Background Rheumatoid Arthritis (RA) patients are at risk of cardiovascular disease (CVD) and carotid intima media thickness (cIMT) is an excellent marker of subclinical atherosclerosis. However, cIMT and the CVD biomarkers among RA patients with low disease activity and remission are not well studied.
Objectives To assess the carotid intima media thickness (cIMT) in RA patients who were in low disease activity state and lacking concomitant co-morbidities potentially influencing cIMT. This study was also aimed to determine the correlation between serum IL-17 with cIMT.
Methods Rheumatoid Arthritis patients who were in low disease activity or remission (DAS28<3.2) from Rheumatology Clinic, National University of Malaysia Medical Centre were recruited. Patients with traditional CVD risk factors were excluded. Carotid ultrasound was performed in RA patients and their age and gender-matched healthy controls to determine the cIMT thickness. Serum IL-17 was measured using ELISA method.
Results A total of 76 patients were screened and 22 RA patients who were in low disease activity or remission were included. Patients with RA had significantly higher median cIMT, 0.53 (IQR0.13) mm compared to controls, 0.47 (IQR 0.14) mm, p=0.01. In RA patients, the cIMT had significant positive correlation with age (rs=0.84, p=0.00), systolic BP (rs=0.45, p=0.04), waist circumference (rs=0.43, p=0.04), total cholesterol (rs=0.54, p=0.01), BMI (rs=0.45, p=0.04) and serum IL-17 (rs=0.45, p=0.03) but negative correlation with total HDL (rs=-0.43, p=0.05).
Conclusions Patients with RA had significantly higher cIMT as compared to healthy controls despite minimal disease activity and lack of traditional CV risk factors, suggesting that the vascular injury due to previous inflammation may not be reversible. Serum IL-17 was also found to be correlated significantly with cIMT, suggesting that it may play a role in atherogenesis among RA patients.
van Sijl AM et al, Carotid intima media thickness in rheumatoid arthritis as compared to control subjects: a meta-analysis. Semin Arthritis Rheum. 2011;40(5):389–97
Targonska-Stepniak B et al. The relationship between carotid intima media thickness and the activity of rheumatoid arthritis. J Clin Rheumatol. 2011;17(5):249–55
Disclosure of Interest None declared
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