Arterial stiffness in rheumatoid arthritis

In rheumatoid arthritis (RA) mortality is higher than in the general population and is due to cardiovascular diseases (CVD) associated with traditional risk factors (TRFs) and autoimmune inflammation. An early predictor of CVD is arterial stiffness (AS), determined by pulse wave velocity (PWV) and the augmentation index (AIx). AS assessment can be used for cardiovascular risk stratification, complementing PWV and improving the accuracy of predicting cardiovascular events.

The aim – to study the parameters of arterial stiffness in patients with rheumatoid arthritis, their relationship with clinical and immunological parameters and cardiovascular diseases traditional risk factors.

Materials and methods. The study included 100 female patients with RA (90% of whom were seropositive for rheumatoid factor (RF)) with a median age of 43 [34; 51] years, disease duration of 5.3 [3.0; 12.0] years. High activity according to the DAS28 (Disease Activity Score 28) was predominantly present in 61% of RA patients. Extra-articular manifestations were detected in 37%, and complications – in 22%. The control group included 30 healthy women matched for age. All subjects underwent determination of TRFs and AS parameters – PWV and AIx.

Results. RA patients, compared with controls, had higher PWV values: 7.1 [6.1; 8.0] m/s versus 6.2 [6.0; 7.0] m/s, respectively (p=0.004). No difference in AIx was observed. PWV and AIx correlated with age (r=0.655 and r=0.351), QRISK-3 (r=0.627 and r=0.504), intima-media thickness (r=0.463 and r=0.37), the presence of atherosclerosis (r=0.439 and r=0.295), and RA duration (r=0.271 and r=0.335) (p<0.05). AIx was associated with anti-cyclic citrullinated peptide (anti-CCP; r=0.204; p=0.04).

Elevated AS values were more common in patients with arterial hypertension, menopause, overweight, RF+/antiCCP+ patients, and with the development of complications (p<0.05). Smoking and a history of cardiovascular disease did not significantly affect AR. We registered higher absolute values of PWV and AIx in hypertension (7.7 [7.0; 9.2] versus 6.8 [5.8; 7.8] m/s, 3.4 [0.9; 8.4] versus 0.4 [–0.7; 4.2]%, respectively) and in menopause (7.9 [7.1; 8.8] versus 6.6 [5.7; 7.7] m/s, 4.4 [1.2; 11.2] versus 0.3 [–0.8; 3.7]%, respectively; p<0.05). In seropositive RA, AIx was higher compared to seronegative: 1.5 [–0.2; 5.0] versus –1.0 [–2.4; 3.6]% (p=0.002). Patients who developed RA complications had higher PWV and AIx values: 7.4 [6.8; 8.8] versus 7.0 [6.0; 7.9] m/s and 4.0 [1.2; 7.9] versus 0.7 [–0.5; 4.3]%, respectively (p<0.05). In patients receiving glucocorticoids and disease-modifying antirheumatic drugs, PWV and AIx values were higher than in patients without therapy.

Conclusion. The obtained results highlight the multifactorial mechanism of AS in RA. These data can serve as the basis for more accurate risk stratification and personalized therapy in patients with RA.

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