ABSTRACT
Systemic vasculitis complicating rheumatoid disease has a reported mortality rate up to 30%. It has been demonstrated at necropasy studies that vasculitis in rheumatoid disease can also, affect coronary arteries mostly of the smaller muscular type. Twenty patients with rheumatoid disease [RD] below the age of 35 years presented with typical or atypical anginal pain. Other coronary risk factors were excluded such as: hypertension, obesity smoking, diabetes mellitus, hyperlipidemia, and hyperuricemia. Twenty healthy controls of matched age and sex were included, both patients and controls were subjected to resting ECG, Echo-Doppler, dobutamine-thallium moyocardial perfusion SPECT studies and serum interleukin-2 [IL-2] assay, to determine the proper evaluation of coronary artery affection and to search for another new risk factors. Resting ECG was normal except sinus tachycardia in 20% of cases. Echo-Doppler study revealed normal findings except mitral incompetence grade I in 20% and diastolic dysfunction in 15% of cases. Dobutamine stress ECG test was normal in 18 rheumatoid patients [90%] and positive ischemic changes in two patients [10%]. Myocardial perfusion study with thallium 201 [SPECT] was positive in nine cases [45%] and negative in eleven cases [55%]. All patients with chest pain, positive pharmacological stress test and/or positive thallium-201 myocardial perfusion, showed cutaneous vascular affection, high level of Rose Waaler titres for rheumatoid factor as well as a high level of serum IL-2. Also, there was a positive correlation between positive thallium study and rheumatoid activity. The study of thallium perfusion in rheumatoid patients had revealed a high incidence of coronary affection due to coronary vasculitis. High Rose Waaler titer for rheumatoid factor as well as high IL-2 in the present study appear to be a new risk factor for coronary vasculitis in rheumatoid patients