title: Screening for atherosclerosis in patients with rheumatoid arthritis: comparison of two in vivo tests of vascular function.
abstract: OBJECTIVE
  Inflammation appears to play a central role in atherosclerosis, and endothelial damage mediated by systemic inflammation may contribute to the increased cardiovascular mortality in rheumatoid arthritis (RA). Brachial artery flow-mediated dilatation (FMD) and pulse wave analysis (PWA) are measures of vascular function. The aim of this study was to determine if FMD and PWA are abnormal in patients with RA.
  
  
  METHODS
  Twenty-five RA patients and 25 matched healthy controls were studied. All were free of traditional cardiovascular risk factors. FMD was measured in all subjects. PWA was performed in 18 RA patients and 18 controls, with results expressed as large and small artery compliance (C1 and C2). Modified Sharp scores were calculated in 13 RA patients.
  
  
  RESULTS
  Results (mean +/- SD) in RA patients and controls, respectively, were as follows: FMD 107.6 +/- 4.6% versus 108.5 +/- 4.1% (P = 0.49), C1 14.8 +/- 2.8 ml/mm Hg x 10 versus 17.9 +/- 3.1 ml/mm Hg x 10 (P = 0.0033), C2 4.5 +/- 2.3 ml/mm Hg x 100 versus 7.7 +/- 3.7 ml/mm Hg x 100 (P = 0.0039). There was an inverse correlation between C2 and modified Sharp scores in the RA patients (Spearman's rho -0.69, P = 0.0085).
  
  
  CONCLUSIONS
  FMD was normal in these RA patients, whereas arterial compliance was markedly reduced. PWA appears to be a more sensitive measure of vascular dysfunction than FMD in RA and may be the preferred surrogate marker of vascular dysfunction in longitudinal studies of RA patients. The inverse correlation between C2 and the modified Sharp score, a measure that reflects disease activity over time, supports the notion that chronic inflammation plays a role in RA-associated atherosclerosis.
authors.affiliation: University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Van Doornum
authors.forename: G
authors.initials: G
authors.lastname: McColl
authors.forename: A
authors.initials: A
authors.lastname: Jenkins
authors.forename: D J
authors.initials: DJ
authors.lastname: Green
authors.forename: I P
authors.initials: IP
authors.lastname: Wicks
mesh_terms: D000328:Adult; D001161:Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology; D003187:Compliance; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D012307:Risk Factors; D014463:Ultrasonography; D014664:Vasodilation