COPENHAGEN — Patients with rheumatoid arthritis have a substantially higher prevalence of peripheral artery disease than do similar people without RA, based on a case-control study with 101 subjects.
PAD “should not be overlooked in rheumatoid arthritis patients,” Dr. Suzan Abou-Raya said at the annual meeting of the European Congress of Rheumatology. RA patients “should be regularly screened [for PAD] to help reduce their incidence of cardiovascular morbidity and mortality,” said Dr. Abou-Raya, a researcher in the geriatric unit at the University of Alexandria (Egypt).
The study enrolled 64 consecutive RA patients (38 women and 26 men), with an average age of 55 years and an average RA duration of 12 years. The patients had no history of cardiovascular disease. Dr. Abou-Raya and her associates also enrolled 37 healthy controls without RA or cardiovascular disease who were matched with the cases by age, sex, body mass index, and their conventional cardiovascular-disease risk factors. All the cases and controls were nonsmokers. The average total cholesterol level was about 190 mg/dL. The researchers assessed PAD by the ankle brachial index (ABI). They measured arterial pressure with a Doppler ultrasound velocity detector at two ankle sites: posterior tibial and dorsalis pedis. An ABI ratio of 0.9 or less in an artery meant it was obstructed; a ratio of 1.0 to less than 1.3 was normal, and a ratio of 1.3 or greater meant an incompressible artery (a marker of significant calcification). Abnormal ABIs, either obstructed or incompressible, existed in 19 RA patients (30%) and in two controls (5%), a statistically significant difference. In a total of 256 arteries examined in the 64 RA patients, 10 (4%) were obstructed and 20 (8%) were incompressible. That's significantly higher than in 148 arteries examined in the 37 controls, with two obstructed (1%) and one incompressible (1%).
In a multivariate analysis, clinical characteristics of the RA patients that significantly correlated with an abnormal ABI were RA disease duration, serum level of C-reactive protein, and a worse score on the Health Assessment Questionnaire (HAQ).
Dr. Abou-Raya said that she and her associates had no financial disc