Background Atherosclerotic cardiovascular disease (ASCVD) is the main mortality cause in patients with rheumatoid arthritis (RA) (1). It has been proven that the carotid intima-media thickness (CIMT) measured with carotid duplex ultrasonography (US) is an important ASCVD predictor with a measurement ≥0.9 mm (2–4).
Objectives To characterize the disease factors related with abnormal carotid duplex US findings in Mexican mestizo patients with RA.
Methods In a cross-sectional setting, we enrolled consecutive RA patients. Patients with overlap syndromes, personal history of ASCVD, dyslipidemia and previous use of any statin were excluded. A board-certified radiologist performed a bilateral carotid duplex US to all patients. Abnormal CIMT was defined as ≥0.9 mm (hypertrophy ≥0.9 – 1.2 mm and carotid plaque ≥1.2 mm). A clinical history and blood tests were performed at the time of the patient's visit. Disease activity was measured with Disease Activity Score using 28 joints–C-reactive protein (DAS28-CRP).
Results We enrolled 57 patients. Demographic characteristics are shown in table 1. A total of 30 (52.2%) patients had an abnormal CIMT. US findings are shown in table 2. A significant correlation between abnormal CIMT and RA disease duration (p=0.04), as well as between the former and anti-cyclic citrullinated peptide antibodies (ACPA) positivity (p=0.033) was found.
Conclusions There is a strong relationship between CIMT and the chronic inflammatory process of RA, as well as ACPA positivity. These results might be influenced by the high mean disease duration of our patients. Prospective studies that evaluate CIMT among disease duration intervals are necessary to support these findings.
Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71(9):1524–9.
Galarza-Delgado DA, Esquivel-Valerio JA, Garza-Elizondo MA, Gongora-Rivera F, Munoz-De Hoyos JL, Serna-Pena G. Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules. Reumatol Clin. 2013;9(3):136–41.
Mateo I, Morillas P, Quiles J, Castillo J, Andrade H, Roldan J, et al. What measure of carotid wall thickening is the best atherosclerotic loading score in the hypertensive patient: maximum or mean value? Rev Esp Cardiol. 2011;64(5):417–20.
Disclosure of Interest None declared