Temporal Acoustic-Window Failure in Female Patients with Rheumatoid Arthritis: An Eight-Year Longitudinal Follow-Up...

Background/Objectives: Rheumatoid arthritis (RA) is associated with increased cerebrovascular risk and altered bone metabolism. Transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCD) require an adequate transtemporal acoustic window (TAW), which may be limited by temporal bone thickness and structure. Our previous cross-sectional work showed a high frequency of temporal acoustic window failure (TAWF) in female RA patients. The present exploratory follow-up study evaluated whether binary TAW status showed detectable net progression over an 8-year interval. Methods: In 2017, 62 female RA patients and 60 age-matched female controls underwent standardized TCD/TCCD assessment and clinical/laboratory characterization. In 2023, 43 of the original RA patients were re-evaluated by the same experienced neurosonographer using standardized transtemporal insonation and TCCD verification when needed. TAW status was recorded bilaterally as existing TAW or TAWF and analyzed using paired transition counts and exact McNemar tests; treatment subgroup comparisons were exploratory. Results: Right-sided TAW was present in 27/43 patients and absent in 16/43 at both time points (TAWF prevalence 37.2%, 95% CI 24.4-52.1%). No right-sided discordant transition was observed (0/43; exact upper 95% bound 8.2%; exact McNemar p = 1.000). Left-sided TAW was present in 20/43 patients and absent in 23/43 at both time points (TAWF prevalence 53.5%, 95% CI 38.9-67.5%). Two left-sided discordant transitions were observed: one apparent gain and one apparent loss of TAW (2/43, 4.7%; exact 95% CI 0.6-15.8%; exact McNemar p = 1.000). Bilateral TAWF remained present in 15/43 patients at both time points. No statistically detectable differences in TAW status were observed among MTX, IFX, and TCZ groups, but these subgroup analyses were underpowered. Conclusions: In this treated female RA cohort, binary TAW status showed no detectable net progression over 8 years. These data do not prove true biological stability of skull sonographic permeability, and smaller changes cannot be excluded. Mechanistic links with disease control, vitamin D status, treatment exposure, or bone remodeling require larger studies with direct temporal bone imaging and semi-quantitative acoustic-window grading.