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AB0389 Ischemic Heart Disease and Rheumatoid Arthritis: Do Inflammatory Cytokines Have a Role?
  1. S.A. El Bakry1,
  2. D. Fayez2,
  3. C.S. Morad2,
  4. A.M. Abdel-Salam3,
  5. Z. Abdel-Salam3,
  6. R.H. Elkabarity4,
  7. A.M. El Dakrony5
  1. 1Internal Medicine Department-Rheumatology Division
  2. 2Internal Medicine Department -Rheumatology Division
  3. 3Cardiology Depatment
  4. 4Clinical pathology Department, Ain Shams University
  5. 5Rheumatology and Rehablitation Department, Cairo University, Cairo, Egypt

Abstract

Background The increase in Rheumatoid arthritis (RA) associated mortality is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis with increased risk of ischemic heart disease about 50% in patients RA compared to controls1.

Objectives To study the pathogenesis of ischemic heart disease in RA, role of inflammatory cytokine interplay, disease activity and rheumatoid factor positivity.

Methods Eighty RA patients and 44 healthy controls were included. All subjects were younger than 45 years for females and 55 years for males with exclusion of all traditional risk factors for atherosclerosis. Interleukin (IL) 1,6 and 18 were assessed in all subjects. RA patients fulfilled ACR/EULAR 2010 criteria2 and were subjected to Dobutamine-stress-echocardiography, diseases activity assessement by DAS-283, X-ray hands for Larcen score4 and function assessment by HAQ5.

Results RA patients had significantly higher serum IL 1,6 and 18 than controls (p=0.00 in all). Thirty four (42.5%) patients had hypertensive reaction on Dobutamine-stress-echocardiography, four of them had ischemic change, and 46 (57.5%) had normal reaction. All patients with hypertensive reaction had positive RF (p=0.00), 10 had DAS-28>5.1, 20 had DAS-28 from 3.2 to5.1 and 4 were in remission (p=0.001). CRP was higher in patients with hypertensive reaction (p=0.003) while serum levels of IL1,6 and 18 showed no significant difference. In all patients, serum levels of IL1,6 and 18 showed significant positive correlation with VAS, HAQ and DAS-28 (p<0.001 in all). Only IL18 showed significant positive correlation with X-ray score in all patients.

Conclusions Disease activity and RF positivity play an important risk factor for ischemic heart disease in RA. Serum levels of IL1,6 and 18 did not help much in detecting patients at risk of ischemic heart disease. Better control of RA disease activity with early remission helps in preventing cardiac complications. More studies on larger number of patients are needed for better understanding of mechanism of ischemic heart disease in RA.

References

  1. Kaplan MJ. Cardiovascular complications of Rheumatoid Arthritis-Assessment, prevention and treatment. Rheum Dis Clin North Am 2010 May;36(2):405–426.

  2. Aletaha D, Neogi T, Silman AJ, et al., 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 201;69(9):1580–8.

  3. Prevoo ML, van 't Hof MA, Kuper HH, et al., Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38(1):44-8.

  4. Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn 1977;18:481–91.

  5. Pincus T, Yazici Y, Bergman M. Development of a multidimensional health assessment questionnaire (MD-HAQ) for the infrastructure of standard clinical care. Clin Exp Rheumatol 2005;23(Suppl.39):S19–28.

Disclosure of Interest None declared

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