Study of Carotid Artery Intimomedial Thickness in Patients with Rheumatoid Arthritis and its Co-relation with Severity of the Disease.

INTRODUCTION RA is a chronic inflammatory state, predisposing for atherosclerosis as it is an immunoinflammatory process. This study focuses on use of Carotid artery intimomedial thickness (CIMT) as a marker for subclinical atherosclerosis. OBJECTIVE To study the assessment of atherosclerosis by Carotid Intimo-Medial Thickness (CIMT) in patients with rheumatoid arthritis and Correlation of ultrasonographic findings with severity of disease (using DAS-28 score). MATERIAL AND METHODS A prospective, case-control study involving 50 cases of diagnosed RA cases, and 50 healthy control. Sonological examination of the carotid and the vertebral arteries was done using a L&T SEQUINA color Doppler scanner with a linear band probe of frequency 6.6 to 14 MHz's. RESULTS This case control study was carried out in 100 subjects (50 cases and 50 controls). Cases comprised of 41 rheumatic women (Mean age 42.08+12.13 yrs) and 9 (mean age 48.4+12.8 years) rheumatic men. Mean CIMT of the study group (0.5996+0.109mm) was significantly greater (p<0.001) than that of control group (0.5290+0.006mm). We observed carotid plaques in 18% subjects of study group compared to 2% in controls (p<0.001). Mean age in the study group was 46.56+12.82 years and that of controls was 46.38+11.69 years (p>0.05). In the study group mean CIMT was significantly increased in RA factor positive patients than in RA factor negative patients. We also calculated the DAS-28 score of the study group subjects and found that 8, 27 and 15 were having Mild, Moderate & severe disease activity respectively. CONCLUSIONS CIMT has significant correlation with the age, and CIMT increases with age. Mean CIMT was found to be more with RF+(ve) patients indicating acute inflammation also has a role. When compared, the mean CIMT in each DAS sub group the result was found to be statistically insignificant.