Background/Purpose:

Rheumatoid Arthritis (RA) patients are more prone to atherosclerosis. Oxidation of Low-density lipoprotein (LDL) is an important event in the development of atherosclerosis, especially of coronary and carotid arteries. We hypothesized that due to increased systemic inflammatory response in RA patients there will be higher subclinical/ clinical morphologic evidence of atherosclerosis in carotid arteries, leading to increased carotid intima media thickness (IMT). Our primary objective was to correlate serum Oxidized LDL level with Carotid IMT in RA patients; secondary objective was to correlate oxidized LDL with disease activity by DAS 28. 

Methods:

This descriptive observational case control study recruited 30 RA patients (1987 ACR criteria) without any comorbidities (diabetes mellitus, hypothyroidism, morbid obesity, dyslipidemia, chronic kidney disease, chronic liver disease, or known atherosclerotic disease) and 30 age and sex matched healthy controls; active smokers and non consenting participants were excluded. After history, examination and routine laboratory investigations, oxidized LDL levels were obtained by ELISA method. Carotid IMT was measured by Doppler ultrasonography (Philips HDI5000): Common carotid IMT (CCIMT), carotid bulb IMT (CBIMT), total carotid IMT (TCIMT), and internal carotid IMT (ICIMT) were measured by trainned radiologist. Means were compared using unpaired “t” test; correlation was measured using Pearson correlation method. SPSS version 19 was used for statistical analysis, and p<0.05 was considered significant.

Results:

Mean age of cases and controls was 43.13±13.32 and 42.87±15.03 years respectively; 86.67% (26/30) of all cases were females. DAS 28 score was found to be high among 27 cases in a range of severe disease activity (>5.1), while in 3 cases it was found that disease activity was in moderate range (3.2-5.1). Values of CCIMT, CBIMT, and TCIMT were significantly higher in RA patients (p<0.05); ICIMT values was not significantly different from controls. Mean oxidized LDL level was significantly higher in RA patients (9.03±6.12 microgram/ml vs 3.01±2.67 microgram/ml; P<0.0001). Pearson correlation test failed to show any correlation between oxidized LDL values and CCIMT, CBIMT, TCIMT, and ICIMT values in both cases and controls (Table 1). Oxidized LDL level was not significantly associated with disease activity (DAS 28) in RA patients.

Table 1:Correlation of oxidized LDL and CIMT in cases

Conclusion:

On comparision with the general population, oxidized LDL values as well as carotid IMT values were markedly higher in RA patients, but the correlation was statistically non signifcant. Oxidized LDL values were also not statistically correlated with disease activity (DAS 28). Oxidized LDL can be used as an inflammatory marker in RA patients. This is the first study in RA patient from India and there is need for larger similar studies after these encouraging results.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-of-oxidized-low-density-lipoprotein-levels-with-carotid-intima-media-thickness-in-rheumatoid-arthritis-patients/