ASYMPTOMATIC ATHEROSCLEROSIS IN NORMOTENSIVE NON-DIABETIC PATIENTS WITH RHEUMATOID ARTHRITIS

Background: Patients with rheumatoid arthritis (RA) have shorter life expectancy compared with general population. Several studies report an increase mortality due to cardiovascular disease in RA patients compared to the general population. The immune dysfunction unique to RA results in a chronic inflammatory state, which may have implications for the atherogenesis seen in these patients. The aim of our study was to proof accelerated asymptomatic atherosclerosis in RA patients and to elucidated importance of risk factors for atherosclerosis in these patients.Objectives: In our study 70 normotensive non-diabetic praemenopausal female RA patient were included (mean age 42,04 years, mean duration of disease 114,64 month). Using B-mode ultrasonography (ATL HDI 3000), we compared intima-media thickness (IMT) and plaque occurrence in the carotid arteries (indicators of atherosclerosis) in RA patients with that in 40 controls matched by age and sex. We also investigated the correlations of these variables to risk factors for atherosclerosis and high-sensitive CRP.Results: The IMT values were higher in RA patients compared with control subjects (0,59 mm versus mean 0,47; p= 0,044). RA patients had more plaques than controls (p< 0,001). Higher levels of high-sensitive CRP was found in RA patients compared with controls (10,62 mg/L versus 1,81 mg/L; p<0,0001). There were no statistically significant difference in haemoglobin, cholesterol (total, HDL and LDL), triglicerides, apolipoprotein A, apolipoprotein B, homocysteine, lipoprotein(a) between patients and controls. Statistically significant negative correlation between IMT and HDL cholesterol was found (r=-0,250; p=0,037). There was also correlation between IMT and triglicerides (r=0,283; p=0,018). With multiple regression analysis we found relationship between age and IMT (p=0,004) and between the presence of plaques and apolipoprotein B (p=0,028).Conclusion: The results indicate that even praemenopausal female RA patients without diabetes or hypertension had accelerated asymptomatic atherosclerosis. We did not find any difference in classical risk factors for atherosclerosis between RA patients and controls. However, we found correlations between IMT and plaque occurrence with some traditional risk factors. Our results indicate that chronic systemic inflammation may play an important role in atherogenesis in these patients.References: 1. Hojs R. Carotid intima-media thickness and plaques in hemodialysis patients. Artificial Organs 2000;24:691-5.2. Rincon I, Williams K, Stern MP et al. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheumat 2003;48.1833-40.3. Witztum JL. The oxidation hypothesis of atherosclerosis. Lancet 1994;344:793-5.4. Wolfe F, Michaud K, Gefeller O, Choi HK. Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum 2003;48:1530-42.5. Wallberg Jonsson S, Ohman ML, Dahlqvist SR. Cardiovascular morbidity and mortality in patient with seroposirive rheumatoid arthritis in northern Sweden. J Rheumatol 1997;24:445-51.6. Manzi S, WaskoWolfe F, Michaud K, Gefeller O, Choi HK. Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum 2003;48:1530-42.Citation: , volume , supplement , year 2004, page Session: Rheumatoid arthritis – Clinical aspects