Objective:The aims of this study were to assess cardiovascular risk in patients with rheumatoid arthritis (RA) classified as low-risk by the Framingham score, before and after the multiplication by 1.5 recommended by the European League Against Rheumatism (EULAR), and to stratify them using carotid and femoral Doppler ultrasound (DUS) in order to optimize the assessment of the asymptomatic cardiovascular disease incidence.Methods: Thirty-five female patients with RA and 35 healthy women (control group), both with low cardiovascular risk by Framingham score, were enrolled in the study (randomized). All of them underwent carotid and femoral DUS studies. Results:The mean age at diagnosis was 44.57 years, the mean disease duration was 12.11 years and the mean disease activity score according to the Disease Activity Score 28 was 1.91, whereas according to the Clinical Disease Activity Index, it was 6.176. The sample was homogeneous. Within the RA group, 46% showed changes in the carotid and/or femoral DUS, compared with 14% in the control group (p = 0.004). Of the DUS with abnormalities, in the RA group, 31% of the carotid DUS and 81% of the femoral DUS (p = 0.005) showed intima-media thickness and/or atherosclerotic plaques. After EULAR 1.5 multiplication factor, 66% remained low cardiovascular risk. Of these, 35% of the patients showed changes in the carotid and/or femoral DUS, compared with 14% of the control group (p = 0.07). Conclusions:The EULAR criteria are effective at identifying patients with high cardiovascular risk. Carotid DUS and, especially, femoral DUS are tools that can be used in clinical practice as ways to detect CVD even in its asymptomatic form.
Background:The increasing of the cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is well know, even with the absence of traditional coronary risk factors. The ultrasound – duplex scan (USD) is a non invasive technique able to early detect atherosclerotic changes in the blood vessel, that gives the possibly to retard the development of symptomatic CVD.Objectives:To evaluate the cardiovascular (CVS) risk in patients with RA classificated as low risk by Framingham Score (FS), before and after the EULAR 1.5 multiplication factor and stratify with the carotid and femoral USD (intima-media thickness - IMT and atherosclerotic plaques - AP)Methods:Thirty-five female patients with RA and low CVS risk by FS and 35 healthy women with low CVS risk by FS (control group) were enrolled for the study. All of them submitted to carotid and femoral USDResults:The groups were homogenous by age and CVS comorbidities -Table 1. Mean age in the diagnosis was 44.57 years, mean disease duration was 12.11 years and mean disease activity was Disease Activity Score 28: 1,91 and Clinical Disease Activity Score: 6.176. In the RA patients group 46% showed changes in the carotid and/or femoral USD compared with 14% of the control group (p = 0,004) –Graphic 1. The USD with abnormalities in RA group 31% of the carotid USD and 81% of the femoral USD (p= 0,005) showed IMT and/or AP. After EULAR 1.5 multiplication factor, 66% remained low CVS risk. Where 35% of the RA patients showed changes in the carotid and/or femoral USD compared with 14% of the control group (p=0,07)Conclusion:The USD is able to early detect the CVD, special attention should be given to the femoral arteries, that are frequently affected. The Eular criteria is also effective and should be used in the clinical practiceReferences:[1]Mota LMH, Cruz BA, Brenol CV, et al. Diretrizes para o diagnóstico da artrite reumatoide.Rev. Bras. Reumatol 2013;53(2)[2]Charles-SchoemanC. Cardiovascular disease and Rheumatoid Arthritis: an update. CurrRheumatol Rep 2012;14(5): 455-62[3]Purcarea A, Sovaila S, Gheorghe A, et al. Cardiovascular disease risk scores in the current practice which to use in rheumatoid arthritis?Journal of Medicine and Life 2014;7(4):461-67[4]Agca R, Heslinga SC, Rollefstad S, etal.EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.AnnRheumDis 2016[5]Abu-Shakra M, Polychuck I, Szendro G, et al. Duplex Study of the Carotidand Femoral Arteries of Patients with Rheumatoid Arthritis: A Controlled Study.Seminars in Arthritis and Rheumatism 2005;35(1):18-23[6]Freire CMV, Alcantara ML, Santos SN, etal. Recomendação para a Quantificação pelo Ultrassom da Doença Aterosclerótica das Artérias Carótidas e Vertebrais: Grupo de Trabalho do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia.ArqBrasCardiol: Imagem cardiovasc. 2015;28:e1- e64[7]Helck A, Bianda N, Canton G et al. Intra-individual comparison of carotid and femoral atherosclerotic plaque features with in vivo MR plaque imaging.Int J Cardiovasc Imaging 2015;31(8):1611-8[8]Lucatelli P, Fagnani C, Tarnoki AD, et al, Genetic influence on femoral plaque and its relationship with carotid plaque an international study.Int J Cardiovasc Imaging 2018;34(4):531-41[9]Cournot M, Bura A, Cambou JP, et al. Arterial Ultrasound Screening as a Tool for Coronary Risk Assessmente in Asymptomatic Men and Women.Angiology 2012;63(4):282-88[10]Peters MJ, Symmons DP, McCarey D, et al.Eular evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010;69:325-3Figure 1.Graphic 1: USD abnormalitiesIMT - intima-media thickness; AP atherosclerotic plaquesDisclosure of Interests:None declared
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