POS0483 SUBCLINICAL ATHEROSCLEROSIS IN THE FIRST FIVE YEARS OF RHEUMATOID ARTHRITIS DIAGNOSIS
Authors: N. Guajardo-Jauregui, I. J. Colunga-Pedraza, J. R. Azpiri-López, D. Á. Galarza-Delgado, A. B. Rodriguez-Romero, S. Lugo-Perez, A. Cárdenas, A. C. Garza Acosta
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with rheumatoid arthritis (RA) have a higher risk of developing a cardiovascular (CV) event than the general population, due to an accelerated process of atherosclerosis (1), which has been documented to begin in early stages of the disease and is directly associated with systemic inflammation (2). Objectives: The aim of this study was to compare the prevalence of subclinical atherosclerosis detected by carotid ultrasound (US) in patients with RA in the first five years of diagnosis and healthy controls. Methods: This was a cross-sectional, observational, and comparative study. A total of 53 patients aged 40-75 years old, with RA diagnosis, in the previous five years, according to the 2010 ACR/EULAR classification criteria, and 53 controls matched by age (±5 years), gender and comorbidities were included in this study. Subjects with a previous CV event, such as myocardial infarction, cerebrovascular event and peripheral arterial disease, another connective tissue disease and pregnant women were excluded from this study. A high-resolution B-mode carotid US was performed in all study subjects. Subclinical atherosclerosis was evaluated as the presence of carotid plaque (CP) or an increased carotid intima media thickness (cIMT). CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm of the surrounding lumen, and an increased cIMT was defined as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ 2 test and Fisher’s exact test for qualitative variables, and Student’s t test and Mann-Whitney’s U test for quantitative variables. A p -value &lt;0.05 was considered statistically significant. Results: Comparisons of demographic characteristics showed no differences between the RA group and the control group (Table 1). When comparing carotid US findings there was a difference in the presence of CP, being more prevalent in RA patients (26.4% vs 11.3%, p =0.047), in the presence of an increased cIMT, being more prevalent in RA patients (34.0% vs 3.8%, p =&lt;0.001), in the cIMT as a quantitative variable, being higher in RA patients (0.70mm vs 0.59mm, p =&lt;0.001 in the right carotid artery, and 0.75mm vs 0.60mm, p =0.001 in the left carotid artery), and in the presence of subclinical atherosclerosis overall, being more prevalent in RA patients (52.8% vs 18.9%, p =&lt;0.001) (Figure 1). Table 1. Demographic and clinical characteristics RA Controls p (n=53) (n=53) Age years, mean ± SD 54.48 ± 9.09 54.86 ± 6.83 NS Women, n (%) 49 (92.5) 49 (92.5) NS T2DM, n (%) 8 (15.1) 7 (13.2) NS HTN, n (%) 17 (32.1) 17 (32.1) NS Dyslipidemia, n (%) 19 (35.8) 19 (35.8) NS Obesity, n (%) 21 (39.6) 20 (37.7) NS Active smoking, n (%) 3 (5.7) 4 (7.5) NS BMI kg/m2, median (p25-p75) 28.78 (25.92-33.21) 27.59 (24.55-33.34) NS Disease duration, mean ± SD 2.48 ± 1.31 - - DAS28-CRP, median (p25-p75) 3.21 (1.89-4.12) - - MTX, n (%) 39 (73.6) - - Glucocorticoids, n (%) 29 (54.7) - - Conclusion: Patients with RA in the first five years of diagnosis have a higher prevalence of subclinical atherosclerosis than the general population. CV evaluation including a carotid US should be done at the time of diagnosis of RA patients, and subsequently it must be individualized according to the CV risk of each patient, with a maximum of five years to identify those patients who would benefit from an opportune treatment. References: [1]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436 [2]Ahmad S, Garg S, Dhar M, et al. Predictors of atherosclerosis in rheumatoid arthritis. Vasa 2012;41(5):353-9. doi: 10.1024/0301-1526/a000221 Disclosure of Interests: None declared