Raouf Rahim Merza, Salah Muhammed Fateh, Hawar Ali Ehsan

Romatoid Artritli Hastalarda Ortak Carotid Arteri Intima-Media Kalınlığının Ultrasonografi ile Ölçümü

Amaç: Romatoid Artrit; eklemsel ve eklem harici organları etkileyen kronik inflamatuvar hastalıktır. Bu hastalığın etkilediği önemli organ sistemlerinde bir tanesi de Romatoid Artrit"li hastalarda mortalite ve morbidite oranlarının yükselmesine yol açan kardiyovasküler sistemdir. Dolayısıyla, Romatoid Artrit"li hastalar arasında hastalığın görülme oranını araştırmakda fayda sağlayacağı gibi uygulanabilir, basti ve düşük masraflı ultrasongrafi aracılığıyla kardiyovasküler sistemin ne derece katılım gösterdiğini bulmak değerli bir araçtır. Ayrıca karotid arter intimal kalınlığı ölçümü aterosklerosis değerlendirilmesinde de uygulanabilecek hassas yöntemlerden bir tanesidir. Çalışmamızın amacı Karotid arterlerinin intimal-media kalınlığını ölçerek sağlıklı kontroller ile karşılaştırarak Romatoid Artriti bulunun hastalarda arteriyal duvar kalınlığında artış olup olmadığını belirlenmek ve böylece Romatoid Artrit hastalarında artan arteriyal intima-medya kalınlığına neden olabilen faktörleri değerlendirmektir. Materyal ve Metod: 32 Romatoid Artrit hastası (7 erkek ve 25 kadın), 30 sağlıklı kontrol (yaş, cinsiyet ve atheroskleroz riskleri açısından uyumlu) karotid intima-media kalınlığı açısından karşılaştırılıp değerlendirildi. Laboratuvar değerlendirmeleri rutin yöntemler ile ölçüldü. Karotid arterlerin intima-media kalınlığı yüksek frekanslı lineer ultrasound probu ile ölçüldü. Bulgular: Karotid arter intima-medya kalınlığının kontrollere kıyasla Romatoid Artrit hastalarında önemli derece de artış gösterdiği belirlenmiştir (p-değeri: 0.003). Karotid intima-media kalınlığı artışı, akut faz reaktantları (ESR, CRP) ve romatoid faktörleri arasında önemli derecede ilişki bulunmuştur ve P değeri sırasıyla 0.000, 0.001 ve 0.000 olarak tespit edilmiştir. Karotid intima-media kalınlığı ile hastalığı düzenleyen anti-romatizmal ilaç kullanımı süresi arasında herhangi bir ilişki bulunmamıştır (p- değeri: 0.051) Sonuç: Romatoid Artrit hastalarında arteriyal intimal kalınlığı artışı control grubuna gore üç kat daha fazladır. Dolayısıyla bu tip hastalarda kardiyovasküler komplifikasyonların görülme olasılığı kronik inflamatuvar süreçlerinin etkilerinden dolayı normal populasyonlara göre çok daha fazladır. Hastalığı düzenleyen anti-romatizmal ilaçların arteriyel intimal-medial duvar kalınlaşması üzerine herhangi bir koruyucu etkisi olmadığı sonucuna varıldı.

Anahtar Kelimeler:

romatoid artrit, karotid intima-media kalınlığı, ultrasonografik ölçüm

Measurement of the Common Carotid Arteries Intima-Media Thickness by Ultrasonography in Patients with Rheumatoid Arthritis.

Purpose: Rheumatoid arthritis is a chronic inflammatory disabling disease affecting articular and extra articular organs and one of these important organs is cardiovascular system which its involvement is a leading cause of morbidity and mortality of Rheumatoid arthritis patients ; it is important to look for the relation of Rheumatoid arthritis and the extent of cardiovascular involvement among those patients by Ultrasound (US ) which is feasible, simple and low cost investigation and sonographic measurement of carotid artery intimal thickness is one of those reliable and sensitive means in assessing generalized atherosclerosis. To determine whether arterial wall thickening is increased in Rheumatoid arthritis patients compared with healthy controls by measuring the intima-media thickness of the common carotid arteries and to evaluate the factors that may be responsible for arterial intima-media thickness increase in patients with Rheumatoid arthritis. Material and methods: 32 Rheumatoid arthritis patients (7 males and 25 females) been evaluated for common carotid intima-media thickness compared with 30 healthy control subjects (8 males and 22 females) matched for (age, sex, and other major risk factors for atherosclerosis). Laboratory variables were measured by routine methods. Intima-media thicknesses of the common carotid arteries were measured by High-frequency linear probe ultrasound. Results: Common carotid artery intima-media thickness was significantly higher (P-value 0.003) in Rheumatoid arthritis patients (mean±SD 0.66±0.11mm) compared with controls (0.58±0.086mm).There was a highly significant association between carotid intima-media thickness increase and the acute phase reactants (ESR, CRP) and Rheumatoid factor as P-value was (0.000, 0.001 and 0.000) successively. No relation between carotid intima-media thickness and duration of disease modifying anti-rheumatic drugs usage was found (P-value 0.051). Conclusion: Rheumatoid arthritis patients are around three fold at a higher risk of developing arterial intimal thickening and in turn they are more prone to develop cardiovascular complications than normal population due to the effects of chronic inflammatory processes& these result concluded that the disease modifying anti-rheumatic drugs has no protective measures on arterial intima medial wall thickening.

Keywords:

Rheumatoid arthritis, Carotid intima-media thickness, Ultrasonographic measurement.,

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Yazışma Adresi / Address for Correspondence: Dr. Hawar Ali Ehsan Sulaimaniya Medical School Department of Rheumatology IRAQ e mail: haekkam@gmail.com geliş tarihi/received :09.12.2013 kabul tarihi/accepted:31.12.2013