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Kim, Kang, Kim, Bae, Lee, Im, Nam, and Kang: Identification of Independent Predictive Factors for Atherosclerosis in Rheumatoid Arthritis: Based on KARRA Cohort Study
Original Article
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(1): 30-38.

Published online: 28 February 2012

DOI: https://doi.org/10.4078/jrd.2012.19.1.30

Identification of Independent Predictive Factors for Atherosclerosis in Rheumatoid Arthritis: Based on KARRA Cohort Study

Ji Hun Kim1, Jong Wan Kang1, Na Ri Kim1, Gi Bum Bae1, Soo-Kon Lee2, Churl Hyun Im1, Eon Jeong Nam1, Young Mo Kang1

1Division of Rheumatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu,

2Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author (ymkang@knu.ac.kr)

Received 28 August 2011       Revised 17 October 2011       Accepted 20 October 2011

Copyright © 2012 Korean College of Rheumatology

Abstract

Objective

This study sought to investigate independent predictive factors for subclinical atherosclerosis in Korean patients with rheumatoid arthritis (RA).

Methods

We used high-resolution B-mode ultrasonography to measure the carotid artery intima-media thickness (IMT) and carotid plaque in 367 patients with RA. Detailed information on the demographic characteristics, cardiovascular (CV) risk factors, and RA disease characteristics were collected on all subjects. The relationship of the carotid artery IMT and carotid plaque to relevant clinical and laboratory variables were examined.

Results

Old age and male sex had the most significant association with increased IMT and presence of plaque than other factors. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and mKHAQ (Korean version of modified health assessment questionnaire) were significantly associated with both increased IMT and presence of plaque after univariate analysis adjusting for age and sex. A multivariable logistic regression analysis revealed that ESR and TJC68 were independent factors associated with the presence of plaque (p<0.001 and p=0.019, respectively). There was a significant linear correlation between the number of plaques and ESR (p<0.001 and R2=0.07).

Conclusion

Our results indicated that markers of systemic inflammation contributed significantly to subclinical atherosclerosis in patients with RA. We emphasize the need for aggressive control of RA disease activity in patients who persistently demonstrate highly elevated ESR levels.

Keywords: Rheumatoid arthritis, Atherosclerosis, Cardiovascular disease, Inflammation, Erythrocyte sedimentation rate

Figures and Tables

Figure 1
(A) Correlation between erythrocyte sedimentation rate (ESR) and the number of plaque (p<0.001 and R2=0.07), (B) Correlation between tender joint count in 68 joints (TJC68) and the number of plaque (p=0.116 and R2=0.01).
jrd-19-30-g001
Table 1
Demographic variables, cardiovascular risk factors, RA disease characteristics, and carotid ultrasonographic findings in RA patients*
jrd-19-30-i001

RA: rheumatoid arthritis, HOMA-IR: homeostasis model of assessment - insulin resistance, mKHAQ: Korean version of modified health assessment questionnaire, TJC: tender joint count, SJC: swollen joint count, DAS: disease activity score, IMT: intima-media thickness, Anti-CCP Ab: Anti-cyclic citrullinated peptide antibody, RF: rheumatoid factor.

Table 2
Baseline characteristics of RA patients sorted by highest quartile and other quartiles of mean intima-media thickness
jrd-19-30-i002

NS=not significant (p>0.05). *Independent t-test was used for comparisons between two groups, †ANCOVA (analysis of covariance) adjusted for age and sex.

Table 3
Baseline characteristics of RA patients according to the presence or absence of plaque
jrd-19-30-i003

NS=not significant (p>0.05). *Independent t-test was used for comparisons between two groups, †ANCOVA (analysis of covariance) adjusted for age and sex.

Table 4
Multivariable logistic regression analysis of factors associated with plaque in RA patients
jrd-19-30-i004

OR: odds ratio, CI: confidence interval.

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