Subclinical diastolic dysfunction and its association with disease activity in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder associated with cardiovascular risk (CVR), regardless of traditional risk factors. The objective of this study was to assess subclinical cardiovascular changes in RA, including cardiac and carotid parameters, and to examine their correlation with disease activity in 60 RA patients and 60 age and sex-matched healthy controls. The clinical variables included epidemiological and laboratory data and disease activity scores (DAS28-PCR). CVR was stratified using SCORE/mSCORE and Framingham scores. The ultrasound (US) methods employed (transthoracic echocardiography and Doppler carotid ultrasonography) allowed to evaluate carotid intima-media thickness (CIMT), atherosclerosis plaque, and cardiac function. The female sex was predominant (RA = 91.7%; controls = 90%) and the mean age was 52 ± 12 years and 52 ± 13 years, respectively. The mean disease duration was 10.43 ± 7.55 years. Serum testing for rheumatoid factor and anti-CCP was double-negative in 36.7%. The DAS28-PCR scores identified 61.7% as 'remission/low activity' and 31.3% as 'moderate/high activity'. CVR was similar in the two groups (p = 0.261). When the echocardiographic data was stratified, diastolic dysfunction was significantly more prevalent in subjects with higher disease activity (p = 0.04). In addition, high clinical CVR scores were associated with greater CIMT and carotid plaque (p < 0.05). Our results suggest that inflammatory activity may play a major role in subclinical cardiovascular dysfunction in RA.