Rheumatoid arthritis
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

https://doi.org/10.1016/j.semarthrit.2011.08.003Get rights and content

Objective

In this study, we aimed to investigate the frequency of endothelial dysfunction and subclinical atherosclerosis in early rheumatoid arthritis (RA) patients by carotid intima-media thickness (cIMT) and endothelial-dependent flow mediated vasodilatation (ED-FMD) as compared with healthy controls.

Methods

The study included 35 early RA patients (disease duration <12 months) and 35 healthy controls. Intima-media thickness of common carotid artery and ED-FMD of brachial artery were measured by high-resolution ultrasonography. Disease activity of RA was assessed by Disease Activity Score and activities of daily living were determined by Health Assessment Questionnaire–Disability Index Score.

Results

RA patients (age 38.3 ± 10.6 years) had average disease duration of 0.46 ± 0.28 years and 22 patients (62.9%) were rheumatoid factor (RF) positive (RF titer >9.56 IU/mL). There were no significant differences between age, sex, and lipid profiles of patient and control group. cIMT was significantly higher in RA patients (0.50 ± 0.16 mm) than in controls (0.44 ± 0.09 mm) (P = 0.007). Similarly, FMD% was significantly lower in RA patients [5.26 (2.9-10.6)] as compared with controls [10.34 (7.4-14.3)] (P = 0.004). Age, systolic blood pressure, tender joint count, and swollen joint count had significant correlations with patient cIMT. RF titer came out to be the major risk factor for increased cIMT of the patients.

Conclusions

Compared with controls, early RA patients have higher cIMT and lower FMD%, denoting premature atherosclerosis. Our data suggest that early determination of FMD% and cIMT may be useful tools to assess cardiovascular risk even in early RA patients.

Section snippets

Patients and Controls

The subjects in the present study were 35 early rheumatoid arthritis (RA) patients (29 women and 6 men) and 35 healthy controls (28 women and 7 men). The 35 consecutive patients with RA, who fulfilled the inclusion criteria, were selected from among the patients attending the “early arthritis clinic” of the Rheumatology Department at the Institute of Postgraduate Medical Education and Research, SSKM Hospital, between December 2009 and May 2010. All patients fulfilled the following inclusion

Results

The study included 35 patients with an average age of 38.3 ± 10.6 years and average disease duration of 0.46 ± 0.28 years. Twenty-two patients (62.9%) were RF positive (RF titer >9.56 IU/mL) with median RF titer of 49.7 (9.56-265.0) IU/mL. Our patient population had a severe disease activity with a median DAS 28 score of 5.61 (4.27-6.87). Physical disability of the study patients was assessed by HAQ-DI score [median = 2.13 (1.38-2.63)]. There were no significant differences between patients and

Discussion

Patients with established RA are at a higher CV risk than normal population having standard mortality ratios between 0.9 and 3.0 as compared with the general population (5). CVD leads to an excess 35 to 50% of the mortality rate in comparison to general population and reduces life expectancy by 5 to 10 years in RA patients (4, 6). Our study was designed to see if atherosclerosis initiates its progression even at early stages of RA. A small amount of literature substantiates that subclinical

Acknowledgments

The authors wish to thank the doctors, coresearchers, and laboratory technicians of the Department of Rheumatology, Institute of Postgraduate Medical Education and Research (IPGME&R), SSKM Hospital, Kolkata for patient recruitment, and Professor Utpalendu Das, Head of the Department of Radiology, IPGME&R, SSKM Hospital for radiological assistance.

The authors also wish to thank Dr Avijit Hazra, Department of Pharmacology, IPGME&R, SSKM Hospital, Kolkata and the senior research scholars of

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    This study was funded by the Indian Council of Medical Research (ICMR), New Delhi vide order No. 5/4 to 5/2/Ortho/2007-NCD-I. This funding source did not have any contribution in the study design, collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. The Indian Council of Medical Research, New Delhi, was a source of support in the form of grants.

    The authors have no conflicts of interest to disclose.

    1

    These authors contributed equally to this article.

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