title: Imaging atherosclerosis in rheumatoid arthritis: evidence for increased prevalence, altered phenotype and a link between systemic and localised plaque inflammation.
abstract: In rheumatoid arthritis (RA), chronic inflammation is thought to drive increased cardiovascular risk through accelerated atherosclerosis. It may also lead to a more high-risk plaque phenotype. We sought to investigate carotid plaque phenotype in RA patients using Dynamic Contrast-Enhanced MRI (DCE-MRI) and Fludeoxyglucose Positron Emission Tomography(FDG-PET). In this pilot study, RA patients and age/sex-matched controls were evaluated for cardiovascular risk factors and carotid plaque on ultrasound. Subjects with plaque >2 mm thick underwent DCE-MRI, and a subgroup of patients had FDG-PET. Comparison of MRI findings between groups and correlation between clinical, serological markers and imaging findings was undertaken. 130 patients and 62 controls were recruited. Plaque was more prevalent in the RA group (53.1% vs 37.0%, p = 0.038) and was independently associated with IL6 levels (HR[95%CI]: 2.03 [1.26, 3.26] per quartile). DCE-MRI data were available in 15 patients and 5 controls. Higher prevalence of plaque calcification was noted in RA, despite similar plaque size (73.3% vs 20%, p = 0.04). FDG-PET detected plaque inflammation in 12/13 patients scanned and degree of inflammation correlated with hs-CRP (r = 0.58, p = 0.04). This study confirms increased prevalence of atherosclerosis in RA and provides data to support the hypothesis that patients have a high-risk plaque phenotype.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Medicine, Biology and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. sarah.skeoch@manchester.ac.uk.|The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. sarah.skeoch@manchester.ac.uk.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-9015-7762
authors.initials: S
authors.lastname: Skeoch
authors.affiliation: Centre for Imaging Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.|School of Psychological Sciences, The University of Manchester, Manchester, UK.
authors.forename: P L Hubbard
authors.initials: PLH
authors.lastname: Cristinacce
authors.affiliation: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: H
authors.initials: H
authors.lastname: Williams
authors.affiliation: Specialist Assay Laboratory, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Pemberton
authors.affiliation: Department of Radiology, University of Washington, Seattle, USA.
authors.forename: D
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Radiology, University of Washington, Seattle, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: James
authors.affiliation: Department of Radiology, University of Washington, Seattle, USA.
authors.forename: C
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Radiology, University of Washington, Seattle, USA.
authors.forename: T
authors.initials: T
authors.lastname: Hatsukami
authors.affiliation: MedTech West, Chalmers University of Technology, Gothenberg, Sweden.|Antaros Medical, Mölndal, Sweden.
authors.forename: P D
authors.initials: PD
authors.lastname: Hockings
authors.affiliation: Healthcare Science Research Institute, Manchester Metropolitan University, Manchester, UK.
authors.forename: M Y
authors.initials: MY
authors.lastname: Alexander
authors.affiliation: Centre for Imaging Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: J C
authors.identifier: http://orcid.org/0000-0002-7734-2290
authors.initials: JC
authors.lastname: Waterton
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Medicine, Biology and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.|The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: I N
authors.initials: IN
authors.lastname: Bruce
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D049268:Positron-Emission Tomography; D015995:Prevalence; D019275:Radiopharmaceuticals; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18