Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, , Santander, Cantabria, Spain.
Ann Rheum Dis. 2013 Nov;72(11):1764-70. doi: 10.1136/annrheumdis-2013-203688. Epub 2013 Jul 13.
To determine the ability of Coronary Artery Calcification Score (CACS) and carotid ultrasonography in detecting subclinical atherosclerosis in rheumatoid arthritis (RA).
A set of 104 consecutive RA patients without history of cardiovascular (CV) events were studied to determine CACS, carotid intima-media thickness (cIMT) and plaques. Systematic Coronary Risk Evaluation (SCORE) modified according to the EULAR recommendations (mSCORE) was also assessed.
The mean disease duration was 10.8 years, 72.1% had rheumatoid factor and/or anti-CCP positivity and 16.4% extra-articular manifestations. Nine were excluded because they had type 2 diabetes mellitus or chronic kidney disease. CV risk was categorised in the remaining 95 RA patients according to the mSCORE as follows: low (n=21), moderate (n=60) and high/very high risk (n=14). Most patients with low mSCORE (16/21; 76.2%) had normal CACS (zero), and none of them CACS>100. However, a high number of patients with carotid plaques was disclosed in the groups with CACS 0 (23/40; 57.5%) or CACS 1-100 (29/38; 76.3%). 72 (75.8%) of the 95 patients fulfilled definitions for high/very high CV as they had an mSCORE ≥5% or mSCORE <5% plus one of the following findings: severe carotid ultrasonography findings (cIMT>0.9 mm and/or plaques) or CACS>100. A CACS>100 showed sensitivity similar to mSCORE (23.6% vs 19.4%). In contrast, the presence of severe carotid ultrasonography findings allowed identifying most patients who met definitions for high/very high CV risk (70/72; sensitivity 97.2% (95% CI 90.3 to 99.7)).
Carotid ultrasonography is more sensitive than CACS for the detection of subclinical atherosclerosis in RA.
确定冠状动脉钙化评分（CACS）和颈动脉超声在检测类风湿关节炎（RA）亚临床动脉粥样硬化中的作用。
对 104 例无心血管（CV）事件史的连续 RA 患者进行了研究，以确定 CACS、颈动脉内膜中层厚度（cIMT）和斑块。还评估了根据 EULAR 建议修改的系统性冠状动脉风险评估（SCORE）（mSCORE）。
平均病程为 10.8 年，72.1%的患者类风湿因子和/或抗 CCP 阳性，16.4%的患者有关节外表现。由于 9 例患者患有 2 型糖尿病或慢性肾脏病，因此将其排除在外。根据 mSCORE，将剩余的 95 例 RA 患者的 CV 风险分为以下几类：低危（n=21）、中危（n=60）和高危/极高危（n=14）。大多数低 mSCORE（21 例中的 16 例；76.2%）患者的 CACS 正常（零），且无一例 CACS>100。然而，在 CACS 为 0（40 例中的 23 例；57.5%）或 CACS 为 1-100（38 例中的 29 例；76.3%）的患者中，发现了大量的颈动脉斑块患者。72（95 例中的 75.8%）例患者符合高/极高 CV 定义，因为他们的 mSCORE≥5%或 mSCORE<5%且存在以下一种情况：严重颈动脉超声表现（cIMT>0.9mm 和/或斑块）或 CACS>100。CACS>100 的敏感性与 mSCORE 相似（23.6%比 19.4%）。相比之下，严重的颈动脉超声表现有助于确定大多数符合高/极高 CV 风险定义的患者（70/72；敏感性 97.2%（95%CI 90.3 至 99.7））。
颈动脉超声对 RA 亚临床动脉粥样硬化的检测比 CACS 更敏感。
