Background/Purpose: Despite a high frequency of cardiovascular disease in rheumatoid arthritis (RA), peripheral arterial disease in RA has received little attention. The objective of the present analysis was to examine the frequency of impaired lower limb arterial function in members of an RA cohort, compared to a control group without RA.

Methods: Patients meeting diagnostic criteria for RA were recruited consecutively from private and public rheumatology practices, from 1996 through 2011. For comparison, we studied participants in the Insulin Resistance and Atherosclerosis Study (IRAS), who were recruited from four clinical centers based on blood glucose tolerance status indicating normal glucose tolerance, impaired glucose tolerance, or diabetes mellitus. The clinical centers were in Los Angeles, Oakland, San Antonio and the San Luis valley in Colorado. The ABI was measured using a blood pressure cuff and a doppler ultrasound probe to measure the systolic blood pressure (SBP) in all four extremities. The ABI was calculated for each ankle provided as the ratio of highest SBP in the ankle to the highest SBP in the upper extremities. The ABI was considered obstructed if ≤0.9, normal if >0.9 but ≤1.3, and incompressible if >1.3. Logistic regression was used to compare the frequency of obstruction or incompressibility between RA and controls, adjusting for age, sex, smoking, diabetes mellitus and hypertension.

Results: We recruited 1328 RA patients, of whom 1182 had an ABI measurement. Their mean age was 58 (range 19-91), and 887 (75%) were women. They were compared to 1624 IRAS study participants, whose mean age was 55 (range 39-69), and 905 were women (55%). An obstructed ABI was present in 113 of the RA patients (9.56%), and in 53 of the IRAS participants (3.26%), odds ratio (OR) 3.09, CI 95% 2.18, 4.41, p< 0.0001. Adjusting for age, sex, smoking, diabetes and hypertension, the frequency of obstruction remained higher in the RA group with an OR of 3.74, CI 95% 2.5, 5.59, P < 0.0001. (Figure) An incompressible ABI was present in 183 of the RA patients (15.48%), and in 286 of the IRAS participants (17.6%), OR 0.92, CI 95% 0.75, 1.14. P 0.47. Multivariable adjustment did not alter the odds of incompressibility between the two groups.

Conclusion: Our findings suggesting an increased frequency of peripheral arterial obstruction in RA patients broadens the scope of cardiovascular morbidity in RA. The clinical significance of the increased frequency of peripheral arterial obstruction in RA deserves further study.

Figure: Unadjusted and adjusted frequency of obstructed ankle brachial index in rheumatoid arthritis and controls. Error bars represent 95% confidence intervals.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-frequency-of-lower-limb-arterial-obstruction-in-rheumatoid-arthritis/