Background Atherosclerosis is accelerated in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Carotid intima media thickness (IMT) is considered as a noninvasive surrogate marker of early atherosclerosis. A meta-analysis suggests that RA might have a stronger effect on carotid IMT than SLE . Only a few studies compared directly IMT in different rheumatic diseases but only carotid IMT was analyzed.
Objectives To compare the influence of RA and SLE on carotid and femoral IMT.
Methods 68 SLE patients (34 with lupus nephritis- SLE LN+ and 34 without LN- SLE LN-), 68 RA patients and 34 healthy controls were included in the study. All groups were matched for age and body mass index. Males, ever-smokers, patients with diabetes or coronary artery disease were excluded. Disease duration in RA and SLE patients was similar (7.1 vs 6.9 years). IMT of the common carotid artery (cIMT) and superficial femoral artery (fIMT) was determined by B-mode US imaging.
Results fIMT was increased in RA (0.419mm, p=0.004), SLE LN+ (0.429mm, p=0.002) and SLE LN- (0.429, p=0.047) compared to controls (0.377mm). Trend towards increased cIMTA was observed in RA, SLE-LN+ and SLE-LN-. No significant differences were found in fIMT and cIMT between RA, SLE LN+ and SLE LN-. Discontinuous (cumulative duration of treatment <90% of disease duration) treatment with disease-modifying antirheumatic drugs (DMARDS) was a strong predictor of increased cIMT and fIMT in both SLE and RA. cIMT and fIMT were significantly higher in RA patients treated discontinuously with DMARDs than in continuously treated RA (0.596mm vs 0.500mm, p=0.003 and 0.448mm vs 0.398, p=0.015, respectively) and SLE patients (0.596mm vs 0.483mm, p=0.004 and 0.448mm vs 0.404, p=0.041, respectively). On the other hand cIMT was increased in discontinuously treated SLE patients compared with continuously treated SLE (0.552mm vs 0.483mm, p=0.043) and RA patients (0.552mm vs 0.500mm, p=0.048). fIMT was also higher in discontinuously treated SLE patients than in continuously treated RA and SLE patients but the difference was insignificant.
Conclusions To our knowledge, this is the first study comparing directly carotid and femoral IMT in SLE and RA. We do not confirm stronger effect of RA on IMT. Our study suggests that other factors than the type of disease determine an increase of IMT. Immunosuppressive therapy seems to have a strong beneficial effect on IMT and thus on atherosclerosis progression in both RA and SLE.
Tyrrell PS, Beyene J, Feldman BM et al. Rheumatic Disease and Carotid Intima Media Thickness: A systematic Review and Meta-Analysis. Arterioscler Thromb Vasc Biol 2010;30:1014-1026.
Acknowledgements This work was supported by Polish Ministry of Science and Higher Education grant number N N402 077234
Disclosure of Interest None declared