Implication of new atherosclerotic carotid plaques in the cardiovascular outcome of patients with rheumatoid arthritis

(RA) is a disease associated with accelerated atherosclerosis and increased risk of cardio-vascular (CV) events. In this issue of Arthritis Research & Th erapy, Zampeli and colleagues [1] longitudinally assessed the association with new carotid artery plaques in a series of non-diabetic patients with RA. Besides highlighting the expected infl uence of age and traditional CV risk factors, the authors highlighted the potential infl u ence of corticosteroid use as an independent risk factor for new plaque formation in the follow-up of these patients [1]. Th is interesting study raises a series of points that deserve to be addressed. First, the importance of early detection of athero sclerosis in RA before the development of CV complica tions. In this regard, the detection of endothelial dysfunc tion by brachial ultrasonography and the presence of abnormally increased carotid artery intima-media thick ness (IMT) and carotid plaques by carotid ultrasound con stitute a major breakthrough as they allow the presence of subclinical atherosclerosis in patients with RA to be identifi ed [2]. In this respect, a recent study confi rmed a correlation between the presence of endo the lial dysfunction (considered an early step in the athero-genesis process) and morphological data showing abnormally increased carotid IMT in RA patients with a disease duration of longer than 7 years [3]. However, carotid ultrasound is technically easier to perform than fl ow-mediated endothelium-dependent brachial ultra-sound and, in the hands of trained professionals, is a technique with low interobserver variability. Furthermore , as observed in low-and intermediate-risk groups of non-rheumatic individuals [4], both carotid IMT and the presence of carotid plaques have proven to be good predictors of CV events in patients with RA [5,6]. Second, in their study, Zampeli and colleagues [1] focused specifi cally on carotid plaques. With respect to this, carotid plaques constitute the best expression of atherosclerotic disease. Also, technically, it may be easier to detect carotid plaques than to evaluate the carotid IMT. Th ird, the study by Zampeli and colleagues confi rmed the implication of age and classic CV risk factors as predictors of new plaque formation in RA. In keeping with these observations, age was found to infl uence the degree of severity of the carotid IMT and the presence of carotid plaques in both patients with RA and matched controls [7]. Nevertheless, Zampeli and colleagues did not disclose any infl uence of the chronic infl ammation as an …