Background Different studies and meta-analysis have shown that subclinical atherosclerosis (AS) and vascular complications (VC) are higher in patients with Systemic Sclerosis (SSc) than in healthy population. A major intrahospital mortality because of VC in patients with SSc as to those with Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) has also been described (Dave AJ, et al. Arthritis Care Res 2014; 66: 323–7).
Objectives To compare the presence of subclinical AS among patients with SSc, RA and a population of healthy people.
Methods Transverse study including patients diagnosed with SSc and RA, controlled in a Rheumatology Department of a tertiary hospital. Patients with previous VC, renal failure and/or diabetes were excluded. The control group (healthy individuals) were volunteers from the same geographical area. We gathered demographic variables (age,gender,BMI), smoking status, clinical (blood pressure), and analytical variables (cholesterol fractions, atherogenic index [AI]). The extracranial branches of carotid artery were explored by ultrasonography (US) using an ESAOTE MyLab XV70 with a 7–12 MHz linear transducer and an automated program measuring intima-media thickness (IMT) through radiofrequency (RFQIMT). The presence of atheroma plaques as per the Mannheim consensus was registered. Statistical analysis was done using the IBM-SPSS Statistics v22.0 package.
Results 266 patients were included, 23,7% (85) with SSc and 50,4% (181) with RA. The control group was conformed by 93 healthy individuals. Women proportion, arterial hypertension and age were greater in RA and SSc patients than in healthy subjects (p<0,001); but smoking status was higher in healthy subjects (p<0,001). BMI showed lower values in patients with SSc than RA (p=0,046) and the healthy group (p=0,008). No differences were found between groups in the rest of analyzed variables. Results of the vascular study, grouped by diagnosis, is shown in the table below.
A major prevalence of atheroma plaque and pathologic US was seen in RA patients than in SSc patients (p=0,002 and p=0,007, respectively) and healthy subjects (p=0,005 and p=0,001, respectively), whereas no differences between SSc and healthy subjects were seen within these results. Patients with SSc, however, showed higher mean IMT values than healthy subjects (p=0,047) but less than patients with RA (p<0,001), with a higher percentage of patients with IMT>0,9 than healthy subjects (p=0,005) in the bivariate analysis. However, this association was lost in the multivariate analysis, and these differences might be due to age and arterial hypertension differences between groups.
Conclusions RA is a more atherogenic disease than SSc, probably because of its higher inflammatory load. Higher mortality by VC in SSc could be attributed to a major multiorganic affection of the disease. In our serie we didn't find a higher prevalence of subclinical AS in patients with SSc than in healthy subjects.
Disclosure of Interest None declared