A One Year Cross Sectional Study To Assess The Clinical Correlation Between Carotid Intima-Media Thickness And Disease Activity In Patients With Rheumatoid Arthritis In A Tertiary Care Hospital

Abstract

Background and objectives Rheumatoid arthritis (RA) is a chronic inflammatory disorder involving the joints with other organs including blood vessels and heart. There is increased of cardiovascular diseases in RA patients which is attributed to accelerated atherosclerosis. Carotid artery intima media thickness (CIMT) is noninvasive, reliable and economical test for assessment of atherosclerosis. The present study explored clinical relationship between CIMT with disease activity in patients with RA. Materials and methods This one year cross-sectional study was done in the Department of Medicine for a tertiary care hospital situated in North Karnataka. Based on the past three year hospital statistics, a total of 50 adult patients with RA were enrolled and evaluated for common carotid artery imaging to measure CIMT using high resolution B-mode ultrasonography. The disease severity was assessed based on Disease Activity Score (DAS) score. Results The male to female ratio was 6.14:1 and mean age was 49.88±12.12 years. With regard to clinical presentation, 76% of the patients had involvement of small joint of hand, 38% had tender joint count between 6 to 10 and swollen joint count of ≤5 (70%). Most of the patients presented with EULAR criteria score of 10 (28%). Based on DAS score, disease activity was severe in 44% and moderate in 48%. Based on the cut-off value of 0.57 for CIMT, majority of the patients had raised CIMT. Mean CIMT was significantly differed with regard to duration of joint pain (p=0.007), tender joint count (p<0.001), swollen joint count (p<0.001), EULAR criteria score (p<0.001) and DAS score (p<0.001). Also significantly positive correlation was noted between CIMT and tender joint count (r=0.711;R2=0.506;p<0.001), swollen joint count (r=0.673;R2=0.453;p<0.001), EULAR criteria score (r=0.611;R2=0.373; p<0.001) and DAS score (r=0.729;R2=0.532;p<0.001). Conclusion The present study proposes strong relationship between CIMT and disease activity in RA hence CIMT can be a useful surrogate marker for detecting atherosclerosis in patients with RA.