Background Rheumatoid arthritis (RA) associates with higher mortality rates than general population, mostly due to cardiovascular (CV) disease . Guidelines recommend CV risk assessment in all RA patients. The European League against Rheumatism (EULAR) has proposed a modified version of SCORE risk estimation system (mSCORE) . Few studies assessed the impact of an increased carotid intima media thickness (cIMT), carotid plaques, and ankle-brachial index (ABI) on the CV risk assessment in patients with RA.
Objectives To assess whether the value of carotid ultrasonography and ABI in the stratification of CV risk in RA.
Methods All RA patients who consecutively attended the outpatient rheumatology clinic of our hospital were enrolled. Exclusion criteria: diabetes mellitus, history of cardio and cerebrovascular events and age>75 years old.
Results The study population was represented by 78 patients, 61 women (78.2%), median age 60 years old and disease duration 6.0 years. The SCORE (median) and EULAR mSCORE were 1.25 and 1.5.
All patients with an abnormal ABI had a normal cIMT. 27/78 (34.6%) patients had High CV risk defined as a)mSCORE ≥5% or b)mSCORE<5% plus cIMT>0.90 mm and/or plaques or an abnormal ABI. A SCORE>5% had a Sensitivity of 29.6% (8/27), an Abnormal ABI 14.8% (4/27), a cIMT>0.90mm plus carotid plaques 70.4% (19/27), a mSCORE<5% plus Abnormal ABI 14.8% (4/27), a mSCORE<5% plus cIMT>0.90mm and/or carotid plaques 55.6% (15/27) and an Abnormal ABI plus cIMT>0.90mm and/or carotid plaques 85.2% (23/27).
Conclusions SCORE showed a low sensitivity to identify high risk RA patients, and mSCORE did not improve it. Carotid ultrasonography assessment showed a higher sensitivity than mSCORE and ABI to detect high CV risk. Despite its low sensitivity, an abnormal ABI identify high risk patients not discriminated by using mSCORE nor cIMT. Carotid ultrasound seems to be more sensitive than ABI, SCORE and mSCORE to identify high CV risk in patients with RA.
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Peters MJ, Symmons DP, McCarey D, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010;69:325e31.
Disclosure of Interest None declared
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