Prevalence of subclinical atherosclerosis in rheumatoid arthritis

Objective. To study the parameters of the morpho-functional state of the vascular wall in patients with rheumatoid arthritis (RA) with different levels of total cardiovascular risk (CVR).

Materials and methods. 181 patients with active RA (mean age 40.4 [31.8; 49.6] years) were examined, and 2 groups were formed: 1) patients with the seronegative subtype (n=87); 2) those with the seropositive subtype (n=94). CVR was determined using the modified Systematic COronary Risk Evaluation (SCORE) scale; the intima-media complex thickness (IMCT) and the stiffness index (SI) of common carotid arteries (CCA) were assessed with specific methods.

Results. Low CVR was determined in 86 (48%), moderate risk - in 47%, and high risk - in 5% patients with RA. 176 (97%) patients with RA had signs of subclinical atherosclerosis, with simultaneous IMCT increase above the 75^th percentile and SI increase over 10 m/s in 21% patients. Mean IMCT values and SI in the 2^nd group were higher than in the 1^st group (р=0.018 and р=0.048, respectively). The lower risk was more commonly accompanied by the IMCT increase; as the CVR increased, the proportion of RA patients with SI over 10 m/s increased (р<0.01). A correlation was detected between the age and SI (r=0.58, p=0.035), IMCT parameters (r=0.64, p=0.002). SI correlated with the body mass index (BMI) (r=0.64, p=0.04), and IMTC correlated with the С-reactive protein level (r=0.61, p<0.01). Direct correlation was detected between SI, IMTC, and the Disease Activity Score 28 (DAS28) (r=0.51, p=0.02; r=0.45, p=0.008), RA duration (r=0.42, p=0.04; r=0.58, p=0.04), rheumatoid factor (RF) (r=0.68, p=0.04; r=0.49, р=0.04) and anti-citrullinated peptide antibody (ACPA) levels (r=0.62, p=0.018; r=0.45, р=0.003), respectively.

Conclusion. It is feasible to perform an advanced examination for the diagnosis of subclinical atherosclerosis along with the routine evaluation of total CVR using the SCORE scale in patients with active RA.

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