Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality in rheumatoid arthritis (RA) patients. It has been postulated that chronic inflammatory activity is important for the development of CVD in RA even after adjustment for traditional cardiovascular risk factors.(1) One of the changes occurring in the context of inflammation is citrullination. Development of anti-citrullinated protein antibodies (ACPA) is implicated in higher frequency of extra-articular manifestations including cardiovascular complications.(2)
Objectives To assess the relation of ACPA to subclinical cardiac affection in RA patients.
Methods Thirty RA patients fulfilling the 2010 ACR-EULAR classification criteria for RA with no clinically evident CVD were subjected to full history taking and clinical examination. Disease activity was assessed by 28-joint disease activity score based on C-reactive protein (DAS28-CRP) (4 variables). The levels of ACPA, CRP, total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol were measured. The patients were subjected to M-mode and colour Doppler echocardiographic examination.
Patients were subdivided into two subgroups according to ACPA positivity (ACPA positive patients represented “group A” and ACPA negative patients represented “group B”).
Results The frequency of subclinical cardiac affection by echocardiographic examination was significantly higher among group A patients (4 patients had valvular lesion and 9 patients had diastolic dysfunction) than in group B patients (3 patients had diastolic dysfunction), (p=0.011). ACPA level showed significant positive correlation with isovolumic relaxation time (IVRT) in group A patients (prolongation of IVRT is a sign of diastolic dysfunction), (p=<0.001).
Conclusions The presence of ACPA is related to development of subclinical cardiac involvement in RA patients and all RA patients with high level of ACPA should be routinely evaluated with echocardiography to assess their cardiovascular status.
Arnab B, Biswadip G, Arindam P, Shyamash M, Anirban G, Rajan P. Anti-CCP antibody in patients with established rheumatoid arthritis: Does it predict adverse cardiovascular profile? J Cardiovasc Dis 2013; 4(2):102–6.
Crowson C, Liao K, Davis J, Solomon D, Matteson E, Knutson K, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J 2013; 166(4):622–28.
Disclosure of Interest None declared