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High serum amyloid A associated with inflammation, CV risk in patients with RA
High levels of serum amyloid A were associated with persistent inflammation and risks for cardiovascular disease in rheumatoid arthritis patients, according to a new research.
The study included 140 patients with rheumatoid arthritis (RA) enrolled and treated at the Department of Rheumatology and Connective Tissue Diseases at the Medical University of Lublin in Lublin, Poland. Diagnosis of RA was confirmed using American College of Rheumatology criteria. Disease activity score was based on the evaluation of 28 joints (DAS28), tender joint and swollen joint counts, erythrocyte sedimentation rate (ESR) value, and patient’s global assessment. The ability to perform daily activities was measured using the Modified Health Assessment Questionnaire (M-HAQ). Other tests included serum concentration of C-reactive protein (CRP), creatinine, total protein, albumen, fibrinogen and a lipid panel. Serum was also tested for IgM-rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs).
Cardiovascular health factors included calculation of BMI and resting blood pressure, and a standard 12-lead transthoracic electrocardiogram was used measure the corrected Q-T interval in each patient. Carotid intima-media thickness (cIMT) was measured using ultrasound to assess atherosclerosis.
Disease-modifying anti-rheumatic drugs (DMARDs) were prescribed for 135 patients, predominantly methotrexate (58.6%). Biological DMARDs were prescribed for 36 patients (15 etanercept, 15 infliximab, three adalimumab and three rituximab). Low-dose concurrent prednisone was administered to 108 patients.
Most patients tested positive for RF and ACPAs and had erosive form RA of low or moderate activity (DAS28 score of up to 5.1). A majority of patients had above normal serum amyloid A (SAA) levels. Significant, positive correlations were seen between SAA levels and DAS28, tender joint and swollen joint counts, patient’s global assessment of disease activity, morning stiffness, ESR value, M-HAQ and CRP concentration, among other findings, according to the researchers.
Patients with high disease activity, as well as those with advanced atherosclerosis, had higher concentrations of SAA. Additionally, mean SAA level was significantly higher in patients with carotid plaques, but no association was found with the cIMT value, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.