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

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 mm (95% CI -13.3, -2.5)] and at week 24 [MD -6.8 mm (95% CI -12.2, -1.4)]. No significant change in retinal arteriolar calibre was identified at week 6 [MD -0.6 mm (95% CI -4.5, 3.28)] or week 24 [MD 0.7 mm (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 mm (95% CI -2.32, 5.95)] or arteriolar [MD 0.54 mm (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.