Prabhuswamy, M (2013) A Study on Correlation of Carotid Artery Intima-Media Thickness (As a Marker of Atherosclerosis) with Activity and Duration of Rheumatoid Arthritis. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease in which etiology is unknown. It is the commonest inflammatory arthritis affecting 0.5 to 1 percent of general population all over the world. It is characterized by symmetric polyarthritis involving peripheral joints, resulting in joint destruction and disability. Although it is a disease of joints, abnormal immunological responses can lead to a variety of extra-articular manifestations including the involvement of blood vessels and heart. As compared to general population, people with rheumatoid arthritis experience disability, increased mortality and shortened life expectancy. Cardiovascular involvement is the leading cause of mortality in patients with Rheumatoid arthritis. This increased mortality due to cardiovascular involvement has been attributed to accelerated atherosclerosis which has been found to be independent of traditional risk factors for atherosclerosis. Accelerated atherosclerosis in Rheumatoid arthritis has been attributed to inflammation5, increased homocysteine levels, imbalance in homeostasis, immobility, decreased antioxidants level, side effects due to medications, and abnormal lipid levels. Among the above mentioned causes, inflammation has the strongest association for accelerated atherosclerosis in Rheumatoid arthritis patients. In RA patients, indirect evidence of accelerated atherosclerosis comes from studies involving measurement of Carotid artery intima media thickness (CIMT) as a marker of atherosclerotic burden and cardiovascular risk. Measurement of CIMT is an economical and noninvasive test which is quite reliable and sensitive for assessment of atherosclerosis. Increased atherosclerosis in carotid arteries is indicative of atherosclerosis in multiple vascular beds including coronary arteries. So, measurement of CIMT is an important surrogate marker of increased cardiovascular risk including acute coronary syndrome. Early diagnosis of atherosclerosis by measuring CIMT might trigger the preventive steps against atherosclerosis in RA patients thereby decreasing cardiovascular mortality. In this background, a cross sectional study of CIMT in 40 cases of Rheumatoid arthritis patients of various age groups and duration of symptoms was conducted in south Indian patients, in southern districts of Tamilnadu, who were attending Government Rajaji Hospital, Madurai. The study was undertaken in the department of medicine, Government Rajaji Hospital, Madurai. AIMS AND OBJECTIVES OF THE STUDY A) To determine whether carotid artery intima media thickness (CIMT) is advanced in patients with Rheumatoid arthritis (RA), as compared to healthy controls. B) To study the correlation if any between Carotid Intima Media Thickness (CIMT) and duration of Rheumatoid arthritis. C) To study the correlation if any between Carotid Intima Media Thickness (CIMT) and activity of Rheumatoid arthritis. MATERIALS AND METHODS: Setting: Rheumatology outpatient clinic, Government Rajaji Hospital (GRH), Madurai, Tamilnadu. Design of the Study: Matched cross sectional study. Period of Study: April2012 – October 2012. Details of Study Materials and Methods: The study was performed in 40 Rheumatoid arthritis (RA) patients and 40 healthy control subjects. The RA patients were selected from consecutive patients attending Rheumatology outpatient clinic at Govt. Rajaji Hospital (GRH), Madurai, who were diagnosed according to 2010 American College of Rheumatology-European League against Rheumatism (ACR-EULAR) criteria. 40 healthy controls were selected from among the people who were attending local health-check program at GRH Madurai. Written informed consent was taken from all cases and controls. The following exclusion criteria were used to avoid confounding by other known risk factors for atherosclerosis: a) Hypertension (BP > 140/90 mmHg) or use of antihypertensive medications. b) Hypercholesterolemia (Total cholesterol>240mg/dl, LDL >160 mg/dl, triglycerides >200 mg/dl) or use of lipid lowering medication. c) Diabetes Mellitus (diagnosed according to WHO criteria) or use of anti-diabetic medication. d) History of coronary artery disease. e) History of cerebrovascular accidents (CVA). All the subjects included in our study (both cases and controls) were not known cases of IHD (ischemic heart disease), Diabetes Mellitus, or Hypertension and did not suffer any cerebrovascular events in the past. And also did not have any evidence of hepatic or renal impairment. RESULTS: Total of 40 cases were enrolled for the study. Among them 12 cases (30%) were males and 28 cases (70%) were females. So, females form the major number in our study. Control subjects were also in similar distribution as that of cases in relation to total number and gender distribution. CONCLUSION: In this cross sectional study on Rheumatoid arthritis, • Carotid intima media thickness in RA cases was found to be significantly increased when compared to age and sex matched healthy controls indicating that Rheumatoid arthritis is an independent risk factor for accelerated atherosclerosis. • Increase in carotid intima media thickness was found to be directly related to the duration of the disease. • Our study did not show significant relationship between disease activity and carotid intima media thickness. So, early diagnosis of evidence of unfavorable vascular profile in RA patients and instituting appropriate preventive therapies can decrease the cardiovascular mortality due to Rheumatoid arthritis.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Carotid Artery Intima-Media Thickness ; Marker of Atherosclerosis ; Activity ; Duration ; Rheumatoid Arthritis. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Mar 2018 03:24 |
| Last Modified: | 20 Mar 2018 15:16 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6387 |
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