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Decreased flow-mediated dilatation in patients with rheumatoid arthritis: a meta-analysis
  1. Shu-Zhen Xu1,2,
  2. Peng Wang1,2,
  3. Shi-Yang Guan1,2,
  4. Hong-Miao Li1,2,
  5. Rui-Xue Leng1,2,
  6. Hai-Feng Pan1,2,
  7. Dong-Qing Ye1,2
  1. 1Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
  2. 2Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
  1. Correspondence to Professor Dong-Qing Ye, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; ydqahmu{at}, ydq{at}


Objectives To derive a more precise comparison of flow-mediated dilatation (FMD%) of the brachial artery between patients with rheumatoid arthritis (RA) and normal controls by performing a meta-analysis of appropriate studies.

Methods PubMed and EMBASE databases were searched for all relevant articles. STATA (V.12.0) software was used to perform the meta-analysis. Quality estimation of all appropriate studies was evaluated according to the Newcastle-Ottawa Scale (NOS). Standardised mean difference (SMD) with 95% CIs were calculated with a random-effects model. The Cochrane Q test and I2 statistic were used to evaluate the heterogeneity. Funnel plot and Egger's test were conducted to assess the publication bias.

Results In total, 464 articles were obtained after searching the two databases. Ten studies were included in the meta-analysis on the basis of the inclusion and exclusion criteria. Significant heterogeneity was observed among these 10 studies (Q=102.89, p<0.001, I2=91.3%) with random-effects modelling. The results showed that the RA group had significantly lower FMD% (SMD: −1.405; 95% CI −1.992 to −0.817; p<0.001) than the control group. Egger's test (p=0.004) indicated that the funnel plot showed a skewed or asymmetrical shape and publication bias existed. Sensitivity analyses suggested the robustness and credibility of our results.

Conclusions FMD% in patients with RA is significantly decreased compared with healthy controls. FMD% is an important early marker of atherosclerosis. It may be used as a parameter to forecast cardiovascular disease in patients with RA.

  • rheumatoid arthritis
  • inflammation
  • flow-mediated dilitation
  • meta-analysis

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  • S-ZX and PW contributed equally to this work and should be considered co-first authors.

  • Contributors SZX, PW, R-XL, H-FP and D-QP designed the study. S-ZX, PW, S-YG and H-ML collected data and performed the statistical analyses. S-ZX and PW drafted the manuscript. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.