Rheumatoid arthritis affects 1% of the population and can cause permanent joint destruction and death. Chronic inflammation associated with rheumatoid arthritis is known to play a role in predisposing patients to heart disease and heart failure.
Mortality caused by rheumatoid arthritis is predominantly due to cardiovascular complications. With 50% of cardiovascular disease associated deaths occurring in people who suffer from rheumatoid arthritis, gaining better control of this condition may help decrease diagnosis of accelerated coronary artery, cerebrovascular arteriosclerosis, and heart failure. Rheumatoid arthritis is a chronic autoimmune disorder in which the immune system mistakenly attacks the body’s own tissues, such as the lining of the joints. The severity of this condition has been linked to damaging body systems such as the eyes, skin, lung, blood vessels, and the heart. Proteins such as rheumatoid factor, attack healthy tissues and influence the inflammatory process. Rheumatoid arthritis’s role in activating inflammatory processes and increasing inflammatory molecules such as interleukin 1beta (IL-1beta), interleukin 6 (IL-6), tumor necrosis factor (TNF), and necrosis can influence the heart and blood vessels. As substances secreted by inflammatory cells, cytokines exacerbate the inflammatory process by up regulating or influencing the breakdown of other molecules that are known to cause cardiovascular dysfunction. Therefore, investigating the role of inflammatory cytokines, rheumatoid factor positivity, and its association with ischemic heart disease is important for patients suffering from rheumatoid arthritis.
A cross sectional observational study randomly recruited 80 rheumatoid arthritis patients and 44 healthy controls from the Internal Medicine inpatient department and outpatient clinics of Rheumatology, at Ain Shams University and Cairo University. Levels of interleukin (IL) 1, 6, and 18 were assessed in males younger than 55 years old and females younger than 45 years old.Rheumatoid arthritis disease activity was assessed by using the 28 tender and swollen joint count disease activity score (DAS-28) and patient outcomes were additionally divided according to their DAS-28 score into severe, moderate, and remission disease activity. A functional assessment of patients with rheumatoid arthritis was performed using a health assessment questionnaire (HAQ). Patients with rheumatoid arthritis had significantly higher serum levels of IL 1, 6, and 18 than the healthy controls; and all patients with a hypertensive reaction had positive levels of rheumatoid factor. Results from the Dobutamine-stress-echocardiography testrevealed34 of the patients with a hypertensive reaction, 4 with ischemic change, and 46 had a normal reaction. In all patients, serum levels of IL1, 6, and 18 showed a significant positive correlation with the visual analogue scale, HAQ and DAS-28; with IL18 being the only cytokine with a significant positive correlation with X-ray scores in all patients.
Though investigating serum levels of IL1, 6, and 18 did not help much in detecting patients at risk of ischemic heart disease, using stress echocardiography as a screening test for coronary artery diseases is appropriate for patients with rheumatoid arthritis; due to its high sensitivity and specificity. In conclusion, this study found that chronic inflammation associated with rheumatoid arthritis plays a role in predisposing patients to ischemic heart disease. It is possible that early treatment of rheumatoid arthritis may help prevent the onset of cardiac conditions.
Written by Viola Lanier, Ph. D., M. Sc.
Ischemic heart disease and rheumatoid arthritis: Do inflammatory cytokines have a role? Samah A. El Bakrya,⁎, Dalia Fayeza, Caroline S. Morada, Ahmed Mohamed Abdel-salamb, Zeinab Abdel-Salamb, Rania H. ElKabarityc, Al Hussein M. El Dakronyd, Cytokine., 96 (2017) 228–233