Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Traditional and Novel Risk Markers for Atherosclerosis but Not Clinical Measures of Inflammatory Disease Are Associated with Atheromatous Plaque Presence in Early Inflammatory PolyarthritisResults from the Norfolk Arthritis Register (NOAR).

Mirjafari3,  Hoda, Verstappen2,  Suzanne M. M., Bunn6,  Diane, Edlin5,  Helena, Charlton-Menys4,  Valentine, Pemberton5,  Philip, Marshall6,  Tarnya

Arthritis Research UK Epidemiology Unit, Stopford Building, The University of Manchester, Manchester, United Kingdom
Arthritis Research UK Epidemiology Unit, Stopford Building, The University of Manchester
Arthritis Research UK Epidemiology Unit, The University of Manchester
Cardiovascular Research Group, The University of Manchester
Manchester Royal Infirmary
Norfolk and Norwich University Hospital
Univ of Manchester, Manchester, United Kingdom

Purpose:

Patients with inflammatory polyarthritis (IP) have an excess risk of cardiovascular (CVD) mortality due to accelerated atherosclerosis. Markers identifying individuals with subclinical atheromatous plaque may allow for attenuation of CVD risk. The objective of this study was to identify risk markers associated with atheromatous plaque in an incident cohort of patients with early IP.

Methods:

Consecutive patients with early IP (> or equal to 2 joints swollen for > or equal to 4 weeks) aged 18–65 years, who were within 24 months of symptom onset were recruited as part of a primary-care based inception cohort between 2004–2008. Patients underwent assessment of classic risk factors, completion of a health assessment questionnaire (HAQ) and a 28 joint count for calculation of disease activity score (DAS28). Blood was taken for rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA), C-reactive protein (CRP), high sensitivity CRP (hs-CRP), fasting glucose, novel and traditional lipid levels (LDL, HDL, triglycerides, paroxonase 1 (PON1) apolipoprotein (Apo) A1 and B), markers of vascular damage (E-selectin, vascular adhesion molecule (VCAM)) and adipocytokines (leptin and adiponectin). All patients underwent B mode Doppler ultrasound examination of the carotid arteries to assess for the presence of plaque. In univariate analyses we identified factors that were associated with plaque presence after age and gender adjustment. An additive stepwise multivariable logistic regression model investigated the independence of any associations.

Results:

Of the 316 patients studied 93 (29%) patients were male. The median (IQR) age and symptom duration at study entry was 51 (42–58) years and 6.6 (4.2–11.2) months respectively. The patients had a mean (SD) blood pressure of 134/82 (17/10) mmHg, 71(23%) were smokers and 149 (47%) had detectable plaque. From the univariate analysis; age, smoking, total cholesterol, triglycerides, Apo B, hs-CRP, adiponectin and E-selectin were significantly associated with plaque presence. There was no significant association found between HAQ score, DAS28, exposure to steroid therapy and DMARDs, RF and ACPA status and plaque presence at baseline (OR (95% CI); 0.97 (0.68, 1.40), 1.06 (0.85, 1.32), 0.77 (0.39, 1.51), 0.98 (0.58, 1.64), 1.54 (0.92, 2.57), 1.39 (0.81, 2.39)). In an additive stepwise multivariable logistic regression model age, smoking, systolic blood pressure, Apo B, hs-CRP and adiponectin remained significant independent predictors of plaque (Table).

Table. Multivariable logistic regression association with plaque

VariableOdds Ratio (95% CI)
Age (years)1.11 (1.07, 1.16)
Smoker (Y/N)2.91 (1.28, 6.64)
Systolic blood pressure (/mmHg)1.02 (1.00, 1.04)
Apo B (/g/l)7.63 (2.28, 25.51)
hs-CRP (/mg/L)1.04 (1.01, 1.07)
Adiponectin (/mg/l)1.19 (1.05, 1.36)

Conclusion:

Markers known to be associated with atherosclerosis in the general population including smoking, higher systolic blood pressure and Apo B are associated with early atherosclerosis in this population. The association with hs-CRP and adiponectin suggests that low grade inflammation, even in early disease, may contribute to atherogenesis in early IP.

To cite this abstract, please use the following information:
Mirjafari, Hoda, Verstappen, Suzanne M. M., Bunn, Diane, Edlin, Helena, Charlton-Menys, Valentine, Pemberton, Philip, et al; Traditional and Novel Risk Markers for Atherosclerosis but Not Clinical Measures of Inflammatory Disease Are Associated with Atheromatous Plaque Presence in Early Inflammatory PolyarthritisResults from the Norfolk Arthritis Register (NOAR). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1067
DOI: 10.1002/art.28834

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