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Calcification of coronary arteries in early rheumatoid arthritis prior to anti-rheumatic therapy

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Abstract

Accelerated coronary atherosclerosis is common in patients with rheumatoid arthritis (RA). To examine coronary artery calcification (CAC) frequency and severity, its correlation with traditional risk factors (TRF) of cardiovascular diseases (CVD) and inflammatory markers in patients with early RA prior to anti-rheumatic therapy. RA adult patients (ACR/EULAR criteria, 2010, duration ≤ 12 months, without prior administration of disease-modifying anti-rheumatic drugs, glucocorticoids) underwent 32-row scanning for CAC scoring. Agatston, volume and mass calcium scores were calculated. Additionally, we used calculators on the website of the Multi-Ethnic Study of Atherosclerosis. 74 RA patients (women n = 54 (73%), median age 56 years, median RA duration 6 months) with moderate/high RA activity (median DAS28 [ESR] 5.4) were enrolled within the framework of the observational study. Most of the patients had multiple TRFs of CVD and subclinical organ damage. CAC has been detected in 34 (46%) early RA patients. Calcification severity was significantly higher in men and in patients with ischemic heart disease (IHD). In patients younger than 45 years (n = 16) CAC was not detected. Among patients older than 45 years (n = 58), the frequency of CAC was 59%: asymptomatic patients—n = 46 (48%), IHD patients—n = 12 (100%). Among asymptomatic patients the presence of CAC associated with a significantly higher frequency of arterial hypertension (1.6 fold) compared with cases without CAC. Coronary age in asymptomatic patients with CAC and IHD patients was significantly greater than their actual age. More than half of early RA patients older 45 years had CAC. The presence and severity of CAC correlated positively with TRFs, but not with lipid levels and RA activity.

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Authors and Affiliations

  1. Department of Rheumocardiology, V.A. Nasonova Research Institute of Rheumatology, Kashirskoe Shosse 34A, Moscow, Russian Federation, 155522

    Helen V. Udachkina, Diana S. Novikova, Irina G. Kirillova & Evgenia I. Markelova

  2. Department of Systemic Rheumatic Diseases, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation

    Tatiana V. Popkova & Eugeniy L. Nasonov

  3. Department of Early Arthritis, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation

    Elena L. Luchikhina & Galina V. Lukina

  4. Department of Radiology, Federal Center of Treatment and Rehabilitation, Moscow, Russian Federation

    Valentin E. Sinitsyn

  5. V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation

    Dmitry E. Karateev

Authors
  1. Helen V. Udachkina
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  2. Diana S. Novikova
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  3. Tatiana V. Popkova
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  4. Irina G. Kirillova
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  5. Evgenia I. Markelova
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  6. Elena L. Luchikhina
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  7. Galina V. Lukina
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  8. Valentin E. Sinitsyn
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  9. Dmitry E. Karateev
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  10. Eugeniy L. Nasonov
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Contributions

EVU, DSN contributed to the conception and design of the study, data collection and analysis, manuscript writing and final approval of the manuscript. IGK, YNG, EIM, ELL, DNV, MAB, GVL contributed to data collection and analysis, critical revision and final approval of the manuscript. VES revision of draft manuscript, approval of final version to be published. TVP, DEK, ELN substantial contributions to the conception and design, revision of draft manuscript, approval of final version to be published. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Helen V. Udachkina.

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Conflict of interest

There are no potential conflicts of interest relevant to this article.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol had been approved by the local ethics committee in V.A. Nasonova Research Institute of Rheumatology (protocol #3, 24th of January 2012).

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 Informed consent was obtained from all individual participants included in the study.

Research involving human and animal participants

The research involved human participants.

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Udachkina, H.V., Novikova, D.S., Popkova, T.V. et al. Calcification of coronary arteries in early rheumatoid arthritis prior to anti-rheumatic therapy. Rheumatol Int 38, 211–217 (2018). https://doi.org/10.1007/s00296-017-3860-9

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  • DOI: https://doi.org/10.1007/s00296-017-3860-9

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