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AB0367 Cardiac abnormalities and cardiovascular risk in egyptian patients with rheumatoid arthritis
  1. D. Abdel Mohsen,
  2. M.M. Abu Gabal,
  3. S.A.M. Hassan,
  4. A.M. Farouk
  1. Internal Medicine - Rheumatology Division, Ain Shams University - Cairo - Egypt, Cairo, Egypt

Abstract

Background A large spectrum of cardiac involvement in rheumatoid arthritis (RA) was already described. The most common cardiac involvement in RA is pericarditis [1]. RA-associated valvular heart disease is common [2]). Also RA patients had higher incidence of heart failure compared to general population due to left ventricular diastolic dysfunction [3], which remains clinically asymptomatic for a long time [4].

Objectives This study was designed to assess cardiac abnormalities in a population of Egyptian patients with rheumatoid arthritis, their association with cardiovascular risk factors and disease characteristics

Methods Our study included 50 RA patients and 10 healthy individuals as controls. For all included subjects, detailed medical history was taken, general and local examination were performed as well as laboratory investigations including (complete blood count, ESR, BUN, serum creatinine, AST, ALT, HDL, LDL, cholesterol, triglycerides, hs-CRP, vWF, RF), ECG and echocardiography. RA disease activity was assessed using DAS28 (ESR).

Results On Echocardiography, 2 (4%) patients had minimal pericardial effusion, 18 (36%) patient had diastolic dysfunction and 40 (80%) patients had valvular disease: 18 (36%) patients had MR, 6 (12%) patients had AR, 12 (24%) patients had TR and 4 (8%) patients had PR. Patients with valvular lesions were older than other patients (P<0.001). RA patients had significantly higher vWF, hs-CRP, ESR (p<0.001) and diastolic dysfunction prevalence (p=0.023) when compared to controls. Diastolic dysfunction was more in older patients and patients with longer disease duration, higher disease activity, higher hs-CRP (p<0.001), DM, hypertension, longer NSAIDS use and in presence MR, AR and pericardial effusion. vWF was not different (p=0.11) between those with diastolic dysfunction and those without diastolic dysfunction. hs-CRP ≥6.25 ug/ml had high sensitivity (82.4%) and low specificity (51.6%) in diagnosis of diastolic dysfunction in RA patients.

Conclusions Patients with RA have significantly higher inflammatory markers (ESR, h-CRP and vWF) as compared to controls. Valvular lesions and diastolic dysfunction are common in RA patients. The prevalence of diastolic dysfunction in RA patients increases with older age, presence of DM, hypertension, longer disease duration, more disease activity, longer use of NSAIDS and high titre of hs-CRP.

  1. Voskuyl AE (2006): The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology Oxford; 45 Suppl 4:iv 4-7.

  2. Roldan CA, DeLong C, Qualls CR and Crawford MH (2007): Characterization of valvular heart disease in rheumatoid arthritis by transesophageal echocardiography and clinical correlates. Am J Cardiol; 100: (3), 496-502.

  3. Udayakumar N, Venkatesan S and Rajendiran C (2007): Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease. Singapore Med J; 48 (6):537.

  4. Philbin EF, Rocco TA, Lindenmuth NW, Ulrich K and Jenkins PL (2000): Systolic versus diastolic heart failure in community practice: clinical features, outcomes and the use of angiotensin-converting enzyme inhibitors.Am J Med; 109:605-613.

Disclosure of Interest None Declared

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