Introduction. The risk of cardiovascular disease is increased in rheumatoid arthritis (RA). A meta-analysis showed increased intima media thickness (IMT) in RA. It has been shown that disease modifying antirheumatic drugs (DMARDs) may influence the progression of atherosclerosis. However, it was suggested that biologics may be more efficient than other DMARDs (including methotrexate—MTX) in protecting against atherosclerosis. Objectives. The aim of this study was to assess the influence of different RA characteristics and treatment regimens on IMT and atherosclerotic plaques. Patients and Methods. 317 RA patients and 111 controls were included in the study. IMT was measured in carotid (CIMT) and femoral (FIMT) arteries. Arteries were screened for the presence of plaques. Results. CIMT, FIMT, and prevalence of plaques were lower in patients treated with methotrexate (MTX) ≥ 20 mg/wk, cyclosporine (CsA), or biologics than in patients treated with lower doses of MTX and other disease modifying antirheumatic drugs. No differences in IMT between patients treated with MTX ≥ 20 mg/wk, biologics, or CsA were found. Conclusions. We found a beneficial effect of MTX ≥ 20 mg/wk, biologics, and CsA on atherosclerosis. We do not confirm a stronger influence of biologics on IMT compared with therapeutic doses of MTX.

Rheumatoid arthritis (RA) is a common systemic autoimmune disease characterized by increased cardiovascular morbidity. Several previous studies assessed associations between common atherosclerotic genetic risk factors and subclinical atherosclerosis (SA) in RA patients, yet most of them gave negative results. We undertook a cross-sectional study to evaluate the association between previously reported SNPs and subclinical atherosclerosis in a cohort of Polish RA patients. 29 SNPs associated with atherosclerosis in general population were genotyped in 289 RA patients: 116 patients with SA (increased carotid intima-media thickness and/or presence of carotid plaque) and 173 patients without SA. To assess the cumulative effect of SNPs we calculated 3 weighted genetic risk scores: GRS IMT , GRS CP and GRS CAD , comprising intima-media thickness-associated SNPs, carotid plaque-associated SNPs and coronary artery disease-associated SNPs, respectively. None of the SNPs showed a significant association with SA. However, we found an association between SA and GRS IMT. Interestingly, this association was limited to patients with short disease duration (P = 0.00004 vs. P > 0.5, for comparison of GRS IMT among patients within the 1st quartile of disease duration vs. others, respectively). Patients within the 1st quartile of disease duration were more frequently disease modifying anti-rheumatic drugs (DMARDs)-naïve and less frequently treated with biologics. Our study suggests that in patients with early RA subclinical atherosclerosis may be driven by similar genetic factors as in general population, while in long-lasting disease, the role common genetic risk factors may decrease. Possibly, this effect may be due to the influence of DMARDs.

We found a correlation between atherosclerosis and several classical cardiovascular risk factors and disease-related factors. A beneficial effect of continuous immunosuppressive treatment on IMT suggests that appropriate disease control with steroid-sparing agents may protect against atherosclerosis in SLE patients.

Background Atherosclerosis is accelerated in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Carotid intima media thickness (IMT) is considered as a noninvasive surrogate marker of early atherosclerosis. A meta-analysis suggests that RA might have a stronger effect on carotid IMT than SLE [1]. Only a few studies compared directly IMT in different rheumatic diseases but only carotid IMT was analyzed. Objectives To compare the influence of RA and SLE on carotid and femoral IMT. Methods 68 SLE patients (34 with lupus nephritis- SLE LN+ and 34 without LN- SLE LN-), 68 RA patients and 34 healthy controls were included in the study. All groups were matched for age and body mass index. Males, ever-smokers, patients with diabetes or coronary artery disease were excluded. Disease duration in RA and SLE patients was similar (7.1 vs 6.9 years). IMT of the common carotid artery (cIMT) and superficial femoral artery (fIMT) was determined by B-mode US imaging. Results fIMT was increased in RA (0.419mm, p=0.004), SLE LN+ (0.429mm, p=0.002) and SLE LN- (0.429, p=0.047) compared to controls (0.377mm). Trend towards increased cIMTA was observed in RA, SLE-LN+ and SLE-LN-. No significant differences were found in fIMT and cIMT between RA, SLE LN+ and SLE LN-. Discontinuous (cumulative duration of treatment <90% of disease duration) treatment with disease-modifying antirheumatic drugs (DMARDS) was a strong predictor of increased cIMT and fIMT in both SLE and RA. cIMT and fIMT were significantly higher in RA patients treated discontinuously with DMARDs than in continuously treated RA (0.596mm vs 0.500mm, p=0.003 and 0.448mm vs 0.398, p=0.015, respectively) and SLE patients (0.596mm vs 0.483mm, p=0.004 and 0.448mm vs 0.404, p=0.041, respectively). On the other hand cIMT was increased in discontinuously treated SLE patients compared with continuously treated SLE (0.552mm vs 0.483mm, p=0.043) and RA patients (0.552mm vs 0.500mm, p=0.048). fIMT was also higher in discontinuously treated SLE patients than in continuously treated RA and SLE patients but the difference was insignificant. Conclusions To our knowledge, this is the first study comparing directly carotid and femoral IMT in SLE and RA. We do not confirm stronger effect of RA on IMT. Our study suggests that other factors than the type of disease determine an increase of IMT. Immunosuppressive therapy seems to have a strong beneficial effect on IMT and thus on atherosclerosis progression in both RA and SLE. References Tyrrell PS, Beyene J, Feldman BM et al. Rheumatic Disease and Carotid Intima Media Thickness: A systematic Review and Meta-Analysis. Arterioscler Thromb Vasc Biol 2010;30:1014-1026. Acknowledgements This work was supported by Polish Ministry of Science and Higher Education grant number N N402 077234 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2743

Background Atherosclerosis is accelerated in rheumatoid arthritis (RA). Cardiovascular disease has become a major cause of morbidity and mortality in RA. Carotid intima media thickness (IMT) is considered as a noninvasive surrogate marker of early atherosclerosis. Studies in RA showed an accelerated progression of IMT and plaques in carotid arteries [1]. Recent studies showed a negative correlation between IMT and duration of anti-inflammatory therapy [2]. Objectives To assess the influence of disease modifying anti-rheumatic drugs (DMARDs) on IMT in RA. Methods 232 RA patients and 145 healthy controls were included in this study. IMT of the common carotid artery (cIMT) and superficial femoral artery (fIMT) was determined by B-mode ultrasound imaging. Detailed information on RA course and treatment was obtained from patients’ medical records (47.84% have been treated continuously with DMARDs- cDMARDs group, in 52.16% of patients DMARDs have not been used or have been used discontinuously- dDMARDs group). Adjustment for age was used in all statistical analyses. Results Mean cIMT (McIMT), mean fIMT (MfIMT), maximal cIMT (MAXcIMT) and maximal fIMT (MAXfIMT) were significantly greater in dDMARDs group than in controls (0.743mm vs. 0.706mm, p=0.049; 0.555mm vs. 0.499mm, p=0.017; 0.890mm vs. 0.816mm, p=0.022; 0.662mm vs. 0.574mm, p=0.002, respectively). In contrast, no significant differences were observed for cDMARDs group. In analyses of subgroups we found that differences in IMT parameters between cDMARDs and dDMARDs groups were limited to smoking patients and males. In smoking patients a mean difference in McIMT, MfIMT, MAXcIMT and MAXfIMT between dDMARDs and cDMARDs was 0.085mm (p=0.048), 0.085mm (p=0.047), 0.162mm (p=0.025) and 0.146mm (p=0.015), respectively; in males: 0.072mm (p>0.05), 0.182mm (p=0.013), 0.131mm (p>0.05) and 0.225mm (p=0.023), respectively. The greatest differences were observed in smoking male patients: 0.158mm (p=0.039), 0.203mm (p=0.028), 0.315mm (p=0.025) and 0.247mm (p=0.049), respectively. Conclusions Our study suggests that continuous use of DMARDs decreases IMT progression, which is in agreement with previous studies. However, we found that this effect is strongly pronounced in patients with other (than RA) atherosclerosis risk factors (i.e. male sex, smoking). Cardiovascular disease is a major cause of morbidity and mortality in RA patients. Thus it seems important to monitor closely compliance with DMARDs (especially in atherosclerosis high-risk patients) to diminish cardiovascular morbidity and mortality in RA. References Tyrrell PN, Beyene J, Feldman BM et al. Rheumatic Disease and Carotid Intima-Media Thickness. A Systematic Review and Meta-Analysis. Arterioscler Thromb Vasc Biol 2010; 30(5): 1014-26. Ristić GG, Lepić T, Glišić B et al. Rheumatoid arthritis is an independent risk factor for increased carotid intima media thickness: impact of anti-inflammatory treatment. Rheumatology 2010; 49:1076-1081. Disclosure of Interest None Declared