The main cause of death in rheumatoid arthritis (RA) is cardiovascular events. We evaluated the relationship of anticyclic citrullinated peptide (anti-CCP) antibody levels with increased carotid intima-media thickness (cIMT) in RA patients. Methods. Forty-five anti-CCP positive and 37 anti-CCP negative RA patients, and 62 healthy controls (HC) were studied. All groups were assessed for atherogenic index of plasma (AIP) and cIMT. Anti-CCP, C-reactive protein (CRP), and levels of tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA). Results. The anti-CCP positive RA patients showed increased cIMT compared to HC and anti-CCP negative (P < 0.001). Anti-CCP positive versus anti-CCP negative RA patients, had increased AIP, TNFα and IL-6 (P < 0.01), and lower levels of high density lipoprotein cholesterol (HDL-c) (P = 0.02). The cIMT correlated with levels of anti-CCP (r = 0.513, P = 0.001), CRP (r = 0.799, P < 0.001), TNFα (r = 0.642, P = 0.001), and IL-6 (r = 0.751, P < 0.001). In multiple regression analysis, cIMT was associated with CRP (P < 0.001) and anti-CCP levels (P = 0.03). Conclusions. Levels of anti-CCP and CRP are associated with increased cIMT and cardiovascular risk supporting a clinical role of the measurement of cIMT in RA in predicting and preventing cardiovascular events.

IntroductionLeptin has a prominent role in the development and maintenance of acute and chronic inflammatory states such as rheumatoid arthritis (RA) and obesity. Nevertheless, the association of serum leptin (sLep) and soluble leptin receptor (sLepR) in RA pathogenesis has not been clarified. The purpose of this study was to evaluate the association of sLep, sLepR and leptin production indexes such as sLep/fat mass ratio with clinical activity and biomarkers and anti-cyclic citrullinated peptide (anti-CCP) antibodies in RA compared with body mass index (BMI) matched control subjects.MethodsWe included 64 RA patients and 66 controls matched for age, gender and BMI. Subjects were evaluated for BMI, fat mass distribution, sLep, sLepR, sLep/fat mass ratio and sLepR/fat mass ratio. Patients were evaluated for clinical activity and anti-CCP antibodies.ResultsWe found two or three fold increased sLep levels, sLep/sLepR ratio and sLep/fat mass ratio in obese anti-CCP positive RA patients vs. controls. Partial correlations showed that anti-CCP antibodies were correlated with sLep/fat mass ratio (partial r = 0.347, P = 0.033) after adjustment for age, subcutaneous adipose tissue and fat mass.ConclusionsIn preobese and obese RA patients there is and increased production of sLep according to anti-CCP positivity. This phenomenon suggests there is an additive effect of chronic inflammation resulting from RA and obesity in which leptin favors the humoral response against citrullinated proteins. In summary, the data observed in our study suggests sLep could be a surrogate marker of chronicity and humoral immunity in RA in the presence of obesity.

Objectives: This study aims to evaluate the association of hearing impairment with carotid intima-media thickness and subclinical atherosclerosis in rheumatoid arthritis (RA) patients. Patients and methods: A total of 41 RA patients (2 males, 39 females; mean age 46.5±10.2 years; range 20 to 63 years) with no known traditional cardiovascular risk factors were included. Routine clinical and laboratory assessments for RA patients were performed. Pure tone air (250-8000 Hz) and bone conduction (250-6000 Hz) thresholds were obtained, tympanograms and impedance audiometry were conducted. Sensorineural hearing impairment was defined if the average thresholds were ≥25 decibels. Carotid intima-media thickness was assessed and classified with a cut-off point of 0.6 mm. Results: Thirteen patients (31.7%) had normal audition, while 28 (68.3%) had hearing impairment. Of these, 22 had bilateral sensorineural hearing impairment. Four patients had conductive hearing impairment (right in three patients and left in one patient). Patients with sensorineural hearing impairment had increased carotid intima-media thickness in the media segment of carotid common artery compared to patients with normal hearing (right ear p=0.007; left ear p=0.075). Thickening of the carotid intima-media thickness was associated with sensorineural hearing impairment in RA patients. Conclusion: Rheumatoid arthritis patients should be evaluated by carotid intima-media thickness as a possible contributing factor of hearing impairment in patients without cardiovascular risk factors.

BackgroundThere is scarce information about the usefulness of ultrasound and biopsy of the thyroid gland in rheumatoid arthritis (RA) patients with thyroid nodules classified as TIRADS 4 (Thyroid Imaging Reporting and Data System). In this study, we also described the prevalence of thyroid dysfunction and autoimmune thyroid disease in a cohort of RA patients without comorbidities. The purpose of this study was to support the clinical utility of thyroid gland screening in RA.MethodsWe included 78 RA patients and 81 healthy controls (HC) classified by thyroid function. All of them underwent thyroid ultrasound and anti-thyroid antibodies screening. Subjects with TIRADS ≥4 were subjected to fine needle aspiration biopsy (FNAB). Continuous variables were analyzed with Student t test. Categorical variables were evaluated with c2 test or Fisher exact test. Correlations between variables were tested with Pearson r coefficient.ResultsWe found hypothyroidism in 24.4% vs. 1.2% in RA compared to HC (P=0.003). Of these, 89.5% were classified as subclinical hypothyroidism and 10.5% as overt hypothyroidism. In hypothyroid vs. euthyroid RA patients, we found higher titers of anti-TPOAb (310.38±633.73 vs 31.26±27.13, P=0.01) and anti-TGAb (417.85±1052.51 vs 18.40±19.17, P=0.02). According to TIRADS classification, we found a statistical difference vs HC, being the most common TIRADS 1 in both groups, follow by 2,3,4a and 4b. FNAB was performed in 7 RA patients and 1 HC, all of them reported as autoimmune thyroiditis.ConclusionsThe clinical and US assessment of the thyroid gland in RA patients showed that the TIRADS classification has to be interpreted with a different context applied for the general population, since, despite the risk of malignancy that implies TIRADS 4 category, all of our cases were classified with autoimmune thyroiditis. The most common functional thyroid status was subclinical hypothyroidism and not development of anti-thyroid antibodies. Further studies are needed to evaluate the utility of imaging, immunological and functional status of thyroid gland in RADisclosure of InterestNone declared