Background/Purpose: Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease. The incidence of the cardiovascular (CV) disease is significantly increased in patients with RA compared with the general population, which is related to the fact that atherosclerosis has an inflammatory etiology. We previously have shown a synergistic interaction between inflammatory burden and conventional CV risk factors in the development of carotid atherosclerosis. In this study, we investigated the association between bone mineral density (BMD) and the formation of new carotid plaque in RA patients in a Kyungpook National University Hospital Atherosclerosis Risk in Rheumatoid Arthritis (KARRA) cohort study.

Methods: After a baseline evaluation for KARRA cohort enrollment, RA patients were prospectively followed up for 5 years or until deaths. We analyzed the demographic findings, conventional CV risk factors, RA disease activity, and BMD. Carotid ultrasounds at baseline and year 5 were performed for evaluation of the intima-medial thickness (IMT) and presence and progression of carotid plaques. BMD was measured at the lumbar spine (L-spine, L1-L4), femur neck (femoral neck), and distal forearm (radius).

Results: A total of 417 RA patients were included in the baseline KARRA cohort, and 325 patients with RA were followed for the 5 year period. New carotid plaque formation was found in 90 of 212 (42.5%) patients at year 5. New development of carotid plaques at year 5 in RA patients was associated with total and LDL cholesterols, ATP risk factor number, DAS28-ESR, DAS28-CRP, ESR area under the curve (AUC) and CRP AUC at year 5. The BMD in the L-spine, femur, and radius was significantly lower in patients with new carotid plaques (n = 77), compared to patients without new plaques (n = 111) (1.07 g/cm² ± 0.16 vs. 1.01 g/cm² ± 0.19, p = 0.012 for L-spine; 0.87 g/cm² ± 0.13 vs. 0.83 g/cm² ± 0.15, p = 0.034 for femur; and 0.61 g/cm² ± 0.11 vs. 0.55 g/cm² ± 0.13, p = 0.001 for radius, respectively). Multivariate logistic regression analysis revealed that age (OR 1.12 [95% CI 1.06 – 1.18; p < 0.001]), LDL cholesterols (OR 1.02 [95% CI 1.00 – 1.03; p = 0.016]), DAS28-ESR at year 5 (OR 1.31 [95% CI 1.09 – 1.61; p = 0.030]), 5-year ESR AUC (OR 1.05 [95% CI 1.00 – 1.70; p = 0.036]), and BMD at radius (OR 2.07 [95% CI 1.08 – 2.66, p = 0.042]) were independent risk factors for new carotid plaque formation during the 5-year followed period. Correlation coefficients were calculated to analyze the relationship between 5-year ESR AUC and BMD. L-spine BMD (RR -0.206 [p < 0.001]), femur BMD (RR -0.297 [p < 0.001]), wrist BMD (RR -0.344 [p < 0.001]), and 5-year ESR AUC all showed the good correlation.

Conclusion: This study implicates that carotid plaque formation measured by ultrasound is associated with BMD as well as the conventional CV risk factors and inflammatory burden in RA patients, which supports further investigation of the linking processes between juxta-articular bone health and carotid atherosclerosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-of-bone-mineral-density-and-inflammatory-burden-with-carotid-plaque-formation-in-rheumatoid-arthritis-a-5-year-prospective-study/