Correlação da composição corporal com medidas antropométricas na avaliação da obesidade e risco cardiovascular em pacientes com Artrite Reumatoide

Abstract

INTRODUCTION: Rheumatoid Arthritis (RA) is a systemic autoimmune disease characterized by symmetric polyarthritis with the potential for erosion and extra-articular manifestations, in addition to progression to deformities and loss of functional capacity. Patients with RA are at high risk of cardiovascular disease (CVD) and associated obesity contributes to this increase. Existing screening methods for diagnosing obesity may have limitations in this population. OBJECTIVES: To determine whether there is a correlation between Dual Emission X-ray Densitometry (DEXA) and anthropometric measurements in the diagnosis of obesity and stratification of CVR in patients with RA. METHODS: Cross sectional study carried out on individuals with RA aged 20 years or over treated at the Rheumatology service of the Professor Alberto Antunes University Hospital (HUPAA) – Federal University of Alagoas (UFAL). The prevalence of sociodemographic factors and comorbidities for CVD was assessed and the Clinical Disease Activity Index (CDAI) and the Health Assessment Questionnaire – Disability Index (HAQ-DI) were applied. Anthropometric measurements such as Body Mass Index (BMI) and Waist Circumference (WC) were evaluated and compared with the findings of adiposity variables by Dual Emission X-ray Densitometry (DXA). Cardiovascular risk was classified using the Framingham Risk Score (ERF). Carotid and vertebral duplex scan and transthoracic Doppler Echocardiogram were also performed to evaluate the presence of target organ damage (LOA). RESULTS: Our sample included 55 patients and of these, 51 underwent DEXA. The average age was 55 years and there was a higher prevalence of females (91%). The duration of the disease had a median of 7 years (IQR 6.00). 92.7% had active disease with a median score of 16, (IQR 24.50) with 60% having moderate/high disease activity and around 35% having functional disability above moderate intensity. 43.6% were using prednisone and 63.4% were using immunomodulators The percentage of hypertension was 50%; 23.2% diabetics, 7.14% active smokers and 85.4% sedentary. The obesity rate found was high, corresponding to 36.3% by WC, 98% by CC and 41.8% by DEXA. 49% of patients were stratified by ERF into moderate/high risk. However, there were no association between the score and the body fat index (p value = 0.605), visceral fat (p value = 0.465) or BMI (p value = 0.718). All fat compartment variables analyzed by DEXA were positively and significantly correlated (p-value < 0.001) with BMI and WC. We found a high prevalence of plaque in the carotid territory (74%) and only 4 patients had left ventricular hypertrophy on Echocardiogram. CONCLUSION: Our results corroborate previous data in the literature that patients with RA have a high cardiovascular risk with an increased prevalence of risk factors. The DEXA method did not bring advantages in relation to routine anthropometric measurements such as BMI and WC in this study, these tools being of great value in clinical practice and with good use in diagnosing obesity in patients with rheumatoid arthritis.