P. Sathya Murthy1, Gopi Krishna Jaladi2, Muthaiah Kothandaraman Sudhakar3
BACKGROUND
Rheumatoid arthritis is a well-known chronic inflammatory autoimmune disease which affects multiple joints usually in a symmetrical manner. Apart from the joints, RA can affect numerous other systems of the body like cardiovascular, neurological, haematological, skin, blood vessels, etc. The most common cause of death of RA patients has been found to be cardiovascular disease due to coronary artery disease. Chronic inflammatory state and dyslipidaemia1,2 have been proposed as the reasons for accelerated atherosclerosis in RA. There are very few studies in India about lipid profile abnormality in rheumatoid arthritis and its relationship with the severity of the disease in RA patients. There is lacuna of knowledge about this aspect of disease in Indian patients. This study aims to address this issue.
AIM
To study lipid profile abnormalities and its relationship with the severity and number of ACR criteria of Rheumatoid Arthritis.
MATERIALS AND METHODS
This cross-sectional study was conducted from August 2009 – August 2011, patients fulfilling the American College of Rheumatology 1987 criteria for Rheumatoid Arthritis.,3 newly diagnosed and patients on treatment for Rheumatoid Arthritis are taken into consideration. Dyslipidaemia defined using the high cut-off values of National Cholesterol Education Programme- Adult Treatment Panel. Disease Activity Score DAS-28(4) was employed to calculate the disease activity. For all patients after an overnight fasting blood samples were collected and serum was separated and Fasting Lipid Profile was done enzymatically using standardised Flex® reagent cartridges for Total Cholesterol, High Density Lipoproteins, Low Density Lipoproteins and Triglycerides. RA factor was done using Latex Agglutination Test. ESR for assessing DAS 28 was done using Wintrobe’s method. The significance of difference in mean between two groups were analysed by student t?test. The correlation between Lipid profile and Disease Activity, number of ACR criteria fulfilled and newly diagnosed and old cases was calculated by using the Pearson's correlation coefficient method.
Statistical significance was taken when p value < 0.05. Statistical analysis was carried out using standard formulae. Microsoft Excel 2007 and SPSS (statistical package for social sciences) version 13 software was used for data entry and analysis.
RESULTS
A total of 80 patients with Rheumatoid Arthritis (newly diagnosed and known cases) were studied. In this study, 67 (83.8%) were females and 13 (16.3%) were females, the female to male ratio is 5.15. All the 80 patients fulfilled the American College of Rheumatology 1987 criteria for the diagnosis of Rheumatoid Arthritis 25. The age of patients ranged from 24 to 80 yrs., with mean age of 44.2 ± 11.3 yrs. Out of 80 patients, 35 (43.75%) fulfilled 4 ACR criteria, 34 (42.5%) fulfilled 5 ACR criteria and 11 (13.75%) fulfilled 6&7 criteria. Out of 80 patients, 44 (55%) had Dyslipidaemia, of which 41 (51.25) had low High Density Lipoproteins. In this study, TC decreases with the increase in the activity of the disease with a P-value of 0.063. LDL decreases with the increase in the activity of the disease with a P-value of 0.091. HDL decreases with the increase in the activity of the disease with a P-value of <0.001. Triglycerides decreases with the increase in the activity of the disease with a P-value of 0.005. TC/HDL increases with the increase in the activity of the disease with a P-value of 0.0001. In this study, TC decreases with the increase in the number of ACR criteria fulfilled with a P-value of 0.024. LDL was low in patients fulfilling 6&7 ACR criteria fulfilled with a P-value of 0.056. HDL decreases with the increase in the number of ACR criteria fulfilled with a P-value of 0.014. TG decreases with the increase in the number of ACR criteria fulfilled with a P-value of 0.028. TC/HDL increases with the increase in the number of ACR criteria fulfilled with a P-value of 0.234.
CONCLUSION
Lipid Profile in Rheumatoid Arthritis patients depends on the severity of the disease. There is an inverse relationship between TC, LDL-C, HDL-C and Triglycerides and severity of the Rheumatoid arthritis. Which is statistically significant for HDL-C and Triglycerides. There is direct relationship between TC/HDL-C and severity of disease which is statistically significant. These factors in part explain the high risk of Coronary Artery Disease in patients with Rheumatoid Arthritis and the importance of effective treatment of RA.
