PHILADELPHIA — The increased atherosclerotic disease that generally accompanies rheumatoid arthritis may not consistently involve carotid artery stenosis, according to two reports at the annual meeting of the American College of Rheumatology.
In one study with 195 rheumatoid arthritis patients and a nearly equal number of controls, carotid atherosclerosis was not clearly linked with coronary atherosclerosis in patients with RA, although the link existed in control patients, said Dr. Jon T. Giles, a rheumatologist at Johns Hopkins Medical Center in Baltimore.
Results from a second study, a meta-analysis of 22 prior reports with 1,384 RA patients, showed that the average extent of carotid intima-media thickness was “far less than expected.” Patients' average carotid stenosis corresponded to about a 10%-15% increase in cardiovascular risk, compared with similar people without RA, said Dr. Michael T. Nurmohamed, a rheumatologist at the Free University Medical Center in Amsterdam.
But the relationship between RA and carotid disease is more complex, according to a second set of results reported by Dr. Nurmohamed. Preliminary results from measurement of carotid intima-media thickness in 100 patients with RA showed enough stenosis to produce “a significantly increased cardiovascular risk,” Dr. Nurmohamed said.
“What is the best way to assess atherosclerosis in RA patients? For now, there is no recommendation on how to measure” subclinical cardiovascular disease, Dr. Giles said in an interview.
The study he reported included 195 RA patients enrolled in ESCAPE-RA (Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis). Patients were 45-84 years old at enrollment and met the 1987 ACR classification criteria for RA, with moderate disease activity on average.
For this analysis, the RA patients were matched by age, sex, and ethnicity with 198 controls who did not have RA. Carotid intima-media thickness was measured by B-mode ultrasound, and coronary calcium was measured by multidetector row CT.
The results showed that carotid stenosis was linked to a high level of coronary calcium in both the RA patients and controls. But many RA patients without carotid atherosclerosis nonetheless had an increased prevalence of coronary calcium, an incongruous combination that was not seen in the controls.
“The absence of carotid atherosclerosis cannot rule out coronary atherosclerosis in RA patients in the same way that it does in the general population,” Dr. Giles said.
The meta-analysis of 22 studies by Dr. Nurmohamed and his associates involved a total of 1,147 controls as well as more than 1,300 RA patients. In 17 of the studies, the carotid intimal-medial thickness was greater in the RA patients than in the controls. But the average intimal-medial thickness in the RA patients was 0.71 mm, an average of 0.09 mm larger than in the controls, a difference that corresponds to a modest 10%-15% higher rate of cardiovascular risk.
The carotid data collected directly by Dr. Nurmohamed and his associates came from the CARRÉ (Cardiovascular Research and Rheumatoid Arthritis) study, a prospective study that tracked the incidence of cardiovascular events in patients with RA and in controls.
So far, they have measured the carotid intima-media thickness in 100 of these RA patients. In this preliminary assessment, the average intima-media thickness in RA patients was 0.83 mm. The carotid atherosclerosis in RA patients showed no link with inflammatory parameters or with disease duration, Dr. Nurmohamed said.
Arthritis patients' carotid stenosis corresponded with 'a significantly increased cardiovascular risk.'
Source DR. NURMOHAMED