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Background: Atherosclerosis and cardiovascular diseases have been known as the cause of increasing mortality among rheumatoid arthritis (RA) patients. Carotid intima media thickness (CIMT) measurement by ultrasound has been used as surrogate marker of atherosclerosis and cardiovascular disease.

Methods: A cross sectional study of 86 RA patients fulfills EULAR/ACR 2010 critera for RA was conducted to study proportion and predictor factors of atherosclerosis and atherosclerosis plaque in rheumatoid arthritis patients.

Results: Atherosclerosis and plaque was found in 47,7% and 29 % of patients. Age ≥ 40 yo, hypertension and duration of illness ≥ 24 mo were associated with atherosclerosis in multivariate logistic regression analysis with OR 10.70 (95% CI: 2.93-39.10), 4.99 (95% CI: 1.15-21.61) and 3.66 (95% CI: 1.11-11.99) respectively. Whereas hypertension, presence of antiCCP antibody and age ≥ 40 yo, were associated with plaque formation with OR 3.96 (95% CI: 1.15-13.57), 3.20 (95% CI: 1.11-9.24) and 3.61 (95% CI: 1.03-12.63) respectively.

Conclusions: Age ≥ 40 yo, hypertension and duration of illness ≥ 24 mo was the predictors of
atherosclerosis, while hypertension, presence of antiCCP antibody and age ≥ 40 yo was the predictors of atherosclerosis plaque.

Key words: atherosclerosis, intima media thickness, predictor, rheumatoid arthritis, ultrasonography.

Article Details

How to Cite
Pambudi, J. R., Isbagio, H., Mulyadi, R., & Abdullah, M. (2018). Predictor Factors of Atherosclerosis and Atherosclerosis Plaque in Rheumatoid Arthritis Patients. Indonesian Journal of Rheumatology, 8(2).


  1. Sattar N, McInnes IB. Atherosclerosis in rheumatoid arthritis. In: Firestein
  2. GS, Budd RC, Jr. EDH, editors. Kellys’Textbook of Rheumatology. 8 ed. Philadelphia: Saunders Elsevier; 2008.
  3. Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O’Fallon WM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis & Rheumatism. 2003;48(1):54-58.
  4. van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis & Rheumatism. 2002;46(4):862-873.
  5. Solomon DH, Karlson EW, Rimm EB, al. e. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107:1303-1307.
  6. del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis & Rheumatism. 2001;44(12): 2737-2345.
  7. Dessein PH, Joffe BI. When is a patient with rheumatoid arthritis at risk for cardiovascular disease? J Rheumatol. 2006;33:201-203.
  8. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.
  9. PERKENI. Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2011. Jakarta: Pusat Penerbitan Ilmu Penyakit Dalam FKUI; 2011.
  10. Centers for Disease CP. State-specific second hand smoke exposure and current cigarette smoking among adults - United States, 2008. MMWR Morbidity and mortality weekly report. 2009;58(44):1232-1235.
  11. Program NCE. Detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). National Institutes of Health; 2002.
  12. Region WWP. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia Pty Limited; 2000.
  13. Nambi V, Chambless L, Folsom AR, He M, Hu Y, Mosley T, et al. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study. Journal of the American College of Cardiology. 2010;55(15):1600-1607.
  14. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovascular diseases. 2012;34(4):290-6.
  15. Ravindran V, Rachapalli S. An overview of commonly used radiographic scoring methods in rheumatoid arthritis clinical trials. Clinical rheumatology. 2011;30(1):1-6.
  16. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the atherosclerosis risk in communities (ARIC) study, 1987-1993. Am J Epidemiol 1997;146(6):483-94.
  17. Nair SB, Malik R, Khattar RS. Carotid intima-media thickness: ultrasound measurement, prognostic value and role in clinical practice. Postgraduate medical journal. 2012;88(1046):694-9.
  18. Park YB, Ahn CW, Choi HK, Lee SH, In BH, Lee HC, et al. Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound. Arthritis & Rheumatism. 2002;46(7):1714-9.
  19. Kumeda Y, Inaba M, Goto H, Nagata M, Henmi Y, Furumitsu Y, et al. Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis & Rheumatism. 2002;46(6):1489-97.
  20. Roman MJ, Moeller E, Davis A, Paget SA, Crow MK, Lockshin MD, et al. Preclinical carotid atherosclerosis in patients with rheumatoid arthritis. Annals of Internal Medicine. 2006;144(4):249-56.
  21. Gonzalez-Juanatey C, Llorca J, Testa A, Revuelta J, Garcia-Porrua C, Gonzalez-Gay MA. Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid arthritis patients without clinically evident atherosclerotic disease. Medicine. 2003;82(6):407-13.
  22. Ahmed HMMS, Youssef M, Mosaad YM. Antibodies against oxidized low-density lipoprotein are associated with subclinical atherosclerosis in recent-onset rheumatoid arthritis. Clinical rheumatology. 2010;29(11):1237-43.
  23. Lim TK, Lim E, Dwivedi G, Kooner J, Senior R. Normal value of carotid intima-media thickness--a surrogate marker of atherosclerosis: quantitative assessment by B-mode carotid ultrasound. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2008;21(2):112-6.
  24. del Rincon I, O’Leary DH, Freeman GL, Escalante A. Acceleration of atherosclerosis during the course of rheumatoid arthritis. Atherosclerosis. 2007;195(2):354-60.
  25. Maradit-Kremers H, Nicola PJ, Crowson CS, Ballman KV, Gabriel SE. Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis. Arthritis & Rheumatism. 2004;50(11):3450-7.
  26. Escalante A, Haas RW, del Rincón I. Paradoxical effect of body mass index on survival in rheumatoid arthritis. Arch Intern Med. 2005;165:6.
  27. Lopez-Longo FJ, Oliver-Minarro D, de la Torre I, Gonzalez-Diaz de Rabago E, Sanchez-Ramon S, Rodriguez-Mahou M, et al. Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis. Arthritis and rheumatism.2009;61(4):419-24.
  28. Yuliani IW. Prevalensi dan makna klinis antibodi anti-cyclic citrullinated peptide (antibodi anti-CCP) pada pasien artritis reumatoid [Thesis]. Jakarta: Program Studi Ilmu Penyakit Dalam FKUI; 2005.
  29. Manuaba IRW. Korelasi antara titer faktor reumatoid, antibodi anti-cyclic citrullinated peptide, interleukin-18 dan lama sakit dengan kerusakan sendi pada radiografi manus pasien artritis reumatoid [Thesis]. Jakarta: Program Studi Ilmu Penyakit Dalam FKUI; 2009.
  30. Gerli R, Bocci EB, Sherer Y, al. e. Association of anti-cyclic citrullinated peptide antibodies with subclinical atherosclerosis in patients with rheumatoid arthritis. Annals of the rheumatic diseases. 2008;67:724-25.