Subclinical Atherosclerosis Measure by Carotid Ultrasound and Inflammatory Activity in Patients with Rheumatoid Arthritis and Spondylarthritis

Abstract

Objective: To compare the effect of inflammation on subclinical atherosclerosis using carotid ultrasound in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Methods: Cross-sectional study including 347 participants (148 RA, 159 SpA, and 40 controls). We measured the carotid intima media thickness (cIMT) and detection of atheromatous plaques using carotid ultrasound. We recorded disease activity (DAS28-CRP/ASDAS-CRP) and traditional cardiovascular risk factors. We performed descriptive, bivariate, and linear multivariate analyses (dependent variable: cIMT) to evaluate the influence of diagnosis on cIMT in all patients. Two additional multivariate analyses were performed by stratifying patients according to their inflammatory activity. Results: cIMT correlated with the mean CRP during the previous 5 years in RA, but not with CRP at the cut-off date. We did not find such differences in patients with SpA. The first multivariate model revealed that increased cIMT was more common in patients with RA than in those with SpA (β coefficient, 0.045; 95% confidence interval (95% CI), 0.0002–0.09; p = 0.048) after adjusting for age, sex, disease course, and differential cardiovascular risk factors (arterial hypertension, smoking, statins, and corticosteroids). The second model revealed no differences in cIMT between the 2 groups of patients classified as remission–low activity (β coefficient, 0.020; 95% CI, −0.03 to 0.080; p = 0.500). However, when only patients with moderate–high disease activity were analysed, the cIMT was 0.112 mm greater in those with RA (95% CI, 0.013–0.212; p = 0.026) than in those with SpA after adjusting for the same variables. Conclusions: Subclinical atherosclerosis measured by carotid ultrasound in patients with RA and SpA is comparable when the disease is well controlled. However, when patients have moderate–high disease activity, cIMT is greater in patients with RA than in those with SpA after adjusting for age, sex, disease course, and cardiovascular risk factors. Our results point to greater involvement of disease activity in subclinical atherosclerosis in patients with RA than in those with SpA.

Cardiovascular Risk in Systemic Inflammatory Arthritis

“…These results support the need for the early assessment of CVD risk in all subjects with pre-clinical RA and RA [7]. A Spanish group [8], in a cross-sectional study including 347 participants (148 RA, 159 SpA, and 40 controls), which measured the carotid intima media thickness (cIMT) and looked for atheromatous plaques using carotid ultrasound, underlined the greater role of disease activity in subclinical atherosclerosis in patients with RA than in those with SpA. Specifically, the authors showed that cIMT correlated with the mean C-reactive protein (CRP) during the previous 5 years in RA but not with CRP levels at the chosen sampling time-point.…”

“…However, they did not find such differences in patients with spondyloarthritis (SpA). Furthermore, in patients with moderate-high disease activity, cIMT was greater in patients with RA than in those with SpA after adjusting for age, sex, disease course, and cardiovascular risk factors [8]. Finally, subclinical atherosclerosis measured by carotid ultrasound in patients with RA and SpA was comparable when the disease was well controlled.…”

“…The strengths of these studies include new useful findings for CV management in SIA patients [8] and are of value in clinical practice to help physicians maximize health and quality of life and reduce the CV risk of ASI patients.…”

Factors associated with atherosclerosis in radiographic and non-radiographic axial spondyloarthritis. A multicenter study on 838 patients

“…The weaker inflammatory response that characterizes axSpA compared with other IRD, the Clean revised SAR-D-22-00160 difficulty of objectively measuring the disease activity, and the limited sample size of the existing studies are factors that could explain the contradictory results of previous studies, most of which failed to demonstrate this association [14][15][16][17]. In this regard, a recent study by Rojas-Gimenez et al found no association between cIMT and ASDAS-CRP, nor with the mean CRP values of the previous five years, unlike what occurred in RA [34]. It is widely accepted that systemic inflammation in IRD can significantly influence classic risk factors like dyslipidemia, insulin resistance, or obesity [35].…”

Management of Cardiovascular Disease Risk in Rheumatoid Arthritis

“…Whether disease activity can increase atherosclerosis to a similar extent in individuals with spondyloarthritis as in individuals with RA is currently uncertain. This question was addressed by Rojas-Gimenez and colleagues [ 21 ] in the present Special Issue. Ultrasound-determined carotid intima–media thickness (cIMT) and plaque were recorded in 148 patients with RA and 159 with spondyloarthritis, as well as in 40 control subjects.…”