POS0520 ASSOCIATIONS BETWEEN THE NEOVASCULARIZATION OF CAROTID ATHEROSCLEROTIC PLAQUES, LIPID PARAMETERS AND IMMUNOLOGICAL DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: E. Gerasimova, T. Popkova, O. Pogorelova, O. Fomicheva, I. Kirillova, T. Balakhonova
Journal: Annals of the Rheumatic Diseases (2021)

Background: Development of carotid atherosclerotic plaques (CAP) in patients (pts) with rheumatoid arthritis (RA) is associated with accumulation of traditional risk factors and immunological disorders. CAP neovascularization is associated with its’ inflammation and increasing vulnerability. Therefore, early detection of CAP neovascularization is important for prevention of potential cardiovascular complications, preferably using a non-invasive technique, such as contrast-enhanced ultrasound (CEUS) of the carotid arteries. Objectives: to identify the relationship between the severity of CAP neovascularization, lipid parameters and RA-related parameters. Methods: Evaluation of 23 RA pts, 8 males and 15 females, mean age 61 [58; 65] years, with a longstanding disease (7 [3;12] years), seropositivity for IgM rheumatoid factor (RF) (76%) and anti-cyclic citrullinated peptide (ACCP) (62%) and moderate clinical disease activity (DAS 28 3,9 [3,2;4,8]). Nineteen RA pts (83%) received Methotrexate, 35% - biological agents, 35% - low-dose glucocorticoids. All patients underwent bilateral CEUS of the carotid arteries using a PHILIPS IU22 ultrasound system with 3-9 MHz linear array transducer and i/v administration of SonoVue contrast agent. The severity of carotid intraplaque neovascularization (IPN) was visually assessed on a scale from 0 to 3 (Shah et al. 2007): 0 - no neovascularization, 1 (mild) - limited to moderate neovascularization, 2 (severe) - extensive appearance of neovascularization, 3 - in the presence of a pulsating vessel in the plaque image. Results: Carotid IPN was found in all RA pts. Grade 1 of neovascularization was established in 39% pts (group I) and Grade 2 - in 61% pts (group II). Groups were comparable in terms of age, sex, body mass index, smoking, disease duration and activity RA (DAS 28 score). The degree of carotid IPN positively correlated with the LDL-C level (R = 0,46, p=0,04), and the TG level (R=0,56, p=0,01) and negatively correlated with the HDL-C level (R= -0,52, p=0,02) in all pts. The degree of neovascularization was also associated with RA duration (R=0,52, p&lt;0,05) and ACCP-positivity (R=0,57, p=0,007). Aforementioned correlations were significant for both groups of RA pts. No association was found between the severity of IPN and the levels of RF, DAS28. Association between the degree of carotid stenosis and CRP concentrations (R=-0,73, p&lt;0,05) was found in pts of group II. Conclusion: CEUS of carotid arteries demonstrated the presence of a predominantly extensive carotid IPN in RA pts. Cases of more severe carotid IPN were associated with lipid parameters (positively with the LDL-C, TG levels and negatively with the HDL-C level), RA duration and ACCP-positivity. The relationship between the degree of carotid artery stenosis and CRP requires additional studies to determine the role of immunological disorders in the development of carotid intraplaque neovascularization in RA pts. References: [1]Shah F., Balan P., Weinberg M., Reddy V., Neems R., Feinstein M., Dainauskas J., Meyer P., Goldin M., Feinstein S.B. Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis? Vasc Med. 2007;12(4):291-7. https://doi.org/10.1177/1358863x07083363 Disclosure of Interests: None declared