Peripheral Arterial Abnormalities Among Rheumatoid Arthritis Patients without Previous Cardiovascular Event

Background: Peripheral arterial abnormalities suggestive of vasculitis are frequent in RA patients. Color duplex ultrasound (CDUS) plays an important role in the assessment of extremity vasculature. It also helps in the differential diagnosis of vasculitis and atherosclerosis. Measuring the intima-media thickness (IMT) is the preferred method of assessment. Objectives: This study aimed to detect peripheral arterial abnormalities in rheumatoid arthritis (RA) patients and to assess their relation to disease features. It also aimed to determine cut-off values for intima-media thickness (IMT) of extremities’ arteries. Patients and methods: This study comprised 60 patients with RA and 30 healthy controls. Duplex ultrasound was performed to assess arteries of both upper and lower limbs, measuring the caliber and IMT. Also, IMT of both common carotid arteries was measured. Results: 56 (93.3%) of patients were females with a median age of 34 (29-38) years, age at disease onset was 28 (23.5-32) years and disease duration was 4 (2-6.5) years. Increased IMT of extremities’ arteries was detected in RA patients in comparison with controls. This difference was significant in all examined arteries (p< 0.01 in all arteries except for right axillary artery, p= 0.026), while common carotid arteries IMT was comparable between patients and controls (p= 0.629 and p= 0.314 for right and left arteries respectively). Receiver operating characteristic (ROC) curve analysis was performed to detect cut-off points for extremities’ arteries. Accordingly, abnormalities suggestive of vasculitis were detected in 42 (70%) of RA patients. A significant relation between rheumatoid factor (RF) positivity, titer and duplex findings was detected (p =0.027 and p= 0.031 respectively). Conclusion: Peripheral arterial abnormalities suggestive of vasculitis were frequent in RA patients, evidenced by increased IMT of extremities’ arteries. There was a significant relation between duplex findings in RA patients and RF positivity and titer.