Peripheral plaque burden in the diagnosis of coronary atherosclerosis in rheumatoid arthritis

Aim. To assess plaque burden according to peripheral artery ultrasound examination in patients with rheumatoid arthritis (RA) with low and moderate disease activity in comparison with the coronary artery condition.

Material and methods. The study included 64 patients, of which 43 patients with an established diagnosis of RA and 21 patients with coronary artery disease (CAD) without RA (comparison group). All patients underwent a clinical and paraclinical examination to verify myocardial ischemia and/or CAD according to the 2020 national guidelines, as well as a carotid and femoral artery ultrasound (the latter, only for patients with RA) with determination of plaque burden.

Results. In patients with RA in combination with CAD, plaque burden is higher than in patients with RA without coronary artery disease regarding the carotid plaque number 4,0 [4,0; 5,0]/2,0 [1,0; 3,5], proportion of maximum stenosis 35,0 [35,0; 45,0]/30,0 [25,0; 35,0] and the proportion of total stenosis 120,0 [110,0; 152,5]/85,0 [40,0; 110,0]. Three or more carotid plaques determine significant coronary atherosclerosis in RA. In RA patients with CAD, the combination of caro­tid and femoral plaques is associated with significant coronary atherosclerosis in 75% of cases. In a comparative analysis of patients with RA CAD+/RA CAD-, no significant differences were found in the main cardiovascular risk factors, lipid, and inflammatory parameters. When comparing the plaque burden indicators, the severity of coronary atherosclerosis was not revealed between RA patients with CAD+ and the comparison group.

Conclusion. Determining the peripheral plaque burden parameters increases the clinical significance of ultrasound as a stage of non-invasive CAD diagnosis in RA.

1. Arida A, Zampeli E, Konstantonis G, et al. Rheumatoid arthritis is sufficient to cause atheromatosis but not arterial stiffness or hypertrophy in the absence of classical cardiovascular risk factors. Clin Rheumatology. 2015;34(5):853-9. doi:10.1007/s10067-015-2914-1.

2. Nasonov EL, Popkova TV, Novikova DS. Cardiovascular disease in rheumatic diseases. Therapeutic Archive. 2016;88(5):4-12. (In Russ.) doi:10.17116/terarkh20168854-12.

3. Pope JE, Nevskaya T, Barra L, et al. Carotid Artery Atherosclerosis in Patients with Active Rheumatoid Arthritis: Predictors of Plaque Occurrence and Progression Over 24 Weeks. Open Rheumatol J. 2016;10:49-59. doi:10.2174/1874312901610010049.

4. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflam­matory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17-28. doi:10.1136/annrheumdis-2016-209775.

5. Boytsov SA, Pogosova NV, Ansheles AA, et al. Cardiovascular prevention 2022. Russian national guidelines. Russian Journal of Cardiology. 2023;28(5):5452. (In Russ.) doi:10.15829/1560-4071-2023-5452.

6. Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a metaanalysis. Atherosclerosis. 2012;220(1):128-33. doi:10.1016/j.jcmg.2013.11.014.

7. Ridker PM, Cushman M, Stampfer MJ, et al. Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. Circulation. 1998;97(5):425-8. doi:10.1161/01.cir.97.5.425.

8. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-8. doi:10.1136/ard.2010.138461. Erratum in: Ann Rheum Dis. 2010;69(10):1892.

9. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Mana­gement of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016;253:281344. doi:10.1016/j.atherosclerosis.2016.08.018.

10. Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004—2006—2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34:2906. doi:10.1159/000343145.

11. Sakaguchi M, Kitagawa K, Nagai Y, et al. Equivalence of plaque score and intima-media thickness of carotid ultrasonography for predicting severe coronary artery lesion. Ultrasound Med Biol. 2003;29(3):367-71. doi:10.1016/s0301-5629(02)00743-3.

12. Ternovoy SK, Sinitsyn VE. Spiral computer and electron beam angiography. M.: Vidar, 1998. 141 p. (In Russ.) ISBN: 5-88429-035-7.

13. 2020 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.) doi:10.15829/29/1560-4071-2020-4076.

14. Meune C, Touz´e E, Trinquart L, et al. Highrisk of clinical cardiovascular events in rheuma­toid arthritis: levels of associations of myocardial infarction and stroke through a syste­matic review and meta-analysis Archives of Cardiovascular Diseases. 2010;103(4):253-61. doi:10.1016/j.acvd.2010.03.007.

15. Amaya-Amaya J, Montoya-Sánchez L, Rojas-Villarraga A. Cardiovascular involvement in auto­immune diseases. Biomed Res Int. 2014;2014:367359. doi:10.1155/2014/367359.

16. Kobayashi H, Giles JT, Polak JF, et al. Increased prevalence of carotid artery atherosclerosis in rheumatoid arthritis is artery-specific. J Rheumatol. 2010;37(4):730-9. doi:10.3899/jrheum.090670.

17. Gerasimova EV, Popkova TV, Shalygina MV, et al. Subclinical atherosclerosis of the carotid arteries in patients with rheumatoid arthritis with low cardiovascular risk. Terapevti­cheskii Arkhiv (Ter. Arkh.). 2023;95(5):375-9. (In Russ.) doi:10.26442/00403660.2023.05.202203.

18. Aubry MC, Maradit-Kremers H, Reinalda MS, et al. Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis. J Rheumatol. 2007;34(5):937-42.

19. Evans MR, Escalante A, Battafarano DF, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum. 2011;63:1211-20. doi:10.1002/art.30265.

20. Ershova AI, Meshkov AN, Shalnova SA, et al. Ultrasound parameters of carotid and femo­ral atherosclerosis in patients with coronary heart disease. Russian Journal of Preventive Medicine and Public Health. 2014;17(6):56-63. (In Russ.) doi:10.17116/profmed201417656-63.

21. Semb AG, Rollefstad S, Provan SA, et al. Carotid plaque characteristics and disease activity in rheumatoid arthritis. J Rheumatol. 2013;40(4):359-68. doi:10.3899/jrheum.120621.

22. Störk S, van den Beld AW, von Schacky C, et al. Carotid artery plaque burden, stiffness, and mortality risk in elderly men: a prospective, population-based cohort study. Circulation. 2004;110(3):344-8. doi:10.1161/01.CIR.0000134966.10793.C9.

23. Gerasimova EV, Popkova TV, Novikova DS, et al. Risk factors of coronary artery stenosis in patients with rheumatoid arthritis. Nauchno-Prakticheskaya Revmatologiya Rheumatology Science and Practice. 2017;55(6):628-33. (In Russ.) doi:10.14412/1995-4484-2017-628-633.

24. Liang KP, Liang KV, Matteson EL, et al. Incidence of noncardiac vascular disease in rheu­matoid arthritis and relationship to extraarticular disease manifestations. Arthritis Rheum. 2006;54(2):642-8. doi:10.1002/art.21628.

25. Frerix M, Stegbauer J, Kreuter A, et al. Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events. Arthritis Res Ther. 2014;16(1):R54. doi:10.1186/ar4489.