Screening of endothelial dysfunction in rheumatoid arthritis in Black African subjects in the Physiology Department of the Faculty of Medicine of Dakar: a cross-sectional study.

Abstract

Introduction: the vascular endothelium plays an essential role in many basic physiological vascular regulations. Endothelial dysfunction is the first stage of atherosclerosis. The latter would be the main basis of the cardiovascular events responsible for the high mortality of rheumatoid arthritis. The aim of this study was to screen for subclinical endothelial dysfunction in rheumatoid arthritis in a quick, easy and non-operator dependent way.

Methods: this is a cross-sectional and prospective study conducted in the department of physiology and functional explorations from the Faculty of Medicine, of Pharmacy and of Odontostomatology (FMPOS) of the Cheikh Anta Diop University (UCAD) of Dakar in Senegal. Were excluded patients under 18 years and those with rheumatoid arthritis was associated with severe complications or other medical conditions or pregnancy. Therefore, we included subjects, aged 18 and over, with rheumatoid arthritis without clinically detectable cardiovascular complications. The reactive hyperemia index (RHI) was measured by an EndoPAT2000® (Itamar Medical Ltd-Israel) to explore endothelial function. Biochemical parameters were analyzed from fasting serum and plasma using an automated Abbott device. We used SPSS software to study endothelial dysfunction and the factors associated with it for simple and multiple linear regression calculations.

Results: the mean age of the study population was 42.84 ± 12.80 years. The sex ratio (M/F) was 0.19. The reactive hyperemic index was significantly lower than the normal value in more than half of the patients with rheumatoid arthritis (11 subjects out of the 19 patients, i.e. 57.89%), indicating endothelial dysfunction in these patients. After Spearman correlation tests, a positive correlation was found between reactive hyperemic index and systolic blood pressure (rho=0.753 p=0.0002), mean blood pressure (rho= 0.660 p= 0.002), hs-CRP (rho= 0.486 p= 0.035) and uremia (rho= 0.476 p= 0.039). After a multiple linear regression test, a positive association was noted between the reactive hyperemia index and the systolic blood pressure (β 0.049, 95% CI [0.011 - 0.087]; p= 0.015).

Conclusion: the endothelial dysfunction is a new concept in the management of rheumatoid arthritis. Screening and detection of this endothelial dysfunction in the subclinical state is possible thanks to new tools including EndoPATH2000. This could make it possible to predict the risk of cardiovascular events notably high blood pressure in general, and high systolic blood pressure in particular.