Background/Purpose:  Persons with rheumatoid arthritis (RA) have increased morbidity and mortality attributable to atherosclerotic cardiovascular disease (ASCVD) events. It is unknown how presence of subclinical ASCVD, as measured by arterial health parameters, is affected by the current state of RA disease activity. The objective of this study was to determine the relationship between non-invasive arterial health measures and measures of both current and average disease activity over time in patients with established RA.

Methods:   50 patients with RA underwent non-invasive arterial health testing (measures of arterial stiffness: corrected aortic augmentation index; pulse wave velocity) and rheumatologic assessment of clinical disease activity (tender/swollen joint counts; the Clinical Disease Activity Index (CDAI); the Health Assessment Questionnaire (HAQ) disability index). Clinical measures of disease activity during 3 years prior to the study visit were averaged to obtain time-averaged measures. The AHA/ACC Pooled Cohort Equation (estimated 10-year CV risk %) was used to classify patients as low/intermediate/high risk. Spearman methods were used to determine the correlation between the rheumatologic disease activity scores and arterial health testing parameters.

Results:   In the 50 patients (mean age: 57.5 years; 76% female, mean RA disease duration: 6.4 years), the disease activity was moderate, with mean (±SD) CDAI of 16.9 (15.3). At the study visit, the corrected aortic augmentation index correlated with the CDAI (r=0.37, p=0.009) and the HAQ (r=0.33, p=0.019). The corrected aortic augmentation index correlated with time-averaged measures of the tender joint count (r=0.37, p= 0.008); CDAI (r=0.36, p=0.01); HAQ (r=0.36, p=0.009); swollen joint count (r=0.36, p =0.01); patient global assessment (r=0.33, p=0.02); physician global assessment (r=0.35, p=0.014); and pain score (r=0.38, p=0.007). Marginally significant correlations emerged between the aortic pulse wave velocity and the time-averaged CDAI (r=0.26, p=0.07); tender joint count (r=0.26, p=0.07); and physician global assessment (r=0.28, p=0.05). Adjusted correlations between time-averaged CDAI and corrected aortic augmentation showed statistical significance (r=0.41, p=0.007) when adjusted for the pooled cohort CV risk score, and marginal significance when adjusted for the pooled cohort CV risk score and use of prednisone, methotrexate and/or biologics (r=0.3, p=0.07).

Conclusion:   The results demonstrate that measures of arterial stiffness, especially the corrected aortic augmentation index, correlate with the time-averaged burden of disease activity as well as current disease activity. The findings suggest that non-invasive arterial health testing provides a means to measure the effects of inflammatory disease burden on arterial function even after accounting for estimated CV risk scores.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-assessment-in-persons-with-rheumatoid-arthritis-a-correlative-study-of-non-invasive-arterial-health-testing-with-the-inflammatory-burden-of-disease/