Evaluation of carotid artery stiffness by shear wave elastography in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is associated with increased cardiovascular risk and accelerated atherosclerosis secondary to chronic inflammation. Carotid intima-media thickness (IMT) is widely used for vascular assessment; however, arterial stiffness may reflect earlier vascular dysfunction. This study evaluated carotid artery stiffness using shear wave elastography (SWE) and investigated its complementary role alongside IMT in patients with RA. This cross-sectional study included patients with RA and healthy controls. Bilateral common carotid arteries were assessed using B-mode ultrasound and SWE. Carotid IMT, carotid stiffness, and carotid narrowing were evaluated. Clinical and inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were analyzed. Combined carotid stiffness was significantly higher in patients with RA compared with controls (53.53 ± 12.28 vs. 48.46 ± 14.70, p = 0.034), while carotid IMT measurements did not significantly differ between groups. After multivariable adjustment, the association between RA and carotid stiffness became non-significant ( p = 0.076). Carotid stiffness demonstrated significant positive correlations with CRP and ESR, whereas inflammatory markers were not associated with IMT. Patients with RA demonstrated increased carotid artery stiffness despite comparable IMT measurements. SWE may provide complementary value to conventional IMT assessment for detecting early vascular functional changes in RA.