To Study Endothelial Dysfunction in Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased morbidity and mortality. This excess mortality attributable to cardiovascular events. Endothelial dysfunction represents the earliest stage of atherosclerosis. It can be measured noninvasively by peripheral tests of function, such as pulse wave analysis.

OBJECTIVES: To evaluate the influence of chronic inflammatory state on endothelial function in patients with RA free of cardiovascular disease or risk factors by measuring endothelial reactivity.

METHOD: A total number of 62 patients of RA and 18 normal healthy controls participated in the study. The pulse wave velocity (PWV), reflection index (RI) and augmentation or stiffness Index (SI) were measured at baseline and vasodilatory response was measured. Waveform analyzer and Micromedical Pulse Trace Analyser were used.

RESULTS: Heart brachial PWV and brachial ankle PWV were not statistically significant in healthy and RA patient groups. RI was higher in RA patients than controls. SI in RA patient group (7.94 ± 1.20) was statistically significant (p < .0001) as compared to healthy controls (6.75 ± 0.65). RA patients with low SI had active disease indicated by DAS28 (5.03 ± 1.20) increased ESR and CRP levels as compared to the controls.

CONCLUSIONS: RA with high disease activity, free from cardiovascular risk factors and overt cardiovascular disease had premature aging (increased vascular stiffness). Inflammatory process associated with RA was responsible for findings. It is suggested that the increased arterial stiffness contributes to the observed increased cardiovascular mortality and morbidity in subjects with RA.