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. 2004 Jul 22;64(3):425–432. doi: 10.1136/ard.2003.018671

Lower limb arterial incompressibility and obstruction in rheumatoid arthritis

I del Rincon 1, R Haas 1, S Pogosian 1, A Escalante 1
PMCID: PMC1755423  PMID: 15271772

Abstract

Background: Despite increased cardiovascular morbidity and mortality in rheumatoid arthritis, the peripheral arteries remain understudied.

Objective: To examine the lower limb arteries in age and sex matched, non-smoking subjects with and without rheumatoid arthritis.

Methods: The ankle-brachial index (ABI) was measured at the posterior tibial and dorsal pedal arteries. Arteries were classified as obstructed with ABI ⩽0.9, normal with ABI >0.9 but ⩽1.3, and incompressible with ABI >1.3. Multinomial logistic regression was used to estimate differences in ABI between patients and controls, adjusting for cardiovascular risk factors, rheumatoid arthritis manifestations, inflammation markers, and glucocorticoid dose.

Results: 234 patients with rheumatoid arthritis and 102 controls were studied. Among the rheumatoid patients, 66 of 931 arteries (7%) were incompressible and 30 (3%) were obstructed. Among the controls, three of 408 arteries (0.7%) were incompressible (p = 0.002) and four (1%) were obstructed (p = 0.06). At the person level, one or more abnormal arteries occurred among 45 rheumatoid patients (19%), v five controls (5%, p = 0.001). The greater frequency of arterial incompressibility and obstruction in rheumatoid arthritis was independent of age, sex, and cardiovascular risk factors. Adjustment for inflammation markers, joint damage, rheumatoid factor, and glucocorticoid use reduced rheumatoid arthritis v control differences. Most arterial impairments occurred in rheumatoid patients with 20 or more deformed joints. This subgroup had more incompressible (15%, p⩽0.001) and obstructed arteries (6%, p = 0.005) than the controls, independent of covariates.

Conclusions: Peripheral arterial incompressibility and obstruction are increased in rheumatoid arthritis. Their propensity for patients with advanced joint damage suggests shared pathogenic mechanisms.

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Figure 1.

Figure 1

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 (A) Ankle-brachial index (ABI) in 931 arteries from patients with rheumatoid arthritis and 408 arteries from controls. The two dotted horizontal lines represent the upper and lower boundaries for the normal ABI. Values above the top dotted line indicate arterial incompressibility. Values below the lower dotted line indicate arterial obstruction. The mean ABI is similar in both groups, but the rheumatoid group shows tails extending above and below the normal range. Among controls, three of the arteries (0.7%) were incompressible and four were obstructed (1%), while in the rheumatoid group 66 of the arteries (7%) were incompressible and 30 were obstructed (4%). (B) Stratification according to the number of deformed joints showed that most of the values outside the normal range occur among rheumatoid patients with more than 20 deformed joints. In this group, 53 arteries (15%) were incompressible and 20 (6%) were obstructed. This increase in the proportion of abnormal arteries among rheumatoid patients with >20 deformed joints was independent of age, sex, cardiovascular risk factors, and markers of inflammation. See text for details.

Figure 2.

Figure 2

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 Calcification of the ulnar and radial arteries in two patients with advanced joint damage caused by rheumatoid arthritis. In both of these patients, neither the dorsal pedal nor the posterior tibial arteries bilaterally could be compressed at a cuff pressure of more than 250 mm Hg.

Selected References

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