Effect of glucocorticoids on the arteries in rheumatoid arthritis
Effect of glucocorticoids on the arteries in rheumatoid arthritis
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DOI：
10.1002/art.20661
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发表时间：
2004-12-01
影响因子：
--
通讯作者：
Escalante, A
中科院分区：
文献类型：
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作者：
del Rincón, I;O'Leary, DH;Escalante, A
目标。糖皮质激素被怀疑是导致动脉粥样硬化的原因。由于糖皮质激素的抗炎作用可能是抗动脉粥样硬化的，因此本研究观察了糖皮质激素对类风湿关节炎(RA)患者动脉的影响。我们对647例RA患者的动脉进行了评估。使用高分辨率颈动脉超声测量中央动脉粥样硬化斑块的存在和颈动脉内膜-中层厚度(CAIMT)的范围。通过测量足背动脉、胫骨后动脉和臂动脉的收缩压来评估周围动脉粥样硬化，以获得踝臂指数(ABI)。累积糖皮质激素剂量是使用药房记录并辅以自我报告来确定的。通过临床和实验室方法确定心血管危险因素和类风湿关节炎的临床表现。在研究的RA患者中，427例(66%)接受了糖皮质激素治疗。在从未接受过糖皮质激素治疗的患者中，215人中有100人(47%)有颈动脉斑块，219人中有17人(8%)有大于或等于1条不可压缩的下肢动脉(ABI>；1.3)。在终生接触糖皮质激素最高的患者中，颈动脉斑块的发生率增加到138人中的85人(62%)(P=0.006)，下肢动脉不可压缩的频率增加到140人中的24人(17%)(P=0.008)，在调整了发病年龄、病程、性别、心血管危险因素和类风湿关节炎临床表现(关节压痛、肿胀和畸形关节计数、皮下结节、类风湿因子血清阳性和血沉)后，差异仍然显著。CAIMT也随糖皮质激素暴露剂量增加而增加，但差异无统计学意义。下肢动脉阻塞(ABI小于或等于0.9)与糖皮质激素暴露无关。在此RA样本中，糖皮质激素暴露与颈动脉斑块和动脉不可压性相关，与心血管危险因素和RA临床表现无关。这支持了糖皮质激素在类风湿关节炎发生的心血管并发症中的作用。
Objective. Glucocorticoids are suspected to cause atherosclerosis. Because of the possibility that their antiinflammatory effect may be antiatherogenic, this study investigated the effect of glucocorticoids on the arteries of patients with rheumatoid arthritis (RA).Methods. We assessed the arteries of 647 patients with RA. Central atherosclerosis was measured using high-resolution carotid ultrasound for the presence of plaque and for the extent of carotid artery intima-media thickness (CaIMT). Peripheral atherosclerosis was assessed using the systolic pressures of the dorsal pedal, posterior tibial, and brachial arteries to obtain the ankle-brachial index (ABI). Cumulative glucocorticoid dose was determined using pharmacy records, supplemented by self-report. Cardiovascular (CV) risk factors and RA clinical manifestations were ascertained using clinical and laboratory methods.Results. Among the RA patients studied, 427 (66%) had received glucocorticoids. Of those who had never received glucocorticoids, 100 (47%) of 215 had carotid plaque and 17 (8%) of 219 had greater than or equal to1 incompressible lower-limb artery (ABI > 1.3). Among patients in the highest tertile of lifetime glucocorticoid exposure (> 16.24 gm prednisone), the frequency of carotid plaque increased to 85 (62%) of 138 (P = 0.006) and that of lower-limb arterial incompressibility increased to 24 (17%) of 140 (P = 0.008), with differences remaining significant after adjustment for age at onset, disease duration, sex, CV risk factors, and RA clinical manifestations (tender, swollen, and deformed joint counts, subcutaneous nodules, rheumatoid factor seropositivity, and erythrocyte sedimentation rate). The CaIMT also displayed an increase with higher glucocorticoid exposure, but the differences did not reach significance. Lower-limb artery obstruction (ABI less than or equal to0.9) was not associated with glucocorticoid exposure.Conclusion. In this RA sample, glucocorticoid exposure was associated with carotid plaque and arterial incompressibility, independent of CV risk factors and RA clinical manifestations. This supports a role for glucocorticoids in the CV complications that occur in RA.