Increased Prevalence of Severe Subclinical Atherosclerotic Findings in Long-Term Treated Rheumatoid Arthritis Patients Without Clinically Evident Atherosclerotic Disease

Abstract

We conducted the current study to search for subclinical atherosclerosis in patients with rheumatoid arthritis (RA) without clinically evident atherosclerosis or its complications who had been treated for a long duration, and to assess whether demographic or clinical factors affect the development of atherosclerotic disease. Forty-seven white patients fulfilling the 1987 American College of Rheumatology classification criteria for RA were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients were required to have been treated for at least 5 years, including current treatment with 1 or more disease-modifying antirheumatic drugs. Patients with diabetes mellitus, renal insufficiency, hypertension, cardiovascular or cerebrovascular disease, and smokers were excluded. Forty-seven matched controls were also studied. Carotid intima-media wall thickness (IMT) and carotid plaques were measured in the right common carotid artery. The study was performed using high-resolution B-mode ultrasound. Patients had greater carotid IMT (0.779 +/- 0.164 mm) than did controls (0.699 +/- 0.129 mm); (p = 0.010). Sixteen (34%) patients showed carotid plaques compared with only 7 (15%) controls (p = 0.031). There was a positive correlation between the age at the time of study and the carotid IMT. Patients with carotid plaques had significantly greater carotid IMT (0.859 +/- 0.116 mm) than those without plaques (0.739 +/- 0.171 mm) (p = 0.014). Also, RA patients with carotid plaques had a significantly longer disease duration (mean, 21.0 yr) and more extraarticular manifestations (63%) than those without plaques (mean, 12.7 yr and 26%, respectively). Age at the time of the study and disease duration were the best predictive factors for the development of severe morphologic expression of atherosclerotic disease. The present study confirms an increased frequency of severe subclinical atherosclerotic findings in long-term actively treated RA patients from northwest Spain.

HLA–DRB1 and persistent chronic inflammation contribute to cardiovascular events and cardiovascular mortality in patients with rheumatoid arthritis

“…Although in some cases traditional risk factors known to promote the progression of atherosclerotic lesions may be absent in patients with RA (6), accelerated atherosclerosis has been observed in these patients (9 -12). High-resolution B-mode ultrasound of the common carotid artery, a surrogate marker of atherosclerotic disease, disclosed increased carotid artery intima-media thickness (IMT) and carotid plaques in patients with RA without classic atherosclerosis risk factors compared with matched controls (13). A significant linear trend for increased carotid IMT associated with increasing C-reactive protein (CRP) levels was also reported in these patients (14).…”

“…At the time of recruitment, patients' data regarding traditional CV risk factors (hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking history); history of CV events; clinical manifestations, including data on tender and swollen joints and extraarticular manifestations of the disease (nodular disease, Felty's syndrome, pulmonary fibrosis, rheumatoid vasculitis, or secondary Sjö gren's syndrome) (13); and radiologic and laboratory features (rheumatoid factor, glucose, lipid profile, CRP level, erythrocyte sedimentation rate [ESR]) were registered. Also, available information from the time of disease diagnosis on comorbidities, joint involvement, extraarticular manifestations, rheumatoid factor, and laboratory tests (glucose, lipid profile, CRP level, and ESR) was reviewed at that time.…”

Increased coronary‐artery atherosclerosis in rheumatoid arthritis: Relationship to disease duration and cardiovascular risk factors

“…indicators of coronary atherosclerosis, such as carotidartery intima-media thickness, were used suggest that atherosclerosis is more prevalent in patients with RA as compared with controls (13)(14)(15). However, the prevalence of coronary-artery atherosclerosis and the mechanisms underlying the increased risk of ischemic heart disease in RA patients are not known.…”

Treatment after anterior cruciate ligament injury: Comment on the article by Ageberg et al

“…Regrettably, this was not the case for 47 long-term corticosteroid-treated patients Letterswith RA (mean prednisone cumulative dose 15,900 mg) (6).…”

“…It is possible that the early increase in lipids demonstrated in the present study was mediated by glucocorticoids, and this effect was no longer evident at 6 months. In contrast, whereas the early improvement in FMD is likely to be a steroid effect, the continuing improvement at 6 months coincides with the timing of rituximab maximum efficacy (6). Of note, the authors mention that there is "accumulating" evidence showing worsening lipid profile in patients treated with rituximab.…”