Risk Factors Of Carotid Atherosclerosis And The Significance Of Complement C5 In Patients With Rheumatoid Arthritis

Objective: To analyze the characteristics of lipid profile and the risk factors of carotid atherosclerosis(CAS)in patients with rheumatoid arthritis(RA).And to investigate the clinical significance of serum complement C5 in RA.Methods: Two hundred and sixteen consecutive hospitalized patients with RA were included in the study,and 214 with age-and sex-matched healthy subjects without CAS plaques served as normal controls.The clinically relevant data of the subjects were collected,and serum C5 levels were measured by ELISA in 154 RA patients and 77 normal controls.The Disease Activity Score in 28 joints(DAS28)were calculated.CAS plaques were determined by color Doppler ultrasound.Lipid levels were compared between RA patients and healthy controls,and the influencing factors were analyzed.RA patients were divided into RA with plaque group and RA without plaque group to find independent risk factors for CAS plaques.The serum C5 levels of three groups of study subjects were compared,and the correlation between C5 levels and the clinical data of RA patients were analyzed.Results:1.TC,LDL-C,and HDL-C levels were lower(P<0.001,P=0.001,P<0.001,separately)and TC/HDL-C and LDL-C/HDL-C were higher(P=0.003,P=0.009,separately)in the RA patients group than in the healthy controls.2.In RA group,TC and HDL-C were negatively correlated with hs-CRP(r=-0.237,P=0.002;r=-0.351,P<0.001),NLR(r=-0.210,P=0.006;r=-0.182,P=0.018);LDL-C was negatively correlated with NLR(r=-0.200,P=0.009),TG was negatively correlated with ESR(r=-0.184,P=0.016),TC/HDL-C was positively correlated with hs-CRP and NLR(r=0.286,P < 0.001;r=0.159,P=0.039),LDL-C/HDL-C was positively correlated with hs-CRP(r=0.161,P=0.040).In patients with RA,HDL-C levels were higher and TG and TC/HDL-C levels were lower in the group treated regularly with cs DMARDs than without cs DMARDs(P=0.035,P=0.003,P=0.006,separately).3.The prevalence of CAS plaques in RA patients was 37.5%.Age,disease duration,prevalence of hypertension,prevalence of diabetes,LDL-C/HDL-C,Hcy and hs-CRP levels were higher in the RA with plaque group than in the RA without plaque group(P<0.001,P=0.023,P=0.016;P=0.019,P=0.017,P=0.010,P<0.001,separately).4.Logistic regression showed that age(OR=1.085,95%CI 1.045～1.128),disease duration(OR=1.008,95%CI 1.003～1.014),diabetes(OR=4.326,95%CI 1.606～11.655),and hs-CRP(OR=1.022,95%CI 1.006～1.038)were independent risk factors for the presence of CAS plaques in RA patients.5.Serum C5 levels were lower in RA patients than in controls,serum C5 levels were higher in the RA with plaque group compared with the RA without plaque group,serum C5 levels in the RA plaque group was close to that in the healthy control group(P=0.014,P=0.020,P=0.333,separately);serum C5 levels were positively correlated with hs-CRP and FIB in RA patients(r=0.405,P<0.001;r=0.274,P=0.001).Conclusion:1.Patients with RA are more likely to exhibit lipid metabolic abnormalities which mainly manifested as low cholesterol levels(TC,LDL-C,HDL-C)and high lipid ratios(TC/HDL-C,LDL-C/HDL-C).Such disordered lipid profileis are associated with gender,inflammatory and drug therapy.2.Age,disease duration,inflammatory status,and diabetes are independent risk factors for CAS plaques in RA patients.Effective control of inflammatory status are important goals of RA management and may also be essential to delay the progression of AS.3.There may be "dynamic changes" in serum C5 levels in RA patients,which approach healthy controls when associated with CAS plaques.Dynamic detection of changes in serum C5 levels in RA patients may be helpful for early detection of CAS plaques in RA patients.