ACTA FAC MED NAISS 2019;36(3):177-187

Original article

UDC: 616.72-002.77:616-008
616.72-002.77:616.1

DOI: 10.5937/afmnai1903177A

The Impact of Disease Activity in Patients with Rheumatoid Arthritis on Metabolic Syndrome and Cardiovascular Risk Assessment

Ivana Aleksić¹, Sonja Stojanović^1,2, Ivan Tasić^1,2, Bojana Stamenković^1,2

¹Institute for Treatment and Rehabilitation "Niška Banja", Niš, Serbia
²University of Niš, Faculty of Medicine, Niš, Serbia

summary


Patients with rheumatoid arthritis (RA) have a 1.5 times higher cardiovascular disease mortality compared to the general population, while the life expectancy of these patients is 5-10 years shorter compared to the general population. In RA patients, all stages of atherogenic process are accelerated. Systemic inflammation underlying RA is an independent risk factor for the development of cardiovascular diseases. The main objectives of the study were: a) to examine the lipid status and frequency of metabolic syndrome in RA patients and their association with disease activity and functional impairment; b) to assess the cardiovascular risk of RA patients in relation to disease activity and presence of metabolic syndrome components. Investigation was performed in RA patients diagnosed according to classification criteria the American Association of Rheumatologists (1987). All RA patients underwent clinical examination, laboratory analyses, measurement of blood pressure, body weight and height (body mass index was calculated). The presence of the metabolic syndrome (MetS) was determined by the definition of the International Federation for Diabetes. ACC/AHA ASCVD risk calculator was used to calculate the cardiovascular risk. Disease activity was evaluated with DAS28 and CDAI score. Functional ability of patients was assessed based on the modified Health Assessment Questionnaire (HAQ). Comparison of continuous variables was performed by the Mann-Whitney test, while comparison of the attributes was performed with the Chi-square test. Statistical data processing was performed in the program package R. The study enrolled 81 RA patients (19 men and 62 women) whose mean age was 59.7 ± 11.2 years, with average disease duration of 5.89 ± 6.25 years. According to disease activity measured by DAS28, all patients were divided into two groups - high disease activity group (HAD) with DAS28 > 5.1 which consisted of 37 patients (45.7%) and moderate, low disease activity and remission (MLA) group with DAS28 ≤ 5.1, which consisted of 44 patients (54.3%). The average total cholesterol level in all patients was 5.44 ± 1.03. Total cholesterol was 5.22 ± 1.03 in HAD group and 5.68 ± 1.03 in MLA group (p = 0.029). The average level of LDL cholesterol in all patients was 3.09 ± 0.80. In the HAD group, the levels were statistically significantly lower (p = 0.033) compared to the MLA group (2.84 ± 0.80 vs. 3.34 ± 0.80). The prevalence of metabolic syndrome in the study population was 54.3% (44/81 patients). Patients with metabolic syndrome had statistically significantly higher DAS28 values (p = 0.004), CDAI (p = 0.007) and higher functional incapacity determined by HAQ questionnaire (p = 0.001). Cardiovascular risk in the HAD group was 12.18 ± 8.09% which was higher compared to MLA group 10.74%, but without significance between the compared groups (p = 0.943). Cardiovascular risk was statistically significantly higher in patients with metabolic syndrome (p < 0.001). Our results suggest statistically significantly more frequent presence of metabolic syndrome in RA patients, which is accompanied with higher disease activity and more severe functional disability. Total cholesterol and LDL cholesterol levels were lower in patients with high disease activity. Cardiovascular risk was statistically significantly higher in patients with metabolic syndrome and RA, but without a significant difference regarding the disease activity.

Key words: rheumatoid arthritis, lipid profile, metabolic syndrome, cardiovascular risk