Carotid ultrasound improves risk management in rheumatoid arthritis

By Andrew Czyzewski, medwireNews Reporter

A trial of radiofrequency ultrasound in patients with rheumatoid arthritis (RA) has shown that carotid intima-media thickness (IMT) is significantly greater in patients treated only with synthetic therapeutics compared with those who are also taking biologics.

Esperanza Naredo (Hospital General Universitario Gregorio Marañón, Madrid, Spain) and colleagues suggest that "biologic therapy may have a protective effect on the increased carotid IMT and atherosclerotic process widely described in the literature on RA patients."

In RA, an increased carotid IMT assessed by ultrasound has shown independent predictive value in relation to both subclinical atherosclerosis and cardiovascular events.

However, the current standard 'B-mode' ultrasound is manual or semi-manual and therefore requires substantial specific training, and the results are ultimately dependent on the experience of the operator.

Technology based on radiofrequency provides an automated method for measuring carotid IMT, which could circumvent some of these issues.

In the current study, the researchers assessed carotid IMT using radiofrequency ultrasound in 94 patients with RA and 94 gender- and age-matched controls.

Of the patients, 45 had been treated with synthetic disease-modifying antirheumatic drugs (DMARDs; mainly methotrexate and leflunomide) and 49 with synthetic and biologic DMARDs (such as adalimumab, infliximab, etanercept, and rituximab).

Naredo et al found that carotid IMT measurements ranged from 349 to 744 mm in the control group, from 377 to 851 mm in the RA group treated with synthetic DMARDs, and from 300 to 773 mm in the RA group treated with synthetic and biologic DMARDs.

Analysis showed that mean carotid IMT was significantly greater in RA patients treated only with synthetic DMARDs than in controls. In addition, mean carotid IMT was significantly greater in patients treated only with synthetic DMARDs than in patients treated with synthetic and biologic DMARDs.

There was no significant difference in mean carotid IMT between RA patients treated with synthetic and biologic DMARDs and controls.

Discussing the findings, Naredo et al conclude in Rheumatology that "implementation of carotid IMT in rheumatology practice may provide additional value to RA management."

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