Background Atherosclerosis (Ath) is the most important associated disease of rheumatoid arthritis (RA) (1). Hypertension (HT) and adult type II diabetes mellitus (DM) increase the risk of Ath (2). Islet amyloidosis (IA) (islet amyloid polypeptide prohormone fragment deposition localized to islets of Langerhans) may be regarded as a good microscopic indicator for clinically latent (undetected) or manifest (diagnosed) (3).
Objectives The aim of this study was to determine the influence of HT, DM and IA on incidence and mortality of Ath, in rheumatoid arthritis RA.
Methods A non-selected autopsy population of 234 in-patients with RA was studied. Tissue samples of pancreas were available in 150 patients. RA was confirmed clinically according to the criteria of the ACR. The presence of Ath and IA were histologically determined on autopsy material. The diagnosis of HT, DM was based on clinical data. The relationships between Ath, HT, DM and IA were analyzed by c2 -test.
Results Ath associated to RA in 62 (41.33%) patients, and in 27 (18.0%) of them – as basic disease – led to death. HT was diagnosed in 26 (17.33%), and led to death in 2 (1.33%) of them. DM was diagnosed in 31 (20.66%) cases, and IA was detected in 15 (10.0%) of 150 patients. Clinically controlled DM never led directly to death; lethal diabetic coma was clinically not detected.
HT was associated with Ath in15 of 62 patients and in 10 of 27 lethal cases, DM was associated with Ath in17 of 62 patients and in 11 of 27 lethal cases, and LA was associated with Ath in 8 of 62 patients and in 6 of 27 lethal cases.
The statistical link between coexistent associated diseases accompanying RA and the prevalence and mortality of Ath is summarized in Table.
Conclusions In present autopsy population of 150 RA patients there was a significant correlation between HT and mortality of Ath, between DM and mortality of Ath, furthermore between IA and mortality of Ath, but did not influence significantly the prevalence of Ath.
IA represents a clinically latent (undetected) or manifest (diagnosed) stage of DM. Histologically detected IA, in the pancreas – removed for any reason – may contribute to the early diagnosis of DM and introduction of effective treatment for it.
Bély M, Apáthy Ά: Clinical pathology of rheumatoid arthritis: Cause of death, lethal complications and associated diseases in rheumatoid arthritis. First English edition, 1-440 pp. Akadémiai Kiadό, Budapest 2012 http://www.akkrt.hu
Park HY, Schumock GT, Pickard AS, Akhras K: A Structured Review of the Relationship Between Microalbuminuria and Cardiovascular Events in Patients With Diabetes Mellitus and Hypertension. Pharmacotherapy 2003; 23:1611-1616
Bély M, Apáthy Ά: Hormone-Related (Isolated) Amyloidosis Localized to the Islets of Langerhans and Adult Type II Diabetes Mellitus in Rheumatoid Arthritis- A Retrospective Clinicopathologic Statistical Study of 161 Autopsy Patients. Ann Rheum Dis 70 (Suppl 3):586 (2011) http://www.abstracts2view.com/eular/
Disclosure of Interest None declared