Background: Patients with rheumatoid arthritis (RA) are exposed to a multifactorial cardiovascular risk: chronic inflammation, endogenous and exogenous factors, and treatment.

Objectives: The aim of this study was to investigate the impact of RA treatments on cardiovascular risk and the influence of supra aortic trunks.

Methods: This is a prospective study conducted on RA patients followed-up between March and December 2020 at the rheumatology department of the Mohamed Kassab Institute of Orthopedics and Traumatology. Socio-demographic data of patients and characteristics of the disease were collected. The disease activity was evaluated by the Disease Activity Score 28. Prescribed treatments were specified. Ultrasonography of the supra aortic trunks was performed by measuring, in centimeters, the Intima-media Thickness (IMT) at the level of the left (LCC) and right (RCC) common carotid arteries, the left (LIC) and right (RIC) internal carotid arteries and the left (LEC) and right (REC) internal carotid arteries.

Results: Of the 47 patients surveyed, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The average RA progressed from 86.25 ±63 [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. The treatments taken were: Methotrexate (MTX) (54.5%), Sulfasalazine (SLZ) (1.8%), Leflunomide (LFN) (3.6%), a combination of cs-DMARDs (5.5%), and biotherapy (10.9%). The prescribed biotherapies were: Etanercept (3.6%), Adalimumab (1.8%), Certolizumab (1.8%), Infliximab (3.6%). Corticosteroids (CT) were prescribed in 38.2% of patients, non-steroidal anti-inflammatory drugs (NSAIDs) (3.6%), and analgesics (41.8%).

CT had a protective effect on IMT in LIC (p=0.031) and RIC (p=0.016). MTX had a significant protective effect on IMT in RIC (p=0.002) and LEC (p=0.033).

SLZ was associated with an increase in IMT at the RIC level (p=0.05). There was no association between NSAID use and IMT. MTX and CT were significantly associated with a decrease in SCORE (p=0.02; p=0.05, respectively). There was a non-significant association between SLZ or LFN and decreased SCORE (p=0.140, p=0,970).

Conclusion: In our series, patients taking MTX and CT had a lower IMT than those not taking these drugs. SLZ was associated with an increase in IMT. NSAIDs did not affect IMT in our study.

REFERENCES:

[1]Pasquale Ambrosino and al, Subclinical atherosclerosis in patients with rheumatoid arthritis A meta-analysis of literature studies. Thrombosis and Haemostasis 113.5/2015

[2]Hyun-Je Kim and al, Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis. The Korean Academy of Medical Sciences 2015.

Disclosure of Interests: None declared