Major Finding: This study showed that 20% of RA cases had pericardial disease at the time of death, compared with 9.5% of controls.
Data Source: Case-control study of 84 patients with RA diagnosed in 1981–1996.
Disclosures: Dr. Goodson had no conflicts of interest. The study was funded by a Clinical Fellowship awarded by the Devonshire Royal Hospital Endowment Fund.
BIRMINGHAM, ENGLAND — Pericardial disease remains a common cardiovascular complication of rheumatoid arthritis, judging from findings from a recent study.
Findings from the case-control study showed that 20% of patients with RA had pericardial disease at the time of their death, compared with 9.5% of controls. Patients who were rheumatoid factor positive were more likely than RF-negative cases to have pericardial disease.
“This rate is lower than that reported in previous autopsy studies. And it may reflect more recent and more effective disease suppression of rheumatoid arthritis,” said Dr. Nicola J. Goodson, a clinical research fellow at the Arthritis Research U.K. Epidemiology Unit of the University of Manchester (England).
Previous research has found that at the time of their death, 50% of RA patients had pericardial disease (Arch. Intern. Med. 1969;124:714–9). However, the population of patients studied was diagnosed in the 1950s, rather than in the 1980–1990s as in the current review, Dr. Goodson said.
Dr. Goodson reported the results of a study that looked at the presence of cardiovascular disease detected at autopsy in patients with RA who were part of an inception cohort. Of 1,010 RA patients recruited between 1981 and 1996, 565 (56%) had died, and 145 of those had postmortem examinations. Of these, 84 autopsy records were obtained and compared with 84 postmortem reports from the general population that were matched for age, sex, and date of autopsy.
The mean age of the cohort at the time of death was 73.3 years for both cases and controls, and 71% were female. The median duration of arthritis was 8 years, and 80% of patients were RF positive.
According to the death certificates, two-thirds of cases and two-thirds of controls had most likely died as a result of cardiovascular disease. Similar proportions of cases and controls had died as a result of respiratory, malignant, traumatic, or gastrointestinal causes.
Similar cardiovascular causes of death were identified on the death certificates in both cases and controls, with ischemic heart disease, MI, and atherosclerotic disease noted as the most common findings.
RA was listed as a possible contributing cause of death in only 8 (9.5%) of the 84 RA death certificates, although it was cited in the history or examination sections of the autopsy reports in 49 cases.
A consultant histopathologist reviewed the autopsy reports and identified a similar rate of cardiovascular diseases in cases and controls, with the exception of pericardial disease.
Pericardial disease occurred in 22% of patients who were RF positive and in 11% of those who were RF negative.
“Pericardial thickening was the predominant finding,” Dr. Goodson observed, adding that the presence of pericardial disease did not appear to contribute to the overall cause of death.
Because the study was conducted in a contemporary RA population, perhaps a similar prevalence of atherosclerosis in cases and controls was due to the improved overall treatment of RA and cardiovascular risk factors in recent years, she said.
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Source Elsevier Global Medical News