Background/Purpose: Patients with rheumatoid arthritis (RA) have a greater cardiovascular risk than does the general population. The coronary calcium score is a measure used to determine subclinical coronary disease in patients with low or intermediate cardiovascular risk. (Pearson GJ, et al. Can J Cardiol. 2021;37:1129–50). Incidental findings in cardiac computer tomography scans (CT) in the general population have been described in up to 28% of patients, and 3–39% are of clinical relevance (Bendix K, et al. Eur J Radiol. 2011;80:109–114). However, although there is information about cardiovascular risk measured by coronary calcium scores in patients with RA, incidental findings have not been systematically described. The objective of this subanalysis is to describe the incidental CT findings of coronary calcium studies in patients with RA.

Methods: CT studies of patients with RA who attended the rheumatology outpatient clinic of a national reference center for cardiovascular diseases were included. The patients included were of indistinct sex, seropositive for RA, and 18 years of age or older. Cardiovascular risk was classified according to the Canadian Society of Cardiology. Incidental CT findings were classified according to the anatomy of their location, system, and clinical significance. The records of all the participants were reviewed, and they provided their informed consent for the CT procedure. Informed consent was signed for this protocol.Descriptive statistics were performed, and the data are expressed according to the distribution of the data based on normality analysis. A value of p< 0.05 was considered statistically significant.

Results: Fifty-four patients were analyzed, 87% of whom were women. The mean age was 57 years (+/-10), with a median RA evolution of 11.5 years (IQR 5-16), 67% were in remission and the rest (33%) had some degree of activity measured by the DAS-28PCR at the time of the study. A total of 74% of the patients were under treatment with methotrexate, 31% with sulfasalazine, 21% with leflunomide, 34% with hydroxychloroquine, and 5% with biological DMARDs. Fifty-four CT scans were analyzed, revealing a minimum coronary calcium score of 0 in 61% of the patients and a maximum of 4,530 in the group with increased cardiovascular risk.The frequency of incidental findings was 96%, of which 30% were clinically significant; 18% required some type of medical follow-up. The most prominent findings were pulmonary nodules (41%) and atelectasis (31%), cardiovascular findings, atherosclerosis (11%), pericardial effusion (9%), and osteodegenerative changes (60%).

Conclusion: The percentage of incidental findings found in the measurement of coronary calcium in patients with RA in a reference center for cardiovascular diseases is high, with the most frequent findings being osteodegenerative, pulmonary, and cardiovascular findings. Interestingly, more than 10% of cases are clinically relevant and require some type of follow-up. To date, this is the first study to report incidental findings in patients with RA in whom coronary calcium was measured. However, larger studies are needed to confirm these results.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/coronary-computed-tomography-incidental-findings-in-rheumatoid-arthritis/