AB0298 COMPLICATIONS OF RHEUMATOID ARTHRITIS AND ALLIED DISORDERS– A STATISTICAL COMORBIDITY STUDY OF 234 AUTOPSY PATIENTS

Abstract

Background: Complications of rheumatoid arthritis (RA) may modify the clinical course and symptoms of allied disorders leading to missed diagnosis or late recognition of associated diseases. Objectives: The aim of this study was to determine the possible role of classic complications of RA: systemic autoimmune vasculitis (AV), AA amyloidosis (AAa), lethal cardiac insufficiency (CI) caused by endo-, myoor pancarditis, furthermore lethal septic infection (SI) on prevalence and mortality of coexistent associated diseases: atherosclerosis (Ath), hypertension (HT), type 2 diabetes mellitus (DM) and tuberculosis (Tb) with miliary dissemination (mTb). Methods: 234 non- selected autopsy patients with RA were studied. RA was confirmed clinically according to the criteria of the ARA. The presence of AV, AAa, CI and SI was determined at autopsy and confirmed by a detailed review of extensive histological material. The prevalence and mortality of associated diseases Ath, HT, DM, Tb or mTb were analyzed retrospectively, reviewing the clinical and pathological reports. The link between AV, AAa, CI or SI and Ath, HT, DM, Tb or mTb was analyzed by (c2) test. Results: RA was complicated by AV in 43 (18.4%), by AAa in 48 (20.5%), by CI with lethal outcome in 15 (6.4%), and by lethal SI in 33 (14.1%) of 234 patients. RA associated with severe Ath in 106 (45.3%), with HT in 41 (17.5%), with DM in 41 (17.5%), and with Tb in 28 (11.9%), with active mTb in 9 (3.8%) of 234 patients. As a basic disease Ath led to death in 61 (26.1% of 106), HT in 2 (0.9% of 41), DM in none (0% of 41), and Tb with mTb in 3 (1.3% of 28) of 234 patients. Tb without miliary dissemination was not lethal in our patient population. The statistical links (“p” values of significance) between complications of RA and prevalence or mortality of allied disorders are summarized in Table. (∗asterisk indicates a negative value of associations' coefficient with inverse relationship). Conclusion: The inverse correlations between AV, AAa, CI, SI and Ath, HT, DM, Tb or mTb indicate that the prevalence and mortality of allied disorders were not influenced basically by the complications of RA. The consequently inverse and (in most cases) significant correlations between prevalence of AV, AAa, CI, SI and the prevalence and mortality of Ath show that these are are independent entities in RA. The AV, AAa, CI and SI are the most important complications of RA, and are characterize severe forms of disease, mostly involving younger patients, with an earlier onset (without pronounced Ath); while Ath is basically an age dependent phenomenon, characteristically present in RA patients with advanced age. RA patients with Ath may represent a special group of RA, characterized by lower incidence of AV, AAa, CI or SI, and a better prognosis. The positive and significant relations AV to Tb or mTb suggest an increased risk of Tb, e.g. the presence of AV may promote Tb or endogenous exacerbation and miliary dissemination of Tb.