TY - JOUR T1 - Patients with Rheumatoid Arthritis Have More Vulnerable Arterial Plaques, But Lowering Disease Activity May Stabilize This Threat JF - The Journal of Rheumatology JO - J Rheumatol SP - 348 LP - 349 DO - 10.3899/jrheum.130104 VL - 40 IS - 4 AU - Vokko P. Van Halm Y1 - 2013/04/01 UR - http://www.jrheum.org/content/40/4/348.abstract N2 - Patients with rheumatoid arthritis (RA) die of cardiovascular disease (CVD)1. Although the inflammatory part of RA is better controlled with conventional and especially modern medicine, CV risk still seems to be double that of people without RA2. The risk of future CVD can be predicted by the presence of carotid artery plaques (CP). If they are present, the risk for future acute coronary syndromes and stroke is increased 2- to 4-fold3,4. Moreover, as shown by Kobayashi and colleagues, CP seem to be more prevalent in RA5.The presence of CP could prove helpful in identifying which RA patients are most at risk for future CV events. Additionally, it is shown that not only the presence of CP but also certain characteristics of these plaques are of great importance. A thin cap and less fibrous tissue inside plaques make them more vulnerable to rupture and more likely to cause CV events. Different types of CP have been identified together with their specific CV risk6. However, how does one reliably identify these vulnerable plaques? Simple eyeballing does not seem good enough. A more objective method could be measuring the gray-scale median (GSM). A lower score means less fibrous tissue and consequently a more vulnerable plaque. The usefulness of this GSM method in identifying vulnerable plaques has been shown by several authors6,7.It is stipulated that the … Address correspondence to Dr. Van Halm; E-mail: vpvanhalm{at}gmail.com. ER -