Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease leading to significant increase in cardiovascular morbidity and mortality. Development of cardiovascular diseases (CVD) in RA patients is associated with the accumulation of traditional risk factors and immunological disorders. Carotid Artery Doppler Ultrasound (DUS) Exam is the gold standard to identify early atherosclerosis.

Objectives: To evaluate the cardiovascular risk and analyze its relationship with detection of early carotid artery atherosclerotic lesion in patients with rheumatoid arthritis (RA).

Methods: One hundred and nine RA patients (female/male 93/16), aged 45 to 60 without established CVD were included in the study. The median age was 52 [48; 54] years, duration of RA was 120 [36; 204] months, DAS28 was 4,7 [3,5; 5,6] points. 54% (n=59) of patients received methotrexate (median dose 20 [15;27]mg/week), 12% - leflunomide (20mg/day), 12% - sulfasalazine (2000mg/day), 40% - glucocorticoids (median dose 4 [2;8]mg/day), 44% - non-steroidal anti-inflammatory drugs. None of study participants had biologics or statins in their therapeutic regiments at the time of inclusion. CVD risk was calculated with mSCORE, RRS, ASSIGN, QRISK3, ERS-RA scales and results of Carotid Artery DUS imaging in all patients.

Results: Traditional risk factors were highly among RA patients without CVD, including: arterial hypertension - in 73%, dyslipidemia - 68%, overweight - 53%, family history of CVD - 43% and smoking - 39% patients. A combination of three traditional risk factors was found in 60% of patients with RA, and combination of two – in 25%. High risk was found in 5, 5, 14, 6, and 38% of patients according to mSCORE, RRS, ASSIGN, QRISK3, ERS-RA scales, respectively. Carotid atherosclerotic plaques were found in 30% of patients, more often in men (48%) than in women (28%, p=0,049), with similar prevalence regardless RA activity or stage od disease. Positive correlations of carotid intima-media thickness were established with scores of all CVD risk calculators: mSCORE (R = 0,50), RRS (R = 0,40), ASSIGN (R = 0,40), QRISK3 (R = 0,36), ERS-RA (R = 0,26), p <0,05 in all cases, as well as with age (R = 0,41; p = 0,04), the level of total cholesterol (R = 0,23; p = 0,01), systolic blood pressure (R = 0,66; p = 0,02), diastolic blood pressure (R = 0,33; P = 0,03), erythrocyte sedimentation rate (R = 0,26; p = 0,04), IL-6 levels (R = 0,65; p = 0,01). The sensitivity and specificity of the CVR algorithms in prognostication of atherosclerotic carotid artery lesions were 73 and 67% for mSCORE, 64 and 63% for RRS, 64 and 56% for ASSIGN, 73 and 49% for QRISK3, respectively, p<0.05 in all cases, 67 and 50% for ERS-RA, p=0,06.

Conclusion: RRS, mSCORE, ASSIGN, QRISK 3 calculators equally predicted the presence of carotid atherosclerotic plaques in RA patients. The optimal ratio of specificity and sensitivity is shown for the mSCORE scale. Stratification of CVR in RA patients should include assessment of the carotid intima-media thickness. mSCORE calculation and carotid intima-media thickness were the most informative methods identify CVR assessment in RA patients.

Disclosure of Interests: None declared