Prevalence of peripheral arterial disease among rheumatoid arthritis patients at the Kenyatta National Hospital

Abstract

Background Rheumatoid arthritis is a disease that not only leads to severe disability but also increases the risk of developing premature cardiovascular disease (CVD) that reduces life expectancy by close to a decade. Despite recent interest in cardiovascular disease in RA, the peripheral arteries have been understudied. Peripheral arterial disease (PAD) a manifestation of systemic atherosclerosis relates to cardiovascular morbidity and mortality independent of other adjusted risk factors.Recognition of PAD in clinical practice identifies patients at high risk of subsequent coronary and cerebrovascular events regardless of whether symptoms of PAD are present or not. objectLve. To determine the magnitude of atherosclerotic arterial disease in Rheumatoid Arthritis (RA) patients at Kenyatta National Hospital. MetViocis. In a time based cross-sectional study; the Ankle Brachial Index (ABI) was measured. Arteries were classified as per the standard grading of ABI measurements. Bivariate analysis using chi-square test was used to calculate association between PAD and cardiovascular risk factors. Odds ratios were calculated as a measure of risk magnitude. Binary logistic regression was used to analyze for independency of risk factors. Edinburgh claudication questionnaire was used to determine PAD symptomatology . ReSults. We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD,none had severe PAD. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age (2:45years males, 2:55years females), Established RA (> 5yr duration) and severe RA were found to be associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. 25(27.7%) of the study subjects exhibited symptoms of intermittent cilludication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detection of PAD in RA patients. c.oVl-ClustoV\,. There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impaired arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients.