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. 2017 Sep 26;19(1):213.
doi: 10.1186/s13075-017-1422-x.

Assessment of intracranial vessels in association with carotid atherosclerosis and brain vascular lesions in rheumatoid arthritis

Csaba Oláh  1 , Zsófia Kardos  2 , Mariann Sepsi  3 , Attila Sas  4 , László Kostyál  3 , Harjit Pal Bhattoa  5 , Katalin Hodosi  6 , György Kerekes  7 , László Tamási  2 , Attila Valikovics  4 , Dániel Bereczki  8   9 , Zoltán Szekanecz  10
Affiliations

Assessment of intracranial vessels in association with carotid atherosclerosis and brain vascular lesions in rheumatoid arthritis

Csaba Oláh et al. Arthritis Res Ther. .

Abstract

Background: Stroke has been associated with rheumatoid arthritis (RA). We assessed patients with RA and healthy control subjects by transcranial Doppler (TCD), carotid ultrasonography and brain magnetic resonance imaging (MRI).

Methods: Altogether, 41 female patients with RA undergoing methotrexate (MTX) or biologic treatment and 60 age-matched control subjects underwent TCD assessment of the middle cerebral artery (MCA) and basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI) and circulatory reserve capacity (CRC) were determined at rest (r) and after apnoea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) were also determined. Intracerebral vascular lesions were investigated by brain MRI.

Results: MCA PI and RI values at rest and after apnoea were significantly increased in the total and MTX-treated RA populations vs control subjects. MCA CRC was also impaired, and basilar artery PI was higher in RA. More patients with RA had carotid plaques and increased cIMT. Linear regression analysis revealed that left PI(r) and RI(r) correlated with disease duration and that left PI(r), RI(r), PI(a), PI(h) and basilar PI correlated with disease activity. Right CRC inversely correlated with 28-joint Disease Activity Score. Disease activity was an independent determinant of left PI(a) and right CRC. Compared with long-term MTX treatment alone, the use of biologics in combination with MTX was associated with less impaired cerebral circulation. Impaired cerebral circulation was also associated with measures of carotid atherosclerosis.

Conclusions: To our knowledge, this is the first study to show increased distal MCA and basilar artery occlusion in RA as determined by TCD. Patients with RA also had CRC defects. We also confirmed increased carotid plaque formation and increased cIMT. Biologics may beneficially influence some parameters in the intracranial vessels.

Keywords: Biologic therapy; Carotid artery; Cerebrovascular disease; Methotrexate; Rheumatoid arthritis; Stroke; Transcranial Doppler.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval (1046-63/2015) was obtained from the Regional/Institutional Review Board of Miskolc University. The study was performed according to the principles of the Declaration of Helsinki.

Consent for publication

No data that could identify individual patients are presented; therefore, consent was not needed.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
MCA PI(r) (a), PI(a) (b) and PI(h) (c) values in patients with RA and control subjects. See text for abbreviations. a *p < 0.001 vs controls; # p < 0.05 vs controls; @ p < 0.001 vs MTX. b *p < 0.001 vs controls; # p < 0.05 vs controls. c @ p < 0.05 vs MTX
Fig. 2
Fig. 2
MCA RI(r) (a), RI(a) (b) and RI(h) (c) values in patients with RA and control subjects. See text for abbreviations. a *p < 0.001 vs controls; # p < 0.05 vs controls; @ p < 0.05 vs MTX b *p < 0.001 vs controls c # p < 0.05 vs controls
Fig. 3
Fig. 3
Basilar artery PI(r) values in patients with RA and control subjects. See text for abbreviations. # p < 0.05 vs controls
Fig. 4
Fig. 4
MCA CRC values in patients with RA and control subjects. See text for abbreviations. *p < 0.001 vs controls; # p < 0.05 vs controls
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