Ferraz-Amaro Iván, Corrales Alfonso, Atienza-Mateo Belén, Vegas-Revenga Nuria, Prieto-Peña Diana, Blanco Ricardo, González-Gay Miguel Á
Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain.
Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39011 Santander, Spain.
J Clin Med. 2021 Oct 27;10(21):4975. doi: 10.3390/jcm10214975.
Patients with rheumatoid arthritis (RA) have a higher incidence of subclinical atherosclerosis and cardiovascular (CV) disease. It is postulated that the appearance of accelerated atherosclerosis in these patients is a consequence of the inflammation present in the disease. In this study, we aim to determine if baseline disease activity in patients with RA predicts the future development of carotid plaque. A set of consecutive RA patients without a history of CV events, cancer or chronic kidney disease, who did not show carotid plaque in a carotid ultrasound assessment, were prospectively followed up for at least 5 years. At the time of recruitment, CV risk factors and disease-related data, including disease activity scores, were assessed. At the end of the follow-up, a carotid ultrasound was repeated and patients were divided into two groups; those who developed carotid plaque, and those who did not. A multivariable regression analysis was performed to define the predictors for the development of carotid plaque. One hundred and sixty patients with RA were followed up for an average of 6 ± 1 years. After this time, 66 (41%) of the patients had developed carotid plaque, and 94 (59%) did not. Patients with carotid plaque were significantly older (47 ± 13 vs. 55 ± 9 years, < 0.001) at baseline, were more frequently diabetic (0% vs. 6%, = 0.028), and had higher total cholesterol (197 ± 36 vs. 214 ± 40 mg/dL, = 0.004) and LDL cholesterol (114 ± 35 vs. 126 ± 35 mg/dL, = 0.037) at the beginning of the study. After multivariable adjustment, patients who were in the moderate and high disease activity (DAS28-CRP) categories displayed a higher odds ratio for the appearance of carotid plaque (OR 2.26 [95% CI 1.02-5.00], = 0.044) compared to those in the DAS-28-CRP remission category. Remarkably, when patients were divided in patients within the low-risk SCORE category, and patients included in the remaining SCORE categories (moderate, high and very high), the relation between DAS28-CRP and the development of carotid plaque was only significant in the low-risk SCORE category. In conclusion, disease activity predicts the future development of subclinical atherosclerosis in patients with RA.
类风湿关节炎（RA）患者发生亚临床动脉粥样硬化和心血管（CV）疾病的几率更高。据推测，这些患者加速动脉粥样硬化的出现是该疾病中存在的炎症的结果。在本研究中，我们旨在确定RA患者的基线疾病活动度是否能预测颈动脉斑块的未来发展。一组连续的无CV事件、癌症或慢性肾病病史且在颈动脉超声评估中未显示颈动脉斑块的RA患者被前瞻性随访至少5年。在招募时，评估CV危险因素和疾病相关数据，包括疾病活动评分。随访结束时，重复进行颈动脉超声检查，并将患者分为两组；出现颈动脉斑块的患者和未出现的患者。进行多变量回归分析以确定颈动脉斑块形成的预测因素。160例RA患者平均随访6±1年。此后，66例（41%）患者出现了颈动脉斑块，94例（59%）未出现。有颈动脉斑块的患者在基线时年龄显著更大（47±13岁对55±9岁，P<0.001），糖尿病发生率更高（0%对6%，P=0.028），且在研究开始时总胆固醇更高（197±36对214±40mg/dL，P=0.004）和低密度脂蛋白胆固醇更高（114±35对126±35mg/dL，P=0.037）。经过多变量调整后，与处于DAS-28-CRP缓解类别的患者相比，处于中度和高度疾病活动（DAS28-CRP）类别的患者出现颈动脉斑块的比值比更高（OR 2.26[95%CI 1.02-5.00]，P=0.044）。值得注意的是，当将患者分为低风险SCORE类别内的患者和其余SCORE类别（中度、高度和非常高）的患者时，DAS28-CRP与颈动脉斑块形成之间的关系仅在低风险SCORE类别中显著。总之，疾病活动度可预测RA患者亚临床动脉粥样硬化的未来发展。
