Systematic review on the association between concomitant rheumatoid arthritis and peripheral arterial disease

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Rheumatoid arthritis (RA) has been recognized as an independent risk factor for cardiovascular diseases. The risk is accentuated by the use of steroids for the management of associated flares, atherosclerotic changes contributed by disease inflammation, and associated vascular morbidities such as peripheral arterial disease (PAD). Now, the findings of a systematic review published in Rheumatology International have reported an association between RA and PAD.

The review carried out by Tayser Zoubi, from Flinders University, Australia, and Hendry Gordon, from Glasgow Caledonian University, observed grade II levels of evidence to support the positive association between RA and PAD. The researchers also observed a graded I level of evidence for the association between the ankle-brachial pressure index (ABPI) and RA, thereby suggesting the role of RA as an independent risk factor for arterial obstruction or incompressibility. The level of evidence analysis was insufficient to evaluate the impact of concomitant manifestations on health-related quality of life (HRQOL) and functional capacity.

A 2010 study by Stamatelopoulos et al. has noted a more advanced occurrence of subclinical peripheral arterial disease in RA patients than in controls. The researchers noted significantly increased femoral intima-media thickness (IMT) and plaque prevalence in RA patients than controls (P=0.001 and 0.008, respectively).

Further studies are warranted to investigate the impact of symptomatic PAD on HRQOL and functional capacity in the RA population. Corroborating the association may provide additional prognostic value during risk stratification of the disease for primary prevention.

References

  1. Zoubi T, Gordon, H. Systematic review of associations between concomitant rheumatoid arthritis and peripheral arterial disease, health-related quality of life and functional capacity. Rheumatol Int (2022).
  2. Stamatelopoulos KS, Kitas GD, Papamichael CM, Kyrkou K, Zampeli E, Fragiadaki K, Panoulas VF, Mavrikakis M, Sfikakis PP. Subclinical peripheral arterial disease in rheumatoid arthritis. Atherosclerosis. 2010 Sep;212(1):305-9.