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Association of rheumatoid arthritis disease activity, severity with electrocardiographic findings, and carotid artery atherosclerosis

Abstract

Aim

The aim was to detect specific ECG changes in rheumatoid arthritis (RA) patients as well as to study atherosclerotic changes of the carotid arteries as an indicator of cardiovascular system risk factors and to correlate findings with disease activity and severity parameters to elucidate possible associations between these variables.

Patients and methods

This study included 30 RA patients, 30 age-matched and sex-matched systemic lupus erythematosus patients and 30 age-matched and sex-matched healthy volunteers as control groups. The patients were subjected to clinical examination, assessment of disease activity score-28 (DAS28), functional disability Health Assessment Questionnaire, and laboratory and radiological assessments. ECG and measurement of the carotid intima media thickness (CIMT) by carotid ultrasound scan was also done.

Results

Ten (33.3%) RA patients had ECG abnormalities, with ST or T-wave abnormality being the most common abnormality present. RA patients had the highest frequencies of ECG abnormalities. Most ECG changes occurred in RA patients using steroids (90%). ST or T-wave abnormality in RA occurred more in patients with a higher swollen joint count, higher DAS28, and a higher patients’ global health assessment. RA patients had the highest mean. The mean CIMT was significantly higher in RA patients with ECG abnormalities. There were significant positive correlations of average CIMT with DAS28, Health Assessment Questionnaire, and Simple Erosion Narrowing Score. There were significant positive correlations of mean CIMT with the level of triglycerides, cholesterol, high-density lipoprotein, erythrocyte sedimentation rate, and a highly significant correlation between mean CIMT and C-reactive protein. CIMT at a cut-off point of 0.75 mm can predict ECG abnormalities with high sensitivity and specificity.

Conclusion

ECG changes were present in 33.3% of RA patients. Increased CIMT was observed in RA patients and correlated well with disease activity and severity parameters.

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Correspondence to Samia M. Abd El-Monem.

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Abd El-Monem, S.M., Ali, A.Y., Hashaad, N.I. et al. Association of rheumatoid arthritis disease activity, severity with electrocardiographic findings, and carotid artery atherosclerosis. Egypt Rheumatol Rehabil 46, 11–20 (2019). https://doi.org/10.4103/err.err_36_18

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  • DOI: https://doi.org/10.4103/err.err_36_18

Keywords

  • cardiovascular risk
  • carotid artery atherosclerosis
  • electrocardiography
  • rheumatoid arthritis
  • systemic lupus erythematosus