A Multi Marker Evaluation of Cardiovascular Disease Risk in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA), an inflammatory joint disease, is also associated with systemic effects. Patients with RA have an increased risk of morbidity and mortality that is mainly attributable to cardiovascular disease (CVD). Both traditional and novel risk factors are implicated in causing the increased CVD risk in RA patients.

Forty six RA patients, diagnosed with RA as per 1987 revised ARA criteria and forty six age and sex matched healthy controls were studied. Fasting lipid profile (Total cholesterol, triglycerides, HDL cholesterol), inflammatory markers (high sensitivity C reactive protein [hsCRP] and fibrinogen), oxidant and antioxidant markers (malondialdehyde [MDA] and ferric reducing ability of plasma [FRAP]), uric acid, homocysteine and Nitric oxide (NO) were measured in all subjects.

Among the traditional lipid parameters studied, triglycerides were increased in RA patients compared to controls (p=0.023). Both hsCRP (p<0.001) and fibrinogen (p=0.006) were elevated in RA patients than in controls. MDA levels were increased (p<0.001) and FRAP levels decreased (p<0.001) in patients with RA compared to controls. Uric acid and homocysteine levels showed no significant difference between RA patients and controls. Nitric oxide levels were increased in RA patients when compared with controls (p=0.030).

Patients with rheumatoid arthritis were found to have an increased risk of CVD as evidenced by increased triglyceride levels, increased inflammatory markers, presence of oxidative stress. Hence, management of these patients should also include evaluation of CVD risk besides treatment of joint symptoms.