Correlation of Carotid Intima Media Thickness with Disease Duration and Activity of Rheumatoid Arthritis
DOI:
https://doi.org/10.12970/2311-052X.2019.07.03Keywords:
Splenectomy, thrombocytopenia, computer tomography, 3D modelling, hemostasis, vascularization.Abstract
Context: Rheumatoid Arthritis (RA) patients have a higher chance of adverse cardiovascular events due to accelerated atherosclerosis. The objective of this study was to assess if there is any correlation of duration and disease activity of Rheumatoid Arthritis with carotid intima media thickness (CIMT), an efficient marker of atherosclerosis and predictor of future adverse cardiovascular events.
Aims: To look for any correlation between CIMT and disease duration and activity of Rheumatoid Arthritis.
Settings and Design: Cross-sectional observational study.
Methods and Material: Sixty patients of Rheumatoid Arthritis, diagnosed as per 2010 ACR/EULAR guideline, were divided in three groups depending on disease duration and then disease activity was measured by DAS28 scoring. Carotid intima medial thickness was measured using USG and correlation was calculated by statistical measures.
Statistical Analysis Used: Correlations between the variables were measured using Chi Square test and Pearson Correlation test.
Results: Significant statistical correlation with the haematological parameters and inflammatory parameters were found to the disease activity of RA. Disease activity of RA was also strongly correlated with dyslipidemia. Also thickened Carotid IMT was associated with older age and it was strongly associated with Rheumatoid Factor and Anti CCP positivity. Disease duration was found to be strongly correlated with thickened carotid intima media and carotid plaque in this study. Disease activity also showed similar strong correlation with carotid intima media thickness and carotid plaque.
Conclusions: Both disease duration and disease activity were strongly associated with increased CIMT and carotid plaque, marker of accelerated atherosclerosis, in RA patients.
References
Solomon DH, Goodson NJ, Katz JN, et al. Patterns of cardiovascular risk in rheumatoid arthritis. Ann Rheum Dis 2006; 65: 1608-1612. https://doi.org/10.1136/ard.2005.050377
Maradit-Kremers H, Crowson CS, Nicola PJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2005; 52: 402-411. https://doi.org/10.1002/art.20853
Peters MJ, van Halm VP, Voskuyl AE, et al. Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study. Arthritis Rheum 2009; 61: 1571-1579. https://doi.org/10.1002/art.24836
Peters MJ, Symmons DP, McCarey D, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010; 69: 325-331. https://doi.org/10.1136/ard.2009.113696
Symmons DP, Jones MA, Scott DL, Prior P. Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. J Rheumatol 1998; 25: 1072- 7.
Wallberg-Jonsson S, Ohman ML, Dahlqvist SR. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J Rheumatol 1997; 24: 445-51.
Mutru O, Laakso M, Isomaki H, Koota K. Ten year mortality and causes of death in patients with rheumatoid arthritis. BMJ 1985; 290: 1797-9. https://doi.org/10.1136/bmj.290.6484.1797
Isomaki HA, Mutru O, Koota K. Death rate and causes of death in patients with rheumatoid arthritis. Scand J Rheumatol 1975; 4: 205-8. https://doi.org/10.3109/03009747509165257
Erhardt CC, Mumford PA, Venables PJ, Maini RN. Factors predicting a poor life prognosis in rheumatoid arthritis: an eight year prospective study. Ann Rheum Dis 1989; 48: 7-13. https://doi.org/10.1136/ard.48.1.7
Kobayashi H, Giles JT, Polak JF, Blumenthal RS, Leffell MS, Szklo M, Petri M, Gelber AC, Post W, Bathon JM. Increased prevalence of carotid artery atherosclerosis in rheumatoid arthritis is artery-specific. J Rheumatol 2010; 37(4): 730-9. https://doi.org/10.3899/jrheum.090670
Park YB, Lee SK, Lee WK, Suh CH, Lee CW, Lee CH, et al. Lipid profiles in untreated patients with rheumatoid arthritis. J Rheumatol 1999; 26: 1701-4. https://doi.org/10.1016/S0002-9343(02)01186-5
Park Y-B, Choi HK, Kim M-Y, Lee W-K, Song J, Kim D-K, et al. Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: a prospective study. Am J Med 2002. In press.
Kaplan MJ. Cardiovascular disease in rheumatoid arthritis. Curr Opin Rheumatol 2006; 18(3): 289-97. https://doi.org/10.1097/01.bor.0000218951.65601.bf
Singh H, Goyal M, Sen J, et al. Correlation of Intima Media Thickness (as a Marker of Atherosclerosis) with Activity and Duration of Rheumatoid Arthritis using Carotid Ultrasound JIACM 2011; 12(1): 15-20.
Mohan V, Ravikumar R, Shanthi Rani S, Deepa R. Intimal medial thickness of the carotid artery in South Indian diabetic and non-diabetic subjects: The Chennai Urban Population Study. Diabetologia 2000; 43: 494-9. https://doi.org/10.1007/s001250051334
Casadei A, Floreani M, Catalini R, Serra C, Assanti AP, Concif P. Sonographic characteristics of carotid artery plaques: Implications for follow-up planning? J Ultrasound 2012; 15(3): 151-157. https://doi.org/10.1016/j.jus.2012.06.002
Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular Manifestations in Rheumatoid Arthritis. Maedica 2010; 5(4): 286-91.
Mandal SK, Sarkar P, Sarkar RN, et al. Assessment of carotid atherosclerosis in rheumatoid arthritis in Asian Indian cohort: a cross-sectional study. JEMDS 2016; 5(65): 4666- 72. https://doi.org/10.14260/jemds/2016/1063
Myasoedova E, Crowson CS, Kremers HM, et al. Is the incidence of rheumatoid arthritis rising? Results from Olmsted County, Minnesota, 1955-2007. Arthritis Rheum 2010; 62: 1576-82. https://doi.org/10.1002/art.27425
Pawlowska J, Solenska Z, Daca A, et al. Older age of rheumatoid arthritis onset is associated with higher activation status of peripheral blood CD4+ T cells and disease activity. Clin Exp Immunol 2011; 163(2): 157-184. https://doi.org/10.1111/j.1365-2249.2010.04294.x
Jawaheer D, Olsen J, Lahiff M, et al. Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA study. Clin Exp Rheumatol 2010; 28(4): 454- 461.
Extra-Articular-Manifestations-Of-Rheumatoid-ArthritisNow.pdf
[Internet].
[cited 2017 Oct 15]. Available from: http: //emjreviews.com/wp-content/uploads/Extra-ArticularManifestations-Of-Rheumatoid-Arthritis-Now.pdf.
Syed KM, Pinals RS, et al. Leukocytosis in Rheumatoid Arthritis. J Clin Rheumat 1996; 2(4): 197-202. https://doi.org/10.1097/00124743-199608000-00007
Silva I, Mateus M, Branco JC, et al. Assessment of ESR and CRP on RA activity prediction. Acta Rhematol Port 2010; 35(5): 456-62.
Park Y‐B, Ahn C‐W, Choi HK. Atherosclerosis in rheumatoid arthritis: Morphologic evidence obtained by carotid ultrasound. Arthritis Rheum 2002; 46: 1714-19. https://doi.org/10.1002/art.10359
Harrison’s principles of Internal Medicine,19th Edition, chap 380: p. 2898.
Del Val del Amo N, Ibanez Bosch R, Fito Manteca C. Anticyclic citrullinated peptide antibody in rheumatoid arthritis: relation with disease aggressiveness. Clin Exp Rheumatol 2006; 24(3): 281-6.
Itcheson CT, Peebles C, Joslin F. Characteristics of anti neuclear antibodies in rheumatoid arthritis. Arthritis Rheum 1980; 23: 528-38. https://doi.org/10.1002/art.1780230503
Cardiovascular involvement in Rheumatoid Arthritis. pdf
[Internet].
[cited 2017 Nov 15]. Available from http://www.apiindia.org/pdf/ medicine_update_2011/ 48_cardiovascular_involvement_ in.pdf.
Roman Matty J, Moeller E, Adrienne D, et al. Preclinical carotid atherosclerosis in patients with RA. Ann Intern Med 2006; 144: 249-56. https://doi.org/10.7326/0003-4819-144-4-200602210- 00006
Pope JE, Nevskaya T, Barra L, et al. Varotid Artery Atherosclerosis in patients with active Rheumatoid Arthitis. Open Rheumat J 2016: 10: 49-59. https://doi.org/10.2174/1874312901610010049
Gonzalez JC, Llorca J, Terta A, et al. Increased prevalence of severe sub-clinical atherosclerosis findings in long-term treated RA patients without clinically evident atherosclerotic disease. Medicine (Baltimore) 2003; 82: 407-13. https://doi.org/10.1097/01.md.0000101572.76273.60
DelRincon I, Freeman GL, Hass RW, et al. Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestation to atherosclerosis. Arthritis Rheum 2005; 52: 3413-23. https://doi.org/10.1002/art.21397
Mahajan V, Handa R, Kumar U, et al. Assessment of atherosclerosis by carotid intimomedial thickness in patients with rheumatoid arthritis. JAPI 2008; 56: 587-90.
