ATHEROSCLEROSIS AND RHEUMATOID ARTHRITIS: EVALUATION OF INTIMA-MEDIA THICKNESS AND CORRELATION WITH INFLAMMATORY AND ATHEROGENIC MARKERS

Background: Recent studies have focused on the role of inflammation in the development of atherosclerosis (AT), there are some similarities in the inflammatory/immunologic response observed in AT and rheumatoid arthritis (RA), the prototype of autoimmune disease. Molecular and cellular mediators of inflammation in RA may be the key to development of atherosclerotic lesions in these patients (1,2). Objectives: To investigate whether the intima-media thickness (IMT) of the common carotid arteries is greater in RA patients than healthy subjects, and to investigate the presence of inflammation and atherogenic lipoprotein markers and their possible correlation with IMT. Methods: We studied 21 patients (15 F, 6 M; age 48-62 median 55) with RA according to the criteria established by the American College of Rheumatology, and 10 controls (6 F, 4 M; age 44-66, median 52). The healthy subjects were compared with RA patients with regard to risk factors for AT, including age, sex, smoking, blood pressure, body mass index and postmenopausal status. Clinical variables reflecting RA were measured: patient's global assessment, physician's global assessment, patient's assessment of pain, physical disability score (HAQ), acute-phase reactant level, numbers of tender and swollen joints, duration of morning stiffness, disease activity score (DAS 28). Laboratory variables relevant to RA: activity erythrocyte sedimentation rate, C-reactive protein level and rheumatoid factor positivity were measured. Laboratory variables relevant dyslipidemic status: serum total cholesterol, trygliceridies, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprtein AI (Apo AI), apolipoprotein B (Apo B) were determined. IMT and plaques were measured in the left and right common carotid arteries (CCA). Three measurements of ITM were made in common carotid arteries and were averaged to determine the mean IMT (3). Mann-Wythney test was used to compare mean value between two groups. Results: The mean ± SD IMT of the left and right CCA was significantly greater in 21 RA patients than in 10 control subjects (1.09±0.3 vs. 0.68±0.3; p=0.0029). Total plasma levels of cholesterol (173±26.2 vs. 182.6±44.6), HDL-cholesterol (58.5±20.3 vs. 60.2±26), LDL-cholesterol (95.3±28.6 vs. 100.1±32.8), were in the normal range in RA patients and were similar to those in the controls; the concentration of triglycerides (122.1±55.6 vs. 154.5±51.8; p=0.8), ApoAI (167.4±52.2 vs. 213.3±68.3; p=0.9) and ApoB (117.8±46.8 vs. 146±33.1; p=0.9) levels were lower in the RA patients than in controls, but this was not statistical significant. In the RA group, IMT did not correlate with inflammatory variables, atherogenic markers, and parameters of activity of RA. Conclusion: In the present study, we demonstrated that the IMT of the common carotid was significantly higher in RA patients than in controls. Our study may contribute to explain the increase in cardiovascular death reported in RA and will allow physicians early stratification of patients with vascular disease.1. Pasceri V, Yeh ET. A tale of two diseases: atherosclerosis and rheumatoid arthritis. Circulation 1999; 100:2124-6.; 2. Manzi S, Wasko MC. Inflammation-mediated rheumatic diseases and atherosclerosis. Ann Rheum Dis 2000; 59:321-5.; 3. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Inimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74, 1399-406.