Increased Aortic Stiffness in Patients at Risk for Rheumatoid Arthritis

Patients who are at risk for rheumatoid arthritis (RA) have subclinical increases in aortic stiffness, according to results published in the Annals of the Rheumatic Diseases. The results suggest that anti-cyclic citrullinated peptide (anti-CCP) may play a role in accelerated atherosclerosis.

The study included anti-CCP-positive participants with any new musculoskeletal symptoms, but not clinical synovitis, and no prior history of cardiovascular disease (CVD; n=18), as well as healthy control participants matched for age and sex (n=30). Participants underwent multiparametric 3.0T cardiac magnetic resonance imaging with late Gadolinium enhancement.

Those considered at risk for RA were categorized as low risk (<50%) or high risk (>50%), based on a published clinical risk model. They were followed for 12 months to track progression to a clinical diagnosis of RA. The researchers conducted analysis using a statistics program, unpaired Student t-tests, and Mann-Whitney tests to compare continuous variables.

Among the participants at risk for RA, 22% (n=4) were men, the mean (±standard deviation) age was 53±15 years, mean anti-CCP was 136±136 IU/mL, and mean predicted absolute risk for RA was 49%±17%.

The results indicated that at-risk participants had significantly lower aortic distensibility (3.6±1.3×10⁻³ mm Hg⁻¹), which indicates greater arterial stiffness, compared with healthy control participants (4.9±2.1×10⁻³ mm Hg⁻¹). When at-risk participants were stratified by low and high risk, those at high risk had significantly lower aortic distensibility (3.1±0.6×10⁻³ mm Hg⁻¹) compared with those at low risk (4.2±1.7×10⁻³ mm Hg⁻¹).

“These data advance the concept of anti-CCP-mediated atherosclerosis and support additional investigation in larger, and both anti-CCP-positive and anti-CCP-negative control populations,” the researchers wrote.

Reference

Fent G, Mankia K, Erhayiem B, et al. First cardiovascular MRI study in individuals at risk of rheumatoid arthritis detects abnormal aortic stiffness suggesting an anti-citrullinated peptide antibody-mediated role for accelerated atherosclerosis [published online March 9, 2019]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-214975