THU0160 Juxta-articular bone health affects new carotid plaque formation independent with glucocorticoid therapy in postmenopausal patients with rheumatoid arthritis
Authors: J.W. Kang, N.R. Kim, J.S. Eun, J.H. Kim, J.Y. Kang, J.S. Seo, G.B. Bae, S.J. Lee, E.J. Nam, Y.M. Kang
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease. The incidence of cardiovascular (CV) disease is increased in patients with RA, compared with the general population, which is related to the fact that atherosclerosis has an inflammatory etiology. Several studies revealed that RA is associated with systemic bone loss, and long-term glucocorticoid therapy is also known to affect CV events as well as bone health such as osteoporosis. Especially in postmenopausal women, the prevalence of osteoporosis and its complications are important medical issues. <h3>Objectives</h3> In the present study, we investigated the bone mineral density (BMD) for the carotid plaque formation in RA patients in the Kyungpook National University Hospital Atherosclerosis Risk in Rheumatoid Arthritis (KARRA) cohort study. <h3>Methods</h3> After a baseline evaluation for KARRA enrollment, RA patients were prospectively followed up for 5 years or until deaths. We analysed the demographic findings, conventional CV risk factors and RA disease activity. Carotid ultrasound at baseline and year 5 was performed to evaluation of the intima-medial thickness (IMT) and presence and progression of carotid plaque. A total 323 patients (272 female) with RA, who performed dual-photon x-ray absorptiometry and carotid ultrasound, were included. We assessed disease activity of RA, risk factors for atherosclerosis including hypertension, diabetes mellitus and dyslipidemia, presence of carotid plaque, BMD and cumulative glucocorticoid doses. <h3>Results</h3> A total of 417 RA patients were included in the baseline KARRA cohort, and 327 patients with RA were followed for the 5 year period. Of the 417 baseline RA patients, 212 patients had no carotid plaque. At year 5, new carotid plaque formation was found in 91 of 214 patients who underwent BMD examination. The BMD in the l-spine, femur, and radius was significantly lower in patients with carotid plaques (n=154), compared to patients without plaques (n=172) (1.016 g/cm2±0.22 vs. 1.066±0.18, p=0.013 for l-spine; 0.817±0.15 vs. 0.865±0.14, p&lt;0.001 for femur; 0.542±0.14 vs. 0.605±0.13, p&lt;0.001 for radius. In postmenopausal patients, the BMD was significantly lower in carotid plaque group (n=93) than non-plaque group (n=109) (0.962±0.171 vs. 1.056±0.174, p&lt;0.001 for L spine; 0.780±0.14 vs. 0.857±0.12, p&lt;0.001 for femur; 0.502±0.110 vs. 0.593±0.112, p&lt;0.001 for radius). The cumulative steroid dose was confirmed in postmenopausal female patients, and the glucocorticoid dose was correlated with new carotid plaque formation. (r=0.334, p=0.04). Multivariate logistic regression analysis revealed that but radius BMD (p=0.04) was independent risk factors for new carotid plaque formation during the 5 year followed period after correlation with cumulative glucocorticoid dose, but l-spine (p=0.06) and femur BMD (p=0.07) were not statistically significant. <h3>Conclusions</h3> This study shows formation of new plaques after long-term follow-up depends on the juxta-articular bone health in postmenopausal RA patients. <h3>Disclosure of Interest</h3> None declared