PATTERNS OF CARDIOVASCULAR COMORBIDITIES IN RHEUMATOID ARTHRITIS PATIENTS IN A TERTIARY CARE HOSPITAL

Dr. Chandan Saha*, Dr. Sujat Paul, Dr. M.D. Saidul Alam Rajib and Dr. Dipan Baidya

ABSTRACT

Background: Almost half of the deaths in patients of rheumatoid arthritis (RA) are due to cardiovascular diseases (CVD). Many studies have shown that patients of RA are at increased risk of mortality and morbidity from ischemic heart disease (IHD). In half of the RA patients with confirmed IHD, the disease was clinically silent. Hence, early detection of the silent IHD and other CVD is important to reduce the morbidity and mortality in patients of RA. Objectives: The aim of this study was to determine the pattern of cardiovascular comorbidities in RA patients. Methods: It was a hospital based cross- sectional study. Study was conducted at Medicine Department of Chittagong Medical College Hospital (CMCH) for six months period from July’2018 to December’2018. A total 58 diagnosed RA case were selected purposively from both outdoor and indoor of Medicine Department of CMCH. Those having different comorbid condition like stroke, heart failure, chronic kidney disease, diabetes, pregnancy, encephalopathy, bleeding disorder, hypothyroidism, hyperthyroidism or unwilling to be included in the study were excluded. Patients’ demographics, serology results including rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP) and antinuclear antibody (ANA), as well as, disease activity score in 28 joints (DAS28) were recorded in a case record form. With all available aseptic precaution blood sample was collected and sent for FBS, 2HABF, lipid profile, serum creatinine and ESR analysis. ECG and echocardiography was done to detect cardiovascular comorbidities. Results: A total 58 patients enrolled, 84.5% were female, mean of age 51.74 ± 8.41years and RA disease mean duration was 3.56 ±2.16 years. Among the cardiovascular diseases only IHD was detected in the studied patients and its frequency was 13.8%. Percentage of the patients newly diagnosed as hypertensive and diabetic were 8.6% and 5.2% respectively. RA patients with IHD were 14%, had prolonged disease duration 3.56 ± 2.16 and high disease activity 27.6%. Percentages of patients had hypercholesterolemia, low high density lipoprotein (HDL), High Low density lipoprotein (LDL ) were 81%, 98.3% and 100% respectively. Conclusion: This study evaluated newly detected cardiovascular comorbidities among RA patients. Among the CVDs only IHD was detected in the studied patients and its incidence was 13.8%. Proportions of the patients were newly diagnosed as hypertensive and diabetic were 8.6% and 5.2% respectively. RA patients with IHD were more aged, had prolonged disease duration and high disease activity.

Keywords: Rheumatoid arthritis, cardiovascular diseases, ischemic heart disease.