POS0521 FACTORS ASSOCIATED WITH SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: N. Mena-Vázquez, F. G. Jiménez-Núñez, M. Rojas-Giménez, L. Cano Garcia, S. Manrique Arija, A. Fernandez-Nebro
Journal: Annals of the Rheumatic Diseases (2021)

Objectives: To describe the prevalence of subclinical atherosclerosis measured as carotid intima-media thickness (cIMT) in patients with rheumatoid arthritis (RA) and to analyze the associated factors. Methods: We performed an observational study of 60 patients with RA and 60 sex and age-matched controls. Patients with dyslipidemia were excluded. The main variable was the cIMT measured by ultrasound. The maximum cIMT was measured and atheromatous plaque was defined as focal thickening of the arterial wall protruding toward the lumen and measuring &gt;0.5 mm or more than 50% of the neighboring cIMT. The other variables included were clinical and laboratory values, lipid metabolism, the 28-joint Disease Activity Score (DAS28), International Physical Activity Questionnaire (METs) and Adherence to a Mediterranean diet (MEDAS). Descriptive, bivariate and two multivariate models were constructed to identify factors associated with pathologic cIMT in all subjects and other in RA patients. Results: The baseline characteristics of both groups are shown in Table 1. The RA patients did not have differences in the mean (SD) of maximum cIMT in relation to the controls (0.77 [0.1] vs 0.75 [0.1]; p = 0.392), nor in the number of plaques (16 [26.7%] vs 10 [16.7]; p = 0.184). The factors associated with maximum cIMT in the total sample were male sex (ß= 0.182; p = 0.039), age (ß = 0.010; p &lt;0.001), METs (ß= -2.19; p = 0.008), MEDAS (ß = -0.177; p = 0.038); While the factors associated with maximum cIMT in patients with RA were: male sex (ß = 0.155; p = 0.003), age (ß = 0.005; p = 0.007), MEDAS (ß = -0.022; p = 0.017), DAS28 (ß = 0.036; p = 0.003) and ACPA (ß = 0.082; p = 0.052). Table 1. Baseline characteristics of 60 patients with RA and 60 controls. Variable Patients n=60 Controls n=60 p-value Age in years, mean (SD) 54.0 (11.1) 54.2 (110.4) 0.943 Female sex; n (%) 53 (88.3) 51 (85.0) 0.591 Smoking 0.300 Never smoked, n (%) 27 (45.8) 30 (54.5) Exsmoker, n (%) 23 (39.0) 14 (25.5) Active smoker, n (%) 9 (15.3) 11 (20,0) BMI (kg/m 2 ), mean (SD) 28.0 (5.5) 27.3 (4.9) 0.540 MET-minute, median (IQR) 533.2 (605.1) 809 (716.9) 0.028 MEDAS, median (IQR) 9.4 (1.8) 9.1 (2.1) 0.349 Progression of RA, months, mean (SD) 119.7 (84.1-170.5) - - Diagnostic delay, months, median (IQR) 5.7 (5.1-14.4) - - Erosions, n (%) 25 (43.1) - - RF &gt;10, n (%) 45 (75.0) 0 (0.0) &lt;0,001 ACPA &gt;20, n (%) 48 (80.0) 0 (0,0) &lt;0,001 High-sensitivity CRP (mg/dl), median (IQR) 8.1 (4.2) 2.0 (4.5) 0.009 ESR (mm/h), median (IQR) 21.1 (16.6) 13.9 (12.3) 0.008 DAS28 at protocol, mean (SD) 3.1 (2.2-4.2) - - Synthetic DMARDs, n (%) 52 (88.1) - - Methotrexate, n (%) 36 (61.0) - - Leflunomide, n (%) 6 (10.2) - - Sulfasalazine, n (%) 7 (11.9) - - Hydroxychloroquine, n (%) 4 (6.8) Biologic DMARDs, n (%) 32 (54.2) - - Anti TNF-α, n (%) 23 (39.0) - - Jak inhibitor, n (%) 1 (1.7) - - Anti-IL-6, n (%) 6 (10.2) - - Abatacept, n (%) 1 (1.7) - - Abbreviations: RA, rheumatoid arthritis; ACPA, anti-citrullinated peptide antibodies; RF, rheumatoid factor; SD, standard deviation; MEDAS: Mediterranean Diet Adherence Survey; DAS28, 28-joint Disease Activity Score; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; DMARD, disease-modifying antirheumatic drug; IL-6, interleukin 6; Anti TNF, anti–tumor necrosis factor. Conclusion: In patients with well-controlled established RA, subclinical atherosclerosis is associated, in addition to sex, age, and mediterranean diet, with inflammatory activity and ACPA value. Acknowledgements: Grant for Medical Researchers from “Fundación Española de Reumatología” 2019 Grant from “Fundación Española de Reumatología” 2018 for non-funded projects. Disclosure of Interests: None declared