Duplex study of the carotid and femoral arteries of patients with rheumatoid arthritis: a controlled study

BACKGROUND: "Ultrasonic biopsy" (U-B) is a noninvasive screening technique to detect early atherosclerotic plaques and arterial wall changes. AIM: To identify atherosclerosis (AS) in the common carotid artery (CCA) and common femoral artery (CFA) of patients with rheumatoid arthritis (RA) and their matched controls. METHODS: Fifty-seven consecutive RA patients were enrolled in the study. Controls were matched by age, sex, ethnicity, and AS risk factors. All patients and controls underwent U-B study of the CCA and CFA. The U-B features were classified and scored as follows: Class A, normal (score 0); Class B, interface disruption (score 2); class C, intima-media (I-M) granulation (score 4); Class D, plaque without hemodynamic disturbance (score 6); Class E, stenotic plaque (score 8); and Class F, plaque with symptoms (score 10). Total score per patient was calculated. Classes A-B indicate an intact media or minimal interphase changes; classes D-F point to a significant medial involvement. Class C signifies a borderline lesion, with a potential for regression to normal, being unchanged, or progression to a plaque. RESULTS: Mean ages were 52.1 years for RA and 51.4 years for controls (P = 0.81). Eighty-six percent of the patients and 85% of controls were women. The mean disease duration of RA was 12.8 years. Frequencies of risk factors among the RA patients compared with controls were hypertension (28% versus 32%), smoking (37% versus 29%), dyslipidemia (23% versus 25%), diabetes mellitus (DM) (14% versus 14%), and family history of cardiovascular disease (CVD) (4% versus 7%). Forty-five percent of the RA patients had at least a single Classes D-F lesion (plaque) in 1 of the 4 vessels tested, compared with 40% in the control group (P = 0.19). The mean total U-B scores of the RA patients and controls were not significantly different (8.87 versus 9.49, P = 0.7). Univariate analyses have shown that the development of plaques in RA patients was associated with age >50 years, disease duration, hypertension, dyslipidemia, and smoking. Multivariate analysis found plaques to be strongly associated with age above 50 years and dyslipidemia. CONCLUSION: In unselected RA patients, besides classic AS risk factors, older age and longstanding disease may help predict the development of a severe morphological expression of AS.