Background It is widely accepted that patients with rheumatoid arthritis (RA) have increased mortality and morbidity from premature cardiovascular disease. Up to 50% of this mortality excess is secondary to ischemic heart disease closely followed by cerebrovascular disease [1]. Objectives To investigate intima-media thickness (IMT) and plaque formation with relation to age, disease duration and disease severity, myocardial infarction (MI) and stroke in patients with RA in order to detect and estimate cardio and cerebrovascular risk factors and events. Methods Forty five patients (female 91.1%) with confirmed RA (aged 20-82) were selected. Carotid artery hemodynamic parameters, IMT and plaques were measured by using high resolution B-mode and Doppler–mode ultrasound to detect blood flow velocities, maximal IMT, size of atherosclerotic plaques. Rheumatoid arthritis severity was measured by DAS28, SDAI, CDAI scores and HAQ questionnaires. For cardiovascular risk detection Framingham risk score and AIP (Atherogenic Index of Plasma (log10 TG/HDLC)) were used. Data analysis was performed using IBM SPSS 21.0. Results Patients with previous MI were statistically significant older than patients without MI (69.0±10.6 and 52.7±15.7 years, respectively). Previous MI had 13.33% of patients, and previous stroke 4.44% of patients. There were no statistically significant correlations between atherosclerotic plaques on the right and left side of brachiocephalic vessels, IMT dx and sin, and the duration of RA and the age when diagnosis was confirmed (p>0.05). Statistically significant correlation between IMT sin and age of patients was found (r=0.63; p<0.001); IMT dx and age of patient (r=0.62; p<0.001). No statistically significant correlations between IMT dx and sin, atherosclerotic plaques dx and sin and activity markers of RA (p>0.05) were found. The duration of disease was not statistically longer for patient with MI than for patients without MI (p=0.34). Atherosclerotic lesions were not more pronounced to patients with MI than without (p=0.80). Anti CCP levels did not differ between patients with and without MI (p=0.900). Conclusions Previous MI did not show significant association with BMI, smoking habits, atherosclerotic lesions of vessels (atherosclerotic plaques), disease severity, activity markers and AIP. This preliminary observation indicates the changes of immune system long before appearance of RA, triggering severe cardiovascular events without traditional cardiovascular risk factors. References Wallberg-Jonsson S, Ohman ML, Dahlqvist SR:Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J. Rheumatol 1997;24:445–51. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5841
Background BACKGROUND AND AIMS: It is widely accepted that patients with rheumatoid arthritis (RA) have increased mortality and morbidity from premature cardiovascular disease. Up to 50% of this excess mortality is secondary to ischaemic heart disease closely followed by cerebrovascular disease. The aim of this study was to investigate changes in arterial wall elastic properties, intima-media thickness (IMT) and plaque formation with relation to age, disease duration and inflammation markers in patients with RA in order to detect and estimate cerebrovascular risk factors. Methods METHODS. 20 patients with confirmed RA and 27 sex and age matched healthy controls (aged 27-70) were recruited. Carotid arteries haemodynamic parameters, elastic properties, IMT and plaques were measured using high resolution B-mode, M-mode and Doppler–mode ultrasound to calculate arterial wall distensibility and stiffness indices, blood flow velocities and resistance indices, maximal IMT, size of atherosclerotic plaques. Subjects with arterial hypertension and smoking had been excluded from trial. C-reactive protein was used to measure systemic inflammation. The correlations between brachial arterial blood pressure, carotid haemodynamic, wall elastic indices and patients age, stage of disease, inflammation markers were calculated separately and in comparison with controls. Results RESULTS. Statistically, patients with RA had mean values of IMT higher than healthy subjects (+-SD 1,02+-0,21 vs 0,85+-0,22, t=2,45, p=0,19; sin 1,01+-0,28 vs. 0,82+-0,19, t=2,47, p=0,18). This difference was more pronounced in a group of thirty-year. No statistically proved correlations between carotid stiffness parameters, IMT and duration of disease was found. The presence of carotid plaque correlated with the period of rheumatoid arthritis and markers of RA seropositivity - RF and anti CCP, although the changes in IMT and carotid elastic indices did not differ significantly according to seropositivity. These preliminary observations can indicate the need of further investigation with the recruitment of larger number of patients with RA to prove the role of systemic inflammation in the atherosclerotic process. Conclusions The presence of carotid plaque correlated with the period of rheumatoid arthritis and markers of RA seropositivity - RF and anti CCP, although the changes in IMT and carotid elastic indices did not differ significantly according to seropositivity Disclosure of Interest None Declared
BackgroundPatients with rheumatoid arthritis (RA) have increased mortality and morbidity due to premature cardiovascular disease (CVD). Some factors involved in the development of RA-associated CVD have not yet been fully delineated.ObjectivesThe aim of the study was to verify whether female gender, the reproductive period, smoking history, atherosclerotic lesions in brachiocephalic vessels, carotid intima-media thickness (IMT), traditional CV risk factors, as well as RA disease activity and disease duration influence excess CVD and cerebrovascular disease in patients with RA.MethodsA case-control study was performed within the prospective cohort of 94 RA patients (female: 84%; age: 20–82). Cases were 26 patients who developed their first myocardial infarction (MI) after the diagnosis of RA. Controls and cases had comparable disease duration. Traditional (BMI, smoking history, diabetes mellitus), pulmonary arterial hypertension (PAH) and disease-specific risk factors for MI were assessed. Atherogenic Index of Plasma (AIP; log TG/HDL-C) calculated. Carotid artery hemodynamic parameters, IMT and plaques were assessed using high resolution B-mode and Doppler-mode ultrasound in order to detect blood flow velocities, maximal IMT and size of atherosclerotic plaques, respectively. RA activity and severity were determined by DAS28, CDAI, SDAI scores, ultrasonography of synovitis and HAQ questionnaires. Statistical analysis was performed by using IBM SPSS 21.0ResultsPatients with MI were mostly females (96%), with a median age of 61 (54–69) years. The mean disease duration was 3.5 (1–9) years. About 34% of cases were smokers. The risk of MI in RA women was 3.91 (OR). In female patients, who smoked it was 1.36. Patients with MI were not significantly older compared to control RA patients (p=0.316). Interestingly, 88% of RA cases with MI and 100% of non-MI conrtols (p=0.005). High RA disease activity (DAS28 above 4,17) was observed in 46% of patients with MI. Seropositivity was found in 92%, while erosions in small joints in 58% of cases. Joint replacement surgery was necessary in 13% of MI cases. Strokedeveloped in 13% of cases and 10% of controls. PAH was detected in 75%, of patients with MI. No statistically significant difference in IMT between MI cases and controls could be found (p=0.217). Furthermore, atherosclerotic lesions were not more pronounced in RA patients with versus without MI (p=0.874).Altogether 91,7% patients with MI had atherosclerotic plaques in brachiocephalic vessels resulting in <50% luminal stenosis, while 8,3% of patients had plaques causing >50% lumen obstruction. IMT exerted significant correlation with age (p<0,001), plaques in brachiocephalic vessels (p=0.045), PAH (p=0.001), joint erosions (p<0.05) and symptom onset in RA (p<0.05). PAH also correlated with brachiocephalic vessel plaques (p=0.01). Bivariate logistic regression revealed that in females with late onset menarche (>16 years) and early menopause (<45 years) had lower, while patients with late onset menopause had greater risk for dev...
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