Journal List > J Rheum Dis > v.20(4) > 1064050

J Rheum Dis. 2013 Aug;20(4):231-237. Korean.
Published online August 31, 2013.
Copyright © 2013 by The Korean College of Rheumatology
Microvascular Findings in Patients with Rheumatoid Arthritis - Assessed, Using Fundus Photography and Fluorescein Angiography
Hyun Jung Yeo, Ji Hyun Lee, Hong Jik Lee, Ki Sup Byun, Ho Joon Im and Min Jung Kim
Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.

Corresponding to: Ji Hyun Lee, Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea. Email:
Received March 12, 2013; Revised May 24, 2013; Accepted May 24, 2013.

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.



Although a series of trials support that rheumatoid arthritis (RA) is associated with increased atherosclerosis, the link between microvascular structural changes and the disease activity of RA has not been clarified. We measured changes in the retinal microvasculature using fundus fluorescein angiography (FAG) and investigated the association between the retinal vasculature and clinical parameters of RA.


Seventy-five RA patients and sixty healthy control were included. Morphometric and quantitative features in the capillary images including retinal vascular signs and vessel diameters were measured with fundus photography and FAG. RA activity was assessed based on high sensitivity C-reactive protein (hsCRP), disease activity score with 28 joints (DAS 28), and health assessment questionnaire (HAQ).


Central retinal arteriolar equivalents (CRAE) was 118.1±31.3 µm in RA patients and 123.8±19.9 µm in control subjects, showing the tendency of retinal arteriolar narrowing in patients with RA but without statistical significance. The mean central retinal venular equivalents (CRVE) was 162.4±26.4 µm which was significantly higher than that of control group (144.1±23.1 µm, p<0.001). The prevalence of AVN was 34.7%, and significantly higher in RA group. Among retinal findings, the presence of early pinpoint hyperfluorescence and areas of delayed choroidal perfusion correlated with hsCRP. Age, disease duration, DAS 28, HAQ, and rheumatoid factor (RF) had no effect on CRAE and CRVE. In multivariate analysis, only hsCRP was found to be associated with wider venular caliber.


Retinal venular widening was more common in RA patients. Retinal venular diameter had significant correlation with disease activity of RA. Retinal imaging is a comparative method for the assessment of microvascular findings of RA patients.

Keywords: Rheumatoid arthritis; Fundus photography; Central retinal arteriolar equivalents; Central retinal venular equivalents


Table 1
Clinical characteristics and parameters of the retinal vascular changes of the study population
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Table 2
Characteristics of RA patients with and without AVN
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Table 3
Correlation coefficients (p-value) between the parameters of retinal vascular diameter and clinical parameters of RA group (n=75)
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Table 4
Correlation coefficients between FFA features and clinical parameters of RA group (n=75)
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Table 5
Multiple linear regression analysis of CRVE and parameters of arterial stiffness of common carotid artery in RA groups
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