Romatoid Artritli Hastalarda Ortak Carotid Arteri Intima-Media Kalınlığının Ultrasonografi ile Ölçümü

Raouf Rahim Merza; Salah Muhammed Fateh; Hawar Ali Ehsan

doi:10.17826/cutf.35581

EN TR

Measurement of the Common Carotid Arteries Intima-Media Thickness by Ultrasonography in Patients with Rheumatoid Arthritis.

Abstract

Purpose: Rheumatoid arthritis is a chronic inflammatory disabling disease affecting articular and extra articular organs and one of these important organs is cardiovascular system which its involvement is a leading cause of morbidity and mortality of Rheumatoid arthritis patients ; it is important to look for the relation of Rheumatoid arthritis and the extent of cardiovascular involvement among those patients by Ultrasound (US ) which is feasible, simple and low cost investigation and sonographic measurement of carotid artery intimal thickness is one of those reliable and sensitive means in assessing generalized atherosclerosis. To determine whether arterial wall thickening is increased in Rheumatoid arthritis patients compared with healthy controls by measuring the intima-media thickness of the common carotid arteries and to evaluate the factors that may be responsible for arterial intima-media thickness increase in patients with Rheumatoid arthritis. Material and methods: 32 Rheumatoid arthritis patients (7 males and 25 females) been evaluated for common carotid intima-media thickness compared with 30 healthy control subjects (8 males and 22 females) matched for (age, sex, and other major risk factors for atherosclerosis). Laboratory variables were measured by routine methods. Intima-media thicknesses of the common carotid arteries were measured by High-frequency linear probe ultrasound. Results: Common carotid artery intima-media thickness was significantly higher (P-value 0.003) in Rheumatoid arthritis patients (mean±SD 0.66±0.11mm) compared with controls (0.58±0.086mm).There was a highly significant association between carotid intima-media thickness increase and the acute phase reactants (ESR, CRP) and Rheumatoid factor as P-value was (0.000, 0.001 and 0.000) successively. No relation between carotid intima-media thickness and duration of disease modifying anti-rheumatic drugs usage was found (P-value 0.051). Conclusion: Rheumatoid arthritis patients are around three fold at a higher risk of developing arterial intimal thickening and in turn they are more prone to develop cardiovascular complications than normal population due to the effects of chronic inflammatory processes& these result concluded that the disease modifying anti-rheumatic drugs has no protective measures on arterial intima medial wall thickening.

Keywords

Rheumatoid arthritis, Carotid intima-media thickness, Ultrasonographic measurement.

Romatoid Artritli Hastalarda Ortak Carotid Arteri Intima-Media Kalınlığının Ultrasonografi ile Ölçümü

Öz

Amaç: Romatoid Artrit; eklemsel ve eklem harici organları etkileyen kronik inflamatuvar hastalıktır. Bu hastalığın etkilediği önemli organ sistemlerinde bir tanesi de Romatoid Artrit"li hastalarda mortalite ve morbidite oranlarının yükselmesine yol açan kardiyovasküler sistemdir. Dolayısıyla, Romatoid Artrit"li hastalar arasında hastalığın görülme oranını araştırmakda fayda sağlayacağı gibi uygulanabilir, basti ve düşük masraflı ultrasongrafi aracılığıyla kardiyovasküler sistemin ne derece katılım gösterdiğini bulmak değerli bir araçtır. Ayrıca karotid arter intimal kalınlığı ölçümü aterosklerosis değerlendirilmesinde de uygulanabilecek hassas yöntemlerden bir tanesidir. Çalışmamızın amacı Karotid arterlerinin intimal-media kalınlığını ölçerek sağlıklı kontroller ile karşılaştırarak Romatoid Artriti bulunun hastalarda arteriyal duvar kalınlığında artış olup olmadığını belirlenmek ve böylece Romatoid Artrit hastalarında artan arteriyal intima-medya kalınlığına neden olabilen faktörleri değerlendirmektir. Materyal ve Metod: 32 Romatoid Artrit hastası (7 erkek ve 25 kadın), 30 sağlıklı kontrol (yaş, cinsiyet ve atheroskleroz riskleri açısından uyumlu) karotid intima-media kalınlığı açısından karşılaştırılıp değerlendirildi. Laboratuvar değerlendirmeleri rutin yöntemler ile ölçüldü. Karotid arterlerin intima-media kalınlığı yüksek frekanslı lineer ultrasound probu ile ölçüldü. Bulgular: Karotid arter intima-medya kalınlığının kontrollere kıyasla Romatoid Artrit hastalarında önemli derece de artış gösterdiği belirlenmiştir (p-değeri: 0.003). Karotid intima-media kalınlığı artışı, akut faz reaktantları (ESR, CRP) ve romatoid faktörleri arasında önemli derecede ilişki bulunmuştur ve P değeri sırasıyla 0.000, 0.001 ve 0.000 olarak tespit edilmiştir. Karotid intima-media kalınlığı ile hastalığı düzenleyen anti-romatizmal ilaç kullanımı süresi arasında herhangi bir ilişki bulunmamıştır (p- değeri: 0.051) Sonuç: Romatoid Artrit hastalarında arteriyal intimal kalınlığı artışı control grubuna gore üç kat daha fazladır. Dolayısıyla bu tip hastalarda kardiyovasküler komplifikasyonların görülme olasılığı kronik inflamatuvar süreçlerinin etkilerinden dolayı normal populasyonlara göre çok daha fazladır. Hastalığı düzenleyen anti-romatizmal ilaçların arteriyel intimal-medial duvar kalınlaşması üzerine herhangi bir koruyucu etkisi olmadığı sonucuna varıldı.

Anahtar Kelimeler

romatoid artrit, karotid intima-media kalınlığı, ultrasonografik ölçüm

Kaynakça

Rose NR, Bona C. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol Today. 1993;14:426–30.
Mün evver Serdaroğlu, Haşim Çakırbay, Orhan Değer, Sevil Cengiz, and Sibel Kul . The association of anti-CCP antibodies with disease activity in rheumatoid arthritis.Rheumatol Int. 2008;28: 965–70.
AI-Rawi ZS, AI-Azzawi AJ, AI-Ajili FM, AI-Wakil R.RA in population samples in Iraq. Ann Rheum dis 1987;37:73.
Klippel JH, Stone JH, Crofford LJ, White PH. (2008) Primer on the Rheumatic Disease. 13 edition. Springer Science & Business Media, New York, USA. 2008;16-7, 118-9.
Ross R. The pathogenesis of atherosclerosis: a perspective for the1990s. Nature 1993;362:801–9.
Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ. 2000;321:199–204.
Yasojima K, Schwab C, McGeer EG, McGeer PL. Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol. 2001;158:1039–51.
Urieli-Shoval S, Linke RP, Matzner Y. Expression and function of serum amyloid A, a major acutephase protein, in normal and disease states. Curr Opin Hematol. 2000;7:64–9.
Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how“high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003;108:2957–63. del Rincon I, Williams K, Stern MP, Freeman GL, O’Leary DH, Escalante A. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheum. 2003;48:1833–40.
Gerli R, Schillaci G, Giordano A, Bocci EB, Bistoni O, Vaudo G, Marchesi S, Pirro M, Ragni F, Shoenfeld Y, Mannarino E. CD4+CD28– T lymphocytes contribute to early atherosclerotic damage in rheumatoid arthritis patients, Circulation. 2004;109: 2744–8.

Zal B, Kaski JC, Arno G, Akiyu JP, Xu Q, Cole D, Whelan M, Russell N, Madrigal JA, Dodi IA, Baboonian C. Heat-shock protein 60–reactive CD4 + CD28 null T cells in patients with acute coronary syndrome. Circulation. 2004;109:1230–5.
Salonen R, Salonen JT. Progression of carotid atherosclerosis and its determinants: a populationbased ultrasonography study. Atherosclerosis. 1990;81:33–40.
Kawamori R, Yamasaki Y, Matsushima H, Nishizawa H, Nao K, Hougaku H, et al. Prevalence of carotid atherosclerosis in diabetic patients: ultrasound highresolution B-mode imaging on carotid arteries. Diabetes Care 1992;15:1290–4.
Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kajimoto Y, et al. Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging. Diabetes. 1994;43:634–9.
Wofford J, Kahl F, Howard G, McKinney W, Toole J, Crouse JI. Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis. Arterioscler Thromb 1991;11:1786–94.
Lekakis JP, Papamichael CM, Cimponeriu AT, Stamatelopoulos KS, Papaioannou TG, Kanakakis J, et al. Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis. Am J Cardiol. 2000;85:949–52.
Simons PC, Algra A, Bots ML, Grobbee DE, van der Graaf Y. Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of Arterial disease). Circulation. 1999;100:951–7.
Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993;87:1156-65.
Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997;146:483–
O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22.
Li C, Engstrom G, Berglund G, Janzon L, Hedblad B. Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure. A prospective cohort study. Cerebrovascular Dis. 2008;26:297-303.
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115:459–67.
Kablak-Ziembicka A, Przewlocki T, Tracz W, Pieniazek P, Musialek P, Sokolowski A. Gender differences in carotid intima-media thickness in patients with suspected coronary artery disease. Am J Cardiol. 2005;96:1217–22.
Arnett FC, Edworthy SM, Bloch DA. et al. The American Rheumatism Association 1987 revised criteria for the classifi cation of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.
Kawagishi T, Nishizawa Y, Konishi T, Kawasaki K, Emoto M, ShojiT, et al. High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia. Kidney Int. 1995;48:820–6.
Poli A, Tremoli E, Colombo A, Sirtori M, Pignoli P, Paoletti R. Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients: a new model for the quantitation and follow-up of preclinical atherosclerosis in living. human subjects. Atherosclerosis. 1988;70:253–61.
Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA et al. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994;37:481 94.
Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107:1303-7.
Myllykangas-Luosuja¨rvi, Aho K, Kautiainen H, Isoma¨ki H. Cardiovascular mortality in women with rheumatoid arthritis. J Rheumatol. 1995;22:1065–7.
Wållberg-Jonsson S,O¨ hman M-L, Rantapa¨a¨Dahlqvist S. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in northern Sweden. J Rheumatol. 1997;24:445–51. del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 2001;44:2737-45.
Watson DJ, Rhodes T, Guess HA. All-cause mortality and vascular events among patients with rheumatoid arthritis, osteoarthritis, or no arthritis in the UK General Practice Research Database. J Rheumatol. 2003;30:1196-202.
Turesson C, Jarenros A, Jacobsson L. Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study. Ann Rheum Dis. 2004;63:952-5.
Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2005;52:402-11.
Kremers, HM, Crowson, CS, Therneau, TM, et al. High ten-year risk of cardiovascular disease in newly diagnosed rheumatoid arthritis patients: a populationbased cohort study. Arthritis Rheum. 2008;58:2268.
Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986;74:1399–406.
Bots ML, Hofman A, De Jong PT, Grobbee DE. Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study. Ann Epidemiol. 1996;6:147–53.
Heiss G, Sharrett AR, Barnes R, Chambless LE, Szklo M, Alzola C. Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study. Am J Epidemiol 1991;134:250–6.
Pujia A, Gnasso A, Irace C, Colonna A, Mattioli PL. Common carotid arterial wall thickness in NIDDM subjects. Diabetes Care. 1994;17:1330–6.
Bots, ML, Baldassarre, D, Simon, A, et al. Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?. Eur Heart J. 2007;28:398.
Yasuro Kumeda,et al, Increased Thickness of the Arterial Intima-Media Detected by Ultrasonography in Patients With Rheumatoid Arthritis, Arthritis & Rheumatism. 2003;48:1833–40.
Miguel A González-Gay1, Carlos GonzálezJuanatey2, Javier Llorca3. Carotid ultrasound in the cardiovascular risk stratification of patients with rheumatoid arthritis: when and for whom? Ann Rheum Dis doi: 10.1136 /annrheumdis-2011-201209.
Published Online First 5 May 2012.
Jonsson SW, Backman C, Johnson O, Karp K, Lundstro¨m E, Sundqvist KG, et al. Increased prevalence of atherosclerosis in patients with medium term rheumatoid arthritis. J Rheumatol. 2001;28:2597–602.
Park YB, Ahn CW, Choi HK, Lee SH, In BH, Lee HC, et al. Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound. Arthritis Rheum. 2002;46:1714–9.
Christopher V. Tehlirian, Joan M. Bathon, Primer on the Rheumatic Diseases Thirteenth Edition, Springer Science+Business Media, LLC. Chapter 6, Rheumatoid Arthritis, Clinical and Laboratory Manifestations. 2008;114-21.
Jean-Marc Waldburger, Gary S. Firestein, Primer on the Rheumatic Diseases Thirteenth Edition, Springer Science+Business Media, LLC. Chapter 6, Rheumatoid Arthritis, Epidemiology, Pathology, and Pathogenesis. 2008;122-32.
Pasceri V, Yeh ET. A tale of two diseases: atherosclerosis and rheumatoid arthritis. Circulation. 1999;100:2124–6.
Roberts, WL, Moulton, L, Law, TC, et al. Evaluation of nine automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications. Part 2. Clin Chem 2001; 47:418. Ridker, PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107:363.
Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998;97:2007–11.
Uyama O, Yoshimoto Y, Yamamoto Y, Kawai A. Bone changes and carotid atherosclerosis in postmenopausal women. Stroke. 1997;28:1730–2.
Barengolts EI, Berman M, Kukreja SC, Kouznetsova T, Lin C, Chomka E. Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int. 1998;62:209–13.
Mayumi Nagata-Sakurai et al, Inflammation and Bone Resorption as Independent Factors of Accelerated Arterial Wall Thickening in Patients With Rheumatoid Arthritis, Arthritis & Rheumatism Vol. 48, No. 11, November 2003, pp 3061–3067 DOI 1002/art.11327.
S. Van Doornum et al, Accelerated Atherosclerosis An Extraarticular Feature of Rheumatoid Arthritis?, Arthritis & Rheumatism. 2002; 46:862–73.
Yazışma Adresi / Address for Correspondence: Dr. Hawar Ali Ehsan Sulaimaniya Medical School Department of Rheumatology IRAQ e mail: haekkam@gmail.com geliş tarihi/received :09.12.2013 kabul tarihi/accepted:31.12.2013

Ayrıntılar

Birincil Dil

Türkçe

Konular

-

Bölüm

-

Yazarlar

Raouf Rahim Merza Bu kişi benim

Salah Muhammed Fateh Bu kişi benim

Hawar Ali Ehsan Bu kişi benim

Yayımlanma Tarihi

22 Temmuz 2014

Gönderilme Tarihi

22 Temmuz 2014

Kabul Tarihi

-

Yayımlandığı Sayı

Yıl 2014 Cilt: 39 Sayı: 2

DOI

https://doi.org/10.17826/cutf.35581

IZ

https://izlik.org/JA26JC47EF

MLA

Merza, Raouf Rahim, vd. “Romatoid Artritli Hastalarda Ortak Carotid Arteri Intima-Media Kalınlığının Ultrasonografi ile Ölçümü”. Cukurova Medical Journal, c. 39, sy 2, Haziran 2014, ss. 213-2, doi:10.17826/cutf.35581.

Bu eser Creative Commons Atıf-Gayriticari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.

Measurement of the Common Carotid Arteries Intima-Media Thickness by Ultrasonography in Patients with Rheumatoid Arthritis.

Abstract

Keywords

Romatoid Artritli Hastalarda Ortak Carotid Arteri Intima-Media Kalınlığının Ultrasonografi ile Ölçümü

Öz

Anahtar Kelimeler

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

DOI

IZ

Kaynak Göster