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Study of Cardiovascular Involvement in Rheumatoid Arthritis and it's Correlation with Severity of Disease.

Rheumatoid arthritis is a chronic systemic disease of unknown ethology characterised by persistent inflammatory synovitis usually affecting peripheral joints with symmetric distribution. Most common cause of death in RA is cardiovascular disease and pericarditis is the most common form of cardiac involvement. Valvular disorders, coronary vasculitis and ventricular diastolic dysfunction can be seen. The aim and objective was to study the prevalence of cardiovascular involvement in the patients of RA and correlate the cardiovascular involvement with duration and severity of disease.


MATERIAL
The present study was conducted in the Rheumatology Division of department of medicine Sardar Patel medical college Bikaner. It's a cross sectional study done on 100 consecutive patients, diagnosed with RA according to ACR-EULAR classification criteria for RA 2010. Patients with history of smoking, renal failure, diabetes, hypertension, pregnancy, thyroid dysfunction and other systemic diseases were excluded. CBC, DLC, rheumatoid factor, ESR, C-Reactive protein, Anti-CCP antibody, LFT, RFT, Blood glucose, lipid profile and thyroid profile was done on the patients. Electrocardiography and ECHOCARDIOGRAM were also done. For statistical analysis SPSS17 for windows, standard version was used.


OBSERVATION
We observed in our study that a large number of RA patients had ECG (38%) and ECHO (32%) abnormalities. We found that Polyarthritis was the most common symptom (63%) while Dyspnoea (25%) and chest pain (16%) were the most common cardiovascular symptoms. Patients who had bradycardia, heart block and P-pulmonale in ECG were likely to have severe RA. In our study patients with longer duration of disease had more chances of VPCs in ECG. LVH and T-wave inversion in lead ll, lll and aVF were found to be significantly associated with duration of treatment. Patients who had dilated left atrium in ECHO were more likely to have severe disease. Longer duration of treatment was associated with ECHO finding of concentric LVH. As the age increases, prevalence of T wave changes also increases.


CONCLUSION
This study indicates the high prevalence of cardiac involvement in RA patients, so early detection of cardiac involvement (using ECG, echocardiography, etc.) may reduce the morbidity and mortality.