title: Validated methods for assessment of subclinical atherosclerosis in rheumatology.
abstract: Rheumatoid arthritis, as well as other types of arthritides and connective tissue diseases, is associated with accelerated atherosclerosis, and increased cardiovascular morbidity and mortality. The early signs of cardiovascular disease therefore need to be recognized in patients with these conditions so that effective cardiovascular protection can be introduced. This Review provides an overview of validated techniques that are currently available to determine subclinical atherosclerosis in patients with rheumatic conditions. Techniques for early assessment of endothelial dysfunction include brachial artery flow-mediated vasodilation and laser Doppler flowmetry. Coronary circulation can be assessed by measuring coronary flow reserve using CT, MRI or PET based techniques. The standard indicators of arterial stiffness are pulse-wave velocity and the augmentation index. Carotid atherosclerosis is determined by the common carotid intima-media thickness (ccIMT) measurement or by the assessment of plaques and plaque areas. The combination of ccIMT with plaque assessment is likely to increase the predictive value of this approach. The potential use of a multimarker approach to increase the diagnostic and prognostic value of these clinical assessments is also discussed.
authors.affiliation: Angiology and Intensive Care Unit, Third Department of Medicine, University of Debrecen Medical and Health Sciences Center, 98 Nagyerdei Street, Debrecen H-4032, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Kerekes
authors.forename: Pál
authors.initials: P
authors.lastname: Soltész
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gonzalez-Gay
authors.forename: Maurizio
authors.initials: M
authors.lastname: Turiel
authors.forename: Edit
authors.initials: E
authors.lastname: Végh
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: Iain
authors.initials: I
authors.lastname: McInnes
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szekanecz
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards*; D049268:Positron-Emission Tomography / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*