Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, Reade.
Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center.
Rheumatology (Oxford). 2021 Jul 1;60(7):3360-3368. doi: 10.1093/rheumatology/keaa789.
RA is associated with higher risk of cardiovascular (CV) disease. Ongoing systemic inflammation is presumed to accelerate atherosclerosis by increasing inflammation in the arterial wall. However, evidence supporting this hypothesis is limited. We aimed to investigate arterial wall inflammation in RA vs OA, and its association with markers of inflammation and CV risk factors.
18-fluorodeoxyglucose PET combined with CT (18F-FDG-PET/CT) was performed in RA (n = 61) and OA (n = 28) to investigate inflammatory activity in the wall of large arteries. Secondary analyses were performed in patients with early untreated RA (n = 30), and established RA, active under DMARD treatment (n = 31) vs OA.
Patients with RA had significantly higher 18F-FDG uptake in the wall of the carotid arteries (beta 0.27, 95%CI 0.11-0.44, P <0.01) and the aorta (beta 0.47, 95%CI 0.17-0.76, P <0.01) when compared with OA, which persisted after adjustment for traditional CV risk factors. Patients with early RA had the highest 18F-FDG uptake, followed by patients with established RA and OA respectively. Higher ESR and DAS of 28 joints values were associated with higher 18F-FDG uptake in all arterial segments.
Patients with RA have increased 18F-FDG uptake in the arterial wall compared with patients with OA, as a possible marker of early atherosclerosis. Furthermore, a higher level of clinical disease activity and circulating inflammatory markers was associated with higher arterial 18F-FDG uptake, which may support a role of arterial wall inflammation in the pathogenesis of vascular complications in patients with RA.
类风湿关节炎（RA）与心血管疾病（CV）风险增加相关。持续的全身炎症被认为通过增加动脉壁的炎症而加速动脉粥样硬化。然而，支持这一假说的证据有限。我们旨在研究 RA 与骨关节炎（OA）患者的动脉壁炎症及其与炎症标志物和 CV 危险因素的关系。
对 61 例 RA 患者和 28 例 OA 患者进行 18-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG-PET）联合 CT（18F-FDG-PET/CT）检查，以研究大动脉壁的炎症活性。对未经治疗的早期 RA（n=30）、接受 DMARD 治疗的活动性 RA（n=31）和 OA 患者进行了二次分析。
与 OA 相比，RA 患者颈动脉壁（β 0.27，95%CI 0.11-0.44，P<0.01）和主动脉壁（β 0.47，95%CI 0.17-0.76，P<0.01）的 18F-FDG 摄取明显更高，调整传统 CV 危险因素后仍如此。早期 RA 患者的 18F-FDG 摄取最高，其次是活动性 RA 患者和 OA 患者。所有动脉节段的 18F-FDG 摄取与较高的 ESR 和 28 关节 DAS 值相关。
与 OA 患者相比，RA 患者的动脉壁 18F-FDG 摄取增加，这可能是早期动脉粥样硬化的标志物。此外，更高的临床疾病活动度和循环炎症标志物与更高的动脉 18F-FDG 摄取相关，这可能支持动脉壁炎症在 RA 患者血管并发症发病机制中的作用。
