Abstract
Objectives:(1) To compare the prevalence of preclinical atherosclerosis in diabetic vs. non-diabetic rheumatoid arthritis (RA) patients; (2) to determine the influence of classical and RA-related factors on atherosclerosis; (3) to assess the usefulness of combined carotid and femoral ultrasonography in detecting atherosclerosis.Methods:The study comprised 42 non-diabetic RA patients, 42 diabetic RA patients and 42 controls. Intima media thickness (IMT) was measured in the common carotid and superficial femoral arteries. These vessels were screened for atherosclerotic plaque.Results:Plaque was more prevalent in diabetic RA patients than in non-diabetic RA patients or controls. Carotid IMT and femoral IMT were higher in diabetic RA patients compared to controls. So was femoral IMT in diabetic compared to non-diabetic RA patients. The prevalence of increased IMT and plaque was comparable in carotid ultrasonography and combined carotid and femoral ultrasonography in all groups.Conclusions:Subclinical atherosclerosis was found to be higher in diabetic RA patients than in non-diabetic RA patients. The combination of carotid and femoral artery ultrasonography did not improve the detection of atherosclerosis in RA.
Highlights
Rheumatoid arthritis (RA) and diabetes mellitus (DM) are associated with increased cardiovascular (CV) morbidity and mortality
No significant differences were found in disease activity score in 28 joints (DAS28), erythrocyte sedimentation rate (ESR), concentration of C-reactive protein (CRP), prevalence of rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA) positivity and bone erosions between non-diabetic RA patients (NDRA) and diabetic RA patients (DRA) groups (Tables-I, TableII)
We compared the prevalence of CV risk factors in controls, NDRA and DRA patients and demonstrated lower HDL concentration in DRA group than in NDRA group and controls
Summary
Rheumatoid arthritis (RA) and diabetes mellitus (DM) are associated with increased cardiovascular (CV) morbidity and mortality. Several studies have assessed the prevalence of DM in RA patients but the results are contradictory. Han et al reported a higher prevalence of type 2 DM in RA patients compared to age- and sexmatched controls,[4] but other studies found no relationship between RA and DM.[5,6] it should be emphasized that abnormalities in glucose metabolism (i.e. insulin resistance- IR) have been well documented in RA and may correlate with RA activity.[7] to what is observed in Atherosclerosis in rheumatoid arthritis & diabetes mellitus general population, IR seems to be an independent CV risk factor in RA patients.[8,9] one might wonder whether overt DM increases CV risk in RA patients substantially or it is moderate because of abnormalities in glucose metabolism, which exists in many RA patients
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