Background/Purpose: Rheumatoid arthritis (RA) is a chronic, inflammatory disease that is complicated by accelerated atherosclerosis associated with the risk of adverse cardiovascular (CV) events and death. Traditional risk factors do not fully explain the increased CV risk in RA. RA-related inflammation that is responsible for joint damage may be implicated in the development of accelerated atherosclerosis. Carotid intima-media thickness (cIMT) has been approved as a surrogate marker of early atherosclerosis. The goal of the study was to assess (1) prospectively cIMT in patients with established RA, (2) the relationship between  cIMT and RA activity estimated by clinical examination and ultrasonography of joints.   

Methods: The study group consisted of 40 consecutive RA patients, 33 (82,5%) female and 7 male (17,5%) with the mean (SD) age 52.3 (9.8) (range 24-68) and disease duration 18.6 (9.6) years (range 6.5-45). The assessment of cIMT was performed twice, in the space of six years (the initial in 2008 and consecutive in 2014) and was determined by high-resolution B-mode ultrasonography. The activity of RA was estimated by clinical examination [with disease activity score in 28 joints (DAS28)] and ultrasonography of joints (synovial hypertrophy in 24 small joints). At the consecutive visit, high disease activity was observed in 7 (17,5%) patients, and low RA activity or remission in 23 (57,5%). Most patients, 35 (87,5%) were treated with biological disease modifying antirheumatic drugs (DMARDs) during the six years period and only synthetic DMARds were used in 5 (12,5%) patients.     

Results: The mean (SD) cIMT value was significantly greater at consecutive than initial assessment [0.86 (0.45) vs 0.75 (0.13) mm, p= 0.02]. The number of RA patients with advanced atherosclerosis (presence of plaques) increased from 6 (15%) at the initial to 9 (22,5%) at the consecutive assessment (NS). The number of patients without atherosclerosis (cIMT < 0.6 mm) deceased from 4 (10%) at the initial to 3 (7,5%) at the consecutive assessment. The value of cIMT correlated positively with the age of patients (p< 0,001) and the two cIMT values correlated with each other (p=0,01). There was no correlation between cIMT value and parameters of RA activity (DAS28 and synovial hypertrophy in ultrasonography). There was a positive correlation between DAS28 value and the number of joints with synovial hypertrophy assessed in ultrasonography.

Conclusion: During the six-years course of established RA, progression of atherosclerosis was observed, estimated by significantly greater mean cIMT value, as well as increased number of patients with atherosclerotic plaques. Progressive atherosclerosis occurred in spite of intensive RA treatment, including biological DMARDs. The process seems to be dependent on the age and was not correlated with the current RA joint activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prospective-assessment-of-carotid-intima-media-thickness-in-relation-to-activity-of-the-disease-in-patients-with-rheumatoid-arthritis/