Arterijska hipertenzija u bolesnika s reumatoidnim artritisom i bolesnika s osteoartritisom [Arterial hypertension in patients with rheumatoid arthritis and patients with osteoarthritis]

Šalamon, Lea (2016) Arterijska hipertenzija u bolesnika s reumatoidnim artritisom i bolesnika s osteoartritisom [Arterial hypertension in patients with rheumatoid arthritis and patients with osteoarthritis]. PhD thesis, Sveučilište u Zagrebu.

Abstract

INTRODUCTION: Excessive cardiovascular morbidity and mortality leading to premature death is common in rheumatoid arthritis patients. Chronic systemic inflammation is thought to have a pivotal role in increased cardiovascular disease risk in rheumatoid arthritis, contributing to vascular damage (endothelial dysfunction, accelerated atherosclerosis and atherosclerotic plaque instability). Among the classic cardiovascular risk factors, hypertension has a prominent role in rheumatoid arthritis patients. An increased prevalence of hypertension in rheumatoid arthritis patients was found in a number of studies, but not in all. A 52% do 73% prevalence of hypertension in rheumatoid arthritis patients was found in the studies with a large number of patients that used the current definition of hypertension. The mechanisms leading to frequent hypertension in rheumatoid arthritis patients are not clear; the association is likely due to a complex interplay of various factors, including chronic systemic inflammation. Metabolic syndrome is a cluster of major risk factors for cardiovascular disease such as dyslipidemia, hypertension, insulin resistance, impaired glucose tolerance or diabetes, and obesity. In addition to insulin resistance, inflammation is closely associated with the pathogenesis of metabolic syndrome. Reported prevalence of metabolic syndrome in rheumatoid arthritis patients is somewhat conflicting. A 17-45.2% prevalence of metabolic syndrome in rheumatoid arthritis patients was found in the studies with a large number of patients that used the current definitions of metabolic syndrome. OBJECTIVES: In this study, we compare the prevalence of arterial hypertension as the primary aim and the prevalence of metabolic syndrome among secondary aims in rheumatoid arthritis and osteoarthritis patients, exposed to high- and low- grade chronic inflammation, respectively, to assess the possible association between chronic inflammation and cardiovascular risk factors hypertension and metabolic syndrome. METHODS: A total of consecutive 627 rheumatoid arthritis and 352 osteoarthritis patients were enrolled in this multicentric study. Hypertension was defined as a systolic blood 75 pressure ≥140 and/or diastolic blood pressure ≥ 90 mmHg or current use of any antihypertensive drug. Overweight/obesity was defined as body mass index ≥ 25, and patients ≥ 65 years were considered elderly. Metabolic syndrome was defined using The National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: The prevalence of hypertension was higher in the osteoarthritis group than in the rheumatoid arthritis group [73.3 % (95 % CI, 68.4, 77.7) and 59.5 % (95 % CI, 55.6, 68.4) P < 0.001, respectively]. When the results were adjusted for age and body mass index, the hypertension prevalence was similar in both groups [rheumatoid arthritis 59 % (95 % CI, 55.1, 63.8) osteoarthritis 60 % (95 % CI, 58.4, 65.0)]. In both groups, the prevalence of hypertension was higher in the elderly and those who were overweight than in the younger patients and those with a BMI < 25. Overweight (body mass index ≥ 25) and age ≥ 65 were independent predictors of hypertension in multivariate logistic regression model, which showed no association between hypertension and the disease (rheumatoid arthritis or osteoarthritis). A 1.6-fold higher prevalence of metabolic syndrome was found in patients with osteoarthritis compared to the rheumatoid arthritis patients. Among the parameters of metabolic syndrome, patients with osteoarthritis had significantly higher levels of waist circumference, systolic blood pressure, fasting blood glucose, and triglycerides whereas HDL-cholesterol and diastolic blood pressure values were similar in both groups of patients. Higher values of inflammatory markers (C-reactive protein, Erythrocyte Sedimentation Rate) in metabolic syndrome than in non-metabolic syndrome patients and higher prevalence of metabolic syndrome in patients with C-reactive protein level ≥ 5 mg/L in both rheumatoid arthritis and osteoarthritis patients were found. However, in multivariate logistic regression analysis an association between C-reactive protein and metabolic syndrome was not expressed with significant predictors of metabolic syndrome being type of arthritis (osteoarthritis vs. rheumatoid arthritis; OR 2.5 [95% CI 1.82-3.43]), age (OR 1.04 [95% CI 1.03-1.06]) and Erythrocyte Sedimentation Rate (OR 1.01; [95% CI 1.00-1.01]). The significant association between osteoarthritis and metabolic syndrome was maintained in the regression model that controlled for body mass index. CONCLUSION: The results indicate a robust association of age and body mass index with hypertension prevalence in both rheumatoid arthritis and osteoarthritis. The difference in hypertension prevalence between rheumatoid arthritis and osteoarthritis is due rather to age and body mass index than to the features of the disease, putting into question specific association of hypertension with rheumatoid arthritis. In conclusion, the present analysis suggests that osteoarthritis is associated with increased risk of metabolic syndrome. Cause76 and-effect relationship cannot be determined from an analysis of cross-sectional data; our analysis does not suggest that osteoarthritis leads to metabolic syndrome or vice versa. However, our findings strongly suggest that common pathogenic mechanism may be active in patients with osteoarthritis and patients with metabolic syndrome.

Abstract in Croatian

U ovom istraživanju uspoređivali smo prevalenciju arterijske hipertenzije (HT) kao primarni cilj i prevalenciju metaboličkog sindroma (MetS) kao sekundarni cilj u bolesnika s reumatoidnim artritisom (RA) i osteoartritisom (OA) koje označava visoki odnosno niski stupanj kronične upale, a radi procjene moguće povezanosti kronične upale i kardiovaskularnih čimbenika rizika: arterijske hipertenzije i metaboličkog sindroma. Ukupan broj od 627 bolesnika s RA i 352 bolesnika s OA je uključen prema redoslijedu dolaska u reumatološku ambulantu odnosno prijema u bolnicu u ovo multicentrično istraživanje. Arterijska hipertenzija je bila definirana sistoličkim krvnim tlakom ≥140 i/ili dijastoličkim krvnim tlakom ≥ 90 mmHg ili uzimanjem antihipertenziva. MetS je bio definiran prema NCEP/ATP III (engl. The National Cholesterol Education Program Adult Treatment Panel) kriterijima. Prevalencija HT je bila viša u skupini bolesnika s OA nego u skupini bolesnika s RA [73.3 % (95 % CI, 68.4, 77.7) i 59.5 % (95 % CI, 55.6, 68.4) P < 0.001]. Nakon prilagođavanja za dob i indeks tjelesne mase (ITM), prevalencija HT je bila slična u obje skupine bolesnika [RA 59 % (95 % CI, 55.1, 63.8), OA 60 % (95 % CI, 58.4, 65.0)]. Prevalencija HT je bila viša u starijih bolesnika i u onih s prekomjernom tjelesnom težinom nego u mlađih bolesnika i onih s indeksom tjelesne mase (ITM) < 25 u obje skupine bolesnika. Prekomjerna tjelesna težina (ITM ≥ 25) i dob ≥ 65 godina bili su neovisni prediktori HT u multivarijatnom logističnom regresijskom modelu u kojem nije utvrđena povezanost HT i osnovne bolesti (RA ili OA). U bolesnika s OA je utvrđena 1,6 puta veća prevalencija MetS u usporedbi s bolesnicima s RA. Među parametrima MetS, bolesnici s OA su imali značajno veći opseg struka, više vrijednosti sistoličkog krvnog tlaka, višu koncentraciju glukoze u plazmi natašte i triglicerida dok su koncentracije HDL-kolesterola i vrijednosti dijastoličkog krvnog tlaka bili slični u obje skupine bolesnika. Utvrđene su i više vrijednosti biljega upale [C-reaktivni protein (CRP), sedimentacija eritrocita (SE)] u bolesnika s MetS nego u bolesnika bez MetS i viša prevalencija MetS u bolesnika s vrijednosti CRP-a ≥ 5 mg/L u bolesnika s RA i OA. Međutim, u multivarijatnoj regresijskoj analizi nije izražena povezanost CRP-a i MetS, a kao značajni prediktori MetS su utvrđeni: tip artritisa [OA vs. RA; OR 2.5 (95% CI 1.82-3.43)], dob [OR 1.04 (95% CI 1.03-1.06)] i SE [OR 1.01; (95% CI 1.00-1.01)]. Značajna povezanost OA i MetS je održana u modelu regresije i nakon kontroliranja za indeks tjelesne mase. Rezultati ukazuju na povezanost dobi i indeksa tjelesne mase s prevalencijom HT u 73 RA i OA. Razlika u prevalenciji HT između RA i OA je vjerovatnije posljedica dobi i indeksa tjelesne mase nego značajki osnovne bolesti dovodeći u pitanje specifičnu povezanost HT s RA. Nadalje, izloženo istraživanje ukazuje na povećani rizik metaboličkog sindroma u bolesnika s osteoartritisom u usporedbi s bolesnicima s reumatoidnim artritisom. Uzročno posljedična veza se ne može dokazati presječnim istraživanjem, međutim, naši rezultati snažno ukazuju na činjenicu kako zajednični patogenetski mehanizmi mogu biti aktivni u bolesnika s OA i bolesnika s MetS.

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