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Research ArticleArticle

Carotid Plaque Characteristics and Disease Activity in Rheumatoid Arthritis

Anne G. Semb, Silvia Rollefstad, Sella A. Provan, Tore K. Kvien, Einar Stranden, Inge C. Olsen and Jonny Hisdal
The Journal of Rheumatology January 2013, jrheum.120621; DOI: https://doi.org/10.3899/jrheum.120621
Anne G. Semb
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Silvia Rollefstad
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Sella A. Provan
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Tore K. Kvien
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Einar Stranden
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Inge C. Olsen
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Jonny Hisdal
From the Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker; and Faculty of Medicine, University of Oslo, Oslo, Norway. Dr. Semb has received speaker’s honoraria and/or consulting fees from Merck/Schering-Plough, Abbott, BMS, Pfizer, and Roche. J. Hisdal has received speaker’s honoraria from Pfizer. Dr. Provan has received speaker’s honoraria from Abbott, BMS, and Roche. Dr. Kvien has received speaker’s and/or consulting honoraria and/or research grants from Abbott, BMS, Merck/Schering-Plough, Pfizer, Roche, UCB, and Wyeth. E. Stranden has received speaker’s honoraria from Pfizer, 3M, and Meda and university sponsorship from Hoechts. A.G. Semb, MD, PhD; S. Rollefstad, Medical Student; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; E. Stranden, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker, Faculty of Medicine, University of Oslo; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, PhD, Section of Vascular Investigations, Oslo Vascular Centre, Oslo University Hospital Aker. Address correspondence to Dr. A.G. Semb, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, NO-0319 Oslo, Norway. E-mail: a-semb@diakonsyk.no. Accepted for publication November 19, 2012.
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Abstract

Objective Carotid plaques (CP) are predictive of acute coronary syndrome in patients with rheumatoid arthritis (RA), suggesting that atherosclerotic plaques in these patients are vulnerable. The objective of our study was to characterize vulnerability of CP in patients with RA compared to a control population, and between RA patients with different levels of disease activity.

Methods Ultrasound examination of carotid arteries was performed in 152 patients with RA and 89 controls. CP echolucency was evaluated by the Gray-Scale Median (GSM) technique. Lower GSM values indicate higher vulnerability of plaques. CP characteristics were compared between RA patients with active disease and in remission, and between patients and controls. All analyses were performed with adjustment for confounding factors (sex, age, smoking, and blood pressure). Poisson regression analysis was used for count data, mixed modeling for GSM and area per plaque, and analysis of covariance for minimum GSM value per patient.

Results Patients with RA more frequently had CP (median 2, range 0, 4) compared with controls (median 1, range 0, 3; p < 0.001), after adjustment for age and sex. Patients with active RA disease according to the Clinical Disease Activity Index (CDAI) had lower median GSM (p = 0.03), minimum GSM (p = 0.03), and a larger CP area (although the latter finding was not significant; p = 0.27), compared with patients with RA in remission. These findings were not confirmed for other disease measures (Simplified Disease Activity Index, Disease Activity Score-28, C-reactive protein, erythrocyte sedimentation rate).

Conclusion Patients with RA had more CP compared with controls and patients in CDAI remission, and controls had more stable CP than patients with active disease; these findings point to the importance of achieving remission in RA.

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Carotid Plaque Characteristics and Disease Activity in Rheumatoid Arthritis
Anne G. Semb, Silvia Rollefstad, Sella A. Provan, Tore K. Kvien, Einar Stranden, Inge C. Olsen, Jonny Hisdal
The Journal of Rheumatology Jan 2013, jrheum.120621; DOI: 10.3899/jrheum.120621

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Carotid Plaque Characteristics and Disease Activity in Rheumatoid Arthritis
Anne G. Semb, Silvia Rollefstad, Sella A. Provan, Tore K. Kvien, Einar Stranden, Inge C. Olsen, Jonny Hisdal
The Journal of Rheumatology Jan 2013, jrheum.120621; DOI: 10.3899/jrheum.120621
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