Lower limb arterial incompressibility and obstruction in RA

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Ann Rheum Dis. 2004 Jul 22 [Epub ahead of print]

Lower limb arterial incompressibility and obstruction in rheumatoid

arthritis.

Del Rincon I, Haas RW, Pogosian S, Escalante A.

University of Texas Health Science Center, USA.

OBJECTIVE: Despite increased cardiovascular (CV) morbidity and mortality

in rheumatoid arthritis (RA), the peripheral arteries remain

understudied. We examined the lower limb arteries in age- and

sex-matched, non- smoking RA patients and people without RA. METHODS: We

measured the ankle/brachial index (ABI) at the posterior tibial and

dorsal pedal arteries. We classified arteries as obstructed if the ABI

</= 0.9, normal if ABI > 0.9 and </= 1.3, and incompressible if ABI >

1.3. We used multinomial logistic regression to estimate differences in

ABI between RA and controls, adjusting for CV risk factors, RA

manifestations, inflammation markers and glucocorticoid dose. RESULTS:

We studied 234 RA patients and 102 controls. Among the RA patients, 66

of 931 arteries (7%) were incompressible and 30 (3%) were obstructed.

Among the controls, 3 of 408 arteries (0.7%) were incompressible (P =

0.002) and 4 (1%) were obstructed (P = 0.06). At the person level, one

or more abnormal artery occurred among 45 RA patients (19%), vs. 5

controls (5%, P = 0.001). The greater frequency of arterial

incompressibility and obstruction in RA was independent of age, sex, and

CV risk factors. Adjustment for inflammation markers, joint damage,

rheumatoid factor and glucocorticoid use, reduced RA vs. control

differences. Most arterial impairments occurred in RA patients with 20

or more deformed joints. This subgroup had more frequent incompressible

(15%, P pound 0.001) and obstructed (6%, P = 0.005) arteries than the

controls, independent of covariates.

CONCLUSION: Peripheral arterial incompressibility and obstruction are

increased in RA. Their propensity for patients with advanced joint

damage suggests shared pathogenic mechanisms.

PMID: 15271772

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