AB1212 PREVALENCE OF CAROTID SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH PSORIATIC ARTHRITIS VS RHEUMATOID ARTHRITIS: A CASE CONTROL STUDY

Abstract

Background:Rheumatic diseases such as Psoriatic Arthritis (PsA) and Rheumatoid Arthritis (RA) are associated with increased morbidity and mortality, mainly due to cardiovascular causes. Cardiovascular outcomes in patients with PsA and RA cannot be completely explained by traditional cardiovascular risk factors, suggesting that the systemic inflammation that characterizes these diseases may have an important role on accelerated atherosclerosis.1Objectives:To compare carotid intima-media thickness (cIMT) and asymptomatic carotid plaque (CP) prevalence, between patients with PsA, RA and controls.Methods:Cross-sectional observational study. Seventy patients, aged 35-75 years, with PsA and RA who fulfilled the CASPAR and ACR/EULAR 2010 classification criteria, respectively, who were active on a cardio-rheuma preventive clinic were recruited, matched with 70 healthy controls. All groups underwent a noninvasive examination using B-mode ultrasonography of the right and left common carotid artery. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or cIMT ≥1.2 mm; hyperplasia of the carotid intima was defined as cIMT ≥ 0.9 mm to 1.1 mm. Descriptive data were analyzed by continuous and categorical variables. Continuous variables with normal distribution are shown as mean ± standard deviation (SD), and non-normal distribution as median and quartiles (25q-75q). ANOVA, Kruskal Wallis,X2and Mann-Whitney U were used to compared data. Apvalue ≤0.05 was considered statistically significant. Statistical analysis was done using SPSS version 24 (IBM Corp., Armonk, NY, USA).Results:Clinical and demographic characteristics are shown in Table 1. The global prevalence of carotid atherosclerosis was 25.7% and 38.6% in RA and PsA respectively, and 27.1% in controls (p=0.170). Intimal hyperplasia was found in 20%, 12.9% and 0% in RA, PsA and controls (p=0.001), respectively (Table 2).Table 1.Clinical and demographic characteristicsRAn=70PsAn=70Controlsn=70PvalueGender Male9 (12.9%)31 (44.4%)11 (15.7%)<0.001 Female61 (87.1%)39 (55.7%)59 (84.3%)Age, years54.51±9.65753.1±10.8753.54±7.48NSBody Mass Index, BMI, kg/m228.99 (25.95-32.34)29.04 (26.23-31.92)27.44 (24.98-30.95)NSComorbidities Diabetes Mellitus11 (15.7%)14 (20%)8 (11.4%)NS Hypertension24 (34.3%)27 (38.6%)15 (21.4%)NS Dyslipidemia19 (27.1%)30 (42.9%)18 (25.7%)NS Active smoker7 (10%)16 (22.9%)15 (21.4%)NSDisease duration Duration, years8.45 (3.34-15.88)5 (2.75-8)-0.005Statins9 (12.9%)12 (17.1%)10 (14.3%)NSTable 2.Ultrasonographic characteristicsRAn=70PsAn=70Controlsn=70PvalueRight CIMT, mm0.8 (0.6-1.1)0.6 (0.5-0.9)0.6 (0.5-0.8)<0.001Left CIMT, mm0.8 (0.6-0.9)0.6 (0.5-0.7)0.6 (0.5-1.2)0.002Any Hyperplasia14 (20%)9 (12.9%)00.001Right intimal hyperplasia7 (10%)5 (7.1%)00.021Left intimal hyperplasia13 (18.6%)2 (2.9%)0<0.001Any plaque18 (25.7%)27 (38.6%)19 (27.1%)NSConclusion:This study shows the high prevalence of asymptomatic atherosclerosis in RA and PsA compared to general population. Even though it was shown a higher prevalence of CP in PsA, subclinical atherosclerosis in RA patients may have an increased clinical significance. The presence of carotid plaque between groups was not statistically significant. We observed increased prevalence of carotid intimal hyperplasia in RA and PsA compared with age-matched controls. We emphasize the value of ultrasonography in the detection of early atherosclerosis lesions.