Background Systemic diseases of connective tissue associated with the early development of atherosclerosis [1,2]. It is well-known that the main cause of decrease the quality of life patients with rheumatoid arthritis (RA) is a chronic pain syndrome. The cause of pain can be joint inflammatory process, systemic manifestations of RA (vasculitis, pericarditis, pleurisy, polyneuropathy), complications of drug therapy, comorbid conditions. Pain in the stomach area may be associated with NSAID-gastropathy, problems with spinal discs, and perhaps with atherosclerotic lesions of the abdominal aorta.
Objectives To estimate atherosclerotic changes of arteries in patients with RA and determine possible sources of pain in the abdomen by ultrasound-control palpation.
Methods We included 75 patients with RA (age 38,7±7,4, males 93,3%) and 29 healthy subjects, matched for age and gender, without a history of cardiovascular diseases. An ultrasound investigation of the arterial vassal with measurement of the intima-media thickness (IMT) of carotids was performed. To determine the source of pain in the abdominal cavity ultrasound-control palpation of duodenal bulb, gallbladder, lumbar discs, and abdominal aorta was done. Severity of pain was assessed using the VAS.
Results It has been determined, that in RA group IMT was 0.8 mm (0.7–0.9), compared with 0,6 mm (0,6–0,7) in control group. IMT positively correlate with the age, duration of disease, Ritchie index, C-reactive protein level. In 22 (29,3%) patients with RA we found atherosclerotic plaques lesion in carotids, aorta, and vessels of the lower extremities. Present of atherosclerotic plaques associated with disease durations (12 years (10–15) in group with plaques and 5 years (3–8) in group without plaques). The presence of atherosclerotic plaques is associated with rheumatoid factor (c2=1,02, p>0,05), and systemic manifestations of RA (c2=15,89, p<0,001).
In RA group 36 (48%) patients had indicated the presence of pain in the abdomen while performing ultrasound control palpation. In 15 (20%) cases was detected pain during palpation of the lumbar spine, VAS 48 (36–59). In 21 (28%) cases, patients indicated pain during palpation of the abdominal aorta, VAS 42 (31–65). In this group of patients we found signs of the atherosclerotic lesions of aorta: change in the contour of the vessel, the heterogeneous structure of the vascular wall. Atherosclerotic plaques in the abdominal aorta are founded in 21 (28%) cases.
Conclusions Patients with RA had an increase thickness of IMT and atherosclerotic plaques, which appear in various vascular regions. During performing ultrasound-control palpation in 36 (48%) patients was detected pain, associated with vertebral changes 15 (20%), and with atherosclerotic changes of abdominal aorta – 21 (28%).
High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. I.D. del Rincon et al. Arthritis Rheum. 2001;44:2737–2745.
Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. C. Han et al. J. Rheumatol. 2006;33(11):2105–2107.
Disclosure of Interest None declared
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