THU0441 Endothelial disfunction in polymyalgia rheumatica

Background Polymyalgia Rheumatica(PMR)is an inflammatory disease that affects people over 50 years old, characterised by pain and functional limitation of shoulder and hip, acute phase reactant elevation and a dramatic response to low doses of steroids. Atherosclerosis is a chronic inflammatory process that affects the arterial vessels of multiple districts. Endothelial dysfunction is an early event of the atherogenic process. Chronic inflammatory diseases have an increased risk of accelerated atherosclerosis and cardiovascular disease. A study on 41 subjects with giant cell arteritis with and without PMR showed an increased mean-intimal thickness, suggesting a pro-atherogenic role of PMR. However there are no studies that evaluated endothelial dysfunction which is a more precocious marker of subclinical atherosclerosis in PMR patients Objectives Aim of the study was to compare endothelial function among PMR patients to a control population. Moreover, the trend of endothelial disfuncion was evaluated over time in relationship to the improvement of clinical, laboratory and instrumental parameters. Methods The study involved 16 treatment-naive patients with a new PMR diagnosis. Every 3 months routine visits were performed;at each visit laboratory and clinical data and the endothelial function at the brachial artery were evaluated. The endothelial function was evaluated at the brachial artery level after 15 min of rest; the brachial artery diameter and the basal flow was measured at baseline and after the positioning of sphygmomanometerfor 5 min to induce the forearm ischemia. The flow was measured again 15 s after deflation of the sleeve and 60–90 s after the diameter of the artery reassessed to obtain flow-mediated dilatation (FMD). The FMD, which represents endothelium-dependent vasodilatation was expressed as percentage increase to the starting diameter after stimulation Results 16 PMR patients(mean age 73.9±5.8, 7 Female)were compared with a population of 16 healthy controls age-matched(70.8±8.1,p=ns). The two groups differed for the values of Erythrocyte Sedimentation Rate(ESR)(61.1±28 vs 19.3±16 mm/h, p<0.001)and C-Reactive Protein (CRP)(35.6±28.1 mg/L vs 2.4±0.4 mg/L, p<0.001). At the sixth month of follow-up ESR was 31.2±29,9 mm/h while CRP was 8±5.9 mg/L; at the twelve month of follow-up ESR was 22.7±13.6 and CRP was 9.1±8.2 mg/L In PMR patients group 11 patients had hypertension, 5 dyslipidemia, 1 diabetes and 5 patients were smokers, while in control group 9 had hypertension, 10 dyslipidemia, 6 were smokers and no one had diabetes. Healthy subjects matched by age, sex and comorbidity were chosen as controls. At baseline FMD of patients was lower than controls(6.6±3.4 vs 10.7±2.3, p<0.001). After 6 months of steroid therapy the difference between the two groups remained significant(6.1±2.7 vs 10.7±2.3 p=0.001), while at the twelfth month the two groups achieved comparable FMD values(8.7±3.6 vs 10.7±2.3,p=0.067). The FMD values show an inverse correlation with values of ESR(R=−0.42 p=0.019)and CRP(R=−0.56 p=0.001)at baseline. Conclusions Endothelial dysfunction in patients with PMR appears early during the course of the disease and is related to levels of acute phase reactant; steroid therapy gradually improves these values;only after a year of therapy comparable values are observed between patients and healthy controls. Disclosure of Interest None declared