Cardiovascular system changes in rheumatoid arthritis patients with continued low disease activity

Abstract

Systemic inflammation and disease activity seem to contribute to excessive prevalence of cardiovascular (CV) diseases (CVDs) in patients with rheumatoid arthritis (RA). The objective of the study was to assess chosen CV parameters in RA patients who have continuous low disease activity. The study group consisted of 70 RA patients without known CVD and 33 healthy controls, of a comparable age. All RA patients had continued low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. The groups were assessed for: blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography (ECG), ejection fraction (EJ) and diastolic dysfunction (E/A ratio) in echocardiography. In RA patients in comparison with controls, significantly greater values of cIMT [0.83 (0.21) vs 0.62 (0.1) mm, p < 0.001] were found, as well as higher incidence of atherosclerotic plaques [43 (61.4%) vs 10 (30.3%), p = 0.003], prolonged QTc interval [439.6 (23.7) vs 414.0 (27.9) ms, p < 0.001]. High or very high Systemic Coronary Risk Evaluation (SCORE) was found in 32.9% of patients with RA and increased serum NT-proBNP in 71.4%. The mean values of CV parameters (cIMT, E/A, NT-proBNP, SCORE) were associated with age, disease duration, rheumatoid factor (RF-IgM), erythrocyte sedimentation rate (ESR). The results of our study indicate, that RA with continued low disease activity is associated with atherosclerosis and heart dysfunction. Strong relationships were found between CV parameters and patients’ age, disease duration. Deterioration of CV parameters was associated with higher DAS28, ESR, RF-IgM concentration and bone erosions.

Evaluation of risk factors for atherosclerosis using carotid ultrasonography in Japanese patients with rheumatoid arthritis

“…In our patients who had low disease activity (average DAS28‐ESR of 2.7), DAS28‐ESR correlated positively not with cIMT but with the development of plaques. A similar report concluded that in RA with continued low disease activity, the plaque score was more sensitive than the mean IMT in predicting the development of atherosclerosis or CVD . Other previous studies have reported that disease activity correlated positively with atherosclerosis or CVD .…”

Time course of changes in the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with rheumatoid arthritis during therapy with an interleukin-6 receptor inhibitor

“…[21] зависимость концентрации NT-proBNP от степени активности РА повышает вероятность негативного воздействия воспа-О р и г и н а л ь н ы е и с с л е д о в а н и я лительных цитокинов на миокард. По данным других авторов, даже при низкой активности заболевания уровень NT-proBNP остается более высоким, чем у здоровых лиц [22]. Выявленная нами взаимосвязь концентрации NT-proBNP с возрастом согласуется с результатами других исследований пептида у больных РА [5,14,15,23] и в общей популяции [24,25].…”

Diastolic dysfunction in rheumatoid arthritis patients with low disease activity

“…The study was performed on outpatients with RA, treated in the Regional Outpatient Clinic in Rzeszów, Poland, as described previously [8]. All patients fulfilled the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for RA [9].…”