Department of Rheumocardiology, V.A. Nasonova Research Institute of Rheumatology, Kashirskoe Shosse 34A, Moscow, Russian Federation, 155522.
Department of Systemic Rheumatic Diseases, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation.
Rheumatol Int. 2018 Feb;38(2):211-217. doi: 10.1007/s00296-017-3860-9. Epub 2017 Oct 27.
Accelerated coronary atherosclerosis is common in patients with rheumatoid arthritis (RA). To examine coronary artery calcification (CAC) frequency and severity, its correlation with traditional risk factors (TRF) of cardiovascular diseases (CVD) and inflammatory markers in patients with early RA prior to anti-rheumatic therapy. RA adult patients (ACR/EULAR criteria, 2010, duration ≤ 12 months, without prior administration of disease-modifying anti-rheumatic drugs, glucocorticoids) underwent 32-row scanning for CAC scoring. Agatston, volume and mass calcium scores were calculated. Additionally, we used calculators on the website of the Multi-Ethnic Study of Atherosclerosis. 74 RA patients (women n = 54 (73%), median age 56 years, median RA duration 6 months) with moderate/high RA activity (median DAS28 [ESR] 5.4) were enrolled within the framework of the observational study. Most of the patients had multiple TRFs of CVD and subclinical organ damage. CAC has been detected in 34 (46%) early RA patients. Calcification severity was significantly higher in men and in patients with ischemic heart disease (IHD). In patients younger than 45 years (n = 16) CAC was not detected. Among patients older than 45 years (n = 58), the frequency of CAC was 59%: asymptomatic patients-n = 46 (48%), IHD patients-n = 12 (100%). Among asymptomatic patients the presence of CAC associated with a significantly higher frequency of arterial hypertension (1.6 fold) compared with cases without CAC. Coronary age in asymptomatic patients with CAC and IHD patients was significantly greater than their actual age. More than half of early RA patients older 45 years had CAC. The presence and severity of CAC correlated positively with TRFs, but not with lipid levels and RA activity.
动脉粥样硬化加速在类风湿关节炎（RA）患者中很常见。为了检查 RA 患者在接受抗风湿治疗前的冠状动脉钙化（CAC）频率和严重程度，及其与心血管疾病（CVD）传统危险因素（TRF）和炎症标志物的相关性，我们对符合 ACR/EULAR 标准（2010 年）的成年 RA 患者（病程≤12 个月，无疾病修饰抗风湿药物、糖皮质激素治疗史）进行了 32 层螺旋 CT 扫描以进行 CAC 评分。计算了 Agatston、容积和质量钙评分。此外，我们还使用了多民族动脉粥样硬化研究网站上的计算器。在观察性研究框架内，我们纳入了 74 例 RA 患者（女性 n=54（73%），中位年龄 56 岁，中位 RA 病程 6 个月），这些患者的 RA 活动度处于中高度（中位 DAS28[ESR]5.4）。大多数患者存在多种 CVD 的 TRF 和亚临床器官损害。34 例（46%）早期 RA 患者检测到 CAC。男性和缺血性心脏病（IHD）患者的钙化严重程度显著更高。年龄小于 45 岁的患者（n=16）未检测到 CAC。年龄大于 45 岁的患者（n=58）中 CAC 的发生率为 59%：无症状患者 n=46（48%），IHD 患者 n=12（100%）。在无症状患者中，CAC 的存在与 CAC 患者动脉高血压的发生频率显著增加相关（1.6 倍），而 CAC 患者的发生频率则无差异。有 CAC 的无症状患者和 IHD 患者的冠状动脉年龄明显大于其实际年龄。超过一半的年龄大于 45 岁的早期 RA 患者存在 CAC。CAC 的存在和严重程度与 TRF 呈正相关，但与血脂水平和 RA 活动度无关。
