DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20212605

Cardiac function abnormalities in rheumatoid arthritis and its association with duration of disease: a hospital-based case control study

Rajbeer Singh, Ramkesh Singh Parmar, Stuti Verma, P. D. Meena, Vineet Kumar Pathak, Ajeet Singh Bhadoria

Abstract


Background: Rheumatoid Arthritis is associated with many extra-articular manifestations including cardiac abnormalities, which increases the risk of morbidity and premature death. Sub-clinical cardiac abnormalities occur many years before their clinically overt manifestations. The objective of the present study is to compare cardiac function abnormality in rheumatoid arthritis patients and healthy controls by echocardiography and to determine its relation with duration of disease.

Methods: A hospital based case control study was conducted at a tertiary care centre of northern India including 70 rheumatoid arthritis patients and 70 controls. All subjects were evaluated by Electrocardiography and Trans-thoracic Echocardiography to determine cardiac function abnormalities.

Results: ECG abnormalities were detected in 30% of RA cases as compared to only 7.1% of controls. Most common ECG abnormality was LV diastolic dysfunction (p=0.001), followed by pericardial effusion. A weak positive correlation was found between duration of disease and IVRT (r=0.329, p=0.005) indicating worsening of cardiac function with increasing duration of disease.

Conclusions: Echocardiographic abnormalities are fairly common among RA patients with LV diastolic dysfunction being most common. Cardiac abnormalities increase with duration and severity of disease.  


Keywords


Rheumatoid arthritis, Echocardiography, Diastolic dysfunction, Pericardial effusion

Full Text:

PDF

References


Alamonas Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev. 2005;4(3):130-6.

Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58:15-25.

Dowman B, Campbell RM. Estimating the burden of rheumatoid arthritis in Africa: A systematic analysis. J Glob Health. 2012;2(2).

Malaviya AN, Kapoor SK, Singh RR. Prevelance of rheumatoid arthritis in adult Indian population. Rheumatology Int. 1993;13:131-34.

Ahlmén M, Svensson B, Albertsson. BARFOT Study Group. Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage. Ann Rheum Dis. 2010;69(1):230-3.

Cojocaru M, Cojocaru IM. Extra-articular Manifestations in Rheumatoid Arthritis. Mædica. 2010;5(4):286-91.

Hochberg MC, Johnston SS, John AK. The incidence and prevalence of extra-articular and systemic manifestations in a cohort of newly-diagnosed patients with rheumatoid arthritis between 1999 and 2006. Curr Med Res Opin. 2008;24(2):469-80.

Ndirangu KM, Oyoo GO, Bhatt KM. Disease activity measurement in Rheumatoid Arthritis: Comparison of 3 disease activity index tools at Kenyatta National Hospital, African journal of Rheumatology. 2016;3(3).

Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol. 2002;29:62-7.

Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O'Fallon WM et al. Survival in rheumatoid arthritis: a population based analysis of trends over 40years. Arthritis Rheum. 2003;48:54-8.

Pincus T, Callahan LF. Taking mortality in rheumatoid arthritis seriously - predictive markers, socioeconomic status and comorbidity. J Rheumatol. 1986;13:841-5.

Cronstein BN. Interleukin-6--a key mediator of systemic and local symptoms of rheumatoid arthritis. Bull NYU Hosp Jt Dis. 2007;65(1):S11-5.

Gordon DA, Stein JL, Broder I. The extra-articular features of rheumatoid arthritis. A systematic analysis of 127 cases. Am J MED. 1973;54(4):445-52.

Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(2):115-26.

Gabriel SE. Heart disease and rheumatoid arthritis: understanding the risks. Ann Rheum Dis. 2010;69(1):i61-64.

Turesson C, McClelland RL, Christianson TJ, Matteson EL. Severe extra-articular disease manifestations are associated with an increased risk of first ever cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis. 2007;66:70-75.

Mutra O, Laakso M, Isomaki H, Koota K. Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology. 1989;76:71-7.

Kobayashi Y, Giles JT, Hirano M, Giles JT, Hirano M, Yokoe I et al. Assessment of myocardial abnormalities in rheumatoid arthritis using a comprehensive cardiac magnetic resonance approach: a pilot study. Arthritis Res Ther. 2010;12:R171.

Ntusi NA, Piechnik SK, Francis JM, Ferreira VM, Matthews PM, Robson MD et al. Diffuse myocardial fibrosis and inflammation in Rheumatoid Arthritis: Insight from CMR T1 Mapping. JACC Cardiovasc Imaging. 2015;8:526-36.

Corrao S, Sallì L, Arnone S, Scaglione R, Amato V, Cecala M et al. cardiac manifestations in rheumatoid arthritis: evidence of silent heart disease. Eur heart J. 1995;16:253-6.

Aletaha D, Neogi T, Silman AJ, Raymond L. Naden, David T. Felson, Rohit Aggarwal, et al. 2010 Rheumatoid Arthritis Classification Criteria. An American College of Rheumatology/ European League Against Rheumatism Collaborative Initiative Arthritis Rheum. 2010;62:2569-81.

Left ventricular function -123 sonography. https://123sonography.com/node/855. Accessed on 24 August 2019.

Liang KP, Myasoedova E, Crowson CS, Davis JM, Rodger VLIII, MPH, Karon BL et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Annuals of rheumatic disease. 2010;69:6.

Vizzardi E, Cavazzana I, Bazzani C, Pezzali N, Ceribelli A, Bonadei I et al. Echocardiographic Evaluation of Asymptomatic Patients Affected by Rheumatoid Arthritis. Journal of investigative medicine. 2016;60:8.

Masooleh MI, Zayeni H, Haji-Abbasi A, Azarpira M, Hadian A, Hassankhani A, et al. Cardiac involvement in rheumatoid arthritis: A cross-sectional study in Iran. Indian Heart J. 2016;68(3):332-5.

Merza RR. Cardiac Involvement in Rheumatoid Arthritis MMJ. 2008;7:27‐30.

Udayakumar N, Venkatesan S, Rajendiran C. Diastolic function abnormalities in rheumatoid arthritis: relation with duration of disease. Singapore Med J. 2007;48(6):537-42.

Guedes C, Bianchi-Fior P, Cormier B. Cardiac manifestations of rheumatoid arthritis: a case-control transesophageal echocardiography study in 30 patients. Arthritis Rheum. 2001;45(2):129-35.

Sibia P. Study of Cardiovascular Manifestations of Rheumatoid Arthritis and Correlation with Disease Duration and Severity. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2018;17:35-39.

Asai K. Electrocardiographic changes in rheumatoid arthritis. Japan heart journal. 1965;6:4.

Maoine S, Valentini G, Giunta A, Tirri R, Giacummo A, Lippolis C et al. Cardiac involvement in rheumatoid arthritis: an echocardiographic study. Cardiology. 1993;83:234-39.

Jaunatey CG, Testa A, Garcia-Castelo A, Garcia-Porrua C, Llorca J, Ollier WE, Echocardiographic and Doppler findins in long term treated rheumatoid arthritis patients without clinically evident cardiovascular disease. Semin Arthritis Rheum. 2004;33:231-8.

Little WC, Cheng CP. Diastolic dysfunction. Cardiol Rev. 1998;6:231-9.

Coskun S, Ozoran K, Mermerci B, Aydogdu S, Keles T. Cardiac involvement in patients with rheumatoid arthritis. APLAR J Rheumatol. 2005;8:23-31.

Levendoglu F, Temizhan A, Ugurlu H, Ozdemir A, Yazici M. Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study. Rheumatology international. 2004;24:141-6.

Bonfiglio T, Atwater EC. Heart disease in patients with seropositive rheumatoid arthritis; a controlled autopsy study. Arch Intern Med. 1969;124:714-9.

Dawson JK, Goodson NG, Graham DR, Lynch MP. Raised pulmonary artery pressures measured with Doppler echocardiography in rheumatoid arthritis patients. Rheumatology (Oxford). 2000;39(12):1320-5.

Rudominer RL, Roman MJ, Devereux RB, Paget SA, Schwartz JE, Lockshin MD, et al. Arthritis Rheum. 2009;60(1):22-9.

Mustonen J, Laakso M, Hirvonen T, Mutru O, Pirnes M, Vainio P et al. Abnormalities in left ventricular diastolic function in male patients with rheumatoid arthritis without clinically evident cardiovascular disease. Europeon journal of clinical investigation. 1993;23:246-53.

Di Franco M, Paradiso M, Mammarella A, Paoletti V, Labbadia G, Coppotelli L et al. Diastolic function abnormalities in rheumatoid arthritis. Evaluation By echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease. Ann Rheum Dis. 2000;59(3):227-9.

Del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 2001;44:2737-45.