[Asymptomatic carotid atherosclerosis and its predictors in patients with rheumatoid arthritis]

The aim of this work was to study prevalence, severity, and possible pathogenetic mechanisms of asymptotic atherosclerotic lesions in carotid arteries of young and middle-aged patients with rheumatoid arthritis (RA). A total of 100 cases without clinical manifestations of atherosclerosis (AS) were examined. Risk factors (RF) of cardiovascular complications were analysed and stratified. Ultrasound scanning and dopplerography of carotid and vertebral arteries included measurement of common carotid arteries intima-media thickness. Echocardiographic studies were performed and ankle-brachial index (ABI) determined. The study revealed high frequency of asymptomatic increase of the intima-media thickness and carotid AS (in 55 and 18% of the cases respectively). These changes related to the patients" age, duration of RA, activity of immunoinflammatory processes, and traditional RF of cardiovascular complications. The findings provide a basis for the search of therapeutic modalities to correct the above lesions by controlling RA activity and modifying cardiovascular RF. The latent clinical course of RA and AS requires thorough instrumental studies for optimization of the treatment of such patients. Structural changes in carotid arteries in RA are associated with atherosclerotic lesions in the aorta, increased vascular wall stiffness (high ABI) and left ventricular hypertrophy. This implies that remodeling cardiovascular system during RA is an integrated pathological process. It is concluded that cardiovascular disturbances associated with RA should be regarded as a multifactor pathology resulting from persistent autoimmune inflammation and metabolic disorders.