Non traditional risk factors of carotid atherosclerosis in rheumatoid arthritis

ABSTRACT

Cardiovascular events are markedly increased in rheumatoid arthritis, and they remain poorly understood. To investigate inflammatory markers, markers of endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis-related factors as non traditional risk factors for occurrence of carotid atherosclerosis in rheumatoid arthritis patients. Thirty RA patients were included in this study. All of them were females and their ages ranged from 23 to 62 years with a mean of 43.95 +/- 7.2 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment, bone erosion assessment by Modified Larsen score and functional assessment by health assessment questionnaire [HAQ] score. Carotid Duplex was done to measure the intima-media thickness [IMT] and carotid plaques. The patients who proved to have carotid atherosclerosis by ultrasound were subjected to ultrasound examination of brachial artery flow mediated dilatation [FMD] to confirm presence of endothelial dysfunction in those patients. Ten out of 30 RA patients [33.3%] had carotid atherosclerosis in whom there was impaired FMD denoting endothelial dysfunction. Among those patients, the risk factors that associated with occurrence of carotid atherosclerosis included higher levels of inflammatory markers [CRP, ESR and IL-6] and VCAM-1 [a marker of endothelial dysfunction], lower levels of antioxidant vitamins A and E, and RA-related factors as longer duration of disease, increased RF titer, increased HAQ-score, bone erosion, duration of prednisone use and prednisone cumulative dose. The prevalence of carotid atherosclerosis in rheumatoid arthritis patients was 33.3%. Among those patients, a statistically significant association was found between occurrence of carotid atherosclerosis and inflammatory markers, endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis related factors