Study on Cardiac Manifestations in Rheumatoid Arthritis

Atma, S Raj (2015) Study on Cardiac Manifestations in Rheumatoid Arthritis. Masters thesis, Coimbatore Medical Collegel, Coimbatore.


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INTRODUCTION: Rheumatoid arthritis is a chronic inflammatory disease of unknown etiology affecting approximately 1% of the adult population worldwide. Its primary target is the synovium where it results in uncontrolled proliferation of the synovial tissue. This results in excessive fluid production which leads to the erosion of the surrounding bone, ultimately damaging the tendons and ligaments. Even though rheumatoid arthritis is principally a disease of joints, several extra – articular manifestations are also noted involving cardiac, pulmonary, haematological, ocular and neurological systems. AIMS AND OBJECTIVES: AIM: To document the incidence of cardiac involvement in patients suffering from Rheumatoid Arthritis (RA) OBJECTIVES: 1. To observe the cardiac manifestations in patients with RA by echocardiograph, collect the data, and to analyse the same. 2. To investigate the correlation between RA and cardiac diseases. 3. To find out the relation, if any, between cardiac lesions with the degree, severity and duration of RA. METHODOLOGY: The study is undertaken on the patients approaching the out- patient (OP) department as well as the IP department of the Coimbatore Medical College Hospital, Coimbatore during the period of study (ie September 2013 to August 2014). A total of fifty (50) subjects who had, approached the Rheumatology Department in the Hospital, and having satisfied the modified ACR (2010) criteria were selected for the study. These patients were compared with another fifty (50) control group, who had come to the OP department for non-specific complaints. The control group was selected on a random basis. SELECTION CRITERIA: Inclusion criteria: 1. Adult patients (both sex) between the age group of 18 to 60, 2. Patients satisfying modified ACR criteria (2010) for RA. Exclusion criteria 1. Pregnant women, 2. Minors (below the age of consent), 3. Persons suffering from congenital heart diseases, 4. Persons suffering from ischemic heart diseases, 5. Persons suffering from valvular heart diseases, 6. Persons suffering from hypertension, 7. Persons suffering from diabetes mellitus, 8. Persons not capable of giving consent (psychiatric patients), 9. Persons unwilling to undergo the study (who refused to consent). SUMMARY: Our study is a case control study in which 50 patients with rheumatoid arthritis who attended the OP department or were admitted to the medicine wards of Coimbatore Medical College Hospital were compared with 50 control subjects. 1. Cardiac abnormality is an important part of the extra-articular manifestations of rheumatoid arthritis. Most of these abnormalities are to a large extent sub-clinical. 2. When patients with Rheumatoid arthritis were evaluated with Echocardiography, out of 50 patients, 15 patients (30%) were found to have cardiac abnormalities. Out of this 30%, most common abnormality was left ventricular dysfunction which accounted for 18%. The other significant abnormalities were pericardial disease in 10% and pulmonary hypertension in 2%. 3. The maximum incidence of cardiac abnormalities was between 24 to 50 years, with a female preponderance. (male to female ratio 1:1.6). 4. There was higher incidence of cardiac involvement in patients with increased duration of disease with a mean duration of disease being 5.41 years. Left ventricular filling abnormalities were higher with increased disease duration. 5. There was an increased incidence of cardiac abnormalities in patients with rheumatoid nodules which was statistically significant. 6. None of the patients with LV filling defects detected by Echo had clinical symptoms or signs suggestive of cardiac disease, which points towards a sub-clinical cardiac involvement of the patients with Rheumatoid arthritis. 7. There was significant association between number of tender joints involved and the presence of cardiac abnormalities in Rheumatoid arthritis patients. 8. Patients with cardiac abnormalities were found to have higher ESR values, though not statistically significant. 9. Since the most common cause of mortality in patients with Rheumatoid arthritis is cardiovascular disease, these cardiac abnormalities should be detected early and it will aid in the correct assessment and management of patients with rheumatoid arthritis. 10. Therefore, it should be made mandatory that every patient diagnosed to have rheumatoid arthritis should undergo cardiac assessment (especially echocardiography) to help in early detection and treatment of cardiac abnormalities associated with rheumatoid arthritis, to reduce the morbidity and mortality associated with rheumatoid arthritis and to improve the quality of life of patients with Rheumatoid arthritis. CONCLUSION: 1. Cardiac manifestations in Rheumatoid arthritis patients were seen in 15 cases (30%) out of the 50 cases studied. The maximum incidence of the disease was seen in the age group of 24 – 50 years and male to female ratio was 1: 1.6. 2. The mean duration of Rheumatoid arthritis was found to be 5.96 years in the entire study group and 7.66 years in patients presenting with cardiac abnormalities. 3. There was positive correlation of patients with cardiac abnormalities to the number of joints involved, subcutaneous nodules, erosive arthritis and mean duration of the disease. 4. There was no significant correlation between cardiac abnormalities and number of swollen joints, ESR, seropositivity and functional class. 5. Most patients with cardiac abnormalities had normal heart size their chest X- ray. The electrocardiogram revealed minor conduction abnormalities in patients which were comparable to the findings in control subjects. 6. The most common cardiac abnormality seen in this study was left ventricular diastolic dysfunction in 18%. Other abnormalities included pericardial disease in 10% and pulmonary hypertension in 2 %. 7. None of the patients had clinical manifestations of cardiac involvement suggesting that cardiac involvement in rheumatoid arthritis is sub-clinical.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cardiac Manifestations ; Rheumatoid Arthritis.
Subjects: MEDICAL > General Medicine
Depositing User: Punitha K
Date Deposited: 18 May 2018 18:55
Last Modified: 21 May 2018 01:43

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