic alterations.
Results The asymptomatic atherosclerotic alterations of the vessel wall were found in 18 (48,65%) patients with RA. Among them, increased IMT had 44,44%, and atherosclerotic plaques had 55,55% patients.
The patients with atherosclerotic lesions were older, they had a greater BMI and higher triglyceride levels than without these lesions (p=0,0094, p=0,003, p=0,027, respectively). Different positive correlations of investigated parameters were revealed in RA patient with and without atherosclerotic alterations. The patients with carotid atherosclerosis had positive correlation between the disease activity and the levels of IgM aCL, IgM aAnV, the disease duration and IgM aPT, as well as between fibrinogen, hs-CRP and IgG/IgM aAnV. The obtained data suggest the involvement of autoimmune mechanisms in the development of atherosclerosis in RA patients with high disease activity and disease duration.
However, in patients without atherosclerotic lesions, only the relationship between the disease activity, hs-CRP concentration and IgG anti-β2-GP1 was observed.
Conclusions The presence of carotid atherosclerotic alterations in patients with RA was associated both with traditional CV risk factors (age, elevated BMI, triglyceride) and a broad spectrum of aPL producing a damaging effect on the vascular endothelium due to high activity and duration of disease.
Disclosure of Interest None declared
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