Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Rheumatoid arthritis (RA) has been associated with premature atherosclerosis and increased prevalence of cardiovascular disease. 18-fluoro-deoxyglucose positron emission tomography (18-FDG-PET) is a promising imaging technique that has been used previously to evaluate vascular inflammation. Individuals with coronary artery disease (CAD) have been shown to have increased 18-FDG-PET uptake in previous studies. In this study we compare vascular inflammation in individuals with RA with inflammation versus patients with established CAD without underlying autoimmune disease.
Methods:
27 RA patients (aged 35-64)and 70 CAD patients (aged 41-76) without autoimmune disease were recruited as two separate cohorts and underwent PET scans after injection of 10mCi of FDG to measure vascular inflammation. Metrics of PET uptake, the mean, maximum and most diseased segment (MDS) target to background ratios (TBR) were computed for the aorta and carotid arteries and compared across the two groups. Multivariate regression models were run to adjust for differences in age, gender and BMI between the groups. P-values < 0.05 were considered significant.
Results:
The RA cohort had a mean disease duration of 11.3 years and mean DAS28 of 4.6, with 10 (37%) on biologic DMARDs. None of the RA patients had a history of CAD, MI or stroke. The table shows the median +/- standard deviations of the mean, maximum and MDS FDG-PET uptake (TBR values) in the two groups both without and with adjustments for age gender and BMI. For the carotids, no differences were detected in mean, maximum or MDS comparisons in adjusted models. For the aorta, we found that the mean, maximum and MDS TBR values were significantly higher in RA patients than CAD patients in both unadjusted and adjusted analyses.
Conclusion:
Our data indicates that RA patients without known CVD have heightened aortic wall inflammation and similar levels of carotid wall inflammation when compared to CAD patients without autoimmune disease. Increased aortic inflammation might be a mechanism for increased risk for atherosclerosis in RA patients.
Table. Comparison of RA Patients versus CAD Patients Target to Background Ratios
|
Target to Background Ratio (TBR) Measures |
RA patients (median ± SD) |
CAD Patients (median ±SD) |
p-value (unadjusted) |
p-value |
|
Aorta Mean TBR |
1.46±0.40 |
1.25±0.12 |
0.003 |
< 0.0001 |
|
Aorta Max TBR |
2.08±0.57 |
1.75±0.22 |
0.014 |
<0.0001 |
|
Aorta MDS TBR |
2.23±0.62 |
1.87±0.27 |
0.015 |
0.0004 |
|
Carotids Mean TBR |
1.47±0.19 |
1.47±0.21 |
0.261 |
NS |
|
Carotids Max TBR |
1.69±0.25 |
1.84±0.30 |
0.018 |
NS |
|
Carotids MDS TBR |
1.79±0.25 |
1.87±0.31 |
0.005 |
NS |
|
* Adjusted for age, gender and BMI; bold font indicates significant differences |
||||
Disclosure:
J. D. Greenberg,
None;
Z. Fayad,
None;
V. Furer,
None;
M. Farkouh,
None;
M. J. Colin,
None;
P. B. Rosenthal,
None;
J. Samuels,
None;
S. Krasnokutsky Samuels,
None;
S. M. Reddy,
None;
P. M. Izmirly,
None;
C. Oh,
None;
M. Jain,
None;
V. Mani,
None.
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