Background/Purpose:   Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease. The incidence of cardiovascular (CV) disease is 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 that synergistic interaction between inflammatory burden and conventional CV risk factors in the development of carotid atherosclerosis. In the present study, we investigated the risk factors for the progression of the carotid atherosclerosis in RA patients in the Kyungpook National University Hospital Atherosclerosis Risk in Rheumatoid Arthritis (KARRA) cohort study.

Methods:   After a baseline evaluation for KARRA enrollment, all RA patients and healthy controls were prospectively followed up for 5 years or until deaths. We analyzed the demographic findings, conventional risk factors and RA disease activity. Carotid ultrasound at baseline and year 5 was performed to evaluation of the intima-medial thickness (IMT) and presence and progression of carotid plaque.

Results:   A total of 417 patients with RA and 221 age- and sex- matched healthy controls were included in the baseline KARRA cohort, and 314 patients with RA and 160 healthy controls were followed for the 5 year period. Mean age and female frequency of RA patients were not different compared with those of healthy controls at year 5. At year 5, the mean carotid intima-medial thickness (IMT) of RA patients was higher than that of controls [0.85mm (S.D 0.15) vs 0.89 (S.D 0.18), p=0.032]. However, frequency and number of carotid plaque were similar in both groups, which reflects steeper increase of plaque number during 5-year follow-up in healthy controls. Factors associated with plaques at year 5 included IMT, mean blood pressure, and total and LDL cholesterols at baseline. New development of carotid plaques at year 5 in RA patients (n=90) was predicted by IMT and total and LDL cholesterols at baseline, while it was associated with IMT and DAS28-CRP at year 5. Multivariate logistic regression analysis revealed that baseline IMT (OR 36.48 [95% CI 1.66-803.62; P = 0.023]) and DAS28-CRP at year 5 (OR 1.56 [95% CI 1.06-2.30; P = 0.024]) were independent risk factors for new plaque formation in 5-year followed period.

Conclusion:  This study shows that carotid plaque at year 5 is predicted by IMT and dyslipidemia at baseline, whereas formation of new plaques after long-term follow-up depends on the preexisting carotid atherosclerosis that is aggravated by suboptimal disease control.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/generation-of-new-carotid-plaque-is-determined-by-the-prexisting-carotid-atherosclerosis-and-ongoning-disease-activity-of-rheumatoid-arthritis/