Abstract 1904: Atherosclerosis is Present in Recent Onset Rheumatoid Arthritis: A Critical Role for Inflammation.
Background: Rheumatoid arthritis (RA) is associated with cardiovascular mortality and morbidity. Carotid intima-media thickness (cIMT) is a marker of subclinical disease that correlates with atherosclerotic burden, and increased cIMT is reported in established RA. We sought whether cIMT is increased in pts with early RA.
Methods: We studied 40 pts (mean age 53 y) with early RA (symptoms <12m), and 40 control pts matched for age, sex and risk factors, including history of smoking, hypertension, diabetes, hyperlipidemia, family history, fasting lipid profile, and body mass index. All pts underwent carotid imaging using a 12 MHz probe (Philips ie33) and automated measurement of cIMT (Qlab, Philips).
Results: Pts with RA had significantly higher average cIMT than control pts (0.64±0.13 mm vs. 0.58±0.09 mm, p = 0.03), and 10 pts with RA had abnormal cIMT, compared with 3 control pts (p=0.002). cIMT correlated with age in RA pts and controls (p<0.001). In RA, cIMT was associated with duration of smoking (p<0.001), blood pressure (p<0.001), CRP (p=0.02) and disease activity score at presentation and before anti-rheumatic therapy (p=0.001). Independent associations of cIMT were identified with age, ESR, CRP and number of swollen joints - together these accounted for 90 % of the variance.
Conclusions: This study shows for the first time that early RA is associated with increased atherosclerotic burden, and further support an inflammatory association of vascular disease in RA. Since small elevations in CRP have been shown to precede onset of RA, this association between inflammation and accelerated atherogenesis might suggest that vascular disease may precede RA symptom onset.