Background The elevated cardiovascular burden of rheumatoid arthritis is well known and the recent update of EULAR recommendations for cardiovascular disease management (1) establish as overarching principle that the rheumatologist is responsible for CVD risk management in patients with RA. They highlight the need of optimal disease activity control, regular CVD risk assessment, lifestyle counseling, appropriate prescription of NSAIDS,corticosteroids,antihypertensives and statins. Screening for asymptomatic atherosclerotic plaques by use of carotid ultrasound is also suggested: the presence of carotid plaques is associated with poor CVD-free survival and is strongly linked to future acute coronary syndrome in RA patients.
Objectives We performed an overall cardiovascular assessment to evaluate the presence of end-organ damage in a group of RA patients.
Methods We carried out non-invasive 24 hours ambulatory blood pressure monitoring, echocardiography, carotid doppler ultrasound and pulse wave velocity (PWV) in a group of RA patients to optimize non-DMARDs therapy and to evaluate end organ damage.
Results 55 RA patients, 76.4% female, mean age 62.8±9 yrs were examined. The median disease duration was 12 yrs. 84% were RF +, 80% ACPA + and 51% had erosions. Mean DAS 28 CRP was 2.82±1.23 and HAQ 0.54±0.6. All pts were treated with cDMARDs and/or bDMARDs (54%) and Pd mean dosage was ≤5 mg/day. Only 3 patients had previous CV event. 49% were hypertensive, 25% had high cholesterol, 13% diabetes and 16% were smokers: median BMI was 25. MAP monitoring revealed that 43/55 (78%) pts were hypertensive: 13 of them had unknown or not/under treated hypertension: 63% had dipper profile and only 12% were reverse dipper. We did not find increased left ventricular mass and wall thickness, but left ventricular diastolic dysfunction grade I-II was found in 26/55 pts, not related to hypertension nor to RA activity. The IMT median value was 655 mm; only in 3 pts was >900 mm: no relation with disease activity was found. In 11 pts carotid plaques were present and related with age, BMI and ambulatory mean pressure values, but not with RA activity or duration. In one patient the plaque required carotid endarterectomy. The PWV median value was >10m/s in 16 pts, all hypertensive.
Conclusions The accurate evaluation of cardiovascular involvement of this small group of RA patients shows that hypertension is frequent and often not appropriately treated and seems to be the main cause of the increased PWV. Low grade LV diastolic dysfunction was found in half of patients, with no relation with hypertension or RA features, except for CCP presence, but the small numbers do not allow any speculation. Carotid artery involvement was present in 20% of pts, but only in 1 was clinically significant. Once again no relation with RA features was found: the small number of patients, the low disease activity and the tight and overall clinical control could be partial explanations. The clinical tight control of patients with RA is an unique opportunity to fulfill EULAR reccomendations.
Agca R, et al. Ann Rheum Dis 2016.
Disclosure of Interest None declared