Suppression of inflammatory disease activity in rheumatoid arthritis is associated with improvements in retinal microvascular health

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Objective. To investigate the effect of suppressing inflammation on retinal microvascular health in patients with RA.

Methods. Two groups of patients with RA were recruited and studied concurrently. Group A included patients with moderate to high disease activity [28-joint DAS with CRP (DAS28-CRP) >3.2] requiring treatment escalation, while group B had stable low disease activity (DAS28-CRP ≤3.2) not requiring treatment escalation. Retinal photography was performed at baseline and weeks 6 and 24 in group A and at baseline and week 12 in group B.

Results. Group A included 26 patients with a mean age of 50.7 years (S.D. 3.5) and a mean disease duration of 7.1 years (S.D. 8.0). Disease activity significantly improved during follow-up and was accompanied by a significant reduction in retinal venular calibre at week 6 [mean difference (MD) −7.9 μm (95% CI −13.3, −2.5)] and at week 24 [MD −6.8 μm (95% CI −12.2, −1.4)]. No significant change in retinal arteriolar calibre was identified at week 6 [MD −0.6 μm (95% CI −4.5, 3.28)] or week 24 [MD 0.7 μm (95% CI −3.1, 4.5)]. Group B included 27 patients with a mean age of 54.6 years (S.D. 1.8) and a mean disease duration of 14.5 years (S.D. 10.9). Disease activity and therapy remained unchanged during follow-up and no significant changes in retinal venular [MD 1.81 μm (95% CI −2.32, 5.95)] or arteriolar [MD 0.54 μm (95% CI −2.77, 3.86)] calibre were observed.

Conclusion. We demonstrated that suppression of inflammation in RA is associated with a reduction of retinal venular calibre, suggesting that therapies targeting inflammation could improve vascular health in RA.

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