THU0107 Evaluation of cardiovascular risk in patients with rheumatoid arthritis and anti-tnf-alpha therapy
Authors: D. Anghel, L. Panturu, V.C. Jurcut, M.M. Muresan, E.L. Dilirici, M.M. Negru, R.A. Bursuc
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis is a chronic inflammatory autoimmune disease that causes systemic inflammation associated with increased risk of coronary, cerebral and peripheral ischaemic accidents. Biological therapy, by decreasing systemic inflammation, implicitly reduces cardiovascular risk in patients with rheumatoid arthritis. The assessment of carotid atheromatosis in Doppler ultrasound examination can be a useful element in the diagnosis of patients with cardiovascular risk. <h3>Objectives</h3> We followed the cardiovascular risk as well as the development of the carotid artery plaque by carotid Doppler ultrasound, lipid profile and arterial hypertension in patients with rheumatoid arthritis who have undergone biological treatment with anti-TNF-alpha. We also studied the correlation of the intima-medium thickness index in the carotids with the activity of rheumatic disease (DAS28, CRP, VSH) and the evolution of these parameters under biological therapy. <h3>Methods</h3> Our study included 37 patients with rheumatoid arthritis in treatment with DMARD's (group 1) and 50 patients with rheumatoid arthritis in treatment with anti-TNF-alpha (etanercept, adalimumab, infliximab) biological therapy (group 2). The following parameters were assessed in all patients: DAS28, lipid profile (total cholesterol, LDL, HDL, triglycerides), which were followed at 0, 6, and 12 months. The Intima-Medium Thickness Index was measured by Mode B sonography at the level of the common carotid artery, bifurcation of both arteries and the external carotid artery. The value of the index above 0.7 mm was considered pathological. <h3>Results</h3> In lot 1, after the carotid Doppler ultrasound, of the 37 patients, 21 presented the carotid artery plaque, and in lot 2 of the 50 patients, 34 showed these changes. A full evaluation (DAS28, lipid profile, arterial tension, carotid ultrasound) of all patients was performed at the start of the study. At 6 months, inflammatory markers and DAS28 showed a decrease in baseline values in both groups, more significant in the biological therapy group. Reduction of the intima-medium thickness index and blood pressure was observed in both groups, with no significant differences. At 12 months, CRP and DAS28 in the DMARD-treated group corresponded to disease remission values in 33 patients (89%), and in the group treated with biological therapy, the same remission rates of the disease were recorded in 49 patients (97.7%). The intima-medium thickness index in the DMARD-treated group decreased from the 6 month values. In patients with biological therapy, the reduction in the mid-thickness index recorded a progressive decrease from the previous assessment. <h3>Conclusions</h3> There is a direct correlation between the markers of inflammation and the evolution of carotid atheromatosis in patients with rheumatoid arthritis. The intima-medium thickness index is a paraclinical feature useful in assessing cardiovascular risk in patients with rheumatoid arthritis. Biological therapy, by controlling the underlying disease, also improves cardiovascular prognosis. Treatment with anti-TNF-alpha makes good control, together with lipid-lowering and antihypertensive medication of associated cardiovascular pathology, in patients with rheumatoid arthritis. <h3>Disclosure of Interest</h3> None declared