Cardiovascular Profile of Rheumatoid Arthritis Patients and its Correlation with Disease Activity

  • A Prince Prabhakaran Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
  • R Periyasamy Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
  • R Nandini Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
Keywords: Cardiovascular disease, Cardiovascular risk, Rheumatoid arthritis


Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, involving joints and extra-articular manifestations. About 50% mortality in RA is due to cardiovascular disease. Cardiovascular events occur approximately a decade earlier in RA like that in diabetes mellitus.
Aim: The aim of the study was to correlate and compare the association between disease severity and various clinical and cardiovascular manifestations in RA patients.
Materials and Methods: This prospective cross-sectional study is carried out in known RA patients fulfilling the American College of Rheumatology criteria 2010 attending General Medicine and Rheumatology outpatient clinic of Tirunelveli Medical College Hospital between April 2017 and April 2018. They have been subjected to detail clinical and laboratory investigations and their cardiovascular manifestations are compared with their clinical profile and disease activity score.
Results: In this study, 50 patients were included, with a mean age of 47.76 years and 72% of female patients. The mean clinical disease activity index (CDAI) score among them is 25.16 ± 10.4. The disease severity was high among our study group with 60% of cases occupying high CDAI score with no patients under remission. The most common electrocardiogram abnormality found in the study group was left axis deviation (30%) followed by nonspecific ST-T changes (24%). Mean carotid intima-media thickness (CIMT) was found to be increased in 68% of patients. Asymptomatic carotid plaque was present in 8% of patients. The most common echocardiographic abnormality is left ventricular (LV) diastolic dysfunction, which contributes 44% in our study group.
Conclusion: Cardiovascular abnormalities such as LV diastolic and systolic dysfunction, premature atherosclerosis occur commonly in RA patients and positively correlate with CDAI score, disease duration, and treatment duration. All RA patients should be screened for chorionic villus sampling abnormalities through echocardiography and CIMT periodically.

Author Biographies

A Prince Prabhakaran, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India

Associate Professor, Department of Medicine, 

R Periyasamy, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India

Associate Professor, Department of Medicine,

R Nandini, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India

Postgraduate Scholar, Department of Medicine, 


1. Alkaabi JK, Ho M, Levison R, Pullar T, Belch JJ. Rheumatoid arthritis and
macrovascular disease. Rheumatology (Oxford) 2003;42:292-7.
2. van den Hoek J, Boshuizen HC, Roorda LD, Tijhuis GJ, Nurmohamed MT,
van den Bos GA, et al. Mortality in patients with rheumatoid arthritis: A 15-
year prospective cohort study. Rheumatol Int 2017;37:487-93.
3. Solomon DH, Goodson NJ, Katz JN, Weinblatt ME, Avorn J, Setoguchi S,
et al. Patterns of cardiovascular risk in rheumatoid arthritis. Ann Rheum Dis
4. Peters MJ, van Halm VP, Voskuyl AE, Smulders YM, Boers M, Lems WF,
et al. Does rheumatoid arthritis equal diabetes mellitus as an independent
risk factor for cardiovascular disease? A prospective study. Arthritis Rheum
5. Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL,
Jacobsen SJ, et al. Increased unrecognized coronary heart disease and
sudden deaths in rheumatoid arthritis: A population-based cohort study.
Arthritis Rheum 2005;52:402-11.
6. Singh H, Kumar H, Handa R, Talapatra P, Ray S, Gupta V. Use of clinical
disease activity index score for assessment of disease activity in rheumatoid
arthritis patients: An Indian experience. Arthritis 2011;2011:146398.
7. Shenavar Masooleh I, Zayeni H, Haji-Abbasi A, Azarpira M, Hadian A,
Hassankhani A, et al. Cardiac involvement in rheumatoid arthritis: A crosssectional
study in Iran. Indian Heart J 2016;68:332-5.
8. Merza RR. Cardiac involvement in rheumatoid arthritis. MMJ 2008;7:27-30.
9. Coskun S, Ozoran K, Mermerci B, Aydogdu S, Keles T. Cardiac involvement
in patients with rheumatoid arthritis. APLAR J Rheumatol 2005;8:23.
10. Dawson JK, Goodson NG, Graham DR, Lynch MP. Raised pulmonary
artery pressures measured with Doppler echocardiography in rheumatoid
arthritis patients. Rheumatology (Oxford) 2000;39:1320-5.
11. Mahajan V, Handa R, Kumar U, Sharma S, Gulati G, Pandey RM, et al.
Assessment of atherosclerosis by carotid intimomedial thickness in patients
with rheumatoid arthritis. J Assoc Physicians India 2008;56:587-90.
12. Homma S, Nobuyoshi H, Ishida H. Carotid plaque and intima-media
thickness assessed by b-mode ultrasonography in subjects ranging from
young adults to centenarians. Stroke 2001;32:830-5.