Letter to the Editor
Usefulness of the Ankle-brachial Index as a Survey Method for Subclinical Vascular Disease in Patients With Rheumatoid Arthritis
Utilidad del índice tobillo-brazo como método de cribado de enfermedad vascular subclínica en pacientes con artritis reumatoide
Cristina Marcos de Frutos, Daniel Abad Pérez
, Carmen Suárez Fernández
Corresponding author
Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
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In recent years its natural history has changed thanks to advances in treatment, so comorbidities have become more important; in fact, increased mortality compared to the general population is primarily a result of diseases of cardiovascular origin,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> with rates up to 50% or higher.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In RA underlying atherosclerotic disease is increased<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> secondary to chronic inflammation, which involves activation of T lymphocytes and macrophages, production of proinflammatory cytokines<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> (gamma interferon, tumor necrosis factor, IL-1 and IL-6). It is potentiated due to classic cardiovascular risk factors (CVRF), including the metabolic syndrome, which is more prevalent probably due to less physical activity because of joint pain and moreover, dyslipidemia follows a more atherogenic<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> pattern.</p><p id="par0015" class="elsevierStylePara elsevierViewall">With all these data, we conclude that the RA is a situation with a high CVR, where cardiovascular morbidity is related to the disease activity, so its control could reduce the risk.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Therefore, this study proposes to detect subclinical CVD by measuring the ankle-brachial index (ABI).</p><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a descriptive cross-sectional study on 60 RA patients with no history of CVD, at the University Hospital of La Princesa, Madrid, selected consecutively in the rheumatology clinic during the 6 months when the study was carried out. Sociodemographic variables, analytical data, classic CVRF, duration of RA and immunomodulatory treatment were collected. ABI was defined as abnormal if less than 0.9.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Of the 60 patients enrolled, 3 were men (5%) and 57 women (95%) with a mean age<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation of 53.75 years (53.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.38, range 29–87). 38 had mild RA (63.3%), while 22 (36.7%) had important deformities. The time of disease progression was 9.14 years (9.14<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.505, range 0.6–40), 58 patients (96.7%) were under immunomodulatory therapy, mostly with methotrexate (75%). The result of the ABI was similar in both lower limbs: 1.074 (1.074<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.082, range 0.88–1.28) on the right and 1.077 (1.077<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.088, range 0.92–1.27) on the left, with no significant differences between them. Only one patient (1.7%) had an abnormal ABI: a woman of 87 years, with hypertension, and RA for 12 years and using corticosteroids during virtually all this time; the ABI on the other extremity was 0.92. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the ABI results.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In our sample, there is an overrepresentation of women (19:1) with respect to other RA populations (3:1). However, the profile of CVR did not differ regarding the Spanish general population.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Only one pathological case was detected, much lower than other studies,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> with rates of 20%–25%, although the frequency cutoff point considered as pathological was 1, rather than the value of 0.9 currently accepted. However, in another publication with the same cutoff,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> the prevalence was 10%, although in their sample the mean age, duration of RA and, above all, the prevalence of cardiovascular risk factors (especially diabetes and dyslipidemia) were superior. Other possible factors involved could be the adequate control of the disease, since only 3.3% of patients had no specific treatment and the value of the acute phase reactants was normal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A major limitation to the study was accessibility, as the ABI was performed after the patient visit, so many of the patients excluded were those who refused to participate, claiming physical difficulty to go and get tested, which may have been a selection bias, having lost the sickest patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, based on our results we do not consider routine ABI testing justified in asymptomatic patients with RA from a cardiovascular point of view.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marcos de Frutos C, Abad Pérez D, Suárez Fernández C. Utilidad del índice tobillo-brazo como método de cribado de enfermedad vascular subclínica en pacientes con artritis reumatoide. Reumatol Clin. 2014;10:268–269.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 915 "Ancho" => 2666 "Tamanyo" => 184404 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Results of the ABI on the left and right lower extremities.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular death in rheumatoid arthritis: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 41 | 26 | 67 |
| 2024 September | 37 | 15 | 52 |
| 2024 August | 50 | 26 | 76 |
| 2024 July | 51 | 28 | 79 |
| 2024 June | 40 | 25 | 65 |
| 2024 May | 55 | 26 | 81 |
| 2024 April | 33 | 23 | 56 |
| 2024 March | 47 | 27 | 74 |
| 2024 February | 30 | 28 | 58 |
| 2024 January | 36 | 32 | 68 |
| 2023 December | 25 | 26 | 51 |
| 2023 November | 34 | 28 | 62 |
| 2023 October | 31 | 37 | 68 |
| 2023 September | 45 | 39 | 84 |
| 2023 August | 29 | 15 | 44 |
| 2023 July | 25 | 21 | 46 |
| 2023 June | 33 | 30 | 63 |
| 2023 May | 40 | 18 | 58 |
| 2023 April | 22 | 8 | 30 |
| 2023 March | 39 | 29 | 68 |
| 2023 February | 33 | 22 | 55 |
| 2023 January | 24 | 12 | 36 |
| 2022 December | 38 | 24 | 62 |
| 2022 November | 33 | 30 | 63 |
| 2022 October | 39 | 20 | 59 |
| 2022 September | 30 | 26 | 56 |
| 2022 August | 34 | 44 | 78 |
| 2022 July | 35 | 37 | 72 |
| 2022 June | 21 | 35 | 56 |
| 2022 May | 42 | 45 | 87 |
| 2022 April | 39 | 46 | 85 |
| 2022 March | 34 | 45 | 79 |
| 2022 February | 40 | 34 | 74 |
| 2022 January | 32 | 33 | 65 |
| 2021 December | 24 | 40 | 64 |
| 2021 November | 41 | 48 | 89 |
| 2021 October | 30 | 53 | 83 |
| 2021 September | 30 | 56 | 86 |
| 2021 August | 31 | 30 | 61 |
| 2021 July | 19 | 23 | 42 |
| 2021 June | 25 | 35 | 60 |
| 2021 May | 37 | 39 | 76 |
| 2021 April | 42 | 98 | 140 |
| 2021 March | 48 | 19 | 67 |
| 2021 February | 26 | 17 | 43 |
| 2021 January | 19 | 22 | 41 |
| 2020 December | 19 | 12 | 31 |
| 2020 November | 22 | 17 | 39 |
| 2020 October | 21 | 15 | 36 |
| 2020 September | 28 | 21 | 49 |
| 2020 August | 23 | 20 | 43 |
| 2020 July | 15 | 12 | 27 |
| 2020 June | 43 | 27 | 70 |
| 2020 May | 22 | 16 | 38 |
| 2020 April | 18 | 18 | 36 |
| 2020 March | 12 | 11 | 23 |
| 2020 February | 2 | 0 | 2 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 62 | 5 | 67 |
| 2018 March | 82 | 6 | 88 |
| 2018 February | 47 | 2 | 49 |
| 2018 January | 44 | 6 | 50 |
| 2017 December | 43 | 6 | 49 |
| 2017 November | 46 | 6 | 52 |
| 2017 October | 25 | 4 | 29 |
| 2017 September | 22 | 4 | 26 |
| 2017 August | 24 | 3 | 27 |
| 2017 July | 22 | 6 | 28 |
| 2017 June | 35 | 8 | 43 |
| 2017 May | 40 | 11 | 51 |
| 2017 April | 27 | 8 | 35 |
| 2017 March | 24 | 5 | 29 |
| 2017 February | 14 | 6 | 20 |
| 2017 January | 24 | 6 | 30 |
| 2016 December | 55 | 18 | 73 |
| 2016 November | 41 | 7 | 48 |
| 2016 October | 57 | 10 | 67 |
| 2016 September | 76 | 9 | 85 |
| 2016 August | 42 | 5 | 47 |
| 2016 July | 24 | 8 | 32 |
| 2016 April | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 20 | 6 | 26 |
| 2015 June | 19 | 5 | 24 |
| 2015 May | 40 | 4 | 44 |
| 2015 April | 31 | 7 | 38 |
| 2015 March | 31 | 7 | 38 |
| 2015 February | 35 | 6 | 41 |
| 2015 January | 52 | 18 | 70 |
| 2014 December | 41 | 4 | 45 |
| 2014 November | 56 | 12 | 68 |
| 2014 October | 38 | 12 | 50 |
| 2014 September | 48 | 11 | 59 |
| 2014 August | 52 | 29 | 81 |
| 2014 July | 46 | 23 | 69 |
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