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

Abstract

This study aims to review the evidence regarding the association between peripheral artery disease (PAD) and rheumatoid arthritis (RA), as well as influential underlying factors and diagnostic options. Eligible literature was searched in PubMed published up to June 1, 2020, in English. Case studies, case series, reviews, and meta-analyses were excluded. We also excluded non-human studies and those 20 years and older. A total of 44 studies were finally incorporated in the narrative review. The results indicated that compared to controls, RA patients are more prone to PAD. Traditional risk factors, disease-characteristics, vitamin D deficiency, therapy used, and other relevant conditions have a variable effect on overall PAD progression. Studies comparing diagnostic options revealed that vascular function and morphology are connected but are still distinctive processes. In early-stage disease, there are functional alterations in the endothelium that can be controlled by anti-inflammatory medications. Ankle-Brachial Index (ABI) <0.9 might not be quite susceptible to PAD evaluation. Supplemental diagnostic tools could detect vascular disease in the preclinical stage. Most risk factors are adjustable, and the management will have a good impact on vascular health. PAD is mostly subclinical when the therapeutic options have a better impact. Diagnostic modalities should be chosen depending on the features of RA. In addition, multiple diagnostic options increase the accuracy of PAD diagnosis. Future prospective studies with larger populations at different age groups and different disease activity duration are essential to make firm conclusions and better understand the phenomenon of RA and PAD.

Ischemic Heart Disease and Rheumatoid Arthritis—Two Conditions, the Same Background

“…The ultrasound method enables a non-invasive achievement of images that show specific aspects of the vascular system and changes that may appear early in RA development. This detailed evaluation of the vessels correlates with and is influenced by CV factors (traditional or non-traditional), so ultrasound examination may provide useful information regarding CVD risk stratification, contributing to optimal treatment [ 212 , 213 , 214 , 215 ].…”

Visualizing novel connections and genetic similarities across diseases using a network-medicine based approach

“…Machine learning-based models are also able to leverage on (non-causal or not) genetic variants to help reveal missing heritability and epistatic interactions on GWAS-based datasets 69 . Indeed, we also demonstrate that the proposed methodology identifies true biological signal by being able to recover clinically relevant disease relationships such as cancer and vitiligo 29,30 , Type II Diabetes and Alzheimer's disease [32][33][34][35][36][37] , and Rheumatoid arthritis and PAD [54][55][56][57][58] . Furthermore, previous studies 63,70 identified predictions that leverage GWASbased variants and further validated observations with experimental and clinical data.…”

“…Our network also showed novel edges connecting rheumatoid arthritis (RA) to PAD and glomerular filtration rate (GFR). Previous studies have highlighted supporting evidence of the association between RA and GFR 52,53 and RA and PAD [54][55][56][57][58] . Indeed, RA has pathological processes that also occurs in atherosclerosis, such as endothelial activation, inflammatory cell infiltration, neovascularization, and collagen degradation 59 .…”

“…Indeed, RA has pathological processes that also occurs in atherosclerosis, such as endothelial activation, inflammatory cell infiltration, neovascularization, and collagen degradation 59 . However, most studies investigating the association of rheumatoid arthritis with PAD are small and cross-sectional and future research is needed [54][55][56][57][58] . After removal of traits unrelated to diseases from the visualization, the most connected nodes in the community were coronary heart disease (1), stroke (2), coronary artery disease (3), metabolic syndrome (4), cardiovascular disease (5), hypertriglyceridemia (6), gout (7), chronic kidney disease (8), diabetes mellitus (9), and atrial fibrillation (10) 4 and 5) highlight that genetics data revealed by MVP studies can help identify relationships among diseases that were not known before, indicating areas for future research related to disease mechanism, treatment, and prevention.…”

Cardiovascular Risk Assessment in Rheumatoid Arthritis: Accelerated Atherosclerosis, New Biomarkers, and the Effects of Biological Therapy

“…This is extremely useful for screening patients at high cardiovascular risk, as elevated cIMT (≥1 mm) is correlated with the risk of acute cardiovascular events such as stroke or MI [ 13 , 132 ]. Studies have demonstrated strong predictive value for cardio- and cerebrovascular complications, as well as close links with most traditional cardiovascular risk factors, inflammatory syndrome, and hyperhomocysteinemia [ 13 , 133 , 134 , 135 ]. Doppler ultrasound of the carotid arteries also highlights the presence of atheromatous plaques, as well as the degree of stenosis that they produce.…”