الفهرس 
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Abstract
RA is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent
inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. Beyond joint disease,
the chronic systemic inflammation that underlie RA process is considered as an important risk factor for
increase CV events particularly atherosclerosis and CHF in RA.
RA increases the risk of CV mortality by up to 50% compared with the general population and CVD is the
leading cause of death in RA patients. Patients with RA appear to have a significantly greater burden of
atherosclerotic carotid plaques, suggesting the presence of generalized atherosclerosis. Atherosclerosis is
considered as an extra-articular manifestation of RA. Subclinical atherosclerosis, indicated by the increased
IMT as measured by carotid U/S, is more prevalent in RA patients compared to matched controls.
There is a high prevalence of diastolic filling abnormalities in RA patients, observed in 42.2% of
asymptomatic RA. LVDD is the most common pathological mechanism leading to the development of HF
which remains clinically asymptomatic for a long time.
The aim of the study is to assess cIMT by carotid U/S and Tie index by TDI in patients with RA.
This case control study was carried out on 30 female patients with RA (Group I). Diagnosis of RA was made
by 2010 ACR/ EULAR Classification criteria for early arthritis. This study also included 30 apparently
healthy volunteers of matched age and sex who serve as a control group.
All patients were subjected to history taking, general examination, musculoskeletal examination and
laboratory tests including RF, anti-CCP, complete blood count, ALT, AST, serum creatinine, ESR, lipid
profile. Carotid U/S, two dimensional echocardiography and TDE were performed.
The main findings of the present study:
DD is more frequent in the RA patients than in the controls based on prolonged IVRT, prolonged DT, lower
E/A ratios and lower (b) as compared to the controls.
IMT is significantly thicker in the RA patients compared to the controls and significantly correlated with age
and with disease duration.
The frequency of the occurrence of subclinical HF (Tei index >40 and DD) in RA patients is more than
controls and significantly correlated with age and with RA duration.
Sobel test revealed that the association between RA and Tei index (presence of asymptomatic HF or DD) is
partially mediated by infalmmation and IMT.