(23-05-06) Plaque Found Early in Inflammatory Arthritis

GLASGOW (EGMN) -Subclinical atherosclerosis is common among patients early in the course of inflammatory polyarthritis, even among those not considered to be otherwise at high risk for cardiovascular disease, Diane K. Bunn reported at the annual meeting of the British Society for Rheumatology.
Increased awareness of the excess mortality-primarily from cardiac causes-associated with rheumatoid and undifferentiated arthritis prompted institution of the Norfolk Arthritis Register, a primary-care-based inception cohort of patients with inflammatory polyarthritis, according to Ms. Bunn of Norfolk and Norwich (England) University Hospital.
The register now has enroled 93 patients, 61 of whom are female. On recruitment, patients underwent baseline assessments of medication history and comorbidities. A cardiac risk profile that includes measurement of fasting lipids and glucose, blood pressure, height, and weight also was performed.
In addition, patients underwent a duplex ultrasound examination of the carotid arteries using a B-mode Doppler.
Median age of the cohort was 50 years, and median disease duration at presentation was 7 months. On recruitment, 56 (60%) were taking disease-modifying antirheumatic drugs, and 59 (63%) were taking nonsteroidal anti-inflammatory drugs. Among this latter group, 12 were being treated with coxibs and the remainder with traditional nonsteroidals.
Blood pressure was 140/90 or higher in 31 (33%), but only 7 were taking antihypertensive medication. Fasting cholesterol was 5.1 mmol or more in 44 (47%), yet only 3 (2 of whom were known diabetics) were taking a statin drug, she wrote in a poster session. A total of 16 (17.2%) were smokers.
Cardiovascular risk, calculated using the Joint British Societies Cardiac Risk Assessor (www.bnf.org/BNF/extra/current/450024.htm) was 15% or greater (indicating high risk) in only 6 (6.5%) patients, but carotid plaque was present in 45 (48%). A single plaque was identified in 16 (17%), and two or more plaques were found in 29 (31%). In addition, one patient had complete stenosis of the right internal carotid artery, Ms. Bunn noted.
The finding that a large proportion of the cohort had subclinical atherosclerosis early in the course of their disease highlights the importance of considering cardiovascular risk right from the start in patients with inflammatory polyarthritis, she concluded.
"Further follow-up of this cohort will help quantify atheroma progression and, in particular, how inflammation, metabolic factors, and therapy contribute to the process in early inflammatory polyarthritis," she wrote.

Source: Elsevier Global Medical News.

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