Cardiovascular risk factors in filipinos with rheumatoid arthritis included in the rheumatoid arthritis database and registry (RADAR)

Abstract

Introduction Rheumatoid arthritis (RA) is a chronic, symmetric, inflammatory, polyarthritis of unknown etiology. It is the most common inflammatory arthritis worldwide and the world prevalence of RA might be around 0.3–1.2%.1 In the Philippines, the prevalence of rheumatic diseases were reported in Philippine Journal of Internal Medicine Original Article surveys through the Community Oriented Programme for the Control of Rheumatic Diseases (COPCORD) initiated by the World Health Organization (WHO) and International League of Association for Rheumatology (ILAR). Prevalence rates for RA were 0.17% for a Filipino urban population2 and 0.2% for a rural population.3 Cardiovascular disease (CVD) remains a major problem for patients with RA. The mortality rate from CVD is increased in RA patients.4,5,6 RA and many other autoimmune diseases can be considered as a prothrombotic state and a risk factor for venous thromboembolism (VTE) and CVD. Inflammation is probably the link between these illnesses. The inflammatory cytokine network, when activated, induces several prothrombotic conditions such as endothelial The PHILIPPINE JOURNAL OF INTERNAL MEDICINE is a peer reviewed journal and a copyrighted publication of the Philippine College of Physicians Volume 57 Number 1 April-June, 2019 93 Introduction: Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis of unknown etiology. Cardiovascular disease (CVD) remains a major problem for these patients. This paper aims to describe the presence of cardiovascular risk factors among filipino patients with rheumatoid arthritis seen in the Philippine General Hospital Rheumatology outpatient department. This will also serve as a baseline database for patients with cardiovascular risk factors for future studies on the impact of rheumatoid arthritis on cardiovascular morbidity and mortality. Objective: To describe the presence of cardiovascular risk factors among filipino patients with rheumatoid arthritis seen in the Philippine General Hospital Rheumatology outpatient department included in the Rheumatoid Arthritis Database and Registry (RADAR) Methods: Cases entered in the study were taken from the RADAR. Included patients were those worked up for traditional and non-traditional cardiovascular risk factors. Demographic data, traditional and nontraditional cardiovascular risk factors and management for RA and CVD were extracted. Descriptive statistics were applied. This study is approved by the Institutional Review Board. Results: Ninety eight patients were included in this study. Ninety four percent were female with mean age at diagnosis of 49.95±10.17 (SD) years and mean disease duration of 63.01 months. For traditional cardiovascular risk factors: 18% were smokers; 34% (24/71) were obese; mean BMI was 23.85±4.60 (SD) kg/m2; 39% (38/98) had hypertension of which 87% were on antihypertensive medication; 19% has impaired fasting glucose (IFG) or diabetes and 55% had dyslipidemia but only 53% and 33% were on oral hypoglycemic agents and statins, respectively. For non-traditional CV or diseaserelated risk factors, 20% still had high disease activity and 65% had elevated sedimentation rate (mean 45.58±18.36 (SD) mm/hr) on latest consult. Eighty seven percent were taking methotrexate but only three percent were on biologic agents. Conclusion: This study shows the presence of important traditional risk factors such as hypertension, diabetes, dyslipidemia, and obesity in this population. Significantly, more than half the cases have dyslipidemia. In addition, RA disease activity was high to moderate. The combination of traditional and disease related risk factors for cardiovascular disease is ominous and warrants aggressive treatment. In addition, patient education and weight control should be emphasized. It is recommended that this cohort be followed up prospectively.