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Background: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease. The existing evidence suggests that serum uric acid (SUA) contributes to the progression of atherosclerosis by disrupting lipid metabolism, inhibiting nitric oxide synthesis in endothelial cells, fostering the proliferation of vascular smooth muscle cells, and exacerbating inflammation. The serum uric acid/serum creatinine ratio (SUA/SCr), which represents the levels of uric acid in the blood with normalized renal function, is associated with an increased cardiovascular risk. The association between SUA/SCr and the presence of carotid plaque (CP) in patients with RA has not been established.
Objectives: Compare the SUA/SCr and SUA levels in patients with and without the presence of CP in patients with RA.
Methods: A cross-sectional, observational, and descriptive study was carried out. Patients aged from 40 to 75 years with a diagnosis of RA who met the ACR/EULAR 2010 classification criteria were recruited. Patients with a history of cardiovascular disease, overlap syndrome or pregnancy were excluded. Biochemical profiles were performed. SUA/SCr was calculated using the formula SUA/SCr= Serum Uric Acid/ Serum Creatinine . Hyperuricemia was considered as values above 6.8 mg/dL. Carotid ultrasounds were performed by a board-certified radiologist, blinded to clinical information. The presence of CP was defined as a diffuse thickness of the carotid intima media (CIMT) ≥1.2 mm or a focal thickness ≥ 0.5 mm. The distribution was evaluated using the Kolgomorov-Smirnov test. Comparisons were made with Chi-square, Fisher’s exact, Student’s T or Mann Whitney U tests, as appropriate. A p<0.05 was taken as statistically significant
Results: We included 148 patients. Our cohort was composed mainly of women (90.5%), the mean age was 55 ±9.81 years. The prevalence for carotid plaque was of 30.4%. The overall average SUA levels were 4.43 ±1.21 mg/dL and 7.19 ±2.13 mg/dL for SUA/SCr. Patients with CP were significantly older than those without CP [57.83 ±8.86 vs. 53.95 ±10.02; p=0.010]. There were no significant differences in the prevalence for type 2 diabetes mellitus, hypertension, dislipidemia, obesity or active smoking. Patients with CP had higher SUA/SCr than those without CP [7.80 ±2.70 vs. 6.90 ±1.78, p=0.040], without significant differences in SUA levels [4.67 ±1.36 vs. 4.30 ±1.12, p=0.NS]. (Table 1)
Conclusion: In our cohort, SUA/SCr was higher in patients with CP, despite showing no significant differences in SUA levels. Due to the kidney´s role in modulating SUA excretion, employing SUA/SCr as part of the cardiovascular evaluation in patients with RA would minimize the influence of different degrees of renal dysfunction on SUA levels.
Clinical and sociodemographic characteristics
|
Patients without carotid plaque
|
Patients with carotid plaque
| p -value | |
|---|---|---|---|
| Age, years, median ±SD | 53.95 ± 10.02 | 57.83 ± 8.86 | 0.010 |
| Woman, n (%) | 94 (91.30) | 40 (88.90) | NS |
| DAS28-CRP, median± SD | 3.37 ± 1.57 | 3.69 ± 1.44 | NS |
| Diabetes Mellitus, n (%) | 16 (15.50) | 12 (2.70) | NS |
| Hypertension, n (%) | 34 (33.00) | 21 (46,70) | NS |
| Dyslipidemia, n (%) | 45 (43.70) | 15 (33.30) | NS |
| Obesity, n (%) | 33 (32.00) | 16 (35.60) | NS |
| Active Smoking, n (%) | 12 (11.70) | 8 (17.80) | NS |
| SUA, mg/dl, median ± SD | 4.30 ± 1.12) | 4.67 ± 1.36 | NS |
| Hyperuricemia, n (%) | 1 (1.00) | 3 (6.70) | NS |
| SUA/SCr, ± SD | 6.90 ± 1.78 | 7.80 ± 2.70 | 0.040 |
SD, Standard deviation; DAS28-CPR, 28 joint Disease Activity Score/ C- reactive protein; SUA, Serum Uric Acid; SUA/SCr, serum uric acid/creatinine index; NS, non-significative.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.