Echocardiographic abnormalities in patients with rheumatoid arthritis attending the rheumatology clinic at the Kenyatta National Hospital.

Abstract

Background: The risk for cardiovascular disease (CVD) in Rheumatoid arthritis (RA) is not related primarily to traditional atherosclerosis risk factors or to drugs but rather has a complex multifactorial interaction. Traditional management of RA has been directed against joint inflammation and damage and not against increased cardiac abnormalities, however, the detection and/or prevention of cardiac abnormalities in RA merits as much attention as the reduction of joint inflammation and disability. Objectives: To determine the prevalence of echocardiographically detected cardiac abnormalities in patients with RA at Kenyatta National Hospital (KNH). Secondary objectives were to determine associations between cardiac abnormalities in RA with disease activity using the clinical disease activity index (CDAI) and to determine associations between cardiac abnormalities in RA and duration of disease. Materials and Methods: A cross-sectional descriptive study of 104 RA patients consecutively sampled over 3 months. Clinical examination and transthoracic 2D echocardiography were done for all patients. The echocardiogram outcome variables included pericardial disease, cardiomyopathy/myocarditis, valvular disease and pulmonary hypertension. Clinical outcome variables included CDAI and duration of illness. The study population was described using demographic and clinical characteristics. Continuous data were presented as means and medians, categorical data as percentages and the prevalence of cardiac abnormalities was presented as proportions with a corresponding 95% CI. Results: One hundred and four RA patients fulfilled the inclusion criteria with a mean age of 51 years and a female to male ratio of 25:1. The prevalence of echocardiographic abnormalities was found to be 62.5% and was unrelated to CDAI and duration of disease. The most common cardiac lesion was pericardial effusion at 39.4%. The tricuspid valve was the most commonly affected valve with 15.4% having tricuspid regurgitation (TR). Pulmonary hypertension was found in 5.5% of patients. Conclusion: This study shows a high prevalence of cardiac abnormalities among RA patients despite these patients being on disease modifying medications and being diagnosed relatively earlier. Majority of the patients were in remission with duration of illness less than 5 years.