Subclinical atherosclerosis and endothelial dysfunction in patients with early rheumatoid arthritis as evidenced by measurement of carotid intima-media thickness and flow-mediated vasodilatation: an observational study.
OBJECTIVE
In this study, we aimed to investigate the frequency of endothelial dysfunction and subclinical atherosclerosis in early rheumatoid arthritis (RA) patients by carotid intima-media thickness (cIMT) and endothelial-dependent flow mediated vasodilatation (ED-FMD) as compared with healthy controls.


METHODS
The study included 35 early RA patients (disease duration <12 months) and 35 healthy controls. Intima-media thickness of common carotid artery and ED-FMD of brachial artery were measured by high-resolution ultrasonography. Disease activity of RA was assessed by Disease Activity Score and activities of daily living were determined by Health Assessment Questionnaire-Disability Index Score.


RESULTS
RA patients (age 38.3 ± 10.6 years) had average disease duration of 0.46 ± 0.28 years and 22 patients (62.9%) were rheumatoid factor (RF) positive (RF titer >9.56 IU/mL). There were no significant differences between age, sex, and lipid profiles of patient and control group. cIMT was significantly higher in RA patients (0.50 ± 0.16 mm) than in controls (0.44 ± 0.09 mm) (P = 0.007). Similarly, FMD% was significantly lower in RA patients [5.26 (2.9-10.6)] as compared with controls [10.34 (7.4-14.3)] (P = 0.004). Age, systolic blood pressure, tender joint count, and swollen joint count had significant correlations with patient cIMT. RF titer came out to be the major risk factor for increased cIMT of the patients.


CONCLUSIONS
Compared with controls, early RA patients have higher cIMT and lower FMD%, denoting premature atherosclerosis. Our data suggest that early determination of FMD% and cIMT may be useful tools to assess cardiovascular risk even in early RA patients.
Department of Rheumatology, Institute of Postgraduate Medical Education and Research, SSKM Hospital, Kolkata, India.
Maitrayee
M
Chatterjee Adhikari
Aharna
A
Guin
Sumit
S
Chakraborty
Pradyot
P
Sinhamahapatra
Alakendu
A
Ghosh
D000203:Activities of Daily Living; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology; D050197:Atherosclerosis / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000473:pathology; D017536:Carotid Artery, Common / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D015897:Comorbidity; D042241:Early Diagnosis; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006304:Health Status; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis / Q000503:physiopathology; D007194:India / Q000453:epidemiology; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D008297:Male; D011788:Quality of Life; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D014664:Vasodilation