Background/Purpose: Patients with rheumatoid arthritis (RA) have an elevated cardiovascular (CV) disease risk, explained both by an increased prevalence of traditional CV risk factors and the presence of chronic systemic inflammation that leads to (1) increased arterial stiffness, (2) thickening of the arterial wall and (3) impairs vascular function.

In this study we investigated the effect of anti-inflammatory treatment on prognostic markers for preclinical cardiovascular disease (arterial wall thickening and arterial stiffness) and the correlation of these markers with RA disease parameters.

Methods: Carotid ultrasound (using Artlab echotracking system) was used to determine far wall carotid intima media thickness (IMT) and pulse wave analysis was done with SphygmoCor tonometry to calculate carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx). Paired t-test was used to compare PWV, AIx and IMT prior and after 6 months of therapy. Pearson correlation was calculated to investigated the correlation of PWV, AIx and IMT with (natural logarithm of) C-reactive protein (CRP), (natural logarithm of) erythrocyte sedimentation rate (ESR) and disease activity score-28 (DAS28). For correlations, data from both time points were pooled.

Results: In total 61 consecutive RA patients (50% early arthritis starting with csDMARD and 50% established RA starting with adalimumab) were asked to undergo arterial analysis just prior to start of therapy and after 6 months. PWV was performed in 45 patients at baseline and 39 at follow-up, IMT in 56 and 45 patients respectively and AIx in 51 and 44 patients respectively. Both signs of arterial stiffness (PWV and AIx) decreased after 6 months of therapy (mean difference 0.7 and 0.8 respectively; table 1), although this did not reach statistical significance. IMT remained stable during 6 months of therapy.

PWV (n=84) showed a significant correlation with ESR (0.262, p< 0.02) and DAS28 (0.269, p< 0.02). Both AIx (n=95) and IMT (n=101) showed a significant correlation with CRP (-0.223, p< 0.05 and 0.244, p< 0.02, respectively). Other correlation coefficients were not statistically significant (data not shown, p >0.05).

Table 1. Prognostic markers of atherosclerosis prior and after 6 months of anti-inflammatory therapy

Conclusion: Arterial stiffness as measured with PWV tended to decrease after 6 months of anti-inflammatory treatment. Arterial stiffness and arterial intima media thickness correlated with serological inflammatory parameters. Altogether, these changes might suggest that effective anti-rheumatic therapy has favorable cardiovascular effects. Whether or not this ultimately leads to a significant reduction of clinical cardiovascular endpoints remains to be established in prospective studies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prognostic-markers-for-preclinical-cardiovascular-disease-in-rheumatoid-arthritis-and-correlation-with-disease-activity/