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Background: Rheumatoid arthritis (RA) is established as a systemic inflammatory disease that primarily affects joints but also entails a significant increase in cardiovascular morbidity and mortality. Despite numerous research, unmet needs persist in this field. Studies have demonstrated endothelial dysfunction as a precursor to atherosclerosis, thus stimulating the search for non-invasive methods for early detection.
Objectives: To assess differences in clinical and serological characteristics based on endothelial dysfunction parameters in patients with rheumatoid arthritis.
Methods: A cross-sectional study with 100 RA patients from Reina Sofía University Hospital in Córdoba analyzed clinical characteristics (gender, age, ultrasound presence of carotid plaque, smoking, etc.) and serological factors (total cholesterol, ACPA, rheumatoid factor, apolipoproteins A and B, etc.). The presence of endothelial dysfunction was evaluated using a Periflux 5010 Laser-Doppler, dividing patients into two groups (n=50) based on the median hyperemia area (1417.18).
Results: The univariate analysis (Table 1) showed a lower median age in the group with a larger hyperemia area (53.23 (12.31) vs. 56.58 (12.09)), with no statistical significance (p = 0.31). Other clinical variables of interest (smoking, disease duration, diagnostic delay) did not reach the threshold of significance. Serological variables of interest in cardiovascular health, such as mean total cholesterol (201.97 (35.51); 191.67 (37.46)), mean LDL (123.23 (26.26); 114.24 (32.9)), or ApoA levels (157.5 (47.5); 151 (23)), showed a tendency to be higher in the group with lower hyperemia area, although not reaching significance.
Parameters of endothelial dysfunction measured by Periflux, such as resting flow (RF) or peak flow (PF), were significantly lower in the group with a smaller hyperemia area (p < 0.01; p = 0.04).
In the multivariate analysis adjusted for ApoA levels, statistically significant differences persisted in PF (OR 1.15; 95% CI (1.08-1.27)), RF (OR 0.79; 95% CI (0.66-0.88)), and ACPA titer (OR 1.001; 95% CI (1.001-1.002)).
Conclusion: Endothelial dysfunction evaluated with Periflux could be useful in clinical practice to stratify cardiovascular risk in RA patients, independent of classic parameters. The univariate analysis detected trends that did not reach the threshold of statistical significance, likely due to a small sample size. Nevertheless, additional cohorts are needed to validate the findings and determine their utility in clinical practice, combined with other well-known cardiovascular risk factors (CVRF).
Patient characteristics according to the Hyperemia Area measured by Periflux.
| Variable | Hyperemia Area < 1417.18 (n=50) | Hyperemia Area ≥ 1417.18 (n=50) | p-value |
|---|---|---|---|
| Age (years), mean (SD) | 56.58 (12.09) | 53.23 (12.31) | 0.31 |
| Gender (female), n (%) | 38 (76) | 35 (70) | 0.65 |
| Ever smoked, n (%) | 24 (48) | 25 (50) | 0.54 |
| Disease duration (years) | 11 (10.5) | 8 (11) | 0.88 |
| Diagnostic delay (years) | 0.7 (3) | 0 (2) | 0.79 |
| BMI (kg/m2), mean (SD) | 28.09 (5.62) | 26.38 (4.66) | 0.14 |
| ApoA (mg/dl), mean (SD) | 157.5 (47.5) | 151 (23) | 0.07 |
| ApoB (mg/dl), mean (SD) | 89.5 (21.75) | 80.71 (20.32) | 0.09 |
| Total cholesterol (mg/dl), mean (SD) | 201.97 (35.51) | 191.67 (37.46) | 0.23 |
| LDL (mg/dl), mean (SD) | 123.27 (26.26) | 114.24 (32.90) | 0.21 |
| Positive RF, n (%) | 33 (66) | 38 (76) | 0.17 |
| Positive ACPA, n (%) | 35 (70) | 41 (82) | 0.23 |
| ACPA titer, median (IQR) | 161.4 (330.86) | 343.1 (724.91) | 0.06 |
| RF titer, median (IQR) | 57 (162) | 84 (109) | 0.21 |
| RF, median (IQR) | 14.1 (9.36) | 18.65 (12.50) | 0.04 |
| PF, median (IQR) | 35.7 (25.06) | 77.33 (31.66) | <0.01 |
| PF – RF, median (IQR) | 20.16 (15.44) | 57.71 (31.48) | <0.01 |
| Carotid plaque (Yes), n (%) | 6 (12) | 8 (16) | 0.35 |
| DAS28-CRP, median (IQR) | 4.4 (2.23) | 3.54 (2.3) | 0.47 |
SD stands for Standard Deviation and IQR stands for Interquartile Range.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.