High anti-CCP titre linked to severe carotid plaque in rheumatoid arthritis
Patients with rheumatoid arthritis (RA) appear to have a high prevalence of any carotid plaques and severe carotid plaques, with high titre of anticyclic citrullinated peptide (anti-CCP) antibodies a risk factor for severe carotid atherosclerotic plaque in RA.
The study included 200 patients with RA and 202 matched healthy controls. Researchers analysed the carotid ultrasound, clinical data and cardiovascular risk factors for each individual. Atherosclerotic plaque was defined as an intima-media thickness of ≥1.1 mm. The severity of plaque was evaluated by the plaque score, which was calculated as the sum of the maximal thickness of all plaques in bilateral carotid arteries.
Carotid plaque was found to be more common in the RA group vs the control group (47.0 vs 36.1 percent; p=0.027), with plaque score being significantly higher among RA patients (p=0.032).
On logistic regression analysis, RA emerged as an independent risk factor for the presence of plaque (adjusted odds ratio, 1.68; 95 percent CI, 1.03 to 2.74). Compared with RA patients without plaque, those with plaque had significantly higher anti-CCP antibodies titre (315.8 vs 281.1 U/mL; p=0.005).
A multiple linear regression analysis demonstrated an association between anti-CCP antibody titre and plaque score among patients with RA.
The leading cause of mortality in RA is cardiovascular death, attributed to approximately half of the total deaths. Excess CV risk in this population may be explained by traditional risk factors such as hypertension, type 2 diabetes, smoking, hypercholesterolemia, obesity and physical inactivity. Carotid artery plaque, as identified using ultrasound, indicates very high CV risk and is reported to strongly predict incident cardiovascular event rates in both RA patients and non-RA controls. [Open Rheumatol J 2016;10:49–59; Arthritis Res Ther 2015;17:55]