Background Rheumatoid arthritis (RA) is a chronic, inflammatory joint disease, characterized by accelerated atherosclerosis and increased cardiovascular (CV) morbidity, with cardiovascular disease (CVD) as the leading cause of death. Chronic systemic inflammation responsible for the joint damage, along with traditional CV risk factors, are synergistically involved in the development of progressive atherosclerosis. Carotid intima-media thickness (cIMT) has been approved as a surrogate marker of early atherosclerosis.
Objectives The goal of the study was to assess prospectively traditional CV risk factors and cIMT in patients with established RA; to evaluate relationship between cIMT and RA activity, estimated by clinical examination and ultrasonography of joints.
Methods The study group consisted of 40 consecutive RA patients, 33 (82,5%) female and 7 male (17,5%), with the mean (SD) age 52.3 (9.8) (range 24–68) and disease duration 18.6 (9.6) years (range 6.5–45). The assessment of cIMT was performed twice, at an interval of 6 years [the initial in 2008 (visit 1, V1) and consecutive in 2014 (visit 2, V2)] and was determined by high-resolution B-mode ultrasonography. The activity of RA was estimated by clinical examination at V1 and V2 [with disease activity score in 28 joints (DAS28)] and ultrasonography of joints at V2 (synovial hypertrophy in 24 small joints). At V1 and V2 body mass index (BMI), lipid profile and atherogenic index (AI) were assessed. During the 6 years between V1 and V2, 35 (87,5%) patients were treated with biological disease modifying antirheumatic drugs (DMARDs); nothing by synthetic DMARDs were used in 5 (12,5%) patients. At V2, high disease activity was observed in 7 (17,5%) patients; low RA activity or remission in 23 (57,5%).
Results The mean (SD) cIMT value was significantly greater at V2 than V1 assessment [0.86 (0.45) vs 0.75 (0.13) mm, p=0.02]. The number of RA patients with advanced atherosclerosis (presence of plaques) increased from 6 (15%) at V1 to 9 (22,5%) at V2 (NS). The number of patients without atherosclerosis (cIMT <0.6 mm) decreased from 4 (10%) at V1 to 3 (7,5%) at V2. There were positive correlations between cIMT value and the age of patients at V1 and V2 (p<0.001). The value of cIMT at V2 correlated negatively with HDL-cholesterol at V1 (p=0.02) and positively with AI at V1 (p=0.01), as well as DAS28 at V1 (p=0.02). There was no correlation between cIMT value and parameters of RA activity at V2 (DAS28, synovial hypertrophy in ultrasonography). A positive correlation was found between DAS28 value and number of joints with synovial hypertrophy assessed in ultrasonography. Lipid profiles and AI value did not differ significantly between V1 and V2. The value of BMI increased significantly between V1 and V2 [24.7 (3.1) vs 25.8 (3.5) kg/m2, p=0.002].
Conclusions During the six-years course of established RA, progression of atherosclerosis was observed, estimated by significantly greater mean cIMT value, as well as increased number of patients with atherosclerotic plaques. In patients with long-standing RA, treated intensively with DMARDs, progressing atherosclerosis seems not to be correlated with the current RA joint activity. The atherosclerotic burden seems to be dependent on the age, previous disease activity and unfavorable lipid profiles associated with high grade inflammation.
Disclosure of Interest None declared
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