Impaired arterial function associated with thinning of cortical bone in rheumatoid arthritis

Abstract

Objective. To evaluate the association between peripheral arterial function and cortical bone thickness in rheumatoid arthritis (RA). Methods. In a cross-sectional study, we measured the combined cortical thickness (CCT) of the second metacarpal bone from hand radiographs, and the ankle-to-arm systolic blood pressure ratio, also known as ankle-brachial index (ABI), in RA patients. We evaluated the association between the 2 using multinomial logistic regression. Results. We obtained CCT and ABI measurements in 588 RA patients. The mean ؎ SD CCT was 3.62 ؎ 1.16 mm. The proportion of patients with >1 ABI value <0.9, indicating obstructed lower limb arteries, increased from 18 (9.2%) of 191 patients in the highest CCT tertile to 25 (12.5%) of 200 in the middle CCT tertile to 38 (19.2%) of 198 in the lowest CCT tertile (P for trend 0.005). We noted a similar pattern for ABI values >1.3, indicative of arterial incompressibility (frequencies in high, middle, and low CCT tertiles were 4.7%, 9.5%, and 19.9%, respectively; P for trend <0.001). These trends remained significant after multivariable adjustment for potential confounders. After adjustment for the manifestations of RA and cumulative glucocorticoid dose, the association between CCT and arterial obstruction remained significant, but that with arterial incompressibility weakened considerably. Conclusion. There is an association between metacarpal cortical bone thinning and obstruction or incompressibility of the peripheral arteries in RA. The association with incompressibility may be mediated by systemic inflammation and/or glucocorticoids, but that with obstruction is independent of a wide array of potential confounders. Clinicians should be alert to the possibility of impaired arterial function RA patients with thinned metacarpal cortical bone.

Evaluation of the Risk of Getting Peripheral Artery Disease in Rheumatoid Arthritis and the Selection of Appropriate Diagnostic Methods

“…Thus, if specialists find bone changes among RA patients, they need to worry about arterial lesions and vice versa. These two findings are separately associated with glucocorticoid use [25].…”

“…Many studies ruled out smokers from study groups because of the evident vasoconstrictor effect, and only some studies showed a higher prevalence of smokers [5,6]. Not only current smoking but also former smoking harms the vasculature [25]. Inflammatory markers might partially induce higher prevalence of these conditions; tumor necrosis factor-alpha (TNF-alpha), interleukin 10 (IL10), interleukin 6 (IL6), and C-reactive protein (CRP) are correlated with SBP, and CRP, von Willebrand factor (VWF) have a correlation with triglyceride level [6].…”

“…RA patients with particular genetic factors such as Human Leukocyte Antigen DRB1 beta chain (HLA DRB1) specific genotypes are more prone to ED and resulting accelerated atherosclerosis [25,41]. If confirmed by prospective studies, genotype status might be a predictor of future cardiovascular events in RA.…”

“…The outcome was that people with early-stage disease and age <49 had a higher chance of getting peripheral arterial occlusive disease (PAOD). Insulin resistance induced by immune dysregulation is the primary mechanism of hyperglycemia, a condition associated with arterial stiffness [6,25]. Lipid metabolism abnormalities are associated with both ED and arterial stiffness.…”

“…Prevalence does not necessarily mean causation. High SBP, DBP, total serum cholesterol, LDL, BMI, insulin resistance, and smoking are related to vascular morphological characteristics, measured by pulse wave velocity (PWV), augmentation index (Aix), and ankle-brachial Index (ABI) [ 5 , 6 , 18 - 20 , 23 , 25 ]. ED is associated with SBP, LDL, smoking, and age [ 2 , 24 , 28 ].…”