Males with Rheumatoid Arthritis Often Evidence Carotid Atheromas on Panoramic Imaging: A Risk Indicator of Future Cardiovascular Events

Publication date: Available online 16 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Urie K. Lee, Tina I. Chang, Neal Garrett, Arthur H. Friedlander
PurposeMales with rheumatoid arthritis (RA) are at exceedingly high risk of adverse intraoperative ischemic events given the role of systemic inflammation in the atherogenic process. We hypothesized that their panoramic images would demonstrate calcified carotid artery atheromas (CCAP) significantly more often than a general popular of similarly aged males.MethodsThe investigators implemented a retrospective observational study. The sample was composed of male patients over age 55 having a panoramic image. The predictor variable was a diagnosis of RA confirmed by a positive rheumatoid factor (RF) titer and the outcome variable was the prevalence rate of CCAP. The other major study variable was the level of (RF) among patients evidencing CCAP. The prevalence of CCAP among the patients with RA was then compared to that of a historic general population comprised of similarly aged males. Descriptive and bivariate statistics were computed and the p value was set at .05ResultsOf the 100 males (mean age 69.89 ± 8.927) with RA, 29 (29%); (mean age 72.10 ± 7.68) had atheromas (CCAP+), and of these (n = 25) 86% (mean age 71.88 ± 7.43) had RF titer value of ≥ 41 IU/mL which is twice normal. There was a statistically significant (p < .05) association between a diagnosis of RA and the presence of an atheroma on the panoramic image in comparison to the 3% rate manifested by the historic cohort.ConclusionThe results of this study suggest that calcified carotid artery plaque, a risk indicator of future adverse cardiovascular events is frequently seen on the panoramic images of male patients with RA and that these individuals routinely manifest with high titer levels of RF, a biologic marker of inflammation. Oral and maxillofacial surgeons planning surgery for male patients with RA must be uniquely vigilant for the presence of these lesions.



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