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Background: Carotid plaque (CP) is one of the surrogate markers of atherosclerosis. The association of ultrasound carotid and tibial intima-media morphology abnormalities with clinical and laboratory markers of atherosclerosis in patients with rheumatoid arthritis (RA) is uncertain. Objectives: To determine the diagnostic and prognostic value of the carotid and tibial arteries ultrasound changes in women with RA, depending on age, menopause and laboratory parameters. Methods: The study was performed on 105 women with RA according to the ACR/EULAR 2010 criteria in the mean age 44,2±13,3 years without history of CVD. Female patients were divided in two groups by menopause: 51.4% premenopausal (PreM) and 48.6%; postmenopausal (PM) women. Carotid and tibial arteries ultrasonography examination included the measurement of cIMT in 3 points, detection of focal plaques in the extracranial carotid tree, blood flow velocity and morphology of the intima was performed. 30 age-matched healthy women were examined by the same parameters. Results: The сIMT > 0.9 mm was detected in 38 (36.2%) patients. Patients with cIMT > 0.9 mm had significantly higher age, RA duration, serum levels of the total cholesterol (TC), LDL, apolipoprotein apo B and CRP. CPs were observed three times more often in patient with cIMT > 0.9 mm than without thickness of carotid intima-media (cIM) ((50% vs 16,4%, p 0.9 mm (97.4%). In the most Prem RA women (58.1%) with low CV risk according to mSCORE calcinosis of the tibial artery (TA) was identified. Among the patients with CP 86.7% had calcinosis of the TA, 92% of whom were PM. No vascular abnormalities were detected in healthy control. The TC and LDL levels were significantly higher in patients with CP, cIMT > 0.9 mm, TA fibrosis and calcinosis than without (5.4 mmol/L vs 4.6 mmol/L). The significant correlations between LDL level and cIMT > 0.9 mm (r=0.32; p= 0.04); presence of CP (r=0.38; p=0.00006), cIM fragmentation (r = 0.34; p = 0.0003), RI CA (r=0.21; p=0.03), diffuse TA fibrosis (r = 0.44; p = 0.03) were identified. The DAS28, CRP level, Vps CA, anti-CCP positivity, cIMT > 0.9 mm had high predictive value for the development TA fibrosis in PreM RA women. The TA calcinosis was positively correlated with carotid intima-media morphology abnormalities (χ2=31.6; p 0.9 mm (χ2=8.5; p Conclusion: According to the data of multiple logistic regression the risk factors for the development of moderate, high and very high CV risk in RA women were DAS28, levels of CRP and LDL, swollen joint count, menopause, cIMT > 0.9 mm and TA fibrosis. Prem RA women with low CV risk according to mSCORE, high level of TC and/or LDL, presents of cIMT > 0.9 mm and/or carotid intima-media morphology abnormalities and/or TA calcinosis can be candidate for initiation lipid-lowering therapy. Disclosure of Interests: None declared |
