Background The role of inflammation and anti-CCP status in the pathogenesis of cardiovascular disease in RA remains unclear. Previous studies have suggested that both disease activities as well as disease duration are associated with atherosclerosis and a higher mortality rate caused by coronary artery disease.
Objectives We wanted to investigate how disease activity and anti-CCP status in treatment-naive early RA impacts the left ventricular (LV) systolic function.
Methods 41 patients (18 men, median age 60 range (28-81)) with steroid and DMARD-naive early RA. Disease activity was scored by the use of the Danish national DANBIO registry (number of swollen joints (NSJ (28)), number of tender joints (NTJ (28)), CRP, HAQ. Visual analog scales 1-100 was used to assess pain, fatigue and global assessment by the patient as well as global assessment by doctor and as composite score DAS28(CRP)). IgMRF and anti-CCP titers were evaluated by standardized techniques. One experienced senior rheumatologist and one experienced cardiologist performed all the clinical assessments as well as all the transthoracical echocardiography (TTE). We performed an extensively TTE measuring conventional measurements of LV systolic function including the novel technology, global longitudinal strain analysis.
Results Disease activity before treatment at baseline NSJ(28) median 7 range (1-16), NTJ(28) 8 (1-15), CRP 9 mg/l (0-42), HAQ 2.625 (0.5-2.625), pain VAS 54 (7-100), fatigue VAS 48 (2-100), doctors global assessment 55 (28-79), DAS28(CRP) 4.7 (3.3-6.2), pulse 65 (50-87), diastolic blood pressure (BP) 88 mmHg (66-158), systolic BP 147 mmHg (78-158). 18 (43.9%) patients was IgMRF positive and 26(63.4%) was anti-CCP positive.
We found LV systolic function by conventional Ejection Fraction (EF), median 52% (24-74), non-significant correlated to disease activity (CRP: r= 0.19, p=0.23; baseline NSJ: r=-0.11, p=0.5; NTJ: r=-0.04, p=0.81; HAQ: r=0.27, p=0.1; pain VAS: r=-0.1, p=0.53; fatigue VAS: r=0.1, p=0.56; doctors global assessment: r=-0.07, p=0.67 and DAS28: r=0.03, p=0.86). However using a more sensitive measurement of the longitudinal systolic LV function (s`) we found a significant correlation, in means of CRP (r=0.40; p=0.015) and doctors global assessment VAS (r=0.47; p=0.003), to disease activity; both corrected for relevant confounders (age, gender, pulse and blood pressure). Furthermore using strain analysis of LV function we found a significant difference in global LV longitudinal systolic strain (GLS) values in 11(26.8%) patients with high values of anti-CCP (values ≥ 340 (GLS: -18.7% (-20.6—14.4)) vs. in 30(73.2%) patients with anti-CCP <340; p=0.04. For patients with high IgMRF the result was non-significant.
Conclusions We observed a significant correlation between increasing CRP, doctors global, anti-CCP anti-CCP <340 and increased longitudinal LV systolic function.
Disclosure of Interest None Declared