Abstract

ObjectivesRheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD). In the present study, we evaluated the inflammatory activity of the ascending aorta in RA patients who received biological treatment.MethodsWe assessed the aortic wall inflammation of RA patients using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography before and after 6 months of biologic therapies. We also compared the inflammatory activity at the aortic wall in RA patients with remission or low disease activity (RLDA) and those with moderate or high disease activity (MHDA). The aortic uptake was measured by the standardized uptake value (SUV) and the target-to-background ratio (TBR).ResultsA total of 64 patients were included in the analysis (mean age, 58.4 ± 13.8 years old; female, 77%). The Disease Activity Score for 28 joints (DAS28) erythrocyte sedimentation rate (ESR) had significantly decreased after 6 months: from 5.0 ± 1.2 to 3.3 ± 1.2 (p < 0.001). The FDG uptake in the ascending aorta changed from baseline to 6 months, showing a maximum SUV (SUVmax) of 1.83 ± 0.34 to 1.90 ± 0.34 (p = 0.059) and TBR of 1.71 ± 0.23 to 1.75 ± 0.24 (p = 0.222). The SUVmax and TBR after 6 months were significantly higher in the RLDA group than in the MHDA group (2.05 ± 0.32 vs. 1.79 ± 0.33 (p = 0.002) and 1.89 ± 0.33 vs. 1.65 ± 0.20 (p = 0.001), respectively). The percentage of monocytes also significantly increased from baseline to 6 months: from 5.9 ± 1.6 to 6.9 ± 2.6 (p = 0.032).ConclusionThe inflammation activity at the ascending aorta in RA patients did not change significantly after 6 months of biological treatment. RA patients with a low disease activity or in clinical remission after 6 months of biological treatment still had an increased inflammatory activity at the aortic wall.

Highlights

  • Rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD) [1,2,3]

  • The FDG uptake in the ascending aorta changed from baseline to 6 months, showing a maximum standardized uptake value (SUV) (SUVmax) of 1.83 ± 0.34 to 1.90 ± 0.34 (p = 0.059) and to-background ratio (TBR) of 1.71 ± 0.23 to 1.75 ± 0.24 (p = 0.222)

  • The Maximum standardized uptake value (SUVmax) and TBR after 6 months were significantly higher in the remission or low disease activity (RLDA) group than in the moderate or high disease activity (MHDA) group (2.05 ± 0.32 vs. 1.79 ± 0.33 (p = 0.002) and 1.89 ± 0.33 vs. 1.65 ± 0.20 (p = 0.001), respectively)

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Summary

Introduction

Rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD) [1,2,3]. An accelerated progression of atherosclerosis leads to an increased mortality in RA patients [4,5,6,7,8,9,10]. Because both an inflamed synovial membrane and atherosclerotic plaque share important common pathological processes, chronic systemic inflammation might accelerate the development of atherosclerosis in RA patients [10]. FDG PET/CT has been widely used to evaluate atherosclerosis, since the 18F-FDG uptake reflects the glucose metabolism of macrophages in atherosclerotic plaque [17,18,19,20,21]. While FDG PET/CT is a highly reproducible method of evaluating arterial inflammation, there have been few reports regarding its utility in assessing aortic inflammation in RA patients

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