Duplex study of the carotid and femoral arteries of patients with rheumatoid arthritis: a controlled study.
BACKGROUND
"Ultrasonic biopsy" (U-B) is a noninvasive screening technique to detect early atherosclerotic plaques and arterial wall changes.


OBJECTIVE
To identify atherosclerosis (AS) in the common carotid artery (CCA) and common femoral artery (CFA) of patients with rheumatoid arthritis (RA) and their matched controls.


METHODS
Fifty-seven consecutive RA patients were enrolled in the study. Controls were matched by age, sex, ethnicity, and AS risk factors. All patients and controls underwent U-B study of the CCA and CFA. The U-B features were classified and scored as follows: Class A, normal (score 0); Class B, interface disruption (score 2); class C, intima-media (I-M) granulation (score 4); Class D, plaque without hemodynamic disturbance (score 6); Class E, stenotic plaque (score 8); and Class F, plaque with symptoms (score 10). Total score per patient was calculated. Classes A-B indicate an intact media or minimal interphase changes; classes D-F point to a significant medial involvement. Class C signifies a borderline lesion, with a potential for regression to normal, being unchanged, or progression to a plaque.


RESULTS
Mean ages were 52.1 years for RA and 51.4 years for controls (P = 0.81). Eighty-six percent of the patients and 85% of controls were women. The mean disease duration of RA was 12.8 years. Frequencies of risk factors among the RA patients compared with controls were hypertension (28% versus 32%), smoking (37% versus 29%), dyslipidemia (23% versus 25%), diabetes mellitus (DM) (14% versus 14%), and family history of cardiovascular disease (CVD) (4% versus 7%). Forty-five percent of the RA patients had at least a single Classes D-F lesion (plaque) in 1 of the 4 vessels tested, compared with 40% in the control group (P = 0.19). The mean total U-B scores of the RA patients and controls were not significantly different (8.87 versus 9.49, P = 0.7). Univariate analyses have shown that the development of plaques in RA patients was associated with age >50 years, disease duration, hypertension, dyslipidemia, and smoking. Multivariate analysis found plaques to be strongly associated with age above 50 years and dyslipidemia.


CONCLUSIONS
In unselected RA patients, besides classic AS risk factors, older age and longstanding disease may help predict the development of a severe morphological expression of AS.
Abu-Shakra
Mahmoud
M
Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. mahmoud@bgumail.bgu.ac.il
Polychuck
Ilya
I
Szendro
Gabriel
G
Bolotin
Arkadi
A
Jonathan
Bat-Sheva
BS
Flusser
Daniel
D
Buskila
Dan
D
Sukenik
Shaul
S
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016037:Single-Blind Method; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*