Background/Purpose: Rheumatoid arthritis (RA) has long been associated with an increased cardiovascular risk, and despite substantial improvements in disease management, its associated mortality remains high. Several reports have suggested that treatment with TNF inhibitors might have a beneficial effect on the cardiovascular risk. However, few studies have quantitatively investigated the relationship between RA and atherosclerotic inflammation. [18F] fluorodeoxyglucose-positron emission tomography (FDG-PET) has been used to assess synovitis in patients with RA and to evaluate the disease activity of RA. In addition, the FDG accumulation has been reported to indicate atherosclerotic inflammation. The aim of this study was to evaluate the relationship between atherosclerotic inflammation and biologics using FDG-PET.

Methods: Sixty RA patients (14 males, 46 females, average age 58.3 [range 17-80] years) treated with biological therapies were assessed. FDG-PET was performed at baseline and six months after the initiation of biological therapy. The carotid FDG uptake was measured by obtaining the standardized uptake values from the carotid of each patient, and the ratio of the carotid to background (blood) activity was determined (TBR). We also evaluated the Disease Activity Score 28 C-reactive protein (DAS28-CRP) and several clinical parameters (CRP, erythrocyte sedimentation rate [ESR], anti-cyclic citrullinated peptide antibody [ACPA], rheumatoid factor [RF], matrix metalloproteinase 3 [MMP-3]). Student’s t-test, chi-square test and logistic regression analysis were used to assess the factors influencing the decrease in the TBR.

Results: At six months after starting biological therapies, the values for DAS28-CRP, CRP, ESR, and MMP-3 were significantly decreased. However, the carotid TBR was not significantly improved (1.17 to 1.18). The ACPA and RF values also did not change markedly after treatment. The age, change in the white blood cell count, and carotid TBR at baseline were lower in the decrease TBR group than in increase TBR group. In the logistic regression group, a young age and a low carotid TBR at baseline were factors influencing the decrease in the carotid TBR.

Conclusion: In this study, a young age and a low carotid TBR at baseline were factors influencing the decrease in the carotid TBR. These results suggest that biologics improve not only the disease activity but also atherosclerotic inflammation, especially in young RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/atherosclerotic-inflammation-in-rheumatoid-arthritis-patients-a-post-hoc-study-using-fluorodeoxyglucose-positron-emission-tomography-computed-tomography/