Rheumatology

doi: 10.25005/2074-0581-2019-21-3-432-435
RELATIONSHIP BETWEEN ANEMIA AND HEART DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS

L.I. Feyskhanova1, E.V. Sukhorukova2, A.I. Akhmetzyanova1

1Department of Hospital Therapy, Kazan State Medical University, Kazan, Russian Federation
2Department of Rheumatology, Republican Clinical Hospital, Kazan, Russian Federation

Objective: To determine the impact of anemia on the structural-geometrical condition of the heart in patients with rheumatoid arthritis (RA).

Methods: 154 patients with RA were included in the study: 37 patients with anemia (1st group) and 117 – without systemic manifestations of RA (2nd group). All patients underwent echocardiography.

Results: Both groups were comparable in age, sex, ratio of seropositive and seronegative patients. A comparative analysis of both groups revealed that in 1st group DAS28 was higher than in 2nd group (p<0.05). The left ventricular myocardial mass index was higher in 1st group than in the 2nd group (p<0.05). The same applies to the left ventricular end-diastolic diameter: in patients with anemia, it was more than in patients without it (p<0.05). Our results suggest that patients with anemia often have a violation of diastolic myocardial function, which is accompanied by an increase in myocardial mass. The correlation analysis in both groups revealed a direct relationship between age and left ventricular mass index (r=0.62, p<0.0005), inverse relationship between age and E/a parameter of mitral valve (r=-0.71, p<0.00001). In addition, in 1st group we revealed the inverse relationship between DAS28 and E/a parameter of tricuspid valve (r=-0.43, p<0.05).

Conclusions: Thus, regardless of the presence of anemia, the patients with RA observed dependence of structural and functional changes in the heart of age: a violation of diastolic function of the left ventricle, an increase of the left ventricular myocardial mass index. However, in patients with anemia, an increase in the activity of the disease is accompanied by diastolic dysfunction of the right ventricle that requires correction in patient management process.

Keywords: Rheumatoid arthritis, anemia, echocardiography, diastolic dysfunction.

Download file:


References
  1. Mercado U, Barbosa B. Manifestaciones extraarticulares de artritis reumatoide. Med Int Mex. 2016;32(6):607-11.
  2. Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular manifestations in rheumatoid arthritis. A Journal of Clinical Medicine. 2010;5(4):286-91.
  3. Bonfiglioli KR, Carriço H, Mota L, Vargas-Santos AB, Albuquerque C, Giorgi R, et al. Extra-articular manifestations in rheumatoid arthritis: a comprehensive analysis in a large cohort. Annals of the Rheumatic Diseases. 2018;77:301.
  4. Talukdar M, Barui G, Adhikari A, Karmakar R, Ghosh UC, Das TK. Heamatological parameters and disease activity in rheumatoid arthritis. Journal of Clinical and Diagnostic Research. 2017;11(1):EC01-EC04.
  5. Fraenkel PG. Understanding anemia of chronic disease. American Society of Hematology. 2015;1:14-8.
  6. Poggiali E, De Amicis MM, Motta I. Anemia of chronic disease: A unique defect of iron recycling for many different chronic diseases. European Journal of Internal Medicine. 2014;25:12-7.
  7. Madu AJ, Ughasoro MD. Anaemia of chronic disease: an in-depth review. Med Princ Pract. 2017;26:1-9.
  8. Cullis J. Anaemia of chronic disease. Clinical Medicine. 2013;13(2):193-6.
  9. Möller B, Scherer A, Förger F, Villiger P, Finckh A. Anaemia may add information to standardized disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study. Ann Rheum Dis. 2014;73(4):691-6.
  10. Pascale V, Finelli R, Giannotti R, Coscioni E, Izzo R, Rozza F, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Scientific Reports. 2018;8:5867. Available from: https://doi.org/10.1038/s41598-018-24323-0.
  11. Myasoedova E, Davis JM III, Crowson CS, Roger VL, Karon BL, Borgeson DD, et al. Rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a population-based cross-sectional study. Arthritis & Rheumatism. 2013;65(7):1713-8. Available from: https://doi.org/10.1002/ art.37949.
  12. Erhayiem B, Bissell L-A, McDiarmid AK, Swoboda PP, Kidambi A, Ripley DP, et al. Abnormal left ventricular geometry is prevalent in asymptomatic patients with established rheumatoid arthritis compared with those with early disease and healthy controls. Journal of Cardiovascular Magnetic Resonance. 2015;17(Suppl 1):297.
  13. Kobayashi H, Hirano M, Yoneyama K, Nakajima Y. Left ventricular morphology and function in rheumatoid arthritis patients without cardiac symptoms, using a cardiac magnetic resonance imaging. Journal of Cardiovascular Magnetic Resonance. 2015;17(Suppl 1): 378.
  14. Giles JT, Malayeri AA, Fernandes V, Post W, Blumenthal RS, Bluemke D, et al. Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging. Arthritis & Rheumatism. 2010;62(4):940-51. Available from: https://doi.org/10.1002/art.27349.
  15. Khalid U, Egeberg A, Ahlehoff O, Lane D, Gislason GH, Lip GYH, Hansen PR. Incident heart failure in patients with rheumatoid arthritis: a nationwide cohort study. Journal of the American Heart Association. 2018;7:e007227. Available from: https://doi.org/10.1161/JAHA.117.007227.
  16. Kuna AT. Mutated citrullinated vimentin antibodies in rheumatoid arthritis. Clin Chim Acta. 2012;413(1-2):66-73.
  17. Kopylov FY, Shekochikhin DY. Anemia in cardiology practice. Difficult Patient. 2011;9(4):16-22.
  18. Murkamilov IT, Ayipova DA, Ibragimov AA, Usupbaev DA, Kaliev R. Effects of renal anemia on heart restructuring processesin chronic glomerulonephritis. Cardiovascular Therapy and Prevention. 2016;15(5):74-8.
  19. Polyakova SA, Ruskin TA. Structural and functionalstate of the left ventricular myocardium in women of reproductive age with rheumatoid arthritis. Modern Rheumatology. 2013;1:41-6.
  20. Goncharova EV, Govorin AV, Chistyakova MV. Features of the formation of anemic cardiomyopathy in patients with chronic iron deficiency anemia in the Zaibaikal region. Far-Eastern Medical Journal. 2014;1:10-4.
  21. Vertkin AL, Khovasova NO, Laryushkina ED, Shamaeva KI. Patient with anemia at outpatient admission. Cardiovascular Therapy and Prevention. 2014;13(3):67-77.
  22. Anichkov DA, Shostak NA, Ivanov DS. Left ventricular hypertrophy in patients with rheumatoid arthritis. Rheumatology Science and Practice. 2005;43(3):29.
  23. Jukova NV. The prevalence of concomitant diseases among in-patients on the subject of rheumatic gout. Problems of Social Hygiene, Public Health and History of Medicine. 2010;2:19-21.
  24. Arshin EV, Tuev AV, Shchekotov VV. Left ventricular remodeling and diastolic function in patients with arterial hypertension and rheumatoid arthritis. Russian Journal of Cardiology. 2005;3:32-7.

Authors informations:

Feyskhanova Lyutsiya Iskhakovna Candidate of Medical Sciences, Associate Professor of the Department of Hospital Therapy, Kazan State Medical University ORCID ID: 0000-0001-7830-5283

Sukhorukova Elena Vasilievna Doctor, Department of Rheumatology, Republican Clinical Hospital ORCID ID :0000-0001-6274-4636

Akhmetzyanova Aygul Ildarovna student of Kazan State Medical University ORCID ID: 0000-0003-2724-5115

Address for correspondence:

Feyskhanova Lyutsiya Iskhakovna
Candidate of Medical Sciences, Associate Professor of the Department of Hospital Therapy, Kazan State Medical University

420012, Russian Federation, Kazan, Butlerova str, 49

Tel.: +7 (917) 2752166

E-mail: ljuts@rambler.ru

Materials on the topic: