Gout and rheumatoid arthritis are associated with subclinical vascular damage, reduced brachial vasoreactivity and coronary microvascular dysfunction: a case-control study

Abstract

Gout and rheumatoid arthritis (RA) are distinct disorders, but both of these inflammatory arthropaties are associated with a relatively similar risk of atherosclerotic cardiovascular disease. We aimed to assess carotid intima-media thickness (CIMT), flow-mediated vasodilatation (FMD) and coronary flow reserve (CFR) in both disorders to understand and compare the extent of vascular damage. Patients with recently diagnosed gout (n = 30) and RA (n = 40) without previous cardiovascular disease were included to the present study, and 45 healthy volunteers served as controls. All participants underwent ultrasonographic examinations to measure CIMT, FMD and CFR. In unadjusted analysis, both gout and RA were associated with a significantly higher CIMT and significantly lower CFR as compared to controls, while FMD was only lower in the gout group. After adjustment, there was a significantly higher odds ratio (OR) for CIMT (OR:7.02, 95%CI:2.45-20.58 for gout and OR:2.86, 95%CI:1.27-6.57 for RA) and a lower OR for CFR (OR:0.21, 95%CI:0.08-0.55 for gout and OR:0.17, 95%CI:0.07-0.45 for RA) in both groups, while only gout patients had a lower OR for FMD (OR:0.21, 95%CI:0.08-0.55). There were no significant differences or evidence of a difference between gout and RA patients for CIMT, FMD or CFR. Gout and RA are associated with a similar degree of vascular damage, which may explain the similar incidence of atherosclerotic cardiovascular disease in both diseases.