Abnormal retinal microvasculature found in active rheumatoid arthritis: a different perspective of microvascular health

Abstract

Background/aim: We aimed to assess the association between retinal vascular caliber (RVC) scores and disease activity in rheumatoidarthritis (RA) patients.Materials and methods: Forty-seven RA patients, 32 systemic lupus erythematosus (SLE) patients, and 45 healthy people were enrolled.RA and SLE patients were subdivided into groups according to C-reactive protein (CRP) levels. RA patients were also grouped accordingto Disease Activity Score-28 (DAS-28). Fundus photography was performed for all patients. RVC was summarized as the central retinalartery and vein equivalents (CRAE and CRVE).Results: Mean CRVE for RA patients was 213.3 ± 17.8 µm compared with 209.2 ± 14.1 µm for SLE and 217.5 ± 26.2 µm for the controlgroup (P = 0.17). RVC scores did not differ between the CRP-high and CRP-low groups. As the RA disease activity increased, thewidening of CRVE became more prominent and statistically significant. When the DAS-28 > 5.1 (CRVE, 220.4 (211.8–246.5) µm) groupand DAS-28 ≤ 3.2 (CRVE, 214.4 (172.4–242.3) µm) group were compared, statistical significance was more pronounced (P = 0.03) thanwhen comparing the DAS-28 > 3.2 and DAS-28 ≤ 3.2 groups (P = 0.05).Conclusion: CRVE, which reflects systemic inflammation and possibly increased cardiovascular risk, was significantly increased inactive RA patients. The association between retinal venular widening and disease activity, regardless of CRP, may be a sign that RArelated inflammation may have systemic vascular effects even with normal levels of CRP.