Factors of atherosclerosis progression in rheumatoid arthritis, prospective study data
Authors: Fomicheva O A , Popkova T V , Gerasimova E V , Krougly L B , Pogorelova O A , Balakhonova T V , Karpov Y U A , Tripoten M I 
Published: October 2021

Abstract

Aim of the study
Determine in prospective observation study the factors of progression of atherosclerosis in pts with rheumatoid arthritis (RA) during 3 yrs.

Matherial and methods
This prospective study included 124 patients with RA and suspected ischemic heart disease (IHD), the average age was 58 [52; 63] years. Follow-up period was 3 years (37.5 moths). All RA pts were examined and had treatment, according to European and National guidelines for the diagnosis and treatment of stable CAD (2013) and EULAR for RA (2016). Carotid ultrasound and coronary angiography were also completed. In course of all RA pts the following risk factors were assessed: arterial hypertension (AH), smoking, overweightbody (BMI), heredity for cardiovascular diseases (CVD), diabetes mellitus (DM), dyslipidemia (DLP). The laboratory studies were: CBC and total cholesterol (TC), HDL-C, LDL-C, TG, highly sensitive C-reactive protein (hs-CRP), RA detected activity markers: rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), index DAS28. Pro-inflammatory cytokines -interleukin (IL) -1-beta, IL-6, tumor necrosis factor alpha (TNF alpha) were assessed in single RA pts once after 3 years of observation.

Results
The median duration of RA in inclusion in the study was 11 years, the DAS28 index was 3.8 points (middle degree of activity). DLP was detected in 41% RA pts. DM was in 13% pts. In RA pts, initially atherosclerotic plaques with stenosis of the carotid arteries (CA) 20% or more in 94 pts (77%) were revealed, in 3 of them CA stenosis exceeded 50%. 90 RA pts (72%) were examined again. 21 pts had signs of progressing atherosclerosis marked in CA and/or coronary arteries: 12 (13%) RA patients had only progression of atherosclerosis of CA, 7 (8%) - only progression of atherosclerosis of coronary arteries, 2 (2%) had both progression CA and coronary arteries. There are 2 formed subgroups of RA pts: Gr1 with the progression of atherosclerosis (n=21) and Gr 2 without progression of atherosclerosis (n=69). There are no differences between groups of risk factors of atherosclerosis development age, AH, BMI, lipids,TG, hs CRP, index DAS28.
Following rick factors: smoking (n=12 (57%) vs n=21 (30%)), heredity for CVD (n=11 (52%) vs n=17 (25%)), RA duration (13 yrs [10; 18] vs 12 years [6; 18]) were often revealed among pts of Gr 1. All differences p&gt;0.05
Immunological data TNF alfa level, (8,08 [2,3; 8,44] pg/ml vs 1,22 [0,13; 8,00] pg/ml), IL-1β level, 3,97 [3,56; 4,10] pg/ml vs 3,52 [0,30; 4,53] pg/ml, and IL-6 level 3,50 [2,92; 5,76] pg/ml vs 2,52 [0,92; 4,36] pg/ml were significant higher in Gr1 than in Gr2. All differences was p&gt;0.05.

Conclusion
The progression of atherosclerosis in RA with a low and moderate degree of activity of the disease occurs despite antirheumatic and lipid-lowering therapy. The development of atherosclerosis in this disease is defined by lipid, inflammatory and immunological disorders.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russion National Cardiology Research Center Ministry of Health of Russion Federation