Department of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary.
Department of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary.
Arthritis Res Ther. 2017 Sep 26;19(1):213. doi: 10.1186/s13075-017-1422-x.
Stroke has been associated with rheumatoid arthritis (RA). We assessed patients with RA and healthy control subjects by transcranial Doppler (TCD), carotid ultrasonography and brain magnetic resonance imaging (MRI).
Altogether, 41 female patients with RA undergoing methotrexate (MTX) or biologic treatment and 60 age-matched control subjects underwent TCD assessment of the middle cerebral artery (MCA) and basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI) and circulatory reserve capacity (CRC) were determined at rest (r) and after apnoea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) were also determined. Intracerebral vascular lesions were investigated by brain MRI.
MCA PI and RI values at rest and after apnoea were significantly increased in the total and MTX-treated RA populations vs control subjects. MCA CRC was also impaired, and basilar artery PI was higher in RA. More patients with RA had carotid plaques and increased cIMT. Linear regression analysis revealed that left PI(r) and RI(r) correlated with disease duration and that left PI(r), RI(r), PI(a), PI(h) and basilar PI correlated with disease activity. Right CRC inversely correlated with 28-joint Disease Activity Score. Disease activity was an independent determinant of left PI(a) and right CRC. Compared with long-term MTX treatment alone, the use of biologics in combination with MTX was associated with less impaired cerebral circulation. Impaired cerebral circulation was also associated with measures of carotid atherosclerosis.
To our knowledge, this is the first study to show increased distal MCA and basilar artery occlusion in RA as determined by TCD. Patients with RA also had CRC defects. We also confirmed increased carotid plaque formation and increased cIMT. Biologics may beneficially influence some parameters in the intracranial vessels.
中风与类风湿关节炎（RA）有关。我们通过经颅多普勒（TCD）、颈动脉超声和脑磁共振成像（MRI）评估了 RA 患者和健康对照者。
共有 41 名接受甲氨蝶呤（MTX）或生物治疗的女性 RA 患者和 60 名年龄匹配的对照者接受了大脑中动脉（MCA）和基底动脉的 TCD 评估。在休息时（r）和呼吸暂停（a）和过度通气（h）后，确定搏动指数（PI）、电阻率（阻力）指数（RI）和循环储备能力（CRC）。还确定了颈动脉斑块和颈动脉内膜中层厚度（cIMT）的存在。通过脑 MRI 研究了颅内血管病变。
在总 RA 和 MTX 治疗人群中，休息时和呼吸暂停后的 MCA PI 和 RI 值显着高于对照组。MCA CRC 也受损，RA 患者的基底动脉 PI 较高。更多的 RA 患者有颈动脉斑块和增加的 cIMT。线性回归分析显示，左侧 PI（r）和 RI（r）与疾病持续时间相关，而左侧 PI（r）、RI（r）、PI（a）、PI（h）和基底 PI 与疾病活动度相关。右侧 CRC 与 28 关节疾病活动评分呈反比。疾病活动是左侧 PI（a）和右侧 CRC 的独立决定因素。与单独长期使用 MTX 治疗相比，生物制剂联合 MTX 治疗与脑循环受损程度较轻相关。脑循环受损也与颈动脉粥样硬化的措施有关。
据我们所知，这是第一项通过 TCD 显示 RA 中远端 MCA 和基底动脉闭塞增加的研究。RA 患者也存在 CRC 缺陷。我们还证实了颈动脉斑块形成增加和 cIMT 增加。生物制剂可能有益地影响颅内血管的某些参数。
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