RESUMO
Background: Mortality from cardiovascular disease (CVD) is increased in rheumatoid arthritis, not explained by traditional cardiovascular risk factors (CVRF), suggesting a role of inflammation. This process would occur early. The common sonographic markers of subclinical atherosclerosis (SA), are increased carotid intima-media thickness (cIMT) or the presence of carotid atherosclerotic plaque and they are closely related to CVD. Aims: To evaluate sonographic markers and cardiovascular risk factors in early Arthritis (EA). Methods: A case control study of patients with EA, defined by 3 joints swollen with <1 year of evolution, served consecutively from January 2011 to may 2013, matched with healthy controls, by sex, age and cardiovascular risk factors (hypertension, diabetes mellitus, cardiovascular disease -IAM and ACV, dyslipidemia, family history of CVD) was conducted. We studied demographics data, cardiovascular risk factors, carotid ultrasound measuring increased cIMT or the presence of carotid atherosclerotic plaque in Common Carotid Artery (CCA) and Carotid Bulb (BC), laboratory test that included cholesterol, LDL, HDL, triglycerides in mg%, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR ), anti citrullinated peptide (ACCP), rheumatoid factor (RF), antinuclear antibodies (ANA). EA activity was measured by DAS 28, considering high disease activity (HDA) 5.1; moderate (MDA) from 5.1 to 3.2; and low (LDA) <3.2. Statistics: test Mann-Whitney and chi-square were used, p <0.05 was significant. Results: 25 women, 5 men, average age 43 years (DS 14.7) and 30 controls were included. The average DAS 28 was 4, 8 ± 1. 8; 47% had HDA, 33%MDA and 20%BDA. Both groups had similar values cIMT CCA (0, 57 ± 0.10 mm vs. 0.58 ± 0.15 mm, respectively, P = 0.82) and cIMT BC (0.18mm ± 0.67 vs 0.62 ± 0.15 mm respectively, P = 0.47). There were no carotid plaques. The median total cholesterol was 181,5 vs 183,5 (p = 0.35); triglycerides 99 vs 92,5 (p = 0.68); HDL 54,5 vs 52,5 (p = 0.921 and LDL 105 vs 110 (p = 0.27) in EA and controls respectively. The cIMT CCA and CB were not related to RF, ACCP, CRP, DAS 28 and smoking (NS). There was no difference in other cardiovascular risk factors Conclusions: Ultrasound evidence of atherosclerosis subclinical markers was not found in this study, suggesting that this process may occur after a year of diagnosis.
Introducción: La mortalidad por Enfermedad cardiovascular (ECV) temprana está incrementada en enfermedades inflamatorias. Los marcadores ecográficos de aterosclerosis subclínica (AS) están estrechamente relacionados con ECV. Objetivo: Evaluar marcadores de AS ecográficos y Factores de Riesgo Cardiovascular (FRCV) en Artritis temprana (AT) y correlacionarlo con la actividad de la enfermedad. Material y Métodos: Estudio transversal de casos y controles en pacientes con AT, definida por 3 articulaciones inflamadas con menos de 1 año de evolución, realizado desde 2011 a 2013, apareados con controles sanos, por sexo, edad y FRCV. Se registraron datos demográficos, FRCV, rigidez de pared (cIMT) en Arteria Carótida Común (ACC) y en Bulbo Carotídeo (BC) y presencia de placas ateroscleróticas por ecografía, perfil lipídico, Proteína C Reactiva, eritrosedimentación, anticuerpos anti péptido citrulinado, Factor reumatoide, anticuerpos antinucleares. La actividad de AT se midió por Disease Activity Score (DAS) 28. Estadística: Se usaron test U de Mann-Whitney, Kruskal Wallis y chi-cuadrado, p <0,05 fue significativo. Resultados: Se incluyeron 25 mujeres, 5 hombres con edad promedio 40 años (18-61) y 30 controles. El DAS 28 promedio fue 4,8 ±1.8. Pacientes y controles tuvieron similares valores cIMT ACC (0, 57 ±0.10 mm vs 0,58 ± 0,15 mm, respectivamente) y cIMT CB (0,67 ±0,18mm vs 0,62 ±0,15 mm), no hubo placas carotídeas y el perfil lipídico fue similar en ambos grupos, PNS. El cIMT CCA y CB no tuvieron relación con DAS 28, serología, ni FRCV, P: NS. Conclusiones: La aterosclerosis subclínica se produciría después del primer año de enfermedad en artritis temprana.
