Evaluation of subclinic aterosclerosis by ultrasonography and comparison of disease activities in patients using anti TNF and dmard with romatoid arthritis

Rheumatoid arthritis (RA) is the most common chronic autoimmune inflammatory arthritis. RA is associated with increased mortality compared to the general population. Cardiovascular diseases are the leading causes of mortality in RA. This increased cardiovascular risk in RA patients was found to be independent of traditional risk factors causing atherosclerosis. Inflammation increase is the strongest factor in RA in relation to early atherosclerosis. The increase in atherosclerosis in the carotid arteries is correlated with many vascular beds, including coronaries. Therefore, increased carotid intima-media thickness (CIMT) is an important marker in showing cardiovascular risk, including acute coronary syndromes. In the light of this information, we aimed to detect subclinical atherosclerosis and to determine the relationship between CIMT and disease activity by measuring carotid ultrasonography in patients with RA. 60 RA patients and 30 healthy volunteers who met the inclusion criteria from the patients who applied to Gaziosmanpaşa University Faculty of Medicine Physical Medicine and Rehabilitation Department between October 2018 and October 2019 were included in our study. Disease activity score was evaluated with Disease Activity Score-28 (DAS-28) and functional status was evaluated with Health Assessment Questionnaire (HAQ). Those with DAS-28 values above 3.2 were included in the active disease group, and those below 3.2 and below were included in the inactive disease group. All the participants in the study were measured by carotid artery ultrasonography and CIMT by the same radiologist. In the literature, there are studies that describe the presence of subclinical atherosclerosis, which is revealed by the increase in CIMT in RA patients. In some studies, it has been shown that there is no statistically significant difference in CIMT compared to control subjects in RA patients. In our study, a statistically significant correlation was found between the age, triglyceride (TG) level and presence of atherosclerotic plaque, which are potential cardiovascular disease risk factors affecting CIMT (p values 0.001, 0.014, respectively). However, no statistically significant correlation was found between sedimentation (ESR) indicating disease activity, C-reactive protein (CRP), Rheumatoid Factor, Anti-cyclic citrated peptide levels, and HAQ score. Treatment of the underlying disease process in patients with RA, thus preventing atherosclerosis offers a great opportunity to simultaneously prevent acute complications. Obtaining information on RA-related mechanisms in atherosclerosis will be of great importance in the prevention of RA's cardiovascular complications with large future randomized controlled studies. Key words: Rheumatoid arthritis, carotid intima media thickness, atherosclerosis