Traditional and nontraditional cardiovascular risk factors in women with active rheumatoid arthritis: relation to disease activity

Cardiovascular event rates are markedly increased in rheumatoid arthritis [RA], and RA atherogenesis remains poorly understood. The relative contributions of traditional and nontraditional risk factors to cardiovascular disease [CVD] in RA await elucidation. To compare traditional and nontraditional cardiovascular risk factors in RA patients Vs age and sex-matched healthy control population and in seropositive Vs seronegative RA patients and to correlate these potential risk factors with the disease duration and activity. Thirty nine active RA women were divided according to the presence or absence of rheumatoid factor into two groups and twenty nine age- and sex-matched apparently healthy control women. After controlling for age and menopausal status, traditional cardiovascular risk factors including body mass index [BMI], waist circumference, hypertension, fasting lipids [Triglycerides [TG], Total cholesterol [TC], Low density lipoprotein cholesterol [LDL-C] and High density lipoprotein cholesterol [HDL-C]], and insulin sensitivity [IS], and nontraditional cardiovascular risk factors, including high-sensitivity C-reactive protein [hs-CRP], IL-1, IL-6 and tumor necrosis factor-a were compared in RA patients versus healthy control individuals and in seropositive versus seronegative RA patients. Insulin sensitivity was determined by the Quantitative Insulin Sensitivity Check Index [QUICKI]. Traditional and nontraditional risk factors for CVD were correlated with disease duration and activity. Rheumatoid factor was positive in twenty six [67%] of RA patients. Significant higher percentage of individuals with hypertension [p<0.05], significant lower levels of HDL-C and QUICKI [p<0.001, <0.05 respectively] and significant higher levels of LDL-C and hs-CRP, IL-1, IL-6 and TNF-a concentrations [p<0.05, 0.001, 0.001, 0.001 and 0.001 respectively] were observed in RA patients Vs controls. Significant lower HDL-C [p<0.05] and higher hs-CRP, and IL-6 concentrations [p<0.01, 0.05 respectively] were observed in seropositive Vs seronegative RA patients. No correlation was found between traditional and nontraditional risk factors for CVD and duration of disease. HDL-cholesterol, hs-CRP, Interleukin -1 and Interleukin -6 correlated significantly with disease activity score [p<0.05, <0.01, <0.05 and <0.02 respectively]. Excess traditional and nontraditional cardiovascular risk factors were observed in RA patients as compared with controls and in seropositive RA patients as compared with seronegative RA patients. This results in a tendency towards increased frequency of CV death in RA patients, more commonly in seropositive patients. Non-traditional risk factors play a more important role than traditional risk factors in cardiovascular disease in RA

Association of interstitial pulmonary fibrosis and rheumatic disorders in chronic hepatitis c virus infection patients

To investigate the association of idiopathic pulmonary fibrosis [IFF] and rheumatological disorders in patients with chronic hepatitis C virus [HCV] infection via clinical laboratory and radiological studies. Fifty one patients, 36 males and 15 females, with documented HCV and 25 healthy subjects, 18 males and 7 females, were enrolled in the study. Clinical examination, laboratory investigations [biochemical, virological and immunological] and plain chest X-ray [CXR], high resolution computed tomography [HRCT] and pulmonary function tests [PFT] were performed in all subjects. The presence of arthralgia, myalgia, fibromyalgia, polymyositis [PM], type II mixed cryoglobulinaemia [MC], purpura, and Raynaud's phenomenon and pulmonary fibrosis, were observed in 8/51, 10/51, 4/51, 5/51, 9/51, 2/51, 1/51 and 9/51 of HCV-positive patients, respectively. The presence of high serum creatinine kinase [CK], RF, ANA, complement-4 [C4] reduction and Anti-Jo-1 antibodies were observed in 5/51,5/51, 2/51, 3/51 and 3/51 of HCV-positive patients, respectively. There was a significant difference between controls and patients with HCV for the presence of arthralgia, myalgia, polymyositis, type II MC and IFF on HRCT [p<0.01, <0.01, <0.05, <0.01 and <0.01 respectively]. Pulmonary fibrosis was found in 3/5 and 5/9 patients with polymyositis and type II MC respectively. HRCT findings of IFF consisted of nodular areas of high attenuation, ground-glass attenuation, consolidation, septal lines, non-septal lines, and honeycombing in 6/51, 2/51, 1/51, 2/51, 4/51, and 1/51 patients with HCV, respectively. Our nine patients with interstitial pulmonary involvement had HRCT scores consistent with mild parenchymal abnormalities in 3, moderate in 5 and severe in one patient. Only one case in the controls [1/25] had ground-glass attenuation on HRCT. PFT abnormalities were present in only 13 patients [-26%]. PFT measurements revealed that VC, FVC, FEV1, and FEF25-75 were below 80% of the predicted value in 10/51, 11/51, 8/51 and 16/51 patients with HCV, respectively. DLCO was decreased in 21/51 patients. However, there was no significant difference between controls and patients with HCV infection in mean PFT parameters. No correlation was found among HRCT features and PFT abnormalities. The results of this study suggest that chronic HCV infection appears to be involved in the pathogenesis of rheumatic diseases and pulmonary fibrosis. An association between interstitial lung disease [ILD] and polymyositis and/or type II mixed cryoglobulinemia seems to occur frequently in patients with chronic HCV infection. HRCT provides a sensitive and noninvasive technique than PFTs for detecting pulmonary involvement in HCV despite absence of symptoms, normal chest radiograph, and normal pulmonary function testing