Sensorineural Hearing Impairment and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients without Traditional Cardiovascular Risk Factors

Hector Macias Reyes¹, Sergio Duran-Barragan^2,3, Cynthia Cardenas Contreras⁴, Cesar Chavez Martin⁴, Eduardo Gomez², Rosa Navarro Hernandez², Jorge Aguilar Arreola^2,5, Paul Perez-Cruz^2,5, Carlos Yanowsky Gonzalez² and Monica Vazquez-Del Mercado^2,5, ¹1. Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico, ²Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Instituto de Investigación en Reumatología y del Sistema Musculoesquelético, Guadalajara, Mexico, ³Clinica de Investigación en Reumatología y Obesidad, Guadalajara, Mexico, ⁴Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico, ⁵Servicio de Reumatología, División de Medicina Interna, Hospital Civil Dr. Juan I. Menchaca, Guadalajara, Mexico

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Atherosclerosis, Disability, rheumatoid arthritis (RA) and ultrasound

Session Information

Date: Monday, November 9, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Rheumatoid arthritis (RA) is characterized by inflammation of the synovial membrane of the diarthrodial joints which include arthrodesis of the middle ear, (incudomalleolar and incudostapedial joints) causing conductive hearing impairment (CHI). Extra-articular involvement may also affect the auditory system targeting the inner ear causing sensorineural hearing impairment (SNHI). The majority of the risk factors for SNHI reported in the literature are related to the cardiovascular system, as the inner ear may be vulnerable to circulatory alterations affecting the labyrinthine artery; however the physiopathology of hearing impairment in RA remains unclear. We decided to evaluate, in a cohort of RA patients without known cardiovascular risk factors, the association of hearing impairment and subclinical atherosclerosis.

Methods: RA patients (according to the ACR classification criteria) with no known traditional cardiovascular risk factors were included. Routine clinical and laboratory assessments for RA patients were included. Pure tone air (125 – 8000 Hz) and bone conduction (250 – 6000 Hz) thresholds were obtained, tympanograms were classified according to Jerger and impedance audiometry was done. SNHI was defined if the average thresholds for at least one of low-, mid-, or high-frequency ranges were ≥25 decibels (dB) hearing level in one or both ears. Carotid Intima-Media Thickness (cIMT) was assessed. Two segments from the common carotid artery (CCA), one from the carotid bifurcation (BF) and two from the internal carotid artery (ICA) were evaluated. Patients were classified according to the cIMT with a cut-off point of 0.6mm.

Results: Forty-one RA patients were included into the study, 39 (95.1%) were female. Mean (SD) age and disease duration were 46.46 (10.20) and 7.05 (7.37) years respectively. Twelve patients (29.2%) had normal audition, 29 (70.8%) had hearing impairment; of them, 28 (68.3%) had SNHI [22 (53.6%) bilateral, 24 (58.5%) left and 26 (63.4%) right], three patients (7.3%) had right CHI and one (2.4%) had left CHI. No significant differences were found between disease activity, rheumatoid factor and anti-CCP among SNHL and normal hearing RA groups. Patients with SNHI had thicker levels of cIMT in the media segment of carotid common artery vs patient with normal hearing (right ear 0.21±0.29 vs 0.02±0.10 mm, p = 0.007; left ear 0.20±0.30 vs 0.06±0.18 mm, p= 0.075) (Table 1)

Table 1. Type of audition according to the cIMT

	Rigth ear			Left ear
cIMT (right and left, respectively, mm)	Normal n = 15	SNHI n = 26	p	Normal n = 17	SNHI n = 24	p
Proximal CCA	0.43 ± 0.29	0.46 ± 0.29	0.740	0.41 ± 0.28	0.50 ± 0.32	0.370
Media CCA	0.02 ± 0.10	0.21 ± 0.29	0.007	0.06 ± 0.18	0.20 ± 0.30	0.075
Distal CCA	0.44 ± 0.42	0.61 ± 0.45	0.244	0.45 ± 0.31	0.57 ± 0.39	0.341
Bulb	0.48 ± 0.36	0.51 ± 0.34	0.784	0.54 ± 0.44	0.50 ± 0.41	0.754
Proximal ICA	0.44 ± 0.30	0.46 ± 0.28	0.791	0.49 ± 0.36	0.40 ± 0.30	0.420
Distal ICA	0.34 ± 0.30	0.40 ± 0.38	0.562	0.35 ± 0.34	0.39 ± 0.29	0.704

cIMT, carotid intima media thickness; SNHI, sensorineural hearing impairment; CCA, carotid common artery; variables are expressed as mean ± standard deviation. Statistical significance: p≤0.05

Conclusion: Thickening of the carotid Intima-Media was associated with SNHI in RA patients. Unknown cardiovascular risk factors may contribute to accelerated atherosclerosis and hearing impairment in RA patients. Further studies are needed to elucidate this association.

Disclosure: H. Macias Reyes, None; S. Duran-Barragan, None; C. Cardenas Contreras, None; C. Chavez Martin, None; E. Gomez, None; R. Navarro Hernandez, None; J. Aguilar Arreola, None; P. Perez-Cruz, None; C. Yanowsky Gonzalez, None; M. Vazquez-Del Mercado, None.

To cite this abstract in AMA style:

Macias Reyes H, Duran-Barragan S, Cardenas Contreras C, Chavez Martin C, Gomez E, Navarro Hernandez R, Aguilar Arreola J, Perez-Cruz P, Yanowsky Gonzalez C, Vazquez-Del Mercado M. Sensorineural Hearing Impairment and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients without Traditional Cardiovascular Risk Factors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/sensorineural-hearing-impairment-and-subclinical-atherosclerosis-in-rheumatoid-arthritis-patients-without-traditional-cardiovascular-risk-factors/. Accessed .

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