Giles Jon T, Post Wendy S, Blumenthal Roger S, Polak Joseph, Petri Michelle, Gelber Allan C, Szklo Moyses, Bathon Joan M
Columbia University, New York, New York, USA.
Arthritis Rheum. 2011 Nov;63(11):3216-25. doi: 10.1002/art.30542.
To explore predictors of change in measures of carotid atherosclerosis among rheumatoid arthritis (RA) patients without known cardiovascular disease (CVD) at baseline.
RA patients underwent carotid ultrasonography at 2 time points separated by a mean ± SD of 3.2 ± 0.3 years. The associations of baseline and average patient characteristics with the average yearly change in the mean maximal intima-media thickness (IMT) of the common carotid artery (CCA) and the internal carotid artery (ICAs) and with incident or progressive plaque in the ICA/carotid bulb, were explored.
Among the 158 RA patients, the maximal CCA-IMT increased in 82% (median 16 μm/year; P < 0.001) and the maximal ICA-IMT increased in 70% (median 25 μm/year; P < 0.001). Incident plaque was observed in 14% of those without plaque at baseline (incidence rate 4.2 per 100 person-years [95% confidence interval 1.6, 6.8]). Plaque progression was observed in 5% of those with plaque at baseline. Among RA predictors, the adjusted average yearly change in the maximal CCA-IMT was significantly greater in patients with earlier RA than in those with disease of longer duration. Those taking tumor necrosis factor (TNF) inhibitors at baseline had a 37% lower adjusted rate of progression in the maximal CCA-IMT compared with nonusers (14 μm/year versus 22 μm/year; P = 0.026). For the maximal ICA-IMT, cumulative prednisone exposure was associated with progression after adjustment (1.2 μm/year per gm [95% confidence interval 0.1, 2.4]) and was lower in patients who were prescribed statins concomitant with prednisone. Higher swollen joint counts and higher average C-reactive protein levels were both associated with incident or progressive plaque, primarily in patients with elevated CVD risk at baseline based on the Framingham Risk Score.
These prospective data provide evidence that inflammation is a contributor to the progression of subclinical atherosclerosis in RA and that it is potentially modified favorably by TNF inhibitors and detrimentally by glucocorticoids.
探讨基线时无已知心血管疾病（CVD）的类风湿关节炎（RA）患者颈动脉粥样硬化测量指标变化的预测因素。
RA患者在两个时间点接受颈动脉超声检查，时间间隔平均为3.2±0.3年。探讨基线和患者平均特征与颈总动脉（CCA）和颈内动脉（ICA）平均最大内膜中层厚度（IMT）的年均变化以及ICA/颈动脉窦处新发或进展性斑块之间的关联。
在158例RA患者中，82%的患者CCA最大IMT增加（中位数为16μm/年；P<0.001），70%的患者ICA最大IMT增加（中位数为25μm/年；P<0.001）。在基线时无斑块的患者中，14%观察到新发斑块（发病率为每100人年4.2例[95%置信区间1.6，6.8]）。在基线时有斑块的患者中，5%观察到斑块进展。在RA预测因素中，早期RA患者的CCA最大IMT调整后年均变化显著大于病程较长的患者。与未使用者相比，基线时服用肿瘤坏死因子（TNF）抑制剂的患者CCA最大IMT调整后进展率低37%（分别为14μm/年和22μm/年；P=0.026）。对于ICA最大IMT，调整后累积泼尼松暴露与进展相关（每克1.2μm/年[95%置信区间0.1，2.4]），同时服用他汀类药物与泼尼松的患者该值较低。较高的肿胀关节计数和较高的平均C反应蛋白水平均与新发或进展性斑块相关，主要见于基于弗雷明汉姆风险评分在基线时心血管疾病风险升高的患者。
这些前瞻性数据提供了证据，表明炎症是RA中亚临床动脉粥样硬化进展的一个因素，并且TNF抑制剂可能对其有有利影响，而糖皮质激素可能对其有不利影响。
