Understanding Rheumatoid Arthritis and Its Impact on Cardiovascular Health
Prevalence and Consequences
Rheumatoid arthritis (RA) affects approximately 1% of the global population, leading to significant joint damage and potential mortality. Chronic inflammation linked to RA is a contributing factor to heart disease and heart failure. Notably, cardiovascular complications are the primary cause of death in individuals with RA, accounting for 50% of deaths associated with cardiovascular disease in this population. Therefore, effective management of RA could reduce the risk of conditions such as accelerated coronary artery disease, cerebrovascular arteriosclerosis, and heart failure.
Mechanism of RA and Its Inflammatory Response
Rheumatoid arthritis is classified as a chronic autoimmune disorder, wherein the immune system erroneously targets the body’s tissues, particularly the synovial lining of joints. The severity of RA is connected to its detrimental effects on various body systems, including the eyes, skin, lungs, blood vessels, and heart. Proteins such as rheumatoid factor attack healthy tissues, contributing to the inflammatory response.
This inflammatory process activates the production of inflammatory mediators like interleukin 1 beta (IL-1β), interleukin 6 (IL-6), tumor necrosis factor (TNF), and necrosis, which can adversely affect the heart and blood vessels. Cytokines, secreted by inflammatory cells, worsen the inflammatory response by upregulating or promoting the degradation of molecules known to impair cardiovascular function. Consequently, exploring the role of inflammatory cytokines and rheumatoid factor positivity in relation to ischemic heart disease is crucial for individuals with RA.
Study Overview and Findings
A recent observational study was conducted involving 80 RA patients and 44 healthy controls, recruited from the Internal Medicine inpatient department and outpatient Rheumatology clinics at Ain Shams University and Cairo University. The researchers assessed levels of interleukin (IL) 1, 6, and 18 in male participants under 55 years and female participants under 45 years.
RA disease activity was evaluated using the 28 tender and swollen joint count disease activity score (DAS-28), categorizing patients into severe, moderate, or remission based on their scores. The health assessment questionnaire (HAQ) was employed for functional assessment. Results indicated that RA patients exhibited significantly elevated serum levels of IL-1, IL-6, and IL-18 compared to healthy controls, with all hypertensive patients testing positive for rheumatoid factor.
The Dobutamine-stress-echocardiography test results showed that among the hypertensive patients, 34 had a hypertensive response, 4 exhibited ischemic changes, and 46 demonstrated normal reactions. Notably, serum levels of IL-1, IL-6, and IL-18 were significantly correlated with the visual analogue scale, HAQ, and DAS-28 scores. IL-18 was uniquely associated with X-ray scores across all patients.
While the investigation of serum levels of IL-1, IL-6, and IL-18 did not significantly aid in identifying patients at risk for ischemic heart disease, the use of stress echocardiography as a screening tool for coronary artery disease proved effective for RA patients due to its high sensitivity and specificity.
Conclusion and Implications
This study concludes that chronic inflammation from rheumatoid arthritis contributes to the risk of ischemic heart disease. Early intervention and treatment for RA may be essential in preventing the development of cardiac complications.
Author and Reference
Written by Viola Lanier, Ph.D., M.Sc.
Reference: Ischemic heart disease and rheumatoid arthritis: Do inflammatory cytokines have a role? Samah A. El Bakry, Dalia Fayeza, Caroline S. Morada, Ahmed Mohamed Abdel-salam, Zeinab Abdel-Salam, Rania H. ElKabarity, Al Hussein M. El Dakrony, Cytokine., 96 (2017) 228–233.