Elevated Peripheral T Helper Cells Are Associated With Atrial Fibrillation in Patients With Rheumatoid Arthritis

Abstract

Patients with rheumatoid arthritis (RA) have a significantly high risk of atrial fibrillation (AF). This study aimed to compare the absolute and relative changes in peripheral T cells in patients with RA who were also affected with and without AF. To help make an early diagnosis and prevent the initiation and progression of AF, the changes in the lymphocyte subsets were assessed in RA patients with and without AF. A propensity score matching (PSM) system (1:3) was used to perform a matched case-control study with 40 RA-AF cases and 120 RA controls. Changes in the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-citrullinated peptide antibody (ACPA), and rheumatoid factor (RF) were examined. The percentage and absolute number of T, B, natural killer (NK), T helper (Th)1, Th2, Th17, and T-regulatory (Treg) cells in the peripheral blood of patients with and without RA-AF were determined using flow cytometry. Univariate and multivariate analyses were performed to determine the association between peripheral lymphocytes and RA-AF. Demographic data, ESR, CRP, ACPA, and the percentage, as well as the absolute value of B, NK, Th2, and Treg cells, showed no significant differences between the propensity score-matched groups of RA and RA-AF. Meanwhile, the absolute number and percentage of Th1 cells, the absolute number of Th17 cells, the ratio of Th1/Treg, Th17/Treg, and RF were significantly higher in patients with RA-AF than those in the control groups (P < 0.05). Univariate and multivariate logistic regression analyses also revealed that the percentage of Th1 cells, the absolute number of Th17 cells, and the ratio of Th1/Treg were associated with a significantly higher risk of AF. This PSM study demonstrated that the incidence of AF was higher in RA patients with Th cell immunological derangements.

Association between rheumatoid arthritis and atrial fibrillation: A systematic review and meta‐analysis

“…Wang et al. further suggest that RA patients with AF may have significant changes in their peripheral T cell profiles, including higher percentages of Th1 cells, higher absolute numbers of Th17 cells, and altered Th1/Treg ratios, which are associated with a higher risk of AF 35 . It highlights the potential role of Th cell immunological derangements in the development of AF in RA patients and the importance of early diagnosis and intervention to prevent AF initiation and progression in this population.…”

“…28,33,34 Wang et al further suggest that RA patients with AF may have significant changes in their peripheral T cell profiles, including higher percentages of Th1 cells, higher absolute numbers of Th17 cells, and altered Th1/Treg ratios, which are associated with a higher risk of AF. 35 Several other factors may contribute to the association between RA and AF. Shared risk factors, including age, hypertension, and obesity, are prevalent in both conditions and may contribute to an increased risk of developing AF.…”

Non-Coding RNAs and Gut Microbiota in the Pathogenesis of Cardiac Arrhythmias: The Latest Update

“…Consequently, gut microbiota could play a vital role in the pathogenesis of both atrial fibrillation and Graves’ disease [ 52 ]. The imbalance of Th17/Treg cells induced by the alteration of gut microbiota could also play a dynamic role in the pathogenesis of arrhythmias [ 53 , 54 ], suggesting that the immune response and arrhythmias are closely related. In particular, Th17 cells might be involved in the pathogenesis of atrial fibrillation, since increased levels of Th17-associated cytokines may be independently associated with an increased risk of atrial fibrillation [ 53 ].…”

Circulating Th17/Treg as a promising biomarker for patients with rheumatoid arthritis in indicating comorbidity with atherosclerotic cardiovascular disease

“…Some patients with RA may present with disease manifestations in other organs. A growing number of studies show that RA patients have a higher risk of interstitial lung disease, 2 cardiovascular disease (CVD), 3 and even atrial fibrillation (AF), 4 mortality than the general population. CVD resulting from chronic inflammation plays a vital role in increasing the economic burden and mortality of RA patients 5 .…”