Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Retinal vascular calibre measurement is a non-invasive tool for assessing systemic and vascular health. Widened retinal venular calibre (RVC) is associated with systemic inflammation, increased cardiovascular (CV) risk and has previously been associated with rheumatoid arthritis (RA), particularly high disease activity1. To date there have been no longitudinal studies assessing the effect of suppressing systemic inflammation on RVC in RA. The aims of this study were to investigate the stability of serial retinal vascular calibre measurements (RVC and retinal arteriolar calibre (RAC)) in well controlled RA and the effect of reducing systemic inflammation in RA patients requiring treatment escalation.
Methods:
Two groups of patients with RA were recruited and studied concurrently. Group A included patients with moderate or high disease activity (DAS28-CRP>3.2) who required treatment escalation as standard of care. Group B had stable low disease activity (DAS28-CRP≤3.2) not requiring any alteration of medical therapy and were the control for Group A. Both groups underwent retinal photography at baseline and at weeks 6 and 24 (to assess the early and later response respectively) in Group A and at week 12 in Group B. Images were analysed by purpose designed software and a trained assessor blinded to subject identity and timing of retinal photography. Simple linear regression and paired t-tests were used to compare serial retinal vascular calibre measurements in Groups A and B respectively, with a p value <0.05 considered significant.
Results:
Group A included 24 patients (71% female) with a mean (SD) age of 50.9 (18) years and a mean (SD) disease duration of 5.8 (6.4) years. Between baseline and week 6, disease activity improved significantly (DAS28-CRP mean reduction of -2.0 (95% CI -2.5 to -1.5). This was accompanied by a significant reduction in RVC (mean difference (MD) -7.6µm; 95% CI -13.4 to -1.7µm, p=0.01), whereas RAC remained unaltered (MD -2.29µm; 95% CI -5.7 to 1.1µm, p=0.18). Week 24 data collection from Group A is ongoing. Group B included 26 patients (81% female) with a mean (SD) age of 54 (9) years and a mean (SD) disease duration of 14.5 (10.8) years. Disease activity and therapy remained unchanged between baseline and week 12 (DAS28-CRP MD -0.1, 95% CI -0.36 to 0.15, p=0.39). There was no significant change in RVC (MD 1.37µm; 95% CI -2.82 to 5.57µm, p=0.5) or RAC (MD 0.39µm; 95% CI -3.04 to 3.82µm, p=0.82) in Group B over this period.
Conclusion:
This is the first study to demonstrate that suppressing inflammatory disease activity in RA reduces RVC widening as early as 6-weeks after treatment escalation. In contrast, RVC measurements were unchanged in RA with stable, low-level systemic inflammation during short-term follow-up. Taken together, these findings suggest that retinal vascular calibre measurement may be a biomarker of RA disease activity as well as CV risk and that immunosuppressive treatment may also have potential vascular benefits in RA.
References
1. Van Doornum S et al. Retinal vascular calibre is altered in patients with rheumatoid arthritis: a biomarker of disease activity and cardiovascular risk? Rheumatology (Oxford) 2011;50:939-43.
Disclosure:
J. H. Moi,
None;
L. A. Hodgson,
None;
I. P. Wicks,
None;
T. Y. Wong,
None;
S. Van Doornum,
None.
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