AB0298 COMPLICATIONS OF RHEUMATOID ARTHRITIS AND ALLIED DISORDERS– A STATISTICAL COMORBIDITY STUDY OF 234 AUTOPSY PATIENTS
Authors: Miklós Bély, Ágnes Apáthy
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Complications of rheumatoid arthritis (<b>RA</b>) may modify the clinical course and symptoms of allied disorders leading to missed diagnosis or late recognition of associated diseases. <h3>Objectives</h3> The <b>aim</b> of this study was to determine the possible role of classic <b>complications</b> of <b>RA</b>: systemic autoimmune vasculitis (<b>AV</b>), AA amyloidosis (<b>AAa</b>), lethal cardiac insufficiency (<b>CI</b>) caused by endo-, myo- or pancarditis, furthermore lethal septic infection (<b>SI</b>) on <b>prevalence</b> and <b>mortality</b> of coexistent <b>associated diseases</b>: atherosclerosis (<b>Ath</b>), hypertension (<b>HT</b>), type 2 diabetes mellitus (<b>DM</b>) and tuberculosis (<b>Tb</b>) with miliary dissemination (<b>mTb</b>). <h3>Methods</h3> <b>234</b> non-selected autopsy patients with <b>RA</b> were studied. <b>RA</b> was confirmed clinically according to the criteria of the <b>ARA</b>. The presence of <b>AV</b>, <b>AAa</b>, <b>CI</b> and <b>SI</b> was determined at autopsy and confirmed by a detailed review of extensive histological material. The prevalence and mortality of associated diseases <b>Ath</b>, <b>HT</b>, <b>DM</b>, <b>Tb</b> or <b>mTb</b> were analyzed retrospectively, reviewing the clinical and pathological reports. The link between <b>AV</b>, <b>AAa</b>, <b>CI</b> or <b>SI</b> and<b>Ath</b>, <b>HT</b>, <b>DM</b>, <b>Tb</b> or <b>mTb</b> was analyzed by (χ<sup>2</sup>) test. <h3>Results</h3> <b>RA</b> was complicated by <b>AV</b> in <b>43</b> (<b>18.4</b>%), by <b>AAa</b> in <b>48</b> (<b>20.5</b>%), by <b>CI</b> with lethal outcome in <b>15</b> (<b>6.4</b>%), and by lethal <b>SI</b> in <b>33</b> (<b>14.1</b>%) of <b>234</b> patients. <b>RA</b> associated with severe <b>Ath</b> in <b>106</b> (<b>45.3</b>%), with <b>HT</b> in <b>41</b> (<b>17.5</b>%), with <b>DM</b> in <b>41</b> (<b>17.5</b>%), and with <b>Tb</b> in <b>28</b> (<b>11.9</b>%), with active <b>mTb</b> in <b>9</b> (<b>3.8</b>%) of <b>234</b> patients. As a basic disease <b>Ath</b> led to death in <b>61</b> (<b>26.1</b>% of 106), <b>HT</b> in <b>2</b> (<b>0.9</b>% of 41), <b>DM</b> in <b>none</b> (<b>0</b>% of 41), and <b>Tb</b> with <b>mTb</b> in <b>3</b> (<b>1.3</b>% of 28) of <b>234</b> patients. <b>Tb</b> without miliary dissemination was not lethal in our patient population. The statistical links ("p" values of significance) between complications of <b>RA</b> and prevalence or mortality of allied disorders are summarized in Table. (<b>*</b>asterisk indicates a negative value of associations' coefficient with inverse relationship). <h3>Conclusion</h3> The inverse correlations between <b>AV</b>, <b>AAa</b>, <b>CI</b>, <b>SI</b> and<b>Ath</b>, <b>HT</b>, <b>DM</b>, <b>Tb</b> or <b>mTb</b> indicate that the prevalence and mortality of allied disorders were not influenced basically by the complications of<b> RA</b>. The consequently inverse and (in most cases) significant correlations between prevalence of <b>AV</b>, <b>AAa</b>, <b>CI</b>, <b>SI</b> and the prevalence and mortality of <b>Ath</b> show that these are are independent entities in <b>RA</b>. The <b>AV</b>, <b>AAa</b>, <b>CI</b> and <b>SI</b> are the most important complications of <b>RA</b>, and are characterize severe forms of disease, mostly involving younger patients, with an earlier onset (without pronounced Ath); while <b>Ath</b> is basically an age dependent phenomenon, characteristically present in <b>RA</b> patients with advanced age. <b>RA</b> patients with <b>Ath</b> may represent a special group of <b>RA</b>, characterized by lower incidence of <b>AV</b>, <b>AAa</b>, <b>CI</b> or <b>SI</b>, and a better prognosis. The positive and significant relations <b>AV</b> to <b>Tb</b> or <b>mTb</b> suggest an increased risk of Tb, e.g. the presence of <b>AV</b> may promote <b>Tb</b> or endogenous exacerbation and miliary dissemination of <b>Tb</b>. <h3>Disclosure of Interests</h3> None declared