IM - ORIGINAL Evaluation of differences in carotid intima-media thickness in patients affected by systemic rheumatic diseases Marco Matteo Ciccone 1 • Pietro Scicchitano 1 • Annapaola Zito 1 • Francesca Cortese 1 • Cinzia Rotondo 2 • Laura Coladonato 2 • Michele Gesualdo 1 • Antonella Notarnicola 2 • Florenzo Iannone 2 Received: 28 November 2014 / Accepted: 17 April 2015 Ó SIMI 2015 Abstract The objective of this study is to investigate whether rheumatic autoimmune diseases, systemic sclero- sis (SSc) in particular, are associated with increased carotid intima-media thickness (C-IMT). A total of 108 clinical outpatients (93 females), mean age 51 ± 14 years suffer- ing from CTD were consecutively enrolled. Patients were subdivided into the following two groups: (1) Systemic Sclerosis (SSc, 60 patients); (2) non-Systemic Sclerosis (NoSSc, 48 patients). No randomization was managed. All patients underwent structured clinical interview, physical examination, laboratory evaluation and two-dimensional echo-color Doppler of the carotid arteries to measure C-IMT and atherosclerotic plaques. Framingham risk score was also calculated. We also enrolled 108 healthy controls (HC), matched by sex and age. The primary outcome was to stratify cardiovascular risk of CTD patients. There were no significant differences between SSc and NoSSc patients regarding any of the demographics and traditional cardio- vascular risk factors. Mean C-IMT was not significantly different between the whole CTD patients (0.86 ± 0.13 mm) and HC (0.83 ± 0.13 mm). C-IMT was significantly higher in SSc than in NoSSc group (0.91 ± 0.1 mm vs 0.80 ± 0.14 mm, p \ 0.001). Fur- thermore, C-IMT in SSc group was significantly higher than C-IMT in controls (0.91 ± 0.1 mm vs 0.83 ± 0.13 mm, p \ 0.001). C-IMT did correlate neither with disease activity nor with drug intake. SSc patients had a significant increase in C-IMT as compared to NoSSc patients and healthy controls. Keywords Systemic rheumatic diseases Á Systemic sclerosis Á Carotid intima-media thickness Á Cardiovascular risk Introduction Systemic rheumatic diseases are a heterogeneous group of illnesses characterized by abnormal immune response di- rected against various self-antigens. It is widely accepted that these diseases are caused by not-well-defined interac- tions among genetic factors, immune-system dysfunctions and environmental factors [1]. Several studies [2–6] showed the strong connection existing between some sys- temic autoimmune conditions, such as systemic lupus erythematosus (SLE), anti-phospholipids syndrome (APS), systemic sclerosis (SSc), polymyositis and dermatomyosi- tis (PM/DM), mixed connective tissue disease (MCTD), Sjo ¨gren syndrome (SS) and premature atherosclerosis. Traditional risk factors and the use of immune-suppressive drugs, such as glucocorticoids, cannot fully explain the extent of observed premature atherosclerosis in these pa- tients, and a possible explanation should be searched in the pathogenic mechanisms underlining these diseases, such as autoimmunity and chronic inflammation [7, 8]. According to a recent study, next to traditional risk factors (age, smoking, dyslipidemia, diabetes mellitus, etc.), vascular disease in autoimmune rheumatic patients can be ascribed to disease and therapy-related factors [9]. Disease duration, acute phase reactants, autoantibodies, increased production & Marco Matteo Ciccone marcomatteo.ciccone@uniba.it 1 Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy 2 Interdisciplinary Department of Medicine, Rheumatology Unit, School of Medicine, University of Bari, 70124 Bari, Italy 123 Intern Emerg Med DOI 10.1007/s11739-015-1250-4