Main Article Content
Abstract
ABSTRACT
Background and rationale. Chronic inflammatory rheumatic disease represent a heterogeneous group of diseases associated to a high inflammatory state. There are associated to a huge morbidity mainly due to cardiovascular complications. Although cardiovascular risk factors associated to CIRD are well described, the major cardiovascular anomalies are largely unknown inour context. Aim. Identify the major cardiovascular anomalies in a Cameroonians population of patient with chronic inflammatory rheumatic disease. Methodology. We carried out a cross sectional study which included CIRD patients followed at the rheumatology unit of the Yaoundé Central Hospital. The cardiovascular complications were diagnosed by determining Ankle to brachial systolic arterial pressure index (ABPI) and performing Electrocardiogram (ECG), transthoracic echocardiography (TTE) and supra aortic trunk ultrasound (SATU). Blood samples were done for evaluating lipid profile and cardiovascular risk were assessed by using the Framingham criteria. Results. In total, 52 patients with CIRD were included. The range of age was 14-82 years the female (71.15%) were more present. In our population, determination of ABPI 1.92% had obliterans arteriopathy of lower limb and 5.76% had mediacalcosis. In ECG, we observed 13 cases of branch block (25%) and 01 case of left ventricular hypertrophy (1.92%). TTE revealed 4.08% of pericarditis and 44.9% of valvulopathies. We found among patients who realized SATU 02 cases atheromatic plaques on 03 cases (7.89%) and 05 patients with calcification (13.15%). We did not found any associated factors to cardiovascular complications through univariate statistical analysis and the assessment of cardiovascular risk showed a globally low risk among the majority of our population. Conclusion. The cardiovascular anomalies in CIRD were numerous in our population instead of the fact that the assessment of the cardiovascular risk using Framingham showed low risk for the majority. We can therefore concluded that this tools underestimated the risk among CIRD.
RÉSUMÉ
Contexte et justification. Les rhumatismes inflammatoires chroniques (RIC) représentent un groupe hétérogène de pathologies associées à un processus inflammatoire important. Elles sont la cause d’une grande morbidité chez ces patients par l’intermédiaire des complications cardiovasculaires (CCV) qu’elles entrainent. Malgré le fait que les facteurs de risque cardiovasculaires (FDRCV) dans les RIC ont été étudiés dans notre contexte, des zones d’ombres subsistent toujours quant aux CCV majeurs retrouvées dans cette population. Objectifs. Identifier les CCV majeures retrouvées chez les patients atteints de RIC. Méthodologie. Nous avons mené une étude transversale descriptive chez des patients suivis pour RIC au sein du service de Rhumatologie de l’Hôpital Central de Yaoundé. Les pathologies cardiovasculaires ont été recherchées à travers la détermination de l’index de pression systolique par la mesure automatique, la réalisation de l’électrocardiogramme (ECG), l’échographie transthoracique (ETT), et de l’échographie des troncs supra aortiques (ETSA). Les prélèvements sanguins étaient destinés à la détermination du profil lipidique et le risque cardiovasculaire a été évalué en utilisant les critères de Framingham. Résultats. Au total, notre population était constituée 52 patients. Le sexe féminin était majoritairement représentée (71,15%) et les extrêmes d’âges étaient 14 et 84 ans. Aussi, 1’artériopathie des membres inférieurs et la médiacalcose étaient retrouvées chez respectivement 1, 92% et 5,76% de nos participants. A l’ECG, nous avons observés 13 cas d’anomalies de la conduction (25%) at 01 cas hypertrophie ventriculaire gauche (1,92%). L’ETT a détecté des cas de péricardites (4,08%) et de valvulopathies (44,9%). Parmi les patients ayant réalisés l’ETSA, nous avons retrouvé 03 cas de plaques athéromateuses (7,89%) et 05 cas de calcification artérielle (13,15%). Nous n’avons pas retrouvé de facteurs associés CCV et notre population avait majoritairement un risque cardiovasculaire faible. Conclusion. Les CCV dans les RIC étaient diverses dans notre population malgré le faible risque cardiovasculaire retrouvé. L’utilisation des critères de Fragmingham aurait donc sous-évalué ce risque dans notre population.
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References
- López-Pedrera C, Pérez-Sánchez C, Ramos-Casals M, Santos-Gonzalez M, Rodriguez-Ariza A, José Cuadrado M. Cardiovascular Risk in Systemic Autoimmune Diseases: Epigenetic Mechanisms of Immune Regulatory Functions [Internet]. Journal of Immunology Research. 2012 [cité 21 nov 2018]. Disponible sur: https://www.hindawi.com/journals/jir/2012/974648/
- Castañeda S, Nurmohamed MT, González-Gay MA. Cardiovascular disease in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol. 2016;30(5):851‑69.
- Cooper GS, Stroehla BC. The epidemiology of autoimmune diseases. Autoimmun Rev. mai 2003;2(3):119‑25.
- Cooper GS, Bynum MLK, Somers EC. Recent insights in the epidemiology of autoimmune diseases: improved prevalence estimates and understanding of clustering of diseases. J Autoimmun. déc 2009;33(3‑4):197‑207.
- Article medicale Tunisie, Article medicale [Internet]. [cité 21 nov 2018]. Disponible sur: http://www.latunisiemedicale.com/article-medicale-tunisie_2112_fr
- Singwe-Ngandeu M, Meli J, Ntsiba H, Nouédoui C, Yollo AV, Sida MB, et al. Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon. East Afr Med J. sept 2007;84(9):404‑9.
- Masson E. Athérome et polyarthrite rhumatoïde [Internet]. EM-Consulte. [cité 21 nov 2018]. Disponible sur: http://www.em-consulte.com/article/39033/article/atherome-et-polyarthrite-rhumatoide
- Dhelft F, Laville M, Ninet J, Miossec P, Jullien D, Hot A. Une cohorte prospective sur la morbi/mortalité cardiovasculaire chez des patients atteints de sclérodermie systémique. La Revue de Médecine Interne. 1 déc 2016;37:A133‑4.
- Ngaïdé AA, Ly F, Ly K, Diao M, Kane A, Mbaye A, et al. Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas. Bull Soc Pathol Exot. 1 déc 2016;109(5):345‑52.
- Brites F, Martin M, Guillas I, Kontush A. Antioxidative activity of high-density lipoprotein (HDL): Mechanistic insights into potential clinical benefit. BBA Clinical. 1 déc 2017;8:66‑77.
- Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. mars 1988;31(3):315‑24.
- Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. sept 2010;62(9):2569‑81.
- Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. nov 1982;25(11):1271‑7.
- Avouac J, Kahan A, Allanore Y. Sclérodermie systémique : critères diagnostiques et de suivi. /data/revues/18786227/v77i2/S1878622710000238/ [Internet]. 2 juin 2010 [cité 21 nov 2018]; Disponible sur: http://www.em-consulte.com/en/article/253490
- Wendling, D., Prati, C., Toussirot, é. and Ornetti, P. (2010) Spondylarthrite, spondylarthropathies Critères de diagnostic et de classification. Revue du Rhumatisme Monographies, 77, 43-47. - References - Scientific Research Publishing [Internet]. [cité 21 nov 2018]. Disponible sur: https://www.scirp.org/(S(lz5mqp453edsnp55rrgjct55) )/reference/ReferencesPapers.aspx?ReferenceID=1676264
- Hoogendijk JE, Amato AA, Lecky BR, Choy EH, Lundberg IE, Rose MR, et al. 119th ENMC international workshop: trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis, 10-12 October 2003, Naarden, The Netherlands. Neuromuscul Disord. mai 2004;14(5):337‑45.
- Ortega-Hernandez O-D, Shoenfeld Y. Mixed connective tissue disease: an overview of clinical manifestations, diagnosis and treatment. Best Pract Res Clin Rheumatol. févr 2012;26(1):61‑72.
- OMS | Que faire pour éviter une crise cardiaque ou un accident vasculaire cérébral? [Internet]. WHO. [cité 21 nov 2018]. Disponible sur: http://www.who.int/features/qa/27/fr/index.html
- Ko SH, Bandyk DF. Interpretation and significance of ankle-brachial systolic pressure index. Semin Vasc Surg. sept 2013;26(2‑3):86‑94.
- Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, et al. Diagnostic criteria for dyslipidemia. J Atheroscler Thromb. 2013;20(8):655‑60.
- Treeprasertsuk S, Leverage S, Adams LA, Lindor KD, Sauver J, Angulo P. THE FRAMINGHAM RISK SCORE AND HEART DISEASE IN NONALCOHOLIC FATTY LIVER DISEASE. Liver Int. juill 2012;32(6):945‑50.
- Wang L, Wang F-S, Gershwin ME. Human autoimmune diseases: a comprehensive update. J Intern Med. oct 2015;278(4):369‑95.
- Vojdani A, Pollard KM, Campbell AW. Environmental Triggers and Autoimmunity. Autoimmune Dis [Internet]. 2014 [cité 21 nov 2018];2014. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290643/
- Fairweather D, Rose NR. Women and Autoimmune Diseases1. Emerg Infect Dis. nov 2004;10(11):2005‑11.
- Benjamin O, Lappin SL. Disease Modifying Anti-Rheumatic Drugs (DMARD). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 [cité 21 nov 2018]. Disponible sur: http://www.ncbi.nlm.nih.gov/books/NBK507863/
- Hall BM, Head, Neurology H of. Corticosteroids in autoimmune diseases. Australian Prescriber. 1 févr 1999;22(1):9‑11.
- Castañeda S, Martín-Martínez MA, González-Juanatey C, Llorca J, García-Yébenes MJ, Pérez-Vicente S, et al. Cardiovascular morbidity and associated risk factors in Spanish patients with chronic inflammatory rheumatic diseases attending rheumatology clinics: Baseline data of the CARMA Project. Seminars in Arthritis and Rheumatism. 1 juin 2015;44(6):618‑26.
- Myasoedova E, Crowson CS, Kremers HM, Fitz-Gibbon PD, Therneau TM, Gabriel SE. Total cholesterol and LDL levels decrease before rheumatoid arthritis. Ann Rheum Dis. juill 2010;69(7):1310‑4.
- Wisse BE. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. nov 2004;15(11):2792‑800.
- Giles JT, Bartlett SJ, Andersen R, Thompson R, Fontaine KR, Bathon JM. Association of body fat with C-reactive protein in rheumatoid arthritis. Arthritis Rheum. sept 2008;58(9):2632‑41.
- John H, Kitas G. Inflammatory arthritis as a novel risk factor for cardiovascular disease. Eur J Intern Med. oct 2012;23(7):575‑9.
- Choy E, Ganeshalingam K, Semb AG, Szekanecz Z, Nurmohamed M. Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatology (Oxford). déc 2014;53(12):2143‑54.
- Solomon A, Tsang L, Woodiwiss AJ, Millen AME, Norton GR, Dessein PH. Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification [Internet]. BioMed Research International. 2014 [cité 21 nov 2018]. Disponible sur: https://www.hindawi.com/journals /bmri/2014/826095/abs/
- Semb AG, Rollefstad S, Riel PV, Kitas GD, Matteson EL, Gabriel SE. Cardiovascular disease assessment in rheumatoid arthritis: A guide to translating knowledge of cardiovascular risk into clinical practice. Annals of the rheumatic diseases. 2014;73(7):1284‑9.
- Soubrier M, Barber Chamoux N, Tatar Z, Couderc M, Dubost J-J, Mathieu S. Cardiovascular risk in rheumatoid arthritis. Joint Bone Spine. juill 2014;81(4):298‑302.
References
López-Pedrera C, Pérez-Sánchez C, Ramos-Casals M, Santos-Gonzalez M, Rodriguez-Ariza A, José Cuadrado M. Cardiovascular Risk in Systemic Autoimmune Diseases: Epigenetic Mechanisms of Immune Regulatory Functions [Internet]. Journal of Immunology Research. 2012 [cité 21 nov 2018]. Disponible sur: https://www.hindawi.com/journals/jir/2012/974648/
Castañeda S, Nurmohamed MT, González-Gay MA. Cardiovascular disease in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol. 2016;30(5):851‑69.
Cooper GS, Stroehla BC. The epidemiology of autoimmune diseases. Autoimmun Rev. mai 2003;2(3):119‑25.
Cooper GS, Bynum MLK, Somers EC. Recent insights in the epidemiology of autoimmune diseases: improved prevalence estimates and understanding of clustering of diseases. J Autoimmun. déc 2009;33(3‑4):197‑207.
Article medicale Tunisie, Article medicale [Internet]. [cité 21 nov 2018]. Disponible sur: http://www.latunisiemedicale.com/article-medicale-tunisie_2112_fr
Singwe-Ngandeu M, Meli J, Ntsiba H, Nouédoui C, Yollo AV, Sida MB, et al. Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon. East Afr Med J. sept 2007;84(9):404‑9.
Masson E. Athérome et polyarthrite rhumatoïde [Internet]. EM-Consulte. [cité 21 nov 2018]. Disponible sur: http://www.em-consulte.com/article/39033/article/atherome-et-polyarthrite-rhumatoide
Dhelft F, Laville M, Ninet J, Miossec P, Jullien D, Hot A. Une cohorte prospective sur la morbi/mortalité cardiovasculaire chez des patients atteints de sclérodermie systémique. La Revue de Médecine Interne. 1 déc 2016;37:A133‑4.
Ngaïdé AA, Ly F, Ly K, Diao M, Kane A, Mbaye A, et al. Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas. Bull Soc Pathol Exot. 1 déc 2016;109(5):345‑52.
Brites F, Martin M, Guillas I, Kontush A. Antioxidative activity of high-density lipoprotein (HDL): Mechanistic insights into potential clinical benefit. BBA Clinical. 1 déc 2017;8:66‑77.
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. mars 1988;31(3):315‑24.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. sept 2010;62(9):2569‑81.
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. nov 1982;25(11):1271‑7.
Avouac J, Kahan A, Allanore Y. Sclérodermie systémique : critères diagnostiques et de suivi. /data/revues/18786227/v77i2/S1878622710000238/ [Internet]. 2 juin 2010 [cité 21 nov 2018]; Disponible sur: http://www.em-consulte.com/en/article/253490
Wendling, D., Prati, C., Toussirot, é. and Ornetti, P. (2010) Spondylarthrite, spondylarthropathies Critères de diagnostic et de classification. Revue du Rhumatisme Monographies, 77, 43-47. - References - Scientific Research Publishing [Internet]. [cité 21 nov 2018]. Disponible sur: https://www.scirp.org/(S(lz5mqp453edsnp55rrgjct55) )/reference/ReferencesPapers.aspx?ReferenceID=1676264
Hoogendijk JE, Amato AA, Lecky BR, Choy EH, Lundberg IE, Rose MR, et al. 119th ENMC international workshop: trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis, 10-12 October 2003, Naarden, The Netherlands. Neuromuscul Disord. mai 2004;14(5):337‑45.
Ortega-Hernandez O-D, Shoenfeld Y. Mixed connective tissue disease: an overview of clinical manifestations, diagnosis and treatment. Best Pract Res Clin Rheumatol. févr 2012;26(1):61‑72.
OMS | Que faire pour éviter une crise cardiaque ou un accident vasculaire cérébral? [Internet]. WHO. [cité 21 nov 2018]. Disponible sur: http://www.who.int/features/qa/27/fr/index.html
Ko SH, Bandyk DF. Interpretation and significance of ankle-brachial systolic pressure index. Semin Vasc Surg. sept 2013;26(2‑3):86‑94.
Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, et al. Diagnostic criteria for dyslipidemia. J Atheroscler Thromb. 2013;20(8):655‑60.
Treeprasertsuk S, Leverage S, Adams LA, Lindor KD, Sauver J, Angulo P. THE FRAMINGHAM RISK SCORE AND HEART DISEASE IN NONALCOHOLIC FATTY LIVER DISEASE. Liver Int. juill 2012;32(6):945‑50.
Wang L, Wang F-S, Gershwin ME. Human autoimmune diseases: a comprehensive update. J Intern Med. oct 2015;278(4):369‑95.
Vojdani A, Pollard KM, Campbell AW. Environmental Triggers and Autoimmunity. Autoimmune Dis [Internet]. 2014 [cité 21 nov 2018];2014. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290643/
Fairweather D, Rose NR. Women and Autoimmune Diseases1. Emerg Infect Dis. nov 2004;10(11):2005‑11.
Benjamin O, Lappin SL. Disease Modifying Anti-Rheumatic Drugs (DMARD). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 [cité 21 nov 2018]. Disponible sur: http://www.ncbi.nlm.nih.gov/books/NBK507863/
Hall BM, Head, Neurology H of. Corticosteroids in autoimmune diseases. Australian Prescriber. 1 févr 1999;22(1):9‑11.
Castañeda S, Martín-Martínez MA, González-Juanatey C, Llorca J, García-Yébenes MJ, Pérez-Vicente S, et al. Cardiovascular morbidity and associated risk factors in Spanish patients with chronic inflammatory rheumatic diseases attending rheumatology clinics: Baseline data of the CARMA Project. Seminars in Arthritis and Rheumatism. 1 juin 2015;44(6):618‑26.
Myasoedova E, Crowson CS, Kremers HM, Fitz-Gibbon PD, Therneau TM, Gabriel SE. Total cholesterol and LDL levels decrease before rheumatoid arthritis. Ann Rheum Dis. juill 2010;69(7):1310‑4.
Wisse BE. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. nov 2004;15(11):2792‑800.
Giles JT, Bartlett SJ, Andersen R, Thompson R, Fontaine KR, Bathon JM. Association of body fat with C-reactive protein in rheumatoid arthritis. Arthritis Rheum. sept 2008;58(9):2632‑41.
John H, Kitas G. Inflammatory arthritis as a novel risk factor for cardiovascular disease. Eur J Intern Med. oct 2012;23(7):575‑9.
Choy E, Ganeshalingam K, Semb AG, Szekanecz Z, Nurmohamed M. Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatology (Oxford). déc 2014;53(12):2143‑54.
Solomon A, Tsang L, Woodiwiss AJ, Millen AME, Norton GR, Dessein PH. Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification [Internet]. BioMed Research International. 2014 [cité 21 nov 2018]. Disponible sur: https://www.hindawi.com/journals /bmri/2014/826095/abs/
Semb AG, Rollefstad S, Riel PV, Kitas GD, Matteson EL, Gabriel SE. Cardiovascular disease assessment in rheumatoid arthritis: A guide to translating knowledge of cardiovascular risk into clinical practice. Annals of the rheumatic diseases. 2014;73(7):1284‑9.
Soubrier M, Barber Chamoux N, Tatar Z, Couderc M, Dubost J-J, Mathieu S. Cardiovascular risk in rheumatoid arthritis. Joint Bone Spine. juill 2014;81(4):298‑302.