Assessment of Carotid Atherosclerosis in Patients with Knee Osteoarthritis

Abstract

Background: Atherosclerosis is a highly prevalent chronic disorder that substantially impacts quality of life and leads to significant morbidity and mortality. Atherosclerosis is an important feature associated with increased cardiometabolic risk. Several factors may account for relationship between Knee osteoarthritis (KOA) and cardiovascular diseases (CVD) Aim:The aim of this study is to assess the association between the severity of KOA and carotid atherosclerosis. Subjects and Methods:A total of 100 consecutive patients with primary symptomatic KOA were invited to participate in this study. Patients were recruited from the Outpatient Rheumatology Clinic at Mansoura University Hospitals. The study included also 100 consecutive non-KOA subjects matched for age, sex and BMI with KOA patients. All patients met the 2010 EULAR criteria for diagnosis of KOA and patients had to show evidence of radiological changes of KOA by plain radiography and Knee Ultrasonography. Blood samples were collected from all participants to test for ESR, CRP, fasting blood sugar and lipid profile. Assessment of carotid atherosclerosis is made by measurements of Carotid intima media thickness (cIMT). Results:Comparison between KOA group and non-KOA group. The mean Waist hip ratio was significantly higher in KOA group than non-KOA group (p<0.001). KOA patients had significantly more frequent HTN (p=0.034), T2DM (p=0.025) and Met syndrome (p=0.002). The mean FBS level, serum total cholesterol level of the KOA group was significantly higher than non-KOA group (p=0.021, p=0.039). KOA group had higher cIMT the non-KOA group (p=0.003) and more frequently had carotid plaques that non-KOA group (p=0.005). the rate of presence of HTN, T2DM and MetS differed significantly among the KOA subgroups (p=0.032, p=0.013 and p=0.020 respectively) with the KOA-KL4 subgroup had the highest rate of the three co-morbidities. The cIMT differed significantly among the KOA subgroups based on KL grading being thickest in the KOA-KL4 subgroup of patients (p<0.001). The rate of presence of carotid plaques differed among the groups, with rate being highest in KOA-KL4 subgroup (79.2%), followed by KOA-KL3 subgroup (35.7%) and is lowest in KOA-KL2 subgroup (8.3%). These differences were significant (p<0.001). Conclusion:Carotid Atherosclerosis is associated with KOA, therefore, a diagnosis of OA may serve as a red flag for warning to evaluate CVD. The presence of the MetS, serum TC, radiological KL grade and higher US cartilage thickness grading were the strongest factors that predict the higher cIMT and higher prevalence of carotid plaques in patients with KOA. The presence of the MetS, serum TC and radiological KL grade were the strongest factors that predict the higher cIMT in patients with KOA (p=0.026, p=0.006, p=0.004 and p=0.015 respectively)