AB0169 INTEREST OF THE ECHOCARDIOGRAPHY IN SCREENING OF CARDIAC INVOLVEMENT IN RHEUMATOID ARTHRITIS PATIENTS
Authors: M. Brahem, H. Ibn Hadj Amor, R. Sarraj, R. Rouabhia, E. Hmaier, H. Hachfi, A. Ben Salem, S. Abdellatif, R. Ben Tekaya, Y. Mohamed
Journal: Annals of the Rheumatic Diseases (2021)

Background: Rheumatoid arthritis (RA) is the most common chronic inflammatory disease which usually affects peripheral joints.Extra-articular manifestations can occur during the course of this disease and even before the onset of arthritis, such as cardiac impairment that is a common cause of mortality in RA. Objectives: The aim of our study is to identify the prevalence of cardiac manifestations in RA using the echocardiography exam and to elaborate its associated factors. Methods: This is a cross-sectional study including consecutive RA’s patients which consulted the rheumatology department in Taher Sfar hospital. The diagnosis of RA was elaborate according to ACR/EULAR 2010 criteria. The epidemiological, clinical and biological data were collected from patients’ records. Echocardiography was performed by a trained cardiologist in the same hospital, using the transthoracic approach. Results: Our study included 67 patients: 63 women (94%) and 4 men (6%), with an average age of 52.55 years [21-75 years] and mean disease duration of 11.85 years [10-40]. Joints deformities were present in 37 cases (55.2%) and radiographic joint damage in 49 cases (73.1%). 34 (50.7%) of the patients had an ESR greater than 30 mm/hour and 24 (35.8%) had a CRP greater than 6mg/L. The mean DAS28-CRP was 3.35 [1.24-6.7] and the mean DAS28-ESR was 4 [1.4-7.35]. Cardiac symptomatology was present in 22 cases (32.8%), dominated by dyspnea on effort in 22 cases (32.8%), dyspnea at rest in 4 cases (6%), chest pain in 8 cases (11.9%)and palpitation in 2 cases (3%). The echocardiography abnormalities were found in 44 cases. Valve damage was detected in 35 patients (52.2%), of which only 2 were significant. Valvular abnormalities were dominated by mitral valve regurgitation and mitral valve thickening in 11 cases (16.4%) each, aortic valve regurgitation in 6 cases (9%),aortic valve thickening in 2 cases (3%), aortic valve stenosis in 3 cases (4.5%),aortic valve calcification in 12 cases (17. 9%) aortic valve nodule in 1 case (1.5%), pulmonary insufficiency in 10 cases (14.9%) and tricuspid insufficiency in 25 cases (37.3%).Pericarditis was found in 2 cases (3%), pulmonary arterial hypertension (PAH) in 5 cases (7,5%) and Left ventricular hypertrophy in 14 cases (20,9%). The study of E/A and E/E’ ratios revealed diastolic dysfunction in 23 cases (34.3%).The mean of longitudinal global strain measure was -17,83 [-21,9 to -10] and it revealed systolic dysfunction in 18 cases (26.86%). Cardiac impairment detected by echocardiography did not appear to be associated with the age (p=0.39) or the disease duration (p=0.62) nor the importance of biological inflammation(p=0.1). However, joints deformities and RA activity (DAS28) were significant predictors of cardiac involvement (p=0.01; p=0.03). Conclusion: Our study shows that cardiac impairment in RA was often asymptomatic and was correlated with the disease activity. The echocardiography with the strain measure represents an excellent tool for its detection in early stages. References: [1]Guedes C, Bianchi-Fior P, Cormier B, Barthelemy B, Rat AC, Boissier MC. Cardiac manifestations of rheumatoid arthritis: A case-control transesophageal echocardiography study in 30 patients. Arthritis Care Res. 2001;45(2):129–35. Disclosure of Interests: None declared