AB0219 ASSOCIATION OF DISEASE ACTIVITY AND THE PRESENCE OF BILATERAL CAROTID PLAQUE IN RHEUMATOID ARTHRITIS PATIENTS

BackgroundCardiovascular (CV) disease is the major cause of death of RA patients. There is a direct association of systemic inflammation and an accelerated process of atherosclerosis, which is related to higher CV morbimortality (1). Additionally, RA patients with bilateral carotid plaque (CP) had a two-fold risk of developing a CV event compared to patients with unilateral CP (2).ObjectivesTo compare disease activity and other disease characteristics of RA patients with bilateral and unilateral CP.MethodsThis was a cross-sectional study nested of a RA patients’ cohort. We recruited RA patients who fulfilled the 2010 ACR/EULAR classification criteria. Patients with a previous CV event, another connective tissue disease, or pregnancy were excluded. Disease activity was assessed with DAS28-CRP. A carotid ultrasound was performed to all RA patients, and the presence of CP was considered as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing ≥ 0.5 mm. All RA patients with bilateral CP were included in this study and matched by age (± 5 years), gender, and traditional CV risk factors to RA patients with unilateral CP by a rheumatologist blinded to clinical information. Comparisons were done with Chi-square test for qualitative variables and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered statistically significant.ResultsMean age of RA patients with bilateral CP was 61.98 ± 6.82 years as compared to 59.70 ± 6.74 years in patients with unilateral CP (p = NS). Demographic characteristics are shown in Figure 1. When comparing disease characteristics, we found a difference in C-reactive protein (CRP) levels, higher in patients with bilateral CP (1.06 mg/dl vs 0.64 mg/dl, p = 0.012), in disease activity assessed with DAS28-CRP as a continuous variable, higher in patients with bilateral CP (3.83 vs 3.05, p = 0.023), and as moderate-high disease activity classification, more prevalent in patients with bilateral CP (70.0% vs 43.3%, p = 0.037) (Table 1). A binary logistic regression, including traditional CV risk factors and disease activity, showed that classification of disease activity in the moderate-high activity category is an independent risk factor for the presence of bilateral CP, OR 3.18, 95% CI 1.033-9.812, p = 0.044.Table 1.Comparison of disease characteristics.VariablesRA patients with bilateral CP (n=30)RA patients with unilateral CP (n=30)p-valueDisease duration, years, median (IQR)7.86 (2.97-19.18)9.02 (6.45-13.66)NSCRP, mg/dl, median (IQR)1.06 (0.67-1.93)0.64 (0.43-1.06)0.012DAS28-CRP, mean ± SD3.83 ± 1.273.05 ± 1.320.023Moderate-high activity, n (%)21 (70.0)13 (43.3)0.037Anti-CCP, median (IQR)15.30 (3.16-196.15)115.73 (1.60-196.05)NSFR IgG, median (IQR)5.84 (2.00-17.13)5.25 (2.00-20.41)NSFR IgM, median (IQR)156.86 (27.91-200.00)197.22 (65.71-200.00)NSFR IgA, median (IQR)85.87 (13.60-200.00)46.83 (5.33-129.93)NSMTX, n (%)22 (75.9)21 (70.0)NSGC, n (%)16 (55.2)11 (36.7)NSbDMARD, n (%)3 (10.3)6 (20.0)NSNS, no significant; RA, rheumatoid arthritis; CRP, C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide antibodies; RF, rheumatoid factor; MTX, methotrexate; GC, glucocorticoids; bDMARD, biologic disease modifying antirheumatic drugs.ConclusionWe found that RA patients with bilateral CP had higher levels of CRP levels, higher DAS28-CRP, and a higher prevalence of being classified in the moderate-high disease activity category, which was independently associated to the presence of bilateral CP. Emphasis should be placed on tight disease control to prevent the development of a major CV events in RA patients.References[1]Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol. 2015;11(7):390-400.[2]Evans MR, Escalante A, Battafarano DF, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum. 2011;63(5):1211-20.Disclosure of InterestsNone declared