RISK OF SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN INDIA

OBJECTIVE: Patient with rheumatoid arthritis (RA) has high cardiovascular morbidity and mortality as compared to the general population. Carotid intima media thickness (IMT) as measured by ultrasound is a validated surrogate marker of atherosclerosis. We studied the prevalence of subclinical atherosclerosis in Indian patients with RA. METHODS: Common carotid IMT (CCA IMT) was measured at the level of carotid bifurcation in 64 RA patient and 48 age and sex matched controls. Values of mean CCA IMT above mean +/- 2 SD of the control group were defined as abnormal IMT. Variables of disease activity and severity were measured in RA patients. Patients and controls with known traditional cardiovascular risk factors were excluded from the study. Student-t test and chi-square test for proportion were used for statistical analysis. A logistic regression analysis was done to find out independent predictors of abnormal IMT. RESULT: Twenty-four RA patient (37.5%) and four controls (6.25%) had abnormal IMT values. RA patient had significantly increased mean CCA IMT (0.648 +/- 0.142 mm) as compared to controls (0.316 +/- 0.003 mm; P<0.0001). Age >= 46 years, duration of disease >= 6 years, and tender joint count >= 4 predicted increased risk of having abnormal CCA IMT in a logistic regression analysis. CONCLUSION: Nearly more than one third of RA patients in our study had subclinical atherosclerosis. Age, tender joint count and duration of disease were independent predictors of abnormal CCA IMT.