Clinical evaluation of coronary vasculitis, rheumatoid disease and interleukine-2 interrelationship

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