الفهرس | Only 14 pages are availabe for public view |
Abstract Systemic inflammation and disease activity seem to contribute to excessive prevalence of cardiovascular diseases in patients with rheumatoid arthritis. RA is currently regarded as a novel, independent CVD risk factor. Accelerated atherosclerosis, considered as an extraarticular manifestation of RA, occurs as a result of interaction between traditional CV risk factors and inflammatory activity of joint disease. Both atherosclerosis and RA have in common inflammatory mediators. The mechanisms which induce synovial inflammation are similar to those in unstable atherosclerotic plaque. This study represents one of the studies that aimed to detect the value of serum Glycated Albumin measurement as a marker for RA associated coronary artery atherosclerosis and also a marker for RA disease activity. The present study included thirty middle aged RA patients who were selected from outpatient clinic of Rheumatology, Physical Medicine and Rehabilitation of Ain Shams University Hospitals, diagnosed according to the 2010 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria and fifteen age matched patients known to have established coronary artery disease were taken as controls from the cardiology department of Ain Shams University Hospitals.All patients were subjected to detailed history taking, clinical examination, laboratory investigations as CBC, ESR, CRP, lipid profile, liver and kidney functions and calculation of DAS28. Serum Glycated Albumin (GA) level was measured in all RA patients and controls by ELISA technique. All RA patients and controls underwent carotid ultrasound to measure the carotid intima-media thickness (IMT). Statistical analysis of the obtained clinical and laboratory data showed a significant elevation of serum GA level in the case group ranging from 28 to 120 pg/ml mean (48.333 ± 19.808) compared to the control group 15 to 30 pg/ml mean (21.733 ± 4.891) pg/ml, as well as a significant difference in the ESR results between the RA patients 12 - 93 and the control group (19.7 - 32). A statistically high significant correlation was found between the GA and the DAS-28 disease activity scores among the patients and also a significant positive correlation between the GA and ESR and GA and CRP. A highly significant difference was noticed regarding the mean cIMT between the patients results 0.35-1.115mm and the control group results 0.715-0.115mm with a statistically high significant correlation between the GA and the mean cIMT.A positive correlation between the mean cIMT and the disease duration of the rheumatoid patients was detected denoting the more the disease duration the more the risk of developing subclinical atherosclerosis. The comparison between the presence of soft atheromatous plaque and the mean cIMT gave positive increase but negative results with the disease duration. The correlation between the severe disease activity and the mean cIMT was statistically significant while it revealed a non-significant difference between mild and moderate disease activity and mean cIMT. In conclusion, our study highlighted that serum Glycated Albumin sensitivity and specificity were 83.33% and 87.50% . According to these findings serum GA is correlated with disease activity and provides an additional diagnostic value in detecting the subclinical atherosclerosis in RA patients. |