Background: Clinical and experimental data confirm the role of both systemic and arterial inflammation in potentiating atherosclerosis and increasing cardiovascular risk in patients with rheumatoid arthritis (RA) against the background of severe immunological disorders.

Objectives: To study the severity of ultrasound signs of atherosclerotic lesions of brachiocephalic arteries and heart valve apparatus in patients with rheumatoid arthritis (RA).

Methods: 57 patients with RA (50 women and 7 men; mean age 50,45±10,12 years old; mean duration of disease 9,2±6,8 years; DAS28 activity: low - 3,5%, medium - 86%, high - 10,5%) were examined. Laboratory examination included determination of serum IgG-RF, CRP, antibodies to cyclic citrullinated peptide (ACCP), antibodies to modified citrullinated vimentin (MCV), total antinuclear antibodies (ANA), and levels of proinflammatory cytokines (IL-1, IL-6, TNF-α, angiopoietin-like proteins types 2, 3, and 4 - ANGPTL 2, 3, 4) by enzyme immunoassay.

Cardiac ultrasound examination was performed according to the traditional technique on an Accuvix V10 ultrasound diagnostic system (Samsung Medison, South Korea) equipped with a multifrequency microconvex transducer with a frequency of 2-4 MHz. All patients underwent duplex scanning of brachiocephalic arteries (BCA) with assessment of the severity of atherosclerotic changes (А0 - absence of BCA atherosclerosis, АI - isolated thickening of intima-media complex as a manifestation of non-stenotic BCA atherosclerosis, АII - presence of atherosclerotic plaques and artery stenosis as manifestation of stenotic BCA atherosclerosis). The following gradation was used to estimate the degree of cardiac valve calcification: 0 - no calcification, 1st degree - unexpressed calcification, 2nd degree - moderate calcification, 3rd degree - expressed calcification of cardiac valves.

Results: Signs of cardiovascular system lesions (pericarditis, heart valve lesions, cardiomyopathies, cardiac conduction pathway lesions, myocarditis, endocarditis, coronary arteritis etc.) were diagnosed in 28 (49,1%) RA patients. Heart valve dysfunction was manifested by mitral valve (MV) and/or aortic valve (AV) insufficiency in the majority of cases. In RA patients, ultrasound signs of cardiac valve calcification occurred in 40.4% (23/57) of cases; there was a high prevalence of aortic valve calcification of varying severity (19/23; 82.6%) and less detectable mitral valve calcification (12/23; 52.17%); patients with grade II-III cardiac valve calcification predominated (16/23; 69.6%); 5 patients (21.7%) had combined AV and MV lesions. In 25 (43.8%) patients with RA the signs of atherosclerosis of brachiocephalic arteries were determined: in 19 (33.3%) - non-stenotic (AI), in 6 (10.5%) - stenotic atherosclerosis (АII).

No statistically significant correlations were found between changes of cardiac valve apparatus, BCA lesions and main clinical characteristics of RA (disease activity, erosions, RF and ACCP positivity). Increased levels of ANGPTL2 (χ2=4.6, p=0.032) were observed in the group of RA patients with cardiac valve lesions, and ANA (χ2=3.91, p=0.049) and elevated IL-6 (χ2=4.28, p=0.039) were detected more frequently in patients with signs of atherosclerotic lesions of BCA.

The presence of autoimmune chronic inflammatory process is an independent sign of premature atherosclerosis development and causes the highest risk of atherosclerotic lesion of BCA and accelerates the processes of cardiac valve calcification in RA patients.

Conclusion: Regular echocardiography (with duplex scanning of BCA and heart valve examination) in RA patients can contribute to earlier identification of groups of patients possible requiring changes in therapeutic approaches to treatment and prevention of vascular accidents.

Disclosure of Interests: None declared