Rheumatoid arthritis (RA) is associated with a 5 to 10 years reduction in life expectancy due to premature atherosclerosis. This reduction is the consequence of traditional cardiovascular risk factors (TCRF) as well as systemic inflammation. The aim of the present study was to describe the prevalence and factors associated with subclinical atherosclerosis in RA at the University Hospital of Kinshasa (UHK). Patients with a diagnosis of RA based on the 2010 ACR/EULAR criteria were included in this cross-sectional study from 1 June 2014 to 31 May 2015 at the UHK. RA disease activity was measured using the DAS28-ESR. Active RA was defined by a DAS 28 > 2.6. Severe RA was defined by the presence of extra-articular manifestation, joint erosions on X-rays or HAQ ≥0.5. An assessment of subclinical atherosclerosis was performed by the measurement of the carotid intima-media thickness (cIMT) using two-dimensional ultrasonography. Subclinical atherosclerosis was defined by a cIMT ≥0.9 mm. A diagnosis of atheroma plaque was retained when the cIMT was ≥1.5 mm. The association between subclinical atherosclerosis and potential risk factors was modeled using logistic regression analysis. We recruited 75 patients. The average age was 51.8 ± 14.6 years, with a sex ratio F/M of 4. The prevalence of subclinical atherosclerosis was 32%. In logistic regression being a woman of ≥55 years old (aOR 10.6, 95% CI [2.087–53.82], p = 0.028), DAS28-ESR > 2.6 (aOR 3.5,95% CI [1.55–10.38], p = 0.044), severe RA (aOR 32.6,95% CI [1.761–60.37],p = 0.035), high blood pressure (aOR 22.4,95% CI [5.04–99.41], p = 0.005) and obesity (aOR 32.3, 95% CI [2.606–40.73], p = 0.026) emerged as factors associated with subclinical atherosclerosis. Subclinical atherosclerosis is common in RA patients attending the UHK. It appears to be associated with RA disease activity and severity apart from traditional cardiovascular risk factors. These results suggest that early management of subclinical atherosclerosis targeting remaining RA disease activity and cardiovascular risk factors could slow down progression to clinical cardiovascular disease.

中文翻译：

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金沙萨大学医院类风湿关节炎亚临床动脉粥样硬化患病率及相关因素

由于过早的动脉粥样硬化，类风湿性关节炎 (RA) 与预期寿命缩短 5 至 10 年有关。这种减少是传统心血管危险因素 (TCRF) 和全身炎症的结果。本研究的目的是描述金沙萨大学医院 (UHK) 的 RA 亚临床动脉粥样硬化的患病率和相关因素。根据 2010 年 ACR/EULAR 标准诊断为 RA 的患者于 2014 年 6 月 1 日至 2015 年 5 月 31 日在 UHK 被纳入这项横断面研究。使用 DAS28-ESR 测量 RA 疾病活动。活动性 RA 由 DAS 28 > 2.6 定义。重度 RA 定义为存在关节外表现、X 射线上的关节侵蚀或 HAQ ≥0.5。通过使用二维超声检查测量颈动脉内膜中层厚度 (cIMT) 来评估亚临床动脉粥样硬化。亚临床动脉粥样硬化定义为 cIMT ≥0.9 mm。当 cIMT ≥ 1.5 mm 时，动脉粥样硬化斑块的诊断得以保留。使用逻辑回归分析对亚临床动脉粥样硬化和潜在危险因素之间的关联进行建模。我们招募了 75 名患者。平均年龄为 51.8 ± 14.6 岁，性别比 F/M 为 4。亚临床动脉粥样硬化的患病率为 32%。在逻辑回归中，女性≥55 岁（aOR 10.6, 95% CI [2.087–53.82], p = 0.028），DAS28-ESR > 2.6（aOR 3.5,95% CI [1.55–10.38], p = 0.044 )、重度 RA (aOR 32.6,95% CI [1.761–60.37],p = 0.035)、高血压 (aOR 22.4,95% CI [5.04–99.41], p = 0。005) 和肥胖 (aOR 32.3, 95% CI [2.606–40.73], p = 0.026) 成为与亚临床动脉粥样硬化相关的因素。亚临床动脉粥样硬化在就读于 UHK 的 RA 患者中很常见。除了传统的心血管危险因素外，它似乎与 RA 疾病的活动性和严重程度有关。这些结果表明，针对剩余的 RA 疾病活动和心血管危险因素的亚临床动脉粥样硬化的早期管理可以减缓临床心血管疾病的进展。