Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound.

OBJECTIVE Recent studies have suggested increased cardiovascular disease among patients with rheumatoid arthritis (RA). We undertook this study to obtain morphologic evidence of subclinical atherosclerosis in RA patients. METHODS We used high-resolution B-mode ultrasound to compare carotid artery intima-media wall thickness (IMT) between 53 postmenopausal women with RA and 53 controls matched by age, sex, and menopause status. No subject in either group had a history of atherosclerosis or its complications. We investigated the association between IMT and relevant clinical and therapeutic variables, including the impact of low-dose corticosteroid therapy (< or = 10 mg/day prednisolone). RESULTS The mean +/- SD IMT of the left and right common carotid arteries in RA patients was significantly greater than that in controls (0.77 +/- 0.09 mm versus 0.68 +/- 0.14 mm; P < 0.001). Early RA (duration < or = 1 year) was associated with lesser IMT than was RA of longer duration (0.72 +/- 0.03 mm versus 0.78 +/- 0.01 mm; P < 0.04). Prednisolone use was not associated with increased IMT (0.78 +/- 0.02 mm in nonusers versus 0.76 +/- 0.01 mm in users; P = 0.38). CONCLUSION Our data indicate that RA patients have an ultrasonic marker of early atherosclerosis consistent with an increased risk for atherosclerosis.

[1]  L. Kuller,et al.  Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. , 1999, Arthritis and rheumatism.

[2]  M. Laakso,et al.  Ten year mortality and causes of death in patients with rheumatoid arthritis. , 1985, British medical journal.

[3]  M. Matsumoto,et al.  Ischemic stroke events and carotid atherosclerosis. Results of the Osaka Follow-up Study for Ultrasonographic Assessment of Carotid Atherosclerosis (the OSACA Study). , 1995, Stroke.

[4]  Y. Yamasaki,et al.  Atherosclerosis in Carotid Artery of Young IDDM Patients Monitored by Ultrasound High-Resolution B-Mode Imaging , 1994, Diabetes.

[5]  L. Punzi,et al.  Pro-inflammatory interleukins in the synovial fluid of rheumatoid arthritis associated with joint hypermobility. , 2001, Rheumatology.

[6]  P. Metcalf,et al.  Reproducibility of extracranial carotid atherosclerotic lesions assessed by B-mode ultrasound: the Atherosclerosis Risk in Communities Study. , 1996, Ultrasound in medicine & biology.

[7]  A. Gnasso,et al.  Common Carotid Arterial Wall Thickness in NIDDM Subjects , 1994, Diabetes Care.

[8]  N. Yamakita,et al.  Body fatness and fat distribution as predictors of metabolic abnormalities and early carotid atherosclerosis. , 2001, Diabetes care.

[9]  D G Altman,et al.  Analysis of serial measurements in medical research. , 1990, BMJ.

[10]  A. Hofman,et al.  Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study. , 1996, Annals of epidemiology.

[11]  P. Venables,et al.  Factors predicting a poor life prognosis in rheumatoid arthritis: an eight year prospective study. , 1989, Annals of the rheumatic diseases.

[12]  G. Heiss,et al.  Hypertension and subclinical carotid artery atherosclerosis in blacks and whites. The Atherosclerosis Risk in Communities Study. ARIC Investigators. , 1996, Archives of internal medicine.

[13]  L. Chambless,et al.  Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study. , 1991, American journal of epidemiology.

[14]  C. Suh,et al.  Lipid profiles in untreated patients with rheumatoid arthritis. , 1999, The Journal of rheumatology.

[15]  F. Arnett.  Revised criteria for the classification of rheumatoid arthritis. , 1990, Orthopedic nursing.

[16]  G. Heiss,et al.  Hypertension and Subclinical Carotid Artery Atherosclerosis in Blacks and Whites: The Atherosclerosis Risk in Communities Study , 1996 .

[17]  A. Frattoni,et al.  Structural Changes in the Heart and Carotid Arteries in Hypertensive Patients Associated with Cardiovascular Risk Factors , 1997, Journal of cardiovascular risk.

[18]  V. Pasceri,et al.  A tale of two diseases: atherosclerosis and rheumatoid arthritis. , 1999, Circulation.

[19]  M. Woodward,et al.  Cardiovascular risk factors, including thrombotic variables, in a population with rheumatoid arthritis. , 2001, Rheumatology.

[20]  A. Sharrett,et al.  Risk factors for popliteal and carotid wall thicknesses in the Atherosclerosis Risk in Communities (ARIC) Study. , 1999, American journal of epidemiology.

[21]  Hyon K. Choi,et al.  Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: a prospective study. , 2002, The American journal of medicine.

[22]  A. Silman,et al.  Increased mortality in seropositive patients during the early years of inflammatory polyarthritis , 2001 .

[23]  D. Symmons,et al.  Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. , 1998, The Journal of rheumatology.

[24]  S. R. Dahlqvist,et al.  Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. , 1997, The Journal of rheumatology.

[25]  O. Wiklund,et al.  On quantifying plaque size and intima-media thickness in carotid and femoral arteries. Comments on results from a prospective ultrasound study in patients with familial hypercholesterolemia. , 1996, Arteriosclerosis, thrombosis, and vascular biology.

[26]  S. Soraci,et al.  Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. , 1983, Arthritis and rheumatism.

[27]  J. Salonen,et al.  Ultrasound B-mode imaging in observational studies of atherosclerotic progression. , 1993, Circulation.

[28]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[29]  P Pignoli,et al.  Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. , 1986, Circulation.

[30]  L. Chambless,et al.  Carotid artery intimal-medial wall thickening and plasma homocyst(e)ine in asymptomatic adults. The Atherosclerosis Risk in Communities Study. , 1993, Circulation.

[31]  I. Rosenberg,et al.  Abnormal homocysteine metabolism in rheumatoid arthritis. , 1997, Arthritis and rheumatism.

[32]  H. Isomäki,et al.  Death rate and causes of death in patients with rheumatoid arthritis. , 1975, Scandinavian journal of rheumatology.

[33]  H K Genant,et al.  How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? , 1985, Arthritis and rheumatism.

[34]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[35]  R. Frye,et al.  Monoclonal T-cell proliferation and plaque instability in acute coronary syndromes. , 2000, Circulation.