Correlation between subclinical common carotid artery atherosclerosis & plasma homocysteine level in rheumatoid arthritis

الملخص EN

Objective : to detect subclinical morphologic atherosclerotic changes of common carotid artery in rheumatoid arthritis patients and to correlate it with plasma level of homocysteine, C-reactive protein and disease severity.

Methodology : the study included twenty five rheumatoid arthritis females as a patient group, their age ranged from 42 to 66 years.

Their disease duration was more than 5 years.

Nine apparently healthy females served as a control group, their age ranged from 42 to 65 years.

All patients and controls were chosen with exclusion criteria including: presence of hypertension, diabetes mellitus, renal insufficiency, history of any cardiovascular or cerebrovascular events, hyperlipidemia, using lipid lowering agents, smoking and intake of contraceptive pills.

Patients were subjected to full history taking, thorough clinical examination, disease severity assessment using disease severity index, disease activity assessment using the modified disease activity score (DAS), physical activity assessment using Stanford Health Assessment Questionnaire (HAQ), laboratory investigations especially C-reactive protein and serum homocysteine level.

Intima media thickness of the right common carotid artery and plaques were detected with B-mode ultrasound.

Results: Seventeen patients (68 %) out of 25 had increased intima media thickness of right common carotid artery (subclinical atherosclerosis).

Among them 6 showed atherosclerotic plaques and 11 without atherosclerotic plaques.

Intima media thickness and homocysteine level were significantly higher in patients as compared to controls.

Age, disease duration, severity index, C-reactive protein, homocysteine level and intima media thickness were significantly increased in patients with subclinical atherosclerosis as compared to those without atherosclerosis.

Intima media thickness showed a significant positive correlation with age, disease duration, severity index, C-reactive protein and level of homocysteine.

Conclusion : our results suggest the presence of subclinical atherosclerosis in rheumatoid arthritis patients as indicated by increased intima media thickness of common carotid artery.

Chronic inflammation may play an important role in development of this atherosclerosis.

We also suggest that increased homocysteine level may be a nontraditional risk factor for atherosclerosis in rheumatoid arthritis.

B-mode ultrasound can be considered a useful tool for detection of early morphologic atherosclerotic changes in carotid artery despite absence of clinical manifestations for this atherosclerosis.