Increased coronary artery atherosclerosis in rheumatoid arthritis (RA) may cause significant
mortality. Tumor necrosis factor (TNF) is a potent proinflammatory cytokine that has been involved in RA
pathogenesis and atherosclerosis.
Aim of the work: To determine the association between TNF-a rs1800629 polymorphism and carotid
atherosclerosis in RA patients.
Patients and methods: This study was carried out on 50 RA patients and 40 age and sex matched healthy
control. All patients were subjected to full history taking, thorough clinical examination, and assessment
of disease activity score (DAS28). Carotid artery intima–media thickness (IMT) was measured by Doppler
ultrasonography. TNF-a
308A/G (rs1800629) polymorphism was assessed.
Results: The mean age of patients was 41.2 ± 13.2 years with disease duration of 6.1 ± 4.5 years. The
mean DAS28 was 4.1 ± 0.8 and Larsen score 2.1 ± 0.9. The mean IMT was significantly higher in patients
(0.78 ± 0.47 mm) compared to the control (0.44 ± 0.16 mm) (p < 0.001). Carotid plaques and calcifications
were present in 2 and 3 patients respectively. Regarding the TNF-a polymorphism, there was a significantly higher frequency of GG (60%) followed by GA (24%) and AA (16%) (p < 0.0001). All control had
GG genotype except 1 patient had GA. The G allele was significantly increased (72%) compared to the
A allele (28%) (p < 0.0001). The mean carotid IMT was significantly higher in AA genotype
(1.2 ± 0.4 mm) compared to GA (1.02 ± 0.5 mm) and GG (0.5 ± 0.3 mm) (p < 0.001).
Conclusion: Rheumatoid arthritis and atherosclerosis are strictly linked to each other; TNF-a
308A/G
polymorphism might increase atherosclerotic susceptibility in RA patients through increased risk of
inflammation with subsequent abnormal lipid profile.

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