Clinical and Sonographic Characteristics of Carotid Intima-media Thickness in Rheumatoid arthritis patients

Background/Purpose: Rheumatoid arthritis (RA) is a chronic and systemic disease with high cardiovascular (CV) risk. Carotid intima media thickness (CIMT) is an independent surrogate marker of subclinical atherosclerosis. Several instruments may underestimate CV risk in RA (1). Objectives: to describe demographic and clinical characteristics, CV risks and carotid ultrasound(US) measurements ; to assess the differences among three RA-groups according to CIMT and to assess the usefulness of CV risk scores as predictors of higher CIMT.

Methods: All patients fulfilled 1987 ACR and/or 2010 ACR/EULAR classification criteria. Subjects between 40-75 years old were included. CV risk was calculated by seven scales. Carotid US was performed by a board-certified radiologist and reviewed by two radiologists. Carotid plaque (CP) = CIMT ³0.12 cm or a ³50% focal increase of CIMT compared to the surrounding normal arterial wall. Three RA-groups were created according to CIMT.

Results: One hundred RA-patients were included, demographic data are in figure 1. CIMT: 25 had <0.079 cm (group 1), 38 had 0.08-0.09 cm (group 2) and 37 had CIMT ³ 0.09 cm (group 3). Six scores had statistically significant result. The highest sensitivity to detect increased CIMT was obtained by SCORE-moderate risk (75.7%) and the highest specificity was 100% with Framingham-lipids-high risk.

Conclusion: CIMT can be used as an independent surrogate marker of subclinical atherosclerosis in RA-patients. Different CV risk scores did not predict the presence of CP.

Reference: 1) Galarza-Delgado DA., et al. "Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management." Clinical rheumatology 36.6 (2017):1387-1393.

CRP = C-reactive protein;  ESR = erytrocyte sedimentation rate; RF = Rheumatoid Factor;  antiCCP = Anti-cyclic citrullinated peptide; DAS28-CRP = disease activity score; CDAI = Clinical Disease Activity; CDAI = Clinical Disease Activity Index; SDAI = Simplified Disease Activity Index; ACC-AHA 2013 = THe American College of Cardiology and American Heart AssociationÕs 2013; FRS-lipids = Framingham Risk Score using lipids; FRS-BMI = Framingham Risk Score using lipids; SCORE = Systemic Coronary Risk Evaluation; ERS-RA = Extended Risk Score-Rheumatoid Arthritis; RRS = Reynolds Risk Score; CIMT = Carotid Intima-Media Thickness ;PPV = Positive Predictive Value ; NPV =  Negative Predictive Value.