Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis.
OBJECTIVE
To estimate atherosclerosis progression and identify influencing factors in rheumatoid arthritis (RA).


METHODS
We used carotid ultrasound to measure intima-media thickness (IMT) in RA patients, and ascertained cardiovascular (CV) risk factors, inflammation markers and medications. A second ultrasound was performed approximately 3 years later. We calculated the progression rate by subtracting the baseline from the follow-up IMT, divided by the time between the two scans. We used logistic regression to identify baseline factors predictive of rapid progression. We tested for interactions of erythrocyte sedimentation rate (ESR) with CV risk factors and medication use.


RESULTS
Results were available for 487 RA patients. The mean (SD) common carotid IMT at baseline was 0.571 mm (0.151). After a mean of 2.8 years, the IMT increased by 0.050 mm (0.055), p≤0.001, a progression rate of 0.018 mm/year (95% CI 0.016 to 0.020). Baseline factors associated with rapid progression included the number of CV risk factors (OR 1.27 per risk factor, 95% CI 1.01 to 1.61), and the ESR (OR 1.12 per 10 mm/h, 95% CI 1.02 to 1.23). The ESR×CV risk factor and ESR×medication product terms were significant, suggesting these variables modify the association between the ESR and IMT progression.


CONCLUSIONS
Systemic inflammation and CV risk factors were associated with rapid IMT progression. CV risk factors may modify the role of systemic inflammation in determining IMT progression over time. Methotrexate and antitumour necrosis factor agents may influence IMT progression by reducing the effect of the systemic inflammation on the IMT.
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
Inmaculada
I
del Rincón
Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts, USA.
Joseph F
JF
Polak
Ultrasound Reading Center, Tufts Medical Center, Boston, Massachusetts, USA.
Daniel H
DH
O'Leary
Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Daniel F
DF
Battafarano
Division of Cardiology, Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
John M
JM
Erikson
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
Jose F
JF
Restrepo
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
Emily
E
Molina
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
Agustín
A
Escalante
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000235:genetics / Q000276:immunology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000276:immunology*; D001799:Blood Sedimentation; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000276:immunology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D059811:HLA-DRB1 Chains / Q000235:genetics; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000276:immunology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D010456:Peptides, Cyclic / Q000276:immunology*; D012217:Rheumatoid Factor / Q000276:immunology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D018501:Antirheumatic Agents; D059811:HLA-DRB1 Chains; D007004:Hypoglycemic Agents; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
Atherosclerosis; Cardiovascular Disease; Rheumatoid Arthritis