Background In rheumatoid arthritis (RA), higher mortality is mainly due to cardiovascular disease, as a consequence of accelerated atherosclerosis found in this diseases (1). Finding methods for assessing vascular dysfunction during the early stages of the disease is important, particularly in patient groups at high CV risk (2).

The use of noninvasive imaging techniques may help identify high-risk individuals who may benefit from active therapy to prevent clinical disease. Two of them, brachial ultrasonography to determine the presence of endothelial dysfunction and carotid ultrasonography to assess carotid intima-media wall thickness (IMT) have been found to be useful in the assessment of the cardiovascular risk of patients with RA (3). Prothrombotic markers have been shown to be able to predict cardiovascular risk in patients with RA (4).

Objectives The first aim of the study was to investigate whether early signs of atherosclerosis and endothelial dysfunction, as measured by IMT and brachial artery flow-mediated (FMD) vasodilatation, were present in patients with RA compared with controls. The second aim was to analyze correlation between serum levels of vWf and IMT and FMD in patients with RA.

Methods Fifty-two patients with RA and 30 matched healthy controls without clinically evident CV disease were studied. Brachial and carotid ultrasonography was performed to determine FMD and IMT, respectively. We also assayed immunological, inflammatory and metabolic laboratory markers.

Results IMT was significantly higher in RA patients (1.00±0.16 mm) patients than in controls (0.89±0.13 mm) (P=0.001). FMD% was significantly lower in RA (9.16±7.03) as compared to controls (12.60±5.49) (p=0.005). It showed statistically higher values of vWF in the RA patients compared to the control group (p=0.01).

Patients with RA is divided into two groups according to the value of the IMT, below 9mm and 0.9mm and above. vWFact is statistical significantly higher in the group with thicker IMT (p=0.046), as well as the percentage of men (p=0.030). Other parameters did not show statistical significance in relation to the value of the IMT.

Conclusions In patients with RA, increased serum levels of vWF and impaired FMD and IMT, indicating endothelial dysfunction and accelerated atherosclerosis. IMT measurement is the first candidate to evaluate against conventional evaluation of cardiovascular risk in prospective studies.

References

1. Dessein PH, Joffe BI, Singh S. Biomarkers of endothelial dysfunction, cardiovascular risk factors and atherosclerosis in rheumatoid arthritis. Arthritis Res Ther 2005;7:634–643.

2. Tousolis D, Antoniades C, Bosinakou E et a. Differences in inflammatory and thrombotic markers between unstable angina and acute myocardial infarction. Int J Cardiol 2007;115:203–207.

3. Fuchs I, Frossard M, Spiel A, Riedmuller E, Laggner AN, Jilma B. Platelet function in patients with acute coronary syndrome (ACS) predicts recurrent ACS. J Thromb Haemost 2006;4:2547–2552.

4. Jonsson SW, Backman C, Johnson O et al. Increased prevalence of atherosclerosis in patients with medium term rheumatoid arthritis. J Rheumatol 2001;28:2597–2602.

References

Disclosure of Interest None declared