1. Annals of Internal Medicine
Preclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis
Mary J. Roman, MD; Elfi Moeller, AB; Adrienne Davis, AB; Stephen A. Paget, MD; Mary K. Crow, MD; Michael D. Lockshin, MD; Lisa Sammaritano, MD; Richard B. Devereux, MD; Joseph E. Schwartz, PhD; Daniel M. Levine, PhD; and Jane E. Salmon, MD
Ann Intern Med. 2006;144:
In Ah Choi / Inst Yeon Ah Lee

2. Cardiovascular Disease
INTRODUCTION
In Patients with Rheumatoid Arthritis
Cardiovascular Disease
Increased Mortality and Morbidity
Increased Cardiovascular events due to …
1. Specific aspects of of rheumatoid arthritis?
2. Treatment might highten the risk?

3. OBJECTIVES
To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis
To identify clinical and biological markers for atherosclerotic disease in this patient population

4. METHODS Study Sample 1. American College of Rheumatology’s
classification criteria for a diagnosis
of rheumatoid arthritis
2. Rheumatoid Arthritis Registry at the
Hospital for Special Surgery in New York
age < 18 years,
serum creatinine level < 3.0 mg/dL
CrCl < 30 mL/min
current or recent pregnancy
Exclusion criteria
normotensive and hypertensive individuals
who participated in longitudinal studies
at the Hypertension Center of The New
York Hospital and who underwent
similar imaging protocols.
matched to controls on the basis of age
(within 5 years), sex, and ethnicity.

5. METHODS Carotid Ultrasonography
experienced research sonographers
who used an identical protocol
single cardiologist,
blinded to the study
participants
In extracranial carotid arterial systems
Atherosclerosis : discrete plaque protruding into the lumen
at least 50% beyond the diameter of the
surrounding wall obstruction.
Intima media thickness : measured from end diastolic M-mode
images of distal common carotid artery

6. RESULTS

7. RESULTS
(con’t)

8. RESULTS

9. RESULTS

10. RESULTS

11. RESULTS

12. RESULTS

13. Atherosclerosis ↑ in RA Traditional Risk Factor
CONCLUSION
Atherosclerosis ↑ in RA
Chronic Inflammation
Traditional Risk Factor
Aggressive control of disease activity!!