类风湿关节炎诊断后 5 年内的颈动脉粥样硬化：一项横断面研究。

Carotid atherosclerosis in the first five years since rheumatoid arthritis diagnosis: a cross sectional study.

机构信息

Rheumatology Service, Internal Medicine Department, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.

Cardiology Service, Internal Medicine Department, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.

出版信息

Adv Rheumatol. 2023 Jul 28;63(1):36. doi: 10.1186/s42358-023-00319-x.

DOI:10.1186/s42358-023-00319-x

PMID:37507812

Abstract

BACKGROUND

Systemic inflammation, documented before rheumatoid arthritis (RA) diagnosis, is associated with accelerated atherosclerosis. We aimed to compare the prevalence of carotid plaque (CP) in RA patients in the first five years since diagnosis and healthy controls, and to determine disease characteristics associated with the presence of subclinical atherosclerosis in RA patients.

METHODS

This was a cross-sectional study. We recruited 60 RA patients in the first five years since diagnosis and 60 matched healthy controls. Carotid ultrasound was performed to detect the presence of CP and measure carotid-intima media thickness (cIMT). Subclinical atherosclerosis was considered as the presence of CP and/or increased cIMT. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were made with Chi-square or Fisher's exact test for qualitative variables and Student's t or Mann-Whitney's U test for quantitative variables. A p-value < 0.05 was considered significant.

RESULTS

There were no differences in the demographic characteristics between RA patients and controls. The mean disease duration was 2.66 ± 1.39 years. A higher prevalence of CP (30.0% vs. 11.7%, p = 0.013), bilateral CP (18.3% vs. 3.3%, p = 0.008), increased cIMT (30.0% vs. 6.7%, p = 0.001), and subclinical atherosclerosis (53.3% vs. 18.3%, p = < 0.001) was found in RA patients. RA patients with subclinical atherosclerosis were older (56.70 years vs. 50.00 years, p = 0.002), presented a higher prevalence of dyslipidemia (53.1% vs. 14.3%, p = 0.002), and higher prevalence of classification in moderate-high disease activity category measured by DAS28-CRP (68.8% vs. 35.7%, p = 0.010). The latter variable persisted independently associated with subclinical atherosclerosis in the binary logistic regression (OR 6.11, 95% CI 1.51-24.70, p = 0.011).

CONCLUSIONS

In the first five years since diagnosis, higher prevalence of subclinical atherosclerosis, including CP was found in RA patients. Carotid ultrasound should be considered part of the systematic CVR evaluation of RA at the time of diagnosis.

摘要

背景

类风湿关节炎（RA）诊断前的系统性炎症与动脉粥样硬化的加速发展有关。本研究旨在比较 RA 患者在诊断后五年内与健康对照组之间颈动脉斑块（CP）的患病率，并确定与 RA 患者亚临床动脉粥样硬化相关的疾病特征。

方法

这是一项横断面研究。我们招募了 60 名 RA 患者和 60 名匹配的健康对照组，这些患者在诊断后五年内。通过颈动脉超声检测 CP 的存在并测量颈动脉内膜中层厚度（cIMT）。亚临床动脉粥样硬化被认为是 CP 的存在和/或 cIMT 增加。通过 Kolmogorov-Smirnov 检验评估分布。对于定性变量，采用卡方检验或 Fisher 精确检验进行比较，对于定量变量，采用 Student t 检验或 Mann-Whitney U 检验进行比较。p 值<0.05 被认为具有统计学意义。

结果

RA 患者和对照组在人口统计学特征方面无差异。平均疾病持续时间为 2.66±1.39 年。RA 患者 CP（30.0% vs. 11.7%，p=0.013）、双侧 CP（18.3% vs. 3.3%，p=0.008）、cIMT 增加（30.0% vs. 6.7%，p=0.001）和亚临床动脉粥样硬化（53.3% vs. 18.3%，p<0.001）的患病率更高。存在亚临床动脉粥样硬化的 RA 患者年龄更大（56.70 岁 vs. 50.00 岁，p=0.002），血脂异常的患病率更高（53.1% vs. 14.3%，p=0.002），且疾病活动度评估的 DAS28-CRP 分类中度-高度疾病活动的患者比例更高（68.8% vs. 35.7%，p=0.010）。在校正了年龄和疾病活动度等混杂因素后，二元逻辑回归分析显示，DAS28-CRP 分类为中度-高度疾病活动度与亚临床动脉粥样硬化独立相关（OR 6.11，95%CI 1.51-24.70，p=0.011）。