Department of Internal Medicine, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, SP, Brazil.
Department of Internal Medicine, São Paulo State University (UNESP), Botucatu Medical School,, Botucatu, SP, Brazil.
Med Sci Monit. 2023 Jan 7;29:e938989. doi: 10.12659/MSM.938989.
BACKGROUND Rheumatoid arthritis (RA) can cause extra-articular manifestations, and the myocardium can be a target. This study aimed to describe structural and functional cardiac echocardiographic variables in RA patients and to evaluate whether vitamin D (VD) levels and inflammation markers, evaluated by Disease Activity Score-28 for Rheumatoid Arthritis with C-reactive protein (DAS28-CRP), are associated with cardiac remodeling (CR) in this population. MATERIAL AND METHODS This prospective observational study evaluated 90 patients with RA in Botucatu University Hospital wards from 2014 to 2017. Clinical data were recorded, including demographic information, comorbidities, length of disease, and treatment type. Serum VD and C-reactive protein levels were measured, and the DAS28-CRP was calculated. A transthoracic echocardiography study was performed. The outcome evaluated was CR. This parameter was assessed by left ventricular geometric patterns and left atrium diameter. RESULTS We evaluated 90 RA patients. The mean age was 52.9±10.8 years, and 17.8% were male. The length of the disease was 96 (60-180) months. Serum VD levels were 30.7±10.4 ng/mL and the DAS28 was 2.7±0.9. Regarding the CR parameters, 56.7% had altered left ventricular geometric patterns and 25.8% had enlargement of left atrium diameter. Even in multivariate analysis, the left ventricular geometric patterns were not associated with the VD levels and the inflammation marker used. However, sufficient VD levels protect from left atrium enlargement (OR: 0.905; IC 95%: 0.843-0.973; P=0.007). CONCLUSIONS Low serum vitamin D values, but not inflammation, are associated with CR in patients with RA.
类风湿关节炎（RA）可引起关节外表现，心肌也可能成为靶器官。本研究旨在描述 RA 患者的结构性和功能性心脏超声变量，并评估维生素 D（VD）水平和炎症标志物（通过 C 反应蛋白（DAS28-CRP）评估的 28 项类风湿关节炎疾病活动评分）是否与该人群的心脏重构（CR）相关。
本前瞻性观察研究评估了 2014 年至 2017 年期间在博图卡图大学医院病房的 90 例 RA 患者。记录了临床数据，包括人口统计学信息、合并症、疾病持续时间和治疗类型。测量了血清 VD 和 C 反应蛋白水平，并计算了 DAS28-CRP。进行了经胸超声心动图研究。评估的结果是 CR。该参数通过左心室几何形态和左心房直径来评估。
我们评估了 90 例 RA 患者。平均年龄为 52.9±10.8 岁，17.8%为男性。疾病持续时间为 96（60-180）个月。血清 VD 水平为 30.7±10.4ng/mL，DAS28 为 2.7±0.9。关于 CR 参数，56.7%的患者存在左心室几何形态改变，25.8%的患者存在左心房直径增大。即使在多变量分析中，左心室几何形态也与 VD 水平和使用的炎症标志物无关。然而，足够的 VD 水平可预防左心房增大（OR：0.905；95%CI：0.843-0.973；P=0.007）。
低血清维生素 D 值与 RA 患者的 CR 相关，而炎症则不然。
