Stroke has been associated with rheumatoid arthritis (RA). We assessed patients with RA and healthy control subjects by transcranial Doppler (TCD), carotid ultrasonography and brain magnetic resonance imaging (MRI). Altogether, 41 female patients with RA undergoing methotrexate (MTX) or biologic treatment and 60 age-matched control subjects underwent TCD assessment of the middle cerebral artery (MCA) and basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI) and circulatory reserve capacity (CRC) were determined at rest (r) and after apnoea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) were also determined. Intracerebral vascular lesions were investigated by brain MRI. MCA PI and RI values at rest and after apnoea were significantly increased in the total and MTX-treated RA populations vs control subjects. MCA CRC was also impaired, and basilar artery PI was higher in RA. More patients with RA had carotid plaques and increased cIMT. Linear regression analysis revealed that left PI(r) and RI(r) correlated with disease duration and that left PI(r), RI(r), PI(a), PI(h) and basilar PI correlated with disease activity. Right CRC inversely correlated with 28-joint Disease Activity Score. Disease activity was an independent determinant of left PI(a) and right CRC. Compared with long-term MTX treatment alone, the use of biologics in combination with MTX was associated with less impaired cerebral circulation. Impaired cerebral circulation was also associated with measures of carotid atherosclerosis. To our knowledge, this is the first study to show increased distal MCA and basilar artery occlusion in RA as determined by TCD. Patients with RA also had CRC defects. We also confirmed increased carotid plaque formation and increased cIMT. Biologics may beneficially influence some parameters in the intracranial vessels.

Background/Objectives: Rheumatoid arthritis (RA) has been associated with accelerated atherosclerosis and cerebrovascular alterations. Our 2017 study compared 60 RA patients to healthy controls, assessing vascular, neurological, and cognitive parameters. The present study is a follow-up of these RA patients to evaluate disease progression and vascular changes over time, using their 2017 results as baseline. Methods: In 2023, we reassessed 43 of the original 60 RA patients using laboratory testing, carotid ultrasound, functional transcranial Doppler (TCD) and brain magnetic resonance imaging (MRI) examinations. Changes over time were analyzed within the same individuals. Results: Inflammatory markers and lipid profiles showed a trend toward improvement, though changes were not statistically significant, except for a significant increase in vitamin D (p < 0.001) and a decrease in Disease Activity Score in 28 Joints (DAS28) scores (p < 0.001). Carotid ultrasound revealed a significant increase in plaque burden (p = 0.022 on the right side and p = 0.008 on the left), while carotid intima media thickness (cIMT) showed a non-significant rise. TCD measurements indicated significantly increased pulsatility (p < 0.001 on the right, p = 0.001 on the left side) and resistance (p = 0.001 on the right, p = 0.012 on the left side) indices and reduced flow velocities (p < 0.001 on the right and p = 0.001 on the left side) in bilateral middle cerebral arteries (MCAs). The cerebrovascular reserve capacity was significantly lower on the right side overall (p = 0.013), with further decline noted in the methotrexate (MTX)-treated subgroup on the left side (p = 0.043). MRI findings showed non-significant numerical trends toward worsening lacunar small-vessel disease (p = 0.405) and cerebral atrophy (p = 0.063), with higher but stable lacunar infarction scores among MTX users (p = 0.023). Conclusions: Despite improved inflammatory control, RA patients demonstrated progressive vascular and hemodynamic alterations over time, while MRI changes should be interpreted as trends. These findings support multimodal vascular monitoring in RA.

Background/Objectives: Rheumatoid arthritis (RA) is associated with increased cerebrovascular risk and altered bone metabolism. Transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCD) require an adequate transtemporal acoustic window (TAW), which may be limited by temporal bone thickness and structure. Our previous cross-sectional work showed a high frequency of temporal acoustic window failure (TAWF) in female RA patients. The present exploratory follow-up study evaluated whether binary TAW status showed detectable net progression over an 8-year interval. Methods: In 2017, 62 female RA patients and 60 age-matched female controls underwent standardized TCD/TCCD assessment and clinical/laboratory characterization. In 2023, 43 of the original RA patients were re-evaluated by the same experienced neurosonographer using standardized transtemporal insonation and TCCD verification when needed. TAW status was recorded bilaterally as existing TAW or TAWF and analyzed using paired transition counts and exact McNemar tests; treatment subgroup comparisons were exploratory. Results: Right-sided TAW was present in 27/43 patients and absent in 16/43 at both time points (TAWF prevalence 37.2%, 95% CI 24.4–52.1%). No right-sided discordant transition was observed (0/43; exact upper 95% bound 8.2%; exact McNemar p = 1.000). Left-sided TAW was present in 20/43 patients and absent in 23/43 at both time points (TAWF prevalence 53.5%, 95% CI 38.9–67.5%). Two left-sided discordant transitions were observed: one apparent gain and one apparent loss of TAW (2/43, 4.7%; exact 95% CI 0.6–15.8%; exact McNemar p = 1.000). Bilateral TAWF remained present in 15/43 patients at both time points. No statistically detectable differences in TAW status were observed among MTX, IFX, and TCZ groups, but these subgroup analyses were underpowered. Conclusions: In this treated female RA cohort, binary TAW status showed no detectable net progression over 8 years. These data do not prove true biological stability of skull sonographic permeability, and smaller changes cannot be excluded. Mechanistic links with disease control, vitamin D status, treatment exposure, or bone remodeling require larger studies with direct temporal bone imaging and semi-quantitative acoustic-window grading.