Constitutional symptoms at the onset of rheumatoid arthritis and subsequent arterial stiffness

The onset of rheumatoid arthritis (RA) can be associated with constitutional symptoms. Systemic inflammation may be a common factor behind such symptoms and the subsequent development of arterial disease. The aim of this study was to determine if a relationship exists between constitutional symptoms and arterial stiffness. We recruited 103 ambulatory RA patients (85 female) without overt arterial disease aged between 40 and 65 years attending hospital clinics. A research nurse measured arterial stiffness (heart rate standardised augmentation index, AIX) using the ‘SphygmoCor’ device, fasting lipids and erythrocyte sedimentation rate (ESR). Assessment included patient recall of constitutional symptoms at arthritis onset (aching muscles, tiredness, generalised weakness, low mood/depression, fever, loss of weight, loss of appetite) and a detailed medical record review. Regression analysis was used to adjust mean differences in AIX in the presence/absence of constitutional symptoms for current age, sex, arthritis duration, age arthritis onset, study ESR, ever smoked, mean arterial blood pressure (BP), treated hypertension and cholesterol. Mean age was 54 years (age arthritis onset 42 years), brachial BP 125/82 mmHg, cholesterol 5.4 mmol/L, ever smoked 59%, median RA duration 9 years, median ESR 16 mm/h and mean AIX 31.7 (SD 7.8). Unadjusted mean difference in AIX was −0.7 (95%CI −4.5 to 3.1; p = 0.72) in the presence of constitutional symptoms and the adjusted mean difference was −0.1 (−3.2 to 2.9; p = 0.93). No individual symptoms were significantly associated with increased arterial stiffness. In conclusion, we found no convincing association between constitutional symptoms at the onset of arthritis and subsequent arterial stiffness.