Subclinical Vasculitis as a Potential Mechanism to Explain the Heightened Cardiovascular Risk in Rheumatoid Arthritis

One decade ago, James Rudd, who also coauthored the present article, published the results of the first prospective trial investigating 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for imaging of inflammatory changes in carotid artery disease in Circulation. 1 Since that time, FDG-PET has emerged as a powerful noninvasive technique to measure vascular inflammation due to atherosclerosis.1–10Article see p 2473The FDG uptake in the inflamed arterial wall or in inflamed vascular plaques is thought to depict macrophage activity, which by itself might be driven by hypoxia.11–13 Over time, several prospective and retrospective studies evaluated the diagnostic impact of vascular FDG-PET not only in the clinical, but also in the animal setting. Today, there is emerging evidence indicating that noninvasive PET imaging shows a significant correlation with established clinical cardiovascular risk factors such as obesity, smoking, older age, male sex, hypercholesterolemia, Framingham risk score, diabetes mellitus, insulin resistance, C-reactive protein, and matrix metalloproteinases, and plaque high-risk morphological features.14–19 Furthermore, it was also shown that FDG-PET is able to serve as a predictive marker for emerging cardiovascular events.20 Most interestingly, inflammatory vascular …