DOI: http://dx.doi.org/10.18203/2349-3933.ijam20163728

Carotid intima media thickness as a marker of subclinical atherosclerosis in rheumatoid arthritis: a case control study

Renu Saigal, Vivek Mathur, Laxmikant Goyal

Abstract


Background: Increased cardiovascular morbidity and mortality has been observed in rheumatoid arthritis (RA) because of accelerated atherosclerosis. We measured carotid intima-media thickness (CIMT) as a surrogate marker of subclinical atherosclerosis in RA in this study.

Methods: In this study 40 cases of RA and 26 matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using DAS28, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels.

Results: Mean age of the study groups was 52.45±7.43 years (range 41-69 years). Average disease duration was 9.34±4.18 years (range 5-20 years). Thirty two (32/40, 80%) cases of RA were RF positive. ESR was significantly higher in RA cases (51.75±24.13 mm Ist hr) compared to healthy controls (17.31±9.08 mm Ist hour, p <0.001). Significantly increased CIMT was observed in cases as compared to the control group (0.68 ± 0.06 mm versus 0.63±0.07; 𝑃 0.002). CIMT in the cases positively correlated with age (𝑟 = 0.500; 0.001), duration of disease (𝑟= 0.594; 𝑃 0.001). CIMT negatively correlated with HDL (𝑟 = -0.345; 0.029).

Conclusions: Subclinical atherosclerosis (increase CIMT) is common in RA and correlated well with disease duration. So every patient of RA should be evaluated for development for atherosclerosis.


Keywords


Atherosclerosis, Intima-media thickness, Rheumatoid arthritis

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References


Bruce IN, Gladman DD, Urowitz MB. Premature atherosclerosis in systemic lupus erythematosus, Rheum Dis Clin North America. 2000;26(2):257-78.

Gabriel SE. Cardiovascular morbidity and mortality in rheumatoid arthritis, American J Med. 2008;121(10):S9-14.

Gupta N, Saigal R, Goyal L. Carotid Intima Media Thickness as a Marker of Atherosclerosis in Ankylosing Spondylitis. Internat J Rheumatol. 2014:Article ID 839135:5.

Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135-43.

Van den Oever IAM, van Sijl AM, Nurmohamed MT. Management of cardiovascular risk in patients with rheumatoid arthritis: evidence and expert opinion, therapeutic advances in musculoskeletal. Disease. 2013;5(4):166-81.

Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59:1690-7.

Bartoloni E, Alunno A, Bistoni O, Gerli R. How early is the atherosclerotic risk in rheumatoid arthritis? Autoimmun Rev. 2010;9:701-7.

Ozbalkan Z, Efe C, Cesur M, Ertek S, Nasiroglu N, Berneis K. An update on the relationships between rheumatoid arthritis and atherosclerosis. Atherosclerosis. 2010;212:377-82.

Greenland P, Alpert JS, Beller GA. ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. Journal of American College of Cardiology. 2010;56:e50-e103.

O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. The New England Journal of Medicine. 1999;340(1):14-22.

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315-24.

Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.

Grover S, Sinha RP, Singh U, Tewari S, Aggarwal A, Misra R. Subclinical atherosclerosis in rheumatoid arthritis in India. J Rheumatol. 2006;33:244-7.

Van der Heijde DM, van 't Hof M, van Riel PL, van de Putte LB. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993;20(3):579-81.

Ross R. Atherosclerosis: An inflammatory disease. N Engl J Med. 1999;340:115-26.

Tyrrell PN, Beyene J, Feldman BM, Mccrindle BW. Rheumatic disease and carotid intima-media thickness: a systematic review and metaanalysis, Arteriosclerosis, Thrombosis, and Vascular Biology. 2010;30(5):1014-26.

Chatterjee MA, Guin A, Chakraborty S. Subclinical Atherosclerosis and Endothelial Dysfunction in Patients with Early Rheumatoid Arthritis as Evidenced by Measurement of Carotid Intima-Media Thickness and Flow-Mediated Vasodilatation: An Observational Study. Semin Arthritis Rheum. 2012;41(5):669-75.

Singh H, Goyal M, Sen J, Kumar H. Correlation of Intima Media Thickness (as a Marker of Atherosclerosis) with Activity and Duration of Rheumatoid Arthritis using Carotid Ultrasound. JIACM. 2011;12(1):15-20.

Mahajan V, Handa R, Kumar U. Assessment of atherosclerosis by carotid intimomedial thickness in patients with rheumatoid arthritis. JAPI. 2008;56:587-90.

Alkaabi K. Rheumatoid arth and macrovascular dis. Rheumatology. 2003;42:292-7.

González-Juanatey C, Llorca J, González GMA. Correlation between endothelial function and carotid atherosclerosis in rheumatoid arthritis patients with long-standing disease. Arthritis Res Ther. 2011;13:101.

Goodson NJ, Symmons DP, Scott DG, Bunn D, Lunt M, Silman AJ. Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year follow up study of a primary care-based inception cohort. Arthritis Rheum. 2005;52:2293-9.

Nagata-Sakurai M, Inaba M, Goto H, Kumeda Y, Furumitsu Y, Inui K, et al. Inflammation and bone resorption as independent factors of accelerated arterial wall thickening in patients with rheumatoid arthritis. Arthritis Rheum. 2003;48:3061-7.

Del Rincon I, Williams K, Stern MP, Freeman GL, O'Leary DH, Escalante A: Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy sub. Arthritis Rheum. 2003;48:1833-40.

Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109:II2-10.

Maradit KH, Nicola PJ, Crowson CS, Ballman KV, Gabriel SE. Cardiovascular death in rheumatoid arthritis: a population based study. Arthritis Rheum. 2005;52:722-32.

Book C, Saxne T, Jacobsson LT. Prediction of mortality in rheumatoid arthritis based on disease activity markers. J Rheumatol. 2005;32:430-4.

Porto FD, Lagana` B, Lai S, Nofroni I, Tinti F, Vitale M, et al. Response to anti-tumour necrosis factor alpha blockade is associated with reduction of carotid intima-media thickness in patients with active rheumatoid arthritis. Rheumatology. 2007;46:1111-5.

Kumeda Y, Inaba M, Goto H, Nagata M, Henmi Y, Furumitsu Y. Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis Rheum. 2002;46:1489-97.

Vottery R, Sagital R, Singhal N, Gupta BS. Lipid profile in rheumatoid arthritis and its relation to disease activity. J Assoc Phys Ind. 2001;49:1188-99.

Haddy N, Sass C, Droesch S. IL-6, TNF-𝛼 and atherosclerosis risk indicators in a healthy family population: The STANISLAS cohort, Atherosclerosis. 2003;170(2):277-83.

Khovidhunkit W, Kim MS, Memon RA. Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host, Journal of Lipid Research. 2004;45(7):1169-96.

Roman MJ, Moeller E, Davis A, Paget SA, Crow MK, Lockshin MD. Preclinical carotid atherosclerosis in patients with rheumatoid arthritis. Ann Intern Med. 2006;144:249-56.